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.

We are in a new global era, framed and shaped by migration and record movements across borders. The intersection of migration, mental health, and psychosocial wellbeing represents an increasingly important matter in the humanitarian space. Global rates of migration are at an all-time high, with internal and cross-border migration hitting record figures (United Nations Department of Economic and Social Affairs, Population Division, 2020). Mexico is a country that has been particularly affected by migration, as a top country of transit, as well as destination for migrants and asylum-seekers from the Americas and across the globe. The rise of displaced people traveling to Mexico and the United States, in combination with limited protection and legal support for migrants, has resulted in an unprecedented situation requiring attention. Population displacement results from an array of push factors, including political instability, climate degradation, natural disasters, and economic/physical insecurity. As growing numbers of people migrate to and through Mexico in search of protection and improvements in livelihoods, it is crucial to consider gaps in access to support services for migrants and asylum-seekers. Access to health care has long been a challenge for migrant populations in Mexico (Infante, 2022), and in particular, barriers have been reported in relation to Mental Health and Psychosocial Support (MHPSS) for people migrating while seeking asylum further North (Allande, 2022). Thus, there exists a need for the provision of improved and adapted MHPSS programs for migrants in Mexico, with particular attention to those from outside of Mexico seeking asylum in the United States. Working in collaboration with local partners, this Integrated Learning Experience (ILE) summarizes findings from a multi-stage exploratory assessment. The overarching goal of this ILE was to identify opportunities for improving the design and implementation of MHPSS for migrant populations in Mexico. To do so, this research focused on addressing three specific aims: identify major gaps and challenges in delivering MHPSS services from the perspectives of practitioners and scholars (Aim 1); assess perceptions of existing MHPSS services from the perspective of intended users through in-depth inquiry with migrant communities (Aim 2); and, map barriers and facilitators to accessing MHPSS services as well as co-creating implementation strategies, tools and key recommendations through participatory workshops with key actors (Aim 3). The specific research methods utilized in this assessment included: A) synthesis of 3 years of survey data gathered from service providers, along with key informant interviews (KIIs) with service providers to identify existing programs, gaps, and challenges; B) focus group discussions with migrant populations combined with ethnographic observations to assess support and how they are perceived, and C) participatory workshops with key actors to co-create implementation strategies to improve supports from a systems perspective. By mapping existing MHPSS supports in key locations and engaging with different stakeholders through participatory methods, this ILE presents a systematic, conceptual approach to identify leverage points for improvements in programs that fit the unique situation and lived experiences of people on the move. The final recommendations outline practical steps to promote more coherent and comprehensive approaches to MHPSS programming while recognizing and responding to overlapping risks of violence, discrimination, and other challenges this population may face. Key takeaways reveal overall shortages in availability of services, and gaps in information-sharing and coordination. Most importantly, findings show a cultural disconnect with many MHPSS programs, calling for a rethink of how to design and implement services in a manner that better fit the realities and preferences of migrant communities. Ways forward include promoting cultural humility, community engagement, listening, and promoting agency in order to strengthen MHPSS practices that are grounded in and sensitive to the views of those migrating.

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