Improving Immigrant Populations’ Access to Mental Health Services in Canada: A Review of Barriers and Recommendations

Caught between two worlds: mental health literacy and stigma among bicultural youth

PURPOSE

Bicultural youths are at higher risk of mental health problems and are less likely to utilize mental health services, yet our knowledge of their mental health literacy and help-seeking behaviours remains limited.

METHODS

To fill this gap, the current study explored bicultural youths' mental health literacy and stigma by conducting semi-structured interviews with 14 Canadian university students in 2021.

RESULTS

Our analysis revealed that bicultural youths may be torn between two worlds: intergenerational tensions between participants assimilated into individualistic Canadian culture and their more collectivist parents meant that they had different cultural perceptions of mental health literacy and stigma. While being caught between these two worlds may be detrimental for bicultural youth, our results also suggested that a trans-cultural factor-celebrities' mental health journeys-may promote help-seeking behaviour across participants. Furthermore, our study speaks to the ways that unprecedented events such as the COVID-19 pandemic impact mental health literacy among bicultural youth. Our findings might be used by university mental health services to encourage help-seeking among bicultural students.

CONCLUSION

The acculturation of mental health literacy, stigma, and associated intergenerational differences needs to be considered by university wellness services.

Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa

BACKGROUND

Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population.

METHODS

Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach.

RESULTS

The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants.

CONCLUSIONS

This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.

Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada

LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.

Exploring uses of visual arts-based interventions for mental health of marginalized populations: a scoping review

BACKGROUND

The intentions of this scoping review are to determine current uses of visual arts-based interventions for mental health and trauma support of marginalized populations, and to identify current gaps in knowledge in this emergent field.

METHOD

Six databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, JSTOR) were searched for relevant studies. Following the PRISMA guidelines, 38 articles met the inclusion criteria.

RESULTS

Most interventions focused on improving the mental health of participants, or to provide opportunities for participants to process their experiences of mental health. Participants reported increased well-being, experiences of relaxation and/or distraction, and processing of mental health experiences. They perceived arts-based interventions as helpful and developed mutual social support with other participants.

CONCLUSION

Arts-based interventions have the potential to inform the development of culturally safe and relevant mental health care for marginalized populations beyond current mainstream mental health practices.

The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study

OBJECTIVES

Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada.

METHODS

Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities.

RESULTS

Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines.

CONCLUSION

Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol

INTRODUCTION

In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools.

METHODS AND ANALYSIS

The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.

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.

Mental Health Care Access Among Arab Immigrants in the United States: Application of Public Arena Model

Arab immigrants constitute a sizable portion of the US population, and their adjustment and relocation challenges might escalate mental health issues. Nevertheless, mental health care accessibility among such populations is not recognized as policy issue. Hence, it is crucial to explore the political tools that might be employed to improve immigrants' access to mental health treatment. The Public Arenas Model (Hilgartner and Bosk, American Journal of Sociology 94:53-78, 1988) provides better understanding of how access to mental health care is defined in the public sphere, why mental health inaccessibility among Arabs has not received attention, and how stakeholders worked to raise the public's attention to such issue (Smith, Policy, Politics & Nursing Practice 10:134-142, 2009). Ultimately, several policy options are proposed to address Arab immigrants' access to mental health care issue, including increasing mental health service providers' language proficiency and cultural competency, integration of behavioral health and primary care services for immigrant populations, and considering novel modes of mental health delivery.

Understanding the Mental Health Perspectives and Experiences of Migrants to Canada

Few researchers have explored Canadian migrants' experiences of mental health and service access. We interviewed 10 migrants to Canada from a local settlement organization about mental health and services and 5 organization staff about their experiences supporting migrants' mental health and service access. Our interviews with migrants revealed cultural perceptions of mental health and unmet service needs. Our focus group with staff indicated challenges experienced by migrants and the tension between their openness with mental health difficulties and stigmatization from their cultural communities. A call to restructure existing mental health support for this underserved population is needed.

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.

Experiences and Priorities in Youth and Family Mental Health: Protocol for an Arts-Based Priority-Setting Focus Group Study

BACKGROUND

During the COVID-19 pandemic, eHealth services enabled providers to reach families despite widespread social distancing restrictions. However, their rapid adoption often occurred without community partners' involvement and without an understanding of how they prioritize aspects of their mental health and associated service provision, both of which promote family and community-centered health care delivery. Establishing priorities in health care is essential for developing meaningful and reliable health services. As such, there is an urgent need to understand how eHealth service users, especially families who may have historically faced oppression and systemic barriers to service access, can best benefit from them. Arts-based approaches can elicit an understanding of priorities by providing an engaging and expressive means of moving beyond readily expressible discursive language and stimulating meaningful dialogue reflective of participants' lived experiences.

OBJECTIVE

The purpose of this research is to determine the priorities and preferences of youth; parents or caregivers; newcomers and immigrants; and Indigenous community members regarding the use of eHealth in supporting their mental health using an innovative arts-based priority-setting method.

