'I thought we would be cherished and safe here': understanding the multi-faceted nature of mental health among Arab immigrants/refugees in Ontario, Canada- the CAN-HEAL study

Sarah Elshahat; Tina Moffat; Basit Kareem Iqbal; K Bruce Newbold; Mahira Morshed; Haneen Alkhawaldeh; Olivia Gagnon; Mafaz Gehani; Keon Madani; Tony Zhu; Lucy Garabedian; Yumnah Jafri; Nour Kanaa; Aya Mohamed; Naya Nadeem; Zena Shamli Oghli; Salima Zabian; Amal Shah; Asil Samhat; Sahiba Khaira; Hussyin Jelal; Jessica Kaloti; Sriyasri Varadarajan; Youyou Xu; Megan Laing

doi:10.1007/s00127-024-02668-4

'I thought we would be cherished and safe here': understanding the multi-faceted nature of mental health among Arab immigrants/refugees in Ontario, Canada- the CAN-HEAL study

Soc Psychiatry Psychiatr Epidemiol. 2024 Apr 25. doi: 10.1007/s00127-024-02668-4. Online ahead of print.

Authors

Sarah Elshahat¹, Tina Moffat², Basit Kareem Iqbal², K Bruce Newbold³, Mahira Morshed⁴, Haneen Alkhawaldeh⁵, Olivia Gagnon⁶, Mafaz Gehani⁷, Keon Madani⁸, Tony Zhu⁹, Lucy Garabedian¹⁰, Yumnah Jafri¹¹, Nour Kanaa⁶, Aya Mohamed⁴, Naya Nadeem⁴, Zena Shamli Oghli⁴, Salima Zabian¹², Amal Shah¹³, Asil Samhat¹⁴, Sahiba Khaira¹⁵, Hussyin Jelal¹⁶, Jessica Kaloti¹¹, Sriyasri Varadarajan⁴, Youyou Xu¹⁷, Megan Laing⁴

Affiliations

¹ Department of Anthropology, Faculty of Social Sciences, McMaster University, Chester New Hall, Hamilton, ON, L8S 4L9, Canada. elshahas@mcmaster.ca.
² Department of Anthropology, Faculty of Social Sciences, McMaster University, Chester New Hall, Hamilton, ON, L8S 4L9, Canada.
³ School of Earth, Environment and Society, McMaster University, Hamilton, ON, Canada.
⁴ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁵ Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, ON, Canada.
⁷ Department of Psychological and Health Sciences, University of Toronto, Scarborough, ON, Canada.
⁸ Integrated Biomedical Engineering and Health Sciences Faculty, McMaster University, Hamilton, ON, Canada.
⁹ Department of Criminology and Sociolegal Studies, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Biomedical and Molecular Sciences, Faculty of Arts and Science, Queen's University, Kingston, ON, Canada.
¹¹ Department of Biology, Faculty of Science, McMaster University, Hamilton, ON, Canada.
¹² Physiology and Pharmacology Department, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
¹³ Department of Psychology, Faculty of Sciences, University of Toronto, Mississauga, ON, Canada.
¹⁴ Department of Political Science, Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada.
¹⁵ The Munk School of Global Affairs and Public Policy, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada.
¹⁷ Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.

PMID: 38664285
DOI: 10.1007/s00127-024-02668-4

Abstract

Purpose: Mental health (MH) is a critical public health issue. Arab immigrants/refugees (AIR) may be at high risk for MH problems owing to various unique stressors, such as post-September/11 demonization. Despite the growing AIR population in Western countries, there is a lack of AIR-MH research in these nations. The CAN-HEAL study examined MH experiences and needs among AIR in Ontario, Canada.

Methods: This study employed a cooperative community-based participatory research and integrated knowledge translation approach. The study used photovoice, qualitative interviews and a questionnaire survey. Sixty socio-demographically diverse AIR adults partook in this study. The research was informed by the "social determinants of health" framework and the "years since immigration effect" (YSIE) theory.

Results: The term "mental health" was deemed offensive for participants aged > 30 years. Participants proposed other culturally-appropriate words including "well-being" and "emotional state". The prevalence of poor mental well-being in the sample was alarming (55%). Of first-generation immigrant participants, 86.8% reported negative changes in MH since migration. The negative changes are not straightforward; they are complex and dynamic, and mainly related to micro/macro-aggression, cross-cultural pressures, dissatisfaction with the health and social care system, and poor living conditions. Intersections between different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion) amplified the negative changes in MH and exacerbated inequities.

Conclusions: MH needs among AIR are distinct and intersectionality aggravated inequities. Culturally and structurally competent healthcare and structural/policy reformation are required to tackle MH inequities. This can be fulfilled through intersectoral cooperation and including AIR in decision-making.

Keywords: Anxiety; Community-based participatory research; Distress; Immigrants; Inequities; Social determinants of health.