Does the healthy immigrant effect apply to mental health? Examining the effects of immigrant generation and racial and ethnic background among Australian adults

Rennie Lee

doi:10.1016/j.ssmph.2018.10.011

Abstract

The healthy immigrant effect (HIE) refers to the phenomena in which immigrants show greater health outcomes than the native-born population. However, it is unclear what is the extent to which HIE applies to various outcomes and populations. Much of the work on HIE has revolved around physical health outcomes; mental health, however, has not garnered the same level of attention with regard to HIE. It is also uncertain whether immigrants’ health advantage persists beyond one generation. This study assesses the mental health of the first, second, and third and higher generations (70,517 person-year observations) for individuals from various racial and ethnic backgrounds in Australia using Waves 1−16 of the Household Income and Labour Dynamics in Australia survey. The dependent variable is mental health score and key independent variables include generation and racial and ethnic background. I control for age, educational attainment, labor force status, marital status, remoteness, household income, language, neighborhood disadvantage, citizenship, weight, and gender. Using linear regression with random effects, this study finds that mental health varies by generation; the third and higher generation show the greatest mental health score, followed by the first generation and the second generation, net of controls. Mental health score also varies by racial and ethnic background. Except for English-speaking groups, native-born Australians show a clear advantage over Europeans, North Africans/Middle Easterners, and Asians. Racial and ethnic disparities differ by generation and are strongest among the first generation. My findings extend HIE, which typically emphasize immigrants’ superior health outcomes over the native-born population but do not focus on racial and ethnic disparities among immigrants. My results suggest that immigrant groups vary widely in their mental health outcomes but these lessen over time. Overall, the findings suggest the limited applicability of HIE for a broad range of health outcomes and populations.

Highlights

There is growing international focus on mental health illnesses as a public health priority, given its association with worse physical health, decreased productivity, and premature death (Judd & Humphreys, 2001)
This study’s analysis of mental health among the first, second, and third and higher generations across several racial and ethnic backgrounds highlight some of the limitations of healthy immigrant effect (HIE)
Diverging patterns of mental health by generation show the limited applicability of HIE for a broad range of outcomes and populations

Summary

Introduction

There is growing international focus on mental health illnesses as a public health priority, given its association with worse physical health, decreased productivity, and premature death (Judd & Humphreys, 2001). The risk of mental health issues, are not distributed across the population. In particular, are at risk; nearly 15% of foreign-born individuals in Australia experience some kind of mental disorder (Minas et al, 2013). The reasons range from receiving lower access to care, experiencing discrimination in the host society, and facing migration-related challenges (Minas et al, 2013; Schweitzer, Brough, Vromans & Asic-Kobe, 2011). Understanding the mental health issues of these communities is especially salient in Australia, where nearly half of the population is an immigrant or a child of an immigrant (Australian Bureau of Statistics, 2013, 2016). Continuous migration remains a primary driver of population growth in Australia so the mental health outcomes of these communities have tremendous long-term social, economic, and health consequences (Spinks & Koleth, 2010)

Results

Discussion

Conclusion