In this blog, I will discuss the latest systematic reviews and meta-analysis of eating disorders (EDs) in international immigration by Siddiqi et al. (2024).
this “Healthy Immigration Effect”In the past few decades, phenomena in immigration research have shown Immigration has better overall health than relative domestic population (Elshahat et al., 2022). This seems to be a bit backward given the many challenges immigrants may face (i.e. discrimination, employment difficulties, trauma, etc.), but experts point out that this may be the result of immigration policy where healthier and more educated people are more likely to choose or allow immigration (Brababete, 2017).
Understand whether there is a gap in ED gap among immigrant populations, and whether this is another condition that may be related to the healthy immigration effect. ED affects nearly 9 million people worldwide ((Statistics of eating disorders2022), is one of the most misunderstood mental health conditions (Marzola et al., 2022). Siddiqi et al. (2024) published the first systematic review to address the prevalence of ED among international migration compared to local populations.
this “Healthy Immigration Effect” It refers to a phenomenon in immigration research that found that the overall health of immigrants is better than that of the local population. But is this a condition of eating disorder?
method
The author searched four main databases to determine:
- population: First generation immigrants of all ages, genders, etc.
- exposure: “International Migration” as defined by the Office of the High Commissioner for Human Rights
- Comparator: Local population
- result: Any ED (e.g., anorexia nervosa [AN]bulimia nervosa [BN]overeating [BED]ETC. )
- Research Design: All observational study types.
A manual search of reference list was also performed to ensure that all relevant studies were captured. Non-English studies were included, but no unpublished studies or grey literature was mentioned.
Meta-analysis was performed using random effects models to fill in the prevalence odds ratio (ORS) in the included studies. Any narrative synthesis that does not provide enough data to calculate OR. The risk of bias was assessed using the NIH quality assessment tool for observation cohort and cross-sectional studies.
result
Ten studies were included in the review, six of which were in line with the meta-analysis. All included studies are based on High-income countriesmost of them use Cross-sectional design ((n = 7). The study included data from over 64,000 participants, most of which surveyed any ED (n = 6), although two studies focused on bed, one study BN and BED, one study. Quality assessment of the six studies included in the meta-analysis showed that most scores were good (n = 4), the rest is fair (n = 1) or poverty (n = 1).
Meta-analysis
The results of the meta-analysis found that immigrants or 0.45 (95% CI) compared to the domestic population [0.35 to 0.59]),instruct 55% of immigration reduces chances of ED.
However, when studying heterogeneity, reviewers explored the effects of different diagnostic tools on ED. Research using Eating Disorder Test (EDE) reported a 31% reduction in the chance of immigration, while studies using SCOFF instruments (patients, controls, one, fats, food) reported an 84% increase in the chance of immigration.
Narrative Comprehensive
Interestingly, four studies included in the narrative synthesis found different results without the effect of migration (ed Ed prevalence) (n = 3), or the prevalence of ED is higher among immigrant populations (n = 1).
In a meta-analysis of six studies by Siddiqi et al. (2024), immigration has a 55% lower chance of eating disorders compared to local populations.
in conclusion
The findings of this meta-analysis suggest that immigration may reduce the likelihood of experiencing ED compared to local populations. However, due to the small size of the meta-analysis, potential confounders of the age of use and type of use, Unable to confirm whether this discovery is reliable.
It is important to note that this systematic comments Focus on the prevalence of official diagnosis. The authors highlight one major limitation of this approach: many immigrants are unlikely to seek medical care due to various barriers such as barriers, cultural differences and stigma. As a result, the data provided may not be comprehensive. It may not accurately reflect the overall health of the entire immigrant population, especially those who may be experiencing ED but have not received a formal diagnosis.
Although this meta-analysis suggests that the prevalence of eating disorders among immigrants may be lower than that of local populations, the lack of research, potential confounders and focus on formal diagnosis means that these findings should be interpreted with caution.
