Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 10, pp 1275–1284 | Cite as

Acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States

  • Kyle WaldmanEmail author
  • Ai Koyanagi
  • Julia Shu-Huah Wang
  • Justine Ko
  • Jordan DeVylder
  • Hans Oh
Original Paper



Empirical research has largely ignored the potential links between immigration-related stress and disability as well as immigration-related stress and health service utilization despite increasing scholarship on the association between acculturative stress and health. This study examined the associations between acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States.


Data were from the National Latino and Asian American Study (NLAAS), a nationally representative survey of Asians and Latinos living in the United States. The analytic sample contained 2653 immigrants. We utilized multivariable logistic regression and negative binomial regression analyses to examine the associations between acculturative stress and disability domains. We also examined the association between acculturative stress and treatment utilization, as this may have implications for how to best intervene to address any functional disability related to acculturative stress.


Acculturative stress was significantly associated with self-reported disability across five domains: self-care, cognition, mobility, time out of role, and social interaction. Additionally, acculturative stress was significantly associated with a greater frequency of disability domains. Acculturative stress was not significantly associated with utilization of services from mental health or general health sectors, but was significantly and positively associated with utilization of non-health care services. The findings were robust regarding the inclusion of everyday discrimination as well as demographic and socioeconomic covariates.


Acculturative stress may be an important yet overlooked correlate of disability among immigrants in the United States. Non-health care services may provide an effective pathway for intervening for these individuals.


Migration Disability Treatment Acculturative stress Discrimination 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

127_2019_1691_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 47 KB)


