Pathways and barriers to mental health care for immigrants and refugees

The statement for the project was prepared by the main researcher, Laurence Kirmayer.

Research field of the project : Mental health. Accessibility. Cultural sensitivity.


The main researcher conducted a community survey of the general population in an urban multicultural neighbourhood (Côte-des-Neiges), define as the catchment area of a community clinic (CLSC). The focus was on three groups of immigrants to Canada (Anglophone Caraibbeans, Vietnamese and Filipinos) and Canadian-born comparison groups. The objectives included : (1) to identify the health care utilization of individuals with current depressive, anxiety or somatoform symptomatology or with recent social problems ; (2) to determine the perceived barriers to mental health care in primary care and specialty mental health sectors ; (3) to examine the relationship between cultural models of illness and healing and (A) patterns of symptom expression, help-seeking and health care utilization ; (B) variations in the resolution of common mental disorders and social problems ; (4) to examine the relationship between patterns of acculturation and (A) the prevalence and symptomatic expression of somatization, depression and anxiety, and (B) help-seeking and health care utilization.

Main researcher and associate

Laurence Kyrmayer (U. McGill) Associate : Morton Weinfeld (U. McGill)

Partner to the project

Jewish General Hospital

The study had a two-stage design : (1) telephone interview of 2246 persons, designated as the  » Stage 1 interview  » ; and (2) follow-up telephone interview at three months of 576 persons divided approximately equally into five cultural groups (anglophone Canadian-born, francophone Canadian-born, Vietnamese, Caribbean, and Filipino), designated as the  » Stage 2 interview « . A third ethnographic component was also part of the study, for which 117 in depth semi-structured interviews were completed face-to-face with a sub-sample from Stage 2, containing approximately equal numbers of persons from the five cultural groups. The three phases of the project are completed.

Scientific results

Overall rates of utilization of medical services in the past year were similar in immigrant (78.1 %) and non-immigrant (76.4%) groups. However, rates of utilization of health care services for psychological distress were significantly lower among immigrants (5.5 vs. 14.7%, p<0.001). This difference was attribuable both to a significantly lower rate of utilization of specialty mental health services by immigrants (2.6 vs.11.6%, p<0.001) and to differential use of medical services for psychological distress (3.5 vs.5.8%, p=0.02). Higher rates of utilization of mental health services were associated with greater emotional distress (on the GHQ) more somatic symptoms and more life events. Individuals with more than high school education were also more likely to use services for a psychological problem. The lower rates of utilization were found for all three ethnocultural groups but were most marked for Vietnamese and Filipino groups. Within the three immigrant groups, length of stay in Canada was not related to the tendency to use mental health services.

Multivariate analyses showed that the lower rate of utilization by immigrants could not be explained entirely by differences in sociodemographics or levels of somatic or psychological symptoms, or life events. For respondents with at least one symptom of psychological distress in the last year on the GHQ we explored the reasons why they did not seek help. The most important factors were a tendency to minimize, normalize and deal with problems on one’s own (common to all groups but especially marked among the immigrant groups) and perceived ethnic mismatch among the immigrants. Ethnic mismatch involved the perception that available care providers would not understand or be prejudiced against the respondent’s culture and that professionals from their cultural background were not available. Other important barriers to care included the fear of stigmatization, mistrust of the health care system and practical obstacles, including getting time away from work.


The main investigator is a psychiatrist who has an intensive practice at the Jewish General Hospital. This ensures, that the findings will be used by himself, his residents as well as other colleagues in their professional interventions with clients from ethnocultural groups. Morover, the general findings will be of interest for policymakers at the hospital or governmental levels.

Activities, national and international collaborations

The research results were presented widely abroad, especially in Sweden and Japan where the principal investigator has given conferences and training sessions.

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