Abstract
Background: This thesis critically examines the mental health challenges and needs of female migrants, employing a mixed-methods approach. It had four primary objectives:1. Establish a collaborative research framework for female migrant health.
2. Explore the obstacles and facilitators to accessing mental health support.
3. Examine key themes and coping strategies for mental health challenges.
4. Compare referral patterns and diagnostic severities between female migrants and their British-born counterparts.
Methods: The PhD included four work packages aligned with the research objectives:
1. Over 28 months, develop and utilise a collaborative research framework with a core co-production group of female migrants and professionals.
2. Conduct a systematic review analysing barriers and facilitators in mental health support, using a feminist perspective, complemented by a lived experience commentary.
3. Perform qualitative interviews with 18 female migrants, employing reflexive thematic analysis to understand their mental health needs and service access.
4. Analyse referral pathways and diagnostic severity through secondary analysis of patient data from the South London and Maudsley Mental Health Trust's Clinical Records Interactive Search, which encompassed 40,833 British-born women and 18,991 foreign-born women at the time of the research.
Findings: The co-designed Empowering Migrant Bridges: Active Research and Knowledge (EMBaRK) framework grounded in gender sensitivity, cultural security and participatory methods, guided the research and shaped the analysis.
Systematic review findings: The review identified 19 studies. Barriers included information scarcity, stigma, religious and cultural practices, and a lack of gender-specific considerations. Facilitators included gender-sensitive services, supportive general practitioners, and religious leaders.
Qualitative findings: Interviews confirmed these barriers, revealing how structural violence and systemic inequities exacerbate socio-economic disparities and cultural stigma. Interpreter limitations, distrust in services, and the male gaze further compounded access issues. Trust-building with providers, alongside faith and spirituality, emerged as essential facilitators of engagement.
Quantitative findings: Analysis of clinical records from 59,824 women revealed significant disparities. Foreign-born women were more likely to be referred through emergency pathways (OR = 1.331). Severity differences were driven by ethnicity, not migrant status alone. Despite lower odds of emergency referrals for Black women (OR = 0.771), their raw numbers remain high due to systemic, socio-economic, and cultural factors.
Conclusions: The EMBaRK process was central to addressing gendered and racialised healthcare disparities by embedding cultural security and lived experience at every stage of the research. This thesis highlights the critical need for inclusive, co-produced, and culturally sensitive healthcare that acknowledges structural violence and the intersecting challenges faced by female migrants. Addressing stigma, fostering trust, and promoting tailored approaches to healthcare delivery can mitigate barriers and improve mental health outcomes for migrant populations.
| Date of Award | Aug 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Carrie Llewellyn (Supervisor), Marija Pantelic (Supervisor) & Chrissie Jones (Supervisor) |