Laura Simich

Mental Distress, Economic Hardship and Expectations of Life in Canada among Sudanese Newcomers

As part of a settlement needs assessment of 220 recently arrived Sudanese refugees and immigrants in seven cities, we examined overall health status, indicators of mental distress, economic hardship and expectations of life in Canada. Data were collected in a community-based study using qualitative and quantitative techniques. Results indicate that those Sudanese for whom life in Canada was not what they expected and those who experienced economic hardship as measured by worry over having enough money for food or medicine experienced poorer overall health and reported a greater number of symptoms of psychological distress. After controlling for demographic and related variables, we found that individuals who were experiencing economic hardship were between 2.6 and 3.9 times as likely to experience loss of sleep, constant strain, unhappiness and depression, and bad memories as individuals who do not experience hardship. Healthcare providers should be aware of how postmigration social disadvantages may increase the risk of mental distress particularly among refugees.

Developing Theory From Complexity: Reflections on a Collaborative Mixed Method Participatory Action Research Study

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

Regional effects on the mental health of immigrant children: Results from the New Canadian Children and Youth Study (NCCYS)

Children in immigrant families from Hong Kong, Mainland China, and the Philippines living in Toronto and Montreal are at higher risk of Emotional Problems than children in immigrant families in Winnipeg, Calgary, Edmonton, and Vancouver (Beiser et al., 2010). The current publication explores human capital, social capital, institutional receptivity, and perceptions of welcome as explanations for regional disparities. Parents lack of linguistic fluency, and depressive symptoms provided the most likely explanation for Montreals mental health disadvantage. Immigrant human and social capital, poor home-school relationships, marginalization, and lack of neighborhood organization contributed to the prediction of risk for emotional problems among immigrant children in Toronto, but may not fully account for differences between Toronto and Vancouver.

Taking culture seriously: ethnolinguistic community perspectives on mental health.

OBJECTIVE Ethnolinguistic communities are underserved by mental health systems in immigrant-receiving, multicultural societies, but their perspectives are seldom elicited in mental health research or reform planning. This article helps fill this gap by presenting community perspectives on concepts of mental health, mental illness and mental health experiences with five ethnocultural communities (Latin American, Mandarin-speaking Chinese, Polish, Punjabi Sikh and Somali) in Ontario, Canada. METHODS Data were collected from 21 focus groups as part of a large-scale, participatory action research project called Taking Culture Seriously in Community Mental Health. RESULTS The analysis focuses on how mental health and mental illnesses are described, how mental health care is experienced and what recommendations community members provide to improve the mental health system. CONCLUSIONS Study findings illustrate the importance of the social context of immigration and settlement in conceptualizing mental health and mental distress. We conclude that systemic changes are needed to formulate collaborative, community-based strategies for mental health promotion and interventions.

From social liminality to cultural negotiation: Transformative processes in immigrant mental wellbeing

The underlying psychosocial processes that produce immigrant mental wellbeing are understudied in anthropology and medicine. This paper provides insights into these processes by describing culturally diverse immigrants’ perceptions of mental health and adaptation strategies. Qualitative data were collected from 21 focus groups as part of a large, multidisciplinary, participatory action research project about mental health with five ethnolinguistic groups (Mandarin-speaking Chinese, Polish, Punjabi Sikh, Somali and Spanish-speaking Latin American) in Ontario, Canada. In framing the analysis, transformative concepts are applied to address dimensions of power and culture – social liminality and cultural negotiation – to the ongoing psychosocial processes of coping with mental distress. ‘Social liminality’ describes how immigrants perceive themselves to be in a psychologically stressful, transitional state, whereas ‘cultural negotiation’ describes how they actively cope with cultural tensions and respond to mental health challenges. Study findings show that while social liminality and cultural negotiation are stressful, they also have the potential to help individuals adapt by producing a positive synthesis of ideas about mental health in new social and cultural contexts. The study contributes to the shift from problem identification using a biomedical model of mental illness to a more psychosocial and ecological approach that reveals the potential for resolving some mental health problems experienced in immigrant communities. Describing active psychosocial process of adaptation also reinforces the therapeutic and educational value of partnerships between practitioners and clients and immigrant communities and mental health systems.

