Onset of Major Depressive Disorder Among Foreign-Born Individuals in the United States

Background and Purpose: While a substantial amount of research has been conducted on the prevalence of MDD, little is known about racial/ethnic variations in its onset. Considering heterogeneity within foreign-born individuals in the United States, this study aims to examine racial variations in the onset of MDD and the factors associated with MDD onset among foreign-born individuals in the U.S. Using a nationally representative sample, the present study addresses the following research questions: (1) To what extent does MDD onset differ by race? (2) What are the factors associated with MDD onset among foreign-born individuals in the U.S.?

Methods: The study analyzed data from the Collaborative Psychiatric Epidemiology Surveys (CPES). The sample consisted of 19,729 adults from diverse racial groups including Asians, Latinos, African-Americans, and non-Latino Whites. A diagnosis of MDD was obtained from DSM-IV code (296.2). Kaplan-Meier method was employed to estimate survival functions by race. Cox proportional hazards model was employed to explore the factors associated with MDD onset, after controlling for socio-demographic and immigration-related characteristics.

Results: About 14 percent of the sample had experienced MDD onset in their lifetime. Asians showed the highest survival function, followed by African-Americans. Although Latinos and non-Latino Whites showed similar patterns to each other, Latinos had the lowest survival function. Cox proportional hazards model with only foreign-born individuals (n = 3,167) indicated that those who were younger, males, non-Asians were more likely to experience the onset of MDD when compared to their older, females, and Asians counterparts. Among immigration-related characteristics, only age at immigration was significantly associated with MDD onset among foreign-born individuals (p <. 05). In other words, those who immigrated at a younger age were more likely to experience MDD onset than were those who immigrated at an older age (hazard ratio = 0.82). None of U.S. citizenship status, length of residence in the U.S., and English proficiency were not associated with MDD onset. Among native-born individuals (n = 16,562), those who were younger, females, white, and unmarried were more likely to experience MDD onset when compared to their older, males, non-white, and married (p < .001).

Conclusions and Implications: Findings from this study show that different racial groups experience different patterns of MDD onset over time. Exploring factors associated with MDD onset will help mental health providers identify vulnerable subpopulations among foreign-born individuals in the U.S. and, in turn, facilitate MDD prevention as well as provision of adequate mental health services by facilitating access to mental health preventive services as well as by eliminating barriers to access to mental health care.