Introduction

Social connection has many benefits for human health and wellness, including reduced risk for morbidity and mortality [1,2,3]. Levels of social connection are important measures of health and well-being and are predictors of positive health statuses [4]. Cacioppo and colleagues have confirmed that social connectedness and integration have a large influence on quantitative measures of happiness and positive mood [5].

Unfortunately, social isolation and loneliness are widespread in Western countries and around the world [2]. Alarmingly, social isolation and loneliness are twice as harmful to physical health than obesity is [6] and the chronic impacts of prolonged loneliness can cause lifelong detrimental impacts on health and wellbeing [7]. Previous studies have also identified a strong association between social isolation and mental health complication such as depression [7], and suicidality [8]. Moreover, the problem becoming more lonely and the size of our social networks has decreased to one third of what it was two decades ago [9]. Because this problem is wide-spread and has only gotten worse, it has been declared a public health crisis [10],Pomeroy n.d).

Like many public health crises, social isolation and loneliness impacts some populations more drastically than others. For newcomer populations who migrate to countries with vastly different social structures and connections are at an even higher risk of social isolation and loneliness as they attempt to integrate into the new culture, while simultaneously facing many barriers and stressors [11]. Important social relationships that allow for social capital, a profound tool in determining a variety of positive social outcomes, are often difficult to attain as integration is initially difficult. Newcomers integrating into what is often a society and community that is much less involved and engaged when compared to their home countries, especially in Asia and the Middle East, understandably face a myriad of barriers and challenges within the context of the country migrated to [12]. Migrants who have recently immigrated find themselves in drastically different networks of social relationships and experiences [13], often suffering multiple stressors and culture shock upon arrival [11]. These culturally dependent and subjective stressors no doubt contribute to the mental health complications disproportionately impacting in migrant populations [11]. Migrants are also at an increased risk of suicidality because of the stress of acculturation and the lack of social support available to newcomers [14]. Unfortunately, studies show that this risk only worsens over time if meaningful social connections are not made and loneliness prevails, as the risks of long-term residents who are first generation migrants is higher than newcomers in North America [15].

Despite all this, there is no clear narrative describing the influence on social isolation and loneliness on mental health and the risk of suicide in the current literature. Because of the public health urgency of suicide in the twenty first century, and the composition of the population of anglo-sphere countries, this review was conducted to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding the relationship between social connection and suicide among newcomers, immigrants, and asylum seekers.

Methods

We conducted a systematic review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [16]. We searched Web of Science and Pubmed with search terms related to (1) social isolation and loneliness, (2) suicide and suicidal ideation, and (3) newcomer, immigrant, and asylum-seeking populations. Inclusion was limited to studies that were published in English and conducted between January 2001 and July 2021 in core anglosphere countries (Canada, United States, Australia, United Kingdom, Scotland, Wales, and Ireland). The specific search strategy and keyword parameters selected based on previous reviews are outlined in the appendix. Position papers and literature reviews were excluded in this search.

The geographical limitations were chosen based on the premises of the individualism-collectivism framework that states our self-concept and value orientation develop as a response to our collective environment, which is quite similar in anglo-sphere countries, and therefore we assume that integration into these countries for newcomers will be similar. This paper will be using the term ‘newcomer’ as the government of Canada indicates that this is an umbrella term that includes immigrants, migrants, refugees, & asylum seekers. Two major categories of articles were identified through this search based primarily on the methodology of the articles found. Themes, results, and main concepts surrounding suicide and suicidal ideation in relation to social isolation and loneliness in immigrant populations are described below.

Results

The initial search yielded 136 articles, 3 of which were duplicates; 133 articles were screened, and 112 were identified as potentially relevant references. 106 abstracts were assessed of the 112 articles against the inclusion criteria. Of the 106, 12 met the inclusion criteria and were retrieved as full-text articles. We incorporated the 12 appropriate articles, including if only abstracts were available, in the full-text review. A data extraction form was developed and used independently to assess the 12 articles deemed appropriate for inclusion in the meta-analysis. The search strategy can be found in Fig. 1.

