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Grochtdreis T, König HH, Dams J. Migration-related determinants of health-care service utilization among persons with a direct migration background in Germany: an exploratory study based on the German Socio-Economic Panel (SOEP). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01708-9. [PMID: 39004694 DOI: 10.1007/s10198-024-01708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND It is known that the health-care service utilization in primary care of persons with a direct migration background is lower compared to non-migrants. However, potential migration-related determinants of health-care service utilization are not known. Therefore, this study aimed to analyze the associations between health-care service utilization and migration-related characteristics of persons with a direct migration background in Germany. METHODS The migration samples (M1 and M2) of the German Socio-Economic Panel (SOEP) were used as the sample for this study. Associations between the number of visits to primary care physicians in the previous three months and migration-related characteristics were examined using generalized linear models. Associations between the hospitalization within one year and migration-related characteristics were examined using logit models. RESULTS The mean number of visits to primary care physicians was about 2, and 8% of persons were hospitalized. Being born in a country other than Russia was associated with a higher number of visits to primary care physicians (+ 26% to + 34%). Both, a very strong connectedness with the country of birth and very good oral German language skills were associated with higher number of visits to primary care physicians (both + 13%) compared to no connectedness and fairly bad oral German language skills. CONCLUSION Only the country of birth, connectedness with the country of birth and oral German language skills may be migration-related determinants of health-care service utilization with regard to the number of visits to primary care physicians by persons with a direct migration background in Germany. With regard to hospitalization, no potential migration-related determinants of health-care service utilization could be identified.
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Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Gao C, Cho LL, Dhillon A, Kim S, McGrail K, Law MR, Sunderji N, Barbic S. Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review. PLoS One 2024; 19:e0304907. [PMID: 39008453 PMCID: PMC11249267 DOI: 10.1371/journal.pone.0304907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.
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Affiliation(s)
- Chloe Gao
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Avneet Dhillon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soyeon Kim
- Department of Psychiatry, McMaster University, Hamilton, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Healthcare, Penetanguishene, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadiya Sunderji
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Kuerban A, Seo JY. Conventional or Alternative Mental Health Service Utilization According to English Proficiency Among Asians in the United States. J Immigr Minor Health 2024; 26:91-100. [PMID: 37676448 DOI: 10.1007/s10903-023-01538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015-2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18-64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly.
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Affiliation(s)
- Aliya Kuerban
- Barbara Hagan School of Nursing & Health Sciences, Molloy University, Rockville Centre, New York, USA.
| | - Jin Young Seo
- Hunter-Bellevue School of Nursing Hunter College, CUNY, New York, NY, USA
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Krzyż EZ, Antunez Martinez OF, Lin HR. Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants-a scoping review. Front Public Health 2023; 11:1284784. [PMID: 38170142 PMCID: PMC10761300 DOI: 10.3389/fpubh.2023.1284784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
Background Migration is a worldwide occurrence that carries significant implications for healthcare systems, and it entails challenges to mental healthcare. The Andersen Behavioral Model is widely used by researchers to determine healthcare service utilization among many populations, including migrants. Our study aimed to explore the ways of using the Andersen Health System Utilization Framework in the literature to discover the utilization of mental healthcare by migrants. Methods This scoping review was based on Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Results A total of 12 articles from January 1992 to July 2023 identified various versions of the Andersen Behavioral Model to provide an overview of mental health services utilization among migrants. The analysis identified four significant trends in the literature. First, there is a predominant focus on individual characteristics over contextual factors. Second, researchers tend to integrate multiple versions of the Andersen Behavioral Model, and the most is the version from 1995. Third, additional factors specific to migrant populations are incorporated into the model, but the categorization is sometimes unclear. Finally, the majority of studies have used a quantitative approach and are based in North America, suggesting a focus on the significance of mental health in migrant communities in that context. Conclusion In summary, our scoping review calls for further research using the Andersen Behavioral Model to study mental healthcare utilization among migrants. Notable findings include the adaptation of the model to migrant populations, a focus on individual characteristics, a need for more diverse research methods, and the proposal of a new conceptual model to guide research and policy development in this field.
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Affiliation(s)
- Ewa Zuzanna Krzyż
- PhD Program, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Jing F, Li Z, Qiao S, Ning H, Zhou S, Li X. Association between immigrant concentration and mental health service utilization in the United States over time: A geospatial big data analysis. Health Place 2023; 83:103055. [PMID: 37311276 PMCID: PMC10527759 DOI: 10.1016/j.healthplace.2023.103055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
Immigrants (foreign-born United States [US] citizens) generally have lower utilization of mental health services compared with US-born counterparts, but extant studies have not investigated the disparities in mental health service utilization within immigrant population nationwide over time. Leveraging mobile phone-based visitation data, we estimated the average mental health utilization in contiguous US census tracts in 2019, 2020, and 2021 by employing two novel outcomes: mental health service visits and visit-to-need ratio (i.e., visits per depression diagnosis). We then investigated the tract-level association between immigration concentration and mental health service utilization outcomes using mixed-effects linear regression models that accounted for spatial lag effects, time effects, and covariates. This study reveals spatial and temporal disparities in mental health service visits and visit-to-need ratio among different levels of immigrant concentration across the US, both before and during the pandemic. Tracts with higher concentrations of Latin American immigrants showed significantly lower mental health service utilization visits and visit-to-need ratio, particularly in the US West. Tracts with Asian and European immigrant concentrations experienced a more significant decline in mental health service utilization visits and visit-to-need ratio from 2019 to 2020 than those with Latin American concentrations. Meanwhile, in 2021, tracts with Latin American concentrations had the least recovery in mental health service utilization visits. The study highlights the potential of geospatial big data for mental health research and informs public health interventions.
