Mental distress and the coping strategies of elderly Indian immigrant women

Of duty and diaspora: (Re)negotiating the intergenerational contract in South Asian Muslim families

In recent years, there has been exponential growth in the South Asian Muslim population in the United States. This demographic trend, along with a rapidly aging North American population, implies that very soon, a significant proportion of U.S. adults 65 years and older will identify as South Asian Muslim. Moreover, more than one-half of Muslims (57%) live in a multi-person/multi-generation household where all members identify as Muslim. Despite this evidence, limited research exists on the dynamics of multigenerational living in aging South Asian Muslim households, particularly around intergenerational support exchanges and the nature and strength of affectual bonds between generations. Additionally, research suggests that espoused within internalized cultural norms around filial obligation and duty, kinwork in South Asian families remains highly gendered. Less is known, however, about the gendered nature of kinwork in immigrant South Asian Muslim families. Based on 30 in-depth narrative interviews with three generations of South Asian Muslim women living in the U.S., this paper addresses these gaps, specifically focusing on intersections of faith, culture, gender, age, immigrant status, and age at migration. The findings from this study point to a renegotiation of the intergenerational contract, wherein care and support for a parent or grandparent were understood and enacted within the framework of an overarching Muslim identity, while simultaneously, for their older relatives, it was reinterpreted within shifting local and global realities such as the increasing participation of the middle generation, the daughters and daughters-in-law, in the paid workforce. In addition to providing insights into ethnic and religious-oriented experiences of aging and care, these findings may help inform policymakers and stakeholders (e.g., community service providers and faith leaders such as imams of mosques, researchers, and family members) in culturally congruent ways to support the health and well-being of aging South Asian Muslim families.

Evaluation of bio-psycho-social and socio-cultural problems of Syrian elderly living in Turkey

BACKGROUND

Older persons are among the vulnerable groups most affected by war and migration due to physical weakness, illness, social environment, and cultural adaptation difficulties.

AIMS

The aim of this study is to determine the economic, biopsychosocial, and socio-cultural problems of the older Syrians living in Turkey.

METHODS

Convergent mixed design was used within the scope of the research. For the qualitative phase of the research, 19 older persons migrants were interviewed. A semi-structured interview form was used to collect data in the interviews. For the quantitative phase of the research, 432 participants were reached. In order to collect data, Geriatric Depression Scale (GDS-15) and Socio-cultural Adaptation Scale (SCAS-R) were used together with the demographic information form.

RESULTS

The mean age of the participants was 66.2 ± 7.10 (Min: 60; Max: 91), the majority (87%) between the ages of 60 to 74 and 53.2% were male. The mean SCAS-R score of the older Syrians was 2.48 ± 0.88 (Min: 1; Max: 5) and the mean GDS-15 was 2.63 ± 3.84 (Min: 0; Max: 15). About 22.7% of older Syrian participants had mild or severe depressive symptoms. Experienced traumatic events, changing economic situation, and family relationships affected both physical and mental health of the older persons. The socio-cultural adaptation of the older persons was affected by language, temporary protection, and exposure to exclusion. The Older Syrians, who lacked information on social services, were experiencing problems with nutrition, clothing, bill payment, and rent due to economic problems. However, they mostly did not want to return to Syria because their living order in Syria was deteriorating and they were afraid.

CONCLUSION

Syrian elderly immigrants living in Turkey have biopsychosocial, economic, and cultural problems. National and international support programs and policies should be developed for elderly Syrian refugees who are expected to live in Turkey unless a safe living environment is provided.

Taking Refuge in Religion: Buddhist-Oriented Coping following Late-Life Immigration

Despite a recognition of religion as a resource for coping in later life, few studies have examined how religion is summoned to cope with the stressors of late-life immigration. Drawing upon data generated in a phenomenological study of the aging-out-place experience, this article presents a hermeneutic analysis of textual extracts addressing 10 Sri Lankan-born late-life immigrants' Buddhist beliefs and practices, and how these beliefs and practices contributed to coping with immigration stressors. Four shared experiences facilitated through religious engagement were revealed: religious engagement as a source of purpose, making meaning of suffering and experiencing hope, non-attachment, and connecting to the past and the ethnoreligious community. Late-life immigrants drew on religious engagement to remain resolute amidst adversities, thus reinforcing the importance of culturally responsive milieus and services to support religion-focused coping. Findings are interpreted in relation to Pargament's (1997) theory of religious coping.

Nepali Migrant Workers and the Need for Pre-departure Training on Mental Health: A Qualitative Study

Every year around 1000 Nepali migrant workers die abroad. Every one in three females and one in ten males commit suicide, reflecting a high mental health risk among Nepali migrant workers. This study aims to identify triggers of mental ill-health among Nepali migrant workers and their perceptions on the need of mental health components in the pre-departure orientation programme. We conducted five focus group discussions (FGD) and seven in-depth interviews with Nepali migrant workers and eight semi-structured interviews with stakeholders working for migrants. Participants were invited at Kathmandu’s international airport on return from abroad, at hotels or bus stations near the airport, through organisations working for migrants, and participants’ network. All FGD and interviews were conducted in Kathmandu and audio recorded, transcribed and translated into English. Data were analyzed thematically. High expectations from families back home, an unfair treatment at work, poor arrangements of accommodation, loneliness and poor social life abroad were frequently reported factors for poor mental health. Access to mental health services abroad by Nepali migrant was also poor. We found little on mental health in the pre-departure orientation. We need to improve our knowledge of mental health risks to provide better, more focused and more up-to-date pre-departure training to new migrant workers leaving Nepal.

