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The influence of immigrant status and concentration on psychiatric disorder in Canada: a multi-level analysis

Published online by Cambridge University Press:  25 February 2011

N. M. Menezes ,
K. Georgiades  and
M. H. Boyle
N. M. Menezes*
Affiliation:
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
K. Georgiades
Affiliation:
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
M. H. Boyle
Affiliation:
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
*
*Address for correspondence: Dr N. M. Menezes, 25 Charlton Ave E., #703, Hamilton, ON L8N 1Y2, Canada. (Email: [email protected])
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Abstract

Background

Many studies have reported an increased incidence of psychiatric disorder (particularly psychotic disorders) among first generation adult immigrants, along with an increasing risk for ethnic minorities living in low-minority concentration neighborhoods. These studies have depended mostly on European case-based databases. In contrast, North American studies have suggested a lower risk for psychiatric disorder in immigrants, although the effect of neighborhood immigrant concentration has not been studied extensively.

Method

Using multi-level modeling to disaggregate individual from area-level influences, this study examines the influence of first generation immigrant status at the individual level, immigrant concentration at the neighborhood-level and their combined effect on 12-month prevalence of mood, anxiety and substance-dependence disorders and lifetime prevalence of psychotic disorder, among Canadians.

Results

Individual-level data came from the Canadian Community Health Survey (CCHS) 1.2, a cross-sectional study of psychiatric disorder among Canadians over the age of 15 years; the sample for analysis was n=35 708. The CCHS data were linked with neighborhood-level data from the Canadian Census 2001 for multi-level logistic regression. Immigrant status was associated with a lower prevalence of psychiatric disorder, with an added protective effect for immigrants living in neighborhoods with higher immigrant concentrations. Immigrant concentration was not associated with elevated prevalence of psychiatric disorder among non-immigrants.

Conclusions

The finding of lower 12-month prevalence of psychiatric disorder in Canadian immigrants, with further lessening as the neighborhood immigrant concentration increases, reflects a model of person–environment fit, highlighting the importance of studying individual risk factors within environmental contexts.

Keywords

Epidemiologyimmigrantsmental healthmultilevel analysisprevalence
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2221 - 2231
Copyright
Copyright © Cambridge University Press 2011

