For the first 100 years of Canadas existence, most immigrants came from Europe; since the 1960s, there has been a marked shift, with greater immigration from Asia, Africa, and Central and South America.1 The mix differs across the provinces, although nearly all immigrants settle in Canadas largest cities.2 The task of preventing, recognizing and appropriately treating common mental health problems in primary care is complicated for immigrants and refugees because of differences in language, culture, patterns of seeking help and ways of coping.36. In book: Textbook of Cultural Psychiatry (pp.503-511) Authors: Would you like email updates of new search results? FOIA The stigma of a psychiatric diagnosis affects not only patients but also their siblings and other family members. 8600 Rockville Pike A mental health strategy for refugees' mental health is of utmost importance. Rather than excluding them because of privacy, meeting family members together soon before meeting alone with a patient can be an important step to building trust and a source of valuable information. The Calgary Refugee Program, Champlain Local Integrated Network and Canadian Institutes of Health Research (Institute of Health Services and Policy Research) contributed to dissemination. Participants and procedure. Mental Wellbeing and Social Resilience of Eritrean Refugees Living in Germany. How many immigrants have mental health problems?Generational status is associated with increased lifetime risk for all psychiatric disorders, such that lifetime prevalence rates for first-, second-, and third-generation immigrants are 19.3%, 35.27%, and 54.64%, respectively (9).Can immigration cause depression?We found that migration stressors increased the risk of both depressive symptoms and . The children, Prospective study of displaced childrens symptoms in wartime Bosnia. Careers. The Public Health Agency of Canada funded background papers in chronic diseases and mental illness. Mental health among children seeking asylum in Denmark the effect of length of stay and number of relocations: a cross-sectional study, Psychological needs, service utilization and provision of care in a specialist mental health clinic for young refugees: a comparative study, Mental distress, economic hardship and expectations of life in Canada among Sudanese newcomers, Discrimination, mental problems and social adaptation in young refugees, Longitudinal research to promote effective refugee resettlement, Long-term effects of organized violence on young Middle Eastern refugees mental health, Popular health promotion strategies among Chinese and East Indian immigrant women. However, a personalized referral (e.g., giving a specific name or calling the person in front of the patient) is much more likely to result in success, particularly in the case of a depressed, anxious and traumatized patient for whom re-establishment of a social network is difficult because of fear and distrust. More detailed information and resources for locating interpreters and culture brokers can be found at www.mmhrc.ca. Resettlement after migration is strongly affected by the policies, practices and opportunities of the resettlement society as well as existing ethnocultural community organizations and religious institutions, which support migrants in work and in legal, religious and social aspects of their adaptation.9,23,132 The presence of welcoming links within ethnic communities or religious congregations can buffer the effects of migration losses, isolation and discrimination. PTSD and depression are more common in refugees and refugees than in most individuals. For counselling and treating youth, interventions should be framed in ways that avoid alienating family members or aggravating intergenerational conflicts. Primary care consultations about medically unexplained symptoms: how do patients indicate what they want? Rates change based on the regions of the refugee populations, conditions of resettlement, and past historical trauma, but recent studies have shown up to 40% of settled adult refugees experience PTSD, and up to 15% experience major depression. All Rights Reserved. We provide a descriptive synthesis and discussion of the results. Note: SR = systematic review. To sign up for email alerts or to access your current email alerts, enter your email address below: Enter multiple addresses on separate lines or separate them with commas. References have been grouped into four major sections. Explain the need for especially close translation in the mental status examination (e.g., to ascertain thought disorder, emotional range and appropriateness, suicide risk). For example, although Canadian law protects confidentiality for youth older than 14 years and recognizes adult status at age 18, the cultural legitimacy of parental authority over adolescents should be taken into account. Finally, when ambivalence toward treatment or nonadherence is an issue, involvement of such mediators as a key family member or trusted family ally in discussions of the different treatment alternatives can strengthen the therapeutic alliance, empower the family and provide necessary support to the patient.124. Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way. Federal government websites often end in .gov or .mil. General health practitioners can serve as a gateway to mental health services; however, the referral process can Traditionally the refugee experience is divided into three categories: preflight, flight, and resettlement. Author(s): Laurence J Kirmayer1, Lavanya Narasiah, Marie Munoz, Meb Rashid, Andrew G Ryder, Jaswant Guzder, Ghayda Hassan, Ccile Rousseau, Kevin Pottie Publication date (Electronic): Sep 06 2011 These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Mental Health Problems among Immigrants in Israel Alexander M. Ponizovsky. Changing patterns of migration to Canada pose new challenges to the delivery of mental health services in primary care. In general, immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress.5863 This can reflect both structural and cultural barriers, including the lack of mobility or ability to take time away from work, lack of linguistically accessible services, a desire to deal with problems on ones own, the concern that problems will not be understood by practitioners because of cultural or linguistic differences, and fear of stigmatization.6468 In many developing countries, mental health services are associated only with custodial or hospital treatment of the most severely ill and psychotic patients. 