Psychological predictors of loneliness among Palestinian university students in the West Bank

The purpose of this study was to examine the predictive role of life satisfaction, perceived social support, and psychological problems on loneliness among Palestinian university students in the West Bank. Participants were 254 volunteer undergraduate students (50.4% males and 49.6% females), ranging from 18 to 26 years of age. Data was collected using the Loneliness Scale (UCLA), Satisfaction with Life Scale (SWLS), Multidimensional Scale of Perceived Social Support (MSPSS), Psychological Problems Scale and a Demographic Information Form. There was a significant gender bias towards loneliness, male students being lonelier than female students. Results showed that students who had higher loneliness, felt less satisfied with their life and perceived less support from friends, family and significant others. Furthermore, students who had high loneliness also presented more psychological problems. These results also indicated that, after accounting for psychological problems, life satisfaction, and social support from friends and significant others are negative predictors of loneliness. These findings suggest that universities should create strategies to improve well-being and social support to protect students from the negative effects of loneliness.

Protective Factors and Processes Fostering Resilience and Buffering Psychosocial Distress among Later-Life Egyptian Immigrants

This qualitative study explores and describes the protective factors and processes that foster resilience and buffer psychosocial distress among later-life Egyptian immigrants post immigration to the US. Open-ended structured interviews were conducted with (30) later-life Egyptian immigrants who came to the United States after turning 60 years of age. Thematic analysis was used to analyze patterns within the data. The findings of this study reveal that the availability and utilization of psychosocial resources - due to opportunities embedded in their sociocultural context and coping strategies embedded in their individual strengths and cultural or religious beliefs - play a pivotal role in buffering the losses and acculturative stressors triggered by transitioning to a new environment. The findings of this study can be used to inform psychosocial and therapeutic interventions and guide the development of appropriate social work programs and services for later-life Egyptian immigrants in particular and older Arabic-speaking immigrants in general.

Distressing encounters in the context of climate change: Idioms of distress, determinants, and responses to distress in Tuvalu

Across the globe there is a critical need for culturally informed and locally valid approaches to mental health assessment and intervention, particularly among disadvantaged and marginalized populations. To be optimally effective, such approaches must be informed by a sound understanding of locally relevant idioms of distress and its determinants, including those caused or exacerbated by global power disparities and structural inequities. Climate change, arising due to anthropogenic sources located predominantly in industrialized nations, is one potential determinant of distress having disproportionate adverse impacts on already marginalized populations. The present study formed part of a broader project examining the intersections of culture, climate change, and distress in the Polynesian nation of Tuvalu - a focal point of global concern over the human costs of climate change. The study explored determinants and idioms of distress and culturally prescribed responses to coping with distress. Results are based on fieldwork conducted in 2015 entailing semi-structured interviews with 16 key informants and 23 lay residents of Funafuti atoll, recruited using maximal variation purposive sampling. Findings are examined in consideration of the unfolding impacts of climate change and the threat it portends for the future, both of which were identified as salient determinants of distress, in keeping with theorized relationships between climate change and mental health. The study underscores the necessity of attending to the relationships between global forces, local cultures, and individual experiences of distress, as efforts to provide access to culturally informed social and mental health services expand globally.

Adaptation of the Barts Explanatory Model Inventory to dementia understanding in South Asian ethnic minorities

OBJECTIVE

Studies indicate a limited understanding of dementia and its associated symptoms, causes and consequences among South Asian older adults. As a consequence, fewer people from this ethnic group receive a diagnosis of dementia. The aim of this study was to adapt the previously designed Barts Explanatory Model Inventory Checklist (BEMI-C), a tool designed to elicit perceptions of mental illness from people with different cultural backgrounds, for use with people with dementia in the South Asian population.

METHOD

Both a literature review and 25 qualitative interviews were conducted to find themes and perceptions that are relevant to the South Asian culture in recognising and dealing with symptoms of dementia. The emergent themes and perceptions were then added to the BEMI-C through synthesis of findings.

RESULTS

The initial four checklists of symptoms, causes, consequences and treatments from the BEMI-C were retained in the new BEMI-Dementia (BEMI-D) and expanded with six additional themes, including 123 new perceptions relevant to the understanding of dementia. All new themes emerged from the qualitative interviews, some of which were also found in the literature.

CONCLUSION

Given the national priority of improving dementia awareness and timely diagnosis, the BEMI-D can serve as a useful tool, in research and perhaps practice, to assess the barriers to dementia service uptake in this population and their understandings of dementia. Based on the detailed methodological description of the adaptation of the BEMI-C, this paper further suggests how this tool can be adapted to suit other ethnic minority groups.

