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Different Outcomes for Different Health Measures in Immigrants: Evidence from a Longitudinal Analysis of the National Population Health Survey (1994–2006)

Abstract

The response of immigrants to new societies is dynamic. There may be an initial period of happiness followed by peaks of stressful periods. These reactions along with socio-economic changes are likely to influence their health, which may start converging towards the average health of the host population. We used a longitudinal analysis to assess the differences in health outcomes (mental health and self-rated health), separately in men and women, in Canadian born and immigrants over a 12-year period (and the associated socio-economic factors). We used random effects logistic regression models for evaluation of these health outcomes in 3,081 men and 4,187 women from the National Population Health Survey (1994/95 to 2006/07). After adjusting for all the covariates, non-white immigrants were less likely to have severe psychological distress compared with the Canadian born individuals [odds ratio (OR) Men: 0.49, 95% confidence intervals (CI) 0.24–1.00, Women-OR: 0.54; 95% CI: 0.32–0.92]. Immigrant women (white and non-white) were more likely to rate their health as poor through this 12-year period than the Canadian born women (White-OR: 1.64, 95% CI: 1.17–2.64; Non-white-OR: 1.82, 95% CI: 1.01–3.28). Immigrants in the lowest income adequacy category reported higher psychological distress and poorer health than those in the highest income categories. We did not find any significant differences in the mental health and self-rated health of Canadian men and white male immigrants throughout this 12-year period. Though, non-white immigrant women were less likely to have severe psychological distress through this 12 year period, they were the ones most likely to rate their health as poor.

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References

  1. Statistics Canada. Population by immigrant status and period of immigration, 2006 counts, for Canada, provinces and territories—20% sample data. 2009. Available from. [last accessed on 2009 11 September].

  2. Grinberg L, Grinberg R. A psychoanalytic study of migration: its normal and pathological aspects. J Am Psychoanal Assoc. 1984;32:13–38.

    PubMed  Article  CAS  Google Scholar 

  3. Hertz DG. Identity–lost and found: patterns of migration and psychological and psychosocial adjustment of migrants. Acta Psychiatr Scand Suppl. 1988;344:159–65.

    PubMed  Article  CAS  Google Scholar 

  4. Hertz DG. Bio-psycho-social consequences of migration stress: a multidimensional approach. Isr J Psychiatry Relat Sci. 1993;30:204–12.

    PubMed  CAS  Google Scholar 

  5. Rumbaut RG. Mental health and the refugee experience: a comparative study of Southeast Asian refugees. In: Owan TC, editor. Southeast Asian mental health: treatment, prevention, services, training, and research. Rockville: National Institute of Mental Health; 1985.

    Google Scholar 

  6. Sluzki CE. Migration and family conflict. In: Moos RH, editor. Coping with life crises: an intergrated approach. New York: Plenum Press; 1986.

    Google Scholar 

  7. Brink PJ, Saunders JM. Cultural shock: theoretical and applied. In: Brink PJ, editor. Transcultural nursing: a book of readings. Englewood Cliffs: Prentice-Hall, Inc.; 1976. p. 126–38.

    Google Scholar 

  8. Bagely C. The adjustment of elderly Punjabi immigrants in Canada. In: Ghosh R, Kanungo R, editors. South Asian Canadians: current issues in the politics of culture. New Delhi: Shastri Indo-Canadian Institute; 1992. p. 124–9.

    Google Scholar 

  9. Beiser M, Hou F, Hyman I, Tousignant M. Poverty, family process, and the mental health of immigrant children in Canada. Am J Public Health. 2002;92:220–7.

    PubMed  Article  Google Scholar 

  10. Glazier RH, Creatore MI, Cortinois AA, Agha MM, Moineddin R. Neighbourhood recent immigration and hospitalization in Toronto, Canada. Can J Public Health. 2004;95:I30–4.

    PubMed  Google Scholar 

  11. Noh S, Kaspar V, Wickrama KA. Overt and subtle racial discrimination and mental health: preliminary findings for Korean immigrants. Am J Public Health. 2007;97:1269–74.

