Health and service use of newcomers and other adults with intellectual and developmental disabilities: A population-based study

Authors:
Anna Durbin, James Jung, Hannah Chung, Elizabeth Lin, Robert Balogh, Yona Lunsky

Location:
Ontario

Context:
Do adult newcomers with intellectual and developmental disability (IDD) use more health services than Canadian-born persons with IDD? What about the health status of adult newcomers with IDD, specifically their mental health?

This research, which builds on a previous study, sets out to answer these questions, and more. Examples of IDD include, but are not limited to, persons living with fetal alcohol syndrome, autism and Down’s syndrome.

This was a population-based retrospective cohort study with 2,830 adult newcomers and 61,804 Canadian-born adults with IDD living in Ontario.

The authors linked data from Immigration, Refugees and Citizenship Canada and health and social services administrative data to identify adults with intellectual and developmental disabilities as newcomers, or non-newcomers, and compared their health status and health service outcomes.

Immigrants and refugees were divided into two categories:

• Screened: these were persons admitted to Canada based on their expected economic contribution to the country and the expected five-year cost of their health and social service use, when compared to the same costs for the average Canadian. An example of a screened newcomer will be those in the economic class.
• Unscreened are persons admitted to Canada not based on their expected use of health and social services, for example, children and spouses of a Canadian citizen or a permanent resident or conventional refugees.

What did the researchers find?

• Newcomers with IDD were slightly more likely to make visits to psychiatrists and primary care.
• Both groups of newcomers were less likely to have emergency department visits than Canadian-born persons with IDD.
• Screened newcomers also were less likely to be hospitalized and less likely to be frequently hospitalized (defined as two or more admissions).
• Psychosis was more prevalent among unscreened adult newcomers with IDD when compared to Canadian-born persons with IDD.
• Rates of psychotic disorder among screened newcomers were the same as Canadian-born persons with IDD.
• Rates of substance use were the same for unscreened newcomers and Canadian-born persons with IDD.

How does this research apply to my work?

• Tailor services: Understand the unique needs of newcomers who are and who are not screened before their arrival so services can meet their health and settlement needs.
• Promote community-based care: the use of primary and community-based care should be encouraged because they offer continuity of care and is better for mental health promotion, prevention and early intervention.
• Increase access to mental health services of newcomers with IDD: facilitate access to culturally appropriate mental health support to complement psychiatric care.
• Acute distress may present as psychosis: behaviours that seem psychotic for persons with IDD may be stress responses or reactions from being in unfamiliar situations.

What should I take away from this research?

The findings do not support the suggestion that newcomers with IDD are more likely to have higher healthcare costs than Canadian-born adults with IDD. This is especially true for hospital visits since they had less hospital visits. Hospital visits are costly. Based on the differences in the findings between screened and unscreened newcomers, the authors recommend these two groups be treated separately.

The findings are also consistent with the “healthy immigrant effect” which states that new immigrants and refugees are healthier than the native-born population upon arrival but lose this health advantage over time in the new country.

Within the population of persons living with IDD in Ontario, newcomers with IDD had lower or similar rates of health issues, except for higher rates of psychosis among the unscreened group.

Resources:

Full article (journal access required to view full text)

Access in Action toolkit. This resource by the Ontario Council of Agencies Serving Immigrants, contains information and resources on the specific struggles and needs of immigrants and refugees with disabilities and d/Deaf newcomers.

Self-directed course: Building Access & Equity for Im/migrants & Refugees with In/Visible Disabilities. This course is offered by the Ontario Council of Agencies Serving Immigrants. Setting up an account is required.