Stressors Experienced by Immigrant Youth and Their Families: Overview of Mental Health & Practical Recommendations 2/2/23

According to the American Immigration Council, there are approximately 44.9 million immigrants in the United States, representing 14% of the US population¹. This large body of immigrant population has nearly tripled since 1970 and more than 1 million immigrants are still arriving yearly². Although the United States is often regarded as the “land of opportunity”, immigrants face various stressors throughout their migration experience. In a systematic review by Bas-Sarmiento et al³, authors found that depression, anxiety, and somatic disorders are more prevalent among immigrants and are associated with the migration experience and stressors. These stressors can be exacerbated in immigrants lacking formal status, who can live under the fear of deportation, lack adequate access to proper healthcare, and discrimination⁴.

Of note, there are around 2.5 million immigrant children in the United States¹, and 5 million US-born child and adolescent living with at least one unauthorized immigrant parent⁵. Given the critical impact of early childhood experiences on long-term mental, emotional, and physical health, increased awareness should be devoted to how the immigrant experience affects child and adolescent mental health. Research has shown that immigrant youth may experience lower self-esteem, have more somatic complaints, and have increased anxiety and depression⁶.

To better care for immigrant youth, the American Academy of Pediatrics released a policy statement⁷ in 2019 with the following recommendations for providers. These recommendations should be considered to better address the integrated needs of immigrant youth and their families.

• Cultural humility and safety: clinicians should respect cultural differences, understand power differentials, recognize diverse cultural beliefs, and strive for equitable clinic encounters.
• Mastery of the following core competencies: adapting a cross-cultural approach, understanding migration health issues, expertise in communicable and noncommunicable diseases, oral health, nutrition and growth, developmental and educational considerations, mental health, and understanding the traditional healthcare and cultural practices of immigrant families.
• Effective utilization of interpreter and translator services.
• Timely social determinants of health screening followed by community-based organization referrals.
• Utilizing an interdisciplinary healthcare team composed of mental health providers, social workers, legal advocates, patient navigators.
• Provide care through a trauma-informed lens, paying particular attention to multigenerational trauma.
• Connecting immigrant families to local grassroots organizations and systems of care, including schools, non-profit and faith-based organizations, immigrant law firms and legal aid centers.

In San Diego, the following agencies provide services to the refugee communities:

• International Rescue Committee: https://www.rescue.org/united-states/san-diego-ca
• Jewish Family Services: https://jfssd.org/our-services/refugees-immigration/refugee/
• San Ysidro Health Center (Caldean/Iraqi): http://www.syhc.org/cmss-social-services/
• Catholic Charities: https://www.ccdsd.org/refugee-services
• Somali: http://www.somalifamilyservice.org/
• SD County Behavioral Health Services: https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/bhs/TRL/TRL%20Section%203/BHS-CYF%20Outpatient%20Clinics%204-4-19.pdf

References:

1. “Immigrants in the United States.” American Immigration Council, 21 Sept. 2021, https://www.americanimmigrationcouncil.org/research/immigrants-in-the-united-states.
2. Budiman, Abby. “Key Findings about U.S. Immigrants.” Pew Research Center, Pew Research Center, 22 Sept. 2020, https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/.
3. Bas-Sarmiento, P., Saucedo-Moreno, M. J., Fernández-Gutiérrez, M., & Poza-Méndez, M. (2017). Mental Health in Immigrants Versus Native Population: A Systematic Review of the Literature. Archives of psychiatric nursing, 31(1), 111–121. https://doi.org/10.1016/j.apnu.2016.07.014
4. Sangaramoorthy, T., & Carney, M. A. (2021). Immigration, Mental Health and Psychosocial Well-being. Medical anthropology, 40(7), 591–597. https://doi.org/10.1080/01459740.2021.1931174
5. Passel, Jeffrey S., et al. “Number of U.s.-Born Babies with Unauthorized Immigrant Parents Has Fallen since 2007.” Pew Research Center, Pew Research Center, 30 May 2020, https://www.pewresearch.org/fact-tank/2018/11/01/the-number-of-u-s-born-babies-with-unauthorized-immigrant-parents-has-fallen-since-2007/.
6. Caqueo-Urízar, A., Atencio, D., Flores, J., Narea, M., Urzúa, A., & Irarrázaval, M. (2021). Mental Health in Immigrant Children and Adolescents in Northern Chile Mental Health in Immigrant Children and Adolescents. Journal of immigrant and minority health, 23(2), 280–288. https://doi.org/10.1007/s10903-020-01101-7
7. Linton, J. M., Green, A., & COUNCIL ON COMMUNITY PEDIATRICS (2019). Providing Care for Children in Immigrant Families. Pediatrics, 144(3), e20192077. https://doi.org/10.1542/peds.2019-2077

Thanks to contributors:

Leo Meller, BS, is a first-year medical student at UCSD School of Medicine passionate about immigrant health.

Shawn Sidhu, MD, FAPA, is a child and adolescent psychiatrist at UCSD/Rady and program director of the Child & Adolescent Psychiatry Fellowship Program at UCSD.