An Overview of Mental Health Issues for Latino and Asian Immigrants in the United States

Transcription

1 An Overview f Mental Health Issues fr Latin and Asian Immigrants in the United States Kimberly Rth, MHS, PhD Candidate DMH Nntime Seminar February 21, 2018 Baltimre, MD

2 Outline Terminlgy Challenges Why Study Immigrant Health? Immigrant Health Paradx Examples Acculturatin and related experiences Latins: Acculturatin and Disrder by Generatinal Status Asians: Acculturatin, Intergeneratinal Cultural Dissnance and Alchl Use Caveats Cultural Cnsideratins Service Use and Barriers t Care

3 Terminlgy Immigrant Latin vs. Hispanic Subethnicity Cuntry f rigin, Ancestry Nativity Generatinal Status U.S. Census Bureau (2015, 2017); Pew Research Center; Lim et al (2011)

4 Challenges in Studying Immigrant Health Measurement Changing definitins Lack f data Subgrup cmparisns Cmplex phenmena Plitics N agreement f peratinalizatin U.S. Census Bureau (2015, 2017); Pew Research Center; Lim et al (2011)

5 Why Study Immigrant Health? Immigratin at highest rate since end f 19 th century US has mre immigrants than any ther cuntry 13.4% f US ppulatin, up frm 4.7% in 1970 Latins are the largest and third-fastest grwing minrity grup 17.8% f ttal U.S. ppulatin (~57 millin) 25% f ppulatin by 2060 Largest freign-brn ppulatin Asian Americans represent the fastest grwing racial ppulatin in the U.S. 5.6% f ttal U.S. ppulatin (~18 millin) 2 nd largest freign-brn ppulatin (~30%) Prjected t be the largest by 2055 U.S. Census Bureau (2015, 2017); Pew Research Center; Lim et al (2011)

6 Immigrant Health Paradx Minrity health disparities, with increased: Mrtality Physical illnesses Smking and alchl-related prblems Psychlgical distress Freign-brn individuals exhibit decreased: Mrtality Physical illnesses Substance use Despite lwer SES and ther stressrs assciated with minrity status r immigratin Risk reaches (and ften surpasses) US-brn whites after spending time in the US (Lariscy, 2015; Ortega et al., 2000)

7 Lifetime Prevalence f Disrder in Latins and Nn-Hispanic Whites in the US, by ancestry Percent with Disrder Puert Rican Cuban Mexican Other All Latins Nn-Hispanic Whites 0 Data frm the NLAAS Depressive Anxiety Substance Use Any Disrder DSM-IV Disrder Categry (Alegria et al., 2007)

8 Lifetime Prevalence f Disrder in Latins and Nn-Hispanic Whites in the US, by nativity Percent with Disrder US-brn Latin Freign-brn Latin US-brn White Freign-brn White 0 Depressive Anxiety Substance Use Any Disrder DSM-IV Disrder Categry Data frm the NLAAS (Alegria et al., 2007)

9 Lifetime Prevalence f Disrder in Asians and Nn-Hispanic Whites in the US, by ancestry Percent with Disrder Chinese Filipin Vietnamese Other All Asians Nn-Hispanic Whites 0 Data frm the NLAAS Depressive Anxiety Substance Use Any Disrder DSM-IV Disrder Categry (Hng et al., 2014; Takeuchi et al., 2007; Alegria et al., 2007)

10 Lifetime Prevalence f Disrder in Asians and Nn-Hispanic Whites in the US, by nativity Percent with Disrder US-brn Asian Freign-brn Asian US-brn White Freign-brn White 0 Depressive Anxiety Substance Use Any Disrder DSM-IV Disrder Categry Data frm the NLAAS (Hng et al., 2014; Alegria et al., 2007)

11 Lifetime Prevalence f Disrder in Asians in the US, by Immigratin Characteristic 0-5 yrs 6-10 yrs yrs >=21 yrs US-brn US-brn <= >= First Secnd Third Percent with Disrder Years in US Age at Immigratin Generatinal Status Data frm the NLAAS (Takeuchi et al., 2007)

12 Acculturatin [encmpasses] thse phenmena which result when grups f individuals having different cultures cme int cntinuus firsthand cntact, with subsequent changes in the riginal culture patterns f either r bth grups." (Redfield, Lintn & Herskvits, 1936, p.149) New Culture Unidimensinal Mdel Accultured Nt Accultured Bidimensinal Mdel Enculturatin the prcess f preserving the nrms f the native grup, whereby individuals retain identificatin with their ethnic cultures f rigin. (Guarnaccia et al., 2007) New Culture Accultured/ Assimilated Marginalized Bi-cultural Culture f Origin Traditinal/ nt Accultured (Lara et al., 2005)

13 Related Experiences Cntext f Exit Varies by subgrup Experiences in the U.S. Discriminatin Acculturative Stress Family Cnflict / Intergeneratinal Dissnance Access t services Similar yet different than refugees!

