Journal of Immigrant and Minority Health

, Volume 9, Issue 4, pp 349–357 | Cite as

Health Service Utilization by Ethiopian Immigrants and Refugees in Toronto

  • Haile Fenta
  • Ilene Hyman
  • Samuel Noh


The purpose of this study was to examine the health service utilization patterns of Ethiopian immigrants and refugees in a random sample of 342 adults residing in Toronto. The results suggested that 85% of the study participants used one or more type of health services, most often from a family physician. However, only 12.5% of them with a mental disorder received services from formal healthcare providers, mainly family physicians. While the presence of somatic symptoms was significantly associated with increased use of healthcare (p < 0.05), having a mental disorder was associated with lower rate of health service use (p < 0.05). These findings suggest that family physicians could play important role in identifying and treating Ethiopian clients who present with somatic symptoms, as these symptoms may reflect mental health problems. Further research is necessary to determine the reasons for the low rates of mental health services use in this population.


Health services utilization Mental health Family physician visits Ethiopian immigrants 



This research project was supported by research grant from Heritage Canada to Dr. Ilene Hyman (1998) and from the Centre of Excellence for Research in Immigration and Settlement to Dr. Samuel Noh and Dr. Ilene Hyman. We also acknowledge Li Clark whose editorial work has improved significantly the quality of this manuscript. We want to thank all the participants of the study and the Ethiopian Community leaders without whose honest contributions to the present study would have not been possible.


  1. 1.
    Statistics Canada. 2001 census: Analysis Series Canada’s Ethno-cultural Portrait-the Changing Mosaic. Ottawa, On: statistics Canada, Census Operations Division, 2003.Google Scholar
  2. 2.
    Citizenship and Immigration Canada. Annual report to Parliament on Immigration, 2004.Google Scholar
  3. 3.
    Tabora BL, Flaskerud JH. Mental health beliefs, practices, and knowledge of Chinese American immigrant women. Issues Ment Health Nurs 1997;18(3):173–189.PubMedCrossRefGoogle Scholar
  4. 4.
    Li HZ, Browne AJ. Defining mental illness and accessing mental health services: perspectives of Asian Canadians. Can J Commun Ment Health 2000;19(1):143–159.PubMedGoogle Scholar
  5. 5.
    Yaphe J, Schein M, Naveh P. Ethiopian parents’ perception of their children’s health: a focus group study of immigrants to Israel. Isr Med Assoc J 2001;3(12):932–936.PubMedGoogle Scholar
  6. 6.
    Ying YW, Miller LS. Help-seeking behaviour and attitude of Chinese Americans regarding psychological problems. Am J Community Psychol 1992;20(4):549–556.PubMedCrossRefGoogle Scholar
  7. 7.
    Stuart GW, Minas IH, Klimidis S, O’Connell S. English language ability and mental health service utilisation: a census. Aust N Z J Psychiatry 1996;30(2):270–277.PubMedGoogle Scholar
  8. 8.
    Leduc N, Proulx M. Patterns of health services utilization by recent immigrants. J Immigr Health 2004;6(1):15–27.PubMedCrossRefGoogle Scholar
  9. 9.
    Leclere FB, Jensen L, Biddlecom AE. Health care utilization, family context, and adaptation among immigrants to the United States. J Health Soc Behav 1994;35(4):370–384.PubMedCrossRefGoogle Scholar
  10. 10.
    Van der Stuyft P, De Muynck A, Schillemans L, Timmerman C. Migration, acculturation and utilization of primary health care. Soc Sci Med 1989;29(1):53–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Selikowitz HS, Holst D. Dental health behaviour in a migrant perspective: Use of dental services of Pakistani immigrants in Norway. Community Dent Oral Epidemiol 1986;14(6):297–301.PubMedCrossRefGoogle Scholar
  12. 12.
    Bedos C, Brodeur JM, Benigeri M, Olivier M. Utilization of preventive dental services by recent immigrants in Quebec. Can J Public Health 2004;95(3):219–223.PubMedGoogle Scholar
  13. 13.
    Chen J, Ng E, Wilkins R. The health of Canada’s immigrants in 1994–95. Health Rep 1996;7(4):33–45.PubMedGoogle Scholar
  14. 14.
    Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med 2000;51(1):123–133.PubMedCrossRefGoogle Scholar
  15. 15.
    Zeeb H, Baune BT, Vollmer W, Cremer D, Kramer A. Health situation of and health service provided for adult migrants–a survey conducted during school admittance examinations. Gesundheitswesen 2004;66(8–9):527.Google Scholar
  16. 16.
    Aponte JF and Barnes JM. Impact of acculturation and moderator variables on the treatment of ethnic groups. In: JF Aponte, R Young Rivers, and J Wohl (eds). Psychological Intervention and Cultural Diversity 1995;2:19–39.Google Scholar
  17. 17.
    Mcspadden L, Moussa H. I have a name: the gender dynamics in asylum and in resettlement of Ethiopian and Eritrean refugees in North America. J Refug Stud 1993;6(3):204–225.Google Scholar
  18. 18.
    Citizenship and Immigration Canada: Citizenship and Immigration Statistics 1996. Ministry of Public Works and Government Services Canada, Ottawa, (1999).Google Scholar
  19. 19.
    George U, Mwarigha MS (1999) Consultation on settlement programming for African newcomers: Final report. Toronto: Center for Applied Social Research, University of Toronto.Google Scholar
  20. 20.
    Vega WA, Kolody B, Aguilar-Gaxiola S, Catalano R. Gap in service utilization by Mexican Americans with mental problems. Am J Psychiatry 1999;156(6):928–934.PubMedGoogle Scholar
  21. 21.
    Globerman S (1998) Immigration and health care utilization patterns in Canada. Final report. Vancouver (BC):Vancouver Centre for Excellence, Research on Immigration and integration in the Metropolis Working paper series No.8–08;Google Scholar
  22. 22.
    Gross R, Brammli-Greenberg S, Remennick L. Self-rated health status and health care utilization among immigrant and non-immigrant Israeli Jewish women. Women Health 2001;34(3):53–69.PubMedCrossRefGoogle Scholar
  23. 23.
    Muennig P, Fahs MC. Health status and hospital utilization of recent immigrants to New York City. Prev Med 2002;35(3):225–231.PubMedCrossRefGoogle Scholar
  24. 24.
    Carrasquillo O, Pati S. The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States. Prev Med 2004;39(5):943–950.PubMedCrossRefGoogle Scholar
  25. 25.
    Yu SM, Huang ZJ, Singh GK. Health status and health services utilization among US Chinese, Asian Indian, Filipino, and other Asian/Pacific Islander children. Pediatrics 2004;113(1 Pt 1):101–107.PubMedCrossRefGoogle Scholar
  26. 26.
    Han E, Liu G. Racial disparities in prescription drug use for mental illness among population in US. J Ment Health Policy Econ 2005;8(3):131–143.PubMedGoogle Scholar
  27. 27.
    DesMeules M, Gold J, Kazanjian A, Manuel D, Payne J, Vissandee B, McDermott S, Mao Y. New approaches to immigrant health assessment. Can J Public Health 2004;95(3):I22–126.Google Scholar
  28. 28.
    Chen AW, Kazanjian A. Rate of mental health service utilization by Chinese immigrants in British Columbia. Can J Public Health 2005;96(1):49–51.PubMedGoogle Scholar
  29. 29.
    Wen SW, Goel V, Williams JI. Utilization of health care services by immigrants and other ethnic/cultural groups in Ontario. Ethn Health 1996;1(1):99–109.PubMedCrossRefGoogle Scholar
  30. 30.
    Kirmayer LJ, Galbaud du Fort G, Young A, Weinfeld M, Lasry J (1996) Pathways and barriers to mental health care in urban multi-cultural milieu: an epidemiological and ethnographic study. Montreal (PQ):Sir Mortimo B. Davis-Jewish General Hospital, Culture and Mental Health Research Unit. Report No. 6(1).Google Scholar
  31. 31.
    Hjelm K, Apelqvist J, Nyberg P, Sundquist J, Isacsson A. Health, health care utilization and living conditions in foreign-born diabetic patients in southern Sweden. J Intern Med 1997;242(2):131–141.PubMedCrossRefGoogle Scholar
  32. 32.