  1. 1.
    Sirin SR, Ryce P, Gupta T, Rogers-Sirin L (2013) The role of acculturative stress on mental health systems for immigrant adolescents: a longitudinal investigation. Dev Psychol 49:736–748. CrossRefPubMedGoogle Scholar
  2. 2.
    Finch BL, Frank R, Vega WA (2004) Acculturation and acculturation stress: a social-epidemiological approach to Mexican migrant farmworkers’ health. Int Migr Rev 38:236–262CrossRefGoogle Scholar
  3. 3.
    Rogler LH, Cortes DE, Malgady RG (1991) Acculturation and mental health status among Hispanics: convergence and new directions for research. Hisp J Behav Sci 46:585–597Google Scholar
  4. 4.
    Schwartz SJ, Unger JB, Zamboanga BL, Szapocznik J (2010) Rethinking the concept of acculturation: implications for theory and research. Am Psychol 65:237–251. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Arbona C, Olvera N, Rodriguez N, Hagan J, Linares A, Wiesner M (2010) Acculturative stress among documented and undocumented Latino immigrants in the United States. Hisp J Behav Sci 32:362–384CrossRefGoogle Scholar
  6. 6.
    Lueck L, Wilson M (2010) Acculturative stress in Asian immigrants: the impact of social and linguistic factors. Int J Intercult Rel 34:47–57CrossRefGoogle Scholar
  7. 7.
    Noh S, Kaspar V (2003) Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health 93:232–238CrossRefGoogle Scholar
  8. 8.
    McEwen BS (2008) Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol 583:174–185. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Whitworth JA, Williamson PM, Mangos G, Kelly JJ (2005) Cardiovascular consequences of cortisol excess. Vasc Health Risk Manag 1:291–299CrossRefGoogle Scholar
  10. 10.
    Lundberg U (2005) Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology 30:1017–1021CrossRefGoogle Scholar
  11. 11.
    Calcia MA, Bonsall DR, Bloomfield PS, Selvaraj S, Barichello T, Howes OD (2016) Stress and neuroinflammation: a systematic review of the effects of stress on microglia and the implications for mental illness. Psychopharmacology 233:1637–1650. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Haasen C, Demiralay C, Reimer J (2008) Acculturation and mental distress among Russian and Iranian migrants in Germany. Eur Psychiatry 23(Suppl. 1):10–13. CrossRefPubMedGoogle Scholar
  13. 13.
    Ruiz RJ, Stowe RP, Goluszko E, Clark MC, Tan A (2007) The relationships among acculturation, body mass index, depression, and interleukin 1-receptor antagonist in Hispanic pregnant women. Ethn Dis 17:338–343PubMedGoogle Scholar
  14. 14.
    Stawski RS, Sliwinski MJ, Smyth JM (2006) Stress-related cognitive interference predicts cognitive function in old age. Psychol Aging 21:535–544. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA (2004) Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med 164:394–400. CrossRefPubMedGoogle Scholar
  16. 16.
    Cook B, Alegría M, Lin JY, Guo J (2009) Pathways and correlates connecting Latinos’ mental health with exposure to the United States. Am J Public Health 99:2247–2254CrossRefGoogle Scholar
  17. 17.
    DeVylder JE, Oh HY, Yang LH, Cabassa LJ, Chen F, Lukens EP (2013) Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States. Schizophr Res 150:223–228CrossRefGoogle Scholar
  18. 18.
    Torres JM, Wallace SP (2013) Migration circumstances, psychological distress, and self-rated physical health for Latino immigrants in the United States. Am J Public Health 103:1619–1627CrossRefGoogle Scholar
  19. 19.
    Hovey JD, King CA (1996) Acculturative stress, depression and suicidal ideation among immigrant and second-generation Latino Adolescents. J Am Acad Child Adolesc Psychiatry 35:1183–1192. CrossRefPubMedGoogle Scholar
  20. 20.
    Panchang S, Dowdy H, Kimbro R, Gorman B (2016) Self-rated health, gender, and acculturative stress among immigrants in the U.S.: new roles for social support. Int J Intercult Rel 55:120–132. CrossRefGoogle Scholar
  21. 21.
    Chung H, Epstein NB (2014) Perceived racial discrimination, acculturative stress, and psychological distress among Asian immigrants: the moderating effects of support and interpersonal strain from a partner. Int J Intercult Rel 42:129–139. CrossRefGoogle Scholar
  22. 22.
    Finch KF, Hummer RA, Kolody B, Vega WA (2001) The role of discrimination and acculturative stress in the physical health of Mexican-origin adults. Hisp J Behav Sci 23:399–429CrossRefGoogle Scholar
  23. 23.
    González P, González G (2008) Acculturation, optimism, and relatively fewer depression symptoms among Mexican immigrants and Mexican Americans. Psychol Rep 103:566–576. CrossRefPubMedGoogle Scholar
  24. 24.
    Hummer RA, Rogers RG, Amir SH, Forbes D, Frisbie W (2000) Adult mortality differentials among Hispanic subgroups and non-Hispanic Whites. Soc Sci Q 81:459–476PubMedGoogle Scholar
  25. 25.
    Turra C, Goldman N (2007) Socioeconomic differences in mortality among U.S. adults: insights into the Hispanic Paradox. J Gerontol Ser B Psychol Sci Soc Sci 62:S184–S192. CrossRefGoogle Scholar
  26. 26.
    Ettinger WH, Fried LP, Harris T, Shemanski L, Schulz R, Robbins J (1994) Self-reported causes of physical disability in older people: the Cardiovascular Health Study. J Am Geriatr Soc 42:1035–1044. CrossRefPubMedGoogle Scholar
  27. 27.
    Dewa CS, Lin E (2000) Chronic physical illness, psychiatric disorder and disability in the workplace. Soc Sci Med 51:41–50. CrossRefPubMedGoogle Scholar
  28. 28.
    Reichard A, Stolzle H, Fox MH (2011) Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disabil Health J 4:59–67. CrossRefPubMedGoogle Scholar