METHODS

This study uses a mixed-methods approach combining qualitative, quantitative, and arts-based research. It follows a survey used to identify key knowledge partners who are interested in improving eHealth services for mental health support in Manitoba, Canada. Knowledge partners interested in group-based priority setting will be contacted to participate. We will facilitate approximately two focus groups across each subgroup of youth, parents or caregivers, newcomers or immigrants, and Indigenous community members using an integrative, quantitatively anchored arts-based method termed the "Circle of Importance" to understand participants' mental health priorities and how eHealth or technology may support their mental well-being. The Circle of Importance involves placing small objects, whose meaning is determined by participants, on a visual board with concentric circles that correspond to a 5-point Likert scale of importance. Following each focus group, we will evaluate participants' and focus group facilitators' experiences of the Circle of Importance using a survey and follow-up structured in-person interviews to garner how we can improve the arts-based approach used in the focus groups.

RESULTS

The PRIME (Partnering for Research Innovation in Mental Health through eHealth Excellence) theme received institutional ethics approval on August 23, 2023. Data collection is projected for August 2023, with follow-up focus groups occurring in early 2024 as required. Data analysis will occur immediately following data collection.

CONCLUSIONS

Findings will directly inform a multiyear applied research agenda for PRIME aimed at improving mental health services through engaging key knowledge partners. The results may inform how arts-based methods in a priority setting can reflect aspects of experience beyond the capacities of qualitative or quantitative methods alone, and whether this approach aligns well with a positive experience of research participation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50208.

Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial

BACKGROUND

The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands.

METHODS

The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated.

DISCUSSION

To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience.

TRIAL REGISTRATION

Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations.

OBJECTIVE

This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations.

METHODS

A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions.

RESULTS

The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023.

CONCLUSIONS

This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50798.

Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use

BACKGROUND

Significant disparities in utilization of mental health services exist among immigrant and Canadian-born populations. These gaps may be associated with a 'double stigma' - stigma related to being from a racialized background exacerbated by mental health stigma. Immigrant young adults may be particularly susceptible to this phenomenon, given developmental and social transitions from adolescence to adulthood.

AIMS

To investigate the joint effects of racial microaggression and mental health stigma on mental health and service use among first-generation immigrant and Canadian-born university students.

METHOD

We conducted an online cross-sectional study among first-generation immigrant and Canadian-born university students (N = 1,280, Mage = 19.10, SD = 1.50).

RESULTS

Despite no differences in anxiety or depression symptoms, first-generation (foreign-born) immigrants were less likely to have received therapy and to have taken medication for mental health issues compared to Canadian-born participants. First-generation immigrants also reported experiencing higher levels of racial microaggression and stigma toward service use. Results suggest the presence of a double stigma, mental health stigma and racial microaggression, each explained significant additional variance in symptoms of anxiety and depression and medication use. No effects of double stigma for therapy use were found - while higher mental health stigma predicted lower use of therapy, racial microaggression did not predict unique variance in therapy use.

CONCLUSIONS

Our findings highlight the joint effects of racial microaggression and stigma toward mental health and service as barriers to help-seeking among immigrant young adults. Mental health intervention and outreach programmes should target overt and covert forms of racial discrimination while incorporating culturally sensitive anti-stigma approaches to help reduce disparities in mental health service use among immigrants in Canada.

Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons

PURPOSE

Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada.

METHODS

The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis.

RESULTS

An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics.

CONCLUSION

Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

Mental disorder and subsequent marital separation among migrant and non-migrant women

Using national register data between 2006-2014, we investigated the relationship between outpatient mental health service use (a proxy for mental disorder) and subsequent marital separation among women in Norway and whether the strength of the association differed for migrant and non-migrant women. Our sample population included 679,928 married women aged 18-60 years. Service use was strongly associated with marital separation among all women. The relationship was stronger for Filipinas but weaker for Somalis and Russians, compared with non-migrant women. Migration-related factors may influence marital separation among migrant women and barriers to care are likely to exist.

Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong

BACKGROUND

Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities.

AIMS

This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong.

METHODS

Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use.

RESULTS

Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools.

CONCLUSION

This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.

Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada

OBJECTIVES

Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment.

METHODS

Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC.

RESULTS

Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters.

DISCUSSION

To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.

Attachment and trauma-informed programme to support forcibly displaced parents of youth in Sweden: feasibility and preliminary outcomes of the eConnect Online programme

OBJECTIVES

To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents.

DESIGN

The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments.

SETTING

Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden.

PARTICIPANTS

Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8-17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect).

INTERVENTION

eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent-child attachment insecurity.

RESULTS

The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η 2=0.29) and family functioning significantly improved (η 2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η 2=0.16).

CONCLUSIONS

The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment.

