Social Psychiatry and Psychiatric Epidemiology

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Social Psychiatry and Psychiatric Epidemiology Predictors of Immigrant Children's Mental Health in Canada: Selection, Settlement, Culture or all of the above? --Manuscript Draft-Manuscript Number:

SPPE-D-13-00110R2

Full Title:

Predictors of Immigrant Children's Mental Health in Canada: Selection, Settlement, Culture or all of the above?

Article Type:

Original Paper

Keywords:

immigrant children; immigrant youth; emotional problems; immigrant settlement; culture

Corresponding Author:

morton beiser, CM, MD. FRCP Ontario Metropolis Centre of Excellence for Research on Immigration and Settlement Toronto, Ontario CANADA

Corresponding Author Secondary Information: Corresponding Author's Institution:

Ontario Metropolis Centre of Excellence for Research on Immigration and Settlement

First Author:

morton beiser, CM, MD. FRCP

Order of Authors:

morton beiser, CM, MD. FRCP Alasdair M Goodwill, PhD Kelly McShane, PhD, CPsych Matilda Nowakowski, PhD Patrizia Albanese, PhD

Abstract:

Background and study aims: A previous publication from the New Canadian Children and Youth Study (NCCYS), a national study of immigrant children and youth in Canada, showed a gradient of levels of emotional distress with children from Hong Kong (HK) at the most severe end, Filipino children at the least severe, and children from the People's Republic of China (PRC) in between. Based on the premise that country of origin can be regarded as an index for differing immigration trajectories, the current study examines the extent to which arrival characteristics, resettlement contingencies and cultural factors account for country-of-origin variations in immigrant children's mental health. Arrival characteristics included child's age at arrival, parental education, parental fluency in English or French, and assistance from family at arrival. Resettlement contingencies included parental mental health, intra-familial conflict, settlement stress, separations from parents and child's age when mother started working outside the home. Cultural factors included one-child family composition and parenting styles. Methods: A national survey of 2,031 families with at least one child between the ages of 4 and 6 or 11 and 13 from HK, the PRC and the Philippines was conducted with the Person Most Knowledgeable (PMK) in a snowball-generated samples in 6 different cities across Canada. Predictors of the dependent variable, Emotional Problems (EP) were examined in a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; arrival characteristics were added in model 2; resettlement contingencies in model 3 and cultural factors in model 4. Results: The final set of predictor variables accounted for 19.3 percent of the variance in EP scores among the younger cohort and 23.2 percent in the older. Parental human and social capital variables accounted for only a small amount of the over-all variance in EP, but there were statistically significant inverse relationships between EP and PMK fluency in English or French. Settlement contingencies accounted for a significant increase in the explanatory power of the regression equation, net of the effects of country of origin and selection characteristics. This block of variables also accounted for the Filipino mental health advantage. Levels of parent's depression and somatization, harsh parenting, intrafamilial conflict, and resettlement stress each varied directly with levels of children's EP. Cultural variables made a significant contribution

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to explaining the variance in EP scores. Harsh parenting was significantly associated with increased levels of EP in both age groups, and supportive parenting was a mental health protective factor for younger children. Conclusions: Immigrant family human and social capital, according to which immigrants are selected for admission to Canada play a relatively small role in determining children's mental health. These effects are overshadowed by resettlement contingencies and cultural influences. Concentrating on trying to find a formula to select the "right" immigrants while neglecting settlement and culture is likely to pay limited dividends for ensuring the mental health of children.

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*Authors' Response to Reviewers' Comments Click here to download Authors' Response to Reviewers' Comments: Response to SPPE reviewiers second time around.docx

Ref.: Ms. No. SPPE-D-13-00110 Predictors of Immigrant Children's Mental Health in Canada: Selection, Settlement, Culture or all of the above? Social Psychiatry and Psychiatric Epidemiology Dear Professor beiser, Our reviewers have now commented on your paper. You will see that they are advising that you revise your manuscript. The suggested revisions are considerable but, if you are prepared to undertake the work required, I would be pleased to reconsider your paper. In view of the reviewers' comments, I may need to seek the further opinion of referees. For your guidance, the comments are appended below. Incidentally, it is in your interest, and ours, if you cast an eye over previous, especially recent, issues of SPPE in order to see if there are articles that could be appropriately quoted in your paper. When resubmitting, please list the changes you have made (or a rebuttal) against each of the reviewer's points. Your revision is due by 01-09-2013. To submit a revision, go to http://sppe.edmgr.com/ and log in as an Author. You will see a menu item call Submission Needing Revision. You will find your submission record there. Yours sincerely Claudia Cooper Editor Social Psychiatry and Psychiatric Epidemiology Reviewers' comments: Reviewer #1: This is a fascinating paper about 3 groups of immigrant children in Canada. The paper is beautifully and thoughtfully written. The authors know the immigration and epidemiology literature, and the findings are important for both fields of research. Thank you for your kind words and helpful suggestions. I have some minor comments. First, I had trouble keeping track of the abbreviations, so fewer would be appreciated. This excellent suggestion has been addressed in the text. Second, the design is a 3 (country of origin) x 2 (age groups). I would have preferred that the analysis and tables follow the design, rather than merge the two age groups together. On p. 13, the authors state the regression findings were not appreciably different when the age groups were kept as separate strata. I think for the reader, it would be far more informative to see the data for the two age groups. Thank you for the suggestion. We have revised the text and tables accordingly.

Table 2 describes the measures - but they are also described in Methods. I think Table 2 is unnecessary, and the alpha values and ranges could go into the Methods narrative.

Agreed. We have deleted Table 2 and inserted the information in the Methods narrative. Table 3 shows the descriptive findings for the 3 immigrant groups, and these data are more valuable than the distributions shown in Table 2. I would actually have preferred a 3a (younger kids) and 3b (older kids) although I realize that it's a lot of data to present. But it would match the design and might be more informative than combining the age groups. Perhaps the separate regression analyses noted on p. 13 could be shown in an appendix if the decision is to keep the two age groups in the one analysis. In this revised version of the paper, we present separate tables, one for each of the age groups Third, since 95% of the informants were moms, why not just present data from the mothers and therefore keep the source of information consistent. The designation of the PMK has a long methodolgical, and publication history. Canada’s Longitudinal Survey of Children and Youth, the Ontario Health Study and our own previous publications have used this carefully considered method in which the family identifies the person most knowledgeable. As noted, this is almost always the mother, but if there is no biological mother, it may refer to a step-mother, to a caretaker grandmother, etc. The idea is that there will be one person who knows more about the child than anyone else, whether or not that is the biological mother. Never, to my knowledge, has the procedure the reviewer suggests above been used. To do so now would reduce the sample size and statistical power. In addition, changing the method now wold compromise comparability with other important studies and will introduce confusion into our own inter-related publications. .

Fourth, we aren't told about the correlations among the measures -- such as parent depression (maternal depression?) and somatization, or maternal depression and family conflict. Again, an appendix showing the inter-relationships among the independent variables would be useful. An appendix with these data has been supplied. Fifth, although the older children signed consent forms -- no data from them were included. If the separate age group analyses had been presented, we could have seen how the variables predicted maternal reports of emotional problems in the older kids as well as the kids' self-reported emotional problems. This is a valuable suggestion but it calls for a new paper. In other publications, we have described predictors of emotional problems from the separate viewpoints of parents and children. It is not simply a question of comparing results using a dependent variable assessed from different perspectives, i.e. parent and child. Many of the independent variables such as quality of parenting are also assessed by both parent and child meaning that there are at least 4 different types of analysis that could be carried out – parent rated predictors of parent-rated child mental health, parent rated predictors of child-rated mental health, child-rated predictors of child-rated mental health, and child-rated predictors of parent-rated mental health. This would constitute an interesting set of analyses, and we have considered some, but introducing another dependent variable into this paper would take us far beyond an encompassable scope, not to mention page length. Since the majority of studies regarding children’s mental health that have appeared in the epidemiological literature use parent ratings, the current study adds to this body of knowledge and enables important comparisons. One last thought is about the meaning of separation. In parts of mainland China, it is customary for babies and toddlers to be raised by their grandparents so that the young couple can work, complete their education, or start their careers. If the interview contains information on .who raised the child during the separation, and if it was a grandmother - that would help explain why separation was pretty much a nonissue.

