Expert Commentary

Mental health issues among immigrants: New research

New research on immigrant health from the American Public Health Association's 2018 annual meeting.

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For reporters looking to broaden their immigration coverage, journalist Maria Hinojosa has a recommendation: “I haven’t seen a lot of coverage of immigrant mental health issues for mainstream journalists,” Hinojosa, the executive producer of the long-running NPR show Latino USA, said in a recent interview with Journalist’s Resource.

As it turns out, many public health scholars have been researching the mental health effects of being an immigrant or refugee in America today.

“We don’t always acknowledge the sacrifices that migrants take in leaving their homelands — how they risk so much in terms of safety and stability and opportunity,” said Cindy Sangalang, an assistant professor of social work at California State University, in a phone interview with Journalist’s Resource. “Going on this journey can be at a cost to their mental health, and these things can potentially worsen as other stressors increase once they’re here in the United States.”

In the third week of November, public health professionals from across the country gathered in San Diego for the American Public Health Association’s annual meeting. Among the hundreds of research presentations were several that focused on immigrant mental health. Researchers presented published, peer-reviewed studies and working papers and gave reports on early stage research.

Journalist’s Resource contacted a few scholars presenting at the meeting on the topic of immigrant health. Here, we’ve summarized their research, which covers topics from mental health to participation in health and social services. We also highlight a new working paper on mental health among Muslim college students in the United States. Most of the research has not yet been published in peer-reviewed journals, but, where possible, we’ve linked to publicly accessible versions of the work.


Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States
Sangalang, Cindy; et al. Journal of Immigrant and Minority Health, 2018.

In an interview with Journalist’s Resource, lead author Cindy Sangalang explained that her research was motivated by the “record high” number of displaced migrants around the world. She explained that U.S. legal definitions place distinctions between refugees and immigrants, but in reality now “boundaries are starting to blur.”

“In the context of what’s going on right now, a lot of migrants who might be seen as fleeing for economic reasons might be encountering violence,” Sangalang said, making reference to the fact that refugees are often labeled as such because they are fleeing conflict or persecution.

In light of this context, Sangalang was interested in comparing the experiences of Asian refugees and Latino immigrants both coming to the U.S. Do Latino immigrants report traumas and stresses similar to those experienced by refugees during migration and resettlement?

Analyzing survey and interview responses from over 3,200 respondents, the authors found that Asian refugees and Latino immigrants both experienced pre- and post-migration trauma and associated mental disorders and distress, including depressive disorders.

Further, discrimination increased the risk for mental disorders and distress among both groups. She added that current immigration policies contribute to a “broader climate that facilitates more experiences of discrimination,” which, in turn, could exacerbate mental health concerns.

Sangalang concluded that the findings indicate that pre- and post-migration trauma among immigrants, and Latino immigrants in particular, is more common than previously thought.

“How Does the Election of an Anti-Immigrant Presidential Candidate Affect Health and Social Service Utilization? Findings from Southeast Michigan”
Fleming, Paul J.; et al. University of Michigan School of Public Health working paper, 2018.

This study investigated the effects of the 2016 presidential election on health and social service utilization among immigrants in southeastern Michigan. To do so, the researchers conducted and analyzed 29 in-depth interviews with staff members at two Federally Qualified Health Centers – community health centers that provide care to all people, regardless of income or insurance status. These employees are familiar with the immigrant communities they serve and their concerns. The researchers found that in the weeks after the election, staff perceived a decrease in the number of immigrants using their services. In the year after the election, staff noted downturns that corresponded with immigration enforcement actions within the community. Staff also reported that clients asked about arranging for power of attorney and making plans for the care of their children in the event that they were deported.

In a phone call with Journalist’s Resource, lead author Paul Fleming, an assistant professor at the University of Michigan School of Public Health, suggested a few policy interventions to support immigrants’ access to health and social services. He suggested social service agencies and clinics that serve immigrants prioritize creating not only welcoming spaces, but also safe spaces, where protecting clients is the primary goal. Staff should know how to respond to immigration enforcement officers if they arrive at clinics, Fleming said. Further, he suggested, clinics should post signs with critical information in multiple languages and offer the services of interpreters. Fleming said that health and social service agencies should adapt to this new climate of fear by finding new ways to reach clients, including offering services over the phone or through video, using trusted community members at schools, churches or other organizations as a go-between, and expanding or providing transportation. (Allowing immigrants who have entered the country without permission to have driver’s licenses, so that they can drive themselves to critical appointments, is another policy suggestion Fleming made.)

Fleming also noted that clinicians and researchers can influence policy by offering public comment on legislation that could impact immigrant communities. This might involve sharing stories about the effects immigration policies have had on their clients.

“Rise in Mental Health Problems Among Muslim Young Adults in the United States Following the 2016 Election”
Abelson, Sara; et al. University of Michigan School of Public Health working paper, 2018.

This research looks at data collected from the Healthy Minds Study, the largest national study of college student mental health. The Healthy Minds Study has been distributed annually since 2007. It uses a number of standardized mental health questionnaires to measure depression, generalized anxiety and eating disorders. The researchers were interested in the number of responses that corresponded to a clinically moderate-to-severe diagnosis.

