Migration Circumstances,Psychological Distress,and Self-Rated Physical Health for Latino Immigrants in the United States

Objectives. We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants.Methods. We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002–2003 National Latino and Asian American Study (n = 1603).Results. Mean psychological distress scores (range = 10–50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents.Conclusions. The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors.Theories of acculturation, defined as “the acquisition of the cultural elements of the dominant society,”1^(p369) dominate Latino immigrant health research.2–4 Acculturation studies highlight important aspects of how individuals make meaning of their life experiences, including health experiences, through language, cultural norms, and values.5 In addition, studies of Latino mental health have demonstrated the influence of cultural change within immigrant families; uneven levels of acculturation within families can lead to family cultural conflict, which may have adverse mental health impacts.6,7Nevertheless, the focus on cultural determinants of health (i.e., acculturation) often comes at the expense of other factors related to migration, including social, political, and economic adversity in both places of origin and the United States.8–12 A particularly understudied set of influences on Latino immigrant health relates to the circumstances of departure, including whether individuals had to migrate because of political conflict, dire economic conditions, or other pressures.13 Exposure to such conditions in one’s place of origin may have lingering affects on mental health.14,15 The degree to which migration is planned might also have a long-term impact on health; unplanned migration may lead to a more sudden rupture of the social networks that support both psychological and physical well-being.16–19 Acculturation-focused studies typically do not consider the influence of migration or country-of-origin context on immigrant health, given that the frame of reference for acculturation is US society.11Stressors related to the conditions of migration include a set of social and structural inequities that immigrants may experience upon arriving and settling in the United States. These include unfair treatment attributable to legal status, nativity status, and accent, as well as unequal access to social benefits, such as health care.20–24 These forms of discrimination are often subsumed in the immigrant health literature within the construct of “acculturative stress,”25 suggesting erroneously that they can be attributed to an individual’s level of acculturation. More accurately, however, these stressors relate to the diverse social, political, and economic climates in receiving communities and not necessarily to whether immigrants have “acculturated.”8 For example, immigrants who are proficient in English may continue to experience discrimination based on their legal status.26 We therefore prefer the more expansive term “immigration-related stress” instead of “acculturative stress,” which is conceptually limited to the challenges involved with cultural change, including language learning and retention.27 Immigration-related stressors may comprise discrimination, including legal status discrimination, and may also refer to the challenges of familial cross-border separation, which does not necessarily relate to level of acculturation.28 Immigration-related stress has been shown to be associated with adverse health outcomes for specific Latino subgroups,3,29 but it has received less attention in national studies.We tested the relationship of migration circumstances to both psychological distress and self-rated physical health for a national sample of Latino immigrants in the United States. We hypothesized that stressful conditions leading to migration, as well as adverse experiences of arrival and settlement, would be associated with higher levels of psychological distress and poorer overall physical health. We expected that the relationships between premigration circumstances and health outcomes would be moderated by Latino subgroup, given that migration experiences vary greatly among Latino groups, which include peoples from distinct social, cultural, political, and economic contexts.30,31 For example, Puerto Rican–born migrants are US citizens and therefore have different conditions of migration than those migrating without legal documents or who have to navigate the immigration system for legal entry.32 In addition, some Latin American immigrants have faced distinct migration circumstances because of the political context in both their countries of origin and the United States. For example, early waves of Cuban migrants received refugee status and resettlement assistance,18 whereas the majority of those fleeing civil wars in Central America were never granted refugee status, limiting their access to benefits.30,33,34 For some Latino subgroups, such as Cubans and many Central and South Americans, unplanned or involuntary migration might refer more to political reasons for migration, or a combination of political and economic motivations,18 whereas for other groups (e.g., Puerto Ricans or Mexicans), identifying migration as involuntary or unplanned might refer more to dire economic circumstances or family obligations that motivated migration.32 We therefore hypothesized that circumstances of migration would be more strongly associated with poor health outcomes for Cubans and many other Latinos, given that many of these groups were motivated to migrate, at least in part, by political circumstances such as civil war or political persecution.We also hypothesized that migration circumstances would be related to psychological distress and physical health above and beyond measures of individual- and family-level acculturation. This reflects our argument that structural contexts can cause stress for Latino immigrants in both places of origin and of settlement.Finally, we expected to find different patterns in the association between migration circumstances and health outcomes by gender. In part, we expected that women would report higher levels of psychological distress than men, although there may be fewer differences in physical health outcomes. Men and women experience different migration circumstances, with significant variation by ethno-national subgroup.32–35 For example, Mexican women have historically been more likely to join family members already settled in the United States, although they are increasingly initiating migration; many Mexican men established migration networks in the 20th century through labor projects directly targeting male workers.36,37 Puerto Rican men were similarly recruited in the early and mid-20th century to work on the US mainland. Women became increasingly incorporated into circular labor migration patterns over the second half of the 20th century, often fulfilling familial and economic obligations in both Puerto Rico and the mainland.32,38 Central American and Dominican women were historically more likely to initiate migration in their family networks, taking jobs in factories or as domestic workers and facilitating men’s migration later on.33,34 Political refugees, including Cubans and some South Americans, were more likely to migrate as families.38 Given these differences, the meaning of migration planning and decision-making might vary qualitatively for men and women. This suggests the need for an analysis stratified by gender, although we expected that reporting unplanned migration or having to migrate (vs wanting to migrate) would be associated with poorer health for both men and women.Researchers have also documented gendered experiences of settlement for immigrants, including lesser access to legal and occupation-related resources for women compared with men,38,39 and greater continued attachment of women to countries of origin,40,41 with women more likely to maintain family caregiving roles both in places of settlement and abroad. These additional disadvantages resulting from stressful migration circumstances may lead to poorer health outcomes for female migrants than for male migrants, and they provide additional rationale for stratified analyses by gender, although we expected that immigration-related stressors would be negatively associated with psychological and physical health for both men and women.