Stresses of Passage, Balms of Resettlement, and Posttraumatic Stress Disorder among Sri Lankan Tamils in Canada:

Objectives: To explore the salience of pre- and postmigration stresses as risk factors for posttraumatic stress disorder (PTSD) and to identify resilience factors and explore their mental health salience. Methods: We conducted a mental health survey of 1603 Sri Lankan Tamils in Toronto, incorporating the World Health Organization Composite International Diagnostic Interview for PTSD. Results: According to the International Classification of Diseases, 10th Revision, criteria, lifetime prevalence for PTSD was 12%; according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria it was 5.8%. Female sex and the number of stresses of passage increased the probability of PTSD, whereas satisfaction with life and the availability of nonfamily social relations reduced it. Conclusions: Consideration of pre- and postmigration stresses of passage and of the nature of resilience contributes to an improved understanding of PTSD among refugees.

Paved with Good Intentions: Canada's Refugee Destining Policy and Paths of Secondary Migration

This article describes the results of a qualitative investigation completed for Citizenship and Immigration Canada into reasons for secondary migration of government-assisted refugees (GAR s) in Ontario. Over 100 officials, settlement counsellors, and GARs were interviewed about the migration process, beginning with overseas destining through arrival in Canada to the decision to relocate to Onta rio. The study revealed contradictions in destining policy and practice. The findings suggest the import ance of ensuring that refugees are able to make informed choices about the communities to which they are sent, and that they have meaningful social support in those receiving communities. This research on immigrant mobili ty has policy implications for the current discussions about geographic dispersal of immigrants and settlem ent outcomes.

Narratives of "dissonance" and "repositioning" through the lens of critical humanism: exploring the influences on immigrants' and refugees' health and well-being.

The focus of this article is on narratives of “starting over,” and the embedded processes, conceptualized as “dissonance”—between what people had expected to find in Canada and their actual experiences, and “repositioning”—how they subsequently restructured their lives and redefined their identities. This narrative analysis is one way of illuminating the complex ways in which social support networks influence dissonance and repositioning, and subsequently influence health and well-being.

Impacts of a social support intervention for Somali and Sudanese refugees in Canada

Purpose – The aim of this paper is to design and pilot test a culturally tailored intervention that meets the support needs and preferences of two refugee groups.Design/methodology/approach – The study employed a multi‐method participatory research design and was conducted in two urban centres in western and central Canada. Support was delivered to Sudanese and Somali refugees (n=58), by trained peer and professional helpers, in face‐to‐face groups matched by gender and ethnicity and in telephone dyads. Participants completed three quantitative measures before (pre‐test) and following (post‐test) the intervention. Group interviews with refugee participants and individual interviews with peer and professional helpers conducted at post‐test, elicited qualitative data on perceived impacts and factors influencing impacts of the intervention. Service providers and policy influencers (n=22) were interviewed in groups about the implications of this intervention study for services, programs and policies.Findings ...

Alone in Canada: A Case Study of Multi - Lingual Mental Health Promotion

This article describes the development of a popular, multilingual self-help booklet for single immigrants and refugees who may require psychological and social support during settlement and adaptation in Canada. First we explain the need for this type of mental health promotion, with reference to immigration patterns in Ontario, Canada, and social determinants of immigrant mental well-being. We then describe the collaborative process by which the booklet was developed, and some of the adaptation challenges addressed, offering practical tips for producing similar resources We conclude that the booklet has been successful because it portrays common psychosocial adaptation challenges in a relevant context, using accessible language and immigrant voices that affirm lived experiences and offer helpful advice for overcoming problems. We suggest that such health promotion resources are not only helpful for individuals, but may also help engage newcomer communities and others in understanding the complex factors affecting immigrant mental health.