Beyond access: Psychosocial barriers to undocumented students’ use of mental health services

Immigration Status, Legal Vulnerability, and Suicidal/Self-harm Ideation Disparities Among Immigrant-Origin Latinx Young Adults in the U.S

Theories of suicidality typically center intrapersonal processes, with limited attention to social determinants of mental health disparities. Using a legal vulnerability framework, we examined the association between self/parental immigration status and suicidal and self-harm ideation (SI) disparities in three groups of immigrant-origin Latinx young adults attending college in the USA: undocumented students (n = 564), US citizens with undocumented parents (n = 605), and US citizens with lawfully present parents (n = 596). We also evaluated whether self/parental immigration status differences in SI could be accounted for by six dimensions of legal vulnerability and, based on prominent theories of suicidality, explored the role of campus belongingness as a protective factor. Participants completed self-report measures, and SI was assessed using one item from the Patient Health Questionnaire-9, a screening tool that assesses the severity of depression symptomatology. Rates of SI were significantly higher among undocumented students (23.1%) and US citizens with undocumented parents (24.3%) compared to US citizens with lawfully present parents (17.8%). Immigration policy-related social exclusion and discrimination-mediated self/parental immigration status differences in SI. Although food insecurity did not differ by self/parental immigration status, greater food insecurity was associated with higher likelihood of SI. Greater campus belongingness was associated with a lower likelihood of endorsing SI for all students regardless of immigration status or legal vulnerability factors. Findings underscore the importance of examining self and parental immigration status as a social determinant of SI and the value of investigating aspects of legal vulnerability as explanatory factors.

Help-Seeking Undocumented Migrants in the Netherlands: Mental Health, Adverse Life Events, and Living Conditions

Undocumented migrants are a particularly vulnerable group regarding (mental) health, living conditions, and restricted access to health care. The aim and objective of the study was to examine the prevalence and correlates of mental health problems in a help-seeking population of undocumented migrants. Observational study was performed by integrating cross-sectional questionnaire data with retrospective electronic patient record data. Undocumented migrants attending medical and psychological consultation hours of a Netherlands-based non-governmental organization completed the Self-Reporting Questionnaire (SRQ). We examined scores of the instrument's 24 items version (SRQ-24) and its 20 items version (SRQ-20). Correlates of mental health were estimated using parametric tests. On the SRQ-20, 85% (95% CI 77-91%) of the sample (N = 101) scored ≥ 8, the clinical cut-off value for common mental disorders; mean = 12.4 ± 4.6, range 0-20. Adverse life events like physical and sexual assault were reported in 37% of the medical records (N = 99) and had a medium-to-large effect (Cohen's d = 0.76) on SRQ-24 scores. Mental health problems are common in help-seeking undocumented migrants. This study underlines the need of improving access to mental health care for undocumented migrants.

Was the 2020 Presidential Election Nerve-Wracking?: Changes in Mental Health Among College Dreamers

U.S. presidential elections can be stressful for many Americans; however, there is little research as to how elections might influence mental health of undocumented immigrants specifically. The 2020 U.S. Presidential Election had the potential to dramatically influence immigration policies with the Democratic candidate promising a pathway toward citizenship for undocumented immigrants who arrived in the U.S. as minors (i.e., dreamers), and the incumbent Republican candidate threatening to terminate the DACA program. Using an online survey method, this exploratory longitudinal study examined whether dreamers' mental health changed following the U.S. presidential election, while also examining risk factors associated with their mental health. We employed GAD-7 and PHQ-9 questionnaires as preclinical screens for anxiety and depression. We found that the mean anxiety and depression scores decreased significantly following the election, i.e., when the democratic candidate was declared the winner. Risk factors for mental health problems also differed before and after the election. Risk factors for depression before the election included being female, Hispanic white, having a low self-reported status on the subjective social ladder, and having high perceived discrimination; risk factors for depression after the election included coming to the U.S. at an older age and high perceived discrimination. Risk factors for anxiety before the election included being female, having more siblings, both parents working, and high perceived discrimination. Risk factors for anxiety after the election included low self-reported status on the subjective social ladder, being a freshman, and high perceived discrimination. Preliminary results suggest that mental health of dreamers improved after the election. In addition, while risk factors differed before and after the election, perceived everyday discrimination remained a consistent risk factor for mental health issues.

Barriers and facilitators to healthcare for people without documentation status: A systematic integrative literature review

AIMS

To identify the barriers and facilitators to healthcare for people without documentation status.

