REACHING OUT: SOCIAL SUPPORT AND MENTAL HEALTH PROBLEMS OF BOSNIAN IMMIGRANTS IN SWITZERLAND

A state of well being in which one realizes own potentials, can cope with every day stressors, can work productively and is able to constructively contribute to community is called mental health. Many stressful and negative events can interfere with these abilities and thus endanger someone’s mental health. Migration is one of them. With its’ pre and post phases/stages, migration represents great sources of stress and stressors. Immigrants need good personal and social resource in order to lessen down negative effects of migration on their mental health. The aim of this study is to explore presence of mental health problems in non clinical population of Bosnian immigrants (N=101, F=48, M=53) in Switzerland. It was assumed that migration stress acts negatively on immigrant’s mental health. General health questionnaire was used to test this hypothesis. Participants mean score results on total GHQ28 questionnaire were M=51.06, S.D. =14.30, its subscales on depression M=10.12 S.D.=3.75, somatic complaints M=13.04 S.D.=4.5, anxiety/insomnia M=13.34 S.D. 4.8, and social dysfunction M=14.37 S.D.=3.5. This indicates presence of mental health problems among Bosnian immigrants. At the same time, the study shows presence of social support seeking (N=83 subjects listed family and friends) as primary coping strategy used by Bosnian immigrants while dealing with difficulties and problems rather than seeking professional help (N=3 subjects listed professional help seeking). Thus, social support seeking acts positively on mental health of Bosnian immigrants.


Background to the study
According to Kakar (Fernando, 2001) concept of mental health is a term which covers different aspects and concerns such as: absence of disabling symptoms, integration of psychological functioning, successful leading of personal and social life, and feeling of ethical and spiritual wellbeing.However, for our purpose, mental health defined as the ability to think logically and rationally, to adjust to transitions, stress, trauma and losses which happen to everyone, in a way which allows emotional stability and growth, suites better (Hales and Hales, 1995).
Immigrants belong to a risk group for mental health disorders due to many pre emigrational, emigrational as well as post emigrational factors and phases that they go through.
Acculturation phases, adjustment, immigrants' age as well as effects of factors such as small income, immigrants' status, low access to psychiatric treatment etc, are in close relation to the emergence of mental health problems like depression, anxiety, suicide, alcohol and drug use by immigrants.Immigrants are at risk for mental health problems due to much pre-migration, migration as well post migration factors and phases which ^͘ ƌĂŐĂŶŽ|ŝđ ^ŽĐŝĂů ^ƵƉƉŽƌƚ ĂŶĚ DĞŶƚĂů ,ĞĂůƚŚ WƌŽďůĞŵƐ ŽĨ ŽƐŶŝĂŶ /ŵŵŝŐƌĂŶƚƐ ϮϬϭ ƉŝƉŚĂŶǇ͗ :ŽƵƌŶĂů ŽĨ dƌĂŶƐĚŝƐĐŝƉůŝŶĂƌǇ ^ƚƵĚŝĞƐ͕ sŽů͘ ϳ͘ EŽ͘ ϭ͕ ;ϮϬϭϰͿ Ξ &ĂĐƵůƚǇ ŽĨ ƌƚƐ ĂŶĚ ^ŽĐŝĂů ^ĐŝĞŶĐĞƐ immigrants experience.Acculturation phase, adjustment, immigrants' age, interrelated factors such as low income, immigrants' status, low access to psychiatric care etc. are related to appearance of mental health problems such as depression, anxiety, suicide, and alcohol and drug abuse in immigrants' population.Immigrants are risk population especially when they migrate with low or no prior knowledge about country they migrate to.Their coping strategies are not always efficient and acceptable.Coping strategies represent immigrant's efforts, mainly psychological and behavioural, which immigrants use, tolerate, decrease or minimize stressful events.Lazarus and Folkman (Horwitz and Scheid, 2006) coping strategies define as cognitive or behavioural attempts to cope with situational demands that someone perceives demanding or those that overcome someone's ability to cope.In other words, coping is actually a process by which people try to cope with perceived difference between demands and own resources which they assess in a given situation.People cope with certain problems by making certain efforts in order to adjust to a problem or change their perception about it.As such, these efforts could be effective (seeking social support for example) or ineffective (avoiding problems) leading to problems solving or the opposite.
Effective coping strategies in a form of social support can decrease effects of permanent stressors and act positively on immigrants' mental health.On contrary, ineffective coping strategies which could appear in a form of avoidance or retreat when different stressors appear, contribute to emergence of mental health problems (Busse and O'Mahoney, 2000).Coping strategies are usually divided into primary and secondary coping strategies and problem focused and emotion focused coping strategies.Primary coping strategies are direct measures or, overt, problem focused behaviour directed to change of disturbing events in stressful environment (looking for social support).Unlike primary, secondary coping strategies are more cognitive than behavioural and they are most often related to changing perception and assessment of stressful situations and events.In another words, primary coping strategies mean changing environment so it will suite "me" and secondary, changing "me" so I will suit the environment.Looking for social support contributes to adjustment and helps individuals to easily cope with problems because persons with social support are emotionally more stable and cope with different environmental demands as well as with mental health problems more easily (Horwitz and Scheid, 2006).
Social support is related to someone's social contacts and relations, social integration and relation inside primary group.
Social support and relations (resources) and relations with others from where support emerges are not only basis for mental health but also can serve as protective factors from negative effects of different stressors.Resources or sources of coping (social support, strong felling of control etc.) and coping strategies reduce or diminish negative psychological effects of stress and stressors (Horwitz and Scheid, 2006).Horwitz and Sheid (2006) cite many studies which researched significance of relation between mental health and social support (Cohen and Willis, 1985;Cohen and Syme, 1985;Dean and Lin 1977;Gottlieb, 1981;Kessler et all 1985;Sarason and Sarason, 1985;Sarason, Sarason and Pierce, 1990;Turner 1983;Vaux 1988;Veil and Bauman, 1992)  shows great correlation with little or no support and ill mental health in general, especially with frequent depression.Cassel and Cobb with their research have set preliminary foundation for hypothesis which dominates inside these researches: "social support is important moderator in effects of life stressors on mental health" and as such it represents significant protective factor (Horwitz and Scheid, 2006).Ward states that social support is related to improvement of psychological wellbeing (greater social support, better psychological wellbeing and vice versa) (Ward, Bochner and Furnham, 2003).Besides, sociological studies in domain of social support suggest abating effect of psychological problems when there is strong or just present social support regardless if it comes from ethnic community or local citizens (Khuo and Tsai, 1986).
Aim of this study is to explore presence and role of social support in mental health problems in non clinical population of Bosnian immigrants in Switzerland.It was assumed that social support has a role in mental health of Bosnian immigrants in Switzerland.

