Introduction

According to the World Health Organisation (WHO), mental health includes an individual’s ability to cope with stresses in life [1]. Coping strategies often vary depending on gender, age, sociocultural and economic positions. From a gender perspective, evidence from high-income countries such as the United Kingdom suggests that women are more likely to use ruminative emotional coping styles, which focus on the acceptance of circumstances linked to the causes of their mental health problems [2]. Drawing on religious and cultural practices, for example, prayer is the most common coping strategy when faced with distressful situations among South Asian women, which differentiates them from the White British population in the UK, who are likely to seek professional help [2–4]. Given the socioeconomic challenges that shape the lives of older Nepalese women, including migration status, widowhood, and poverty, such studies highlight that coping strategies must be understood within the realities of everyday lives and experiences of the communities. Given findings across various settings that highlight how mental well-being is linked to these wider structural realities, and there is also a need to reflect on coping with these environments that contribute to overall efforts to promote mental well-being and manage mental distress [5]. The term ‘‘mental distress” is used in this paper as a term that acknowledges the troubling or adverse experiences as used in line with the previous literature [5, 6].

Previous studies indicate that older Nepalese women’s mental wellbeing is also heavily influenced by the intersections of a range of social challenges, such as economic hardship, family/relationship problems, and adjustment to the physical environment (i.e. weather patterns) in the UK [7, 8]. While many studies acknowledge that South Asian communities, including Nepalese communities, have low levels of awareness and uptake of mental health services in the UK [4, 8, 9], very few studies have explored indigenous coping strategies used by these migrant communities to tackle their mental health needs [2, 10]. However, none of these studies have directly explored the coping strategies employed by older Nepalese migrant women in the UK. According to the recent census in 2021, the current Nepalese ethnic population in the UK is over a hundred thousand, and the number of women 60 years and over is 5849 [11]. Hence, it is important to explore the issues experienced by this population group, given the increasing number of older women in this population group, so that appropriate support can be considered in the policy and practices to address their needs. In this study, we aim to explore coping strategies employed by older Nepalese migrant women in managing their mental distress. Under mainstream mental health paradigms, coping is often linked to strategies attempting to an effort to manage the demands created by stressful events [12]. Seminal work by Folkman and Lazarus categorised coping strategies as either problem-focused or emotion-focused [13]. Problem-focused strategies aim to solve the problem or reduce mental stress by taking direct action and seeking assistance. In contrast, emotion-focused strategies aim to manage distress associated with the situation without changing the source of the stress. Since then, these coping approaches have been applied by several studies, such as the spouse of the military in the US [14] and gender differences in the outcomes of coping in education [14, 15]. However, in our understanding, none of the studies have applied the concept to older Nepalese migrant women; this is the first research of its kind.

Methods

Results

Our analysis identified one global theme and three organising themes describing the coping strategies used by older Nepalese women to address the issues around their mental health and wellbeing: i) Engaging others to access human, social and economic resources in problem focussed strategies; ii) Using emotion-focussed strategies through drawing on human and social recourses and iii) Employing emotion-focussed strategies through prayer and acceptance. We discuss these themes below in separate headings, and the visualisation of the one global theme and three organising themes are presented (Fig 1). All the basic themes are presented as a quote. It is worth noting that when participants were asked about their access to formal mental health services, all women answered that they had never used mental health services in the UK and did not know what they were.

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Fig 1. Coping strategies employed by older Nepalese migrant women.

https://doi.org/10.1371/journal.pone.0310832.g001

All names of the participants have been changed to protect participant identity. The details of the demographic characteristics of the participants are included in Table 1.

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Table 1. Participants demographic characteristics.

https://doi.org/10.1371/journal.pone.0310832.t001

Discussion

Our study highlights that despite living through multiple forms of adversity, Nepalese older women readily deployed individual and collective approaches in accessing human, social and economic resources/support to cope with the social determinants and their experiences of mental distress. To our knowledge, this study is the first of its kind to explore coping strategies employed by older Nepalese migrant women in the UK, viewing psychosocial coping as a process geared at reducing emotional and mental distress during stressful times. We also argue that it is important to consider what resources and strategies women themselves employ in the management of a wide range of challenges linked to their mental wellbeing, particularly in response to structural and emotional determinants of distress. These adaptations highlight the importance of their social networks and cultural practices as pivotal strengths and assets in enhancing their mental health and wellbeing due to their poor understanding and complexities of navigating mental health services.

Our findings confirm the positive benefits of residing in communities with shared ethnic backgrounds and experiences. This is in line with Bhugra and colleague [27] findings that suggest the settling process is eased as the ethnic density increases for migrants from the same community. In that case, evidence suggests that the presence of Nepalese ethnicity is evident in Greenwich [21], and they are more likely to receive from their own community, which was possible when these older women took the opportunity to socialise and contact people from the same ethnicity with whom they share their sociocultural norms and language. Their increasing social contacts, through spending time in the park and talking to each other about their daily lives, counter-acts the distress of isolation for women living alone or away from their children, highlighting that socialising activities positively impact higher life satisfaction among the older Nepalese population [28, 29]. Findings highlighted that the most significant source of social, material, and relational resources to support and improve mental wellbeing in the UK were connected to family, children, and the wider Nepalese community. For older Nepalese women in this study, many benefited from receiving information about the host country and an arrangement of housing before their arrival, contributing to their ability to cope with the situation in the UK. Therefore, we assert that social support network helps older Nepalese women cope with distressing situations and promote their wellbeing, which is in line with the findings from other research, especially studies which report the importance of social support on the quality of life of older people [30, 31]. Some women in our study were fortunate to receive support from family and relatives while they were in the UK. They worked to maintain frequent contact with their family members living elsewhere or in Nepal, citing it as key to maintaining their wellbeing. Such findings are supported by other studies arguing that maintaining a good relationship and contact with people improves wellbeing [29]. Access to financial support from the family positively impacted older women’s mental health and wellbeing. In contrast, separation from family was a leading cause of distress highlighted in previous work [7].

