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123]||Clickheretodownloadfre
journal

Indian J. PsycMat.

(1972).

14,

115-121

MIGRATION AND MENTAL HEALTH

B. B. SETHI, M.B.B.S.. M.Sc (Psychiat.). D.Sc. (Psychiat), Diplomats American Board of
Psychiatry and Neurology.1 S. C. GUPTA, M.A., D.M., & S.P.,
R. K. MAHENDRU, M.B.B.S.3 and Miss P. KUMABI. M.A., M.A.4

(Received for Publication on 22nd February 1971)

Introduction :
Numerous studies have indicated that
migration is associated with a high occurrence of psychiatric disorders. Odegaard
(1932) in his classical paper on Norwegian
imigrants had found a comparatively high
rate of mental hospital admissions amongst
the immigrants. Malzberg (1940) reported
greater prevalence of psychiatric illness
among immigrant negroes in New York.
Several other investigators such as Murphy
(1955), Malzberg and Lee (1956), Eitinger
(1959), Mezey (1960), Keeler et al. (1963)
and Gordon (1965) have also reported a
higher occurrence of mental disorders in
the migrated populations. As contrasted
with these studies Odegaard (1945) showed
that people born locally had higher psychiatric illness than those born elsewhere.
Further, Mailer (1966) found a greater
frequency of suicide among immigrants
and he maintained that migration induces
feelings of insecurity and disturbed interpersonal relations. In another study of
migrants Malzberg (1967) emphasized that
higher incidence of mental disorders is
closely associated with the minority status
of immigrants. Bhaskaran et ol. (1970)
conducted a similar study for migrated
industrial workers at Ranchi and found
psychiatric illness in 35% of the indus1 Professor oi Psychiatry,
2 Lecturer-cum-Clinical Psychologist,
3 Assistant Research Officer, Indian Council of
Medical Research,
4 Field Worker, Indian Council of Medical Research.

trial population. Since our country has

also witnessed unparalleled migrations it
would be quite interesting to determine
its significance in uprooted communities.
The present study is therefore aimed at
investigating the occurrence of psychiatric
disorders in a selected refugee population
of Lucknow.
Method and Material:
n
Several hundred families from Pakistan
migrated to India in 1947 and settled themselves in different localities of Lucknow.
For the purposes of this study 250 refugee
families of Laj pat Nagar and Chandra
Nagar were selected since the residents of
these colonies had been receiving intensive
medical facilities from King George's
Medical College, Lucknow. Lajpat Nagar
is quite adjacent to this college and in
Chandra Nagar there is a well-established
Urban Health Centre as part Of peripheral
service programme of this college. These
two localities are inhabited by 250 refugee
families in all and they thus formed the
sample for this study. The survey team
consisting of a psychiatrist, a clinical psychologist and a psychiatric social worker
visited each house and interrogated the
head of the family or housewife. A questionnaire was directed at obtaining mental

King George's Medical College, Lucknow.

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116

B. B. Sethi et al

health status of each member of the family

and the individuals identified with psychiatric manifestations were clinically evaluated and later longitudinally observed.
The migrated families were compared with
250 permanently domiciled families which
were taken in a consecutive order from
Babuganj (area closest to the University
of Lucknow).

the groups were 148 (9.6%) and 59 (4.2%)

respectively.

T h e diagnostic breakup of these patients

has been shown in Table-2. There w e r e 46
(31.1%) cases of psychoneuroses and 23
(15.5%) cases of depression in the migrated population.
The occurrence of these
disorders in the non-migrated group was
considerably low (15 and 8 patients resResults :
pectively). Cases of schizophrenia and
Table 1 shows the occurrence of psy- other psychoses were comparatively small
chiatric disorders among the migrated and in number. Mental retardation was evenly
non-migrated families. The two groups distributed in both the groups (14.2 per
consisted of a population of 1547 and 1410 1000 population). The miscellaneous cateindividuals respectively. It may be ob- gory of ailment in the migrated group inserved that there were 111 (44.4'V) psy- cluded psychophysiological reaction (7),
chiatrically ill families in the migrated transient situational reaction (5), epilepsy
(5), stammering (3) and organic brain
group whereas there were only 48 (19.2%)
disturbed families in t h e non-migrated syndrome (2). I n the non-migrated group
group. A psychiatrically disturbed family miscellaneous group comprised of epirepresents one or more than one psy- lepsy (3). alcoholic addiction (2), and
chiatric patient in its fold.
The total stammering (2). It is a striking revelation
number of psychiatric patients in each of that distribution of disease is more than
TABLE
Psychiatric

