Abstract
Objetivo
Observar diferencias entre población étnica y autóctona en la frecuencia de trastornos mentales. Estudiar datos epidemiológicos y su nivel de registro.
Diseño
Estudio descriptivo.
Emplazamiento
Área Básica de Salud Raval Sud. CAP Drassanes. Barcelona.
Pacientes
Muestra aleatoria de 112 pacientes inmigrantes, pertenecientes a minorías étnicas, visitados entre enero de 1995 y diciembre de 1997, apareados por edad y sexo con 112 autóctonos.
Intervenciones
Se estudiaron variables relacionadas con patología mental en inmigrantes: edad, origen, motivo de migración, situación laboral, estado civil, convivientes, estudios, conocimiento del castellano y hábitos tóxicos. Se recogieron impresiones diagnósticas como ansiedad, depresión, somatización, psicosis, trastorno de personalidad, número de visitas para cada diagnóstico, tratamientos y número de visitas global entre enero de 1995 y diciembre de 1997. Estudio estadístico: análisis descriptivo y ji-cuadrado.
Mediciones y resultados
Edad media, 39 ± 14; varones, 52,7%; magrebíes, 36,6% (27,6–45,5), e indostaníes, 23,2% (15,4–31). Un 43% (33,6–52) comprende el castellano. El tabaquismo es superior en los autóctonos (59,8% [50,7–68,9] frente 26,8% [18,5–34,9]; p < 0,001), así como el abuso de alcohol (24,1% [16,1–32] frente al 5,4% [1,1–9,5]; p < 0,001). El grupo étnico tiende a presentar mayor porcentaje de depresión (15,2% [8,5–21,8] frente al 13,4% [7–19,7]; p = ns) y trastorno por somatización (10,7% [4,9–16,4] frente al 6,3% [1,7–10,7]; p = ns), pero es infratratado (19,8% [12,4–27,2] frente al 32,1% [23,4–40,7]; p = ns). El total de visitas es superior en el grupo autóctono (1.138/1.017), así como las visitas por trastornos mentales (17,9% [15,7–20,1] frente al 13% [10,9–15], p = ns).
Conclusiones
No hay diferencias en el porcentaje de trastornos mentales en inmigrantes, aunque sí tendencia a la depresión y trastorno por somatización. Las características de la población de referencia y el bajo nivel de registro de datos observado podrían sesgar el resultado, influenciado por las dificultades comunicativas de los inmigrantes que dificultan el diagnóstico. Es necesario formar a los profesionales para mejorar su calidad asistencial.
Palabras clave: Etnia, Salud mental, Atención primaria de salud
Abstract
Aim
To observe the differences between ethnic groups and the autochthonous population in the frequency of mental disorders. To study epidemiological data and the accuracy of recording of such data.
Design
Descriptive study.
Setting
Raval Sud Basic Health Care Area. Drassanes Primary Health Care Center, Barcelona, Spain.
Patients
A random sample of 112 immigrant patients belonging to ethnic minorities, seen between January 1995 and December 1997, matched for age and sex with autochthonous patients.
Interventions
We studied variables related with mental disorders in immigrants. Variables included age, country of origin, reason for immigrating, employment status, marital status, other persons in household, educational level, knowledge of Spanish and toxic habits. We recorded the following impressions of diagnosis: anxiety, depression, somatization, psychosis, personality disorder, number of visits for each diagnosis, treatment, and overall number of visits between January 1995 and December 1997. Statistical studies consisted of descriptive analysis and chi-squared tests.
Measures and results
Mean age was 39 ± 14 years, 52.7% of the immigrant patients were men, 36.6% (95% CI, 27.6–45.5%) were from the Maghreb region, and 23.2% (95% CI, 15.4–31.0%) were Hindustani. 43% (95% CI, 33.6–52.0%) understood Spanish. Smoking was more frequent among autochthonous patients (59.8%; 95% CI, 50.7–68.9%) than in immigrant patients (26.8%; 95% CI, 18.5–34.9%; p < 0.001), as was alcohol abuse (24.1%; 95% CI, 16.1–32.0%, versus 5.4%; 95% CI, 1.1–9.5%; p < 0.001). Depression tended to be more frequent in patients belonging to ethnic groups (15.2%; 95% CI, 8.5–21.8%) than in autochthonous patients (13.4%; 95% CI, 7.0–19.7%; p = ns), as did somatization disorder (10.7%; 95% CI, 4.9–167.4%, versus 6.3%; 95% CI, 1.7–10.7%, p = ns), but was undertreated (19.8%; 95% CI, 2.4–27.2%, versus 32.1%; 95% CI, 23.4–40.7%; p = ns). The total number of visits during the study period was higher in autochthonous patients (1138 versus 1017), as was the number of visits for mental disorders (17.9%; 95% CI, 15.7–20.1%, versus 13%; 95% CI, 1.9–15.0%; p = ns).
Conclusions
There were no differences in the percentages of mental disorders between immigrants and autochthonous residents, although depression and somatization disorder tended to be more frequent in the former group. The characteristics of the reference population, and the frequency with which epidemiological data were missing from the medical record, might have biased the results; this in turn might have been influenced by communication problems which make the diagnosis in immigrants more difficult. Health professionals should be appropriately trained to enable them to provide better care.
Key words: Ethnic group, Mental health, Primary health care
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