Interpreter-mediated psychiatric assessments: Metacommunication as key

Psychiatric assessments of non-native migrant patients facilitated by an interpreter pose specific communication challenges to all participants. In this study, we developed an original interdisciplinary approach to the verbal and non-verbal practices in this triadic activity. The aim was a data-based description of challenges for clinicians and interpreters, and the identification of relevant strategies. We filmed, transcribed and translated 10 interpreter-mediated consultations focused on the psychiatric assessment of the patient. Subsequently, we submitted the consultations to clinical, interactional sociolinguistic, and interdisciplinary analyses. We identified six challenges for interpreters and clinicians engaged in psychiatric assessments: barely comprehensible and confusing speech, speech about emotions and subjective perceptions, sensitive remarks in relational terms, conclusive clinician interventions, interruptions during interpreter renditions, and non-verbal communication. Attempts by the interpreter to avoid relational offenses (protection of positive face) and to defend the participants' autonomy (protection of negative face) play a major role in these challenges. So does an insufficient awareness of mutual needs by the clinician and the interpreter. We identified specific strategies of inter-professional metacommunication for each challenge. Clinicians and interpreters should be aware of the challenges they may face in triadic psychiatric assessments. They should take a reflexive stance towards their common practices and may consider using metacommunication tools to reach better communicational and clinical outcomes.

Patient-Oriented Research to Improve Internet-Delivered Cognitive Behavioural Therapy for People of Diverse Ethnocultural Groups in Routine Practice

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community representatives, ICBT clinicians, managers, and researchers was formed. The working group examined archival feedback on ICBT from past patients who self-identified as being from diverse ethnocultural backgrounds (N = 278) and the results of interviews with current patients (N = 16), community representatives (N = 6), and clinicians (N = 3). The archival data and interviews revealed the majority of the patients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples, and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians, and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Reimagining mental health care for newcomer children and families: a qualitative framework analysis of service provider perspectives

BACKGROUND

Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada.

METHODS

Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method.

RESULTS

Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake.

CONCLUSIONS

The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.

Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study

Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.

"Putting words to their feelings"- civic communicators' perceptions and experiences of an in-depth course on mental health for newly settled refugee migrants in Sweden

BACKGROUND

Newly settled refugee migrants face psychological stressors stemming from pre-, during- and post-migration experiences. In Sweden, mental health promotion is part of the health module in the civic orientation classes for newly settled refugee migrants. Training courses are offered to civic communicators and workshop leaders to facilitate communication about mental health; however, the training is seldom evaluated. In the current study, we aim to explore civic communicators' perceptions and experiences of an in-depth mental health training course in relation to observed needs among newly settled refugee migrants.

METHOD

We interviewed ten civic communicators that had partaken in the in-depth training course on mental health. All respondents had prior migratory experience and worked as civic communicators in their native languages. The interviews were semi-structured and data were analyzed using thematic analysis.

RESULTS

Three themes were identified: (1) Intertwined mental health needs related to migration, (2) Multi-layered barriers to addressing mental health, and (3) Becoming aware of the mental health journey. One overarching theme was arrived at through synthesizing the three themes 'Acquired new tools to lead reflective conversations about mental health and well-being'.

CONCLUSION

The in-depth mental health training course led to the attainment of new knowledge and new tools enabling civic communicators to lead reflective conversations about mental health and well-being with newly settled refugee migrants. Mental health needs were related to pre- and post-migration experiences. Barriers to talking about mental health included stigma and a lack of arenas to promote the mental health of refugee migrants. Increasing knowledge among civic communicators can facilitate the promotion of mental self-help capacity and resilience among newly settled refugee migrants.

Navigating the quality-of-life impacts of a chronic inflammatory disease (CID) among South Asian children and parents

This study investigates quality-of-life impacts (QOL) associated with managing a chronic inflammatory disease (CID) among first and second generation South Asian children and parents in the Greater Toronto Area, Ontario. While empirical evidence on both the rise of CIDs among immigrants and the QOL impacts of managing a CID is increasing, little attention has been given to the QOL impacts of managing a CID among immigrant adult children and their families. Drawing on analysis of 24 in-depth interviews with adult children and parents (14 adult children, 10 parents) the results indicate that first and second generation South Asian adult children and parents experience challenges acquiring a CID diagnosis (e.g., bureaucratic issues, transportation, inconsistent and unavailable physician care), and encounter multidimensional short- and long-term QOL implications associated with CID management. These challenges are compounded further by culturally insensitive care and language barriers in the health system. QOL impacts associated with CID management among adult children ranged from comfort and peace of mind due to increased ability to participate in daily life, while others reported intensified anxiety, stress and depression due to their inability to fully engage in daily life. Although all parents reported heightened stress due to their child's CID diagnosis and new management regimens, parents employed different coping mechanisms that created new short term QOL challenges for their families. The findings suggest that a patient centered approach to CID diagnosis and management, informed by personal experiences, cultural sensitivities and lived experiences of QOL representations are needed to mitigate negative QOL outcomes across a patient's life and deliver appropriate evidence informed care for those in need.

