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Mental health at the intersections: understanding South Asian Muslim youth mental health in Peel Region, Toronto, Canada
Abstract
Purpose
The purpose of this study was to understand the unique mental health concerns and access barriers experienced by South Asian Muslim youth populations living in the Peel Region of Toronto, Canada.
Design/methodology/approach
For this qualitative exploratory study, interviews (n = 15) were conducted with mental health professionals, educators and spiritual leaders (n = 11) who work with South Asian Muslim youth living in Peel Region, as well as with South Asian Muslim youth themselves (n = 4, aged 20–23). Interview transcripts were analyzed using reflexive thematic analysis.
Findings
Four primary themes emerged from the data: challenges and stressors, barriers, facilitators and hope and recovery. South Asian Muslim youth navigate a number of unique stressors related to the domains of culture, religion and family dynamics, as well as the impact of migration.
Practical implications
The findings stress the necessity of creating culturally safe, multilevel strategies to meet the nuanced challenges and diverse needs of South Asian Muslim youth communities.
Originality/value
This is one of the few papers to the knowledge that addresses the mental health needs and service access barriers of youth populations at the intersections of South Asian diasporic community belonging and Muslim faith in Canada.
ResearchGate has not been able to resolve any citations for this publication.
This article uses data from the 2001 and 2021 censuses of population to examine population growth and changing demographics of racialized people. The study presents new data for 11 subgroups of the racialized population, their generational composition and changes in their share of people with a mixed racialized–White identity. Between 2001 and 2021, the overall number of racialized people in Canada increased 130%. While the arrival of new immigrants was the primary driver of this population’s growth, the second generation had the fastest growth rate. In 2021, most racialized second-generation Canadians lived in households that included first-generation members, ranging from 60% for the Japanese population to 94% for the West Asian population. The share of Canadians with a racialized and White background increased for most groups between 2001 and 2021, and the share was particularly high and increased the most among those in the third generation or more.
Objective The purpose of this study was to explore perspectives of Muslims residing in the Bay Area, California on the role of the mosque community in supporting community members’ mental health needs and barriers to mental health care for members who experience mental health challenges. Methods This study employed a CBPR-focused qualitative approach in the form of content analysis of three focus group discussions organized and conducted with the help of a Community Advisory Board made up of members of the Muslim Community Association. Results Two major themes were identified upon examination of the data: services needed in the mosque community and barriers to addressing mental health issues in the mosque community. Specifically, participants reported wanting support groups within the mosque space, mosque-based activities, virtual support, community social workers, and family-oriented services. Barriers reported included community stigma, lack of cultural awareness of race-ethnic minorities within the community, attribution of mental illness to lack of faith or supernatural causes, and specific barriers unique to vulnerable/special subgroups within the community. Conclusion These findings highlight the need for developing mental health-related services and social support initiatives within the mosque space, specifically for those Muslim Americans living in the Bay Area in California. Furthermore, special attention needs to be placed on the barriers to accessing these services as identified by the community members.
South Asian Americans are part of the fastest growing racial/ethnic group in the United States and make up a substantial portion of the U.S. immigrant population. Research on this group has often focused on acculturation, the adoption of different values and behaviors in a new sociocultural environment. While there is evidence to suggest that acculturation (and the stress associated with this process) has a negative effect on the health and well-being of Asian Americans, more recent research has emphasized the need to examine the role of broader social forces—including everyday racism—in impacting mental health. Drawing on the stress process model, this study uses an original survey instrument to investigate the relationships between acculturative stress, anti-Asian racism, and mental health among a community sample of 200 South Asians in Texas. Results from hierarchical multiple regression models indicate that both acculturative stress and everyday racism are strongly linked to higher levels of anxiety-related symptoms and more frequent depressive symptoms. Everyday racism, however, explained variance in these outcomes, well beyond the effect of acculturative stress and other sociodemographic factors. These results underscore the potential benefit and importance of including questions about racism in community health surveys that aim to study health disparities among Asian Americans and highlight the persistence of social issues that U.S. South Asians face.
The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n = 22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.
While young adults experienced mental health challenges during the COVID-19 pandemic, little is known about how their mental health needs were subsequently met through access to mental health services (MHS). From October to December 2020, we conducted an online survey of young adults (18-29 years) living in Canada and France to investigate factors associated with unmet MHS needs. Of the 3222 participants expressing a need to access MHS (50.7% of the total sample), 58.2% in Canada and 74.8% in France reported unmet MHS needs. In both countries, those who identified as men and those who lost income due to COVID-19, were more likely to report unmet MHS needs. In Canada, participants from Quebec, those living in rural areas, and those who experienced ethno-racial discrimination had higher odds of reporting such unmet needs. Urgent investments are needed to improve access to MHS for young adults during and after the COVID-19 pandemic.
