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NSG5125 Health Assessment Question: Write research article analysis: Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. Answer: Introduction Studies have attributed immigration to be a source of multiple mental health stressors. However, not all immigrant groups enrol for mental health services. This is despite the increasing rate of global immigration (Rechel, Mladovsky, Ingleby, Mackenbach, & McKee, 2013). Little research has also been done on the existing patterns of the usage of mental health services. Additionally, the existing studies on the same topic do not factor in the aspect of the diversity of immigrant migrations (Martinez et al., 2015) since multiple studies have associated mental health stressors to immigration (Giacco, Matanov, & Priebe, 2014; Bhugra et al., 2014). It is essential that immigrant groups are aware of the significance of mental health services (Whitley & Berry, 2013). Hence, the study by Durbin, Moineddin, Lin, Steele, and Glazier (2015) is aimed at assessing the utilisation of mental health services by immigrants and non-immigrants in Ontario, Canada. The authors contend that most of the new immigrants did not make use of mental health services because of the healthy immigrant effect which assumes that the new immigrants experience overall mental health benefits unlike the native-born individuals (Kim, Carrasco, Muntaner, McKenzie, & Noh, 2013). Are these the only factors for healthy immigrant effect?  This may not be conclusive because other studies have also found new immigrants to suffer increased mental health diseases or higher rates of the use of mental health services. For instance, Wilson-Mitchell & Rummens (2013) found out that the loss of protective factors that were linked to the deserted country of origin led to the low usage of mental health services because it could not substitute the causing factors. The study points out that examples of multiple factors that might lead to healthy immigrant effect include screening and self-selection. Perhaps some of the most common elements that should have been involved in the study include birth outcomes such as birth weight, gestational period and mortality within 24 hours of birth. This is because research has found out that birth outcomes among expectant immigrant women were much better compared to the pregnant women in the native countries (Farré, 2016). The research by Farré (2016) tends to imply that healthier behaviours inherited in the native state are not the only explanation for health advantage and low usage of mental health services. The authors observe that there is a similarity in the first utilisation of primary mental health care both in the new immigrants and long-term residents, and subsequent decline among the new immigrants. The authors argue that this difference can be as a result of the disengagement with the western health services may be due to cultural disparities. So when does the culture shock become severe, is it during the initial experience or after being acclimatised with the new culture? Other studies have shown that new immigrants rarely used speciality mental health care due to lack of familiarity on how the services are delivered such as they are provided in Ontario (Makhashvili, & van Voren, 2013). The report by Mossialos and  Wenzl (2016)  also supported a similar argument. Mossialos and  Wenzl (2016)  found out that immigrants from developed countries with the relatively similar healthcare system to that of Canada made use of the speciality mental health services because they were used to navigating the mental health care system in their country.  The study recommends the reduction of health differences among the immigrants through providing awareness of mental health services to those ignorant of the services (Durbin et al., 2015). Does this mean that health differences are the leading cause of low rates for using mental health services? What about other factors? Research has indicated that migration is ever on the rise with the immigrants coming from different parts of the industrialised and unindustrialised world with varying cultures and beliefs (Lee, Martins, & Lee, 2015).  These aspects cause a lot of disparities and thus making it difficult to be addressed in a lumpsum as recommended by the authors. Durbin et al. (2015) contend that lower mental health needs among some immigrants from industrialised countries could be attributed to the strict screening measures on health status as a way of contributing to the health economy of the host state (Durbin et al, 2015). But what about instances when immigrants from the same country and admitted both to the same class exhibit different mental health needs? The research by Lee, Martins, & Lee (2015) has indicated that the cultural practices and beliefs amongst the immigrants from North Africa and the Middle East towards health contributed to the lower mental health needs, unlike the Asian immigrants. Moreover, Han and Pong (2015) found out that mental disorders were attributed to Western diseases and are expressions of weakness by the Korean communities in the family or society. Therefore, to contend that strict health screening of the immigrants allocated to the economic class as the reason for the low need for mental health services is an assumption that cannot be generalised. This is because the mental health needs of immigrants are complex (Giacco et al., 2014). And can only be solved by addressing each case on an individual basis. Conclusion Mental health service use by immigrants is a complex matter that needs to be addressed separately depending on specific factors relevant to the case under consideration. This is because of the multiple factors that are attributed to the low mental health service needs. Future studies should assess the mental health need and hindrances to care in addition to other specific factors so as to explain the potential causes for the patterns observed among the new immigrants from different countries. Exploring these causal factors alongside their association to the utilisation of service care may be of help to the policymakers and general practitioners on how service delivery should be designed to meet the exceptional needs, customs, attitudes and insight of different immigrants in a multi-cultural context like Canada. References Bhugra, D., Gupta, S., Schouler-Ocak, M., Graeff-Calliess, I., Deakin, N. A., Qureshi, A., … & Till, A. (2014). EPA guidance mental health care of migrants. European Psychiatry, 29(2), 107-115. Durbin, A., Moineddin, R., Lin, E., Steele, L. S., & Glazier, R. H. (2015). Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC health services research, 15(1), 336. Farré, L. (2016). New evidence on the healthy immigrant effect. Journal of Population Economics, 29(2), 365-394. Giacco, D., Matanov, A., & Priebe, S. (2014). Providing mental healthcare to immigrants: current challenges and new strategies. Current opinion in psychiatry, 27(4), 282-288. Han, M., & Pong, H. (2015). Mental health help-seeking behaviors among Asian American community college students: The effect of stigma, cultural barriers, and acculturation. Journal of College Student Development, 56(1), 1-14. Kim, I. H., Carrasco, C., Muntaner, C., McKenzie, K., & Noh, S. (2013). Ethnicity and postmigration health trajectory in new immigrants to Canada. American Journal of Public Health, 103(4), e96-e104. Lee, S. Y., Martins, S. S., & Lee, H. B. (2015). Mental disorders and mental health service use across Asian American subethnic groups in the United States. Community mental health journal, 51(2), 153-160. Makhashvili, N., & van Voren, R. (2013). Balancing community and hospital care: a case study of reforming mental health services in Georgia. PLoS medicine, 10(1), e1001366. Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., … & Chavez- Baray, S. (2015). Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. Journal of Immigrant and Minority Health, 17(3), 947-970. Mossialos, E., &  Wenzl, M. (2016). 2015 International Profiles of Health Care Systems. Retrieved from  Rechel, B., Mladovsky, P., Ingleby, D., Mackenbach, J. P., & McKee, M. (2013). Migration and health in an increasingly diverse Europe. The Lancet, 381(9873), 1235-1245. Whitley, R., & Berry, S. (2013). Trends in newspaper coverage of mental illness in Canada: 2005–2010. The Canadian Journal of Psychiatry, 58(2), 107-112. Wilson-Mitchell, K., & Rummens, J. A. (2013). Perinatal outcomes of uninsured immigrant, refugee and migrant mothers and newborns living in Toronto, Canada. International journal of environmental research and public health, 10(6), 2198-2213.

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