Worse Mental Health Among More-Acculturated and Younger Immigrants Experiencing Discrimination: California Health Interview Survey, 2015–2016
Experiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation—the process by which immigrants acquire the beliefs and practices of a host culture—influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility. Conversely, the acculturative process may increase exposure to, and recognition of, discrimination.
We examined the relationship between discrimination and mental illness across racial/ethnic groups, and pathways by which acculturation and age relate to the discrimination-mental health relationship.
A secondary data analysis using population data from the 2015–2016 California Health Interview Survey.
The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with K6 score ≥ 13 associated with severe mental illness. Discrimination was measured using a self-reported measure of lifetime experience of unfair treatment in getting medical care. We used a 5-point acculturation index (constructed by measures of nativity, years living in the USA, and home language use). A weighted logistic regression model predicted mental illness as a function of discrimination. We ran mediational analysis using the Karlson-Holm-Breen method and used predictive margins to present predicted probabilities of mental illness for people reporting discrimination at different acculturation and age levels.
There were independent effects on mental illness associated with increased discrimination (OR 3.85, 95% CI = 2.46, 6.03, p < 0.001) and increased acculturation (OR 1.72, 95% CI = 1.24, 2.38, p = 0.001), including when stratified across racial/ethnic groups. Higher levels of acculturation led to a significant increase in discrimination’s association with mental illness. There was a higher probability of mental illness in younger age groups than in older age groups.
While discrimination is associated with poor mental health, a stronger link between discrimination and mental illness exists among younger immigrants and immigrants with increased acculturation. Health practitioners should not overlook the mental health needs of younger immigrants and immigrants who may seem more integrated into US society.
KEY WORDSdiscrimination acculturation immigrants mental health
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 6.Gee GC, Ryan A, Laflamme DJ, Holt J. Self-Reported Discrimination and Mental Health Status Among African Descendants, Mexican Americans, and Other Latinos in the New Hampshire REACH 2010 Initiative: The Added Dimension of Immigration. Am J Public Health. 2006;96(10):1821-1828. doi: https://doi.org/10.2105/AJPH.2005.080085 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Beatty Moody DL, Waldstein SR, Tobin JN, Cassells A, Schwartz JC, Brondolo E. Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2016;35(4):333-342. doi: https://doi.org/10.1037/hea0000270 CrossRefGoogle Scholar
- 16.Abraído-Lanza AF, Echeverría SE, Flórez KR. Latino Immigrants, Acculturation, and Health: Promising New Directions in Research. Annu Rev Public Health. 2016;37:219-236. doi: https://doi.org/10.1146/annurev-publhealth-032315-021545 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.California Health Interview Survey. CHIS 2015-2016 Methodology Series: Report 4 -Response Rates. 2017. http://healthpolicy.ucla.edu/chis/design/Documents/CHIS_2015-2016_MethodologyReport4_ResponseRates.pdf. .Google Scholar
- 23.Erinosho TO, Berrigan D, Thompson FE, Moser RP, Nebeling LC, Yaroch AL. Dietary Intakes of Preschool-Aged Children in Relation to Caregivers’ Race/Ethnicity, Acculturation, and Demographic Characteristics: Results from the 2007 California Health Interview Survey. Matern Child Health J. 2012;16(9):1844-1853. doi: https://doi.org/10.1007/s10995-011-0931-5 CrossRefPubMedGoogle Scholar
- 24.Byrd DR. Race/Ethnicity and Self-Reported Levels of Discrimination and Psychological Distress, California, 2005. Prev Chronic Dis. 2012;9. doi: https://doi.org/10.5888/pcd9.120042
- 25.Kohler U, Karlson K. KHB: Stata module to decompose total effects into direct and indirect via KHB-method. February 2019.Google Scholar
- 27.California Health Interview Survey. CHIS 2015-2016 Methodology Series: Report 5 -Weighting and Variance Estimation. 2017. http://healthpolicy.ucla.edu/chis/design/Documents/CHIS_2015-2016_MethodologyReport5_WeightingAndVarianceEstimation.pdf. .
- 34.Fung HH, Carstensen LL, Lang FR. Age-Related Patterns in Social Networks among European Americans and African Americans: Implications for Socioemotional Selectivity across the Life Span. Int J Aging Hum Dev. 2001;52(3):185-206. doi: https://doi.org/10.2190/1ABL-9BE5-M0X2-LR9V CrossRefPubMedGoogle Scholar