Abstract

Background

Few quantitative studies have used national-level data to examine access to mental health consultation (MHC) by immigrants in Canada, and even fewer studies investigate MHCs using the following variables: immigrant admission category, duration in Canada since landing and world source regions. This study examines MHCs by immigrants and refugees—compared with those of Canadian-born respondents—while controlling for self-reported mental health (SRMH) and immigrant characteristics, using a population-based survey linked to immigrant landing information. This study, which is based on a linked database, allows for much richer insight into immigrant populations than most previous studies.

Data and methods

Based on data from four cycles (2011 to 2014) of the Canadian Community Health Survey linked to data from the Longitudinal Immigration Database, the odds ratios of having had MHCs are compared between the Canadian-born population and immigrants by immigration dimensions, while controlling for SRMH. Results are hierarchically adjusted for age, sex, socioeconomic factors and sense of belonging.

Results

After the above-mentioned factors were controlled for, immigrants were much less likely than Canadian-born respondents to access MHCs. Specifically, compared with the Canadian-born population that had high levels of SRMH, immigrants with high levels of SRMH were statistically less likely to have had an MHC (odds ratio [OR]=0.5, 95% confidence interval [CI] from 0.4 to 0.5), while those with low SRMH levels were more likely to report an MHC (OR=4.8, 95% CI from 4.5 to 5.1, for the Canadian-born population but OR=1.8, 95% CI from 1.5 to 2.1, for immigrants). Most Asian immigrants with low SRMH levels were only as likely to report MHCs as Canadian-born respondents with high SRMH levels. Refugees with low SRMH levels also had only a slightly elevated MHC level (OR=1.6, 95% CI from 1.1 to 2.3) compared with Canadian-born individuals with high SRMH levels. Overall, refugees were not more likely than immigrants of other admission categories to report having had an MHC, even though previous findings have shown that refugees report low levels of SRMH.

Interpretation

This study provides new evidence on the differences in access to MHC between Canadian‐born individuals and immigrants by various characteristics, while controlling for SRMH. Results probably reflect the structural or cultural barriers to MHC and point to a possible pathway to either maintain or improve mental health among immigrants.

Keywords

immigrant category, refugee, mental health consultations, linked data

DOI: https://www.doi.org/10.25318/82-003-x202100600001-eng

Findings

The share of immigrants and refugees in Canada reached 22% in 2016, a historical high in almost a century. Immigration is expected to be a key driver of Canada’s economy and the country’s population growth into the future. As the number of immigrants grows, and given that the immigration process and the subsequent settlement challenges can be stressful, a better understanding of newcomers’ mental health outcomes and their use of services becomes particularly important for policymakers and service providers. Mental health research is especially needed for immigrant populations and subgroups, such as refugees. Because of existing data gaps, few quantitative studies have examined immigrants’ mental health outcomes by admission class, and those that did generally reported that refugees experienced higher stress or poorer mental health outcomes than others (compared with other immigrants or the Canadian-born population). One such study, based on a nationwide health survey (i.e., the Canadian Community Health Survey [CCHS]) recently linked to the Longitudinal Immigration Database (IMDB), showed that immigrants, and especially refugees, were less likely than Canadian-born respondents to have a high level of self-reported mental health (SRMH), before controlling for socioeconomic and demographic factors. The SRMH levels significantly differed by immigrants’ world source region and by how long they had been in Canada; for example, recent arrivals and those from North Africa, the Middle East, and West and East Asia had lower levels of SRMH than the Canadian-born population. Given that mental health consultation (MHC) is important to prevent mental illness and to promote mental well-being, there is a need to examine whether a lower level of SRMH is correlated to a lack of MHC. [Full article]

Authors

Edward Ng (edward.ng@canada.ca) is with the Health Analysis Division at Statistics Canada, and Haozhen Zhang is with the Research and Evaluation Branch of Immigration, Refugees and Citizenship Canada, in Ottawa, Ontario.

End of text box