A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa,Ethiopia,and Toronto,Canada

Abstract

According to a literature of theory and advocacy, immigration and resettlement jeopardize the mental health of children and youth, largely because of factors such as intergenerational tensions arising from conflicts about the retention of traditional values, and experiences of prejudice and discrimination. The current study examines the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada, were compared with a matched sample of Ethiopian youngsters in Addis Ababa, Ethiopia. Data came from structured interviews with the person most knowledgeable about the family (usually a parent), as well as from the children themselves. Youth reported higher levels of emotional problems (EP) than their parents. Predictors differed for parent and child ratings. In both the Toronto and Addis Ababa samples, parental mental health predicted parent-rated, but not self-rated EP. Contrary to immigration stress theory, parental perceptions of prejudice predicted EP in Addis Ababa, but not Toronto, and parent–child discordance regarding ethnic adherence were predictors of self-rated emotional problems in Ethiopia, but not in Canada. Perceived discrimination was a significant predictor of self-rated emotional problems in both settings. Implications for theory and further research are discussed.

Keywords

refugee youth emotional problems acculturation ethnic retention prejudice discrimination Ethiopia Canada

A large immigration-centred literature of theory and advocacy (Amaral-Dias, Vicente, Cabrita, & de Mendon, 1981; Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees, 1988) and a comparatively limited number of empirical studies (Sluzki, 1979; Szapocznik, Scopetta, & Tillman, 1978; Youngmann, Shokeid, & Zilber, 2010) implicate postmigration stresses in the genesis of mental health problems among refugee children and youth. Parent–child dissonance in acculturation, discrimination, and prejudice are among the most frequently cited postmigration challenges (Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees, 1988; Costigan & Dokis, 2006; Fuligni, 1998; Kasinitz, 2008; Kasinitz, Mollenkopf, Waters, & Holdaway, 2008; Lau et al., 2005; Virta, Sam, & Westin, 2004; Zhou & Bankston, 1998). Parent–child conflicts over traditional versus “modern” values are usually described as either unique attributes of the resettlement experience, or else amplified by resettlement, and discrimination and prejudice tend to be viewed as experiences unique to countries of resettlement. However, even after major conflicts in refugee-producing countries are resolved, the prejudice and discrimination that cause people to flee their homelands in the first place do not immediately dissipate, nor is the intergenerational transmission of ethnocultural identity within home countries seamless and void of conflict. The current report from the Ryerson University Leavers and Stayers project—a study of Ethiopian children and their families in Toronto, and their counterparts in Addis Ababa (AA), Ethiopia—investigates the salience of putatively migration-specific mental health risk factors for youth in resettlement countries as compared with youth who have remained at home. The overall study questions include: (a) Are the stresses of dissonant acculturation and their effect on mental health unique to the immigration context, or, in an increasingly global world, do they also challenge and jeopardize the mental health of “stayers,” i.e., children and youth who grow up in the home country? and (b) Are prejudice, discrimination, and intergenerational value conflicts immigration-specific mental health challenges, or are they also salient for youth who remain in the country of origin?

Literature review and study background

According to a rapidly expanding literature on resettlement stress, intergenerational cleavages arising from acculturation disparities create mental health risk for immigrant children and youth (Costigan & Dokis, 2006; Hyman, Vu, & Beiser, 2000; Rick & Forward, 1992; Stevens, Vollebergh, Pels, & Grijnen, 2005; Tardif & Geva, 2006; Tobin & Friedman, 1984). For youth growing up in countries of resettlement, competition between the centripetal pull of the heritage culture and the centrifugal force of the receiving society may amplify the normal developmental challenge of identity formation (Amaral-Dias et al., 1981; Rick & Forward, 1992; Sluzki, 1979; Szapocznick et al., 1978). Prejudice and discrimination, all too frequent experiences for immigrant families and their children, may also create mental health risk (Correa-Velez, Gilford, & Barnett, 2010; Paradies, 2006; Stevens et al., 2005; Veling, Hoek, & Mackenbach, 2008). According to Canada’s Ethnic Diversity Survey (Badets, Chard, & Levett, 2003) almost one third of Blacks, 21% of South Asians and 18% of Chinese reported experiencing discrimination within 5 years prior to interview. According to some authorities, high rates of poverty among newcomer families constitute an additional mental health risk (Amaral-Dias et al., 1981; Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees, 1988; Darwish, Joung, Verhulst, Mackenbach, & Crijnen, 2004). However, a number of empirical studies have failed to demonstrate either direct (Beiser, Hou, Hyman, & Tousignant, 2002; Kasinitz, 2008) or moderating influences (Virta et al., 2004) of socioeconomic status on immigrant children’s mental health.

Many studies of migration document associations between risk factors and mental health outcome, but Vega, Gil, Warheit, Zimmerman, and Apospori (1993) are among the relatively few researchers to formulate specific mechanisms linking risk factors to mental health outcome. According to Vega et al., intergenerational strains within immigrant families can create a predisposition to delinquency among youth. Deviant behaviour subsequently develops as a product of the interaction between predisposition and acculturation experiences such as discrimination. The well-known theory of “segmental assimilation” (Portes & Zhou, 1993) offers a complementary perspective. This theory identifies race (or colour) and location as key determinants of a downward trajectory of adaptation. Racialized immigrants, Blacks in particular, encounter discrimination and prejudice that militates against their participation in the receiving society (see also Feagin, 1991; Li, 2000). Added to this, the concentration of immigrant households in poor neighbourhoods—the majority of whose inhabitants have also been marginalized—can lead immigrant youth to adopt referent groups from an adversarial subculture, rather than taking on values and skills relevant to eventual participation in the larger society. Kasinitz and colleagues (Kasinitz, 2008; Kasinitz et al., 2008) present a more optimistic picture of immigrant youth assimilation in North American society, but they agree with Portes and Zhou’s contention that Blacks experience particularly formidable challenges (see also Alba et al., 2010; Waters, 1999).