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References

Alegria, M, Canino, G, Shrout, PE, Woo, M, Duan, N, Vila, D, Torres, M, Chen, CN, Meng, XL (2008). Prevalence of mental illness in immigrant and non-immigrant US Latino groups. American Journal of Psychiatry 165, 359–369.CrossRefGoogle ScholarPubMed
Alegria, M, Canino, G, Stinson, FS, Grant, BF (2006). Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67, 56–65.CrossRefGoogle ScholarPubMed
Alegria, M, Mulvaney-Day, N, Torres, M, Polo, A, Cao, Z, Canino, G (2007 a). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health 97, 68–75.CrossRefGoogle ScholarPubMed
Alegria, M, Shrout, PE, Woo, M, Guarnaccia, P, Sribney, W, Vila, D, Polo, A, Cao, Z, Mulvaney-Day, N, Torres, M, Canino, G (2007 b). Understanding differences in past year psychiatric disorders for Latinos living in the US. Social Science and Medicine 65, 214–230.CrossRefGoogle ScholarPubMed
Ali, JS, McDermott, S, Gravel, RG (2004). Recent research on immigrant health from statistics Canada's population surveys. Canadian Journal of Public Health 95, I9–I13.CrossRefGoogle ScholarPubMed
Andrews, G, Hall, W, Teeson, M, Henderson, S (2000). The Mental Health of Australians. Department of Health and Aged Care: Canberra.CrossRefGoogle Scholar
Bourque, F, van der Ven, E, Malla, A (2010). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine. Published online: 21 July 2010. doi:10.1017/S0033291710001406.Google ScholarPubMed
Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG, Murray, RM (2001). Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. British Medical Journal 323, 1336–1338.CrossRefGoogle ScholarPubMed
Braucht, GN (1979). Interactional analysis of suicidal behavior. Journal of Consulting and Clinical Psychology 47, 653–669.CrossRefGoogle ScholarPubMed
Brekke, JS, Barrio, C (1997). Cross-ethnic symptom differences in schizophrenia: the influence of culture and minority status. Schizophrenia Bulletin 23, 305–316.CrossRefGoogle ScholarPubMed
Breslau, J, Aguilar-Gaxiola, S, Kendler, KS, Su, M, Williams, D, Kessler, RC (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine 36, 57–68.CrossRefGoogle Scholar
Breslau, J, Borges, G, Hagar, Y, Tancredi, D, Gilman, S (2009). Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration. Psychological Medicine 39, 1117–1127.CrossRefGoogle Scholar
Bresnahan, M, Begg, MD, Brown, A, Schaefer, C, Sohler, N, Insel, B, Vella, L, Susser, E (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity? International Journal of Epidemiology 36, 751–758.CrossRefGoogle Scholar
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.CrossRefGoogle ScholarPubMed
Chui, T, Tran, K, Maheux, H (2006). Immigration in Canada: A Portrait of the Foreign-born Population, 2006 Census: Findings. Statistics Canada: Ottawa, Ontario.Google Scholar
Cook, B, Alegria, M, Lin, JY, Guo, J (2009). Pathways and correlates connecting Latinos' mental health with exposure to the United States. American Journal of Public Health 99, 2247–2254.CrossRefGoogle ScholarPubMed
Diez-Roux, AV (1998). Bringing context back into epidemiology: variables and fallacies in multilevel analysis. American Journal of Public Health 88, 216–222.CrossRefGoogle ScholarPubMed
Duncan, GJ, Raudenbush, SW (1999). Assessing the effects of context in studies of child and youth development. Educational Psychologist 34, 29–41.CrossRefGoogle Scholar
Faris, RE, Dunham, WH (1939). Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses. The University of Chicago Press: Chicago, IL.Google Scholar
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 1541–1550.CrossRefGoogle ScholarPubMed
Georgiades, K, Boyle, MH, Duku, E (2007). Contextual influences on children's mental health and school performance: the moderating effects of family immigrant status. Child Development 78, 1572–1591.CrossRefGoogle ScholarPubMed
Geronimus, A, Bound, J, Neidert, L (1996). On the validity of using census geocode characteristics to proxy individual socioeconomic characteristics. Journal of the American Statistical Association 91, 529–537.CrossRefGoogle Scholar
Gordon, RA, Savage, C, Lahey, BB, Goodman, SH, Jensen, PS, Rubio-Stipec, M, Hoven, CW (2003). Family and neighborhood income: additive and multiplicative associations with youths' well-being. Social Science Research 32, 191–219.CrossRefGoogle Scholar
Grant, BF, Stinson, FS, Hasin, DS, Dawson, DA, Chou, SP, Anderson, K (2004). Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 1226–1233.CrossRefGoogle ScholarPubMed
Halpern, D, Nazroo, J (2000). The ethnic density effect: results from a national community survey of England and Wales. International Journal of Social Psychiatry 46, 34–46.CrossRefGoogle ScholarPubMed
Hutchinson, G, Haasen, C (2004). Migration and schizophrenia: the challenges for European psychiatry and implications for the future. Social Psychiatry and Psychiatric Epidemiology 39, 350–357.CrossRefGoogle ScholarPubMed
