Mental Health Status of a Sample of Iraqi Immigrants - Article Example

Title NURS1102 Nursing Inquiry and Critique Due date: Computer word count: 1833 Mental health status of migrant Introduction Over the past years, mental illness has been on the increase across the world. However, despite the worrying trend, few studies have been done. This paper presents a critical review of the research entitled “Mental health status of a sample of Iraqi immigrants in Malaysia” by Daher et al (2012). The paper aims at summarizing the findings on the mental health status of immigrants, identifying gaps in knowledge, and suggests further research directions. The study, mental health status of a sample of Iraqi immigrants in Malaysia, sought to assess the Mental Health (MH) of Iraqis living in Malaysia. Daher and his colleagues were motivated to carry the study due to little research on the health of migrants to less developed or developing nations. They highlighted that limited study conducted on the health status of Iraqi based immigrant populace and that there was a heightened paucity of information on the subject matter hence they felt it was of great necessity to have a database of the Iraqi immigrants in Malaysia, which would also be useful for future assessment. Study design Daher et al (2012) employed the use of a cross-section research based approach, which commenced on September 2009 and ended on April 2010. In a bid to achieve their set objectives, Daher and his colleagues considered total of three hundred Iraqi based immigrants in Malaysia as their sample population. The sample was recruited using a simple random sampling with the aid of Epi Info 6 software from a sampling frame comprising of a list of registered immigrants with their residence and email addresses as provided by the Iraqi embassy. Independent samples t test was used to give a comparative analysis with the consideration of the mean between two groups and ANOVA for taking the comparative mean of more than two groups. Multiple Linear Regressions (MLR) was also conducted so that they could control for confounding variables at a Significance level, which was set at 0.05 (Daher et al, 2012, p.145). Strengths and limitations of study design The cross-sectional study has various benefits including the fact that it doe not require follow-ups hence it is relatively cheap compared to other approaches and it can be carried out more easily as opposed to other designs. The design is also quite representative of a population, rather than a smaller sub-population. The other key strength of the study is the adoption of simple random sampling to recruit study participants. According to classical statistical sampling theory, if selection of study participant is conducted using simple random from a known population is performed, profiles or characteristics of the study sample can be inferred and tend to mirror corresponding characteristics of the population (Dattalo, 2010). However, the study is open to numerous biases. For instance, random sampling may be a good standard methodological method for maximizing external validity and optimizing on the sample size though in reality, random sampling if faced with a number of challenges. According to Dattalo (2010), it is difficult to conduct random sampling unless there are deliberate arrangements to balance a sample’s composition in relation to uniqueness and diversity. He adds that random sampling can only work best when exposed to a randomization tests, a broader perspective on external validity, and sequential sampling as well as by the use of a planned missing data designs. The study is at risk of misclassification especially when looking at specific diagnoses of mental ill health among immigrants due to inter-cultural diversity (Hollander, 2011). Shahar and Shahar (2013) assert that cross-sectional is liable to bias, and has a lot uncertainty on the measure of association. According to Wood , Goesling & Avellar (2007) studies which depend on cross-sectional design have the weakness of not able to isolate the effect of certain variables on depressive symptoms as such studies cannot sufficiently control for the differences in background characteristics on study subjects. According to the three scholars, Studies which rely on longitudinal data are comparatively better able to control for possible selection especially when looking at mental health status in tow major ways: (1) by taking care for measures of baseline mental health, or secondly, by emphasizing on changes in ill mental health symptoms (Wood , Goesling & Avellar, 2007). Nevertheless, with appropriate precautions to counter possible shortcomings, the study design adopted by Daher et al (2012) is generally appropriate for the study of this nature. Study Findings From the study findings, Daher et al (2012) observed a mean mental health score of 61.9(SD ±17.8). Their Univariate analysis revealed the lowest age bracket had significantly lower Mental Health scores 57.62 (SD ±17.27) and p=0.001).The study participants that were had not employment, those married and those who had attained some higher levels of education attainment registered significantly higher mental health score (p=0.017, p=0.001 and p=0.036 in the same order. Stepwise multiple linear regressions indicated that only marital status was associated with mental health (b = 8.907, p < 0.001). Daher et al (2012) concluded from their research that Iraqi immigrants residing in Malaysia have mental health scores that might be indicative of a relatively moderate mental health. They also concluded that marital status affected mental health. Strengths and limitations of the study The major strength of the study it liked to the use of a large sample size of three hundred Iraqi based immigrants and a relatively high response rate, which is very important for representativeness. Such population-level findings give a very important insight for Mental Health study particularly in areas where such information is scant or limited (Penfold et al, 2010). The other major strength of the study is its ethical consideration. The participants were contacted personally and were informed about the aims of the study and that the participation is voluntary. In addition, they were informed that the results of the study will be used for publication and no personal data will be revealed (Daher et al, 2012, p.1149). Furthermore, the study’s strengths related to the detailed information on origin and the precision in which the authors looked at mental health of immigrants(Daher et al ,2012) considered a holistic review and understanding of mental health and its associated determinants carried out by reviewing pertinent