    PubMed  Article  Google Scholar 

  12. Beiser M. Influences of time, ethnicity, and attachment on depression in Southeast Asian refugees. Am J Psychiatry. 1988;145:46–51.

    PubMed  CAS  Google Scholar 

  13. Boman B, Edwards M. The Indochinese refugee: an overview. Aust N Z J Psychiatry. 1984;18:40–52.

    PubMed  Article  CAS  Google Scholar 

  14. Nguyen SD. The psycho-social adjustment and mental health needs of Southeast Asian refugees. Psychiatr J Univ Ott. 1982;7:26–35.

    PubMed  CAS  Google Scholar 

  15. Pernice R, Brook J. The mental health pattern of migrants: is there a euphoric period followed by a mental health crisis? Int J Soc Psychiatry. 1996;42:18–27.

    PubMed  Article  CAS  Google Scholar 

  16. Ritsner M, Ponizovsky A. Psychological distress through immigration: the two-phase temporal pattern? Int J Soc Psychiatry. 1999;45:125–39.

    PubMed  Article  CAS  Google Scholar 

  17. Pernice R, Trlin A, Henderson A, North N, Skinner M. Employment status, duration of residence and mental health among skilled migrants to New Zealand: results of a longitudinal study. Int J Soc Psychiatry. 2009;55:272–87.

    PubMed  Article  Google Scholar 

  18. Ali J. Mental health of Canada’s immigrants. Suppl Health Rep. 2002;13:101–13.

    Google Scholar 

  19. Bergeron P, Auger N, Hamel D. Poids, sante generale et sante mentale: la situation de divers sous-groupes d’immigrants au Canada. Can J Public Health. 2009;100:215–20.

    PubMed  Google Scholar 

  20. Chen J, Ng E, Wilkins R. The health of Canada’s immigrants in 1994–95. Health Rep. 1996;7(33–45):37–50.

    Google Scholar 

  21. Gee EM, Kobayashi KM, Prus SG. Examining the healthy immigrant effect in mid- to later life: findings from the Canadian Community Health Survey. Can J Aging. 2004;23(Suppl 1):S61–9.

    PubMed  Google Scholar 

  22. Dunn JR, Dyck I. Social determinants of health in Canada’s immigrant population: results from the National Population Health Survey. Soc Sci Med. 2000;51:1573–93.

    PubMed  Article  CAS  Google Scholar 

  23. Newbold B. Health status and health care of immigrants in Canada: a longitudinal analysis. J Health Serv Res Policy. 2005;10:77–83.

    PubMed  Article  Google Scholar 

  24. Newbold KB. Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Soc Sci Med. 2005;60:1359–70.

    PubMed  Article  Google Scholar 

  25. Newbold KB, Danforth J. Health status and Canada’s immigrant population. Soc Sci Med. 2003;57:1981–95.

    PubMed  Article  Google Scholar 

  26. Duleep HO, Dowhan DJ. Research on immigrant earnings. Soc Secur Bull. 2008;68:31–50.

    PubMed  Google Scholar 

  27. Newbold KB. Chronic conditions and the healthy immigrant effect: evidence from Canadian immigrants. J Ethn Migr Stud. 2006;32:765–84.

    Article  Google Scholar 

  28. Llacer A, Zunzunegui MV, del Amo J, Mazarrasa L, Bolumar F. The contribution of a gender perspective to the understanding of migrants’ health. J Epidemiol Community Health. 2007;61(Suppl 2):ii4–10.

    PubMed  Article  Google Scholar 

  29. Vissandjee B, Desmeules M, Cao Z, Abdool S, Kazanjian A. Integrating ethnicity and migration as determinants of Canadian women’s health. BMC Womens Health. 2004;4(Suppl 1):S32.

    PubMed  Article  Google Scholar 

  30. Statistics Canada. National Population Health Survey. 2008. Available from: http://www.statcan.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SurvId=3225&SurvVer=0&InstaId=15280&InstaVer=5&SDDS=3225&lang=fr&db=IMDB&dbl=E&adm=8&dis=2. [last accessed on 2009 August 03].