Although often discussed as if they were risk factors unique to immigration and resettlement (Canadian Task Force, 1988; Fuligni, 1998; Rick & Forward, 1992; Stevens et al., 2005; Tardif & Geva, 2006; Tobin & Friedman, 1984) intergenerational tensions centred on the socialization of children and youth, and conflicts between heritage and wider society cultures are probably becoming ever more ubiquitous as travel and exchange of information stimulate a global cross-pollination of values, behaviours, and societal trends. Similarly, although a great deal of the literature on mental health and development (Correa-Velez et al., 2010; Paradies, 2006; Stevens et al., 2005; Veling et al., 2008) creates the impression that prejudice and discrimination are factors unique to countries of resettlement, this formulation overlooks the obvious fact that immigrant and refugee source countries are far from ethnically homogenous, culturally static, or strife-free.

The widely held view that resettling in a new country is associated with elevated rates of mental disorder among children and youth (Amaral-Dias et al., 1981; Canadian Task Force, 1988) is plausible, but empirical studies have produced inconsistent findings, some supporting the hypothesis (Slonim-Nevo & Sharaga, 1997; Sluzki, 1979; Youngmann et al., 2010) and others refuting it (Beiser et al., 2002; McKelvey et al., 2002; Munroe-Blum, Boyle, Offord, & Kates, 1989). Choice of comparison group is one source of inconsistency. Most studies compare immigrant to native-born children. Although investigations of this type are valuable, comparative data from the home country are essential in order to triangulate on the question of mental health risk. Consider, for example, a situation in which rates of mental disorder among immigrant or refugee children were found to equal rates for native-born children. The most likely conclusion would be that immigration-related stress does not create mental health risk. However, if one were to discover that rates for children resettling in a new society were higher than the rates for their home-country counterparts, this would lead to the directly opposite conclusion, i.e., that immigration might, in fact, jeopardize mental health.

Psychopathology and maladaptive behaviour have tended to be the foci for immigrant and refugee-related research, but most newcomers overcome challenge, integrate more or less satisfactorily with the receiving society, and never develop a psychiatric disorder (Beiser, 1999; Hodes, 2001; Keyes, 2000; Sharon, Levav, Brodsky, Shemesh, & Kohn, 2009; Vaage et al., 2010). According to the results of a recently reported meta-analysis (Porter & Haslam, 2005), exposure to trauma is an insufficient predictor of variations in refugee mental health. Observations such as these have stimulated a relatively recent interest in resilience, conceptualized as the product of personal attributes, social capital, and environmental advantage (Garmezy, 1983; Luthar, Cichetti, & Becker, 2000).

The Ryerson University Leavers and Stayers project is an investigation of mental health, stress and resilience among 64 Ethiopian preadolescent boys and girls between the ages of 11 and 13 living in Toronto, Canada, and a matched sample of 175 youth in Addis Ababa. The study investigates the extent to which intergenerational conflict, prejudice, and discrimination are mental health challenges unique to countries of resettlement, and to what extent they might also be salient in the home country. The report also includes an investigation of the possible protective role of self-esteem, an important dimension of personal resilience (Pyszcynski, Greenberg, Solomon, Arndt, & Schimmel, 2004), and a predictor of achievement regardless of cultural context (Luthar et al., 2000; Ungar, 2008).

Ethiopians in Canada and in Ethiopia

Ethiopians in Canada

The Ethiopian community in Toronto, Canada’s largest city, numbers between 45,000 and 50,000 (Fenta, Hyman, Rourke, Moon, & Noh, 2010). Many came to Canada after internments in refugee camps or long periods in third-country havens spent waiting to be judged to fit the U.N. definition of refugee. In theory, immigrants and refugees in Canada have the same labour market opportunities as native-born Canadians. However, the country’s increasingly well-trained and competitive domestic labour force, together with structural barriers such as difficulties in recognizing foreign credentials and work experience are placing recent newcomers at increasing disadvantage (Badets & Howatson-Leo, 2002; Kunz, Milan, & Schetagne, 2000; Li, 2000; Reitz, 1998; Smith & Jackson, 2002). In 2004, one in five recent immigrants of working age was living in poverty compared to fewer than one in 10 other Canadians (Fleury, 2007). Immigrants who manage to find work are underpaid and underemployed (Statistics Canada, 2006). Although the research literature has produced inconsistent findings regarding the salience of socioeconomic status as a risk factor for immigrant children’s psychological well-being (Beiser et al., 2002; Kasinitz, 2008; Virta et al., 2004), the association between family poverty and risk of compromised child mental health among majority culture populations is one of the most robust findings in the child mental health literature (Evans, 2004; Miech, Caspi, Mofﬁtt, Wright, & Silva, 1999; Santiago, Wadsworth, & Stump, 2011).

Acculturation is usually defined as taking on the culture of a dominant group (Canadian Task Force, 1988). In resettlement countries, children and youth learn the dominant society language and incorporate its behaviours, manners and modes of dress more quickly than do their parents with, according to some studies (Bhattacharya, 1998, 2000; Phinney & Ong, 2002), a concomitant increase in mental health risk.

Prejudice and discrimination are part of the experience of too many visible minority immigrants in Canada. Prejudice is a social construct—a derogatory portrayal of groups in order to control others when competing for scarce resources (Fleras & Elliott, 2007). Discrimination refers to direct experience. According to Blank, Dabady, and Citro (2004), discrimination is any restrictive act, whether deliberate or not, that has the intent or effect of adversely affecting (denying or excluding) others on grounds other than merit or ability. Prejudice is about belief and attitude, discrimination about putting prejudgements into practice. In North America, being poor and black is a combination highly likely to lead to experiences with structural racism, in which disadvantage is built into the social stratification system (Waters, 1999).

Ethiopia

With a population of more than 80 million distributed over 1.1 million square kilometres, Ethiopia is Africa’s second most populous country. Addis Ababa, the country’s capital and its largest city, has a population of 3.5 million (Central Statistical Agency of Ethiopia, 2007). Like many African countries, Ethiopia is a multiethnic state. Although intermarriage over the years has blurred ethnic distinctions, many remain, a fact symbolized by the persistence of more than 80 different languages. In numerically descending order, the principal ethnic groups in Ethiopia are Oromo, (about 35% of the population), Amhara (27%), Somali (6%) and Tigre (6%) (Central Statistical Agency of Ethiopia, 2007). Amharic is the official language.

