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Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Data for US adults (18 +  years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants’ health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.

The purpose of this paper is to examine the association between immigrants’ sense of community belonging and self-rated general and mental health status in Canada as well as estimate how this relationship is moderated by sex differences.

This cross-sectional study used pooled data from seven cycles of the Canadian Community Health Survey (N = 98,011) conducted between 2005 and 2018. Data were pooled to increase the sample size of the immigrant population. The surveys covered content areas such as well-being, sociodemographic, chronic diseases, self-rated general and mental health. A binary logistic regression fitted the model. Both univariate and multivariate analyses were performed between predictor variables and immigrants’ self-rated general and mental health. Descriptive statistics and adjusted odds ratios and 95% confidence intervals were estimated. Sex differences were also assessed.

This study found that slightly more than half of the respondents were female (53.2%). Generally, immigrants with a weak sense of community belonging were more likely to rate their general and mental health as poor although the association is stronger in mental health. Also factors such as older age, lower educational level, those single or never married, smoking status, physical inactivity, overweight or obesity and life stress were predictors of both poor self -rated general and mental health among immigrants. Sex differences in these risk factors were also noted.

This study has several limitations that should be noted. The first limitation is the fact that causality cannot be deduced due to the cross-sectional nature of our pooled data. Secondly, responses from this data are subject to recall bias given that the data were self-reported. Therefore, the interpretation of these results must be done with caution. Further, questions regarding the primary exposure variable of this study were restrictive. The definition of the local community which forms part of the one-item community belonging question did not define what is meant by local community, and as such, the question might be subject to different interpretations (i.e. urban or rural geography?). Lastly, this study’s findings did not stratify immigrants into countries or continents of origin. Immigrants from some countries or continents may be more prone to mental health than others.

This study shows a link between weak immigrants’ sense of community belonging and poor self-rated general and mental health status in Canada and provides suggestive evidence of how contextual factors influence health outcomes differently in society.

The purpose of this study was to explore the perceptions of African community leaders, on factors that influence substance use and mental health status of Sub-Sahara African immigrants living in the northeast region of the USA.

A social constructionist approach to grounded theory was used to understand social life’s complexity in the African community. Data analysis consisted of initial coding and focused coding, which led to the emerging of the following mid-range theories.

The following mid-range theories are developed: the work culture of Sub-Sahara African immigrants may influence substance-use behaviors, impact treatment for mental health and contribute to interpersonal conflicts related to marriage and parenting; there may be a relationship between the culture of privacy and spirituality because the church is often a place of comfort, and many may not seek treatment for mental health for fear of losing that community; Sub-Sahara African immigrants’ mental health and substance-use behaviors are influenced by unique factors that stem from balancing living in the new culture while also preserving their unique cultural norms.

The analysis of perceptions of African community leaders underscored “On the go” as a metaphor for describing Sub-Sahara African immigrants.

During exposure to new cultures, immigrants face numerous life changes and challenges, which negatively affect mental health, yet environmental supports may address these concerns. This study aims to examine how neighborhood quality, acculturation and acculturative stress are associated with immigrants’ mental health.

The sample consisted of 511 Asian immigrants who were born in their country of origin and immigrated to the USA. Path analysis using analysis of moment structures (version 22.0) was conducted to test the hypothesized model.

The results from the path analysis indicated that perceived neighborhood quality and acculturative stress had direct effects on mental health among Asian immigrants. The study also found a significant indirect pathway to mental health where more favorable perceptions of neighborhood quality were associated with higher levels of acculturation and lower levels of acculturative stress, which, in turn, resulted in better mental health.

The results of the study highlight the importance of improving neighborhood quality as a means by which to facilitate cultural adjustment/adaptation to US culture and thus, improve mental health among Asian immigrants. In addition, the authors suggested considering cultural origin in designing health programs and/or policies for Asian immigrants, which could promote mental health among Asian immigrants. Based on the results of the model, this study produced insightful information and suggestions on how to improve Asian immigrants’ mental health more effectively.

High socioeconomic status (SES) is associated with better health and lower use of health care services in the general population. Among immigrants, the relationship appears less consistent. The purpose of this paper is to determine if the relationship between income level (a proxy for SES) and use of primary health care services for mental health problems differs for natives and five immigrant groups in Norway. It also explores the moderating effect of length of stay (LoS) among immigrants.

Using data from two registers with national-level coverage, logistic regression analyses with interactions were carried out to determine the association between income level and having used primary health care services for mental health problems.

For Norwegian men and women there was a clear negative relationship between income and service use. Interaction analyses suggested that the relationship differed for all immigrant groups compared with Norwegians. When stratifying by LoS, income was not associated with service use among recently arrived immigrants but was negatively associated among immigrants staying more than two years (with the exception of Pakistani and Iraqi women).

Country of origin and LoS should be considered when applying measures of SES in immigrant health research.

There may be an initial transition period for recently arrived immigrants where competing factors mask the association between SES and service use.

This study benefits from nationwide coverage, eliminating self-selection biases. It demonstrates the complexity of the relationship between SES and health care use.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings.

Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston.

Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services.

Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth.

Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations.

In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted.

Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed.

Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.

Compte tenu du nombre croissant de réfugiés et d'immigrants au Canada, cette étude vise à identifier les obstacles aux services de santé mentale pour les nouveaux arrivants immigrants et réfugiés au Québec et à examiner comment les services de santé mentale peuvent être améliorés pour ces populations.

Dans cette étude qualitative, des entretiens individuels semi-structurés avec professionnels de la santé parlant le Farsi et entretiens avec des participants des organisations communautaires au Québec ont été menées.

