Skip to main content

The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain

Administration and Policy in Mental Health and Mental Health Services Research volume 43, pages 616–627 (2016)Cite this article

Abstract

Since the mid-1990s, Spain has started to receive a great number of migrant populations. The migration process can have a significantly negative impact on mental health of immigrant population and, consequently, generate implications for the delivery of mental health services. The aim of this article is to provide empirical evidence to demonstrate that the mental health of immigrants in Spain deteriorates the longer they are resident in the country. An empirical approach to this relationship is carried out with data from the National Survey of Health of Spain 2011–2012 and poisson and negative binomial models. Results show that immigrants who reside <10 years in Spain appear to be in a better state of mental health than that observed for the national population. Studying health disparities in the foreign population and its evolution are relevant to ensure the population’s access to health services and care. The need for further research is especially true in the case of the immigrant population’s mental health in Spain because there is scant evidence available on their situation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  • Adams, P., Hurd, M. D., Mcfadden, D., Merrill, A., & Ribeiro, T. (2003). Healthy, wealthy and wise? Tests for direct causal paths between health and socioeconomic status. Journal of Econometrics, 112, 3–56.

    Article  Google Scholar 

  • Aglipay, M., Colman, I., & Chen, Y. (2013). Does the healthy immigrant effect extend to anxiety disorders? Evidence from a nationally representative study. Journal of Immigrant and Minority Health, 15(5), 851–857.

    Article  PubMed  Google Scholar 

  • Ali, J. (2002). Mental health of Canada’s immigrants. Health Reports, 13, 101–113.

    Google Scholar 

  • Antecol, H., & Bedard, K. (2005). Unhealthy assimilation: Why do immigrants converge to American health status levels?. IZA Discussion Paper, 1654. Bonn: IZA.

  • Baca-García, E., Pérez, M., Quintero, F. J., Martínez, M., Basurte, I., Sevilla-Vicente, J., et al. (2005). Acceso, itinerarios y utilización de los servicios psiquiátricos en la población inmigrante. Monografías de Psiquiatría, 17(4), 11–17.

    Google Scholar 

  • Bellón, J. A., Delgado, A., De Dios, J., & Lardelli, P. (1996). Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11. Atención Primaria, 18, 153–163.

    Google Scholar 

  • Bergeron, P., Auger, N., & Hamel, D. (2009). Weight, general health and mental health: status of diverse subgroups of immigrants in Canada. Canadian Journal of Public Health, 100, 215–220.

    PubMed  Google Scholar 

  • Bhugra, D., & Jones, P. (2001). Migration and mental illness. Advances in Psychiatric Treatment, 7, 216–233.

    Article  Google Scholar 

  • Biddle, N., Kennedy, S., & McDonald, J. T. (2007). Health assimilation patterns amongst Australian immigrants. Economic Record, 83(260), 16–30.

    Article  Google Scholar 

  • Broadhead, W. B., Gehlbach, S. H., de Gruy, F. V., & Kaplan, B. H. (1988). The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Medical Care, 26(7), 709–723.

    CAS  Article  PubMed  Google Scholar 

  • Cameron, A. C., & Trivedi, P. K. (2010). Microeconometrics using stata. Revised edition. College Station: Stata Press.

    Google Scholar 

  • Cantarero, D., & Pascual, M. (2008). Salud y utilización en la población inmigrante: una revisión del caso español. Atención Sanitaria y Nuevas Necesidades Poblacionales: Inmigración y Demanda. Santiago de Compostela: FEGAS.

    Google Scholar 

  • Carta, M. G., Bernal, M., Hardoy, M. C., & Haro-Abad, J. M. (2007). Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clinical Practice and Epidemiology in Mental Health, 1, 13.

    Article  Google Scholar 

  • Chen, J., Edward, N. G., & Russell, W. (1996). The Health of Canada’s Immigrants in 1994–95. Health Reports, 7(4), 33–45.

    CAS  PubMed  Google Scholar 

  • Chen, A. W., Kazanjian, A., & Wong, H. (2008). Determinants of mental health consultations among recent Chinese immigrants in British Columbia, Canada: implications for mental health risk and access to services. Journal of Immigrant and Minority Health, 10, 529–540.

