Global movement and health potential of black migrants in Germany: A study of mental health indices using MMPI

Erhabor S. Idemudia (University of Limpopo, South Africa)
[BIO]

Abstract

The aim of this paper is to describe the psychological responses of African migrants living in Germany and to empirically demonstrate the relationship between international migration and mental health.

Using a Non-experimental (hypothesis testing) field study design, data was collected from seventy nine (79) African migrants consisting of 58 (73%) males and 21 (26%) females with age in years ranging from 15 to 46 with a mean age of 31.6 (SD) =7.34. Through the snowballing approach participants were reached in the following cities: Bremen, Hamburg, Bonn, Düsseldorf, Köln, Bayreuth, Frankfurt, Stuttgart, and Munich.

The results of the hypothesis testing study one showed that: migrants reported negative living conditions and experiences (53% of 76 respondents), and racial discrimination as the most serious problems (40.5%) and these experiential stressors significantly affected migrants' psychological dysfunctions on all measures on MMPI-2: Anxiety, Depression, Health Concerns, Bizarre Mentation, Anger, Social Discomfort, Family Problems, Work Interference, Self Esteem, and Negative Treatment. Racial discrimination, also significantly affected the migrant's psychological dysfunction report on all MMPI-2 measures except health concerns, anger, and selfesteem. Hypothesis two which stated that the stressful experience of migrants would reflect on males and females differently as far as their symptom report was concerned, such that females would report higher psychological dysfunctions than males, showed a significant report of psychological dysfunctions on only five of the psychological measures: Anxiety, Depression, Bizarre Mentation, Self Esteem and Negative Treatment. Although differences were observed, the following measures did not reach acceptable levels of significance: Health Concerns, Anger, Social Discomfort, Family problems, and Work Interference.

These results have far reaching implication for the mental health potential of migrants and international migration particularly those from Africa and as such have been discussed and recommendations made in accordance with the findings of the study .

Introduction

The pressures and opportunities associated with the process of globalisation have led to an increase in the number of people moving from one country and continent to another. Globalisation the acronym for the liberalisation of international trade and the revolution in communication is arguably one of the most important factors generating increased levels of international migration

Trade liberalisation according to Chimanikire (2002) has placed developing economies under economic pressures, often generating increased unemployment, reduced social spending and a decline in living standards. These pressures, according to Boswell and Crisps (2004), generate political insecurity, creating grievances over limited or inequitably distributed resources, or frustration at the declining capacity of states to provide socio-economic security. Globalisation, they say, has not only increased 'push factors' inducing emigration, but has expanded possibilities for the flow of information, communication and movement between States and also increased the demand for both high and low skilled workers. Unfortunately however, migrant flows are always from the poorest countries with a low probability of employment towards less poor and more dynamic countries where there is an opportunity to find some sort of a job.

International migration according to Martin (2002) is usually a major individual or family decision that is carefully considered and has two broad categories: those who migrate to another country for primarily economic reasons, and those who moved primarily for non-economic reasons. He grouped the factors that encourage a migrant to actually move into 3 categories: demand-pull, supply-push and network factors or what Chimanikire (2002) also described as economic (employment, study, retirement), social (family or ethnic reasons, marriage unification) and political (refugees, persecution of war, famine, mass expulsion and general political and economic disorder or environmental crises). Economic migrants will move due to the demand-pull factor to be recruited as guest workers, while non-economic motivations to cross borders may be the desire to join family members, while others again migrate because they hear or have been told about work and good conditions in countries abroad (network factors).

The current global and cross border movements has led many European countries to close up their borders and this tendency has been dubbed 'the fortress Europe' by the media. The consequence of such closures has led to the use of illegal routes which has significantly increased human trafficking and smuggling networks.

Recently, Africans have been known to travel by unsafe means: trolleys, ships, deserts etc. Some even meet their untimely death while trying to cross borders. Many find themselves on arrival in lock ups, prisons and asylums, and have psychological difficulties brought about by settling in a new country, the frustrations and loneliness induced by racism, and the inevitable clash of values.

However, it is important to note that migration and health can be related positively or negatively in a number of ways. Literature to date has shown that the relationship can be controversial.

There is no doubt that moving from one society to another can cause emotional difficulties. This is because migrants pass from one set of cultural values to another. Immigrants to other countries bring with them psychological responses to difficulties of their own community. Different migrating populations have diverse resources and a different ability to cope with the stresses encountered. Immigrant groups are subject to discrimination in housing, employment, in education services and in everyday interpersonal relations. According to Littlewood and Lipsedge (1989), virtually in every European Union (EU) country, housing of ethnic minorities indicates that they occupy the transitional zones of town areas, which are falling into disrepair and are scheduled for eventual demolition, and in accommodation, which has rudimentary sanitation and cooking facilities.

