Immigrant Minorities and Mental Health

The United States has long been described as a melting pot of cultures, a country of immigrants.
With over 41 million foreign-born U.S. residents 13% of the total population, the relationship
between immigration and risk of psychiatric illness has significant public health implications.
Historically, observations of socioeconomic disadvantage in immigrant groups shaped early
theories causally linking immigration, stress, and mental illness. Multiple epidemiological
studies over the past 30 years have provided evidence to the contrary for mood, anxiety, and
substance use disorders, while demonstrating a different pattern for psychotic disorders.
Approximately 18% of US adults have a diagnosable mental disorder within a given year, and
approximately 4% of adults have a serious mental illness. Mental and behavioral disorders are
among the leading causes of disability in the U.S. accounting for 13.6% of all years of life lost to
disability and premature death. Mental disorders are among the costliest health conditions for
adults 18 to 64 in the U.S., along with cancer and trauma-related disorders. An estimated 43% of
people with any mental illness will receive mental health treatment.

As the U.S. population is continuing to become more diverse, by the year 2044 more than half of
all Americans are projected to belong to a minority group (any group other than non-Hispanic
White alone). Most racial/ethnic minority groups overall have similar or in some cases, fewer
mental disorders than whites. However, the consequences of mental illness in minorities may be
long lasting. Ethnic/racial minorities often bear a disproportionately high burden of disability
resulting from mental disorders. Although rates of depression are lower in blacks (24.6%) and
Hispanics (19.6%) than in whites (34.7%), depression in blacks and Hispanics is likely to be
more persistent.

New research provides evidence that immigrants to the United States are far less likely than US-
born individuals to experience several psychiatric disorders. The study appears in the Journal
of Psychiatry Research. Researcher Christopher P. Salas-Wright of Boston University states;
“Over the last several years, my colleagues and I have conducted more than two dozen national
studies focused on the health and well-being of immigrants in the United States.”
Research on immigrants is critical as the United States is home to a very large number of
immigrants, currently roughly 40 million foreign-born individuals live in the US, and one in four
people in the US is either an immigrant or the child of an immigrant. The topic of Immigration
has become a hot -button issue in our national discourse is expected to be responsible for most of
the population growth over the next 30 years. Paying attention to the mental health of immigrants
is important because we know that adjusting to life in a new context and culture can be very

The researchers of this study analyzed data from the National Epidemiologic Survey on Alcohol
and Related Conditions (2012–2013), a nationally representative survey of 36,309 adults in the
United States. Along with face-to-face structured psychiatric interviews, the survey also asks
participants about their immigration status.

The researchers found that immigrants were significantly less likely to meet the criteria for an
anxiety, depressive, and trauma-related disorder. The findings provide support for the healthy
migrant hypothesis.

This study provides evidence that, despite the stresses of migration and adapting to life in a new
country, immigrants are far less likely to have mental health problems compared to people born
in the United States This was the case for immigrants from Africa, Asia, Europe, and Latin
America, as well as from top immigrant-sending countries such as Mexico, China, India, and El
Salvador. The study also found that immigrants were far less likely to report that their mother
and father struggled with anxiety or depression.

We argue that this is likely because migration is not random, rather people who are motivated
and able to pick up everything to start a new life in a foreign country are more likely to be
physically and psychologically healthy compared to those who do not migrate. There is a lot of
support for this idea, and scholars have even coined a term for it: the healthy migrant effect. The
basic notion here is that self-selection is a core feature of migration, and that those who self-
select for migration tend to be part of a uniquely hearty and healthy subset.

The researchers also found that the risk for psychiatric problems was lowest among those who
migrated to the United States after age 12. Individuals who migrated during childhood (age 11 or
younger) were, on average, no more or less likely than people born in the US to have mental
health problems as adults. Those who migrate as children tend to more closely resemble persons
born in the US than those who migrate later in life. Scholars are still trying to pinpoint exactly
why this is the case, but there are several possibilities. One is that people who migrate as
children tend to take on many of the practices and values of their new country faster than those
who migrate as teenagers or adults. It may be that, in ‘becoming more American in how they
think and act, immigrants also come to more closely resemble US-born individuals in terms of
mental health risk. It is also quite possible that those who immigrate as children are more likely
to be negatively impacted by bullying, discrimination, and other migration-related stressors that
can place them at risk for mental health problems like depression and anxiety.

