Household, Neighbourhood, and Community Contexts and the Mental Health of Immigrants and Immigrant Mothers: An Ecological Perspective

Abstract

Abstract There is growing recognition in the public health field that the determinants of mental health extend beyond biological aspects to include one’s living environment and social context. Research from an ecological perspective has emphasized the importance of contextual factors across multiple levels, such as households and neighbourhoods, in determining mental health. In addition, social positions such as immigrant status, being a woman, and motherhood shape exposure to different contexts and influence mental health outcomes. This dissertation investigates how household, neighbourhood, and community-level factors influence the mental health of immigrants as well as immigrant, racialized and ethnic minority mothers in Canada. In the empirical chapters of this dissertation, Statistics Canada’s survey data were analysed to examine the associations between contextual factors at multiple levels and mental health. First, the Canadian Community Health Survey 2015/16 and the Canadian Index of Multiple Deprivation (CIMD) were used to investigate the association between factors in the household, neighbourhood, and community contexts and the mental health of immigrants in Canada. Second, the General Social Survey 2016, 2017, and 2018 were used to explore how family structure, dwelling characteristics, and household contextual factors relate to the mental health of immigrant and Canadian-born mothers. The final study is a scoping review of the literature from Canada and the United States, focusing on identifying risk and protective factors within the neighbourhood and community contexts affecting the mental health of immigrant and racialized and ethnic minority mothers. Evidence emerged for some factors that can be considered risks and others that are protective of mental health across contextual levels. At the household level, socioeconomic disadvantage in the form of low income adequacy and low household income was related to poor mental health among immigrants and Canadian-born mothers. Being a single versus a partnered mother was also associated with poor mental health outcomes. Factors related to children, such as the age and number of children at home, were not associated with mental health outcomes. At the neighbourhood and community level, negative factors included a weak sense of belonging to the local community and living in an area with higher ethnocultural concentration, reflecting marginalization as measured in the CIMD. Negative factors also included a high proportion of dwellings in need of repair and lower education levels, captured using the situational vulnerability dimension in the CIMD. Findings from the scoping review suggested that deteriorated physical conditions and violence within neighbourhoods negatively impact mental health. On the other hand, a larger household size was associated with lower odds of having a mental health condition and was protective for both immigrant and Canadian-born mothers. While the empirical studies did not directly assess the role of social support and community programming, findings from the scoping review suggest that mental health outcomes are shaped by these factors. Community-based programs related to social and mental health services may help mitigate the effects of socioeconomic disadvantage and foster social inclusion. Social support from friends and family was also found to mitigate the relationship between poor neighbourhood environments and depression among racialized mothers. The findings from all three studies could be used to inform strategies for mental health equity at the community and neighbourhood levels in Canada. This includes interventions at the community level with tailored supports for diverse and larger families to promote the mental well-being of immigrant and racialized populations. In addition, affordable childcare and housing supports for single and low-income mothers could also be beneficial for protecting mental health.