Current research identifies gender, age, and ethnic patterns for the healthy immigrant effect related to mental health, but little research explores what determines immigrants’ mental health and how mental health deterioration occurs. This dissertation investigates the ‘what’ and the ‘how’ questions by applying the Social Determinants of Health (SDOH) Perspective and the Stress Process Model. To answer the ‘what’ question, this dissertation draws on the SDOH framework to examine potential social determinants—in the form of structural conditions, behavioral risks and psychosocial demands—affecting long-term immigrants’ lower mental health status. To approach the ‘how’ question, it employs the Stress Process Model to investigate the differential exposure to behavioral risks and psychosocial demands between recent and long-term immigrants. The analysis of the data from the Canadian Community Health Survey-Mental Health 2012 and the General Social Survey-Social Identity 2013 indicates that structural conditions, behavioral risks, and psychosocial demands co-influence immigrants' mental health to some extent. Behavioral risks have independent contributions to mental health, but the contributions are small. Psychosocial resources and demands, however, have the greatest impact on mental health. An examination of the relationships between length of migration and psychosocial resources indicates that, compared to recent immigrants, long-term immigrants are in the state of 'high support and high strain,’ and the differences in these psychosocial resources and demands translate into mental health differences (the so-called healthy immigrant effect) between long-term and recent immigrants. / Thesis / Doctor of Philosophy (PhD)

Through conceptualizing migration as a social process, this dissertation examines the role of social support among urban migrants. Existing research examining social support is often framed in North American or European contexts and ignores its connectivity with migration or mobility. There remains critical opportunity for research to examine how social support paradigms function in Low and Middle Income Countries (LMICs) and from the perspective of urban migrants, including refugees and economic migrants. By expanding the frame of both migration and social support research, this dissertation endeavors to enrich the empirical knowledge surrounding the role of social support among urban migrants. To accomplish this, this dissertation examines the intersection of trauma, social support, and depression among two urban migrant populations. Through its integration of data from female Syrian refuges in Jordan and male economic migrants in Kazakhstan, this dissertation aims to describe social support, potentially traumatic events (PTEs), and depressive symptomology; identify the direct association of social support and depressive symptomology, and; examine the moderating role of social support on depressive symptomology related to PTEs. This dissertation is guided by the Push-Pull Theory, the Stress-Buffering Hypothesis, and van Brenda’s conceptualization of resilience. Findings from this dissertation suggest that social support plays a critical role, both directly and indirectly, in influencing outcomes of depressive symptomology. Findings have several implications for social support measurement and direct practice of mental health clinicians, as well as informing how community-based interventions and mental-health policies within LMICs can integrate social support within their resiliency frameworks.

No description available.

Bibliogrpahy: leaves 288-306. / xvi, 325 leaves : ill., maps ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 2000

The 2016 presidential election and restrictive immigration policies implemented under the Trump administration created a climate of heightened tension and uncertainty for undocumented immigrants from Latin America. There is a gap in the psychological literature regarding the mental health of undocumented immigrants from Latin America residing in the U.S., the largest number of which reside in California, and few studies have examined the experiences of mental health clinicians conducting therapy with undocumented immigrants, particularly keeping in mind the impact of national policy agendas that fuel anti-immigrant sentiment. Following Consensual Qualitative Research (CQR) methodology, this study gathered first-person narratives from 15 mental health professionals who work with undocumented immigrants from Latin American in California, with a focus on the effect of change in political leadership following the 2016 U.S. presidential election. Nine domains emerged from the analysis. Mental health clinicians reported that the 2016 election had a significant impact on their work, including client’s distress and the clinician’s own emotional response to the political climate. Themes in therapy following the election, challenges to conducting therapy with undocumented clients, and the risk and protective factors that were reported to have the greatest influence on client mental health are discussed. Clinical implications and recommendations for the provision of mental health services to undocumented immigrants from Latin America are offered, including a separate set of recommendations for supporting mental health clinicians who provide mental health services to undocumented immigrants from Latin America.