    Article  PubMed  Google Scholar 

  • Chen, J., & Vargas-Bustamante, A. (2011). Estimating the effects of immigration status on mental health care utilizations in the United States. Journal of Immigrant and Minority Health, 13(4), 671–680. doi:10.1007/s10903-011-9445-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Costa, E., Barreto, S. M., Uchoa, E., Firma, J. O., Lima-Costa, M. F., & Prince, M. (2006). Is the GDS-30 better than the GHQ-12 for screening depression in elderly people in the community? The Bambui health aging study (BHAS). International Psychogeriatrics, 18, 493–503.

    Article  PubMed  Google Scholar 

  • European observatory on health systems and policies. (2011). Migration and health in the European Union. New York: Open University Press/McGraw-Hill.

    Google Scholar 

  • Fossion, P., Servais, L., Rejas, M. C., Ledoux, Y., Pelc, I., & Minner, P. (2004). Psychosis, migration and social environment: an age-and-gender controlled study. European Psychiatry, 19(6), 338–343.

    CAS  Article  PubMed  Google Scholar 

  • Goldberg, D. P., Gater, R., Satorius, N., Üstün, T. B., Piccinelli, M., Gureje, O., & Rutter, M. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197.

    CAS  Article  PubMed  Google Scholar 

  • Goldberg, D., & Williams, P. (1988). A user’s guide to the general health questionnaire. Windsor: Nfer-Nelson.

    Google Scholar 

  • Gómez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., & Sidney, S. (2004). Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organisation. American Journal of Public Health, 94(11), 1977–1984.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gotor, L., & González-Juárez, C. (2004). Psychiatric hospitalization and continuity of care in inmigrants treated in Madrid. Social Psychiatry and Pychiatric Epidemiology, 39, 560–568.

    Google Scholar 

  • Greene, W. H. (2011). Econometric analysis. New Jersey: Prentice Hall.

    Google Scholar 

  • Grossman, M. (2000). The human capital model. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics (pp. 347–408). Amsterdam: Elsevier.

    Google Scholar 

  • Grüsser, S. M., Wölfling, K., Mörsen, C. P., Albrecht, U., & Heinz, A. (2005). Immigration-associated variables and substance dependence. Journal of Studies on Alcohol and Drugs, 66(1), 98–104.

    Article  Google Scholar 

  • Gutiérrez, M. D. (2002). Trastornos mentales en minorías étnicas: ¿un tema para investigar en atención primaria? Atención Primaria, 29, 6–13.

    Article  Google Scholar 

  • Health & Consumer Protection Directorate-General. (2004). The state of mental health in Europe. Luxembourg: European Commission.

    Google Scholar 

  • Hernández-Quevedo, C., & Jiménez-Rubio, D. (2009). A comparison of the health status and health care utilisation patterns between foreigners and the national population in Spain: new evidence from the Spanish national health survey. Social Science and Medicine, 69, 370–378.

    Article  PubMed  Google Scholar 

  • Hoeymans, N., Garssen, A., Westert, G., & Verhaak, P. (2004). Measuring mental health of the Dutch population: a comparison of the GHQ-12 and the MHI-5. Health Quality Life Outcomes, 2, 13–23.

    Article  Google Scholar 

  • Instituto Nacional de Estadística. (2013). Encuesta Nacional de Salud 2011–2012. Madrid: Instituto Nacional de Estadística.

    Google Scholar 

  • Jasso, G., Massey, D., Rosenzweig, M., & Smith, J. (2004). Immigrant health: selectivity and acculturation. IFS Working Paper, 04/23. London: Institute for Fiscal Studies.

  • Kirmayer, L. J., Weinfeld, M., Burgos, G., du Fort, G. G., Lasry, J. C., & Young, A. (2007). Use of health care services for psychological distress by immigrants in an urban multicultural milieu. Canadian Journal of Psychiatry, 52(5), 295–304.

    PubMed  Google Scholar 

  • Krueger, A. B. (1993). How computers have changed the wage structure: Evidence from microdata 1984–1989. Quaterly Journal of Economics, CVIII, 33–60.

