title: The relationship between acculturation strategies and depressive and anxiety disorders in Turkish migrants in the Netherlands.
abstract: BACKGROUND
  Turkish migrants in the Netherlands have a high prevalence of depressive and/or anxiety disorders. Acculturation has been shown to be related to higher levels of psychological distress, although it is not clear whether this also holds for depressive and anxiety disorders in Turkish migrants. This study aims to clarify the relationship between acculturation strategies (integration, assimilation, separation and marginalization) and the prevalence of depressive and anxiety disorders as well as utilisation of GP care among Turkish migrants.
  
  
  METHODS
  Existing data from an epidemiological study conducted among Dutch, Turkish and Moroccan inhabitants of Amsterdam were re-examined. Four scales of acculturation strategies were created in combination with the bi-dimensional approach of acculturation by factor analysis. The Lowlands Acculturation Scale and the Composite International Diagnostic Interview were used to assess acculturation and mood and anxiety disorders. Socio-demographic variables, depressive, anxiety and co-morbidity of both disorders and the use of health care services were associated with the four acculturation strategies by means of Chi-Squared and Likelihood tests. Three two-step logistic regression analyses were performed to control for possible, confounding variables.
  
  
  RESULTS
  The sample consisted of 210 Turkish migrants. Significant associations were found between the acculturation strategies and age (p < .01), education (p < .01), daily occupation (p < .01) and having a long-term relationship (p = .03). A significant association was found between acculturation strategies and depressive disorders (p = .049): integration was associated with a lower risk of depression, separation with a higher risk. Using the axis separately, participation in Dutch society showed a significant relationship with a decreased risk of depressive, anxiety and co-morbidity of both disorders (OR = .15; 95% CI: .024 - .98). Non-participation showed no significant association. No association was found between the acculturation strategies and uptake of GP care.
  
  
  CONCLUSIONS
  Turkish migrants who integrate may have a lower risk of developing a depressive disorder. Participation in Dutch culture is associated with a decreased risk of depressive, anxiety and co-morbidity of both disorders. Further research should focus on the assessment of acculturation in the detection of depression.
authors.forename: Burçin
authors.initials: B
authors.lastname: Ünlü Ince
authors.forename: Thijs
authors.initials: T
authors.lastname: Fassaert
authors.forename: Matty A S
authors.initials: MA
authors.lastname: de Wit
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Jan
authors.initials: J
authors.lastname: Smit
authors.forename: Jeroen
authors.initials: J
authors.lastname: Ruwaard
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000208:ethnology* / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000208:ethnology*; D004812:Epidemiologic Methods; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D014171:Transients and Migrants / Q000523:psychology*; D014421:Turkey / Q000208:ethnology; D055815:Young Adult