Explanations of mental health among migrant population tend to be anchored on the migration-morbidity hypothesis (Klimidis and Minas, 1995) advanced to suggest a link between the prevalence of psychiatric disorder and migrant status. According to Gorman, Brough and Ramirez (2003), this hypothesis has been viewed as too simplistic, because of the complex nature of psychiatric morbidity and migrant status which involves many risk factors, such as socioeconomic status, pre-migration stresses and events, post-migration resettlement factors, migrant status, access to health etc.

Access to health and feeling of wellbeing are factors that are also strongly related to discrimination among African migrants in Germany, (Idemudia and Boehnke, 2005). Gorman, Brough and Ramirez (2003), have also claimed that people with non-English-speaking background (NESB) are disadvantaged in terms of access and quality of service in the Australian monocultural Anglo-Celtic health setting, although it is officially supposedly a multicultural society. Earlier LoGiudice et al (2001) have also made a similar observation that due to an absence of cultural sensitivity and understanding, young people and all culturally and linguistically diverse (CALD) clients do not have access to mental health services, and some researchers (Blackford et al, 1997, Comino et al 2001) have claimed that such clients do are at risk of poor or even destructive experiences when they do access mental health services.

According to Hutchinson and Haasen (2004) there is increased-risk of schizophrenia for non-white migrants in Europe, with Africans and Caribbean patients being especially vulnerable in the United Kingdom; as well as Turkish patients in Germany. The same vulnerability to increased risk has also been found among Caribbean, East and West African migrants in the Netherlands. Social inequalities, family fragmentation and migratory stress have been the main hypothesis proposed for the increased rate of vulnerabilities.

Unfortunately, there is only a small amount of 'hard' data on migrant's mental health and life satisfaction or general well being. To try and address the paucity of data, especially quantitative data which would help provide empirical indices of mental health of migrants, particularly that of Africans in a European country (Germany), two hypotheses are stated: (1) That African migrants living in Germany would find the German environment stressful (due to the need to acquire a new language, as most Africans only speak English and French, and also due to the lack of proper integration because of discriminatory practices) and as a result would report significant mental health problems measured with the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) and (2) that the stressful experience would reflect on male and female differences, such that females would report higher psychological dysfunctions than males.

Method:

Design

This study is anchored on a Non-experimental (hypothesis-testing) field study design using the snowballing method for collecting data from participants. Due to the sensitive nature of the research, particularly among those who were illegally residing in the country, the snowballing method of sampling was used. The researcher was viewed by many participants as a "government agent" or "spy", and many were thus reluctant to return questionnaires. Structured questionnaires in a booklet format were sent to participant's addresses by mail and were returned in pre-paid envelopes to eliminate the possibility of identifying respondents. The questionnaire has four sections A, B, C, & D. Section A tapped information on demographic data such as sex (males/females), age in years, marital status, educational level (before and after migrating to Germany), reasons for migration, present experiences in Germany (positive, negative and neutral), problems encountered in Germany (yes/no), nature of problem encountered (criminal, immigration, miscellaneous) and general problems in Germany (none, racial, economic, social, psychological, legal, housing, unspecified). Section B measured the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) while sections C and D measured the Migrant Attitude Questionnaire (MAQ) developed by this researcher (see Idemudia 2004, Idemudia & Boehnke 2005) and section D contained the Schwartz Value Survey (PVQ-Portrait Version) respectively. In this paper only sections A and B are used.

Study sample and settings:

The study populations are African Immigrants resident legally or illegally in Germany in the year 2003. Data was collected from seventy nine (79) African migrants consisting of 58 (73%) males and 21 (26%) females with ages ranging from 15 to 46 years, with a mean age of 31.6 (SD) =7.34. Among the seventy nine migrants, 32 (38.1%) were single, 15 (19.9%) married, 14 (16.7%) were separated and 27.4% were divorced. Eight (10.5%) of the respondents had primary/or lower levels of education, 43 (56.6%) had secondary or equivalent level, 9 (11.8%) had post secondary education and 16 (21.1%) had university education. Fifteen (19.0%) migrated to study, 9 (10.6%) to work, 32 (40.5%) migrated for economic reasons, 16 (20.0%) for political reasons and 7 (8.9%) for family reasons.