Jarvis, GE (2007). Rethinking social causes of psychosis. Canadian Journal of Psychiatry 52, 275–276.CrossRefGoogle ScholarPubMed
Kennedy, S, McDonald, JT, Biddle, N (2006). The Healthy Immigrant Effect and Immigrant Selection: Evidence from Four Countries: Social and Economic Dimensions of an Aging Population Research Papers. McMaster University.Google Scholar
Kim, D (2008). Blues from the neighborhood? Neighborhood characteristics and depression. Epidemiologic Reviews 30, 101–117.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB (2007). Neighbourhood-level effects on psychoses: re-examining the role of context. Psychological Medicine 37, 1413–1425.CrossRefGoogle ScholarPubMed
Kreft, IG (1994). Multilevel models for hierarchically nested data: potential applications in substance abuse prevention research. NIDA Research Monograph 142, 140–183.Google ScholarPubMed
Kupersmidt, JB, Griesler, PC, DeRosier, ME, Patterson, CJ, Davis, PW (1995). Childhood aggression and peer relations in the context of family and neighborhood factors. Child Development 66, 360–375.CrossRefGoogle ScholarPubMed
Little, RA, Rubin, DB (2002). Statistical Analysis with Missing Data (2nd edn). John Wiley and Sons, Inc.: New York.CrossRefGoogle Scholar
McDonald, JT, Kennedy, S (2004). Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Social Science and Medicine 59, 1613–1627.CrossRefGoogle ScholarPubMed
McGrath, J, El-Saadi, O, Cardy, S, Chapple, B, Chant, D, Mowry, B (2001). Urban birth and migrant status as risk factors for psychosis: an Australian case-control study. Social Psychiatry and Psychiatric Epidemiology 36, 533–536.CrossRefGoogle ScholarPubMed
March, D, Hatch, SL, Morgan, C, Kirkbride, JB, Bresnahan, M, Fearon, P, Susser, E (2008). Psychosis and place. Epidemiologic Reviews 30, 84–100.CrossRefGoogle ScholarPubMed
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655–664.CrossRefGoogle Scholar
Odegaard, O (1932). Emigration and insanity: a study of mental disease among Norwegian born population in Minnesota. Acta Psychiatrica et Neurologica Scandinavica 7, 1–206.Google Scholar
Pickett, KE, Pearl, M (2001). Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology and Community Health 55, 111–122.CrossRefGoogle ScholarPubMed
Rasbash, J, Browne, W, Goldstein, H, Yang, M, Plewis, I, Healy, M, Woodhouse, G, Draper, D, Langford, I, Lewis, T (2000). A User's Guide to MLwiN, version 2.1. Institute of Education: London.Google Scholar
Rasbash, J, Steele, F, Browne, W, Prosser, B (2004). A User's Guide to MLwiN, version 2.0. Institute of Education: London.Google Scholar
Silver, E, Mulvey, EP, Swanson, JW (2002). Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science and Medicine 55, 1457–1470.CrossRefGoogle ScholarPubMed
StatsCan (2003). Characteristics of Canada's Newest Immigrants. Longitudinal Survey of Immigrants to Canada: Process, Progress and Prospects. Statistics Canada: Ottawa, Ontario.Google Scholar
Strakowski, SM, Flaum, M, Amador, X, Bracha, HS, Pandurangi, AK, Robinson, D, Tohen, M (1996). Racial differences in the diagnosis of psychosis. Schizophrenia Research 21, 117–124.CrossRefGoogle ScholarPubMed
Supina, AL, Patten, SB (2006). Self-reported diagnoses of schizophrenia and psychotic disorders may be valuable for monitoring and surveillance. Canadian Journal of Psychiatry 51, 256–259.CrossRefGoogle ScholarPubMed
Swinnen, SG, Selten, JP (2007). Mood disorders and migration: meta-analysis. British Journal of Psychiatry 190, 6–10.CrossRefGoogle ScholarPubMed
van Os, J, Castle, DJ, Takei, N, Der, G, Murray, RM (1996). Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychological Medicine 26, 203–208.CrossRefGoogle ScholarPubMed
van Os, J, Driessen, G, Gunther, N, Delespaul, P (2000). Neighbourhood variation in incidence of schizophrenia. Evidence for person-environment interaction. British Journal of Psychiatry 176, 243–248.CrossRefGoogle ScholarPubMed
Vega, WA, Kolody, B, Aguilar-Gaxiola, S, Alderete, E, Catalano, R, Caraveo-Anduaga, J (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry 55, 771–778.CrossRefGoogle Scholar
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, JP, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.CrossRefGoogle ScholarPubMed
Weich, S, Holt, G, Twigg, L, Jones, K, Lewis, G (2003). Geographic variation in the prevalence of common mental disorders in Britain: a multilevel investigation. American Journal of Epidemiology 157, 730–737.CrossRefGoogle Scholar
Weich, S, Nazroo, J, Sproston, K, McManus, S, Blanchard, M, Erens, B, Karlsen, S, King, M, Lloyd, K, Stansfeld, S, Tyrer, P (2004). Common mental disorders and ethnicity in England: the EMPIRIC study. Psychological Medicine 34, 1543–1551.CrossRefGoogle ScholarPubMed
WHO (2004). The Global Burden of Disease: 2004 Update. WHO: Geneva.Google Scholar
Wittchen, HU (1994). Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 57–84.CrossRefGoogle ScholarPubMed