  29. 29.
    Appel HB, Huang B, Ai AL, Lin CJ (2011) Physical, behavioral, and mental health issues in Asian American women: results from the National Latino Asian American Study. J Womens Health (Larchmt) 20:1703–1711. CrossRefGoogle Scholar
  30. 30.
    Huang B, Appel HB, Nicdao EG, Lee HJ, Ai AL (2013) Chronic conditions, behavioral health, and use of health services among Asian American men: the first nationally representative sample. Am J Mens Health 7:66–76. CrossRefPubMedGoogle Scholar
  31. 31.
    Lee S, Laiewski L, Choi S (2014) Racial-ethnic variation in U.S. mental health service use among Latino and Asian non-U.S. citizens. Psychiatr Serv 65:68–74. CrossRefPubMedGoogle Scholar
  32. 32.
    Manseau M, Case BG (2014) Racial-ethnic disparities in outpatient mental health visits to U.S. physicians, 1993–2008. Psychiatr Serv 65:59–67. CrossRefPubMedGoogle Scholar
  33. 33.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:629–640CrossRefGoogle Scholar
  34. 34.
    Kim G, Worley CB, Allen RS, Vinson L, Crowther MR, Parmelee P, Chiriboga DA (2011) Vulnerability of older Latino and Asian immigrants with limited English proficiency. J Am Geriatr Soc 59:1246–1252. CrossRefPubMedGoogle Scholar
  35. 35.
    Derose KP, Escarce JJ, Lurie N (2007) Immigrants and health care: sources of vulnerability. Health Aff (Millwood) 26:1258–1268CrossRefGoogle Scholar
  36. 36.
    Ku L, Matani S (2001) Left out: immigrants’ access to health care and insurance. Health Aff (Millwood) 20:247–256CrossRefGoogle Scholar
  37. 37.
    Jackson JS, Brown TN, Williams DR, Torres M, Sellers SL, Brown K (1996) Racism and the physical and mental health status of African Americans: a thirteen year national panel study. Ethn Dis 6:132–147PubMedGoogle Scholar
  38. 38.
    Ren XS, Amick BC, Williams SDR (1999) Racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status. Ethn Dis 9:151–165PubMedGoogle Scholar
  39. 39.
    Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 2:335–351. CrossRefGoogle Scholar
  40. 40.
    Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32:20–47. CrossRefPubMedGoogle Scholar
  41. 41.
    Alegria M, Takeuchi D, Canino G, Guan N, Shrout P et al (2004) Considering context, place and culture: the National Latino and Asian American Study. Int J Methods Pyschiatr Res 13:208–220CrossRefGoogle Scholar
  42. 42.
    Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P (2004) Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES). Int J Methods Psychiatr Res 13:221–240CrossRefGoogle Scholar
  43. 43.
    Vega WA, Kolody B, Aguilar-Gaxiola S, Al-derete E, Catalano R, Caraveo-Anduaga J (1998) Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry 55:771–778CrossRefGoogle Scholar
  44. 44.
    Hair JF, Black WC, Babin BJ, Anderson RE (2009) Multivariate data analysis, 7th edn. Prentice Hall, Engelwood CliffsGoogle Scholar
  45. 45.
    Rehm J, Üstün TB, Saxena S, Nelson CB, Chatterji S, Ivis F, Adlaf E (1999) On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. Int J Methods Psychiatr Res 8:110–122CrossRefGoogle Scholar
  46. 46.
    Fortuna LR, Alegria M, Gao S (2010) Retention in depression treatment among ethnic and racial minority groups in the United States. Depress Anxiety 27:485–494CrossRefGoogle Scholar
  47. 47.
    Federici S, Bracalenti M, Meloni F, Luciano JV (2017) World Health Organization disability assessment schedule 2.0: an international systematic review. Disabil Rehabil 39:2347–2380. CrossRefPubMedGoogle Scholar
  48. 48.
    Ferri CP, Schoenborn C, Kalra L, Acosta D, Guerra M et al (2011) Prevalence of stroke and related burden among older people living in Latin America, India and China. J Neurol Neurosurg Psychiatry 82:1074–1082. CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Sousa RM, Dewey ME, Acosta D, Jotheeswaran AT, Castro-Costa E et al (2010) Measuring disability across cultures—the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey. Int J Methods Psychiatr Res 19:1–17. CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Lopez G, Ruiz NG, Patten E (2017) Key facts about Asian Americans, a diverse and growing population. Accessed 1 Sept 2018
  51. 51.
    U.S. Census Bureau (2018) QuickFacts United States. Accessed 1 Sept 2018
  52. 52.
    Alpers L (2018) Distrust and patients in intercultural healthcare: a qualitative interview study. Nurs Ethics 25:313–323. CrossRefPubMedGoogle Scholar
  53. 53.
    Degrie L, Gastmans C, Mahieu L, Dierckx de Casterle B, Denier Y (2017) How do ethnic minority patients experience the intercultural care encounter in hospitals? A systematic review of qualitative research. BMC Med Ethics. CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Tran AN, Ornelas IJ, Kim M, Perez G, Green M, Lyn M, Corbie-Smith G (2013) Results from a pilot promotora program to reduce depression and stress among immigrant Latinas. Health Promot Pract 15:365–372. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sol Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Universitat de Barcelona, Parc Sanitari Sant Joan de DéuBarcelonaSpain
  3. 3.Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud MentalMadridSpain
  4. 4.Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
  5. 5.Keck School of MedicineUniveristy of Southern CaliforniaLos AngelesUSA
  6. 6.Graduate School of Social ServiceFordham UniversityNew YorkUSA
  7. 7.Suzanne Dworak-Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesUSA

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