The Ethiopian empire, which dates from biblical times, lasted until 1974, when a military coup deposed Haile Selassie, the last emperor. The Provisional Military Administrative Council, informally known as the Derg, and led by Major Mengistu Haile Mariam, quickly assumed power, and declared Ethiopia a republic. However, the new republic proved to be little more than a facade for a Mengitsu dictatorship. In 1975, leftist forces launched the White Terror, an attempt to undermine the military regime through urban guerrilla warfare. To quell the resistance, the government supplied arms to peasants, workers, public officials, and students considered loyal to the government, thereby launching what it called the Red Terror. Between 1977 and 1978, 100,000 people suspected of being enemies of the government were killed or disappeared. A series of droughts created additional stress, further intensified by the Mengistu government’s mistrust of Westerners, which hampered worldwide efforts to provide food and medical aid. Between 1980 and 2005, one million people died from starvation, more than one million were internally displaced and 1.25 million fled to neighbouring countries, some to be accorded refugee status in North America and the EU. Today, despite progress and an estimated annual growth rate of nearly 10%, Ethiopia remains one of the poorest and most hunger-prone countries in the world. More than half the population lives on less than $1.00 per day (Bariagaber, 2006). In the eyes of the international community, there are reasons for continuing vigilance concerning human rights in Ethiopia. For example, on May 25, 2010, the U.S. National Security Council’s spokesman, Mike Hammer, released the following statement: “In recent years, the Ethiopian government has taken steps to restrict political space for the opposition through intimidation and harassment, tighten its control over civil society, and curtail the activities of independent media” (The White House, 2010).

Method

The first step in planning the Leavers and Stayers Study was to recruit a Community Advisory Council consisting of community leaders and health professionals from the Ethiopian community of Toronto. The Advisory Council worked with the investigators on all phases of the project from conceptualization and sampling, to judging the appropriateness of measures, to data preparation and interpretation.

Samples

Sampling new immigrant populations is methodologically challenging, because privacy laws restrict access to data about individuals, and high rates of mobility during the initial years of resettlement make it difficult to create suitable sampling frames. The sample of Ethiopian children included in the current study has its origins in a previous mental health survey of Ethiopian adults in Toronto (Fenta, Hyman, & Noh, 2004) and in the New Canadian Children and Youth Study (NCCYS), an investigation of the mental health and development of approximately 4,000 immigrant and refugee children in Canada (details concerning the NCCYS have been reported elsewhere, see Beiser et al., 2010; Beiser et al., 2011, and are also available at www.nccys.com). The NCCYS concentrated on two cohorts on the verge of important developmental transitions. The current report includes one of these cohorts, preadolescents, 11 to 13 years of age, who are particularly likely to be facing the intergenerational strains and becoming aware of the societal discrimination and prejudice that the immigrant literature characterizes as mental health challenges.

The previous adult survey employed a variety of strategies to develop a sampling frame. First, Ethiopian religious, political, and social organizations in Toronto were asked to contact their members to request permission to include their names in a total community census. A list of Ethiopian names was also extracted from the city telephone directory. Islamic names that might or might not be Ethiopian were reviewed by various Ethiopian organizations in order to identify the Ethiopians. Combining names from each of these sources yielded a sampling frame of 4,584 households. A total census was then conducted in order to identify households containing one or more children who fit the Leavers and Stayers Study criteria (11–13 years of age, and born either outside the country or into a family in which at least one of the parents had been in Canada 10 years or less). Qualifying households were then selected on a probability basis. A member of one of the participating community organizations then contacted the household to ask permission to arrange a follow-up meeting with a member of the research team. Eighty percent of the households contacted agreed to the interview. After a parent supplied written informed consent, the household was included in the study. Every child in the household qualifying for inclusion was recruited. Ethiopian families in the Toronto NCCYS study were asked to nominate at least one relative and one friend from secondary school currently living in Addis Ababa who had at least one child who fulfilled the study’s inclusion criteria and whom they would be willing to contact to ascertain their willingness to take part in a study. Once verbal permission had been obtained in this way, a member of the research team at Addis Ababa University contacted the nominated relative, explained the study and obtained written informed consent. The acceptance rate for interview was 95%.

Toronto and AA sample characteristics appear in Table 1.

Table 1.

Description of samples

	Addis Ababa N = 175		Toronto N = 64
Characteristic	n	%	n	%
Child gender:
Boys	84	48	40	62.5
Girls	91	52	24	37.5
^*PMK education:
High school or less	147	84	28	43.8
Diploma/certificate/BA	28	16	26	40.6
MA or higher	0	0	10	15.6
Family income:
Below official poverty line	113	64.6	42	65.6
Household: Number of people
2–3	37	21.1	14	21.9
4–5	80	45.7	32	50.0
6–7	44	25.1	13	20.3
8 or more	14	8.0	5	7.8

Note. *PMK = person most knowledgeable about the child (in most cases, the mother).

Procedure

NCCYS data sources for the current report include the Parent about Family (PAF), Parent about Child (PAC) and Child about Child (CAC) questionnaires. The PAF, administered to the person most knowledgeable about the child (PMK)—usually the mother—elicits information about parents’ ethnic and religious backgrounds, education, family income, health status, parenting behaviours, perceived social support, assessment of neighbourhood characteristics, pre- and postmigration stressors, and relationships with larger societal institutions. The PAC includes questions about the child’s general health and developmental history, as well as a checklist of psychiatric symptoms and positive behaviours. The CAC includes many items that overlap with items on the PAF, and information about symptoms that overlaps with the PAC.

Prior to including an item in the questionnaire, the Ethiopian Community Advisory Council 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 PAF, PAC, and CAC, and oversaw their translation into Amharic, and subsequent back-translation. A consensus panel comprised of researchers and members of the Advisory Council resolved item ambiguities. After extensive consultation with mental health experts and community leaders in Addis Ababa under the direction of one of the report authors (MA), the NCCYS survey instruments were adapted for use in Addis Ababa. Trained interviewers in Addis Ababa then contacted the Addis Ababa sample respondents, and secured informed consent.

