Key Factors Associated with Mental Health Services Use Among Immigrant Caregivers and Their Children Along a US-Mexico Border Community

Background and Purpose: Immigrant families experience unique challenges that can impact their mental health, with caregiver mental health designated as an urgent issue by the U.S. Surgeon General in 2024. Despite this recognition, immigrant families encounter substantial barriers to accessing mental health treatment. This study examined determinants of mental health service utilization for both immigrant caregivers and their children, organized through Andersen’s Behavioral Model framework of predisposing, enabling, and need domains.

Methods: We conducted a cross-sectional study using purposive and snowball sampling methods to recruit 240 immigrant caregivers with children aged 0-8 in Doña Ana County, New Mexico between June 2022 and March 2023. In-person surveys were administered in English and Spanish. Dependent variables were caregiver and child mental health service utilization. Independent variables included predisposing factors (caregiver age, household composition, gender, education, religiosity, US residency duration, Adverse Childhood Experiences [ACEs], and English proficiency); enabling factors (caregiver resilience, employment, income, insurance status, health/social service utilization, social safety net access, resource navigation, and help-seeking attitudes); and need factors (depression symptoms, immigration stress, and housing insecurity). Domain-specific multiple logistic regression models were constructed followed by final models incorporating variables significant at p<0.05 level from each domain.

Results: For caregiver mental health service utilization, significant predisposing factors included number of adults in the home, education level, ACEs, and English-speaking proficiency. Significant enabling factors were social safety net use and help-seeking attitudes, while depression symptoms emerged as a significant need factor. In the final model, only positive help-seeking attitudes and greater depression symptoms remained significantly associated with caregiver mental health service utilization. For child mental health service utilization, significant predisposing factors were number of adults in the home and caregiver ACEs. Significant enabling factors included health/social service use and social safety net participation, while housing insecurity was a significant need factor. After controlling for all variables in the final model, only higher rates of health/social service use were associated with child mental health service use.

Conclusions and Implications: This study identifies critical factors influencing mental health service utilization among immigrant families. Positive help-seeking significantly predicted caregiver service use, underscoring the importance of promoting mental healthcare benefits through culturally responsive outreach. The association between depression severity and service utilization suggests that those with greater need are receiving care, highlighting the necessity of ensuring adequate mental health resources for immigrant caregivers. For children, the relationship between other health/social services use, and mental health services, demonstrates how engagement with one service facilitates connections to others. These findings emphasize the value of initial service engagement as a pathway to addressing multiple family needs, including child mental health concerns. Practitioners should leverage existing service connections to enhance mental health treatment access for this underserved population.