Immigrant adolescent health: Background and context

Introduction

Adolescents make up a substantial proportion of newcomers to Canada. From 2016 to 2021, adolescents under the age of 15 years made up 20.6% of all recent immigrants in Canada. Among recent immigrants of all ages, 62% came from Asia and 83% were racialized.¹

Figure 1. Top places of birth among recent immigrants to Canada, 2021¹

Adolescence is a critical developmental period, involving rapid brain development and significant physical, cognitive and social-emotional changes and challenges across various stages of development. Important developmental milestones in adolescence include:

• Developing a sense of identity (individual and peer);
• Building relationships;
• Acquiring the skills to cope with stress and life challenges.

During adolescence, youth establish lifelong health habits that will profoundly affect physical and mental health into adulthood. Many immigrant adolescents may also experience specific challenges related to:

• The effects of migration and resettlement on their identity development;
• Stressors in their everyday lives, which can affect cognitive and physiological development;
• Behaviours risky to health.

Newcomer adolescents are a heterogeneous population with diverse and variable socioeconomic status, education and levels of social support. Population-based data should be interpreted cautiously, as research on “broad groups” such as immigrant adolescents or even a “subset” such as Asian adolescent immigrants can obscure significant differences within smaller, marginalized subgroups. Young people affected by trauma and political conflict (e.g., as refugees), poverty, violence, racism, discrimination and social exclusion have different life experiences and health outcomes than others in their age group who have not faced these challenges.²

In clinical practice, health professionals should consider the length of time an adolescent has been in Canada and their immigration or refugee status. Both factors influence the degree of settlement and acculturation.

Key terms

• Adolescent: A person aged 10 to 19 years

• Youth: A person aged 15 to 24 years

• First generation: A person born outside of Canada who has migrated with or without their family to live in Canada

• 1.5 generation: A person born outside of Canada who arrives in middle childhood (6 to 12 years of age)

• Second generation: A person born in Canada with at least one immigrant parent

• Newcomer: A person who has moved to Canada recently and is in the process of integration and resettlement

For definitions of immigration categories, see An Overview of Immigrants and Refugees in Canada.

Clinical vignette: A bullied adolescent from China

Ben has been referred to a local clinic. He came to Canada alone about a year ago. Ben lives with a Canadian host family and attends high school while his parents live in China.

At 15 years old, he is bullied at school and feels lonely. Ben is teased at school because of his accent. He is struggling to feel “Canadian”, at the same time he no longer feels “Chinese”.

Ben is also bullied by students who think he is gay. He is very upset and is questioning his sexual identity. Recently, Ben told his parents that he might be gay, which they found difficult to accept, saying, “We don’t accept that in our family.” His father has not spoken to Ben for a month. Ben is anxious and scared about telling his host family about his emerging sexuality, because they have made derogatory comments about gay people. He feels isolated and emotionally distressed.

Questions to consider

What are a health care provider’s primary concerns?

• Social isolation
• Mood and anxiety symptoms, especially if related to discrimination and harassment
• Challenges related to identity formation: Sexual orientation, racial/ethnic identity, and acculturation
• Lack of strong family bonds, likely related to cultural differences
• Status as a “homestay” student (not living with parents) is a risk factor for decreased connectedness with parents

What are culturally safe next steps?

• Complete a HEEADSSS or SSHADESS assessment to evaluate Ben’s mental health symptoms, safety and suicide risk, including protective factors.
• Provide supportive counselling and/or connect Ben with appropriate mental health resources.

What services should Ben be connected with?

• School counsellor
• Culturally safe mental health services: Individual, possibly family counselling (preferably with family members in China via telephone, with an interpreter)
• Immigrant youth or community groups
• 2SLGBTQIA+ adolescent groups, organizations or services
• A clinician, preferably in an adolescent medicine or adolescent mental health clinic, who can follow him serially and coordinate care

Learning points

The aim is to enhance Ben’s protective factors and reduce risk factors at each level: individual, family and community. Assuring Ben that health care encounters are a safe and confidential space to explore experiences can help build the rapport needed for Ben to feel comfortable accepting support.

Individual interventions

• Perform a developmentally appropriate, confidential adolescent psychosocial assessment (HEEADSSS) or SSHADESS routinely, especially when there are psychosocial concerns.
• Validate and support Ben around his stressors: Discrimination, harassment, family conflicts and identity development questions.
• Perform a mental health assessment (including a safety assessment) and treat promptly or refer as needed.
• Use affirming language to model inclusivity and comfort with Ben's sexual identity.

