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Race and Social Problems

, Volume 10, Issue 3, pp 235–247 | Cite as

Mental Health Among Mexican-Origin Immigrant Families: The Roles of Cumulative Sociodemographic Risk and Immigrant-Related Stress

  • Catherine DeCarlo Santiago
  • Laura M. L. Distel
  • Anna M. Ros
  • Stephanie K. Brewer
  • Stephanie A. Torres
  • Jaclyn Lennon Papadakis
  • Anne K. Fuller
  • Yvita Bustos
Article

Abstract

The current study examined the unique effects of cumulative sociodemographic risk and immigrant-related stress on mental health symptoms among Mexican-origin immigrant parents and their school-age children. Further, this study tested whether the effects of cumulative sociodemographic risk and immigrant-related stress on child mental health were mediated by parent mental health. Participants included 104 Mexican-origin immigrant families. Families in the study had a child between the ages of 6 and 10 (Mage = 8.39; 61% female). Data were collected across three time points spaced 6 months apart. Immigrant-related stress was found to predict parent mental health, which in turn predicted child mental health. Cumulative sociodemographic risk did not predict parent or child mental health. Mental health symptoms generally decreased over time, but for children, change in mental health symptoms depended on parent mental health symptoms. Given the high levels of mental health symptoms among Mexican-origin parents and children, reducing a context of stress and promoting mental health interventions for Mexican-origin immigrants is critical.

Keywords

Cumulative risk Stress Immigrant Mental health Parent psychopathology 

Introduction

Mexican-origin immigrants are the largest group of foreign-born individuals residing in the United States, with an estimated 11.6 million foreign-born Mexican-origin individuals in the U.S. today (Center for American Progress 2014). Furthermore, Mexican-origin children and adolescents constitute 69% of the overall Latino population under the age of 18 (Patten 2016). Recent research suggests that the social ecological context of immigrants’ experience has a powerful influence on mental health functioning (APA 2012). In particular, macro-level factors, including a hostile immigration climate and restrictive immigration policies, can contribute to mental health difficulties among Latino families (e.g., Gulbas and Zayas 2017; Hatzenbuehler et al. 2017). Moreover, Mexican-origin immigrant communities are more likely to experience systemic inequalities, such as poverty, as compared to other non-immigrant groups (Child Trends 2014; Gonzalez-Barrera and Lopez 2013). Thus, Mexican-origin immigrants may be at risk for experiencing high levels of stress due to both poverty and sociocultural/immigrant-related stressors, such as discrimination and fear of deportation, which have increased in the current sociopolitical climate (Yoshikawa et al. 2016). This stress, in turn, increases risk for mental health problems for both parents and U.S.-born children of immigrants (Berry et al. 2006; Yoshikawa et al. 2016). Latino adults have been found to score higher than non-Latino white adults on measures of depression and anxiety (Mendelson et al. 2008), and Mexican-origin children are at high risk for mental health problems such as anxiety and depression (McLaughlin et al. 2007).

Given these disparities, it is important to understand the processes that place immigrant parents and their children at risk for mental health problems. One model that has frequently been used to examine the effects of poverty is the Cumulative Risk Model (e.g., Evans 2004; Evans et al. 2013). This model draws from Bronfenbrenner’s (1979) ecological model indicating that macro-level sociodemographic factors such as parental income and educational attainment affect children’s mental health and development. The Cumulative Risk Model posits that such sociodemographic risk factors (e.g., family income, parental education) have an additive effect on mental health functioning, and research has supported its use when examining a wide variety of outcomes in both children and adults (Evans et al. 2013). The Family Stress Model (Conger et al. 2010) also examines how the context of poverty influences the mental health of children and adults; however, this model places greater emphasis on the impact of stress on parent functioning, which, in turn, affects child functioning. Although traditionally studied separately, both models can contribute to understanding the complex and interrelated factors creating mental health disparities among Mexican-origin immigrant families. Mexican-origin immigrant families may experience greater sociodemographic risk due to living in a context of poverty as well as experience high levels of stress associated with economic strain, discrimination, fear, and family separation related to being an immigrant in the current sociopolitical context. As such, cumulative sociodemographic risk and immigrant-related stress may be key factors increasing risk for mental health problems among Mexican-origin immigrant parents and their children. The current study aimed to extend our understanding of how key tenets of the Cumulative Risk Model and Family Stress Model might be applied to Mexican-origin immigrant families, taking into consideration both poverty-related risk factors as well as additional stressors immigrant families may face.

Cumulative Sociodemographic Risk

Cumulative sociodemographic risk is conceptualized as the summation of multiple risk factors thought to negatively impact mental and physical health (Evans 2004). Previous research has examined a range of constructs as indices of cumulative risk, including sociodemographic factors (e.g., income-to-needs ratio, parental education), physical factors (e.g., housing quality/overcrowding), and psychosocial factors (Evans 2004; Trentacosta et al. 2008); however, definitions of cumulative risk have varied significantly across studies (Evans et al. 2013). Although cumulative risk models have sometimes included a measure of stress within the cumulative risk construct, the current study focuses on sociodemographic factors (e.g., income, maternal education) as indices of cumulative risk while accounting for immigrant-related stress and parent mental health separately. This allows us to better understand the unique influences of cumulative sociodemographic risk on immigrant mental health. Appleyard et al. (2005) found support for a linear model of risk from early childhood through adolescence, wherein children who experienced more early risk factors experienced more internalizing and externalizing problems later in life. In addition, cumulative risk impacts adult mental health outcomes as well. For example, it has been found that multiple sociodemographic risks are associated with depressive symptoms among adults (Hudson et al. 2013).