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Affiliation(s)
- Fengrui Jing
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
| | - Zhenlong Li
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Huan Ning
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Suhong Zhou
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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Grundy A, Ng E, Rank C, Quinlan J, Giovinazzo G, Viau R, Ponka D, Garner R. Mental health and neurocognitive disorder-related hospitalization rates in immigrants and Canadian-born population: a linkage study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:692-704. [PMID: 36809592 PMCID: PMC10348999 DOI: 10.17269/s41997-023-00740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Mental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada. METHODS Hospital records from the Discharge Abstract Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada's 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health-related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available. RESULTS Overall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently. CONCLUSION Differences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.
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Affiliation(s)
- Anne Grundy
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada.
| | - Edward Ng
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Claudia Rank
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Jacklyn Quinlan
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - George Giovinazzo
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Rachel Viau
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - David Ponka
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
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Abu Bakar NS, Ab Hamid J, Mohd Nor Sham MSJ, Sham MN, Jailani AS. Count data models for outpatient health services utilisation. BMC Med Res Methodol 2022; 22:261. [PMID: 36199028 PMCID: PMC9533534 DOI: 10.1186/s12874-022-01733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/15/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Count data from the national survey captures healthcare utilisation within a specific reference period, resulting in excess zeros and skewed positive tails. Often, it is modelled using count data models. This study aims to identify the best-fitting model for outpatient healthcare utilisation using data from the Malaysian National Health and Morbidity Survey 2019 (NHMS 2019) and utilisation factors among adults in Malaysia. METHODS The frequency of outpatient visits is the dependent variable, and instrumental variable selection is based on Andersen's model. Six different models were used: ordinary least squares (OLS), Poisson regression, negative binomial regression (NB), inflated models: zero-inflated Poisson, marginalized-zero-inflated negative binomial (MZINB), and hurdle model. Identification of the best-fitting model was based on model selection criteria, goodness-of-fit and statistical test of the factors associated with outpatient visits. RESULTS The frequency of zero was 90%. Of the sample, 8.35% of adults utilized healthcare services only once, and 1.04% utilized them twice. The mean-variance value varied between 0.14 and 0.39. Across six models, the zero-inflated model (ZIM) possesses the smallest log-likelihood, Akaike information criterion, Bayesian information criterion, and a positive Vuong corrected value. Fourteen instrumental variables, five predisposing factors, six enablers, and three need factors were identified. Data overdispersion is characterized by excess zeros, a large mean to variance value, and skewed positive tails. We assumed frequency and true zeros throughout the study reference period. ZIM is the best-fitting model based on the model selection criteria, smallest Root Mean Square Error (RMSE) and higher R2. Both Vuong corrected and uncorrected values with different Stata commands yielded positive values with small differences. CONCLUSION State as a place of residence, ethnicity, household income quintile, and health needs were significantly associated with healthcare utilisation. Our findings suggest using ZIM over traditional OLS. This study encourages the use of this count data model as it has a better fit, is easy to interpret, and has appropriate assumptions based on the survey methodology.
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Affiliation(s)
- Nurul Salwana Abu Bakar
- Centre for Health Policy Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia.
| | - Jabrullah Ab Hamid
- Centre for Health Equity Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Mohd Shaiful Jefri Mohd Nor Sham
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Mohd Nor Sham
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Anis Syakira Jailani
- Centre for Health Outcome Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
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Shafeek Amin N, Driver N. Health care utilization among Middle Eastern, Hispanic/Latino, and Asian immigrants in the United States: an application of Andersen's behavioral model. ETHNICITY & HEALTH 2022; 27:858-876. [PMID: 33054364 DOI: 10.1080/13557858.2020.1830034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To examine whether Andersen's model explains health care utilization among Middle Eastern immigrants and to examine gender and ethnic differences in health care utilization of Middle Eastern, Hispanic/Latino, and Asian immigrants in the United States. METHOD Using data from the 2000-2017 National Health Interview Surveys (NHIS), this study compares patterns of health care utilization among Middle Eastern (ME) immigrants to those among Hispanic/Latino and Asian immigrants in the U.S. Specifically, we use Andersen's Behavioral Model of Health Care Utilization to model the likelihood of seeing a doctor in the past 12 months for these three immigrant groups. Additionally, the current study emphasizes the predisposing factor of gender and its differences across and within these groups. RESULTS Andersen's behavioral framework is partially suited to predict the likelihood of seeing a doctor in the past 12 months among ME immigrants. Immigrant women, regardless of their ethnicity, are significantly more likely than men to report seeing a doctor in the past 12 months. Moreover, the effects of the predisposing, need, and enabling characteristics for Hispanics and Asians are significantly different from those for ME immigrants. Additionally, although Asians are significantly less likely to utilize the health care system than ME immigrants, there are no significant differences comparing Hispanics/Latinos to ME immigrants. Furthermore, Andersen's behavioral framework explains ethnicity and gender differences particularly when comparing Asian men to ME men and Asian women to ME women. CONCLUSIONS This study highlights the importance of considering ethnicity and gender differences when examining health outcomes of immigrants.