The study areas are German cities. The cities include Bremen, Hamburg, Bonn, Düsseldorf, Köln (Cologne), Bayreuth, Frankfurt, Stuttgart and Munich. Migrants are defined as those Africans living in Germany irrespective of their place of origin in Africa. They include both legal and illegal residents. Temporary visitors were excluded from the study. Some illegal residents were also registered as asylum seekers. The mean length of stay/residence in Germany is 5.77 years (SD=4.91).

Instruments and psychometric properties

The Minnesota Multiphasic Personality Inventory- (MMPI) (Hathaway and McKinley 1943) is an objective test that focuses on the assessment of personality and psychopathology. The MMPI was initiated in the late 1930s in a hospital setting at the University of Minnesota with a selected large pool of empirically derived items that discriminated subjects for psycho-diagnostic.

The new MMPI-2 is the re-standardization of the MMPI on a full cross-section of Americans. It contains, among others scales, 10 clinical scales, 3 validity scales and 15 content scales that assess the underlying content and major themes of all items in the pool clearly defined in the scales. The MMPI-2 eliminates problems with the original version, (Helmes and Reddon, 1993; Newmark and McCord, 1996). The scale has been validated for African populations, (Berner 1998). According to Anastasi, (1988), the MMPI is the most extensively researched and widely used tool in the world. It has been translated into more than 100 languages (Myres, 1995) and, although it assesses psychological disorders rather than "normal" personality traits, its uses are extended to several areas.

The ten content scales standardised and used for this study include: Anxiety (ANX), Depression (DEP), Health concerns (HEA), Bizarre Mentation (BIZ), Anger (ANG), Low self esteem (LSE), Social discomfort (SOD), Family problems (FAM), Work interference (WRK), Negative treatment indicators (TRY) and the Lie, F and K scales. The MMPI-2 is answered by 'Yes' or 'No'. Computation of scores for all measures was such that half a standard deviation above and below the mean was used to cut off low and high scorers. High scores on any psychological measures indicate a high report of psychological dysfunction.

Psychometric properties of the original MMPI-2 scales has been known to range from .89 (Depression), .89 (Health Concerns), .65 (Bizarre Mentation), .79 (Anger), .78 (Low Self Esteem), .92 (Social Discomfort) to .86 (Family Problems), .85 (Work Interference) and .75 for Negative Treatment. Using samples of 1,425 subjects in Ibadan, Nigeria, Berner (1998) standardized the MMPI-2 content and validity scales among the Yoruba population. Validity coefficients (alpha coefficients) for all the scales used in this study ranged from .71 to .96 which demonstrates that the scales were valid for use. A pre-test of the scales was carried outt among 20 migrants in Germany. Split-half reliability obtained for this sample ranged from .70 to 94 on the ten clinical scales used. This also indicates that the MMPI-2 was highly reliable for use among Africans in Germany.

Data Analysis

The data collected was analyzed by the use of simple statistical techniques such as frequencies, cross tabulations, and percentages, t-tests and the Analysis of Variance (ANOVAR).

Results: Hypothesis 1

Based on the broad hypothesis stated, results are analysed from the perspective of the living conditions of migrants in Germany. Respondents were asked to rate their present German experience and the results are shown in table 1 below:

Table 1: Present German Experience

From the results above, 27 (35.5%) rated living positively, 8 (10.5%) were neutral and 41 (53.9%) rated living in Germany negatively.

On the nature of the problems encountered in Germany tagged (General problems experienced in Germany), results (table 2) showed that 10 (13.5%) had no problem at all, 30 (40.5%) rated racial discrimination as the biggest problem, 3 (4.1%) rated economic problems such as no jobs, 5 (6.8%) rated social problems such as interracial mix, 4 (5.4%) rated psychological factors such as feeling lonely always, 9 (12.2%) rated legal problems, 2 (2.7%) rated housing problems, and 11 (14.9%) rated problems that did not fall into any of the above categories of problems and are thus labelled as unspecified (or miscellaneous problems).

Table 2: General problems in Germany

How do these experiential stresses (present German experience and general problems in Germany) affect the mental health of migrants?

