Psychological functioning and bereavement care needs of bereaved Chinese immigrants in Canada

The death of a loved one can be associated with significant physical and psychological morbidity for bereaved individuals. Bereavement care services aim to foster healthy adjustment to loss. Research and clinical observations, however, suggest that such services are under-utilized by ethnic minorities and immigrants. Using a mixed methods design, the current research examined the psychological functioning of bereaved Chinese-Canadian immigrants, and factors related to their access and utilization of bereavement care. Twenty-five first-generation Chinese-Canadian immigrants from Hong Kong, Taiwan, or Mainland China, who had been bereaved for 6 months to 3 years, completed Chinese-translated questionnaires on depression, anxiety, somatic symptoms, coping, and acculturation. Semi-structured interviews focused on their grief experiences, knowledge and experiences with bereavement care, and perception on barriers to access and ways to improve services. Quantitative results revealed that over half of the participants scored above clinical cut-offs on depression (56%), state anxiety (60%) and trait anxiety (64%). Eight themes emerged from the qualitative data. Chinese cultural grammar, being an immigrant in a foreign land, and navigating uncharted territories in a foreign health care system represented contextual forces that interacted to form barriers to accessing bereavement care. Bereavement as a lonely journey represented the core concern of the participants, with coping strategies, religion and spirituality, post-loss changes and growth, and ideal services emerging as outcome categories. Combined analyses on quantitative and qualitative data found that those displaying intense grief during interview also scored higher on depression and state anxiety. Emotion-oriented coping was associated with poorer psychological functioning, while taking solace in “good death”, cognitive reframing and discussing the loss with family predicted better adjustment. Those whose family members passed away in Canada or had received palliative care prior to death were more likely to receive pre-bereavement and/or bereavement follow-up care. Psychological morbidity and lack of discussion of grief with family were associated with increased initiative to seek professional help. Initiative to seek help, together with psychological morbidity, predicted subsequent access to bereavement interventions.