Interactive Effect of Immigration-Related Factors with Legal and Discrimination Acculturative Stress in Predicting Depression Among Asian American Immigrants

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

Immigration stress and internalizing symptoms among Latinx and Asian American students: The roles of school climate and community violence

Immigration-related problems and stressors are prevalent and pressing concerns among Latinx and Asian American school-age youth. Youth fears related to family deportation have been associated with adverse mental health outcomes. This study used an ecological framework to examine the impact of immigration stress and school- and community-level resources and protective factors on Latinx and Asian American youth internalizing symptoms. The sample included 1309 Asian American and 701 Latinx students (N = 2010) who participated in a routine school-based mental health needs assessment survey. Multilevel regressions analyses revealed that first-generation youth, Latinx youth, and female youth were more vulnerable to experiencing immigration-related problems and worry. Student perceptions of negative school climate and community violence were associated with greater internalizing symptoms regardless of immigration worry. Moderation analyses revealed that immigration-related problems and worry were positively associated with internalizing symptoms and that this relationship did not differ by race/ethnicity. However, immigration worry was a particular risk factor for students who perceived their neighborhood community as safe. Findings highlight that a sociopolitical climate that sows immigration-related challenges fuels youth distress and that students' experiences of their community environment can play an essential role as a psychological resource.

Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework

OBJECTIVES

Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama.

DESIGN

Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23-75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression.

RESULTS

Perceived race discrimination was significantly associated with greater depressive symptoms (β = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (β = .247, SE = 1.118, p < .001), had lower level of health literacy (β = -.121, SE = .280, p < .05), and had higher social isolation scores (β = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms.

CONCLUSION

Rural-living KA immigrants' depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

The role of pharmaceutical side-effects in depression among immigrants

OBJECTIVES

This study explores the role of pharmaceuticals with depression or suicidality as a side-effect in explaining the immigrant depression paradox. Immigrants generally report less depression than their native-born peers, despite the socio environments that are less conducive to well-being. This immigrant advantage in mental health tends to recede with time in the US and more acculturation. To date, an explanation for this pattern has remained elusive, partly because acculturation is also associated with many desirable outcomes, suggesting less depression with more acculturation.

DESIGN

Data came from seven two-year waves (2005-2006 to 2017-2018) of the National Health and Nutrition Examination Survey (NHANES). Depression was measured using the Patient Health Questionnaire (PHQ-9). Linear and logistic regressions were used to estimate the immigrant differences in depression, while controlling for sociodemographic characteristics, healthcare access, health conditions, and the use of medications with depression or suicidality as a side-effect.

RESULTS

30.3% and 22.7% of US-born adults used at least one medication with depression or suicidality as a side-effect, compared to 16.4% and 9.2% of foreign-born adults. Access to healthcare improved with time in the US and with acculturation, and both of these factors were also positively associated with the use of medications with depression or suicidality as a side-effect. The magnitude of the mediation associated with medication side-effects was significant, in many cases sufficient to eliminate the relationship between acculturation - whether expressed in terms of time in the US, English-language use, or nativity - and depression.

CONCLUSION

Exposure to medications with depression or suicidality as a side-effect helped explain part of the relative mental health advantage of foreign-born residents, as well as the diminishing advantage associated with time in the US and with acculturation.

Generation and age of immigration on later life cognitive performance in KHANDLE

OBJECTIVES

We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans.

DESIGN

Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017.

SETTING

Older adults in Northern California.

PARTICIPANTS

Our cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8).

MEASUREMENTS

We used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education.

RESULTS

Generational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = -0.96; 95% CI: -1.12, -0.81) than immigration in adolescence (β = -0.68; 95% CI: -0.96, -0.41) or childhood (β = -0.28; 95% CI: -0.49, -0.06). Moreover, immigration in adulthood was associated with lower executive function (β = -0.63; 95% CI: -0.78, -0.48) than immigration in adolescence (β = -0.49; 95% CI: -0.75, -0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores.

CONCLUSIONS

Our study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.

A Biopsychosocial Framework to Examine Risk for Type 2 Diabetes in Asian Pacific Islander Immigrants

There is large disparity in the incidence of Type 2 diabetes (T2D) for Asian Pacific Islanders (APIs), one of the fastest growing minority populations in the United States. It is critical to examine biopsychosocial pathways and vulnerability factors that intensify risk for T2D in API. Increasing evidence links chronic stress to poor health outcomes and accelerated development and progression of diseases of aging, such as diabetes. Immigrant populations face unique life stressors, including the challenges associated with the process of adapting to a new environment, new language, and cultural differences. In addition, immigrants experience high levels of psychological distress related to changes of identity and values, loss of support, discrimination, and disempowerment. The purpose of this article is to propose a biopsychosocial framework to explicate potential mechanistic pathways that link cumulative life stress to risk for T2D in the API immigrant population. Unique to the proposed framework is the emphasis on inflammatory processes and accelerated cellular aging (telomere biology). A deeper understanding of biopsychosocial pathways can lead to tailored and targeted interventions to reduce the incidence of T2D in the API immigrant population.