DESIGN

We conducted a systematic integrative literature review following the Whittemore and Knafl methodology.

METHODS

Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social-ecological model.

DATA SOURCES

Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022.

RESULTS

The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti-immigrant rhetoric) and policy-related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety-net clinics and supportive federal policies emerged as key facilitators.

CONCLUSION

These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population.

IMPACT

This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide.

REPORTING METHOD

The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was needed.

TRIAL AND PROTOCOL REGISTRATION

The study protocol was registered with the PROSPERO database (registration number: CRD42022366289).

Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States

Introduction

Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations.

Methods

Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness.

Results

Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups).

Conclusion

Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.

Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review

BACKGROUND

Immigrant students face various challenges in high-income countries that can contribute to the decline of their mental well-being upon arrival in their host country. Despite the growing population of these students in several high-income countries, there is inadequate attention given to their mental health needs and their access to mental health services. Thus, this systematic scoping review aimed to identify gaps in existing research relating to the barriers and facilitators associated with access to and use of mental health services in high-income countries.

METHODS

Following the PRISMA-ScR checklist as guidance we systematically searched Ovid Medline, APA PsycInfo, Education Source, CINAHL, Web of Science databases for peer reviewed articles related to barriers and facilitators of mental health service use among immigrant students. We conducted a narrative evidence synthesis to highlight barriers and facilitators to the use of mental health services.

RESULTS

Out of the 2407 articles initially found, 47 studies met the inclusion criteria and were considered for this review. The increasing attention towards the mental health concerns of immigrant students and their access to mental health services is evident. However, various barriers like stigma, insufficient knowledge, or adherence to traditional gender roles (such as masculinity) hinder their utilization of these services. On the other hand, factors such as being a woman, having a strong sense of cultural adaptation, or possessing adequate mental health literacy serve as facilitators for accessing mental health services.

CONCLUSION

These students have unique experiences, and their needs are often unmet. To improve their mental health and use of mental health services, it is important to consider the barriers they face and their unique experience in their specific life context and to develop tailored prevention and intervention programs.

Barriers to School-Based Mental Health Resource Utilization Among Black Adolescent Males

Black adolescent males use available mental health services at a disproportionately lower rate compared to males of other racial groups. This study examines barriers to school-based mental health resource (SBMHR) use among Black adolescent males, as a means of addressing reduced usage of available mental health resources and to improve these resources to better support their mental health needs. Secondary data for 165 Black adolescent males were used from a mental health needs assessment of two high schools in southeast Michigan. Logistic regression was employed to examine the predictive power of psychosocial (self-reliance, stigma, trust, and negative previous experience) and access barriers (no transportation, lack of time, lack of insurance, and parental restrictions) on SBMHR use, as well as the relationship between depression and SBMHR use. No access barriers were found to be significantly associated with SBMHR use. However, self-reliance and stigma were statistically significant predictors of SBMHR use. Participants who identified self-reliance in addressing their mental health symptoms were 77% less likely to use available mental health resources in their school. However, participants who reported stigma as a barrier to using SBMHR were nearly four times more likely to use available mental health resources; this suggests potential protective factors in schools that can be built into mental health resources to support Black adolescent males' use of SBMHRs. This study serves as an early step in exploring how SBMHRs can better serve the needs of Black adolescent males. It also speaks to potential protective factors that schools provide for Black adolescent males who have stigmatized views of mental health and mental health services. Future studies would benefit from a nationally representative sample allowing for more generalizable results regarding barriers and facilitators to Black adolescent males' use of school-based mental health resources.

Knowledge of legal rights as a factor of refugee and asylum seekers' health status: a qualitative study

OBJECTIVES

To examine health behaviours of refugees and asylum seekers, in relation to their knowledge of public benefits and legal rights.

DESIGN

Qualitative study, utilising an open-ended, semi-structured interview guide to ensure information-rich data collection. Thematic content was analysed using qualitative research software.

SETTING

Participants were drawn from the Weill Cornell Center for Human Rights (WCCHR) in New York City, a single-center, human rights clinic with a globally representative patient population. All interviews were conducted at the Weill Cornell Medicine Clinical and Translational Science Center, a multidisciplinary space within an urban academic medical center.

PARTICIPANTS

Twenty-four refugees and asylum seekers currently living in the greater New York City area. Eligible participants were 18 years of age or older and had previously sought services from the WCCHR. The recruitment rate was 55%.