    Article  Google Scholar 

  • Lay, B., Lauber, C., Nordt, C., & Rössler, W. (2006). Patterns of inpatient care for immigrants in Switzerland: A case control study. Social Psychiatry and Psychiatric Epidemiology, 41(3), 199–207.

    Article  PubMed  Google Scholar 

  • Lindert, J., Schouler-Ocak, M., Heinz, A., & Priebe, S. (2008). Mental health, health care utilisation of migrants in Europe. European Psychiatry, 23(1), 14–20. doi:10.1016/S0924-9338(08)70057-9.

    Article  PubMed  Google Scholar 

  • Llop-Gironés, A., Vargas, I., Garcia-Subirats, I., Aller, M. B., & Vázquez, M. L. (2014). Acceso a los servicios de salud de la población inmigrante en España. Revista Española de Salud Pública, 88(6), 715–734. doi:10.4321/S1135-57272014000600005.

    Article  PubMed  Google Scholar 

  • Lou, Y., & Beaujot, R. (2005). What happens to the ‘Healthy Immigrant Effect’: The mental health of immigrants to Canada. PSC Discussion Papers Series, 19(15), article 1. London/Canada: Population Studies Centre, University of Western Ontario.

  • Marmot, M. G., Adelstein, A. M., & Bulusu, L. (1984). Lessons from the study of immigrant mortality. Lancet, 1(8392), 1455–1457.

    CAS  Article  PubMed  Google Scholar 

  • Marmot, M. G., & Syme, S. L. (1976). Acculturation and coronary heart disease in Japanese–Americans. American Journal of Epidemiology, 104(3), 225–247.

    CAS  PubMed  Google Scholar 

  • Mcdonald, J. T., & Kennedy, S. (2004). Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Social Science and Medicine, 59, 1613–1627.

    Article  PubMed  Google Scholar 

  • Ministerio de Sanidad, Servicios Sociales e Igualdad. (2014). Transversalidad y Continuidad Asistencial en Salud Mental. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad.

    Google Scholar 

  • Ministry of Health and Consumer Affaire. (2007). Summary of the strategy in mental health of the national health system. Madrid: Ministry of Health and Consumer Affairs.

    Google Scholar 

  • Newbold, B., & Danforth, J. (2003). Health status and Canada’s immigrant population. Social Science and Medicine, 57, 1981–1995.

    Article  PubMed  Google Scholar 

  • Nolan, A. (2012). The’healthy immigrant’ effect: initial evidence for Ireland. Health Economics, Policy and Law, 7, 343–362.

    Article  Google Scholar 

  • Ochoa, E., Vicente, N., & Díaz, H. (2004). Asistencia psiquiátrica a inmigrantes: Demanda en un centro de salud mental y hospitalización. Psiquiatria, 8(3), 1–10.

    Google Scholar 

  • Oppedal, B., Røysamb, E., & Lackland, D. (2004). The effect of acculturation and social support on change in mental health among young immigrants. International Journal of Behavioral Development, 28(6), 481–494. doi:10.1080/01650250444000126.

    Article  Google Scholar 

  • Palloni, A., & Arias, E. (2003). A re-examination of the hispanic mortality paradox. Center for Demography and Ecology Working Paper, 2003–01. University of Wisconsin: Madison.

  • Palloni, A., & Morenoff, J. (2001). Interpreting the paradoxical in the ‘hispanic paradox’: Demographic and epidemiological approaches. In M. Weinstein, A. Hermalin, & M. Stoto (Eds.), Population health and aging (pp. 140–174). New York: New York Academy of Sciences.

    Google Scholar 

  • Perez, C. (2002). Health status and health behaviour among immigrants. Health Reports, 13. Ottawa: Statistics Canada.

  • Pevalin, D. J. (2000). Multiple applications of the GHQ-12 in a general population sample: An investigation of long-term retest effects. Social Psychiatry and Psychiatric Epidemiology, 35(11), 508–512.

    CAS  Article  PubMed  Google Scholar 

  • Putnam, R. (1993). Making democracy work. Civic traditions in modern Italy. Princeton: Princeton University Press.