14 Latins: Acculturatin and Disrder by Generatinal Status

15 Acculturative Experiences by Generatinal Status Percent GOOD/EXCELLENT DISCRIMINATION MEDIUM/HIGH FAMILY CONFLICT ENGLISH PROFICIENCY ACCULTURATIVE STRESS 1st Generatin 1.5 Generatin 2nd Generatin 3rd Generatin All differences p<0.0001; Acculturative stress items nt assessed in US-brn ppulatin 9.3

16 Past 12-Mnth Disrder Prevalence by Generatinal Status 22.7 Percent ANY DEPRESSIVE ANY ANXIETY DISORDER ANY SUBSTANCE USE ANY DISORDER DISORDER DISORDER 1st Generatin 1.5 Generatin 2nd Generatin 3rd Generatin All differences p<0.0001; n/a = Acculturative stress items nt assessed in US-brn ppulatin

17 Adjusted Relative Odds f Past 12-Mnth Depressive Disrder English Prficiency Gd/Excell vs. Nne/Pr Discriminatin 1 st Generatin (n=1,257) 1.5 Generatin (n=365) 2 nd Generatin (n=522) 3 rd Generatin (n=397) ( ) Ever vs. Never ( )* ( ) Acculturative Stress Med/High vs. Nne/Lw Family Cnflict 1.71 ( )* -- n/a n/a Ever vs. Never 2.40 ( )** 1.67 ( ) 3.05 ( )** 1.54 ( ) All mdels adjusted fr fr age at interview and sex. Sme adjusted fr martial status, educatin, and ancestry/natinality. *p<.05; **p<.001; OR, dds rati (CI, cnfidence interval); Acculturative stress items nt assessed in US-brn ppulatin

18 Adjusted Relative Odds f Past 12-Mnth Anxiety Disrder 1 st Generatin (n=1,257) 1.5 Generatin (n=365) 2 nd Generatin (n=522) 3 rd Generatin (n=397) English Prficiency Gd/Excell vs. Nne/Pr Discriminatin Ever vs. Never 1.29 ( ) 14.6 ( )* 2.98 ( )* 2.28 ( ) Acculturative Stress Med/High vs. Nne/Lw 1.95 ( )** -- n/a n/a Family Cnflict Ever vs. Never 2.00 ( )** 1.67 ( ) 2.84 ( )* -- All mdels adjusted fr fr age at interview and sex. Sme adjusted fr martial status, educatin, and ancestry/natinality. *p<.05; **p<.001; OR, dds rati (CI, cnfidence interval); Acculturative stress items nt assessed in US-brn ppulatin

19 Adjusted Relative Odds f Past 12-Mnth Substance Use Disrder 1 st Generatin (n=1,257) 1.5 Generatin (n=365) 2 nd Generatin (n=522) 3 rd Generatin (n=397) English Prficiency Gd/Excell vs. Nne/Pr 14.1 ( )* Discriminatin Ever vs. Never 2.71 ( ) ( ) Acculturative Stress Med/High vs. Nne/Lw 2.68 ( ) -- n/a n/a Family Cnflict Ever vs. Never 10.2 ( )* 4.06 ( ) 6.04 ( )* -- All mdels adjusted fr fr age at interview and sex. Sme adjusted fr martial status, educatin, and ancestry/natinality. *p<.05; **p<.001; OR, dds rati (CI, cnfidence interval); Acculturative stress items nt assessed in US-brn ppulatin

20 Latins: Cnclusins Latin generatins are extremely hetergeneus Generatin 1.5 ften resemble their US-brn cunterparts mre than ther first generatin immigrants Generatinal grups have different relatinships with mental disrder Effects als vary by type f mental disrder Take int accunt generatinal status and age at migratin Avid cllapsing psychiatric disrders int ne categry

21 Asians: Intergeneratinal Cultural Dissnance and Alchl Use

22 Asian Americans & Alchl Use Underage drinking is a widespread prblem with multiple negative utcmes Asians experience a range f adverse utcmes frm alchl misuse Alchl use prblems differ acrss adlescent Asian subgrups Higher rates f use and binge drinking amng Krean, Japanese, and Filipin Americans Lwer rates amng Chinese and Asian Indian Americans Very few data n Vietnamese and Cambdian American yuth Wu et al. (2011); Iwamt et al. (2012); Lee et al. (2009); Makimt (1998); Cheng et al. (2012)