Mental Health and Service Issues Faced by Older Immigrants in Canada: A Scoping Review

Une population vieillissante et la croissance de la population sur la base de l’immigration nécessitent que la recherche, la pratique et la politique doivent se concentrer sur la santé mentale des immigrants âgés, surtout parce que leur santé mentale semble se détériorer au fil du temps. Cette revue se concentre sur: Qu’est-ce que l’on sait sur les déterminants sociaux de la santé mentale chez les immigrants âgés, et quels sont les obstacles à l’accès aux services de santé mentale confrontés par les immigrants âgés? Les résultats révèlent que (1) les déterminants sociaux décisifs de la santé mentale sont la culture, le sexe et les services de santé; (2) que les immigrants plus âgés utilisent les services de santé mentale de moins que leurs homologues nés au Canada à cause des obstacles tels que, par exemple, les croyances et les valeurs culturelles, un manque de services culturellement et linguistiquement appropriées, des difficultés financières, et l’âgisme; et (3) quelles que soient les sous-catégories dans cette population, les immigrants âgés éprouvent des inégalités en matière de la santé mentale. La preuve des recherches disponibles indique que de combler les lacunes des service de santé mentale devrait devenir une priorité pour la politique et la pratique du système de soins de santé au Canada.

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.

Perspectives on ageing, later life and ethnicity: ageing research in ethnic minority contexts

This special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of 'ethnicity' (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of 'otherness' within the predominant existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic 'difference'. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and 'otherness' is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly (re)produced, within (and through) research itself - for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à-vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants' ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.

South Asian older adults with memory impairment: improving assessment and access to dementia care

OBJECTIVE

With increasing international migration, mental health care of migrants and ethnic minorities is a public health priority. South Asian older adults experience difficulties in accessing services for memory impairment, dementia and mental illness. This review examines barriers and facilitators in the pathway to culturally appropriate mental health care.

METHODS

Web of Knowledge, Pubmed and Ovid databases were searched for literature on South Asian older adults or their family carers, their understandings of mental illness and dementia and their pattern of service use. Dates were from 1984 to 2012. Abstracts were assessed for relevance, followed by detailed reading of salient papers. Three researchers rated the quality of each included study. A narrative synthesis was undertaken of extracted and charted data.

RESULTS

Eighteen studies met the eligibility criteria for the review. South Asians and health professionals highlighted several difficulties which deterred help seeking and access to care: a lack of knowledge of dementia and mental illness, and of local services; stigma; culturally preferred coping strategies; and linguistic and cultural barriers in communication and decision making.

CONCLUSIONS

To improve access for these groups, service users and providers need to be better informed; services need to be more culturally tailored, sometimes employing staff with similar cultural backgrounds; and health professionals can benefit from dementia education and knowledge of local services. These factors are key to the delivery of the National Dementia Strategy in England.

Immigration and loneliness in later life

Although the loneliness of both older adults and immigrants is frequently asserted, knowledge regarding the implications of immigration for loneliness in later life is limited. In particular, little attention has been directed to the impact of factors that might differentiate individuals within the immigrant population. Using data from the 2007 General Social Survey (GSS-21) conducted by Statistics Canada, this study examined the effects of immigrant status as well as immigrant generation, length of residence in Canada and race/ethnicity on loneliness among adults aged 60 and over (N=10,553). Regression analyses (ordinary least squares) estimating both the general and age-specific effects of immigrant experience on loneliness, indicated that immigrants report higher levels of loneliness than native-born Canadians, that race/ethnicity influenced loneliness particularly among immigrants and that generational status as well as length of residence also had an impact, but one that differed across age groups. Immigration-related variables appeared less consequential for loneliness in the oldest-old (aged 80+) than in younger elderly age groups. These findings attest to the significance of immigrant status for an understanding of loneliness in later life but suggest a need to acknowledge the diversity of immigrant experiences associated with lifecourse and other factors.

Theorising about ageing, family and immigration

This article critically reviews the ways in which theories in social gerontology have been used to explain the influence of ethnicity and immigration on older adults. The purpose of this cursory examination is to explore how these theories can be used for further theory advancement without serious modifications to existing theories. Current theories do not have the capacity to capture the effects of immigration at the structural level and its link to the social, psychological and family levels, let alone the physical ageing of individuals or societies. The overriding complexity of ageing and immigration requires at minimum, a long-term view and an integrating framework with multiple levels that can accommodate a variety of theoretical interests. The conclusions are that a lifecourse perspective, in conjunction with existing theories, can be employed in two different ways to further this theoretical agenda. A lifecourse perspective provides scaffolding for other theories where seemingly incommensurate epistemological positions can be easily accommodated and the principles of the lifecourse can be integrated into existing theories for a more fine-grained analysis of ethnicity and immigration. These approaches leave the theoretical door open to everyone including the positivists, the constructionists and critical and postmodern scholars with the possibility for interdisciplinary theory building to advance the understanding of the lives of immigrant families.