Health, migration and quality of life among Kurdish immigrants in Sweden

• Background: Although immigrants generally have poorer health and higher psychological distress than the native population, information on health, migration and quality of life among Kurdish immigrants is limited. Aims: Study I, to explore the association between (i) ethnicity and self-reported health (SRH) and (ii) complaints of psychological distress. Study II, to determine whether there was an association between (i) sex and poor SRH and (ii) psychological distress in Kurdish immigrants. Study III, to examine the association between (i) ethnicity and poor psycholo-gical well-being (PW) and (ii) to assess the relationship between sociodemographic characteristics, SRH, somatic pain, GIC and poor PW. Study IV, to describe mental health among 14 Kurdish men based on their own individual stories with regard to migration. Study V, to explore the coping patterns reported by 10 Kurdish men through their individual life stories during the whole migration process. Methods: Study I was based on responses from a total of 111 Kurdish men originating from Turkey and Iran from Inv-ULF (the first Swedish National Survey of Immigrants) and 1412 Swedish men from SALLS (Swedish Level-of-Living Surveys-SALLS) data collected in 1996 by Statistics Sweden. Study II was based on a whole Kurdish sample (n=197) from Inv-ULF. Study III, Kurdish sample from Inv-ULF and 1407 Swedes from SALLS were studied. The odds ratios with 95% Confidence intervals were calculated using unconditional logistic regression in all three quantitative studies (studies I-III). Studies IV and V, 10 men were interviewed face-to-face and one focus group of 4 participants was used. The analyses were done using Grounded Theory in study IV and Narrative analysis in study V. Results: Study I showed that the age-adjusted odds for poor SRH and sleeping difficulties among Kurdish men were about 3.5 times higher than among Swedish men. The odds decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Study II showed that Kurdish men and women had a high prevalence of poor SRH and psychological distress. Sex differences in anxiety remained also when all explanatory variables were taken into account. Study III showed that the odds ratios for Kurdish individuals for having poor PW were twice as high as for Swedish individuals after adjustment for age, sex, employment and SRH. Men with poor SRH had more than threefold higher odds ratios for having poor PW compared to those with good SRH. Futhermore, being female, having somatic pain and recurrent GIC regardless of ethnicity increased the odds for poor PW. Study IVdescribed emerged model with two major themes and interlinked categories. The themes were: 1) protective factors for good mental health (self-satisfaction, sense of freedom, sense of belonging, creation and re-creation of Kurdish identity) and 2) risk factors for poor mental health (dissatisfaction with Swedish society, lack of sense of freedom, yearning, worrying about the current political situation in the home country). Study V identified the coping strategies such as: contributing to the Kurdish culture and the home country; getting an education; creating one´s own society / building a family; achieving inner security and balance; being active and occupied and finally, coping with ongoing political instability in the country of origin. Conclusions: In the present thesis we found that Kurdish men and women reported a high prevalence of poor SRH and psychological distress. Negative experiences of pre-migration as well as postmigration were associated with the outcomes. Protective factors for good mental health and risk factors for poor mental health were emerged in this study. In order to cope with the Swedish society itwas important for Kurdish men to be included in it and acknowledged as individuals and to be able to contribute to the Kurdish culture and the home country. Findings in this thesis may be helpful inenabling the primary health services to take the impact of the migration experiences of Kurdish men into account.

Nyckelord

Immigrants, Kurds, ethnicity, self-reported health, psychological distress, psychological well-being, coping strategies, quantitative, qualitative, Sweden

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