title: Common mental disorders among adult members of 'left-behind' international migrant worker families in Sri Lanka.
abstract: BACKGROUND
  Nearly one-in-ten Sri Lankans are employed abroad as International migrant workers (IMW). Very little is known about the mental health of adult members in families left-behind. This study aimed to explore the impact of economic migration on mental health (common mental disorders) of left-behind families in Sri Lanka.
  
  
  METHODS
  A cross-sectional survey using multistage sampling was conducted in six districts (representing 62% of outbound IMW population) of Sri Lanka. Spouses and non-spouse caregivers (those providing substantial care for children) from families of economic migrants were recruited. Adult mental health was measured using the Patient Health Questionnaire. Demographic, socio-economic, migration-specific and health utilization information were gathered.
  
  
  RESULTS
  A total of 410 IMW families were recruited (response rate: 95.1%). Both spouse and a non-spouse caregiver were recruited for 55 families with a total of 277 spouses and 188 caregivers included. Poor general health, current diagnosed illness and healthcare visit frequency was higher in the non-spouse caregiver group. Overall prevalence of common mental disorder (CMD; Depression, somatoform disorder, anxiety) was 20.7% (95%CI 16.9-24.3) with 14.4% (95%CI 10.3-18.6) among spouses and 29.8% (95%CI 23.2-36.4) among non-spouse caregivers. Prevalence of depression (25.5%; 95%CI 19.2-31.8) and somatoform disorder 11.7% (95%CI 7.0-16.3) was higher in non-spouse caregiver group. When adjusted for age and gender, non-returning IMW in family, primary education and low in-bound remittance frequency was associated with CMD for spouses while no education, poor general health and increased healthcare visits was significantly associated in the non-spouse caregiver group.
  
  
  CONCLUSIONS
  To our knowledge, this is one of the first studies to explore specific mental health outcomes among adult left-behind family members of IMW through standardized diagnostic instruments in Sri Lanka and in South Asian region. Negative impact of economic migration is highlighted by the considerably high prevalence of CMD among adults in left-behind families. A policy framework that enables health protection whilst promoting migration for development remains a key challenge for labour-sending nations.
authors.affiliation: Faculty of Medical Science, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK. chesmal@gmail.com.|Institute for Research & Development, Colombo, Sri Lanka. chesmal@gmail.com.
authors.forename: Chesmal
authors.initials: C
authors.lastname: Siriwardhana
authors.affiliation: International Organization for Migration, Colombo, Sri Lanka. wickramage.kolitha@gmail.com.
authors.forename: Kolitha
authors.initials: K
authors.lastname: Wickramage
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. nipuna@stmail.lk.|Department of Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka. nipuna@stmail.lk.
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. puwalani@gmail.com.|Department of cardiothoracic vascular surgery, National University Hospital, Singapore, Singapore. puwalani@gmail.com.
authors.forename: Puwalani
authors.initials: P
authors.lastname: Vidanapathirana
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. danu_j82@yahoo.com.
authors.forename: Buddhini
authors.initials: B
authors.lastname: Jayasekara
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. sweerawarna@gmail.com.
authors.forename: Sulochana
authors.initials: S
authors.lastname: Weerawarna
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. gayanipannala@yahoo.com.
authors.forename: Gayani
authors.initials: G
authors.lastname: Pannala
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. anushkaadikari@yahoo.com.
authors.forename: Anushka
authors.initials: A
authors.lastname: Adikari
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. kaushj@gmail.com.
authors.forename: Kaushalya
authors.initials: K
authors.lastname: Jayaweera
authors.affiliation: Ministry of Health, Colombo, Sri Lanka. sharikapeiris@gmail.com.
authors.forename: Sharika
authors.initials: S
authors.lastname: Pieris
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. athula.sumathipala@keele.ac.uk.|Research Institute for Primary Care and Health Services, School for Primary Care Research, Faculty of Health, Keele University, Newcastle, UK. athula.sumathipala@keele.ac.uk.
authors.forename: Athula
authors.initials: A
authors.lastname: Sumathipala
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D013188:Sri Lanka / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult