Students

Introduction
Studies conducted in both the United States and Canada have repeatedly shown that despite an equal or greater need for mental health support, immigrants from Asia, Central and South America, and Africa underutilize mental health services (Durbin et al., 2014; Derr, 2016). Currently, international migrants represent about 3.6 percent of the world’s population and this number is projected to continue to increase in the coming years (UNDESA, 2020). With the global increase in immigration, especially to Canada, the United States, and Europe, understanding the barriers to accessing mental health care is an issue of utmost importance. For many migrants, the process of immigration and settlement in a new country is stressful and presents numerous challenges. Upon arrival in a new country, migrants are often required to develop new social ties, rebuild a social network, learn a new language, and understand new norms and values (Masgoret & Ward, 2006). Experiencing significant life changes, such as those that occur upon migration, can be associated with both psychiatric illness and lower well-being (Salleh, 2008; Wheaton, 1990). Migration has also been associated with poor mental health outcomes and higher rates of mental disorders (Das-Munshi et al., 2012; Patel et al., 2017; Kirmayer, Narasiah, & Munoz, 2011). Although many migrants face significant mental health challenges upon arrival in a new country, they are less likely to access the available mental health resources, despite an equal or greater need. Because of the high salience of negotiating novel social contexts and norms during the process of immigration, and because attitudes towards mental health care are formed and molded via socialization and interactions with one’s social network, this study focuses on social context and social norms as the drivers of migrants’ attitudes towards seeking mental health care.

Participants
The present study involved 153 immigrants to Canada (Mage = 33.76, SD = 9.17; 119 women, 34 men). Participants immigrated from a wide variety of countries and cultural backgrounds: 36 (23.5%) participants were of North African origin, 29 (19 %) participants were of Asian origin, 26 (17%) participants were of European origin, 16 (10.5 %) participants were of South American origin, 14 (9.2 %) participants were of Middle Eastern origin, 14 (9.2 %) participants were of African origin, 13 (8.5 %) participants were of Central American or Mexican origin, four (2.6 %) participants were of American origin, one (0.7 %) participant was of Australian origin.

Findings
This study addresses migrants’ attitudes towards seeking mental health care by leveraging a combination of proximal (norms in one’s immediate network), distal social norms (cultural and societal norms), and acculturation orientations. Psychological openness– the degree to which an individual is open to recognizing the presence of a psychological problem– was negatively associated with migrants’ orientation towards their heritage culture. Mainstream acculturation (ß(SE)= .11(0.04), p < .05, 95% CI = [0.03, 0.20]) was significantly positively associated with psychological openness while heritage acculturation was significantly negatively association with psychological openness (ß(SE)= -.09(.04), p < .05, 95% CI = [-0.17, -0.01]). Help-seeking propensity– one's willingness to seek help– was positively associated with proximal norms of migrants’ heritage culture. One’s willingness and perceived ability to seek help for psychological problems decreases as societal norms in their heritage culture increase. In the last step of the model, Adding proximal norms increased the R2 of the model to 17% (F(9,143) = 3.25, p = 0.001). Indifference to stigma– the extent to which individuals are concerned about stigma– was influenced by distal norms in the mainstream and heritage cultures. Both mainstream (ß(SE)= 0.14(0.05) p < .01, 95% CI = 0.04, 0.25]) and heritage distal norms (ß(SE)=- 0.09(0.04), p < .05, 95% CI = [0.01, 0.18]) are significantly positively associated with indifference to stigma.

Implications for future research and policy
These findings may guide the development of measures to facilitate access to psychological support for migrants including but not limited to health communication campaigns, public policy, and community mental health initiatives.