The Influence of Neighborhood Structural Characteristics on Treatment Attendance and Mental Health: Comparing Immigrants and Non-Immigrants

Background/Purpose: According to the U.S Census Bureau (2019), approximately 13.7% of the residents in the United States and 21.1% of the residents in Florida are immigrants. The literature provides evidence that immigrants have better mental and physical health outcomes compared to U.S. residents. This phenomenon is referred to as the Immigrant Health Paradox (IHP). This study examined the IHP phenomenon by analyzing the data from a clinic that served an uninsured and underinsured population.

Methods: This study utilized secondary data obtained by merging datasets Neighborhood characteristics retrieved from publicly available census data (American Community Survey 2017) and individual characteristics from Electronic Medical Records (EMRs) from a clinic serving in Central Florida serving an uninsured and underinsured population. The data included (N=2,725) with Immigrants (n=403) and Non-immigrants (n=2,322). The two datasets were merged utilizing ArcGIS software and several additional software programs were used to examine the results (SPSS, HLM, and Arc Map). The results generated maps that created a visual representation of the relationships between neighborhood characteristics and mental health, and the relationships between neighborhood characteristics and treatment attendance. Visual distinctions for immigrants and nonimmigrants were used to create a better understanding of the impact of being immigrant has these relationships.

Results: The results of this study supported that after controlling other individual and neighborhood characteristics, being an immigrant was associated with higher treatment attendance (O/R=1.91,(p<.05)) and lower likelihood of having mental health disorders (O/R=0.56; p<.05) such as substance use disorder (O/R=0.27(p<.05)), medically related disorders(O/R=0.32; p<.05) and likelihood of having a comorbidity/dual diagnosis(O/R=0.53(p<.05). In addition to these findings, living in residential neighborhoods with higher immigrant density was associated with better mental health outcomes for the stress and anxiety related disorders (O/R=0.98; p<.05), substance use disorder (O/R=0.96; p<.05) and likelihood of having comorbidity/dual diagnosis (O/R=0.98; p<.05).

Implications: The findings of this study have implications for policy and the policy making process. The protective effect of immigrant density on mental health wellbeing is not only important and applicable for mental health related policies but can also play a role in the implementation of support programs. In this study, immigrant density created a protective mental health wellbeing effect in the neighborhood. This can contradict negative perceptions towards this population and this awareness can be used as a foundational belief for future policy making decisions.