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Exploring Experiences of Mental Health in Second Generation South Asian Canadians

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Exploring Experiences of Mental Health in Second Generation South Asian Canadians Exploring Experiences of Mental Health in Second Generation South Asian Canadians by Nurul Hinaya Cader A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Health Sciences in The Faculty of Health Sciences Program University of Ontario Institute of Technology August, 2017 © Nurul Hinaya Cader, 2017 Abstract Although many studies have focused on the conceptualization of mental health, the literature only sparsely describes this phenomenon within the South Asian Canadian immigrant population. Furthermore, despite experiencing differential acculturation, there is a paucity in the literature concerning second generation South Asian Canadians. Thus, this research explored their experiences of mental health using Interpretive Description to conduct seven individual in-depth interviews. Seven themes were identified during data analysis: mental health stigma; mental health literacy; the in-between space; primary care; stress; the positive mind; and community participatory approaches. This research highlights the complexity of the conceptualization of mental health, the prevalence of the stigma of mental health, as well as the need for increased mental health literacy in the South Asian community. Findings of this research have implications for the development of targeted anti-stigma campaigns and for advocating for increased cultural safety and humility in the Canadian healthcare system. Keywords: mental health, stigma, culture, South Asian ii Acknowledgements I would firstly like to recognize the efforts of my thesis supervisor, Dr. Victoria Smye, for her ongoing support, patience, and guidance throughout my journey as a graduate student at UOIT. Thank you for providing me with the help and encouragement I needed to see this through to the end. I would like to express my gratitude to Dr. Wendy Stanyon and Dr. Pierre Côté for serving on my thesis committee with their rich expertise and providing me with valuable feedback. I would also like to sincerely thank Dr. Gail Lindsay for opening my eyes to the delightful world of qualitative research. To Yvonne Mais, Melanie Dissanayake, and Derek Manis, thank you for the incredible experiences we have had on this journey together. I treasure your friendships and look forward to celebrating many more successes with you. I would like to express my deepest gratitude to my wonderful family for providing me with unwavering support and being my source of strength. To my parents, thank you for everything you have done to raise me to be the successful individual I am today. I am proud to be your daughter. To my siblings, thank you for all the laughs, tears, and unconditional love; thank you for always having my back. To my husband, I cannot even begin to describe the praise I have for all that you have done to support me throughout this chapter of my life. Your endless words of motivation, your sincere determination to ensure I achieve all my goals, and your unequivocal love have not gone unnoticed. Thank you for helping me stay on track, and thank you for the entertaining distractions you provided during the more difficult stages of this journey. I am blessed to have such a strong and devoted family. Thank you for always believing in me. I love you all dearly. iii Table of Contents Abstract…………..………………………………………………………………………..ii Acknowledgements……………………………………………………………………....iii CHAPTER ONE: Introduction ........................................................................................... 1 1.1 Background ............................................................................................................... 1 1.2 Purpose of Study ....................................................................................................... 3 1.3 Overview of Thesis ................................................................................................... 4 CHAPTER TWO: Literature Review ................................................................................. 5 2.1 Search Strategy & Criteria ........................................................................................ 5 2.2 Mental Health and Illness: Differing Worldviews .................................................... 6 2.2.1 Traditional Paradigms of Mental Health ............................................................ 8 2.2.2 Emerging Paradigms of Mental Health ............................................................ 11 2.2.3 Access to Mental Health Services .................................................................... 13 2.3 Stigma...................................................................................................................... 16 2.3.1 Defining Stigma ................................................................................................ 16 2.3.2 Types of Stigma ................................................................................................ 18 2.3.3 Fighting Stigma ................................................................................................ 19 2.3.4 Stigma & Mental Health ................................................................................... 20 2.3.5 Stigma, Mental Health, and Culture ................................................................. 23 2.4 Culture ..................................................................................................................... 24 2.4.1 Culture, Cultural Safety, Cultural Competence/Humility ................................ 25 2.4.2 Individualism vs. Collectivism ......................................................................... 28 2.5 South Asians in Canada........................................................................................... 30 2.6 Research Questions ................................................................................................. 32 CHAPTER THREE: Methodology and Methods ............................................................. 34 iv 3.1 Research Design ...................................................................................................... 34 3.1.1 Qualitative Research ......................................................................................... 34 3.1.2 Interpretivism.................................................................................................... 35 3.1.3 Interpretive Description .................................................................................... 36 3.1.4 Individual In-Depth Interviews ........................................................................ 37 3.2 Researcher’s Positionality ....................................................................................... 38 3.3 Ethical Considerations............................................................................................. 40 3.4 Setting...................................................................................................................... 41 3.4.1 Recruitment Criteria & Sampling ..................................................................... 41 3.5 Data Collection ........................................................................................................ 42 3.6 Data Analysis .......................................................................................................... 43 3.7 Scientific Rigor ....................................................................................................... 44 CHAPTER FOUR: Results .............................................................................................. 47 4.1 Demographics.......................................................................................................... 47 4.2 Defining Mental Health ........................................................................................... 48 4.3 Mental Health Stigma.............................................................................................. 50 4.3.1 Fear of labeling ................................................................................................. 52 4.4 Mental Health Literacy and its Intersections........................................................... 54 4.4.1 Cultural Preconceptions: Attitudes towards Mental Health in South Asia ...... 55 4.4.2 Age and Generational Differences ................................................................... 57 4.4.3 Acculturation Experience ................................................................................. 58 4.4.4 Education and Exposure to Mental Health Issues ............................................ 59 4.5 Living in the In-Between Space .............................................................................. 61 4.5.1 Pressure to Succeed .......................................................................................... 63 4.6 Access to Primary Care: relationship, trust, and credibility .................................... 65 v 4.7 Stress: Having Too Much on Your Plate ................................................................ 67 4.8 The Positive Mind as the Healthy Mind.................................................................. 71 4.9 Community Participatory Approaches .................................................................... 74 CHAPTER FIVE: Discussion and Conclusions ............................................................... 79 5.1 “An asterisk next to my name”: the Stigma of Mental Health ................................ 79 5.2 A Lack of Mental Health Literacy: Explaining the Stigma of Mental Health ........ 83 5.3 Positivity and Mental
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