  31. Setia MS, Quesnel-Vallee A, Abrahamowicz M, Tousignant P, Lynch J. Convergence of body mass index of immigrants to the Canadian-born population: evidence from the National Population Health Survey (1994–2006). Eur J Epidemiol. 2009;24(10):611–23.

    PubMed  Article  Google Scholar 

  32. Curtis S, Setia MS, Quesnel-Vallee A. Socio-geographic mobility and health status: a longitudinal analysis using the National Population Health Survey of Canada. Soc Sci Med. 2009;69(12):1845–53.

    PubMed  Article  Google Scholar 

  33. Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U. The world health organization composite international diagnostic interview short-form (CIDI-SF). Int J Methods Psychiatr Res. 1998;7:171–85.

    Article  Google Scholar 

  34. Kessler RC, Ustun TB. The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res. 2004;13:93–121.

    PubMed  Article  Google Scholar 

  35. Nelson CB, Kessler RC, Mroczek D. Scoring the World Health Organization’s Composite International Diagnostic Interview Short Form. 2001. Available from: http://www.hcp.med.harvard.edu/ncs/ftpdir/cidisf_readme.pdf. [last accessed on 2009 September 15].

  36. Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. London: Sage Publication; 2004. p. 1–266.

    Google Scholar 

  37. Akaike H. A new look at the statistical model identification. IEEE Trans Automat Contr. 1974;19:716–23.

    Article  Google Scholar 

  38. Vittingghoff E, Glidden DV, Shiboski SC, McCulloch CE. Regression methods in biostatistics. New York: Springer Science+Business Media Inc.; 2004. p. 1–333.

    Google Scholar 

  39. van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18:681–94.

    PubMed  Article  Google Scholar 

  40. Van Buuren S, Oudshoorn K. Flexible multivariate imputation by MICE (TNO report PG/VGZ/99.054). 1999. Available from: http://www.multiple-imputation.com/. [last accessed on 2009 February 15]; 3–19.

  41. Carlin J, Galati J, Royston P. A new framework for managing and analyzing multiply imputed data in Stata. Stata J. 2008;8:49–67.

    Google Scholar 

  42. Royston P. Multiple imputation of missing values: update. Stata J. 2005;5:188–201.

    Google Scholar 

  43. Royston P. Multiple imputation of missing values: update of ice. Stata J. 2005;5:527–36.

    Google Scholar 

  44. Setia MS, Quesnel-Vallee A, Abrahamowicz M, Tousignant P, Lynch J. Access to health care in Canadian immigrants: a longitudinal study of the National Population Health Survey. Health Soc Care comm. doi:10.1111/j.1365-2524.2010.00950.x.

  45. Smith KL, Matheson FI, Moineddin R, Glazier RH. Gender, income and immigration differences in depression in Canadian urban centres. Can J Public Health. 2007;98:149–53.

    PubMed  Google Scholar 

  46. Bhugra D. Migration and mental health. Acta Psychiatr Scand. 2004;109:243–58.

    PubMed  Article  CAS  Google Scholar 

  47. Beiser M, Edwards RG. Mental health of immigrants and refugees. New Dir Ment Health Serv. 1994;Spring(61):73–86.

    Article  Google Scholar 

  48. Guglani S, Coleman PG, Sonuga-Barke EJ. Mental health of elderly Asians in Britain: a comparison of Hindus from nuclear and extended families of differing cultural identities. Int J Geriatr Psychiatry. 2000;15:1046–53.

    PubMed  Article  CAS  Google Scholar 

  49. Acharya MP, Northcott HC. Mental distress and the coping strategies of elderly Indian immigrant women. Transcult Psychiatry. 2007;44:614–36.

    PubMed  Article  Google Scholar 

  50. Noh S, Beiser M, Kaspar V, Hou F, Rummens J. Perceived racial discrimination, depression, and coping: a study of Southeast Asian refugees in Canada. J Health Soc Behav. 1999;40:193–207.

