Does the Healthy Immigrant Effect Extend to Anxiety Disorders? Evidence from a Nationally Representative Study

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

Association of depression and self-reported health status by birthplace and citizenship status: Results from the 2010-2018 National Health Interview Survey

BACKGROUND

Self-reported health (SRH) is an important indicator of mental health outcomes. More information, however, is needed on whether this association varies by birthplace (defined as US-born or non-US-born) and citizenship status (i.e., non-US-born citizen, non-US citizen, and US-born citizen).

METHODS

We examined the associations between SRH and depression among non-US-born US citizens, non-US citizens, and US-born citizens aged 18 years and older using weighted cross-sectional data from the 2010-2018 National Health Interview Survey (n = 139,884). Logistic regression models were used to assess the association between depression and SRH by citizenship status, adjusting for covariates.

RESULTS

US-born citizens reported the highest prevalence of depression (40.3 %), and non-US-born citizens reported the highest prevalence of poor/fair SRH (14.5 %). Individuals with fair/poor SRH had a significantly increased likelihood of depression relative to those with good/very good/excellent for non-US-born US citizens (Adjusted Odds Ratio [AOR] = 2.42, 95 % Confidence Interval [95 % CI] = 2.04-2.88), non-US citizens (AOR = 2.80, 95 % CI = 2.31-3.40), and US-born citizens (AOR = 2.31, CI = 2.18-2.45).

LIMITATIONS

The study is cross-sectional, reducing the strength of determining causal relationships. Also, there is a possible response bias due to the self-reported nature of the data.

CONCLUSIONS

Our study indicates that fair/poor SRH is significantly associated with an increased likelihood of depression regardless of an individual citizenship status. Additionally, immigrants with fair/poor SRH had higher increased odds of depression. Therefore, mental healthcare interventions tailored for immigrants can reduce mental health problems and disparities among immigrants.

Eating disorders among international migrants: a systematic review and meta-analysis

PURPOSE

Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations.

METHODS

A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations.

RESULTS

There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35-0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence.

CONCLUSION

Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools.

Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada

OBJECTIVES

Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus.

METHODS

This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10).

RESULTS

Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters.

DISCUSSION

Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.

Assessing the "healthy immigrant effect" in mental health: Intra- and inter-cohort trends in mood and/or anxiety disorders

BACKGROUND

The healthy immigrant effect implies that, at the time of immigration, new immigrants are typically healthier than the Canadian-born population. Furthermore, this health advantage fades the longer cohorts of immigrants remain in the host country.

METHODS

Most studies assessing the healthy immigrant effect rely on strong, untestable assumptions to extract unique effects for length of stay (LOS) (i.e., how long an immigrant has been in a host country), period (i.e., year of observation), and cohort (i.e., year of immigration). Rather than attempting to parse out separate effects for LOS, period, and cohort, we adopt a descriptive, cohort-centric approach to study immigrant mental health, which examines intra- and inter-cohort trends, that is, joint LOS-period and cohort-period parameters, respectively. While intra-cohort trends show how immigrants' mental health change with LOS across periods, inter-cohort trends reveal how the mental health of successive cohorts of immigrants differ across time periods. To provide a thorough assessment of the healthy immigrant effect, we use both survey and administrative data on cohorts of Canadian immigrants from 2003 to 2013.

RESULTS

The survey data reveal that mental health declines steeply (i.e., there is an increase in mood and/or anxiety disorders) within and across immigrant cohorts, while the administrative data show little overall change in mental health care utilization within and across cohorts. The divergent results may reflect issues related to barriers in access to mental health services because the administrative data, which are based on health care utilization, do not the capture the increase in mental disorders seen in the survey data.

CONCLUSION

This study highlights the benefit of a cohort-based approach to assess the healthy immigrant effect as it pertains to mental health as well as the importance of using different types of data, which may be measuring different aspects of immigrant mental health and health care utilization.