Depressive Symptom Severity and Immigration-Related Characteristics in Asian American Immigrants

The study examined immigration factors associated with depressive symptom severity among Asian American immigrants. Participants were 458 Chinese, Korean and Vietnamese adults. Depressive symptom severity was measured by PHQ-9. Overall, the likelihood of being moderately to severely depressed was significantly increased among immigrants living in the US for < 10 years and Korean Americans compared to Chinese Americans. However, mild level of depressive symptoms was not associated with any immigration-related factors. The positive impact of shorter duration of living in the US and a younger age at immigration (≤ 17) on depressive symptoms was evident among women but not among men. For men, marital status and education level were significant predictors of being moderately to severely depressed. Differentiating immigrant factors and identifying depressive symptom severity can help drive community and clinical interventions to detect and treat depression early among Asian American immigrants.

Discrimination as a social determinant of stress and health among New York City taxi drivers

Discrimination is associated with poorer mental and physical health outcomes. Taxi drivers have a higher risk of exposure to discrimination and higher rates of chronic conditions. A cross-sectional needs assessment was conducted with a multilingual group of 535 male taxi drivers in New York City. Drivers reporting higher discrimination were more likely to have higher perceived stress and were more likely to have anxiety/depression and chronic pain, adjusting for confounders. Workplace-based interventions designed to help drivers cope with discrimination, stress, and chronic health conditions, interventions to educate the taxi-riding public, and greater attention to these issues from administrative agencies are warranted.

The Relationship of Acculturation, Traumatic Events and Depression in Female Refugees

Recent research has identified significant correlations between traumatic events and depression in refugees. However, few studies have addressed the role of acculturation strategies in this relationship. This study explored the relationship between cultural orientation, traumatic events and depression in female refugees from Syria, Afghanistan, Eritrea, Iran, Iraq, and Somalia living in Germany. We expected acculturation strategies to moderate the effect of traumatic experiences on depression. The sample included 98 female refugees in Germany. The depression scale of the Hopkins Symptom Checklist (HSCL) represented the dependent measure. The trauma checklists derived from the Post-traumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ) as well as the Frankfurt Acculturation Scale (FRACC) were used as independent measures for traumatic events and orientation toward the host culture as well as orientation toward the culture of origin, respectively. A moderation analysis was conducted to examine whether the relationship between the number of traumatic events and depression was influenced by the women's orientation toward the culture of origin and the host culture. We identified a significant model explaining 26.85% of the variance in depressive symptoms (Cohen's f2 = 0.37). The number of traumatic events and the orientation toward the host culture exerted significant effects on depressive symptoms. The moderating effect was not significant, indicating that the effect of the number of traumatic events was not influenced by cultural orientation. Based on our results, orientation toward the host culture as well as traumatic experiences exert independent effects on depressive symptoms in refugees.

Policies of Exclusion: Implications for the Health of Immigrants and Their Children

Public policies play a crucial role in shaping how immigrants adapt to life in the United States. Federal, state, and local laws and administrative practices impact immigrants' access to education, health insurance and medical care, cash assistance, food assistance, and other vital services. Additionally, immigration enforcement activities have substantial effects on immigrants' health and participation in public programs, as well as effects on immigrants' families. This review summarizes the growing literature on the consequences of public policies for immigrants' health. Some policies are inclusive and promote immigrants' adaptation to the United States, whereas other policies are exclusionary and restrict immigrants' access to public programs as well as educational and economic opportunities. We explore the strategies that researchers have employed to tease out these effects, the methodological challenges of undertaking such studies, their varying impacts on immigrant health, and steps that can be undertaken to improve the health of immigrants and their families.

Resilience, Acculturative Stress, and Family Norms Against Disclosure of Mental Health Problems Among Foreign-Born Filipino American Women

The present study explores the relationships between resilience, acculturative stress, and family norms against disclosure of mental health problems among foreign-born Filipino American women. The sample consisted of 159 foreign-born Filipino American women aged 18 years and above and residing in Las Vegas, Nevada, United States. Participants completed paper-and-pencil questionnaires. Results indicated high levels of resilience and moderate levels of acculturative stress. Findings also showed a significant negative correlation between resilience and acculturative stress, and a significant predictive effect of resilience on acculturative stress. We also found a significant negative relationship between resilience and family norms against disclosure of mental health problems but no significant mediating effect of resilience on the relationship between acculturative stress and family norms. This lack of significant findings related to the mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental illness may be due to the absence of theoretical models and research regarding the role of resilience in the context of acculturation among Filipino American women. Our findings imply the need to further explore underlying mechanisms that explain the relationships between resilience, acculturative stress, and family norms. The findings of the study also confirm the need to develop interventions and resources that ameliorate acculturative stress and promote an increase of the disclosure and reporting of mental health problems among Filipino American women.

Immigration and Mental Health

Purpose of review

While the experience of migration and resettlement in a new country is associated with mental health risks, immigrants generally demonstrate better mental health than expected. This review describes patterns in mental health outcomes among immigrants. We discuss a conceptual model of the potential underlying mechanisms that could buffer the stress and disadvantage experienced by this substantial and growing population.

Recent findings

While epidemiological studies have established a general pattern of lower risk for mental health disorders among first-generation (foreign-born) immigrants in the U.S., recent studies highlight how this pattern varies substantially by the intersection of race, ethnicity, national origin, gender, and socioeconomic status. Contextual factors including the family and neighborhood context; an immigrant's social position; experiences of social support and social exclusion; language competency and ability; and exposure to discrimination and acculturative stress further influence the relationship between immigration and mental health.

Summary

We conclude with an emphasis on social resilience processes, with a focus on how immigrants develop social relations, social capital and social networks. We recommend future directions for research that prioritize identifying and understanding social adaptation strategies adopted by immigrant groups to cope with immigration stressors.