Disparities in the mental health of migrant children and youth: an analysis of determinants and unmet need

Abstract

Background: Global migration has significantly increased in recent decades, emphasizing the need to understand and address the mental health needs of migrant populations, particularly children and youth who face unique challenges pre-, during-, and post-migration. Despite these challenges, evidence suggests conflicting mental health patterns. Some studies suggest migrant children and youth experience fewer mental health difficulties compared to their non-migrant peers – a pattern often referred to as the “healthy migrant paradox,” while other studies challenge the phenomenon. This thesis examines differences in mental health problems and access to care between migrant and non-migrant children and youth, and identifies social and contextual factors that may mitigate or attenuate group differences. Methods: Three manuscripts address key objectives: (1) a systematic review and meta-analysis of 59 studies quantifying differences in mental health outcomes among migrant and non-migrant children and youth in high-income countries; (2) an analysis of differences in mental health-related service contacts between migrant and non-migrant children and youth, and social and economic factors that account for between group differences using a large, representative sample of children and youth in Ontario, and (3) an investigation into the moderating effect of migrant concentration in schools and the mediating role of school processes (loneliness and belonging at school) in the association between migrant background and mental health symptoms, using advanced epidemiologic methods including structural equation modelling and multilevel moderated mediation models. Results: Overall, the fundamental findings of this body of work are: 1) substantial heterogeneity exists in current evidence, influenced by substantive and study methodological factors; 2) after accounting for mental health symptoms and perceptions of need, migrant children and youth, compared to their non-migrant peers, were significantly less likely to have mental health-related service contacts; 3) adjusting for social and economic factors did not fully account for between group differences in mental health-related service contacts; 4) the concentration of migrants in schools is associated with lower levels of externalizing symptoms for migrant youth when migrant concentration is high, and this effect is mediated by youth feelings of loneliness at school. Conclusions: Together, these papers provide a comprehensive understanding of migrant mental health among children and youth. They underscore evident heterogeneity in mental health outcomes among migrant and non-migrant children and youth, influenced by a number of socio-contextual and economic factors. The findings highlight consistent evidence of mental health service shortfalls for migrant children and youth.