Mental health in migrants contacting the mental health operational unit of the National Institute for Health, Migration and Poverty (NIHMP): preliminary data

Aim

Migration can lead to an increase in stress rates and can impact mental health, especially in certain migrant groups. Nonetheless, mental health needs and the importance of public health are not well captured in most studies using national samples. This study aimed to show the correlation between mental disorders, socio-demographic and cultural aspects among migrants.

Subject and methods

One hundred nineteen migrants, applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, were recruited.

Results

Migrants frequently reported mood disorders (mainly women). Men reported PTSD, somatization and adjustment disorders.

Conclusions

Over time, diverse factors may produce a decline in an initially healthy migrant status. The research unveils a new focus on the psychopathology of migrants accessing the NIHMP, with important implications for migrants’ mental health treatment and prevention.

Global prevalence of anxiety and PTSD in immigrants: a systematic review and meta-analysis

BACKGROUND

A systematic and meta-analysis of the prevalence of anxiety and posttraumatic stress disorder (PTSD) in immigrants was conducted.

METHODS

Based on the keywords, scientific databases were systematically searched to identify articles. The search included the three databases PubMed, Google Scholar and Research Gate until June 2020. The analysis was performed to assess the prevalence of anxiety and PTSD; subgroups were examined based on anxiety disorders.

RESULTS

The prevalence of agoraphobia, PTSD, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social phobia and specific phobia were 4, 25, 9, 4, 3, 5 and 8%, respectively.

CONCLUSIONS

Considering the findings of the present study regarding the significant prevalence of anxiety and PTSD in the immigrant population, it is necessary to pay special attention to the mental health of this population.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

The Impact of Employment on Immigrant Mental Health: Results from a National Survey

Mental illness and unemployment are both well documented in the literature as potentially having harmful and even detrimental impacts on individuals' lives. However, less is known about the intersections of mental illness and unemployment in the U.S. immigrant population. This study examined whether unemployment is a predictor of mental illness in a sample of immigrants in the United States (N = 3,732). Data were from the National Epidemiologic Survey on Alcohol and Related Conditions, a three-wave, nationally representative dataset. Multivariate logistical regression analysis examined whether the main effects of a negative employment status were associated with a mental health diagnosis at Wave 2. Negative employment status was a significant predictor of all mental health diagnoses in the multivariate logistic regression models. The results from this study indicate that unemployment is associated with mental health problems among immigrants. This article presents discussion and implications for social work practice, policy, and research.

Secular Trends in Physical Activity Among Immigrants in the United States, 2009-2018

BACKGROUND

The objective of this study was to evaluate secular trends in domain-specific physical activity in the immigrant population in the US between 2009 and 2018.

METHOD

A secondary data analysis from the 2009-2018 National Health and Nutrition Examination Survey; a total of 7282 immigrants in the US were included in this analysis. All domain-specific physical activity was assessed by a self-reported questionnaire. Tests for linear trends were performed to examine the trends of each physical activity time using orthogonal polynomial coefficients. Physical activity trends were assessed by the whole group and the various subgroups.

RESULTS

Total physical activity showed an upward linear trend in female (Ptrend = .04) and young adult (Ptrend = .009) immigrants. Work-related physical activity showed an upward linear trend in young adult immigrants (Ptrend = .01). Recreational physical activity showed an upward linear trend in young adult (Ptrend = .03) and Mexican American (Ptrend < .001) immigrants and in immigrants living in the US for 15-29 years (Ptrend = .02). In contrast, we observed downward linear trends in transit-related physical activity for immigrants across male (Ptrend = .04), middle-aged adult (Ptrend = .01), and non-Hispanic black groups (Ptrend = .004) and in immigrants living in the US for 15-29 years (Ptrend = .03).

CONCLUSION

There were no significant linear trends in the 4 domains of physical activity in the overall US immigrant population; however, trends in domain-specific physical activity in the US immigrant population differed by gender, age, race/ethnicity, and length of residence. These findings may inform physical activity promotion strategies targeting US immigrant populations with diverse sociocultural backgrounds.

Inequalities in depressive symptoms between natives and immigrants in Europe: the mediating role of social exclusion

The aim of this study was to analyze inequalities in depressive symptoms between natives and immigrant groups according to their length of residence in Europe, and to test the mediating role of social exclusion in explaining these differences. The study is based on cross-sectional data from the 7th round of the 2014 European Social Survey (sample of 1,792 immigrants and 22,557 native-born Europeans). Dependent variables: self-reported depressive symptoms. Independent variables: immigrant background and social exclusion factors that were classified into four groups. Socially excluded individuals were those less advantaged in each factor. All analyses were stratified by the length of residence. The independent and overall associations between Social Exclusion and health outcomes were examined using binary logistic regression models (OR; IC95%). Immigrants had a higher prevalence of self-reported depressive symptoms than natives; those residing in Europe for 1-10 years and > 20 years had the highest prevalence. Multidimensional social exclusion factors analyzed together completely explained these differences for immigrants residing in Europe for 1-10 years and partially for immigrants residing for > 20 years. The economic factors also explained these differences completely for 1-10 years and partially for immigrants residing for > 20 years. Policies should offer migrants the possibility to settle in good social and economic condition, promote efforts to eliminate social exclusion and prevent the associated health inequalities.

Undiagnosed depression, persistent depressive symptoms and seeking mental health care: analysis of immigrant and non-immigrant participants of the Canadian Longitudinal Study of Aging

AIMS

Early diagnosis and treatment of depression are associated with better prognosis. We used baseline data of the Canadian Longitudinal Study on Aging (2012-2015; ages 45-85 years) to examine differences in prevalence and predictors of undiagnosed depression (UD) between immigrants and non-immigrants at baseline and persistent and/or emerging depressive symptoms (DS) 18 months later. At this second time point, we also examined if a mental health care professional (MHCP) had been consulted.

METHODS

We excluded individuals with any prior mood disorder and/or current anti-depressive medication use at baseline. UD was defined as the Center for Epidemiological Studies Depression 10 score ⩾10. DS at 18 months were defined as Kessler 10 score ⩾19. The associations of interest were examined in multivariate logistic regression models.

RESULTS

Our study included 4382 immigrants and 18 620 non-immigrants. The mean age (standard deviation) in immigrants was 63 (10.3) years v. 65 (10.7) years in non-immigrants and 52.1% v. 57.1% were male. Among immigrants, 12.2% had UD at baseline of whom 34.2% had persistent DS 18 months later v. 10.6% and 31.4%, respectively, among non-immigrants. Female immigrants were more likely to have UD than female non-immigrants (odds ratio 1.50, 95% confidence interval 1.25-1.80) but no difference observed for men. The risk of persistent DS and consulting an MHCP at 18 months did not differ between immigrants and non-immigrants.

CONCLUSIONS

Female immigrants may particularly benefit from depression screening. Seeking mental health care in the context of DS should be encouraged.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA)

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (<3/day; aORs = 1.24–1.26), and pastry consumption (>1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people

BACKGROUND

Refugees are at higher risk of some psychiatric disorders, including post-traumatic stress disorder (PTSD) and psychosis, compared with other non-refugee migrants and the majority population. However, it is unclear whether this also applies to substance use disorders, which we investigated in a national register cohort study in Sweden. We also investigated whether risk varied by region of origin, age at migration, time in Sweden, and diagnosis of PTSD.