In the West, Islam has been historically ‘othered’ as a religion and frequently linked to negative media representation, terrorism, and fundamentalism. As the aftermath of 9/11 witnessed a global rise in anti-Muslim rhetoric and action, there was a parallel increase in academic research on the Muslim community, including adults, youth, and children. In this paper, a systematic literature review was undertaken to explore how empirical studies over the last two decades have investigated experiences of growing up as young Muslims in an age of Islamophobia.
Based on objective inclusion and exclusion criteria, pertinent databases were searched for research with contextual, temporal, topical relevance. NVivo Plus software was used for content-coding, quantitative processing, and qualitative thematic analyses of data. A rigorous screening process resulted in the identification, compilation, and methodical review of 87 journal articles, between 2001 - 2021, on the topic ‘Islamophobia and Young Muslims.’
The descriptive analysis represented that there has been a substantial increase in empirical studies on young Muslims in the last five years, particularly in the field of educational studies. A majority of these studies covered experiences of adolescent Muslims, between 13-20 years, residing in western countries like U.K., U.S.A., and Australia. Qualitative research designs were frequently employed, with a sample size of >50 participants. Through the word-count frequency output of NVivo, four meaningful and recurrent themes of ‘Islamophobia’, ‘Identity’, ‘School’, and ‘Women’ were derived. Content analysis of these themes revealed that studies widely researched on diverse interpretations of Islamophobia in the lives of young Muslims, identity negotiation strategies adopted by Muslim minority youth, school-based religious bullying, and gendered facets of Islamophobia.
Research gaps showed a requirement for studies that capture heterogeneous narratives of Muslim youth in non-western countries and early childhood settings. Future research recommendations are of a unique child or youth-based theoretical conceptualization of Islamophobia, that particularly highlights youth perspectives of their own lived realities.
The current study explored shadeism (i.e., prejudice based on skin shade) within interpersonal, social, and cultural contexts amongst South Asian women living in Canada. Phase I consisted of an online survey with 169 women from South Asian ethnicities and living in Canada. These women responded to measures assessing perceptions of their skin tones, mental health, body image, appearance-related attitudes, and bicultural identity integration. Phase II involved virtual, face-to-face, semi-structured interviews with 13 South Asian women living in Canada, who narrated their experiences and implications of shadeism in interpersonal, social, and cultural settings. In Phase I, the hypotheses were not supported. However, darker skin tone evaluation and frequency of skin-lightening practices significantly correlated with negative perceptions of one’s appearance, appearance-fixing tendencies, and bicultural identity integration. Using reflexive thematic analysis, four broad themes were derived from the interview data in Phase II: 1) colonial origins of shadeism; 2) experiences of shadeism (i.e., interpersonal, social, and cultural spaces, media portrayals, and intersections of shadeism with other forms of oppression [e.g., racism]); 3) protective factors against shadeism (e.g., coping, resilience, and resistance; older age and maturity; interpersonal support; living in Canada; and having a bicultural identity); and 4) outcomes of shadeism on perceptions of skin tone, skin-lightening practices, and psychological wellbeing. The limitations and future implications of this study are discussed.
Discourses of research impact shape the ways in which critical qualitative research and researchers are evaluated in contemporary academic environments. Mainstream conceptualizations of research impact arise from a positivist perspective that challenges the aims and approaches of critical qualitative research. In this paper, we propose a framework for conceptualizing the impact of critical qualitative research on policy, practice, and science. After critiquing literature that presents mainstream views on research impact, we summarize a recent framework for conceptualizing the impact of critical research specifically. We then add to the Machen framework by highlighting the impacts of critical qualitative research on the institutions and practices of science. We provide examples of ways in which researchers at the Centre for Critical Qualitative Health Research at the University of Toronto have made contributions to the impact of critical qualitative research on science, and conclude by addressing implications of this framework for the ways in which critical qualitative researchers can plan and evidence the impact of their work.
Research infrequently includes the perspectives of vulnerable and marginalized youth. As the population of newcomer youth in Canada continues to grow, it is imperative that attention is devoted not only to challenges they experience, but also to resilience factors they perceive to support their adjustment and well-being. To address this gap, this qualitative research explored newcomer youths' experiences and advice for other newcomer youth who have recently arrived in Canada. Thirty-seven newcomer youth from two medium-sized cities in Ontario participated in focus groups. Participants ranged from 14 to 22 in age and identified mostly as female refugees from the Middle East. Through thematic analysis, five overarching themes were found across groups: (1) moving to a new country is hard, (2) maintain a healthy mindset, (3) take an active role in the adjustment process, (4) stay true to who you are, (5) and you are not alone. Youth described hardships that make moving to a new country difficult including lack of belonging due to racism and bullying, insufficient orientation to new systems, language barriers, and high levels of stress. Findings demonstrated youths' resilience, coping skills, and strategies to lead meaningful lives. Youth discussed resilience strategies such as maintaining a connection with home culture and religion, reframing thinking to be positive, receiving emotional support, accessing community support at newcomer agencies, and building language proficiency. Findings provide implications for professionals working with newcomer youth and reflect the importance of addressing structural barriers and racism. The opportunity for newcomer youth to share experiences as experts in research may also help to promote resilience.
Background
Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions.
Methods
The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT.
Discussion
The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups.
Trial registration
ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
Objective: In order to inform the development of culturally safe models of mental healthcare and promotion, this concurrent mixed methods study explored the following research questions: 1) What are the characteristics of community members with positive attitudes toward seeking mental health services and 2) What are the barriers and promoters of mental health service access for Bangladeshi immigrants living in the "Little Bangladesh" locale in Toronto, Canada which has one of the highest rates of people seeking mental health care in the city. Method: Participants were surveyed in the quantitative phase (n = 47) using a sociodemographic questionnaire and the Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS) and interviewed during the qualitative phase (n = 20). Results: The quantitative phase found that male gender, attending school in Canada, and being employed in one's field of study/work were associated with more positive attitudes toward seeking mental healthcare. Lack of economic integration, mental health awareness and education, mental health literacy, and the presence of community mental health stigma were identified as the major barriers toward seeking care in the qualitative phase. Conclusion and Implication: After merging phases, the common factor that emerged from both legs of the study was the stressor of economic insecurity during the migration and resettlement process and how that acts as a barrier to seeking mental healthcare. Participants recommended a multi-pronged, targeted mental health outreach campaign to facilitate economic integration for new immigrants, address mental health stigma, promote available mental health resources, and develop new models of care.
The stigma of addiction in Muslim communities is a significant barrier to accessing mental health services. The objective of this study was to evaluate the impact of a newly developed spiritually-adapted addictions psychoeducational program with adult Muslims in the mosque setting. Ninety-three individuals were recruited from nine different mosques within Toronto, Canada. Ninety-minute seminars were presented. This study used a convergent mixed method design. There was a significant increase in the participants’ self-reported knowledge (t = 3.6; p < 0.001), a more positive attitude on two scales (t = 3.7; p < 0.001 and t = 2.9; p = 0.005) and an increase in willingness to seek help from a medical doctor and mental health professional (t = 4.4; p < 0.001 and t = 2.2; p = 0.03, respectively) post-seminar as compared to baseline. Qualitative data confirmed these changes. Evidence-informed spiritually-adapted outreach program in the mosque setting can help reduce addiction related stigma in Muslim communities.
Background: The developmental period from 0 to 25 years is a vulnerable time during which children and young people experience many psychosocial and neurobiological changes and an increased incidence of mental illness. New clinical services for children and young people aged 0 to 25 years may represent a radical transformation of mental healthcare.
Method: Critical, non-systematic review of the PubMed literature up to 3rd January 2019.
Results: Rationale: the youngest age group has an increased risk of developing mental disorders and 75% of mental disorders begin by the age of 24 and prodromal features may start even earlier. Most of the risk factors for mental disorders exert their role before the age of 25, profound maturational brain changes occur from mid-childhood through puberty to the mid-20s, and mental disorders that persist in adulthood have poor long-term outcomes. The optimal window of opportunity to improve the outcomes of mental disorders is the prevention or early treatment in individuals aged 0 to 25 within a clinical staging model framework. Unmet needs: children and young people face barriers to primary and secondary care access, delays in receiving appropriate treatments, poor engagement, cracks between child and adult mental health services, poor involvement in the design of mental health services, and lack of evidence-based treatments. Evidence: the most established paradigm for reforming youth mental services focuses on people aged 12–25 who experienced early stages of psychosis. Future advancements may include early stages of depression and bipolar disorders. Broader youth mental health services have been implemented worldwide, but no single example constitutes best practice. These services seem to improve access, symptomatic and functional outcomes, and satisfaction of children and young people aged 12–25. However, there are no robust controlled trials demonstrating their impact. Very limited evidence is available for integrated mental health services that focus on people aged 0–12.
Conclusions: Children and young people aged 12–25 need youth-friendly mental health services that are sensitive to their unique stage of clinical, neurobiological, and psychosocial development. Early intervention for psychosis services may represent the starting platform to refine the next generation of integrated youth mental health services.
Objectives
This qualitative study set out to understand the mental health challenges and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada.
Setting
In-depth semistructured interviews were carried out with South Asian youth living in Peel Region (Mississauga, Brampton and Caledon), a suburb of Toronto, Canada, home to over 50% of Ontario’s South Asian population.
Participants
South Asian youth (n=10) engaged in thoughtful, candid dialogue about their mental health and service access barriers.
Primary and secondary outcome measures
Qualitative interview themes related to mental health stressors and mental health service access barriers experienced by youth living in Peel Region were assessed using thematic analysis.
Results
South Asian youth face many mental health stressors, from intergenerational and cultural conflict, academic pressure, relationship stress, financial stress and family difficulties. These stressors can contribute to mental health challenges, such as depression and anxiety and drug use, with marijuana, alcohol and cigarettes cited as the most popular substances. South Asian youth were only able to identify about a third (36%) of the mental health resources presented to them and did not feel well informed about mental health resources available in their neighbourhood.
