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Racial Identity and the Healthy Immigrant Effect : Does Racial Background Affect Mental Health Among… Liu, Kyara Jia Yen 2021-04-25

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Racial Identity and the Healthy Immigrant Effect: Does Racial BackgroundAffect Mental Health Among Immigrants in Canada?Kyara Jia Yen LiuDepartment of Sociology, University of British ColumbiaSOCI 449: HonoursDr. Gerry Veenstra (Supervisor)April 25th, 20211PrefaceThis thesis presents original, unpublished, and independent work by the author, Kyara Liu. Noethics approval was required for the completion of this research.AcknowledgementsI would like to thank Dr. Gerry Veenstra for all of his encouragement, support and insight in thisthesis, which would not have been possible without his guidance. I’d also like to thank Dr. OralRobinson for his support as the Sociology Honours Chair throughout this process. Finally, to myparents, whose experiences of immigration inspired this work. Thank you for all of your hardwork and sacrifices for me.2AbstractThe concept of the “Healthy Immigrant Effect” emerged through findings suggesting thatimmigrants are healthier than the native-born population due to a selection process favouringimmigrants of better health and higher education, but that their health diminishes over time dueto the unique challenges they encounter in their new nation of residence. The purpose of thisstudy is to identify the role of racial identity in shaping immigrant mental health in Canada. Inthis study, I implemented ordered logistic regression using a hybrid variable consisting of racialidentity and length of time since migration in order to investigate social determinants ofimmigrant mental health. The findings of my study suggest that both White and visible minorityimmigrants residing in Canada for 10 to 20 years had worse mental health than immigrants whoimmigrated less than 10 years ago, with implications varying depending on gender. Furtherresearch should look to the gendered processes shaping immigrant distress as well as the effectsof rising xenophobia as a result of the COVID-19 pandemic.3IntroductionCanada is a country built on immigration (Elamoshy & Feng, 2018). The healthy immigranteffect is a phenomenon observed in Canada where, due to their job skills and educationalqualifications, immigrants tend to have better health than non-immigrants (Constant 2018; Yang,2020). However, it has been noted that their health tends to decline over time towards, or evenbelow, the national average. Declines in immigrant’s health can begin as soon as two years afterarrival (Newbold, 2009). Similar trends have also been observed in the mental health ofimmigrants. Long-term impacts of immigration on health can be explored further as the yearssince migration increase since the large waves of immigrants arrived. Whilst this decline inhealth can be partly attributed to the result of individual lifestyle factors such as diet andsmoking behaviour, poor mental health can also cause poor lifestyle choices (Keuroghlian,Frankenburg & Zanarini, 2013). In addition, the stressors of adapting to a new culture such aslanguage barriers, limited economic resources, downward mobility, clashing cultural values andsocial isolation can contribute to declines in immigrant mental health (Lee & Hadeed, 2009). Ontop of immigration, racial identity has been identified in previous studies as an important socialdeterminant of health (Williams & Mohammed, 2013; Ramraj, Shahidi, Darity, Kawachi, Zuberi& Siddiqi, 2016). Experiences of racism, including violence, stereotyping and “culturalassumptions and practices which place non White or racialized minorities outside legitimateavenues of power and decision-making” (Fleras, 2014, pp. 123-124) can also negatively affectone’s mental health, thus indicating a need for research and interventions that focus onimmigrant visible minority groups. The goal of this thesis is to identify processes shapingimmigrant mental health in Canada, focusing on the impact of racial background on theexperiences of immigrants.4In this thesis, I will implement ordered logistic regression for my analysis of my immigrantsample from the mental health 2012 cycle of the Canadian Community Health Survey (CCHS). Iapproached this plan of analysis noting the literature surrounding the Health Immigrant Effecttheory and the stress process model (SPM). The SPM is a useful conceptual model to analyze myresearch question in explaining the health decline of immigrants noted in the healthy immigranteffect. It treats “status inequality as the starting point from which marginalized groups areexposed to greater psychosocial stressors that erode their psychosocial resources, eventuallymanifesting in greater mental health risks than those faced by more privileged groups” (Yang,2020, p. 3). I will focus my analysis on the immigrants in the CCHS sample. The sample will bestratified into two groups based on gender in order to explore differences in the associationbetween time since immigration and psychological distress. This was done as previous literatureidentifies the contrasting experiences that different intersectional identities face in the majorstressor affecting their health outcomes tied to racial identity and gender. I created a six parthybrid variable that combines racial identity and length of time since migration. The originalracial identity variable has thirteen categories, including White, Black, seven different Asianidentities, Arab, Latin American, other and mixed race. It is not included in the public use filedue to the sensitivity of the information. I will therefore focus on the binary distinction betweenWhite and visible minority status.Literature ReviewThere is a vast amount of literature exploring the topics of immigrant health and racial healthinequality. However, there is a need for more research addressing the experiences of visible5minority immigrants in particular that negatively affect their mental health. Inspired by Yang(2020), I hypothesize that mental health declines the longer immigrants reside in Canada butespecially so for visible minorities because of experiences of racism, as well as furtherexacerbations in health for female immigrants.The Healthy Immigrant EffectThe Healthy Immigrant Effect suggests that immigrants are healthier than nonimmigrants due tothe selection process in Canada for their health status, job skills and educational qualifications(Constant 2018; Premji & Shakya, 2017; Yang, 2020) and health assessment prior to migration.However, this superior level of health is seldom maintained. This is due to a range of factorssuch as poorer labour market outcomes (Creese & Wiebe, 2012; Premji & Shakya, 2017),experiences of discrimination (Noh, Kaspar & Wickrama, 2007) and barriers in health careaccess (Ahmed, Shommu, Rumana & Turin, 2016). The current literature exemplifies thedifficulties immigrants face throughout their migration and establishment in their new countrythat become pathways to poor health. Language barriers associated with accessing resources canalso have a negative effect on the health of immigrants (Clarke & Isphording, 2017). This isbecause language deficiency affects access to resources such as employment and socialintegration (Clarke & Isphording, 2017) as well as health care. It also enables individuals tomore efficiently utilize these resources for maintaining their health status (Clarke & Isphording,2017). These barriers act as a form of status inequality, noted in the stress processes model thatdeteriorate immigrant health.Conceptualizing Racism and Discrimination6Racism can be defined as a system of oppression that categorizes and ranks social groups basedon racial identity that devalues, disempowers, and differentially allocates desirable societalopportunities and resources to groups deemed as inferior (Bonilla-Silva, 1997; Williams &Mohammed, 2013). It can lead to the “development of negative attitudes (prejudice) and beliefs(stereotypes) toward nondominant, stigmatized racial groups and differential treatment(discrimination) of these groups by both individuals and social institutions (Williams &Mohammed, 2013). Racism occurs on many levels from individual to societal. On the individuallevel, racism can occur in the actions and beliefs of a person, but also in more hidden forms ofadverse racism and unconscious bias. Societal racism includes institutional and cultural racism.Culture is persistent in Canadian culture, through the portrayal of racial minorities in the mediaand other materials. This can create internal racism among racial minorities as well as thestereotype threat, defined as the “activation of negative stereotypes among stigmatized groupsthat creates expectations, anxieties, and reactions that can adversely affect social andpsychological functioning” such as the stigmas of inferiority that cause negative health processesfor racial minorities (Williams & Mohammed, 2013, p. 1163). Institutional racism occurs on agreater scale and is deeply embedded in our societal systems on the basis of white superiorityand the inferiority of visible minority identities (Phillips, 2011). Some argue that it is the mostdamaging form of racism due it’s reproduction in our policies, education, healthcare systems andmore that shape health (Hansen et al., 2018). These different sub concepts of racism can beapplied to the three aforementioned areas of immigrant distress in the labour market, healthcareaccess and social integration.The Paradox of Immigrant Labour Outcomes7Work-related stress has been shown to have an effect on health for reasons pertaining to issuessuch as job security, low levels of perceived control in work and stress from overqualification.These issues manifest more deeply in immigrant populations who have to navigate a forignlabour market lacking the cultural and social capital Canadian-born workers often take forgranted (Creese & Wiebe, 2012, Cukier, 2020). Cultural capital, which is most important toimmigrant integration into the labour market, takes form in institutionalized cultural capital, suchas academic credentials, as well as embodied cultural capital, such as accents and other localcultural competences (Creese & Wiebe, 2012). Between 1991 and 2001, it was found that 1 in 4immigrants who held a post secondary degree was employed in work that required no more thana high school education (Cukier, 2020). Globally, the majority of immigrant workers end up inthe “3D” occupations, categorized for being dirty, dangerous, and difficult, occupations thatCanadian workers will not take and leave for immigrant workers (Creese & Wiebe, 2012; Kosny,Santos & Reid, 2016). This is especially hazardous to immigrants who typically face moreoccupational health and safety risks in comparison to Canadian-born workers, perhaps due toreasons linked to lacking knowledge in “workplace rights and protections or have problemscommunicating health and safety risks or concerns'' (Smith & Mustard, 2010, p.1296).Immigrants are also regularly hired for jobs they are overqualified for, often engaging inlow-skilled, low-wage, insecure forms of ‘‘survival employment’’ due to the labour market’scommon demands for ‘‘Canadian experience,’’ ‘‘Canadian credentials,’’ and ‘‘Canadian accents’’(Creese & Wiebe, 2012). Some immigrants, despite being formally educated in English in theirhome countries, are treated as if they are incompetant at the language by others upon hearingtheir accent (Creese & Wiebe, 2012, Cukier, 2020). This results in many immigrants workingjobs far below their credentials and skill level which can lead to psychological distress (Harari,8Manapragada & Viswesvaran, 2017) and is harmful to the Canadian labour market by deskillingimmigrants, who lose access to the occupations they previously held (Creese & Wiebe, 2012).This emphasizes a problematic contradiction in Canada’s immigration policy “that recruitshighly educated newcomers and labour market practices that deny them the ability to use theirskills (Creese & Wiebe, 2012, p. 64). In addition, some resources meant to help immigrantemployment has also been found to be more harmful than helpful. Studies have found that“settlement counselors have an ‘‘overwhelming influence’’ directing foreign-trained engineersinto particular jobs with ‘‘negative or inappropriate advice’’ that made it more unlikely theycould ever recertify in British Columbia” (Creese & Wiebe, 2012, p. 59). These settlementagencies channel immigrants into low-wage work, using the discourse of ‘‘survivalemployment’’ to urge immigrants into these types of jobs that are harmful to their health (Creese& Wiebe, 2012). Overall, this thus creates a paradox in immigrant labour outcomes, where welleducated immigrants who are selected based on their skills are pushed into work that does notallow them to contribute to Canadian society in the manner in which they intended uponmigration.Racial Bias Contributing to the Deskilling Immigrants of Colour in the Labour MarketIt has become increasing clear in ethnically diverse countries in this era of ongoing immigrationthat the labour market is racialized wherein “White and Canadian-born men and women farebetter than their counterparts of colour, immigrants, and Aboriginal Canadians with equivalenteducational backgrounds and skill levels” (Creese & Wiebe, 2012, p. 58). In addition, Whiteimmigrants faring better is contributing to a racialized “economic aparthied” in the Canadianlabour market (Creese & Wiebe, 2012). In a study of African immigrants in Vancouver,participants “identified dismissal of their skills, education and experience as racialization9processes that preserved better jobs for White Canadians” (Creese & Wiebe, 2012, p. 63) such asmanufacturing because “White people don’t like [doing that work]” (Creese & Wiebe, 2012, p.63). A participant of the study also added that while she was told that her ‘‘African accent’’ whenspeaking English was the justification for limiting her job options, she is convinced that the realreason she was not promoted to a job that interacts directly with customers (one that she isoverqualified for based on her credentials) was because she is Black (Creese & Wiebe, 2012).The study also found that African men were more likely to be better educated than their femalecounterparts at the time of migration, but were more trapped in manual labour jobs as they weremore likely to be hired for them but were then unable to move up (Creese & Wiebe, 2012).Therefore, despite being more highly educated, “African men had the most to lose in theCanadian labour market” (Creese & Wiebe, 2012, p. 66). This may be due to Western perceptionsof Black men due to media portrayals that stem from a long history of cultural racism.Implications for immigrant women were also found in this study. African immigrant women,facing the intersections of immigration, racism and sexism suffer even more. In Creese andWiebe’s study, while most of the women were highly educated, they were mostly employed inlow skilled, manual work, unemployed or homemakers (2012).These structures of racism have shown to be especially harmful to immigrants of colour, whoseday to day experiences of racism in the workplace were often pushed under the table despite theefforts of anti-racism policies (Creese & Wiebe, 2012). Racism and discrimination affectimmigrant health through work in a number of ways. The larger scale systemic barriers tofinding work for visible minority immigrants often mean accepting “working conditions thatwere deleterious to mental and physical health, including ones characterized by racializeddiscrimination and harassment” (Kosny et al., 2016, p. 495). Additionally, while some report that10their experiences of “everyday” racism in the workplace are usually non-intentionally malicious,these events are still negatively associated with a number of well-being indicators over time(Kosny et al., 2016).The Gendered Experience of the Immigrant Labour MarketGender is an important factor of the immigrant experience to consider. It adds another layer ofcomplexity as immigrants navigate and negotiate their adaptation pathways according to gendernorms and expectations within their own and the host communities (Chuang & Tamis-LeMonda,2013). Gender is regarded as a social construct in references to the appropriate duties, rights andresponsibilities defined by a culture for males and females (Chuang et al., 2013; Wade & Tavris,1999). A central component of gender inequality focuses on the divides in the division ofhousehold labour, which has been noted as a way for men and women to display their traditionalgender roles (Chuang et al., 2013). In additionally, women face the additional pressures of themother and caretaker roles. An integral part of this is employment status; employment is thoughtto lead to a lesser burden of domestic labour as individuals would as a result have fewer hours todedicate to work at home (Chuang et al., 2013). Additionally, house work is also shaped byrelative resources. It is thought that domestic labour is influenced by power dynamics betweenhusbands and wives and by their comparative advantage in the labor market. As such, theindividuals with more resources such as education, earnings, and occupational prestige incomparison to their spouse can utilize these resources to “buy” themselves out of housework(Chuang et al., 2013).This creates a divide in the labour experiences between male and female immigrants. As notedpreviously, immigrants already struggle in the labour market in finding work. It is suggested that11immigrant women experience further hardships in the labour market in their struggles againstsexism (Creese & Wiebe, 2012). As a result, this can cause women to be pushed into jobs theyare overqualified for and are unfulfilled in or further into the homemaker role, despite theirexpectations to hold a position similar to that held in their home country due to their experienceand educational qualifications.Immigrant Health Care AccessibilityAs the majority of immigrants to Canada come from countries where neither English or French isspoken, a language barrier in accessing health care presents itself (Ahmed et al., 2016; Durbin,Moineddin, Lin, Steele, & Glazier, 2015). Patient-provider interactions can become difficult as aresult and affect their ability to provide more optimal care due to frustration and an inability tocommunicate effectively. Professional translators often lack clarity in their role and difficulties inconveying a patient's exact feelings, and as a result their availability is limited in health caresettings across Canada (Ahmed et al., 2016). Migration has shown to worsen one’s financialstatus, particularly in the first few years (Ahmed et al., 2016). While in theory financial statusshould not be an issue due to Canada’s universal health care system, socioeconomic status stillhas a multifaceted effect on accessing this service (Ahmed et al., 2016). Due to the unstable andinsecure working conditions immigrants often find themselves in, having the time to spend goingto receive health care is very difficult, made worse with the long wait times to see a physician(Ahmed et al., 2016, Durbin et al., 2015). Transportation to these services are also a barrier forthis group (Ahmed et al., 2016). Lack of knowledge has also been identified as a barrier toaccessing health care for immigrants. New immigrants are not given any orientation about theCanadian health care system and utilizing it or ways of finding necessary health and resources(Ahmed et al., 2016).12Discrimination: The Added Barrier to Health CareDiscriminatory practices in health care, presents itself in forms of cultural insensitivity andignorant treatment from providers has presented itself as a barrier for immigrants, withexperiences varying based on the racial/ethnic identity of the immigrant (Edge & Newbold,2013, p. 143, Durbin et al., 2015). Studies have found that ignorant treatment and frustration inrespect the religious and cultural practices and physician gender preferences are commonly seenin Asian, South Asian and practicing Muslim women (Edge & Newbold, 2013, Ahmed et al.,2016). Beyond this, Asian women and Muslim women often prefer physicians from the sameethnic background because they believe these physicians would better understand their culturaland religious norms, something that becomes more difficult due to lack of representation amongdoctors in some parts of Canada (Ahmed et al., 2016.) Racial identity and ethnicity is seen tofurther impact immigrants in health care when examining patient provider relationships.Internalized stereotypes and beliefs about certain groups of patients as pathways to producingclinically unwarranted disparities in health services, highlighting that even to well-intentionedproviders a patient’s race-ethnicity can result in unconscious social cognition processes that inturn results in racial-ethnic inequalities in health care (Shim, 2010). As a result, a physician’spersonal beliefs and biases about a patient’s racial identity can impact their behaviour towardsthe patient as well as their interpretations of health information which can have an effect on thepatient’s self management and acceptance of physician advice (Shim, 2010). This putsimmigrants, especially visible minority immigrants, at a further disadvantage in regards to theirhealth care. Characteristics like accent, English speaking ability and knowledge of Westernmedicine practices are things that impact most immigrant’s cultural health capital which in turnaffects their health status, but visible minority immigrants have the added dimension of their13racial identity and skin colour. Overall, the barriers to health care for minority newcomerpopulations can be traced to “inadequate cultural competency and respect for alternative healthvalues and practices'' (Edge & Newbold, 2013, p. 145). Studies have also found that most visibleminority groups have lower socio-economic status in comparison to their White counterparts(Williams, Priest & Anderson, 2016). As socioeconomic status was mentioned previously tohave an effect on immigrants’ ability to access health care for reasons due to work, it can besuggested that visible minority immigrants are also hit harder with the same disadvantages due totheir racial identity.Struggles in Social IntegrationBeyond this, immigrants face the struggle of social integration in society. Differing politicalideologies on immigration as well as distrust of the outsider impact immigrant acceptance (daSilva Rebelo, María José, Fernández & Achotegui, 2016). Norms of reciprocity, a foundationalaspect of generalized trust, allows individuals in society to engage in social, economic, andpolitical exchanges with the belief that others will likewise treat them with respect and honesty(Bilodeau & White, 2016). This concept promotes social interactions, and thus generalized trustis also thought to be an important part of immigrant integration. Due to views of themselves andby others of them being ‘outsiders’ who are foreign to the expectations and norms structuringsocial interactions in their new country of residence, this status has implications for their overallintegration (Bilodeau & White, 2016). While the level of trust immigrants have for Canadians isrelated to pre-migration experiences, it is suggested that post-migration experiences are moreinfluential (Bilodeau & White, 2016). It is indicated that the quality of relationship with the newcountry’s society declines with experiences of discrimination, and these negative experiencesaccumulated may be apart of the reason for the decline in trust in other Canadians as immigrants14time in Canada increases (Bilodeau & White, 2016). As a result, this limits immigrant integrationinto Canadian society which can have consequences for their health outcomes.How Racism Hurts Social IntegrationStudies have found that “most discriminatory encounters in Canada today are “subtle, elusive orsystemic relative” (Edge & Newbold, 2013, p. 143) in comparison to more traditionally overtforms like physical violence and verbal abuse. These subtle forms can include exclusion,dismissal and being treated unfairly or rudely (Edge & Newbold, 2013). Additionally, studiessuggest that even “small” everyday experiences of discrimination and insults that do not overtlythreaten physical harm, conceptualized as “microagressions,” are associated with major riskfactors to health, including increased blood pressure and cholesterol levels (Ramraj et al., 2016).A study of Korean immigrants in Canada examined overt and subtle effects of discriminations ondual dimensions of positive and depressive effects to identify mediating roles of emotionalarousal and cognitive appraisal (Noh et al., 2007). Perceived discrimination was measured on theLikert scale, emotional arousal and cognitive appraisal was measured by asking respondents torate a discriminatory experience and categorized into a number of variables describing thefeeling of the experience and positive and depressive symptoms were measured using the Centrefor Epidemiological Studies - Depression Scale (CES-D) containing 16 items of psychologicaldistress (Noh et al., 2007). Noh et al. noted that experiences of overt discrimination had a directrelationship to an erosion of positive affects, and this association appeared to be independent ofemotional or cognitive mediators; however, subtle forms of discrimination resulted in greatercomplexities of both emotional and cognitive appraisal of experiences that also producesymptoms related to distress (Noh et al., 2007). The authors attribute this correlation to the factthat “minority immigrants may question whether they are fully accepted members of society and15its social networks, or whether they are unfairly treated at individual and structural levels” (Nohet al., 2007, p. 1272).MethodsSampleThe Canadian Community Health Survey - Mental Health 2012 (CCHS-MH) dataset collectedby Statistics Canada was used in this study. The CCHS-MH used a multistage stratified clusterprobability sampling to Canadians 15 and older in all provinces and territories. This survey isrepresentative of the population up to 97%, excluding people in military service, Aboriginalsliving on reserves and people who are institutionalized who made up less than 3% of the targetpopulation. The sample in this investigation was reduced to n=3191 by only investigating thosewho were age 25 and older. This was decided as the 2 of the major components investigated arework and health care access, which can be examined more accurately for this age group. Thesample is examined separately by male and female gender. In this study, gender is regarded as asocially constructed concept, referring to the behaviours a culture considers appropriate formales and females and differing from sex as a biological distinction.MeasuresFocal dependent variables. Mental health is operationalized as overall mental wellbeingexamined with two variables. Psychological distress is the first dependent variable, measured bythe Kessler K10 Distress scale consisting of a 10-item questionnaire intended to produce ameasure of distress. It is based on questions about anxiety and depressive symptoms that aperson has experienced in the most recent 4 week period wherein higher scores indicate higher16levels of distress from the respondent (Yang, 2020). Scores ranged from 0 to 40 and were codedinto three groups from 1 to 3 for this study. These three groups were rescaled, with responses 1, 2and 3 coded as 1 indicating low levels of distress, responses 4-13 as 2 indicating medium levelsof distress and responses 14 and higher as 3 indicating high levels of distress. This breakdownwas done in order to establish 3 distinct groups that will be meaningfully large enough foranalysis. The next focal dependent variable is positive mental health. This variable was measuredusing Keyes’ 14 item scale that examined three dimensions of positive mental health: emotional,psychological and social well being (Yang, 2020). This scale is scored from 0 to 70 and wasreverse coded into three groups from 3 to 1 so that overall higher scores reflected more positivemental health. This variable was also rescaled so that responses 0-50 were coded as 3 indicatinglowest levels of positive mental health, responses 51-64 were coded as 2 and responses 65 andover were coded as 1 to indicate highest levels of positive mental health. These two variableswere chosen to operationalize mental health in two dimensions: mental distress and mentalwellbeing.Focal independent variables. Racial identity was used as one of the focal independentvariables. It was broken down into a dichotomous variable as visible minority and White. Aspreviously mentioned, a more specific examination of the racial identity variable was notinvestigated due to the limitations of the public use dataset. In this study, racial identity is not areified category of biological difference, but instead a social construct due to the problematicnature of the term that has fueled racism (Fernando, 2017). It is used to “capture the experienceof race relations rooted in broader structures of racial oppression and domination” (Ramraj et al.,2016, p. 20). In addition, time spent in Canada was investigated as an independent variable as itis thought that the adverse effects of racism and discrimination takes years to manifest. These17two variables were combined together as a six-part variable indicating racial identity and lengthof time since migration. White immigrants who migrated less than 10 years ago were set as thereference for both men and women. This was done in reference to the Healthy Immigrant Effect,which positions recent immigrants at the best state of health in comparison to more establishedimmigrants.Control variables. Due to previous literature highlighting the importance of demographic andsocioeconomic factors, a variety of such factors were incorporated in analysis. These weregender, age, household size, marital status, household income, language spoken at home,education, current employment status, full-time/part-time employment status, chronic conditions,smoking and alcohol consumption. Gender was dummy coded as male (reference) and female.Household size was coded as one-person household (reference), two persons, and three or more.Household income was coded into 5 values as no income or less than $20,000, $20,000 to$39,999, $40,000 to $59,999, $60,000 to $79,999, and over $80,000 (reference). Marital statuswas coded as single, married or common-law (reference) and divorced, separated, or widowed.Education was coded as less than high school, high school and post secondary degree(reference). Employment status was recoded as employee (reference) and self employed.Full-time versus part-time employment status was coded as full time (reference), part time andnot applicable. Language spoken at home was coded as not English or French and either English,French and/or another foreign language (reference). Presence of a chronic condition was codedas yes or no (reference). Smoking was coded as nonsmokers (reference), former smokers,occasional smokers, daily smokers and alcohol consumption was coded as nondrinkers(reference), occasional drinkers and daily drinkers.18Plan of AnalysisI used ordered logistic regression to implement my investigation. I created a 6-part hybridvariabel to combine categories of racial identity and length of time since migration. Table 1describes the socio-demographic characteristics of the immigrant sample of the CCHS-MHseparately by gender. Table 2 provides the ordered logistic regression of the variables. Model 1describing the racial identity and length of time since migration variable and psychologicaldistress (K10) variable controlling for age (as it was found to have a heavy influence), Model 2controls for other demographic characteristics, Model 3 investigating the key variables withdemographic and socioeconomic characteristics and Model 4 examining the key variables withdemographic, socioeconomic characteristics and health factors. Table 3 depicts the samesequence of models as previously mentioned, but with the female sample. Table 4 repeats thesame model with positive mental health (Keyes) as the dependent variable instead on the malesample. Positive mental health was reverse coded so that higher scores reflected lower positivemental health to be more comparable to the psychological distress variable. Table 5 proceedswith the same process as Table 4 with the female sample. Regressions with the ‘visible minorityand recent’ category as the reference was also set for each table and model. This was done so inorder to compare the declines in mental health within each racial identity group to then afterexamine the outcomes between groups.19ResultsDescriptive StatisticsTable 1 describes socio-demographic characteristics of the immigrant sample, separately bygender. A few key things should be noted from this Table. First, due to the historical context ofCanadian immigration, proportionately more White immigrants have resided in Canada for over20 years. Furthermore, proportionately more White immigrants are in the older age groups thanvisible minority immigrants, again for reasons tied to the historical context of Canadianimmigration. A few gender differences stand out. Many more men (58%) and fewer women(37%) indicated engaging in full time work (Table 1). Additionally, more men reported smokingbehaviours in comparison to women.Racial Identity and Length of Time Since Migration: Psychological DistressIn Table 2, none of the comparisons between “White and not recent” and the other Whiteimmigrant categories were statistically significant though across categories, White daily recentimmigrants were more likely to report higher psychological distress across all models.  When“visible minority and not recent” was set as the reference, significance emerged in Model 3 aftersocioeconomic factors were controlled for in that visible minority fairly recent immigrants weremore likely to report higher psychological distress than their reference (OR = 1.74, CI = 1.00 -3.01). Significance was lost when health factors were controlled for in Model 4.Table 3 examines female psychological distress and racial identity/length of time sinceimmigration. When “White and recent immigrants” were set as the reference, no statisticallysignificant results emerged, nor were any major differences between length of time categoriesobserved among White immigrants. When visible minority recent immigrants were set as the20reference, similar to the last model no statistically significant results emerged, nor were anymajor differences between length of time categories observed among visible minority groups.Racial identity and Length of Time Since Migration: Positive Mental HealthIn Table 4 regresses lower reported positive mental health with racial identity/length of time formale immigrants. This variable was reverse coded so that higher scores reflected lower levels ofpositive mental health and lower scores reflected higher levels of positive mental health in orderto be more easily compared to the previously mentioned psychological distress variable. In thefirst row of the table setting White and recent immigrants as the reference, no significantassociations were observed within the other White categories. When the reference category wasshifted in the second row to visible minority and recent immigrants, fairly recent visible minorityimmigrants were found to be more likely to report worse mental health than recent visibleminority immigrants when only controlling for age (OR = 1.71, CI = 1.04 - 2.79). Significancehowever disappears in Model 2 when controlling for other demographic characteristics andreappears when adding on controls for socioeconomic characteristics (OR = 1.68, CI = 1.00 -2.79). Significance disappears when controlled for health characteristics.Table 5 examines the relationship between lower positive mental health with the hybrid racialidentity/length of time since immigration for female respondents. Again, this variable wasreverse coded so that higher scores reflected lower levels of positive mental health and lowerscores reflected higher levels of positive mental health in order to be more easily compared to thepreviously mentioned psychological distress variable. When White and recent immigrants wereset as the reference, Model 1 controlling for just age did not yield any significant associations.However, in Model 2 when adding on other demographic controls, White and fairly recent21immigrants were found to be significantly more likely to report worse mental health than thereference group (OR = 2.40, CI = 1.09 - 5.26). Significance persisted in that White and fairlyrecent immigrants were found to be significantly more likely to report worse mental health thanthe reference group when controlling for socioeconomic characteristics (OR = 2.55, CI = 1.17 -5.54) and health factors (OR = 2.62, CI = 1.17 - 5.88). When visible minority and recentimmigrants were set as the reference in order to compare visible minority mental health acrosscategories, no significant associations between the categories were found across all models.DiscussionThe existing literature emphasizes barriers in the labour market, accessibility to health care andsocial integration as important factors in shaping immigrant mental health outcomes, as well asthe fact that experiences of racism and discrimination have an deteriorating outcome onimmigrant health (Berger & Sarnyai, 2015). In my findings, White immigrants who have been inCanada over 10 years stood out right away as being more likely to report worse mental health incomparison to recent White or visible minority immigrants. When recent visible minorityimmigrants were set as the reference, declines in mental health were also noted in visibleminority fairly recent immigrants reporting worse mental health, however appearing to be lessdrastic than seen in White immigrants.Expectations and the Patriarchy declining White identifying Immigrants’ Mental healthThere is a significant finding in this sample that among White fairly recent female immigrants’mental health was worse than recent White immigrants (when mental health was measured with22the Keyes Positive Mental Health scale). There are a few possible explanations for this. Whiteimmigrants may come to Canada with higher expectations for what their experiences will be like,such as obtaining a job of similar occupational status as they previously held in their homecountry. However, after 10 to 20 years, their actual experiences violate their expectations and thedecline in positive images can lead to life dissatisfaction and subsequently, poorer mental health(Baran et al., 2018). Labour market outcomes could be a contributor to this. As seen in previousliterature, immigrants are often hired for jobs they are overqualified for, often engaging inlow-skilled, low-wage, insecure forms of ‘‘survival employment’’ (Creese & Wiebe, 2012). Thisfinding that immigrant females reporting worse mental health can also be linked to thepatriarchy. Immigrant women as seen in Creese and Wiebe (2012) found that women are evenmore disadvantaged in the labour market, which similarly to men, lead to doing overqualifiedwork for their educational qualifications. On top of that, this may further push women intodomestic labour or additionally add on stress in perhaps putting in more paid labour hours thenexpected along with the stress of the same amount of unpaid domestic labour (Khoudja, 2018).The Racial Paradox in Mental HealthDeclines in mental health were also observed in visible minority immigrants, though less drasticthan the White immigrants in this study. A concept known as the racial mental health paradoxcould be a potential explanatory factor. Emerging from research examining Black-White mentalhealth outcomes, studies have found similar or better mental health outcomes among Blacks thanWhites (Mouzon, 2013). As such, this may provide some explanation for the mental health ofvisible minority immigrants in this sample. Family relationships have been found to be protectiveof mental health. Previous studies have shown that family members are a critical part ofwellbeing in Chinese, Korean and Indian immigrants in the United States (Cobb et al., 2019). In23a study examining aging in racial minority communities, authors found that social support gainedfrom close relationships may reduce stress in everyday life, help maintain positive interpersonalattachments and promote healthy behaviours. In cross tab examinations of the sample (not shownin the paper), more White immigrants live in smaller households, while visible minorityimmigrants are more likely to have more than three members in their household as seen in Table1.In comparison, visible minority immigrants may come to the country with less expectations forthemselves in comparison to their White immigrant counterparts, and perceive their migration asa necessary sacrifice for their family and especially their children (Guo, 2013). This cancontribute to a more content life in comparison to White immigrants. Cultures especially rootedin collectivism, seen in East Asian countries for example, are reflective of this  (Cobb et al.,2019). In addition, female visible minority immigrants may be less affected by labour marketstressors by choosing to stay home, such as in the case of Chinese immigrants, who see it as away of self sacrifice for their family as well as valuing traditional gender norms (Yu, 2015).Labour Market Burdens on Visible Minority MenSocioeconomic controls strengthened the association for higher psychological distress for visibleminority immigrant men. While cultural ideologies in visible minority women may allow morecognitive ease in conforming to ‘traditional gender roles,’ these ideals may produce morepressure on minority immigrant men (Yu, 2015). Visible minority immigrant men may facelayers of deeply rooted traditional masculinity that intersects with their racial and culturalidentity, especially cultures that place high emphasis on traditional “masculine” ideals of strengthand breadwinning (Harris, 2018), thus contributing to the strengthening of the declines in mental24health when controlled for socioeconomic characteristics (Table 2, Model 3). As previouslymentioned, visible minority immigrants in particular face an array of challenges in the labourmarket, and often end up in low wage, deskilling work (Creese & Wiebe, 2012; Kosny et al.,2016). Given men’s traditional role as primary providers, family responsibilities, theunwelcoming atmosphere of the Canadian labour market to immigrants (especially minorities)can cause difficulties in providing and supporting family, in addition to feelings of inadequacy infulfilling their internalized gender role, thus contributing to mental health declines (Artazcoz,Benach, Borrell & Cortes, 2004).Cultural Perceptions of Mental HealthIt is important to note that the cultural context of mental health in Western cultures incomparison to others. Studies have found that mental health and illness is deeply stigmatized inmany Asian countries, such as China (Seeman et al., 2016). As a result, when completing thissurvey set, visible minority immigrants may be more reluctant in reporting poor mental healthdue to reasons of unawareness, or even shame. Especially with visible minority immigrant menwho face ‘masiculine ideals’ in conjunction with cultural stigma, may have led to underreporting of poor mental health. As such, the differences in the K10 psychological distress scaleand the Keyes positive mental health scale may have contributed to the findings for eachvariable. While K10 aims to determine the psychological distress caused by mental healthdisorders, the Keyes scales look more closely at mental well being. Clearer disparities in mentalhealth are noted with the positive mental health variable, possible due to these differences incultural perceptions about mental health.25Fundamentally, mental health is a concept that is difficult to operationalize and measure. Thedifferences observed in the Kessler K10 verses the Keyes scale is a reflection of this. Due to thesubjectivity of psychological distress and positive mental health in addition to the outcomes ofmultiple intersections such as culture and gender, careful consideration should be given.Gendered Language Divides in Female and Male ImmigrantsWhite women’s mental health worsened after controlling for demographic characteristics (Table5, Model 2). This finding may exemplify how language barriers manifest in mental healthoutcomes differently for men and women. The literature points to the damaging impacts ofpatriarchal systems on the mental health of immigrant women. As previously mentioned, despitebeing highly educated, immigrants often end up in overqualified and deskilling work, especiallywomen who face the intersections of their immigrant identity navigating through patriarchalinstitutions (Creese & Wiebe, 2012). As a result, many immigrant women may end upunemployed or spending time at home doing domestic unpaid labour, thus contributing to theirmental health outcomes in a few ways. Unemployment has been found to lead to poor mentaland physical health due to decrease in income, loss of status and self-esteem, unhealthybehaviours and coping strategies (Premji & Shakya, 2017). Underemployment has also beenlinked to worse overall health and chronic diseases (Premji & Shakya, 2017). This as a result cansocially isolate immigrant women and also prevents them from strengthening their English orFrench proficiency through the