Mental Health Outcomes and Service Utilization Among Immigrant Youth in Canada

• In Event: 1-076 - Unpacking Heterogeneity in the Immigrant Paradox: Evidence from Canada, the US, and Greece

Integrative Statement

Existing Canadian evidence suggests more favorable mental health outcomes among immigrant youth, compared to their non-immigrant peers – a pattern of findings referred to as the ‘immigrant paradox.’ This evidence, however, arises primarily from secondary analyses of general population studies that have notable limitations, including a failure to enlist representative samples of immigrant youth and to measure important individual and contextual level determinants of mental health linked to the process of migration and resettlement. While studies conducted in the United States and Europe address some of these limitations, the applicability to a Canadian context is questionable given important cross-national differences in immigration and integration policies and health care systems that likely condition health outcomes of immigrant children (Marks et al., 2018).

Using data from an epidemiological study explicitly designed to address the aforementioned limitations, the objectives of this paper are to examine differences in mental health and service utilization between immigrant and non-immigrant youth and determine the extent to which differences vary as a function of mental health domain (internalizing versus externalizing), informant (parent, teacher, youth) and migrant sub-group (English Language Learners [ELL], refugees).

A 2-stage (school, student) stratified random sampling approach was used to enlist 1,449 students in grades 5-8, their primary caregiver and teacher from 36 schools. Face-to-face structured interviews were conducted with youth and their primary caregiver separately in their homes or school. Assessment data from teachers and school administrative records were also collected. Internalizing and externalizing symptoms were measured using the Child Behavior Checklist (CBCL/6-18) and Youth Self-Report (YSR/11-18) (Achenbach et al., 2007). A series of multilevel (student, schools) linear and binary logistic regression models were used to examine associations between immigrant background and mental health-related outcomes, with non-immigrant youth serving as the reference.

Sample characteristics are presented in Table 1. The magnitude of group differences varied as a function of mental health domain, informant and migrant sub-group (see Table 2). Parent-reported externalizing behaviors were consistently lower for 1st generation immigrant, compared to non-immigrant youth (d’s ranged from -0.35 to -0.52). A similar pattern was evident for youth-reported externalizing behaviors, although the magnitude of effect was consistently smaller, particularly for ELL youth (d=-0.19). Teacher reports of externalizing behaviors revealed significant group differences only when all foreign-born youth were examined together. Group differences in levels of internalizing behaviors were fewer in number, consistently smaller in magnitude and most evident in teacher reports. In terms of mental health service utilization, after adjusting for socio-demographic co-variates and internalizing and externalizing behaviors, immigrant youth were consistently less likely to use mental health services (OR=0.36, 95% CI=0.29-0.44).

These findings provide insights on the generalizability of the immigrant paradox, or lack thereof, as a function of mental health domain, informant and migrant sub-group within a Canadian context. Despite partial support for an immigrant paradox, our findings consistently document lower rates of mental health service use, underscoring the need to identify and address barriers to recognition and treatment of mental health concerns among youth from immigrant backgrounds.

Authors

• Katholiki Georgiades, McMaster University
  Presenting Author

• Steven Trung Hieu Ma, McMaster University
  Non-Presenting Author

• Irene Vitoroulis, McMaster University
  Non-Presenting Author