Fig. 1
figure 1

Identification of Studies Via Databases and Registers

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The themes are broken down into two sections based on study methods: qualitative and quantitative. The qualitative theme is: Qualitative Assessment of the Perspectives of Health and Integration. The quantitative theme is: Assessment of the Risk of Suicide Burden and Impact of Social Support and Engagement on Health and Wellbeing. More information regarding the components of the quantitative theme can be found in the DAG in Fig. 2. Tables 1 and 2 summarize these articles in their respective theme(s).

Fig. 2
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Directed Acyclic Graph of the Subthemes Within the Quantitative Studies Found

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Table 1 Qualitative assessment of the perspectives of health and integration
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Table 2 Quantitative Assessment on the Risk of Suicide Burden and the Impacts of Social Integration on Health
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Qualitative Studies

Qualitative Assessment of the Perspectives of Health and Integration of Newcomers

Five articles qualitatively assessed perspectives of newcomers and/or their communities on their mental health/suicidality and social integration/connectedness. Four of the fives articles focused on Asian and South Asian immigrant populations [17,18,19,20] in the United States and one focused on African immigrants [21] in Australia. These articles highlighted key risk factors for immigrant populations. For example, in a study among (n = 1,116) Korean American seniors by Lee-Tauler et al. [20], participants identified that feelings of failure, not achieving material success, and poor relationships with their children were all related to depression and mental health ailments [20]. Similarly in a study among African immigrants (n = 31) in South Australia by Mwanri, Okyere, & Pulvirenti [21], the majority of participants reported challenging migration journeys to Australia, strained relationships with family members back home, and a poor sense of belonging [21]. These studies clearly demonstrate that migrant and immigrant populations face an array of social stressors that contribute to suicide.

Optimistically, social support and social connection were identified across all of the included studies as a key factor in preventing suicide and helping immigrant populations manage the stressors the face. For example in two studies among Bhutanese refugee communities in the United States of America (USA) [17, 18], Brown et al. [17] and Chase & Sapkota [18] found that nearly all participants cited social connection to be fundamentally important, stressing and identifying the roles of family, friends, and neighbors in proactively helping manage individual distress [18]. These qualitative studies assert that family, friendship, and neighbours play an important role in managing mental health burden and navigating challenges faced by newcomers.

Brown et al. identified that mental health stigma within immigrant communities and broader host cultures was a major barrier to communicating mental health needs for migrants [17]. This lack of openness was identified as a challenge to social connection. Unfortunately, these difficulties persistent even following suicide attempts. Illustrating this reality, Chung and colleagues conducted chart analysis (n = 44) and interviews (n = 12) with individuals who had attempted suicide at least twice (2015). Participants reported that they faced not only self-blame and self-harm, but also adverse pressures from their family and overall sense of not belonging. While these interviews also highlighted the important role that social connection and physiological well-being have as protective factors following suicide [19], they underscored the complex social realities of navigating mental health challenges, even with close confidants and key supporters.

Quantitative Studies & Reviews

Quantitative Assessment of the Risk of Suicide Burden and Impact of Social Support and Engagement on Health and Wellbeing of Newcomers

Five of the included articles identified social health risk factors associated with suicide death for newcomers. Four articles looked at newcomers to the United States [22,23,24,25] and one used a European database of newcomers [26]. All of the articles mentioned here focused on the burden of suicide on newcomers and the risk factors associated with suicidality within their respective populations of interest.

Several of these studies described similar risk factors of suicide for newcomers, regardless of the country immigrated to. For example, immigration status and duration of stay in country immigrated to was found to be significantly associated with poorer mental health outcomes and suicidal ideation [24, 25]—the longer an individual was in the country immigrated to, the better their health outcomes were. Social integration and acculturation is also dependent on time lived in the new country, and both studies show that the better socially integrated participants were, the better their health statuses, both mental and physical [24, 25]. It is then evident that mental health complications such as depression were also found to have a strong correlation with suicidal ideation, especially with the distress involved in immigration. This was also found specifically for a subset of both older [22] and adolescent [23] Korean-American newcomers. From this we can deduce that poor social integration and the mental health complications that arise from culture shock are related to poor health outcomes and suicidality.