    Blais R, Maiga A. Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada. Soc Sci Med 1999;48(9):1237–1245.PubMedCrossRefGoogle Scholar
  33. 33.
    Baleydier B, Damsa C, Schutzbach C, Stauffer O, Glauser D. Comparison between Swiss and foreign patients characteristics at the psychiatric emergencies department and the predictive factors of their management strategies. Encephale 2003;29(3 Pt 1):205–212.PubMedGoogle Scholar
  34. 34.
    Norredam M, Krasnik A, Moller Sorensen T, Keiding N, Joost Michaelsen J, Sonne Nielsen A. Emergency room utilization in Copenhagen: a comparison of immigrant groups and Danish-born residents. Scand J Public Health 2004;32(1):53–59.PubMedCrossRefGoogle Scholar
  35. 35.
    Anagnostopoulos DC, Vlassopoulou M, Rotsika V, Pehlivanidou H, Legaki L, Rogakou E, Lazaratou H. Psychopathology and mental health service utilization by immigrants’ children and their families. Transcult Psychiatry 2004;41(4):465–486.PubMedCrossRefGoogle Scholar
  36. 36.
    Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees (1988) After the Door Has Been Opened: Mental Health Issues Affecting Immigrants and Refugees in Canada. Ottawa: Ministry of Supply and Services CanadaGoogle Scholar
  37. 37.
    Beiser M, Gill K, Edward RG. Mental Healthcare in Canada: Is it accessible and equal? Canada’s Mental Health 1993;41(2):2–7.Google Scholar
  38. 38.
    Hough RL, Landsverk JA, Karno M, Burnam MA, Timbers DM, Escobar JL, Regier DA. Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites. Arch Gen Psychiatry 1987;44(8):702–709.PubMedGoogle Scholar
  39. 39.
    Sent L, Ballem P, Paluck E, Yalland L, Vogel AM. The Asian women’s health clinic: addressing cultural barriers to preventive care. CMAJ 1998;159:350–354.PubMedGoogle Scholar
  40. 40.
    Grunfeld E. Cervical cancer: screening hard to reach groups. CMAJ 1997;157:543–545.PubMedGoogle Scholar
  41. 41.
    Martinez C, Martin HW. Folk diseases in Mexican Americans. JAMA 1996;196:161–164.CrossRefGoogle Scholar
  42. 42.
    Alvidrez J, Azocar F, Miranda J. Demystifying the concept of ethnicity for psychotherapy researchers. J Consult Clin Psychol 1996;64(5):903–908.PubMedCrossRefGoogle Scholar
  43. 43.
    Reiff M, Zakut H, Weingarten MA. Illness and treatment perceptions of Ethiopian immigrants and their doctors in Israel. Am J Public Health 1999;89(12):1814–1818.PubMedGoogle Scholar
  44. 44.
    Sohn L, Harada ND. Knowledge and use of preventive health practices among Korean women in Los Angeles county. Prev Med 2005;41(1):167–178.PubMedCrossRefGoogle Scholar
  45. 45.
    Young RF, Bukoff A, Waller Jb Jr, Blount SB. Health status, health problems and practices among refugees from the Middle East, Eastern Europe and Southeast Asia. Int Migr Rev 1987;21(3):760–782.PubMedCrossRefGoogle Scholar
  46. 46.
    Chugh U, Dillmann E, Kurtz SM, Lockyer J, Parboosingh J. Multicultural issues in medical curriculum: implications for Canadian physicians. Med Teach 1993;15(1):83–91.PubMedGoogle Scholar
  47. 47.
    Woodward AM, Dwinell AD, Arons BS. Barriers to mental health care for Hispanic Americans: A literature review and discussion. Special Issue: Multicultural mental health and substance abuse services. J Ment Health Adm 1992;19:224–236.PubMedCrossRefGoogle Scholar
  48. 48.
    Millet PE, Sullivan BF, Schwebel AI, Myers LJ. Black Americans’ and White Americans’ views of the etiology and treatment of mental health problems. Community Ment Health J 1996;32(3):235–242.PubMedCrossRefGoogle Scholar
  49. 49.
    Edman JL., kameola VA. Cultural differences in illness schemas: An analysis of Filipino and American illness attributions. Journal of Cross-Cult Psychol 1997;23(3):252–265.CrossRefGoogle Scholar
  50. 50.
    Landrine H, Klonoff EA. Cultural diversity in causal attributions for illness: The role of the supernatural. J behav Med 1994;17(2):181–193.PubMedCrossRefGoogle Scholar
  51. 51.
    Goldberg D, Hodes M. The poison of racism and the self-poisoning of adolescents. Journal of Family Therapy 1992;14:51–67.CrossRefGoogle Scholar
  52. 52.
    Waidmann TA, Rajan S. Race and ethnic disparities in health care access and utilization: an examination of state variation. Med Care Res Rev 57 Suppl 2000;1:55–84.CrossRefGoogle Scholar
  53. 53.
    Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care 2002;40(1 Suppl):127–134.Google Scholar
  54. 54.
    Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D, Ortega AN. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv. 2002;53(12):1547–1555.PubMedCrossRefGoogle Scholar
  55. 55.
    Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res 2003;38(3):809–829.PubMedCrossRefGoogle Scholar
  56. 56.
    DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003;93(5):786–791.PubMedGoogle Scholar
  57. 57.
    Becker G, Newsom E. Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health 2003;93(5):742–748.PubMedGoogle Scholar
  58. 58.
    Katz S, Hofer T. Socio-economic disparities in preventive care persist despite universal coverage: Breast and cervical cancer screening in Ontario and the United States. JAMA 17 1994;272(7):530–534.CrossRefGoogle Scholar
  59. 59.
    Canada House of Commons (1984) Canada Health Act. Ottawa: Queen’s Printer.Google Scholar
  60. 60.
    Wlodarczyk K. The inter-hospital interpreter project. Can Nurse 1998;94(5):22–25.PubMedGoogle Scholar
  61. 61.
    Stevens S. Newcomer Canadians and mainstream services. Health and Culture 1993;2:277–291.Google Scholar
  62. 62.
    Health Canada (2001) Certain Circumstances: Equity in and responsiveness of the health care system to the needs of minority and marginalized populations. A collection of papers and reports prepared for health CanadaGoogle Scholar
  63. 63.
    Sadavoy J, Meier R, Ong AY. Barriers to access to mental health services for ethnic seniors: the Toronto study. Can J Psychiatry 2004;49(3):192–199.PubMedGoogle Scholar
  64. 64.
    Kinnon D (1999) Canadian research on immigration and health: An overview. Ottawa: Health Canada. Available at http// Scholar
  65. 65.
    Anderson RM, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly Journal 1973;51:95–124.CrossRefGoogle Scholar
  66. 66.
    Anderson RM. Revising the behavioural model and access to medical care: does it matter? J Health Soc Behav 1995;36:1–10.CrossRefGoogle Scholar
  67. 67.
    Honda K. Factors underlying variation in receipt of physician advice on diet and exercise: Applications of the behavioural model of health care utilization. Am J Health Promot 2004;18(5):370–377.PubMedGoogle Scholar
  68. 68.
    Broyles RW, Narine L, Brandt EN Jr. Equity concerns with the use of hospital services by the medically vulnerable. J Health Care Poor Underserved 2000;11(3):343–360.PubMedGoogle Scholar
  69. 69.
    Cunningham PJ, Cornelius LJ. Access to ambulatory care for American Indians and Alaska Natives the relative importance of personal and community resources. Soc Sci Med 1995;40(3):393–407.PubMedCrossRefGoogle Scholar
  70. 70.
    Champion V, Menon U. Predicting mammography and breast self-examination in African American women. Cancer Nurs 1997;20(5):315–322.PubMedCrossRefGoogle Scholar
  71. 71.
    Hulka BS, Wheat JR. Patterns of utilization. The patient perspective. Med Care 1985;23(5):438–460.PubMedCrossRefGoogle Scholar
  72. 72.
    Suarez L, Lloyed L, Weiss N, Rainbolt T, Pulley L. Effect of social network on cancer screening behaviour of older Mexican-American women. J Natl Cancer Inst 1994;86:775–779.PubMedCrossRefGoogle Scholar
  73. 73.
