Mental disorders generally lower in immigrant/refugee vs. nonimmigrant youths

Prevalence of mental disorders among first- and second-generation immigrant and refugee children and youth was generally lower relative to similar populations of nonimmigrants, per a Canadian cohort study published in JAMA Network Open.

“For at least half of all mental health problems across the life course, onset is in childhood or adolescence. Understanding mental disorder prevalence prior to adulthood is critical for prevention and intervention,” Anne M. Gadermann, PhD, of the Human Early Learning Partnership in the school of population and public health at the University of British Columbia, and colleagues wrote.

“In the Canadian context, child and adolescent mental health strategies need to consider the large and growing immigrant and refugee population.”

Gadermann and colleagues sought to determine and compare the prevalence of conduct, ADHD and mood/anxiety disorders in immigrant, refugee and nonimmigrant children and youth in the Canadian province of British Columbia.

The researchers examined health records of 470,464 young residents of British Columbia, from birth to age 19 years, between 1996 and 2016. Nonimmigrant children and youth made up 65.5% of the study population (307,902). Among those who migrated, 142,011 were first- or second-generation immigrants, and 19,686 were first- or second-generation refugees.

Physician billings, hospitalizations and drug dispensations were linked to immigration records to estimate adjusted prevalence of mental disorder diagnosis based on the amount of time immigrant and refugee youths resided in the province, against those from nonimmigrant backgrounds. Results were organized by migration status, generational position, age and sex. Analyses were conducted from August 2020 to November 2021.

Results showed that children and youth from immigrant and refugee backgrounds of both generations generally had a lower prevalence of conduct disorder (age 6 to 12: first-generation immigrant, 2.72% [95% CI, 2.56%-2.90%] vs. nonimmigrant, 7.03% [95% CI, 6.93%-7.13%]), ADHD (age 6 to 12: first-generation immigrant, 4.30% [95% CI, 4.10%-4.51%] vs. nonimmigrant, 9.20% [95% CI, 9.08%-9.31%]) and mood/anxiety disorders (age 13 to 19: first-generation immigrant, 11.07% [95% CI, 10.80%-11.36%] vs. nonimmigrant, 24.54% [95% CI, 24.34%-24.76%]).

Among the immigrant cohort, second-generation children and youth generally showed higher prevalence of all examined mental disorders than first-generation counterparts. Data additionally revealed second-generation refugees’ children had the highest prevalence estimates for mood/anxiety in children aged 3 to 5 years relative to first- and second-generation immigrant and nonimmigrant children. Diagnoses of all examined mental disorders were diversified by age and sex within all three cohort populations.

“Future research is needed to tease apart the nuances underlying these differences, including the examination of cultural and systemic differences, such as cultural differences in symptomatology, presentation and etiologies as well as systemic barriers to accessing health services,” Gadermann and colleagues wrote.