Conclusions
They offered recommendations for improved youth support directed at parents, education system, South Asian community and mental health system. Institutions and bodies at all levels of the society have a role to play in ensuring the mental health of South Asian youth.
As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted as trustworthy, qualitative researchers must demonstrate that data analysis has been conducted in a precise, consistent, and exhaustive manner through recording, systematizing , and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Although there are numerous examples of how to conduct qualitative research, few sophisticated tools are available to researchers for conducting a rigorous and relevant thematic analysis. The purpose of this article is to guide researchers using thematic analysis as a research method. We offer personal insights and practical examples, while exploring issues of rigor and trustworthiness. The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data. We detail our step-by-step approach to exploring the effectiveness of strategic clinical networks in Alberta, Canada, in our mixed methods case study. This article contributes a purposeful approach to thematic analysis in order to systematize and increase the traceability and verification of the analysis.
Purpose:
Perceived ethnic discrimination (PED) is positively associated with depressive symptoms in ethnic minority groups in Western countries. Psychosocial factors may buffer against the health impact of PED, but evidence is lacking from Europe. We assessed whether ethnic identity, religion, and ethnic social network act as buffers in different ethnic minority groups in Amsterdam, the Netherlands.
Methods:
Baseline data were used from the HEalthy Living In a Urban Setting study collected from January 2011 to June 2014. The random sample included 2501 South-Asian Surinamese, 2292 African Surinamese, 1877 Ghanaians, 2626 Turks, and 2484 Moroccans aged 18-70 years. Depressive symptoms were assessed using the Patient Health Questionnaire-9. PED was measured with the Everyday Discrimination Scale. Ethnic identity was assessed using the Psychological Acculturation Scale. Practicing religion was determined. Ethnic social network was assessed with the number of same-ethnic friends and amount of leisure time spent with same-ethnic people.
Results:
PED was positively associated with depressive symptoms in all groups. The association was weaker among (a) those with strong ethnic identity in African Surinamese and Ghanaians, (b) those practicing religion among African Surinamese and Moroccans, (c) those with many same-ethnic friends in South-Asian Surinamese, Ghanaians, and Turks, and (d) those who spend leisure time with same-ethnic people among African Surinamese and Turks.
Conclusions:
Ethnic identity, religion, and ethnic social network weakened the association between PED and depressive symptoms, but the effects differed by ethnic minority group. These findings suggest that ethnic minority groups employ different resources to cope with PED.
Mental illness stigma continues to be a major barrier for individuals with mental illness. In this paper, we define constructs that comprise stigma (e.g., attitudes, stereotypes, prejudice, discrimination), discuss the harmful effects (e.g., label avoidance, public stigma, self-stigma) and present factors that may influence them (e.g., concealability). In order to better understand mental health stigma in Muslim community, we focus on intersectional stigma and present literature on the complex relationships among race/ethnicity, gender, class, religion, and health status among Muslims. In addition, we include literature highlighting culturally specific presentations of symptoms and mental health problems. Finally, we offer suggestions for future stigma research in Muslim communities.
The present study sought to examine South Asian Canadian undergraduate students' (N = 7) experiences with racial microaggressions at a research-intensive Canadian university. Participants ranged in age from 19-23 years and comprised various ethnic groups (e.g., Indian, Bangladeshi, Sri Lankan, and Tamil). Data were collected during a semistructured focus group interview and were analyzed using the consensual qualitative research method (Hill, Thompson, & Williams, 1997). Eight themes emerged. Novel themes included the following: perceived as fresh off the boat, excluded from social life, notion that being Brown is a liability, assumption of ties to terrorism, and compelled to be a cultural expert. Three additional themes were consistent with prior research on Asian Americans (Sue, Bucceri, Lin, Nadal, & Torino, 2007): ascription of intelligence in stereotypical domains, invalidation of interethnic and racial differences, and treated as invisible. Implications for research and campus interventions are discussed. © 2014 National Association of Diversity Officers in Higher Education.
It has been suggested that CBT needs adaptation for it to be effective for clients from Non Western cultures, as it is underpinned by Western values. In prior studies we demonstrated that, CBT (Cognitive Behaviour Therapy) could be adapted for Pakistani clients in Southampton, England, and for local population in Pakistan. Findings from these studies suggest that, CBT can be adapted for clients from Non Western cultures using a series of steps. In this paper we focus on these steps, and the process of adapting CBT for specific groups. The adaptation process should focus on three major areas of therapy, rather than simple translation of therapy manuals. These include; (1) Awareness of relevant cultural issues and preparation for therapy; (2) Assessment and engagement; and (3) Adjustments in therapy. We also discuss the best practice guidelines that evolved from this work to help therapists working with this population.
We reiterate that CBT can be adapted effectively for clients from Non Western cultures. This is however an emerging area in psychotherapy and further work is required to refine the methodology and to test adapted CBT.
