Depression Among Older Adults in Institutions

The causes of depression in older adults can be found issues such as the loss of a life partner, family, or friends, and changes in social roles and health. Although changes are inevitable in a person’s life they can be more challenging for older adults to handle, especially because these changes tend to occur at the same time. Older adults living in institutions have an extremely high rate of depression, with 30 to 40 percent suffering from mental illnesses (Canadian Mental Health Association, Ontario). For the older adults who can not afford private housing, moving into a care home may be their only option. This loss of independence along with leaving behind many of their personal possessions to move into a care home in itself a depressing situation for older adults. The causes of mental illness in older adults can be brought back to poor lifestyle and self-care, and their ability in adapting to modern-day society (Murray, M., Pullman, D. & Rodgers, T., 2003). This statement highlights some of the reasons why there is an extremely high rate of depression among older adults residing in care homes. The controversial issue with older adults suffering from depression in these institutions is that caregivers can overlook their symptoms, as they are masked by the inevitable results of aging.

The older adult’s lifestyle changes completely, having to get used to the new norms and having to make new relationship with other residents of the care home. The transition can be likened to a culture shock. The caregivers and residents of the care home promote relationships between residents by organizing tournament games, clubs and parties for all residents to participate in. In care homes caregivers are responsible to help older adults who are no longer capable of completing self-care tasks such as, bathing and feeding. For older adults who loose the ability to preform theses once basic tasks, they often feel a loss of autonomy, which ultimately results in depression. Older adults  have the belief that they should return to more traditional, non-medical approaches to healthcare and begin to look after themselves rather than turning to medicine (Murray, M., Pullman, D. & Rodgers, T., 2003). The reasoning for this is not only to reduce their dependency for medication but also to give themselves a sense of independence in handling their own health.

It is vital that older adults are capable of adapting to modern-day society, especially in care homes where there are already norms that they are expected to follow. When an older adult looses focus on what role they have in their environment, they can feel as if they do not serve a purpose in society. In attempting to follow norms older adults may believe that they are behaving in a socially responsible manner whereas if they deviate they feel they are behaving in an irresponsible manner (Murray, M., Pullman, D. & Rodgers, T., 2003). Thus they feel guilty and search for reasons to justify why they differ from modern-day society. This can lead to mental illnesses due to the stress of feeling isolated from other residents and caregivers in their care home.

Older adults that have depression within an institution are often untreated due to caregivers not recognizing their condition. This happens because older adults may  express or exhibit certain symptoms that are common to both aging and depression more frequently and in specific ways, which leads to caregivers to under diagnosing and therefore not treating the depression. The types of symptoms commonly shared with aging  and depression are physical problems such as having difficulty with sleep,  insomnia, and feeling tired all the time (Canadian Mental Health Association, Ontario). This a difficult obstacle for care givers to determine if an older adult has depression, which results in individuals not receiving treatment. The older adults with untreated depression often also suffer from other common mental disorders that include; Alzheimer's disease and other dementias, anxiety disorders or delirium (Canadian Mental Health Association, Ontario). This is an issue that can not be easily fixed in care homes because of the difficulties in clearly identifying and diagnosing symptoms of depression while taking into account the normal effects of aging.      

There are a variety of successful strategies that are available for older adults to overcome depression, which include talk therapies, increased social support, and psychiatric medications. The recovery rate for moderate to severe clinical depression is 60 to 80 percent using talk therapy and medication in combination (Canadian Mental Health Association, Ontario). Through socialization older adults can attain meaningful relationships with other residents that not only help them escape from isolation but give them the means to fit into society. This is why having residents participate in tournament games, clubs and parties is a very important aspect of care homes. Not only will they be able to have a role along side other residents, they can make meaningful relationships that help prevent depression.

In suggesting how to prevent mental illness in older adults, it can be brought back to achieving self-actualization. When an older adult can adapt to the lifestyle of living in an institution, it can create a role for the individual (Murray, M., Pullman, D. & Rodgers, T., 2003). Thus, giving the older adult a sense of purpose in the care home that results in the individual recovering from their mental illness. Although diagnosing older adults with depression is difficult, once it is, the worsening of the depression can be prevented by having social interaction with others, talk therapy, and in severe cases using medication. Looking back at older adults suffering from depression when adapting to the norms of their care homes, all they actually need is a support system that recognizes their needs and helps them meet them.    