Though Mexican-origin immigrants may be particularly susceptible to experiencing high cumulative sociodemographic risk, less research has been conducted on the effects of cumulative risk among this population. Recent policy related to immigration in the U.S., as well as language barriers, may limit educational and employment opportunities. Further, Mexican immigrants may face discrimination and exploitation in the workplace, further contributing to sociodemographic risk factors, such as income and employment (Segal and Mayadas 2005). These sociodemographic factors are linked to internalizing and externalizing symptoms among Latino adolescents, but more research is needed to understand the effects of cumulative sociodemographic risk on Mexican-origin families (Loukas et al. 2008).

Immigrant-Related Stress

In addition to cumulative sociodemographic risk, immigrant-related stress is likely to lead to poor mental health outcomes among immigrant families. Consistent with the Family Stress Model, low socioeconomic status (SES) creates a context of stress, which contributes to poor mental health (Conger et al. 2010; Wadsworth et al. 2008). This context of stress often includes an array of accumulating stressors, such as economic strain, family conflict, frequent moves and transitions, discrimination, and other traumatic experiences (Evans and Kim 2013; Wadsworth et al. 2008). Low-income immigrant families often experience these types of stressors in addition to stressors related to the immigrant experience—discrimination, legal problems, family separation, and exposure to violence (Cervantes et al. 2012). These stressors are present during the immigration process and after families have arrived in the U.S. Additionally, immigration policies and anti-immigrant attitudes have increased concerns regarding family separation and family reunification, and have intensified a sense of hypervigilance related to being arrested or deported (Cruz Nichols et al. 2018; Salas et al. 2013). In such a climate, Latino immigrant individuals may experience discrimination through both policy and interpersonal interactions (Androff et al. 2011; Dreby 2015; Zeiders et al. 2013).

This accumulated immigrant-related stress contributes to the development of mental health problems among children and adults (Berkel et al. 2010; Evans and Kim 2013). The current study builds on prior work linking high levels of stress to mental health problems (e.g., Gonzales et al. 2011; Wadsworth et al. 2008) by examining a broad array of stressors that are associated with both poverty and immigration (referred to as immigrant-related stress for the purposes of this study). Further, this study examined how these stressors directly and indirectly impact parent and child mental health.

Parent Mental Health

As described previously, cumulative sociodemographic risk and immigrant-related stress may increase vulnerability to mental health problems among parents, which may further increase risk for the development of mental health problems in children (Laor et al. 2001). A large body of research has shown that within the context of poverty, parent mental health problems borne of economic strain cause disruptions in parenting and family relationships, which ultimately lead to child mental health problems (Conger et al. 2002, 2010; Gonzales et al. 2011). Although this model has substantial support, there is limited research applying this model to Mexican-origin immigrant families (e.g., Gonzales et al. 2011) while accounting for immigrant-related stress. Still, there is research showing that parental feelings of legal vulnerability affect both parents and children (Brabeck and Xu 2010). Further, among Asian immigrant families, parental discrimination relates to child mental health through parent depression symptoms (Kim et al. 2018). Given research literature finding increased adult stress due to changes in immigration policy and current sociopolitical climate (Cruz Nichols et al. 2018), it is imperative to examine how parent mental health may impact that of children in this population. Research examining cumulative sociodemographic risk, immigrant-related stress, and parent mental health allows researchers to account for these factors simultaneously and determine the strongest direct and indirect predictors of child mental health.

Current Study

The current study examined cumulative sociodemographic risk and immigrant-related stress among Mexican-origin immigrant families. Although past research supports the hypothesis that both constructs are implicated in the development of mental health problems, few studies have examined these constructs’ relative contributions to mental health symptoms over time. Further, there is limited research examining these constructs among immigrant families, who may be more likely to experience both cumulative sociodemographic risk and immigrant-related stress. The hypotheses of the current study are (1) cumulative sociodemographic risk and immigrant-related stress will be associated with mental health symptoms among parents over time; (2) cumulative sociodemographic risk, immigrant-related stress, and parent mental health symptoms will be associated with mental health symptoms among children over time; and (3) cumulative sociodemographic risk and immigrant-related stress will have indirect effects on child mental health through parent mental health.

Method

This research was approved and conducted in compliance with the University’s Institutional Review Board.

