Research reportDepression and generalised anxiety in the general population in Belgium: A comparison between native and immigrant groups
Introduction
Most European epidemiological research on mental disorders in immigrant groups is restricted to less common conditions such as schizophrenia. Such studies usually find an increased admission rate into psychiatric facilities and a higher prevalence of mental morbidity among (some) immigrant groups (e.g. Selten et al., 2001). Community-based evidence on common mental disorders in immigrant groups is limited (for an exception, see Shaw et al., 1999). In this paper, we determine the prevalence of depression and generalised anxiety in the population in Belgium and we assess whether region of origin is a significant risk factor.
In Belgium, no official data are available on region of origin of the population; all that is registered is current nationality. Looking at the statistics for 2002, we observe that 66.6% of the population of foreign nationality came from other countries of the European Union (EU) (www.antiracisme.be). Belgium first became a significant immigration country in the 1920s, when it attracted immigrants from neighbouring countries and from Central Europe. Immediately after World War II, more immigrants followed from Southern European countries, such as Greece, Italy and Spain. In the 1960s, diversification of economic activity led to a new immigration wave, primarily of Turks and Moroccans. Although Turks and Moroccans are considered to be the most visible group of immigrants in the media and to policymakers, statistics show them to represent only 5% and 11% respectively of the immigrant population. They do, however, constitute the largest groups within the non-EU immigrant population (Timmerman et al., 2003).
In 1973, an official moratorium was called on labour immigration into Belgium, but this has not stopped various migration flows, generated by economic and other factors. The EU-headquarters in Brussels, for example, create many employment opportunities for well-educated civil servants and managers from all over Europe. And Belgium also attracts immigrants from its neighbour, the Netherlands, because of its lower taxes, better housing conditions and good childcare facilities. Migration flows to Belgium from outside Europe consists mostly of family reunions, marriage migration (mainly from Turkey and Morocco), illegal migration and refugee migration. These latter forms of migration often involve individuals or families from economically underprivileged regions.
Since the drastic change in the 1990s to Belgian legislation on naturalisation, current nationality is no longer a good indicator for identifying immigrants. Under the new law, large numbers of immigrants from Turkey and Morocco have acquired Belgian nationality. Furthermore, descendents of immigrants now automatically receive Belgian nationality if they are born in Belgium. Obtaining Belgian nationality does, however, not necessarily change people's social reality, their cultural values, their socioeconomic position or experiences of discrimination, racism or social exclusion (Lodewyckx et al., 2004). Consequently, it does not alter the context within which mental health problems such as depression and anxiety are expected to develop.
An alternative way of differentiating the immigrant from the native population is to consider country of birth (e.g. Schrier et al., 2001, Mulder et al., 2006). However, if the research focus is not on first-generation immigrants, this too may be an inadequate strategy. In the case of Belgium, this would categorise large numbers of immigrants as Belgians, thereby obscuring the differences between their social reality and that experienced by the native population (Lodewyckx et al., 2004).
In the present study, we rely on information regarding nationality as well as country of birth, in an attempt to obtain a more accurate picture of immigrant status. In accordance with Belgian immigration history, we distinguish four regions, namely Belgium, Southern Europe (Greece, Italy and Spain), all other countries in Europe and non-European countries (Turkey and Morocco). These four regions reflect not only the duration of stay in Belgium but also sociodemographic and socioeconomic similarities, cultural similarities and generally perceived group identities. Migrants originating from outside the EU (except Turkey and Morocco) are not considered, since this group is quite diverse and relatively small in our sample, so that its inclusion would compromise the robustness of our findings.
Section snippets
Sample
The 2001 Health Interview Survey (HIS) is the second national health survey to be organised in Belgium. An extensive description of the methods, sampling frame and respondents is provided elsewhere (WIV, 2002). Suffice it to say that this survey is representative of the population in private and collective households and that it is based on a multistage stratified cluster sample (5530 households, 12,770 individuals). It provides information on respondents' physical and mental health and on
Prevalence
Table 1 shows the prevalence of depression and anxiety by region of origin. Depression and anxiety are measured in terms of symptoms and as a syndrome.
Prevalence of most depressive symptoms is much higher among Turkish and Moroccan immigrants. One in five reports feeling everything is an effort, loneliness, tearfulness or lack of energy. These symptoms are much less prevalent in the other groups (4.19% to 10.17%). The Turkish and Moroccan groups notably also exhibit increased prevalences of low
Key findings
In this paper, we consider region of origin as a risk factor for depression and anxiety in the general population (aged 18–65) in Belgium. Turkish and Moroccan immigrants are found to have higher rates of severe anxiety symptoms. This observation may be explained by their lower position in terms of education, labour market position, income and home ownership status. While their lower socioeconomic position results largely from the low level of educational attainment of first-generation
Conclusion
Our study shows that the prevalence of depression and anxiety in the general, non-elderly population in Belgium is higher among Turkish and Moroccan immigrants than in other population groups. It also suggests that the socioeconomic position of these immigrants is low, and that it is significantly associated with higher risks of common mental disorders. Our cross-sectional analysis does not enable us to test whether this association is due to social causation or to social selection mechanisms.
Acknowledgements
The data used in this study were gathered by the Unit of Epidemiology, Scientific Institute of Public Health, Belgium.
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