Although religion/spirituality has been shown to play a potential role in the treatment of mental health problems, there is a growing body of evidence suggesting that it may be mis-conceptualized as a substitute for mental health and substance use treatment among those who are religious/spiritual. Therefore, this study aims to: 1) examine the association between religiousness/spirituality and perceived need for care, and, 2) determine whether there is an inverse relationship between religion/spirituality and treatment-seeking behaviour, among a distressed Canadian population.

Cross-sectional data from a subsample of 2307 distressed Canadians in the nationally representative 2022 Mental Health and Access to Care Survey was analyzed. Modified Poisson regression analysis was conducted, with perceived need for care and treatment-seeking behaviour (formal and informal) as the outcomes and religiousness/spirituality as the exposure. Effect modification by minority and immigrant status was examined, and associations were adjusted for age, gender, education, and income.

Perceived need for care and treatment-seeking behaviour was lower among distressed individuals who were religious/spiritual compared to non-religious/non-spiritual individuals (p < 0.05). The likelihood of a perceived need for care and formal treatment-seeking behaviour was lowest among visible minorities (non-White) and non-immigrants, who were religious/spiritual compared to non-religious/non-spiritual counterparts. When stratifying by immigrant status, informal treatment-seeking behaviour was higher among immigrants who are religious/spiritual than among those who are non-religious/non-spiritual.

Differences in the relationship between religiousness/spirituality and help-seeking among visible minorities and immigrants suggest that integration of religion/spirituality into de-stigmatizing treatment approaches may be warranted to better support at-risk individuals.

Racialized immigrants have low rates of accessing mental healthcare services. However, there are notable differences among immigrant groups (e.g., refugees, international students, dependants). The aim of this study is to understand racialized immigrants' experiences of accessing mental healthcare services at both systemic and individual levels. Through a qualitative descriptive methodology, interviews were conducted in English with 16 racialized immigrants to understand barriers and facilitators encountered. Additionally, focusing on how cultural and social conceptualizations ideas shape mental healthcare services. Interviews were analyzed through Braun & Clarke's six-step method to reflexive thematic analysis in identifying factors. Three major themes were identified: structural constraints, individual influences, and appraisal of services. With the first, racialized immigrants signaled to issues related to the systemic level that included affordability, wait times, and trust in the system. Individual influences highlighted factors of mental health literacy, social supports, stigma, severity of the issues, and awareness of services themselves. Lastly, extending on the previous theme, appraisal of services was reflective of how social and cultural ideals shaped attitudes towards the appropriateness of the provider or services themselves. The findings from this paper emphasize that racialized immigrants are not homogenous in their experiences and attitudes towards mental healthcare services. While there were similarities across different groups in the individual and systemic factors identified, there were key distinctions driven by appraisal of services themselves and if they were congruent based on their needs, more specifically, what was contributing to their negative mental health status.

Low accessibility to mainstream psychosocial services disadvantages culturally and linguistically diverse (CALD) populations, resulting in delayed care and high rates of unsupported psychological distress. Non-clinical interventions may play an important role in improving accessibility to psychosocial support, but what characterises best practice in this space remains unclear. This critical rapid review addressed this gap by searching for, and critically analysing, existing research on non-clinical psychosocial support services, drawing from a critical realist framework and Brossard and Chandler's (Brossard and Chandler, Explaining mental illness: Sociological perspectives, Bristol University Press, 2022) taxonomy of positions on culture and mental health. We searched PubMed, PsycInfo, LILACS, Scopus and Sociological Abstracts to identify non-clinical psychosocial support interventions for first-generation immigrant CALD populations delivered by lay-health workers. Thirty-eight studies were included: 10 quantitative, 7 mixed-methods and 21 qualitative. Most studies were conducted in North America (n = 19) and Europe (n = 7), with few conducted in low-income countries (Tanzania and Lebanon, n = 3 each, Kenya [n = 1]). Studies often focussed on specific interventions (e.g. psychoeducation) for targeted populations (e.g. refugees, Latinx immigrants); multimodal interventions (e.g. psychological support and food distribution) for broad populations were less common. Thirty-five different outcome scales were identified across quantitative and mixed-methods studies, with most covering depression, stress and trauma. Most studies identified significant improvements for at least one psychosocial outcome despite interventions being relatively short in sessions. Findings from qualitative studies highlighted varied engagement with theory-informed models of service, and identified important barriers to non-clinical psychosocial support services, including precarious resourcing. Our analysis suggests most studies were underpinned by split-relativist frameworks and focussed on interventions aimed at helping clients navigate the eurocentricity and complexity of mainstream services. Recognising the eurocentrism of universalist frameworks, working from a culturally relativist position, prioritising social determinants of health and using models that centre clients, flexibility, context, culture and community are likely to ensure best practice for non-clinical psychosocial support interventions.

We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic.

We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group.

The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust.

The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.