Adapting to a new home: resettlement and mental health service experiences of immigrant and refugee youth in Montreal

Resettlement and mental health services are critical support systems for refugee and immigrant youth (RIY) as they navigate the complexities of settling into their new homes. These services play a vital role in meeting the needs of RIY and helping them feel welcomed into Canadian society. The purpose of this study is to provide insight into RIY's experiences with resettlement and mental health service providers in Montreal, Canada. Adopting a descriptive quantitative research approach, this study utilized online surveys to gather data. The findings indicate that cultural and linguistic barriers are the major obstacles faced by refugee and immigrant youth when accessing resettlement and mental health services in Montreal. Protective resources, such as family, friends, and ethnic communities, were identified as important facilitators of successful integration into Canadian society. To improve services, cultural sensitivity should be a priority for providers, as recommended by this study. By acknowledging the significance of cultural barriers in accessing resettlement and mental health services, this study emphasizes the need for service providers to prioritize cultural sensitivity in their efforts to improve services.

Immigrants' Experience of Health Care Access in Canada: A Recent Scoping Review

Existing literature has reported inequities in access to Canadian health care services among immigrants. The aim of this scoping review was (a) to explore research regarding Canadian immigrants' unique experiences in accessing healthcare, and (b) to provide suggestions for future research and programming considering the identified immigrant-specific service gaps in health care. We searched MEDLINE, CINAHL, EMBASE, and Google Scholar, following the Arksey and O'Malley (2005) framework. The review's findings suggest unmet health care access needs specific to immigrants in Canada, with the most common access barriers including communication, socioeconomic, and cultural barriers. The scoping review expands on the immigrant health care experiences and accessibility factors through a thematic analysis. Findings suggest that developing community-based programming, improving training for health care providers in culturally competent care, and policies that address the social determinants of health can improve health care accessibility among immigrants.

Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.

Compulsory admission: are there differences between migrants and natives? Data from a psychiatric emergency service of an Italian metropolitan area

Background

As compared to natives, higher rates of involuntary admission were found among migrants in most European countries. A possible strategy to reduce this phenomenon is to develop preventive strategies targeting risk and protective factors of compulsory admission specific to the migrant population.

Aims

The first aim of the present study was to evaluate compulsory admission rates in the migrant population as compared to natives admitted for an acute mental disorder. The second aim was investigate whether sociodemographic, clinical, and care-related variables associated with compulsory admission differed between migrants and natives. Moreover, in the whole sample we assessed whether migrant status affected the risk of compulsory admission.

Methods

Retrospective single-center study on patients hospitalized in the period between January 1, 2018 and December 31, 2020 in a large metropolitan academic hospital. We compared sociodemographic, clinical, and care-related variables between migrants and natives, voluntary or compulsory admitted. We investigated the association between compulsory admission and the variables collected in the whole sample and in the migrants' and natives' groups with a correlation analysis followed by hierarchical logistic regression models.

Results

The sample included 185 migrant patients and 933 native patients. The prevalence of compulsory admission was significantly higher in the migrants' group. Male gender, lower education, non-comprehension of the local language, a diagnosis of a schizophrenia spectrum disorder, and aggressive behavior were associated with compulsory admission in the migrants' sample, partially differing from the natives.

Conclusion

Our study highlighted how migrant status is associated with a higher risk for compulsory admission. Inclusion policies or the presence of cultural mediators in emergency settings might be preventive strategies in this context.

"Of course, you get depression in this situation": Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece

BACKGROUND

Afghan refugees and asylum seekers constitute one of the largest groups that live in camp settings in Greece. While they experience psychological distress, they are facing significant barriers in accessing appropriate mental health care. Explanatory Models (EMs) provide a context-sensitive framework for understanding the differences between health professionals, refugees and NGOs that operate on the field. This study aims at further understanding how Afghan refugees perceive and explain depression and largely psychological distress, and how this influences their choices for coping strategies and help-seeking.

METHODS

This qualitative study included six vignette-based semi-structured focus-group discussions with Afghan refugees and asylum-seekers (total N = 19, 12 female and 7 male) residing largely in camp settings in Northern Greece. The vignette describes a fictional person with symptoms of depression in line with DSM-5 and ICD-10 criteria. The interviews were recorded, transcribed, and analysed through template analysis.

RESULTS

EMs for depression are explained through Pre-migration Traumatic Experiences (PMTE) and Post-migration Living Difficulties (PMLD) relating to camp settings. Female participants identified gender-based and domestic violence as contributing to psychological distress while males highlighted conflict and persecution. Life in the camp with associated inactivity, and uncertainty for the future, was perceived as a significant risk factor for psychological distress among females and males. In terms of coping strategies, females tended to focus on mobilizing collective resources within the camp (e.g. safe space for women facilitating emotional support), while males advocated for self-empowerment and solution-oriented coping. The value of engagement in peer helper-roles was highlighted.

CONCLUSIONS

The results highlight the potential value of community-based psychosocial approaches to support and promote mental health within camp settings. Additionally, they may inform policies and practices regarding access to appropriate mental health care for Afghan refugees. Further research is needed to establish the efficiency of such interventions in this context.

What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol

Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.

Psychosocial Distress in Patients With Advanced CKD by Racial Group and Immigrant Status: A Canadian Cross-sectional Study

RATIONALE & OBJECTIVE

Patients with advanced chronic kidney disease (CKD) have been reported to experience profound psychosocial distress. Other work has established that patients with CKD from marginalized populations (including individuals who on the basis of race often face racism and related discrimination, termed "racialization") experience health care inequities. Given limited information on the intersection of these 2 phenomena, we assessed the association of psychosocial distress with racialized status and immigrant status in Canadians with advanced CKD.