Participants

The study took place in a large, urban Midwestern city, with a long-standing history of Mexican migration. Participants were recruited through community partnerships with human service organizations, local parochial schools, community centers, libraries, churches, and doctors’ offices. Bilingual research assistants summarized the research project to potential participants. Families interested in participating then completed an initial eligibility screening. Eligibility for the study included having at least one Mexican-origin immigrant parent, one child between the ages of 6 and 10, and family income at or below 150% of the federal poverty line. Secondary caregivers, who were a second parent, grandparent, or other adult involved in caring for the child, were encouraged to participate. One hundred and sixty-two participants were interested in participating in the study; however, of those recruited, 25 families did not meet eligibility criteria, 17 were no longer interested, and 16 were not able to be contacted. Thus, the final sample consisted of 104 families.

Data collection began in 2013 (Time 1). At Time 1, 104 children and primary caregivers participated, and 72 secondary caregivers participated; at Time 2, 99 children and primary caregivers participated, and 67 secondary caregivers participated; and at Time 3, 97 children and primary caregivers participated, and 61 secondary caregivers participated. At Time 1, 97% of primary caregivers (Mage = 37.13) were female and 98% were mothers; 82% of secondary caregivers (Mage = 43.14) were male and 79% were fathers (aunt/uncles, grandparents, an older sibling, and a stepfather were also represented). The majority of children (61%) were female (Mage = 8.39). All families included at least one Mexican-origin immigrant parent. All primary caregivers (100%) and most secondary caregivers (97%) identified as Latino. Furthermore, 91% of primary caregivers and 90% of secondary caregivers were born outside of the U.S. Among child participants, 97% were born in the U.S., and 97% identified as Latino. Some of the child participants (3%) identified as mixed race and ethnicity (e.g., African American and Latino). At Time 1, parents reported an average monthly income of $1806.53 with an average of four people supported. Regarding primary caregivers’ education status, 32% did not finish high school, 26% received a high school diploma or a GED, 35% received a training certificate, attended some college, earned their associates, or college degree, 2% earned an advanced degree, and 5% were currently in school.

Procedure

Data collection consisted of three home visits lasting 3 hours each that were conducted 6 months apart. Bilingual research assistants obtained informed consent from both caregivers and assent from the participating child. After obtaining consent, research assistants then administered observational tasks and questionnaires. Questionnaires were administered verbally. Caregivers and children were interviewed separately for privacy. Families who endorsed a significant amount of distress and mental health symptoms received a list of referrals, which included low-cost and Spanish-speaking services. Each family received a $100 gift card for completing each home visit at each of the three time points.

Measures

For the purposes of this study, cumulative sociodemographic risk and immigrant-related stress were calculated at Time 1, whereas all three time points were utilized for mental health outcomes.

Demographic Information

Caregivers reported demographic information for the child and caregivers. Demographic information collected included age, gender, race/ethnicity, country of birth, and length of time in the U.S. Additionally, caregivers reported their family’s monthly income, marital status, education, and occupation.

Cumulative Sociodemographic Risk

A cumulative sociodemographic risk index was calculated for each family using four risk factors: income-to-needs ratio, average household occupation, primary caregiver education, and primary caregiver marital status. Each of these risk factors was assigned a value of 0 (risk absent) or 1 (risk present), and these values were summed to create a cumulative sociodemographic risk index, consistent with previous research (Trentacosta et al. 2008).

Income-to-Needs Ratio

The income-to-needs ratio was calculated by dividing reported family income by the 2013 federal poverty level for a family of that size. Risk was considered to be present for families with income-to-needs ratio less than one.

Occupation

Primary caregivers reported their occupation and their partner’s occupation. Responses were coded according to the Hollingshead occupation codes (Hollingshead 1975). The mean occupational status for each primary caregiver and his or her partner was calculated using the Hollingshead codes. Risk was considered to be present when the mean was less than 3 (Machine Operators and Semiskilled Workers).

Education

Primary caregivers reported their educational attainment at Time 1. Risk was considered to be present for primary caregivers who reported that they did not finish high school or receive a GED.

Marital Status

Primary caregivers reported their marital status at Time 1. Risk was considered to be present for primary caregivers who were single, divorced, separated, or widowed.

Immigrant-Related Stress

Caregivers completed the Hispanic Stress Inventory (HSI), a culturally informed measure of stress among Latinos (Cervantes et al. 1991). The HSI includes 73 items consisting of five subscales including: Immigration Stress (e.g., “I feared the consequences of deportation,” “I’ve been discriminated against”), Family/Culture Stress (e.g., “I had serious arguments with family members”), Parental Stress (e.g., “My children haven’t respected my authority as they should”), Marital Stress (e.g., “My spouse has expected me to be more traditional in our relationship”), and Occupational/Economic Stress (e.g., “Since I’m Latino, I’m expected to work harder”). Items tapping discrimination stress are embedded within Immigration Stress as well as Occupational/Economic Stress, although there is not a separate scale to represent this domain. Caregivers reported if their family had experienced the stressor in the previous 3 months for each of the 73 items and rated the perceived stressfulness of each endorsed item on a five-point scale (1 = not at all to 5 = extremely). When caregivers reported they did not experience a particular stressor, that item’s stressfulness rating was coded as 1. The five scales were totaled together for an overall stressfulness score. To demonstrate the overall stress in each family, the total stressfulness scores on each of the five scales for primary and secondary caregivers were averaged together. If there was not a secondary caregiver report, primary caregiver data were used alone. Primary and secondary caregiver reports on the HSI subscales were significantly correlated; correlations ranged from .38 (Occupational/Economic Stress) to .75 (Marital Stress). The subscales were also significantly correlated with one another for both caregivers, ranging from .40 to .75 for primary caregiver and .55 to .83 for secondary caregiver report. Previous versions of the HSI have demonstrated high internal consistency. In the current study, primary caregiver alphas spanned from .79 (parental stress) to .86 (immigration stress). Secondary caregiver alphas spanned from .66 (Parental Stress) to .85 (occupational/economic stress).

