Interplay of premigration crisis exposure and postmigration cultural stress on depressive symptoms among Venezuelan crisis migrants in Colombia.

OBJECTIVES: A growing body of research points to a relationship between exposure to migration-related cultural stress and mental health problems. However, such research is often conducted with the tacit assumption that postmigration experiences are the primary-if not singular-driver of psychological distress. In the present study, we aim to extend the cultural-stress paradigm by examining the influences of both premigration crisis exposure and postmigration cultural stress on depression in a sample of Venezuelan crisis migrants in Colombia. METHOD: Survey data for the present study were collected from Venezuelan youth (N = 429, ages 12-17, Mage = 14.0 years, 49% female) and adults (N = 566, ages 18+, Mage = 35.1 years, 82% female) in Bogota and Medellin, Colombia between April and June 2023. RESULTS: Both crisis exposure and discrimination were independently related to depressive symptoms. However, when examined in a multivariate model along with discrimination, crisis exposure was not a significant predictor of depressive symptoms among youth, and its influence weakened considerably among adults. Among both youth and adults, a Crisis Exposure × Discrimination interaction term significantly predicted depressive symptoms, indicating that discrimination was a more robust predictor of depressive symptoms among those endorsing lower levels of crisis exposure than among those reporting high levels of crisis exposure. CONCLUSION: Our research provides new insights into the experiences of Venezuelan migrant youth and adults in Colombia. It provides further support for the importance of drawing from a crisis-informed cultural-stress framework when working with crisis migrant populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Online xenophobia and mental health among Venezuelan migrant youth in Colombia: The interplay with "in-person" discrimination.

Emerging research provides insights into migration-related cultural stress experiences and mental health among Venezuelan migrants; however, prior studies have not considered the critical distinction between online xenophobia and in-person discrimination. To address this gap, we assess the psychometric properties of an abbreviated version of the Perceived Online Racism Scale (PORS) with Venezuelan migrant youth and examine the interplay between online xenophobia, in-person discrimination, and mental health. Survey data were collected from Venezuelan migrant youth (N = 319; ages 13-17, 49.5% female) in Colombia in April-July 2023. Confirmatory factor analysis (CFA) was used to examine the PORS, and multiple regression was conducted to examine key associations. The CFA showed excellent model fit: χ²(7) = 13.498, p = .061; comparative fit index = .989; Tucker-Lewis index = .977; root-mean-square error of approximation = .055; standardized root-mean-square residual = .026. Controlling for demographic factors, online xenophobia was associated with depressive symptoms (ß = .253, p < .001) and anxiety (ß = .200, p = .001). The online xenophobia-mental health association weakened when controlling for in-person discrimination but remained nevertheless significant (depression: ß = .181, p = .002, anxiety: ß = .135, p = .026). Interaction effects (Online × In-Person) revealed a pattern in which greater exposure to online xenophobia was associated with greater distress, but only at relatively low levels of in-person discrimination. Findings provide new insights regarding (a) the properties of an increasingly relevant measure of cultural stress, (b) how online xenophobia relates to mental health, and (c) the interplay of online and in-person cultural stressors vis-à-vis mental health among Venezuelan migrant youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Crisis Migration Experience Scale: Developing and validating a tool for Venezuelan youth and adults residing in Colombia.

OBJECTIVE: Although prior research has shown that an array of distinct experiences related to crisis migration are associated with mental health, there is a pressing need for a theory-driven, multidimensional measure to assess the broad spectrum of crisis migration experiences. As such, the present study focused on developing and validating the Crisis Migration Experience Scale (CMES) with a sample of Venezuelan migrants in Colombia. METHOD: Participants were adolescent (ages 12-17; n = 430) and adult migrants from Venezuela (ages 18+; n = 569). Randomly splitting the adolescent and adult samples in half, exploratory factor analysis and confirmatory factor analyses were conducted with 26 original items. After identifying a satisfactory factor structure to generate a 16-item CMES (CMES-16), we examined the associations of the CMES-16 with mental health outcomes. RESULTS: We provide evidence for reliability, factorial validity, and concurrent validity of scores generated by the CMES-16 in a sample of Venezuelan crisis migrants in Colombia. Whereas our a priori conceptualization included seven domains, the exploratory and confirmatory factor analyses indicated that four are especially salient: material hardship, desperation, danger, and unplanned departure. CONCLUSIONS: Crisis migration is an increasingly important construct frequently referenced in the literature on migrant health and by international humanitarian organizations. The number of crisis migrant groups worldwide is increasing, with Ukrainians and Afghans recently added to the list of such groups, along with Venezuelans, Syrians, South Sudanese, Iraqis, and Central Americans. Developing and validating the CMES-16 with Venezuelan crisis migrants opens up important avenues of research, including work that incorporates other crisis migrant populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Experiences of cultural stress among U.S. citizen migrants: A mixed method approach.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico, devastating the archipelago and forcing thousands of Puerto Ricans to migrate to the U.S. mainland. Guided by a cultural stress theory framework, the present mixed method study examined how various cultural stressors impact participants' daily interactions and mental health outcomes. A total of 319 adult Hurricane Maria survivors residing on the U.S. mainland participated in the study. A mixed method sequential explanatory design was used. First, we used latent profile analysis (LPA) and multinomial logistic regression to identify the varied cultural stress experiences that participants had. Then we used data from semistructured interviews to better understand the experiences of participants classified into the different LPA profiles. Four profiles were identified: "moderate cultural stress" (35%), "overall low" (29%), "high cultural stress" (26%), and "low language stress" (10%). Multinomial regression indicated that members of the moderate cultural stress, high cultural stress, and low language stress profiles all reported significantly higher depressive and anxiety symptoms compared to members of the overall low profile. Qualitative data exemplified the daily experiences of participants placed into each profile, demonstrating that participants have rich and varied experiences that can contribute to their mental health symptoms. The present study documents the contributions of hurricane trauma and cultural stress vis-à-vis current mental health symptoms. Clinicians working with Hurricane Maria survivors should be cognizant of and inquire about migration-related cultural stressors including discrimination, feelings of being unwelcomed, and difficulty communicating in the destination community's dominant language. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring Anxiety Among Latino Immigrant Populations: Within-Country and Between-Country Comparisons.