STUDY DESIGN

Secondary analysis of cross-sectional data.

SETTING & PARTICIPANTS

536 patients with advanced CKD (estimated glomerular filtration rate<30mL/min/1.73m², with or without kidney replacement therapy) from multiple clinical centers in Toronto.

EXPOSURE

Racialized status (individuals who identify as Asian or as African, Caribbean, or Black Canadian), immigrant status, and combined immigrant-racialized status.

OUTCOME

Psychosocial distress, defined as the presence of depression, anxiety, or social difficulties (ie, a score of≥10 points on the Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, or Social Distress 16 scales, respectively).

ANALYTICAL APPROACH

The independent associations of racialized status and immigrant status with psychosocial distress, depression, anxiety, and social difficulties were examined using univariable- and multivariable-adjusted logistic regression.

RESULTS

Mean age of the 536 participants was 57±16 (SD) years, 62% were male, and 45% were immigrants. Of the sample, 58% were White, 22% were African, Caribbean, or Black Canadian, and 20% were Asian. Psychosocial distress was present in 36% of participants (depression in 19%, anxiety in 12%, and social difficulties in 31%). To assess the combined impact of racialized and immigrant status, we created a variable with mutually exclusive categories: White nonimmigrant, racialized nonimmigrant, White immigrant, and racialized immigrant participants. In our final multivariable-adjusted model, compared with White nonimmigrant participants, racialized immigrant participants were more likely to have psychosocial distress (OR, 2.96 [95% CI, 1.81-4.81]), depression (OR, 1.87 [95% CI, 1.05-3.34]), and social difficulties (OR, 3.36 [95% CI, 2.03-5.57]). Overall similar associations were seen for racialized nonimmigrants and for White immigrants.

LIMITATIONS

Convenience sample; small subgroups; combined exposure variable grouping Asian and African, Caribbean, and Black participants together; lack of data about mechanisms.

CONCLUSIONS

Both racialized and immigrant status based on self-report of demographic characteristics were associated with psychosocial distress among patients with advanced CKD. These patients may benefit from culturally competent psychosocial support.

PLAIN-LANGUAGE SUMMARY

Psychosocial distress is frequent in patients with advanced chronic kidney disease and impacts quality of life and clinical outcomes. Psychosocial distress may be especially scarring in people who are racialized (marginalized on account of their membership in a particular racial group) and/or who are immigrants. We assessed the association of psychosocial distress with racialized and immigrant status in Canadians with advanced chronic kidney disease. Among 536 participants from multiple medical centers in Toronto, we found that racialized and immigrant participants were more likely to have psychosocial distress, depression, and social difficulties compared with White nonimmigrant participants. This is likely related to the multiple intersectional challenges, including experience with racism and discrimination that racialized immigrant patients may face. Further studies are needed to elucidate the specific factors that contribute to more distress. The potential impact of culturally competent and safe support for these patients will also need to be studied.

Risk of Diagnosed Adolescent-Onset Non-Affective Psychotic Disorder by Migration Background in British Columbia: A Retrospective Cohort Study

OBJECTIVE

We recently found that the risk of diagnosed non-affective psychotic disorder between the ages of 13 and 19 was lower for immigrant adolescents compared to those without a personal or parental migration history in British Columbia (BC), Canada. In the current study, we further examined the risk for migrants compared to non-migrants by region of origin and immigrant generation (first vs. second), adjusting for several demographic factors and migration class.

METHODS

Administrative data were used to construct a cohort of individuals born 1990-98 and residing in South-Western BC (N = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits with a primary diagnosis of a non-affective psychotic disorder. Poisson regression was used to estimate incidence rate ratios (IRR) of a diagnosed non-affective psychotic disorder by region of origin among first- and second-generation migrants compared to non-migrants, adjusting for sex, birth year, neighbourhood income and low family income.

RESULTS

Risk of diagnosed non-affective psychotic disorder was lower among first-generation migrants from East Asia (IRR = 0.34[95% CI: 0.25-0.46]), South-Asia (IRR = 0.47[95% CI: 0.25-0.89]) and South-East Asia (IRR = 0.55[95% CI: 0.32-0.93]) and second-generation migrants from East Asia (IRR = 0.49[95% CI: 0.35-0.69]) and South Asia (IRR = 0.52[95% CI: 0.37-0.73]), compared to non-migrants. Adjusting for migration class attenuated but did not fully explain variation in risk by region among first-generation migrants. No groups exhibited a significantly elevated risk of the diagnosed non-affective psychotic disorder compared to non-migrants.

CONCLUSION

Findings from this study underline the complexity of the association between migration and psychotic disorders. Future research should investigate why certain groups of migrants are less likely to be diagnosed and whether there are specific sub-groups that face an elevated risk.