Though, studies show that as a result of the risk factors identified, there are some definite protective factors for newcomers that are socially derived in the country immigrated to. Nearly all the studies pointed to strong family ties and support both during the immigration process and staying in touch settlement as a huge indicator of wellbeing [22,23,24,25]. The protective nature of familial support was identified as important, and especially so for adolescent newcomers [23]. Cho & Haslam identified that Korean adolescents who immigrated without their parents were more likely to have suicidal ideations than those who immigrated with their parents [23]. These studies clearly show that having someone to confide to alleviates major stressors during a time where stress is inevitable, and aids in the overall wellbeing of newcomers during difficult times. As well, Lipsicas et al. point to the importance of the country and culture where the newcomer is coming from (specifically this article found countries in the Middle East), and that there is a minimized risk of attempted suicide despite high levels of suicidality evident in questionnaires used [26]. This further emphasizes the importance of family connectedness and closeness and the support provided to the family members who immigrate and how this support has protective effects despite the immense amount of stress and change the newcomer is initially and continually dealing with.

Four of the included articles looked at social support and social engagement on the health and wellbeing of migrants. Articles looked at a variety of anglo-sphere countries including the USA, Australia, and Canada [25, 27, 28]. The articles show that there exists a positive relationship between social engagement in the country immigrated to and quality of life [27]. Social engagement in cultural settings similar to the country immigrated from also serves as a protective factor and decreases suicidality, when compared to assimilated individuals who were not socially connected with these cultural groups [27]. This suggests that it is not simply social connection, but rather the type and meaningfulness of the connection is a vital component of social integration and wellbeing.

Lia et all show individual-level connections to peers and friends in newcomers’ immediate surroundings, community participation, and religious involvement are all protective factors and positively influence overall wellbeing and contribute to social integration [28]. These connections were identified as the foundation of newcomers’ integration and greatly influence their trajectory of social connectedness and health [28]. Kposowa et al. and Lai et al. both identify that meaningful and effective integration of immigrants in receiving societies also allows for the prospect of finding friends and partners in the country immigrated to, leading to higher integration and levels of well-being [25, 28]. Having solid connections with friends and co-habiting with an individual/individuals and being married are all protective factors also [25]. Ultimately, these analyses and review show that social networks have a strong positive effect on wellbeing and a strong effect in reducing loneliness in newcomer populations, which consequently combat mental health complications and suicidality.

Discussion

Primary Findings

We conducted a systematic review to understand the existing evidence relating social connection to suicide risk among newcomer, immigrant, and asylum-seeking populations. The findings of this review suggest that social connection and belonging are key components of wellbeing and health for newcomer populations in anglo-sphere countries, and ultimately help combat the mental health complications and suicidality. Social support and connection was also identified across all of the included studies as a key factor in helping immigrant populations manage the plethora of immediate and long-term stressors newcomers face. The more connected a newcomer feels to their families [29] and their community [30], the better their overall health and wellbeing will be. This was fundamentally decrease mental health complications that are on the causal pathway for suicidal ideation and attempts As Iwamoto & Lui explain, cultural values and one’s ethnic identity have large effects om race-related stress and wellbeing, especially for Asian immigrants [31]. This is especially important because many subgroups of newcomers have disproportionately higher rates of mental health complications with an emphasis on stress related disorders [32]. The complex interplay of culture shock or bereavement during the migration and settlement process no doubt contributes to this disparity in mental health ailments [33] and ultimately leads to an increase in the burden of suicide in newcomer populations [28].

Limitations of Studies

The studies included in our review are limited by the lack of a clear consensus on a precise operational definition of social connectedness. None of the studies we included considered differences in social integration through a social determinants of health approach [34] considering gender, sexuality, and the differences between countries immigrated from. An intersectional approach [35, 36] considering the additive impacts of identities was also not used in these studies. We know from the literature that racism is experienced differently by different populations, and that racism contributes to feelings of isolation and disconnection [37]. This was also not identified by any of the studies we considered as a possible contributor to social isolation and perceived loneliness.