Advantages and limitations
This system evaluates one Establish a good search strategyincluding main databases and manual search reference lists. Two independent reviewers also conducted research inclusion and data extraction. This increases our confidence in all relevant research captures.
Although Including non-English language studies It is of great help in expanding the scope of evidence. Using Google Translate in Data Filtering is not a reliable tool for conversion. Parallel and back translation will be the preferred method and should be considered in future studies.
In addition, there is one Highly heterogeneity in the study Included in the meta-analysis, confounders can therefore explain the overall results (lower prevalence of ED).
Finally, there is Not included unpublished research or grey literature. Considering that the studies included in this review vary in their results based on many different factors, this will be beneficial to limit publication bias to include any potentially relevant unpublished work.
The advantage of the meta-analysis of Siddiqi et al. (2024) is that it includes non-English language studies. However, when parallel and back translation are the preferred method, they are not ideal for Google Translate to do this.
Impact on practice
The main finding of this meta-analysis is that the prevalence of immigration in emergency rooms may be lower than that of the family population, thus supporting the healthy immigration effect.
However, we cannot be sure of the reliability of these findings. More high-quality cross-sectional and longitudinal studies are needed In this field, higher power analysis can be performed in different subgroups.
Future research should also be based on Migration-specific factors This may have different effects on some groups, Better understand the impact of diagnostic tools.
But, as the author mentioned The results of this meta-analysis may not necessarily be universal For the wider population, immigrants, in particular, are less likely to access health care. This means greater work is needed Increase access to immigrant mental health careThis can be achieved by identifying and coping with experienced barriers and enhancement facilitators (see Anamarija’s Psychological Elf Blog for barriers and facilitators for mental health support for women in Europe).
Consider Introduction to ED in immigration may be different from the domestic population (Mellor et al., 2013; Pike & Dunne, 2015), clinicians need to be aware of this in practice. Cultural and contextual factors may also further complicate the diagnosis, especially in low- and middle-income countries (LMICs) and underrepresented groups, leading to potential misunderstandings and minimization.
In fact, it is important for clinicians to realize that eating disorders that occur in immigration may differ from the introduction of the local population.
Statement of interests
Nothing.
Link
Main paper
Siddiqi, S., Akther, A., Blair, D.-L., Eccles, H., Frangione, B., Keeshan, A., Nagi, S. , & Colman, I. (2024). Eating disorders in international migrants: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology,,,,, 59(9), 1483-1495.
Other references
Brabete, AC (2017). Chapter 8 – Check the health of immigrants from a gender perspective. In MpSánchez-lópez and RM Limiñana-Gras (edit) The Psychology of Gender and Health (Pages 231-250). Academic Press.
Statistics of eating disorders. (2022). National Association for Anorexia nervosa and Related Diseases. Searched from December 13
Elshahat, S., Moffat, T. , & Newbold, KB (2022). Understanding the immigration effects of health in the context of mental health challenges: a systematic critical review. Journal of Immigration and Minority Health, 24(6), 1564-1579.
Marzola, E., Panero, M., Longo, P., Martini, M., Fernàndez-Aranda, F., Kaye, WH, & Abbate-Daga, G. (2022). Research on eating disorders: Misunderstanding that serious mental illness is a niche specialty. Diet and weight disorders in anorexia, bulimia and obesity, 27(8), 3005-3016.
Mellor, D., Waterhouse, M., Bt Mamat, NH, Xu, X., Cochrane, J., McCabe, M. , & Ricciardelli, L. (2013). What physical characteristics are related to physical dissatisfaction among female adolescents? Intercultural studies in Australia, China and Malaysia. Body image,,,,, 10(1), 54-61.
Pike, KM, & Dunne, PE (2015). The Rise of Eating Disorders in Asia: Comments. Eating Disorders Magazine,,,,, 31-14.
Veic, A. (2024). Mental health support for European female immigrants: Insights from systematic reviews. Spiritual Elf.