While the literature on Black-white differences in major depressive disorder (MDD) and depressive symptoms is robust, less robust is the literature on how these outcomes are patterned within the US Black population and why differences exist. Given increasing numbers of first-generation immigrants from the Caribbean, sub-Saharan Africa, Latin America, among other regions of the world, as well as increasing numbers of second- and third-generation immigrants, continued aggregation has the potential to mask intra-racial differences between these ethnic-immigrant groups and Black Americans with more distant ancestral ties to Africa (i.e., African Americans). Among these subgroups, the extremely limited data disaggregating the US Black population suggest the following patterns. First, foreign-born Black immigrants have lower levels of MDD and related symptoms relative to US-born Black Americans, a finding which is consistent with theories of foreign-born health advantage. Second, among the US-born, Caribbean adults have higher levels of MDD and related symptoms relative to all other Black Americans, a finding which is inconsistent with theories related to intergenerational declines in health toward convergence to native-born levels. Lastly, and contrary to results among adults, first- and second-generation Caribbeans have lower levels of depressive symptoms relative to all other Black youth. This dissertation sought to better understand how depression and its related symptoms are patterned within the US Black population, as well as how mechanisms causing these outcomes may vary across subgroups defined by domains related to immigration. Chapter 1 was a systematic review, which comprehensively synthesized depression and related symptoms within the US Black population across these domains, including a summary of mechanisms proposed toward explaining intra-racial variation. Using longitudinal data, Chapter 2 examined whether, and if so when, growth curve models of depressive symptoms varied by immigrant generation contrasts among a representative sample of Black youth followed into adulthood. And using representative data from the largest study of Black mental health, Chapter 3 examined whether the relationship between racial identity, a presumed protective factor against depression and related symptoms, and MDD varied between US-born Caribbeans and all other US-born Black Americans. The systematic review of Chapter 1 revealed substantial variation in the prevalence of depression and its related symptoms within the US Black population by nativity, region of birth, age at immigration, and Caribbean ethnic origin. Results additionally confirmed that much of what is known about intra-racial heterogeneity comes from a single data source, the National Study of American Life (NSAL). Using longitudinal data of youth followed into adulthood, Chapter 2 found evidence of diverging depressive symptoms trajectories among Black respondents by immigrant generation (first/second-generation compared with third and higher generations); notably, contrasts among Black respondents varied from those of other racial/ethnic groups (Asian, Hispanic/Latinx, non-Hispanic white). Lastly, results from Chapter 3 suggest aspects of racial identity may not be protective for US-born Caribbeans, pointing to variations in racialization experiences as a distal cause. Additional research using larger sample sizes, more diverse subgroups of Black ethnic immigrants, as well as longitudinal data, is needed to further understand patterns of and additional sources underlying heterogeneity of depression and its related symptoms within the US Black population.

