Impact of Migration on Explanatory Models of Illness and Addiction Severity in Patients With Drug Dependence in a Paris Suburb

Abstract

Objectives of this study were to assess explanatory models (considering illness experience and meaning), addiction severity among patients with drug dependence, and the role of migration. Adapted Explanatory Model Interview Catalogue interviews were conducted with 70 outpatients in a Paris suburb. Among them, 42 were either first- or second-generation immigrants, most from North Africa. Explanatory models were analyzed qualitatively and quantitatively according to migration status, assessing potential confounders with multivariate linear models. Explanatory models were heterogeneous. Compared with nonmigrants, migrants reported fewer somatic and violence-related symptoms. They attributed the causes of their addiction more frequently to social and magico-religious factors and less to psychological factors. Conversely, no difference in addiction severity was found between migrants and nonmigrants. Considering local patterns of illness experience and meaning of drug dependence is a critical component of culturally sensitive clinical care.

RÉSUMÉ

Impact de la migration sur les modèles explicatifs et la sévérité de l'addiction de patients dépendant aux drogues dans une banlieue de Paris

Les objectifs de cette étude étaient d’évaluer les modèles explicatifs (en particulier l'expérience des troubles et leurs sens), la sévérité de l'addiction chez des patients présentant une dépendance aux drogues et le rôle de la migration. Des entretiens EMIC (Explanatory Model Interview Catalogue) ont été menés avec 70 patients consultant dans un hôpital d'une banlieue de Paris. Parmi eux, 42 étaient migrants de première ou de seconde génération, la plupart d'Afrique du Nord. Les modèles explicatifs ont été analysés sur les plans qualitatif et quantitatif selon le statut migratoire avec des modèles multivariés. Les modèles explicatifs de ces patients étaient hétérogènes. Les patients migrants ont rapporté moins de symptômes somatiques et de symptômes en rapport avec la violence et la délinquance que les non-migrants. Ils ont attribué à leur addiction des causes plus souvent sociales et magico-religieuses et moins souvent psychologiques. A l'inverse, aucune différence n'a été retrouvée entre migrants et non-migrants en terme de sévérité de l'addiction. Il est indispensable de s'intéresser à l'expérience des troubles des patients et aux sens qu'ils leurs donnent pour construire des dispositifs de soins prenant en compte les facteurs culturels.

Mots-clés: Modèles explicatifs de la maladie, sévérité de l'addiction, dépendance aux drogues, migration, Paris

RESUMEN

Impacto de la emigración sobre los modelos explicativos y la severidad de la adicción de pacientes drogadictos en un suburbio de París.

Los propósitos de este estudio eran evaluar los modelos explicativos (en particular la experiencia de los trastornos y su significado), la severidad de la adicción en los pacientes drogadictos y el papel de la migración. Unas entrevistas EMIC (Explanatory Model Interview Catalogue) han sido llevadas a cabo con 70 pacientes que han tenido consulta en un hospital de un suburbio de París. Entre ellos, 42 eran migrantes de primera o de segunda generación, la mayoría procedían de Africa del Norte. Los modelos explicativos han sido analizados desde el punto de vista cualitativo y cuantitativo según el estatuto migratorio con modelos multivariados. Los modelos explicativos de dichos pacientes eran heterogéneos. Los pacientes migrantes han explicado menos síntomas somáticos y síntomas relacionados con la violencia y la delincuencia que los no-migrantes. Las más veces, han atribuido a sus adicciones causas sociales y magicoreligiosas y menos veces sicológicas. Por el contrario, ninguna diferencia se ha podido encontrar entre los migrantes y los no-migrantes encuanto a la severidad de la adicción. Es imprescindible interesarse a la experiencia de los trastornos de los pacientes y a los significados que éstos les dan para establecer dispositivos de curaciones que tomen en cuanta los factores culturales.

Palabras-clave: modelos explicativos de la enfermedad, severidad de la adicción, drogadicción, migración, París.

Keywords :

• explanatory models of illness
• addiction severity
• drug dependence
• migration
• Paris

THE AUTHORS

Olivier Taïeb, M.D., Ph.D., works in the Department of Child and Adolescent Psychiatry and General Psychiatry at the Avicenne Hospital, APHP, EA4403, Paris 13 University, and in the Inserm U669 unit. His work focuses on adolescent psychiatry and addictions, integrating transcultural and narrative approaches.

Sylvie Chevret, M.D., Ph.D., leads the Department of Biostatistics at the Saint-Louis Hospital, APHP, Paris Diderot University, and the Inserm U717 unit. Her work focuses on methods used in clinical trials.

Marie Rose Moro, M.D., Ph.D., leads the Department of Adolescent Psychiatry at the Cochin Hospital, APHP, Paris Descartes University, and works in the Inserm U669 unit. Her research has pioneered development of the field of transcultural psychiatry, especially in children and adolescents. She directs the review, L'autre, Cliniques, Cultures et Sociétés, published by La Pensée Sauvage, Grenoble, France.

Mitchell G. Weiss, M.D., Ph.D., leads the Health Social Sciences unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, Basel. His research group has pioneered development of the field of cultural epidemiology, integrating interdisciplinary orientations of quantitative epidemiology and qualitative interests and methods of medical anthropology. His work focuses on community experience and meaning of mental health and other health problems and the impact of illness experience and meaning on the effectiveness of clinical care and public health action.

Anne Biadi-Imhof, is an anthropologist who worked in the Centre National de la Recherche Scientifique, especially in the Groupe d'analyse du social et de la sociabilité. Her work focuses on mental health and delinquency with a particular interest in social dimensions of therapeutic relationships.

Aymeric Reyre, M.D., leads the Addiction Treatment Unit of the Department of Child and Adolescent Psychiatry and General Psychiatry at the Avicenne Hospital, APHP, EA4403, Paris 13 University, and works in the Inserm U669 unit. His work focuses on ethical issues in addiction psychiatry.

Thierry Baubet, M.D., Ph.D., leads the Department of Child and Adolescent Psychiatry and General Psychiatry at the Avicenne Hospital, APHP, EA4403, Paris 13 University, and works in the Inserm U669 unit. His work focuses on transcultural psychiatry with a specific interest in post traumatic syndromes in children and adolescents.