We tried to address this issue in our previous version but obviously unsuccessfully. We fully agree with the reviewer and have expanded on this point in the discussion.

Reviewer #2: Globally the paper is well written and directed to an interesting and pertinent problem: immigration policies and immigration selection criteria of Canada toward children mental health it is doing so by a literature review plus a survey on 2000 children originated from three different countries well contrasted. The authors are well experienced with the topic but there are some problems with interpretation of results and the way they deal with the data -they got data on two different children age population 4 to 6 and 11 to 13; however this is never used nor discussed in the interpretation. Please see the responses to the same point raised by Reviewer #1. Both reviewers were rightfully concerned about this point and we have revised the text and tables to address these concerns. Age at arrival is discussed and certainly linked to it but psychological distress which is the main outcome variable may largely differ in the two populations; I am not clear what the reviewer means unless he or she is raising the question of the age appropriateness or age equivalence of the dependent measure. I believe that the remarkably consistent (and high) alpha levels obtained across age and ethnic groups suggest that the measure of emotional problems can be used as we have done. Furthermore, an abundant literature using these or very similar measures of PMK-rated emotional problems attests to their utility among younger as well as older children. -in addition the scale that was used for this main outcome is not well described ; they just present questions on happiness which is much more a quality of life than negative mental health scale and relies very much on the parents projection of happiness for their kids and not on symptoms of psychological distress. I suggested to add the scale in an annex so the reader could judge what it is measuring exactly and to provide much more details of the origin, content and psychometric properties on the scale plus some discussion about what is measured exactly as a concept A large literature concerning this scale has accumulated during the decades since it was first developed. It has been used in national surveys including Statistics Canada’s National Longitudinal Survey of Children and Youth, the Ontario Child and Youth Study, as well as our own New Canadian Child and Youth Study as well as in international research. Given the measure’s long history and numerous citations in the literature, it seems unnecessary at this late stage to provide details about its origin, etc. However, for readers who may not be familiar with the scale and its use as a measure of distress, the Methods section has been revised to provide added citations as well as several items to better describe the scale’s content. -the literature review is too long and should be condensed and not interpreted; this has to be in the discussion part; With all due respect, I must disagree. The literature review is sparse indeed, focused only on presenting a rationale for the inclusion of each of the predictors of mental health included in this study. This is necessary because there is a theoretical rationale guiding the selection of each variable included. I have, however, omitted one sentence from the literature review which might be considered too interpretive. some interpretation are not wise such as maternal employment and child development and well being which is very negative when in fact this may be due to the fact that child care are not adequate and not due to maternal employment by itself which has been proved as a protective factor in women depression for example;

It is important to keep in mind that the focus of this paper is children’s mental health. Although there is literature suggesting that employment may be good for mother’s mental health, we are not concerned with that here, but with the literature which suggests that maternal employment during early years of development can be a risk factor for children’s mental health. In addition since the authors did not find any effect they conclude that with "good child arrangements " maternal absence my promote resilience which contradicts their first literature review output Our findings do contradict the literature review and fail to support the research hypothesis. Research does not always confirm beliefs. For me, in fact, the most interesting research results are those that challenge beliefs. The negative finding concerning separations is one of those surprises that challenges assumptions and that calls for revising them. We tried to do so in the discussion section of the previous version, perhaps too briefly – but there are space limitations that have to be honoured. In this revision, however, in an attempt to address the reviewer’s concerns, we have amplified the discussion. Please also see our comments to reviewer 1 on the issue of maternal separation. -other interpretations are not so sounded : effect of poverty on immigrants is not well discussed. Poverty in Canada and poverty in the Philippines or main land China does not mean the same thing and people evaluate their quality of life by comparisons with what they know; in addition the selection bias of what does it means to be poor in the country of origin versus the immigrant countries could be the reverse. I am not clear what the reviewer has in mind. Poverty is a risk factor for children’s mental health both among the general and immigrant populations (see ref. 9 for example. Beiser, M., Hou, F., Hyman, I. & Tousignant, M. (2002). Poverty, family process, and the mental health of immigrant children in Canada. American Journal of Public Health, 92, 220-227). Consistent with other studies addressing this issue, the current study shows that, with certain personal and familial factors controlled, the mental health effect of poverty is reduced. If the reviewer means that we haven’t measured whether or not immigrant families were poor in the home country and find their situation in Canada better by comparison, that’s certainly true but it doesn’t seem likely that young children, many of whom were actually born in Canada, perceive that there are differences in poverty between Canada and the Philippines and Mainland China, and that these perceptions affect their mental health. The reviewer may be suggesting that home country/resettlement country differences in poverty levels are responsible for differential effects on parent’s mental health, but this intriguing line of speculation goes beyond the boundaries of the current paper. . Children without sibling are not a risk group : in term of school achievement for example they are considered as a protected group as well as for further adult professional achievement School achievement is not the outcome variable in this study. We are addressing mental health. For a long time, and in a good deal of the literature, some of which has been cited, being an only child has been considered a mental health risk. -the most important criticism is toward considering PMK depression and PMK somatisation as "Settlement experiences" in fact these scales are measuring an actual characteristic without any reference to past episode or personal traits; to interpret their actual levels as "due to settlement" is not correct ; what can be said is that there is a correlation with the actual level of these scales and children EP but their relation ships with settlement is unknown . Since PK somatisation is the main predictors of child EP; we are just finding a commune relationship between parental MH and children MH which exists in immigrants as well as in non immigrants families and do not establish any specific role of immigration ; same for punitive behaviour which is linked to parental distress in immigrants as well as in non immigrants families. Since both of these are the main predictors of children EP in the paper , this is a problem and has to be discussed seriously The reviewer seems to be concerned about our inclusion of parent depression in a category of resettlement contingencies We are examining the effects of various variables on children’s’ mental health using temporally and conceptually driven blockings of variables for this purpose, i.e. pre-migration,

settlement contingencies, culture. . We are not claiming that resettlement causes parents’ mental health problems or their parenting styles, but that these are settlement contingencies that affect children’s mental health. Parental mental health and parenting styles are among the many contingencies that either challenge or protect the immigrant child’s mental health. In an attempt to mitigate confusion on this point, we have tried to respond to the reviewer’s reservations by substituting the term resettlement contingencies for resettlement experiences and by adding a few sentences to the discussion -the snow ball sampling method may not underestimate the parental distress, on the contrary some papers have showed that the most successful immigrants are leaving outside the immigrants neighbourhood and may escape the sampling because they well integrated to the country with not so much contact with their community from origin. Would the reviewer be willing to supply references, particularly with respect to immigrants living in a resettlement country for less than 10 years, the group who constitute the focus of our current study? I’m not aware of such research and a literature review we carried out after we received these comments did not turn anything up. If the reviewer thinks it important, and will be kind enough to supply the references, we will be more than happy to review the references and, if the point is supported, we will be happy to incorporate it into the discussion.

