Predictors of positive mental health among refugees: Results from Canada's General Social Survey.

Do refugees have lower levels of positive mental health than other migrants? If so, to what extent is this attributable to post-migration experiences, including discrimination? How does gender affect the relationships between post-migration experience and positive mental health? To address these questions, the current study uses data from Statistics Canada's 2013 General Social Survey (GSS), a nationally representative household study that included 27,695 Canadians 15 years of age and older. The study compares self-reported positive mental health among 651 refugees, 309 economic immigrants, and 448 family class immigrants from 50 source countries. Immigration-related predictors of mental health were examined including sociodemographic characteristics, discrimination, acculturation variables, and experiences of reception. Separate analyses were carried out for women and men. Refugees had lower levels of positive mental health than other migrants. Affiliative feelings towards the source country jeopardized refugee, but not immigrant mental health. A sense of belonging to Canada was a significant predictor of mental health. Perceived discrimination explained refugee mental health disadvantage among men, but not women. Bridging social networks were a mental health asset, particularly for women. The implications of anti-refugee discrimination net of the effects of anti-immigrant and anti-visible minority antipathies are discussed, as well as possible reasons for gender differences in the salience of mental health predictors.

Differential impact of parental region of birth on negative parenting behavior and its effects on child mental health: Results from a large sample of 6 to 11 year old school children in France.

BACKGROUND: In France, one in 10 residents has immigrated mainly from North Africa, West Africa or the Caribbean including the French West Indies. However little is known about how parents from these regions behave when they migrate to countries that have different cultural norms. It is therefore important to determine how ethno-cultural background affects parental behavior and subsequent child mental health in the context of immigration. The objectives are: 1) to compare negative parenting behaviors of French residents from diverse ethno-cultural backgrounds 2) to examine the relationship between parental region of origin and child mental health, and 3) to investigate the extent to which ethno-cultural context moderates the effect of parenting styles on child mental health. METHODS: A cross-sectional study was conducted in 2005 in 100 schools in South-East France. The Dominic Interactive and the parent-reported Strengths and Difficulties Questionnaire were used to assess child psychopathology. The Parent Behavior and Attitude Questionnaire was used to assess parenting styles. The final sample included data on 1,106 mother and child dyads. RESULTS: Caring and punitive attitudes were significantly different across mothers as a function of region of origin. This association was stronger for punitive attitudes with the highest prevalence in the Caribbean/African group, while mothers from Maghreb were more similar to French natives. Differences in caring behaviors were similar though less pronounced. Among children of Maghrebian descent, punitive parenting was associated with an increased risk of internalizing disorders while this association was weaker among children of African and Afro-Caribbean descent. CONCLUSIONS: Parental region of origin is an important component of both parenting styles and their effect on child mental health. Interventions on parenting should consider both the region of origin and the differential impact of origin on the effect of parenting styles, thus allowing for a finer-grained focus on high-risk groups.

Mental Health Effects of Premigration Trauma and Postmigration Discrimination on Refugee Youth in Canada.

This report examines the role of pre- and post-migration trauma in explaining differences in refugee and immigrant mental health. Data were derived from mother-youth refugee and immigrant dyads from six countries of origin who were living in Canada at the time of the study. Youth reports of emotional problems (EP) and aggressive behavior (AB) were the mental health outcomes. EP and AB were regressed on predictor blocks: a) status (refugee versus immigrant), visible minority, and gender; b) premigration trauma and postmigration discrimination; c) parent and youth human and social capital; d) poverty, neighborhood, and schools. Refugees suffered higher levels of EP and AB, premigration traumas, and discrimination. Postmigration perception of discrimination predicted both EP and AB and explained immigrant versus refugee differences in EP. Antirefugee discrimination net of discrimination based on immigrant or visible minority status has deleterious mental health consequences.

Chronic health conditions, labour market participation and resource consumption among immigrant and native-born residents of Canada.

