Study identifies role of contextual determinants of depression in Chinese immigrant communities

York University Professor Farah Ahmad is the lead author on a recent study that examined the symptoms and experiences of depression among Chinese immigrant communities in the West through a systematic review of literature published since 1999.

Alan Fung

Alan Fung

Farah Ahmad

Farah Ahmad

Together with colleagues, including Alan Fung from North York General Hospital, the team of researchers identified the role of contextual determinants in the development of depression of migrants.

Their work, published in the November/December 2018 issue of the Harvard Review of Psychiatry, was funded by the North York General Hospital Exploration Fund.

“Based on this finding, migration should not be treated as the cause of mental illness. Rather, one needs to consider the conditions and events that migrant communities experience as protective or risk factors in order to inform mental health programs and policies,” said Ahmad, a professor in the School of Health Policy & Management, Faculty of Health, and affiliate scientist at the North York General Hospital.

A key finding in the study was the subtle variations in somatization – bodily aches, pains and other symptoms when experiencing depression – that challenges the monolithic notion of somatization associated with people from Chinese culture.

The study’s authors call for further research to explore the notion of cultural scripts, where people attend and react to experiences in culturally based ways, while cultures shift with time and place.

Other crucial findings included low rates of professional help-seeking among Chinese communities in the West, and knowledge gaps around effective means of enhancing cultural sensitivity in care. Fung, a psychiatrist, Chair of the Research Ethics Board at North York General Hospital and faculty member at the University of Toronto and Tyndale University College, emphasized the need to develop effective models for cultural sensitivity such as “co-construction of illness narratives and finding common ground, especially when stigma of mental illness is high in the community.”

Given increasing global migration, understanding experiences of mental health conditions among immigrant communities in the West is important, said Ahmad. Currently, almost 22 per cent of Canada’s population are first-generation immigrants and, in the 2016 census, Chinese descent Canadians are estimated to be 1.57 million.

Further, she said, migration is not without challenges and the rates of common mental disorders are on the rise globally. The World Health Organization predicts that depression will rank first in the burden of diseases for high-income countries by 2030.

Given high mental health stigma, low professional help-seeking for depression and somatization experiences among Chinese immigrant communities in the West, culturally sensitive health care is needed, along with upstream policies to address post-migration challenges experienced by them. The authors recommend expanding the role of primary care to reach migrant Chinese communities early on and to enhance scholarly work on these determinants.

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