METHODS AND FINDINGS

Using linked Swedish register data, we followed a cohort born between 1984 and 1997 from their 14th birthday or arrival in Sweden, if later, until an International Classification of Diseases, 10th revision (ICD-10), diagnosis of substance use disorder (codes F10.X-19.X), emigration, death, or end of follow-up (31 December 2016). Refugee and non-refugee migrants were restricted to those from regions with at least 1,000 refugees in the Swedish registers. We used Cox proportional hazards regression to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) in refugee and non-refugee migrants, compared with Swedish-born individuals, for all substance use disorders (F10.X-19.X), alcohol use disorders (F10.X), cannabis use disorders (F12.X), and polydrug use disorders (F19.X). In adjusted analyses, we controlled for age, sex, birth year, family income, family employment status, population density, and PTSD diagnosis. Our sample of 1,241,901 participants included 17,783 (1.4%) refugee and 104,250 (8.4%) non-refugee migrants. Refugees' regions of origin were represented in proportions ranging from 6.0% (Eastern Europe and Russia) to 41.4% (Middle East and North Africa); proportions of non-refugee migrants' regions of origin ranged from 11.8% (sub-Saharan Africa) to 33.7% (Middle East and North Africa). These groups were more economically disadvantaged at cohort entry (p < 0.001) than the Swedish-born population. Refugee (aHR: 0.52; 95% CI 0.46-0.60) and non-refugee (aHR: 0.46; 95% CI 0.43-0.49) migrants had similarly lower rates of all substance use disorders compared with Swedish-born individuals (crude incidence: 290.2 cases per 100,000 person-years; 95% CI 287.3-293.1). Rates of substance use disorders in migrants converged to the Swedish-born rate over time, indicated by both earlier age at migration and longer time in Sweden. We observed similar patterns for alcohol and polydrug use disorders, separately, although differences in cannabis use were less marked; findings did not differ substantially by migrants' region of origin. Finally, while a PTSD diagnosis was over 5 times more common in refugees than the Swedish-born population, it was more strongly associated with increased rates of substance use disorders in the Swedish-born population (aHR: 7.36; 95% CI 6.79-7.96) than non-refugee migrants (HR: 4.88; 95% CI 3.71-6.41; likelihood ratio test [LRT]: p = 0.01). The main limitations of our study were possible non-differential or differential under-ascertainment (by migrant status) of those only seen via primary care and that our findings may not generalize to undocumented migrants, who were not part of this study.

CONCLUSIONS

Our findings suggest that lower rates of substance use disorders in migrants and refugees may reflect prevalent behaviors with respect to substance use in migrants' countries of origin, although this effect appeared to diminish over time in Sweden, with rates converging towards the substantial burden of substance use morbidity we observed in the Swedish-born population.

Gaps in Understanding of the Epidemiology of Mood and Anxiety Disorders among Migrant Groups in Canada: A Systematic Review

OBJECTIVE

Estimates of mood and anxiety disorders are highly variable among migrant groups, as they are influenced by the socio-political context. Our objective was to conduct a systematic review and meta-analysis to synthesize available Canadian evidence on the prevalence and incidence of mood and anxiety disorders among migrant groups.

METHODS

Studies were identified from MEDLINE, EMBASE, and PsycINFO. They were included if they used population-based samples, presented data on the incidence or prevalence of diagnosed or self-reported mood or anxiety disorders for first-generation migrant groups in Canada, and used a Canadian-born or long-term resident reference group.

RESULTS

Nineteen studies met our inclusion criteria. Prevalence ratios ranged from 0.48 to 0.87, and nearly all estimates were obtained from population health surveys. Prevalence estimates among migrant groups were lower than the reference group, with the 90th percentile of estimates ranging from 1.5% to 8.2%. Risk factors for mood and anxiety disorders among migrants included being female, younger, unemployed, having lower income, and living in neighborhoods with a lower proportion of migrants.

CONCLUSIONS

There remain many gaps in our current understanding of mood and anxiety disorders among migrant groups in Canada. Although evidence suggests the prevalence of mood and anxiety disorders are consistently lower among migrant groups, a lack of incidence estimates limits the strength of this conclusion. Future research should focus on comparisons of self-reported and diagnosed estimates, the use of a range of different primary or secondary data sources, and consideration of important risk factors.

PROSPERO CITATION

Jordan Edwards, Malini Hu, Amardeep Thind, Saverio Stranges, Maria Chiu, Kelly Anderson. The burden of mood and anxiety disorders among immigrant and refugee populations in Canada: a systematic review. PROSPERO 2018 CRD42018087869 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087869 .