OBJECTIVES: To compare chronic illnesses, economic dependence and health-care use by immigrants and native-born Canadians. METHODS: A secondary analysis of the Canada Community Health Survey national data (2009-2010) was conducted. RESULTS: Recent and established immigrants were healthier than native-born Canadians. Healthy, established immigrants were more likely than native-born Canadians to be working, and no more likely to use transfer payments. Health-challenged recent immigrants had high employment rates, but low rates of health care. Health-challenged established immigrants and native born were equally likely to be working, depending on transfer payments and using health care. Regardless of nativity or health, education, male gender and linguistic fluency increased the probability of employment. Female gender and advancing age increased the likelihood of dependency. Residents of Canada's most prosperous regions were the most likely to be employed and the least likely to receive transfer payments. CONCLUSIONS: Immigrants with chronic illnesses do not inevitably dilute the economic benefits of immigration or create excessive burden. Timely programs to promote integration can help ensure a favourable balance between economic contribution and social cost. Neglecting the health of new immigrants may eventuate in long-term disability.

Predictors of immigrant children's mental health in Canada: selection, settlement contingencies, culture, or all of the above?

BACKGROUND AND STUDY AIMS: A previous publication from the New Canadian Children and Youth Study, a national study of immigrant children and youth in Canada, showed a gradient of levels of emotional distress with children from Hong Kong (HK) at the most severe end, Filipino children at the least severe, and children from the People's Republic of China (PRC) in between. Based on the premise that country of origin can be regarded as an index for differing immigration trajectories, the current study examines the extent to which arrival characteristics, resettlement contingencies and cultural factors account for country of origin variations in immigrant children's mental health. Arrival characteristics included child's age at arrival, parental education, parental fluency in English or French, and assistance from family at arrival. Resettlement contingencies included parental mental health, intra-familial conflict, settlement stress, separations from parents and child's age when mother started working outside the home. Cultural factors included one-child family composition and parenting styles. METHODS: A national survey of 2,031 families with at least one child between the ages of 4 and 6 or 11 and 13 from HK, the PRC and the Philippines was conducted with the Person Most Knowledgeable (PMK) in snowball-generated samples in 6 different cities across Canada. Predictors of the dependent variable, emotional problems (EP), were examined in a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; arrival characteristics were added in model 2; resettlement contingencies in model 3 and cultural factors in model 4. RESULTS: The final set of predictor variables accounted for 19.3 % of the variance in EP scores among the younger cohort and 23.2 % in the older. Parental human and social capital variables accounted for only a small amount of the overall variance in EP, but there were statistically significant inverse relationships between EP and PMK fluency in English or French. Settlement contingencies accounted for a significant increase in the explanatory power of the regression equation, net of the effects of country of origin and selection characteristics. This block of variables also accounted for the Filipino mental health advantage. Levels of parent's depression and somatization, harsh parenting, intrafamilial conflict, and resettlement stress each varied directly with levels of children's EP. Cultural variables made a significant contribution to explaining the variance in EP scores. Harsh parenting was significantly associated with increased levels of EP in both age groups, and supportive parenting was a mental health protective factor for younger children. CONCLUSIONS: Immigrant family human and social capital, according to which immigrants are selected for admission to Canada, play a relatively small role in determining children's mental health. These effects are overshadowed by resettlement contingencies and cultural influences. Concentrating on trying to find a formula to select the "right" immigrants while neglecting settlement and culture is likely to pay limited dividends for ensuring the mental health of children.

A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa, Ethiopia, and Toronto, Canada.

According to a literature of theory and advocacy, immigration and resettlement jeopardize the mental health of children and youth, largely because of factors such as intergenerational tensions arising from conflicts about the retention of traditional values, and experiences of prejudice and discrimination. The current study examines the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada, were compared with a matched sample of Ethiopian youngsters in Addis Ababa, Ethiopia. Data came from structured interviews with the person most knowledgeable about the family (usually a parent), as well as from the children themselves. Youth reported higher levels of emotional problems (EP) than their parents. Predictors differed for parent and child ratings. In both the Toronto and Addis Ababa samples, parental mental health predicted parent-rated, but not self-rated EP. Contrary to immigration stress theory, parental perceptions of prejudice predicted EP in Addis Ababa, but not Toronto, and parent-child discordance regarding ethnic adherence were predictors of self-rated emotional problems in Ethiopia, but not in Canada. Perceived discrimination was a significant predictor of self-rated emotional problems in both settings. Implications for theory and further research are discussed.

Perceived ethnic discrimination and social exclusion: newcomer immigrant children in Canada.