-Chandra B

References

Murray, M., Pullman, D. & Rodgers, T. (2003). Heath Social Representations of Health and Illness among ' Baby−boomers' in Eastern Canada. Journal of health psychology, 8(5), p.485 – 499.

Canadian Mental Health Association, Ontario. (n.d.). Seniors and Depression. Retrieved from: http://www.ontario.cmha.ca/seniors.asp?cID=5800

Physical Disability Goes Hand in Hand with Mental Illness

The word disability is ironically in itself a challenge added to people with a physical disability because of the stigma that society attaches to the word itself and consequently to the people themselves. Whether people are born with a physical disability or have attained one over time, the potential for the individual to develop a mental illness remains the same. Individuals with a physical disability struggle to keep up with developmental norms, from graduating from kindergarten with their peers to having a family of their own. This is where the policies of the social welfare state come into use; to protect and help individuals who are in need of guidance through their personal struggles. Although there are policies that help protect from societies stigmas against people with a physical disability, the limitations put on these individuals runs deeper than the surface. 

It was found that amongst Canadian children between the ages of 5 and 14, approximately 155,000 or 4% of all children in this age group that have some form of activity limitation (Statistics Canada, 2008). McDougall et al. (2004) have found “children with activity-limiting conditions/impairments were significantly more likely to be socially isolated and have psychiatric disorders, low competence in recreational activities, and school difficulties compared to children without such health problems” (p. 36).  This statement is easy to understand because of the obvious challenges that children with physical disabilities will face when trying to accept their disability and be accepted by their peers. When a child is trying to understand that they are different from their peers they  can develop mental illnesses; this can come from the resentment of their own disability and the trauma that comes with not meeting societies norms at a tender age.

Children with a physical disability are likely to experience mental health conditions and learning disabilities, have missed school days, receive special education, visit health professionals, have been hospitalized, and used prescription medication (McDougall et al., 2004). These experiences that children with a physical disability endure in order to succeed in school and socialize with peers, shows in the limitations put on the child’s potential achievements and societies norms. Not only will these barriers hold back children with physical disabilities from keeping up with developmental norms in school, it will also affect the child’s mental development. Canadians who are born with a physical disability are likely to be happier than individuals who experienced the disability later in life (Statistics Canada, 2007). This shows that although children may have challenges keeping up with societies norms as they develop into adults, it can also help them learn to adapt to living with their physical disability.

            People with a physical disability are 5 times more likely than their nondisabled counterparts to be involuntarily unemployed (Turner, B. & Turner, J., 2004). When looking at this unjustified ratio, it gives a broader scope on the limitations put on individuals with a physical disability as adults. For individuals with a physical disability who already have a psychiatric disorder or have struggled with one as a child, the added stressor of being unemployed can amplify their mental illness. The psychiatric disorders among people with physical disabilities show a need for the social welfare state to provide guidance through their personal struggles.

            Rehabilitation efforts of individuals with a physical disability were well beyond the period of active rehabilitation efforts (Turner, B. & Turner, J., 2004). This shows that people with a physical disability are in need of more services to help recover from their physical disabilities limitations. Having more services available to people with physical disabilities will also give them an equal start in relation to their peers to be able to function in society. For adults with a physical disability getting counseling and having access to services is an opportunity for individuals who are showing signs of depression to get the help they need. Adults with a physical disability have social challenges and psychiatric challenges that intensify one another:

“The observation that persons with a physical disability are at increased risk for depression is presumably associated with the fact that physical disability implies a condition characterized by diminished capacity to perform social and occupational roles and, therefore, to meet personal needs and achieve related satisfactions” (Turner, B. & Turner, J., 2004, p. 247).

This statement, in a nutshell is trying to explain why people with a physical disability are at such a high risk of depression. People with a physical disability feel that their condition characterizes them as incapable of functioning as a self-sufficient member in society.

Overall all persons with a physical disability have a high risk of depression because of the stigma that society attaches to the word disability. Individuals who have a physical disability can feel that the condition they are in means that they cannot live up to their expected role in society. In hindsight this is not the case for persons with a physical disability, they are just as capable as their nondisabled counterparts when given job opportunities. The welfare state needs to provide more programs that enhance the sense of mastery that may well contribute directly toward decreased risk for depression (Turner, B. & Turner, J., 2004). When society thinks of the word disability they attach unrealistic limitations on to the individual; perhaps the language used to describe persons with a physical disability is in need of a revolution.

-Chandra B

References

McDougall, J., King, G., de Wit, D., Miller, L., Hong, S., Offord, Da., LaPorta, J., & Meyer, K. (2004). Chronic physical health conditions and disability among Canadian school-aged children: a national profile. Disability and Rehabilitation, 26 (1), 35–45.

Turner, B. & Turner, J. (2004). Physical Disability, Unemployment, and Mental Health. Rehabilitation Psychology, 49 (3), 241 – 249.

Statistics Canada. (2006). Study: Disability and well-being. Retrieved from: http://www.statcan.gc.ca/daily-quotidien/060912/dq060912d-eng.htm

Statistics Canada. (2008). Children with disabilities and the educational system — a provincial perspective. Retrieved from: http://www.statcan.gc.ca/pub/81-004-x/2007001/9631-eng.htm

   

Physical Disabilities and Unemployment

My dad use to be a nurse, working along side my mother.  They travelled all over the world, including the middle east or working on reserves in the north.  He loved his work and he loved traveling. He was the type of person that always needed to be on the go.  Unfortunately, one of his work trips called him again to the north.  On the way to his destination his plane crashed and he suffered severe injuries.  His injuries disabled him to the point that he was unable to be a nurse any longer.  As the years passed, he slowly started to get more and more depressed.  I never understood why this caused him so much depression at a young age. I thought that since we were still here, his family, that was all that should matter.  From my previous research on older adults, it was noted that a significant type of treatment for those suffering from a mental illness is working, by having a job.  By being in the professional work sphere, that person feels that they have a purpose in this life. And it was noted that having a purpose is a significant determinant for mental health and well being. 

 We live in a society where having a career is a major factor in defining who we are, how we live, and how others see us. Relating this to my father, his physical disability took away his purpose. It took away something that he had been working towards his entire life. So that purpose, that kept him motivated every day, was lost. From that perspective I understand why this loss caused him to be depressed. But having a physical disability does not only affect that one person. My mom than had to take on all the responsibility.  She had to work full to over time to support a husband and her two children.  I could tell that after a while it was starting to take it’s toll.  To a young girl I did not recognize that she was depressed, but now realizing the cue’s and symptoms of depression, I recognize she had suffered from it as well. 

For all the age groups put together, the employment rate for people with disabilities was almost 44% compared to just over 78% for those without disabilities. That makes a 34% difference. (Canadian Association of Professionals with Disabilities, 2011).  Sustainable employment is a major issue amongst people with disabilities.  It is even more difficult in securing and sustaining employment for those who have a certain types of disabilities- those that are perceived as more real or severe. Those that do attain a job find that they are too part time or short term to be able to contribute enough hours to be eligible for employment insurance (Canadian Association of Professionals with Disabilities, 2011). So again, the financial aid that they need sometimes is not available.  There are people with disabilities who have given up looking for employment out of frustration and sadness of coming up short. The continual rejection and barriers that a person with disabilities faces in terms of employment eventually takes a toll. It takes a toll on an individual emotionally, physically, socially and financially especially when there seems to be no light at the end of the tunnel (Canadian Association of Professionals with Disabilities, 2011).

It is not surprising the impact of unemployment has on a person with a disability because work impacts every aspect of our lives. It impacts the ability of someone to have a good life, to be involved in opportunities, take risks that bring a feeling of independence. It impacts such critical aspects of our lives that as a society we do not think about; like the ability to move out and get a place of our own, the choice to remain single, to enter into a relationship, ability to have children, to socialize, access to home ownership, transportation, health care. Even more areas such career opportunities, planning for retirement, and active community involvement are affected (Canadian Association of Professionals with Disabilities, 2011). 

Unemployment is a problem for physically disabled persons that is still persisting today.  Looking more closely at the affects that unemployment has on a person, it is not surprising that epidemiological studies have reliably shown that those with a physical disability have increased rates of emotional and behavioral difficulties and more incidences of mental health issues (Australian Psychological Society, 2001). Those suffering from a physical disability have more negative life experiences than those with no physical disability (Australian Psychological Society, 2001).  The epidemiological studies have shown that some physically disabled people lack meaningful career opportunities because of their handicap and as a result there is a heightened career stress (Australian Psychological Society, 2001). The sum of all of these factors have a huge bearing on an individuals mental health.

-Morgan

References:

Citizenship and Immigration Canada. (2010). Adapting to culture shock. Retrieved from:

Canadian Association of Professionals with Disabilities. (2011). As it stands now.... Retrieved from: http://www.canadianprofessionals.org/about.htm

Australian Psychological Society (2001). Physical Disabilities. Retrieved from: http://www.psychology.org.au/

Immigrants and Refugees

I read an article by S.Adler that talked about a Laotian group that immigrated to the US after 1975.  After there immigration to the united states, a great number of their people were starting to die from an unknown cause. Medical professionals later labelled there death as SUNDS: sudden unexpected nocturnal death syndrome.  They hypothesized that the cause of their death was due to intense emotional stress (Adler, 1995).  This was a group that had a number of entities that were important to them, including good and evil spirits.  And so this emotional stress was a result of the men not being able to deal with there ancestors properly.  It was a result of losing some of the cultural beliefs that were central to their identity (Adler, 1995).  

Reading this article raised my awareness on every aspect that an immigrant and refugee faces when moving to another country- in this case the leaving behind of a culture and tradition that has been long held.  Immigrants and refugees have several hardships they face when moving to a country different from their own.  The common struggles include: the almost constant learning of English or/and french to improve their language skills; having to take the first job or home that is less than what they originally expected; gender roles tend to change as women often enter the job market before men do (Guruge &Collins & Bender, 2010)).  

In summary the difference between their old life and their new life will be great.  Often times because of these hardships, immigrants and refugees suffer from culture shock and later on certain mental disorders. 

What I found interesting is that upon arrival in Canada, immigrants and refugees are generally in better health than those in Canada. However, after 10 years in Canada, immigrants and refugees are more likely to be in poorer health than their Canadian born counterparts (Guruge, Collins & Bender, 2010).  This is because the common factors that follow migration are associated with mental health.  Most of these common factors have been recognized as social determinants of health. These include income and social status, employment and working conditions, physical and social environments, gender, culture, and access to health services.  Additional determinants that have a huge weight on mental health are social isolation, language barriers, financial and employment constraints, role reversal struggles, racism, and discrimination (Guruge, Collins & Bender, 2010). I wanted to write one after the other just to prove the point of how many struggles that are ahead of those moving into Canada.  Some of these aspects that I have mentioned may be dehumanizing and extremely stressful. 

Immigrants and Refugees often have to respond to repetitive questions regarding their experience of violence and abuse for the immigrant procedures necessary to come into Canada.  These repetitive questions, that cause them to relive traumatizing experiences, can have immense implications on their mental health. Common mental illness’s that are found among immigrants and refugees are depression, anxiety disorders, and post-traumatic stress disorder. (Guruge, Collins, & Bender, 2010).

What I found also to be extremely surprising is that one of the major health determinants for immigrants and refugees into Canada is their access to services (Guruge, Collins, & Bender, 2010).  While there are many services that are intended to assist those new to our country during the post migration period, the actual accessing of such services can be extremely difficult. This is a result of trying to navigate bureaucratic hurdles, completing many application forms with a language barrier, or physically getting to various agencies that may not be in close proximity to them.  Lastly, volunteer or untrained interpreters may not be able to translate the language accurately (Guruge, Collins, & Bender, 2010).  Stress, as a result of these circumstances, can affect psychological and emotional well being, and exacerbate existing mental illness’s or result in new mental illness’s.

Programs such as Language Instruction for Newcomers (LINC) was specifically formed for newcomers coming into Canada. It was made to help reduce the language barrier between immigrants and refugees and the rest of the canadian population. As well, as lend knowledge about the lifestyle that these newcomers have entered (Canadian Mental Health Association, 2003). It is programs like these that help reduce the barriers that immigrants and refugees face when coming into Canada. It is programs like these that will help maintain and improve their mental health years after their migration. 

 -Morgan

References

Guruge,S., Collins, E., & Bender, A. (1999). Working with immigrant women: guidelines for mental health professionals. Canadian journal of Nursing Research, 41(3), 114-124.

Canadian Mental Health Association.(2003). Immigrants and Refugees Mental Health. Retrieved: 

http://www.cmha.ca/data/1/rec_docs/505_immigrationEN.pdf

Whitaker, E.D. (2006). Health and healing in comparative perspective. Upper Saddle River, NJ: Pearson Education Inc. 