Morbidity

Rate*

Migrated
Group
250

Surveyed families
Psychiatrically d i s t u r b e d families
Surveyed population

U l (44.4)
1547

N u m b e r of psychiatrio p a t i e n t s

148 ( 9 . 6 % )

TABLE
Diagnostic

Mental Deficiency
Enuresis
Miscellaneous

Total

46(31.1%)

250
48 ( 1 9 . 2 7 J

/ .001

1410
59 (4.2%)

/ .001

Classification

N u m b e r of p a t i e n t s
Migrated
Non-Migrated
Psychoneuroses
(Excluding depression!i
Depression
Schizophrenia
P e r s o n a l i t y Disorder

Non-Migrated
Group

15 (25.4%

R a t e per 1000
Migrated
Non-Migrated
29.7

10.6

14.9
3.3
2.6
14.2

5.7
1 4
2.1
14.2
2.8
5.0
41.8

23 (15.5%)
r> ( 3.4%)
4 ( 2.7%)

8 (13.5%)
2 ( 3 4%)
3 ( 5.1%)

22 (14.9%)
26 (17.5%)
22 (14.9%)

20 (33.9%)
7 (10.9%)

16.8
14.2

148 (100.0%)

59 (100.0%)

95.7

4 ( 6.8%)

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Migration and Mental Health

double in the migrated group as compared
to the non-migrated group (95.7 and 41.8
per 1000, respectively).

The families in the two groups were

further compared in terms of certain social
variables (Table-4) . In the migrated
group there was a vast majority of Hindus
(77.2%). Sikhs formed about one fourth
of the sample (22.8%). Among the migrated sample, Hindus had a much greater
proportion (94.8%), Muslims constituted
6% and there was no Sikh family. Statistical analysis does not reveal any significant difference in the two groups with
respect to their family structure, family
size or economic status. Similarly no significant difference was observed when psychiatrically ill families were examined in
terms of theses variables.

Table 3 shows that the migrated patients

had a longer duration of illness. 30.4%
of the migrant patients had been ill for
more than 10 years while the non-migrated
patients of such a duration were only
10.2%. In addition, about half of these
migrated patients of longer duration were
found to have developed psychiatric illness soon after migration. In the nonmigrated group patients with such a length
of illness were few.
TABLE
Duration

of Psychiatric

Illness

117

in Migrated

and Non-Migrated

Group

Below 5 y e a r s

5-10 years

Above 10 years

Migrated
( 1*8 )

60 (40.5 0)

43 (l!9.1/)

45 (30.4%)

Non-Migrated
(59)

34 (57.6'/o)

19 (32.2/)

6 (10.2/ o )

Social

TABLE 4
in the Migrated and Non-Migrated

Variables

T o t a l Families

Variables

Migrated
(250)
Religion
Hindu
Muslim
Sikh
Economic Status
(Monthly P. O. I. in
U p t o 39
40 79
80 129
130 289
270 & a b o v e

77-2

Families

P s y c h i a t r i e a l l y dis t u r b e d
families

Non-Migrated
(250)
94.0
6.0

22.8

Migrated
(111)
72.1

Noia-Migrated
(48)

93.7
6.3

27.9

St.)
34 0
39.2
16.0
9.2
1.6

44.8
28.8
18.0
6.8
1.6

35.1
40.6
14.4
9.0
0.9

56.2
29.2
8.3
6.3

Family
Structure
Joint
Unitary

38.8
61.2

37.2
62.8

39.6
60.4

43.7
56 3

Family
Small
Large

60.4
39.6

67.2
32-8

51.4
48.6

64.5
35.5

Size

( F i g u r e s in p e r c e n t a g e )
None of t h e a b o v e v a r i a b l e s was found significant.

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118

B. B. Sethi et al

The data analysis was also done to delineate significant variables for the psychiatrie population of the two groups (Table 5).
Sex, age and family size were found to
be significant determinants in the distribution of migrated and non-migrated
.. ,
- n i
J.- *
i
J.
patients. Female patients were almost
double in the migrated group whereas sex
had an equal ratio in the non-migrated
sample. The age classification suggests
that the migrated patients were compara-

tively fewer in the age group 0 20 years

(42.5% and 66.0% respectively) whereas
they had an overrepresentation in the
upper age groups (57.5% and 34.0%) of
t h e t w o r e s p ective groups were beyond the
^ 0 n\
TO. V.;-*.,*-* J
a
Se OI 20).
The highest difference was
.. , . ^
., .
_
notlced m the a
& ^ " P 4 1 " 60^
quency of migrated patients in this age
range was thrice than that of the nonmigrated patients (23.7% Vs 6.8%).