issues especially those related to socioeconomic factors including, marital status. In addition, the authors undertook more contextualized relevant peer-reviewed and grey literature findings to enhance the details of the identified key areas. The study is not without challenges or shortcomings. One of the shortcoming relates to the issue of generalization which is affected the study methodology. Although the data are representative of the study area it is likely that frequencies of immigrants may vary between different regions in sub-Saharan Africa (Penfold et al, 2010). Another shortcoming is linked to the absence of information pertaining to undocumented migration in Iraqi. The authors attribute this to lack of documented information on Iraqi population. Unfortunately, this might compromise the comparative analysis of the two groups, which is between the Iraqi immigrants in Malaysia with those residing in Iraq. Furthermore, the study focused on only a small number of variables (age, gender, working condition and education status) may have compromised the level of understanding the various problems confronting Iraqi immigrants in Malaysia. At the same time, impact of extreme forms of fear and stigma may have prevented a full exploration of sensitive issues such as criminal acts which may also be of great significant to the study of this nature(Magalhaes, 2010). In addition, the study lacked a more authoritative study, which would have given a more persuasive evidence or voice for any causal effect of socioeconomic factors of immigrants on their mental health. The study also did not take a consider information on chronic illnesses and smoking habits among Iraqi immigrants as a result of limited information which the authors thought might have compromised the results. Moreover, Daher et al (2012) excluded population who were not registered with the Iraqi embassy thus compromising the generation of the study. Another aspect that is unexplored by the current study is the personal experience and impact of living in a new country as well as the numerous of related settlement processes which may include, but not limited to de-skilling and re-skilling processes, interpersonal relations with Malaysian and established immigrants or familial issues like intergenerational conflicts(Magalhaes,2010). Studies from the Netherlands suggest that the settlement process plays an important role as a factor for mental ill health among immigrants especially for women (Hollander et al, 2011). In order to cater for the limited documented studies on the mental health of Iraqi Immigrants in Malaysia, a consideration of public opinion or media information might have given the researchers an additional (Magalhaes, 2010). Again, even with the acknowledgment of Gender as a significant variable in measuring vulnerability to mental health, Daher et al (2012) have not adequately addressed how gender based attributed uniquely affect the health and well-being of participants. For instance, Hollander et al (2011) in their study entitled “Gender-related mental health differences between refugees and non-refugee immigrants- a cross-sectional register-based study’ observed that female exhibited a higher risk of ill mental health compared to male refugees who had the same risk patterns as non-refugee immigrants (Hollander et al 2011). Implications of the reviewed study Daher et al (2012) give important population-level information about mental health status of migrants in Malaysia. The study gives a clear demonstration that mental health status of migrants is a multifaceted and intersects with various socioeconomic factors such as education, employment, working conditions, marital status, and age. Taking marital status as an example, Wood, Goesling and Avellar(2007) affirm that “Having a spouse to monitor one’s behavior may encourage healthier living habits—such as a better diet, less heavy drinking, and more physical activity”(p.9). In addition, marital status tends to reduce sign and symptoms of depression its effects on social based support and intimate relationship connection. However, the trend may be associated by the virtue of the fact that people with fewer depressive symptoms tend to have high chances of getting married or stay married partly because they are often viewed as more attractive marriage partners (Wood, Goesling & Avellar, 2007, p.9). Daher et al (2012) findings offer vital evidence, which can be useful in establishing suitable or appropriate policy interventions in improving mental health status of migrants. Lastly, the study is a stepping-stone for critically addressing the complex issues surrounding the undocumented data on mental health status of migrants. Conclusion and Recommendations This paper aimed at a critical review on research related to mental health status of migrants. The study has highlighted important and valuable information pertinent to the topic. However, there are also various methodological flaws and other information gaps have been have been indentified hence the need for more research. In particular, a more detailed and gender- based study is required in order to enhance a to a better understanding of the diverse effects of being a migrants. This is especially quite essential when assessing the effects of other socioeconomic variable like employment on access to health, as job opportunities are often gender-mediated. References Daher, A.M., and Daher T. M., Ibrahim H. S., and Anbori A. K. (2012). Mental health status of a sample of Iraqi immigrants in Malaysia Journal of Advanced Medical Research Vol.2 (4): 144-152 Dattalo, P. (2010). Ethical Dilemmas in Sampling, Journal of Social Work Values and Ethics, Volume 7, Number 1 (2010) Hollander, A.C., Bruce, D., Burström, B., and Ekblad S. (2011). Gender-related mental health differences between refugees and non-refugee immigrants - a cross-sectional register-based study, BMC Public Health 2011, 11:180 doi: 10.1186/1471-2458-11-180 Magalhaes, L., and Gastaldo, D. (2010). Undocumented Migrants in Canada: A scope literature review on health, access to services, and working conditions, vol.12 (1): 132–151. Penfold S, Hill Z, Mrisho M, Manzi F, Tanner M, et al. (2010) A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania. PLoS ONE 5(12): e15593. doi:10.1371/journal.pone.0015593 Shahar, E., and Shahar, D.J (2013). Causal diagrams and the cross-sectional study Clinical Epidemiology Volume 2013:5(1):57 – 65 Wood, R.G., Goesling, B., and Avellar, S. (2007). The Effects of Marriage on Health: A Synthesis of Recent Research Evidence, Mathematica Policy Research, Inc available online at: http://aspe.hhs.gov/_/topic/subtopic.cfm?subtopic=377 Read More