All children deserve the same

There are many people, who deal with several types of Physical Disabilities. According to Canadian statistics, disabilities escalate with age. Statistics show that only 3.7 percent of children 14 and under will have a disability compared to the 43.4 percent of adults 65 and older with disabilities (Disabled world, 2008). According to this data, as you get older you are more likely to get a disability due to injuries obtained in any of the following areas: workplace, sports, motorized accidents, old age.etc

Reflecting off the experience of an individual who I knew very well, relates to the topic of individuals diagnosed with Physical Disabilities. At birth this girl was diagnosed with a minor cause of Cerebral Palsy. This physical disability affects your muscles as well as balance. This is caused from loss of oxygen to the brain during the growth of the baby. This physical disability limits the amount of active movement a person can do (Shevell, 2010).

This individual has difficulties learning but she was still active in class room activities. She was able to walk, but with difficulty. During my high school years I witnessed, the way my school dealt with children with Physical Disabilities.  This girl was a very dedicated individual who happen to love the sport baseball. Throughout elementary, she would participate to the best of her ability. As the years went by the competition got harder and that meant only the “best” play. This girl who attended all practices and was always there for the team, felt as though she wasn’t wanted anymore. I worked with her this past summer and she told me that the reason she no longer was on the team was because “she saw herself as a set back and that she would slow down the team”.  After hearing what “she thought” about herself, I felt ashamed that our school as well as her teammates didn’t do more for her. This girl had spent every summer until grade 10 playing her favourite sport and now felt unwanted and incompetent. It has affected her thoughts toward both the sport and herself. 

There are many children and teenagers going through similar emotional problems where they feel unwanted on sports teams due to their lack of skill, but in even more cases these children are not permitted to play at all. The emotional stress that these children suffer through may result in depression. I think that schools need to include more policies into their physical education. This would result in all kids getting a chance to participate in team building and would help reduce depression. I wish my school would have done something like this for her.

Sara

Citations:

Disabled World, (2008).Disability Statistics Canada

Retrieved from: http://www.disabled-world.com/disability/statistics/disability-statistics-canada.php

Shevell, M.I. (2010). Classifying cerebral palsy subtypes, Future Neurology.

Retrieved from: http://go.galegroup.com.proxy2.lib.umanitoba.ca/ps/i.do?id=GALE%7CA237504546&v=2.1&u=univmanitoba&it=r&p=HRCA&sw=w

Depression among Older Adults

Older adults have experienced and witnessed countless events throughout their lives that have impacted them both physically and emotionally. This causes many changes in their behaviour that may lead to several illnesses. If these changes in their environment are severe enough they may induce mental illnesses. The changes that are common causes of stress include: retirement, lower income, as well as passing of friends, family, and spouses (Canadian Mental Health Association).

   Common illnesses in older adults are depression, Anxiety, suicidal behaviour, dementia and many more (Help to help, 2008).  In the Article Seniors’ mental health and substances use issues states, 7 percent of older adults 65 + show signs of depression, as well 22 percent of suicide is from 60 years and older (Help to Help, 2008). This could pertain back to the loss of a loved one, and can’t handle dealing with the stress of being alone.  Dementia also known as Alzheimer’s is very common in seniors. This mental illness is when one losses memory as well as changes in mood behaviour, and ability to communicate (Help to help, 2008).  
    Treating these problems can be very difficult for the Older Adult as well as the doctor. Normal ageing can be mistaken for an illness, as well as the signs in older adults may look different to those younger (Help to help, 2008). In result of this doctors could potentially prescribe their patients with certain drugs, even though they could already be taking something else (Help to help, 2008).  Also a common case in older adults is that they are feeling emotions (which are normal) such as grief, sadness, anxiety and get prescribed medication to help them deal with these feelings (Help to help, 2008). I believe that everyone feels different sometimes and its not always the best solution to get drugs to help you cope with your emotions.

      I believe that many problems older adults face in care homes are because of the lack of social interaction which in results could potentially make you depressed.  An example would be my aunt who was diagnosed with Alzheimer’s. Her ability to remember even her immediate family was slowly diminishing.  It wasn’t long before she was unable to work or live on her own. Our family made the tough decision to put her in a home where she would be properly taken care of. She was lonely in her new home and couldn’t do any of her regular activities she would be doing in her own home. Even though her physical health was well in her new home her mental health was not. She soon became incapable of communicating due to lack of social interaction.

