Journal of Psychiatric and Mental Health Nursing, 2015, 22, 655–667

Social support, social conflict, and immigrant women’s mental health in a Canadian context: a scoping review S . G U R U G E 1 RN F. C H A Z E 4 M S W

Ph D,

M. S. THOMSON2

Ph D,

U. GEORGE3

Ph D

&

1

Associate Professor, School of Nursing, 2Project Coordinator, Office of the Dean, Faculty of Community Services, Professor, Dean, Faculty of Community Services, and 4PhD (Cand.), Instructor, School of Social Work, Faculty of Community Services, Ryerson University, Toronto, ON, Canada 3

Keywords: Canada, immigrant women,

Accessible summary

mental health, reciprocity, social conflict, social support

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Correspondence: S. Guruge School of Nursing Ryerson University

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350 Victoria Street Toronto ON M5B2K3 Canada E-mail: [email protected] Accepted for publication: 3 March 2015 doi: 10.1111/jpm.12216

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Social support has positive and negative dimensions, each of which has been associated with mental health outcomes. Social networks can also serve as sources of distress and conflict. This paper reviews journal articles published during the last 24 years to provide a consolidated summary of the role of social support and social conflict on immigrant women’s mental health. The review reveals that social support can help immigrant women adjust to the new country, prevent depression and psychological distress, and access care and services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women’s mental health. It is crucial that interventions, programmes, and services incorporate strategies to both enhance social support as well as reduce social conflict, in order to improve mental health and well-being of immigrant women.

Abstract Researchers have documented the protective role of social support and the harmful consequences of social conflict on physical and mental health. However, consolidated information about social support, social conflict, and mental health of immigrant women in Canada is not available. This scoping review examined literature from the last 24 years to understand how social support and social conflict affect the mental health of immigrant women in Canada. We searched MEDLINE, PsycINFO, CINAHL, Healthstar, and EMBASE for peer-reviewed publications focusing on mental health among immigrant women in Canada. Thirty-four articles that met our inclusion criteria were reviewed, and are summarized under the following four headings: settlement challenges and the need for social support; social support and mental health outcomes; social conflict and reciprocity; and social support, social conflict, and mental health service use. The results revealed that social support can have a positive effect on immigrant women’s mental health and well-being, and facilitate social inclusion and the use of health services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women’s mental health. The results also highlighted the need for health services to be linguistically-appropriate and culturally-safe, and provide appropriate types of care and support in a timely manner in order to be helpful to immigrant women.

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Introduction The (re)settlement experiences, along with related factors such as acculturation stress, limited or loss of social networks and social isolation, language and cultural barriers, un/under employment, low socioeconomic status, and lack of and/or barriers to access to services, are known to have negative effects on immigrants’ mental health (Guruge et al. 2008, Reitmanova & Gustafson 2008, MacDonnell et al. 2012). Researchers have also identified the role of gender in relation to immigrant settlement and mental health (Schreiber et al. 1998, 2000, Spitzer 2005, Guruge et al. 2009, O’Mahony & Donnelly 2013). Furthermore, compared with Canadian-born women, immigrant women are significantly more likely to have low levels of social support, unmet health literacy needs, low family incomes, and require financial assistance (Sword et al. 2006). Social exclusion, poor work conditions, and poverty are some of the social determinants that have been linked with the health and well-being of immigrant women (Guruge & Collins 2008, MacDonnell et al. 2012). Based on a recently conducted scoping review, this paper presents a summary of the state of knowledge about social support and social conflict, and immigrant women’s mental health. It is divided into four parts: Part 1 introduces the concepts of social support, social conflict, and reciprocity in relation to immigrant women’s health. Part 2 details the purpose of the scoping review, research questions, method of the review, and demographic characteristics of the studies reviewed. Part 3 presents the key findings of the scoping review. Part 4 concludes the paper with a discussion of how enhancing social support and reducing conflict may improve mental health among immigrant women, with the goal of informing practice and policy as well as providing directions for future research.

Part 1 Background Social support has been defined as ‘cognitive appraisal of being connected to others, and knowing that support is there if needed’ (Barrera 1986, cited in Weber 1998, p. 1). Social support can be categorized into four types: informational (provision of information for problem-solving); emotional (provision of care and/or trust); appraisal (provision of information that helps self-evaluation); and instrumental (provision of tangible goods and/or services) (Langford et al. 1997). Social support can be provided by informal networks of friends, families, and ethnic communities, as well as by formal networks such as those provided 656

by health-care/social work practitioners (Guruge & Humphreys 2009, Gagnon et al. 2013). Social support has been recognized as one of the key social determinants of health (Public Health Agency of Canada 2004). Support from families, friends, and communities can be very important in helping people solve problems and deal with adversity, as well as in maintaining a sense of mastery and control over life circumstances. The caring and respect that can occur in social relationships, and the resulting sense of satisfaction and well-being, appear to act as buffers against health problems (Public Health Agency of Canada 2004, p. 10). Social support is also known to be a determinant of mental and physical health that affects health-related beliefs and behaviours (Dennis et al. 2009, Thornton et al. 2006, O’Mahony & Donnelly 2010). Social support can serve as a buffer against the harmful effects of stress, as a coping resource that protects against physical and mental health risks, and/or as a potential source of help that encourages successful coping during stressful situations (Simich et al. 2004, p. 2). Lack of social networks and support has been associated with increased risk for distress and mental illness (Cohen & Wills 1985, Thoits 1995, Tang et al. 2007, Puyat 2013, Sethi 2013). Even when social networks are present, they can be a source of conflict (Tilden & Galyen 1987, O’Mahony & Donnelly 2010). In some situations, the same relationship or social network can provide positive support while being a source of contention or disaccord (Tilden & Galyen 1987). Furthermore, social support may be provided by formal or informal sources with expectations of reciprocity that may create stress to individuals due to feelings of obligation (Tilden & Galyen 1987). Multiple factors contribute to immigrant women experiencing a reduction in their sources of support. For example, immigration generally entails separation from one’s existing social networks, which, in turn, results in decrease in one’s accustomed levels of support with respect to childcare and/or intervention in cases of marital discord (Guruge & Humphreys 2009). Post-migration social support is also likely to be differentially experienced by immigrant women depending on their particular social location. For example, educated, English-speaking, immigrant women might be able to access supports that other immigrant women might not. The lack of English-language proficiency can make women dependent on Englishlanguage speakers in the family and limit their social interactions with others. Connections with informal and/or formal social supports might be further constrained due to individual and contextual barriers (such as lack of transportation and financial limitations), as well as systemic problems (such as the lack of culturally-safe or linguisti© 2015 John Wiley & Sons Ltd

Social support, social conflict and immigrant women’s mental health

cally appropriate services) (Guruge & Humphreys 2009, Guruge et al. 2011). The impact of these may be exacerbated for immigrant women from racialized backgrounds because of the experiences of social exclusion (Sword et al. 2006, Guruge & Collins 2008, Alvi et al. 2012).

Part 2 Research aim and questions This scoping review was aimed at consolidating the existing evidence on the role of social support and social conflict in mental health and well-being of immigrant women and providing the practitioners with recommendations on how to help improve social support and reduce social conflict. For the purposes of this review, social support is defined as informational, instrumental financial, emotional, and/or appraisal help provided by formal or informal supports available to immigrant women, while social conflict is defined as discord, tension, or stress within these relationships (Guruge et al. 2012). We focused on the following research questions: (1) How do social support and social conflict affect immigrant women’s mental health in Canada? and (2) What strategies could help to enhance social support and reduce social conflict for immigrant women?

Method Scoping reviews ‘aim to map rapidly the key concepts underpinning a research area and the main sources and types of evidences available, and can be undertaken as stand-alone projects in their own right, especially, where an area is complex or has not been reviewed before’ (Mays et al. 2001, p. 194). Arksey & O’Malley (2005) proposed four objectives for scoping reviews: (1) to examine the extent, range, and nature of research activity; (2) to determine the value of undertaking a systematic review; (3) to summarize and disseminate the research findings; and (4) to identify the research gaps in the existing literature. We focused on Objectives 1, 3, and 4. Following Arksey & O’Malley (2005)’s framework, we: (1) identified the research question (see above); (2) searched relevant studies; (3) selected studies; (4) charted the data; and finally, (5) collated and summarized the results. Steps 2 to 5 are addressed next. We searched the MEDLINE, PsycINFO, CINAHL, Healthstar, and EMBASE databases using the terms: emigrant/immigrant/transient/migrant/refugee and mental health/mental illness/mental disorders/adjustment disorders; and Canada. We also used combinations of keywords and terms that exploded from the subject headings. © 2015 John Wiley & Sons Ltd

Articles were scanned using the following inclusion criteria: (1) peer-reviewed research articles; (2) focused on the Canadian context; (3) focused on immigrant women; (4) written in English; and (5) published between January 1990 and 2014. The database searches yielded 206 abstracts, of which 71 duplicates were removed. Literature reviews and secondary studies were also omitted. In total, 34 articles were selected for review (see Fig. 1) and charted (see Table 1). Since the aim of scoping studies is to map the extent and nature of literature, rather than to assess the quality of the individual studies (as per Arksey & O’Malley 2005), quality appraisal of the included literature was not performed.

Demographic characteristics of the studies reviewed Provincial distributions of the studies were as follows: nine studies were conducted in Ontario (n = 9; 26%), followed by Quebec (n = 8; 23%), Alberta (n = 7; 21%), British Columbia (n = 4; 12%), Newfoundland (n = 1, 3%), and Nova Scotia (n = 1, 3%). Four articles (n = 4; 12%) were based on research conducted in more than one province. Sample sizes of the studies ranged from 10–5329 participants. In total, 22 articles (65%) focused on immigrant women and 12 (35%) focused on immigrant and refugee women. Twelve (36%) studies reported focusing on immigrants or refugees from Asia (i.e. Sri Lankan Tamils/ Indians/Mainland Chinese/Hong Kong Chinese/Taiwanese/ Koreans/Vietnamese) and/or Mexico, South America (Brazil, Columbia), Central America (Costa Rica), Africa etc. One (3%) study focused on populations emigrating from the Caribbean, Africa, and the Middle East, and on Black immigrants, in general. Three (9%) studies focused on diverse ethnicities including ‘Anglophones’, ‘Anglophone Euro-Canadians’, and ‘Anglophone AfroCaribbean’. The remaining studies focused on immigrants without specifying their ethnic backgrounds. Overall, 65% (n = 22) of the studies used qualitative methods, 29% (n = 10) used quantitative methods, and 6% (n = 2) used mixed methods, combining qualitative and quantitative methods. Six studies used a longitudinal design; all the other studies were cross-sectional. Many studies compared the social support received by immigrants and/or refugees in Canada to their pre-migration experiences (e.g. Ahmad et al. 2004, Chiu et al. 2005, Zelkowitz et al. 2008, Guruge & Humphreys 2009, Donnelly et al. 2011, MacDonnell et al. 2012, O’Mahony et al. 2012a, 2012b, Stewart et al. 2012). Others compared the social supports available for immigrant women and non-immigrant women (Mechakra-Tahiri & Zunzunegui 2007, Reitmanova & Gustafson 2008, Landy et al. 2009, Miszkurka et al. 2010, Alvi et al. 2012). 657

Abstracts generated through database searches = 206 Duplicates removed = 71

Abstracts screened = 135

Abstracts excluded = 32

Full-text articles assessed for eligibility = 103

Articles excluded = 69

Included

Screened

Identified

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Articles focused on immigrant women’s social support, social conflict, and mental health in Canada = 34

Part 3 Results Settlement challenges and the need for social support Post-migration challenges are compounded by stressful experiences of social isolation (Ali & Toner 2001, Katz & Gagnon 2002, Fung & Dennis 2010). Social isolation and exclusion are known to contribute to mental health problems and illness among diverse immigrant and refugee groups (Beiser et al. 1993, Ahmad et al. 2004, Beiser & Hou 2006, Ahmed et al. 2008, Whitley & Kirmayer 2008, Simich et al. 2009). In Ahmed et al.’s study of depressive symptoms among immigrant, refugee, and asylum-seeking mothers, many participants attributed their depressive symptoms to social isolation, feeling overwhelmed, and financial worries (2008); facilitators to recovery included having support from friends, family, and community support groups, among others. In Stewart et al.’s (2008a) study of Somali and Chinese immigrants, participants noted that they needed support to deal with various 658

Figure 1 Flow chart: literature search and selection

settlement-related challenges including: language difficulties; inadequate child care; navigating the system; securing employment; family problems that emerged after migration; challenges of contending with the reality of living in Canada compared with their idealistic expectations; and, discrimination. Supportive social interactions are also useful to help refugees deal with the psychological distress associated with acculturation (Jorden et al. 2009). Social support and mental health outcomes The relationship between lack of social support and depression among immigrant women is well documented (Dennis & Ross 2006a, Dennis & Ross 2006b, Sword et al. 2006, Dennis et al. 2007, Mechakra-Tahiri & Zunzunegui 2007, O’Mahony et al. 2012a, 2012b). Stewart et al. (2012) found that pregnant new immigrants who experienced violence also had inadequate levels of social support and reported more depression, anxiety, somatization, and posttraumatic stress disorder on standardized tests. Social isolation was identified as one of the main reasons for the depressive symptoms exhibited by © 2015 John Wiley & Sons Ltd

Social support, social conflict and immigrant women’s mental health

Table 1 Data extraction table Author information

Sample information

Research design

Focus area

1. Acharya and Northcott (2007)

Ethnicity or country/Continent of Birth/Origin: South Asians (Indians) Age: Range = 60–74 Immigration status: Immigrants Gender: F Sample Size: 21 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Qualitative analysis

Determinants of mental health

2. Ahmad et al. (2004)

Ethnicity or country/Continent of Birth/Origin: South Asians(Indians) Age: Range =18–69 Immigration status: Immigrants Gender: F Sample size: 24 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Focus groups Analysis: Qualitative analysis

Determinants of mental health

3. Ahmed et al. (2008)

Ethnicity or country/Continent of Birth/Origin: China, India, Pakistan, South America, Egypt, Haiti Age: Range = 20–40 Immigration status: Family class immigrants, refugees, and asylum seekers Gender: F Sample Size: 10 Location: Toronto/Montreal/ Vancouver

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Constant comparative analysis

Determinants of mental health (Depression)

4. Alvi et al. (2012)

Ethnicity or country/Continent of Birth/Origin: not specified Age: Range = 19–66 Immigration status: Immigrants and non-immigrant women Gender: F Sample size: 91 Location: Ontario

Method: Mixed Design: Cross-sectional Collection: Questionnaire Analysis: Comparative and exploratory analysis (descriptive, bivariate, and regression analysis)

Determinants of mental health

5. Chiu et al. (2005)

Ethnicity or country/Continent of Birth/Origin: South and East Asians (Indians, Mainland China, Taiwan, Vietnam, Hong Kong, Brunei) Age: Range = 26–67 Immigration status: First generation immigrants Gender: F Sample size: 30 Location: British Columbia

Method: Qualitative Design: Cross-sectional Collection: Naturalistic, descriptive research design with ethnographic interviews (face to face and semi-structured) Analysis: Thematic analysis

Mental illnesstreatment choices

6. Dennis and Ross (2006a)

Ethnicity or country/Continent of Birth/Origin: n/a Age: Range = 17–44 Immigration status: Immigrants and Canadian born Gender: F Sample size: 594 Location: British Columbia

Method: Quantitative Design: Longitudinal study Collection: Questionnaires, Instruments Analysis: Chi-square analysis and t-tests

Determinants of metal health (Depression)

7. Dennis and Ross (2006b)

Ethnicity or country/Continent of Birth/Origin: n/a Age: Range = 18–43 Immigration status: Immigrants and Canadian born Gender: F Sample Size: 396 Location: British Columbia

Method: Quantitative Design: Longitudinal study Collection: Questionnaires Analysis: Descriptive and multiple regression analysis

Determinants of metal health (Postpartum depression)

8. Donnelly et al. (2011)

Ethnicity or country/Continent of Birth/Origin: China and Sudan Age: Range = n/a Immigration status: Immigrants and refugees Gender: F Sample size: 10 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Descriptive exploratory qualitative research based on an ecological conceptual framework and post-colonial feminist perspective

Determinants of mental health

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Table 1 Continued Author information

Sample information

Research design

Focus area

9. Etowa et al. (2007)

Ethnicity or country/Continent of Birth/Origin: African Canadian Age: Range = 40–65 Immigration status: Family class immigrants, refugees, and asylum seekers Gender: F Sample size: 113 Location: Nova Scotia

Method: Mixed Design: Cross-sectional Collection: Interviews, standardized instrument, community workshops, and focus groups Analysis: Triangulation of quantitative, qualitative, and participatory action research. Thematic analysis and descriptive statistics

Determinants of mental health (Depression)

10. Gagnon et al. (2013)

Ethnicity or country/Continent of Birth/Origin: Middle East, South and East Asia, Russia, Serbo-Croatia, Latin America, and Somali Age: Range = n/a Immigration status: International migrant women Gender: F Sample size: 16 Location: Toronto/Montreal

Method: Qualitative Design: Cross-sectional Collection: Focused ethnography including in-depth interviews and participant observation Analysis: Thematic data analysis

Determinants of mental health

11. Hynie et al. (2011)

Ethnicity or country/Continent of Birth/Origin: Colombia, El Salvador, Jamaica, Ecuador, Trinidad, Caribbean islands, Portugal, Brazil, Azores, Mexico, Angola, Costa Rica, Cuba, Pakistan and Afghanistan Age: Range = 19–50 Immigration status: Permanent, refugees, and precarious (those awaiting decisions on claims and those without official status Gender: F Sample size: 87 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Interviews and focus groups Analysis: Thematic analysis

Determinants of mental health

12. Landy et al. (2009)

Ethnicity or country/Continent of Birth/Origin: n/a Age: Range = n/a Immigration status: Immigrant and non-immigrant women Gender: F Sample size: 24 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: In-depth interviews Analysis: Qualitative content analysis

Determinants of mental health

13. MacDonnell et al. (2012)

Ethnicity or country/Continent of Birth/Origin: Africa, South Asia, Asia, Central or South America, and Caribbean Age: Range = n/a Immigration status: Racialized immigrant women Gender: F Sample size: 35 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Focus groups Analysis: Theoretical sampling and analysis based on constructivist grounded theory

Mental health promotion

14. Majumdar and Ladak (1997)

Ethnicity or country/Continent of Birth/Origin: Africa and Middle East Age: Range = 30–49 Immigration status: Immigrants, refugee, and racial minority women Gender: F Sample Size: 67 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Questionnaire, focus groups Analysis: Descriptive analysis

Determinants of mental health

15. Malta et al. (2012)

Ethnicity or country/Continent of Birth/Origin: n/a Age: Range = 18–5 and over Immigration status: Canadian born and immigrants Gender: F Sample size: 1319 Location: Alberta

Method: Quantitative Design: Cross-sectional Collection: Questionnaire and instruments Analysis: Chi-square and multivariate logistic regression analysis

Determinants of mental health (Post partum Depression)

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Social support, social conflict and immigrant women’s mental health

Table 1 Continued Author information

Sample information

Research design

Focus area

16. MechakraTahiri et al. (2007)

Ethnicity or country/continent of birth/origin: n/a Age: 20–35 and over Immigration status: Immigrants and non-immigrants Gender: F Sample size: 1875 Location: Quebec

Method: Quantitative Design: Longitudinal study Collection: Interviews and instruments Analysis: Descriptive including logistic regression analysis

Determinants of mental health (Depression)

17. Miszkurka et al. (2012)

Ethnicity or country/continent of birth/origin: Latin America, Caribbean, Maghreb, Sub-Saharan Africa, Middle East, Asia, Southeast Asia, South Asia, Europe Age: Range = 18–35 and over Immigration status: Canadian born and foreign born Gender: F Sample Size:5,329 Location: Quebec

Method: Quantitative Design: Cross-sectional Collection: Questionnaires and instruments Analysis: Descriptive statistical analysis chi-square tests, prevalence odds ratio, and logistic regressions

Determinants of mental health (Depression)

18. Miszkurka et al. (2010)

Ethnicity or country/continent of birth/Origin: Latin America, Caribbean, Maghreb, Sub-Saharan Africa, Middle East, Asia, Southeast Asia, South Asia, Europe Age: Range = 18–35 and over Immigration status: Canadian born and immigrants Gender: F Sample Size: 5,329 Location: Quebec

Method: Quantitative Design: Cross-sectional Collection: Questionnaires an instruments Analysis: Descriptive statistical analysis chi-square tests, prevalence odds ratio, and logistic regressions

Determinants of mental health (Depression)

Method: Quantitative Design: Cross-sectional Collection: Questionnaire, Interviews Analysis: Quantitative analysis

Determinants of mental health (Depression)

19. Moghaddam Ethnicity or country/continent of birth/origin: India Age: Range = 19–64 et al. Immigration status: Immigrant women (1990) Gender: F Sample Size: 104 Location: Quebec 20. Morrow et al. (2008)

Ethnicity or country/Continent of birth/origin: China, India, Hong Kong. Taiwan, England Age: Range = 27–49 Immigration status: Immigrant women Gender: F Sample Size: 18 Location: British Columbia

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Ethnographic approach, qualitative analysis

Determinants of mental health (Postpartum Depression)

21. O’Mahony & Donnelly (2013)

Ethnicity or country/continent of birth/origin: Mexico, South America (Brazil, Columbia), Central America (Costa Rica), South East Asia (Philippines), South Asia (India, Pakistan), China, Middle East, Africa Age: Range = 18 and over Immigration Status: 22 immigrants and 8 refugees Gender: F Sample size: 30 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Ethnographic approach, qualitative analysis

Determinants of mental health (Postpartum Depression)

22. O’Mahony et al. (2013)

Ethnicity or country/continent of Birth/origin: Mexico, South America (Brazil, Columbia), Central America (Costa Rica), South East Asia (Philippines), South Asia (India, Pakistan), China, Middle East, Africa Age: Range = 18 and over Immigration status: 22 immigrants and 8 refugees Gender: F Sample size: 30 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Qualitative analysis

Determinants of mental health (Postpartum Depression)

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Table 1 Continued Author information

Sample information

Research design

Focus area

23. O’Mahony et al. (2012a)

Ethnicity or country/continent of birth/origin: Mexico, South America (Brazil, Columbia), Central America (Costa Rica), South East Asia (Philippines), South Asia (India, Pakistan), China, Middle East, Africa Age: Range = 18 and over Immigration status: 22 Immigrants and 8 refugees Gender: F Sample size: 30 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Qualitative analysis

Determinants of mental health (Postpartum Depression)

24. O’Mahony et al. (2012b)

Ethnicity or country/continent of birth/origin: Mexico, South America (Brazil, Columbia), Central America (Costa Rica), South East Asia (Philippines), South Asia (India, Pakistan), China, Middle East, Africa Age: Range = 18 and over Immigration status: 22 Immigrants and 8 refugees Gender: F Sample size: 30 Location: Alberta

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Qualitative analysis

Determinants of mental health (Postpartum Depression)

25. Reitmanova and Gustafson (2008)

Ethnicity or country/continent of birth/origin: n/a Age: Range = 25–40; Mean = Immigration Status: Immigrant women Gender: F Sample Size: 6 Location: Newfoundland

Method: Qualitative Design: Cross-sectional Collection: In-depth interviews Analysis: Qualitative analysis

Determinants of mental health

26. Stewart et al. (2012)

Ethnicity or country/continent of birth/origin: Asylum seekers, refugees and non refugee immigrants Age: Range = n/a Immigration status: Non refugee, refugees, and asylum seekers Gender: F Sample size: 774 Location: Toronto, Montreal, Vancouver

Method: Qualitative Design: Cross-sectional Collection: Questionnaires Analysis: Qualitative analysis

Determinants of mental health (Violence)

27. Stewart et al. (2008a, 2008b, 2008c)

Ethnicity or country/continent of birth/origin: China, India, Pakistan, South America, Egypt, Haiti Age: Mean = 29.3:S.D 5.3 Immigration status: Non refugees, asylum seekers, refugees, and Canadian-born Gender: F Sample size: 719 Location: Toronto, Montreal, Vancouver

Method: Qualitative Design: Cross-sectional Collection: Interview- assisted questionnaires Analysis: Descriptive statistics, bivariate analysis, and logistic regression analysis

Determinants of mental health (Postpartum Depression)

28. Tang et al. (2007)

Ethnicity or country/continent of birth/origin: China, Hong Kong, Taiwan Age: Mean = 37.57:S.D.5.99 Immigration status: Immigrant women Gender: F Sample size: 50 Location: Ontario

Method: Quantitative Design: Longitudinal study Collection: Questionnaires and interviews Analysis: Chi-square analysis and hierarchical regression analysis

Determinants of mental health

29. Teng et al. (2007)

Ethnicity or country/continent of birth/origin: China, India, Pakistan, South Africa, China, Afghanistan, Hong Kong Age: n/a Immigration status: Immigrants Gender: F Sample size: 16 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Qualitative semi-structured interviews Analysis: Constant comparative analysis

Determinants of mental health (Postpartum Depression)

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Table 1 Continued Author information

Sample information

Research design

Focus area

30. Whitley and Kirmayer (2008)

Ethnicity or country/continent of birth/origin: Euro Canadian and Anglophone Afro Caribbean Age: Range = 20–30 Immigration status: Immigrants Gender: F Sample size: 33 Location: Quebec

Method: Qualitative Design: Cross-sectional Collection: Interviews Analysis: Exploratory analysis

Determinants of mental health

31. Whitleyand Green (2008)

Ethnicity or country/continent of birth/origin: Black women Age: n/a Immigration status: Family class immigrants, refugees, and asylum seekers Gender: F Sample size: 12 Location: Quebec

Method: Qualitative Design: Cross-sectional Collection: In-depth interviews Analysis: Qualitative content analysis

Determinants of mental health

32. Wong et al. (2004)

Ethnicity or country/continent of birth/origin: Korea, Hong Kong, Mainland China, Taiwan, and Vietnam Age: Range = n/a Immigration status: Immigrants Gender: F Sample size: 102 Location: Ontario

Method: Qualitative Design: Cross-sectional Collection: Focus groups Analysis: Constant comparative analysis

Determinants of mental health

33. Zelkowitz et al. (2008)

Ethnicity or country/continent of birth/origin: Middle Eastern/North African countries, Europe, Asia, Latin America, Africa, and Caribbean Islands Age: Mean = 30.6: S.D. 4.9 Immigration status: Canadian citizens or landed immigrants Gender: F Sample size: 106 Location: Quebec

Method: Quantitative Design: Longitudinal Collection: Questionnaires, Instruments Analysis: Quantitative analysis

Determinants of mental health (Depression)

34. Zelkowitz et al. (2004)

Ethnicity or country/continent of birth/origin: Middle Eastern/North African countries, Europe, Asia, Latin America, Africa, and Caribbean Islands Age: Mean = 30.6: S.D.4.9 Immigration status: Canadian citizens or landed immigrants Gender: F Sample size: 106 Location: Quebec

Method: Quantitative Design: Longitudinal Collection: Questionnaires, Instruments Analysis: Quantitative analysis

Determinants of mental health (Depression)

women who have been in Canada less than five years (Ahmed et al. 2008). Zelkowitz et al. (2004) found that pregnant immigrant women who are depressed had poorer functional status and somatic symptoms, lacked social support, experienced more stressful life events, and exhibited ‘poor marital adjustment’. Poor social support was identified as one of the key risk factors for postpartum depression among immigrant women (Logsdon et al. 2005, Dennis & Ross 2006a, 2006b, Stewart et al. 2008a, Fung & Dennis 2010, O’Mahony & Donnelly 2013, O’Mahony et al. 2013). For example, in a comparative study of postpartum depression among immigrant and non-immigrant women, Stewart et al. (2008a) found that immigrant women with elevated depressive symptoms had significantly lower social support scores than non-immigrant © 2015 John Wiley & Sons Ltd

women. Zelkowitz et al. (2008) reported that marital quality of life was the best predictor for postpartum depression among immigrant women, particularly because they may lack social support from extended family they might otherwise have relied on after giving birth. Similarly, Mechakra-Tahiri & Zunzunegui (2007) reported that compared with non-immigrant mothers, immigrant mothers receiving weak spousal support had higher prevalence rates of depression. Tang et al.’s (2007) longitudinal study of married Chinese women who are new to Toronto revealed that social support had neither a direct effect on mental health nor a buffer effect on the relationships between life events, financial difficulties, and mental health of the participants. However, most literature documents positive effects of 663

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social support on immigrant mental health (Wong & Tsang 2004, Gibney & McGovern 2011). Some suggests that social support can improve mental health and/or alleviate the negative effects of mental illnesses or other ‘social pathologies’ (Coker et al. 2002, Wu & Hart 2002, Mulvaney-Day et al. 2007, Gibney & McGovern 2011). Dennis et al. (2009) found that providing emotional and informational support by telephone was effective in preventing postpartum depression among ‘high-risk women’, while Miszkurka et al. (2010, p. 359) found that social support ‘favoring integration and poverty reduction interventions could reduce [the] risk of antenatal depression’. In a study of Black women in Montreal, Whitley & Green (2008) found that social support from the extended family is a key variable that helps buffer psychosocial stressors. Social conflict and reciprocity When social support is ineffective and/or inappropriate, it can create further stress that negatively affects immigrant women’s mental health and well-being (Weber 1998). This may be particularly true for informal support. For example, Morrow et al. (2008) found that postpartum stressors and depression among their study participants were directly connected to conflict they experienced with their informal networks. Teng et al. (2007) reported that immigrant women whose family members pooled resources to send them overseas for the purpose of entering into an arranged marriage feel obligated or feel pressured to remain in such relationship to ensure future support and sponsorship. Guruge et al. (2012) also explored how social conflict and/or reciprocity might affect women (including immigrant women) seeking help for intimate partner violence: Friends, relatives, or formal sources of support may create distress for women by: minimizing the abuse, blaming the victim, maintaining secrecy about the abuse, discouraging women from seeking help, siding with the abuser, criticizing the women’s choices, telling them what to do, or placing conditions on their help. They suggested that these ‘intrusive costs of relationships interfere with women’s abilities to promote their health and the health of their families and to build a better life after leaving an abusive partner’ (Guruge et al. 2012, p. 2). Social support, social conflict, and mental health service use Overall, the literature is limited on the role social conflict and reciprocity within informal social networks play in shaping the access and use of mental health services among immigrant women. However, the literature is clear about the role of problematic formal sources of support on immigrant women’s access to and use of mental health care and 664

services. Immigrants are more likely to underutilize formal sources of social support for several reasons: they are unaware of these services or unable to access them (Sword et al. 2006, Ahmed et al. 2008, Reitmanova & Gustafson 2009a, Donnelly et al. 2011); they face transportation problems or mobility issues (Chiu et al. 2005, Stewart et al. 2011); there is a lack of culturally-safe (Lai & Surood 2008, 2010) and linguistically-appropriate services (Taylor et al. 2005, Beiser & Hou 2006, Etowa et al. 2007, Chen & Tse 2010, Lai & Surood 2010); and, there is stigma associated with seeking help, particularly for mental health issues (Ryder et al. 2000, Chiu et al. 2005, Whitley et al. 2006, Hsu & Alden 2008, Chen & Tse 2010).

Part 4 Implications for practice This scoping review highlighted the positive role of social support and the negative effects that a lack of social support can have on immigrant women’s mental health. The review also highlighted that social support is complex and context-specific, and that reciprocity and conflict arising from the informal social network, can also lead to or add to mental health problems. Problematic formal social support can also become a source of stress for immigrant women. This impact may be heightened for women who do not have supportive family, friends, and other informal sources of support. Our review demonstrates the need for social support interventions, programmes, and services for immigrant women to improve their mental health and well-being. It also reveals the need to develop practice and policy mechanisms to address the social support needs of immigrant women. One important way to improve social support for immigrant women is by meeting their informational needs (Dennis et al. 2009). Both informal and formal sources of support can play a crucial role in meeting this need (George & Chaze 2009). Much of the stress faced by immigrants in the settlement period is caused by financial uncertainties, and formal and informal sources of support can play an important role in helping immigrants build social networks that can facilitate finding employment (Sword et al. 2006, George & Chaze 2009b) and/or managing the stressful credentialing processes. It is also important to advocate for supportive work environment and fair wage as well as social inclusion of immigrants into the larger society (MacDonnell et al. 2012). Providing social support at the right time, in the appropriate manner can improve mental health outcomes for immigrant women (Stewart et al. 2008a, Dennis et al. 2009). In order for immigrant women to feel comfortable © 2015 John Wiley & Sons Ltd

Social support, social conflict and immigrant women’s mental health

accessing services, they need to be linguisticallyappropriate and culturally-safe (Pepler & Lessa 1993, Lai 2000, Pottie et al. 2005, Etowa et al. 2007, Hong & Woody 2007, Lai & Chou 2007, Lai & Surood 2008, 2010, Mason et al. 2008, Chow 2010). In particular, services could be made more accessible through means such as: using the services of trained translators and interpreters (Ahmed et al. 2008); linking immigrant women to existing support groups and community alliances (Ahmad et al. 2004); ensuring a diverse workforce (Sadavoy et al. 2004, Etowa et al. 2007); facilitating support groups in the community where immigrant women can meet other women and share information and experiences (Ahmad et al. 2004, Ahmed et al. 2008); and involving the immigrant communities in improving services, increasing self-awareness about well-being and mental health, and improving the use of preventive health practices (Bottoroff et al. 2001, Ahmad et al. 2004, Nadeau & Meacham 2005, Piat et al. 2007, O’Mahony & Donnelly 2007a, 2007b). Mental health practitioners must also encourage the creation, funding, and evaluation of programmes for newcomers to reduce isolation and facilitate the social inclusion. These programmes should also increase immigrant women’s awareness of, and knowledge about, the social, psychological, and physical correlates of mental health and illness.

Overall, current social and structural support systems in Canada are inadequate and hinder the successful transition, settlement, and integration of immigrant women (Tang et al. 2007, Stewart et al. 2008b): needed are policies and programmes that provide culturally-safe support and intersectoral collaboration to provide appropriate and timely informational, financial, emotional, instrumental, and appraisal support for immigrant women. It is also important to ensure that service responses are appropriate through evaluative research (Alvi et al. 2012, Guruge et al. 2012). Researchers need to continue to evaluate the relationships between social support, social conflict, and mental health among immigrant women, and to introduce health interventions to ensure that the needs of this population are being addressed effectively.

Acknowledgment This study was supported by Ministry of Health and Long Term Care, Ontario, Canada (MOHLTC Grant # 06662). The first author also acknowledges financial support for her work from the Institute of Gender and Health of Canadian Institutes of Health Research (CIHR) in the form of a New Investigator Award.

American Journal Community Psychology 14,

References

Coker A.L., Smith P.H., Thompson M.P., et al. (2002) Social support protects against the

413–445. Beiser M., Johnson P.J. & Turner R.J. (1993)

negative effects of partner violence on mental

Acharya M.P. & Northcott H.C. (2007) Mental

Unemployment, underemployment and depres-

health. Journal Women’s Health & Gender-

distress and the coping strategies of elderly

sive affect among Southeast Asian refugees.

Indian immigrant women. Transcultural Psy-

Psychological Medicine 23, 731–743. Beiser M.N. & Hou F. (2006) Ethnic identity,

chiatry 44, 614–636.

Based Medicine 11, 465–476. Dennis C.L. & Ross L.E. (2006a) Depressive symptomology in the immediate postnatal

Ahmad F., Shik A., Vanza R., et al. (2004) Voices

resettlement stress and depressive affect among

period. Canadian Journal of Psychiatry 51,

of South Asian women: immigration and mental

Southeast Asian refugees in Canada. Social

265–273.

health. Women and Health 40, 113–130.

Science & Medicine 63, 137–150.

Dennis C.-L. & Ross L.E. (2006b) Women’s per-

Ahmed A., Stewart D.E., Teng L., et al. (2008)

Bottorff J.L., Johnson J.L., Venables L.J., et al.

ceptions of partner support and conflict in

Experiences of immigrant new mothers with

(2001) Voices of immigrant South Asian

the development of postpartum depressive

symptoms of depression. Archives of Women’s

women: expressions of health concerns. Journal

symptoms. Journal of Advanced Nursing 56,

Mental Health 11, 295–303.

of health care for the poor and underserved 12,

Ali A. & Toner B.B. (2001) Symptoms of depres-

392–403.

588–599. Dennis C.-L., Ross L.E. & Grigoriadis S. (2007)

sion among Caribbean women and Caribbean-

Chen X. & Tse H.C.H. (2010) Social and

Psychosocial and psychological interventions

Canadian women: an investigation of self-

psychological adjustment of Chinese Canadian

for treating antenatal depression. Cochrane

silencing and domains of meaning. Psychology

children. International Journal of Behavioral

Database System Revised, 3. CD006309. doi:

of Women Quarterly 36, 163–173.

Development 34, 330–338.

Alvi S., Zaidi A., Ammar N., et al. (2012) A com-

10.1002/14651858.CD006309.pub2.

Chiu L., Ganesan S., Clark N., et al. (2005) and

treatment

choices

Dennis C.-L., Hodnett E., Reisman M., et al.

parative and exploratory analysis of socio-

Spirituality

by

(2009) Effect of peer support on prevention of

cultural factors and immigrant women’s mental

South and East Asian women with serious

postnatal depression among high risk women:

health in a Canadian context. Journal of Immi-

mental illness. Transcultural Psychiatry 42,

multisite randomized controlled trial. British

grant and Minority Health / Center for Minority

630–656.

Medical Journal 338, a3064.

Chow H.P. (2010) Growing old in Canada: physi-

Donnelly T.T., Hwang J.J., Este D., et al. (2011) If

Arksey H. & O’Malley L. (2005) Scoping studies:

cal and psychological well-being among elderly

I was going to kill myself, I wouldn’t be calling

towards a methodological framework. Interna-

Chinese immigrants. Ethnicity & Health 15,

you. I am asking for help: challenges influencing

tional Journal of Social Research Methodology

61–72.

immigrant and refugee women’s mental health.

Public Health 14, 420–432.

8, 19–32. Barrera M. (1986) Distinction between social support

concepts,

measures,

© 2015 John Wiley & Sons Ltd

and

models.

Cohen S. & Wills A.T. (1985) Stress, social support

Issues in Mental Health Nursing 32, 279–290.

and the buffering hypothesis. Psychological Bul-

Etowa J., Keddy B., Egbeyemi J., et al. (2007)

letin 98, 310–357.

Depression: the ‘invisible grey fog’ influencing

665

S. Guruge et al.

the midlife health of African Canadian women.

Hynie M., Crooks V.A. & Barragan J. (2011)

International Journal of Mental Health Nursing

Immigrant and refugee social networks: deter-

lence. Violence against women 14, 1397–1412.

16, 203–213.

minants and consequences of social support

Mays N., Roberts E. & Popay J. (2001)

among women newcomers to Canada. Cana-

Synthesizing research evidence. In: Studying the

dian Journal of Nursing Research 43, 26–46.

Organization and Delivery of Health Services:

Jorden S., Matheson K. & Anisman H. (2009)

Research Methods (eds Fulop, N., Allen, P.,

Gagnon A.J., Carnevale F., Mehta P., et al.

Supportive and unsupportive social interac-

Clarke, A., et al.), pp. 188–220. Routledge,

(2013) Developing population interventions

tions in relation to cultural adaptation and

with migrant women for maternal-child health:

psychological distress among Somali refugees

Mechakra-Tahiri S. & Zunzunegui M.V. (2007)

a focused ethnography. Biomedical Central

exposed to collective or personal traumas.

Self-rated health and postnatal depressive symp-

Public Health 13, 471.

Journal of Cross-Cultural Psychology 40, 853–

toms among immigrant mothers in Québec.

Fung K. & Dennis C.L. (2010) Postpartum depression among immigrant women. Current Opinion in Psychiatry 23, 342–348.

George U. & Chaze F. (2009) Tell me what I need

874.

Women’s Perceptions of Intimate Partner Vio-

London.

Women and Health 45, 1–17.

to know: South Asian Women, social capital

Katz D. & Gagnon A.J. (2002) Evidence of

Miszkurka M., Goulet L. & Zunzunegui M.V.

and settlement. Journal of International Migra-

adequacy of postpartum care for immigrant

(2010) Contributions of immigration to depres-

tion and Integration 10, 265–282.

women. The Canadian Journal of Nursing

sive symptoms among pregnant women in

Research 34, 71–81.

Canada. Canadian Journal of Public Health –

George U. & Chaze F. (2009b) Social capital and employment: South Asian women’s experiences.

Lai D.W.L. (2000) Depression among the elderly

Revue Canadienne de Santé Publique 101, 358–

Affilia: Journal of Women and Social Work 24,

Chinese in Canada. Canadian Journal on Aging

364. Available at: http://www.usi.umontreal.ca/

394–405.

19, 409–429.

pdffile/2011/janvier/miszkurka.pdf (accessed 24

Gibney S. & McGovern M. (2011) Social support

Lai D.W.L. & Chou S.B.Y. (2007) Effects of service

networks and mental health: evidences from

barriers on health status of older Chinese immi-

February 2015). Miszkurka M., Goulet L. & Zunzunegui M.V.

grants in Canada. Social Work 52, 261–269.

(2012) Immigrant status, antenatal depressive

Lai D.W.L. & Surood S. (2008) Predictors of

symptoms, and frequency and source of vio-

Guruge S. & Collins E. (2008) Working with

depression in aging South Asian Canadians.

lence: what’s the relationship? Archives of

Women: Issues and Strategies for Mental Health

Journal of Cross-cultural Gerontology 23,

Professionals. Centre for addiction and mental

57–75.

share. Journal of Epidemiology and Community Health 65, 1–431.

health (CAMH), Toronto.

Lai D.W.L. & Surood S. (2010) Types and factor

Women’s Mental Health 15, 387–396. Moghaddam F.M., Ditto B. & Taylor D.M. (1990) Attitudes and attributions related to psychologi-

Guruge S., Kanthasamy P. & Santos E.J. (2008)

structure of barriers to utilization of health ser-

cal

Addressing older women’s health: a pressing

vices among aging South Asians in Calgary,

women. Journal of Cross-Cultural Psychology

need. In: Working with Immigrant Women:

Canada. Canadian Journal on Aging 29, 249–

Issues

258.

and

Strategies

for

Mental

Health

symptomatology

in

Indian

immigrant

21, 335–350. Morrow M., Smith J.E. & Lai Y. (2008) Shifting

Professionals (eds Guruge, S. & Collins, E.),

Landy C.K., Sword W. & Valaitis R. (2009) The

landscapes: immigrant women and postpartum

pp. 235–256. Centre for addiction and mental

experiences of socioeconomically disadvantaged

depression. Health Care for Women Interna-

health (CAMH), Toronto.

postpartum women in the first 4 weeks at home.

Guruge S., Maheu C., Zanchetta C., et al. (2011)

Qualitative Health Research 19, 194–206.

tional 29, 593–617. Mulvaney-Day N.E., Alegria M. & Sribney W.

Social support for breast cancer management

Langford C.P.N., Bowsher J., Maloney J.P., et al.

(2007) Social cohesion, social support and

among Portuguese-speaking immigrant women.

(1997) Social support: a conceptual analysis.

health among Latinos in the United States.

The Canadian Journal of Nursing Research 43,

Journal of Advanced Nursing 25, 95–100.

48–66.

Social Science and Medicine 64, 477–495.

Logsdon C.M., Birkimer J.C., Simpson T.,

Nadeau L. & Meacham T. (2005) Immigrants and

Guruge S., Ford-Gilboe M., Samuel-Dennis J.,

et al. (2005) Postpartum depression and social

mental health services: increasing collaboration

et al. (2012) Rethinking social support and con-

support in adolescents. Journal Obstetrics,

with other service providers. The Canadian

flict: lessons from a study of women who have

Gynecologic, and Neonatal Nursing: JOGNN /

Child and Adolescent Psychiatry Review 14,

separated from abusive partners. Nursing

NAACOG 34, 46–54.

Research and Practice 12, 1–10. doi: 10.1155/ 2012/738905.

73–76.

MacDonnell J.A., Dastjerdi M., Bokore N.,

O’Mahony J.M. & Donnelly T.T. (2007a) Health

et al. (2012) Becoming resilient: promoting

care providers’ perspective of the gender influ-

Guruge S. & Humphreys J. (2009) Barriers affect-

the mental health and wellbeing of immigrant

ences on immigrant women’s mental health care

ing access to and use of formal social supports

women in a Canadian context. Nursing

experiences. Issues in Mental Health Nursing

among abused immigrant women. The Cana-

Research and Practice 4, 1–10.

dian Journal of Nursing Research 41, 64–84.

28, 1171–1188.

Majumdar B. & Ladak S. (1997) Management of

O’Mahony J.M. & Donnelly T.T. (2007b) The

Guruge S., Khanlou N. & Gastaldo D. (2009)

family and workplace stress experienced by

influence of culture on immigrant women’s

Intimate male partner violence in the migration

women of colour from various cultural back-

mental health care experiences from the per-

process. Intersection of gender, race and class.

grounds. Canadian journal of public health 89,

spectives of health care providers. Issues in

Journal of Advanced Nursing 66, 103–113.

48–52.

Mental Health Nursing 28, 453–471.

Hong J.J. & Woody S.R. (2007) Cultural media-

Malta L.A., McDonald S.W., Hegadoren K.M.,

O’Mahony J.M. & Donnelly T.T. (2010) A

tors of self-reported social anxiety. Behaviour

et al. (2012) Influence of interpersonal violence

postcolonial feminist perspective inquiry into

Research and Therapy 45, 1779–1789.

on maternal anxiety, depression, stress and par-

immigrant women’s mental health care experi-

Hsu L. & Alden L.E. (2008) Cultural influences on

enting morale in the early postpartum: a com-

ences. Issues in Mental Health Nursing 31, 440–

willingness to seek treatment for social anxiety

munity based pregnancy cohort study. BMC

in Chinese- and European-heritage students.

pregnancy and childbirth 12, 153.

Cultural Diversity and Ethnic Minority Psychology 14, 215–223.

666

449. O’Mahony J.M. & Donnelly T.T. (2013) How

Mason R., Hyman I., Berman H., et al. (2008)

does gender influence immigrant and refugee

‘Violence Is an International Language’ Tamil

women’s postpartum depression help-seeking

© 2015 John Wiley & Sons Ltd

Social support, social conflict and immigrant women’s mental health

experiences? Journal of Psychiatric and Mental

ethnic seniors: the Toronto study. Canadian

health of Chinese immigrant women. Journal of

Health Nursing 20, 714–725. doi: 10.1111/

Journal of Psychiatry 49, 192–199.

Immigrant and Minority Health/ Center for

Schreiber R., Stern P.N. & Wilson C. (1998) The

jpm.12005.

Minority Public Health 9, 281–290.

O’Mahony J.M., Donnelly T.T., Este D., et al.

contexts for managing depression and its stigma

Taylor L.E., Taylor-Henley S. & Doan L. (2005)

(2012a) Using critical ethnography to explore

among black West Indian Canadian women.

Older immigrants: language competencies and

issues among immigrant and refugee women

Journal of Advanced Nursing 27, 510–517.

mental health. Canadian Journal of Community

seeking help for postpartum depression. Issues

Schreiber R., Stern P.N. & Wilson C. (2000) Being

in Mental Health Nursing 33, 735–742. O’Mahony J.M., Donnelly T.T., Bouchal S.R., et al. (2012b) Barriers and facilitators of social

Mental Health 24, 23–33.

strong: how black West-Indian Canadian

Teng L., Robertson B.E. & Stewart D. (2007)

women manage depression and its stigma.

Healthcare worker’s perceptions of barriers to

Journal of Nursing Scholarship 32, 39–45.

care by immigrant women with postpartum

supports for immigrant and refugee women

Sethi B. (2013) Newcomers health in Brantford

coping with postpartum depression. Advances

and the counties of Brant, Haldimand and

Archives of Women’s Mental Health 10,

in Nursing Science 35, E42–E56.

Norfolk: perspectives of newcomers and service

93–101.

O’Mahony J.M., Donnelly T.T., Bouchal S.R., et al. (2013) Cultural background and socioeco-

providers. Journal of Immigrant and Minority Health 15, 925–931.

depression: an exploratory qualitative study.

Thoits P.A. (1995) Stress, coping and social support processes: where are we? What next?

nomic influence of immigrant and refugee

Simich L., Mawani F., Wu F., et al. (2004)

women coping with postpartum depression.

Meanings of Social Support, Coping and

Journal of Immigrant and Minority Health 15,

Help-seeking Strategies Among Immigrants

300–314.

and Refugees in Toronto. Available at: http://

et al. (2006) Weight, diet, and physical activity –

www.ceris.metropolis.net/wp-content/uploads/

related beliefs and practices among pregnant

Portuguese children. Canadian Journal of Psy-

pdf/research_publication/working_papers/

and postpartum Latino women: the role of

chiatry 38, 46–50.

wp31.pdf (accessed 24 February 2015).

social support. Maternal and Child Health

Pepler D.J. & Lessa I. (1993) The mental health of

Journal of Health and Social Behavior 35, 53–79. Thornton P.L., Kieffer E.C., Salabarría-Peña Y.,

Piat M., Ricard N., Sabetti J., et al. (2007) The

Simich L., Maiter S. & Ochocka J. (2009)

values and qualities of being a good helper: a

From social liminality to cultural negotiation:

Tilden V.P. & Galyen R.D. (1987) Cost and con-

qualitative study of adult foster home caregivers

transformative processes in immigrant mental

flict the darker side of social support. Western

for persons with serious mental illness. Interna-

wellbeing. Anthropology & Medicine 16, 253–

tional Journal of Nursing Studies 44, 1418–

266.

1429. Pottie K., Brown J.B. & Dunn S. (2005) The resettlement of central American men in Canada: from emotional distress to successful integra-

Journal 10, 95–104.

Journal of Nursing Research 9, 9–18. Weber M.L. (1998) She Stands Alone: A Review of

Spitzer D. (2005) Engendering health disparities.

the Recent Literature on Women and Social

Canadian Journal of Public Health = Revue

Support. Prairie Women’s Health. Available at:

Canadienne de Santé Publique 96, 78–96.

http://www.pwhce.ca/pdf/weber.pdf

Stewart D.E., Gagnon A.J., Merry L.A., et al.

(accessed

24 February 2015).

(2012) Risk factors and health profiles of recent

Whitley R. & Green S. (2008) Psychosocial

Public Health Agency of Canada (2004) The

migrant women who experienced violence asso-

stressors and buffers affecting black women in

Social Determinants of Health: An Overview

ciated with pregnancy. Journal of Women’s

Montreal. Canadian Journal of Community

Implications for Policy and the Role of the

Health 21, 1100–1106.

tion. Refugee 22, 101–111.

Health

Sector.

Available

at:

http://www

.phac-aspc.gc.ca/ph-sp/resources-ressources/ subject_determinants-eng.php

(accessed

24

February 2015).

Mental Health 27, 37–48.

Stewart D.E., Gagnon A., Saucier J.-F., et al.

Whitley R. & Kirmayer L.J. (2008) Perceived stig-

(2008a) Postpartum depression symptoms in

matization of young mothers: an exploratory

newcomers. Canadian Journal of Psychiatry 53,

study of psychological and social experience.

121–124.

Social Science & Medicine 66, 339–348.

Puyat J.H. (2013) Is the influence of social support

Stewart M., Anderson J., Beiser M., et al. (2008b)

Whitley R., Kirmayer L.J. & Groleau D. (2006)

on mental health the same for immigrants and

Multicultural meanings of social support among

Understanding immigrants’ reluctance to use

non-immigrants? Journal of Immigrant and

immigrants and refugees. International Migra-

mental health services: a qualitative study from

Minority Health 15, 598–605.

tion 46, 123–159.

Montreal. Canadian Journal of Psychiatry 5,

Reitmanova S. & Gustafson D.L. (2008) ‘They

Stewart M., Makwarimba E., Barnfather A., et al.

can’t understand it’: Maternity healthcare needs

(2008c) Researching reducing health disparities:

Wong R.Y.L. & Tsang A.K.T. (2004) When Asian

of immigrant Muslim women in St. John’s,

mixed-methods approaches. Social Science &

immigrant women speak: from mental health to

Newfoundland. Maternal and Child Health

Medicine 66, 1406–1417.

strategies of being. The American Journal of

Journal 12, 101.

Stewart M., Shizha E., Makwarimba E., et al.

205–209.

Orthopsychiatry 74, 456–466.

Reitmanova S. & Gustafson D.L. (2009a) Primary

(2011) Challenges and barriers to services

Wu Z. & Hart R. (2002) Social and health factors

mental health care information and services for

for immigrant seniors in Canada: ‘you are

associated with support among elderly immi-

St. John’s visible minority immigrants: gaps and

among others but you feel alone’. International

grants in Canada. Research on Aging 24, 391–

opportunities. Issues in Mental Health Nursing

Journal of Migration, Health and Social Care 7,

412.

30, 615–623.

16–32.

Zelkowitz P., Schinazi J., Katofsky L., et al. (2004)

Ryder A.G., Alden L.E. & Paulhus D.L. (2000) Is

Sword W., Watt S. & Krueger P. (2006) Postpar-

Factors associated with depression in pregnant

acculturation unidimensional or bidimensional?

tum health, service needs, and access to care

immigrant women. Transcultural Psychiatry 41,

A head-to-head comparison in the prediction of

experiences of immigrant and Canadian-born

personality,

adjustment.

women. Journal of Obstetrics, Gynecologic,

Zelkowitz P., Saucier J.-F., Wong T., et al. (2008)

Journal of Personality and Social Psychology

and Neonatal Nursing: JOGNN / NAACOG

Stability and hange in depressive symptoms

79, 49–65.

35, 717–727.

from pregnancy to two months postpartum in

self-identity,

and

Sadavoy J., Meier R. & Yuk Mui Ong A. (2004)

Tang T.N., Oatley K. & Toner B.B. (2007) Impact

Barriers to access to mental health services for

of life events and difficulties on the mental

© 2015 John Wiley & Sons Ltd

445–464.

childbearing immigrant women. Archives of Women’s Mental Health 11, 1–11.

667