Parent Mental Health

Primary caregivers reported their own mental health symptoms using the Brief Symptom Inventory (BSI; Derogatis and Melisaratos 1983). This is a 53-item measure consisting of nine subscales (somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism). Caregivers rated the degree to which they were distressed by each symptom using a five-point scale (0 = not at all to 4 = extremely). The depression, anxiety, hostility, and somatization subscales were used as parental mental health outcomes in the current study. The total score Global Severity Index (GSI) was used in child analyses as an indicator of parent mental health symptoms. Mean scores were calculated for each subscale and for all items on the measure. Previous research using the GSI with Latino samples has found similar variability among the original normed populations and Latino samples, although some research has found that Latino samples tend to report higher levels of distress (e.g., Coelho et al. 1998). Primary caregiver report of GSI and depression, anxiety, hostility, and somatization subscales were significantly correlated at all time points; correlations ranged from .58 (T1 hostility & somatization) to .94 (T3 anxiety and GSI). Internal consistency in the current sample was high for both the GSI (α = .97) and its subscales (alphas ranging from .77 for hostility to .88 for depression).

Child Mental Health

Primary caregivers reported children’s internalizing and externalizing behaviors over the past 6 months using the Child Behavior Checklist for Ages 6–18 (CBCL; Achenbach and Rescorla 2001). The internalizing scale consists of 32 items that assess anxiety, depression, and somatic symptoms. The externalizing scale consists of 35 items that assess aggressive and rule-breaking behavior. Items were rated by caregivers using a three-point scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true). The CBCL has previously demonstrated excellent reliability and validity (Achenbach and Rescorla 2001) and moderate agreement with youth reports (Huang 2017). In the current sample, internal consistency was high. Alphas ranged from .82 to .89 for the internalizing scale and .83 to .87 for the externalizing scale.

Analytic Plan

Primary Analyses

To analyze longitudinal data collected across three time points, hierarchical linear modeling (HLM) was used. This approach allows for time to be nested within persons and capitalizes on repeated measurements, providing augmented power in analyses. Further, HLM capitalizes on all existing data points nested within individuals, meaning that listwise deletion does not occur for missing data at level 1. Thus, data imputation was not conducted.

At level 2, Time 1 cumulative sociodemographic risk and Time 1 immigrant-related stress were entered as independent predictors. For child models, Time 1 parent mental health and gender were also included at level 2. The level 2 equations were set as fixed, as their slopes were assumed to be similar across individuals. Time was entered at level 1. Four models were tested for the following parent outcomes (including three repeated measurements over time): depression, anxiety, hostility, and somatic problems. Two models were tested for child outcomes (including three repeated measurements over time): internalizing and externalizing symptoms. Significant cross-level interactions with time were probed using Rweb (Preacher et al. 2006). An example of the parent model equations is shown below:
$${\text{Level}}\,{\text{1}}:{\left( {{\text{Parent}}\,{\text{Depression}}} \right)_{{\text{ti}}}}={\pi _{0{\text{i}}}}+{\pi _{1{\text{i}}}}{\left( {{\text{time}}} \right)_{{\text{ti}}}}+{e_{{\text{ti}}}},$$
$$\begin{aligned} {\text{Level}}\,2: {\pi _{{\text{0i}}}}={\beta _{{\text{00}}}}+{\beta _{{\text{01}}}}{\left( {{\text{Cumulative}}\,{\text{Sociodemographic}}\,{\text{Risk}}} \right)_{\text{i}}}+{\beta _{02}}{\left( {{\text{Immigrant-Related}}\,{\text{Stress}}} \right)_{\text{i}}}+{r_{0{\text{i}}}} \\ {\pi _{1i}}={\beta _{10}}+{\beta _{11}}{\left( {{\text{Cumulative}}\,{\text{Sociodemographic}}\,{\text{Risk}}} \right)_{\text{i}}}+{\beta _{12}}{\left( {{\text{Immigrant-Related}}\,{\text{Stress}}} \right)_{\text{i}}}. \\ \end{aligned}$$