Participants
Participants (N=200) were 48 female and 53 male, ages between 18 and 60, Bosnian immigrants currently residing in Switzerland.
Mean age for the total sample was 32.9±, mainly married, who migrated to Switzerland in three periods, before the war (1992)(1993)(1994)(1995), during the war, after the war.Out of total number 129 surveys were completed and delivered to researcher.28 of them could be only partially used due to incomplete data (demographics or unanswered questions.Participants were generally healthy and were not cognitively or perceptually impaired.They were recruited from a large Bosnian community in Switzerland.

Procedure
Participation in the study was voluntary and no compensation was given.The survey, entitled "Mental Health," consisted of sociodemographic questionnaire and general health questionnaire GHQ 28.

Questionnaires
Demographic questionnaire, and participants demographics: A few independent variables stated as important predictors which act positively on mental health of immigrants, as proved by former  Secondly, reaching out and social support seeking results in diminishing of short and long term stressful issues and problems.
Still, sharing problems with others results in short stress relief.
Operational definition of migration in our paper is based on the fact that migration is closely related with psycho social process of loss and change as well as adjusting to a number of stressors.In psychiatric terminology loss is linked to the grieving process (Carta, Bernal, Hardoy, Haro-Abad, 2005.)  a specific psychosocial stressor (a loss of a loved one for example) but it is not considered as psychological disorder.
However, if grieving is severe or prolonged more than it should be, then it belongs to the category of major depressive disorder or adjustment disorder (First, Frances and Pincus, 1997).
This grieving process during migration is explained through seven stages which cause anxiety and distress in immigrants: family, friends, language, culture, homeland, loss of status, loss of contact with ethnic group and exposure to the physical risks (Carta, Bernal, Hardoy and Haro-Abad, 2005).Above this, researchers consider that this emigrational grieving is interrupted/discontinuous because sources of grieving disappear during the contact with homeland and appear again after the return.This is not the case with grieving for the loss of the loved one which is continuous process (contact with a person completely ceased due the death).Thus, host country acceptance is of crucial importance in this case because difficulties in showing the grief might cause many psychological problems.
The loss of contact with family and friends, loss of status, adapting to the new language, culture, environment and all the discriminated, feeling of being a citizen of second order, feeling of not belonging there, feeling rejected and unwanted.Perceived discrimination is related to increased psychological distress and pain (Furnham andShiek, 1993, Ying, 1996).Such feelings form solid basis for immigrants' even greater wish to close up and remain within own ethno-group.Members of their own ethnogroup understand one another and have the same or similar problems.This leads to immigrants need to meet and associate even more often and discuss their problems.In the end, although they talk about their problems and social support as coping strategy is strongly present, strong feelings of not belonging, discrimination and rejection might still cause distress.Thus, mental health problems might appear showing that immigrants are vulnerable and at risk to develop mental health problems.