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Affiliation(s)
- Neveen Shafeek Amin
- Department of Sociology and Anthropology, University of Arkansas at Little Rock, Little Rock, AR, USA
| | - Nichola Driver
- Clinton School of Public Service, University of Arkansas, Little Rock, AR 72201, USA
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Salam Z, Odenigbo O, Newbold B, Wahoush O, Schwartz L. Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:552-574. [PMID: 35066740 DOI: 10.1007/s10488-021-01183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.
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Affiliation(s)
- Zoha Salam
- Department of Global Health, McMaster University, 1280 Main St. West MDCL 3500, Hamilton, ON, L8S 4L8, Canada.
| | - Odera Odenigbo
- School of Counselling, Psychotherapy, and Spirituality, Saint Paul University, Ottawa, Canada
| | - Bruce Newbold
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Rivera JMB, Puyat JH, Wiedmeyer ML, Lavergne MR. Primary Care and Access to Mental Health Consultations among Immigrants and Nonimmigrants with Mood or Anxiety Disorders: Soins de première ligne et accès aux consultations en santé mentale chez les immigrants et les non-immigrants souffrant de troubles de l'humeur ou anxieux. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:540-550. [PMID: 32878459 PMCID: PMC8138741 DOI: 10.1177/0706743720952234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the association between usual place of primary care and mental health consultation among those with self-reported mood or anxiety disorders. We also describe access to mental health services among people who are recent immigrants, longer-term immigrants, and nonimmigrants and determine whether the association with place of primary care differs by immigration group. METHODS We used data from the Canadian Community Health Survey (2015 to 2016) to identify a representative sample of individuals with self-reported mood or anxiety disorders. We used logistic regression, with models stratified by immigration group (recent, longer-term, nonimmigrant), to examine the association between usual place of primary care and receiving a mental health consultation in the previous 12 months. RESULTS Higher percentages of recent and longer-term immigrants see a doctor in solo practice, and a higher percentage of recent immigrants use walk-in clinics as a usual place of care. Compared with people whose usual place of care was a community health center or interdisciplinary team, adjusted odds of a mental health consultation were significantly lower for people whose usual place of care was a solo practice doctor's office (AOR = 0.71; 95% CI, 0.62 to 0.82), a walk-in clinic (AOR = 0.75; 95% CI, 0.66 to 0.85), outpatient clinic/other place (AOR = 0.72 95% CI, 0.59 to 0.88), and lowest among people reporting no usual place other than the emergency room (AOR = 0.59; 95% CI, 0.51 to 0.67). Differences in access to mental health consultations by usual place of primary care were greatest among immigrants, especially recent immigrants. CONCLUSIONS People with mood or anxiety disorders who have access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Expanded access to team-based primary health care may help reduce barriers to mental health services, especially among immigrants.
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Affiliation(s)
- Joanna Marie B Rivera
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
| | - Joseph H Puyat
- Faculty of Medicine, Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei-Ling Wiedmeyer
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - M Ruth Lavergne
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
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She R, Wang X, Zhang Z, Li J, Xu J, You H, Li Y, Liang Y, Li S, Ma L, Wang X, Chen X, Zhou P, Lau J, Hao Y, Zhou H, Gu J. Mental Health Help-Seeking and Associated Factors Among Public Health Workers During the COVID-19 Outbreak in China. Front Public Health 2021; 9:622677. [PMID: 34046387 PMCID: PMC8144452 DOI: 10.3389/fpubh.2021.622677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The COVID-19 outbreak in China has created multiple stressors that threaten individuals' mental health, especially among public health workers (PHW) who are devoted to COVID-19 control and prevention work. This study aimed to investigate the prevalence of mental help-seeking and associated factors among PHW using Andersen's Behavioral Model of Health Services Use (BMHSU). Methods: A cross-sectional survey was conducted among 9,475 PHW in five provinces across China between February 18 and March 1, 2020. The subsample data of those who reported probable mental health problems were analyzed for this report (n = 3,417). Logistic and hierarchical regression analyses were conducted to examine the associations of predisposing, enabling, need, and COVID-19 contextual factors with mental health help-seeking. Results: Only 12.7% of PHW reported professional mental help-seeking during the COVID-19 outbreak. PHW who were older, had more days of overnight work, received psychological training, perceived a higher level of support from the society, had depression and anxiety were more likely to report mental help-seeking (ORm range: 1.02–1.73, all p < 0.05) while those worked in Centers for Disease Control and Prevention were less likely to seek help (ORm = 0.57, p < 0.01). The belief that mental health issues were not the priority (64.4%), lack of time (56.4%), and shortage of psychologists (32.7%) were the most frequently endorsed reasons for not seeking help. Conclusions: The application of BMHSU confirmed associations between some factors and PHW's mental health help-seeking. Effective interventions are warranted to promote mental health help-seeking of PHW to ameliorate the negative impact of mental illness and facilitate personal recovery and routine work.