    PubMed  Article  CAS  Google Scholar 

  51. Wu Z, Noh S, Kaspar V, Schimmele CM. Race, ethnicity, and depression in Canadian society. J Health Soc Behav. 2003;44:426–41.

    PubMed  Article  Google Scholar 

  52. Kirmayer LJ, Weinfeld M, Burgos G, du Fort GG, Lasry JC, Young A. Use of health care services for psychological distress by immigrants in an urban multicultural milieu. Can J Psychiatry. 2007;52:295–304.

    PubMed  Google Scholar 

  53. Whitley R, Kirmayer LJ, Groleau D. Understanding immigrants’ reluctance to use mental health services: a qualitative study from Montreal. Can J Psychiatry. 2006;51:205–9.

    PubMed  Google Scholar 

  54. Raj A, Silverman JG, McCleary-Sills J, Liu R. Immigration policies increase south Asian immigrant women’s vulnerability to intimate partner violence. J Am Med Womens Assoc. 2005;60:26–32.

    PubMed  Google Scholar 

  55. Ho C. Migration as feminisation? Chinese women’s experiences of work and family in Australia. J Ethn Migr Stud. 2006;32:497–514.

    Article  Google Scholar 

  56. Boyd M. At a disadvantage: the occupational attainments of foreign born women in Canada. Int Migr Rev. 1984;18:1091–119.

    PubMed  Article  CAS  Google Scholar 

  57. De Jong GF, Madamba AB. A double disadvantage? Minority group, immigrant status, and underemployment in the United States. Soc Sci Q. 2001;82:117–30.

    Article  Google Scholar 

  58. De Maio FG, Kemp E. The deterioration of health status among immigrants to Canada. Glob Public Health 2010;5(5):462–78.

    PubMed  Article  Google Scholar 

  59. Crossley TF, Kennedy S. The reliability of self-assessed health status. J Health Econ. 2002;21:643–58.

    PubMed  Article  Google Scholar 

  60. De Maio FG. Health inequalities in Argentina: patterns, contradictions and implications. Health Sociol Rev. 2007;16:279–91.

    Article  Google Scholar 

  61. Sen A. Health: perception versus observation. BMJ. 2002;324:860–1.

    PubMed  Article  Google Scholar 

  62. Benyamini Y, Idler EL. Community studies reporting association between self-rated health and mortality—additional studies, 1995 to 1998. Res Aging. 1999;21:392–401.

    Article  Google Scholar 

  63. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;21:267–75.

    PubMed  Article  Google Scholar 

  64. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.

    PubMed  Article  CAS  Google Scholar 

  65. Jylha M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69:307–16.

    PubMed  Article  Google Scholar 

  66. Miller TR, Wolinsky FD. Self-rated health trajectories and mortality among older adults. J Gerontol B Psychol Sci Soc Sci. 2007;62:S22–7.

    PubMed  Article  Google Scholar 

  67. Patten SB. Performance of the Composite International Diagnostic Interview Short Form for major depression in community and clinical samples. Chronic Dis Can. 1997;18:109–12.

    PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank Dr. Abby Lippman for comments on the manuscript. The study was funded by the Canadian Institutes of Health Research (MOP 77800 PI AQV). MSS is funded by CIHR-IHSPR Fellowship and CIHR-RRSPQ Public Health Training Programme for his doctoral studies at McGill University. Additional funding was provided by the QICSS Matching Grant 2007.

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Correspondence to Maninder Singh Setia.

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Setia, M.S., Quesnel-Vallee, A., Abrahamowicz, M. et al. Different Outcomes for Different Health Measures in Immigrants: Evidence from a Longitudinal Analysis of the National Population Health Survey (1994–2006). J Immigrant Minority Health 14, 156–165 (2012). https://doi.org/10.1007/s10903-010-9408-7

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  • DOI: https://doi.org/10.1007/s10903-010-9408-7

Keywords

  • Immigrants
  • Mental health
  • Self-rated health
  • Longitudinal study