Corps de l’article

Immigration from one’s country of origin to another country can be a stressful process with significant consequences for the mental health of immigrants (Emami & Tishelman, 2004; Singhammer & Bancila, 2011; Wong et al., 2010). Newcomers, in particular, may struggle with the resettlement process in regards to finding adequate housing and employment (Caxaj & Gill, 2017; Fung & Guzder, 2018), the loss of lifelong relationships, changes in both family roles and economic circumstances (Guruge, Refaie Shirpak, et al., 2010), and the disruption of social support networks (Guruge, Refaie Shirpak, et al., 2010). Moreover, newcomer immigrants may experience racism and discrimination within the host country (Guruge, Refaie Shirpak, et al., 2010; Kim & Noh, 2014). Existing research by Kim and Noh (2014) and Veenstra et al. (2020) shows that post-migratory challenges may be detrimental to mental health due to tensions and challenges in fulfilling resettlement demands and developing one’s sense of belonging within Canada (Caxaj & Gill, 2017).

The process of migration can be especially challenging for immigrant women due to experiences of gender-related discrimination (Dominguez-Fuentes & Hombrados-Mendieta, 2012; Singhammer & Bancila, 2011; Yaghoub Zadeh et al., 2008). Marginalized immigrant women who are excluded from mainstream society because of their ethnocultural background, socioeconomic status, dis/ability, or gender or sexual identity may be at greater risk of experiencing post-migration stressors than those who immigrate to Canada and do not have intersectional identities (Dossa, 2006; Logie et al., 2016; Sethi, 2013). Some of the challenges that marginalized immigrant women face involve negotiating culturally defined responsibilities within the host society, such as being the primary caregivers to family members (Guruge, Kanthasamy, et al., 2010; Hynie et al., 2011; Lou & Beaujot, 2005; Martins & Reid, 2007; Sethi, 2013), while also expressing emotions and disclosing concerns, given the cultural norms within their ethnic community. In a study on physical and mental health trends among migrant women in Canada, Guruge et al. (2012) found that some immigrant women in Canada experienced discomfort in disclosing domestic violence because doing so may be contrary to their ethnic community’s expectations.

Importance of social support in strengthening mental health

Despite the potential for mental health challenges during migration, studies with immigrant populations also demonstrate the importance of social support on mental health, including relationship-based and institutional support within the host country (Dastjerdi & Mardukhi, 2015; Dominguez-Fuentes & Hombrados-Mendieta, 2012; Kim et al., 2012). Learning about available resources and obtaining informational and emotional support can facilitate integration into a host society (Kim et al., 2012), as well as protect immigrant women against hopelessness (Marsiglia et al., 2011). A number of studies have found that using a wide range of coping strategies — helping others, asking for information or advice, learning the language of the host country, and maintaining their ethnic language and culture — can support immigrant women to develop resilience (Gagnon et al., 2013; Rashid & Gregory, 2014; Rezazadeh & Hoover, 2018). In a study examining coping strategies and resiliency among migrant women during and after pregnancy, Gagnon et al. (2013) found that the resiliency of migrant mothers was improved and maternal–child health promoted by tailored programs such as access to interpreters and follow-up visits by service providers. In a similar study, MacDonnell et al. (2017) found that racialized and newcomer immigrant women received a boost to their experiences and feelings of resilience when they engaged in diverse activities in their communities, such as peer support groups, community-based research, or policy advocacy. Involvement with others helped newcomer immigrant women develop social skills, challenge inequity, and demonstrate activist identities (MacDonnell et al., 2017). Findings such as these showcase the potential impact of activism in promoting and strengthening the mental health and well-being of racialized immigrant women through community activities (MacDonnell et al., 2017).