Update Oct. 18 2013. Following email correspondence with Dr. Cooper, we have further modified the paper as follows: 1. We have shortened the introduction. 2. In order to make clear that including PMK mental health under the category of resettlement contingencies is not meant to imply that we attribute parents’ mental health problems to resettlement. Instead, parental mental health is one of a considerable number of contingencies that are potential risk or protective factors for immigrant children’s mental health. We address this issue by substituting the term “resettlement contingencies” for “resettlement experiences” throughout the text. We have also added text on page 3 to make clear that parental mental health may be a result of predisposition, pre-existing disorder, response to stress or a combination of all three. For the purposes of this paper, it doesn’t matter since the focus is the mental health of the child and the potential contribution of parental mental health to predicting children’s mental health. Text on page 15 addresses this issue from the point of view of interpreting results.

*Manuscript Click here to download Manuscript: Final version for SPPE version 29 text only.docx

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Selection Settlement or Culture Predictors of Immigrant Children’s Mental Health in Canada: Selection, Settlement Contingencies, Culture, or all of the above? Morton Beiser, Alasdair M Goodwill, Patrizia Albanese, Kelly McShane, Matilda Nowakowski Introduction Although many live in poverty and experience prejudice and cultural dislocation, immigrant children on the whole have fewer psychological and health problems than their native-born counterparts [9, 25, 69].

Research bearing on this “immigrant paradox” [25, 69]

has tended to be either very inclusive, for example lumping all immigrant children into one category in order to make immigrant/non-immigrant comparisons [9], or very exclusive, for example focusing on only one ethnocultural or country-of-origin group [69]. Attending to intragroup variation by taking account of country of origin can help identify the effects of selection, settlement contingencies and cultural factors on immigrant children’s mental health. . A previous report from the New Canadian Child and Youth Study (NCCYS), an investigation of mental health among immigrant children in Canada, showed a gradient of emotional distress among children from these three Asian origin groups. Children in families from Hong Kong (HK) were at the high end of the gradient, Filipino-origin youngsters at the low end, and children originating from the People’s Republic of China (PRC) in between. Country of origin categories are more than administrative conveniences: they encapsulate different routes of entry, different post-arrival socioenvironmental circumstance and differences in culture, each or all of which may affect children’s mental health. This paper examines the mental health salience of selection, settlement contingencies and culture among children in families originating from Hong Kong, the People’s Republic of China origin and the Philippines.

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Selection Settlement or Culture Study Background The NCCYS is an investigation of immigrant children’s mental health involving two agedefined inception cohorts: children four through six and children 11 through 13. Children in the study were either born outside Canada or were living with at least one foreign-born parent who had immigrated to Canada during the ten years preceding the study’s inception. Since most immigrants settle in cities [62], samples were recruited from Canada’s major urban areas: Vancouver, British Columbia; Edmonton, Alberta; Calgary, Alberta; Winnipeg, Manitoba; Toronto, Ontario; and Montreal, Quebec. Canada admits immigrants under three categories: i) Independent class, in which selection is based on points awarded for the principal applicant’s human and social capital ii) Entrepreneurial class, in which financial capital and entrepreneurial know-how replace points as the basis for selection and expedited admission [24]. iii) Live-in-Caregivers (LIC), admitted to Canada to care for children or the elderly. After 24 months of paid service, LIC’s are "fasttracked" to permanent resident status [21- 23].1 During the 1990s, the decade preceding the study’s inception, the Peoples’ Republic of China (PRC), Hong Kong (HK) and the Philippines were Canada’s “top three” immigrant source countries [21]. Most PRC families were admitted under the points system while HK accounted for the majority of Entrepreneurial class immigrants [21-23, 34] and the Philippines for the majority of Live-in Caregivers [17]. Inter-group differences made it possible to examine the respective contributions of arrival characteristics, settlement circumstance and culture in predicting children’s mental health. Arrival Characteristics

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“Refugee and humanitarian” is a fourth admission category but, since none of the participants in this NCCYS study gained admission by this route, the category is not addressed in this publication.

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Selection Settlement or Culture Among immigrant children, age at arrival has an inverse relationship with mental health risk [3, 14, 66, 67]. Some of the parental and family characteristics that determine immigrant eligibility also affect children’s mental health. For example, education and fluency in English or French are two major selection criteria, and limited parental education and poor facility in the receiving society language jeopardize immigrant children’s mental health [7,8], Social capital is another important selection criterion. Immigrant families gain points if they have pre-existing social connections in Canada; social support is also a protective factor for mental health [5, 8, 64, 65]. Settlement Contingencies Whether the result of predisposition, pre-migration history, the stresses of resettlement, or a combination of one or more of these factors, mental ill-health in parents has an adverse effect on children’s mental health [6-8, 30]. This apparently universal mental health risk factor -universal because it is associated with compromised mental health among immigrant and nonimmigrant children alike -- may exert all or part of its effect through harsh parenting practices, and intra-familial conflict [30]. Other circumstances of family life with mental health salience are more specific to the immigrant situation.

For example, resettlement stress experienced by families appears to

jeopardize children’s well-being [5, 8].

For Filipino families, parent-child separations

consequent to the Live-in Caregiver program may have a deleterious effect on children’s mental health [12]. Parent-child separations are also common in HK families, but these occur postmigration, as a result of parents leaving their children in Canada for prolonged periods while they pursue business interests in China and elsewhere. Authorities have cautioned that the result

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Selection Settlement or Culture – what some have called “astronaut parents” -- may create mental health risk for children [40, 73]. A number of authors [11, 28, 35] have suggested that, even in intact immigrant families, maternal employment – particularly when children are very young – can adversely affect development and well-being. Poverty is a well-established risk factor for children’s mental health [13, 59, 71].: almost one in three immigrant families with children live in severe poverty during their first ten years in Canada [9, 33, 60]. Culture In 1979, the PRC introduced a one-child per household policy. Although it may seem unusual to include a policy-based family structure as a cultural variable, the explicit intent of the policy was in fact to reshape Chinese family culture by redefining one child per family as normative [37]. Only child status has long been considered a mental health risk [48]. Culture affects parenting styles.

Chinese parenting, based on Confucian ideals,

emphasizes patriarchal authority and age stratification, and is often portrayed in the literature as harsh, strict, controlling, and emotionally constrained [58]. By contrast, Filipino parents tend to be egalitarian rather than patriarchal, less constrained in expressing emotion, and more relaxed in interacting with their children [1]. Warm parenting tends to be associated with good child mental health, whereas parenting characterized by harshness and disciplinary inconsistency increases the risk of emotional problems [39, 42-45].

The Current Study: Methods and Measures

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Selection Settlement or Culture The current study explores selection, settlement and cultural factors that might account for previously reported differences in levels of emotional problems among children from Hong Kong, the People’s Republic of China and the Philippines.

Study Sample and Recruitment

The sample consists of HK, PRC and Filipino immigrant families and children between four and six years (pre-school and early school sample) or between 11 and 13 years of age (preadolescent sample) living in cities in each of four major regions in Canada – Montreal (Eastern region), Toronto (Central), Winnipeg, Calgary, and Edmonton (Prairies) and Vancouver (West). The study aimed to recruit a sample of 180 children in each region, stratified to provide equal numbers by ethnicity, and age-group (4-6 and 11-13), for a total of 2,160. The NCCYS employed a combination of key-informant and snowball sampling recommended for hard to find, highly mobile groups [68, 74], and more fully described in previous publications [6-8]. The method included forming Community Advisory Councils who, through their own networks, identified families with at least one child satisfying the study’s inclusion criteria and who then secured consent for an initial contact by a member of the NCCYS investigative team. Among the families approached by NCCYS team members, the over-all acceptance rate was 95 percent. Children in the older cohort also gave written informed consent. Participating families helped to recruit other families with children who met the study's inclusion criteria. The final sample, described in Table 1, shows that the sample fell slightly short of its recruitment goals, particularly among the younger and the Hong Kong Chinese cohorts.