More than 107,000 students from 132 colleges and universities participated in the study. At schools with more than 4,000 students, the survey was sent to a random sample of students. At smaller schools, all students were invited to participate.

The data analyzed in this study spans the three semesters prior to and the three semesters following the 2016 presidential election. Author Sara Abelson and her colleagues were interested in changes in reported mental health symptoms for Muslim and non-Muslim college students before and after the election.

What they found was that regardless of religion, students reported significantly worse mental health after the election. However, the prevalence of students with a mental health concern increased more among Muslims than non-Muslims – there was an 11.5 percent increase among Muslims, and a 5.3 percent increase among non-Muslims.

While proving a causal link between the election and worse mental health outcomes among Muslim students is difficult, Abelson said in an interview that “we were not aware of other things happening in that time that would have uniquely driven up the rate among Muslim students.”

She added that more research is needed to understand the intervening mechanisms that have led to increases in mental health concerns among Muslim students. Among the outstanding questions: Is discrimination increasing? How is the climate on campus changing?

She noted that irrespective of the driving mechanism, for doctors, therapists and social workers on campus, this research identifies a key population for further outreach.

“White Privilege: Comparing Fear of Crime, Bullying, Detainment and Deportation between University Students of Color and White University Students”
Grinshteyn, Erin; Couture, Marie-Claude; Valencia-Garcia, Dellanira. APHA annual meeting presentation, 2018.

For this study, conducted in 2017, researchers asked 1,415 students at the University of San Francisco to rate their fear of 11 different crimes and aggressions, as well as bullying, detainment and deportation, on a scale of one to 10, with zero being no fear and 10 indicating maximum fear. They compared the responses of white students with those of students of color. They found that median fear scores were higher for students of color than for white students. For example, students of color were more afraid of hate crimes, hate speech, threats and physical assault. They also had higher median scores for aggregate fear of crime than white students. Proportionally, more students of color reported being afraid of bullying many times a day or every day than white students. A smaller proportion of students of color reported never being afraid of bullying on and off campus as compared with white students. Students of color were also more likely to feel worried about themselves, friends and family being detained and deported.

The research presented did not look at changes in fear over time. However, lead author Erin Grinshteyn, an assistant professor at the University of San Francisco, said in a phone call with Journalist’s Resource that national ratings of fear in general have remained fairly stable since 1980. Meanwhile, crime rates have decreased.

Grinshteyn said this merits further research and analysis to understand why people are afraid. But first and foremost, she believes that fear should be addressed as a public health issue. At present, fear remains something like a specter: felt but unaddressed, she said.

“Trends in Food Insecurity and SNAP Participation Among Immigrant Families of U.S. Born Young Children”
Bovell-Ammon, Allison; et al. APHA annual meeting presentation, 2018.

This research finds that despite their eligibility, many immigrant parents whose children are U.S. citizens do not participate in the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. . The study involved 35,207 mothers who were not born in the U.S. but have children who were.

The findings indicate a sharp decline in participation among immigrant families in the first six months of 2018. In a phone call with Journalist’s Resource, lead researcher Allison Bovell-Ammon said that the findings document a “chilling effect” in immigrant communities in which fear prevents immigrants from accessing social programs despite their continuing eligibility. This matches anecdotal reports from frontline providers, she added.

Bovell-Ammon’s research finds that among foreign-born mothers who had been in the United States for less than five years, SNAP participation stood at 43 percent in 2017. It then dropped to 34.8 percent in the first half of 2018. For families that had been in the U.S. for more than five years, SNAP participation grew to 44.7 percent in 2017 and then dropped to 42.7 percent in 2018.

Meanwhile, food insecurity grew among immigrant families who had been in the United States for less than five years from 9.9 percent in 2007 to 17.8 percent by 2017. It increased from 10.8 percent to 17.5 percent in the same time span among families who had been in the United States for more than five years.

Other research has documented similar effects: A 2018 working paper by Marcella Alsan of Stanford Medical School and Crystal Yang of Harvard Law School finds that enrollment in SNAP and the Affordable Care Act declined among Hispanic U.S. citizens after the Secure Communities immigration enforcement program took effect.

“Food insecurity is associated with poor health outcomes from the prenatal period all the way through old age,” Bovell-Ammon told Journalist’s Resource. “SNAP is effective at reducing food insecurity, which improves health,” she added.

“Undocumented Immigrant Youth are Denied Equitable Access to Higher Education, a Barrier to Better Long-Term Health Outcomes”
Diaz, Mayra; Reyes, Katherine; Cabuslay, Edith. APHA annual meeting presentation, 2018.

The San Mateo County, California Health System conducted focus groups with 55 individuals, most of whom identified as undocumented or preferred not to report their immigration status, in order to understand the impact of immigration laws and the rescinding of the federal Deferred Action for Childhood Arrivals (DACA) policy on education and health.

Those who participated in the focus groups reported signs of depression and anxiety among children in their community. In particular, they said that older children who previously would have qualified for DACA shared feelings of hopelessness and low self-esteem. Some children are so upset they “refuse to continue their studies,” according to the abstract.

The authors conclude that anti-immigration laws and the rescinding of DACA have had profound negative effects in San Mateo County. They also said lower educational attainment could have public health implications in the future.

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