Worse Mental Health Among More-Acculturated and Younger Immigrants Experiencing Discrimination: California Health Interview Survey, 2015–2016

Abstract

BACKGROUND: Experiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation-the process by which immigrants acquire the beliefs and practices of a host culture-influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility. Conversely, the acculturative process may increase exposure to, and recognition of, discrimination. OBJECTIVES: We examined the relationship between discrimination and mental illness across racial/ethnic groups, and pathways by which acculturation and age relate to the discrimination-mental health relationship. DESIGN: A secondary data analysis using population data from the 2015-2016 California Health Interview Survey. MAIN MEASURES: The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with K6 score ≥ 13 associated with severe mental illness. Discrimination was measured using a self-reported measure of lifetime experience of unfair treatment in getting medical care. We used a 5-point acculturation index (constructed by measures of nativity, years living in the USA, and home language use). A weighted logistic regression model predicted mental illness as a function of discrimination. We ran mediational analysis using the Karlson-Holm-Breen method and used predictive margins to present predicted probabilities of mental illness for people reporting discrimination at different acculturation and age levels. KEY RESULTS: There were independent effects on mental illness associated with increased discrimination (OR 3.85, 95% CI = 2.46, 6.03, p < 0.001) and increased acculturation (OR 1.72, 95% CI = 1.24, 2.38, p = 0.001), including when stratified across racial/ethnic groups. Higher levels of acculturation led to a significant increase in discrimination's association with mental illness. There was a higher probability of mental illness in younger age groups than in older age groups. CONCLUSIONS: While discrimination is associated with poor mental health, a stronger link between discrimination and mental illness exists among younger immigrants and immigrants with increased acculturation. Health practitioners should not overlook the mental health needs of younger immigrants and immigrants who may seem more integrated into US society.

Somatic, Anxiety, and Depressive (SAD) Symptoms in Young Adult Latinx Immigrants: Prevalence and Predictors

“…The presence of each additional factor was associated with greater SAD symptoms in a striking dose-response fashion and we are newly describing this group of factors as the immigration distress index (IDI). Among the different IDI factors, discrimination was associated with the highest SAD scores, consistent with other studies reporting a strong link between discrimination and psychological distress [40]. Fears of deportation for both self and family member were also notable contributors to the IDI and highlight stresses specific to this patient population.…”

Associations Between Trauma, Sleep, and Cognitive Impairment Among Latino and Asian Older Adults

“…The association between PTSD and cognitive impairment that we observe in this study could also be due to variations in acculturation, with previous studies suggesting variations in mental health outcomes among immigrants based on acculturation 42 . Previous literature has also found that Asian Americans, compared to white Americans, perceive social support as less helpful when faced with stressful situations 43 .…”

Self-Selection in Physical and Mental Health Among Older Intra-European Migrants

“…As the initial immigrant health advantage attenuates, health levels assimilate downwards to those of the native population, and they may decline even below that level (Antecol and Bedard, 2006;Constant et al, 2014;Kennedy et al, 2015;Hall and Cuellar, 2016;Giuntella and Stella, 2017;Constant et al 2018). Factors that adversely affect immigrants' health over the long-term in the host country include improved socioeconomic status (Bollini and Siem, 1995;Wilkinson and Marmot, 2003;Ronellenfitsch and Razum, 2004), working under poor conditions in risky occupations (Orrenius and Zavodny, 2013), having poor or no access to health care (Derose et al 2007;Lindert et al, 2008), 2 experiencing discrimination due to xenophobia and "otherness" (Grove and Zwi, 2006;Saadi and Ponce, 2020), and assimilating into unhealthy eating, smoking, and sedentary life-styles (Popovic-Lipovac and Strasser, 2015;Fenelon, 2013). Recent exceptions to the HIP include Jatrana et al ( 2018), who use panel data and find health stability among immigrants in Australia.…”