Table 1 Included articles depicting Iranian immigrant studies

Alizade-khoie 2011 Australia

To explore the impact of acculturation on health status

N = 302 Iranians Age > 65 y

Developed questionnaire from the NSW Older People’s Health Survey 1999

• Iranian elderly immigrants suffer from high level psychological issues and physical activity limitation

Quantitative

• English proficiency decreases the rate of depression and anxiety

Khavarpour 1997 [25] Australia

To determine the levels and predictors of psychological distress within the Iranians living in Sydney

N = 161 Iranians

General Health Questionnaire (GHQ-20)

• Students more likely to report psychological distress compared to full-time workers

Quantitative

• migration contributes to psychological distress

• social support can reduce the experience of distress of unemployment and poor English proficiency

Steel et al. 2011 [27] Australia

To examine for differences in the trajectory of psychological symptoms and key indices of social adaptation amongst refugees over two years

N = 104 Iranian and Afghan immigrant

• The Harvard trauma questionnaire

• Language insufficiency results in increasing mental distress, social isolation, difficulty in acculturation process, and on-going resettlement difficulties

Quantitative

• The Hopkins symptom checklist-25

• The general health questionnaire

• The Penn State Worry questionnaire

• Post-migration living difficulties and detention experiences checklist

Neale 2007 [33] Australia

To examine the knowledge, use and satisfaction of local health care services

N = 98 Iranians, Afghan and Iraqi N = 23 Iranians

• Semi structured questionnaire

• poor English proficiency = dissatisfaction from health care services

Qualitative

• focus group

• multiple-choice questionnaire

•open-ended questionnaire

Jafari 2010 [14] Canada

To examine the impact of immigration on mental health

N = 44 Iranians

• Focus group

• Low English proficiency resulted in social isolation, anxiety, mental problems, joblessness and unstable and aggressive behaviours

Qualitative

• In-depth review

Dastjerdi 2012 [3] Canada

To identify the obstacles and issues that Iranian immigrants face to access to health care services through the lens of Iranian health care providers

N = 50 Iranian immigrant who work as health providers

• in-depth semi-structured individual interviews

• Language barrier and lack of knowledge of Canadian health care systems.

Qualitative

• three focus groups

• Lack of trust in Canadian health care services due to financial limitations and fear of disclosure

• Narrative inquiry

Dastjerdi 2012 [15] Canada

To explore the Process of access to Health care services

N = 17 Iranians

• Individual face to face interview with a broad question then focused on health-relate experiences

• Getting isolated as a result of poor English skill

Qualitative

• Telling story

• Tackling obstacles and being integrated

Dossa 2002 [31] Canada

To explore the pedagogical potential of stories of post revolution Iranian women living in Canada

N = 40 Iranian women

• Semi-structured interview

• Iranians experience discrimination

Qualitative

• two focus groups

• Iranians experience depression

• Story telling

• language barriers can result in unemployment or underemployment

Tyndale et al. 2007 Canada

To explore the needs and experiences of Iranian immigrants about sexual health

N = 20 Iranians

• Semi structured interview

• difficulty in adjusting with new culture where sexuality is a usual fact

Qualitative

• difficulties in receiving sexual health care because of misunderstanding (culture diversity) and shame and modesty

Guruge 2012 [38] Canada

To examine the relationship of violence and physical and mental health

N = 30 Iranian women

• Brief symptom Inventory

• about one third of Iranian immigrant women suffer from mental illness because of intimate partner violence

Quantitative

• Harvard trauma Questionnaire

Ebrahimian 2012 Canada

To examine the effects of immigration on mental health of the Iranian immigrants residing in Toronto by comparing them to their counterparts in Iran

N = 200 Iranians

• Demographic questionnaire

• The rate of depression is higher amongst elderlies then younger immigrants

Quantitative

• Depression Scale

• highly educated immigrants are less depressed than low-educated ones

Singhammer 2011 [26] Denmark

To explore the relationship of violence and mental health among Iranian immigrants

N = 991 Iranian women

• A questionnaire including health indicators, health risk factors, healthy behaviours & health care services

• Iranian women had the greatest rate of divorce among other ethnic minorities in Denmark

Quantitative

• The rate of violence was reported higher amongst Iranian women than other minorities

Lipsicas et al. 2012 [4] European countries

To compare the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their

N = 4160 immigrants from various countries included Iran

• Data were obtained from the WHO/EURO Multi-centre Study on Suicidal Behaviour

• Iranians displayed high suicide attempt rate in European countries despite low suicide rates in Iran

Quantitative

• Immigration process in itself and the difficulties in acculturation can result in high- suicide attempt rates

Haasen et al. 2008 [22] Germany

To find evidence for a relationship between acculturation stress and mental health problems, mainly depressive symptomatology

N = 100 Iranians

• Acculturation-stress-index (ASI)

• 28 % of Iranian immigrants suffer from mental disorders without treatment

Quantitative

• SCL-90-R

• Depression score was high amongst Iranian immigrant

• Hamilton Depression scale (HAM-D)

• Inaccessibility of mental care centres

Gerristen et al. 2006 Netherlands

To estimate the prevalence rates of physical and mental health

N = 410 Iranians, Afghan and Somali N = 117 Iranians

• medical outcome study (MOS)