This article examines relationships between perceived ethnic discrimination, social exclusion, psychosocial functioning, and academic performance among newcomer immigrant children from the People's Republic of China, Hong Kong, and the Philippines using a subsample from the New Canadian Children and Youth Study of children aged 11-13 years (1,053) living in Montreal, Toronto, Vancouver, and the Prairies. Bivariate analysis showed that 25% of children reported being treated unfairly by peers and 14% by teachers because of who they are. Regression analyses revealed that perceived ethnic discrimination by peers and teachers was negatively related to children's sense of social competence in peer relationships. Children's self-esteem and sense of academic competence were negatively related to perceived discrimination by teachers. One in 5 children reported feeling like an outsider, with boys revealing higher levels of psychological isolation than girls. More than 1 in 10 were socially isolated and reported never participating in organized activities. This may reflect economic exclusion, as over one third of respondents belonged to families living below the Canadian Income Adequacy Measure. Psychological isolation, social isolation, and economic exclusion were significant predictors of children's sense of academic competence and actual academic grades. Variations exist across age, sex, ethnicity, family structure, parental education, region of settlement, and length of time since arrival in Canada.

Stresses of passage, balms of resettlement, and posttraumatic stress disorder among Sri Lankan Tamils in Canada.

OBJECTIVES: To explore the salience of pre- and postmigration stresses as risk factors for posttraumatic stress disorder (PTSD) and to identify resilience factors and explore their mental health salience. METHODS: We conducted a mental health survey of 1603 Sri Lankan Tamils in Toronto, incorporating the World Health Organization Composite International Diagnostic Interview for PTSD. RESULTS: According to the International Classification of Diseases, 10th Revision, criteria, lifetime prevalence for PTSD was 12%; according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria it was 5.8%. Female sex and the number of stresses of passage increased the probability of PTSD, whereas satisfaction with life and the availability of nonfamily social relations reduced it. CONCLUSIONS: Consideration of pre- and postmigration stresses of passage and of the nature of resilience contributes to an improved understanding of PTSD among refugees.

A career in culture and psychiatry research: reflections on forty-plus years.

The report chronicles a 44-year career in cultural psychiatry spent at Duke, Cornell, Harvard, the University of British Columbia, the University of Toronto, and Ryerson Universities. It describes my studies in a rural community in Nova Scotia, in traditional villages in Senegal, West Africa, on Canadian First Nations reserves and American Indian reservations, in refugee camps in Southeast Asia, among immigrant and refugee communities in Canada, in Ethiopia, and in Israel. The report summarizes major findings resulting from these research efforts, and discusses contributions to theory as well as potential implications for practice as well as policy. The article concludes with reflections about the present state of cultural psychiatry, raises concerns about where the field seems to be in danger of going wrong, and offers suggestions about what needs to be done next.

Regional effects on the mental health of immigrant children: results from the New Canadian Children and Youth Study (NCCYS).

Children in immigrant families from Hong Kong, Mainland China, and the Philippines living in Toronto and Montreal are at higher risk of Emotional Problems than children in immigrant families in Winnipeg, Calgary, Edmonton, and Vancouver (Beiser et al., 2010). The current publication explores human capital, social capital, institutional receptivity, and perceptions of welcome as explanations for regional disparities. Parent's lack of linguistic fluency, and depressive symptoms provided the most likely explanation for Montreal's mental health disadvantage. Immigrant human and social capital, poor home-school relationships, marginalization, and lack of neighborhood organization contributed to the prediction of risk for emotional problems among immigrant children in Toronto, but may not fully account for differences between Toronto and Vancouver.

Human-initiated disaster, social disorganization and post-traumatic stress disorder above Nigeria's oil basins.

