Background: an experience of migration in youth is a very important event which profoundly affects the identity of an individual. Many factors could influence the stress (Bhugra, 2004) related to the migration: loneliness of migration; legality of the trip; reception in the host country, political asylum condition, etc..The lived stress due to migration may be expressed or not with psychological symptoms. It could be that the individual's cultural background may play an important role in the expression of the type of psychological symptoms. Objective: The aim of this study was to investigate the expression of psychopathological symptoms, in a sample of immigrated adolescents in a emergency reception center (ERC) located in Rome. The work was presented during the II Workshop on Medical Anthropology in Rome, October 14th - 15th 2011.

1. Cultural differences in the expression of psychopathological symptoms in a sample of immigrated adolescents Carlo Lai

2. Background: an experience of migration in youth is a very important event which profoundly affects the identity of an individual. Many factors could influence the stress (Bhugra, 2004) related to the migration: loneliness of migration; legality of the trip; reception in the host country, political asylum condition, etc.. The lived stress due to migration may be expressed or not with psychological symptoms. It could be that the individual's cultural background may play an important role in the expression of the type of psychological symptoms.

3. Objective: The aim of this study was to investigate the expression of psychopathological symptoms, in a sample of immigrated adolescents in a emergency reception center (ERC) located in Rome.

4. Method: The psychological symptoms were divided in the following: impulsivity, other-directed aggression, depressive state, self-harm, anxiety, psychosomatic diseases, sleep disorders, flashback, mood disorders, affectivity disorders, delirium. The symptoms of immigrated adolescents coming at the ERC from 2006 to 2009 were collected from their medical records.

5. Method 1: The adolescents were from different countries: -Afghanistan, -Africa, -Bangladesh, -Egypt, -Albania, -Kosovo, -Romania, -Ex-Yugoslavia, -North-East Europe ( Moldova, Czech Republic, Ukraine ) -North-West Africa (Morocco, Algeria), -Middle East (Turkey, Iran, Iraq, Pakistan), -South America (Uruguay, Peru, Equador). Some of them were asking political asylum in Italy.

6. Method 2: Chi square test (p<.05) was performed on the distributions of psychological symptoms in order to test differences between asking / non asking political asylum adolescents. *: p<.05 **: p<.01 ***: p<.001 NS : p=non significant

7. Results: 1258 adolescent subjects were entered in the ERC in the four years. 889 did leave the ERC in three days. 369 remained for more than three days, 337 of the 369 were foreign and 62 of the 337 did show psychological symptoms. Of the 337 foreign adolescents 112 have asked for political asylum. Foreigns Italians 62/337 337 32 889 1258 Total 18/90 90 4 46 140 2009 13/102 102 6 87 195 2008 14/72 72 3 219 294 2007 17/73 73 19 537 629 2006 Symptomatic foreign cases Cases in more than 3 days Cases out in 3 days Total cases Year

8. Results1: Of the 337 foreign adolescents 112 asked for political asylum. 112 83 29 (26%) Foreign asylum seekers 225 192 33 (15%) Foreign non asylum seekers 337 275 62 Total Foreign Total Non Symptomatic Symptomatic The symptomatic / non symptomatic distribution was significantly different between asylum seekers vs. non asylum seekers: 29[26%] vs. 33[15%]: Chi square (df:1):62.4***.

9. Results 2: The symptomatic non asylum seeker adolescents (n:33) presented impulsivity and other-directed aggressiveness, while symptomatic asylum seeker adolescents (n:29) showed: dissociative, post-traumatic, depressive state. Both showed anxiety and self-harm. 3.7* 0 7 Delirium 1.1 NS 4 2 affectivity disorders 0.7 NS 8 6 mood disorders 17.9*** 5 13 depressive state 3.0 NS 0 6 flashback 108.5*** 4 23 sleep disorders 56.3*** 2 12 psychosomatic diseases 1.4 NS 15 16 anxiety 0.9 NS 15 15 self-harm 18.1*** 16 2 other-dir. aggression 10. 4 *** 16 5 Impulsivity Chi Square (fd: 1) Symptomatology of Foreign non asylum seekers N: 33/225 Symptomatology of Foreign Asylum seekers N: 29/112 Symptoms

10. anxiety, psychosom dis 0 1 5 South America (Uruguay Peru Equador). anxiety, delirium 7 1 8 Middle East (Turkey Iran Iraq Pakistan) self harm, anxiety, depr state 0 1 13 NorthWest Africa (Morocco Algeria) self harm, anxiety 0 1 18 NorthEast Europe (Moldova Czech Republic Ukraine) self harm, depr state, affective dis 0 4 13 Ex Yugoslavia other directed aggressivity, impulsivity, mood dis 0 15 66 Albania, Kosovo, Romania self harm, anxiety, psychosom dis 0 11 66 Egypt no symptom 0 0 39 Bangladesh sleep dis, anxiety, depr state 13 7 17 Africa sleep dis, anxiety, self harm 92 21 92 Afghanistan more expressed symptoms asylum seeker Symptomatic cases Total cases Country of origin

11. Discussion: -Decreasing of adolescents who go out in three days: This indicates an increased ability to take charge of the child by the ERC ; -Higher vulnerability of asylum seekers vs non asylum seekers; - Asylum seekers are distributed in Afghanistan, Africa and Iraq. The expression of symptoms seems to be related to the PTSD spectrum with anxiety depression and self harm. The self-harm is present only in the cases from Afghanistan; -The Egyptians have very similar symptoms from neighbors Algerians and Moroccans. The difference didn’t showed about more impulsivity is probably due to the fact that the Egyptian migrants in Rome often come from poor and backward region where the migration of the child is due in most cases the indebtedness of the family who risked prison. This may explain the aggressiveness and impulsivity also directed straight to the institutions; -Foreign coming from Albania, Kosovo and Romania differently from the others expressed other directed aggressiveness and impulsivity. They were only males (the two females with symptomatology showed only self harm). It could be that in these countries, social desirability does not favor the “manifestation of male emotional weakness”. -Foreign Ukrainians and Moldovans as Bangladeshis are silent from a symptomatic point of view. Could play an important role given to the value that is “emotional control” in these countries. -Asylum seekers show centered on the body symptoms (depressive states, sleep disorders and psychosomatic diseases), non-asylum seekers more impulsive symptoms. This difference may be due not only to the different places of origin, but also to the different targets of migration.

12. Conclusion: -the degree of social desirability of some behaviors differs from country to country. This variability could have an important role in guiding the expression of psychological symptoms. -it is desirable that all social-assistance operators who work with individuals migrated from other countries can access to the information about the behaviors, values, beliefs of the peoples of those countries in order to correctly interpret the behaviors, signs and symptoms of the immigrated subject.

13. Thank you for your attention and I’m sorry for my terrible english