Prior to the Toronto survey, two authors (MB and BT) conducted a 2-day training session with the interviewers. In Addis Ababa, (MB) and (YB) carried out a similar 2-day interviewer training session to help ensure comparability of data collection and procedures. Toronto data were collected using laptop computers whereas interviewers in Addis Ababa relied on paper and pencil instruments. The interviewers were instructed to interview the adolescents without their parents being present, and vice versa. Coded data were sent to Toronto via diskettes to be checked for completeness and accuracy by BT, the Toronto-based project coordinator. Ambiguities and problems with missing data were resolved through communication between BT and YB.

Measures

Depending on whether the dependent variable was parent-rated or self-rated mental health, a slightly different set of predictor variables was employed. Measurements and their properties are therefore presented in two different sections.

I. Parent-rated predictors and outcomes

Dependent variable

Emotional problems (EP)

An eight-item scale derived from the Ontario Child Health Survey (Boyle et al., 1993; Fleming, Boyle, & Offord, 1993) was incorporated into the Leavers and Stayers Parent About Child (PAC) survey. Each item has three forced-choice responses. Depending on the wording of the item, the responses were: (a) never, or not true; (b) sometimes, or sometimes true; (c) often, or very true. Sample PAC items include: “How often would you say that [name of index child] (i) seems unhappy, sad, or depressed?” and (ii) “… not as happy as other children?” Standardized alpha coefficients for the scale = 0.78 (Toronto sample), and 0.80 (AA sample).

Predictor variables

Predictors for EP include child’s gender and parental education. Other predictors include vulnerability factors (PMK depression and somatization), and stressors (poverty, parent–child dissonance regarding ethnic way of life, and perceptions of prejudice and of discrimination). The demographic variables of children’s gender and level of parental education appear in Table 1. The derivation of vulnerability and stressor variables is described in the following text and the measures described in Table 2.

Table 2.

Measures of vulnerability and stress (parent (PAC) ratings)

Measure	Coefficient alpha	Range	Mean	SD	t	p	Effect size**
Vulnerability
1. PMK depression
Toronto	0.88	16–39	22.8	5.9	1.80	.073	–
Addis Ababa	0.94	16–46	20.9	7.8
2. PMK* Somatization
Toronto	0.87	9–25	11.6	3.3	1.04	>0.10	–
Addis Ababa	0.90	9–36	11.5	4.3
Stress
Dissonance re ethnic way of life
Toronto	–	(−1) to 2	0.20	0.54	3.84	.0001	Small
Addis Ababa	–	(−1) to 2	0.01	0.25
Prejudice
Toronto	0.85	6–26	15.5	4.7	10.7	.0001	Large
Addis Ababa	0.92	6–24	8.9	4.0
Discrimination
Toronto	–	10–12	11.9	0.43	3.46	0.001	Small
Addis Ababa	–	6–7	6.10	0.13

PMK = person most knowledgeable about child.

Effect size for statistically significant differences in mean scores: small, d = 0.2; moderate d = 0.5; large d = 0.8 (Cohen, 1992).

Vulnerability was assessed with measures of depression and somatization.

PMK depression

Used in a variety of cultural settings (Beiser, 1986; Beiser, Benfari, Collomb, & Ravel, 1976; Beiser & Fleming, 1986), this 16-item scale consists of items such as: (a) “Have you been feeling unhappy?” (b) “Have you been feeling discouraged?” (c) “Have you been feeling low and hopeless?” Each item has four forced-choice responses: (a) rarely or none of the time, (b) some or a little of the time, (c) occasionally or a moderate amount of time, and (d) most or all of the time.

PMK somatization

Is a nine-item emotional distress scale that has been used in studies of mental health in Africa, as well as among Southeast Asian and Tamil populations in North America (Beiser, 1986, 1999; Beiser et al., 1976; Beiser & Fleming, 1986). The scale consists of items such as: (a) “Loss of appetite in past few weeks?” (b) “Food seems tasteless and hard to swallow in past few weeks?” (c) “Feeling sickly in past few weeks?” Each item has four forced-choice responses: (a) rarely or none of the time, (b) some or a little of the time, (c) occasionally or a moderate amount of time, and (d) most or all of the time.

Stresses included poverty, dissonance regarding ethnic way of life, perceived prejudice and discrimination:

Poverty

For the Toronto sample, the study used Statistics Canada’s low income cut-off (LICO) for 2004, an index based on total household income, number of people in the household and regionally adjusted costs for provisions and services (see http://www.gov.ns.ca/coms/department/backgrounders/poverty/Poverty_Stats-May2008.pdf). People in households with incomes below the LICO were defined as living in poverty. Calculating the rate of poverty among the Addis Ababa sample rested on the World Bank definition of locally adjusted purchasing power of less than the equivalent of $1.25 per day (http://www.worldbank.org). AA families living in households whose combined total income in Birrh (the local currency) was less than US$1.25 per day were classified as living in poverty.

Dissonance regarding ethnic way of life

Derived from Oetting and Beauvais (1990), this measure is based on an item that appeared in both the PAF and CAC. PAF: “To what extent does your family follow your ethnic way of life?” CAC: “To what extent do you follow your ethnic way of life?” The four forced-choice responses are: (a) not at all, (b) not often, (c) sometimes, and (d) a lot of the time. Dissonance was measured as the difference obtained by subtracting the CAC scores from the PAF scores.

Perceived prejudice

A six-item PAF scale that includes items such as: (a) “A lot of people tend to look down on people from my place of birth,” (b) “People from my place of origin portrayed in media less fairly than other groups,” (c) “People from my place of origin treated less fairly at government offices.” Each item has five forced-choice responses: (a) strongly disagree, (b) disagree, (c) not sure, (d) agree, and (e) strongly agree.

Perceived discrimination

A six-item scale derived from research with immigrant groups in Canada (Beiser, Noh, Hou, Kaspar, & Rummens, 2001), the measure includes items such as: (a) “Family member unfairly fired/denied promotion,” (b) “Family member not hired for job for unfair reasons,” (c) “Family member unfairly treated by police.” Each item has two forced-choice responses: (a) yes = 2, and no = 1). The “yes” responses were totalled in order to arrive at a final discrimination score.

Measures of the predictors and their properties are described in Table 2.

II. Child-rated predictors and outcomes

Dependent variable

EP self-report

The content of the self-report EP scale is identical with the scale derived from the PAC, except that the questions are phrased as “How often would you say that you are unhappy, sad, or depressed?” Standardized alpha coefficients for the scale were = 0.79 (Toronto sample) and 0.84 (AA sample).

