We are entering a new period of mass human displacement. A recent study by the UN Refugee Agency (UNHCR) reports that in 2021 over 89 million people were forced to relocate from their homes due to war, violence, persecution, and human rights abuses, and human displacement has increased every year for the past decade. The Ukraine/Russian conflict alone has resulted in the relocation to other countries of over five million people, half of whom are children.
Although several types of migrant populations have been identified and different motivations underlie peoples’ decisions to relocate, most of the recent human movement has been in response to severe hazards, including exposure to war and other forms of extreme violence, political oppression, poverty, natural disasters, and climate change. The psychological trauma associated with poor living conditions in the sending countries and the challenge of migration undoubtedly increases the mental health burden for those who resettle. However, not all immigrant populations are adversely affected. This article provides a brief overview of some of the risk and protective factors that have so far been identified with respect to the patterns of mental health associated with migration. A major focus of this report will be on Hispanic immigration to the United States.
Race, Ethnicity, and Mental Health
Linkages between race/ethnicity, socioeconomic status (SES), and exposure to discrimination have been shown to be robust and persistent over time. Ethnic minorities tend to receive less education, poorer quality education and, by extension, poorer payoffs from their educational achievements compared to non-Hispanic Whites. Ethnic minorities are also burdened by disproportionate exposure to acute and chronic stressors. Racial/ethnic differences in exposure to adversity is now understood to be the inevitable consequence of structurally based social disadvantage that characterizes the lives of many minority populations and heightens risk for mental health problems.
The health consequences of racism are also well documented. At a macro level, the structural constraints of discrimination have been shown to systematically restrict opportunities for social mobility, availability, and quality of received health care, and increased risk for exposure to noxious neighborhood and work environments. In addition, subjective perceptions of discrimination have been linked to a broad array of adverse physical and mental health outcomes. Thus, although race and ethnic minority status have little or no biological bearing on population differences in health, these social statuses continue to delineate increased risk for poor health outcomes.
Equally important is the growing realization that race, nativity, ethnicity, and cultural contexts act to raise or lower opportunities for upward mobility that translate into health (dis)advantages, and that failing to take into consideration these important social distinctions may cloud or misrepresent racial/ethnic differences in health and well-being. For example, the Hispanic American pan-ethnic category is highly diverse, consisting of ethnic groups originating from over two dozen nationalities. And, although most Hispanic Americans share a common language, there is wide ethnic variation with respect to timing of entry into the United States, their socioeconomic position, and the receptiveness of receiving communities. These distinctions likely account for some part of observed ethnic variation in physical and mental health outcomes.
The health challenges of being a racial/ethnic minority that are described above would seem to be exacerbated among immigrant populations. This is so because the challenges of immigration are many. Relocation is physically taxing, and integration into receiving countries can be difficult, especially when new arrivals lack the monetary and language resources needed for early success.
Immigration, Acculturation, and Mental Health
Patterns of assimilation and acculturation vary widely among immigrant populations. For example, European immigrants to the U.S. arriving after World War I achieved rapid assimilation. Today, ethnic distinctions among current generations of these immigrant groups are largely symbolic and voluntary and have little bearing on the mental health profiles of these populations. In contrast, racial prejudice and discrimination has prevented African Americans and Native Americans from attaining full assimilation and they remain a disadvantaged segment of the U.S. population. Immigrants from many Latin American countries have also struggled to integrate themselves quickly and successfully into U.S. society.
The pace of assimilability of a given racial/ethnic group is influenced by several social factors which condition the assimilation process: (1) the history of the immigrant first generation, including the human capital (educational attainment, wealth, and English proficiency) brought by immigrant parents and the context of their reception; (2) the differential pace of acculturation among parents and children, including the development of language gaps between them, and its bearing on normative integration and family cohesiveness; (3) the cultural and economic barriers confronted by second-generation youth in their quest for successful adaptation; and (4) the family and community recourses needed for confronting these barriers.
Theories have been developed to account for the observed patterns of mental health experienced by immigrant groups. Two of these theories are briefly discussed below.
