Abstract
Psychological distress and mental illness has been found to be elevated in migrant groups living in sovereign countries, as well as for indigenous people living under colonial or administrative rule. The north Pacific island of Guam is unusual in its ethnic composition as it has no majority ethnic group, has a large indigenous population and remains a territory of the U.S. This study aimed to identify ethnic differences in self-reported psychological distress between the main ethnic groups on Guam. The study uses a cross sectional design with data linkage methodology, drawing on the Guam Census and the Behavioral Risk Factor Surveillance System health survey for Guam. The results showed that the native Chamorro population had worse self-reported psychological distress (defined as a ‘mental health condition or emotional problem’) than White/Caucasians (OR 2.09, 95% CI 1.52–2.87), particularly for severe distress (OR 3.61, 95% CI 1.33–2.77). This relationship persisted even after adjusting for a wide range of socio-demographic and economic factors (OR 2.58, 95% CI 1.15–5.76). Other Pacific Islanders also had higher psychological distress compared to White/Caucasians, but this association was largely explained by the adjusted factors. The findings are discussed in terms of social and economic disadvantage for Pacific Island peoples on Guam, as well as the impact of colonial administration, disaffection, and lack of autonomy for the Chamorro of Guam. Recommendations are made to improve psychiatric treatment for these groups by considering wider socio-political factors in assessment and treatment, as well as broader implications for the national dialogue on self-determination.
Highlights
Research on the mental health and wellbeing of migrants across the globe shows disproportionately high incidence of psychological distress [1], common mental health difficulties [2] and severe and enduring mental health difficulties and illnesses [3]
White/Caucasian participants had the lowest level of unemployment of all ethnic groups, and over a third of White/Caucasians earned over $75,000 compared to just under 7% of other Pacific Islanders
The results show higher distress amongst Chamorro and other Pacific Islanders compared to White/Caucasians, who had the lowest likelihood of psychological distress
Summary
Research on the mental health and wellbeing of migrants across the globe shows disproportionately high incidence of psychological distress [1], common mental health difficulties [2] and severe and enduring mental health difficulties and illnesses [3]. Puerto Ricans and Mexicans born in the USA have been found to have higher prevalence rates of major depressive disorder than the majority population [5]; and the minority Sami population of Norway reported greater psychological distress than the Norwegian majority [6]. This high level of psychological distress and mental illness amongst migrants and ethnic minority groups has been explained by an array of economic, social and psychological risk factors such as forced migration due to persecution. Inuit populations have been found to have nine times higher mental illness than populations of European decent in Alaska [5], in New Zealand, Cook Island Maoris were found to have the highest 12-month prevalence rate of mental disorders than any other ethnic group [16], and in Canada 13% of First Nations populations were found to suffer from psychological distress compared to 8% in the general population [17]
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