title: Psychological distress among immigrants and visible minorities in Canada: a contextual analysis.
abstract: BACKGROUND
  Immigrants to Canada are less likely to report depression compared with the non-immigrant population. This healthy migrant effect has not so far been explained by demographic and socioeconomic determinants of health.
  
  
  OBJECTIVE
  The present study examined whether the psychological health advantage of immigrants varied across Canadian health regions and investigated the hypothesis of immigrant density as a determinant of immigrant mental health advantage.
  
  
  METHODS
  Data from the 2000-2001 Canadian Community Health Survey were used to build multi-level models estimating variation in depression within and between health regions by immigrant/visible minority status.
  
  
  RESULTS
  Immigrant and visible minority residents were less likely to experience depression compared with the general population. Depression varied across health regions and the extent of variation was greater for visible minorities. The likelihood of depression decreased with increasing percentage of immigrants in the region among visible minority participants but not among whites.
  
  
  CONCLUSIONS
  The protection against depression afforded by immigrant and visible minority status in Canada appears to depend on contextual factors, notably the percentage of immigrants in the region. Future work should seek to better characterize the experiences of visible minorities in different settings.
authors.affiliation: Department of Epidemiology and Public Health, UCL, London, UK. m.stafford@ucl.ac.uk
authors.forename: Mai
authors.initials: M
authors.lastname: Stafford
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Newbold
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002648:Child; D003863:Depression / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology*; D055815:Young Adult