Women Immigrants More Likely to Have Undiagnosed Depression Than Non-Immigrants

Sad woman sitting on the floor near her bed
Mid adult woman sitting home alone, worried.
Researchers conducted a prospective study in immigrant and non-immigrant populations to assess undiagnosed depression, persistent depressive symptoms, and mental health care assistance.

Immigrants, particularly women, are more likely to have undiagnosed depression (UD) and depressive symptoms (DS) that persist over time compared with non-immigrants, suggests a study published in Epidemiology and Psychiatric Sciences.

Canadian researchers examined the difference in prevalence and predictors of UD between 4382 immigrants (mean age, 65±10.7 years; 42.9% women) and 18,620 non-immigrants (mean age, 63±10.3 years; 47.9% women) using baseline data from the Canadian Longitudinal Study on Aging from 2012 to 2015. Eighteen months after enrollment, investigators examined for persistent and/or emerging symptoms of depression and whether a healthcare professional had been consulted for patients with DS.

UD was defined as the Center for Epidemiological Studies Depression 10 score of at least 10. Approximately 12.2% of immigrants had UD at baseline compared with 10.6% of non-immigrant participants. According to the multivariate logistic regression analysis, immigrant women were significantly more likely to have UD at baseline compared with women residents (odds ratio [OR], 1.50; 95% CI, 1.25–1.80). There was no similar association for immigrant men vs non-immigrant men in terms of baseline UD (OR, 1.05; 95% CI, 0.86–1.28). Women were more likely to be depressed compared with men (immigrant women vs immigrant men [OR, 1.85; 95% CI, 1.45–2.37]; non-immigrant women vs non-immigrant men [OR, 1.30; 95% CI, 1.14–1.47]).

A Kessler 10 score of at least 19 defined DS at 18 months. Approximately 34.2% of immigrants had persistent DS at 18 months compared with 31.4% of non-immigrants at this same time point. The multivariate model found that UD at baseline was associated with an increased risk of persistent DS at 18 months in women (OR, 5.10; 95% CI, 4.29–6.06) and in men (OR, 6.02; 95% CI, 4.90–7.41). There was no difference between immigrants and non-immigrants in the overall likelihood of consulting a mental healthcare professional at 18 months (OR, 0.95; 95% CI, 0.77–1.17), regardless of whether or not they had DS at this time.

A limitation of the study was the inclusion of only community-dwelling individuals, which excluded other at-risk individuals including those without homes or other living institutions.

The investigators concluded that clinicians should consider conducting a “systematic inquiry into patients’ migration trajectory” and should perform a “subsequent follow-up on culturally appropriate indicators of health,” which may ultimately “allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.”


Farid D, Li P, Da Costa D, et al. Undiagnosed depression, persistent depressive symptoms and seeking mental health care: analysis of immigrant and non-immigrant participants of the Canadian Longitudinal Study of Aging. Epidemiol Psychiatr Sci. Published online August 14, 2020. doi: 10.1017/S2045796020000670.