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Affiliation(s)
- Rui She
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Zhoubin Zhang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jingdong Xu
- Hubei Province Center for Disease Control and Prevention, Wuhan, China
| | - Hua You
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yan Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yuan Liang
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Li
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Lina Ma
- Hubei Province Center for Disease Control and Prevention, Wuhan, China
| | - Xinran Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiuyuan Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Peien Zhou
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Joseph Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
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12
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Gil MR, Choi CG. Factors Affecting the Choice of National and Public Hospitals Among Outpatient Service Users in South Korea. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019833256. [PMID: 30939970 PMCID: PMC6448112 DOI: 10.1177/0046958019833256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study analyzed factors underlying outpatient service users' choice of national and public (rather than private) hospitals. Based on Andersen's Behavioral Model, we developed a framework that covered needs, enabling, and personal factors. Data of outpatient service usage were obtained from the Korean medical panel survey during 2008 to 2013. Logistic regression analyses were conducted, and results revealed that the rate of national and public hospital use was very low (5.57%), and our model adequately explained variance in service use. Specifically, several demographic factors-older age, low income, national merit and medical care, being chronically ill, and having a disability-were predictive of whether an individual is likely to choose national and public hospitals. We discuss the need to strengthen national and public hospitals' medical services in order to better manage care for low-income vulnerable groups.
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13
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Seo JY, Kuerban A, Bae SH, Strauss SM. Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States. J Womens Health (Larchmt) 2019; 28:1368-1377. [PMID: 31264933 DOI: 10.1089/jwh.2018.7532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.
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Affiliation(s)
- Jin Young Seo
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, New York
| | - Aliya Kuerban
- The Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York
| | - Sung-Heui Bae
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Shiela M Strauss
- Hunter-Bellevue School of Nursing, Hunter College, CUNY, New York, New York.,Rory Meyers College of Nursing, New York University, New York, New York
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14
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Gondek D, Kirkbride JB. Predictors of mental health help-seeking among polish people living the United Kingdom. BMC Health Serv Res 2018; 18:693. [PMID: 30189870 PMCID: PMC6127920 DOI: 10.1186/s12913-018-3504-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/29/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Migration has been shown to be associated with negative mental health outcomes. Moreover, migrants tend to underutilise mental health services. The current study aimed to assess the association between predictors, divided into three groups (predisposing, enabling and need), and two outcome variables: (1) past professional mental health help-seeking during the stay in the United Kingdom; (2) intentions of mental health help-seeking from a mental health professional within the next three months. METHODS The study utilised a population-based cross-sectional survey with the final sample of 536 participants. Multivariate linear and logistic regression models were used to examine the association between predictors and the outcomes. RESULTS We found strong evidence that older age, mental health stigma and living circumstances (predisposing factors), as well as knowledge of the National Health Service, social support, and education (enabling factors) were associated with past and future help-seeking for mental health problems. Finally, mental health status was associated with both past help-seeking and intentions. CONCLUSION Due to large numbers of migrants in the UK it is vital to ensure that these populations receive adequate mental health support. Findings of the present study may inform development of policies and interventions better tailored to specific migrant populations.
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Affiliation(s)
- Dawid Gondek
- Centre for Longitudinal Studies, UCL Institute of Education, 55-59 Gordon Square, London, WC1H 0NU UK
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15
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The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:616-27. [PMID: 26143493 DOI: 10.1007/s10488-015-0668-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Since the mid-1990s, Spain has started to receive a great number of migrant populations. The migration process can have a significantly negative impact on mental health of immigrant population and, consequently, generate implications for the delivery of mental health services. The aim of this article is to provide empirical evidence to demonstrate that the mental health of immigrants in Spain deteriorates the longer they are resident in the country. An empirical approach to this relationship is carried out with data from the National Survey of Health of Spain 2011-2012 and poisson and negative binomial models. Results show that immigrants who reside <10 years in Spain appear to be in a better state of mental health than that observed for the national population. Studying health disparities in the foreign population and its evolution are relevant to ensure the population's access to health services and care. The need for further research is especially true in the case of the immigrant population's mental health in Spain because there is scant evidence available on their situation.