23 Intergeneratinal Cultural Dissnance (ICD) The Acculturatin Gap ICD measures the difference in acculturatin between children and their caregivers Leads t increased miscmmunicatin, misunderstanding, and familial cnflict Assciated with a range f subsequent adverse child utcmes including depressin and alchl use Mst research cmes frm Hispanic ppulatins Prtes & Rumbaut (1996); Lau et al. (2005); Chi et al. (2008); Kim et al. (2009)

24 Cnceptual Framewrk Objective: Estimate the assciatin f ICD and alchl use in Vietnamese and Cambdian adlescents Is this relatinship mediated by depressin? Intergeneratinal Cultural Dissnance Adlescent alchl use Adlescent Depressin Data cme frm the Crss Cultural Families prject

25 3.5 ICD, Alchl Use and Depressin in Vietnamese and Cambdian Adlescents ADJUSTED ODDS RATIO ** ICD and Alchl Use ** ** *Adjusted *Adjusted fr sex, fr sex, age, age, nativity, nativity, natinality, and and acculturatin ** p<.05

26 3.5 ICD, Alchl Use and Depressin in Vietnamese and Cambdian Adlescents ADJUSTED ODDS RATIO ** ** ** ICD and Depressin ** *Adjusted fr sex, age, nativity, natinality, 2014, Jhns and Hpkins acculturatin University. All rights reserved. ** p<.05

27 3.5 ICD, Alchl Use and Depressin in Vietnamese and Cambdian Adlescents ADJUSTED ODDS RATIO ** ** ** ** ** *Adjusted *Adjusted fr sex, fr sex, age, age, nativity, nativity, natinality, and and acculturatin ** p<.05

28 3.5 ICD, Alchl Use and Depressin in Vietnamese and Cambdian Adlescents ADJUSTED ODDS RATIO ** ** ** ** ICD and Alchl Use ** Baseline Depressin and Alchl Use *Adjusted *Adjusted fr sex, fr sex, age, age, nativity, nativity, natinality, and and acculturatin ** p<.05

29 Asians: Cnclusins Cmplex prcesses Pints t a ptential mechanism Preventin f adlescent alchl use by targeting ICD Mre prximal risk factr than acculturatin Enhancing cmmunicatin and bicultural effectiveness training (BET) Randmized trials needed Pwered fr subgrup analyses

30 Special Tpics

31 Caveats and Cultural Cnsideratins Oversimplificatin f cmplex prcesses Validity in Measurement Etic vs. Emic Apprach Smatizatin Culture-Bund Syndrmes Latins: Ataque de Nervis Asians: Khyal cap Resilience Familism, Biculturalism, Spiritualism

32 Service Use Amng Immigrants Less likely t use mental health services Latins: 12-mnth usage: 4.44% Mexicans, 5.55% Cubans Asians: 1/3 less likely, 12-mnth usage: 3.1% Varies by generatin: 3 rd gen. higher rates Mre use f infrmal services Friend/relative Clergy Indigenus healers Spencer et al. (2010); NCLR reprt (2005)

33 Past-Year Mental Health Service Use in Latins in the US, by Immigratin Characteristic Percent using MH Services 0-5 yrs 6-10 yrs yrs >=21 yrs US-brn US-brn <= >= First Secnd Third Years in US Age at Immigratin Generatinal Status Data frm the NLAAS (Alegria et al., 2008)

34 Barriers t Care Structural Insurance, availability and accessibility f services, transprtatin, financial burden Language and cultural cmpetency Cmmunicatin with prvider and staff Legal Fear f deprtatin Stigma Acceptability f mental illness in ne s culture Shame is assciated with less use f services Discriminatin Racism Suspicin f service delivery system Spencer et al. (2010); NCLR reprt (2005)

35 Surce: NLAAS, Spencer et al., 2010

36 Cultural Cnsideratins in a Clinical Setting Disease-related Beliefs Mal de Oj Stigma Culture Fatalism Engagement with family members Cultural cmpetence ability t interact effectively with peple f different cultures [and] helps ensure the needs f all cmmunity members are addressed. (SAMHSA, 2016) t be respectful and respnsive t the health beliefs and practices f diverse ppulatin grups Alegria et al. (2012)

37 Acknwledgements This research was supprted by: NIMH Psychiatric Epidemilgy Training Prgram (5T32MH ; PI: Zandi, Peter) Dr. Jeremy Kane

38 Thank Yu!