Family interventions

• Have a confidential discussion with Ben about his evolving sexual identity, especially about disclosing to his biological and/or host families versus keeping his identity and experiences private.
• If Ben wishes to disclose and discuss his sexual identity with either or both families:
  • Provide family-centred education and resources around adolescent mental health, identity sexual identity development.
  • Advocate for more support for Ben’s evolving identity.

Community interventions

• Liaise with Ben’s school counsellor to discuss strategies to minimize and manage discrimination and harassment at school.
• Help link Ben with a supportive, caring adult (such as a coach, mentor or youth worker), with whom he can engage, be active, and talk about his challenges.
• Connect Ben with community resources that promote positive connections with adults and prosocial peers, as well as healthy identity development (racial/ethnic and sexual).

What health professionals need to know about acculturation, and identity development

Acculturation and identity development are complex processes that shape how young newcomers integrate into life in Canada.

“I feel torn between English and Arabic. Sometimes I miss Arabic so much and I feel like there is a battle in my head … if I want to improve my English skills I would have to stop speaking Arabic and the other way around, and in school or in Canada there is no space for me to speak both.”

Ethnic or cultural identity development involves identifying with and relating to a specific group. It is one component of acculturation, which refers to changes in a group’s culture or in individual psyche in response to a new environment or other factors. These concepts apply to all immigrants, and are covered in more depth in Adaptation and Acculturation. Important issues for immigrant adolescents are described below.

Adolescence is a crucial and sensitive period of identity and behavioural development, when patterns of coping, emotional regulation and health-related behaviour become established. For immigrant adolescents, identity development is complicated due to issues of acculturation, racism, discrimination and social marginalization, as well as a lack of recognition or value placed on pre-immigration life and learning experiences.

Newcomer adolescents face particular challenges, including³:

• Questions of belonging (“Who am I?”, “Where do I fit in?”)

• Creating positive peer relationships (an important protective factor)

• Conflicting values and belief systems (between or with their culture of origin and Canadian culture)

• Bullying or racism, which can create feelings of alienation

While detailed discussion is beyond the scope of this document, it is worth noting that the conceptualization and use of terms such as “acculturation” and “integration” are controversial.^4,5 The role of social determinants of health is, however, increasingly recognized, highlighting social and structural (rather than individual or cultural) factors that influence immigrant health and behaviours.⁶

Acculturation has been defined as the broader process of psychological changes and adaptations in attitudes, identities and social behaviours in response to intercultural contact and living in a new environment.³ The literature on acculturation and health is complex. Less acculturation can be both protective (the “healthy immigrant effect”) and introduce risk for adolescent health-related behaviours.⁷

Which particular strategy of acculturation an adolescent adopts may depend on the degree of affiliation with (or rejection of) their original and new cultures.³ Some evidence suggests that immigrant adolescents with an “integration” profile—affiliating with both their original and their new cultures—have optimal psychological and adaptive functioning.³ Other studies suggest that those with an inconsistent, confused or incoherent (“diffuse”) acculturation profile and identity development have the most trouble functioning.⁴

Immigrant adolescents who arrive in Canada before the age of 10 seem better able to adopt a Canadian identity, rather than continuing to view themselves as foreigners. Compared with their first- or second-generation immigrant peers, “1.5-generation” immigrant adolescents (i.e., those who arrive in middle childhood) appear to experience different acculturation and identity challenges.

Societal attitudes toward immigrants, ethnocultural groups and visible minorities affect identity development. Some youth say that achieving a sense of belonging in Canada is a struggle because of racism and discrimination.⁸ Discrimination experienced by newcomer families has been associated with higher levels of emotional problems in younger adolescents.

Specific questions that any health professional can ask to help assess acculturation, along with other information about next steps, are provided in Immigrant Adolescent Health: Guidance for Clinicians.

The role of social determinants in immigrant adolescent health

Adolescent health is strongly affected by broader social determinants such as community and family poverty, income inequality, access to education and employment, and the extent to which families, schools, and peers are safe and supportive.

Immigrant adolescents disproportionately experience social challenges that negatively impact their health and well-being. They are at increased risk of experiencing poverty, substandard housing, food insecurity, social exclusion, unhealthy or unsafe environments, difficulty transitioning to the employment market, and barriers to accessing health care.

Risk and protective factors for immigrant adolescent health

A large body of literature demonstrates that adverse childhood experiences (ACEs), such as abuse, neglect, chronic poverty, family dysfunction, chronic illness, addiction and/or mental illness increase the risks for poor mental health, school problems, delinquency, substance abuse and unhealthy behaviours in youth. Even so, the negative effects of such factors can be moderated significantly by internal and external protective factors.

