The participants in this research come mainly from nine countries (Bolivia, Ecuador, Colombia, Morocco, Tunisia, Algeria, Senegal, Gambia, Mali) grouped into four different communities: South American, sub-Saharan, Maghrebi and Southern Asian. The cultural differences between these groups are important, although the most distinctive fact is the language: only the South American community has the same language (Spanish) as the host country.
The first hypothesis that was posed was that the fact of belonging to different cultural communities conditioned the perception of psychosocial risk, psychological distress and somatic symptoms. The results obtained would allow us to accept this hypothesis since there are significant differences in the perception of psychosocial risk, as well as in all the scales of psychological distress (BSI) and in the somatization scale (SSI). In addition, the a posteriori contrasts allow us to affirm a clearly differentiated behaviour of sub-Saharan immigrants compared with the other communities since they perceive a greater psychosocial risk, although they exhibit fewer symptoms of psychological and psychosomatic distress.
The second hypothesis that was posed was the existence of differences in the perception of psychosocial risk, psychological distress and somatizations due to gender. The results partially support this hypothesis since in all the evaluation scales, women scored significantly higher than men, showing greater pre-migration and post-migration psychosocial risk, worse psychological health and more somatization disorders. These results are in the same line as the findings of other investigations carried out with the immigrant population in which the female gender presents greater severity of somatic symptoms (21), (22). Female gender is also shown as a significant variable in anxiety, mood disorders, eating disorders and somatization, not only in immigrant communities but also in the indigenous population (9) . However, the score on the global psychosocial risk scale does not show differences between men and women. This was an unexpected result as the pre-migration and post-migration scales are part of the global scale. This difference is determined to be because the global scale adds five single items under the construct “conflict reaction”, which act to moderate psychosocial risk and as a result turn out to be more adaptive coping strategies than those used by men, thereby equalizing the global perception of psychosocial risk.
The third hypothesis supposed that the risk factors for greater psychological distress are female gender, older age, less time residing in the host country, less academic education and psychosocial risk before and after migration. The separate analysis of men and women showed differences in the predictors of psychological distress. In men, the pre-migration and post-migration conditions appear in the model, however in women the post-migration scales, the global DPSI index, the years since migration and being married appear. Therefore, the results partially support the hypothesis since education and older age are not significant, the time residing in the host country and psychosocial risk are significant only in women. Furthermore, to be married appears as predictor of psychological distress in women. The literature shows contradictory results in relation to the effect of educational level of people who emigrate. Having a university degree was a predictor of worse general health among refugee adults in Australia (23) while it was a protective factor in refugees, where having higher education predicted fewer medical conditions (24) and less psychological distress (25). The pre-migration conditions in some studies, had appeared as a strong predictor of depression and other psychological disorders (26). The study by Jamil et al.(24) highlights that the pre-migration situation behaved differently in refugees and immigrants, with refugees being the main risk factor for having worse self-perceived health, whereas it did not influence the self-perceived health of the immigrant population. Regarding pre-migration conditions, Li and Anderson (27) demonstrated that the influence of the pre-migration situation on psychological symptoms was mediated by perceived discrimination, since immigrants with traumatic experiences perceive the world as a dangerous place. In other contexts, these negative beliefs about the lack of benevolence in the world lead to increased levels of vigilance, which in turn increases stress (28). In relation to the effect of marital status, which appears with a negative relationship with psychological distress in women, the literature also shows contradictory results, Aragona found a higher risk of somatization in married people (29), while Shiroma didn’t find significant association between somatization and marital status (30) and Ristner found less somatization in married people (31).
The last hypothesis proposed as somatization risk factors the female gender, older age, less time residing in the destination country, lesser academic education and the psychosocial risk before and after migration. This hypothesis is partially supported since academic education is not significant and the years since the migration is significant only in women. Evidence shows that academic education behaves ambivalently, the lower the formal education, the higher the prevalence of somatization (32), or with greater levels of education than high school, greater somatization in Russian and Hispanic immigrants (30).
The global DPSI scale is not significant for the somatization outcome variable, taking into account that the other dimensions of the perception of psychosocial risk variable, if they are significant, would be indicative that coping strategies would influence the impact that psychosocial risk may have in the onset of somatization disorders. In line with this argument, in 2008, Sachs et al.(33) explored coping strategies and stress in Tibetan refugees in India who had been exposed to traumatic situations, reporting that coping strategies acted as mediators between lived traumatic experiences and decreased somatic symptoms.
Strengths and limitations of the study
This study is the first approach to the study of somatization disorders and psychological distress of immigrants of different origins carried out in Spain. The main strength of the research is found in the composition of the sample, not only due to its high number but also due to being composed of people from 12 countries that contributed, in the year in which the research was carried out, 42% of immigrants to Catalonia (34). The findings are applicable to immigrant populations residing in Europe and specially in the Mediterranean area (France, Italy, Greece, Portugal) because these countries have similar migratory patterns (35).
There are some limitations in the study related to the questionnaires, the main one being the language barrier for some of the participants since Spanish versions of the questionnaires were used. However, to minimize possible comprehension deficits, multilingual interviewers participated as cultural mediators when necessary. Secondly, only the BSI questionnaire had a validated version into Spanish, the SSI and the DPSI were adapted to Spanish following a translation and reverse translation process. Thirdly, the length of the questionnaires required an investment of between 30 and 40 minutes, therefore some fatigue may have affected completing the questionnaires. However, the fact that they were carried out by interviewers and were not self-administered potentially reversed part of this effect.