PRIMARY AND SECONDARY OUTCOME MEASURES

Themes and concepts in participants' health, knowledge, perceptions of and experiences with accessing healthcare and public benefits programmes.

RESULTS

Twenty-four participants represented 18 countries of origin and 11 primary languages. Several impediments to accessing healthcare and public benefits were identified, including pragmatic barriers (such as prohibitive costs or lack of insurance), knowledge gaps and mistrust of healthcare systems.

CONCLUSIONS

There is low health engagement by refugees and asylum seekers, as a result of multiple, complex factors impeding the ability of refugee and asylum seekers to access healthcare and other public benefits for which they are eligible-with resultant detrimental health effects. However, there is an opportunity to utilise novel approaches, such as digital technologies, to communicate relevant information regarding legal rights and public benefits to advance the health of vulnerable individuals such as refugees and asylum seekers.

Mental Health and COVID-19 Pandemic Stressors Among Latina/o/x College Students with Varying Self and Parental Immigration Status

The COVID-19 pandemic has produced significant psychological distress for college students due to the sudden proliferation of stressors. We examine whether and how self and parental immigration status contributes to Latina/o/x college students' mental health and pandemic stressors during the initial months of the pandemic. We draw on quantitative and qualitative survey data collected in March-June 2020 with 1,600 Latina/o/x University of California undergraduate students from three self-identified groups: undocumented students, US citizens with at least one undocumented parent, and US citizens with lawfully present parents. Quantitative analyses reveal that the pandemic produced widespread negative mental health effects but the severity of these effects did not differ by self/parental immigration status. Our qualitative analyses identify common pandemic-related stressors across our three student groups (financial insecurity, COVID-19 virus concerns, academic strains, and social dynamics); however, undocumented students and US citizens with undocumented parents identify unique aspects of these stressors due to legal vulnerabilities. Self and parental undocumented status also compromises the ability to manage common pandemic stressors because of immigration status-related exclusion from necessary resources. Ultimately, we argue that the high-stress nature of the pandemic elevated mental distress across all student groups, but the structural exclusion of undocumented immigrants contributes to unique experiences of stress among Latina/o/x undocumented students and US citizen students with undocumented parents.

Disparities in Pediatric Mental and Behavioral Health Conditions

Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.

First, do no harm: why anti-immigrant policies in the United States are a public health concern

It can be argued that anti-immigrant policies, such as the 287(g) program, can have a direct impact on the health and well-being of the immigrant community in general, particularly undocumented immigrants in the United States. While there is yet to be a comprehensive and conclusive empirical assessment of this issue, what is known is that the immigrant community faces many stress factors and structural barriers that negatively impact health. We argue that it is urgent that public health responds to the unique experiences and challenges of the undocumented and wider immigrant community. In doing so, we propose three recommendations for addressing this issue: (1) Assess the causal relationship between anti-immigration policies and immigrant health, (2) Increase funding and access to health care services for immigrant communities in jurisdictions implementing anti-immigrant policies, and (3) For public health to engage in a conscious effort to service the undocumented immigrant community. Even though we focus specifically on the United States, our recommendations are applicable on a global scale since anti-immigration policies are prevalent across nations and are a pervasive human rights issue around the world.

Hate Crimes and Race-Based Trauma on Latinx Populations: A Critical Review of the Current Research

Traditionally, the literature has sought to understand the impact of racial minority status and trauma as it relates to interpersonal violence, domestic violence, and sexual assault. What has not been as extensively reviewed and summarized is how racially or ethnically motivated hate crimes impact the mental health of minorities-particularly Latinx/Hispanic groups. This review aims to summarize the current body of literature on the intersection of race-motivated hate crime and trauma responses within Latinx community. To do so, the theoretical foundation for this inquiry will build from a race-based trauma perspective. Specifically, this review connects existing frameworks for race and trauma and integrates literature that examines Latinx or Hispanic populations that have experienced discrimination, bias, or hate crime as a result of their identity or perceived identity. The importance of situating bias or hate events within the trauma literature stems from a lack of overall formal evaluation of these events, and how these occurrences are historically overlooked as a traumatic stressor. The findings of this review suggest that (1) experiencing racially motivated victimization can cause adverse mental and physical health outcomes in Latinxs and (2) currently, there is only one study that has examined the impact of hate crime on Latinxs in the United States. This leaves the field with unanswered questions about the impact of hate crime victimization among Latinxs, which is an ever-growing area in need of attention.