with two open ended questions: 1
Goldberg and Hillier (1979) ^ƚƵĚŝĞƐ͕ sŽů͘ ϳ͘ EŽ͘ ϭ͕ ;ϮϬϭϰͿ Ξ &ĂĐƵůƚǇ ŽĨ ƌƚƐ ĂŶĚ ^ŽĐŝĂů ^ĐŝĞŶĐĞƐ health questionnaire was translated to 38 world languages (Croatian is one of them, which we used) it has been validated in more than 50 studies.There are four versions of it at the moment (with 60, 30, 28 and 12 items) available to psychiatrists, qualified doctors, clinical psychologists and experienced counsellors(Jancz, 2000).Cronbach's (1951)alpha coefficient for internal validity for GHQ 28 version ranges from .84 to .93 in different studies.Goldberg and Hillier (1979)cite that test -retest probability coefficient on 87 psychiatric cases with six months follow up was .90 and it appears as reliable and valid assessment technique for psychological or mental health (Jancz, 2000). .Who do you talk to about your problems/difficulties, 2. Who do you seek to share or talk to when you face any kind of problems/difficulties.ŽƵƌŶĂů ŽĨ dƌĂŶƐĚŝƐĐŝƉůŝŶĂƌǇ ^ƚƵĚŝĞƐ͕ sŽů͘ ϳ͘ EŽ͘ ϭ͕ ;ϮϬϭϰͿ Ξ &ĂĐƵůƚǇ ŽĨ ƌƚƐ ĂŶĚ ^ŽĐŝĂů ^ĐŝĞŶĐĞƐ Analysis and categorisation of respondents' answers to the two, above cited open ended questions, indicate four following categories: family and friends, professionals, myself and no one.We used General Health Questionnaire 28 in order to test presence of mental health problems among Bosnian immigrants in Switzerland.Results of means and standard deviations are listed in table below.

Table 3
To test the the difference for variable: talking with family and freinds, and GHQ 28 and its subscales ANOVA test of variance.Results are presented in table below.emotional relief which follows this "cup of talk" or layman's therapeutic sessions (immediate sharing/discussion of problems).
Grieving is reaction to ^͘ ƌĂŐĂŶŽ|ŝđ^ŽĐŝĂů ^ƵƉƉŽƌƚ ĂŶĚ DĞŶƚĂů ,ĞĂůƚŚ WƌŽďůĞŵƐ ŽĨ ŽƐŶŝĂŶ /ŵŵŝŐƌĂŶƚƐ Ϯϭϲ ƉŝƉŚĂŶǇ͗ :ŽƵƌŶĂů ŽĨ dƌĂŶƐĚŝƐĐŝƉůŝŶĂƌǇ ^ƚƵĚŝĞƐ͕ sŽů͘ ϳ͘ EŽ͘ ϭ͕ ;ϮϬϭϰͿ Ξ &ĂĐƵůƚǇ ŽĨ ƌƚƐ ĂŶĚ ^ŽĐŝĂů ^ĐŝĞŶĐĞƐ is typical for Bosnian citizens who turn to mental health professional only as a last resort, when they exhaust all other ways and means.Stigma (mental health issues are still related to "being crazy/mad") related to mental disorders is still present among Bosnians, even when they live in society with different orientation towards mental health/disorders.