By Iris Smith, Ph.D
There are many factors that influence mental health. Children of mentally ill or substance abusing parents1,2, immigrant and refugee children, children of incarcerated parents, children in war-torn areas and those exposed to endemic community stress and violence may have an elevated risk of developing mental health problems.3
In 2020, of the 22,481 individuals that were granted asylum by the U.S. government, 37% were from Asia, 35% from North America, 12% from South America, 9 % from Africa, 7% from Europe and 1% for whom origin was unknown.4 As of 2019, 45 million immigrants were residing in the United States, roughly 13% of the U.S. population, with approximately 11 million having undocumented status.5
Research on the mental health needs of recent immigrant, refugee, and asylum-seeking families is limited. Health and social disparities contribute to both mental and physical health disparities in these groups, compared to other sub-groups of the U.S. population, including limited economic opportunities, unhealthy living environments, reduced access to healthcare, and chronic stress related to changing U.S. policies on immigration.5 The number of individuals and families seeking asylum is increasing globally. Violence, poverty, war, environmental disasters, political, and economic instability are some of the driving factors for these trends.6
The Social Determinants of Health Framework (SDOH) is a useful lens for understanding the complexity of issues that often face newly arrived immigrants and refugees as well as residents without documentation.5,6 At the community level issues such as literacy, anti-immigration rhetoric, and the resulting stigma, create challenges to accessing healthcare, education, and other community level services. Limited financial resources and opportunities, low health literacy, cultural differences, and bureaucratic obstacles may also be barriers to help seeking. However, supportive federal and state policies, health navigators, safety-net clinics, and culturally competent healthcare staff were among the facilitating factors identified in a recent literature review.6 Unfortunately, little is known about the mental health needs of undocumented immigrants, and they are less likely to access mental health services when they are available. A review of existing research suggests that cultural attitudes including the perceived difference between mental “health” and mental “illness” often prevents families from seeking help as they may not see a need for it. While universal communication strategies are important, it is also important to recognize and adapt messaging for focal communities that addresses the diverse beliefs and values attached to mental health within cultural sub-groups. Consideration of group differences based on age, acculturation, gender, and other demographic factors may also be important7 While many refugee and immigrant children have survived multiple traumatic experiences before coming to the United States, research has also found that many children demonstrate remarkable resilience. Successful interventions must be culturally and contextually appropriate, taking into account the complex and multidimensional sources of stress for these families while also acknowledging and building upon their resilience and resourcefulness.8
Resources
CalvanT, Lornell-Garcia M, LaBarrie D, Rodriguez VJ, Moreno O. (2023) Beyond Demographics: Attitudinal Barriers to the Mental Health Service Use of Immigrants in the U.S. Current Opinion in Psychology, 47; pg. 101437
Garcini LM, Nguyen K, Lucas-Marinelli A, Moreno O, Cruz PL (2022) “No One Left Behind": A Social Determinant of Health Lens to the Wellbeing of Undocumented Immigrants. Curr Opin Psychol. 2022 Oct; 47:101455. doi: 10.1016/j.copsyc.2022.101455. Epub 2022 Aug 7. PMID: 36055083; PMCID: PMC9876624.
U.S. Office of Immigration Statistics, (2022). Yearbook of Immigration Statistics 2022. U.S. Department of Homeland Security
Venta A, Mercado A, Rodriguez MM (Eds) Immigration (2023). Current Opinion in Psychology 51, June 27, 2023.
1 Brummelhuis IAM, Kop WJ, Videler AC (2022) Psychological and Physical Well-being in Adults Who Grew Up with a Mentally Ill Parent: A Systematic Mixed-Studies Review. General Hospital Psychiatry Nov-Dec; 79; pg. 162-176. https://doi.org/10.1016/j.genhosppsych.2022.09.006
2 Anderson AS, Siciliano RE,Pillai A, Jiang W, Compas BE (2023). Parental Drug Use Disorders and Youth Psychopathology: Meta-analytic Review. Drug and Alcohol Dependence 244; pg 109793, https://doi.org/10.1016/j.drugalcdep.2023.109793
3 Johnson EJ and Arditti JA (2023). Risk and Resilience Among Children with Incarcerated Parents: A Review and Critical Reframing. Annual Review of Clinical Psychology, 19.
4 U.S. Office of Immigration Statistics, (2022). Yearbook of Immigration Statistics 2022. U.S. Department of Homeland Security
5 Garcini LM, Nguyen K, Lucas-Marinelli A, Moreno O, Cruz PL (2022) “No One Left Behind": A Social Determinant of Health Lens to the Wellbeing of Undocumented Immigrants. Curr Opin Psychol. 2022 Oct;47:101455. doi: 10.1016/j.copsyc.2022.101455. Epub 2022 Aug 7. PMID: 36055083; PMCID: PMC9876624.
6 Clifford N, Blanco N,Bang SH, Heitkemper E, Garcia AA (2023). Barriers and Facilitators to Healthcare for People Without Documentation Status: A Systematic Integrative Literature Review. Journal of Advanced Nursing 2023:00: pg. 1-32.
7 CalvanT, Lornell-Garcia M, LaBarrie D, Rodriguez VJ, Moreno O. (2023) Beyond Demographics: Attitudinal Barriers to the Mental Health Service Use of Immigrants in the U.S. Current Opinion in Psychology, 47; pg. 101437
8 Dangmann C, Dybdahl R, Solberg O (2022). Mental Health in Refugee Children. Current Opinion in Psychology 48: pg.101460