Predictor variables

Predictor variables included the demographic variable of youth gender; vulnerability was measured by PMK depression and somatization (from PAF as described before); stresses, included: poverty (from PAF as described before); dissonance regarding ethnic way of life (from PAF and CAC, as described before). Because the dissonance measure is a product of both the PAF and the CAC, it is described twice, once with parent-based ratings, and once with youth-based ratings (see Tables 2 and 3).

Table 3.

Measures of resilience and stress (self-ratings by youth (CAC)

Measure	Coefficient alpha	Range	Mean	SD	t	p	Effect size*
Resilience
Self-esteem
Toronto	0.83	6–12	10.8	1.7	7.87	.0001	Large
Addis Ababa	0.83	4–12	9.0	1.6
Stress
Dissonance re ethnic way of life
Toronto	–	(−1) to 2	0.2	0.54	3.84	.0001	Moderate
Addis Ababa	–	(−1) to 2	0.01	0.25
Perceived discrimination
Toronto	–	0–5	0.56	0.14	6.27	.0001	Moderate
Addis Ababa	–	0–2	0.01	0.15

Effect size for statistically significant differences in mean scores: small, d = 0.2; moderate d = 0.5; large d = 0.8 (Cohen, 1992).

Perceived discrimination

In order to help youth understand what was being asked of them, the perceived discrimination questions were preceded by the following introduction:

People sometimes get treated unfairly because of who they are—I mean because they look different, were born outside of Canada, speak with an accent, or because of the colour of their skin. I want you to think about the last month and tell me whether you were treated unfairly because of who you are.

The scale consisted of a count of children’s experiences (answered as yes or no) in five different domains: with other children at school; with other children outside school; by teachers; by police; stores or shopping malls. Each positive response was followed by a frequency item: once = 1, a few times = 2, many times = 3, almost regularly = 4. Each setting then gave rise to an item score (Occurrence, Yes or No x Frequency of Occurrence). Item scores were then summed to arrive at a total scale score.

Self-esteem

A three-item scale made up of the following items: (a) “I like the way I am,” (b) “Overall, I have a lot to be proud of,” and (c) “A lot of things about me are good.” Each item has four forced-choice responses: (a) never, (b) sometimes, (c) often, and (d) most of the time.

Measures of the predictors based on youth self-report are described in Table 3.

Results

As described in Table 1, the Addis Ababa sample contained a fairly even balance of boys and girls, whereas the Toronto sample had a higher proportion of boys. The proportion of people with postsecondary education was higher among Toronto than among Addis Ababa PMKs. In both Toronto and Addis Ababa, almost two thirds of the Ethiopian families were living in poverty as defined by local standards. Households tended to be large in both settings. Most of the preadolescents taking part in the Toronto study had been born abroad but came to Canada at a fairly young age. The modal length of stay for the Toronto youth was 8–9 years.

According to parent ratings, there were no statistically significant differences in EP between the two samples (Toronto PAC sample M = 9.46, SD = 2.10; Addis Ababa M = 9.27, SD = 2.1; p = ns). Results based on self-ratings were very different: In comparison with the Addis Ababa sample, Ethiopian youngsters living in Toronto reported higher levels of EP (Toronto CAC sample M = 10.09, SD = 2.56; Addis Ababa M = 8.86, SD = 1.83, p < .001). The effect size (Cohen, 1992) for this difference was moderate.

As described in Table 2, parent ratings of vulnerabilities and stresses suggest that youth in the Toronto immigrant sample were subject to greater challenge than their Addis Ababa counterparts. Although the difference does not meet accepted levels of significance, PMK depression levels tended to be higher in the Toronto sample, as did levels of dissonance regarding ethnocultural retention, perceived prejudice, and perceived discrimination. Although the differences between Toronto and Addis Ababa were statistically significant, the effects—with the exception of perceived prejudice—were small.

Youth self-report data, summarized in Table 3, were consistent with the PMK reports. In addition to higher levels of parent–child dissonance, the Toronto sample reported more perceived discrimination. The Toronto sample reported higher levels of self-esteem than did their Addis Ababa counterparts. These differences were not only statistically significant but also attained a moderate to large effect size.

Two hierarchical linear regression analyses were conducted, the first regressing parent ratings of EP on the parent-derived predictor variables, the second regressing youth self-reports of EP on the youth-derived predictor variables. Since a correlation analysis between the two vulnerability variables (PMK depression and somatization) and self-reported EP revealed no significant association, these two vulnerability variables were omitted from the youth-based multivariate analysis, and only stress and resilience factors were retained. Analyses presented in both Tables 4 and 5 controlled for length of time that the youth study participants had lived in Canada.

Table 4.

Predictors of youth emotional problems in Addis Ababa and Toronto (parent ratings)

	Addis Ababa sample			Toronto sample
	B	t	p	B	t	p
Intercept	9.27	60.2	<.0001	9.46	36.0	<.0001
Block 1: Child gender (male = 1, female = 2)	0.19	0.63	.53	−0.73	−1.36	.18
Block 2: Gender plus vulnerability
Constant	6.9	11.43	<.0001	7.73	5.46	<.0001
Child gender	0.22	0.75	.45	−0.43	−0.79	.43
*PMK depression	0.10	5.3	<.0001	0.10	2.30	.025
*PMK somatization	0.12	4.3	<.0001	0.08	1.28	.23
Block 3: Gender plus vulnerability plus stress
Constant	1.59	0.25	.81	10.74	2.49	.016
Child gender	0.29	1.03	.30	−0.58	−1.03	.31
PMK depression	0.09	5.22	<.0001	0.09	2.08	.042
Poverty	−0.47	−0.77	.44	0.98	1.27	.21
Dissonance ethnic way of life	−0.72	−1.3	.20	0.26	0.53	.60
Perceived prejudice	0.14	3.97	<.0001	0.01	0.18	.86
Perceived discrimination	0.74	0.70	.49	−0.60	−0.94	.35
R²	0.23			0.15
Adjusted R²	0.20			0.07

PMK = person most knowledgeable.

Table 5.

