Pre-migration Persecution, Socioeconomic Factors, and Trajectories of Depression Among New Immigrants to the United States Open Access

Wagner-Flynn, William L. (2016)

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Objective: The objective of this study was to characterize the effects of pre-migration persecution and socioeconomic factors on long-term trajectories of depression among new immigrants to the United States. It utilizes a nationally representative survey of new immigrants to the United States, assessing the effects of self-reported pre-migration persecution and four socioeconomic indicators on three depression outcomes, depression at baseline, depression at follow-up, and depression at both baseline and follow-up. Results presented are controlled for demographic factors and two potential confounders.

Background: While studies have shown United States immigrants to be a generally healthy group relative to the native-born population, the literature has shown considerable variability in immigrant mental health outcomes after resettlement in the United States. Among the key factors influencing post-migration depression identified thus far have been pre-migration psychological trauma and socioeconomic status. However, previous studies have primarily relied upon cross-sectional data for describing the role of these factors. In addition, the accurate estimation of factors influencing long-term mental health trajectories for immigrants is complicated by several processes unique to migration, including selective migration and migration-related stress.

Methods: Weighted odds ratios were calculated using logistic regression. Unadjusted odds ratios for all three depression outcomes were presented for each independent variable analyzed. Next, seven progressively adjusted models were presented separately for each depression outcome: depression at baseline, depression at follow-up, and depression at both baseline and follow-up.

Results: Self-reported pre-migration persecution resulted in an increased odds of all three depression outcomes among refugees, but not other immigrants. Immigrants who were female, single, and from Latin America had greater odds of all depression outcomes. Associations for all of these variables were strongest among the group of immigrants reporting depression at both baseline and follow-up.

Conclusions: Pre-migration persecution is an important predictor of depression among refugees, but not necessarily for other immigrants. Immigrants with a history of persistent, long-term depression show the strongest correlations with persecution and measures of socioeconomic status.

Table of Contents

Chapter 1. Introduction. 1

Context and Significance. 1

Immigrant Mental Health. 3

Problem Statement. 6

Purpose Statement. 6

Research Questions. 6

Study Objective. 7

Significance Statement. 7

Definition of Terms. 8

Chapter 2: Background

Section 1: Measuring immigrant depression. 9

The Immigrant Paradox. 9

Lee's "Theory of Migration. 11

The Healthy Immigrant Effect. 12

The "Salmon Hypothesis. 14

Healthy behavior theories. 15

Migration stress. 18

History of United States immigration policy. 20

Section 2: Factors influencing variability of immigrant depression. 22

Age at migration. 22

Sex. 24

Country of origin. 25

Education. 26

Marital status and socio-familial support. 27

Employment status. 28

English language proficiency. 29

Refugees and asylum seekers. 30

Section 3: Pre-migration persecution and depression: findings from the New Immigrant Survey. 33

Chapter 3: Methodology. 37

New Immigrant Survey. 37

Demographic Measures. 39

Age. 39

Sex. 40

Country of origin. 40

Socioeconomic Measures. 41

Education. 41

English Proficiency scale. 42

Marital Status. 44

Employment status. 45

Visa Category and Refugee status. 45

Persecution. 46

Depression outcomes. 46

Analyses. 50

Chapter 4: Results. 52

Descriptive Statistics. 52

Unadjusted odds ratios. 54

Models for general depression at baseline. 57

Models for general Depression at follow-up. 62

Models for chronic depression. 66

Chapter 5: Discussion

Pre-migration persecution and refugee status. 71

Socioeconomic and demographic factors for depression. 73

Limitations. 77

References. 78

Tables. 92

Table 1. Characteristics of analytic sample (N=4,363) at baseline and follow-up. 92

Table 2. Weighted, unadjusted odds ratios with depression at baseline, depression at follow-up, and chronic depression. 94

Table 3. Weighted models of general depression at baseline. 95

Table 4. Weighted models of general depression at follow-up. 96

Table 5. Weighted modes for chronic depression. 97

Appendix. 98

Appended Table 1: Frequency, Percent, and Mean Sample Weight of Observations, By Sample Stratum. 98

Appended Table 2: Characteristics of analytic sample compared to participants not analyzed. 99

Appended Table 3: Countries of origin categorized into regions. 100

Appended Table 4: Crude odds ratios of increasing level of English proficiency on general depression at baseline and at follow-up. 100

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