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16
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Floyd A, Sakellariou D. Healthcare access for refugee women with limited literacy: layers of disadvantage. Int J Equity Health 2017; 16:195. [PMID: 29126420 PMCID: PMC5681803 DOI: 10.1186/s12939-017-0694-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background Record numbers of people, across the world, are forced to be displaced because of conflict or other violations of their human rights, thus becoming refugees. Often, refugees not only have a higher burden of disease but also compromised access to healthcare, as they face many barriers, such as limited knowledge of the local language. However, there is very limited knowledge on the lived experiences of this population. Moreover, the strategies people might develop in their efforts to access healthcare have not been explored in depth, despite their value in establishing peer- support, community based programs. Methods In this article, we present the findings of a study aiming to explore the lived experiences of accessing healthcare in the greater Vancouver area for recently-arrived, government-assisted refugee women, who were non-literate and non-English-speaking when they arrived in the country. We carried out sixteen semi-structured interviews with eight refugee women, guided by descriptive phenomenology. Results The findings highlight the intersection of limited knowledge of the local language with low literacy, gender, and refugee status and how it impacts women’s access to healthcare, leading to added layers of disadvantage. We discuss three themes: (1) Dependence, often leading to compromised choice and lack of autonomy, (2) Isolation, manifesting as fear in navigating the healthcare system, rejection, or shame for a perceived inadequacy, and (3) Resourcefulness in finding ways to access healthcare. Discussion We propose that a greater understanding of the intersections of gender, low literacy, and refugee status can guide healthcare workers and policy makers in improving services for this population. Furthermore, It is important to enable seldom-heard, hard to reach populations and facilitate their participation in research in order to understand how vectors of disadvantage intersect.
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Affiliation(s)
- Annette Floyd
- Schools of Health Sciences and Nursing, Langara College, Vancouver, Canada
| | - Dikaios Sakellariou
- Cardiff University, School of Healthcare Sciences, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB, UK.
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17
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Patel K, Kouvonen A, Close C, Väänänen A, O'Reilly D, Donnelly M. What do register-based studies tell us about migrant mental health? A scoping review. Syst Rev 2017; 6:78. [PMID: 28399907 PMCID: PMC5387245 DOI: 10.1186/s13643-017-0463-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies investigating the mental health of migrants have shown mixed results. The increased availability of register data has led to a growing number of register-based studies in this research area. This is the first scoping review on the use of registry and record-linkage data to examine the mental health of migrant populations. The aim of this scoping review is to investigate the topics covered and to assess the results yielded from these studies. METHODS We used a scoping review methodology to search MedLine, PubMed, PsychINFO, Web of Science, and SCOPUS for all register-based studies on the mental health of migrants. Two reviewers screened all papers, independently, using iteratively applied inclusion and exclusion criteria. Using gradually broadening inclusion and exclusion criteria for maximum "scope," newly published criteria developed to appraise the methodological quality of record-linkage studies were applied to eligible papers and data were extracted in a charting exercise. RESULTS A total of 1309 papers were screened and appraised, 51 of which met the eligibility and quality criteria and were included in the review. This review identified four major domains of register-based research within the topic of migrant mental health: rates and risks of psychiatric disorders, rates and risks of suicide mortality, the use of psychotropic drugs, and health service utilisation and mental health-related hospitalisation rates. We found that whilst migrants can be at an increased risk of developing psychotic disorders and suicide mortality, they are less likely to use psychotropic medication and mental health-related services. CONCLUSIONS This review systematically charts the register-based studies on migrants' mental health for the first time. It shows the main topics and gaps in knowledge in this research domain, discusses the disadvantages of register-based studies, and suggests new directions for forthcoming studies.
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Affiliation(s)
- Kishan Patel
- Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Anne Kouvonen
- Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, UK.,Department of Social Research, University of Helsinki, Helsinki, Finland.,SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
| | - Ciara Close
- Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Dermot O'Reilly
- Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael Donnelly
- Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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18
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Lo TKT, Parkinson L, Cunich M, Byles J. Factors associated with the health care cost in older Australian women with arthritis: an application of the Andersen's Behavioural Model of Health Services Use. Public Health 2016; 134:64-71. [PMID: 26791096 DOI: 10.1016/j.puhe.2015.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/27/2015] [Accepted: 11/27/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Factors associated with the utilisation of health care have not been rigorously examined in people with arthritis. The objective of this study was to examine the determinants of health care utilisation and costs in older women with arthritis using the Andersen's behavioural model as a framework. STUDY DESIGN Longitudinal cohort study. METHODS Participants of Surveys 3 to 5 of the Australian Longitudinal Study on Women's Health who reported arthritis were included in the study. Information about health care utilisation and unit prices were based on linked Medicare Australia data, which included prescription medicines and health services. Total health care costs of participants with arthritis were measured for the years 2002 to 2003, 2005 to 2006, and 2008 to 2009, which corresponded to the survey years. Potential explanatory variables of the health care cost and other characteristics of the participants were collected from the health surveys. Explanatory variables were grouped into predisposing characteristics, enabling factors and need variables conforming to the Andersen's Behavioural Model of Health Services Use. Longitudinal data analysis was conducted using generalized estimating equations. RESULTS A total of 5834 observations were included for the three periods. Regression analysis results show that higher health care cost in older Australian women with arthritis was significantly associated with residing in an urban area, having supplementary health insurance coverage, more comorbid conditions, using complementary and alternative medicine, and worse physical functioning. It was also found that predisposing characteristics (such as the area of residence) and enabling factors (such as health insurance coverage) accounted for more variance in the health care cost than need variables (such as comorbid conditions). CONCLUSION These results may indicate an inefficient and unfair allocation of subsidised health care among older Australian women with arthritis, where individuals with less enabling resources and more socio-economic disadvantages have a lower level of health care utilisation. Future research may focus on evaluating the effectiveness of policies designed to reduce excessive out-of-pocket costs and to improve equity in health care access in the older population.