15, 69 Although some studies from treatment facilities and small community samples find that migrant youth are at higher risk for psychopathologic disorders, including post-traumatic stress disorder, depression, conduct disorder (juvenile delinquency) and problems resulting from substance abuse, results from a few large-scale community surveys show that the rate of . Mezzich JE, Caracci G, Fabrega H, Jr, et al. Except in urgent situations where there is no alternative, family members or untrained lay people should not be used as interpreters.129 Several studies have documented the limits of nurses acting as interpreters. Funding: The Canadian Collaboration for Immigrant and Refugee Health acknowledges the funding support of the Public Health Agency of Canada, the Canadian Institutes of Health Research (Institute of Health Services and Policy Research), the Champlain Local Health Integrated Network and the Calgary Refugee Program. The https:// ensures that you are connecting to the Consider translation difficulties and misunderstandings and clarify any important communication that was not translated or was unclear, including nonverbal communication. official website and that any information you provide is encrypted This article aims to identify: (1) risk factors and exposures associated with the different phases of the migration trajectory and (2) strategies in the approach to mental health assessment, prevention and treatment of common mental health . Finally, when ambivalence toward treatment or nonadherence is an issue, involvement of such mediators as a key family member or trusted family ally in discussions of the different treatment alternatives can strengthen the therapeutic alliance, empower the family and provide necessary support to the patient.124. A systematic review reported that mental health problems are highly prevalent among Afghan refugees in Iran, with at least one-third suffering from one mental health problem. Struggles with job displacement, family rejection, social isolation, and lack of resources can make matters worse. PMC Refugees who have had severe exposure to violence often have higher rates of trauma-related disorders, including post-traumatic stress disorder and chronic pain or other somatic syndromes. Yoshino Y, Sato M, Abu-Siam I, Khost N, Honda S, Qarawi AT, Hassan OG, Huy NT, Kamiya Y. BMC Public Health. ABSTRACT: The United States is a country of immigrants. Epidemiology of mental health problems among immigrants. Kirmayer LJ, Groleau D, Looper KJ, et al. PubMed PubMed Central Google Scholar Rates of mental disorders vary in different migrant groups, but these differences do not simply reflect the rates in the countries of origin.11 Instead, prevalence of specific types of problems and rates of health care use in particular groups can be linked to migration trajectories in terms of adversity experienced before, during and after resettlement and to policies and practices that determine who gains admittance to Canada.12 Table 1 lists some of the migration-related factors that influence mental health and that can be explored in a clinical assessment.1223 The effect of these factors varies greatly with their severity and with their specific meaning for patients, their families and their communities, as well as for the wider society. Williams DR, Haile R, Gonzalez HM, et al. Zelkowitz P, Schinazi J, Katofsky L, et al. specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies. However, the health of immigrants tends to worsen over time to match that of the general population.29,30 For example, a recent analysis of data from the United States found that rates of depression and other disorders were lower for new immigrants (OR 0.7, 95% CI 0.50.9) but rose over time to local levels. Similarly, disclosure of diagnostic issues and family secrets (e.g., about traumatic events) should be approached carefully, with an understanding of what is at stake for the family. All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries. Nielsen SS, Norredam M, Christiansen KL, et al. 2018 BC Refugee Hub. Furthermore, such risks can create feelings of instability that can encourage substance abuse. : Common mental health problems in immigrants and refugees: general approach in primary care. Common mental health problems in immigrants and refugees: general approach in primary care, Qualitative study on mental health and well-being of Syrian refugees and their coping mechanisms towards integration in the UK, Impact of a culturally tailored parenting programme on the mental health of Somali parents and children living in Sweden: a longitudinal cohort study, Reflections of methodological and ethical challenges in conducting research during COVID-19 involving resettled refugee youth in Canada, Understanding the health and housing experiences of refugees and other migrant populations experiencing homelessness or vulnerable housing: a systematic review using GRADE-CERQual, Psychological concerns of Indian women with breast cancer in different national contexts: a systematic review and mixed-methods synthesis, Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals perspectives, Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol, Healthcare is not universal if undocumented migrants are excluded, Effectiveness and cost-effectiveness of Self-Help Plus (SH+) for preventing mental disorders in refugees and asylum seekers in Europe and Turkey: study protocols for two randomised controlled trials, Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden, Aussiedler Mortality (AMOR): cohort studies on ethnic German migrants from the Former Soviet Union, Adapting primary care for new migrants: a formative assessment, Differences in predictors of permanent work disability between immigrants and natives: a cohort study of adults with sick leave due to common mental disorders, Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial, Burden of common mental disorders in a community health centre sample, Paired suicide in a young refugee couple on the Thai-Myanmar border, Caring for a newly arrived Syrian refugee family, Using machine translation in clinical practice, Obstructive Sleep Apnea, Posttraumatic Stress Disorder, and Health in Immigrants, Canadas ethnocultural mosaic, 2006 census, Population by immigrant status and period of immigration, 2006 counts, for Canada, provinces and territories, 20% sample data (table). Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study, Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis, Ethnic minority groups, particularly AfricanCaribbean and Black African groups, are at increased risk of psychosis in the UK, Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study, The social causes of psychosis in North American psychiatry: a review of a disappearing literature, Schizophrenia and migration: a meta-analysis and review, Mood disorders and migration: meta-analysis. Thank you for your interest in spreading the word on CMAJ. Looking for a place to start? This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Look at and speak directly to the patient; use direct speech (e.g., you instead of she or he). specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and We outline basic clinical strategies for primary mental health care of migrants including the use of interpreters, family interaction and assessment, and working with community resources. The views expressed in this report are the views of the authors and do not necessarily reflect those of the funders. Among immigrants, the prevalence of common mental health problems is initially lower than in the general population, but over time, it increases to become similar to that in the general population. PMC legacy view Palinkas LA, Pickwell SM, Brandstein K, et al. The mental health of black Caribbean immigrants: results from the National Survey of American Life, Perceived racial discrimination, depression, and coping: a study of Southeast Asian refugees in Canada, Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support, Overt and subtle racial discrimination and mental health: preliminary findings for Korean immigrants, International migrations. Different studies have shown rates of PTSD and . Epub 2018 Jul 9. However, a personalized referral (e.g., giving a specific name or calling the person in front of the patient) is much more likely to result in success, particularly in the case of a depressed, anxious and traumatized patient for whom re-establishment of a social network is difficult because of fear and distrust. 2019 Feb 1;26(2):tay150. John Feightner provided crucial editorial input and advice. CMAJ 183 , E959-E967 (2011). Make a Call (855) 404-4397 - OR - Request a Call Get a Call This annotated bibliography, spanning a number of relevant disciplines, contains primarily materials in published scientific literature on refugee mental health. An official website of the United States government. In smaller communities, developing networks across social sectors and ethnocultural groups as well as with colleagues in other centres can be useful.133. Post-traumatic stress disorder seems to be more prevalent among refugees and asylum seekers than the host population Depression and anxiety are also commonly reported, linked to lengthy asylum-seeking processes and poor socioeconomic conditions, such as unemployment or isolation. Laurence J. Kirmayer, Lavanya Narasiah, . Give the patient a chance to ask questions or express concerns that have not been addressed. Discuss whether the interpreters social position in country of origin and local community could influence the relationship with the patient. Chapter 13. Kirmayer, L. J. et al. Prim Care. With the exception of Native-Americans, every other American is, or descends from, an immigrant. Each phase is associated with specific risks and exposures. Discuss the diverse circumstances immigrants and refugees face and list some of the common mental health concerns affecting these populations. The debate often centers on economic issues, overlooking the psychological concerns . Each situation requires a specific assessment of the patients needs and requirements for communication in the language in which he or she is most fluent and comfortable. More recent quantitative research indicates that, among refugees of war, rates of depression range from 3% to 55%, rates of anxiety range from 24% to 54% and rates of PTSD range from 4% to 61%. Careers. Methods: We outline basic clinical strategies for primary mental health care of migrants including the use of interpreters, family interaction and assessment, and working with community resources. However, experts in migrant mental health agree that, for maximum effectiveness, attention must be given to various contextual and practical issues that influence illness behaviour, patientphysician communication and intercultural understanding.100 Specific challenges in migrant mental health include communication, cultural shaping of symptoms and illness behaviour, the effect of family structure and process on acculturation and intergenerational conflict, and the receiving societys facilitation of or impedance of adaptation and social integration.25 There is limited but consistent evidence from qualitative studies and clinical experience in intercultural primary care that these challenges can be addressed through specific enquiry into social and cultural context, the use of interpreters and culture brokers, meetings with families and consultation with community organizations.101104, Because migration often brings people together from very different cultural backgrounds, it is important to give explicit attention to cultural dimensions of the illness experience.105 Place of origin can affect exposure to endemic diseases, childhood immunization and health care experiences. CMAJ 2011; 183:1-9 Crossref, Google . Kay Berckmans and Antonella Clerici provided secretarial support. Discuss the interview and ask the interpreter to assess the patients degree of openness or disclosure. Traditionally the refugee experience is divided into three categories: preflight, flight, and resettlement. Give the patient a chance to ask questions or express concerns that have not been addressed. Healthcare workers perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study. With the exception of Native-Americans, every other American is, or descends from, an immigrant. However, experts in migrant mental health agree that, for maximum effectiveness, attention must be given to various contextual and practical issues that influence illness behaviour, patientphysician communication and intercultural understanding.100 Specific challenges in migrant mental health include communication, cultural shaping of symptoms and illness behaviour, the effect of family structure and process on acculturation and intergenerational conflict, and the receiving societys facilitation of or impedance of adaptation and social integration.25 There is limited but consistent evidence from qualitative studies and clinical experience in intercultural primary care that these challenges can be addressed through specific enquiry into social and cultural context, the use of interpreters and culture brokers, meetings with families and consultation with community organizations.101104, Because migration often brings people together from very different cultural backgrounds, it is important to give explicit attention to cultural dimensions of the illness experience.105 Place of origin can affect exposure to endemic diseases, childhood immunization and health care experiences. 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