    There are many things that need to be done to help our Older Adults from becoming depressed, and even feeling as though they are isolated. Such as, giving older adults a more positive look on life, get them more involved in their communities, don`t just relieve their stress with medication ( Help to help,2008). As well the government should provide Older Adults with social and financial funds that are needed to help them be better-off. Also they should provide easier transportation access, and included more social activities for Older Adults who are frequently stuck at home (Help to help, 2008). In regards to those policies, I believe that it would reduce the chances of depression among Older Adults, as well as the many other mental health problems that can occur. They would be more involved in their communities and would no longer be isolated. As we grow older, we must discipline ourselves to continue expanding, broadening, learning, keeping our minds active and open. - Clint Eastwood

-Sara

Citations:

Canadian Mental Health Association.(n.d).Seniors and Mental Health
Retrieved from: http://www.ontario.cmha.ca/seniors.asp  


Help to help. (2008).Seniors'Mental Health and Substances use issues.
Retrieved from: http://heretohelp.bc.ca/publications/factsheets/seniors 

Immigrants and Refugees

Newcomers to Canada come from all over the world. They make up 17 percent of the Canadian population (Canadian Mental Health Association). This population consists of individuals leaving their homeland by choice to better their lifestyles; these people are known as immigrants. As well, it consists of refugees who are forced to leave their countries due to unsafe environments.

These conditions may be very stressful for the individual as well as their families, which can cause depression. According to Canadian Mental Health Association, article Immigrants and Refugees it states, “Stresses associated with immigration and resettlement may also put immigrants and refugees at increased risk for developing mental health problems” (Canadian Mental Health Association). Many stresses that immigrants deal with are language barriers, age of migration, losing family, friends and cultural background and as well as access to health care (Canadian Mental Health Association).

Influences that affect the individual such as age of immigrant can reflect back to their mental health status. Older Immigrants face more problems “specifically around isolation, abuse, language, culture and mobility” (Khanlou, 2010). Compared to the youth, older immigrants will face more problems, and the younger age will not experience much change in their mental health (Khanlou, 2010). This is the case because they leave behind fewer memories as older adults, plus the majority of youth migrate with their parents who will be taking on most of the stress. Obstacles that come into play with parents are generally education and employment. Dealing with these stresses can potentially lead to mental health issues (Khanlou, 2010). Having the stress of not being able to get a well-paying job to provide for their family, is very hard on an individual who is coming into a new country.

To help immigrants receive the right care and support, there has been many foundations formed, but one in particular called the CIC (Citizen Immigrant Canada) helps individuals in these cases. This program helps with Jobs and house hunting as well it provides various language training opportunities. It also provides support for those who are being abused; as well many of the services are provided in the individual’s first language (Canadian Mental Health Association, 2003).

Some qualities of each program are:

The LINC (Language Instruction for Newcomers) program reduced the language barriers between immigrants. This organizations policy is to provide language assistance to immigrants as well as provide them with knowledge about the Canadian lifestyle (Canadian Mental Health Association, 2003). I believe that this program is a great resource as it helps reduce stress put on immigrants who don’t know the native language. It will also get them involved in the community and this will result in meeting new people and starting to feel at home again.

Another great program is the Host Program which allows the immigrants to shadow a Canadian Citizen for a time being and, while being alongside them, they will learn all about the Canadian ways. It also gives the individual a chance to start learning the language and making new friends and as for the volunteer, they get to learn about other cultures and will also meet a new friend (Canadian Mental Health Association, 2003).

I believe these programs will help minimize stresses that Immigrant and Refugees face when coming to a new country, but I do know that memories will still be apparent. Also I trust that many organizations created to help these individuals, do a great impact on bettering their lives in their new country.


Sara


Citations:


Canadian Mental Health Association.(n.d).Immigrants and Refugees.
Retrieved from:http://www.ontario.cmha.ca/about_mental_health.asp?cID=23054

Canadian Mental Health Association.(2003). Immigrants and Refugees Mental Health.
Retrieved from: http://www.cmha.ca/data/1/rec_docs/505_immigrationEN.pdf

Khanlou,N.(2010). Migrant mental health in Canada1.Canadian Issues.

Retrieved from: http://search.proquest.com/docview/763161581?accountid=14569