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Toulany A, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Moore Hepburn C, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:904-915. [PMID: 36855797 PMCID: PMC9982398 DOI: 10.1177/07067437231156254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Canada
| | - Maria Chiu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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Feng RY, Krygsman A, Vaillancourt T, Vitoroulis I. Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use. Int J Soc Psychiatry 2023; 69:1723-1735. [PMID: 37326034 PMCID: PMC10657499 DOI: 10.1177/00207640231174374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Ruo Ying Feng
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
| | - Amanda Krygsman
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
| | - Tracy Vaillancourt
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
| | - Irene Vitoroulis
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON, Canada
- Counselling Psychology, Faculty of Education, University of Ottawa, ON, Canada
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Comeau J, Wang L, Duncan L, Edwards J, Georgiades K, Anderson KK, Wilk P, Lau T. Correlates of child mental health and substance use related emergency department visits in Ontario: A linked population survey and administrative health data study. Int J Popul Data Sci 2023; 8:2152. [PMID: 37670954 PMCID: PMC10476702 DOI: 10.23889/ijpds.v8i1.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Introduction Knowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting emergency departments (EDs) for mental health or substance use concerns in Ontario, Canada is lacking. Objectives Using data from a population-based survey linked at the individual level to administrative health data, this study leverages a provincially representative sample and quasi-experimental design to strengthen inferences regarding the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit. Methods 9,301 children aged 4-17 years participating in the 2014 Ontario Child Health Study were linked retrospectively (6 months) and prospectively (12 months) with administrative health data on ED visits from the National Ambulatory Care Reporting System. Modified Poisson regression was used to examine correlates of mental health and substance use related ED visits among children aged 4-17 years over a 12-month period following their survey completion date, adjusting for ED visits in the 6 months prior to their survey completion date. Subgroup analyses of youths aged 14-17 years who independently completed survey content related to peer victimisation, substance use, and suicidality were also conducted. Results Among children aged 4-17 years, older age, parental immigrant status, internalising problems, and perceived need for professional help were statistically significant correlates that increased the risk of a mental health or substance use related ED visit; low-income and suicidal ideation with attempt were statistically significant only among youths aged 14-17 years. Conclusions Knowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting EDs for mental health and substance use related concerns is required to better understand patient needs to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits. Highlights Growing rates of child mental health and substance use related ED visits have been observed internationally.A population-based survey linked at the individual level to administrative health data was used to examine the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit in Ontario, Canada.Older age, low-income, parental immigrant status, perceived need for professional help, internalising problems, and suicidality increase the risk of an ED visit.Knowledge of the characteristics of children visiting EDs can be used to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits.
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Affiliation(s)
- Jinette Comeau
- King’s University College at Western University
- Children’s Health Research Institute, Division of Children’s Health and Therapeutics, Lawson Health Research Institute, Western University, London, ON, Canada
| | - Li Wang
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Laura Duncan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jordan Edwards
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katholiki Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Kelly K. Anderson
- Children’s Health Research Institute, Division of Children’s Health and Therapeutics, Lawson Health Research Institute, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Piotr Wilk
- Children’s Health Research Institute, Division of Children’s Health and Therapeutics, Lawson Health Research Institute, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tammy Lau
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Kamali M, Edwards J, Anderson LN, Duku E, Georgiades K. Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:596-604. [PMID: 36503305 PMCID: PMC10411367 DOI: 10.1177/07067437221144630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences. METHODS The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics. RESULTS Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth. CONCLUSION Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.
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Affiliation(s)
- Mahdis Kamali
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
| | - Jordan Edwards
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Archambault É, Vigod SN, Brown HK, Lu H, Fung K, Shouldice M, Saunders NR. Mental Illness Following Physical Assault Among Children. JAMA Netw Open 2023; 6:e2329172. [PMID: 37585201 PMCID: PMC10433085 DOI: 10.1001/jamanetworkopen.2023.29172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/08/2023] [Indexed: 08/17/2023] Open
Abstract
Importance Physical assault during childhood is common and can lead to lasting mental health problems. Yet, there are few studies on the patterns of mental illness (ie, timing of onset, type, and acuity) in survivors of physical assault. Objective To determine the risk of incident health record diagnoses of mental illness among children who experienced assault compared with children who did not. Design, Setting, and Participants This population-based matched cohort study used linked health administrative data sets in Ontario, Canada. Children aged 0 to 13 years who experienced an incident physical assault between 2006 and 2014 were age-matched (1:4) to children who had not experienced assault and followed up for a minimum of 5 years. Data were analyzed from January 2020 to March 2022. Exposure Physical assault resulting in hospitalization or an emergency department (ED) visit between the ages of 0 and 13 years. Main Outcomes and Measures The primary outcome was incident health record diagnosis of mental illness measured as any physician or hospital mental health care use or completed suicide. Secondary outcome measures included the acuity of incident mental illness and mental illness diagnostic category. Cox proportional hazards regression analysis generated hazard ratios (HR) for incident mental illness. Results A total of 21 948 children unexposed to assault and 5487 exposed to assault were included in the study with a mean (SD) age of 7.0 (4.6) years. There were more boys in the group that experienced assault (3006 individuals [54.8%]) compared with the group who did not (9909 individuals [45.1%]). Compared with children unexposed to assault, those exposed were more likely to be in the highest deprivation index quintile (standardized difference, 0.21) and live in rural areas (standardized difference, 0.48). Their mothers more often had active mental illness (standardized difference, 0.35). More than one-third of the exposed children had a health record diagnosis of mental illness (2219 children [38.6%]; incidence rate (IR), 53.3 per 1000 person-years) compared with 23.4% (5130 children; IR, 32.2 per 1000 person-years) of unexposed children, with an overall adjusted hazard ratio (aHR) of 1.96 (95% CI, 1.85-2.08). The greatest risk was observed in the first year following the assault (aHR, 3.08; 95% CI, 2.68-3.54). In both groups, nonpsychotic disorders were the most common type of mental illness. Initial mental illness diagnoses occurred in an acute care setting for 14.0% of exposed children (769 children) vs 2.8% of unexposed children (609 children). Conclusions and Relevance In this population-based matched cohort study, children who experienced assault had, on average, a 2 times higher risk of receiving a mental illness diagnosis and were more likely than children who had not experienced assault to present to acute care for mental illness. Early intervention to support mental health of assaulted children is warranted, particularly in the first year following assault.