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Selection Settlement or Culture INSERT TABLE 1

Based on a population model using 2001 census data, each sample was weighted to the Census Subdivision level. (The Census Subdivision is usually a provincially defined municipality [61]. The study received ethics approval from the Centre for Addiction and Mental Health/University of Toronto Ethics Review Committee in 2002.

Renewal was approved

annually. Data sources for the current report include the Parent about Family (PAF) and Parent about Child (PAC) sections of the total NCCYS questionnaire. The PAF elicits information about parents’ ethnic and religious backgrounds, education, labor force activity, income, health status, parenting behaviors, and pre-and post-migration stressors. The PAC covers the child’s general health and developmental history, as well as symptoms of emotional distress. Prior to including an item in the questionnaire, the Community Advisory Councils in each study region judged its acceptability, the likelihood that it could be appropriately translated, and its face validity. The team then assembled the surviving items into draft versions of the Parent About Family and Parent About Child sections of the NCCYS questionnaire, arranged translation into each of the heritage languages, and back-translation in order to uncover and resolve ambiguities. Each bilingual interviewer took part in a two-day group training session. To ensure standardization, a senior member of the investigative team conducted training in five of the six sites, and personally trained the Montreal-based French-speaking person who trained the francophone interviewers. Project personnel administered the PAF and PAC to the Person Most Knowledgeable in the family [PMK] -- in more than 95 percent of the cases, the child’s mother. Based on the response to a question about the major ethnicity of the family as well as the country

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Selection Settlement or Culture from which the family had emigrated in order to come to Canada, the interviewer assigned the child to one of the study categories: PRC Chinese, Hong Kong Chinese, Filipino.

Measures

A. Emotional Problems (dependent variable): Emotional Problems (EP) was measured by a widely-used eight item PMKadministered scale derived from the Ontario Child Health Survey [6-8, 13, 33, 52]. Each item has three forced-choice responses: (1) never or not true, (2) sometimes or sometimes true, and (3) often or very true. Sample items include: How often would you say that (index child) (a) seems unhappy, sad or depressed? (b) not as happy as other children? (c) appears miserable, unhappy, troubled or distressed? (d) cries a lot? Scale properties were as follows: PRC children ages 4-6 alpha = 0.71; ages 11 – 13 alpha = 0.75; HK age 4-6 alpha = 0.80; age 11-13 alpha = 0.76; Filipino age 4-6 alpha = 0.75; 11-13 alpha = 0.76. In order to handle missing data, item means were substituted, following which items were summed in order to arrive at a total score. Based on item means, the scale scores in the total sample ranged from 1–2.6, M = 1.31, SD = .30.

B. Arrival Characteristics: i)

Children’s Personal characteristics: (a) gender (male = 52 percent) and (b) age in years at time of arrival.

ii)

PMK with University degree: Did the PMK complete at least one University-level

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Selection Settlement or Culture degree (e.g. Master’s, Doctorate or PhD) before arrival? Yes = 1, No = 0. (Yes = 58.7 percent). iii)

PMK arrival fluency in English/French: measured by a single item: ‘‘Prior to coming to Canada, what was your ability to speak English,” or, for the Montreal sample, ‘‘French’’? Fluent=1, Non-fluent=0. (Yes = 22.5 percent) Previous studies [5, 19] support the validity of this single item.

iv)

Arrival assistance from family:

measured as the response to the following

question: “When you arrived in Canada, did you receive assistance from family or friends already living here?” Yes = 1, No = 0. (Yes = 44.9 percent).

C. Settlement Contingencies: i)

PMK depression: a 16-item measure that has been used in previous cross-cultural studies [5, 8]. Forced choice responses to the items making up the scale range from “rarely” or “none of the time” = 1 to “most or all of the time” = 4. Questions included:: “During the past few weeks…(a) Have you been low and hopeless? (b)] Have your thoughts seemed mixed up? (c) Have you been feeling remorseful?” Coefficient alphas among the three ethnic groups ranged from 0.90 to 0.92.

ii)

PMK somatization: a 9-item scale measuring vague somatic complaints that has been used in previous cross-cultural studies [5, 8]. Forced choice responses as for depression.

Items include: “During the past few weeks have you…(a) been

feeling sickly? (b) feeling weak or light-headed? (c) lost appetite?” Coefficient alphas ranged from 0.86 to 0.88.

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Selection Settlement or Culture iii)

Intrafamilial Conflict: a 6-item scale consisting of items such as “(a) Family members don’t get along well together and (b) some family members feel ignored or neglected, “scored as strongly disagree = 1, to strongly agree = 5. Coefficient alphas ranged from 0.70 to 0.72.

iv)

Settlement Stress: a 6-item scale consisting of items such as ” (a)] I worry about the future of my children and (b) I am unable to do the things I used to enjoy.” Scores ranged from never = 1, to very often = 4. Coefficient alphas in the three ethnic groups ranged from 0.86 to 0.88.

v)

Separations: number of years child was separated from mother or father respectively during the 10-year period prior to interview, (a) from mother, range = 0-10 years, M = 0.26, SD = 1.05; (b) from father, range = 0-10, M = 0.25, SD = 1.18.

vi)

Child’s age when mother started working: scored as, under one-year old = 0, oneyear old or more = 1, mother never worked = 2.

vii)

Poverty: based on a Statistics Canada classification [35]: households with 1–2 persons and a total income below $15,000; or 3–4 person households with income below $20,000; or households with 5 or more persons and income below $30,000 are experiencing severe poverty. Yes = 1, No = 0. (Yes = 32.2 percent).

D. Cultural Factors: i)

One-child household: Yes = 1, No = 0 (Yes = 31.5 percent).

ii)

Harsh parenting: a 6-item scale consisting of items such as, “How often do you (a) Raise your voice/scold/yell at your child? and (b) punish your child according to your mood?” Scores range from never = 1, about once a week or less = 2, a few 9

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Selection Settlement or Culture times a week = 3, one or two times a day = 4, or many times each day = 5. Coefficient alphas ranged from 0.68 to 0.69; M = 2.62, SD = 0.57 iii)

Supportive parenting: a 6-item scale with items such as “How often do you…(a) praise child, (b) talk or play together?” Scoring was identical to harsh parenting. Coefficient alphas ranged from 0.81 to 0.82, M = 3.12, SD = 0.73.

Results Descriptive statistics appear in Tables 2a and 2b, along with inter-ethnic and country of origin comparisons. Table 2a data pertain to the pre-school, and 2b to the pre-adolescent cohort.

INSERT TABLES 2a and 2b

Children from Hong Kong had the highest levels of Emotional Problems (EP), followed by children from the People’s Republic of China, and both had higher levels of EP than Filipino children. For both younger and older age groups, Hong Kong PMK’s were less highly educated than the other two groups. Filipino PMK’s were more likely than their Chinese counterparts to be fluent in one of Canada’s official languages. In comparison with the other two groups, PRC PMK’s were far less likely to have received family assistance at arrival. PRC PMK’s were suffering the highest levels of both depression and somatization. Filipinos experienced less intrafamilial conflict than Chinese families but pre-adolescent Filipino children were particularly likely to have experienced maternal separation. HK PMK’s were less likely to have entered the labour force than their PRC or Filipina counterparts. Despite their relatively high level of

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Selection Settlement or Culture education, PRC families were significantly more likely than either HK Chinese or Filipinos to be living in poverty. As expected, the majority of PRC households contained only one child whereas this was a relatively rare pattern for the other two groups. HK PMK’s were the harshest disciplinarians, and Filipinos the most likely to use a supportive style of parenting. In order to examine the respective contributions of arrival characteristics, circumstance and culture to ethnic and country-of-origin differences in immigrant children’s mental health, the research team first examined the correlations among the dependent and independent variables (correlation tables pertaining to the two cohorts appear as appendices a and b respectively) and then conducted a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; Personal and familial arrival characteristics were added in model 2; settlement contingencies in model 3 and cultural factors in model 4. Results for the younger and older cohorts appear in Tables 3a and 3b.respectively. (n’s differ slightly from Table 1 because of missing data).