Les traits d'identité culturelle en lien avec le statut d'immigrant et l'ethnicité : quel lien avec les symptômes de détresse psychologique et les symptômes dépressifs dans la main-d'œuvre canadienne? Résultats des neuf cycles de l'ENSP

PURPOSE

This study investigated variations over time of psychological distress and depressive symptoms among working Canadians according to two cultural identity traits: ethnicity and immigration status.

METHOD

Data came from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 7069 workers, multiple regressions analyses and multilevel regressions models were carried out. Analyses were adjusted for confounders such as age, gender, marital status, household income, social support outside the workplace, level of education, presence of children between 0 and 5 years of age and presence of children from 6 to 11 years of age.

RESULTS

Over time, and after accounting for potential confounders, immigration status is not associated with psychological distress or depressive symptoms. Ethnicity is associated with depressive symptoms, but not with psychological distress symptoms. Visible minorities have less depressive symptoms compared to Caucasians.

CONCLUSION

Unlike immigration status, ethnicity seems to explain a portion of mental health inequities among workers. One area to be explored in future researches is whether in the Canadian workforce, work conditions could explain ethnic inequalities in mental health.

Suicidal Ideation and Healthy Immigrant Effect in the Canadian Population: A Cross-Sectional Population Based Study

Understanding suicidal ideation is crucial for preventing suicide. Although “healthy immigrant effect” is a phenomenon that has been well documented across a multitude of epidemiological and social studies—where immigrants are, on average, healthier than the native-born, little research has examined the presence of such effect on suicidal ideation. The objective of this study is to investigate if there is a differential effect of immigration identity on suicidal ideation and how the effect varies by socio-demographic characteristics in the Canadian population. Data from the Canadian Community Health Survey in year 2014 were used. Multivariate logistic regression was employed. Our findings indicated that recent immigrants (lived in Canada for 9 or less years) were significantly less likely to report suicidal ideation compared with non-immigrants. However, for established immigrants (10 years and above of living in Canada), the risk of suicidal ideation converged to Canadian-born population. Moreover, male immigrants were at significantly lower risk of having suicidal ideation than Canadian-born counterparts; whereas, female immigrants did not benefit from the “healthy immigrant effect”. Our findings suggest the need for targeted intervention strategies on suicidal ideation among established immigrants and female immigrants.

Disentangling the effects of primary and secondary international migration on psychological distress: the role of mastery

OBJECTIVES

This study examined the effect of mode of migration-primary immigration (direct migration from origin country) and secondary immigration (migration from a country of residence other than the origin country)-by level of economic development of country of origin on psychological distress of immigrants to Canada. The study focused on the explanatory role of mastery in the relationship between mode of migration/level of economic development of origin country and distress. Mastery is the belief that one can and does master, control, and shape one's own life.

METHODS

Data from the Neighbourhood Effects on Health and Well-being study, which contains important measures such as the mode of migration, was used to assess the study objectives. The analytic sample included 1496 Canadian-born and 387 foreign-born (non-refugee) participants. Hierarchical linear modeling was used to address the study objectives.

RESULTS

Results point to a "healthy immigrant effect"-lower distress among the foreign-born than the native-born-but only among primary immigrants from less-developed countries. Secondary immigrants from less-developed countries report higher distress than the native-born and their primary-immigrant counterparts. The higher distress among secondary immigrants was due in part to lower mastery among this group. Immigrants from developed origin countries did not report different levels of distress than the native-born, irrespective of mode of migration.

CONCLUSION

This study fills an important gap in the literature on immigration and mental health and reveals that the healthy immigrant effect is not generalizable to all immigrants; it is contingent on the mode of migration/level of economic development of the country of origin.

