Examining the Influence of Cultural Stressors On Depression in Hispanic Adolescents

Objective. Stress associated with family expectations and planning for the future are normative experiences of adolescence. However, Hispanic adolescents also face non-normative culturally specific stressors such as anti-immigrant attitudes, family separation issues, and negative public references toward their ethnic identity. Currently, there are few studies that identify how culturally specific stressors impact mental health, particularly among youth in clinical settings. The current study aimed to identify: (1) how cultural stressors differ for adolescents in clinical treatment compared to adolescents in the general population; (2) the association between cultural stress and depression, net the effects of gender; and (3) if group membership (e.g. clinical versus non-clinical setting) moderates the relationship between cultural stress and depression.

Methods. The current study used data from the Hispanic Stress Inventory-Adolescent (HSI-A) Study, a NIMH funded study of 1,254 Hispanic adolescents (1,037 in a non-clinical and 217 in a clinical sample) from four U.S. urban cities. The independent variable was the HSI-A. The HSI-A consists of 72 items that comprise 8 subscales, including family economic, community, cultural, immigration, family immigration, acculturation, discrimination, and family drug stress. The dependent variable was depression, as measured by the Children’s Depression Inventory-2 (CDI-2). One-way analysis of variance was used to identify differences in cultural stress between Hispanic adolescents in clinical treatment versus those in a non-clinical setting. Generalized Linear Models then tested the moderating effects of group membership on the relationship between the cultural stress and depression. Missing data was addressed using Monte Carlo imputation methods in SAS.

Results. The clinical sample reported significantly higher scores of cultural stress in six of the eight domains (p < .05), as well as significantly higher mean depression scores (mean =11.76) compared to the non-clinical group (mean= 9.53). We found that all 8 domains of stress were correlated with higher scores of depression (p < .05). Yet, when we included all 8 domains of stress in the model and controlled for gender, only family economic (p < .05), discrimination (p< .001), and acculturation stress (p < .001) had a unique effect above and beyond the other domains of stress; and this relationship varied by group membership. Discrimination stress was a marker for depression equally in both the clinical and non-clinical groups. While family economic stress was a marker for depression in both groups, it was a stronger indicator for depression among adolescents in the clinical group. However, acculturation gap stress was a marker for depression only in the non-clinical group.

Conclusion. Hispanic youth experience significantly higher mental health problems than do their non-Hispanic white counterparts. However, few studies have examined how cultural stressors are associated with depression for Hispanic youth who are in clinical treatment. These findings suggest that family economics and exposure to discrimination and acculturation stress have a more significant and negative effect on Hispanic adolescent well-being than compared to other cultural stressors.  Rather than focusing on only commonly cited risk factors in depression among Hispanic youth, this research finds that unique cultural stressors should be considered in the development of treatment approaches.