Tests of Mediation

Mediation analyses were conducted in HLM using a 2-1-1 multilevel mediation model (Tofighi and Thoemmes 2014), in which the independent variable was measured at level 2 (i.e., cumulative sociodemographic risk or immigrant-related stress at Time 1), the mediator variable was measured at level 1 (i.e., parent mental health across all three time points), and the outcome variables were measured at level 1 (i.e., child internalizing and externalizing symptoms across all three time points). Separate mediation models were analyzed for each outcome (i.e., child internalizing and externalizing symptoms). First, multilevel equations were used to test the total effect of the independent variable on the outcome variable (pathway C) and to test the direct effect of the independent variable on the mediator variable (pathway A). Next, the independent and mediator variables were entered into a multilevel equation to obtain the direct effect of the mediator variable on the outcome variable while controlling for the independent variable (pathway B), and to obtain the direct effect of the independent variable on the outcome variable while controlling for the impact of the mediator variables (pathway C′). Indirect mediation effects were estimated using the RMediation package, which computes confidence intervals (CIs) for the mediated effect using the distribution of product of coefficients method (PRODCLIN; Tofighi and MacKinnon 2011) consistent with current recommended practices for testing mediation (Hayes 2018). The coefficients and standard errors for pathways A and B were used to calculate a distribution of the product of the coefficients’ CIs using RMediation. The correlation between the coefficient estimates was assumed to be zero. Significant indirect mediation occurs when the CI for the indirect effect does not contain zero. The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Results

Descriptive Statistics

See Table 1 for correlations among study variables. Data were examined for extreme skewness and kurtosis, and transformations were not deemed necessary. Across cumulative sociodemographic risk indices, 29% of primary caregivers reported single parent status, 32% of primary caregivers reported not finishing high school or receiving a GED, 61% of families had an income-to-needs ratio less than one (i.e., below the poverty line), and 55% of families had average occupation scores less than three (e.g., semiskilled workers). When considering total cumulative sociodemographic risk scores across families, 16% had a cumulative sociodemographic risk index of zero, 26% had an index of one, 31% had an index of two, 21% had an index of three, and 6% had an index of four. Regarding immigrant-related stress, primary caregivers reported experiencing an average of 18.30 stressors in the past three months (SD = 11.89), and secondary caregivers experienced an average of 15.77 stressors (SD = 12.10). Regarding parent mental health symptoms at Time 1, using the recommended clinical cutoff score of t ≥ 63, 32% of primary caregivers met clinical cutoffs on the Global Severity Index (GSI; Derogatis 1993). Additionally, 21% of children met the clinical cutoff for internalizing symptoms, and 7% of children met the clinical cutoff for externalizing symptoms at Time 1.

Table 1

Correlations and descriptive statistics

 

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

1. T1 stress

                      

2. T1 risk

.24*

                     

3. T1 parent depression

.36**

0.12

                    

4. T1 parent anxiety

.31**

.11

.86**

                   

5. T1 parent hostility

.36**

− .04

.63**

.66**

                  

6. T1 parent somatization

.27**

.08

.76**

.84**

.61**

                 

7. T2 parent depression

.19

.049

.52**

.53**

.51**

.53**

                

8. T2 parent anxiety

.17

.07

.42**

.52**

.42**

.56**

.76**

               

9. T2 parent hostility

.26*

− .01

.53**

.57**

.72**

.55**

.78**

.59**

              

10. T2 parent somatization

.22*

.13

.53**

.53**

.40**

.64**

.75**

.78**

.62**

             

11. T3 parent depression

.31**

.09

.65**

.59**

.54**

.53**

.54**

.40**

.56**

.46**

            

12. T3 parent anxiety

.32**

.02

.64**

.72**

.58**

.68**

.53**

.54**

.58**

.53**

.83**

           

13. T3 parent hostility

.36**

.01

.48**

.42**

.70**

.40**

.47**

.34**

.70**

.32**

.68**

.62**

          

14. T3 parent somatization

.26*

.10

.63**

.67**

.48**

.74**

.47**

.48**

.47**

.64**

.68**

.80**

.49**

         

15. T1 GSI

.36**

.11

.92**

.94**

.75**

.87**

.57**

.50**

.64**

.56**

.64**

.73**

.53**

.67**

        

16. T2 GSI

.21*

.09

.56**

.59**

.57**

.59**

.93**

.85**

.81**

.85**

.56**

.59**

.51**

.55**

.64**

       

17. T3 GSI

.33**

.08

.72**

.71**

.62**

.67**

.57**

.48**

.63**

.54**

.91**

.92**

.72**

.84**

.77**

.63**

      

18. T1 child internalizing

.15

.11

.55**

.53**

.30**

.49**

.49**

.45**

.32**

.40**

.49**

.51**

.28**

.47**

.57**

.53**

.55**

     

19. T1 child externalizing

.25*

.00

.55**

.55**

.46**

.47**

.34**

.39**

.40**

.26*

.35**

.42**

.32**

.37**

.56**

.43**

.43**

.72**

    

20. T2 child internalizing

.12

.19

.45**

.38**

.24*

.41**

.58**

.58**

.42**

.56**

.48**

.47**

.29**

.39**

.43**

.63**

.49**

.76**

.48**

   

21. T2 child externalizing

.15

.01

.40**

.36**

.30**

.26**

.46**

.42**

.47**

.33**

.45**

.41**

.35**

.30**

.38**

.49**

.44**

.52**

.71**

.64**

  

22. T3 child internalizing

.08

.19

.38**

.34**

.16

.33**

.38**

.43**

.23*

.41**

.45**

.44**

.26*

.40**

.36**

.46**

.47**

.70**

.45**

.72**

.45**

 