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Affiliation(s)
- Étienne Archambault
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montréal, Quebec, Canada
| | - Simone N. Vigod
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K. Brown
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, Toronto, Ontario, Canada
| | | | - Michelle Shouldice
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natasha Ruth Saunders
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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Grundy A, Ng E, Rank C, Quinlan J, Giovinazzo G, Viau R, Ponka D, Garner R. Mental health and neurocognitive disorder-related hospitalization rates in immigrants and Canadian-born population: a linkage study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:692-704. [PMID: 36809592 PMCID: PMC10348999 DOI: 10.17269/s41997-023-00740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Mental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada. METHODS Hospital records from the Discharge Abstract Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada's 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health-related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available. RESULTS Overall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently. CONCLUSION Differences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.
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Affiliation(s)
- Anne Grundy
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada.
| | - Edward Ng
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Claudia Rank
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Jacklyn Quinlan
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - George Giovinazzo
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Rachel Viau
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - David Ponka
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
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Jia J, Nie XF, Ke L, Liu B, Wang WR. Mental Health and its Influencing Factors Among Immigrants with Chronic Diseases in China. J Immigr Minor Health 2022; 24:1269-1280. [PMID: 35000054 PMCID: PMC8742701 DOI: 10.1007/s10903-021-01311-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Jia Jia
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Xiao-Fei Nie
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China.
| | - Li Ke
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Bing Liu
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
| | - Wen-Ru Wang
- School of Nursing, Hubei University of Medicine, 30 Renmin South Rd., Shi Yan, 422000, Maojian District, China
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Gurung A, Subedi P, Zhang M, Li C, Kelly T, Kim C, Yun K. Culturally-Appropriate Orientation Increases the Effectiveness of Mental Health First Aid Training for Bhutanese Refugees: Results from a Multi-state Program Evaluation. J Immigr Minor Health 2020; 22:957-964. [PMID: 32088846 PMCID: PMC10588671 DOI: 10.1007/s10903-020-00986-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Poor mental health remains a significant source of morbidity and mortality in the Bhutanese refugee community. Mental Health First Aid (MHFA) is a promising intervention that has been used in other immigrant communities to prepare individuals to recognize and respond to mental health warning signs. This was a non-randomized program evaluation. Using pre- and post-training questionnaires developed for prior evaluations of MHFA, we examined the effectiveness of training offered with and without culturally-appropriate orientation to mental health terminology and concepts (N = 458). Pre- to post-training improvement in ability to recognize schizophrenia, ability to respond to schizophrenia and depression, and the overall mental health literacy was greater for Bhutanese refugees who attended orientation relative to other participants (P < 0.05). In scaling up MHFA training for other immigrant communities, we recommend developing and systematically evaluating culturally-appropriate orientation materials that introduce mental health vocabulary and contextualize mental health concepts.
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Affiliation(s)
- Ashok Gurung
- University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
| | - Parangkush Subedi
- Division of Refugee Health, Department of Health and Human Service, Office of Refugee Resettlement, Administration for Children and Families, 330 C Street, SW, Washington, DC, 20201, USA
| | - Mengxi Zhang
- Department of Nutrition and Health Science, College of Health Science, Ball State University, 2000 W. University Ave., Muncie, IN, 47306, USA
| | - Changwei Li
- Department of Epidemiology & Biostatistics, University of Georgia, 120 B.S. Miller Hall, Health Sciences Campus, 101 Buck Road, 30602, Athens, GA, USA
| | - Timothy Kelly
- Division of Refugee Health, Department of Health and Human Service, Office of Refugee Resettlement, Administration for Children and Families, 330 C Street, SW, Washington, DC, 20201, USA
| | - Curi Kim
- Division of Refugee Health, Department of Health and Human Service, Office of Refugee Resettlement, Administration for Children and Families, 330 C Street, SW, Washington, DC, 20201, USA
| | - Katherine Yun
- Policy Lab, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Division of General Pediatrics, Children's Hospital of Philadelphia & University of Pennsylvania Perelman School of Medicine Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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