Exploring barriers and enablers to primary mental health care among South Asian women in Montreal: A qualitative exploratory study

Background: In Canadian health surveys, racialized groups and recent immigrants with symptoms of psychological distress report lower rates of being diagnosed and treated compared to their European white counterparts. Lower detection may be related to difficulties expressing mental health challenges because it is considered as a taboo subject and still stigmatized in many ethnocultural groups, particularly for South Asians. When accessing healthcare in Canada, South Asians face the additional difficulties of expressing their mental health challenges in a second language. South Asian women in traditional households face mental health stressors because of gendered roles and expectations and they have limited agency and control over decision-making, including access to healthcare resources. Objectives: This study seeks: 1) to understand the barriers and enablers to expressing mental health challenges and accessing care among South Asian immigrant women from different linguistic groups who receive primary healthcare services in English; and 2) to assess the acceptability and potential uptake of self-help strategies as a means of managing their mental health challenges.Methods: The exploratory qualitative study used semi-structured in-depth interviews of a purposive sample of 16 South Asian immigrant women from Bangladesh, Pakistan, India, and Sri Lanka. Participants with direct or indirect experience with mental health conditions were referred from a family medicine teaching clinic serving a multicultural neighborhood. Others were recruited from a South Asian women’s community centre in Montreal, Quebec. Data analysis involved an inductive-deductive thematic analysis approach.Preliminary results: Factors such as migration and settlement conditions, generational trauma, lack of family support, and long waiting lists for receiving mental health care were identified as significant mental health stressors among the South Asian women. Moreover, cultural norms, language barriers, family violence, and the reliance on male counterparts for accessing healthcare services emerged as major obstacles to expressing mental health challenges to their primary health care providers. It was observed in the study that most of the women first discuss the experiences of their close family members or friends, before tending to share their own lived experiences. A few participants reported limited knowledge about the available self-help care resources. Those who were aware of these self-help approaches mentioned the lack of cultural appropriateness as a barrier to utilizing these resources. While most participants expressed a preference for professional mental health care, they indicated a willingness to try culturally and linguistically tailored self-help approaches in situations where professional services were inaccessible. Preliminary Conclusion: South Asian women face significant mental health stressors, so exploring impact on mental health is important in primary care encounters. Providing cues of their psychological safety may encourage them disclosing their personal mental health challenges. By promoting the importance of mental health and popularizing the use of self-help strategies to manage mild and moderate mental health challenges, South Asian women can improve their ability to communicate their needs and actively engage in managing their mental health care, both in Canada and worldwide

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