23. T3 child externalizing

.02

.05

.26**

.26*

.15

.21*

.33**

.46**

.29**

.30**

.39**

.38**

.26**

.28**

.27**

.42**

.40**

.58**

.59**

.64**

.71**

.68**

Mean

106.59

2.02

0.7

0.64

0.48

0.63

0.57

0.5

0.41

0.54

0.55

0.54

0.41

0.57

0.66

0.52

0.54

7.29

5.06

5.78

4.02

6.18

4.19

SD

32.14

1.14

0.73

0.7

0.53

0.73

0.69

0.63

0.49

0.68

0.64

0.64

0.52

0.71

0.61

0.55

0.56

7.1

5.57

5.9

4.69

6.24

5.39

T1 time 1, T2 time 2, T3 time 3

**p < .01; *p < .05

Hierarchical Linear Models

Parent Analyses

See Table 2 for a summary of HLM models showing parent outcomes. Immigrant-related stress had a significant main effect on parent depressive symptoms, parent anxiety symptoms, parent hostility, and parent somatic symptoms across time. Greater immigrant-related stress was associated with more parent mental health problems across time. Cumulative sociodemographic risk did not have a significant effect on parent outcomes. However, time had a significant main effect on parent depressive symptoms, in that symptoms decreased over time. No significant two-way interactions emerged between time and immigrant-related stress or between time and cumulative sociodemographic risk.

Table 2

Parent mental health hierarchical linear models: Coefficients and statistical tests

 

Depression symptoms

Anxiety symptoms

Hostility

Somatic symptoms

Coefficient (SE)

df

t ratio

Coefficient (SE)

df

t ratio

Coefficient (SE)

df

t ratio

Coefficient (SE)

df

t ratio

Intercept

0.76 (0.08)

100

9.05**

0.66 (0.08)

100

8.34**

0.50 (0.06)

100

8.72**

0.66 (0.08)

100

7.93**

Cumulative risk

0.02 (0.08)

100

0.24ns

0.05 (0.07)

100

0.67ns

− 0.07 (0.05)

100

− 1.31ns

− 0.004 (0.08)

100

− 0.05ns

Immigrant-related stress

0.008 (0.003)

100

2.94**

0.006 (0.003)

100

2.18*

0.006 (0.002)

100

3.13**

0.006 (0.003)

100

2.20*

Time

− 0.08 (0.03)

292

− 2.41*

− 0.05 (0.03)

292

− 1.72+

− 0.04 (0.02)

292

− 1.85+

− 0.04 (0.03)

292

− 1.45ns

Cumulative risk × time

− 0.002 (0.03)

292

− 0.08ns

− 0.02 (0.03)

292

− 0.81ns

0.01 (0.02)

292

0.64ns

0.02 (0.03)

292

0.49ns

Immigrant-related stress × time

− 0.001 (0.001)

292

− 0.91ns

− 0.0001 (0.001)

292

− 0.08ns

− 0.0001 (0.001)

292

− 0.13ns

− 0.0004 (0.001)

292

− 0.67ns

df degrees of freedom

**p < .01; *p < .05; +p < .10; nsp > .10

Child Analyses

See Table 3 for a summary of HLM models showing child outcomes. Parent mental health symptoms had a significant main effect on child internalizing symptoms and child externalizing symptoms, such that more parent mental health symptoms were associated with more child mental health symptoms across time. Neither cumulative sociodemographic risk nor immigrant-related stress had a significant effect on child mental health symptoms when controlling for parent mental health symptoms. However, time had a significant main effect on child internalizing symptoms and child externalizing symptoms, such that symptoms decreased over time.

Table 3

Child mental health hierarchical linear models: Coefficients and statistical tests

 

Internalizing symptoms

Externalizing symptoms

Coefficient (SE)

df

t ratio

Coefficient (SE)

df

t ratio

Intercept

7.88 (1.83)

98

4.31**

7.96 (1.50)

98

5.31**

Gender

− 0.08 (1.05)

98

− 0.08ns

− 1.54 (0.86)

98

− 1.79+

Cumulative risk

− 0.15 (0.61)

98

− 0.24ns

− 0.65 (0.52)

98

− 1.26ns

Parent mental health

8.29 (1.21)

98

6.86**

6.04 (1.02)

98

5.91**

Immigrant-related stress

− 0.02 (0.02)

98

− 0.78ns

0.02 (0.02)

98

1.00ns

Time

− 0.64 (0.23)

288

− 2.74**

− 0.50 (0.21)

288

− 2.44*

Cumulative risk × time

0.34 (0.21)

288

1.64ns

0.25 (0.18)

288

1.35ns

Parent mental health × time

− 1.62 (0.40)

288

− 4.00**

− 1.27 (0.36)

288

− 3.55**

Immigrant-related stress × time

0.001 (0.008)

288

0.17ns

− 0.01 (0.01)

288

− 1.68+

df degrees of freedom

**p < .01; *p < .05; +p < .10; nsp > .10

There were also significant interactions between time and parent mental health symptoms associated with child internalizing symptoms (see Fig. 1) and child externalizing symptoms (see Fig. 2). All simple slopes (calculated at the 16th, 50th, and 84th percentiles of parent mental health symptoms; Hayes 2018) were significantly different from zero and were negative in value, indicating that children’s internalizing and externalizing symptoms decreased over time regardless of parent mental health symptoms. However, it appeared that when parents had fewer mental health symptoms, children’s symptoms remained low and relatively stable over time, whereas when parents had more mental health symptoms, children’s symptoms decreased over time but still remained higher than when parents had fewer mental health symptoms.