    Suarez L, Ramirez AG, Villarreal R, Marti J, McAlister A, Talavera GA, Trapido E, Perez-Stable EJ. Social networks and cancer screening in four U.S. Hispanic groups. Am J Prev Med 2000;19(1):47–52.PubMedCrossRefGoogle Scholar
  74. 74.
    Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to the use of preventive services? J Gen Intern Med 1997;12:472–477.PubMedCrossRefGoogle Scholar
  75. 75.
    Counte MA, Glandon GL. A panel study of life stress, social support, and the health services utilization of older persons. Med Care 1991;29(4):348–361.PubMedCrossRefGoogle Scholar
  76. 76.
    Freedman VA. Kin and nursing home lengths of stay: a backward recurrence time approach. J Health Soc Behav 1993;34(2):138–152.PubMedCrossRefGoogle Scholar
  77. 77.
    Miller B, McFall S. The effect of caregiver’s burden on change in frail older persons’ use of formal helpers. J Health Soc Behav 1991;32(2):165–179.PubMedCrossRefGoogle Scholar
  78. 78.
    Fenta H, Hyman I, Noh S. Determinants of depression among Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis 2004;192(5):363–372.PubMedCrossRefGoogle Scholar
  79. 79.
    Wolchik SA, Beals J, Sandler I (1989) Mapping children’s support networks: Conceptual and methodological issues. In: Belle D,(ed). Children’s social networks and social support. Wiley series on personality processes. New York: John Wiley and Sons, pp. 191–220.Google Scholar
  80. 80.
    Swartz M, Hughes D, George L, Blazer D, Landerman R, Bucholz K. Developing screening index for community studies of somatization disorder. J Psychiatr Res 1986;20(4):335–343.PubMedCrossRefGoogle Scholar
  81. 81.
    Westermeyer J, Bouafuely M, Neider J, Callies A. Somatization among refugees: An epidemiological study. Psychosomatics 1989;30(1):34–43.PubMedGoogle Scholar
  82. 82.
    Labott SM, Preisman RC, Torosian T, Popovich J Jr, Iannuzzi MC. Screening for somatizing patients in the pulmonary subspecialty clinic. Psychosomatics 1996;37(4):327–338.PubMedGoogle Scholar
  83. 83.
    North CS, Downs D, Clouse RE, Alrakawi A, Dokucu ME, Cox J, Spitznagel EL, Alpers DH. The presentation of irritable bowel syndrome in the context of somatization disorder. Clin Gastroenterol Hepatol 2004;Sep;2(9):787–795.CrossRefGoogle Scholar
  84. 84.
    World Health Organization (1997) Composite International Diagnostic Interview (CIDI) core version 2.1.Google Scholar
  85. 85.
    Addis Ababa University Faculty of Medicine, International Institute for Psychosocial and Socio-Ecological Research of Amsterdam and WHO: IPSER/AAU-Ethiopia core questionnaire (Amharic version). Addis Ababa University, Faculty of Medicine, Addis Ababa, Ethiopia, (1997).Google Scholar
  86. 86.
    Boehnlein JK, Kinzie JD. Refugee trauma. Trans-cultural psychiatry. Research Review 1995;32:223–252.Google Scholar
  87. 87.
    Paykel ES, Myers JK, Dienelt MN, Klerman GL, Lindenthal JJ, Pepper MP. Life events and depression. A controlled study. Arch Gen Psychiatry 1996;21(6):753–760.Google Scholar
  88. 88.
    Paykel ES, Prusoff BA, Uhlenhuth EH. Scaling life events. Archives of General Psychiatry 1971;25:340–347.PubMedGoogle Scholar
  89. 89.
    Noh S, Beiser M, Kaspar V, Hou F, Rummens J. Perceived racial discrimination, depression, and coping: a study of Southeast Asian refugees in Canada. J Health Soc Behav 1999;40(3):193–207.PubMedCrossRefGoogle Scholar
  90. 90.
    Noh S, Kaspar V. Perceived discrimination and depression: Moderating effects of coping, acculturation, and ethnic support. Am J Public Health 2003;93(2):232–238.PubMedCrossRefGoogle Scholar
  91. 91.
