Longitudinal Risk Factors for Depression Among Aging Immigrants in the United States: Examining the Role of Loneliness

Objective: Immigrants represent a growing share of older adults in the United States and typically live longer, more physically healthy lives than their native-born counterparts (Markides and Eschbach, 2005; Mehta, Sudharsanan, and Elo, 2014). Despite these physical health advantages, European research has indicated that older immigrant adults experience an increased risk for depression (Pumariega, Roth, & Pumariega, 2005; Leiden & Reinhold, 2013), which represents a leading cause of disability (Theis et al., 2018). However, the relative prevalence of depression among older foreign-born immigrants in the US has yet to be rigorously analyzed, where the immigrant experience is likely to differ. Drawing on the social stress model of depression (Leiden & Reinhold, 2013), in this paper we investigate (a) whether immigrants have higher rates of depression than their non-disabled counterparts and (b) whether, consistent with the social stress model, loneliness can be identified as a longitudinal risk factor for depression among aging non-depressed immigrant adults.

Methods: We use data from the Health and Retirement Study and analyze three baseline and follow up cohorts age 50 and older from 2006-2010, 2008-2012, and 2010-2014. We conducted cross-sectional and longitudinal predictors of depression. For the longitudinal model, we restrict the sample to adults not experiencing depression at baseline (determined using the CES_D scale) and predict the onset of depression at follow up when including a number of risk and protective factors for depression, including loneliness (UCLA 3-item version). We further cluster the standard errors to control for repeated observations across the cohorts investigated.

Results: The cross-sectional analysis (n= 14,153) indicates that immigrants experience 1.57 increased odds of depression, when controlling for a wealth of sociodemographic (age, age squared sex, income, education, number of children, marital status) and health factors (chronic disease, disability status, inability to complete activities of daily living (ADL), 2 + chronic impairments, and report of experiencing of pain). The longitudinal analysis (n=973) of predictors of depression onset among non-depressed immigrant adults identified loneliness (OR=1.38) and having 2 + chronic impairments (OR=1.37) as significantly predictive of the onset of future depression among aging immigrants.

Implications: Prior research indicates that older immigrants experience higher rates of depression despite physical health advantages. Our results first confirmed this international finding in the context of the US, as being an immigrant was found to increase the likelihood of experiencing depression. Second, our analysis contributes to understandings of how depression manifests in this population, and points to loneliness and chronic health conditions as likely drivers of depression onset among older immigrant adults not experiencing depression. The results suggest that interventions designed to reduce loneliness among immigrant adults could decrease rates of depression and further reduce mental health disparities among immigrant populations.