INSERT TABLES 3.a and b

The final set of predictor variables (model 4) accounted for 19.3 percent of the variance in EP scores for younger children and for 23.2 among the older cohort. In both age groups, Model 1 showed that Filipino children had the best mental health, followed by, in descending order, PRC and HK children. As evidenced by very small R2 increases, Model 2, containing children’s age and gender, together with parent’s human and social capital characteristics made a weak contribution to explaining EP score variance. There were, nevertheless, significant inverse relationships between EP and PMK fluency in English or French for both samples, and for the

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Selection Settlement or Culture younger cohort, between EP and PMK education. The PRC mental health advantage over the HK groups disappeared at this stage. Since there were no significant differences between the HK and PRC levels of language fluency, the disappearance of the PRC mental health advantage is probably attributable – at least for the older cohort -- to the fact that the PRC children were older than their HK counterparts at the point of arrival (correlation between EP and age at arrival=(.131*) for older cohort, n.s. for younger). According to Model 3, settlement contingencies accounted for significant increases in the explanatory power of the respective regression equations, net of the effects of country of origin, demographic and selection characteristics. This block of variables also accounted for the Filipino versus others mental health differences in the older cohort. Levels of PMK depression and somatization, intrafamilial conflict and settlement stress each varied directly with levels of children’s EP, but neither child’s age when mothers started working nor poverty had an apparent effects. Model 4, incorporating cultural variables, contributed an additional 7 percent to the explained variance in EP scores among the younger children and 5 percent among the older. One child family structure had no apparent effect on EP. Harsh parenting was a risk factor for both age groups and supportive parenting a protective factor for the younger group. Harsh parenting, more characteristic of HK than other country of origin groups, apparently accounted for the mental health disadvantage of 11-13 year old HK children.

Conclusions and Discussion The study contributes to an important process -- moving beyond describing associations between child mental health and variables such as ethnicity and country of origin to an understanding of what these associations mean [56].

The study illustrated an important

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Selection Settlement or Culture conceptual distinction between ethnicity and country of origin.

The terms are often used

interchangeably, but they are not synonymous. Taking advantage of contrasts in the respective immigration trajectories of PRC, HK and Filipino immigrant children and their families, the NCCYS investigated the respective contributions of selection and arrival characteristics, settlement contingencies and culture to explaining country-of-origin differences in children’s mental health.

Settlement contingencies and culture proved to be powerful influences on

immigrant children’s mental health net of the selection criteria that often receive the credit [4, 26, 34, 38, 50, 55]. Study limitations include the nature of the sampling, sources of data, and the large number of variables examined. Although weighting was used to offset restricted sample variability, the study samples are not representative of all immigrant children, or even of all immigrant children from HK, the PRC and the Philippines.

Snowball sampling may, for example, result in over-representing

immigrants with the most extensive social networks and, as a result, under-estimate levels of distress. True probability sampling of difficult to locate immigrant families is elusive, and complicated by new settlers' mobility during the initial years of resettlement. The NCCYS does not, however, aim to establish rates and to make cross-sample comparisons, but to investigate the impact of theoretically meaningful factors on the mental health of immigrant children through statistical modeling. Budgetary, time and feasibility constraints militated against collecting family data from more than one source, usually the mother. Other investigators [49] have, however, reported that paternal mental health and father’s level of education contribute little if anything to the prediction of immigrant children’s mental health, net of information from and about the mother.

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Selection Settlement or Culture Although the NCCYS team did not conduct validity tests for each instrument among each of the cultural groups employed, the measures resemble the much-used Achenbach scales whose crosscultural applicability has been repeatedly demonstrated [70]. Furthermore, in the current study, the coefficient alpha for each of the measures was satisfactory. The relatively large number of variables included, together with large sample sizes increases the probability of type 1 error. Whenever possible, as in the between-group analyses reported in Tables 2a and 2b, two-sided adjustments were made for multiple comparisons to militate against the identification of potentially spurious significant relationships. The study did not include length of stay in Canada despite literature suggesting the importance of this variable [2, 55]. The correlation between length of stay and age at arrival was 0.91. To avoid problems associated with collinearity, length of stay had to be excluded from the analyses. Despite methodological limitations, the study contributes to an understanding of the relative importance of risk and protective factors associated with selection, settlement circumstance and culture in explaining immigrant children’s mental health. Each step in the regression analysis made a significant contribution to explaining mental health, but settlement contingencies and culture had more profound effects on children’s mental health than selection. Differing inter-group circumstances also explained the marked mental health advantage of Filipino pre-adolescents compared to the two Chinese groups. Canada’s immigrant selection criteria did not contribute very much to explaining the emotional health of immigrant children. PMK language fluency was the one exception, but this effect disappeared when settlement contingency variables were entered in Model 3. These results suggest that poor language facility may affect children’s mental health because it creates a

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Selection Settlement or Culture risk for depression and somatization among parents [29], and because it predisposes to parentchild misunderstandings and intrafamilial tensions [39]. Parental mental health was an important predictor of children’ mental health. Paralleling the mental health gradient among the children in this study, Filipino PMK’s had lower levels of depression than HK PMK’s, and the PRC group fell in between. Including parents’ mental health as a resettlement contingency is not meant to imply that resettlement causes parents’ emotional problems. This is still a question requiring further research. For example, although mental health is not one of Canada’s immigrant selection criteria, it could be an indirect effect of selection policies. It is, for example, possible that, by selecting the most highly educated, the most linguistically qualified and the people with the largest social networks, Canada also selects the mentally healthiest families [50]. This line of speculation is consistent with the observed differences between PRC and HK parents. PRC immigrants were rigorously selected according to the points system for human and social capital. The HK group, on the other hand, was much more likely to have been admitted on the basis of wealth and entrepreneurial know-how. The result, as could be expected, was that the PRC parents as a group had more human capital. They were also in better mental health than their HK counterparts. Regardless of their etiological underpinnings, PMK depression and somatization are among the many contingencies that can affect the mental health of children settling in Canada. Finding that compromised mental health among parents is a risk factor for children suggests the need for a whole-family approach to promoting mental health and adaptation. Adults burdened by their own mental health problems are unlikely to be optimally effective parents. Furthermore, parents'' mental health problems can be bewildering for children. Even more than among Westerners, Eastern and Southeast families’ fear of stigma constrains recognition and

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Selection Settlement or Culture comprehension of mental health problems [78]. Because they lack understanding of depression and its effects, children in such families may experience an even greater sense of burden in reaction to their parents’ depressed moods than their North American counterparts [58]. Consistent with other studies of immigrant children [9], family income did not prove the powerful predictor of mental health that it is among native-born populations. Beiser et al [9] have proposed that this is because immigrant poverty -- at least during the first decade of resettlement -- is less likely than main-stream family poverty to be associated with family breakdown and intrafamilial hostility, The weak and unstable association between child-parent separation and mental health among the older cohort is surprising but consistent with a recent study by Suarez-Orozco et al. [66] showing that, five years after the reunion of previously separated families, any adverse mental health effects on children had disappeared. In addition, the variable, “separation,” -defined simply as physical separation between parent and child -- is probably too crude. In many parts of the world, leaving children in the care of grandparents or other family while parents pursue education or employment elsewhere is part of a normative pattern of child-rearing. Future studies of the effects of separation should take into account factors such as the meaning and nature of separation as well as the arrangements made for the child in his or her parents’ absence. Investigations [41, 56] suggest that, with good child care arrangements, maternal absence may actually promote resilience. Culture made a difference. Chinese parenting, often portrayed as disciplinarian and emotionally restrained [43], was associated with elevated levels of EP. Even if supported by tradition, some parenting styles may not export well. In fact, recent research suggests that, even in China itself -- where it may be culturally normative -- harsh parenting can jeopardize