Potential of community art in strengthening mental health

In addition to social support, engagement with the arts has been shown to positively impact immigrants’ mental health by centring mental health issues and identifying symptoms of mental health illness (Clini et al., 2019; Kalmanowitz, 2016). Here, I consider “the arts” broadly, encompassing literary (e.g., poetry or novels), performative (e.g., music or dance), visual (e.g., drawing or photography), audiovisual (e.g., video or film), and multimedia (e.g., graphic novels) and multimethod (e.g., a combination of two or more forms) arts (Leavy, 2018). Clini et al. (2019) found that engaging with art can be a venue for self-expression without the pressure of articulating feelings and can help improve self-confidence. Although the existing literature demonstrates the importance and potential for social support and the arts in promoting mental health, their protective roles can be magnified when they occur simultaneously. Such a combination occurs in community arts-based programs in which experienced artists are paired with non-professionals who are actively involved and engaged in art-making projects (Leslie & Hunt, 2013). Jo et al. (2018) and Rose et al. (2018) found that creating art within a group context counteracts social isolation, enhances personal growth, and supports the transition process for immigrant newcomers. Connecting with immigrant peers in a community arts-based program also facilitates the sharing of experiences, coping strategies, and making sense of life experiences, all of which strengthen mental health outcomes (Burnett & Peel, 2001; Hanania, 2018; Rose et al., 2018). These studies suggest that community arts-based programs have the potential to boost mental health by creating art and exchanging social support. Access Alliance, a community centre that provides health and settlement services, offered a group therapy program in which Arabic-speaking women used embroidery to express their life experiences. Embroidery helped the participants to share both pleasant memories with their family and friends as well as experiences of gender-based related violence. Moreover, by participating in embroidery sessions, the women were able to socialize and overcome their isolation (Access Alliance, 2019).

Despite the existence of community art services of diverse forms for immigrant women across Canada — and despite as well, some literature representing the process and benefits of these projects — only a limited number of studies explore the nuances of these programs. In this paper, I address the following research question: how do immigrant women’s experiences of creating art within a community group setting impact their mental health outcomes? In response to this research question, I use a narrative literature review to assess existing studies on art and community art as it relates to mental health. To help contextualize my findings, I start with my positionality and then outline my search strategy, which I follow with an analysis of the relevant literature. I conclude by discussing significant findings and their implications to researchers, service providers and policy-makers.

Positioning myself within community arts-based research

My interest in the area of artmaking, community art-based programs, and immigrant settlment is informed by my work experiences as a counsellor in Iran, where I provided services to native-born and non-Iranian immigrant women from neighbouring countries. Some of my clients experienced difficulties concerning their legal residency in Iran, obtaining suitable housing, registering their children at school, and entering the job market, resulting in financial challenges. These stressful daily struggles negatively affected their marital and parenting relationships, their self-esteem, and ultimately their mental health. As an Iranian and Muslim immigrant woman in Canada, I now experience many similar circumstances that other marginalized immigrant women face. Indeed, my social location as a racialized immigrant woman has built a foundation for rapport-building and mutual understanding with many other immigrant women in Canada. Accordingly, my migratory-related experiences — including my advantages (e.g., access to high-quality education and professional job opportunities, and exposure to cultural diversity) and disadvantage (e.g., experiencing homesickness, limited social support, and a fast-paced life) — have reinvigorated the career passion and academic pathway that I first nurtured in Iran: to learn about and support immigrant women’s mental health.

Enacting Motivation after Migration

After immigrating to Canada, I began volunteering for an immigrant-serving agency. As a volunteer, I worked with resilient individuals who inspried me to propose and subsequently facilitate an arts-based program focused on textile arts to help immigrant women learn new artistic skills while practicing and communicating in English. My voluteer experiences taught me that engagement with the arts carried various meanings for different participants. For instance, some participants viewed their artwork products (e.g., clothes for their family members) as a way to build closer connections by making something useful for their loved ones. Some others used their creations to explore possible new career directions or income sources. Another group of immigrant women used their newly learned artistic skills to express gratitude to their support resources (e.g., the settlement workers at the agency assisting those participants during their resettlement process). I also observed how relationships between predominantly female group members formed, evolved, or changed over time. I witnessed participants sharing stories, concerns, and achievements, as well as exchanging information, showing empathy, and learning new skills. These observations shaped ideas for this literature review as the first step for further investigating this field of study. More specifically, studying grassroots reports related to participating in community art classes and my direct experiences with those arts-based projects highlighted the significant role of community arts-based programs in promoting participants’ mental health. The guiding question for this literature review is: how do immigrant women’s experiences of creating art, in general, and within a community group setting, in particular, impact their mental health?

