As a result of globalization, the number of individuals who travel, work or study abroad is increasing, along with the number of transnational marriages. According to the United Nations [1
], approximately half (49.6%) of the 200 million international migrants in 2005 were women. The UN has argued that globalization opens up a rather personal market of emotional relationships and marriages. Hence, the phenomenon of "mail-order brides" has become an important route for international migration, and the number of women from poor countries who have married men from more developed countries has increased. As a result, the number of marriage bureaus and matchmaking agencies has also risen. Recently, there has been a dramatic rise in the number of "mail-order brides" who have been provided through matchmaking agencies.
Today, cross-border marriages seem to be an alternative to poverty and starvation. Foreign brides usually come from countries such as Indonesia, the Philippines, Vietnam, and Thailand. Since the 1970s, such women have married men from the more affluent Western world, from countries that promise them a better life and a stable future, such as the United States, Canada, and Europe. In Asia, the recruitment of foreign brides has been increasing in Japan, Korea, Hong Kong, and Taiwan since the 1990s.
In 2006, one in every five marriages in Taiwan was transnational [2
], and 89% of the foreign spouses involved were female. The majority of these female foreign spouses originated from countries in Southeastern Asia, including Vietnam and Indonesia. Such marriages were arranged predominantly through a commercial marriage agent [1
]. The most common reason given for the decision to marry a foreign husband was economic stability (58%), because the marriage enables the woman to relocate and to obtain a higher social status and quality of life [3
]. The other reasons included: to obtain a visa (16%), love (16%), curiosity about living in a foreign land (5%), an escape from family problems, and so on.
The impact of a transnational marriage on the relocated spouse includes changes in culture, language, role, and interpersonal interactions. According to Helman [4
], culture is a set of guidelines that individuals inherit as members of a particular society. It tells them how to view the world, how to experience it emotionally, and how to behave in the world in relation to other people, to supernatural forces or gods, and to the natural environment. The context of culture comprises historical, economic, social, political, and geographical elements. Thus, the different cultural backgrounds of people from different countries might cause them to think, experience life, and behave differently. As a result, a move to another country is an important event for people, and it can alter their life dramatically.
Marriage, which is a big step in the life of an individual, also creates a new scenario in which the partners must adjust to their new roles. Female foreign spouses in Taiwan not only face the stress of immigration, but also have to cope with the cultural demands of their husband's family. In general, female foreign spouses go to more affluent countries, such as Japan, Hong Kong, Korea, and Taiwan, to gain a better life and a more stable future. These countries, including Taiwan, actively promote cross-border marriages and encourage the naturalization of foreign spouses in order to ensure a healthy productive line that will serve the needs and interests of neoliberal globalization [3
Shu and colleagues interviewed 19 female foreign spouses and found them to have difficulties in adjustment to their new life in Taiwan [5
]. The major themes raised regarding their living experience were: difficulty in finding a sense of belonging, children being the center of their life, and children being under pressure because of the insecurity and loneliness of their mother. Becoming a mother needs many more resources, and social networks are required to support the development of women emotionally, socially, psychologically, and culturally, while they develop their abilities as competent mothers. The need both to adjust to an alien culture and to serve as a mother causes foreign mothers to suffer from more pressures and conflicts than local mothers. Hence, the role of mental health services is very important in these populations, because mental health problems might result from these pressures [6
Kuan suggested that the health and well-being of female foreign spouses is a critical issue [9
]. Furthermore, the social, cultural, and economic adjustment required during the process of adaptation can be stressful. Immigration has been linked to mental health, but the nature of the association has changed over time. Early notions of immigration and mental health were built on the premise that people encounter difficulties and obstacles as they settle into a new society [10
]. The cultural differences not only cause mental disability, but they also contribute to other problems, including difficulties in interpersonal relationships with partners and others [11
]. Integration, and the adjustment to a new relationship and a new environment, can affect the health of an individual. Cultural differences, changes in life pattern, and feelings of hopelessness are risk factors for deviations from health. When immigrants have difficulty in adapting to new social and cultural norms, mental health problems such as depression, schizophrenia, and anxiety can be manifested [12
However, despite the increasing visibility of transnational female foreign spouses in communities across the island of Taiwan, little is understood about their health, especially their mental health. The lack of health data about these women has become a critical issue as health care providers try to become responsive to the pressing needs of female foreign spouses who come from different cultures and potentially speak or read little or no Chinese. In order to help these female foreign spouses to adjust, it is necessary to understand better the experiences and concerns of these women, who bring their own cultural backgrounds, perceptions, and experiences into the homes of their husbands in Taiwan. Therefore, an understanding of the health care needs and mental health, as well as its related factors, of this specific group in Taiwan is an important issue for mental health nurses.
The specific aims of this study were: (1) to investigate the mental health status, as well as factors related to mental health, of female foreign spouses from Vietnam, Indonesia, and mainland China in transnational marriages, and (2) to understand the mental health care needs of these women.