Fig. 1

Interactive effect of parent mental health symptoms × time associated with child internalizing symptoms

Fig. 2

Interactive effect of parent mental health symptoms × time associated with child externalizing symptoms

Mediation Analyses

Mediation analyses were conducted with immigrant-related stress, and not cumulative sociodemographic risk, because only immigrant-related stress was significantly associated with parent mental health symptoms. However, mediation analyses did control for cumulative sociodemographic risk and time. Parent mental health symptoms significantly mediated the association between immigrant-related stress and child internalizing symptoms across time (see Fig. 3). First, stress did not significantly predict child internalizing symptoms (pathway C), and this effect remained non-significant when accounting for the variance associated with parent mental health symptoms (pathway C′). However, the two mediating pathways were significant—higher stress predicted higher parent mental health symptoms (pathway A), and higher parent mental health symptoms predicted higher child internalizing symptoms when accounting for the variance associated with stress (pathway B). The indirect mediation effect was significant (indirect estimated effect = 0.029, SE = 0.011, 95% CI lower to upper = 0.009–0.051).

Fig. 3

The mediation model of immigrant-related stress, parent mental health symptoms, and child internalizing symptoms. Pathway a: path coefficient for the direct effect of stress on parent mental health. Pathway b: path coefficient for the direct effect parent mental health on child internalizing symptoms, controlling for stress. Pathway c: path coefficients for the total effect and direct effect of stress on child internalizing symptoms. **p < .01, *p < .05, nsp > .05

Parent mental health symptoms also significantly mediated the association between immigrant-related stress and child externalizing symptoms across time (see Fig. 4). First, higher stress predicted higher child externalizing symptoms (pathway C), but this effect was not significant when controlling for parent mental health symptoms (pathway C′). The two mediating pathways were significant—higher stress predicted higher parent mental health symptoms (pathway A), and higher parent mental health symptoms predicted higher child externalizing symptoms when accounting for the variance associated with stress (pathway B). The indirect mediation effect was significant (indirect estimated effect = 0.023, SE = 0.008, 95% CI lower to upper = 0.007–0.040).

Fig. 4

The mediation model of immigrant-related stress, parent mental health symptoms, and child externalizing symptoms. Pathway a: path coefficient for the direct effect of stress on parent mental health. Pathway b: path coefficient for the direct effect parent mental health on child externalizing symptoms, controlling for stress. Pathway c: path coefficients for the total effect and direct effect of stress on child externalizing symptoms. **p < .01, *p < .05, nsp > .05

Discussion

The current study examined cumulative sociodemographic risk and immigrant-related stress among Mexican-origin immigrant families and their impact on parent and child mental health. Immigrant-related stress was found to predict parent mental health problems across time, specifically, parent depression, anxiety, hostility, and somatic symptoms. Further, these mental health problems, in turn, predicted child mental health problems across time. However, cumulative sociodemographic risk was not found to predict parent mental health. Perhaps immigrant-related stress is more strongly linked to immediate mental health symptoms (i.e., over the course of 1 year), whereas cumulative sociodemographic risk confers vulnerability over a longer period of time (Appleyard et al. 2005). It is also possible that Mexican-origin immigrant families are exposed to other risk factors such as neighborhood characteristics and lack of health insurance, which may compound traditional measures of sociodemographic risk. The lack of an association between sociodemographic risk and mental health outcomes may also be due to important intermediary resilience processes, such as effective coping strategies (Taylor et al. 2017).

It is important to recognize the impact of immigrant-related stress on parent mental health given that this context of stress may be worsening due to current policies and the resulting sociopolitical atmosphere in the U.S. For example, Almeida and colleagues (2016) examined a nationally representative sample of Latino adults and found that 68% of Latinos reported experiences of discrimination, an increase from 30% in 2002. Anti-immigration policies are often geared towards undocumented immigrants, yet these policies may lead to a hostile social environment in which Latinos in general are assumed to be undocumented immigrants who are marginalized as “others” in society (Almeida et al. 2016; Viruell-Fuentes et al. 2012). Such policies and hostile environment may exacerbate the stressors immigrant parents face. For example, state-level exclusionary immigration policies have been linked to more frequent poor mental health days when compared to states with more inclusive policies (Hatzenbuehler et al. 2017).