A Qualitative Systematic Review of Experiences and Barriers Faced by Migrant Women with Perinatal Depression in Canada

Perinatal depression is the onset of depressive symptoms during pregnancy and up to one year after childbirth. Migrant women are at higher risk of experiencing perinatal depression due to numerous psychosocial stressors related to their experiences. This qualitative review aims to aggregate the experiences and barriers to care faced by immigrant and refugee women in Canada who have perinatal depression. Qualitative research can elucidate the barriers to treatment and culturally-impacted experiences of Canadian migrant women with perinatal depression. Following PRISMA and Joanna Briggs Institute (JBI) guidelines for conducting qualitative systematic reviews, 13 eligible studies representing 10 samples (N = 262 participants) were identified and included in this review. Participants included service providers, immigrant women, and refugee women. Three synthesized themes were identified by this review using the JBI meta-aggregative approach: (1) culture-related challenges; (2) migration-related challenges; and (3) service accessibility and quality. Within these themes were experiences of migrant women that encompass six categories: (1) conceptualization of perinatal depression; (2) childbirth-specific challenges; (3) migration-related challenges; (4) social isolation; (5) accessibility of services; and (6) quality of care. The role of family, cultural differences, financial challenges, and the effects of these on service accessibility are impactful in the experiences of migrant women. A greater understanding of the role of both culture and migration in the delivery of care, especially regarding service provider attitudes in more representative samples, is recommended.

The association between early marriage and mental disorder among young migrant and non-migrant women: a Norwegian register-based study

Background

Marriage is considered beneficial for mental health when stable and of high quality. Yet, it is unclear whether marriage is equally advantageous for everyone regardless of marital timing or migrant background. This study aimed to investigate the association between early marriage and mental disorder, defined by outpatient mental healthcare (OPMH) service use, and whether the association varies between migrant and non-migrant women.

Methods

Using data from four Norwegian national registers, we applied discrete-time logistic regression analyses to study the aims of interest, among 602 473 young women aged 17–35 years. All women were followed from 2006 or the year they turned 17, and until first OPMH consultation, 2015 (study end), the year they turned 35, when emigrated, died, or changed marital status from married to separated, divorced, or widowed.

Results

Results show that unmarried and early married women had increased odds of mental disorder when compared to on-time married women. However, the differences between the early and on-time married women were explained by differences in educational level. There was no significant interaction between marital status and migrant background.

Conclusions

Differences in mental health between early- and on time married women are attributed to poorer educational attainment of women who marry early. Furthermore, migrant background seems to have a limited role in the association between marital timing and mental disorder. The promotion of formal education among young women could contribute to the accumulation of socioeconomic and psychosocial resources, thus, reducing the risk of mental disorder, also among early married women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01836-5.

Comparison of Mortality Rates between Italian and Foreign-born Patients with Alcohol Use Disorders

In Italy, although the number of foreign-born residents has grown exponentially, there are no data on mortality risk among migrants who have alcohol use disorders (AUDs). We examined the mortality risk and causes of death for natives and non-natives in a cohort of individuals treated for AUDs in Northern Italy in the period from 01/01/1975 to 31/12/2016. We highlight important characteristics of non-natives compared to Italians: 1) a younger age and a higher proportion of females; 2) a better health status; 3) a better social capital 4) a lower risk of death. We found differences in mortality between the various areas of origin, with a higher risk among participants born in Asia and African countries other than Mediterranean. The excess mortality compared to the reference population (SMRs) was at least three times for Italians and two times for migrants. While the non-native patients with AUDs have in general better health than Italians with AUDs, our results highlighted higher percentage of dropouts from treatment and lower access to Mental Health Services, suggesting that barriers to the access and completion of therapeutic programs still exist.

Access to Support Services for Newcomer Youth Through the Process of School Integration: A Critical Narrative Literature Review

While the numbers of newcomer youth continue to grow in Canada, few studies have sought to critically capture experiences of school integration and access to school-based psychosocial support services during their transition. Guided by a critical social justice lens, this research seeks to investigate issues of inequity due to the marginalization of newcomer youth in schools. The intent of this critical narrative review is to summarize, interpret, critique, and synthesize what is currently known about the ways newcomer youth access and experience school-based psychosocial support services (S-BPSS) throughout the process of school integration. This paper presents the critical narrative literature review process, a discussion of the themes that emerged from the review, and a discussion of the literature within the context of school integration. The following themes that underscore the experiences of newcomer youth accessing school-based psychosocial support services were identified: (a) underutilization/discrimination, (b) culture shift, (c) transition planning, and (d) lived experience. Important directions for future research, including the importance of studies that prioritize the perspectives of newcomer youth themselves and the implications of their lived experience for S-BPSS are provided.

Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota

OBJECTIVE

The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County.

METHODS

We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women.

RESULTS

Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63).

CONCLUSION

The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.

South Asian youth mental health in Peel Region, Canada: Service provider perspectives

The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n  =  22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.

Explaining adults' mental health help-seeking through the lens of the theory of planned behavior: a scoping review

BACKGROUND

Despite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged >18 years.

