Social determinants of mental health problems among Nepali migrants living in Australia.

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This project involves quantitative research for identifying social determinants of mental health problems (stress, anxiety, and depression) among Nepali migrants living in Australia. The study aims to explore the social determinants of stress, anxiety, and depression using the DASS-21 scale among Nepali migrants living in Australia. Eligible participants were Nepali migrants aged 18 years or older, living in Australia, excluding those with a clinical diagnosis of severe mental health problems. A preliminary screening questionnaire was administered prior to accessing the main survey to determine participant eligibility. The screening questions assessed whether participants were Nepali migrants living in Australia, their age, and confirming that they have not been diagnosed with any mental health problems. Only respondents who met these criteria were allowed to proceed to the main survey and were included in the study. Convenience and snowball approaches were used to identify Nepali migrants living in Australia. Participants were recruited from social media, particularly Facebook. To reach potential participants, Nepali community organisations and networks were also actively contacted, and permission was requested to share the survey on their Facebook groups and pages. A Facebook page was created where an invitation post containing the study details was published. The sample size was calculated using G*Power software version 3.0 (Heinrich Heine Universität, Düsseldorf, Germany) for regression analysis with 80% power and α = 0.05. Accounting for an estimated 20% attrition, a minimum of 170 participants was required. A questionnaire consisting of two parts was created using the online platform Qualtrics. Part A consisted of questions about the sociodemographic characteristics of participants (including age, gender, marital status, ethnicity, education, income, occupation, duration of stay, generation, religion, and household composition), lifestyle behaviour (nutrition, physical activity, smoking, and alcohol consumption, and sleep, using simple questions), cultural values, early settlement, and access to mental health services. Part B focused on the mental health problems (Depression, Anxiety, and Stress-21 (DASS-21)) along with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Everyday Discrimination Scale (EDS). Descriptive statistics were reported in frequencies, percentages, medians, means, and standard deviation (SD). Inferential statistical analyses were performed, including independent t-tests for bivariate comparisons, one-way ANOVA with Bonferroni post-hoc adjustments for group differences involving more than two categories. Pearson’s correlation was performed to examine the relationships between continuous variables. Multiple linear regression was then used to assess the association between sociodemographic variables and stress, anxiety, and depression scores. Only variables with significant bivariate differences with depression, anxiety, and stress scores were included in the first model to identify their association with mental health problems (Model 1, unadjusted). In Model 2 (adjusted), other lifestyle behaviour variables investigated in this study with significant bivariate differences with depression, anxiety, and stress scores were included to control for their confounding influence on the association between sociodemographic variables and mental health problems. The statistical significance level (α) of < 0.05 was considered. The prevalence of stress was 40.5%, anxiety was 22.6%, and depression was 30.2% among Nepali migrants living in Australia. The results present the multiple linear analysis of depression, anxiety, and stress scores based on the characteristics of participants. In Model 1 (unadjusted for the influence of lifestyle and other variables), higher perceived discrimination was significantly associated with higher stress (β = 2.46, 95% CI: 1.89, 3.69), anxiety (β = 3.36, 95% CI: 2.10, 4.48), and depression (β = 3.39, 95% CI: 2.37, 4.31). Being married was associated with a lower risk of stress (β = -3.31, 95% CI: -3.76, -2.86). In addition, food insecurity was also positively associated with stress β = 8.77, 95% CI: 5.14, 12.40), anxiety (β = 8.63, 95% CI: 4.10, 13.16), and depression (β = 9.28, 95% CI: 5.28, 13.28). In Model 2, after adjustment for the influence of lifestyle and other variables, marital status remained negatively associated with stress (β = -3.53, 95% CI: -4.95, -2.11). Similarly, food insecurity continued to show a positive association with stress (β = 8.77, 95% CI: 4.62, 12.00), anxiety (β = 8.42, 95% CI: 3.88, 12.96), and depression (β = 7.59, 95% CI: 3.26, 11.92). Lower confidence during early migration was only negatively associated with depression (β = -3.39, 95% CI: -5.72, -1.06). Also, discrimination remained strongly and positively associated with stress (β = 2.44, 95% CI: 1.88, 3.70), anxiety (β = 4.14, 95% CI: 2.34, 4.38), and depression (β = 3.49, 95% CI: 2.39, 4.49). Additionally, poor sleep was positively associated with stress (β = 4.64, 95% CI: 0.45, 8.48) and depression (β = 4.23, 95% CI: 0.11, 8.35) and depression (β = 1.84, 95% CI: 1.51, 8.75). The R² values increased in Model 2 compared with Model 1 (stress: 0.27 to 0.35; anxiety: 0.28 to 0.29; depression: 0.29 to 0.35), suggesting Model 2 explains the association better.