Trends in prevalence of depression and serious psychological distress in United States immigrant and non-immigrant populations, 2010 - 2016

Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage

PURPOSE

Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress.

METHODS

We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models.

RESULTS

There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status.

CONCLUSION

The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.

Prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the COVID-19 pandemic

Hispanic/Latino populations experienced disproportionate exposure to depression risk factors during the COVID-19 pandemic. While aggregated data confirm the risks of depressive symptoms among Hispanic/Latino individuals, little research uses disaggregated data to investigate these risks based on ethnic subgroups. Using the "Understanding the Impact of the Novel Coronavirus (COVID-19) and Social Distancing on Physical and Psychosocial (Mental) Health and Chronic Diseases" survey, which was distributed nationally between May 13, 2021, and January 9, 2022 (N = 5413), we estimated the prevalence of depressive symptoms among Hispanic/Latino ethnic subgroups during the pandemic. We performed descriptive analysis on a 116-item survey, which collected disaggregated data from Hispanic/Latino individuals aged ≥ 18 years (n = 1181). About one-third of the participants reported depressive symptoms (31.3%), with those who self-identified as other Hispanic/Latino/Spanish origin (40.2%) reporting the highest depressive symptom prevalence. Among participants who reported depression treatment before the pandemic, the highest reports of treatment were among Puerto Rican (81.8%) participants. More than one-third of participants receiving prior depression treatment (38.7%) reported treatment interference by the pandemic, mostly among Central American individuals (50.0%). This study highlights the need for integrating more disaggregated data into public health approaches which seek to target population subgroups and reduce racial/ethnic mental health disparities.

Influence of biopsychosocial factors on self-reported anxiety/depression symptoms among first-generation immigrant population in the U.S

BACKGROUND

Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S.

METHODS

We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective.

RESULTS

The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26-49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18-25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly.

CONCLUSIONS

The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Effects of length of residency on the development of physical and mental illnesses in immigrant women in Taiwan: a retrospective cohort study using nationwide data

OBJECTIVES

The majority of female immigrants who are married in Taiwan often face a variety of stresses, which may lead to physical or mental illness. Yet few studies have validated the impact of length of residency on physical and mental health using large-scale data. This study combined five nationwide databases and explored the impact of length of residency in Taiwan on the physical and mental health of female marriage immigrants.

DESIGN

This is a retrospective cohort study.

SETTING

Taiwan.

PARTICIPANTS

A total of 168 202 female immigrants, who were registered in the national health insurance database from 2001 to 2017, were enrolled for analysis.

MEASURE

The length of residency was taken as the period from their first appearance in the national health insurance database to the end of 2017. Hypertension and diabetes were chosen as indices of physical health and depression as an index of mental health. Diagnosis standards were based on the International Classification of Disease, ninth or 10th Revision.

RESULTS

The physical and mental health of the immigrants deteriorated with increasing time of residence in Taiwan. Immigrants who had resided in Taiwan for 5-10 years or ≥10 years, respectively, had a 5.8-fold (95% CI: 3.46 to 9.74) or 6.29-fold (95% CI: 4.61 to 8.59) higher adjusted risk of developing hypertension; a 3.97-fold (95% CI: 2.54 to 6.21) or 9.18-fold (95% CI: 5.48 to 15.38) higher adjusted risk of developing diabetes; and a 5.01-fold (95% CI: 3.14 to 8.01) or 12.19-fold (95% CI: 8.65 to 17.18) higher adjusted risk of developing depression than their counterparts who had lived in Taiwan for ≤5 years.

CONCLUSION

These findings suggest the time elapsed since migration can be a factor in the deterioration of both physical and mental health among female marriage immigrants in Taiwan.