Researcher Salas-Wright says, “That is what we have learned about immigrants’ mental health
matches up with other studies showing that, compared to people born in the United States,
immigrants are substantially less likely to: misuse alcohol and other drugs, commit crimes and
enact violence, and take part in risky or dangerous behaviors in general. While some immigrants
certainly have mental health and behavioral problems, a large and growing number of studies
makes clear that immigrants are far less likely to have such problems than those born in the
United States.”

Barriers to access and use of mental health services are language and cultural differences seem to be the most obvious barriers of immigrants receiving and accepting Mental Health Services. However, many immigrants believed mental illness to be a Western concept used by healthcare professionals. Immigrant clients preferred going to family,
friends, or spiritual leaders to address their concerns or receive support for life stressors and were
uncomfortable talking with healthcare professionals about their problems. Often clients
perceived symptoms of mental illness as a crisis of faith, personal weakness, or evil spirits that
invade the body. Immigrants describe emotional or mental distress in terms of physical symptoms. Clients did not recognize symptoms of mental illness even when sensing a lack of
overall well‐being. Mental illness in some communities was associated with overt acts of
aggression or stereotypical depictions of ‘acting crazy’. Persistent sadness, anxiety, or
psychosomatic symptoms were not seen as related to mental health. Because many immigrants
do not have a definition of mental health which adds difficulty for them expressing depression or
anxiety as mental health concerns.

Mental Health Care Professionals recognized the stigma attached to the label of mental illness
and have struggled to find more culturally appropriate language to begin a discussion with clients
who were experiencing mental health difficulties. Stigma is often internalized by clients as a
devalued sense of self where they are presented with feelings of shame and failure. Many
immigrants believe it is their personal responsibility to manage life stressors, keep going, and
‘deal with it’. External stigma can also be found in ethnic communities causing immigrants to
experience discrimination and social exclusion. Overall, stigma means that those suffering from
significant symptoms concealed the issue from family members and extended support networks,
increasing their isolation and exacerbating their mental illness. Even if they acknowledge they
have a problem they will not seek mental health support because they feel ashamed doing that.
They feel that people who go to ask for mental health services or treatment are kind of crazy.
They don’t want to acknowledge that. Even if they do, it is still in secret. They don’t mention it
even in front of their family members. If family members became aware of a mental health
problem, they felt the need to conceal this from their ethnic community to avoid stigmatization.
Having a family member with a mental illness could mean loss of social status, social exclusion,
and discrimination. The lack of discussion and recognition of mental illness in immigrant and
refugee communities have caused individuals and families to suffer in silence, unable or
unwilling to access available mental health supports.

Strategies to improve mental health services for Immigrants
Immigrants learning English and assimilating into the mainstream culture of United States,
educating them on the services provided for mental health care in their areas where they reside,
as well as providing education to help them learn more about mental health would also eliminate
some of the stigma around mental health and the various disorders. This would certainly help to
remove some of the barriers that immigrants and minorities have toward mental health. This
would also help immigrants and minorities learn about the different agencies that can provide
services for them. For the providers for mental health services, it is imperative that they take the
clients’ culture and faith into consideration to provide for the best therapeutic outcomes with
minorities and immigrants.

Writing this blog has been a little personal journey into my life as I am the son and grandson of
immigrants. I remember expressing my early desire to become a mental health counselor with
some older family members and many exclaimed what a strange job that would be and how silly
it is to pay a stranger to help you solve your problems, especially since you have “the family” to
help you if you have problems. I believe that some of the problems many Americans face with
issues such as depression and anxiety may be directly caused by being disconnected from our
families. However, too much family involvement can also cause some anxiety, so there needs to be a balance. Professional counseling can help you have an objective ear with making decisions
about your mental health. Also hearing the stories from my father and other relatives about the
hardships they experienced in the “old country”, the problems they faced traveling here and what
they experienced after arriving here, it was not a complaint but rather an expression of joy
because for them they made it here and now they can live the “American Dream”. What they
have shown me was a resiliency of body, mind, and spirit that seems lacking in modern day
American born citizens.

Jim Katsoudas