The lived experiences of chronic pain among immigrant Indian-Canadian women: A phenomenological analysis

Background: Chronic pain is a growing public health concern affecting 1.5 million people in Canada. In particular, it is a concern among the expanding immigrant population, because immigrant groups report higher pain intensity than non-immigrants. In 2011, the Indian population became the largest visible minority group and continues to be the fastest growing. Though the prevalence of chronic pain among Canadian Indians is unknown, research has found a higher prevalence among Indian women than men in India, Malaysia, Singapore, and the United Kingdom, with women reporting more severe pain. An understanding of how pain is experienced by this particular group is therefore important for providing culturally sensitive care.

Aims

This study explores the lived experiences of chronic pain among immigrant Indian women in Canada.

Methods

Thirteen immigrant Indian women participated in one-on-one interviews exploring daily experiences of chronic pain.

Results

Using thematic analysis informed by van Manen's phenomenology of practice, four themes emerged: (1) the body in pain, (2) pain in the context of lived and felt space, (3) pain and relationships, and (4) pain and time. Women revealed that their experiences were shaped by gender roles and expectations enforced through culture. Specifically, a dual gender role was identified after immigration, in which women had to balance traditional household responsibilities of family labor and care alongside employment outside the home, exacerbating pain.

Conclusions

This research uncovers the multifaceted nature of chronic pain and identifies factors within the sociocultural context that may place particular groups of women at greater risk of living with pain.

Immigrant Women’s Experiences of Acculturative Stress

We examined the relation of two acculturation stressors, exclusion from ordinary privileges and overt discrimination, to two indicators of psychological well-being (i.e., psychiatric symptoms and satisfaction with life) among a diverse sample of immigrant women living in Ireland ( N = 174). We grouped our sample into “visible” immigrant women of color and “nonvisible” White immigrant women. As expected, visible immigrant women reported more experiences of overt discrimination and fewer experiences of ordinary privileges than did nonvisible immigrant women. The associations of belonging to a visible immigrant group with both psychiatric symptoms and satisfaction with life were each mediated through ordinary privileges and overt discrimination. The magnitude of the two indirect effects was equal for psychiatric symptoms, but for satisfaction with life, the indirect effect through ordinary privileges was stronger. After accounting for ordinary privileges and overt discrimination, the average score for satisfaction with life was higher for visible immigrant women than for nonvisible immigrant women. These findings suggest that visible immigrant women experience exclusion from ordinary privileges to a greater extent than nonvisible immigrant women and that this type of exclusion is at least as detrimental to psychological health as more overt forms of discrimination. Our findings demonstrate the importance of attending to discrimination of both visible and nonvisible immigrants and highlight the importance of ordinary privileges to immigrants’ well-being in their countries of destination. We discuss implications for future research and social policy.

Life Satisfaction of Indian Immigrants in Canada

It is a common conception that immigrants face numerous problems and considerable stress in the process of adjustment to a new culture. The life satisfaction of immigrants from India was assessed using the Satisfaction With Life Scale (Diener et al., 1985). As predicted by judgment theory (Micholas, 1986), it was found that Indian immigrants judge their own well-being in comparison to relevant others, such as their peers back home, the majority white community in Canada and other Indian immigrants. Their satisfaction was also predicted by the discrepancy between what they have in Canada and what they feel they could have had if they had stayed in India, with respect to raising children, freedom in making day-to-day decisions, opportunity to realise personal goals and amount of respect. Life satisfaction was correlated with perceived discrimination, guilt over leaving the country of birth and perception of social support, but not with education, socio-economic status, or perception of day-to-day comforts.

"Balan ced Multiculturalism" an d the Challenge of Peaceful Coexistence in Pluralistic Societies

Assimilation and multiculturalism are two contrasting policies for managing pluralistic societies. The first aims to achieve cultural homogeneity, and the second cultural diversity. While assimilation and multiculturalism are associated primarily with immigrant re ceiving countries, such as the United States and Canada, it is argued that these policies are relevant to all pluralistic societies. Underlying assimilation are the similarity-attraction and contact hypotheses, while multiculturalism assumes that feelings of security in the ingroup will lead to the acceptance of others. We examine the validity of these assump tions, and assess the relative merits of assimilation and multiculturalism in an inter national context. Finally, we propose the concept of "balanced multiculturalism" as an improvement on current models.

