Factors Associated with Professional Mental Help-Seeking Among U.S. Immigrants: A Systematic Review

Age of migration and common mental disorders among migrants in early adulthood: a Norwegian registry study

BACKGROUND

Younger age of migration is associated with higher risk of psychotic disorders but the relationship between age of migration and common mental disorders is less clear. This study investigates the association between age of migration and diagnosed common mental disorders among migrants living in Norway.

METHODS

Using national Norwegian register data from 2008 to 2019, we compared the odds of a common mental disorder diagnosis in healthcare services during early adulthood among non-migrants, descendants and migrants with different ages of migration and lengths of stay. We also investigated differences in the relationship for different migrant groups and for men and women.

RESULTS

Descendants and childhood migrants with ≥ 19 years in Norway had higher odds of common mental disorders than non-migrants, while those migrating during adolescence with ≥ 19 years in Norway had similar odds. Those migrating during emerging and early adulthood had lower odds. Overall among migrants, the relationship between age of migration and common mental disorders was more pronounced for migrants < 19 years in Norway than ≥ 19 years and for non-refugees compared with refugees, especially men.

CONCLUSIONS

Descendants and childhood migrants with long stays may have higher odds of common mental disorders due to the associated stress of growing up in a bicultural context compared with non-migrants. Age of migration has a negative association with diagnosed common mental disorders but much of this effect may attenuate over time. The effect appears weaker for refugees, and particularly refugee men, which may reflect higher levels of pre-migration trauma and stress associated with the asylum-seeking period for those arriving as adults. At the same time, migrants, especially those arriving as adults, experience barriers to care. This could also explain the particularly low odds of diagnosed common mental disorders among adult migrants, especially those with shorter stays.

Examining Factors Associated With Intention to Seek Professional Mental Health Support Among First-Generation Iranian Americans

PURPOSE

Research suggests immigrants are at a greater risk of mental health disorders compared to native-born populations. Thus, the current study investigated factors associated with professional mental help-seeking intention among American immigrants.

METHOD

A cross-sectional study was conducted with 207 first-generation Iranian Americans, and data were collected using survey questionnaires.

RESULTS

Younger Iranians living in western states in the United States and those with positive attitudes toward professional mental health services had greater intention to seek these services. Unexpectedly, those with better mental health literacy (MHL) held more mental health stigma (MHS).

CONCLUSION

Findings elucidated valuable insights into the complex dynamics among sociodemographic factors, acculturation, MHL, MHS, attitudes, and intentions toward professional mental health help-seeking. We also highlighted the intricate relationship between MHL and MHS, suggesting that strategies to improve MHL may not necessarily mitigate MHS within this community. Therefore, integrating anti-stigma, contact-based approaches to MHL programs could effectively reduce stigma while facilitating mental health help-seeking. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Exploring early discontinuation of mental health outpatient treatment: language, demographics and clinical characteristics among migrant populations in Japan

BACKGROUND

The fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants' mental health treatment engagement remains limited.

OBJECTIVE

This study examined language proficiency, demographic and clinical characteristics as predictors of early treatment discontinuation among migrants.

METHODS

Electronic health record data from 196 adult migrants, identified from 14 511 patients who received mental health outpatient treatment during 2016 and 2019 at three central hospitals in the Tokyo-Yokohama metropolitan region of Japan, were used. We conducted multivariable regression models to identify predictors of early discontinuation within 3 months.

FINDINGS

The study cohort (65% women, age range: 18-90 years, from 29 countries or regions) included 23% non-Japanese speakers. Japanese and non-Japanese speakers had similar discontinuation rates (26% vs 22%). Multivariable models revealed younger age (OR=0.97; 95% CI: 0.95, 0.99; p=0.016) and those with a primary diagnosis other than a schizophrenia spectrum disorder (OR=3.99; 95% CI: 1.36, 11.77; p=0.012) or a neurotic, stress-related and somatoform disorder (OR=2.79; 95% CI: 1.14, 6.84; p=0.025) had higher odds of early discontinuation. These effects were more pronounced among the Japanese speakers with significant language-by-age and language-by-diagnoses interactions.

CONCLUSION

Younger age and having a primary diagnosis other than a schizophrenia spectrum disorder or a neurotic, stress-related and somatoform disorder increased vulnerability for discontinuing mental health treatment early in Japanese-speaking migrants but not for migrants with limited Japanese proficiency.

CLINICAL IMPLICATIONS

Understanding language needs within a context of mental health treatment should go beyond assumed or observed fluency. Unmet language needs might increase vulnerability for treatment disengagement among migrants. Targeted clinical efforts are crucial for enhancing early treatment engagement and informing health practices in Japan and countries with growing migrant populations.

Screening for latent tuberculosis in migrants-status quo and future challenges

OBJECTIVES

To review the evidence that migrants from tuberculosis (TB) high-incidence countries migrating to TB low-incidence countries significantly contribute to active TB cases in the counties of destination, primarily through reactivation of latent TB.

