Why are African Immigrants in Canada Reluctant to Use Mental Health Services? A Systematic Inventory of Reasons

Abstract

BackgroundStudies suggest that despite a high prevalence of mental health conditions among African immigrants in Western countries, they tend to underuse mental health services, compared with native-born people. This study explored the reasons for underuse of conventional mental health services among African immigrants in Canada.MethodThe study participants were 280 African immigrants who had experienced depressive symptoms but did not use conventional mental health services. They were presented with a questionnaire that contained 50 statements referring to reasons for not using conventional mental health services while experiencing depressive symptoms. They were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis.ResultsA eight-factor structure of reasons was found: "Symptoms underestimation and perceived self-efficacy" (important for 61% of the sample), "Relying on community support" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Denying competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants’ demographics. ConclusionThese findings strongly suggest that strategies to promote the use of mental health services among African immigrants must be multifaceted rather than focused on one single barrier. When implementing these strategies, policymakers should put more emphasis on increasing mental health literacy among African immigrant communities, as well as providing them with culturally sensitive mental healthcare.

Explanatory models of mental health : a qualitative study among East-African migrants and Belgian healthcare professionals

“…However, migrants are underrepresented in conventional mental healthcare systems and different mechanisms hinder their successful integration in those systems (Ceuterick et al 2020;Graetz et al 2017;Lebano et al 2020;Lindert et al 2008). The low representation of migrants in conventional mental healthcare systems can be explained by a complex interplay of at the one hand, factors defining migrants' reluctance to seek mental healthcare in those services (Boukpessi 2021;Kirmayer et al 2007;Knipscheer and Kleber 2008) with at the other hand, structural and systemic barriers impeding their access to mental healthcare services (Lebano et al 2020;Uphoff et al 2020). I argue that among these hindrances, differences in cultural understandings of mental health play an important role.…”

“…While a wide range of evidence proves migrants are more vulnerable to mental health problems than non-migrants , Uphoff et al 2020, Voglino et al 2022, migrants are more reluctant to seek mental healthcare in conventional healthcare services (Boukpessi 2021;Kirmayer et al 2007;Knipscheer and Kleber 2008). This reluctance can be explained by a complex interplay of sociodemographic factors (e.g., gender, age, education), socio-economic factors (e.g., financial barriers, limited access to health insurance), structural and logistical factors (e.g., legal status defining healthcare access, language barriers, system of consultancy appointments) and sociocultural factors (Ahmadinia et al 2022;Anthony 2015;Kirmayer et al 2007;Scheppers et al 2006;Selkirk et al 2014).…”