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Selection Settlement or Culture children’s mental health whereas parental warmth can be protective [18]. Chinese and Southeast Asian children complain that, in comparison with what they observe in the larger society, their parents are too emotionally reticent [10, 39, 42, 43, 72]. The perception of being emotionally short-changed has a deleterious effect on Chinese immigrant children’s mental health [39, 76]. As an intervention, Parke and Buriel [54] suggest that ethnic minority children could be helped to understand their parents better by encouraging them to comprehend ethnic as well as dominant cultural norms of parenting. The literature has less to say about addressing parents, but it seems reasonable to suggest the value of engaging mothers and fathers in this process as well. It is important to be respectful of culture mores, but encouraging parents to consider the extent to which traditional parenting styles retain their functionality in resettlement countries might prove helpful [32]. Contrary to a considerable literature claiming that only children suffer an elevated risk of developing mental health problems [48], the study results showed no risk differentials between immigrant children in single-child or multiple sibling households [see also 37, 48, 77]. The study raises further research questions. For example, the predictor variables in the study analyses explained only one fifth to almost one quarter of the variance in EP scores. Previous NCCYS publications [6-8] have dealt with the mental health salience of other migration-related factors such as home-school tensions, discrimination, prejudice, and region of resettlement. Future NCCYS reports will add to these investigations and will also address longitudinal issues. The current study data are cross-sectional whereas immigrant adaptation is a constantly changing process. A study by Montazer and Wheaton [49] suggests that the relatively good mental health of PRC and Filipino children may not last. According to that study, mental health

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Selection Settlement or Culture among first generation immigrant children in Canada originating from countries with low GNP (which would include the Philippines and the PRC of the 1990’s) was better than the mental health of immigrant children from countries with medium or high GNP. However, the mental health of children born abroad who came to Canada at an early age, as well as second generation children whose families had originally migrated from low GNP countries was worse than their first generation counterparts. Montazer and Wheaton’s results suggest that the mental health of children from Hong Kong may eventually be better than that of their counterparts from the PRC and the Philippines. Like the Montazer and Wheaton report, a US study by Willgerodt and Thompson [75] comparing Chinese, Filipino and European origin immigrant youth produced findings opposite to our NCCYS results. Filipino youngsters were at higher risk than their Chinese or Euro-American counterparts for emotional as well as behavioural disorders. The fact that Willgerodt’s study sample was considerably older than the NCCYS sample is consistent with the Montazer and Wheaton study in suggesting that the mental health advantage of Filipino children evidenced in the NCCYS data may prove evanescent.

Longitudinal studies are

necessary in order to explore this intriguing possibility. Immigrant-receiving countries are preoccupied with finding a formula for immigrant selection that will ensure integration. Authorities in the US [53] and the EU [26] have argued in favor of adopting a human and social capital points system remarkably similar to Canada’s. For children at least, settlement contingencies and culture trump selection.

Concentrating on

selection while neglecting everything else that affects the lives of immigrant children does not make for good policy [see also 72]. What happens after admission -- the relative balance between opportunity and obstacle immigrant children and their families encounter, and the

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Selection Settlement or Culture accommodations they can or are willing to make between past lives and present realities -- seems to matter more.

Acknowledgments This paper is a product of the New Canadian Children and Youth Study (Principal Investigators: Morton Beiser, Robert Armstrong, David Este, Anne George, Linda Ogilvie, Jacqueline Oxman-Martinez, Joanna Anneke Rummens, Lori Wilkinson), a national longitudinal survey of the health and well-being of more than 4,000 newcomer immigrant and refugee children living in Montreal, Toronto, Winnipeg, Edmonton, Calgary and Vancouver. The NCCYS is a joint collaboration between university researchers affiliated with Canada’s four Metropolis Centres of Excellence for research on immigration and settlement, and community organizations representing Afghani, Hong Kong Chinese, Mainland Chinese, Latin American (El Salvadorean, Guatemalan, Colombian), Ethiopian, Haitian, Iranian, Kurdish, Lebanese, Filipino, Punjabi, Serbian, Somali, Jamaican, Sri Lankan Tamil, and Vietnamese newcomers in Canada. Major funding for the project has been provided by the Canadian Institutes for Health Research (CIHR grants FRN-43927 and PRG-80146), Canadian Heritage, Citizenship and Immigration Canada (CIC), Health Canada, Justice Canada, Alberta Heritage Foundation for Medical Research, Alberta Learning, B.C. Ministry of Social Development and Economic Security, B.C. Ministry of Multiculturalism and Immigration, Conseil Quebecois de la Recherche Sociale, Manitoba Labour and Immigration, the Montreal, Prairies, and Ontario Metropolis Centres of Excellence for research on immigration and settlement, and the Ontario Mental Health Foundation.

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Selection Settlement or Culture References 1. Agbayani-Siewert, P. (1994). Filipino American culture and family: Guidelines for practitioners. Families in Society, 75, 429–438. 2. Alati R, Najman JM, Shuttlewood GJ, Williams GM, & Bor W (2003) Changes in mental health status amongst children of migrants to Australia: a longitudinal study. Sociology of Health & Illness (November 2003), 25 (7), pg. 866-888 3. Alegria M, Sribney W, Woo M, Torres M & Guarnaccia P (2007) Looking beyond nativity: the relation of age of immigration, length of residence and birth cohorts to the risk of onset of psychiatric disorder for Latinos, Research in Human Development 4, 19-47 4. Beach C, Green AG, & Worswick C (2006) Impacts of the Point System and Immigration Policy Levers on Skill Characteristics of Canadian Immigrants, Queen’s University Economics Department Working Paper No. 1115, March, 2006 5. Beiser M, (1999) Strangers at the Gate: The “Boat Peoples’” first ten years in Canada, Toronto, University of Toronto Press. 6. Beiser, M., Fenta, H., Baheretebib Y., Pain, C., Arraya, M., Taa, B., (2012) A Comparison of Emotional Problems and their Determinants among Ethiopian Children in Addis Ababa, Ethiopia, and Toronto, Canada, Transcultural Psychiatry 49(5) 651–677. 7. Beiser, M., Zilber, N., Simich, L., Youngmann,R., Zohar, A., Taa, B., & Hou, F. (2011). Regional effects on the mental health of immigrant children: Results from the New Canadian Children and Youth Study (NCCYS). Health & Place, 17, 822-829.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture 8. Beiser, M., Hamilton, H., Rummens, J.A., Oxman-Martinez, J., Ogilvie, L., Humphrey, C., & Armstrong, R. (2010). Predictors of emotional problems and physical aggression among children of Hong Kong Chinese, Mainland Chinese and Filipino immigrants to Canada. Social Psychiatry & Psychiatric Epidemiology, 45, 1011-1021. 9. Beiser, M., Hou, F., Hyman, I. & Tousignant, M. (2002). Poverty, family process, and the mental health of immigrant children in Canada. American Journal of Public Health, 92, 220-227. 10. Beiser, M. & Hyman, I. (2000) Perceptions of stress in Southeast Asian refugee youth: Implications for the development of culturally appropriate measures.” In: F. Ahearn (Ed.), Psychological Wellness of Refugees. Oxford: Berghahn Books, 180178. 11. Berger, L.M., Brooks-Gunn J., Paxson, C., Waldfogel, J. (2008) First-year maternal employment and child outcomes: differences across racial and ethnic groups. Children and Youth Services Review, 30, 365–387 12. Bernhard, J., Landolt, P., & Goldring, L. (2006). Transnational, multi-local motherhood: Experiences of separation and reunification among Latin American Families in Canada. Policy Matters, 24, 1-6. 13. Boyle, M. H., & Lipman, E. L. (2002). Do places matter? Socioeconomic disadvantage and child problem behaviour in Canada. Journal of Consulting and Clinical Psychology, 702, 378-389.

