The concept of migration is defined as “The movement of persons away from their place of usual residence, either across an international border or within a State” (1). The number of international migrants has increased in the last 50 years and it is estimated that 272 million people live in a country different from that of their birth, triple that of 1970, with 48% of them being women (2). In Spain, resident foreigners represent 10% of the population (3), the most recent being those from the migratory movement between 2000 and 2007 motivated by the demand for labour in the construction and domestic service sector mainly and which was later slowed by the economic crisis (INE, 2008). In 2016, there was a new rise in the number of registered resident foreigners caused by conflicts in their countries of origin and also by the reunification of families of immigrants already established in Spain. In Catalonia, population growth in recent years has been due to the immigration of the foreign population, which in 2019 represented 14% of the population (3).
The migratory process is a human experience that affects people's health and is an emerging public health problem that needs a response. Migrating involves high levels of emotional stress that affect health and that can manifest themselves physically and psychically. It is comprised of several phases, and in each one of them the health of immigrants is conditioned by different determinants. In the pre-migration phase, epidemiological profiles of the origin, environmental policies, and personal exposure to conflicts or human rights violations are decisive in defining the state of health. In the migratory movement phase, the duration, circumstances and conditions of the trip are the factors that most affect health. Finally, in the arrival phase, the migration policies of the destination country, access to health systems and the sensitivity of health professionals towards cultural and linguistic differences act as decisive factors on the health of migrants (4). Added to the determinants of the above-mentioned migratory process are others such as loneliness, insecurity, stress suffered during the migratory trip and cultural shock upon arrival in the new country, creating a situation in which the person will have difficulties anticipating and facing the impact of disease, thereby increasing their vulnerability (5). On the other hand, and even with having access to the health system, some groups of migrants may find it difficult to express their symptoms or understand therapeutic instructions, not only because of language barriers but also because the causal mechanisms of the disease may have different cultural constructs, especially the processes related to mental health. Furthermore, it should not be forgotten that having to move through the different healthcare levels is an added difficulty for people who come from systems of disorder (6). A review of reviews published in 2016 suggests that first generation migrants are at increased risk of mental ill-health, including common mental disorders and psychotic disorders(7).
All the afore-mentioned adversities can affect the person's homeostasis and the functioning of the hypothalamic-pituitary-adrenal medullary axis, causing symptoms of psychological distress in the area of depression (sadness and crying), in the area of anxiety (irritability or insomnia), in the confusional area due to an increase in cortisol, as well as somatizations manifested by fatigue, osteoarticular discomfort or headache, among other symptoms. Somatic symptoms may appear in response to chronic stress and are also known as functional somatic symptoms (FSS), medically unexplained symptoms (MUS), bodily distress syndromes (BDS), or somatic symptom disorder (SSD). These names describe persistent physical symptoms that do not have an explanation. In relation to the manifestations associated with the migratory phenomenon, the Syndrome of Extreme Migratory Mourning was described in 1994, also called Ulysses Syndrome (8) in situations in which the chronic stress associated with the migration is extreme. Health professionals respond to somatic symptoms in a polarized way: they trivialize the symptoms due to the lack of objective evidence to explain them, due to ignorance of the syndrome or lack of cultural sensitivity, or they do not adequately diagnose the condition, classifying it as a depressive or psychotic illness, instead of a reactive picture of stress, thus elevating symptoms to the field of psychiatric pathology and adding a new stressor to the person (8), (9).
Consultations for recurrent symptoms of this type are especially relevant in primary care (10), since the deterioration in the quality of life of people who suffer from them leads to 60% more use of primary care services after hours (in primary Out-of-Hours care) than people who do not have these diagnoses (11). A recent systematic review argues that immigrants with somatization disorders perceive a greater need for the use of health services and greater difficulties in their daily lives than those who do not have them. However, there are differences in the prevalence of somatization disorders between different groups of immigrants, depending on culture, exposure to stress, explanatory models of the disease, coping and other individual variables (12).
The IOM (International Organization for Migration), the WHO and the Government of Spain organized a World Consultation on the Health of Migrants in 2010 (6). Four priorities were defined in it: monitoring the health of migrants, monitoring their equitable access to health services, developing health policies and programmes which are sensitive to the migrant population, and strengthening coordination and alliances between countries. Furthermore, it should be taken into account that migrants are not a homogeneous group and that increasing knowledge about their mental health, symptoms of psychological distress and psychosomatic manifestations, while attending separately to the different communities of origin would serve as a basis to better guide the healthcare services.
The research hypotheses were:
Psychosocial risk factors, psychological distress and somatizations show differences depending on the cultural community to which one belongs.
There are differences in the perception of psychosocial risk, psychological distress and somatizations which are related to gender.
Risk factors for psychological distress will consist of female gender, older age, less time residing in the host country, less academic education and psychosocial risk before and after migration.
Risk factors for somatization will consist of female gender, older age, less time residing in the host country, less academic education and psychosocial risk before and after migration.