Racial and Ethnic Disparities in Mental Health Wellbeing Among Foreign-Born Immigrants in the U.S

Background & Purpose: Racial and ethnic disparities in mental health outcomes in the United States are extensively documented and shaped by structural influences such as racism and immigration policy. This study further examines these disparities among immigrants in the United States using data from 2019, 2021 and 2022 of the National Health Interview Survey (NHIS). We investigated the impacts of socio-demographic variables, including length of residence in the U.S. as a marker of exposure to racism, on self-reported measures of mental health wellbeing among immigrants. We hypothesized non-White immigrants will have poorer mental health outcomes compared to White immigrants. Additionally, immigrants with lengthier times of residence will have poorer mental health outcomes, as theorized by the immigrant paradox.

Methods: Using secondary data from the NHIS we examined racial and ethnic disparities among foreign-born immigrants (n=4256) and their self-reported mental health (Anxiety and Depression levels). Accounting for weighting and the complex sample design, we estimated multivariate linear regression models to examine adjusted associations between sociodemographic factors (age, gender, race/ethnicity, length of residency, region, education, and income) on self-reported mental health levels. Additionally, we estimated models that examined the interaction effects of length of residence for each of our predictors and self-reported mental health. Future analyses will include imputed income files for missing data for all three years as a socioeconomic predictor.

Results: Approximately 44% of our sample were Hispanic, 21% were non-Hispanic white, 8% were non-Hispanic Black and 27% were Asian. About 28% of our sample had resided in the U.S. for under 15 years less and 72% have resided in the U.S. for 15 years or more. Our multivariate analyses revealed women significantly reported higher levels of anxiety (p<.05) as compared to men. Non-Hispanic Asians reported higher levels of anxiety as compared non-Hispanic Whites (p<.05). Immigrants from the South compared with the immigrants in the Northeast reported significantly higher anxiety levels (p<.05) and immigrants who have lived in the U.S. for 15 years or more reported lower anxiety levels (p<.05) compared with those who lived in the U.S. for less than 15 years. For depression levels, there were significantly higher depression levels among women, Hispanics, and non-Hispanic Asians (p<.05) compared with men or non-Hispanic Whites. There were no significant interaction effects between length of residence and the other predictors for either outcome.

Our findings provide insights that confirm and disprove our hypotheses. There were higher reported levels of better mental health among non-Hispanic Whites as compared to other ethnicities except for being non-Hispanic Black. A possible reason for this might be due to the relatively smaller sample size of foreign-born Black immigrants. There was also a significant surprising effect on anxiety levels among immigrants who have resided in the U.S. for 15 years or more as they fared better than those who lived in the U.S. for less time. Immigration policies and wider systemic barriers need to continuously be addressed to improve mental health outcomes of immigrants.