Mental Health Care Access Among Arab Immigrants in the United States: Application of Public Arena Model

Arab immigrants constitute a sizable portion of the US population, and their adjustment and relocation challenges might escalate mental health issues. Nevertheless, mental health care accessibility among such populations is not recognized as policy issue. Hence, it is crucial to explore the political tools that might be employed to improve immigrants' access to mental health treatment. The Public Arenas Model (Hilgartner and Bosk, American Journal of Sociology 94:53-78, 1988) provides better understanding of how access to mental health care is defined in the public sphere, why mental health inaccessibility among Arabs has not received attention, and how stakeholders worked to raise the public's attention to such issue (Smith, Policy, Politics & Nursing Practice 10:134-142, 2009). Ultimately, several policy options are proposed to address Arab immigrants' access to mental health care issue, including increasing mental health service providers' language proficiency and cultural competency, integration of behavioral health and primary care services for immigrant populations, and considering novel modes of mental health delivery.

Social Determinants of Health Among Pregnant Hispanic Women and Associated Psychological Outcomes

BACKGROUND

There has been a concerning surge in maternal mortality among Hispanic women in recent years. Compromised mental health is present in nearly half of all maternal deaths, and risk factors include poor social support and depression.

OBJECTIVE

Among Hispanic women who were born in the USA versus those not born in the USA, we sought to describe and compare social determinants of health and maternal psychological outcomes.

METHODS

Hispanic pregnant women (n = 579) were recruited from two clinics in Tampa, FL, and completed various questionnaires related to social determinants of health, depression, stress, and social support.

STATISTICAL ANALYSIS

Descriptive statistics, t-tests, and chi-square analyses were used to compare relationships between maternal nativity and subsequent psychosocial outcomes. Pearson correlations were used to explore associations between variables.

RESULTS

Hispanic pregnant women who were not born in the USA had lower incomes (χ2 = 5.68, p = 0.018, df = 1), were more likely to be unemployed (χ2 = 8.12, p = 0.004, df = 1), and were more likely to be married (χ2 = 4.79, p = 0.029, df = 1) when compared with those born in the USA. Those not born in the USA reported lower social support (t = 3.92, p<0.001), specifically the tangible (t = 4.18, p < 0.001) and emotional support subscales (t = 4.4, p<0.001). When compared with those born in the USA, foreign-born Hispanic women reported less stress (t = 3.23, p = 0.001) and depression (t = 3.3, p = 0.002).

CONCLUSION

Pregnant Hispanic women not born in the USA are at increased risk for suboptimal social determinants of health, including less social support. US-born women were more stressed and depressed and had higher BMIs.

Correlates of Psychological Distress Among Filipino Americans and Filipinos Living in Urban Areas in the United States and the Philippines

INTRODUCTION

Many Asian immigrants, including Filipino Americans (FilAms), experience psychological distress (PD) due to the challenges in adjusting to their new country and culture. This descriptive comparative study aimed to compare FilAms and Filipinos concerning their levels of PD, sources of stress, and use of health-promotion strategies.

METHODS

Data from 89 FilAms and 95 Filipinos living in urban cities, obtained from the I-HELP-FILIPINOS database, measuring cardiometabolic risks, mental health, and environmental stressors in 2017, including PD, were examined.

RESULTS

The mean age of all participants (N = 184) was 44.2 ± 22.8 years old. Both groups rated their health as good to excellent, although Filipinos were significantly more likely to be distressed (p < .001). Filipinos were also more likely to ascribe stress to employment (48.3% vs. 68.2%, p =.006) and finances (28.1% vs. 52.6%, p <.001) than FilAms.

DISCUSSION

While both groups shared comparative perspectives on health, FilAms reported lower PD than Filipinos. The most significant source of stress was the country of residence. We recommend tailoring interventions to each local context's unique social and environmental circumstances.

Age-varying association between depression and cognitive function among a national sample of older U.S. immigrant adults: the potential moderating role of physical activity

OBJECTIVES

This study aimed to (1) investigate age-associated trends in depression and cognition, (2) determine whether the association between depression and cognition varies across age, and (3) test whether this association is moderated by different levels of physical activity among older U.S. immigrant adults aged 60 to 80 years.