The prevalence of depression in Pakistani women in the U.K is unclear, community and hospital admission studies have been unable to settle the debate and have found contradictory findings. The study aimed to measure the prevalence of depression in a random sample of women of Pakistani origin in the U.K and native white origin. Two hundred women (100 white women and 100 women of Pakistani origin) randomly selected from General Practitioners registration lists in Birmingham were screened for depression using the GHQ-28. Women were interviewed alone and special arrangements were made to interview women at a location and time of their preference. The study found that 44% of Pakistani women and 14% of native white women were above the threshold of 10 on the Severe-Depression sub-scale of the GHQ-28. There was no significant difference in depression scores between first-generation and second-generation Pakistani women. It is suggested that Pakistani women living in Birmingham are at an elevated risk of depression. It is believed that interviewing women alone by a Pakistani female researcher facilitated participation and revelation of distress.
Muslim youth living in Western countries are thought to face a variety of risks to
their adjustment, although according to recent research they do not necessarily
have negative outcomes in comparison to non-Muslims.
In order to examine the
complexities of development for Muslim youth in the West, it is necessary to have
a comprehensive understanding of their lived experiences within their intercultural
context. Therefore, this research study qualitatively investigated the indicators
and determinants of participation and success for Muslim young adults in
New Zealand. The results of this study enabled a framework to be developed that
illustrates the most salient ecological resources youth access (family, religion and
the intercultural environment), the risks they face (discrimination and cultural differences),
and outcomes of the acculturation process. Results indicate that while
Muslim youth in New Zealand may be at risk of maladaptative outcomes because
of their exposure to discrimination and cultural transition stressors, ecological
resources may counteract some of the negative effects of these stressors and enable
these young people to become resilient.
A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.
Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities.
Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.
According to Lay and Nguyen(1998), in addition to the general daily hassles encountered by most people, immigrants often face chronic difficulties specific to the acculturation experience, including conflicts with family members, members of the ethnic ingroup, and members of ethnic outgroups. Moreover, it has been suggested that the children of immigrants born in Canada (i.e., second-generation immigrants) may experience different acculturative stressors from their parents (i.e.. first-generation immigrants). This study examined general and acculturation-related daily hassles in 74 first- and second-generation South Asians in Canada, Participants completed a questionnaire that assessed their experience of different types of daily hassles (general, family, ingroup, and outgroup), acculturation attitudes, and level of psychological adjustment. Second-generation individuals reported significantly more ingroup hassles and marginally lower self-esteem than first-generation immigrants. For first-generation immigrants, more ingroup hassles predicted greater depression, and for second-generation individuals, increased ingroup hassles predicted lower self-esteem and more outgroup hassles predicted greater depression. The results emphasize the importance of considering the acculturation experience of second-generation individuals as being unique to that of first-generation immigrants.
This study explored resilience among South Asian (SA) immigrant women who were survivors of intimate partner violence (IPV). Eleven women participated in in-depth interviews. Thematic analysis was conducted using constant comparison. We identified five cross-cutting themes: resources before and after the turning-point (i.e. decision to confront violence), transformations in self, modification of social networks, and being an immigrant. Women drew upon their individual cognitive abilities, social support, and professional assistance to move beyond victimization. All women modified their social networks purposefully. The changes in individual-self included an increased sense of autonomy, positive outlook, and keeping busy. The changes in collective-self occurred as women developed a stronger feeling of belonging to their adopted country. This hybrid identity created a loop of reciprocity and a desire to contribute to their community. Women were cognizant of their surmountable challenges as immigrants. SA immigrant women IPV survivors sought multiple resources at micro, meso and macro levels, signifying the need for socio-ecological approaches in programs and policies along with inter-sectoral coordination to foster resilience.
In the wake of the events of September 11, Muslim-American youth found that the multiple cultures within which they live were suddenly and alarmingly in conflict. The developmental consequences of living in a world fractured by religious and ethnic terror have yet to be determined for Muslim youth in the United States. This exploratory, mixed-method study begins to examine how Muslim youth negotiate their identities in these challenging times. Documented in the surveys, narrated in the interviews, and drawn into their identity maps, Muslim-American youth (n = 70) ages 12 to 18, vividly portrayed their interior lives as a dialectic labor of psychological reconciliation – piecing together what we call hyphenated selves. The results show that Muslim youth experience discrimination, sometimes to an extreme degree. We observed diversity in how youth deal with the challenges of growing up Muslim in post 9/11 US, ranging from “telling nobody” to policing each other within the Muslim community. In addition we found that males and females negotiate their Muslim and American identities in different ways.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Background. This study aims to identify socio-cultural–specific characteristics of depressive symptoms in ageing South Asians.
Introduction
The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents.
Methods
The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services.
Results
Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10–1.51), those who used alcohol (1.14, 1.01–1.29), gender minorities (1.28, 1.03–1.58) and sexual minorities (1.28, 1.03–1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67–2.18), those with anxiety (1.78, 1.56–2.03), females (1.43, 1.31–1.58), gender minorities (1.45, 1.23–1.70) and sexual minorities (1.15, 1.07–1.23).
Conclusion
Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively.