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Affiliation(s)
- T K T Lo
- Research Centre for Gender, Health and Ageing, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - L Parkinson
- Central Queensland University, School of Human Health and Social Sciences, Rockhampton, QLD 4701, Australia
| | - M Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - J Byles
- Research Centre for Gender, Health and Ageing, The University of Newcastle, Callaghan, NSW 2308, Australia
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Abstract
International migration has led to increasingly diverse populations in many high-income countries. With approximately 250,000 newcomers each year, it should be no surprise that developing services that meet the needs of immigrants, refugees, ethnocultural, and racialized populations (IRER) is a major priority in the Mental Health Strategy for Canada. The published Canadian literature on the mental health of diverse populations concludes that differences in the exposure to social risk factors lead to differences in rates of illness for some groups. Whether rates of illness are high or low in a particular group, however, problems in accessing services are ubiquitous. Improving the service response will require political will, leadership, strategic planning, and data, and must include people with lived experience and the populations at highest risk. This paper outlines the “Issues and Options” paper commissioned by the Mental Health Commission of Canada, which used a thorough literature review and a national consultation to develop a model for service development. A health equity approach that utilizes local-population-based planning and the evidence-based interventions that are available for diverse groups could improve services for IRER groups in Canada.
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Affiliation(s)
- Kwame McKenzie
- Centre for Addiction and Mental Health
- Centre for Addiction and Mental Health
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20
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George U, Thomson MS, Chaze F, Guruge S. Immigrant Mental Health, A Public Health Issue: Looking Back and Moving Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13624-48. [PMID: 26516884 PMCID: PMC4627052 DOI: 10.3390/ijerph121013624] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/24/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
The Mental Health Commission of Canada's (MHCC) strategy calls for promoting the health and wellbeing of all Canadians and to improve mental health outcomes. Each year, one in every five Canadians experiences one or more mental health problems, creating a significant cost to the health system. Mental health is pivotal to holistic health and wellbeing. This paper presents the key findings of a comprehensive literature review of Canadian research on the relationship between settlement experiences and the mental health and well-being of immigrants and refugees. A scoping review was conducted following a framework provided by Arskey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). Over two decades of relevant literature on immigrants' health in Canada was searched. These included English language peer-reviewed publications from relevant online databases Medline, Embase, PsycInfo, Healthstar, ERIC and CINAHL between 1990 and 2015. The findings revealed three important ways in which settlement affects the mental health of immigrants and refugees: through acculturation related stressors, economic uncertainty and ethnic discrimination. The recommendations for public health practice and policy are discussed.
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Affiliation(s)
- Usha George
- Faculty of Community Services, Ryerson University, 99 Gerrard Street East, SHE-690; 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
| | - Mary S Thomson
- Faculty of Community Services, Ryerson University, 99 Gerrard Street East, SHE-690; 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
| | - Ferzana Chaze
- Community Studies, Sheridan College, 7899 McLaughlin Road, Brampton, ON L6Y 5H9, Canada.
| | - Sepali Guruge
- School of Nursing; Ryerson University, Faculty of Community Services; 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
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21
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Improving Immigrant Populations’ Access to Mental Health Services in Canada: A Review of Barriers and Recommendations. J Immigr Minor Health 2015; 17:1895-905. [DOI: 10.1007/s10903-015-0175-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Higginbottom G, Reime B, Bharj K, Chowbey P, Ertan K, Foster-Boucher C, Friedrich J, Gerrish K, Kentenich H, Mumtaz Z, O'Brien B, Salway S. Migration and maternity: insights of context, health policy, and research evidence on experiences and outcomes from a three country preliminary study across Germany, Canada, and the United kingdom. Health Care Women Int 2013; 34:936-65. [PMID: 23631670 DOI: 10.1080/07399332.2013.769999] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.
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Affiliation(s)
- Gina Higginbottom
- a Faculty of Nursing, University of Alberta , Edmonton , Alberta , Canada
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23
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Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc11. [PMID: 23133505 PMCID: PMC3488807 DOI: 10.3205/psm000089] [Citation(s) in RCA: 441] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: This systematic review aims to assess the use and implementation of the Behavioral Model of Health Services Use developed by Ronald M. Andersen in recent studies explicity using this model. Methods: A systematic search was conducted using PubMed in April 2011. The search strategy aimed to identify all articles in which the Andersen model had been applied and which had been published between 1998 and March 2011 in English or German. The search yielded a total of 328 articles. Two researchers independently reviewed the retrieved articles for possible inclusion using a three-step selection process (1. title/author, 2. abstract, 3. full text) with pre-defined inclusion and exclusion criteria for each step. 16 studies met all of the inclusion criteria and were used for analysis. A data extraction form was developed to collect information from articles on 17 categories including author, title, population description, aim of the study, methodological approach, use of the Andersen model, applied model version, and main results. The data collected were collated into six main categories and are presented accordingly. Results: Andersen’s Behavioral Model (BM) has been used extensively in studies investigating the use of health services. The studies identified for this review showed that the model has been used in several areas of the health care system and in relation to very different diseases. The 1995 version of the BM was the version most frequently applied in the studies. However, the studies showed substantial differences in the variables used. The majority of the reviewed studies included age (N=15), marital status (N=13), gender/sex (N=12), education (N=11), and ethnicity (N=10) as predisposing factors and income/financial situation (N=10), health insurance (N=9), and having a usual source of care/family doctor (N=9) as enabling factors. As need factors, most of the studies included evaluated health status (N=13) and self-reported/perceived health (N=9) as well as a very wide variety of diseases. Although associations were found between the main factors examined in the studies and the utilization of health care, there was a lack of consistency in these findings. The context of the studies reviewed and the characteristics of the study populations seemed to have a strong impact on the existence, strength and direction of these associations. Conclusions: Although the frequently used BM was explicitly employed as the theoretical background for the reviewed studies, their operationalizations of the model revealed that only a small common set of variables was used and that there were huge variations in the way these variables were categorized, especially as it concerns predisposing and enabling factors. This may stem from the secondary data sets used in the majority of the studies, which limited the variables available for study. Primary studies are urgently needed to enrich our understanding of health care utilization and the complexity of the processes shown in the BM.