• 43.4 % of Iranian asylum seekers suffer from depression and anxiety

Quantitative

• SF-36

• Harvard trauma questionnaire

• Iranians suffer from dental and eye problems, back pain, neck/shoulder complaints, headache

• HSCL-25

Akhavan 2007 [24] Sweden

To analyse females’ perceptions of various factors that influence their health

N = 10 Iranian women

• Semi-structured interview

• Discrimination is the greatest threat for health

Qualitative

• Unemployment and financial issues result is mental problems

• Domestic violence, depression, and divorce as immigration adverse effects

Bayard 2001 [34] Sweden

To examine the association between ethnicity among migrants born in Iran and psychiatric illness and intake of psychotropic drugs

N = 1980 Iranian, Kurd, Turkish, Polish, Chilean N = 293 Iranians

• Swedish Survey of Living Conditions questionnaire plus immigrant specific questions

• Iranian had more risk of mental illness and intake drugs 6 and 5fold more than swedes respectively.

Mixed(Qualitative and Quantitative)

• Face to face interview

• Feeling discrimination by Iranians was higher than other ethnic minorities

Momeni et al. 2011 Sweden

To investigate the self-reported mental health among two Iranian groups; in Sweden and Iran

N = 208 Iranians

• An author-made questionnaire

• 21 % of elder Iranian immigrants suffer from depression same as their counterparts in Iran

Quantitative

• depression rate was higher among Iranian women compared to men

Tinghog et al. 2010 Sweden

To investigate the association of immigrant and non-immigrant-specific factors with mental ill health within a diverse immigrant population

N = 720 from Iran, Iraq and Finland N = 250 Iranians

• The Hopkins symptom checklist-25

• 48 % of Iranian immigrants suffer from depression

Quantitative

• The WHO (World Health Organization) Well-being Index

• 19 % of Iranian immigrants suffer from discrimination

• Unemployment and poor social network can lead to depression

• being female is a risk factor for mental disorders

Wiking 2004 [36] Sweden

To analyse the association between ethnicity and poor health

N = 2160 From Poland, Iran and Turkey N = 480 Iranians

• Standardized & translated questionnaire for assessing the socioeconomic status (SES)

• Discrimination and acculturation are two important mediators between ethnicity and health.

Quantitative

• High discrimination is felt by 34 % & 51 %, respectively, by men and women

• 41 % of women reported poor health status

Lipson 1992 [28] The United States

To examine the immigration experiences of a sample of Iranians in the USA

N = 35 Iranians

• Semi-structured interview

• Lack of social support

Mixed(Qualitative and Quantitative)

• Health opinion survey (HOS)

• Communication problems because of language insufficiency

• culture shock

• difficulty to find a good job

• Financial problems

• Ethnic bias (discrimination)

Martin 2012 [37] The United States

To explore elderlies’ experience of discrimination in American health care system

N = 15 Iranians

• In-depth interview (in person)

• There was no discrimination

Qualitative

• Open ended questions

• Highly positive impression of American health care providers

• Language barrier as a factor for underestimating possible discrimination

Meleis et al. 1992 The United States

To investigate the nature of the relationship between demographic characteristics, ethnicity, length of time in the USA and physical and mental health/illness status, psychological well-being, and perceived health

N = 88 Egyptian, Yemeni, Iranian, Armenian, and Arab immigrant N = 16 Iranians

• Socio-demographic questionnaire

• unavailability of an ethnic community in overseas can result in depression and isolation among elderlies

Quantitative

• Ethnic identity questionnaire

• 10-point rating scale

• Iranians usually enjoy from high integration and assimilation in host countries

• Cornell Medical Index (CMI)

• Revised Bradburn Morale Scale

• integration increases along with increasing the length of stay in the host country

• 10-point Cantril ladder scale

• increasing the length of stay in the host country doesn’t improve the immigrants’ health situation

Saechao et al. 2012 [29] The United States

To examine stressors and barriers to using mental health services among first-generation

N = 30 from Cambodia, Iran, Iraq, Vietnam, Africa, eastern European N = 4 Iranians

• Six focus groups

• Barriers: Language, cost, lack of information about mental health services

Qualitative

• Stressors: discrimination, economic status, difficulty to find suitable job

Ghaffarian 1998 The United States

To explore the relationship of acculturation and mental health

N = 238 Iranians

A five section questionnaire including:

• Acculturation increased = score of mental health decreased (better)

Quantitative

• Demographic Questions

• Men are healthier than women mentally

• Warheit & Buhl's Anxiety, depression and Psychological dysfunction scale

• Iranian version of Mendoza ‘s Cultural Life Style Inventory

Ghaffarian 1987 The United States

To examine Iranian immigrants, their acculturation to the American culture, and specifically, the acculturative differences between males and females

N = 110 Iranians

• Demographic Questionnaire

• Less adjustment to host culture = stress and depression

Quantitative

• Warheit & Buhl's Anxiety scale

• Men are more able to adjust themselves with new societies and cultures

• Traditional family ideology designed by Levinson and Huffman (1955)

• Acculturation scale designed by Cuellar, Harris, and Jasso (1980)