While interest in the mental health of South Asian Muslims has observably increased over the last couple of decades, South Asian Muslims are often grouped together with either other South Asians or other Muslims, depending on the identity of interest in the literature. This chapter aims to explore the gap within research literature in which the intersectional complexities of South Asian Muslims lie by examining the historical and geopolitical contexts of South Asian Muslim experiences in the United States. The aftermaths following the attacks on September 11, 2001 have had an enormous impact on the psychological well-being of South Asian Muslim Americans. We have discussed the ways in which contemporary South Asian Muslim American experiences are further complicated when navigating additional marginalized identities such as gender and sexual orientation, age and generational influences, disability status, class, and national origin.
Since initially writing on thematic analysis in 2006, the popularity of the method we outlined has exploded, the variety of TA approaches have expanded, and, not least, our thinking has developed and shifted. In this reflexive commentary, we look back at some of the unspoken assumptions that informed how we wrote our 2006 paper. We connect some of these un-identified assumptions, and developments in the method over the years, with some conceptual mismatches and confusions we see in published TA studies. In order to facilitate better TA practice, we reflect on how our thinking has evolved – and in some cases sedimented – since the publication of our 2006 paper, and clarify and revise some of the ways we phrased or conceptualised TA, and the elements of, and processes around, a method we now prefer to call reflexive TA.
In a preliminary investigation of socio-cultural influences on parent-adolescent negotiation of time together and apart, six focus groups were conducted with 58 mothers, fathers, adolescent sons and daughters from Muslim immigrant families residing in a mid-sized urban centre in Ontario, Canada. Focus group participants were asked to describe the time they spend together with and apart from their families, and the degree to which adolescence and immigration contribute to this experience. Qualitative analysis was based on social constructionist principles. One of the primary themes evident in this analysis was related to families’ subjective experience of sociocultural differences between countries-of-origin and current Canadian context. An expanded concept of family time that incorporates an element of communal or collective time is supported, suggesting further conceptualization of parental monitoring and family acculturation with corresponding clinical and research directions.
Early intervention is a fundamental principle in health care and the past two decades have seen it belatedly introduced into the field of mental health. This began in psychotic disorders, arguably the least promising place to start. The steady accumulation of scientific evidence for early intervention has eventually overwhelmed the sceptics, transformed thinking in psychotic disorders and created an international wave of service reform. This paradigm shift has paved the way to a more substantial one: early intervention across the full diagnostic spectrum. 75% of mental illnesses emerge before the age of 25 years, and young people bear the major burden for those disorders that threaten the many decades of productive adult life. The paradox is that young people aged between 12 and 25 years have had by far the worst levels of access to mental health care across the whole lifespan. Health services are poorly designed, grossly under-resourced and typically unfriendly to, and untrusted by, young people. Furthermore, until recently there has been a quite striking lack of interest in this transitional age group from clinicians and researchers alike, who had unthinkingly accepted the paediatric–adult split of mainstream medicine without questioning its utility and validity for our field and our young patients. Over the past decade, however, a major shift in momentum has occurred to take early intervention in youth mental health more seriously. Here we discuss the recent advances and evidence supporting an innovative integrated model of youth mental health care and look to the future.
Acculturation, or the process of change that takes place as a result of intercultural contact, can cause a range of stressors. The task of managing this acculturative stress is particularly difficult for Muslim immigrants in Western contexts due to the global rise of Islamophobia. Research investigating the experiences of young migrant Muslims has found inconsistent results regarding the moderating influences of religious identity and religious practices on the relationship between stress and mental health. The current study examined whether levels of religiosity interacted with distinct forms of acculturative stress in the prediction of depression and well-being for Muslim youth in New Zealand. Results painted a complex picture of the relationships between religiosity and mental health, finding that greater religiosity is generally positive for youth outcomes, but it also carries the risk lowering levels of mental health through its interactions with acculturative stress.
As of 2011, the South Asian community became the largest visible minority group in Canada, made up of individuals from Afghanistan, Bangladesh, India, Pakistan, and Sri Lanka. Youth between the ages of 15 and 24 represent the largest portion of this population, and have unique historic, social, and cultural upbringings as a result of being raised with both South Asian and Canadian values. Many of these youth are second-generation, either migrating at young ages to Canada or belonging to immigrant families. Research on second-generation youth within this community has shown that they experience issues of dual-identity formation and cultural conflict, as well as concerns of mental health tension. Eating disorders, for example, have recently been observed to be prevalent in South Asian communities in the West, with self-dissatisfaction beginning at very young ages.