Les participants, tant des professionnels de la santé que des membres de la communauté, ont déclaré que les services de santé mentale sont inaccessibles aux immigrants et réfugiés parlant le Farsi. Obstacles structurels, les barrières linguistiques, la sécurité culturelle et la stigmatisation ont été identifiées comme des obstacles à l'accès aux soins. Les stratégies recommandées pour améliorer l'accès aux soins de santé mentale sont discutées.

De nombreuses études ont montré que les barrières linguistiques et culturelles sont associées à les inégalités en matière de santé et la sous-utilisation des services de santé mentale chez les minorités linguistiques et ethniques. Cependant, les données sont limitées sur de nombreux groupes et contextes, et il est nécessaire de mieux comprendre comment les barrières linguistiques ont une incidence sur les résultats de santé, l'utilisation des services, la satisfaction des patients ou les coûts globaux pour le système de santé ou à la société. En réponse à cet écarte, la présente étude examine comment l'accès aux services de santé mentale pour les nouveaux arrivants parlant le farsi peuvent être limités par des barrières structurelles et linguistiques et des différences culturelles, ainsi que d'identifier les stratégies de réduire les obstacles identifiés.

There is a need for cost-effective strategies to counteract mental health challenges among immigrant women. This study aims to identify how nature might improve the mental health status of immigrant women residing in Norway.

Qualitative data were gathered through individual interviews with 14 immigrant women from Iran (2), Poland (2), Palestine, Afghanistan, Congo, Kenya, Thailand, Russia, Portugal, Latvia, Colombia and Bulgaria.

The qualitative content analysis revealed that interaction with nature positively influenced the immigrant women’s mental health. This occurred because of the following: exposure to nature itself, leading to mood enhancements; familiarization with the new country’s culture, nature, climate and language, facilitating feelings of mastery, attachment and belonging; social interactions, promoting immediate well-being and future social support; interacting with nature in familiar ways, reducing feelings of alienation/loss; and physical activity, improving mood and stress-related conditions. These mental health improvements were a result of interactions with various types of natural environments.

This study supports the promotion of interaction with nature among immigrant women as part of low-cost public health work. Practitioners should consider multiple arenas for potential nature-related mental health gains.

Canadian HIV/AIDS researchers, service providers and policy-makers are faced with new challenges of providing effective and inclusive care that meets the needs of the changing populations infected with and affected by HIV. Since 2005 immigrants and refugees from ethno-racial minority communities have comprised close to 20 percent of all new HIV infections in Canada. Anecdotes shared by PLWHAs and service providers indicated that mental health challenges faced by newcomer PLWHAs was a priority concern for HIV prevention, treatment and care. This paper reports on the results of an exploratory study, which examined the complex factors that influence the mental health of immigrants and refugees living with HIV/AIDS (IR-PLWHAs).

This exploratory study is informed by a critical social science paradigm, which acknowledges that the everyday reality is shaped by interlocking systems of social processes and unequal power relations. The paper used a qualitative interpretative design and focus groups to explore the intersecting effects of living with HIV/AIDS, migration and settlement, and HIV stigma and discrimination on the mental health of IR-PLWHAs.

The paper found that in addition to social and economic marginalization, IR-PLWHAs experienced multiple stressors associated with their HIV status: neurocognitive and physical impairments, HIV stigma and discrimination, and fear of deportation. The paper also found that the experiences of stigma and discrimination among IR-PLWHAs were complex and contextual, closely linked to their social positions defined by the intersecting dimensions of race, class, gender, citizenship, sexualities, body norms, and HIV status. The paper concludes that effective HIV prevention, treatment and care, and mental health promotion in newcomer and ethno-racial minority communities must consider the bio-psycho-social connections of different stressors and the interlocking systems of oppression faced by IR-PLWHAs.

This study was exploratory in nature with a small number of participants who were recruited through AIDS organizations in Toronto. Consequently, the recruitment strategy may reach only those who were connected to the AIDS organizations. The paper believes that IR-PLWHAs who were not connected to the AIDS organizations might experience even more social exclusion and marginalization. These factors may limit the transferability of this study.

This is the first study that explores the bio-psycho-social connections and intersecting determinants of mental health among immigrants and refugees living with HIV and AIDS in Canada. The results of this study contribute to cross-sector dialogue among practitioners and researchers in the HIV/AIDS, mental health, and immigration and settlement services sectors.

The purpose of this paper is to explore if and how community organizations providing services to late-in-life Punjabi immigrants in British Columbia, Canada, offer services with the potential to promote their mental health or well-being. The authors also wanted to know how Punjabi seniors perceived available services and if they supported their mental well-being.

To guide the research, the authors used the VicHealth Framework, which identifies three overarching social and economic determinants of mental health: social inclusion (SI), freedom from violence and discrimination, and access to economic resources and participation. This mixed methods study combines descriptive survey and qualitative focus group data with input from Punjabi seniors and community service providers.

All three mental health determinants were identified as important by service providers and seniors, with SI as the most important. Family dynamics (shaped by migration and sponsorship status) influence all three determinants and can promote or diminish mental well-being.

The pilot study is limited in sample size and scope and further inquiry with different groups of immigrant older adults is warranted.

Service providers assert that more outreach and sustainable funding are needed to reach the majority of potential beneficiaries unable to participate in community programmes. Information on mental well-being of seniors should be targeted at both seniors and their families.

The VicHealth Framework provided a unique lens through which to explore the contributions of community organizations to mental health promotion for immigrant older adults.