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Affiliation(s)
- Birgit Babitsch
- Osnabrück University, School of Human Sciences, Dept. of New Public Health, Osnabrück, Germany
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24
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Hansson EK, Tuck A, Lurie S, McKenzie K. Rates of mental illness and suicidality in immigrant, refugee, ethnocultural, and racialized groups in Canada: a review of the literature. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:111-21. [PMID: 22340151 DOI: 10.1177/070674371205700208] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Studies from around the world point to differences in the rates of mental illnesses between immigrant, refugee, ethnocultural, and racialized (IRER) groups and host populations. Risk of illness depends on social contexts; therefore, to offer the best information for people aiming to develop and offer equitable services, local information on rates of mental illness in different population groups is required. METHODS We performed a literature review of peer-reviewed journals and the grey literature between 1990 and 2009 using standard techniques and identified primary research reporting the rates of mental illness and suicidality in IRER groups in Canada. RESULTS Among the 229 papers we reviewed, 17 were included. Most papers reported rates for depression. There was no clear pattern, with different IRER groups and different age groups reporting either elevated or lower rates, compared with white Canadians. Refugee youth in Quebec have higher rates of numerous mental health problems and illnesses. When immigrant groups were considered as a whole, suicide rates were low but different national origin groups reported different trajectories in rates across the generations. CONCLUSION The literature on rates of mental illness and suicidality in IRER groups in Canada is diverse and not comprehensive. In addition, most research has been conducted in 3 provinces and, in particular, 3 major cities. The rates of mental illness seem to vary by national origin groups, age, and status in Canada. There is very little research on nonimmigrant, culturally diverse populations in Canada. This lack of information may undermine efforts to develop equitable mental health services for all Canadians.
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Affiliation(s)
- Emily K Hansson
- Health Systems and Health Services Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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25
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Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Soc Sci Med 2012; 74:1062-72. [PMID: 22326103 DOI: 10.1016/j.socscimed.2011.11.031] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 09/01/2011] [Accepted: 11/26/2011] [Indexed: 11/21/2022]
Abstract
This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.
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26
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Chen J, Vargas-Bustamante A. Estimating the effects of immigration status on mental health care utilizations in the United States. J Immigr Minor Health 2011; 13:671-80. [PMID: 21286813 PMCID: PMC3132313 DOI: 10.1007/s10903-011-9445-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants’ health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14–29% and 9–28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants’ language barriers, and providing culturally appropriate services.
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Affiliation(s)
- Jie Chen
- Department of Political Science, Economics, and Philosophy, College of Staten Island/City University of New York, 2800 Victory Blvd, Room 2 N-229, Staten Island, NY 10314, USA.
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Liu CH, Ingleby D, Meeuwesen L. Barriers to health care for chinese in the Netherlands. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:635853. [PMID: 22295191 PMCID: PMC3263844 DOI: 10.1155/2011/635853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/12/2011] [Accepted: 05/02/2011] [Indexed: 05/31/2023]
Abstract
This study examines utilisation of the Dutch health care system by Chinese people in the Netherlands as well as their attitudes to the system, paying special attention to mental health. Information was gathered by semistructured interviews (n = 102). The main issues investigated are access, help-seeking behaviour, and quality of care. Results showed that most respondents used Dutch health care as their primary method of managing health problems. Inadequate knowledge about the system and lack of Dutch language proficiency impede access to care, in particular registration with a General Practitioner (GP). Users complained that the care given differed from what they expected. Results also showed that the major problems are to be found in the group coming from the Chinese-speaking region. Western concepts of mental health appear to be widely accepted by Chinese in the Netherlands. However, almost half of our respondents believed that traditional Chinese medicine or other methods can also help with mental health problems. The provision of relevant information in Chinese appears to be important for improving access. Better interpretation and translation services, especially for first-generation migrants from the Chinese-speaking region, are also required.
