The association between Deferred Action for Childhood Arrivals, health access, and mental health: the role of discrimination, medical mistrust, and stigma.

OBJECTIVE: There are approximately 11 million undocumented immigrants in the US, including 1.3 million young adults who are eligible for the Deferred Action for Childhood Arrivals (DACA) program. It is unclear how DACA influences engagement in healthcare or depressive symptoms, and the role of discrimination, medical mistrust, and stigma in healthcare settings. This study assesses the association of DACA on undocumented young adults' engagement with health care and depressive symptoms. DESIGN: We conducted an internet-based survey examining the health-related experiences of undocumented Latino and Asians and Pacific Islander (API) young adults in California (n = 218) between June and August 2017. Multivariable logistic regressions were conducted to assess the influence of DACA, discrimination, medical mistrust, and stigma on healthcare engagement and depressive symptoms. RESULTS: Approximately 78% of respondents had a gap in healthcare, and about 31% reported high levels of depressive symptoms. Controlling for demographic characteristics, compared to those without DACA, DACA-recipients had lower odds of reporting gaps in healthcare engagement (aOR = 0.270, p < 0.05) and depressive symptoms (aOR = 0.115, p < 0.01). Those facing discrimination, medical mistrust, and stigma in healthcare settings were less likely to have a healthcare visit and more likely to have higher depressive symptoms. CONCLUSIONS: DACA is a potential strategy to improve healthcare access and address the mental health of undocumented populations. In particular, issues of discrimination, stigma by healthcare providers, and medical mistrust need to be addressed.

The Influence of Deferred Action for Childhood Arrivals on Undocumented Asian and Pacific Islander Young Adults: Through a Social Determinants of Health Lens.

PURPOSE: There is an urgent need to provide evidence-based policies to address the health of the 11.7 million undocumented immigrants in the United States. Deferred Action for Childhood Arrivals (DACA) offers temporary relief to qualified undocumented immigrants. Asians and Pacific Islanders (APIs), in particular, are the fastest growing immigrant population; yet, little is known about their health challenges. This article examines the influence of DACA on the health of API undocumented young adults. METHODS: In total, 32 unique participants participated in 24 in-depth interviews and four focus group discussions. Participants were aged 18-31 years and identified as undocumented API. RESULTS: DACA potentially improves health outcomes through four potential social determinants: economic stability, educational opportunities, social and community contexts, and access to health care. These determinants improve the mental health and sense of well-being among undocumented young adults. CONCLUSIONS: Targeted outreach and education in communities should be informed by these research findings with an eye toward promoting the economic, education, and health benefits of enrolling in DACA. Social policies that address the social determinants of health have significant potential to address health inequities.