    Google Scholar 

  • Regidor, E., Sanz, B., Pascual, C., Lostao, L., Sánchez, E., & Díaz, J. M. (2009). La utilización de los servicios sanitarios por la población inmigrante en España. Gaceta Sanitaria, 23(1), 4–11.

    Article  PubMed  Google Scholar 

  • Rivera, B., Casal, B., Cantarero, D., & Pascual, M. (2008). Adaptación de los servicios de salud a las características específicas y de utilización de los nuevos españoles. Gaceta Sanitaria, 22(1), 86–95.

    Article  Google Scholar 

  • Rivera, B., Casal, B., & Currais, L. (2013). Healthy immigrant effect: trayectoria de salud de la población inmigrante a partir de la ENSE 2011-2012. Estudios de Economía Aplicada, 31(2), 339–358.

    Google Scholar 

  • Sánchez-López, M. P., & Dresch, V. (2008). The 12-item general health questionnaire (GHQ-12): Reliability, external validity and factor structure in the Spanish population. Psicothema, 20(4), 839–843.

    Google Scholar 

  • Sanz, L. J., Elustondo, I., Valverde, M., Montilla, J., & Miralles, M. (2007). Salud mental e inmigración: adhesión al tratamiento ambulatorio. Revista de la Asociación Española de Neouropsiquatría, 27(100), 281–291.

    Google Scholar 

  • Smith, J. P. (2004). Unravelling the SES health connection. The Institute for Fiscal Studies Working Paper, 04-02. Londres: The Institute for Fiscal Studies.

  • Sorlie, P. D., Backlund, E., & Keller, J. (1995). U.S. mortality by economic, demographic, and social characteristics: The national longitudinal mortality study. American Journal of Public Health, 85, 949–956.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Stephen, E. H., Foote, K., Hendershot, G. E., & Schoenborn, C. A. (1994). Health of the foreign-born population. Advance Data from Vital and Health Statistics, 241, 1–10.

    PubMed  Google Scholar 

  • Stillman, S., Mckenzie, D., & Gibson, J. (2009). Migration and mental health: Evidence from a natural experiment. Journal of Health Economics, 28, 677–687.

    Article  PubMed  Google Scholar 

  • Stoyanova, A., & Diaz-Serrano, L. (2009). El impacto diferencial del capital social sobre la salud mental de la población autóctona y los inmigrantes residentes en Cataluña. Gaceta Sanitaria, 23(1), 93–99.

    Article  PubMed  Google Scholar 

  • Straiton, M., Grant, J. F., Winefield, H. R., & Taylor, A. (2014). Mental health in immigrant men and women in Australia: The North West Adelaide health study. BMC Public Health, 14, 1–15.

    Article  Google Scholar 

  • United Nations. (2014). International migration report 2013. New York: United Nations.

    Google Scholar 

  • Wu, Z., & Schimmele, Ch. (2005). The healthy migrant effect on depression: Variation over time? Canadian Studies in Population, 32(2), 271–295.

    Google Scholar 

  • Instituto Nacional de Estadística (several years). Padrón Municipal: Explotación Estadística. Madrid: Instituto Nacional de Estadística.

  • Yeo, S. (2004). Language barriers and access to care. Annual Review of Nursing Research, 22, 59–73.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the support received from the research project ECON2013-48217-C2-2R “Impacto económico, sanitario y social de las enfermedades y los problemas de salud: información y herramientas para la evaluación de políticas públicas”.

Author information

Affiliations

  1. Department of Applied Economics, Faculty of Economics and Business, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain

    Berta Rivera & Bruno Casal

  2. University College of Labour Relations, University of A Coruña, A Coruña, Spain

    Bruno Casal

  3. Department of Economic Analysis and Business Administration, Faculty of Economics and Business, University of A Coruña, A Coruña, Spain

    Luis Currais

Authors
  1. Berta Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Casal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis Currais
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Berta Rivera.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rivera, B., Casal, B. & Currais, L. The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain. Adm Policy Ment Health 43, 616–627 (2016). https://doi.org/10.1007/s10488-015-0668-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-015-0668-3

Keywords

  • Mental health
  • Immigration
  • Healthy immigrant effect
  • Spanish mental health service
  • Social capital