Deferred depression? Mediation analysis of Deferred Action for Childhood Arrivals and immigration enforcement among Undocumented Asian and Pacific Islander students

OBJECTIVES

Undocumented Asians and Pacific Islanders (UndocuAPI) comprise 25% of undocumented students. Yet few studies have examined UndocuAPI mental health in the context of the contradictory political environment which encompasses both inclusionary policies, such as Deferred Action for Childhood Arrivals (DACA), and exclusionary policies, like immigration enforcement.

METHODS

Using cross-sectional survey data collected in 2019 from UndocuAPI college students and recent alumni in California (n = 174), we used multiple logistic regression to estimate the effect of DACA status on clinical levels of depressive symptoms. We tested whether immigration enforcement experiences mediated this relationship using the Karlson, Holm, and Breen (KHB) method.

RESULTS

Adjusted logistic regression results revealed that UndocuAPI with DACA had significantly lower odds of depression (OR = 0.32, 95% CI: 0.13-0.79). Out of five immigration enforcement factors, limited contact with friends and family (OR = 2.36, 95% CI: 1.08, 5.13) and fearing deportation most or all of the time (OR = 3.62, 95% CI: 1.15, 11.34) were associated with significantly higher odds of depression. However, we did not detect a statistically significant mediation effect of immigration enforcement using KHB decomposition.

CONCLUSION

Findings suggest that the benefits of DACA protected UndocuAPI in California from depressive symptoms, even when accounting for immigration enforcement experiences. Because it was unclear whether immigration enforcement mediates DACA, future research should investigate the underlying mechanisms between immigration policies and mental health with larger samples. Practitioners should consider the short-term need for mental health support and legal services for UndocuAPI students as well as the long-term goal to decriminalize immigrant communities to advance racial health equity.

The Importance of Norms and Efficacy in Predicting Undocumented College Students' Intentions to Talk to an On-Campus Mental Health Professional

Drawing from an extended version of a focus theory of normative conduct, the extended parallel process model, and self-stigma, this study examined factors that predict undocumented college students' (UCS) intentions to talk to an on-campus mental health professional (MHP). Two hundred thirty-seven UCS completed an online survey between January-June, 2019. Structural equation modeling analyses revealed that the more UCS believed their friends talked to an on-campus MHP (i.e., descriptive norms), the more likely UCS were to believe that talking to an on-campus MHP would help them manage their undocumented-related stress (i.e., response efficacy). In turn, UCS were more likely to report intentions to talk to an on-campus MHP. Furthermore, family injunctive norms were positively associated with self-efficacy and communication efficacy, and in turn, intentions to talk to an on-campus MHP. Unexpectedly, friend injunctive norms were not significantly associated with the three types of efficacy or intentions. Lastly, although family and friend injunctive norms were negatively associated with self-stigma, self-stigma was not significantly associated with intentions to talk to an on-campus MHP. This study's findings emphasize the importance of addressing different types of norms and efficacy when attempting to reduce UCS' under-utilization of on-campus mental health services.

A Comparison of Psychological Stress and Sleep Problems in Undocumented Students, DACA Recipients, and U.S. Citizens

Amidst the uncertainty of a shifting political landscape, our study examined stress and sleep problems experienced by both Deferred Action for Childhood Arrivals (DACA) undergraduates and non-DACA undocumented immigrants in an undergraduate population, in relation to students who were US citizens. We surveyed 969 students (93% Hispanic; 69% female) in 2017 or 2019 using established measures of stress, sleep quality, and insomnia. Collapsed across years, undocumented students reported significantly greater stress than citizens and DACA students, but DACA students did not differ from citizens. No differences were found in sleep for either quality or insomnia. Additionally, DACA student stress was significantly higher in 2019 than 2017, rising to a level similar to that of undocumented students and that differed significantly from citizens. Undocumented students appear to experience greater stress than students who are U.S. citizens, but these differences do not extend to sleep quality or insomnia.

Physical and mental health impacts of the COVID-19 pandemic among college students who are undocumented or have undocumented parents

Background

The COVID-19 pandemic may have disproportionately affected the mental and physical health of undocumented students and students with undocumented parents.

Methods

We analyzed primary data from 2111 California college students collected March–June 2020. We estimated the odds of mental or physical health being affected “a great deal” by COVID by immigration group and then examined whether this was moderated by campus belonging or resource use.