METHODS

This scoping review was conducted based on the methodology presented by Arksey and O'Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel.

RESULTS

Initially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results.

CONCLUSIONS

The present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice.

Barriers to Accessing Mental Health Services by Migrant Youth

The purpose of the study was to identify barriers to accessing mental health services by migrant youth in a middle-sized central Canadian city. We asked participants, "What would stop you from talking to someone about mental health stress?". We interviewed 30 youth aged 16 to 22 who migrated from 10 different countries and lived in Canada for an average of 29 months. The data was analyzed using group concept mapping. The participants identified five concepts: fear of being misunderstood or ignored, desire for confidentiality, lack of trust and understanding, talking about it as not appropriate, and fear of the disclosure process. We compare these results with the literature.

Behaviour change interventions to promote health and well-being among older migrants: A systematic review

Background

Whether behaviour change interventions are effective for the maintenance of older migrants’ health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants.

Methods

Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre–post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being).

Results

Forty-three studies (23 randomised controlled trials, 13 pre–post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters.

Conclusions

Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups.

Trial registration

PROSPERO CRD42018112859.

Change in Work-Related Income Following the Uptake of Treatment for Mental Disorders Among Young Migrant and Non-migrant Women in Norway: A National Register Study

Background: Women, and migrant women in particular, are at increased risk of many common mental disorders, which may potentially impact their labor market participation and their work-related income. Previous research found that mental disorders are associated with several work-related outcomes such as loss of income, however, not much is known about how this varies with migrant background. This study investigated the change in work-related income following the uptake of outpatient mental healthcare (OPMH) treatment, a proxy for mental disorder, in young women with and without migrant background. Additionally, we looked at how the association varied by income level. Methods: Using data from four national registries, the study population consisted of women aged 23-40 years residing in Norway for at least three consecutive years between 2006 and 2013 (N = 640,527). By using a stratified linear regression with individual fixed effects, we investigated differences between majority women, descendants and eight migrant groups. Interaction analysis was conducted in order to examine differences in income loss following the uptake of OPMH treatment among women with and without migrant background. Results: Results showed that OPMH treatment was associated with a decrease in income for all groups. However, the negative effect was stronger among those with low income. Only migrant women from Western and EU Eastern Europe with a high income were not significantly affected following OPMH treatment. Conclusion: Experiencing a mental disorder during a critical age for establishment in the labor market can negatively affect not only income, but also future workforce participation, and increase dependency on social welfare services and other health outcomes, regardless of migrant background. Loss of income due to mental disorders can also affect future mental health, resulting in a vicious circle and contributing to more inequalities in the society.

Diagnosed Incidence of Non-Affective Psychotic Disorders Amongst Adolescents in British Columbia and Sociodemographic Risk Factors: A Retrospective Cohort Study

OBJECTIVES

To estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year.

METHODS

Linked individual-level administrative data were used to construct a cohort of individuals born in 1990-1998 and residing in South-Western BC (n = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20-29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period.

RESULTS

We found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants.

CONCLUSIONS

Findings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.

Program evaluation of a pilot mobile developmental outreach clinic for autism spectrum disorder in Ontario

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing prevalence worldwide. Early identification of ASD through developmental screening is critical for early intervention and improved behavioural outcomes in children. However due to long wait times, delays in diagnosis continue to occur, particularly among minority populations who are faced with existing barriers in access to care. A novel Mobile Developmental Outreach Clinic (M-DOC) was implemented to deliver culturally sensitive screening and assessment practices to increase access to developmental health services, reduce wait times in diagnoses, and aid in equitable access to intervention programs among vulnerable populations in Ontario.

Methods

This study applied two evaluation frameworks (process and outcome evaluation) to determine whether the delivery model was implemented as intended, and if the program achieved its targeted goals. A mixed-methods design was undertaken to address the study objectives.

Results

Between September 2018–February 2020, M-DOC reached 227 families with developmental health concerns for their child, while successfully targeting the intended population and achieving its goals. The mean age of the child-in-need at intake was 31.6 months (SD 9.9), and 70% of the sample were male. The program’s success was attributed to the use of cultural liaisons to break cultural and linguistic barriers, the creation of multiple points of access into the diagnosis pathway, and delivery of educational workshops in local communities to raise awareness and knowledge of autism spectrum disorder.

Conclusions

The findings underscore the need for community-based intervention programs that focus on cultural barriers to accessing health services. The model of delivery of the M-DOC programs highlights the opportunity for other programs to adopt a similar mobile outreach clinic approach as a means to increase access to services, particularly in targeting hard-to-reach and vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07789-7.

The Role of Immigrant Admission Classes on the Health and Well-being of Immigrants and Refugees in Canada: A Scoping Review

Many countries offer different pathways through which migrants can enter a new country. In Canada, there are three main immigrant admission classes: economic, family, and refugee. Previous research suggests that there are differences in health outcomes among various subgroups of migrants. A scoping review was conducted to characterize the role of immigrant admission classes on the health and well-being of immigrants and refugees in Canada. MEDLINE, Embase, PsycINFO, Sociological Abstracts, and EconLit databases were searched for quantitative studies published in English after 1990. The screening and selection process identified 27 relevant studies. Studies were categorized into four key reported outcomes: health care and services utilization, self-rated health and mental health, medical conditions and chronic illnesses, and social integration and satisfaction. Findings confirm that certain subgroups have worse health outcomes after arrival, particularly refugees, family class and other dependent immigrants. Health outcomes vary significantly across immigrant subgroups defined by the admission class through which they entered Canada.

