Determinants of Mental Health Service Use among African Immigrants in St. John's Newfoundland and Labrador


Ukeme Eka, Memorial University

Mental health problems are increasingly recognized as a global public health concern (Rehm and Shield, 2019). Immigrants arrive from diverse source countries and settle in different communities. As the source countries have shifted from Europe to Asia, Africa, Latin America, and the Caribbean, understanding how these individuals and their families utilize mental health services has become more critical. As immigrants are prone to higher levels of stress than the general population (Chiu et al., 2018), exploring their use of mental health services is essential. For instance, compared to the larger Canadian population, immigrants are more likely to report poorer self-rated mental health (Kitchen, Williams, and Gallina, 2015), low mental health care utilization (Chen and Kazanjian, 2005; Fenta et al., 2006), and a lower sense of belonging to their local community (Kitchen et al., 2015). African immigrants face considerable challenges (i.e., cultural, economic, social, and political) with the potential to affect their resettlement, acculturation, healthcare needs, and service use patterns (Bacon et al., 2010; Müller and Koch, 2011; Son, 2013). Understanding the influence of cultural and socioeconomic determinants on health and perceived health is essential to understanding the health-seeking behaviour of immigrants in Canada (Cheng and Goodman, 2015). Many studies on mental health use among immigrants homogenously, lumped several ethnicities into a single category (Chen and Kazanjian, 2005; Durbin et al., 2015; Fenta et al., 2006; Kirmayer et al., 2011; Whitley et al., 2017), despite coming from different regions around the world, and encountering unique pre-immigration experiences (i.e., economic, cultural, political, and social) and diverse post-migration experiences, such as resettlement (Kirmayer et al., 201l; Muller and Koch, 2011; Son, 2013). Thus, generalizing immigrant experiences may not account for the diversity among immigrant populations or accurately represent the factors driving the need for services and the use of services (Gushulak et al., 2011; Kirmayer et al., 201l). Applying the Immigrant Health Services Utilization framework by Yang and Hwang’s (2016), we explored the factors that facilitate or impede African immigrants use of mental health services in St. John’s, Newfoundland and Labrador. Between June and December 2020, a cross-sectional mental health service questionnaire was developed and administered utilizing the Qualtrics survey system to survey 272 immigrants of African descent. The framework explores disparities in the utilization of mental health services by immigrants in relation to four broad categories: predisposing factors, including immigrants social and demographic characteristics (age, marital status, gender, etc.); enabling factors, including financial and human resources, immigrant networks; need for care factors such as immigrants self-reported health status; macrostructural and contextual conditions (e.g., policy, politico-economic factors). Complementary log–log regression models were used to examine factors influencing immigrants’ decision to seek mental health services considering Yang and Hwang’s framework. Overall, 11.4% of African immigrants self-reported they used mental health services in the past 12 months preceding the survey, while 88.6% indicated they had not used mental health services. Macrostructural and contextual factors, namely respondents self-rated perception of the provincial healthcare system and experiences with discrimination and racism, were statistically associated with mental service health use. For instance, immigrants with negative perception perceptions and ratings of the provincial healthcare system were 75% less likely to use mental health services. Also, those with experiences of discrimination and racism were about two times more likely to seek mental health services. Other factors, including African immigrants’ sense of belonging and access to social support, were important correlates of mental health services use. Respondents with a strong sense of belonging to their countries of birth were 77% less likely to use, while those with strong social support were about 2 times more likely to use. Our findings underscore the importance of emphasizing structural/contextual factors to improving mental health utilization among African immigrants in St. John’s, NL. Improving access to care and promoting immigrant-friendly healthcare policies that emphasize diversity and inclusion may help their use of mental health services.

Non-presenting author: Eric Tenkorang, Memorial University

This paper will be presented at the following session: