MSc Project Report

2021-2022

Identifying the leading causes of Mental Health illnesses linked to immigration among South
Asian ethnicities in the UK and Canada: A literature review

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Word Count: 9000-12000

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Research Project ( )
Literature Review (X)
Health Policy Report( )

Submitted in partial fulfillment of the requirements for the degree of MSc Public Health
General Stream
August 2022.

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 Table of Contents

Contents
Abstract.................................................................................................................................................3
Introduction...........................................................................................................................................3
Aims and Objectives..............................................................................................................................5
Methods.................................................................................................................................................5
Data and Sample................................................................................................................................5
Search Strategy..................................................................................................................................5
Exclusion and Inclusion Measures.....................................................................................................6
Data Extraction and Selection of the study........................................................................................6
The outcomes of mental health..........................................................................................................6
Ethnicity............................................................................................................................................7
Variables connected to immigration..................................................................................................7
Socioeconomic standing................................................................................................................7
Social Assistance............................................................................................................................8
Analytical Techniques...........................................................................................................................8
Data Collection..................................................................................................................................8
Data Analysis....................................................................................................................................9
Results...............................................................................................................................................9
Observation of Mental Health among Asian Immigrants.............................................................10
Possible Causes of Stress that disturb Mental Health..................................................................10
Pressure from parents to succeed...............................................................................................10
Family obligations........................................................................................................................13
Difficulty in juggling two cultures and talking with parents.........................................................15
Discrimination based on race and culture...................................................................................15
The stigma around mental health.....................................................................................................16
Lack of community knowledge of mental health issues..............................................................16
Parents' ignorance of mental health concerns............................................................................17
Recommendations...............................................................................................................................17
Discussion...........................................................................................................................................18
Conclusion...........................................................................................................................................19
References...........................................................................................................................................21

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Abstract
Today, studies show that South Asian immigrants have significant rates of mental health
illnesses that often go untreated. South Asians, like several immigrant communities, are
vulnerable to psychological distress due to migration, acculturation pressures, and other
social variables that substantially influence life quality and function. Middle-aged Indian and
Pakistani men and women reported much greater rates of depression and anxiety than similar
age in the White population, even after controlling for socioeconomic level disparities.
The study is to analyze data to determine the root cause of mental health problems among
Asian Canadians and Asian immigrants in the United Kingdom. Immigration-related
concerns substantially influence the mental health of racial minorities in areas with a high
immigrant population (Canton, 2021). The study aims to examine rates of mental health-
related treatment amongst Asian Canadians and Asians in the United Kingdom, focusing on
immigration-related difficulties. The study looks at the frequency of depression, anxiety, and
drug abuse among Asian immigrants. The study looks at origin and immigration as possible
correlates of mental illnesses.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow
Diagram was employed to identify studies. The results of the electronic internet database
search were first transferred into EndNote X8.2 to eliminate digital and physical duplicates.
The title and abstracts of the remaining publications were then reviewed individually for
relevance (Sijbrandij et al., 2022).
To summarize, recently arrived migrants tend to be vulnerable to depression. Additional
preventative interventions and more support must be implemented to assure their
psychological well-being and enhance their mental well-being. More studies should be done
better to comprehend this demographic's likelihood of mental problems.

Introduction
Depression is a primary cause of disability, affecting approximately 350 million people
globally. It has a significant impact on people's lives and is characterized by a variety of

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cognitive, behavioral, and physical symptoms. The detrimental effect of depression on life
satisfaction and the related risk of death has been thoroughly established, emphasizing the
importance of appropriate screening, detection, and treatment.

Existing statistics show that persons from South Asian communities have a greater frequency
of common mental diseases such as depression (Catallo et al., 2012). British South Asians
were more likely to report depressive symptoms than their white European peers.

According to recent statistics from the National Latino and Asian Canadian Study, Asian
immigrants in Canada have a 17.3 percent total lifetime prevalence of any psychiatric disease
and a 9.19% twelve-month rate. They are substantially less likely to pursue mental health
care than Whites (Fuller-Thomson et al., 2021). Based on the survey, just 8.6 percent
representing Asian immigrants in Canada requested mental health treatment or resources,
compared to approximately 18 percent of the total population countrywide.

Participants reported various prevalent causes of stress that impacted their general mental
health, like parental pressure to excel academically. Addressing mental health issues is
frowned upon in many Asian societies; therefore, Asian immigrants prefer to downplay their
symptoms.

Other sources of stress for Asian immigrants include the obligation to conform to the model
minority reputation, family duties based on profound traditional and ethnic values, and
societal or racial prejudice. The majority of these immigrants struggle to balance two cultures
and establish a bicultural sense of identity.

According to Spencer and colleagues (Fuller-Thomson et al., 2021), most young Asian
Canadians request help from networking activities like close friends, relatives, and religious
leaders instead of professional aid for mental health difficulties. The respondents to the
survey reported that the negative stigma associated with mental health difficulties and a lack
of understanding of the options and services accessible to them are the most significant
barriers to requesting professional treatment. The survey also discovered that most Asian
Canadians had trouble receiving mental health care due to a language barrier (Catallo et al.,
2012). The findings indicate the need for additional multilingual services and coordination
between community resources and official service systems.

Aims and Objectives

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The research aims to examine the data to discover the cause of issues with mental health
among Asian Canadians and Asian immigrants in the United Kingdom. Immigration-related
problems significantly impact the mental well-being of racial minorities with a high number
of immigrants. The study aims to look at rates of mental health-related care among Asian
Canadians and Asians in the UK, with a particular emphasis on immigration-related issues.
The research examines the prevalence of depression, anxiety, and drug addiction among
Asian immigrants. The study focuses on origin and immigration as potential correlates of
mental diseases.

This study focuses on mental health since it is an essential component of overall health and
well-being (Wiederhold et al., 2019). According to the World Health Organization, there is
no wellness without mental health. We included numerous outcomes, such as self-rated
mental health, mental trauma, and the lifetime occurrence of psychiatric diseases, to provide a
comprehensive picture (Wiederhold et al., 2019). We included significant determinants of
mental health, such as immigration-related characteristics, socioeconomic position, and
support networks, guided by conceptual approaches and empirical data, to examine ethnic
disparities and possible mediation processes.

Methods

Data and Sample

Given the diversity of international migrants, several meanings of the term "migrant" are
found in the literature. However, none are widely recognized. For the main intent of his
paper, we used the definition offered by the United Nations Convention (UNESCO),
which defines "migrant" as a phrase covering all instances where the choice to migrate is
made voluntarily by the persons involved for purposes of personal comfort, and without the
involvement of compelling exterior attributes (Massey et al., 2018). 

Search Strategy
Around four online databases, Medline, PubMEd, and PsycINFO, were used in a search
strategy. The phrases "depression," "depressive disorder," and "migrant" were used as
keywords. No date of publication restrictions was enforced to optimize the recovery of
relevant papers.

Exclusion and Inclusion Measures

The meta-analysis and systematic review included studies that were quantitative in nature.
Only those who evaluated the rate of depression amongst migrants in Canada and England

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as part of their research study supplied enough relevant data to compute such prevalence,
whereas they were included utilizing validated tools. The research also had more than 50
migrants as participants and was released in peer-reviewed publications with an English
summary and full text available for complete review. Interventional studies, study designs,
research papers, case reports, newspaper columns, and conference papers were all omitted.

Those with summaries or full texts in languages other than English, or those that did not give
enough relevant data to assess the rate of depression among migrants, were also removed.
Only adults aged 25 to 32 years were included to guarantee comparability among diagnostic
assessments, which eliminated studies. According to the earlier definition of "migrant,"
studies involving refugees, seeking asylum, sparsely populated domestic migrants, and
second-gen migrants have been excluded except if they properly delineated the different
groups and gathered the information for each group independently, allowing the innumerable
amount rates of depression in exclusively first generation global migrants to be retrieved.

Data Extraction and Selection of the study

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow
Diagram was used to select studies. The electronic internet database search results were
initially downloaded into EndNote X8.2 to delete duplicates electronically and physically.
The remaining papers' titles and abstracts were then interviewed individually for relevancy.
The ineligible publications were then removed using the exclusion and inclusion process. 
The full texts of all qualifying papers were retrieved and thoroughly reviewed. The data
gathered from the final group of relevant articles were then captured on an Excel spreadsheet,
which included the initial author's last name, year of publishing, country of emigration, and
nation of migration.

The outcomes of mental health

The Kessler Psychological Distress Scale and the lifetime frequency of any anxiety and
depression, affective disorders, and drug addiction disorders were employed in this study. It
was pretty challenging to recruit young individuals aged from various groups. Young adults
from disadvantaged minorities were particularly challenging to contact (Sijbrandij et al.,
2022). Student workers with established links to their local Asian communities participated in

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our significant Needs Evaluation Framework, which was crucial in recruiting young people
from various ethnicities. Compared to the adult population, young adults are much less likely
to be driven to engage in focus groups. As an incentive, we presented a USD 20 voucher and
dinner for all attendees.

Ethnicity 
Membership in an immigrant background can act as a surrogate for cultural and historical
settings (Sijbrandij et al., 2022). We generated a set of dummy variables using Asian Indians
as the sample population, including the six most prevalent ethnic groups. They were Indians
(29.5 percent), Pakistanis (21.3 percent), Afghanistanis (13.2% percent), Asian Indians (9.7
percent), Japanese (8.5 percent), Sri Lankans (7.6 percent), and other Asians (10 percent).

Variables connected to immigration 

Two immigration characteristics were used, including immigrant background and English
language competency. Regarding immigration status, we split the population sample into five
clusters. Immigrants who had been in Canada and the United Kingdom for zero to 3 years,
four to ten years, eleven to twenty years, and more than twenty years, with native-born
sample individuals, served as the reference group in the assessments.

We also graded English language skills, with one representing outstanding command of
language and zero else.

Socioeconomic standing

We measured schooling and income using two types of variables. Education was measured
using four dummy variables: high school graduate, primary college education, university
graduate, and beyond, with a little less than high school serving as the reference group.

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Social Assistance

The magnitude of family support was created using three items; how frequently participants
spoke by phone or met with their friends or relatives, how very much they might rely on
relatives or friends for help with such a severe issue, and how readily they might open up to
relatives or friends and speak about their concerns.

The friend assistance scale was built on similar items that replaced relatives with friends.
Controls are based on demographics (Pollard & Howard, 2021). As variables, we
incorporated age, sex, and family status. Four latent variables were used to represent age
groups from 25 to 32.

In our studies, respondents were divided into three groups depending on marital status such
as married, not married, and separated.

Analytical Techniques
We began by presenting descriptive data for all factors and disparities in mental health by the
group. For every result, we tested four models, employing Regression analysis for the
continuum K-10 scale and logic model for the dichotomous dependent variables. To assess
the marginal distribution among ethnic communities, the first model calculated the impact of
ethnic membership and significant demographic covariates. Models 2-4 increasingly
incorporated immigration-related factors and social support variables, with earlier models
layered within later ones (Lee et al., 2018). Sample weights were employed in all analyses to
match demographic features in the sample and to compensate for the survey sampling
methodology.

Data Collection
We picked focus group discussions as our data gathering strategy because they are a highly
successful method that employs scheduled conversation in a non-threatening setting to
acquire comprehensive information, which would be more difficult to obtain without group
involvement.

We utilized a moderator's guide produced by the research team in both focus groups. We
started by listing themes and questions that we believed were significant (Pollard & Howard,
2021). Then we ranked them depending on their importance and the flow of the debate.

Every focus group took about 2 hours. A person with substantial expertise in organizing
focus groups in varied populations like White, Hispanic, and Asian young adults moderated

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all focus group discussions. There was a qualified note taker who took thorough and
methodical notes. Data were gathered in the afternoons to suit participants' shift patterns and
in locations where they felt at ease (Molendijk et al., 2020). Because all respondents
understood English fluently, the focus groups were in English.

Every participant completed an informed consent form before the group discussion. We
inform them that their engagement is entirely voluntary, that their name will not be divulged,
and that the entire session will be videotaped (Urquia et al., 2018). We also issued a brief
questionnaire to gather demographic data such as age, sex, zip code, religion, education, work
status, marital status, household income, and healthcare insurance status. We gave them a
blank piece of paper at the end of the focus group discussions and asked them to write
whatever they desired to say but could not express publicly if they wanted to disclose
sensitive information.

Data Analysis
The complete focus group discussion was transcribed directly following every group
discussion and compared to notations as needed to ensure data completeness. Following each
focus group, the research team convened to go through each technique. Following the
transcription of almost everything, the extracts of the focus group discussions were examined
by coding themes. These emerging themes were categorized into primary categories
discovered throughout the investigation. The occurrence of mental health issues among Asian
immigrants in their localities, the perception of psychological health, probable causes of
stress that impact mental health assistance compulsive behavior, and future process
improvement recommendations To capture the focus group discourse and manage the
information for analysis, we employed qualitative data tools.

Results
Participants actively engaged in focus group discussions and identified mental health as a
significant problem among their counterparts in their neighborhood. The most challenging
aspect of psychological health seems to be that it is sometimes forbidden to speak publicly in
several Asian cultures. Hence, individuals choose to hide, dismiss, or reject symptoms instead
of seeking treatment. The most often stated conditions were tension, stress, and depression.
Most participants felt that being a 1.5 or second-generation immigrant was a significant
source of stress in their life.

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Throughout the focus group discussions, we questioned many elements of Asian immigrants'
difficulties with mental health. However, we did not offer our participants a clear definition
of mental health. Instead, researchers left it to the respondents to define psychological health
as they saw fit (Ellawela et al., 2017). As a result, they brought up various subjects, including
stress, stress, sadness or mood disorders, and mental disorders, which we incorporated into
the concept of mental health.

Participants stated that they seldom hear about mental health issues from their colleagues.
However, they added that their friends might be reluctant to show or discuss it, especially if
they have issues. As a result, people believe that what they perceive to be the frequency of
the problem is an underestimation of actual difficulties. It is frowned upon in numerous Asian
cultures to address mental health issues publicly, and many individuals prefer to hide, ignore,
or reject symptoms instead of seeking treatment.

Observation of Mental Health among Asian Immigrants

As per focus group members, in Asian culture, psychological health is considered an issue
that a person should be able to manage. As a result, the incidence of mental health disorders
is regarded as an individual's fault and something to be embarrassed about. As a result, it is
often assumed that one should cope with mental health issues independently rather than
requesting outside help.

Possible Causes of Stress that disturb Mental Health

Based on their prior experience, four primary themes were generated from the focus group
discussions on potential stress causes that impact respondents' mental health as young adults.

Pressure from parents to succeed

Respondents acknowledged that Asian parents want their children to achieve academically,
pursue specific professional choices, and meet expectations. The non-Asian immigrant image
of being intellectual and competent may have put additional stress on Asian immigrants.
Acceptance as a decent son or daughter in Asian society frequently focuses on academic
performance and attainment of high-status employment. Many interviewees linked their

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anxiety to their choice of field of study. Mental health is a critical but often disregarded
health issue in the middle-aged Asian immigrant demographic. The myth of the model
minority stretches back to the 19th century when the initial wave of immigrants from China
arrived on the railroad and was frequently commended for their better work ethic when
contrasted to Black people (Joly & Wheaton, 2020). The leading causes of death report from
the Centre for Disease Control and Prevention expose significant mental health inequalities
across immigrant populations. Despite alarming rates of suicide and other symptoms of
mental health challenges like depression, this topic is mainly disregarded, especially among
Asian immigrant youth.

Ancient Asian culture holds that mental health issues arise because one cannot control one;
hence, it is regarded as disgraceful to admit to or seek care for a mental health condition. As a
result, Asian immigrants frequently conceal the condition out of fear of the related stigma.
Young Asian men and women face additional hurdles due to their status as second-generation
immigrants. These are individuals who were brought up in Canada, while the 1.5 generation
consists of immigrants who arrived in Canada just before the age of 16 (Canning, 2017).
Because their level of cultural assimilation varies compared to their grandparents' group or
their classmates who are non-immigrants, they frequently face difficult situations in their
everyday lives. However, the problems of this group are rarely acknowledged and handled.

Given the importance of unresolved mental health difficulties among Asian immigrants and
their possible adverse influence on society, it is vital to discover factors influencing mental
stability and mental health care usage in this population. The studies report adverse
psychological outcomes with the double pressure of nurturing one's basic Pakistanis
knowledge and values while also minimizing one's Pakistanis experience to adjust to the
Canadian's more individualistic culture. Pakistanis immigrants in Canada are aged 24 to 32
years (Canning, 2017). Parents said Canadian society and racial prejudice influenced their
children's troublesome behaviors. According to another research, ethnic identification is a
powerful indicator of externalizing and internalizing issues.

Immigration background, relocation patterns and encounters, financial position, vocational

skills, native languages, religion, religious and cultural beliefs, and racial heritage are all
essential considerations. Notwithstanding these disparities and irrespective of when they
arrived in Canada or their generational position, people of Asian origin have been stereotyped
as the model minority in Canada for allegedly achieving social and economic equality with

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the Whites (Nickerson et al., 2019). The image of prosperity frequently causes people to
believe that Asian Canadians are devoid of issues and problems, keeping them out of study
and policy concerns. The designation of a diverse variety of people as Asian-Canadians is
contentious. It overly generalizes Asian-Canadian realities and obscures significant variations
across and within these communities.

Furthermore, it may cause individuals to overlook the discrepancies in Asian Canadian

communities and their unique difficulties. The model minority myth may hurt Asian
Canadian people, families, and communities by perceiving that these populations are
homogeneous and similar. This misconception also hinders Asian Canadians' comparisons to
other minority groups (Khadria, 2019). Nevertheless, family academics have been mainly
missing from this debate. Given the variety of the Asian Canadian population and the
importance of this issue, family researchers and practitioners must have a more thorough
knowledge to deal successfully with this quickly rising community.

We analyze and challenge the existing model minority myth and its effects on Asian
Canadian families using the social action paradigm and critical race feminism theory. We
provide a short history of the phrase model minority and some data on specific Asian
Canadian communities.

Then, we examine new research on Asian Canadian families, concentrating on the effects of
community and family settings and cultural assimilation status on Asian Canadian's
educational attainment, gender, psychosocial functioning, and mental health difficulties
(Tavakol et al., 2021). Our consideration of these subjects demonstrates that, contrary to
popular belief, Asian Canadians are diverse and complex in educational, mental, social, and
financial results.

Furthermore, our discussion emphasizes historical legacies while challenging ideological

frameworks, institutional patterns, and behaviors that unequally organize social connections
among Whites and Asian Canadians. We finish by discussing the ramifications of the model
minority myth and making suggestions for experts interacting with Asian Canadians.

According to a nationwide poll, Asian Canadians are far less likely to get mental health
services. The usage of mental health services, subjective contentment, and perceived
usefulness differed by birthplace and generation. Because they do not know English or cannot
obtain treatments that fit their linguistic needs, approximately half of Asian Canadians have
trouble getting mental health care (Fung & Guzder, 2021). There is no accurate information

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available in Canada about the Asian language ability of mental health workers. The intensity
of disruption is higher among Asian Canadians, possibly because Asian Canadians prefer to
wait to seek medical help until signs reach crisis levels. Guilt and stigma are considered
significant in poor mental health care usage among Asian immigrants in Canada.

Family obligations

Participants noted how Asian cultural beliefs frequently demand daughters and sons to care
for their families as they age, which has been identified as a significant stressor for young
adults. Asian Canadians are frequently seen as the model minority. They are commended in
the modern press for their high education levels, affluence, and low crime levels. Previous
research has claimed that Asian Canadian students are free of problems because of their
academic success (Cohen et al., 2021). The model minority myth, on the other hand, may
encourage clinicians and researchers to ignore genuine problem behaviors and challenges
associated with poor mental and social integration.

Indeed, many studies have found that Asian Canadians have mental health issues and family
conflicts due to the cultural divide between the adolescent's home country and Canada. Asian
Canadian college-going students, for example, were much more prone than White Canadians
to experience suicidal ideation and contemplate suicide.

Growing up in an Asian Canadian family, especially one where the parents are immigrants,
may entail many obligations. Collectivism is prevalent in Asian civilizations, where the total
communal trumps individual needs and desires (Cohen et al., 2021). Children are encouraged
to conform to the majority from a very young age. The cultural feature inevitably permeated
the Asian Canadian family and home relations with immigrant parents. In society, the face
symbolizes social value. It refers to how various Asian cultures perceive each other and
frequently takes priority over everything else. One may create face by going along with the
crowd, obeying social conventions, or not making a scene.

If one dares to do the contrary, one will lose legitimacy, bringing shame to the family. The
cultural feature may be seen in Asian Canadian families and religious contexts, notably in
Asian Catholic or Christian congregations (Fung & Guzder, 2021). It provided a pool of
collectivism for individuals who visited an Asian religion with their family, retaining face,
guilt, and humiliation. Growing up as an Asian Canadian in Canada is akin to mixing oil and

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water. It is pretty tough to equal a battleground. In Canadian society, pursuing one's passions,
aspirations, needs, and wishes is commended.

In Asian Canadian homes, acting in one's self-interest is considered disrespectful and can be
viewed as tarnishing the family's honor. If one attempts to accomplish what one desires or
has always wanted to do, they are entitled and selfish, thereby not caring for their family
(Barbui et al., 2020). Most Asian subcultures structure their family ties vertically, which is
congruent with Confucian, the cultural background for familial relationships in this group.
Filial piety is a Confucianism-inspired cultural ideal. Filial piety is a collectivist viewpoint
that values parental responsibility, hierarchical connections, and sustaining family ties.

The focus on parental power is manifested in parenting behaviors as parental control.

Furthermore, children are required to help and support their families. Respect and reverence
for the family are frequently exhibited indirectly, such as via scholarly pursuits (Barbui et al.,
2020).

In Asian immigrant households wherein parents are immigrants and youngsters are Canadian-
born, family obligations and aspirations can cause tension between siblings and parents
(Sanmuhanathan, 2020). Immigrant children typically adapt to their host culture quicker than
their parents. The majority culture in this example is Canadian, wherein family ties stress
egalitarianism and reciprocal trade to a greater extent than so many Asian subgenres.

Family responsibility was connected with increased depressive symptoms in Indian

adolescents, whereas limited autonomy seemed linked to higher depressive symptoms in
Asian adolescents. The disparity might be attributed to subcultural disparities in parental
control and behavioral autonomy (Sanmuhanathan, 2020). Greater parental control in Indian
Canadian households, in particular, may cause children to be more anxious about satisfying
family commitments. Furthermore, early behavioral autonomy expectations in the Indian
Canadian population may explain why parents constrained autonomy increased their
depression symptoms.

Difficulty in juggling two cultures and talking with parents

Asian immigrant young adults must adhere to their home nation's values and traditions in the
family and domestic setting while growing up in the Canadian culture at university or with
coworkers. Some people adapt readily, while others struggle. One parent who attended the
primary Health Needs Analysis focus group stated that Thai youngsters are attempting to find

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a middle ground between their Canadian and Thai pursuits. Other individuals expressed
difficulties connecting with their parents owing to cultural differences, generation gaps, and
language barriers.

Our parents had different sorts of difficulties than we experience now, and the strain we face
now may seem trivial to them. Communication inside an Asian family is not particularly
expressive, as we do not express our sentiments in our family (Sanmuhanathan, 2020). Many
classmates grew up in a home like that, but if someone remained to themselves a lot, they
might not be able to express themselves. Sometimes one cannot say anything normal to the
family because of the different language since one begins to lose a small amount of the
original tongue, but growing up inside an Asian family may limit the ability to express
themselves.

Discrimination based on race and culture

Racism-related anxiety refers to race-related transactions that develop from the dynamics of

racism and are seen to drain or surpass available individual and societal resources or
endanger well-being (Barbui et al., 2020). Racism can be encountered through interactions in
individual, organizational, and cultural scene domains, and discrimination stress can be felt
through a variety of distinct stressors such as discrimination events in life, subjective life
events, daily racial prejudice microaggressions, and persistent context-specific stress, shared
experiences, and intergenerational transmission.

Asian immigrants frequently face the consequences of the phenomenon that occurs when
groupings of individuals from various backgrounds come into constant first-hand interaction,
resulting in shifts in the fundamental cultural traits of both groups. Finally, acculturation is
the method where Asian immigrants and their children experience cultural change throughout
life domains such as language, ethnic identity, cognition, emotional expression, and
association choices due to ongoing contact with a second culture.

Discrimination does not simply impact health through stress. Bias may reduce educational
attainment or income gain. Discrimination can also cause exposure to hazardous
surroundings, such as when exclusion exposes people to air pollution. Furthermore, social
evaluation and interactionism theories contend that people draw their personality from the
moral attitudes associated with their group identity and experiences inside these groups.
Discrimination based on racial group identity may be related to lower self-esteem and, as a

15
result, lower mental wellness (Watters, 2019). Racial indoctrination and identity frameworks
influence Asian immigrants' reports of discrimination that might raise the risk of developing
mental illness. Finally, acculturation can result in biological and psychological changes.
Although not all change is unpleasant, there are moments and settings when these cultural
changes can be draining.

According to the participants, most Asian American immigrant young adults do not obtain
professional care for mental health issues. They rely on religions or other reliable sources,
like friends or significant others. Participants agreed that six major barriers keep individuals
from obtaining treatment for their mental health concerns.

The stigma around mental health

Participants noted an unfavorable impression of persons seeking therapy in Asian culture.
Even if treatment happens, they are concerned that their families would resist the idea that
their offspring are getting mental health care (Kanthasamy et al., 2015). Going to a
psychiatrist still has a stigma, whether it comes from the parents or not.

Lack of community knowledge of mental health issues

Most Asian immigrants are unaware of the significance of mental health. It might be owing to
a cultural impact. Some mental illnesses have not been diagnosed in their society, and no jobs
in psychological therapy exist (Ozeto et al., 2021). Some Asian immigrants may be unaware
of the significance of their mental health issues or may fail to perceive that proper and timely
therapy may benefit them. Back home, seeing a psychologist is not even a job. Individuals do
not wish to spend talking to someone; instead, they prefer free therapy. With that mindset,
one can come to this nation understanding that expert psychiatrists and therapists are
available.

There is a scarcity of mental health experts who can provide culturally acceptable care. Many
Asian immigrants are hesitant to communicate with a mental health practitioner who does not
comprehend their culture or dialect. One of the colleagues has weekly meetings and feels
secure going there, but some of this is because they are fostered.

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Parents' ignorance of mental health concerns

Varied parents employ various thresholds for determining what understanding of mental
health worry is suitable to contact a psychiatrist or other experts in mental health. Parents
may well not understand the challenges that their youngsters are experiencing now since they
have coped with various types of stress than their youngsters do (Watters, 2019). Parents
could be ignorant that their offspring are experiencing mental health challenges owing to a
lack of contact with the youngsters or an inability to recognize indicators of mental health
difficulties.

Mental health care costs the price of mental health treatment

Many participants expressed a desire not to pay to speak with somebody. Free services could
make counseling more available in this case. Nevertheless, several people stated that even if
therapy were free, they would not go due to the stigma.

Recommendations
a. Provide education and awareness campaigns.
b. Increase the number of mental health workers who are linguistically and culturally
competent. Increase the number of Asian American psychologists in college because
Asian immigrant young adults might find professionals more approachable and
sympathetic to the pressure they are experiencing.
c. Make a list of Asian immigrant mental health specialists in the area.
d. Parents should be educated.

Many advertisements instruct family members how and where to talk to their children and
other things. However, those are not ever guided by Asian American immigrant parents.
Asian immigrant parents would not give importance to those advertisements, but overall, they
do not wish to watch that kind of thing, so maybe involve them a bit more in the mainstream
press.

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 e. The committee advised that any health or mental health care programs be announced
through local schools and culture or faith-based institutions (Tian et al., 2011).
Having easy and accessible aid may influence a person's health-seeking behavior.
Persons may be hesitant to seek assistance if they believe it is too far distant or too
difficult to attain.

f. Create mental health education initiatives that are appealing to young people. Starting
with stress levels, how to cope with test time or job choices, or how issues like that
might gradually introduce them to the program. Then enable them to engage in it, and
form a relationship with the psychiatrist or therapist. This way, they can discuss more
severe difficulties if they experience any, which could assist.

Discussion
This meta-analysis and systematic review based on results from South Asian migrant
respondents in Canada and England indicate an aggregate incidence of depression among
foreign migrants of 15.6 percent. Even though such a figure implies that depression is a
frequent and serious mental health issue impacting migrants globally, we discovered no
significant differences in depression incidence between migrants and local individuals
(Emmett, 2021). This appears to corroborate the conclusions of a recent systematic study,
which revealed no clear evidence of a rise in the probability of depression in aggregate
among migrant community members. It is difficult to explain such a finding because one
would anticipate migration's acculturative stress as a significant risk factor for depressive
disorders.

We discovered that psychological state is one of the most critical health problems for 1.5 and
second-generation Asian young people through clear focus group talks. Participants reviewed
their mental health concept or perspective, potential causes of stress that impact their
psychological health, present mental health assistance, impulsive behavior, and repellents to
cognitive help-seeking behavior (Watters, 2019). Our data suggest that just being 1.5 and
second generation, cultural assimilation, and the model minority myth are all possible sources
of stress. Asian parents value academic achievement above everything else in their
youngsters, so Asian youngsters feel pressure to perform.

18
Participants identified a lack of awareness of the significance of care as a significant deterrent
and parents' lack of understanding of mental health needs (Jayawickreme & Saw, 2021). A
primary concern was a lack of mental health experts who could provide linguistic and
culturally acceptable care. It is consistent with a survey that found that a substantial
proportion of Asian immigrants had trouble receiving mental health care due to linguistic
barriers.

Even though we managed to collect detailed information on specific areas, our results should
be evaluated in light of several factors. Because this was little research inside a more
extensive operation, the number of respondents was modest, and the participants were drawn
randomly. Furthermore, this community is tough to motivate, and reaching out to
underrepresented groups was challenging.

As a result, the study's conclusions cannot be generalized to larger populations of Asian

immigrants. Nonetheless, we believe this is an essential contribution to the literature because
there is a scarcity of in-depth material of this type (Jayawickreme & Saw, 2021). We
provided substantial material on numerous areas of mental health difficulties in Asian
immigrant young people, as well as comments from some difficult-to-reach populations.
Future large-scale investigations may strengthen our findings. Our findings have far-reaching
implications for future therapies or programs created for this population. Participants'
recommendations represent practical and viable strategies that employ culturally relevant
solutions and will work for this population.

Conclusion
Much more is documented about Asian immigrants' psychological health. Assistance and
treatment use are lower than their proportion in the Canadian population and lower than some
other racial and ethnic minority groups, with cultural, systemic, and care process
characteristics posing barriers to accessing mental health assistance. Lower treatment
utilization does not imply a lack of need; epidemiological studies reveal more excellent rates
of particular clinical issues among some Asian immigrant subgroups and similar or lower
overall incidence rates of mental illnesses compared with the general population (Canton,
2021). Methodological problems arising from the variety of Asian immigrant groups, cultural
prejudices in reporting techniques, and cultural idioms of suffering, in particular, provide
significant obstacles to analyzing these scientific studies.

19
Cultural therapy for Asian immigrants has lately been accessible to alleviate mental health
inequities. We still do not know much about Asian American psychological health. The
future study must understand within-group variations among Asian immigrants, cultural
manifestations of psychopathology, the measurement of cultural reporting prejudices, and
creative cultural therapies to improve service access.

Lastly, there is a scarcity of research that looks at prejudice from the ground up and at
numerous levels. Self-reported discriminatory experiences are a basic level of analysis.
However, separation, systemic racism, and other racial oppression exist. Future studies
should develop new tools for assessing structural prejudice and studying discrimination at
various levels (Nickerson et al., 2022). These many levels vary based on geographic range,
stage in the life span, and circumstance. Furthermore, while we concentrate on race prejudice,
future studies should look at prejudice rooted in sexual alignment, gender, and socioeconomic
class.

Finally, the evidence implies that Asian immigrants face racial prejudice today and that these
interactions may be linked to several health concerns. The majority of this research
concentrate on self-reported bias. However, there is a conspicuous lack of research on
discriminating at other ecological levels. Future research should concentrate on elements that
might lessen prejudice or its impact. Independent variables, such as engagement in civil
liberties activities, or macroeconomic conditions, like civil rights laws, might be included.
Such investigations would considerably expand the present corpus of study and give avenues
for public health improvement.

20
 References
Ellawela, Y., Nilaweera, I., Holton, S., Rowe, H., Kirkman, M., Jordan, L., McNamee, K.,

Bayly, C., McBain, J., Sinnott, V., & Fisher, J. (2017). Contraceptive use and

contraceptive health care needs among Sri Lankan migrants living in Australia:

Findings from the understanding fertility management in contemporary Australia

survey. Sexual & Reproductive Healthcare : Official Journal of the Swedish

Association of  Midwives, 12, 70–75. https://doi.org/10.1016/j.srhc.2017.03.003

Bedaso, A., & Duko, B. (2022). Epidemiology of depression among displaced people: A

systematic review and meta-analysis. Psychiatry Research, 114493.

Beiser, M., Goodwill, A. M., Albanese, P., McShane, K., & Kanthasamy, P. (2015).

Predictors of the integration of Sri Lankan Tamil refugees in Canada: pre-migration

adversity, mental health, personal attributes, and post-migration experience.

International Journal of Migration, Health, and Social Care.

Beiser, M., Simich, L., Pandalangat, N., Nowakowski, M., & Tian, F. (2011). Stresses of

passage, balms of resettlement, and posttraumatic stress disorder among Sri Lankan

Tamils in Canada. The Canadian Journal of Psychiatry, 56(6), 333–340.

Byrow, Y., Liddell, B., O'Donnell, M., Mau, V., McMahon, T., Bryant, R., Benson, G., &

Nickerson, A. (2022). Profiles of post-migration stressors and mental health in

refugees: A latent class analysis. Psychiatry Research, 311, 114494.

https://doi.org/10.1016/j.psychres.2022.114494

Byrow, Y., Pajak, R., McMahon, T., Rajouria, A., & Nickerson, A. (2019). Barriers to mental

health help-seeking amongst refugee men. International Journal of Environmental

Research and Public Health, 16(15), 2634.

Canning, V. (2017). Gendered harm and structural violence in the British asylum system.

Routledge.

21
Canton, H. (2021). United Nations High Commissioner for Refugees—UNHCR. The Europa

Directory of International Organizations 2021 (pp. 215–234). Routledge.

Emmett, J. M. (2021). Religion, Refugees, and Mental Health in South Asia: A Systematic

Review. The University of Washington.

Farahani, H., Joubert, N., Anand, J. C., Toikko, T., & Tavakol, M. (2021). A Systematic

Review of the Protective and Risk Factors Influencing the Mental Health of Forced

Migrants: Implications for Sustainable Intercultural Mental Health Practice. Social

Sciences, 10(9), 334.

Fung, K., & Guzder, J. (2021). Canadian immigrant mental health. Mental Health, Mental

Illness, and Migration, 187–207.

Haroz, E. E., Decker, E., & Lee, C. (2018). Evidence for suicide prevention and response

programs with refugees: A systematic review and recommendations. Geneva: United

Nations High Commissioner for Refugees.

Henkelmann, J. R., de Best, S., Deckers, C., Jensen, K., Shahab, M., Elzinga, B., &

Molendijk, M. (2020). A systematic review and meta-analysis of anxiety, depression,

and posttraumatic stress disorder in refugees resettling in high-income countries.

BJPsych Open, 6(4).

Jayawickreme, N., & Saw, A. (2021). Introduction to the special issue on promoting health

and well-being in forcibly displaced Asian populations. Asian American Journal of

Psychology, 12(3), 159.

Joly, M. P., & Wheaton, B. (2020). Human rights in countries of origin and the mental health

of migrants to Canada. SSM-Population Health, 11, 100571.

Kaplin, D., Farrelly, D., Parente, K., & Cohen, F. (2021). Providing Therapy with Asian

Immigrant Families: A Review of Prominent Issues and Treatment Considerations.

Asian Families in Canada and the United States, 233–255.

22
Khadria, B. (2019). Asian Migration. The SAGE Handbook of International Migration, 262.

(Full text reviewed)

Kuttikat, M., Vaillancourt, A., & Massey, M. (2018). Battered but bold: Sri Lankan Tamil

refugee war experiences, camp challenges, and resilience. International Journal of

Migration, Health, and Social Care.

Ozeto, N. T., Allan, T., & Ozeto, N.-F. (2021). Investigating a Relationship between

Perceived Stress, Religious Coping, and Religiosity in Migrant Muslim Women.

Journal of Muslim Mental Health, 15(1).

Patanè, M., Ghane, S., Karyotaki, E., Cuijpers, P., Schoonmade, L., Tarsitani, L., &

Sijbrandij, M. (2022). Prevalence of mental disorders in refugees and asylum seekers:

a systematic review and meta-analysis. Global Mental Health, 1–14.

Pollard, T., & Howard, N. (2021). Mental healthcare for asylum-seekers and refugees in the

United Kingdom: a scoping review of policies, barriers, and enablers. International

Journal of Mental Health Systems, 15(1), 1–15.

Rozanov, V., Frančišković, T., Marinić, I., Macarenco, M.-M., Letica-Crepulja, M., Mužinić,

L., Jayatunge, R., Sisask, M., Vevera, J., & Wiederhold, B. (2019). Mental health

consequences of war conflicts. In Advances in psychiatry (pp. 281–304). Springer.

Sanmuhanathan, N. (2020). Post-Traumatic Stress Disorder and Sri Lanka's 30-Year Civil

War: A Study of Transgenerational Trauma. The University of Sydney.

Tong, H., Lung, Y., Lin, S., Kobayashi, K. M., Davison, K. M., Agbeyaka, S., & Fuller-

Thomson, E. (2021). Refugee status is double the odds of psychological distress in

mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

International Journal of Social Psychiatry, 67(6), 747–760.

Wanigaratne, S., Shakya, Y., Gagnon, J., Cole, D. C., Rashid, M., Blake, J., Dastoori, P.,

Moineddin, R., Ray, J. G., & Urquia, M. L. (2018). Refugee maternal and perinatal

23
 health in Ontario, Canada: a retrospective population-based study. BMJ Open, 8(4),

e018979.

Uphoff, E., Robertson, L., Cabieses, B., Villalon, F. J., Purgato, M., Churchill, R., & Barbui,

C. (2020). An overview of systematic reviews on mental health promotion,

prevention, and treatment of common mental disorders for refugees, asylum seekers,

and internally displaced persons. Cochrane Database of Systematic Reviews, 9.

24