Rifugiati e i richiedenti asilo: per una memoria utile

Summary

Introduction

Refugees and asylum seekers are a growing population in Western countries. The dramatic life situations from which they escape, and the difficulties of integration within host countries, are associated with the onset of trauma-related mental disorders (feelings of displacement, loss of identity) and major psychiatric disorders such as PTSD and Major Depressive Disorder.

Aims and methods

The increasing number of refugees referred by welcome centres, where they live, has led the Bologna BoTPT (Bologna Transcultural Psychiatric Team) Study and Research Centre to develop an operational plan aimed at improving care of these individuals. We chose to cooperate with social workers involved with integration projects to strengthen their listening skills and ability to recognize the needs expressed by asylum-seekers, and get them to compare their work experiences in a self-help/mutual-aid group guided by a mental health professional. Furthermore, we created a setting that responds to patients’ requests for help, focusing not only on traumatic events, but also on distress related to existential uncertainty that they experience when settling in.

Results and critical points

We found an improvement in social workers’ ability to cope with the stress of relating to refugees and their needs. Our work also led us to reappraise the category of PTSD, which is often inadequate to describe the complex experience of these patients.

Conclusions

Our work has helped to identify ways of strengthening collaborative activities between the City Council, as it is the institution in charge of welcoming refugees and asylum seekers, and the Mental Health Centre.

Keys words: Refugees • Asylum seekers • Helping relations • Bologna Transcultural Psychiatric Team (BoTPT)

Migration history, minorities status and risk of psychosis: an epidemiological explanation and a psychopathological insight

I. Tarricone1 2, S. Tosato3, P. Cianconi4, M. Braca5, A. Fiorillo6, L. Valmaggia7 8, C. Morgan8 9

1 Bologna Transcultural Psychosomatic Team, Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, Bologna, Italy; 2 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; 

3 Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy;

4 Department of Mental Health RmA, Casa Circondariale di Regina Coeli, Rome, Italy;

5 Casa di Cura Villa Azzurra, Riolo Terme, Ravenna, Italy;

6 Department of Psychiatry, University of Naples SUN, Naples, Italy;

7 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK;

8 National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College, London, UK;

9 Society and Mental Health Research Group, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK

Correspondence
Ilaria Tarricone, Bologna Transcultural Psychosomatic Team, Department of Medical and Surgical Science
Viale Pepoli 5, 40123 Bologna, Italy
Tel. +39 051 6584292
Fax +39 051 521030
E-mail: ilaria.tarricone@unibo.it

Background:

Objectives - A marked increased incidence of psychosis in migrants and ethnic minorities is a well established phenomenon. We aim to review data and insights arising from epidemiological and clinical/ psychopathological studies regarding the relationship between migration history, minority status and risk of psychosis in order to evaluate the experiences of migrants and minority ethnic groups in host societies. 

Method - A qualitative literature review was conducted to identify population surveys, services based studies, and clinical and biological studies on the relationship between migration and/ or minority status and psychosis. Studies were identified by searching MEDLINE, PsychINFO and EMBASE. The search was supplemented by references provided by personal bibliographies of the investigators and by hand searching content pages of journals considered relevant to the topic. The search was run in June 2015.
Results - Risk differences related to minority groups vary in different countries. Socio-environmental risk factors faced by origin groups operate differently in the countries, depending on social experiences and available resources to cope with adversities. In addition, social factors can represent environmental risk factors because they might regulate gene expression. Facing severe or chronic social stress, such as isolation, low socio-economic status, late-life social adversities may result in long-term sometimes permanent alterations of the biological stress-response system, which can lead to the development of physical and mental illnesses. A number of studies have taken into account psychopathological and clinical features at psychosis onset and follow-up, and they do not support the suggestion that misdiagnosis can explain the high rates found in those populations.

Conclusions - Reviewed papers cover a period of more than 30 years and highlight that history of migration and minority status might both be important in increasing the risk of psychosis. Clinical studies reported that psychopathological differences and misdiagnosis cannot explain the excess of psychosis found in migrants and ethnic minorities. The excess of psychosis in migrant and ethnic minorities may be at least attenuated by several psychosocial interventions, targeted at social disadvantages and at most at-risk individuals and populations.

Key words: Migration • Ethnic minorities • Psychosis • Cultural competent psychopathology