Health Promotion Strategies to Address the Risk of Major Depressive Disorder

Major depressive disorder (MDD) is a mental condition that has a detrimental effect on individuals’ day-to-day life. Notably, MDD impedes social mobility, worsens overall well-being, and often corresponds to other mental issues. The risk of depression is connected to genetics, sex, negative experiences, insufficient support from the surroundings, and even life events like immigration. Canada’s population greatly consists of immigrants, and the country’s economy depends heavily on immigration. The most recent Census shows that immigrants represent 22% of the Canadian population (Evra & Mongrain, 2020). Unfortunately, there is a health disparity between Canadians and immigrants regarding mental health. Consequently, it is vital to consider risk factors of MDD related to the migration process, monitor mental health changes of immigrant residents, and address poor health services provided to them. The current paper explores said disparity and discusses Changing Directions, Changing Lives, a mental health strategy for Canada created to promote mental health in Canadians and immigrants.

The Mental Health Disparity Between Canadians and Immigrants

A health disparity is an evident difference in health levels between social groups in the community. Researchers use the paradigm known as the healthy immigrant effect (HIE) to describe this difference between non-immigrants and immigrants (Diaz, 2017). According to HIE, immigrants tend to be healthier than non-immigrants. Although the tendency is accurate for the initial post-immigration stages, most immigrants lose the advantage with time. Their physical or mental health deteriorates to the levels of non-immigrants or lower because of “inequalities in health service provided” (Diaz, 2017, p. 3). HIE usually applies to physical health, and its correlation with mental status is a relatively recent inquiry.

Ng and Zhang conducted a study comparing Canadian-born and immigrant residents’ self-reported mental health (SRMH). Out of 191,800 respondents, 16% have been immigrants subdivided into three groups: economic class, family class, and refugees (Ng & Zhang, 2020). The statistics show that both Canadians and immigrants, on average, have high SRMH (72% and 71%, respectively) (Ng & Zhang, 2020). The differences emerge when comparing classes and duration of residence. While 72% of the economic immigrants have had high SRMH, the indicators for the family class and refugees have been 3-4% lower (Ng & Zhang, 2020). A similar disparity has been observed between recent immigrants and established immigrants. The most significant impact on SRMH has had the source world region. Immigrants from the Middle East, East, and Western Asia had significantly fewer immigrants with high SRMH (Ng & Zhang, 2020). The study helps emphasize factors that influence the risk of MDD in immigrants. The critical factor is country of origin, followed by the duration of residence and socioeconomic status in Canada.

The current COVID-19 pandemic has shifted the situation with the disparity. As pandemic negatively affects economic stability and causes public unrest, more immigrants suffer from anxiety and depression. Labor Force Survey (2020) shows “that employment among recent immigrants and established immigrants fell more sharply (-23% and -17%, respectively) than it did for those born in Canada (-14%)” (Evra & Mongrain, 2020, para. 1). Furthermore, recent immigrants do not show better SRMH than the Canadian-born population. According to Evra and Mongrain (2020), 28% of recent immigrants have poor SRMH compared to 24% of Canadians and 20% of established immigrants. Recent immigrants have higher anxiety levels and are at risk of major depressive episodes (MDE). Evra and Mongrain (2020) note that the shift is connected to the policy of physical distancing and the negative financial impact of the pandemic. Moreover, female immigrants have reported worsening mental health more often than male participants (39% to 26%) (Evra & Mongrain, 2020). In conclusion, HIE deteriorates due to insufficient mental health support for immigrants and is further diminished by the current situation with the COVID-19 pandemic, thus creating mental health disparity.

The Mental Health Promotion Strategy for Canada

Changing Directions, Changing Lives was created in 2012 by the Mental Health Commission of Canada. It showcases 26 priorities with over a hundred recommendations grouping them under six strategic directions. These directions are as follows: (1) promotion and prevention, (2) recovery and rights, (3) access to services, (4) disparities and diversity, (5) First Nations, Inuit and Métis, (6) leadership and collaboration (“Changing directions, changing lives,” 2017). The recommendations address raising awareness about mental health, its improvement, and mental illnesses. They suggest education and training for healthcare providers to promote early interventions and support initiatives to alleviate mental health problems and foster recovery for people suffering from mental illnesses. The strategy includes creating policies to ensure upholding the rights of the mentally ill and make access to services universal and equal (“Changing directions, changing lives,” 2017). The program also addresses disparities of diverse communities, including First Nations, Inuit and Métis (“Changing directions, changing lives,” 2017). Finally, Changing Directions, Changing Lives fosters strong leadership in healthcare facilities and collaboration between healthcare providers and patients.

Addressing the Identified Disparity

Addressing MDD, the strategy suggests raising awareness about depression in schools and homes, namely its signs, risk factors, and how to get help. It highlights measures to prevent MDD and suicide wherever possible, especially in most affected groups like minors, elders, women, and LGBT people (“Changing directions, changing lives,” 2017). In workplaces, The Psychological Health and Safety Standard and two MHCC projects provide guidelines on approaching mental issues like MDD and how to organize effective and emphatic leadership and improve working conditions. It emphasizes the importance of better access to intensive, acute, and highly specialized mental health and substance use services with traditional, cultural, and clinical approaches.

Meeting the Requirements of Health Promotion

Priorities 4.2 and 6.1 explicitly focus on immigrants, recommending training for settlement workers and healthcare professionals, establishing specialized mental health centers, and coordinating mental health policies concerning immigrants on all governmental levels. The healthcare providers should provide services, treatments, and supports in different languages (“Changing directions, changing lives,” 2017). Overall, presented strategic directions meet the requirements of health promotion as they develop mental health literacy, provide recommendations to build healthy environments in schools and workplaces, and establish health equity.

Barriers the Program Faces

As the directions concern people’s mental health of all ages, occupations, and backgrounds, there should be no barriers to access this health promotion strategy. However, as the program regards many different issues, its implementation nationwide proves difficult. The strategy recommendations are used selectively and locally, and concerned people’s knowledge about the strategy and ways to access it are relatively scarce. Nevertheless, the data provided by MHCC supports strategic directions’ effectiveness. An example is mental health training developed for primary mental health providers in Prince Edward Island. Participants strongly agree that it improved their knowledge and practice (“Changing directions, changing lives,” 2017). Although not generalized, such evidence proves that the program’s implementation is effective.

Current Use of the Strategy

The current use of the strategy is expressed by various fundings, building frameworks to implement it nationwide, creating guidelines supportive projects. Grand Challenges Canada has funded mental health projects in Canada and abroad, spending 35 million Canadian dollars since 2012 (Marquez & Saxena, 2017). GCC also founded the Mental Health Innovation Network to support innovators and researchers with their decision-making and provide an information-sharing platform (Marquez & Saxena, 2017). MHCC created projects such as Opening Minds to fight stigma and prejudice against the mentally ill and Evergreen to guide children and youth mental health initiatives.

Strategy Effectiveness: Evidence and Recommendations

In general, I would rate the strategy as effective for addressing the majority of the issues and disparities within the mental health service and providing a definitive approach to resolving these issues. It is gradually funded and implemented throughout Canada and sets an example for other countries. For instance, the World Health Organization uses the Canadian program to address mental health neglect, especially of immigrants (Marquez & Saxena, 2017). Regarding immigrants, I would recommend undertaking a thorough study of culture, origin, and language correlation with MDE to create culture-specific health care policies. Another recommendation would be strategy familiarization programs to broaden people’s knowledge about it and ways to access it.

Conclusion

Changing Directions, Changing Lives is a health promotion strategy that addresses risks of mental illness, including MDD, in Canada. The program also deals with the disparity between immigrants and Canadian-born people. The statistical data shows that the HIE of immigrants wears off with time, and their mental health deteriorates, often becoming worse than Canadians’. Furthermore, the ongoing pandemic impacted recent immigrants the most, making them more susceptible to anxiety and depression. The reviewed strategy provides six strategic directions with over a hundred recommendations. As MDD is widespread, the directions present awareness-raising, preventative, and screening measures with a social group-oriented approach. It emphasizes accessibility, quality, and variety of mental health services and gives guidelines for schools, workplaces, and medical facilities. Changing Directions, Changing Lives is a necessary step to resolve neglect and disparity in the mental health area, but concrete and large-scale results are yet to be seen.

References

Changing directions, changing lives: The mental health strategy for Canada. (2017). Centre for Innovation in Campus Mental Health. Web.

Diaz, R. (2017). Immigration and depression in Canada: Is there really a healthy immigrant effect? What is the pattern of depression by time since immigration? (Unpublished) [Master’s thesis, University of Calgary]. PRISM: University of Calgary’s Digital Repository. Web.

Evra, R., & Mongrain E. (2020). Mental health status of Canadian immigrants during the COVID-19 pandemic. Statistics Canada. Web.

Marquez, P. V., & Saxena, S. (2017). Advancing global mental health action: Lessons from Canada. The World Bank Group. Web.

Ng, E., & Zhang, H. (2020). The mental health of immigrants and refugees: Canadian evidence from a nationally linked database. Statistics Canada. Web.