GRSJ224/Immigrant and refugee mental health in Canada
Mental health is a level of psychological well-being or an absence of mental illness.[1] According to the World Health Organization (WHO), mental health includes "subjective well-being, perceived self-efficacy, autonomy, competence, inter-generational dependence, and self-actualization of one's intellectual and emotional potential, among others.”[2]
Due to self-selection processes and Canadian immigration policies, cumulative evidence suggests that immigrants arrive in Canada healthier than Canadian-born residents, a phenomenon termed the “healthy migrant effect”.[3] However, this advantage does not persist over time. Within about 10 years of living in Canada, migrant health deteriorates and converges to Canadian-born levels of mental health.[4]
Migration-associated risk factors [5]
The migration trajectory can be divided into three components: pre-migration, migration and post-migration resettlement. Each phase is associated with specific risks and exposures for mental health problems.
The pre-migration period often involves disruptions to usual social roles and networks. During migration, immigrants can experience prolonged uncertainty about their citizenship status as well as situations that expose them to violence. This can provoke or aggravate depression and other mental health issues.
As post-migratory settlement begins, disillusionment, demoralization and depression can occur early as a result of migration-associated losses, or later, when initial hopes and expectations are not realized.
Social determinants of immigrant mental health
Diverse social determinants of health are implicated in migrant mental health disparities in Canada. Three significant determinants of mental health have been identified in the literature as social connectedness, freedom from discrimination and violence, and economic participation.[6] In the case of migrants, these determinants may be more complex as their divergent experiences prior to immigration can intersect with the post-migration determinants to affect their mental health status.
Social connectedness
Social network ties affect mental health most clearly via various kinds of support including emotional, instrumental, appraisal, and informational.[7] The presence of welcoming links within ethnic communities or religious congregations can buffer the effects of migration losses, isolation and discrimination. Migrant youth living in communities with a high proportion of immigrants from the same background are better adjusted, partly because they have positive role models, a stronger sense of ethnic pride and social support, which can help them deal with the stressors of poverty, discrimination and racism.[8] Becoming familiar with existing community and religious organizations can also help provide psychosocial support.[8]
Freedom from discrimination and violence
Discrimination as a determinant of mental health and a source of stress has been linked to many psychological symptoms and subsequent service utilization among immigrants. Visible minorities and immigrants who experienced discrimination or unfair treatment are most likely to experience a decline in self-reported health status.[6]
Economic participation
Migrants face many barriers in accessing employment in Canada, such as the lack of acceptance of their foreign credentials by professional bodies and employers, language-related barriers, and lack of prior Canadian work experience. The inability to secure suitable work compels many migrants to take up low-skilled, precarious work to survive, which can have negative mental health effects.[9]
Mental illnesses
Depression
In general, immigrants to Canada have lower rates of depression than the general Canadian population, whereas refugees have comparable rates of depression.[10] Over time, the rate of depression in immigrant groups increases to match that of the general population. Although migration in itself does not lead to an increase in depression, specific stressors and challenges can contribute to the onset of depression or influence its course, particularly among refugees. Immigrant women are at two to three times the risk of their Canadian-born counterparts for postpartum depression.[11] These numbers can be traced back to a lack of social support, possible difficulty with language, and unfamiliarity with Canadian life and health care. [11]
Post-traumatic stress disorder (PTSD)
Refugees are at substantially higher risk than the general population for a variety of specific psychiatric disorders — related to their exposure to war, violence, torture, forced migration and exile and to the uncertainty of their status in the countries where they seek asylum — with up to 10 times the rate of post-traumatic stress disorder as well as elevated rates of depression, chronic pain and other somatic complaints.[12]
Utilization of health care resources [13]
Non-European immigrants to Canada tend to under use mental health services compared with Canadian-born people, with studies showing immigrants to be three times less likely to seek such supports. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse, such as the lack of mobility or ability to take time away from work, lack of linguistically accessible services, a desire to deal with problems on one’s own, the concern that problems will not be understood by practitioners because of cultural or linguistic differences, and fear of stigmatization. Furthermore, immigrants that do seek help from their primary care providers are less likely to be referred to mental health practitioners. Thus both clinician and patient characteristics appear to contribute to this underuse of mental health services.
References
- ↑ "mental health". Princeton University. Retrieved February 25, 2019.
- ↑ "The world health report 2001 – Mental Health: New Understanding, New Hope" (PDF). WHO. Retrieved 25 February, 2019.
- ↑ Kennedy, S., Kidd, M., McDonald, J., & Biddle, N. (2014). "The Healthy Immigrant Effect: Patterns and Evidence from Four Countries." Journal Of International Migration And Integration, 16(2), 317-332.
- ↑ De Maio, F., & Kemp, E. (2010). "The deterioration of health status among immigrants to Canada." Global Public Health, 5(5), 462-478.
- ↑ Beiser, Morton (1999). Strangers at the Gate: The 'Boat People's' First Ten Years in Canada. University of Toronto Press.
- ↑ 6.0 6.1 Keleher, H., & Armstrong, R. (2006). Evidence-based mental health promotion resource. Melbourne: Public Health Group, Dept of Human Services.
- ↑ Delara, M. (2016). "Social Determinants of Immigrant Women’s Mental Health." Advances In Public Health, 2016, 1-11.
- ↑ 8.0 8.1 Beiser, M., Dion, R., Gotowiec, A., Hyman, I., & Vu, N. (1995). "Immigrant and Refugee Children in Canada." The Canadian Journal Of Psychiatry, 40(2), 67-72.
- ↑ Kirmayer, L., Narasiah, L., Munoz, M., Rashid, M., Ryder, A., & Guzder, J. et al. (2010). "Common mental health problems in immigrants and refugees: general approach in primary care." Canadian Medical Association Journal, 183(12), E959-E967.
- ↑ Kandula, N., Kersey, M., & Lurie, N. (2004). "Assuring the Health of Immigrants: What the Leading Health Indicators Tell Us." Annual Review Of Public Health, 25(1), 357-376.
- ↑ 11.0 11.1 Stewart, D., Gagnon, A., Saucier, J., Wahoush, O., & Dougherty, G. (2008). "Postpartum Depression Symptoms in Newcomers". The Canadian Journal Of Psychiatry, 53(2), 121-124.
- ↑ Lindert, J., Ehrenstein, O., Priebe, S., Mielck, A., & Brähler, E. (2009). "Depression and anxiety in labor migrants and refugees – A systematic review and meta-analysis." Social Science & Medicine, 69(2), 246-257.
- ↑ Kirmayer, L., Weinfeld, M., Burgos, G., du Fort, G., Lasry, J., & Young, A. (2007). Use of Health Care Services for Psychological Distress by Immigrants in an Urban Multicultural Milieu. The Canadian Journal Of Psychiatry, 52(5), 295-304.