Consistent with previous findings (Grant et al., 2004
), Mexican immigrants who arrive after age six to the U.S. show lower risk of depressive disorders than their IUSC counterparts, after age and gender adjustments. As reported in past studies (Escobedo, 1996
; Narrow, Rae, Moscicki, Locke, & Regier, 1990
), IUSC Cubans also reported significantly lower prevalence of depressive disorders than IUSC Mexicans, showing that the risk for U.S.-born Latinos might differ across subethnic groups. Less perceived discrimination, greater neighborhood safety, and lower family conflict and burden appear to contribute to decreased prevalence of depressive disorders among IUSC Cubans in comparison to IUSC Mexicans. Once we adjust for these contextual and family differences in the Final Model, the differences in risk become insignificant.
In contrast, the eight ethnicity/nativity subgroups are not significantly different for anxiety after adjusting for age and gender. It seems that Other Latinos (mostly Bolivians, Nicaraguans, Salvadorians and Colombians) who arrived in the U.S. as children had lower risk of anxiety disorders compared to IUSC Mexicans, after adjusting for all other factors. However, this contrast was not predicted and it was not strong enough to yield a significant omnibus test, which was designed to control Type I error. We note this difference so that it can be monitored in future studies.
As hypothesized, family burden and family cultural conflict, perceived low neighborhood safety, exposure to discrimination, disrupted marital status, being out of the labor force, and perceived low social standing all to varying degrees figure as risk factors for 12-month depressive, anxiety, and substance-use disorders (as shown in the Final Models of ). This implies that demonstrated differences in prevalence of psychiatric disorders among Latinos by ethnicity/nativity subgroups are a function of multiple factors beyond foreign nativity. These results help explain the inconsistent findings of other studies regarding whether foreign nativity is protective against psychiatric disorders, given that type of disorder and variables included in adjustments might produce different results across studies.
We identified several risk and protective factors linked to psychiatric disorders as Latinos integrate into U.S. society. Elevated family cultural conflict and family burden are associated with increased risk for depressive and anxiety disorders. This is consistent with Hovey’s findings (Hovey, 2000a
) showing that family dysfunction and ineffective social support predict depression. After adjusting for family cultural conflict and family burden, LAI Mexicans experience similar risk for depressive disorders as IUSC Mexicans, suggesting the importance of family harmony to counter depression. These factors remain significant, even after adjusting for differences in marital status, perceived neighborhood safety, or social status.
We found no differences in risk for anxiety disorders for LAI relative to IUSC Latinos after age and sex adjustments. Our findings question the existence of a protective effect of nativity for past-year anxiety disorders. Nonetheless, foreign parental nativity emerges as a protective factor for anxiety disorders for U.S.-born Latinos (i.e. after adjusting for the LAI/IUSC distinction). Foreign parental nativity may inhibit the internalization of U.S.-society lifestyles, including expectations that might be incongruous with one’s perceived social status (Dressler, 1988
), diminishing the risk for anxiety disorders. For example, U.S. expectations for the disadvantaged may be unrealistic, with pressure to succeed and achieve the “American dream” without the opportunities to do so (Hochschild, 1995
). Expectations for those whose parents were foreign-born (e.g., having healthy children, getting married) may be more compatible with the hardships and struggles of the disadvantaged, providing for a less stressful and disempowering experience of everyday life, and consequently lower risk for anxiety disorders. These findings highlight the importance of intergenerational effects on health outcomes.
One surprising result from our analysis is that low income (family income less than $15,000) seems to be associated with less anxiety disorder relative to higher income ($35,000 - $74,999). This seems to fly in the face of considerable literature on economic disadvantage. In sensitivity analyses, we determined that this association only appeared when we adjusted for perceived social standing. This suggests that higher perceived social standing may suppress the potentially negative effect of low income, given that once we removed social standing from the model in sensitivity analyses, the protective effect of low income for anxiety disorders is no longer observed. We also cannot rule out that for Latinos in poverty, limited expectations for social mobility might provide buffer from the stresses of low income and be protective for anxiety disorders (Breslau et al., 2006
After age and gender adjustments (Model 1), Later Arrival Immigrants have lower risk for 12-month substance use disorders, independent of subethnicity, when contrasted to IUSC Latinos. This supports the persistence of the Latino immigrant paradox in substance-use disorders. Perceived level of neighborhood safety also seems associated with lower risk for substance-use disorders. This finding is consistent with other research (Cho, Park, & Echevarria-Cruz, 2005
; Lambert, Brown, Phillips, & Ialongo, 2004
; Wandersman & Nation, 1998
) which emphasizes the importance of the receiving context, particularly early exposure to neighborhood disadvantage as a risk factor for illness, even after controlling for individual-level socioeconomic status. For substance-use disorders, the importance of arrival to the U.S. after age 25 offers insight into the context-dependent risk for substance use disorders. Coming to the U.S. as an adult might protect against exposure to risky social networks linked to drug use. Religious attendance also emerges as a factor that facilitates social participation and integration into positive social networks that protect against the negative impact of disadvantageous neighborhoods. This is consistent with evidence that religious involvement may be a protective factor against substance disorders (Miller, 1998
), with the church functioning as a source of social control that discourages deviance.
There are certain limitations of this study. Most importantly, although a cross-sectional study helps us understand some aspects of the process of acculturation and enculturation, identifying causality is best assessed using a longitudinal approach. Some of the observed associations could reflect reverse causation, such as the possibility that family conflict is an outcome of depressive or anxiety disorders. Another limitation involves disentangling the effect of variables that are only proxies for certain cultural processes. For example, while Spanish proficiency might relate to internalization of Latino cultural values and attitudes, it does not indicate which values and attitudes might be protective. Language could also reflect the presence of different networks and lifestyles, independent of acculturation. However, these findings do suggest important future directions for research, such as the importance of contextual environment, religious attendance, and perceived social status for substance-use disorders. For example, findings presented in suggest that Later-Arrival Immigrant Latinos with significantly lower incomes live in neighborhoods they perceive to be less safe and report lower social standing in their U.S. communities, increasing the importance of context in the prospective risk for psychiatric illness.
Our findings show that nativity may be a less important independent risk factor for current psychiatric morbidity than originally thought. In other words, it is not nativity per se that protects from psychiatric illness once immigrants arrive in the U.S., but rather family, contextual and social status factors associated with nativity and age of arrival in the U.S.. Family harmony, marital status, integration in employment and self-perception of high social standing appear to be central to decreased risk of depressive and anxiety disorders for Latinos in the U.S., while late arrival, perceived neighborhood safety, religious attendance, and self-perceptions of high social standing appear more relevant as protective factors for substance-use disorders. The within-group variation among Latinos means that ethnicity/nativity subcategories mask meaningful differences in historic and current living circumstances of ethnic minority populations.
Our results question the generalizability of the finding that all Latino immigrants have better mental health than U.S.-born Latinos. Among Mexicans, once we adjust for family factors, we find no differences between IUSC and LAI. A more complicated picture emerges whereby the risk of psychiatric disorders, depending on the disorder, can be a function of family burden and family conflict, as well as the availability of effective family supports, the contextual environment (including exposure to discrimination, perceived neighborhood safety, and religious attendance) and self-perceived social status in the U.S. Most studies of the “immigrant paradox” lack explanatory factors specific to the Latino experience, and ignore the challenges of disentangling effects of nativity from other risk factors. Our findings suggest that comparing groups of Latinos by subethnicity and nativity is an important way to sort out potential mechanisms involved in increasing or decreasing risk of psychiatric disorders for Latinos living in the United States.