Interestingly, neither immigrant-related stress nor cumulative sociodemographic risk were directly related to child mental health over the course of 1 year. However, immigrant-related stress was indirectly related, as it predicted parent mental health, which, in turn, predicted child mental health. Although previous research suggests that children do experience poverty-related stress directly (e.g., Wadsworth et al. 2008), this study found that school-aged children are impacted by the indirect effect of immigrant-related stress, mediated by the negative impact of stress on parent mental health. Advocates for immigration policy reform have stated that many immigrant families live with significant anxiety regarding the threat of deportation, and in this context, children are negatively affected by the distress of their parents (Levers and Hyatt-Burkhart 2012). Indeed, past research has shown that common difficulties among adult immigrants (e.g., limited resources, adjustment to a new culture, marginalization, living with the threat of deportation) foster high levels of stress, and this increased parental stress results in heightened vulnerability to mental health problems in children (Landale et al. 2015). Consistent with the work of Conger et al. (2010), stress disrupts parent and family functioning, which in turn has damaging effects on child mental health. The current study expands on this literature by demonstrating this process in a sample of Mexican-origin immigrant families facing poverty-related and immigration-related stress. Additionally, the results contribute to a larger literature on how stress associated with discrimination towards racial and ethnic minorities affects parents, which in turn, impacts children’s mental health (e.g., Anderson et al. 2015; Kim et al. 2018).

In the current study, children’s internalizing and externalizing symptoms decreased over time, consistent with research suggesting that symptoms may decrease during late childhood (e.g., Angold et al. 2002; Campbell et al. 2006). Although symptoms decreased over time in general, interactions between time and parent mental health emerged. Children whose parents had more mental health problems had more mental health problems overall, despite these symptoms decreasing over time. Among parents, mental health symptoms appeared relatively stable over time, although parent depression decreased with time. Given that parent mental health predicted child mental health, parents’ decreasing depression symptoms likely contribute to children’s decreasing mental health symptoms over time.

Although this study contributes to the literature on immigrant-related stress and cumulative sociodemographic risk, it has some limitations that are important to note. The measures were self-report, and measures assessing child internalizing and externalizing symptoms were parent report; thus, results may have been impacted by shared method variance. Further, it is well known that there is no single measure of child mental health that is a definitive “gold standard,” and the use of parent report alone may constitute a limitation to the current study (De Los Reyes and Kazdin 2005). Thus, future research should incorporate information from multiple informants when examining the impacts of immigration-related stress on mental health. Additionally, the presence of researchers in families’ homes may have resulted in response bias for participants, which may have changed over time as families became more familiar with the research team and questionnaires. Although the longitudinal design is a strength of this study, the six-month intervals between home visits were relatively brief, which may have limited the ability to detect differences across time. Future studies should examine these constructs across longer time intervals. Moreover, this study included only urban-dwelling immigrants from Mexico. Thus, findings may be less applicable to suburban or rural populations and other Latino groups. Finally, the majority of the children who participated were female. It should also be noted that parents who had multiple children between the ages of 6 and 10 (the study criteria) were allowed to choose the child they wanted to participate and therefore, constitutes a limitation.

Despite its limitations, this study contributes to our understanding of risk processes among Mexican-origin immigrant families. This study examined cumulative sociodemographic risk and immigrant-related stress separately, contributing to a more nuanced understanding of mental health disparities among Mexican-origin immigrants. Given that cumulative risk did not predict mental health symptoms, future research should expand the measurement of this construct as well as examine resilience processes that may promote positive mental health despite risk. Immigrant-related stress was linked to mental health, however, suggesting a need for research to examine potential buffers and practitioners to consider and address stress when working with immigrant families. Compared to other samples (e.g., Myers et al. 2002), parents demonstrated a high rate of mental health symptoms in the clinical range (32%). Using a social–ecological perspective, it is important to consider intervention efforts across multiple systems. On an individual level, culturally informed interventions focused on adaptive coping could help parents combat immigrant-related stress. For example, coping strategies including problem solving, emotion regulation, and cognitive restructuring are associated with better mental health in the context of stress (Wadsworth et al. 2011). Practitioners can also incorporate practical assistance (e.g., connections to social and/or legal services) in order to support families and reduce stress. Moreover, given the strong link between parent and child mental health, family-level interventions that equip both parents and children with tools to manage high levels of stress may be particularly advantageous. Finally, on a broader systems level, it is important to advocate for policies that might reduce this stress and promote wellbeing and empowerment among immigrant Latino families. For example, recent research demonstrates that DACA (Deferred Action for Childhood Arrivals) eligibility among immigrant mothers is related to decreases in child mental health symptoms (Hainmueller et al. 2017).

Notes

Funding

This research was funded by the Foundation for Child Development under Grant No. LUC-1-13 (http://fcd-us.org; PI: Santiago).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Catherine DeCarlo Santiago
    • 1
  • Laura M. L. Distel
    • 1
  • Anna M. Ros
    • 1
  • Stephanie K. Brewer
    • 1
  • Stephanie A. Torres
    • 1
  • Jaclyn Lennon Papadakis
    • 1
  • Anne K. Fuller
    • 2
  • Yvita Bustos
    • 1
  1. 1.Department of PsychologyLoyola University ChicagoChicagoUSA
  2. 2.Center for Depression Research and Clinical CareUT Southwestern Medical CenterDallasUSA

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