21

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture 14. Breslau J, Borges G, Hagar Y, Tancredi D, Gilman S (2009). Immigration to the USA and risk for mood and anxiety disorders : variation by origin and age at immigration. Psychological Medicine 39, 1117–1127. 15. Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees. (1988). After the door has been opened: Mental health issues affecting immigrants and refugees in Canada (No. Ci96–38/1988E). Ottawa: Ministry of Supply and Services Canada 16. Chen, A.B. (1990). Studies on Filipinos in Canada: State of the art. Canadian Ethnic Studies, 22, 83-96. 17. Chen, A.B. (1999). Filipino. In G. Scardellato (Ed.), Multicultural History Society of Ontario: Encyclopedia of Canada’s Peoples (pp. 111-113). Toronto: University of Toronto Press. 18. Chen J.J., & Liu X (2012). The mediating role of perceived parental warmth and parental punishment in the psychological well-being of children in rural China, Social Indicators Research, 107, 483-508. 19. Chiswick, B. R., & Miller, P. W. (1998). Language skill definition: A study of legalized aliens. International Migration Review, 32, 877–900. 20. Chui, T., Tran, K., & Flanders, J. (2005). Chinese Canadians: Enriching the cultural mosaic. (Catalogue No. 11-008). Canadian Social Trends. Ottawa: Statistics Canada. 21. Citizenship and Immigration Canada. (2002). Facts and Figures. Ottawa: Minister of Public Works and Government Services. 22. Citizenship and Immigration Canada, (2006). Facts and Figures 2006 - Immigration Overview: Permanent Residents, Retrieved from Citizenship and Immigration Canada

22

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture website: http://www.cic.gc.ca/EnGLIsh/resources/statistics/facts2006/permanent/12.asp., accessed Oct. 17 2012 23. Citizenship and Immigration Canada. (2007a). Facts and Figures 2006 – Immigration Overview: Canada, Permanent Residents Less than 15 Years of Age by Gender, Age and Category. Retrieved from Citizenship and Immigration Canada website: http://www.cic.gc.ca/english/resources/statistics/facts2006/permanent/07.asp, accessed Oct. 17 2012 24. Citizenship and Immigration Canada. (2012). Investors. Retrieved from Citizenship and Immigration Canada website: http://www.cic.gc.ca/english/immigrate/business/investors/index.asp. Accessed Oct. 5 2012 25. Coll C.G. & Marks A. K. (eds) The immigrant paradox in children and adolescents : is becoming American a developmental risk? Washington, D.C. : American Psychological Association, c2012. 1st ed. 26. Constant A & Zimmerman KF (2005) Immigrant performance and selective immigration policy: a European perspective. National Institute Economic Review. .194 (Oct. 2005) p94.- 105. 27. Degboe A, BeLue R, Hillemeier M (2012) Parental immigrant status and adolescent mental health in the United States: do racial/ethnic differences exist? Child and Adolescent Mental Health, 17, 4, 209-215 28. Dockery, A., Li, J., & Kendall, G. (2009). Parents' work patterns and adolescent mental health. Social Science & Medicine, 68, 689-698.

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Selection Settlement or Culture 29. Dolly JA, de Castro AB, Martine DP, Duran B & Takeuchi DT (2012) Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders, Social Science & Medicine , ISSN 0277-9536, 75, 12, 2085 - 2098 30. Downey, G., & Coyne, J.C. (1990). Children of depressed parents: An integrative review. Psychology Bulletin, 108, 50–76. 31. Driscoll, A., Russell, S., & Crockett, L. (2008). Parenting styles and youth well-being across immigrant generations. Journal of Family Issues, 29, 185-209. 32. Forehand, R., & Kotchick, B.A. (1996) Cultural diversity: A wake-up call for parent training, Behavior Therapy, 27, 2, 187-206 33. Georgiades, K., Boyle, M.H., & Duku, E. (2007). Contextual influences on children’s mental health and school performance: The moderating effects of family immigrant status. Child Development, 78, 1572-1591. 34. Green AG, Green DA Canadian immigration policy and the effectiveness of the points system and other instruments, The Canadian Journal of Economics Vol. 28, No. 4b, Nov., 1995 35. Gregg P., Washbrook E., Propper C., Burgess S (2005) The effects of a mother’s return to work decision on child development in the UK The Economic Journal, 115, F48-F80. 36. Heisz, A., & McLeod, L. (2004). Low-income in census metropolitan areas, 1980 – 2000. (Catalogue No. 89-613-MIE). Ottawa: Statistics Canada.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture 37. Hesketh T, Lu L & Xing ZW (2005) The Effect of China's One-Child Family Policy after 25 Years, The New England Journal of Medicine, ISSN 0028-4793, 353, 11, 1171 - 1176 38. Hochschild, JL., & Cropper, P. (2010). Immigration regimes and schooling regimes: which countries promote successful immigrant incorporation? Theory and Research in Education, 8, 21-61. 39. Hwang, W.C., Wood, J.J., & Fujimoto, K. (2010). Acculturative family distancing (AFD) and depression in Chinese American families. Journal of Consulting and Clinical Psychology, 78, 655-667. 40. Irving, H., Chau, S., Ka Tat Tsang, A., & Benjamin, M. (1998). Satellite children: An exploratory study of their experience and perception. Retrieved from Centre of Excellence for Research on Immigration and Settlement website: http://ceris/metropolis.net/Virual%20Library/community/irving1.html. 41. Jordan LP and Graham E (2012) Resilience and well-being among children of migrant parents in South-East Asia, Child Development, 83, 5, 1672-1688. 42. Juang, L.P., Syed, M., & Takagi, M. (2007). Intergenerational discrepancies of parental control among Chinese American families: Links to family conflict and adolescent depressive symptoms. Journal of Adolescence, 30, 965-975. 43. Kim, S.Y., Chen, Q., Li, J., Huang, X., & Moon, U.J. (2009). Parent-child acculturation, parenting, and adolescent depressive symptoms in Chinese immigrant families. Journal of Family Psychology, 23, 426-437.

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Selection Settlement or Culture 44. Kim SY & Ge X (2000) Parenting Practices and Adolescent Depressive Symptoms in Chinese American Families,

Journal of Family Psychology, ISSN 0893-3200,

9/2000, Volume 14, Issue 3, pp. 420 - 435 45. Kwak, K. (2003). Adolescents and their parents: A review of intergenerational family relations for immigrants and non-immigrant families. Human Development, 46, 115– 136. 46. Le Espritu, Y. (2002). Filipino navy stewards and Filipino health care professionals: Immigration, work and family relations. Asian and Pacific Migration Journal,11, 4766. 47. McKenzie, D. (2008). A profile of the world’s young developing country international migrants. Population & Development Review, 34, 115-135. 48. Mancillas A. (2006). Challenging the stereotypes about only children: A review of the literature and implications for practice. Journal of Counseling and Development, 84, 3, 268-275. 49. Montazer, S., & Wheaton, B. (2011). The impact of generation and country of origin on the mental health of children of immigrants, Journal of Health and Social Behavior, 52, 23-42. 50. Munroe-Blum, H., Boyle MH, Offord DR, and Kates N. (1989). Immigrant Children: Psychiatric Disorder, School Performance, and Service Utilization. American Journal of Orthopsychiatry. Vol. 59 No. 4, 510-519. 51. Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). (2001) Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General.