Table 1 showed that of the 72 respondents, 41 (53.9) rated living in Germany as negative. This variable (present German experience) was computed using a one way analysis of variance (ANOVAR), and results in table 3 below showed that a negative experience of living in Germany had a significant effect on mental health: Anxiety (F (2, 75) = 8.043, P< .001; Depression (F (2, 75) = 6.993, P< .002; Health Concerns (F (2, 75) = 61.512, P< .03; Bizarre Mentation (F (2, 75) = 6.456, P< .003; Anger (F (2, 75) = 4.241, P< .01; Social Discomfort (F (2, 75) = 60672, P< .002; Family problems (F (2, 75) = 6.866, P< .002; Work Interference (F (2, 75) = 3.189, P< .04; Self Esteem (F (2, 75) = 5.561, P< .02; and Negative treatment (F (2, 75) = 4.401, P< .01.

Table 3: Summary of one-way Analyses of variance (ANOVAR) showing the effect of present German experience in Germany on (MMPI-2 scores).

A post hoc analytic comparison of the means of various cells using Turkey's Honestly Significant Test (HSD) (table 4) showed that migrants with negative living experiences reported more psychological dysfunctions on all measures of mental health than those who rated positively or neutral.

Table 4: Summary of cell means showing effect of present living conditions on MMPI-2 scores of African migrants in Germany

Key:

• + Positive
• - Negative
• 0 Neutral

Again, racial discrimination was the single variable that stood out as a major problem of the general problems encountered in Germany (40.5% of the 74 respondents), (table 2) and was computed as such to evaluate its impact on mental health of migrants. Table 5 below showed that racial discrimination had a significant effect on mental health for Anxiety (F (7, 72) = 4.259, P< .001; Depression (F (7, 72) = 3.691, P< .002; Bizarre Mentation (F (7, 72) = 3.794, P< .002; Social Discomfort (F (7, 72) = 3.895, P< .001; Family problems (F (7, 72) = 4.185, P< .001; Work Interference (F (7, 72) = 3.291, P< .005; and Negative treatment (F (7, 72) = 4.334, P< .001.. Only Health Concerns, Anger and Self Esteem did not reach an acceptable level of significance at .05.

Table 5: Summary of one-way Analyses of variance (ANOVAR) showing general problem experienced in Germany on mental health (MMPI-2 scores).

Also, a detailed inspection of the cell means for significant interaction effect for psychological dysfunctions reported, showed that racial discrimination was the main single factor aggravating psychological dysfunctions among migrants compared to other factors, (table 6).

Table 6: Summary table of means of general problem experienced in Germany on mental health (MMPI-2) scores

Hypothesis 2 which predicted that there would be a difference between men and women in their report of psychological dysfunction was analysed with a t-test for independent groups, (see table 7). Results in table 7 showed that the hypothesis was supported in the following psychological measures: Anxiety t = (77) = 7.910, P < .005; Depression t = (77) = 5.524, P < .02; Bizarre Mentation t = (77) = 8.62, P < .004; Self Esteem t = (77) = 9.258, P < .003; and Negative Treatment t = (77) = 6.36, P < .01. There were no differences between males and females in the following psychological measures: Health Concerns, Anger, Social Discomfort, Family problems and Work Interference.

Table 7: Independent t-test showing means and standard deviation of male and female samples of African migrants on MMPI-2 scores

Discussion:

Cross-border movement is as old as history, but the current trend as a result of globalization and of African youths moving to western societies is unprecedented. Many African youths believe that to travel to Europe and the North Americas is to put an end to ones problem, thinking that that these are all bed of roses-lands, 'flowing with milk and honey'. So they travel in droves and in fact many even travel by unsafe means. Some trek through the 'valleys and shadows of death' of the hot Sahara desert, on trolleys, dinghies and cargo ships. On arrival many find that the land that was supposed to flow with honey actually flows with racism, hardships, imprisonment, police harassments, daily apprehension of deportation and hosts of other hostile life situations. Coping life styles are then channelled into drug trade (a common sight in German Hauptbahnhöfe - Main train stations), prostitution, and domestic thefts, and as a result, many then find their homes in prisons, lockouts, asylums and mental institutions.

Results from this study has shown that African migrants reported more negative living conditions and experiences of racial discrimination, making them ceteris paribus, to suffer psychological dysfunctions such as anxiety, depression, health concerns, bizarre mentation, anger, social discomfort, family problems, work interference, self esteem and negative treatment.

