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The mental health of immigrants and refugees: Canadian evidence from a nationally linked database (2020)

Posted on:
August 24, 2020

Overall, immigrants are found to be healthier upon their arrival to Canada than the Canadian-born population—a phenomenon referred to as the healthy immigrant effect (HIE). However, this initial health advantage seems to disappear over time, partly because of stress and other integration challenges.

This study addresses three research questions:

  1. Does self-reported mental health (SRMH) differ between Canadian-born and immigrant respondents?
  2. Does the SRMH of immigrants differ by the three selected dimensions compared with that of Canadian-born respondents?
  3. How does the SRMH of immigrants vary according to duration since landing within each admission category and source world region?

To answer these questions, the authors also looked at socioeconomic factors and individuals’ sense of belonging.

Background

The Canadian government’s Immigration Levels Plan stipulates that almost 1 million immigrants will be admitted to Canada between 2018 and 2020, and immigrants to Canada will increase from 7.5 million to more than 12 million by 2036 (almost 30% of the Canadian population). Because of the growth in Canada’s immigrant population, it is important to monitor the health—including mental health—of immigrants. In light of the COVID-19 pandemic and its impact on mental health, this study can provide a baseline for future studies on the longer-term impact of COVID-19 on immigrants’ mental health by immigrant category.

Whether this HIE and its deterioration also apply to mental health is an area of ongoing research. Past mental health research on immigrants in Canada, typically based on a small sample of recent immigrants or refugees from various war-torn parts of the world, found that immigrants in Canada had a mental health disadvantage. By contrast, recent studies based on nationally representative surveys found that immigrants had a mental health advantage over their Canadian-born counterparts in terms of both SRMH and more specific mental health disorders. However, these studies were not as consistent on whether and when immigrants’ mental health advantage dissipates the longer they live in Canada.

An important dimension to examine when studying immigrants’ health is admission category. Because immigrants are selected through admission classes (mainly economic immigrants, family-class immigrants and refugees), each with distinct pre-migration experience and immigrant selection requirements, post-migration mental health outcomes may differ by admission category. Few studies have examined the mental health of immigrants to Canada by admission category compared with the Canadian-born reference group. One key barrier to studying immigrant health by admission category is the lack of sizable datasets that include detailed immigration-related variables. Exceptions include provincial studies that link immigrant records from recent landing files to provincial health records, such as hospital and laboratory records for Ontario.

Typically, these studies do not have a well-defined Canadian-born comparison group, as the non-links in these record linkage projects include both Canadian-born individuals and more established immigrants. Furthermore, a study based on the Longitudinal Survey of Immigrants to Canada (LSIC) found that refugees had a greater mental health risk than other immigrant subgroups. However, the LSIC did not provide a Canadian-born reference group for comparison.

Linking the Canadian Community Health Survey (CCHS) to the Longitudinal Immigration Database (IMDB) provides opportunities to study the SRMH outcomes of immigrants across admission categories at the national level with a well-defined Canadian-born reference population. This study, based on the linked CCHSIMDB database, fills an information gap by examining the SRMH of immigrant and Canadian-born survey respondents, controlling for confounding factors. In addition, the mental health of immigrants was examined by three immigration-related dimensions—admission category, source world region and duration since landing. It is important to look at duration since landing to evaluate whether the perceived mental health advantage changes over time. Source world region is important because immigrants’ post-migration mental health outcomes are influenced by differences in language, culture, institutions and politics between Canada and their source country.

Findings

This study provides new evidence on immigrants’ mental health. First, there is no significant difference in the unadjusted prevalence of high SRMH between Canadian-born respondents and immigrants overall. When examined by admission category, this finding held true for economic immigrants, but family-class immigrants and refugees were less likely than Canadian-born respondents to have high SRMH. This is consistent with studies that found that economic immigrants tended to have better health outcomes than refugees and—to a lesser extent—family-class immigrants.

Similar proportions of Canadian-born (72%) and immigrant (71%) respondents had high SRMH. Heterogeneity was observed among immigrants across admission categories, compared with Canadian-born respondents. In particular, economic immigrants had high levels of SRMH (72%) similar to their Canadian-born counterparts, but family-class immigrants and refugees were significantly less likely to report high SRMH (69% and 68%, respectively). A higher percentage of recent immigrants had high SRMH (74%), compared with a significantly lower proportion of established immigrants (68%).

The gap in SRMH is significant across immigrants from different source world regions. Across source world regions, significantly fewer immigrants from the Middle East and Western Asia (65%), and East Asia (62%) had high SRMH, while a significantly higher percentage of immigrants from the United States+ (77%) had high SRMH.

Immigrants’ mental health does not improve with time spent in Canada. Recent immigrants have higher unadjusted SRMH than both Canadian-born respondents and established immigrants, reflecting and corroborating evidence of deterioration of the HIE in self-reported health, as well as in mental health outcomes.

 

Summary

Immigrants are found to be healthier upon their arrival to Canada than the Canadian-born population—a phenomenon referred to as the healthy immigrant effect (HIE). Does self-reported mental health (SRMH) differ between Canadian-born and immigrant respondents?
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