The interactions between poverty, inequality, and emotional wellbeing are well documented [32]. Limited economic resources can be a significant detriment to efforts to cope effectively with stressors in one’s life, particularly among marginalised women [33]. Furthermore, the option to rely on informal support, such as family and friends, in times of stress has been associated with lower socioeconomic status among older people in European countries, including the UK [34]. However, in many instances, these supports are described as limitations rather than positive action in accessing the necessary resources and support. For women in our study, lower socioeconomic status was the most significant challenge, as many women were largely dependent on state benefits and pensions and had limited education. We view women’s abilities to mobilise resources as distinct indicators of their empowerment in coping with and managing distress without accessing structured support. Reliance on wider family members to ensure financial stability can lead to unstable realities in the longer term, which are often shaped by wider geopolitical realities, reducing their access to support. This has been widely reported as a concern in previous studies where remittances highlight relationships between migrant wellbeing and economic realities in home countries [35].

Nepal is known for deeply rooted divisions and differentiations among people based on the caste, culture, religion, and language they speak [36]. We found that Nepalese women in the UK rejected these cultural norms to some extent and accepted people from different castes, cultures, and regions of Nepal under an umbrella as a ’Nepalese community in the UK’. We found that this is unique behaviour in coping with the situation, especially because women have limited alternative options to socialise and build a sense of community due to the constraints of language and cultural barriers in the UK. Our findings also affirm the growing body of evidence citing the value of faith and religion to promote emotional wellbeing. In our study, religious practices and beliefs were one of the main emotions-focused coping strategies the older women use, similar to Indian migrant women in Canada [37]. Engaging in religious activities such as daily prayer and worship brings peace of mind to them and hope for a better situation in the future. This finding affirms previous studies that demonstrate religion is a common coping strategy at the time of psychological distress, which associates positive religious coping with lower depressive symptoms [10].

Our findings support recent calls for expanding definitions of the ’social’ within interventions for the mental health of marginalised communities. There has been growing attention to the value of social interventions in mental health [38], with evidence supporting social prescribing to increase access to relationships that support wellbeing, such as choirs and community gardening [39]. However, these interventions focused primarily on the socio-relational dynamics associated with mental health, ignoring the problematic social-structural dynamics that are driving poor mental health outcomes [40]. Through their abilities, the women in our study established a range of successful coping strategies, leveraging social networks and individual capabilities to promote their wellbeing. This would suggest that for women in this population, gaps in support exist in access to systemic and structural supports around livelihood concerns.

All of our participants had no knowledge or experience of mental health services in the UK. This aligns with earlier research within the Nepalese community, which highlighted a lack of awareness about mental health services and inadequate knowledge about the NHS system to access any health services [8]. The previous literature suggests a low usage of mental health services among migrant communities, despite high levels of mental health issues, whereas the diverse background of migrants creates challenges regarding their utilisation of mental health services in the host country [41, 42] Another reason could be a lack of mental health awareness among these research participants, as they do not necessarily recognise the need for it [9]. The importance of health literacy focusing on physical health is widely accepted, whereas a focus on mental health literacy has been relatively neglected, which could lead to limited access to mental health services among migrant communities in the UK [43]. The language barrier and limited knowledge and understanding of the need and access to mental health and wellbeing services were major reasons for not using mental health services by older Nepalese women in this research. While a study conducted in Nepal showed that Nepalese people were more likely to receive social support for mental health issues from family and friends, our study suggests that for those residing in the UK, this may not always be possible as they live geographically distance from family combined with evidence of high levels of mental health support and low uptake of mental health services [8], suggests more action is needed to promote the mental health of this group. Utilising social networks in a structured form could be a crucial strategy in improving knowledge about mental health services among Nepalese older women in the UK. However, given women’s successful efforts to mobilise social support, bringing services more in line to acknowledge and respond to wider dimensions of social need would help to increase their value to women like those in our study.

Strengths and limitations

This study presents an understanding of coping strategies employed by older Nepalese women living in the UK, but we did not explore or have any understanding of the presence of mental health disorders among these women. Furthermore, these coping strategies may change according to socioeconomic circumstances, such as family and financial situation. Our findings in this article cannot be generalised to all Nepalese women living in the UK as this study is based on older women (sixty years and over), residing in one London Borough. However, the value and relevance of this research reside in the importance of understanding the coping strategies of the migrant population, which can inform positive building blocks for formalising support to promote good mental health and well-being in the ethnic minority community.

Conclusion

Our study concludes that older Nepalese migrant women employed both problem-focused and emotion-focused strategies to manage their mental distress while living in the UK. The informal support women were receiving within the family and community was expected to operate in coping with their mental distress instead of formal mental health services. The coping strategies and access to mental health services can significantly promote good mental health and wellbeing. However, the older Nepalese women in this research present a poor understanding of accessing mental health services within the UK’s health system. Therefore, promoting appropriate family and social support combined with adequate access to existing community mental health services would enhance their coping skills and promote mental health and wellbeing. Overall, this paper highlights the need for greater attention and a deep understanding of the sociocultural and economic contexts of older Nepalese women and the ability and resources that underpin their coping strategies for mental health challenges. Further, health and social care service providers should acknowledge these contexts when supporting these women.

Supporting information