Healthy Immigrant Selection. Prior studies suggest that immigrant groups experience better mental health than U.S.-born residents because of selection effects. From this perspective, a minimum level of good health is needed to relocate to another country. In contrast, less healthy individuals may be less likely to navigate the physical challenges of relocation. This selection process, it has been argued, often confers mental health advantages to new arrivals relative to ethnic minorities born and raised in the United States, especially if immigration is “voluntary.”
The Hispanic Paradox. Also known as the Immigrant Paradox or the Epidemiological Paradox, the Hispanic Paradox was developed as an explanation for the relatively good health experienced by some Hispanic ethnic groups, despite their exposure to a range of risk factors that have been described above. For some Hispanic ethnic groups, high rates of poverty, racial discrimination, neighborhood segregation, and physically challenging work conditions do not translate into increased risk for morbidity or mortality. In fact, many previous studies have shown that Hispanic immigrant health is on par with, or better than that of their non-Hispanic White counterparts. Although there is evidence that the health paradox among Hispanics extends to groups of differing national origins, this apparent health advantage has been best documented with respect to Mexican and Cuban Americans. From a public health perspective, it is important to understand the interpersonal and structural factors that underlie this paradox.
This paradox as it relates to psychiatric and substance use disorders was first observed by the Los Angeles site of the Epidemiologic Catchment Area Study. Here U.S.-born Mexican Americans were found to have higher rates of several disorders, including drug abuse or dependence, compared to newly arrived Mexican immigrants. In a comprehensive subsequent study of both rural and urban participants and employing DSM-III R criteria, William Vega and colleagues confirmed the paradox, observing a prevalence rate for any study disorder among U.S.-born persons of Mexican descent to be double that of those observed among immigrants. With respect to drug dependence, the prevalence among immigrants was less than a quarter of that observed for the native-born. Importantly, Vega et al. also provide a comparison with rates observed from people living in Mexico City. In general, rates of psychiatric disorders among immigrants residing in the United States for less than 13 years were similar to those observed for Mexico City residents. For drug dependence, the prevalence among Mexico City residents was substantially lower than for recent immigrants to the United States (0.8 and 3.0 percent respectively), effectively ruling out the “healthy immigrant” hypothesis as an explanation.
These and other similar findings make clear that group-level differences in health risk are attributable to systematic group-level differences in social experience. The acculturation hypothesis—the idea that some aspects of Hispanic culture are protective and their loss or diminishment through acculturation—represents the most plausible explanation for the paradox. For many Hispanic ethnic groups low acculturation may act to reduce risk by buffering the impact of social stress or by limiting exposure to stressful circumstances and events, or both. In addition, the apparent significance of low acculturation may arise largely from associated differences in family social support. A prominent hypothesis in the field is that social support from family, assumed to be characteristically high within Hispanic cultures, contributes to the lower rates of disorder among recent immigrants.
In addition, exposure to the negative or harmful aspects of American culture tends to increase health risks, especially among second- and third-generation ethnic groups. Assimilation tends to be associated with a loosening of protective family ties and increases in negative health behaviors. This theory is supported by research showing that immigrants who are integrated into existing ethnic enclaves tend to be healthier than those who do not have access to social environments that resemble those experienced in the sending counties. It is also important to note that Hispanic Paradox is a relatively new phenomenon, having been observed only in studies conducted after the Immigration and Nationality Act of 1965. As such, the health advantages experienced by some Hispanic ethnic groups are not ahistorical nor guaranteed for future generations of immigrants. This is especially true when U.S. policies such as family separation are enacted. The psychological trauma that has resulted from these actions is severe and will likely have lifelong negative effects.
Conclusion
The new age of global migration that we are now witnessing presents an ongoing challenge that will likely extend into the foreseeable future. As such, it is important to develop strategies for successfully integrating immigrant populations into the U.S. Doing so will be beneficial for the physical and mental wellbeing of new arrivals to this country. Equally important, doing so will help ensure that these populations continue to contribute to the economic and social well-being of receiving societies.
Any opinions expressed in the articles in this publication are those of the author and not the American Sociological Association.
