Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
J Gerontol B Psychol Sci Soc Sci. 2023 Aug 28;78(9):1555-1571. doi: 10.1093/geronb/gbad036.
Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment.
Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC.
Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters.
To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.
当代移民研究通常将具有不同种族背景的移民视为一个整体群体。在理解心理健康护理中的种族和出生地不平等如何相互交织和发展在中年和老年中仍然存在知识差距。本研究旨在探讨种族、移民和老年在塑造心理健康治疗方面的共同影响。
从加拿大社区健康调查（2015-2018 年）中获得汇总数据，并将其限制在患有情绪或焦虑障碍的受访者（年龄≥45 岁）（n=9099）。使用多变量逻辑回归估计种族-移民关系与过去一年心理健康咨询（MHC）之间的关联。应用分类和回归树（CART）分析确定 MHC 的相交决定因素。
与加拿大出生的白人相比，具有种族特征的移民有更大的心理健康需求：自我评估的心理健康状况较差/一般（优势比[OR]为 2.23，99%置信区间[CI]为 1.67-2.99），感知生活压力大（OR 为 1.49，99%CI：1.14-1.95），精神共病（OR 为 1.42，99%CI：1.06-1.89）和未满足的护理需求（OR 为 2.02，99%CI：1.36-3.02）；相比之下，他们在大多数指标上获得心理健康服务的可能性较小：整体过去一年的 MHC（OR 为 0.54，99%CI：0.41-0.71）和家庭医生咨询（OR 为 0.67，99%CI：0.50-0.89），心理学家（OR 为 0.54，99%CI：0.33-0.87）和社会工作者（OR 为 0.37，99%CI：0.21-0.65），但精神病就诊除外（p=0.324）。CART 算法确定了三组 MHC 服务利用率低的风险人群：年龄≥55 岁的具有种族特征的移民，没有高中文凭的移民以及母语为非英语的少数族裔租房者。
为了保障加拿大医疗服务不足社区的医疗保健公平性，多部门需要努力确保对有精神障碍的具有种族特征的老年移民提供文化响应的心理健康护理，提供多种语言服务和负担得起的住房。
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