Adolescent immigrants, the impact of gender on health status

Background

: Although studies have described the 'healthy immigrant effect' in adults, far fewer have examined the 'healthy immigrant effect' for adolescents living in immigrant families. Those few studies that did, noted conflicting results, and also differed on whether gender confounds the results. : This cross-sectional study was informed by the community-based participatory research (CBPR) approach in which researchers obtained the expertise and guidance on instrument design and study implementation. Data collection of self-administered surveys was completed between May 2015 and December 2015 on adolescents. Comparisons were made among six groups based on gender and immigrant status. : Of the total sample ( n = 618), more than a third were first or second generation immigrant adolescents ( n = 239). Comparisons among six groups, categorized by gender and immigrant status (i.e. first generation immigrants, second generation immigrants, native born), indicated many differences. However, when the differences were taken into account using logistic regression models, excellent health status was least likely to be reported by second generation immigrant males (versus native born adolescent females) ( P < 0.01), even after adjusting for the independent associations found for psychological symptoms ( P < 0.0001), not smoking ( P < 0.05) and having normal BMI ( P < 0.05). : This study demonstrates the relative disadvantage of second generation immigrant boys, but not first generation boys or first and second generation immigrant girls relative to their native counterparts. Reasons for the gap may be differences in support services and/or parental expectations; however further studies are needed to confirm these possibilities.

The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain

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.

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

OBJECTIVES

Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

DESIGN

We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects - two common explanations of migrants' health advantage and deterioration, respectively.

RESULTS

We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants' advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

CONCLUSIONS

There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada's foreign-born population consists mostly of core working age adults.

Migraine and Mental Health in a Population-Based Sample of Adolescents

OBJECTIVE

To explore the relationship between migraine and anxiety disorders, mood disorders and perceived mental health in a population-based sample of adolescents.

METHODS

The Canadian Community Health Survey (CCHS) is a cross-sectional health survey sampling a nationally representative group of Canadians. In this observational study, data on all 61,375 participants aged 12-19 years from six survey cycles were analyzed. The relationships between self-reported migraine, perceived mental health, and mood/anxiety disorders were modeled using univariate and multivariate logistic regression. The migraine-depression association was also explored in a subset of participants using the Composite International Diagnostic Interview-Short Form (CIDI-SF) depression scale.

RESULTS

The odds of migraine were higher among those with mood disorders, with the strongest association in 2011-2 (adjusted odds ratio [aOR]=4.59; 95% confidence interval [CI 95%]=3.44-6.12), and the weakest in 2009-10 (aOR=3.06, CI 95%=2.06-4.55). The migraine-mood disorders association was also significant throughout all cycles, other than 2011-2, when the CIDI-SF depression scale was employed. The odds of migraine were higher among those with anxiety disorders, with the strongest association in 2011-2 (aOR=4.21, CI 95%=3.31-5.35) and the weakest in 2010 (aOR=1.87, CI 95%=1.10-3.37). The inverse association between high perceived mental health and the odds of migraine was observed in all CCHS cycles, with the strongest association in 2011-2 (aOR=0.58, CI 95%=0.48-0.69) and the weakest in 2003-4 (aOR=0.75, CI 95%=0.62-0.91).

CONCLUSIONS

This study provides evidence, derived from a large population-based sample of adolescents, for a link between migraine and mood/anxiety disorders.

Factors associated with psychological distress or common mental disorders in migrant populations across the world

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants' residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies.

Immigrating to Canada During Early Childhood Associated with Increased Risk for Mood Disorders

This study explored the impact of age at time of immigration on mental health in Canada. The Canadian Community Health Survey (CCHS) 2011 was analyzed to determine prevalence rates for mood disorders for those who immigrated during early childhood, middle childhood, adolescence, and adulthood. Multivariable logistic regression analysis was carried out on pooled CCHS 2007-2011 data to calculate risk of mood disorders. Those who immigrated during early childhood (before the age of six) had a significantly higher prevalence rate of mood disorders (6.83 %, 95 % CI 6.77-6.89) compared to those who immigrated later in life (4.83-4.88 %, 95 % CI 4.56-4.93). Immigrating during early childhood was also associated with elevated risk of mood disorders (OR 1.40, 95 % CI 1.04-1.88) compared to those who immigrated as adults after adjusting for key factors. Mental health services need to consider the factors associated with early childhood migration and the implications for early intervention programming.