Youth are the locus of deep anxieties about local, national and global politics, for as a liminal category associated with the transition from childhood to adulthood, they are assumed to embody the future and the possibility of change or continuity. The notion that youth is an inherently unstable or shifting ontology means that they are also the objects of overt nationalizing, disciplinary and repressive practices that are revealed when youth are their objects. My research builds on the framework of ‘youthscapes’ that analyses the intersections between popular culture, national ideologies and global markets and migrations (Maira and Soep, 2005). Elisabeth Soep and I developed this conceptual, epistemological and methodological framework for studying youth to integrate an analysis of expressive cultural forms produced and engaged by youth with materialist and historicist approaches, while interrogating the production of the category ‘youth’ itself. Young people are often situated at the centre of debates about national identity and globalization — and often in charged, symbolic and overdetermined ways, given the construction of youth as a ‘transitional’ category in relation to the social order and civic personhood and one on which the tension between dissent and conformity is often pinned (Maira and Soep, 2005).
There is a growing body of research examining how ethnicity and race are implicated in identity development among ethno-racially diverse youth. The current study explored the complex and dynamic ways that racialized youth describe and use their identities in the various social environments that they participate in. Techniques informed by a grounded theory approach were used to understand the personal, social, and situated identities of 26 young South Asian-Canadian women and men (aged 18–25). Findings suggest that these youth were influenced both by a distinct ethnic/racial history and a personal history grounded in “Canadian” experiences. These identities are multi-dimensional, flexible constructs that are created and re-created as youth interact with others around them. Youth actively negotiate various aspects of their environments and draw on their “identity capital” to make deliberate, strategic choices about whether to “brown it up” or “bring down the brown” within different human interactions. This reflects youths' resiliency in dealing with the potentially oppressive situations that arise when living in ethnically/racially heterogeneous environments. The implications of these findings for social work theory, research, and practice are discussed.
There are few explicit discussions in nursing literature of how qualitative research can be made as rigorous as it is relevant to the perspective and goals of nursing. Four factors complicate the debate about the scientific merits of qualitative research: the varieties of qualitative methods, the lack of clear boundaries between quantitative and qualitative research, the tendency to evaluate qualitative research against conventional scientific criteria of rigor, and the artistic features of qualitative inquiry. A framework for understanding the similarities and differences in research approaches and a summary of strategies to achieve rigor in qualitative research are presented.
Over the last two decades, women have organized against the almost routine violence that shapes their lives. Drawing from the strength of shared experience, women have recognized that the political demands of millions speak more powerfully than the pleas of a few isolated voices. This politicization in turn has transformed the way we understand violence against women. For example, battering and rape, once seen as private (family matters) and aberrational (errant sexual aggression), are now largely recognized as part of a broad-scale system of domination that affects women as a class. This process of recognizing as social and systemic what was formerly perceived as isolated and individual has also characterized the identity politics of people of color and gays and lesbians, among others. For all these groups, identity-based politics has been a source of strength, community, and intellectual development. The embrace of identity politics, however, has been in tension with dominant conceptions of social justice. Race, gender, and other identity categories are most often treated in mainstream liberal discourse as vestiges of bias or domination-that is, as intrinsically negative frameworks in which social power works to exclude or marginalize those who are different. According to this understanding, our liberatory objective should be to empty such categories of any social significance. Yet implicit in certain strands of feminist and racial liberation movements, for example, is the view that the social power in delineating difference need not be the power of domination; it can instead be the source of political empowerment and social reconstruction. The problem with identity politics is not that it fails to transcend difference, as some critics charge, but rather the opposite- that it frequently conflates or ignores intra group differences. In the context of violence against women, this elision of difference is problematic, fundamentally because the violence that many women experience is often shaped by other dimensions of their identities, such as race and class. Moreover, ignoring differences within groups frequently contributes to tension among groups, another problem of identity politics that frustrates efforts to politicize violence against women. Feminist efforts to politicize experiences of women and antiracist efforts to politicize experiences of people of color' have frequently proceeded as though the issues and experiences they each detail occur on mutually exclusive terrains. Al-though racism and sexism readily intersect in the lives of real people, they seldom do in feminist and antiracist practices. And so, when the practices expound identity as "woman" or "person of color" as an either/or proposition, they relegate the identity of women of color to a location that resists telling. My objective here is to advance the telling of that location by exploring the race and gender dimensions of violence against women of color. Contemporary feminist and antiracist discourses have failed to consider the intersections of racism and patriarchy. Focusing on two dimensions of male violence against women-battering and rape-I consider how the experiences of women of color are frequently the product of intersecting patterns of racism and sexism, and how these experiences tend not to be represented within the discourse of either feminism or antiracism... Language: en
This research was based on data collected in the Health and Mental Health cycle of the Canadian Community Health Survey to assess the effects of ethnic background on seeking treatment for major depression episodes (MDE) and to investigate types of barriers to mental health care reported by members of different racial/ethnic groups. Findings indicated that racial/ethnic background had a significant effect on treatment-seeking rates, controlling for socio-economic, demographic and health factors. Proportion of MDE sufferers with unmet mental health care needs varied significantly across racial/ethnic groups, with the lowest rate reported among Blacks and the highest among South Asians. Results identified some access problems that were common across all racial/ethnic groups and some problems unique to members of specific groups. For example, two-thirds of depressed individuals of all racial/ethnic backgrounds with unmet needs reported personal barriers to treatment, i.e., they decided not to seek treatment. In contrast, rates of accessibility and availability barriers differed significantly across racial/ethnic groups. Results signaled an urgent need for psycho-educational programs aimed at Canadians of all racial/ethnic backgrounds, as well as the need for culturally sensitive screening and intervention policies to ensure equal access to mental health services for all Canadians.