TABLE

Demographic and Social Variable! in Psychiatric

Variables

Patients

Migrated
(148)

Non-migrated
(59)

Level of significance

Sex
Male
Female

34.5
65.5

49.2
50.8

0.05

Age
Below 20
21 40
41 6 0
61 & above

42.5
28.4
23.7
5.4

66.0
23.8
6.8
3.4

Marital Statu*
Unmarried
Married
Widow k Separated

46.7
41.9
11.4

62.7
32.2
5.1

Education
Illiterate
Upto primary
VI to High School
Above High School

27.0
33.8
28.4
10.8

33.9
37.3
25.4
3.4

Occupation
Skilled & Semi-skilled
Office Work
Business
House wife
Student
Non-working

4.7
7.4
4.0
37.2
33.8
12.9

6.8
1.7
1.7
28.8
42.4
18.6

Family
Small
Large

45.9
54.1

64.4
35.6

0.01

Size

(Figures in percentage)

0.01

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119

Migration and Mental Health

Further, certain demographic and social age range 21 - 60. Some of them were
variables appear to be significant in the also widows. And majority of depressive
diagnostic classification
of
migrated patients (69.6%) had come from small
patients (Table 6). There was an over- sized families. In the group of mental rewhelming majority of females in the group tardation contrasting results were observof psychoneurosis and depression (82.6% ed. The ratio of male to female was 3 : 1.
and 91.2% respectively). Most of these Most of these subnormals were young
subjects were housewives belonging to the children or students of primary classes.
TABLE
Demographic

and Social

Variables

6
in Various

Diagnostic

Groups

P- N(48)

Dep.
(231

M. D.
(22)

Misc
(57)

Sex
Male
Female

17.4*
82.6

8.8**
91.2

72.7***
27.3

43.9
56.1

Age (in years)

Below 20 years
21 40
41 6 0
61 & a b o v e

13-1***
45.6
34-8
6.5

8.8**
39.1
47.8
4-3

81 9***
9.0
9.1

64 8
17.6
10.6
7.0

Marital
Status
Unmarried
Married
Widow & Separated

15.2***
67.4
17.4

130
69.7
17.3

Education
Illiterate
Upto Primary
VI t o H i g h School
Above H i g h School

23 9
30.4
28 3
17 4

21.7
34.9
30.4
13 0

Variables

Occupation
Skilled & Semi-skilled
Office W o r k
Business
House wife
Student
Non-working

8.7
65
67-4
13.1
4-3

Family
Small
Large

52.2
47.8

***

100.0***

50.0
18.2
31 8

22.8
42.1
26-3
8-8

***

4.3
8.6
4.3
69.7
8 8
4.3

64.9
26.3
8 8

50.0
50-0

1.8
8.8
3.5
14.0
54-3
17 6

45.5
54.5

31.6
68.4

Size
69.6**
304

F i g u r e s in p e r c e n t a g e )
* D e n o t e s level of significance a t
**
,.

***

,.

0. 05
0- 01
0.001

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120

B. B. Sethi et al

Discussion :
One of the most significant findings that
h a s emerged from this study points to a
significantly greater occurrence of psychiatric disorders in t h e migrated population as compared to the non-migrated one
(9.6% Vs. 4.2%). Such a high psychiatric
morbidity rate in the migrated group may
indeed appear surprising due to the fact
that two decades have elapsed since they
migrated to India and as such the observation that t h e r e still exists the impact of
migration upon these families may provoke controversy. Whatever might be,
there are two most significant findings
which seem to suggest t h e prevailing adverse effects of migration. Firstly, migrated patients have been found to be psychiatrically ill for a longer duration (i.e.
30% migrated and 10% non-migrated
patients had been sick for more than 10
yrs.). Secondly, the occurrence of psychiatric disorders has been found to be
much greater in the older age groups.
Majority of migrated patients (57%) were
adults whereas in the non-migrated group
adult patients formed one-third of the
sample (34%). Besides, a very high psychiatric casuality was found in the age
group of 41 and above (43 and 6 psychiatric cases in the two respective groups).
It is quite obvious from these observations
that those who were in their critical
periods at the time of migration w e r e more
vulnerable towards developing emotional
disturbances. Most of these patients had
manifested only the symptoms of psychoneuroses, depression or psychophysiological reaction. In addition, there is a considerable evidence to suggest that the
generation born and lived after independence is less prone for developing psychological ailments. Most of the patients belonging to this age group were diagnosed
as cases of subnormality, epilepsy, enuresis
or stammering. Moreover, it would also
be important to mention that the migrated
families h a d frequently reported to the

