Mental Disorders Among First and Second-Generation Immigrants to the United States: Extending the Immigrant Paradox
A growing body of research has examined the “paradox” that immigrants to the United States tend to be healthier than native-born Americans with respect to a number of salient health outcomes (e.g. obesity, chronic disease, etc.). Despite the advances made in understanding the protective effects of immigrant status, however, less evidence has accrued on the mental health patterns of immigrant’s vis-à-vis the native born. Among the studies that have been conducted, one of the major shortcomings is a lack of scope and generalizability. In particular, few, if any, studies have employed nationally representative samples and compared immigrants from all the major regions of the world. We examine immigrant status as a protective factor for mental illness, assess intergenerational effects, and report the prevalence of clinical and personality disorders of immigrants across major world regions.
Method:
Study findings are based on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a nationally representative sample of non-institutionalized U.S. residents aged 18 years and older. Psychiatric interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version (AUDADIS-IV), which provides diagnoses for an array of clinical (i.e. generalized anxiety disorder, bipolar disorder, major depressive disorder, dysthymia, panic disorder, social phobia, specific phobia, posttraumatic stress disorder), and personality disorders (i.e. antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, paranoid, schizoid, schizotypal). Logistic regression analyses were conducted that compared non-immigrants (N = 29,287) with first (N = 5,363) and second-generation (N = 4,826) immigrants in terms of the aforementioned outcomes.
Results:
Controlling for sociodemographic factors (age, gender, race/ethnicity, household income, education level, marital status, region of the United States, urbanicity) as well as lifetime diagnoses of alcohol and illicit drug use disorders, first-generation immigrants were significantly less likely to have met criteria for all clinical disorders and the majority of personality disorders (i.e. antisocial, avoidance, borderline, paranoid, and schizotypal) examined in this study. Moreover, the number of years an immigrant has lived in the United States was found to be associated with the increased likelihood of receiving a diagnosis for a clinical (AOR = 1.01, 95% CI = 1.01-1.02) or a personality disorder (AOR = 1.00, 95% CI = 1.00-1.01). With weaker effects, second-generation immigrants were significantly less likely to have met criteria for the majority of clinical disorders examined in this study (i.e. bipolar disorder, major depression, panic disorder, specific phobia, and posttraumatic stress disorder) as well as two personality disorders (i.e. antisocial, avoidant). Results held for immigrants from major world regions, including Latin America, Asia, Africa, and Europe.
Conclusions and Implications:
Consistent with the broader body of research on the immigrant paradox and health, results suggest that immigrant status and duration are important factors related to mental health and wellbeing among first and second-generation immigrants in the United States. Findings suggest that social workers should work to maintain protective mechanisms associated with immigrant status, particularly among immigrants who have resided in the United States for longer duration and second-generation immigrants.