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Affiliation(s)
- Cha-Hsuan Liu
- Faculty of Social and Behavioural Sciences, Utrecht University, 3508 TC Utrecht, The Netherlands
| | - David Ingleby
- Faculty of Social and Behavioural Sciences, Utrecht University, 3508 TC Utrecht, The Netherlands
| | - Ludwien Meeuwesen
- Faculty of Social and Behavioural Sciences, Utrecht University, 3508 TC Utrecht, The Netherlands
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Maureen O'Mahony J, Truong Donnelly T. A postcolonial feminist perspective inquiry into immigrant women's mental health care experiences. Issues Ment Health Nurs 2010; 31:440-9. [PMID: 20521913 DOI: 10.3109/01612840903521971] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The number of immigrants coming to Canada has increased in the last three decades. As a result, there is greater emphasis on health care providers and the health care system to provide culturally appropriate and equitable care. It is well documented that many immigrant women suffer from serious mental health problems and experience difficulties in accessing and using mental health services. In this paper we advocate for new ways of research inquiry in exploring immigrant women's mental health care experiences, ones that move beyond the individual experiences of health and illness toward recognition that the health of immigrant women must be addressed within the social, cultural, economic, historical, and political context of their lives. Drawing on past research we demonstrate how the postcolonial feminist perspective can be used to illuminate the ways in which race, gender, and class relations influence social, cultural, political, and economic factors, which, in turn, shape the lives of immigrant women. We suggest that postcolonial feminism provides an analytic lens to (a) generate transformative knowledge about immigrant women's mental health care experiences; (b) improve equitable health care; and (c) increase understanding of what would be helpful in meeting the immigrant women's health care needs.
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Chung I. Changes in the sociocultural reality of chinese immigrants: challenges and opportunities in help-seeking behaviour. Int J Soc Psychiatry 2010; 56:436-47. [PMID: 19651695 DOI: 10.1177/0020764009105647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This paper uses findings from a larger study to present a nuanced depiction of the interplay of informal and formal help-seeking processes of a sample of Chinese immigrants in their mental healthcare in New York City. METHOD Thirty one participants who were receiving mental health treatment were interviewed with regard to their experiences preceding their suicide attempt. Their narratives were coded for thematic analysis. FINDINGS Acculturation difficulties, inaccessibility to services and stigma associated with mental illness were major obstacles in the participants' help-seeking process, which was consistent with other studies of immigrants of ethnic minority groups in the USA. In addition, the findings showed how changes in this sample of Chinese immigrants' socio-cultural reality disrupted familiar help-seeking pathways, and perpetuated and amplified the aforementioned stressors. Issues of human connection, immigrants' resiliency and missed opportunities were also identified as potential resources to modify cultural stigmas and help-seeking behaviour. CONCLUSION There are varied socio-cultural factors that need to be considered in mental health outreach services in immigrant communities.
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Affiliation(s)
- Irene Chung
- Hunter College School of Social Work, City University of New York, 129 E. 79th Street, New York, NY 10075, USA.
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Schaffer A, Cairney J, Cheung A, Veldhuizen S, Kurdyak P, Levitt A. Differences in prevalence and treatment of bipolar disorder among immigrants: results from an epidemiologic survey. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:734-42. [PMID: 19961661 DOI: 10.1177/070674370905401103] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants. METHOD Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects (n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use. RESULTS Lifetime prevalence rate of CCHS 1.2-defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P < 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%); however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05). CONCLUSIONS Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Siddiqi A, Zuberi D, Nguyen QC. The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada. Soc Sci Med 2009; 69:1452-9. [PMID: 19767135 DOI: 10.1016/j.socscimed.2009.08.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Indexed: 02/07/2023]
Abstract
Using a cross-national comparative approach, we examined the influence of health insurance on U.S. immigrant versus non-immigrant disparities in access to primary health care. With data from the 2002/2003 Joint Canada/United States Survey of Health, we gathered evidence using three approaches: 1) we compared health care access among insured and uninsured immigrants and non-immigrants within the U.S.; 2) we contrasted these results with health care access disparities between immigrants and non-immigrants in Canada, a country with universal health care; and 3) we conducted a novel direct comparison of health care access among insured and uninsured U.S. immigrants with Canadian immigrants (all of whom are insured). Outcomes investigated were self-reported unmet medical needs and lack of a regular doctor. Logistic regression models controlled for age, sex, nonwhite status, marital status, education, employment, and self-rated health. In the U.S., odds of unmet medical needs of insured immigrants were similar to those of insured non-immigrants but far greater for uninsured immigrants. The effect of health insurance was even more striking for lack of regular doctor. Within Canada, disparities between immigrants and non-immigrants were similar in magnitude to disparities seen among insured Americans. For both outcomes, direct comparisons of U.S. and Canada revealed significant differences between uninsured American immigrants and Canadian immigrants, but not between insured Americans and Canadians, stratified by nativity. Findings suggest health care insurance is a critical cause of differences between immigrants and non-immigrants in access to primary care, lending robust support for the expansion of health insurance coverage in the U.S. This study also highlights the usefulness of cross-national comparisons for establishing alternative counterfactuals in studies of disparities in health and health care.
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Affiliation(s)
- Arjumand Siddiqi
- UNC Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA.
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