Where's the "Culture" in Cross-Cultural Transition?

Research examined psychological and sociocultural adjustment during cross-cultural transitions in two groups of sojourners. One hundred and forty-five Malaysian and Singaporean students in New Zealand and 156 Malaysian students in Singapore participated in the studies. In line with past sojourner research, results revealed that locus of control, life changes, social difficulty, and social support variables predicted psychological adjustment during cross-cultural transitions. In contrast, length of residence in the host culture, cultural distance, interaction with host nationals and co-nationals, extroversion, acculturation strategies, and mood disturbance predicted sociocultural adaptation. In addition to these general findings, culture-specific results also emerged; high host national contact and cultural integration were associated with mood disturbance in Malaysian sojourners in Singapore. As expected, Malaysian and Singaporean students in New Zealand experienced greater social difficulty than Malaysian students in Singapore although there was no significant difference in mood disturbance. Also consistent with the hypothesis, the magnitude of the correlation between psychological and sociocultural adjustment was significantly greater in the Singapore-based compared to the New Zealand-based sample.

Perceived Discrimination, Social Support Networks, and Psychological Well-being Among Three Immigrant Groups

The authors addressed the specific role of and contradictory results previously obtained regarding ethnic versus host support networks in influencing directly and/or buffering the impact of perceived discrimination on the well-being of immigrants. A nationwide adult probability sample ( N= 2,360) included Finnish repatriates and Russian and Estonian immigrants in Finland from Russia, Estonia, and other countries of the former Soviet Union. Perceived discrimination had a significant impact on psychological well-being. The results demonstrated the importance of distinguishing between available and activated social support. In the total sample, strong evidence was obtained for the direct and the buffering effect of host support networks on well-being. In addition, social support provided by ethnic networks abroad was generally beneficial for the psychological well-being of the immigrants. Under some conditions, ethnic support networks were also beneficial for psychological well-being.

Social support, social conflict, and immigrant women's mental health in a Canadian context: a scoping review

ACCESSIBLE SUMMARY

Social support has positive and negative dimensions, each of which has been associated with mental health outcomes. Social networks can also serve as sources of distress and conflict. This paper reviews journal articles published during the last 24 years to provide a consolidated summary of the role of social support and social conflict on immigrant women's mental health. The review reveals that social support can help immigrant women adjust to the new country, prevent depression and psychological distress, and access care and services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. It is crucial that interventions, programmes, and services incorporate strategies to both enhance social support as well as reduce social conflict, in order to improve mental health and well-being of immigrant women.

ABSTRACT

Researchers have documented the protective role of social support and the harmful consequences of social conflict on physical and mental health. However, consolidated information about social support, social conflict, and mental health of immigrant women in Canada is not available. This scoping review examined literature from the last 24 years to understand how social support and social conflict affect the mental health of immigrant women in Canada. We searched MEDLINE, PsycINFO, CINAHL, Healthstar, and EMBASE for peer-reviewed publications focusing on mental health among immigrant women in Canada. Thirty-four articles that met our inclusion criteria were reviewed, and are summarized under the following four headings: settlement challenges and the need for social support; social support and mental health outcomes; social conflict and reciprocity; and social support, social conflict, and mental health service use. The results revealed that social support can have a positive effect on immigrant women's mental health and well-being, and facilitate social inclusion and the use of health services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. The results also highlighted the need for health services to be linguistically-appropriate and culturally-safe, and provide appropriate types of care and support in a timely manner in order to be helpful to immigrant women.

Immigrant Mental Health, A Public Health Issue: Looking Back and Moving Forward

The Mental Health Commission of Canada's (MHCC) strategy calls for promoting the health and wellbeing of all Canadians and to improve mental health outcomes. Each year, one in every five Canadians experiences one or more mental health problems, creating a significant cost to the health system. Mental health is pivotal to holistic health and wellbeing. This paper presents the key findings of a comprehensive literature review of Canadian research on the relationship between settlement experiences and the mental health and well-being of immigrants and refugees. A scoping review was conducted following a framework provided by Arskey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). Over two decades of relevant literature on immigrants' health in Canada was searched. These included English language peer-reviewed publications from relevant online databases Medline, Embase, PsycInfo, Healthstar, ERIC and CINAHL between 1990 and 2015. The findings revealed three important ways in which settlement affects the mental health of immigrants and refugees: through acculturation related stressors, economic uncertainty and ethnic discrimination. The recommendations for public health practice and policy are discussed.

