Contemporary Issues in Understanding Immigrant Mental Health Needs and Challenges

This SCP Blog by Dr. Anu Asnaani is sponsored by the Diversity Committee of SCP and briefly explores contemporary issues in understanding immigrant mental health needs and challenges to detection and treatment of psychological distress in our global communities.

One of our increasing challenges as mental health professionals domestically and internationally is ensuring we are meeting the needs of the truly global populations that make up our local communities. As an immigrant myself to the United States, I have thought deeply and keenly about the formidable differences among diverse groups in perceptions of mental health, access to mental health services, and palatability of current mental health interventions.

It is important to consider within this discussion that immigrants’ experiences are in no way homogenous. For instance, refugees’ and forcibly displaced individuals’ mental health needs are starkly different from those immigrants who have left their home countries voluntarily in search of higher education or improved career possibilities. My colleague Dr. Angela Nickerson (Director of the Refugee Trauma and Recovery Program and Associate Professor at the University of New South Wales) has recently spearheaded an important briefing paper examining the mental health considerations for forcibly displaced individuals for the International Society for Traumatic Stress Studies (ISTSS). A number of us engaged in trauma research across the globe were fortunate to contribute to this comprehensive position paper which both highlights the key important concerns (from scientific, clinical, public health and policy perspectives), and provides thoughtful recommendations for these populations targeted towards a range of stakeholders involved in their care. A full copy of the article can be found HERE.

Another significant factor often examined in the immigration experience and resulting mental health sequelae is the influence of age. Specifically, the age at which one immigrates to a new country has been shown to influence the degree of acculturation, acculturative stress, ethnic identity, and resulting psychological stress from these and other factors. To this end, the cultural nuances included in mental health services may differ for a bilingual child born in the country of immigration to foreign-born parents, compared to a recently immigrated adolescent, or to an adult who has moved to a new country for job opportunities (Betancourt et al., 2017).

I have been particularly struck with this influence of developmental stage on cultural assimilation as a result of my collaborative community-based assessment work with trauma-exposed children and children of displaced families. For one study, we visit the waiting rooms of pediatric primary care clinics around the city to test more interactive ways (using mobile games) to detect post-traumatic stress symptoms in children who have experienced a traumatic event (Asnaani et al., in preparation). Philadelphia is extremely diverse with a number of immigrant communities, and these community clinics provide an interesting context for such data collection; here, psychological phenomena which have far-reaching impacts on mental health and functioning (such as exposure to trauma) uniquely intersect with cultural and immigration issues. As an example, our research team often runs into barriers of assessing children for symptoms based on parents not speaking English (even if their children can and wish to participate in the study), or parents from certain cultural backgrounds being more stigmatized by discussing trauma exposure or mental health problems in general, even though their children seem more comfortable with it. It is certainly more noticeable in immigrant families that there is a greater divide between how immigrant parents react to even being approached about the study, with more general distrust or hesitation towards research participation versus non-immigrant parents (as a general rule, although there are certainly exceptions). Indeed, this is just the tip of the iceberg of barriers to assessing mental health needs in immigrant youth and adult populations. This does not even touch at the additional formidable barriers of stigma towards mental health in general and diverse conceptualizations of psychological distress, both of which can potentially impede provision of effective interventions for mental health concerns in diverse populations (Nickerson et al., 2018; IASC, 2007).

To this end, we’re still largely operating in the dark. Do our interventions as they stand work as effectively and efficiently for psychological distress in individuals of multiple cultural backgrounds? Do we need to modify each intervention to make them “culturally sensitive” (and how do we know to what degree such modifications are needed)? Alternatively, do we need to change anything at all, or do the mechanisms underlying effective treatment of disorders, such as post-traumatic stress disorder, supersede cultural differences? Even with significant work over the past 10 years related to understanding cultural aspects in improving detection and intervention work for psychological distress in immigrant populations (e.g., Kirmayer et al., 2011), a lot of questions remain. More integration of these issues into “mainstream” examination of effective treatments is needed in order for us to appreciably meet the needs of our global communities. I look forward, with many of my colleagues, to making it a priority to cover significantly more ground on such issues in the next decade.

Discussion Questions

  1. What different considerations do we need to have based on reasons for immigration (e.g. forcibly displaced versus voluntary immigration) for individuals seeking psychological help?
  2. How do age and generational influences impact the degree to which immigrant individuals feel comfortable with being assessed and treated for psychological dysfunction? What barriers might we need to consider when doing clinical assessments/interventions with these populations?

Reference article

Nickerson, A., Liddell, B., Asnaani, A., Carlsson, J., Fazel, M., Knaevelsrud, C., Morina, N., Neuner, F., Newnham, E., & Rasmussen, A. (2018). Trauma and mental health in forcibly displaced populations: An International Society for Traumatic Stress Studies briefing paper.

Author Bio

Anu Asnaani, Ph.D., is a clinical psychologist and an Assistant Professor at the University of Pennsylvania Perelman School of Medicine. Dr. Asnaani’s clinical research over the past decade has focused on understanding mechanisms underlying effective treatments for emotional disorders, particularly in terms of improving our current treatments to reach diverse and community-based populations. Dr. Asnaani has published extensively in the areas of mechanisms of cognitive behavior therapy and the intersection with diversity issues, and is currently the Principal Investigator on several lab-based and community-based studies examining integration of technology in the study of anxiety disorders, OCD and PTSD.

References cited

Asnaani, A., Suzuki, N., Zang, Y., Schwartz, B., Yeh, R., Mannarino, A., Cohen, J., & Foa, E.B. (inpreparation). Innovating with technology: Findings for utility of a tablet game in assessing for posttraumatic stress symptoms in pediatric primary care settings.

Betancourt, T. S., Newnham, E. A., Birman, D., Lee, R., Ellis, H., & Layne, C. M. (2017).Comparing trauma exposure, mental health needs and service utilization across clinical samples of refugee, immigrant and non-immigrant children. Journal of Traumatic Stress, 30, 209-218.

Inter-Agency Standing Committee (IASC) (2007). IASC guidelines on mental health andpsychosocial support in emergency settings. Geneva: IASC.

Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … & Pottie, K.(2011). Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association Journal, 183(12), 959- 967.