Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA.
Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan.
BMJ Ment Health. 2024 Jul 3;27(1):e301059. doi: 10.1136/bmjment-2024-301059.
The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants' mental health treatment engagement remains limited.
This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants.
Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months.
The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions.
Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency.
Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.
在日本乃至全球，快速增长的移民人口给精神卫生保健带来了挑战，但针对移民精神健康治疗参与度的研究仍然有限。
本研究旨在探讨语言能力、人口统计学和临床特征与移民早期治疗中断的关系。
利用日本东京-横滨大都市区的三家中心医院在 2016 年至 2019 年期间为 14511 名接受精神科门诊治疗的患者中识别出的 196 名成年移民的电子健康记录数据，采用多变量回归模型来确定 3 个月内提前中断治疗的预测因素。
研究队列（65%为女性，年龄 18-90 岁，来自 29 个国家/地区）包括 23%的非日语使用者。日语和非日语使用者的中断率相似（26%比 22%）。多变量模型显示，年龄较小（OR=0.97；95%CI：0.95，0.99；p=0.016）和主要诊断非精神分裂症谱系障碍（OR=3.99；95%CI：1.36，11.77；p=0.012）或神经症、应激相关和躯体形式障碍（OR=2.79；95%CI：1.14，6.84；p=0.025）的患者提前中断治疗的可能性更高。这些影响在日语使用者中更为明显，存在显著的语言与年龄和语言与诊断的交互作用。
年龄较小以及主要诊断非精神分裂症谱系障碍或神经症、应激相关和躯体形式障碍的患者在日语使用者中更容易出现早期中断精神卫生治疗的情况，但对于日语能力有限的移民则不然。
在精神卫生治疗背景下理解语言需求不应仅限于假设或观察到的流利程度。未满足的语言需求可能会增加移民中断治疗的脆弱性。有针对性的临床努力对于增强早期治疗参与度以及为日本和移民人口增长的国家提供卫生实践信息至关重要。
