Diabetes and depression syndemics in immigrant populations in Piemonte.

In this thesis we will apply the syndemic model of healthcare, which was originally theorised to describe infectious disease interactions, to non-communicable diseases, specifically to diabetes and depression in the setting of immigrant populations in Italy. We compared the use of emergency medical facilities, as an indicator of general health outcomes, to assess the correllation or otherwise of the data to syndemic theory. According to syndemic theory, poverty and disease comorbidity have a cumulative detrimental effect on the individual patient experience, and that certain diseases tend to aggregate in lower social strata (which oftentimes includes ethnic minorities) within a given population. To qualify as a syndemic three criteria must be met; the first is that within a population two or more diseases or conditions are present, the second is that social/cultural behaviours allow the diseases to cluster and the third is that the diseases interact socially or biologically to worsen health outcomes. The syndemic approach involves health system re-engineering with a significant focus on social and political spheres of disease management, such as resource allocation and education, besides the disease therapy and pathological mechanisms; viewing the infrastructure of society as part of the problem and adjusting it the potential solution. The aim of this multifaceted approach is to reduce medical costs whilst simultaneously improving disease outcomes. Depression is a psychological disorder characterised mainly by lack of motivation or hopelessness and also by low mood, suicidal ideation and occupational impairment; the absence from employment constitutes a considerable national economic burden. Diabetes mellitus type 2 (which accounts for 85% of the diabetes burden) is a chronic non-communicable disease that broadly resembles metabolic syndrome and is normally associated with other conditions such as hypertension, cardiovascular disease, cardiac failure, hypertriglyceridemia and ischemic stroke. In this study we accessed archival information of the population in Piedmont and applied the cox analysis to the data. Admission figures to yellow and red codes, and to red exclusively, in the emergency departement were compared between immigrants and natives in the cases of good health, diabetes, depression and diabetes comorbid with depression. Whilst the syndemic interaction between diabetes depression was visible and present in the data, the status of immigrant conversely conferred a beneficial, protective influence. We believe this was due to two phenomena; one is the 'healthy migrant' whereby healthy individuals are selected and more likely to undertake the migration journey, which could be hazardous in itself. The second is the 'Salmon effect' whereby older immigrants with typically poorer health status will return to their countries of origin to retire, and consequently the remaining immigrant populations will appear to have an increased average health status. This conclusion highlights the highly complex and multifactorial nature of the epidemiological field.