Results

Students with undocumented parents were least likely to report COVID-related mental and physical health effects. Undocumented students and students whose parents have lawful immigration status did not differ in their COVID-related physical and mental health. For all students, more campus resource use and higher campus belonging were associated with negative mental and physical health effects.

Discussion

Negative COVID-related mental and physical health was widespread. Separation from campus-based resources was detrimental during the early stages of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11606-x.

Childhood adversity, socioemotional functioning and generalized anxiety in young adults from mixed immigration status families

BACKGROUND

The translation of research on adverse childhood experiences (ACEs) into effective prevention and treatment of psychopathology requires examination of how ACEs impact mental health. Moreover, increased attention to more marginalized populations, such as immigration-affected ethnic-minority young adults, is greatly needed.

OBJECTIVE

The current study tested the hypothesis that greater ACEs would be related to greater generalized anxiety symptoms directly and indirectly, via ACE-related deficits in coping efficacy, self-compassion, and perceived support, above and beyond immigration-related family stress.

PARTICIPANTS AND SETTING

Participants included ethnic minority young adults (n = 322) attending a public university who reported having at least one family member living in the United States without legal protection and/or being undocumented themselves.

METHODS

Data was collected online using validated measures of the primary study variables. Participants also completed a pilot measure of immigration-related stress in their family. A multiple mediation model was tested in a structural equation modeling framework.

RESULTS

A substantial percentage of young adults experienced 4 or more ACEs and clinically-significant generalized anxiety symptoms (38.5% and 20.5%, respectively); a greater number of ACEs were directly (β = 0.33, p < .001) and indirectly, via lower self-compassion (standardized indirect effect 95% CI: 0.04, 0.14), associated with significantly greater generalized anxiety symptoms, above and beyond immigration-related family stress and other indicators of socioemotional functioning.

CONCLUSION

Findings suggest that ACEs and generalized anxiety are prevalent in ethnic minority young adults from mixed legal status families and their association may be partially accounted for by ACE-related deficits in self-compassion.

Psychological distress in middle eastern immigrants to the United States: A challenge to the healthy migrant model?

RATIONALE AND OBJECTIVE

Research has documented a robust mental health advantage among Asian and Latino immigrants to the United States relative to the native-born. The current investigation extended this line of research, asking whether Middle Eastern immigrants to the United States enjoy a similar mental health advantage.

METHODS

Drawing on pooled cross-sections from the 2007-2018 National Health Interview Surveys, we used OLS regression to examine psychological distress in Middle Eastern immigrants relative to both native-born Whites and immigrants from other global regions. We used statistical interactions to assess whether gender and period differences are contingent on region of birth.

RESULTS

Findings reveal that the average level of psychological distress is higher among Middle Eastern immigrants than among both U.S.-born Whites and immigrants from other regions. Despite changing circumstances of migration for Middle Easterners and implementation in the United States of anti-immigrant policies, we see no evidence that distress increased more among immigrants compared to native-born Whites. Results point to greater psychological distress among Middle Eastern women than their native-born White counterparts and women from other immigrant groups, as well as Middle Eastern men. In contrast, psychological distress levels for Middle Eastern and native-born White men were indistinguishable, suggesting that the Middle Eastern mental health disadvantage in the United States is borne solely by women.

CONCLUSIONS

Results show that the mental health advantage enjoyed by some immigrant groups does not extend to Middle Eastern women, contradicting the healthy migrant model and challenging the assumption of a uniform mental health advantage across immigrant groups.

"Waking Up Every Day With the Worry": A Mixed-Methods Study of Anxiety in Undocumented Latinx College Students

To date, little research has taken a mixed-methods strategy to consider the ways in which living "in the shadows" without recognized legal status may affect mental health. In this study, we took this approach, to examine how legal status, as well as stressors (deportation worries, financial concerns) and potentially protective factors (faculty support, peer support), affect anxiety levels of undocumented Latinx undergraduates from colleges across California. We surveyed 486 participants including both standardized measures as well as open-ended responses. We found that rates of self-reported anxiety between undocumented females were 4 times that of the norm population and that of male undocumented students were 7 times higher as measured by the GAD-7 in the moderate and severe ranges. Our predictive models suggested that participants' rates of anxiety were in large part related to worries about financing their education and their daily living expenses as well as detainment and deportation; having an institutional agent such as a professor whom they can turn to for support served to buffer the effects of anxiety. Qualitative findings triangulated the quantitative findings and provided further insights into the experience of living with the stresses of social exclusion and liminal status.