Symptoms of these psychological dysfunctions as reported by migrants include (Anxiety) general symptoms of anxiety including tension, somatic problems (such as heart pounding and shortness of breath, sleep difficulties, worries, and poor concentration; ( Depression) significant depressive thoughts, such as apathy about life, feelings of hopelessness thoughts of suicide etc; (Health Concerns) such as many physical symptoms across several body systems such a gastro-intestinal, neurological, cardiovascular, respiratory and other symptoms; (Bizarre Mentation) include psychotic thought processes such that they report peculiar thoughts, hallucination and paranoid ideation (e.g. believe that someone is trying to poison them); Anger includes anger-control problems. These individuals report being irritable, impatient, hotheaded, annoyed, stubborn, and sometimes lose self-control; (Low Self-Esteem) individuals with low opinions of themselves such as believing that they not liked by others and a burden to others; (Social Discomfort), include people that are very uneasy around others preferring to be by themselves. They see themselves as shy and disliked by others; (Family Problems) individuals report considerable family discomfort, such as unpleasant and quarrelsome family members, lacking of love, or an unhappy marriage lacking in affection; (Work Interference) High scorers show behaviours or attitude such as low self confidence, concentration difficulties, obsessiveness, tension and pressure, and decision making problems which are likely to contribute to poor work performance; and (Negative Treatment Indicators) indicate individuals with negative attitudes towards doctors and mental health treatment. They do not believe anyone can understand or help them.

Unfortunately, how such dysfunctions are developed is unknown among Africans, except that they are exposed to negative life experiences which serve as triggers. The results support the migration-morbidity hypothesis (Klimidis and Minas, 1995) and the study by Hutchinson and Haasen (2004) of increased risk of schizophrenia for non-white migrants in Europe, which are attributed to social inequalities, family fragmentation, and migratory stress.

CONCLUSION

From this study, the following conclusions are made:

• The majority of Africans who participated in this study reported their present German experience as negative.
• Racial discrimination (40%) was singled out as the predominant problem experienced in Germany
• Negative experiences significantly affected mental health report, such as Anxiety, depression, health concerns, bizarre mentation, anger, social discomfort, family problems, work interference, self esteem and negative treatment.
• Racial discrimination also significantly affected mental health outcomes such as anxiety, depression, bizarre mentation, social discomfort, family problems, work interference and negative treatment.
• Anger, health concerns and self esteem did not reach acceptable levels with racial discrimination.
• Females reported more psychological dysfunctions than males on five of the MMPI-2 measure: Anxiety, Depression, Bizarre mentation, self esteem, and negative treatment.
• Health concerns, anger, social discomfort, family problems, and work did not reach an acceptable level of significance although females had higher means on all non-significant psychological disorders.

Recommendations:

The problems of migration are complex. The complexity of Africans migrating to western societies is anchored in person attitudinal and country-problem variables. The person attitudinal variable is a problem among African youths who believe that travelling to first world nations is an end in itself for greener pastures and putting an end to their economic woes. But how true is this belief system to real life experiences in Europe and the Americas? On the country-problem variables, why do migrants run away from their home countries and what are African countries and their leaders doing about this in terms of prevention by creating jobs for the youths, avoiding wars etc. How can the African Union (AU) help in this regard? What about the roles of Continental Europe and America and various host countries? How is international politics helping to aggravate the problem of poverty in African countries, and also finding solutions to the problems?

As earlier said, the situation is complex and demands multifaceted solutions, and these should include broadly: Attitudinal change among youths in Africa. Such behaviour change programme should target real life experiences among migrants in developed nations, e.g. that life in these countries are not bed of roses.

Also, African nations particularly those where migrants are common (West, East and some Southern countries) should expedite economic and social action reforms in their countries to minimize the need to migrate.

Finally, the host countries should put in place humane programmes to minimise triggering factors that can predispose migrants to psychological problems. These programmes should also target the local population on developing positive attitudes to migrants. Discriminatory practices should be abolished and must be seen to reflect on the constitution of the host countries.

Also, psychological practice in host countries should begin to seriously recognise the role of transcultural factors in health including mental health, attributions of illness, diagnoses, and treatment.

© Erhabor S. Idemudia (University of Namibia, Windoek)

Acknowledgement: The author wishes to thank INST Austria, for its financial assistance, the University of Namibia for a part travel grant and Air Namibia for offering me a special fare air ticket to attend the INST/IRICS conference in Vienna Austria. For this I thank the Manager, Corporate Communications - Mr Ellison K. Hijarunguru. I also acknowledge the International University Bremen, Germany for providing lofty logistics and a warm atmosphere for the study, Professor Klaus Boehnke for his inspirations. The study was made possible by Alexander von Humboldt Foundation, Germany.

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8.3. Innovation and Reproduction in Black Cultures and Societies: A comparative Dialogue and Lessons for the Future

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