Predictors of youth emotional problems in Addis Ababa and Toronto: Self-report data

	Addis Ababa sample			Toronto sample
	B	t	p	B	t	p
Intercept	8.86	64.0	< .0001	10.67	28.4	<.0001
Block 1: Gender (male = 1, female = 2)	0.50	1.83	.069	0.62	0.80	.43
Block 2: Gender and stress
Constant	8.58	12.33	<.0001	10.27	7.06	<.0001
Gender	0.41	1.53	.13	0.35	0.44	.66
Poverty (from parent ratings)	−0.40	−0.69	.49	−0.39	−0.36	.72
Dissonance ethnic way of life	−1.05	−1.95	.052	−0.36	−0.9	.37
Perceived discrimination	2.49	2.8	.006	0.68	1.99	.051
Block 3: Gender, stress and resilience
Constant	13.0	11.8	<.0001	8.25	2.95	.005
Gender	0.3	1.19	.24	0.29	0.37	.71
Poverty (from parent ratings)	−0.96	−1.73	.085	−0.31	−0.28	.78
Dissonance ethnic way of life	−0.93	−1.84	.068	−0.66	−0.93	.36
Perceived discrimination	2.75	3.28	.001	0.69	2.0	.05
Self-esteem	−0.41	−4.99	<.0001	0.19	0.85	.40
R²	0.20			0.09
Adjusted R²	0.18			0.05

Table 4 presents the results using PAC (parent-derived) data. The putative predictor variables explained considerably more variance in parental ratings of children’s emotional problems in the Addis Ababa than in the Toronto sample. Furthermore, the list of variables achieving significance in each setting was not identical. PMK depression was the only statistically significant predictor common to both study settings. Perceived prejudice contributed to explaining children’s emotional problems in Addis Ababa, but not in Toronto.

Table 5 describes the results of the regression analyses based on youth self-report. Consistent with the parent-based results, the list of predictors accounted for more variance in the Addis Ababa than in the Toronto sample. Perceived discrimination was a significant factor in both populations, and it was the only significant predictor of self-rated EP for the Toronto sample. Among the Addis Ababa sample, ethnic dissonance was marginally significant, and self-esteem was a significant protective factor.

Discussion

As Stevens and Vollebergh (2008) have pointed out, the level of reported problem behaviour in studies about children and youth depends to a great extent on the perspective of the informant. Consistent with reports by other researchers, the current study showed that parent assessments describe a mental health advantage for immigrant youth over their native-born counterparts (Beiser et al., 2002; Fanning, Haase, & O’Boyle, 2011). However, at least one study (Bengi-Aralan, Verhulst, van der Ende, & Erol, 1997) has produced a contrary finding: according to that study, Turkish immigrant parents in the Netherlands rated their children as more distressed than did parents of Turkish children in Turkey.

Ethiopian preadolescents in Toronto reported more internalizing problems than did their counterparts in Ethiopia and more of such problems than their parents were apparently aware of, a finding consistent with results from studies of Vietnamese children and adolescents in Australia (McKelvey et al., 2002), and Turkish adolescents in the Netherlands (Vollebergh & Huiberts, 1997). Van de Looij-Jansen, Jansen, de Wilde, Donker, and Verhulst (2011) suggest that parent–child differences in rating distress may be attributable, at least in part, to acculturation. Youth may be quicker than their parents to adopt the type of dominant culture’s idioms of distress that, for the most part, make up the items of popularly used mental health survey instruments. The results are also consistent with the relatively few studies that have been carried out using self-report data to compare immigrant children in resettlement countries and their counterparts in the home countries. In comparison with Turkish children living in Turkey, Turkish children in the Netherlands reported higher levels of externalizing behaviours and equivalent levels of internalizing distress (Janssen et al., 2004) and Jewish immigrant children from the former Soviet Union who were living in Israel had higher levels of internalizing as well as externalizing behaviours (Ponizovsky, Ritsner, & Modai, 1999).

Authorities have suggested that comparative validity may vary as a function of the observer (Achenbach & Edelbrock, 1987; Curtis, Dooley, & Phipps, 2001). For internalizing states, self-report may be a more accurate depiction of reality whereas, for externalizing states such as aggressive behaviour, external observers may paint a more accurate picture. Despite the common-sense appeal of these suggestions, the ultimate test of the usefulness of these mental health measures is their predictive validity. For example, van de Looij-Jansen et al. (2011) have reported that parent–child discrepancies in mental health ratings predict future increases in internalizing problems among youth. Future reports from the Leavers and Stayers project, as well as from its parent study, the New Canadian Children and Youth Study, will examine longitudinal data comparing children and parent mental health ratings as predictors of mental health and of various dimensions of integration.

As in many other studies (Downey & Coyne, 1990; Essex, Klein, Miech, & Smider, 2001; Gross, Conrad, Fogg, Willis, & Garvey, 1995; Kessler et al., 2010; Luoma et al., 2001), parental depression predicted parent reports about their children’s mental health. This association did not persist when youth self-report was the dependent variable, lending credence to speculation that depression may bias parents’ perceptions of their children’s mental well-being (Breslau, Davis, & Prabucki, 1988; Kiss et al., 2007; Renouf & Kovacs, 1994). Interestingly, somatization was a salient predictor for Addis Ababa parents’ ratings of their children’s mental health but not for parents resettled in Canada. Perhaps the acculturation of Ethiopian immigrants in Canada reduced the salience of somatization, a culturally influenced expression of distress (Beiser et al., 1976).

In the Addis Ababa sample, self-esteem was a significant protective factor, but there was no corresponding relationship between self-esteem and emotional distress in the Toronto sample. This finding is paradoxical given that a considerable body of theory (Markus & Kitayama, 1991; Triandis, 1989), suggests that concepts relating to the individual self such as self-esteem may have less relevance in sociocentric cultures such as Ethiopia’s as compared to the egocentric cultural ethos of North America. Future reports from the Leavers and Stayers Study will focus on the predictors of self-esteem in the two settings, and on its salience for mental health and adaptation.

Since the association between poverty and children’s emotional distress is one of the most robust findings in the literature (Evans, 2004; Miech et al., 1999; Santiago et al., 2011), the lack of demonstrable relationships between these variables in both Addis Ababa and in Toronto is surprising but nevertheless consistent with other research concerning immigrant and refugee populations (Beiser et al., 2002).