Methodology

In response to my research question, I conducted a narrative review. A narrative review, also known as a “traditional review” (Byrne, 2016; Collins & Fauser, 2005) or a “literature review” (Byrne, 2016; Grant & Booth, 2009) is broad in scope and is suggested when querying topics that cover a wide range of issues within a given topic (Collins & Fauser, 2005). My goal for this literature review is to investigate how art has been discussed in the literature in relationship to the mental health of immigrant women in Canada. Using Social Work Abstracts, Social Services Abstracts, PsycINFO, CINAHL, and ERIC, I reviewed English-written, peer-reviewed research articles that were published between the years 2000 and 2022, and that focused on first-generation immigrant women (aged 18 years old or above) in the Canadian context. Using the search terms immigra*/migra*/refugee*/ newcomer* AND wom?n OR female* AND Canad* AND “mental health” AND/OR “social support” AND art OR creat* OR narrative OR express*, I generated a list of 124 articles in my initial search. Given the limited research on art (and community arts-based programs) with immigrant women in Canada, I have searched for articles related to immigrants, regardless of their gender; immigration status; or adopting country. I limited my search to peer-reviewed journal articles and excluded theses or dissertations. After removing duplicate articles and reviewing abstracts to assess whether the articles respond to my research question, I identified 30 articles to review. These articles were primarily research-based; however, I also included literature reviews regarding the mental health and social support of immigrant women in Canada. Table 1 offers a summary of the articles considered in my review.

Findings

Art as a Medium for Personal Transcendence

Of the 30 articles that I assessed, 12 articles focused on art as a medium for expression. According to Malchiodi (2003), art serves as a pathway for communication between the inner world (e.g., thoughts, feelings) and the outer world (e.g., life experiences) in order to verbalize or illustrate thoughts, emotions, experiences, or future goals (Pooremamali et al., 2011). Art can also reveal the unconscious and raise previously unasked questions that need to be further explored (Rose & Granger, 2013). Jo et al. (2018) explored the impact of programs on the well-being and quality of life of Korean immigrant older adults and found that art promotes self-awareness about attitudes toward life, and that it pushed participants beyond their comfort zones. The articles reviewed in this literature search found that the process of creating art (e.g., using fabrics to create tapestries, or words to create poems) can help newcomer women express their emotions (Ismael, 2013; Linesch et al., 2014; Sjollema et al., 2012). For instance, they can express their loneliness (Ismael, 2013), feelings associated with homelessness or precarious housing (Sjollema et al., 2012), fear of belonging to a minority group, or fear of risky situations for which they need to develop coping strategies (Linesch et al., 2014). The use of art also paves the way for reflecting on the nature of their social networks, as well as experiences of acculturation (Linesch et al., 2012; Linesch et al., 2014). In their study, Linesch et al. (2012) asked immigrant families to use art to reflect on their family relationships and on their acculturation processes. The findings indicated various struggles, as well as strengths and resilience of the families throughout the transition of acculturation (Linesch et al., 2012). Through art (e.g., photography), racialized immigrant women have also expressed their feelings of difference in terms of their bodily appearance, language, and culture (Sethi, 2016). In a qualitative study by Sethi (2016), immigrant women depicted an “odd-looking tree” without branches, to symbolize their feelings of having unrecognized academic degrees from their country of origin, and experiences of underemployment and discrimination in the Canadian workplace (Sethi, 2016, p. 24).

Table 1

Summary of reviewed articles

Summary of reviewed articles

Table 1 (suite)

Summary of reviewed articles

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The richness of art has been found to have positive impacts on immigrant women who deal with post-traumatic stress disorder (Clini et al., 2019; Hanania, 2018; Nakhost Isfahani, 2008) and schizophrenia (Pooremamali et al., 2011) by facilitating self-disclosure and self-reflection, helping immigrants make sense of past trauma (Chu et al., 2019). Given the complexities of immigration and acculturation, some immigrants facing trauma before their arrival can experience mental health challenges related to their precarious status, which elicit anxiety and anger on top of their existing homesickness (Nakhost Isfahani, 2008). As such, relevant research has shown that making art during the therapeutic process could shed light on how cultural differences contribute to mental health symptoms (Nakhost Isfahani, 2008; Pooremamali et al., 2011). Pooremamali et al. (2011) worked with an immigrant woman with schizophrenia and used paintings to illustrate cultural differences between her country of origin (i.e., Turkey) and her country of residence (i.e., Sweden) as a factor contributing to her mental health. The paintings depicted two snakes, each with a flag in its mouth, representing Turkish and Swedish cultures. The participant painted herself with open eyes but a closed mouth, representing her confusion due to getting stuck between the two different cultures. In another artwork, she painted herself between the two flags with an open mouth but half-open eyes to illustrate her willingness to express herself. However, her fears prevented her from completely opening her eyes in the host country as to her “there is no lover like a mother, nor a place like a homeland” (Pooremamali et al., 2011, p. 9).