Survivors of human-initiated disaster are at high risk for mental disorder, most notably post-traumatic stress disorder (PTSD). Studies of PTSD have tended to focus on soldiers returning home after combat or on refugees living in resettlement countries under conditions of relative safety. However, most survivors of human-initiated disasters continue to live in or near the places where they initially experienced trauma. Insufficient attention has been paid to social disorganization in situations of continuing unrest and to its role in creating or stabilizing the symptoms of PTSD. The current study took place in the Niger Delta region of Nigeria, the scene of long-standing violence and human rights abuse that reached its apogee in 1995. The investigation, which took place in 2002, focused on two villages, one that was heavily exposed to the conflict (A, the affected village), the other relatively spared (NA, not affected). Probability samples of 45 adult residents from A and 55 from NA were interviewed with a schedule that contained the PTSD module from the WHO Diagnostic Interview Schedule. The schedule also contained a measure of exposure to the violence and abuses during the height of the conflict, as well as measures of structural and social capital that are components of community resilience. These included economic security, a sense of moral order, a sense of safety and perceived social support. The six month period prevalence of PTSD was 60 percent in A, and 14.5 percent in NA. Degree of exposure to stress as well as compromised sense of moral order, not feeling safe, and perceived lack of social support were independent predictors of PTSD. In places like the Niger Delta, where people do not physically escape from past trauma, sociocultural disintegration may interfere with communal functioning, thereby eroding community capacity to promote self-healing.

Predictors of emotional problems and physical aggression among children of Hong Kong Chinese, Mainland Chinese and Filipino immigrants to Canada.

BACKGROUND AND STUDY AIMS: Data from the New Canadian Children and Youth Study (NCCYS), a national study of immigrant children and youth in Canada, are used to examine the mental health salience of putatively universal determinants, as well as of immigration-specific factors. Universal factors (UF) include age, gender, family and neighbourhood characteristics. Migration-specific (MS) factors include ethnic background, acculturative stress, prejudice, and the impact of region of resettlement within Canada. METHODS: In a sample of children from Hong Kong, the Philippines and Mainland China, the study examined the determinants of emotional problems (EP), and physical aggression (PA). A two-step regression analysis entered UF on step 1, and MS variables on step 2. RESULTS: Universal factors accounted for 12.1% of EP variance. Addition of MS variables increased explained variance to 15.6%. Significant UF predictors: parental depression, family dysfunction, and parent's education. Significant MS variables: country of origin, region of resettlement, resettlement stress, prejudice, and limited linguistic fluency. UF accounted for 6.3% of variance in PA scores. Adding migration-specific variables increased variance explained to 9.1%. UF: age, gender, parent's depression, family dysfunction. MS: country of origin, region of resettlement, resettlement stress, and parent's perception of prejudice. CONCLUSIONS: Net of the effect of factors affecting the mental health of most, if not all children, migration-specific variables contribute to understanding immigrant children's mental health.

Resettling refugees and safeguarding their mental health: lessons learned from the Canadian Refugee Resettlement Project.

The Ryerson University Refugee Resettlement Project (RRP), a decade-long study of 1348 Southeast Asian refugees who came to Canada between 1979 and 1981, is one of the largest, most comprehensive and longest-lived investigations of refugee resettlement ever carried out. Knowledge gleaned from the RRP about research methodology, about the resettlement experience, about the social costs of resettling refugees, about factors that promote or hinder integration, about risk and protective factors for refugee mental health, and about the refugees' consumption of mental health and social services is summarized in the form of 18 "Lessons." The lessons are offered in order to encourage and stimulate further research, as well to suggest policy and practice innovations that could help make resettlement easier, less costly, more effective, and more humane.

Longitudinal research to promote effective refugee resettlement.

Canada's relative generosity in admitting refugees and fairness in considering refugee claims has earned this country an enviable reputation. However, having opened its doors to those selected, Canada's resettlement policies and programs fail to provide for their needs, and to promote their optimal adaptation. Based on a decade-long investigation of the resettlement of more than 1300 Southeast Asian refugee--'Boat People'--the current report examines how research concerning (a) the impact of pre-migration trauma; (b) the mental health impact of social resources such as the like-ethnic community, refugee sponsorship programs, and language training; and (c) individual coping strategies such as suppressing the past, can contribute both to theory and to improving policy and practice. The presentation acknowledges the contributions of Dr. Alexander H. Leighton by demonstrating the importance of his insistence on the need for a longitudinal perspective both for conducting research and for planning programs and services.

Ethnic identity, resettlement stress and depressive affect among Southeast Asian refugees in Canada.

Does commitment to an ethnic identity enhance or jeopardize psychological well-being? Using data from a study of Southeast Asian "Boat People", this study examined the mental health effects of ethnic identification as the former refugees confronted common resettlement stressors in Canada--unemployment, discrimination and lack of fluency in the dominant society language. The study team administered a questionnaire to 647 respondents covering ethnic identification, demographic and employment information, language fluency, experiences with discrimination, and depressive affect. Context helped determine the relationship between ethnic identification and depressive affect. When the Southeast Asians encountered racial discrimination or unemployment, ethnic identity attachment amplified the risk of depressive affect. By contrast, a strongly held ethnic identity provided a psychological advantage for individuals experiencing difficulties with the dominant language.

