Mental health of immigrants and refugees

Perceived Racial Discrimination and Mental Health in Diverse Groups of Asian Americans: The Differing Impacts by Age, Education, and Ethnicity

The aim of this study was to examine how perceived racial discrimination is associated with mental distress among diverse Asian Americans and to explore the potential moderators in the relationship. Based on the 2015 Asian American Quality of Life (AAQoL) survey (n = 2609), direct influences were tested of the contextual (demographic, health-related, and immigration-related) variables and perceived racial discrimination on mental distress, as well as their interactions. About 30% of the sample reported perceived racial discrimination, and 44% fell into the category of having mental distress. Perceived racial discrimination was associated with 1.90 times higher odds of mental distress and had significant interactions with age, education, and ethnicity. The association of mental distress with perceived racial discrimination was higher among those who were 60 or older, less educated, and Vietnamese than among their respective counterparts. Findings can guide strategic and targeted interventions for high-risk groups.

Preference for patient-provider ethnic concordance in Asian Americans

Objectives: The present study examined factors associated with the preference for patient-provider ethnic concordance in Asian Americans.Design: With data drawn from the 2015 Asian American Quality of Life Survey (N = 2535), a logistic regression model of the preference for patient-provider ethnic concordance was tested with demographic (age, gender, ethnicity, marital status, education), health and access (chronic medical conditions, self-rated health, health insurance coverage), immigration-related (place of birth, length of stay in the US, English proficiency, acculturation), and adverse experience (perceived discrimination, communication problems in healthcare settings) variables.Results: Over half (52.4%) of those in the sample preferred to be treated by a healthcare provider from their own ethnic background. In a multivariate model, the odds for preferring ethnic concordance were 1.52-1.64 times higher among individuals in earlier stages of immigration, language acquisition, and acculturation. Individuals who had experienced communication problems in healthcare settings presented 3.74 times higher odds for preferring ethnic concordance than did counterparts without such experience.Conclusions: The results emphasized the value of paying attention to patient-provider concordance when treating Asian Americans either relatively new to the country or who have had previous problems communicating with health professionals. The findings also provide implications for improving workforce diversity in healthcare delivery and medical education.

Willingness to Use a Nursing Home in Asian Americans

This study explores factors associated with willingness to use a nursing home in Asian Americans. Focus is given to demographic variables (age, gender, ethnicity, marital status, and education), health-related variables (chronic medical condition and self-rated health), immigration-related variables (time in the U.S. and acculturation), and family-related variables (family network and family solidarity). Cross-sectional study. Data were drawn from 2551 participants in the 2015 Asian American Quality of Life Survey (aged 18-98). Participants were asked to indicate whether they would be willing to use a nursing home in the future. An affirmative response indicated a personal willingness to use a nursing home. Approximately 38% of the sample demonstrated willingness to use a nursing home. Higher odds for willingness were observed among those with advanced age, female gender, Korean ethnicity (compared with Chinese), better education, presence of a chronic medical condition, longer years of residence in the U.S., and lower levels of family solidarity. Reflecting the current trend of an increase in racial/ethnic minorities in nursing homes, a substantial proportion of the present sample of Asian Americans demonstrated willingness to use a nursing home. Findings on the factors associated with willingness provide implications for policies and services to respond to the long-term care needs of this emerging population.

Source of Health Information and Unmet Healthcare Needs in Asian Americans

BACKGROUND

Responding to the disparities in accessing and obtaining health information and healthcare among immigrant populations, the present study focused on Asian Americans. Using a sample that reflects Asian Americans' cultural and linguistic diversities, the goal was to explore the typologies of health information source and their predictability to unmet healthcare needs (i.e., the experience of not being able to get needed medical care).

METHODS

Data were drawn from the 2015 Asian American Quality of Life Survey (N = 2,592), conducted using culturally and linguistically sensitive approaches. Latent class analysis on nine sources of health information across interpersonal networks (family members, close friends, acquaintances, and health professionals) and Internet-based communication technologies (mobile apps, email listservs, social networking sites, online communities, and health websites) identified six classes: 'resource-heavy,' 'human-oriented,' 'expertise-focused,' 'family-dominant,' 'resource-scarce,' and 'health professional-dominant.'

RESULTS

Compared to the resource-heavy group, the odds of having an unmet healthcare need were 2.94 times greater in the family-dominant group and 4.13 times greater in the resource-scarce group.