Community Art as a Space for Personal and Social Transcendence

Of the 30 articles reviewed in this paper, 24 studies showcased the outcomes of engaging in community-based art programming. The authors speak to the significant impact of making art in the presence of other artmakers and highlight the potential of collaborative artmaking. In a study with the Tamil community from Sri Lanka in Canada, Epp (2013) found intergenerational tensions between children, parents and grandparents in terms of communication and adaption within the host country. However, artistic methods such as drama, singing and storytelling facilitated communication between the different generations, and enabled both younger and older generations to reflect on their challenges, hopes, and values, and to develop mutual understanding and support (Epp, 2013). Dramatherapy, the process of creating drama in a group setting to represent life experiences, can also be healing (Apergi, 2014; Hakki, 2018). Dramatherapy provides a safe space for sharing experiences and developing trust that can help immigrant women overcome isolation and a sense of loneliness; by bringing these women in contact with others in similar situations, dramatherapy can foster mutual understanding and acceptance (Apergi, 2014; Hakki, 2018). Likewise, participatory photography also acts as a vehicle for sharing thoughts and feelings related to settlement experiences and can be done as part of a supportive group (Brigham et al., 2018).

Artmaking within a community offers a way to examine personal history and cultural background, revive connections with one’s heritage, and express cultural identity among women who have recently immigrated (Linesch et al., 2012; Linesch et al., 2014) and among refugee men and women (Hollingsbee, 2019). For instance, digital storytelling — which combines audio-recorded narratives, images, music and other sounds — when combined with groupwork and storytelling though story circles, offered a way of capturing ambiguities and conflicts between what recent immigrant women in Canada knew and orally expressed and that of which they were not aware (Rose & Granger, 2013). In a digital storytelling study by Rose and Granger (2013), researchers described how one participant told two different stories of herself in the story circle (a private space): one about a young female activist who sacrificed herself to save others, and the other about how this participant met her husband. However, when making an artwork to circulate within a public space, she chose to create a video about difficulty learning how to work with a computer. Such shifting from telling personal stories in private to sharing the computer story in public sheds light on what she was not conscious of and what she was not willing to disclose or discuss. Such a shift reveals a personal aspect of this woman that might have been neglected or remained unknown and unexpressed (Rose & Granger, 2013, p. 228).

Community art has provided a space for expression in different contexts. In a study with undocumented migrant workers, Gastaldo et al. (2012) used body mapping to help participants express their stressful journey to Canada, their fear of deportation, and coping strategies such as connecting with family and friends and establishing support networks in Canada. Likewise, using an artist’s drawing to represent Canadian workplace health and safety, McKillopa et al. (2016) provided a space for South Asian participants in Canada to express the disjuncture between their educational and career experiences and their current job positions, their stress due to the long hours working while not fully contributing to financial needs of their families, and their fear of losing their jobs (McKillopa et al., 2016). Research by Chin et al. (2014) found that using theatre as a research method opened space for newcomers to discuss how a lack of work experience in Canada often serves as a barrier for immigrant women to enter the job market (Chin et al., 2014).

Holding arts-informed focus groups (e.g., using collage-making) has been found to empower participants, as art created and discussed in a group enables immigrant women to discuss sensitive issues that may negatively affect their mental health (Vacchelli, 2018). For instance, a participant disclosed her experience of being discriminated against and labeled as a Turkish migrant woman in England. Another participant in the study by Vacchelli (2018) revealed a sense of loss and experience of missing her birth country and loved ones with no personal freedom as a Black refugee woman in British society. These findings frame artmaking as a tool for racialized newcomers to control and disclose their personal experiences (Vacchelli, 2018). Moreover, given that there is no need for any specific artistic skills to participate in arts-based group activities, immigrant women tend to feel confident expressing themselves through artworks (Apergi, 2014). Self-expression then leads to self-empowerment, reducing helplessness and hopelessness among participants (Apergi, 2014). In addition to personal change, community arts contribute to social change (Kohl-Arenas et al., 2014; Sinding & Barnes, 2015) by cultivating empathy and disrupting dominant fashions of knowing (Sinding & Barnes, 2015). Sharing cultural traditions and artistic expression (e.g., music and dance) helps to build more active and stronger communities (Kohl-Arenas et al., 2014).