METHODS

Using national data on elderly U.S. immigrants (N = 375) from the 2011-2014 NHANES, we employed weighted intercept-only linear time-varying effect modeling (TVEM) and weighted linear TVEM to address our research questions.

RESULTS

Weighted intercept-only linear TVEM indicated no trend in depression, but its mean peaked at age 67. Cognition consistently decreased with age, reaching its lowest point at age 78. Weighted linear TVEM revealed a significant inverse association between depression and cognition at some age ranges, with the strongest association at around age 66. Yet, we did not find the moderational relation of physical activity to this age-varying association.

CONCLUSIONS

Although we observed a significant inverse relationship between depression and cognition at a certain age point, physical activity did not moderate the age-varying association. Understanding of age-varying effects on the depression-cognition interaction will promote prevention efforts targeting aging immigrant populations at highest risk for these health outcomes. Further work is needed to test moderating effects of other health behaviors on this association across age.

Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2056139 .

Prevalence and risk factors of psychological distress among foreign-born population in Finland: A population-based survey comparing nine regions of origin

AIMS

Previous research indicates that foreign-born populations experience more psychological distress than general populations. However, it remains unclear how prevalence varies between regions of origin. The role of socio-demographic and migration-related factors also needs to be further investigated. We aimed to (a) compare the prevalence of psychological distress in foreign-born and general Finnish populations, (b) investigate differences in prevalence between nine regions of origin and (c) examine which socio-demographic and migration-related factors are associated with distress among foreign-born populations.

METHODS

The study used data from the Survey on Well-Being among Foreign Born Population (FinMonik), a population-based survey (n=6312) of foreign-born populations living in Finland collected between 2018 and 2019 by the Finnish Institute for Health and Welfare. Psychological distress was measured using the Mental Health Inventory-5 (MHI-5), with a cut-off point of 52. Logistic regression was used to adjust analyses by age and sex to determine the prevalence of psychological distress and the associated socio-demographic factors.

RESULTS

Psychological distress was more prevalent among those who were foreign born (17.4%) than among the general population (12.9%). Migrants from the Middle East and North Africa had the highest prevalence (29.7%) compared to other regions of origin. Unemployment or economic inactivity, international protection as a reason for migration and beginner-level language proficiency were the main factors increasing the odds for distress among foreign-born populations.

CONCLUSIONS

Foreign-born populations experience more psychological distress than the general population, but prevalence varies between regions of origin. Future efforts should aim at a better understanding of the mental health risk factors and the development of targeted interventions for these subpopulations.

Shades of health: Skin color, ethnicity, and mental health among Black Americans

Skin color is an important predictor of health outcomes among Black Americans. Black Americans with darker complexions experience worse physical and psychological functioning than those with lighter complexions. However, most research on the health effects of colorism focuses solely on African Americans, omitting the experiences of other Black subpopulations. Using data from the National Survey of American Life (NSAL), we investigate the relationship between skin color and mental health among African Americans (N = 3393) and Caribbean Blacks (N = 1378). Findings from multivariate logistic regressions reveal that Black Americans with the lightest complexions-regardless of ethnicity-report worse psychological functioning. However, the shape of the association between skin tone and mental health varies significantly based on ethnicity and the specific psychiatric outcome under study. For Caribbean Blacks, the association between skin color and any mental disorders and mood disorders is linear, while the relationship for anxiety disorders is curvilinear. For African Americans, the relationship between skin color and mental health shows an elevated risk among only those with the lightest skin tones. These results illustrate the heterogeneity within the Black community and highlight the importance of recognizing ethnicity in health disparities research.