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Selection Settlement or Culture Rockville (MD): Substance Abuse and Mental Health Services Administration (US); Available from: http://www.ncbi.nlm.nih.gov/books/NBK44243/, accessed Nov. 16 2012 52. Oxman-Martinez J, Rummens JA, Moreau J, Choi YR, Beiser M, Ogilvie L, Armstrong R (2012) Perceived Ethnic Discrimination and Social Exclusion: Newcomer Immigrant Children in Canada, American Journal of Orthopsychiatry, 82, 3, 376 – 388 53. Papademetriou, D G & Yale-Loehr, S (1996) Balancing Interests: Rethinking U.S. Selection of Skilled Immigrants. International Migration Policy Program,Carnegie Endowment for International Peace, Washington, DC 54. Parke, R. D., & Buriel, R. (2006). Socialization in the family: Ethnic and ecological perspectives. In N. Eisenberg,W. Damon, & R.M. Lerner (Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 429– 504). Hoboken, NJ: John Wiley & Sons Inc. 55. Pfarrwaller E & Suris J-C (2012) Determinants of health in recently arrived young migrants and refugees: a review of the literature, Italian Journal of Public Health, 9,3, 7529 1-16. 56. Pottinger AM (2005) Children's Experience of Loss by Parental Migration in InnerCity Jamaica, American Journal of Orthopsychiatry, 75, 4, 485-496 57. Quintana, S.M., Aboud, F.E., Chao, R.K., Conterras-Grau, G., Cross, W.E., Hudley, C., Highes, D., Liben, L.S., Nelson-Le Gall S., Viet\e, D. (2006) Race, ethnicity, and culture in child development: Contemporary research and future directions, Child Development, 77, 5, 1129-1141.

27

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Selection Settlement or Culture 58. Russel ST, Crockett LJ, & Chao RK (eds) (2010) Asian American Parenting and Parent-Adolescent Relationships, Springer Verlag ISBN: 978-1-4419-5727-6 59. Santiago CD, Wadsworth ME, & Stump J (2011) Socioeconomic status, neighbourhood disadvantage and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families, Journal of Economic Psychology, 32, 2, 218-230. 60. Schellenberg, G. (2004). Immigrants in Canada’s census metropolitan areas (Catalogue No. 89-613-MIE). Ottawa: Statistics Canada. 61. Statistics Canada (1997). 1996 Census of Canada: the Nation Series. Ottawa: Minister of Government Works and Public Services 62. Statistics Canada. (2008). 2006 census data products. Ethnic origins, 2006 Counts for Canada, release date April 2, 2008, cata. No. 97-562-XWE2006002 63. Statistics Canada and Human Resources Development Canada (1995) National longitudinal survey of children: overview and survey instruments for 1994-1995, data collection cycle 1, Ministry of Industry, Ottawa 64. Stevens GWJM & Vollebergh WA (2008) Mental health in migrant children, Journal of child psychology and psychiatry, and allied disciplines, 49, 3, 276-294 65. Stewart, M., Anderson, J., Beiser, M., Mwakarimba, E., Neufeld, A., Simich, L., and Spitzer, D., (2008) Multicultural Meanings of Social Support among Immigrants and Refugees, International Migration, ISSN 0020-7985, 46, 3, 123 – 159 66. Suárez-Orozco C, Bang H.J., Kim, H.Y. (2011) I felt like my heart was staying behind: Psychological implications of family separations & reunifications for immigrant youth, Journal of Adolescent Research 26, 2, 222-257

28

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture 67. Takeuchi DR, Hong S, Gile K & Alegria M (2007) Developmental contexts and mental disorders among Asian Americans. Research in Human Development, 4, 4969. 68. Thompson SK, Seber GAF (1996) Adaptive sampling. New York,Wiley.

69. Van Geel M. & Vedder P. (2010) The adaptation of non-western and Muslim immigrant adolescents in the Netherlands: An immigrant paradox? Scandanavian Journal of Psychology, 51, 398-402

70. Verhulst, F.C., & Achenbach, T.M. (1995). Empirically based assessment and taxonomy of psychopathology: Cross-cultural application. A review. European Journal of Child and Adolescent Psychiatry, 4, 61-76. 71. Voyadoff P (1990) Economic stress and family relations, Journal of Marriage and the Family, 52, 1099-1115. 72. Washbrook, E, Waldfogel, J, Bradbury, B, Corak, M, & Ghanghro, AA (2012) The Development of Young Children of Immigrants in Australia, Canada, the United Kingdom, and the United States, Child Development, 83, 5, 1591 - 1607 73. Waters JL (2003) ‘‘Sattlelite kids’’ in Vancouver: transnational migration, education and the experiences of lone children. In: Charney M, Yeoh BSA, Tong CK (eds) Asian migrants and education: the tension of education in immigrant societies and among migrant groups. Kluwer Academic Publishers, London, 65–184 74. Watters JK, Biernacki P (1989) Targeted sampling: options for the study of hidden populations. Soc Problems 36(4):416–430

29

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

Selection Settlement or Culture 75. Willgerodt MA & Thompson EA (2006) Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents. Research in Nursing and Health, 29, 311-324. 76. Wu, C. X., & Chao, R. K. (2005). Intergenerational cultural conflicts for Chinese American youth with immigrant parents: Norms of parental warmth and the consequences. International Journal of Behavioral Development, 29, 516–523 77. Yang,B, Ollendick,TH, Dong,Q, Xia,Y, Lin,L, (1995) Only Children and Children with Siblings in the People's Republic of China: Levels of Fear, Anxiety, and Depression, Child Dev., 66, 5, 1301-1311 78. Yen S, Robins CJ, Lin N (2000) A cross-cultural comparison of depressive symptom manifestation: China and the United States, Journal of Consulting and Clinical Psychology, 68, 6, 993-999 79. Ying, Y., & Han, M. (2006). The Effect of Intergenerational Conflict and SchoolBased Racial Discrimination on Depression and Academic Achievement in Filipino American Adolescents. Journal of Immigrant & Refugee Studies, 4, 19-35

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Table

Predictors of Immigrant Children’s Mental Health in Canada: Selection, Settlement, Culture, or all of the above?

Table 1: Sample Description (Total N=2031)

4 to 6 year olds

11 to 13 year olds

Male Female Total

Male Female Total

PRC Chinese 175

186

361

195

192

387

HK Chinese

134

140

274

167

154

321

Filipino

179

164

343

187

158

345

Total

488

490

978

549

504

1053

Table 2A: Study sample characteristics for 4-6 year old cohort (n = 823)*

Ethnicity and Country of Origin

PRC Chinese Mean or %

Dependent measures Emotional problems (EP) Arrival Characteristics Child age at arrival Male PMK with University degree PMK arrival fluency Arrival assistance from family Settlement Contingencies PMK depression PMK somatisation Intrafamilial conflict Settlement stress Separation from mother Separation from father Child's age mother worked Under 1 years old 1 years old or more Mother never worked Poverty Culture One-child household Harsh parenting Supportive parenting

HK Chinese SD

Filipino

Total

Mean or %

SD

Mean or %

SD

Mean or %

SD

Range

Significance of group differences

1.30a

0.26

1.39b

0.34

1.26a

0.25

1.31

0.29

1-2.4

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