Collectively practicing creativity and making arts can help immigrant women learn new skills and discover hidden talents (Apergi, 2014; Brigham et al., 2018; Ismael, 2013; Rose & Granger, 2013; Vahabi & Damba, 2015). Such activities can include diverse types of arts such as painting (Ismael, 2013), drama (Apergi, 2014), dancing (Vahabi & Damba, 2015), photography (Brigham et al., 2018), or digital video-making (Rose & Granger, 2013). In one example, for instance, creating a mural within a refugee camp provided an opportunity for refugees to apply skills that they had developed in their home countries (Hollingsbee, 2019). In another case, community dance helped North Korean refugee women in South Korea learn rhythm and movement skills that lead to positive mental health consequences. It also helped them feel connected to their host country, given the shared cultural roots (and types of dance) of the two Koreas (Na et al., 2016). In another arts-based research project with refugee women (Rose & Bingley, 2017), the majority of participants had no previous experience with painting. These women practiced painting to depict their real or imaginary spaces of safety. More specifically, practicing the activity of painting helped participants to depict natural landscapes as the spaces they most associated with safety, and which holds therapeutic benefits (Rose & Bingley, 2017).

Artmaking with others in a group setting can serve as an opportunity for immigrant women to make friends (Apergi, 2014; Na et al., 2016; Vahabi & Damba, 2015). Community-based art programs provides a safe space for developing competence in using and representing creativity that can lead to building stronger ties amongst communities, while advancing participants’ mental health and well-being (Beauregard et al., 2020). The process of creating art also cultivates solidarity and a strong sense of community among participants (Brigham et al., 2018; Hollingsbee, 2019). Creating artworks with marginalized immigrants provides a situation in which newcomers can learn about each other’s experiences of survival and resistance. Such a process then can lead to a sense of community and support (Perry, 2018). Community-based art programs provide a fun environment that lifts the mood of immigrant women participants and helps them to develop self-confidence when interacting with their peers (Vahabi & Damba, 2015). In this sense, it provides a space for informal interactions with others through shared activities that facilitate social connectedness (Rose et al., 2018).

Generating creativity and artworks within a community environment is an opportunity for learning and practicing artistic skills as a means of coping with stressful life events (Ismael, 2013). Moreover, sharing experiences of demanding situations between members of a group can lead to exchanging helpful information related to strategies for overcoming difficulties (Beauregard et al., 2020; Ismael, 2013; Kalmanowitz, 2016; Kalmanowitz & Ho, 2016). For example, through storytelling and the use of metaphors, immigrant women in Canada from a variety of backgrounds conveyed that people of diverse ethnocultural heritages could share resources and foster personal and community resilience (Beauregard et al., 2020). One group of women conveyed this by depicting different types of migratory birds in their mural art: the birds, though different, in their migrations, represented the end of winter and of migration-related difficulties. Even with no shared language among some participants, community-based art programs provided a space in which immigrant women developed their commitment to active participation in collective and cooperative artworks (Beauregard et al., 2020).

Discussion

This literature review suggests that artmaking, in general — and artmaking within groups, in particular — can make important contributions to improving the mental health of immigrant women. The implications for this review show how community-based arts projects can be employed by service providers, including practitioners at healthcare centres and settlement agencies, to familiarize and educate their clients and engage them with offered services (Hernandez & Organista, 2013). When treating mental health difficulties, the employment of culturally and linguistically appropriate modalities of artworks may assist service users with learning about those issues and their treatments (Hernandez & Organista, 2013; Warmoth et al., 2017). Additionally, immigrant women who practice arts within groups may experience both support from others and belonging to the group (de Valenzuela, 2014). These promising experiences (i.e., receiving support from others and experiencing belonging) may lead to a stronger sense of connection to their host country. Practicing or creating arts in community-based arts programs may also provide these women with opportunities to learn about and reach out to available resources. Moreover, it may facilitate their integration into Canadian society while still acknowledging and respecting the personal and cultural uniqueness that they bring into their new home (de Valenzuela, 2014). Such benefits for mental health and well-being suggest that policy-makers should facilitate the initiation and improvement of arts-based programs within communities for immigrant women to promote their mental health.

Limitations

One limitation of this study is that most literature in this area fails to clearly define key concepts such as ‘art,’ ‘community,’ and ‘community art.’ Moreover, few articles feature discussions of group dynamics, or of participants’ responses to or relationships with one another (e.g., Kalmanowitz, 2016; Kalmanowitz & Ho, 2016). Finally, literature in the field of community arts has not discussed whether creating art along with other people impacts the perception of the availability of support at times of need, nor does it clarify if participants have actually received assistance from co-participants after the conclusion of art-based programming.