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. 2024 Mar 1;79(3). doi: 10.1093/geronb/gbad104.
Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus.
This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10).
Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters.
Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.
加拿大移民的确诊抑郁症发病率往往低于非移民。有一种理论认为，这种“健康移民效应（HIE）”是由于积极选择造成的。另一种观点认为，移民医疗服务的利用不足可能是潜在的原因。这种不明确的“移民悖论”因种族-移民关系的相互交织而更加复杂。
本基于人群的研究分析了来自加拿大社区健康调查（2015-2018 年）的 28951 名年龄≥45 岁的参与者的数据。采用多变量逻辑回归来研究种族-移民关系与心理健康结果（包括抑郁症状[PHQ-9 得分≥10]）之间的关联。
与加拿大出生的白人相比，无论种族如何，移民一生中接受医疗提供者进行心境/焦虑障碍诊断（M/A-Dx）的可能性较小。有针对性的移民在精神上处于不利地位，未确诊的抑郁症的几率增加（调整后的优势比[AOR]为 1.76，99%置信区间[CI]：1.30-2.37），而白人移民的精神健康状况较好，患 PHQ 抑郁症的几率降低（AOR=0.75，99%CI：0.58，0.96），自我报告的心理健康状况较差的几率降低（AOR=0.56，99%CI：0.33，0.95）。在没有既往 M/A-Dx 的亚人群中（N=25203），有针对性的移民患 PHQ 抑郁症的几率增加（AOR=1.45，99%CI：1.15-1.82）和未被识别的抑郁症的几率增加（AOR=1.47，99%CI：1.08-2.00）比加拿大出生的白人高。未确诊抑郁症的其他风险因素包括缺乏定期护理提供者、急诊室作为常规护理来源以及作为房屋租户。
尽管加拿大拥有全民医疗保健，但未确诊的抑郁症负担不成比例地影响到中年和晚年的有色人种（而非白人）移民。取决于种族-移民关系，心理健康方面的 HIE 可能主要是由白人移民的更健康状况驱动的，部分原因是健康专业人员对有色人种移民的心理健康状况的检测不足和识别不足。需要转变思维方式来估计医疗服务不足人群的晚年抑郁症。