survey team the miseries and hazards of

migration as they w e r e displaced from
Pakistan under chaotic circumstances.
Many had been victims of loot, arson and
rape and hence manifested disease in a
severe form during early years of rehabilitation. Undoubtedly- psychiatric morbidity figure must have been very high had
we conducted studies at that time. The
findings in general seem to be in agreem e n t with our present models of causation
that when a person is uprooted from his
own environment and displaced on another
he goes through so-called an adaptational
crises. They usually perceive the new environment as threatening, hostile and suspicious. Economic and political insecurity,
change of occupation, disruption of social
relations and various other disturbances
associated with migration have to be
given due consideration. Struggle for existence becomes too stressful and often
they find it difficult to establish adequate
social relationships with the native population. P r o b l e m of social adjustment has
been more frequently observed in families
who were transplanted in the segregated
colonies. Our sample was also d r a w n from
such kind of colonies situated in a r a t h e r
secluded area of the city. Finally, as to
why did migration affect only 10% of t h e
population and not more, would be as
exacting a task as it would involve if one
were asked to account for the psychopathology of psychiatric disorders. However,
w e could say that it is in keeping with
clinical observations t h a t a certain fragm e n t of our population reacts to adverse
environments
and
develop
disorders
whereas large number of people may be
able to adapt to a variety of situations.
Some of the other interesting findings relate to housewives and size of the families. We have discussed these findings in
our earlier papers (Sethi et al. 1967, 1969,
1970). Besides, we are on the look-out for
a larger sample and an equally satisfactory

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Migration and Mental Health

control group and would then like to report our findings. In this paper we have
however made an attempt to investigate
a unique phenomenon for the simple
reason that such a large scale migration
of people from one country to another has
not occurred in the history of nations and
deserves study.
Summary :
1) The study was aimed at investigating
the occurrence of psychiatric disorders
among refugee families who came to
Lucknow after India's partition.
2) Two hundred and fifty migrated families were compared with an equal
number of non-migrated families of
Lucknow.
3) In the migrated group psychiatrically
disturbed families numbered to be 111
(44.4%) as compared to 48 (19.2%)
in the non-migrated. The total
number of psychiatric patients were
148 (9.6%) and 59 (4.2%) in the two
groups respectively.
4) Cases of psychoneuroses, depression
and enuresis formed two-third of the
total patients in the migrated population. Mental retardation was evenly
distributed among the two groups.
Cases of schizophrenia were very few.
5) Data analysis was also done in terms
of various demographic and social
variables.

121

Gordos, E. B. (1965) : Mentally 111 West Indian,

Brit. J. Psychiat. I l l : 877.
Keeler, M. H. and Vitols, M. M. (1963) : Migration and Schizophrenia in North Carolina
Negroes, Amer. J. Orthopsychiat.. 33 : 554.
Malzberg, B. (1940) : Social and Biological Aspects of Mental Disease Utica, N . Y.
State Hospitals Press.
Malzberg, B. and Lee, E. S. (1956) : Migration
and Mental Disease, New York: Social
Science Research Council.
Malzberg, B. 1967):
Internal Migration and
Mental Diseases among the White Population of New York State. Int. J. Soc. Psychiat. 13 : 184.
Mailer, O. (1966) : Suicide and Migration, Israel
Annals of Psychiatry and Related Diciplines,
4 : 67. Quoted from Psychological Abstracts
1967.
Mezey, A. G. (1960) :
Personal Background,
Emigration and Mental Disorder in Hungarian Refugees, J, Ment. Set. 106 : 618.
Murphy, H. B. M. (1955) : Flight and Resettlement, UNESCO, Geneva.
Odegaard, O (1932) : Emigration and Insanity,
Acta. Psychiat. Neurol. Supplement, 4.
Odegaard, O. (1945) : Distribution of Mental
Diseases in Norway, Acta. Psychiat. Neurol.,
20 : 247.
Sethi, B. B., Gupta, S. C , Raj Kumar (1967) :
300 Urban Families A Psychiatric Study,
Indian J. Psychiat., 9 : 280.

REFERENCES:
Bhaskaran, K.. Seth, R. C. and Yadava, S. N
(1970) : Migration and Mental Ill-Health in
Industry, Indian J. Psychiat., 12 : 102.

Sethi, B. B. and Gupta, S. C. (1969) :

An
Analysis of 2000 psychiatric patients (To be
published).

Eitinger, L. (1959) : The incidence of mental disease among refugees in Norway, J. Ment.
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Sethi, B. B. and Gupta, S. C. (1970) : An Epidemiological and Cultural Study of Depression, Indian J. Psychiat. 12 : 13.