Other important influences on immigrant adolescent health include pre-migration conditions, the reasons for a family’s migration, migration-related trauma, and the process of settlement and integration in Canada. Clinicians should ask about and evaluate such factors in tandem with health risk and protective factors that affect all adolescents.

Specific considerations are summarized in Table 1.

Table 1. Immigration-related influences on adolescent health

Factor	Evidence
Age at migration	Younger age at migration is associated with a higher risk of mood disorder or anxiety disorder in adults.
Cultural and personal identity	Exploration of cultural or ethnic identity is a key dimension of acculturation and is intensified among immigrant adolescents. An ethnic or cultural identity crisis may occur when a young newcomer faces uncertainty and difficulties in the process of resolving whether to identify strongly – if at all – with various ethnic identities. This is associated with adverse health outcomes.
Family	While a cohesive and supportive family can be protective, poor family relationships and/or specific living arrangements (such as homestay) can be a risk factor for mental health problems (e.g., suicidal ideation). (See also Immigrant Adolescent Health: Guidance for Clinicians).
Pre-migration and migration process	Negative pre- or post-migration experiences – which differ greatly among youth – may be associated with poor mental health.9
Refugee status	Refugee status can increase the risk of poor mental health outcomes, including post-traumatic stress disorder (PTSD).9
Discrimination and social exclusion	Marginalization and discrimination are risk factors for maladaptive behaviours and poor social adaptation, while affiliation with both the culture of origin and the mainstream culture can be protective. For more information, see Immigrant Adolescent Health: Guidance for Clinicians.
High school completion	The dropout rate for immigrant youth is slightly lower than for Canadian-born youth (6.2% versus 9.1% respectively, based on 2009-10 data). This difference may be due in part to the high value that many immigrant youth and parents place on education, as well as the high concentration of immigrants in large cities, where dropout rates are generally lower than in smaller communities. Immigrant adolescents who arrive in Canada before the age of 9 are significantly more likely to graduate from high school than those who arrive at an older age.
Extracurricular activities	Engaging in meaningful extracurricular activities can be protective for immigrant adolescents, because involvement builds self-esteem.
Generational status	First-generation immigrant adolescents are at higher risk for emotional symptoms and psychological distress. Second- and later generation immigrant adolescents are at higher risk for health risk behaviours, including substance use and delinquency, compared to their first-generation immigrant peers.

References

1. Focus on Geography Series, 2021 Census of Population – Canada: Immigrant Status / Statut de l’immigration. Government of Canada, 16 Dec. 2022 (Accessed October 27, 2025).
2. Obeegadoo I, Kingsbury M, Anderson KK, Colman I. Suicidality in first-generation, second-generation and non-immigrant youth in Canada. J Migr Health. 2025;11:100296. doi:10.1016/j.jmh.2024.100296.
3. Güngör D. Immigration and acculturation in adolescence. Encyclopedia on Early Childhood Development. Centre of Excellence for Early Childhood Development, 2023.
4. Grigoryev, Dmitry, et al. “The Integration Hypothesis: A Critical Evaluation Informed by Multilevel Meta-Analyses of Three Multinational Datasets.” International Journal of Intercultural Relations, vol. 97, 2023, p. 101897.
5. Shukla S, Smith RJ, Burik A, Browne DT, Kil H. When and how do parent-child acculturation gaps matter? A systematic review and recommendations for research and practice. Clin Psychol Rev. 2025;117:102568. doi:10.1016/j.cpr.2025.102568.
6. Mason J, Laporte A, McDonald JT, Kurdyak P, Fosse E, de Oliveira C. Assessing the “healthy immigrant effect” in mental health: Intra- and inter-cohort trends in mood and/or anxiety disorders. Soc Sci Med. 2024;340:116367. doi:10.1016/j.socscimed.2023.116367.
7. Horne CV. Acculturation and mental health: A scoping review. Creat Nurs. 2024;30(1):29-36. doi:10.1177/10784535241229146
8. Kaufmann L. Integration in Canada: A systematic review of the youth experience. Int J Intercult Relat. 2021;84:52–64. doi:10.1016/j.ijintrel.2021.06.010.
9. Byrow Y, Liddell B, O'Donnell M, Mau V, McMahon T, Bryant R, Benson G, Nickerson A. Profiles of post-migration stressors and mental health in refugees: A latent class analysis. Psychiatry Res. 2022;311:114494. doi:10.1016/j.psychres.2022.114494.