Suicide is the leading cause of violent death and a major public health and clinical concern. Globally, suicide mortality has decreased over the last three decades, largely due to dramatic declines in pesticide poisonings in Asia. Recent suicide mortality trends, however, have been heterogeneous, and there have been increases in suicide in several countries and regions (e.g., the United States, Jamaica, Cameroon). Monitoring suicide rates is important for surveillance reasons as well as to generate causal hypotheses, two key components of suicide prevention efforts. Suicide increases following major societal crises, such as economic recessions, are often characterized by heterogeneity across population subgroups – with larger increases among vulnerable groups. Examining subgroups, even if evidence of an increase in suicide overall is absent, can guide identification of at-risk groups and development and implementation of targeted prevention strategies. In Spain, a country with one of the lowest suicide rates across Europe, there has been scientific debate regarding whether suicide increased following the 2008 economic recession. Most recent research suggests that suicide remained largely unchanged, but data are scarce on vulnerable groups among whom the downstream economic effects of the recession might have been more intense than in the general population. Following the initial COVID-19 pandemic outbreak, there was generalized concern that suicide rates would go up due to increases in bereavement and loss of loved ones, fear of contagion and death, increases in prevalence of mental health conditions, and negative economic effects of the pandemic and contagion control measures. Initial examinations of suicide trends, however, indicated that suicide mortality either remained unchanged or decreased in most locations across the globe during the initial months following the pandemic onset. Subsequent evidence of delayed increases in suicide in specific places (e.g., Japan), however, pointed out the importance of continued monitoring of suicide rates. In addition, there is increasing evidence that suicide rates during the COVID-19 era have changed heterogeneously across sociodemographic groups with higher vulnerability to specific pandemic-related stressors (e.g., higher suicide risk among minoritized people in the United States or women in Japan). There are no systematic reviews examining suicide during the COVID-19 era beyond the initial 6 months of the pandemic, and there has been no systematic assessment of the variation in suicide changes after the onset of the pandemic across place, over time, and across population subgroups. In Spain, there has also been substantial debate regarding the impact of the pandemic on suicide rates: two studies using a suboptimal methodological approach found somewhat contradictory results. No studies have examined suicide among population subgroups during the pandemic in Spain. The aim of this dissertation is to examine variations in suicide across population groups as defined by sociodemographic characteristics during major societal crises (i.e., the 2008 recession and the COVID-19 pandemic) in Spain, and variations across place, over time, and across sociodemographic groups globally. The first chapter uses two different approaches to age-period-cohort modelling to examine suicide between 2000 and 2019 in Spain, stratifying analyses by foreign-born status – the most salient marker of disadvantage in Spain, and further analyzing suicide among foreign-born individuals without Spanish citizenship – a proxy for lack of residency permit. I found that, while suicide following the recession remained stable among native-born men, it increased slightly among native-born women – largely due to cohort effects affecting middle-aged women, and markedly among foreign-born individuals – largely due to period effects. Suicide increased especially among foreign-born individuals without Spanish citizenship. Notably, access to specialized healthcare and welfare was interrupted for migrants without residency permit shortly following onset of the recession, in the context of austerity politics undertaken across Europe. These results highlight the moderating role of socioeconomic vulnerability on suicide risk during major economic crises. The second chapter is a systematic integrative review of the variation of population-based suicide estimates following the initial pandemic outbreak globally. In this review, I examine methodological features of all published studies examining suicide during the COVID-19 pandemic, highlighting the importance of addressing autocorrelation, non-stationarity, and seasonality in studies using an interrupted time-series analysis (ITSA) approach to test a causal question (i.e., to compare observed vs. expected or counterfactual suicide counts or rates). I also provide rationale to expect substantial heterogeneity in a so-called effect of the pandemic on suicide, given multiple versions of the exposure of interest that make it impossible to estimate a sole causal effect. I critically summarize the results overall with a focus on variation across place, over time, and across population subgroups. My findings indicate substantial geographical heterogeneity; a variable initial period of decreased suicide followed, in several locations, by delayed suicide increases – underscoring the importance of sustained monitoring of rates; and heterogeneity across population subgroups with larger suicide increases among groups at higher risk of suicide contagion and mortality (e.g., older adults, racially minoritized residents) and groups vulnerable to negative economic effects of the pandemic (e.g., groups overrepresented in hospitality and tourism jobs). The third chapter uses Seasonal Autoregressive Integrated Moving Average (SARIMA) prediction models, an approach to ITSA that can adequately deal with autoregression, non-stationarity, and seasonality, to predict monthly suicide counts between April and December 2020 in Spain had the pandemic not taken place. I do so overall and by sex- and age-group, and by foreign-born status in a set of sensitivity analyses, and I then compare observed vs. predicted suicides to determine if suicide increased. I find generalized higher-than-expected suicide rates during spring and summer of 2020, overall and across subgroups – especially among older males during the summer months. I discuss potential explanations and implications for decision-making of these findings considering the theoretical framework developed in chapters 1 and 2.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

In 2012, President Barack Obama used prosecutorial discretion to initiate the Deferred Action for Childhood Arrivals (DACA) program that deferred deportation and provided employment authorization for a two-year renewable period to undocumented immigrant persons that came to the U.S. as children. Under former President Donald Trump’s administration, DACA was rescinded in 2017. A review of the literature suggests this is the only study to explore the perceived impact of a policy shift in DACA status, given the critical time of interviews conducted from April 2016 to October 2018. Thus, substantially advancing the literature, qualitative data on a diverse group (N=10) of young adult DACA beneficiaries revealed positive and negative impacts. The sample included 60% currently gainfully employed, 40% attending college—while 80% had experienced emotional distress by having an unauthorized legal status and facing obstacles to pursuing higher education. Of note, 40% rated themselves as currently relatively healthy, while 60% indicated having experienced a decline in their physical or mental health since entering the United States. As significant sources of stress, 90% had experienced anxiety centered around having to wait to renew their DACA status and having to pay for their status renewals. Given the rescinding of the DACA program in 2017, many were ill-prepared, as 90% had never experienced being undocumented without a DACA status as an adult in the United States. The main body of qualitative data generated six categories that encompassed 51 emergent themes: 1-Participants’ health trajectory across their lifespan; 2-Participants’ experiences of barriers to seeking care and having their health and mental health needs addressed; 3-Participants Living at the Intersection of Contemporary Immigration; 4-The impact of other family members’ immigration status; 5-From enjoying benefits of the DACA program, to having a false sense of normalcy, to feeling ambivalence, and experiencing detriments; and, 6-Potential DACA policy shifts and anticipated impacts ranging from negative (fear, loss, suffering) to positive (relief). These six broad categories suggest how, despite the benefits of their DACA status, substantial barriers and sources of anxiety and stress still impacted the lives of the young adults and their families. Implications of the findings are discussed.