The Acculturation Processes: The Strategies and Factors Affecting the Degree of Acculturation

This article addresses the acculturation process immigrants and refugees go through when immigrating to the United States, and the various factors that impact the process of acculturation for both the individual and the family as a whole. The nature of the acculturative stress, which groups of immigrants are mostly affected by it, and the psychological disorders caused as a result of going through this process have been discussed. Four strategies of coping with the acculturative stress process and the factors that impact the choice of a certain strategy have also been described.

Sociocultural adjustment among sojourning Malaysian students in Britain: a replication and path analytic extension

The present study examined the sociocultural adjustment of 249 sojourning Malaysian undergraduates in Britain. One-hundred and ten Malay and 139 Chinese students enrolled in various courses answered a self-report questionnaire that examined various aspects of sociocultural adjustment and socio-demographics. Overall, Malay students reported significantly poorer sociocultural adjustment than Chinese students, as well as more negative outcomes on a range of predictors. Path analysis for the total sample showed that higher family income led to greater sociocultural adjustment, but partially because it led to more contact with host and conationals, better language proficiency, lower perceived cultural differences and less perceived discrimination. Moreover, participants with higher English proficiency were better adapted, but partially because they perceived less cultural differences as well as having more contact with host nationals. Additionally, individuals reporting better sociocultural adjustment also reported better health statuses. The same model was equally useful at predicting sociocultural adjustment for both Malay and Chinese participants. These results are discussed in terms of the role played by income in buffering against the negative aspects of sociocultural adjustment.

Pakistani Ismaili Muslim adolescent females living in the United States of America: stresses associated with the process of adaptation to U.S. Culture

This study examines correlates of sociopsychological post-migration depression in Pakistani Ismaili Muslim adolescent females residing in the United States using quantitative information obtained through a questionnaire. Analysis of the questionnaire included descriptive statistics, Pearson product moment correlation coefficients, and multiple regression to describe a final model of risk factors related to depression in these adolescents. Longer periods of stay in the United States, young age at migration, and speaking more English were associated with low sociopsychological stress scores. Adolescents who reported a longer period of stay in the United States and lower levels of sociopsychological stress were less likely to be depressed.

Depression trajectories in relatively recent immigrants

This longitudinal study of 253 ever-depressed former Soviet immigrants (1) examined the life circumstances, demographic characteristics, and immigration demands of individuals whose depression lifted, or who remained or became depressed over a 2-year period; and (2) investigated whether immigration demands, local relatives, age at immigration, gender, education, employment, and marital status differed among the three groups. Depression was determined based on depression scores at baseline and at 2-year follow-up. Forty-three percent of the sample remained depressed, 26% became depressed, and 30% had their depression lift over the course of 2 years. The three groups did not differ with regard to demographic characteristics or loss of employment or a negative change in marital status over the 2-year study period. They did differ with respect to the presence of local family and immigration demands (P <.05). Those who remained depressed were less likely to have family in the area and had the highest immigration demand score at both time points. However, the effect for presence of local family was not significant when immigration demands were included in the analysis (P =.32). Analysis of variance (ANOVA) for repeated measures revealed that the group whose depression lifted experienced the greatest change in immigration demand scores over the 2-year study period. Our findings argue that clinicians should not expect immigrants' depression to always decrease over time and should assess depression by asking about immigration demands, even if depression was not present during an earlier clinical encounter.

Predicting psychological distress among former Soviet immigrants

This study investigated whether age, gender, marital status, education, employment, length of time in the U.S. and immigration demands (novelty, occupation, language, discrimination, loss, and not feeling at home) were predictors of psychological distress in a sample of 1,647 former Soviet immigrants. Multiple regression analysis indicated that the combined model of demographic and demand of immigration variables was significant. Results indicated that women, older immigrants, those with less than a college education, and those with greater immigration demands related to novelty, language, discrimination, loss, and not feeling at home were most distressed.