DISCUSSION

Findings provide implications for interventions with respect to subgroups to be prioritized and areas to be targeted in efforts to promote access and acquisition of health information and health services in Asian Americans.

Risk Factors for Social Isolation in Older Korean Americans

OBJECTIVE

Given the importance of social ties and connectedness in the lives of older ethnic immigrants, the present study examined the prevalence of social isolation and its risk factors in older Korean Americans.

METHOD

Using survey data from 1,301 participants (Mage = 70.5, SD = 7.24), risk groups for marginal social ties with family and friends were identified and predictors of each type of social isolation explored.

RESULTS

Male gender and poorer rating of health were identified as common risk factors for marginal ties to both family and friends. Findings also present specific risk factors for each type of social isolation. For example, an increased risk of having marginal ties with friends was observed among individuals with perceived financial strain, greater functional impairment, and a shorter stay in the United States.

DISCUSSION

The common and specific risk factors should be incorporated in programs to reduce social isolation in older immigrant populations.

South Asian populations in Canada: migration and mental health

BACKGROUND

South Asian populations are the largest visible minority group in Canada; however, there is very little information on the mental health of these populations. The objective of this study was to determine the prevalence rates and characteristics of mental health outcomes for South Asian first-generation immigrant and second-generation Canadian-born populations.

METHODS

The Canadian Community Health Survey (CCHS) 2011 was used to calculate the estimated prevalence rates of the following mental health outcomes: mood disorders, anxiety disorders, fair-poor self-perceived mental health status, and extremely stressful life stress. The characteristics associated with these four mental health outcomes were determined through multivariate logistic regression analysis of merged CCHS 2007-2011 data.

RESULTS

South Asian Canadian-born (3.5%, 95% CI 3.4-3.6%) and South Asian immigrant populations (3.5%, 95% CI 3.5-3.5%) did not vary significantly in estimated prevalence rates of mood disorders. However, South Asian immigrants experienced higher estimated prevalence rates of diagnosed anxiety disorders (3.4%, 95% CI 3.4-3.5 vs. 1.1%, 95% CI 1.1-1.1%) and self-reported extremely stressful life stress (2.6%, 95% CI 2.6-2.7% vs. 2.4%, 95% CI 2.3-2.4%) compared to their Canadian-born counterparts. Lastly, South Asian Canadian-born populations had a higher estimated prevalence rate of poor-fair self-perceived mental health status (4.4%, 95% CI 4.3-4.5%) compared to their immigrant counterparts (3.4%, 95% CI 3.3-3.4%). Different profiles of mental health determinants emerged for South Asian Canadian-born and immigrant populations. Female gender, having no children under the age of 12 in the household, food insecurity, poor-fair self-rated health status, being a current smoker, immigrating to Canada before adulthood, and taking the CCHS survey in either English or French was associated with greater risk of negative mental health outcomes for South Asian immigrant populations, while not being currently employed, having a regular medical doctor, and inactive physical activity level were associated with greater risk for South Asian Canadian-born populations.

CONCLUSIONS

Mental health outreach programs need to be cognizant of the differences in prevalence rates and characteristics of mental health outcomes for South Asian immigrant and Canadian-born populations to better tailor mental health services to be responsive to the unique mental health needs of South Asian populations in Canada.

The childbearing health and related service needs of newcomers (CHARSNN) study protocol

BACKGROUND

Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1) Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2) Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women) by the Canadian health care system as delivered in each of the three major receiving cities for newcomers?

METHODS/DESIGN

This is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum). We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born) from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada - Montreal, Toronto, and Vancouver].

DISCUSSION

Knowledge of the extent of harmful health events occurring to asylum-seeking, refugee, immigrant, and Canadian-born women, and the response of the health care system to those events and group differences, if they exist, will inform immigration and health policy makers as well as providers of services.

Suicide attempts among indigenous Sami adolescents and majority peers in Arctic Norway: prevalence and associated risk factors

The prevalence of suicide attempts and associated risk factors such as sociodemographic conditions, emotional/behavioural problems and parent-child relationships were examined among 591 indigenous Sami and 2100 majority adolescents in Arctic Norway. There were no significant ethnic differences in prevalence of suicide attempts. In both ethnic groups, suicidal ideation, anxious/depressed problems and eating behaviour problems were associated with suicide attempts. Cross-cultural differences in risk factors associated with suicide attempts existed. For Sami adolescents, factors diverging from the traditional cultural norms were associated with suicide attempts, such as alcohol intoxication, single-parent home and paternal overprotection (p</=.05). Vocational studies, not living together with parents, current smoking and experienced sexual intercourse were ethnic specific risk factors associated with suicide attempts among majority peers (p</=.05). Clinicians should take into account that risk factors can differ between ethnic groups and should be sensitive to culturally divergent behaviour.