METHODS

This is a narrative review. The different screening programs in the countries of destination are reviewed either based on screening and preventive treatment of latent TB pre or more commonly - post arrival.

RESULTS

Screening can be performed using interferon-gamma release assays (IGRA) or tuberculin skin tests (TST). Preventive treatment of latent TB is using either monotherapy with isoniazid, or in combination with rifampicin or rifapentine. We discuss the ethical issues of preventive treatment in asymptomatic individuals and how these are addressed in different screening programs.

CONCLUSION

Screening migrants from TB high endemic countries to TB low endemic countries is beneficial. There is a lack of standardization and agreement on screening protocols, follow up and treatment.

Influence of biopsychosocial factors on self-reported anxiety/depression symptoms among first-generation immigrant population in the U.S

BACKGROUND

Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S.

METHODS

We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective.

RESULTS

The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26-49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18-25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly.

CONCLUSIONS

The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Health Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review

Black immigrants constitute a rapidly growing population group in the U.S. A comprehensive understanding of health services used by Black immigrant women is necessary to support the complex needs of this population. We conducted a systematic review to (1) understand the types of health services used by Black immigrant women living in the U.S. and (2) examine barriers and motivators to using health services. Relevant studies were identified in the following databases: PubMed, PsychInfo, CINAHL, and Embase. Articles published until October 2022 were included in the review. From a total of 15,245 records, 47 articles that reported on health service utilization practices of Black immigrant women were included in the review. A variety of different health services were accessed by Black immigrant women, such as hepatitis screening, reproductive health services, cancer screenings, substance abuse treatment, mental health services, HIV services, dental services, genetic testing, cardiovascular risk testing, and general health services/ hospitalizations. Motivators for using health services included possession of health insurance, knowledge of health resources and conditions, and positive experiences with providers. Barriers to using health services included challenges navigating the health system, language barriers, and cultural beliefs. Factors that positively influence health service utilization must be expanded at the institutional, societal, and policy levels to improve access to health services for Black immigrant women.

Exploring acculturative stress and family dynamics in African immigrant students in the US: implications for mental health

OBJECTIVES

African immigrants represent a rapidly growing immigrant group in the US, yet relatively little is known about influences on the health of this group. This is a particularly important oversight since adaptation to life in the United States can have deleterious effects on health due to the stress associated with immigrant and minority status as well as separation from family abroad. The present study explores how African immigrants experience acculturative stress - the stress-inducing elements of life as an immigrant - and the mental health implications of these experiences in light of home country values and conceptions of health.

DESIGN

Semi-structured, in-depth interviews were conducted with a purposive sample of sub-Saharan African immigrant students attending a metropolitan university in the northeastern United States (N = 26). Data were analyzed thematically using NVivo 12.

RESULTS

African immigrant students first experience acculturative stress through schools and neighborhoods where they encounter othering processes, including discrimination and racism. Family responsibilities to loved ones in the US and Africa also represent a source of stress that contributes to feelings of isolation and depression experienced while managing college responsibilities. Since these emotional and mental states are not within the purview of how health is viewed in their home countries, many suffer and may not get the care they need to effectively manage their mental health.

CONCLUSION

Findings emphasize shared experiences of navigating cultural dynamics, family pressures, and discrimination that contribute to the stress experienced by African immigrants. Findings also underscore the need for the development of culturally sensitive interventions in university settings so that African immigrant students can be upwardly mobile and healthy in the long-term.

Organizational Facilitation of Latino Substance Use Disorder Treatment: Impact of COVID-19

Purpose

Continued high opioid overdose death rates in the United States and increasing New York State (NYS) Latino opioid overdoses make the facilitation of Latino access to NYS substance use disorder (SUD) treatment essential. SUD treatment facilities in NYS sustained an estimated 37% decrease in Latino enrollment during phase one of the pandemic. This study invited NYS SUD service providers to describe ways in which SUD organizations facilitated Latino SUD treatment prior to and during phase one of the pandemic.

Methods

Using an individual and community interaction framework of vulnerability and a description of organizational enabling resources in four domains, this study used a cross-sectional descriptive design to investigate the levels of organizational facilitators for Latino SUD treatment access and the impact of the pandemic on these organizational facilitators. A convenience sample of 470 NYS SUD clinicians participated in the study.

Results

The outcomes suggest an overall erosion of organizational enabling resources during the pandemic. Erosion was greatest in areas with a higher Latino population density in the domains of insured/immigration/legal information and culture. A pattern of strengthening resources in areas with lower Latino population density in the domains of language and telehealth access has defied the overall pattern of deterioration. The increase in telehealth did not cross the digital divide to stop the decrease in Latino enrollment and did not compensate for the overall erosion of access facilitators.

Conclusions

The overall outcomes suggest opportunities to explore local variations in resource health. Recommendations to improve health equity include the use of participatory research to assess community needs and the implementation of community partnerships to address systemic barriers and rebuild equitable addiction services.