interactions outside their household used as a learning resource(Anisef, 2012). Meanwhile, their male counterparts who participate more actively in theworkforce, are able to raise their English or French proficiency in the workplace and the socialcircles they may cultivate, while still speaking their native non English or French language athome with their family. This manifests implications for immigrant womens’ mental health in a26few ways highlighted in the literature. The language barrier prevents women from integratinginto Canadian society and their communities that can cause further isolation. It also furtherstrains their ability to enter the Canadian labour market and creates more difficulties in accessinghealth resources (Creese and Wiebe, 2012; Noh et al., 2007; Clarke & Isphording, 2017).Historical-Political Context and Economic RecessionWhen interpreting the mental health outcomes of these immigrants, it is important to consider thehistorical political contexts shaping trends of immigration at the time these White immigrantsarrived in Canada. Literature has suggested the implications of mental well being for warrefugees due to PTSD and other mental disorders (Hynie, 2018). As such, tracing back the years,if this survey was collected in 2012, the immigrants who reported their time in Canada as morethan 10 to less than 20 years would have immigrated during the period of 2002 to 1992. Duringthis time period, about 20% of White identifying immigrants were Eastern European looking atimmigration trends (Statistics Canada, 2017). As a result, a number of these immigrants weremigrating after the collapse of the Soviet Union and other Easter Bloc countries.Conclusion, Limitations and Further ResearchImmigrating to Canada is a stressful and difficult experience, with immigrants facing numerouschallenges in the labour market, accessing health care and social integration that can be harmfulto their mental health outcomes. Overall, the findings for all immigrants are consistent with thehealthy immigrant effect, where immigrant health deteriorates over time. In relation to the stressprocess model that predicted worse mental health in visible minority immigrants due to the27exposure to racism as a psychological stressor that erodes health and psychosocial resources, wasalso found for visible minority immigrants, who reported to have slightly worse mental healththan White immigrants in some cases (though these results were not statistically significant andshould therefore not be regarded as concrete). Cultural background and values can be bothprotective and harmful to the mental health outcomes of immigrants in Canada. Whiteimmigrants who have lived in Canada for 10 years in particular, reported the worst levels ofmental health in comparison to their recent White counterparts. This may be explained by thebuilt up exhaustion of challenges in the labour market that deskills qualified immigrants, as wellas the potential higher expectations and disappointing actual outcomes for this group. Thisdataset may have been obscuring the results of visible minority immigrant experiences, whosecultural beliefs and perceptions about mental health differ from Western perspectives which mayresult in inaccurate self reporting and the contrasts in the results in this study from existingliterature.In reference again to the stress processes model and healthy immigrant effect, immigrant mentalhealth would erode as time passes. As this data set was compiled in 2012, at this time, themajority of White immigrants have been established for over 20 years while the majority ofvisible minority immigrants landed less than 20 years ago. According to previously establishedknowledge, experiences of racism and discrimination take time to manifest and impact healthand mental health. Further research should focus on more recently collected data as the years thiswave of visible minority immigrants’ time in Canada has increased and a better examination oftheir health in relation to racism can be explored.Furthermore, this study also highlights the problematic nature of dichotomizing the racialidentity variable. Homogenizing ‘visible minorities’ as a group dismisses the diversity of28cultures and backgrounds and most importantly, the varying levels of racial injustice experienceddue to one’s racial identity. The dichotomization of this variable can result in obscuring data.However, it does illuminate the experiences of White immigrants and identifies areas of need forthis group. 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Journal of Familyand Economic Issues, 36(1), 34-47. doi.org/10.1007/s10834-014-9417-036Table 1 - Socio-demographic characteristics of unweighted sample (n = 3751)Menn (%)Womenn (%)Kessler Psychological Distress1 (lowest)23 (highest)Missing796 (46.28)784 (45.58)116 (6.74)24 (1.40)895 (44.07)959 (47.22)149 (7.34)28 (1.38)Keyes Positive Mental Health1 (highest)23 (lowest)Missing615 (35.76)785 (45.64)122 (7.09)198 (11.51)724 (35.65)899 (44.26)122 (6.01)286 (14.08)Racial IdentityWhiteVisible MinorityMissing816 (47.44)895 (52.03)9 (0.52)1010 (49.80)10.18 (50.12)3 (0.15)Time in Canada0 to 9 years10 or more yearsOver 20 yearsMissing406 (23.60)265 (15.41)1045 (60.76)4 (0.23)469 (23.09)327 (16.10)1231 (60.61)4 (0.20)Racial Identity & Time in CanadaWhite and Recent (0 - 9 years) 97 (5.64) 93 (4.58)37White and Fairly Recent (10 or more years)White and Not Recent (Over 20 years)Visible Minority and Recent (0 - 9 years)Visible Minority and Fairly Recent (10 or more years)Visible Minority and Not Recent (Over 20 years)Missing70 (4.07)648 (37.67)307 (17.85)195 (11.34)390 (22.67)13 (0.76)83 (4.10)833 (41.01)376 (18.51)244 (12.01)395 (19.45)7 (0.34)Age25 to 29 years30 to 34 years35 to 39 years40 to 44 years45 to 49 years50 to 54 years55 to 59 years60 to 64 years65 to 69 years70 to 75 years75 to 79 years80 and olderMissing128 (7.44)155 (9.01)186 (10.81)217 (12.62)138 (8.02)119 (6.92)131 (7.62)146 (8.49)164 (9.53)128 (7.44)89 (5.17)119 (6.92)0141 ( 6.94)211 (10.39)194 (9.55)169 (8.32)173 (8.52)134 (6.60)167 (8.22)202 (9.95)163 (8.03)148 (7.29)133 (6.55)196 (9.65)0Household SizeOne personTwo personsThree or more personsMissing499 (29.01)630 (36.63)591 (34.36)0657 (32.35)699 (34.42)675 (33.23)0Language Spoken at HomeEnglish/French and/or another languageNot English or FrenchMissing1272 (73.95)442 (25.70)6 (0.35)1470 (72.38)549 (27.03)12 (0.59)38Marital StatusSingleMarried/common lawDivorce/separated/widowedMissing288 (16.74)1175 (68.31)252 (14.65)5 (0.29)212 (10.44)1187 (58.44)626 (30.82)6 (0.30)EducationLess than high schoolHigh schoolPost secondaryMissing246 (14.30)188 (10.93)1282 (74.53)4 (0.23)340 (16.74)272 (13.39)1408 (69.33)11 (0.54)Household IncomeNo income or less than $20,000$20,000 to $39,999$40,000 to $59,999$60,000 to $79,999$80,000 or moreMissing84 (4.88)276 (16.05)421 (24.48)306 (17.79)633 (36.80)0168 (8.27)474 (23.34)443 (21.81)350 (17.23)595 (29.301 (0.05)Employment StatusEmployeeSelf employedOtherMissing829 (48.20)268 (15.58)623 (36.22)0812 (39.98)153 (7.53)1062 (52.29)4 (0.40)Work StatusFull time workPart time workNot applicableMissing997 (57.97)93 (5.41)623 (36.22)7 (0.41)751 (36.98)215 (10.59)1062 (52.29)3 (0.15)39Chronic ConditionYesNoMissing971 (56.45)745 (43.31)4 (0.23)1271 (62.58)760 (37.42)0Smoking BehaviourNon smokerFormer smokerOccasional smokerDaily smokerMissing586 (34.07)782 (45.47)90 (5.23)260 (15.12)2 (0.12)1271 (62.58)570 (28.06)65 (3.20)123 (6.06)2 (0.10)Drinking BehaviourNon drinkerOccasional drinkerDaily drinkerMissing418 (24.30)1143 (66.45)156 (9.07)3 (0.17)820 (40.37)1122 (55.24)88 (4.33)1 (0.05)40Table 2 - Ordered Logistic Regression ofRacial Identity and Length of Time Since Migration on Psychological Distress (with 95%Confidence Intervals for Odds Ratios Weighted; n = 1486 ) - MENModel 1OR (95% CI)Model 2OR (95% CI)Model 3OR (95% CI)Model 4OR (95% CI)Racial Identity andLength of Time SinceMigrationVisible minority andrecentVisible minority andfairly recentVisible minority and notrecentWhite and not recentWhite and fairly recentWhite and recent(reference)1.039 (0.548 - 1.969)1.501 (0.747 - 3.017)1.397 (0.722 - 2.704)1.237 (0.605 - 2.531)2.100 (0.949 - 4.647)1.0001.084 (0.585 - 2.010)1.605 (0.806 - 3.217)1.264 (0.667 - 2.395)1.001 (0.500 - 2.003)1.873 (0.852 - 4.114)1.0001.008 (0.511 - 1.988)1.752 (0.511 - 1.988)1.753 (0.816 - 3.764)1.417 (0.697 - 2.876)1.949 (0.850 - 4.467)1.0001.141 (0.575 - 2.267)1.484 (0.743 - 2.962)1.853 (0.873 - 3.930)1.199 (0.575 - 2.267)2.001 (0.915 - 4.377)1.000Racial Identity andLength of Time SinceMigrationWhite and recentWhite and fairly recent0.963 (0.508 - 1.825)2.022 (1.071 - 3.821) *0.922 (0.503 - 1.956)1.933 (0.991 - 3.771)0.992 (0.503 - 1.956)1.933 (0.991 - 3.771) *0.876 (0.441 - 1.740)1.753 (0.906 - 3.394)41White and not recentVisible minority and notrecentVisible minority andfairly recentVisible minority andrecent1.191 (0.694 - 2.043)1.345 (0.843 - 2.146)1.445 (0.861 - 2.424)1.0001.166 (0.722 - 1.882)1.405 (0.855 - 2.309)1.739 (0.855 - 2.310)1.0001.213 (0.683 - 2.154)1.405 (0.855 - 2.309)1.739 (1.004 - 3.013) *1.0001.051 (0.577 - 1.914)1.300 (0.927 - 2.844)1.623 (0.927 - 2.844)1.000p < 0.05 = *, p < 0.01 = **, p < 0.001 = ***Model 1 regresses the dependent variable psychological distress with the focal independent variable racial identity with time sincemigration controlling for age. Model 2 controls for demographic characteristics, Model 3 adds on socioeconomic factors and Model 4adds on health factors.42Table 3 - Ordered Logistic Regression of Racial Identity and Length of Time Since Migration on Psychological Distress (with 95%Confidence Intervals for Odds Ratios Weighted; n = 1,705) - WOMENModel 1OR (95% CI)Model 2OR (95% CI)Model 3OR (95% CI)Model 4OR (95% CI)Racial Identity andLength of Time SinceMigrationVisible minority andrecentVisible minority andfairly recentVisible minority and notrecentWhite and not recentWhite and fairly recentWhite and recent(reference)0.832 (0.470 - 1.473)0.877 (0.469 - 1.642)1.003 (0.543 - 1.851)1.500 (0.833 - 2.703)1.725 (0.829 - 3.588)1.0000.829 (0.461 - 1.489)0.892 (0.467 - 1.704)1.065 (0.566 - 2.005)1.759 (0.923 - 3.349)1.861 (0.884 - 3.917)1.0000.802 (0.442 - 1.454)0.888 (0.460 - 1.715)1.135 (0.596 - 2.163)1.967 (1.018 - 3.798)1.814 (0.854 - 3.856)1.0001.159 (0.595 - 2.255)1.197 (0.584 - 2.454)1.355 (0.672 - 2.730)1.801 (0.823 - 3.941)1.948 (0.964 - 3.935)1.000Racial Identity andLength of Time SinceMigrationWhite and recentWhite and fairly recent1.201 (0.679 - 2.126)2.072 (1.083 - 3.964) *1.207 (0.672 - 2.168)2.245 (1.173 - 4.296) **1.247 (0.688 - 2.262)2.263 (1.191 - 4.300) **0.863 (0.443 - 1.680)1.555 (0.812 - 2.976)43White and not recentVisible minority and notrecentVisible minority andfairly recentVisible minority andrecent (reference)1.802 (1.116 - 2.910) **1.205 (0.725 - 2.001)1.054 (0.627 - 1.772)1.0002.122 (1.262 - 3.568) **1.285 (0.771 - 2.143)1.077 (0.643 - 1.802)1.0002.453 (1.456 - 4.133) ***1.416 (0.852 - 2.352)1.108 (0.664 -- 1.850)1.0001.682 (0.976 - 2.897)1.169 (0.713 - 1.918)1.033 (0.624 - 1.710)1.000p < 0.05 = *, p < 0.01 = **, p < 0.001 = ***Model 1 regresses the dependent variable psychological distress with the focal independent variable racial identity with time sincemigration controlling for age. Model 2 controls for demographic characteristics, Model 3 adds on socioeconomic factors and Model 4adds on health factors.44Table 4 - Ordered Logistic Regression of Racial Identity and Length of Time Since Migration on Positive Mental Health (with 95%Confidence Intervals for Odds Ratios Weighted; n = 1486) - MENModel 1OR (95% CI)Model 2OR (95% CI)Model 3OR (95% CI)Model 4OR (95% CI)Racial Identity andLength of Time SinceMigrationVisible minority andrecentVisible minority andfairly recentVisible minority and notrecentWhite and not recentWhite and fairly recentWhite and recent(reference)0.575 (0.296 - 1.906)0.981 (0.505 - 1.906)0.850 (0.445 - 1.624)0.629 (0.308 -1.286)2.020 (0.848 - 4.809)1.0000.543 (0.270 - 1.093)0.858 (0.421 - 1.743)0.758 (0.381 - 1.508)0.758 (0.371 - 1.508)2.000 (0.820 - 4.877)1.0000.542 (0.267 - 1.103)0.911 (0.445 -1.869)0.794 (0.394 - 1.601)0.643 (0.309 - 1.335)2.007 (0.812 - 4.956)1.0000.594 (0.278 - 1.283)0.968 (0.446 - 2.101)0.822 (0.386 - 1.750)0.595 (0.270 - 1.308)1.874 (0.753 - 4.659)1.000Racial Identity andLength of Time SinceMigrationWhite and recentWhite and fairly recent1.738 (0.893 - 3.379)3.510 (1.636 - 7.527) ***1.840 (0.915 - 3.700)3.680 (1.683 - 8.048) ***1.842 (0.907 - 3.743)3.696 (1.663 - 8.216) ***1.684 (0.780 - 3.639)3.155 (1.463 - 6.808) **45White and not recentVisible minority and notrecentVisible minority andfairly recentVisible minority andrecent (reference)1.093 (0.622 - 1.923)1.476 (0.918 - 2.374)1.705 (1.043 - 2.788)*1.0001.083 (0.605 - 1.938)1.395 (0.851 - 2.287)1.578 (0.851 - 2.287)1.0001.184 (0.659 - 2.125)1.463 (0.863 - 2.479)1.679 (1.001 - 2.791) *1.0001.001 (0.544 - 1.845)1.385 (0.811 - 2.365)1.631 (0.969 - 2.744)1.000p < 0.05 = *, p < 0.01 = **, p < 0.001 = ***Model 1 regresses the dependent variable psychological distress with the focal independent variable racial identity with time sincemigration controlling for age. Model 2 controls for demographic characteristics, Model 3 adds on socioeconomic factors and Model 4adds on health factors.46Table 5 - Ordered Logistic Regression of Racial Identity and Length of Time Since Migration on Positive Mental Health (with 95%Confidence Intervals for Odds Ratios Weighted; n = 1,705) - WOMENModel 1OR (95% CI)Model 2OR (95% CI)Model 3OR (95% CI)Model 4OR (95% CI)Racial Identity andLength of Time SinceMigrationVisible minority andrecentVisible minority andfairly recentVisible minority and notrecentWhite and fairly recentWhite and not recentWhite and recent(reference)0.722 (0.416 - 1.254)0.874 (0.462 - 1.654)0.711 (0.385 -1.309)1.873 (0.930 - 3.774)1.108 (0.607 - 2.025)1.0000.813 (0.461 - 1.425)1.086 (0.574 - 2.053)0.918 (0.493 - 1.707)2.397 (1.092 - 5.262) *1.517 (0.801 - 2.874)1.0000.784 (0.450 - 1.367)1.116 (0.598 - 2.084)1.003 (0.543 - 1.853)2.549 (1.172 - 5.544) *1.636 (0.867 - 3.088)1.0001.053 (0.568 - 1.952)1.466 (0.754 - 2.853)1.198 (0.613 - 2.342)2.617 (1.165 - 5.879) *1.646 (0.840 - 3.226)1.000Racial Identity andLength of Time SinceMigrationWhite and recentWhite and fairly recent1.385 (0.798 - 2.405)2.594 (0.798 - 2.405) **1.230 (0.697 - 2.171)2.949 (1.467 - 5.927) **1.275 (0.731 -2.224)3.250 (1.625 -1.149) ***0.949 (0.512 - 1.759)2.485 (1.214 - 5.088) **47White and not recentVisible minority and notrecentVisible minority andfairly recentVisible minority andrecent (reference)1.536 (0.936 - 2.520)0.984 (0.595 - 1.627)1.210 (0.706 - 2.076)1.0001.866 (1.090 - 3.197) **1.129 (0.685 - 1.860)1.336 (0.789 - 2.261)1.0002.087 (1.214 - 3.587) **1.279 (0.776 - 2.107)1.424 (0.845 - 2.400)1.0001.563 (0.899 - 2.718)1.138 (0.828 -2.340)1.392 (0.828 - 2.340)1.000p < 0.05 = *, p < 0.01 = **, p < 0.001 = ***Model 1 regresses the dependent variable psychological distress with the focal independent variable racial identity with time sincemigration controlling for age. Model 2 controls for demographic characteristics, Model 3 adds on socioeconomic factors and Model 4adds on health factors.48


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