    Clinton-Davis L, Fassil Y. Health and Social Problems of Refugees. Soc Sci Med 1992;35(4):507–513.PubMedCrossRefGoogle Scholar
  92. 92.
    Castillo R, Waitzkin H, Ramirez Y, Escobar JI. Somatization in primary care, with a focus on immigrants and refugees. Arch Fam Med 1995;4(7):637–646.PubMedCrossRefGoogle Scholar
  93. 93.
    Tang S, Fox S. Traumatic experiences and the mental health of Senegalese Refugees. J Nerv Ment Dis 2001;189(8):507–512.PubMedCrossRefGoogle Scholar
  94. 94.
    Hosmer DW, Lemeshow S (1989) Applied logistic regression. John Wiley & Sons IncGoogle Scholar
  95. 95.
    Johnson I., Goettler F, Goral A, Lefley A, Lueske B, Lee-Han H, Mallon J, Mann V, Sahai V, Sanderson R, Schultz S, Yim C, Zaniewski E (2000) Report on the health status of residents of Ontario: Public Health research, Education and development Program.Google Scholar
  96. 96.
    Isaac M, Janca A, Orley J. Somatization–a cultural bound or universal syndrome. Journal of Mental Health 1996;5(3):219–222.CrossRefGoogle Scholar
  97. 97.
    Ritsner M, Ponizovsky, Kurs R, Modai I. Somatization in an important population in Israel: A community survey of prevalence, risk factors, and help-seeking behaviour. Am J Psychiatry 2000;157(3):385–392.PubMedCrossRefGoogle Scholar
  98. 98.
    Escobar J, Waitzkin H, Cohen Silver R, Gara M, Holman A. Abridged somatization: a study in primary care. Psychosom Med 1998;60(4):466–472.PubMedGoogle Scholar
  99. 99.
    Kirmayer LJ, Young A. Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med 1998;60(4):420–430.PubMedGoogle Scholar
  100. 100.
    Berkanovic E, Reeder L. Ethnic, economic, and social psychological factors in the source of medical care. Soc Probl 1973;21:246–259.Google Scholar
  101. 101.
    Hyman I (2001) Immigration and Health. Health Canada. Health Policy Working Paper Series 01–05.Google Scholar
  102. 102.
    Messing SD (1967) Group therapy and social status in the Zar-cult of Ethiopia. In: Torrey EF, (Ed). An introduction to health and health education in Ethiopia. Addis Ababa: Artistic Printers.Google Scholar
  103. 103.
    Messing SD. Interdigitation of mystical and physical healings in Ethiopia. Towards a theory of medical anthropology. Behav Sci Notes 1968;2(3):87–104.Google Scholar
  104. 104.
    Workneh F, Giel R. Medical dilemma: A survey of the healing practice of the Coptic prist and an Ethiopian Sheik. Trop J Med 1975;27(4):431–439.Google Scholar
  105. 105.
    Workneh F (1980) Traditional healing in Ethiopia. In: Kiew A, Muya WJ, Sartorius N (eds). The future of mental health services. Amsterdam Excerpta Medica 63–66.Google Scholar
  106. 106.
    Giel R, Workneh F. Mental illness and its management in Ethiopia. Ethiopia Med J 1977;15:83–89.Google Scholar
  107. 107.
    Jacobsson L, Merdasa F. Traditional perceptions and treatment of mental disorders in western Ethiopia before the (1974) revolution. Acta Psychiatr Scand 1991;84:475–481.PubMedGoogle Scholar
  108. 108.
    Alem A, Jacobsson L, Araya M, Kebede D, Kullgren G. How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia. Acta Psychiatrica Scandinavica Supplementum 1999;397:40–47.PubMedGoogle Scholar
  109. 109.
    Statistics Canada. (1996) Canadian census.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Social Equity and Health ResearchCentre for Addiction and Mental HealthTorontoCanada
  2. 2.Department of PsychiatryUniversity of TorontoTorontoCanada
  3. 3.Joint Centre of Excellence for Research on Immigration and SettlementTorontoCanada
  4. 4.Department of Public Health SciencesUniversity of TorontoTorontoCanada

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