Comparing Mental Health Status of Older Adults By U.S. Nativity, Length of Residence, and County-Level Foreign-Born Population Density

Purpose: Healthy immigrant effects (HIE) suggest that upon immigration, foreign-born individuals are healthier than their native-born counterparts because of the self-selection of healthy individuals into international migration. However, it is unknown whether the HIE apply to mental health status of foreign-born individuals, especially among older adults. Additionally, from the ecological perspective, previous studies have demonstrated a significant relationship between contextual factors regarding where a person lives and the person’s mental health status. Specifically related to foreign-born individuals’ mental health status, this study examined whether living in the county with a high foreign-born population density was a protective or risk factor for mental health symptoms among older adults and whether the relationship differed by U.S.-nativity and length of residence in the U.S. (i.e., interaction effect). Previous studies on the role of ethnic enclaves on foreign-born individuals’ mental health status revealed mixed results.   

Methods: We analyzed the data from the merged 2004-2007 Medical Expenditure Panel Study and 2009 Area Health Resources Files. The two levels of data were merged by common county identifier. The sample included 29,011 individuals aged 50 or older (level-1 sample size) from 920 counties (level-2 sample size) across 50 states and D.C. We compared mental health of U.S.-born, earlier immigrants (15+ years in the U.S.), and recent immigrants(≤ 15 years in the U.S.) using the Mental Component Summary (MCS) of the Short-Form 12 (SF-12), the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2). The county’s foreign-born density was measured as the percentage of foreign-born individuals in the county. Descriptive and bivariate statistics were calculated using STATA’s survey procedures to reflect the complex sampling design of the pooled MEPS data. Multilevel models were tested using STATA XTMIXED.  

Results: Recent immigrants showed worse mental health status on all three measures compared to U.S.-born individuals and on the K-6 and PHQ-2 compared to earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, significant interactions found in the full conditional multilevel models indicated that the high foreign-born population density worked as a risk factor for worse mental health only among recent immigrants, but not among the U.S.-born.

Conclusions: The HIE were not supported for mental health among older individuals. Instead, it revealed the vulnerability of older recent immigrants especially living in the communities with high foreign-born densities. Considering the potential role of acculturative stress among older recent immigrants, further studies should examine its interaction with foreign-born densities to better serve this vulnerable population.