Acculturation strategies and ethnic identity as predictors of behavior problems in arctic minority adolescents

OBJECTIVE

To explore the effect of acculturation attitudes and ethnic and national identity on behavior problems in arctic minority adolescents in northern Norway.

METHOD

The Youth Self-Report, the Multigroup Ethnic Identity Measure, and acculturation strategies were completed by 581 indigenous Sami and 291 Kven high school students in 1994-1995, at age 15-18 years. Response rate was 85%. Behavior problems were in addition to ethnic/national identity and acculturation attitudes studied in relation to ethnicity, gender, age, socioeconomic status, parentage, ethnic language, and ethnic context.

RESULTS

Although there were no ethnic group differences in behavior problems, the impact of ethnocultural predictors differed between ethnocultural and indigenous adolescents. Acculturation attitudes were most significant for indigenous adolescents' mental health, and identity issues showed the strongest impact on ethnocultural peers. The study revealed significant gender differences regarding the influence of ethnocultural factors, and contextual variation among Sami adolescents with the strongest impact in contexts with low density of Sami people.

CONCLUSIONS

The significant ethnic group variations emphasize the importance of conducting both between- and within-group analysis on the impact of ethnocultural issues on behavior problems in minority adolescents.

Illness and treatment perceptions of Ethiopian immigrants and their doctors in Israel

OBJECTIVES

Patient-provider misunderstandings arising from disparate medical and cultural concepts can impede health care among immigrant populations. This study assessed the extent of disagreement and identified the salient problems of communication between Israeli doctors and Ethiopian immigrant patients.

METHODS

Semistructured interviews were conducted with 59 Ethiopian immigrants. Self-reports of health status and effectiveness of treatment were compared with evaluations by the primary care physician and supplemented by qualitative data from descriptions of illness, observations of medical visits, informant interviews, and participant observations conducted by the anthropologist.

RESULTS

Health status and effectiveness of treatment were rated significantly higher by the doctor than by the patients. Low doctor-patient agreement occurred mainly for illnesses with stress-related or culture-specific associations. Qualitative data suggested that more long-term immigrants may alter their expectations of treatment but continue to experience symptoms that are culturally, but not biomedically, meaningful.

CONCLUSIONS

Misunderstandings between immigrant patients and their doctors emerge from the biomedical system's limitations in addressing stress-related illnesses and from culture-based discrepancies in concepts of illness and healing. Including trained translators in medical teams can reduce medical misunderstandings and increase patient satisfaction among immigrant populations.

Influence of ethnic factors on behavior problems in indigenous Sami and majority Norwegian adolescents

OBJECTIVE

To explore the relationship between behavior problems and ethnic factors in indigenous minority Sami and Norwegian majority adolescents in northern Norway.

METHOD

The Youth Self-Report (YSR) was completed by 249 Sami and 210 Norwegian students in junior high school, aged 13 to 16 years. Parents completed the Child Behavior Checklist (CBCL). Behavior problems were assessed in relation to ethnicity and ethnic context (geographic region and family context).

RESULTS

Rates of behavior problems (CBCL and YSR) were generally high in both ethnic groups and were highest among girls. Sami adolescents, particularly those living in assimilated ethnic communities, reported more behavior problems than Norwegian adolescents.

CONCLUSION

Ethnic factors have significant impact on behavior problems in indigenous minority adolescents living in a multiethnic context.

Physical and psychological well-being among immigrant referrals to colonoscopy

The association between immigration and well-being was studied in 2 groups of referrals to colonoscopy in the Negev region of Israel: Eastern Europe born (n = 278) and Israeli born (n = 70). The findings of this study suggest that the first 3 years after migration are associated with inferior physical and psychological well-being, and, to a lesser degree, with poorer family functioning and limited social interactions. The differences between immigrants and Israeli born tended to fade away as years went by, and the most veteran immigrants, those who immigrated more than 40 years prior to the study, scored best on most physical and psychological well-being indicators. Findings are discussed in terms of a life events approach and in terms of Israeli immigration regulations and absorption policy.