Immigrant and Racialized Populations' Cumulative Exposure to Discrimination and Associations with Long-Term Conditions During COVID-19: A Nationwide Large-Scale Study in Canada.

BACKGROUND: This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions. METHODS: A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada's Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates. RESULTS: During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p's < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p's < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41). CONCLUSIONS: Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.

Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada.

OBJECTIVES: Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus. METHODS: This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10). RESULTS: Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters. DISCUSSION: Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.

Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada.

OBJECTIVES: Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. METHODS: Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. RESULTS: Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. DISCUSSION: To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency.

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Chronic Care for All? The Intersecting Roles of Race and Immigration in Shaping Multimorbidity, Primary Care Coordination, and Unmet Health Care Needs Among Older Canadians.

OBJECTIVES: Despite the predominance of chronic disease clustering, primary care delivery for multimorbid patients tends to be less effective and often uncoordinated. This study aims to quantify racial-nativity inequalities in multimorbidity prevalence ≥3 chronic conditions), access to primary care, and relations to past-year subjective unmet health care needs (SUN) among older Canadians. METHODS: Population-based data were drawn from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was performed to estimate the likelihood of multimorbidity, sites of usual source of primary care (USOC), primary care coordination, and multidimensional aspects of SUN. The Classification and Regression Tree (CART) was applied to identify intersecting determinants of SUN. RESULTS: The overall sample (n = 19,020) were predominantly (69.4%) Canadian-born (CB) Whites (1% CB non-Whites, 18.1% White immigrants, and 11.5% racialized immigrants). Compared with CB Whites, racialized immigrants were more likely to have multimorbidity (adjusted odds ratio [AOR] = 1.35, 99% confidence interval [CI]: 1.13-1.61), lack a USOC (AOR = 1.41, 99% CI: 1.07-1.84), and report higher SUN (AOR = 1.47, 99% CI: 1.02-2.11). Racialized immigrants' greater SUN was driven by heightened affordability barriers (AOR = 4.31, 99% CI: 2.02-9.16), acceptability barriers (AOR = 3.11, 99% CI: 1.90-5.10), and unmet needs for chronic care (AOR = 2.71, 99% CI: 1.53-4.80) than CB Whites. The CART analysis found that the racial-nativity gap in SUN perception was still evident even among those who had access to nonpoorly coordinated care. DISCUSSION: To achieve an equitable chronic care system, efforts need to tackle affordability barriers, improve service acceptability, minimize service fragmentation, and reallocate treatment resources to underserved older racialized immigrants in Canada.

The "loneliness epidemic", intersecting risk factors and relations to mental health help-seeking: A population-based study during COVID-19 lockdown in Canada.

BACKGROUND: Pandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada. METHODS: A population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7). RESULTS: The estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26-1.85), those who were younger (OR's range 1.42-3.00), women without college degree (OR = 1.44, 99 % CI: 1.01-2.04), those living alone (OR = 1.56, 99 % CI: 1.09-2.23), immigrant men (OR = 1.79, 99 % CI: 1.23-2.60), those with small network (OR's range: 1.73-3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04-4.28), past-month binge drinkers (OR's range: 1.39-1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12-1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness. Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21-2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17-1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29-2.49). LIMITATIONS: Cross-sectional data prohibits causal inferences. CONCLUSION: The COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.

Generalized anxiety disorder during COVID-19 in Canada: Gender-specific association of COVID-19 misinformation exposure, precarious employment, and health behavior change.

