Pathways and Correlates Connecting Latinos' Mental Health With Exposure to the United States

Objectives. We examined potential pathways by which time in the United States may relate to differences in the predicted probability of past-year psychiatric disorder among Latino immigrants as compared with US-born Latinos.Methods. We estimated predicted probabilities of psychiatric disorder for US-born and immigrant groups with varying time in the United States, adjusting for different combinations of covariates. We examined 6 pathways by which time in the United States could be associated with psychiatric disorders.Results. Increased time in the United States is associated with higher risk of psychiatric disorders among Latino immigrants. After adjustment for covariates, differences in psychiatric disorder rates between US-born and immigrant Latinos disappear. Discrimination and family cultural conflict appear to play a significant role in the association between time in the United States and the likelihood of developing psychiatric disorders.Conclusions. Increased perceived discrimination and family cultural conflict are pathways by which acculturation might relate to deterioration of mental health for immigrants. Future studies assessing how these implicit pathways evolve as contact with US culture increases may help to identify strategies for ensuring maintenance of mental health for Latino immigrants.It has been shown that Latino immigrants have better mental health than their US-born counterparts and non-Latino Whites, despite having disadvantaged socioeconomic status^1–3 (the “immigrant paradox”). It has also been shown that the mental health of immigrants declines over time in the host country³ (the “acculturation hypothesis”). Our findings from the National Latino and Asian American Study (NLAAS) on the prevalence of psychiatric disorders among Latinos in the United States indicate that foreign nativity is protective for some Latino groups (e.g., Mexicans) but not others (e.g., Puerto Ricans),⁴ implying that other factors besides nativity play a part in US Latinos'' risk of psychiatric disorders. Also, there is evidence that risk of psychopathology is the result of differences in immigrants'' length of residence in the United States and age at arrival. For example, Mexican immigrants in the United States for 13 years or more had higher rates of any mental health disorder, any mood disorder, alcohol abuse, and drug abuse than Mexican immigrants in the United States for fewer than 13 years.³ Findings from the NLAAS indicate that the longer that Latino immigrants remain in their country of origin, the less cumulative risk of onset of psychiatric disorders they experience, resulting in lower lifetime rates of disorders.⁵There is a lack of consensus about which aspects of US exposure are relevant for mental health.⁵ A number of hypotheses have linked years in the United States and mental illness among Latinos.³ US-born Latinos may have a weaker affiliation with traditional Latino values that buffer against mental illness than do Latino immigrants. When individuals come into contact with US culture, there may be negative outcomes such as increased intergenerational conflict,⁶ augmenting their risk for psychopathology. Although family factors have been hypothesized to be a protective factor for immigrant Latinos,^7,8 few empirical studies have actually tested this hypothesis with regard to psychiatric disorders. Another hypothesis is that US-born Latinos may have higher expectations for their quality of life than immigrant Latinos because of their citizenship status and their acquisition of skills similar to those possessed by non-Latino Whites.⁹ However, over time, these expectations may remain unfulfilled because of discrimination, resulting in social stress and declining levels of mental health.¹ Also, as time passes, immigrants may have perceptions of low social status¹⁰ that may be associated with higher risk of psychopathology.Other immigration-related factors could also affect adaptation experiences when integrating into the United States. Specifically, those arriving in the United States at early formative ages (0–10 years) may have weaker identification with Latino cultural values¹¹ and may confront significant pressure to acquire English as their dominant language.¹² English language dominance represents a strong cultural anchor for socially constructed meaning¹³ that may enable immigrants to join certain peer networks and not others. The neighborhoods where Latinos typically live are less safe than those inhabited by non-Latino Whites,¹⁴ which may increase Latinos'' likelihood of psychiatric disorders¹⁵ by increasing ambient hazards. In addition, exposure to racial/ethnic based discrimination^16,17 has been associated with negative mental health outcomes. The NLAAS study provides a unique opportunity to explore these pathways because these domains have been assessed for both Latino immigrants and US-born Latino respondents.We assessed the association of time in the United States with past-year risk for psychiatric disorder, with and without adjustment for potentially influential covariates. Then we tested different pathways explaining the link between time in the United States and psychiatric disorders.