Contextualization with Other Related Literature

In measuring social integration, we should look to consider not only the number of relationships, but other factors contributing to the benefit of the social relationships that newcomers build. Recent work by Holt-Lunstad describes social connectedness as a multifactorial construct encompassing the structure, function, and quality of social relationships [38]. The quality and function of these relationships are an important consideration, especially when considering advantages such as social capital. As Nakhaie & Kazemipur describe social capital is a profoundly positive advantage for newcomers as this social tool is factor in determining a variety of social outcomes, including integration into the labour market and academia [39]. Social capital has also been found to help with job acquisition, social mobility, and improvement of health and happiness [40]. This being said, the majority of newcomers do not exercise this tool despite potentially successful social integration, as the quality and function of their relationships do not allow for the benefits that those with connections who have various resources in social networks, which are mobilized for accessing more resources.

Implications for Future Research

The results of this meta-analysis show that numerous studies have sought to quantify the levels of mental health ailments in newcomer populations in relation to social isolation and loneliness, and the perspectives of newcomers regarding their social connections and the quantity and quality of these connections. Future research should build on this work and identify effective tools and practices that allow newcomers to engage in meaningful interactions to decrease social isolation and loneliness in order to mitigate mental health ailments and suicidality. Future research should also investigate the influence of social support and mental health services on newcomer populations to suggest specific and relevant policy and funding changes for that community.

Implications for Practice

Our study highlights the necessity of social integration and community initiatives that aim to provide and build support for newcomer communities. Studies suggest that community initiatives and supports that are of high quality and are culturally sensitive are hugely beneficial to newcomers [38, 41]. Furthermore, community support—defined as support from community members, community organizations, and federal programs—has shown to significantly impact coping and well-being in newcomer populations [42], clearly indicating that organizational level engagement and support is effective. These programs should also consider culturally and linguistically appropriate evidence-based mental health services that are both effective and practical [43].

Once these organizational services have been implemented, in order to increase engagement and utilization, the information about these services and supports should primarily be shared through community centres and organizations dedicated to helping newcomers (“[44]. Though fundamentally, the accessibility and reach of these organizations are dependent on the available funding, government support, and community acceptance and engagement. Outside the silos of community centres, studies also show places where we connect with one another—such as school and work—are also appropriate spaces for efforts to increase social connectedness. For example, within schools, active efforts to move newcomers away from the periphery and into the centre of school participation and engagement both with peers and teachers has had tremendous impacts on social connectedness and well-being that carries on throughout the student’s life course [45]. By actively increasing engagement and celebrating diversity within our communities [46] we can empower health and wellness [41] and improve the mental health of newcomer populations and overall burden of suicide in countries welcoming newcomers to start a new life [47].

Strengths and Limitations

There are inherent strengths and limitations to conducting rapid reviews. Due to the specific parameters and limited number of databases searched (PubMed and Web of Science), there is the potential for missed articles for this review despite using the PRISMA guidelines and rapid review protocol. Our study limitation to papers written in English and published within the core-anglosphere region also limits our reach in terms of the papers available for review. Because of this, our results show several articles focused on Asian newcomers to the United States, and therefore have a limited generalizability to the overall population. Despite these limitations, literature has shown that the results of rapid reviews are often congruent with systematic literature reviews [48]. Rapid reviews are appropriate for topics of importance and specific research questions pertinent to a rapid evolving field of research and science. The evidence suggests this is a critical realm of research, though there is not enough literature to warrant a systematic review, there is value in conducting a rapid review to synthesize the available literature.

Conclusion

Social isolation and loneliness are growing problems in the twenty first century that need to be studied and addressed with the same rigor and force as other chronic health conditions. Especially during these unprecedented times where we are being asked by public health officials to socially isolate, the COVID-19 pandemic has only perpetuated the loneliness of peoples globally [49]. As we become more socially isolated and lonely, the importance of social connection and integration for newcomers should be a priority. The studies included in this analysis show that there is an undoubtable problem with connectedness and integration for newcomers, and that we should consider public health efforts to support newcomers’ joining our communities. Our findings further reinforce the notion that social connectedness and integration are vital to the health and wellness of newcomer populations and suggest positive interventions to support social connection and provide means of access to mental health support. Future research should consider target populations disproportionately impacted by social isolation and loneliness and investigate the impacts of social services and supports in communities to identify important solutions to this growing public health problem. We suggest funds be allocated to supporting community organizations and support services at all levels of academia, and that culturally and linguistically relevant services and supports be widely available and shared. These positive actions will allow cities to build healthy communities that welcome newcomers in a meaningful way, that will in turn support the health and wellbeing of all citizens.