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]).

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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.