| BackgroundThe issue of millions of Three Gorges migrants has currently been a focus of attention to the government and the public. Most of the previous studies concerned a lot the migrant issues in the aspects of relocation and resettlement strategies, social adaptiveness, and economic development and so on. However, little attention was paid to the psychosocial problems of the migrants. Whether the migrants could actively response to and adapt themselves to the various life events caused by relocation, as well as their mentality, would influence the progress of migration work as well as the long-term stability and development of migrants in the new resettlement areas. Therefore, to systematically study on the mental health problems of the Three Georges migrants is of great importance to preventing and improving mental health problems of migrants and their stability.ObjectivesTo understand the mental health status and problems in the Three Gorges migrants; to analyze the relevant risk factors inducing their mental health problems; to systematically review the international interventions on mental health of involuntary migrants, in order to explore intervention strategies targeting the Three Gorges migrants and provide scientific evidence for promoting their mental health.Methods1. Quantitative and qualitative study methods are both used in this cross-sectional survey to identify the mental health problems and relevant factors of the Three Gorges migrants and the local residents.(1) Quantitative studyA total of 1303 migrants and 1433 local residents were selected under a cluster sampling design, and completed a self-designed questionnaire for general status and three mental scales including Symptom Checklist 90 (SCL-90), Psychosocial Stress Survey for Groups (PSSG), Social Support Rating Scale (SSRS). The data were double entered using EPIDATA 3.02. After validation, the data were converted into SPSS format and analyzed using SPSS 11.0.(2) Qualitative studyAccording to semi-structured topic guides, we conducted 41 in-depth interviews with the migrants and 15 key informant interviews with government officials responsible for migration at different levels. Framework approach was applied to analyze narrative data from these interviews, using the software of MAXqda2 to manage, code and retrieve data.2. Systematic review of international intervention studies on mental health of involuntary migrants.We searched 10 international electronic databases and 3 grey literature databases to November 2008. Websites of relevant organizations and Google were searched for any missing information. Research papers that reported describing or evaluating any interventions on preventing and treating mental health problems of involuntary migrants were included. Two reviewers independently screened, appraised and extracted the data, disagreements were resolved by discussion. Implemented interventions were summarized and analyzed by qualitative synthesis method. As there was heterogeneity in the type of interventions, study design, and outcomes, the study results were not pooled statistically in Meta analysis.Results1. Results from cross-sectional survey(1) Mental health status and problems of Three Gorges migrantsGenerally speaking, the Three Gorges migrants had poorer mental health than their local counterparts. The SCL-90 results showed that the total scores and the nine factor scores of all the positive symptoms including somatization, obsessive, interpersonal sensitivity, depression, anxiety, hostility, photic anxiety, paranoid ideation and psychoticism in the migrants were significantly higher than that of their local counterparts. Mental health problems were more prevalent in the migrants in comparison with local residents. It is common that high-expectation, psychological imbalance, complain, anxiety and impatience existing in the migrants. They have psychological characteristics of fear, anaclisis, special residents, and clustering etc. Under different relocation schemes, the mental health status and problems of migrants are different. The group migrated to other counties within the municipality has the poorest mental health status. However, many government officials responsible for migration have not paid enough attention to the existing mental health problems of migrants.(2) Factors influencing mental health of the Three Gorges migrantsFactors influencing mental health of the Three Gorges migrants:â‘ social factors, including life events and psychosocial stress, social support, social culture adaption, occupation and economic factors, quality of life, feeling of security, and migration policy, etc.â‘¡natural environment factors: such as land resource possessed;â‘¢personal factors: gender, age and coping styles, etc.â‘£other factors: relocation schemes and areas, period staying in the resettlement area, etc. Of which, social factors, such as psychosocial stress, social support, occupation and economic factors were most important factors influencing mental health of migrants. 2. Results from systematic reviewOf the 35 studies included in the analysis, 16 studies aimed to describe intervention strategies, while 19 studies were to evaluate effectiveness of interventions. The targeted population were mainly refugees and asylum seekers caused by the war, violence and other tortures, while only one study targeted at reservoir migrants. All the psychological interventions were divided into prevention intervention and treatment intervention. The main interventions include: integrated psychological intervention, group treatment, cognitive behavior therapy, testimony, narrative exposure therapy, supportive counseling service, family support and therapy, etc. Of which, integrated psychological interventions are the most common intervention. Most of the studies evaluating effectiveness are observational studies, while only six are controlled trials. The results of most evaluation studies show that the implemented psychological interventions have positive impact on mental health of involuntary migrants.ConclusionsAs a whole, the Three Georges migrants had poorer mental health than their local counterparts, and migrants under different relocation schemes had specific characteristics in their mental health problems. Social factors, natural environmental factors, personal factors and other factors combined to produce a complex impact on the mental health of migrants. Therefore, an integrated psychological intervention strategy would be helpful to achieve better effects. Based on the general characteristics of mental health problems of the Three Georges migrants, as well as currently available evidence related to psychological interventions on mental health of involuntary migrants, a comprehensive intervention strategy is proposed for the Three Gorges migrants. The strategy adopts comprehensive interventions with prevention as its priority. It focuses on the major factors influencing the mental health of migrants, using various intervention measures at three system levels, including government, community and individual levels, in order to relieve the psychosocial stress of migrants, improve their social support, increase their job chances and economic levels, and thus to improve their mental health level. Besides, different resettlement places should carry out target-oriented psychological interventions, considering the particularity of mental health problems among migrants in a certain resettlement.
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