Immigration and health disparities: insights from the Canadian Longitudinal Study on Aging
Notice bibliographique
Résumé
Background: Immigrants experience socio-economic and acculturation stressors when moving to a host country. These stressors may persist and affect their mental well-being throughout their lifetime. Fear of stigma, failure to recognize depressive symptoms, and delays in seeking mental health care at an early stage increase the risk for major depressive disorders in immigrants and impact their physical health. The overall goal of my thesis was to examine the health disparities in Canadian immigrants compared to non-immigrants in terms of depression risk, depression and diabetes dual effect, and the challenge of longitudinal data collection, using the Canadian longitudinal study on aging (CLSA) data.Methods: The CLSA is a national prospective cohort that collects psychological, medical, biological, social, lifestyle and economic data on 51,338 participants since 2012-2015. In my first manuscript, I used the CLSA Comprehensive cohort (in person data collection, 30,097 participants) baseline and Maintaining Contact data at 18 months to evaluate the risk of undiagnosed depression, persistent depressive symptoms, and seeking mental health care for depressive symptoms in immigrants versus (vs) non-immigrants; in my second manuscript, I used the Comprehensive cohort baseline and 3-year (yr) follow-up data (2015-2018) to study the depression and diabetes bidirectional, longitudinal relationship in immigrants and non-immigrants; and in the third manuscript, I used the combined CLSA Tracking (telephone data collection, 21,241 participants) and Comprehensive cohorts baseline and follow-up data to assess the impact of immigrant status, depression, and language (English, French or bilingual) on loss to follow-up (LFU). Results: My first manuscript showed a sex-dependent higher risk of undiagnosed depression in immigrants vs non-immigrants. Female immigrants were more likely to have undiagnosed depression than female non-immigrants (odds ratio 1.50, 95% confidence interval 1.25-1.80), but no difference was observed for men. The risk of persistent depressive symptoms and consulting a mental health care professional for these symptoms at 18 months did not differ between immigrants and non-immigrants. Immigrants who lived in Canada for either less than 20 yrs (0-5 yrs: 3.30, 1.59-6.85; 6-10 yrs 1.84, 1.08-3.11; 11-20 yrs 1.53, 1.02-2.29) or more than 40 yrs (1.21, 1.02-1.43) had higher risks of undiagnosed depression than non-immigrants. Immigrants who arrived in Canada at age > 40 yrs had twice the risk of undiagnosed depression as those who arrived at an earlier age (2.02, 1.43-2.86). My second manuscript revealed a diabetes and depression bidirectional association in non-immigrants and only a unidirectional relationship between depression and diabetes in immigrants. Specifically, diabetes increased depression risk in non-immigrants (1.27, 1.08-1.49), but not in immigrants (1.12, 0.80-1.56), while depression increased diabetes risk in both non-immigrants (1.39, 1.16-1.68) and immigrants (1.60, 1.08-2.37). My third manuscript revealed that immigration ≤ 20 yrs ago (1.84, 1.34-2.35) or arrival at age > 22 yrs (1.32. 1.10-1.58), and depression (1.23, 1.13-1.46) were associated with higher risks of LFU from the CLSA. Language was associated with LFU with no effect modification by depression or immigrant status. Bilingual (vs French) had lower LFU risk outside (0.45, 0.24-0.86) and inside Quebec (0.78, 0.63-0.98). LFU risk was higher in French (vs English) outside Quebec (2.33, 1.19-4.55), but not inside Quebec.Conclusion: My studies showed disparities between immigrant and non-immigrant Canadians in risks of undiagnosed depression, association between depression and diabetes, and risk of LFU at three years. Sex, time of residency, and age at arrival of immigrants were important determinants of their mental health. Longitudinal research addressing mental and physical health of immigrants may be challenged by LFU and data completeness
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,005 | 0,016 |
| Études des sciences et des technologies | 0,007 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».