Chronic Pelvic Pain in Turkish Immigrant Women in Vienna

Chronic Pelvic Pain (CPP) is a non-cyclic pain in the lower abdomen with a persistence of at least 6 months. Approximately 15-20% of all women between the ages 18 and 50 years suffer from CPP. In more than 50% of all cases multidisciplinary teams of Gynaecologists, Gastroenterologists, Urologists and Surgeons fail to find an underlying somatic pathology, ending up in frustration for both patients and physicians. CPP in the absence of an organic pathology is now accepted as a somatoform disorder according to the DSM-IV diagnostic criteria. So far, no quantitative study has analysed the impact of migration status on the psychopathology, psychiatric co-morbidity and quality of life in immigrant CPP patients. We designed a comparative, multi-center, cross-sectional study. Our aim is to determine the impact of immigrant status on psychopathology, psychiatric co-morbidity and quality of life of CPP patients. We will specifically test the hypothesis that CPP patients with migration experience have higher prevalence and severity of depression than CPP patients without migration experience. First we will assess 30 Turkish immigrant women with CPP in Vienna for depression, psychopathology, psychiatric co-morbidity, pain intensity, quality of life and demographical data. Afterwards we will compare their results with those of 30 native Austrian women with CPP living in Vienna. In correlation to the migration stress effect we expect significantly higher levels of psychopathology, psychiatric co-morbidity, pain intensity, and lower levels of quality of life in Turkish immigrants. However, a significant difference between two groups might also be due to differences between Austrian and Turkish Cultures. Patients from Mediterranean countries are suggested to be more likely to report somatic symptoms than patients from European countries in the literature. We will control the impact of culture through assessing a third group of CPP patients with the same cultural background and without migration experience: Turkish women with CPP in Turkey. Cross-cultural research requires methodological strategies like culturally sensitive translations of instruments or the use of interviewers from the same cultural and language background as the study subjects. The evaluated versions of all psychometric instruments are available in both Turkish and German languages. Turkish and Austrian patients in Vienna will be assessed by a bilingual Physician in Vienna. An experienced physician in international Migration studies in Turkey will assess the data of patients in Turkey. This study will provide data on the associations of immigration, culture and the psychological processes of CPP, which will help to develop new therapeutic strategies for the treatment of Turkish immigrant CPP patients. Bringing new perspectives to immigration research, our results will deepen the understanding of psychopathological specialities of Turkish immigrants; and serve to improve the intercultural competence of Austrian and European health care systems.

The Impact of Immigration on the Psychopathology, Psychiatric Co-Morbidity and Quality of Life in Turkish Immigrant Chronic Pelvic Pain Patients A Cross-Sectional Comparison Study. Chronic pelvic pain (CPP) without organic pathology is a somatoform pain disorder in gynecology, which often frustrates both physicians and patients. The burden becomes much more complicated when patients have emigrational backgrounds. Few studies dealt with both migration and culture by examining differences among migrants and locals in European health care systems. To determine the impact of immigrant status and culture on psychopathology, psychiatric co-morbidity and quality of life of CPP patients, we compared the outcomes of Turkish immigrant patients in Austria with that of Austrian patients in Austria and Turkish patients in Turkey. We specifically tested the hypothesis whether migrants with CPP could have higher prevalence and severity of depression than CPP patients without migration experience. Against our expectations, significantly more Turkish patients in Ankara had Beck Depression Inventory (BDI) scores over 191 (cut off value for moderate depression) than migrants and Austrians. The analysis of three subscales of Symptom Checklist 90 Revealed (SCL-90-R), somatization, obsessive-compulsive and the global scale of Positive Symptom Distress Index (PSDI) were in line with our expectations, showing significantly higher scores among migrants vs. controls. Yet the remaining seven subscales revealed no significant differences among groups. Another surprising result was that Turkish patients in Turkey had significantly lower scores of quality of life compared to migrants and Austrians. Despite missing values we interpreted the outcomes of dissociative experiences scales, which revealed the highest scores among Austrians. Indeed significance was only obvious when compared with Turks in Ankara, but not with migrants. Psychiatric co-morbidity was similarly distributed among migrants and Austrians. Surprisingly, none of Turkish patients fulfilled the diagnostic criteria of SCID-I Interview. Sexual abuse was previously reported to be more common among CPP patients vs. non-CPP controls. Correspondingly, four Austrians reported experience of sexual abuse, but none of Turks and migrants. A significant difference in education levels was observable between Austrians and migrants. Forced marriage was reported by one Austrian and one migrant. The proficiency in German language showed no correlation with main outcomes of migrants. Austrian women had noticeably fewer kids than migrants and Turks. Our study results suggest that differences in psychopathologies between migrants and locals cannot be reduced to general categories such as "Migration" or "Culture". Migrants not showing the expected higher psychopathology vs. controls may suggest psycho cultural adaptation or protective psycho cultural factors in the context of migration. Difficulties related with specific cultural issues, e.g. the experience of sexual abuse, could potentially be comprised with more sensible qualitative research techniques. With these techniques hypotheses could be generated according to findings from transcribed patient narratives.