The Validity and Reliability of the PHQ-9 and PHQ-2 on Screening for Major Depression in Spanish Speaking Immigrants in Chile: A Cross-Sectional Study

BACKGROUND

The study aimed to explore the psychometric properties of two versions of the Patient Health Questionnaires (PHQ-9 and PHQ-2) on screening for Major Depressive Disorder (MDD) among Spanish-speaking Latin American adult immigrants in Santiago, and to explore factors associated with a higher risk of occurrence of MDD among them.

METHODS

A representative sample of 897 Spanish-speaking immigrants completed the PHQ-9. The Composite International Diagnostic Interview (CIDI) was employed to evaluate MDD. Internal consistency and structural validity were evaluated using Cronbach's α coefficient and confirmatory factor analysis (CFA). Convergent validity with the 7-item General Anxiety Disorder Scale (GAD-7) was assessed using Spearman's correlations. Sensitivity, specificity, positive predictive values, and area under the receiver operating characteristic (ROC) curve were calculated for different cut-off points. Logistic regression analysis was used to identify factors associated with the risk of MDD.

RESULTS

Cronbach's α coefficient of the PHQ-9 was 0.90; item-total correlation coefficients ranged from 0.61 to 0.76 and correlation with the GAD-7 was moderate (r = 0.625; p < 0.001). CFA on three alternative models suggests a plausible fit in the overall sample and among two of the subsamples: Peruvians and Venezuelans. Taking the results of CIDI as the gold standard for MDD, the area under the ROC curve was 0.91 (95% confidence interval (CI): 0.83~1.0). When the cut-off score was equal to 5, values of sensitivity, specificity, and Youden's index were 0.85, 0.90, and 0.75, respectively. Multivariate logistic regression analyses showed that the influence of having three or more children (OR = 3.91, 95% CI: 1.20~12.81; p < 0.05), residency in Chile of up to three years (OR = 1.79, 95% CI: 1.07~3.00; p < 0.05), active debt (OR = 2.74, 95% CI: 1.60~4.70; p < 0.001), a one (OR = 2.01, 95% CI: 1.03~3.94; p < 0.05) and two or more events of adversity during childhood (OR = 5.25, 95% CI: 1.93~14.3; p < 0.01) on the occurrence of MDD was statistically significant. Reliability (α = 0.62), convergent (r = 0.534; p < 0.01) and criterion (AUC = 0.85, 95% CI: 0.67~1.00) validity coefficients of the PHQ-2 were weaker than for the PHQ-9.

CONCLUSIONS

The PHQ-2 and the PHQ-9 are reliable and valid instruments for use as screeners for MDD among Spanish-speaking populations of Latin America.

Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health

After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.

Prevalence and predictors of parental depressive episodes: Results from a 15-year longitudinal study

BACKGROUND

Depression affects approximately 7.5 million parents in the United States each year. Parental depression has detrimental consequences for both the parent and the parent-child relationship. The purpose of this study was to: (1) understand the prevalence of parental depressive episodes longitudinally, (2) identify the risk and protective factors for parental depressive episodes, and (3) compare the risk and protective factors for depressive episodes among mothers and fathers.

METHODS

We used six waves of the Fragile Families and Child Wellbeing Study to descriptively examine parental depression over a period of 15 years. We used logistic and fixed effects regressions to assess the association between a number of demographic, health and parenting variables and maternal and paternal depression.

RESULTS

Our sample was primarily Black (48%) and Hispanic/Latino (27%). Fathers had a slightly lower prevalence of depression compared to mothers at all waves (approximately 13% averaged across waves for fathers, compared to 18% for mothers). Factors negatively correlated with depression among mothers and fathers included: social support, employment, and better-perceived health. Factors positively associated with depression for mothers and fathers were substance misuse and having a parent with a history of depression, anxiety, or drug misuse.

LIMITATIONS

Our study was unable to identify causal relationships and the directionality of the relationship between depression and other variables of interest.

CONCLUSIONS

We found that parental depression is prevalent in a sample of predominantly racially minoritized parents. Addressing comorbidities and increasing social support access may help manage parental depression and ensure a healthy child development.