BACKGROUND: Growing evidence has demonstrated the mental health sequelae of the COVID-19 pandemic. Few studies have examined how pandemic-related stressors and resilience factors of anxiety affect women and men differently in Canada. METHODS: Population-based data from the Canadian Perspective Survey Series (CPSS-4: July 20 to 26, 2020) were analyzed to examine the relationship between Generalized Anxiety Disorder-7 scale (GAD-7) with COVID-19 misinformation exposure, precarious employment, and health behavior changes, after adjusting for socio-demographic variables. Stratified by gender, two multinomial logistic regression were conducted to calculate the likelihood of having minimal-mild anxiety (1≤ GAD score <10) and moderate-severe anxiety (GAD score ≥10), compared to no anxiety symptoms (GAD=0). RESULTS: Overall, respondents (n = 3,779) were mainly Canadian-born (76.3%), aged >25 years (85.4%) and high school graduate (87.9%). The population prevalence of moderate-severe GAD was 13.6%, with women significantly higher than men (17.2% vs. 9.9%, p<0.001). For women (n = 2,016), GAD was associated with being absent from work due to COVID-19 reasons (OR=3.52, 99% CI:1.12-11.04), younger age (ORs range from 2.19 to 11.01, p's<0.01), being single/widowed (OR=2.26, 99% CI 1.18-4.33), no past-week contacts outside household (OR=2.81, 99% CI:1.24-6.37), no outdoor exercise (OR=1.86, 99% CI:1.13-3.07). For men (n = 1,753), GAD was associated with frequent fake news exposure (dose-response relations: ORs range from 3.14 to 6.55, p's<0.01), increased time of watching TV (OR=2.62, 99% CI: 1.31 - 5.27), no indoor exercise (OR=1.91, 99% CI:1.07-3.42). For both genders, GAD was associated with increased intake of alcohol, cannabis, and junk/sweet food (p's<0.01). LIMITATIONS: Cross-sectional data prohibits causal inferences; self-reporting biases of GAD symptoms requires confirmation with diagnostic records. CONCLUSION: The gendered impact of the COVID-19 pandemic was observed in the associations between clinically significant anxiety with COVID-19 misinformation exposure, job precarity, and addictive behaviors in Canada. Mental health interventions need to be gender responsive and should tackle upstream social determinants of health in this public health emergency.

A Rapid Realist Review of Effective Mental Health Interventions for Individuals with Chronic Physical Health Conditions during the COVID-19 Pandemic Using a Systems-Level Mental Health Promotion Framework.

The 2020 global outbreak of COVID-19 exposed and heightened threats to mental health across societies. Research has indicated that individuals with chronic physical health conditions are at high risk for suffering from severe COVID-19 illness and from the adverse consequences of public health responses to COVID-19, such as social isolation. This paper reports on the findings of a rapid realist review conducted alongside a scoping review to explore contextual factors and underlying mechanisms or drivers associated with effective mental health interventions within and across macro-meso-micro systems levels for individuals with chronic physical health conditions. This rapid realist review extracted 14 qualified studies across 11 countries and identified four key mechanisms from COVID-19 literature-trust, social connectedness, accountability, and resilience. These mechanisms are discussed in relation to contextual factors and outcomes reported in the COVID literature. Realist reviews include iterative searches to refine their program theories and context-mechanism-outcome explanations. A purposive search of pre-COVID realist reviews on the study topic was undertaken, looking for evidence of the robustness of these mechanisms. There were differences in some of the pre-COVID mechanisms due to contextual factors. Importantly, an additional mechanism-power-sharing-was highlighted in the pre-COVID literature, but absent in the COVID literature. Pre-existing realist reviews were used to identify potential substantive theories and models associated with key mechanisms. Based on the overall findings, implications are provided for mental health promotion policy, practice, and research.

Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature.

This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.

Post-traumatic stress disorder (PTSD) in mid-age and older adults differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA).

PURPOSE: This study aimed to address knowledge gaps about post-traumatic stress disorder (PTSD) in mid-age and older adults, with particular attention to the relationship of PTSD with nutrition and with ethnicity and immigrant status. METHODS: Binary logistic regression analysis of weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (CLSA; n = 27,211) was conducted using the four-item Primary Care-PTSD tool (outcome) and immigrant status by ethnicity (Canadian-born white, Canadian-born minority, immigrant white, immigrant minority). Covariates included various social, economic, nutrition and health-related variables. RESULTS: After controlling for socioeconomic and health variables, immigrants from minority groups had significantly higher odds of PTSD compared to their Canadian-born counterparts, whereas white immigrants had lower odds of PTSD. These relationships were significantly robust across seven cluster-based regression models. After adjusting for ethnicity/immigrant status, the odds of PTSD were higher among those earning lower household incomes, widowed, divorced, or separated respondents, ever smokers, and those who had multi-morbidities, chronic pain, high nutritional risk, or who reported daily consumptions of pastries, pulses and nuts, or chocolate. Conversely, those 55 years and over, who had high waist-to-height ratio, or who consumed 2-3 fiber sources daily had significantly lower odds of PTSD. CONCLUSION: Interventions aimed at managing PTSD in mid-age and older adults should consider ethnicity, immigrant status, as well as socioeconomic, health, and nutrition status.

Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA).

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010-2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45-65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67-0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79-3.52), being a woman (aOR = 1.25, 95% CI: 1.07-1.46), single status (aOR = 1.27, 95% CI: 1.09-1.48), lower income (aORs = 1.28-2.68), multi-morbidities (aORs = 2.73-5.13), chronic pain (aOR = 1.31, 95% CI: 1.18-1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23-1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20-2.92), body fat ≥ 26% (aORs = 1.28-1.79), fruit and vegetable intake (< 3/day; aORs = 1.24-1.26), and pastry consumption (> 1/day; aOR = 1.55, 95% CI: 1.12-1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Psychological distress in older adults linked to immigrant status, dietary intake, and physical health conditions in the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Psychological distress increases mortality risk; there is little knowledge about its prevelance and contributory factors in older populations. METHODS: Canadian Longitudinal Study on Aging baseline data (2010-2015) were analyzed to examine the relationship between Kessler's Psychological Distress Scale-K10 and immigrant status (recent/mid-term,<20 years; long-term, ≥20 years; Canadian-born). Covariates included socioeconomic and health-related variables. Stratified by sex, two series of multinomial logistic regression were used to calculate the likelihood of having mild distress (20 < K10 score ≤24) and moderate/severe distress (K10 score >24). RESULTS: Respondents (n = 25,700) were mainly Canadian-born (82.8%), 45-65 years (59.3%), earning cut-off; OR=1.32, 99% CI 1.02-1.70), and higher nutritional risk (ORs = 2.16-3.31, p's <0.001). For men, psychological distress was associated with under-nutrition (grip strength56 years, ORs=0.19-0.79, p's<0.01), lower income (≤C$149,000, ORs = 1.68-7.79, p's<0.01), multi-morbidities (ORs = 1.67-4.70, p's<0.01), chronic pain (ORs = 1.67-3.09, p's<0.001) and higher intake of chocolate (≥ 0.6 bar/week, ORs=1.61-2.23, p's<0.001). LIMITATIONS: Cross-sectional design prohibits causal inferences. CONCLUSIONS: Nutritional factors, immigration status, social, and health-related problems are strongly associated with psychological distress among midlife and older adults.

Close Relations Matter: The Association Between Depression and Refugee Status in the Canadian Longitudinal Study on Aging (CLSA).

This study examined the prevalence and social determinants of depression among refugee and non-refugee adults aged 45-85 in the Canadian Longitudinal Study on Aging. Bivariate analyses and multivariable binary logistic regression analyses were conducted. The prevalence of depression was higher in a sample of 272 refugees (22.1%) and 5059 non-refugee immigrants (16.6%), compared to 24,339 native-born Canadians (15.2%). The adjusted odds ratio (aOR) of depression for refugees were not attenuated when controlling factors such as, (1) socioeconomic status, (2) health conditions and behaviours, (3) social isolation and online social networking (aORs range from 1.61 to 1.70, p's < 0.05). However, when social support representing close personal relationships was included, the odds of depression for refugees were reduced to non-significance (aOR = 1.30, 95% CI 0.97-1.74, p = 0.08). Refugees' excess vulnerability to depression is mainly attributable to lower levels of affectionate social support. Targeted interventions in nurturing supportive interpersonal relationships for refugees are warranted.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging.

BACKGROUND: Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults. METHODS: Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake. RESULTS: The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression. CONCLUSIONS: The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.