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Principal Investigator: Faustine Williams
Organization: NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES
Fiscal Year: 2024
Award: $797,190
Funding agency: National Institute on Minority Health and Health Disparities
In FY24, we continued to use nationally representative data to identify and understand the individual and structural factors influencing the mental health and well-being of immigrants under Objective 1. In the first study, we utilized the National Interview Survey (NHIS) from 2005-2018 cross-sectional data on (n= 351,457) adults aged ≥18. We examined the association between multiple chronic diseases and psychological distress, and how chronic diseases combine with sex, race/ethnicity, immigration status, and insurance coverage to affect the risks of psychological distress. We found significant interactions between chronic disease status, health insurance, immigration status, and race/ethnicity. In particular, for chronic diseases with immigration status, the odds of psychological distress were higher for foreign-born individuals with 1–2 chronic diseases or ≥3 chronic diseases compared to US-born individuals without chronic diseases. Similarly, foreign-born individuals with ≥3 chronic diseases had the highest probability of psychological distress. In contrast, foreign-born individuals without chronic disease had the lowest probability, followed by US-born persons without chronic disease. The evidence that immigrants have better health outcomes than non-immigrants may not apply in every situation, as the intersection of multiple clinical and psychosocial factors can influence the risk levels and direction of health outcomes between immigrants and non-immigrants.
Evidence has shown that higher life satisfaction reduces risks of mortality, depression, physical functioning limitations, chronic pain, sleep problem onset, and psychological wellbeing problems, while increasing frequent physical activity. Social needs, including food security and employment, significantly impact the life satisfaction of individuals, particularly immigrants. Given the limited research on how social needs influence mental health, which, in turn, affects life satisfaction, using NHIS again, we examined the mediation effects of mental health on the relationship between social needs and life satisfaction among a nationally representative sample of US adult immigrants. Social needs influenced psychological distress, which in turn influenced life satisfaction. Thus, the effects of these social needs on life satisfaction were reduced when accounting for psychological distress. Notably, we found that immigrants with food insecurity (versus food security) or who used healthcare within the past 12 months (versus more than 12 months/never) had increased risks of psychological distress and lower life satisfaction, while those who had employment (versus unemployment) had decreased psychological distress and increased life satisfaction. Increased psychological distress, on the other hand, decreased life satisfaction. Although we did not examine the reasons why healthcare use within the past 12 months led to reduced life satisfaction, this finding underscores the need to develop a multicultural orientation to deliver culturally sensitive care and improve communication in healthcare delivery.
In another study, we investigated the patterns of anxiety, depression, and anxiety/depression symptoms, and estimated the influence of life satisfaction, social support, and other biopsychosocial factors (i.e., sociodemographic characteristics, health utilization) on anxiety/depression symptoms among foreign-born or first-generation immigrant populations. The first-generation population aged 26–49 years was less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18–25. Compared to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds of experiencing anxiety/depression daily, weekly, or monthly, while other/multi-racial/ethnic groups were more likely to experience these symptoms. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes or rarely was associated with higher odds of experiencing anxiety/depression daily, weekly, or monthly. These findings further highlight the need for personalized mental health screening and interventions for first-generation individuals in the US, considering the diversity of immigrant populations and their health-related risks.
Additionally, we examined the association between self-reported health and depression among non-US-born citizens, non-US citizens, and US-born citizens. We hypothesized that (1) individuals reporting fair/poor self-reported health would have significantly higher depression levels, and (2) US-born citizens would exhibit worse depression outcomes compared to non-US-born citizens and non-US citizen respondents. While US-born citizens reported the highest prevalence of depression, non-US-born citizens reported the highest prevalence of poor/fair health. Additionally, we found that compared to individuals with good/very good/excellent self-reported health, non-US-born citizens, non-US citizens, and US-born citizens had the highest odds of experiencing depression, respectively. This study is among the first to demonstrate the non-applicability of the “healthy immigrant effect,” given that non-US citizens with fair/poor self-reported health had the highest likelihood of depression, followed by non-US-born citizens.
With the increasing prevalence of hypertension-related cardiovascular deaths and depression, using NHIS again, we examined the associations of depression with hypertension, citizenship status, and the interaction of hypertension and citizenship status among US adults. We found that a higher proportion of US citizens reported depression than non-citizens. However, non-citizens with hypertension were more likely to report depression compared to U.S. citizens without hypertension. The findings imply that the healthy immigrant paradox, in the context of hypertension-depression prevention and control, may not apply to non-citizens with hypertension.
In another study, we analyzed the extent of changes in substance use categorized by nativity, both before and during the COVID-19 pandemic. The results demonstrated that both U.S.-born and foreign-born participants showed an increase in alcohol consumption. This increase ranged from those who had no alcohol consumption before the pandemic to those who consumed alcohol once to several times a month, and from participants who previously consumed alcohol once to several times a week, up to those who consumed alcohol every day to several times per day. While significant changes were observed in terms of increased alcohol use, the opposite trend was also noted, with this decrease being more pronounced among foreign-born participants. Specifically, a 5.1% overall shift from some level of alcohol use before the pandemic to no alcohol use during the pandemic was observed among foreign-born individuals, in contrast to a 4.3% change among U.S.-born individuals.
Individuals with mental health disorder symptoms are more likely to use substances such as e-cigarettes, cannabis, or their combination. However, given the increasing prevalence of substance use, few studies have examined contributing factors or exclusive or dual usage by immigration. Hence, using our Lab data during the COVID-19 pandemic we examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among adult immigrants and US-born individuals. We found that anxiety/depression was associated with higher odds of exclusive e-cigarette use among immigrants. In contrast, anxiety/depression was associated with higher odds of dual use among US-born individuals. The findings suggest the need to disaggregate data to examine specific substance use behaviors and mental health disorder symptom
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