The effect of rural-to-urban migration on social capital and common mental disorders: PERU MIGRANT study

Christian Loret de Mola 0 1 2 3 4 5 Sanja Stanojevic 0 1 2 3 4 5 Paulo Ruiz 0 1 2 3 4 5 Robert H. Gilman 0 1 2 3 4 5 Liam Smeeth 0 1 2 3 4 5 J. Jaime Miranda 0 1 2 3 4 5 0 C. Loret de Mola P. Ruiz Mental Health Working Group Peru, Universidad Peruana Cayetano Heredia , Lima, Peru 1 C. Loret de Mola P. Ruiz J. J. Miranda Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia , Lima, Peru 2 C. Loret de Mola (&) S. Stanojevic P. Ruiz R. H. Gilman J. J. Miranda CRONICAS, Centro de Excelencia en Enfermedades Cronicas, Universidad Peruana Cayetano Heredia , Av. Armendariz 497, 2do Piso, Miraflores, Lima 18, Peru 3 Migration Social capital 4 L. Smeeth J. J. Miranda Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , London, UK 5 R. H. Gilman Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA Objective This study aims to investigate whether there are differences in the prevalence of common mental disorders and social capital between migrant and non-migrant groups in Peru. Methodology The PERU MIGRANT study is a crosssectional study comprising three groups: an urban group from a shanty town in Lima; a rural group from a community in Ayacucho-Peru; and a migrant group originally from Ayacucho currently living in the same urban shanty town. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12), and social capital was assessed using the Short Social Capital Assessment Tool (SASCAT). Poisson regression with robust standard errors was used to estimate prevalence ratios. - Globally, mental health disorders are ranked the second leading cause of disability-adjusted life years (DALYs) and years of life lived with disabilities; accounting for 12 and 31% of the total global burden of disease, respectively [1]. In Peru, 30% of the people are affected by mental health disorders [2] and in Lima, Perus capital, almost 7% of the population suffer from depression [3]. Given the magnitude of the disease burden in Peru, there is a need to identify country-specific risk factors, so that appropriate prevention and treatment programs can be developed. Peru is a culturally diverse country and, during the past 30 years, has experienced large internal migration from rural-to-urban areas. During the decades of political violence, between the 1970s and 1990s [4], mass migration occurred throughout the country. During this period thousands died and thousands of families were displaced, mostly from rural areas [5, 6] creating a strong pushing factor to migrate. More than half of these deaths occurred in the Andean department of Ayacucho [6] and most of the migration from Ayacucho was to Lima, Perus capital [7]. Migration is an important health issue, as changes in the physical and social environment may influence disease patterns [810], especially those related to mental health [9, 11, 12]. Despite numerous studies investigating the relationship between migration and mental health [9, 12 15], there is inconsistent evidence as to whether migration is a significant risk factor for mental health disorders. Furthermore, very few studies [16] have studied internal migration within developing countries and their findings might not necessarily apply to the Peruvian context. In the context of increased migration and urbanization in lowand middle-income countries, such questions related to mental health and social capital following migration remain to be addressed. It is recognized that rural populations have stronger social structures [17] and thus we would expect the process of internal migration, from rural-to-urban settings, to alter social capital and mental health risk. Social capital, defined as the social relationships, bonds and perceptions within societies or groups of people [18], is strongly related to mental health, and some of such evidence was derived from Peru [18, 19]. A recent literature review in the Latin America and Caribbean region concluded that social capital could have a protective relationship with several health-related areas, and not only mental health. Other areas where social capital has been linked to health include mortality, quality of life, trauma and nutrition [20]. This paper aims to identify the effect of migration on both, social capital and common mental disorders in Peru. Subsequently, we will investigate whether factors such as age at first migration, cumulative time lived in an urban area or percentage of lifetime exposure to an urban environment affect the social capital and common mental disorders. The cross-sectional PERU MIGRANT study, conducted in 2007, aimed to establish the effect of migration on cardiovascular risk factors. Details of the study design have been reported in detail elsewhere [21]. Peru offers a unique opportunity to assess the impact of migration on health. The patterns of migration in Peru changed dramatically during the (...truncated)