Researchers studying the relationships between family poverty and children’s mental health have emphasized explanations centering on social exclusion rather than material deprivation. For example, Redmond (2008, p. 1) suggests that “what concerns children is not lack of resources per se, but exclusion from activities that other children appear to take for granted, and embarrassment and shame at not being able to participate on equal terms with other children.” In a similar vein, Willow (2001, p. 7) the “subtle badges of poverty [that] cast poor children and young people aside from their peers.” Although previous research has found that these “subtle badges of poverty” in Ethiopia (Camfield, 2010) as well as in other developing countries (Attree, 2006) are different from those to be found in Europe and North America, awareness of them, and sensitivity to the reality that they make one “different” are equally sharp.

The high prevalence of poverty among both the Addis Ababa and Toronto families and the apparent lack of impact on children’s mental health points to the need to progress beyond the study of associations between variables to examine mechanisms that may explain these associations. Sime (2008), for example cautions that the term “poverty” tends to homogenize experience, and to obscure differences in children’s understandings and explanations. Children may live in poverty and be perfectly cognizant of its effects, but nonetheless see some offset. For example they may view their parents as more available to them than children in families whose parents make more money but who work longer hours (Tekola, 2009, as cited in Camfield, 2010). Young people are also capable of considering a moral dimension of poverty —that it is something the privileged powerful impose on the less powerful, rather than the result of a moral failure on the part of the poor, or an inevitable consequence of birth or circumstance (Camfield, 2010). In order to explain what appears to be a recurring theme—that poverty may be different for immigrant as compared with nonimmigrant children and their families—future research should explore contextually shaped meanings of poverty as well as strengths within children and their families that account for their apparent resilience in the face of distressing circumstances.

Conclusion

Ethiopian youth in Toronto reported higher levels of emotional problems than did their Addis Ababa counterparts. They also reported higher levels of challenge due to parent–child dissonance in adhering to traditional culture, more experiences of discrimination, and higher levels of perceived prejudice. However, Ethiopian youth and their families in Ethiopia were not strangers to the experiences of ethnocultural dissonance, prejudice, and discrimination. On the contrary, perceived prejudice was a more powerful predictor of parent-rated EP in Addis Ababa than in Toronto, and ethnocultural dissonance was more salient for youth-rated mental health in the Ethiopian than in the Canadian context. Some of the differences in findings between the two samples may be, at least in part, a function of relative sample sizes. However, it does not seem far-fetched to suggest that intergenerational dissonance, discrimination, and prejudice may be equal, or perhaps even more important mental health risk factors in countries that create refugee outflows than in countries that receive them. Ethiopia is not ethnically homogeneous. On the contrary, it is a country inhabited by many different ethnocultural groups, some more powerful at certain stages of the country’s history, others perhaps more powerful at present. Tensions based on past rivalries probably continue to manifest themselves to individuals as experiences of prejudice and discrimination. In addition, youth are exposed to the competing forces of ethnocultural and national identities, as well as an emerging international identity brought to them through travel, visitors, and the media.

The small amounts of variance in mental health scores accounted for by the models must be counted a study limitation. Future studies will examine the mental health effects of premigration stresses, the quality of parent–child relationships in Canada, and the effects of neighbourhood and social networks, variables that may provide additional explanatory power (see Porter & Haslam, 2005; Stevens et al., 2005).

The aim of this study was to investigate whether parent–child ethnocultural dissonance, perceived prejudice, and perceived discrimination are mental health risk factors specific to the immigration context or whether they are also salient in the home country. Although the relatively small sample sizes and focus on one immigrant ethnocultural group limit generalizability, the findings suggest, at the very least, a need to rethink overly simplistic models that attribute bad things to the experience of resettling in a country of permanent refuge, but neglect the bad things people leave behind.

Footnotes

Acknowledgements

The authors wish to acknowledge the support and cooperation of the Ethiopian community in Toronto and of the University of Addis Ababa, Ethiopia. We also thank Dr. Feng Hou of Statistics Canada for his invaluable methodological contribution.

Funding

The research was carried out with the support of a grant from the Canadian Institutes of Health Research (CIHR), Operating Grant 455784, “Leavers and Stayers: A Comparison of the Health and Development of Ethiopian Children Growing Up in Canada and in Ethiopia.”

Morton Beiser, PhD, is Professor of Distinction and Program Director Culture, Immigration and Mental Health, Department of Psychology, Ryerson University; Crombie Professor Emeritus of Cultural Pluralism and Health, University of Toronto; and Founding Director and Senior Scientist, Ontario Metropolis Centre of Excellence for Research on Immigration and Settlement (CERIS). He has received more than $17.5 m in research funding and has authored more than 180 scientific papers, and a book entitled Strangers at the Gate, (University of Toronto Press, 1999). Work outside the academic world included chairing a federal government task force on the mental health of immigrants and refugees that produced a report called After the Door Has Been Opened (1988), membership on the Canadian Multiculturalism Advisory Committee, and chairing the Medical Advisory Committee for Citizenship and Immigration Canada. Pursuing his interest in effecting a crossover from research into policy and public debate, Dr. Beiser developed a 12-part radio series on immigration and settlement in Canada aired on public radio in Ontario and Alberta, as well as grade school and high school curricula subsumed under the title Strangers Becoming Us. Recognition of Dr. Beiser’s achievements has included National Health Scholar and Scientist Awards from Canada’s National Health Research and Development Program (1981–1999); honorary membership by the Belgian Royal Society of Medicine (1975); the Josiah Macy Jr. Foundation (New York) Distinguished Scholar Award (1974–1975); the University of Toronto Beverley Distinguished Professor Award (1988); the Joey and Tobey Tanenbaum Research Award (1994); the Rockefeller Foundation Resident Scholar Award (1995); the Canadian Psychiatric Association’s Alexander Leighton Award for Research in Psychiatric Epidemiology (2002); the Queen Elizabeth II Golden Jubilee medal awarded by the Senate of Canada (2002); and the Diamond Jubilee medal (2012). In 2004, Dr. Beiser received the Order of Canada, the country’s highest distinction for lifetime achievement.