The health of immigrants and refugees in Canada.

Canada admits between more than 200,000 immigrants every year. National policy emphasizes rigorous selection to ensure that Canada admits healthy immigrants. However, remarkably little policy is directed to ensuring that they stay healthy. This neglect is wrong-headed: keeping new settlers healthy is just, humane, and consistent with national self-interest. By identifying personal vulnerabilities, salient resettlement stressors that act alone or interact with predisposition in order to create health risk, and the personal and social resources that reduce risk and promote well-being, health research can enlighten policy and practice. However, the paradigms that have dominated immigrant health research over the past 100 years--the "sick" and "healthy immigrant," respectively--have been inadequate. Part of the problem is that socio-political controversy has influenced the questions asked about immigrant health, and the manner of their investigation. Beginning with a review of studies that point out the shortcomings of the sick immigrant and healthy immigrant paradigms, this article argues that an interaction model that takes into account both predisposition and socio-environmental factors, provides the best explanatory framework for extant findings, and the best guide for future research. Finally, the article argues that forging stronger links between research, policy and the delivery of services will not only help make resettlement a more humane process, it will help ensure that Canada benefits from the human capital that its newest settlers bring with them.

Providing social support for immigrants and refugees in Canada: challenges and directions.

In this article we report research findings from a qualitative study of social support for immigrants and refugees in Canada. We focus on challenges from the perspectives of 137 service providers and policymakers in health and immigrant settlement who participated in in-depth interviews and focus groups in three Canadian cities. Results show that social support is perceived to play an important role in immigrant settlement and to have a positive impact on immigrant health, although immigrants face many systemic challenges. Systemic issues--limited resources, lack of integration of policies and programs and narrow service mandates--also limit service providers' abilities to meet newcomer's needs. This research suggests that changes in public discourse about immigrants' contributions, improved governance and service coordination, and a holistic, long-term perspective are important to more effectively support immigrant settlement and to promote immigrant health and well being.

Social support and the significance of shared experience in refugee migration and resettlement.

This article examines the role of social support as a determinant of refugee well-being and migration patterns during early resettlement. Analysis is based on qualitative in-depth interviews with 47 government-assisted refugees in Canada and 38 key informants (settlement service providers and immigration officials) in Canada and overseas. The study describes refugees' decision making during stages of migration and resettlement, from whom they seek social support in particular situations, what sources are appraised as most important, and what is significant about the support. The authors suggest that a goal of refugees support-seeking strategies is affirmation through shared experience.

Sensitivity and specificity of select biological indices in characterizing psychotic patients and their relatives.

BACKGROUND: Although studies have detailed biological abnormalities in schizophrenia patients and their first-degree biological relatives, few studies have directly compared the utility of biological indices in these individuals. METHODS: Measures of global smooth-pursuit ocular motor (OM) function, low frequency and alpha band electroencephalogram (EEG) power, and nonspecific fluctuations (NSF) in electrodermal activity and visibility of the plexus in the nailfold were collected from 136 schizophrenia patients and 67 of their first-degree biological relatives, 71 affective disorder psychotic patients and 68 of their first-degree biological relatives, and 169 nonpsychiatric comparison subjects. We conducted receiver operator characteristic (ROC) analyses to determine how well each index differentiated the patient groups and the groups of first-degree relatives. RESULTS: Smooth-pursuit ocular motor function, low frequency and alpha band EEG power, and nailfold plexus visibility differentiated schizophrenia patients from nonpsychiatric comparison subjects. Nailfold plexus visibility was the only measure that significantly differentiated schizophrenia patients from both nonpsychiatric controls and affective patients. Smooth-pursuit ocular motor function and the number of electrodermal nonspecific fluctuations differentiated relatives of schizophrenia patients from nonpsychiatric comparison subjects. CONCLUSION: Increased nailfold plexus visibility may mark a process associated with abnormal brain development leading to schizophrenia. Smooth-pursuit dysfunction may mark genetic vulnerability that is relatively specific to schizophrenia.