This study undertakes a scoping review of reviews on barriers to accessing mental health care for refugees and asylum seekers in high-income countries. By assessing mental health care access using the Levesque's conceptual framework, we identify barriers along the patient care pathway and highlight research gaps. Following PRISMA-ScR guidelines, 10 relevant systematic and scoping reviews were identified and analyzed. Seven common barriers were identified, that could be located across different stages of the conceptual framework. Demand-side barriers included: (1) refugees' understanding of mental illness, (2) fear of stigma, (3) lack of awareness of services, (4) attitudes towards formal treatment; while supply-side barriers comprised: (5) language barriers, (6) practical and structural issues, and (7) providers' attitudes and competence. There was a focus on demand-side barriers as key determinants for low service use. We observed a paucity of quantitative studies linking barriers and indicators of access to care. In the context of well-established mental health care systems, previous research has largely explained low access through peculiarities of refugees and asylum seekers, thereby neglecting the role of supply-side factors (including system structures and attitudes of service providers). We discuss how future research can critically question prevailing assumptions and contribute to rigorous evidence.

Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown.

A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary.

Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.

Understanding and addressing how an individual's social, political, economic, and cultural context affects their ability to achieve optimal health is essential to designing and implementing interventions. Before evaluating two parenting programs, in partnership with four children's mental health organizations, we used the Health Equity Impact Assessment tool (HEIA) to identify groups that may experience unintended health impacts, as well as generated mitigation strategies to address these impacts.

HEIA activities included a review of the published literature, a review of organizational documents, key informant interviews with staff (n = 12) and other related community service providers (n = 7), and a geographic information systems analysis. All sources of evidence were considered and analyzed using reflective thematic analysis. Summary reports were shared with all partners.

A range of groups were identified as at risk of experiencing unintended health impacts, including caregivers who are racialized, immigrants, Indigenous, living with mental health issues or addictions, dealing with intellectual challenges and/or low literacy levels, survivors of childhood trauma, single parent families, or families experiencing financial difficulties. Unintended health impacts were sorted into 6 main themes which fell under the overarching themes of accessibility of the programs and cultural appropriateness. Mitigation strategies as well as innovative strategies already being applied by participating organizations are discussed.

Although this HEIA focused on parenting programs, the findings address equity issues applicable to the provision of a wide spectrum of children's mental health services.

Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries.

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies.

Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives.

Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.

The intentions of this scoping review are to determine current uses of visual arts-based interventions for mental health and trauma support of marginalized populations, and to identify current gaps in knowledge in this emergent field.

Six databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, JSTOR) were searched for relevant studies. Following the PRISMA guidelines, 38 articles met the inclusion criteria.

Most interventions focused on improving the mental health of participants, or to provide opportunities for participants to process their experiences of mental health. Participants reported increased well-being, experiences of relaxation and/or distraction, and processing of mental health experiences. They perceived arts-based interventions as helpful and developed mutual social support with other participants.

Arts-based interventions have the potential to inform the development of culturally safe and relevant mental health care for marginalized populations beyond current mainstream mental health practices.

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

Significant disparities in utilization of mental health services exist among immigrant and Canadian-born populations. These gaps may be associated with a 'double stigma' - stigma related to being from a racialized background exacerbated by mental health stigma. Immigrant young adults may be particularly susceptible to this phenomenon, given developmental and social transitions from adolescence to adulthood.

To investigate the joint effects of racial microaggression and mental health stigma on mental health and service use among first-generation immigrant and Canadian-born university students.

We conducted an online cross-sectional study among first-generation immigrant and Canadian-born university students (N = 1,280, Mage = 19.10, SD = 1.50).

Despite no differences in anxiety or depression symptoms, first-generation (foreign-born) immigrants were less likely to have received therapy and to have taken medication for mental health issues compared to Canadian-born participants. First-generation immigrants also reported experiencing higher levels of racial microaggression and stigma toward service use. Results suggest the presence of a double stigma, mental health stigma and racial microaggression, each explained significant additional variance in symptoms of anxiety and depression and medication use. No effects of double stigma for therapy use were found - while higher mental health stigma predicted lower use of therapy, racial microaggression did not predict unique variance in therapy use.

Our findings highlight the joint effects of racial microaggression and stigma toward mental health and service as barriers to help-seeking among immigrant young adults. Mental health intervention and outreach programmes should target overt and covert forms of racial discrimination while incorporating culturally sensitive anti-stigma approaches to help reduce disparities in mental health service use among immigrants in Canada.

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community representatives, ICBT clinicians, managers, and researchers was formed. The working group examined archival feedback on ICBT from past patients who self-identified as being from diverse ethnocultural backgrounds (N = 278) and the results of interviews with current patients (N = 16), community representatives (N = 6), and clinicians (N = 3). The archival data and interviews revealed the majority of the patients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples, and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians, and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada.

Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method.

Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake.

The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.

Migrants, that is people who experience forced displacement or move based on being lesbian, gay, bisexual, trans, two-spirit, queer, and intersex (LGBTQI+), experience increased trauma and stigma when compared to heterosexual and cisgender people. The aim of this paper is to highlight LGBTQI+ migrants' experiences of health and social care encounters in Canada. Gadamerian hermeneutics and an intersectionality lens was used to understand LGBTQI+ migrants' experiences. A total of 16 semi-structured individual interviews were conducted with LGBTQI+ migrants. Themes of stigma and discrimination were identified as (1) "I never went back": Stigma as an exclusionary experience, (2) "Is [your country of birth] really that bad": Fear, safety, and cultural stigma, and (3) "The circle … is not going to fix my life": LGBTQI+ migrants' call for affirming care. Results suggest that health and social care practices are stigmatizing and discriminatory which negatively impacts LGBTQI+ migrant mental health. Salient practices for promoting mental health included affirming LGBTQI+ identities and orientations through health and social care practices that are culturally safe as well as trauma and violence informed.