Busha Taa, PhD, received a Bachelor of Political Science and Comparative Policies degree from York University, a Master’s degree in Political Sciences and Comparative Politics from the University of Western Ontario, and a PhD in the Sociology of Education from the University of Toronto. As Research Coordinator at the University of Toronto and then Ryerson University, he coordinated the New Canadian Children and Youth Study (NCCYS) a national study of mental health and development among 4,000 immigrant children and youth in Canada, as well as Leavers and Stayers, a comparative mental health study of Ethiopian children and youth in Toronto and in Addis Ababa, Ethiopia. Recently he served as Instructor in Sociology at Ryerson University and is currently a Lecturer in Sociology at the University of Toronto. He has been an invited lecturer for several events for important national bodies including the Canadian Society for Political Prisoners, Ottawa, Canada; the African Employment and Training Centre, Toronto; and the University of Toronto. He is author of a book, The Role of Knowledge in Integrating Ethiopian Immigrants to Canada (Lambert Academic Publishing, 2010). Active in community activities, Dr. Taa is past President of the Ethiopian Association of Toronto. In recognition of his community service, the Ethnic Press of Canada awarded him a Best Community Leader Distinction.

Haile Fenta-Wube worked for 10 years in the public health system of Ethiopia after receiving a Bachelor’s degree in Public Health and Clinical Medicine from Addis Ababa University, eventually becoming a Provincial Medical Officer in the Ministry of Health. He then served as Chief Medical Officer in various provinces of Ethiopia, as well as the Chair of Provincial Social Service Development Planning. He subsequently became Executive Administrative Officer, as well as Lecturer at JIMA University, in which capacities he participated in teaching public health and supervising medical students, particularly those who conducted HIV/AIDS-related community-based participatory studies. Dr. Fenta obtained a Master’s degree in Public Health Epidemiology at Tulane University, and then a PhD in Epidemiology and Biostatistics from McGill University. He joined the University of Toronto Department of Psychiatry as a Research Associate and became Co-director of the Toronto Addis Ababa University Psychiatric Project (TAAPP). Most recently, as Ethno-Cultural Research Capacity Development Consultant for the Ontario HIV Treatment Network, Dr. Fenta has promoted research and research capacity building in agencies dealing with HIV/AIDS-related issues as well as the mental health of immigrant and refugee populations. In recognition of his leadership in community-based research and capacity building, he received an Honourable Mention of Community Based Research Award sponsored by the Centre for Urban Health Initiatives, in partnership with the Wellesley Institute, and University College at the University of Toronto. He is immediate past President of the Ethiopian Association of Toronto.

Yonas Baheretibeb, a graduate of Addis Ababa University, completed a fellowship in child psychiatry at the University of Toronto. Currently, he is an Associate Professor and Chair of the Department of Psychiatry, School of Medicine, Addis Ababa University. He is also Chair of the Ethiopian Mental Health Society, a family association actively working on mental health advocacy. Yonas is active in research, teaching, and clinical service development in Addis Ababa University. He opened and currently runs the first child and adolescent clinic in Ethiopia. Yonas is attending a Master’s course in Public Mental Health in South Africa at Cape Town University; his thesis topic is “common mental disorder and traditional healers in rural Ethiopia.” He is PI on a study of first-episode psychosis in Ethiopia. Yonas is also one of the principal investigators of HEAT, Health Education and Training, a collaboration involving The Open University, and Federal Ministries of Health and Education in Africa, that is supported by the UK charity, Autism Speaks. Under the HEAT project, a team of researchers from the EU and Ethiopia are collaborating to raise awareness around mental health issues and about autism in particular. In addition, more than 1,300 Ethiopian health extension workers (HEWs) are currently upgrading their existing training using the HEAT programme.

Clare Pain is an Associate Professor at the Department of Psychiatry, University of Toronto, and Director of the Psychological Trauma Program at Mount Sinai Hospital, Toronto. In 2003 she became the Co-project Director of the Toronto Addis Ababa Psychiatry Project (TAAPP) () through which the Department of Psychiatry at University of Toronto supports Addis Ababa University’s residency training program by sponsoring trips by volunteer University of Toronto faculty to Addis Ababa University for 1 month three times a year. The program has expanded to become a medical school-wide exchange. Clare Pain’s clinical focus is on the assessment and treatment of patients who suffer from the effects of psychological trauma, including refugees whom she works with at the Canadian Centre for Victims of Torture. She has lectured and taught on various aspects of psychological trauma including transcultural aspects; and increasingly on global mental health. She has published a number of articles and two books: Trauma and the Body: A Sensorimotor Approach to Psychotherapy with Pat Ogden and Kekuni Minton (Norton, 2006), and The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic, an edited book with Eric Vermetten and Ruth Lanius, (Cambridge University Press, 2010).

Mesfin Araya, PhD, returned to his country where he worked as general practitioner and medical director at District, Referral and Psychiatric Hospitals after graduating as Medical Doctor from St Petersburg (Leningrad). He later on went to Europe and studied Psychiatry in Groningen (the Netherlands). Returning after the completion of his training to Ethiopia he assumed the directorship of the Amanuel Hospital for Mental Health, overseeing its transformation from a Stone Age institution where one single Yugoslavian doctor had to care for hundreds of chained patients, into a facility where patients are taken care of in modern ways, in touch with mainstream psychiatry and psychotherapy. Amanuel Hospital now treats inpatients as well as outpatients, and serves not only Ethiopia but also the south of Sudan. In 1995, Dr. Araya stepped down as Director of Amanuel Hospital, and became Head of the Department of Psychiatry at Addis Ababa University Faculty of Medicine where he started with his two other colleagues and in collaboration with Department of Psychiatry in University of Toronto, a graduate program (the first of its kind in Ethiopia) in Psychiatry. Since 1996, Dr. Araya has been Director of the TPO-AAU-Ethiopia Program. He has also been active in the creation of a system of psychiatric nursing in all the main hospitals all over Ethiopia. Dr. Mesfin Araya obtained a PhD in Epidemiology at Umeå University, Sweden. He currently teaches Psychiatry at Addis Ababa University and continues to carry out research in transcultural psychiatry. He is also a Provost of St Paul’s Hospital Medical College.

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