Résumé:
Cette recherche s’est faite à partir de données collectées par la partie de l’Enquête sur la santé dans les collectivités canadiennes portant sur la santé mentale, afin d’évaluer les effets du contexte ethnique dans la demande de traitement pour des épisodes majeurs de dépression (EMD), et pour étudier les types d’obstacles aux soins médicaux ad hoc, tels qu’en ont rendu compte des membres de groupes raciaux et ethniques. Selon les résultats, le contexte racial et ethnique joue un rôle important sur les taux de demande de traitement, en contrôlant les facteurs socio-économiques, démographiques et touchant à la santé. La proportion de malades souffrant d’EMD qui n’ont pas reçu de soins médicaux appropriés varie de manière significative d’un groupe à l’autre, les réponses indiquant le taux le plus bas chez les Noirs et le plus élevé chez les Sud-Asiatiques. Nous avons aussi identifié des problèmes d’accès, certains communs à tous les groupes raciaux et ethniques, d’autres propres à des groupes spécifiques. Par exemple, dans tous les contextes concernés, les deux-tiers des personnes dépressives qui n’ont pas reçu de soins adéquats ont indiqué des obstacles d’ordre personnel à un traitement, à savoir qu’elles n’ont pas demandé à en suivre un. Par contraste, les taux d’accessibilité et les obstacles à la disponibilité de soins mentaux diffèrent remarquablement d’un groupe racial ou ethnique à l’autre. Les conclusions indiquent un besoin urgent de dépistage et de politiques d’interventions qui tiennent compte de la culture afin d’assurer un accès égal aux services de santé mentale pour tous les Canadiens.
Adjustment and resettlement of immigrants from India to Canada is often a challenging and difficult process. This study focuses on the acculturative stress experienced by South Asian women in the Atlantic Provinces in Canada. This qualitative inquiry explores the post-migratory experiences of South Asian women in the region. In-depth interviews were held with 14 South Asian women. Emerging themes consisted of forms of acculturative stress such as intergenerational conflict, discrimination, depression, and coping. The impact of the resettlement process on the mental health of South Asian women is considered. It is concluded that multi-ethnic and context-specific mental health promotion approaches and guidelines are essential for immigrant South Asian women.
The authors developed a short course of introductory qualitative research methods to help the lessons learned organizations in the police community improve their data collection techniques. This document provides an annotated version of the course material. It should be of interest to research professionals interested in qualitative research methods. This research was conducted within the Intelligence Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Department of the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community. The authors of this work are Margaret Harrell and Melissa Bradley.
In the present study, we examined how the religiousness of European (Belgian) Muslim immigrants is related to multiple collective identities (origin, new country, European, and cosmopolitan), attachment to one (origin or new) or both cultures, and acculturation as a process realized through a variety of domains in personal and social life. Two groups were included: young Muslims born of immigration from Muslim (Mediterranean) countries and, for comparison, young non-Muslims born of immigration from other countries. In both groups, high religiousness predicted attachment to origin identity and culture; low religiousness and religious doubting predicted identification with the host country and acculturation. Interestingly, the religiousness of Muslim immigrants also predicted high identification as citizen of the world, whereas the religiousness of the other immigrants was related to low European identity. Finally, some discrepancy between claiming new identities and effectively experiencing acculturation was found. Interpretations are provided on both a general level (psychology of religion and immigration) and a contextual level (specific to Muslim Europeans).
The acculturation gap-distress model purports that immigrant children acculturate to their new culture at a quicker pace than their parents, leading to family conflict and youth maladjustment. This article reviews literature on the acculturation gap-distress model, showing that acculturation gaps function in unique ways depending on many social and contextual variables. In contrast to the original model, which only discusses 1 type of acculturation gap, there are at least 4 types of acculturation gaps: (1) the child is more acculturated than the parent in the host culture, (2) the child is less acculturated than the parent in the host culture, (3) the child is more acculturated than the parent in the native culture, and (4) the child is less acculturated than the parent in the native culture. A review of research indicates that each of these types of gaps function in unique ways.
This article discusses what it means to be a “model minority” linguistically by examining how language ideologies, class, and gender shape language use for Desi (South Asian American) teenagers in a Silicon Valley high school. Upper middle-class Desi teens follow monolingual norms while middle-class Desi teens construct heteroglossic “FOB styles” that incorporate Punjabi, Desi Accented English, California slang, and hip-hop lexicon. Style construction is influenced by gendered community norms that also prevail at school, and boys and girls variably regard school spaces as public or private. Nonnormative, gendered ways of speaking are contrasted to “model” ones and analyzed for their racializing consequences. [race, gender, youth, style, South Asian American]