Mental disorder and first-time marriage formation among non-Western migrant women: A national register study

PURPOSE

Studies show that there is a mental health selection into marriage among the general population. This study explored the association between mental disorder and marriage formation among non-Western migrant women living in Norway, and whether the association varied with region of origin, income, education and having a dependent child.

METHODS

Using linked national register data, we followed 49,329 non-Western never married migrant women aged 18-60 living in Norway between 2006 and 2014. As a proxy for mental disorders, we investigated whether outpatient mental health service use was associated with marital formation using discrete time logistic regression analyses.

RESULT

Overall, outpatient mental health service use was associated with lower odds of marital formation, even after controlling for sociodemographic factors. Interaction analyses suggested that the relationship was weaker for South Asian women, who had the highest odds of marriage formation, compared with Sub-Saharan African women, who had the lowest. The relationship was also stronger for women with children and women with low incomes.

CONCLUSION

Mental health selection effects may depend on the universality of marriage. Since marriage may be associated with psychosocial and economic benefits, it is important to identify and treat mental disorder among non-Western migrant women, particularly those with childcare responsibilities and low income.

COVID-19 Pandemic and Im/migrants' Elevated Health Concerns in Canada: Vaccine Hesitancy, Anticipated Stigma, and Risk Perception of Accessing Care

Vaccine hesitancy has taken a toll on COVID-19 immunization globally. This study aims to characterize three COVID-19-related health concerns (i.e., vaccine hesitancy, anticipated stigma, and risk perception) in Canada and how they differ based on im/migration status and other social determinants. Data were obtained from a nationwide probability sample of the Canadian Perspective Survey Series 3 (June 15 to 21, 2020). Multivariable binary logistic regression analysis was performed to investigate the association between each COVID-19 concern and nativity status, while controlling for socio-demographics. Of 3522 participants aged ≥ 25 years, the estimated overall prevalence of vaccine hesitancy was 16.9%, with im/migrants being greater than non-immigrants (21.5% vs. 15.5%, p < 0.001). After controlling for all covariates, im/migrants had around two-fold greater odds of all three health concerns, including risk perception of accessing care (aOR 2.44, 95% CI 1.89–3.15), anticipated stigma of being targeted (aOR 2.24, 95% CI 1.81, 2.78) and COVID-19 vaccine hesitancy (aOR 1.99, 95% CI 1.57–2.52), compared to their Canadian-born peers. Among vaccine-hesitant individuals (n = 596), im/migrants reported higher concerns, than non-immigrants, on vaccine safety (71.3% vs. 49.5%), side effects (66.4% vs 47.3%) and mistrust in vaccinations (12.5% vs 6.6%) as possible reasons of vaccine refusal. For migrant justice, health authorities should ensure equitable access to COVID-19 vaccines and other health-enhancing resources for im/migrants to mitigate their heightened fear, stigma, and mistrust of new vaccines amidst turbulent times.

Understanding the Influence of Ghanaian Women’s Migration Patterns on Access to Health Care

Increased migration rates demonstrate a rise in women seeking relocation as a means to access employment or academic opportunities; this is referred to as the feminization of migration. Migration stimulates female empowerment, increases access to financial opportunities, and promotes cultural diversity, all while simultaneously exposing women to detrimental conditions that impose risks to their physical and psychological well-being. Health is a fundamental human right that female migrants often are deprived of due to various social, cultural, political, and economic factors. A secondary analysis design was implemented to explore the impact of social determinants of health, specifically socioeconomic status, culture, and education, on health outcomes and health care access of Ghanaian internal and external female migrants. Interviews collected from two primary studies were analyzed using thematic analysis and an intersectionality approach. Ghanaian female migrants experienced cultural, financial, social, and health accessibility related barriers in accessing health care services. Our findings will serve as a foundation for improving health outcomes for female migrant populations and support health care professionals’ practice of cultural competence.

Mental Health and its Influencing Factors Among Immigrants with Chronic Diseases in China

Immigrants are a special group in society, and their health is of great concern. Few studies have targeted this population in China. A cross-sectional descriptive correlational study was conducted from July to August 2018 in Hubei Province, China. Chi-square tests, Z-tests and multivariable linear regression analysis were performed to analyze the data using SPSS 24.0. A total of 1068 questionnaires were distributed. The results showed that the variables that affected the mental health of the immigrants with chronic diseases included gender, annual income, life events (L), negative emotion (NE), negative coping styles (NC) and objective support (OS) (p ≤ 0.05). Future research should focus on the physical and mental health of different immigrant groups and design effective, individualized interventions to improve the health status of immigrants, especially those with chronic diseases.