Abstract
Objectives
Immigrants to Canada tend to have a lower incidence of diagnosed depression than non-immigrants. 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 (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 (OR=1.76, 99% CI: 1.40-2.20); whereas White immigrants were mentally healthier with decreased odds of PHQ depression and poor self-rated mental health. Among sub-population without a previous M/A-Dx (N=25,366), racialized immigrants had increased odds of PHQ depression (OR=1.45, 99%CI: 1.15-1.82) and unrecognized depression (OR=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 attributable to the under-detection by health professionals and under-recognition by racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.
© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
Immigrants to Canada tend to have a lower incidence of diagnosed depression than non-immigrants. 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 (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 (OR=1.76, 99% CI: 1.40-2.20); whereas White immigrants were mentally healthier with decreased odds of PHQ depression and poor self-rated mental health. Among sub-population without a previous M/A-Dx (N=25,366), racialized immigrants had increased odds of PHQ depression (OR=1.45, 99%CI: 1.15-1.82) and unrecognized depression (OR=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 attributable to the under-detection by health professionals and under-recognition by racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.
© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
| Original language | English |
|---|---|
| Article number | gbad104 |
| Journal | Journals of Gerontology - Series B Psychological Sciences and Social Sciences |
| Volume | 79 |
| Issue number | 3 |
| Online published | 27 Jul 2023 |
| DOIs | |
| Publication status | Published - Mar 2024 |
Funding
None
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
-
SDG 3 Good Health and Well-being -
SDG 10 Reduced Inequalities
Research Keywords
- Minority aging
- Mental health equity
- Migration
- Race
- Depression care
Publisher's Copyright Statement
- This full text is made available under CC-BY 4.0. https://creativecommons.org/licenses/by/4.0/
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