Anxiety is the most prevalent mental health disorder among adults worldwide. Given its increased prevalence among migrants due to their marginalized position in the societies where they reside, psychometric evaluations of anxiety measures such as the Generalized Anxiety Disorder-7 (GAD-7) are needed for use with migrants. The present study is the first attempt to compare the structure of GAD-7 scores for (a) different Latino groups in the same country and (b) the same Latino group in two different countries. Using three samples of Mexican and Venezuelan migrants (total N = 933), we provide reliability and validity evidence of the GAD-7 for use with adult Latino migrants. Utilizing confirmatory factor analysis and item response theory, we demonstrate that the GAD-7 is internally consistent, possesses a strong single-factor structure, and generates scores with equivalent psychometric properties. GAD-7 is appropriate for use with Mexican and Venezuelan migrants across differing gender groups and education levels.

A machine learning approach using migration-related cultural stress to classify depression and post-traumatic stress disorder among hurricane survivors.

BACKGROUND: Data science approaches have increasingly been used in behavioral health research and may be useful for addressing social factors contributing to disparities in health status. This study evaluated the importance of cultural stress-related factors in classifying depression and post-traumatic stress disorder (PTSD) among adult survivors (N = 319) of Hurricane Maria who migrated from Puerto Rico to the United States mainland. METHODS: We evaluated the performance of random forests (RF) and logistic regression (LR) for classifying PTSD and depression. Models included demographic, hurricane exposure, and migration-related cultural stress variables. We inspected area under the receiver operating characteristic curve (AUC), accuracy, balanced accuracy, F1 score, precision, recall, and specificity. RESULTS: Negative context of reception and language-related stressors were moderately important for accurately classifying depression and PTSD. For classifying depression, RF showed higher accuracy, balanced accuracy, specificity, precision, and F1. For classifying PTSD, RF showed higher accuracy, specificity, precision, and F1. LIMITATIONS: A more thorough classification model would also include biomarkers (e.g., of allostatic load), family, community, or neighborhood-level attributes. Findings may not generalize to other groups who have experienced crisis-related migration. CONCLUSIONS: Findings underscore the importance of culturally and linguistically appropriate and trauma-informed clinical services for recent migrants. Use of assessments to identify pre-migration and post-migration stressors could inform clinical practice with migrants presenting with behavioral health-related difficulties.

The impact of hurricane trauma and cultural stress on posttraumatic stress among hurricane Maria survivors relocated to the U.S. mainland.

OBJECTIVES: Following Hurricane Maria, scores of Puerto Rican "Maria migrants" fled the island with thousands permanently resettling on the United States (U.S.) mainland. Emerging evidence suggests that many Maria migrants are exposed to migration-related cultural stressors, including discrimination, negative context of reception, and language stress. The present study examines the associations of premigration hurricane trauma and postmigration cultural stress with posttraumatic stress disorder (PTSD) symptom severity and positive PTSD screens. METHOD: Participants were 319 adult (age 18+, 71% female) Puerto Rican Hurricane Maria survivors on the U.S. mainland. Data were collected virtually between August 2020 and October 2021. Participants completed Spanish-language measures of hurricane-related trauma, postmigration cultural stress exposure, PTSD symptoms, and positive screens. RESULTS: One in five (20.5%) Maria migrants reported PTSD scores in the range indicating a likely PTSD diagnosis (i.e., positive screen of 50+). Both hurricane trauma and migration-related cultural stressors independently predicted posttraumatic stress and positive PTSD screens. Additionally, controlling for the effect of hurricane trauma, discrimination and language stress were strongly linked with PTSD. Further, hurricane trauma and cultural stressors interact such that cultural stress predicts PTSD-positive screens at low-to-moderate levels of hurricane trauma exposure but not at high-to-very-high levels. CONCLUSION: Findings underscore the importance of providing mental health and other psychosocial supports to hurricane survivors and evacuees beyond the immediate aftermath of the disaster, and the need to consider both premigration trauma and postmigration experiences in terms of the mental health of crisis migrant populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program.

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.

The importance of acculturation orientation in understanding the impact of pre- and post-migration stressors on behavioral health: Evidence from a crisis migrant sample.

OBJECTIVE: We examine the interplay of acculturation orientation, cultural stress, and hurricane trauma exposure with behavioral health among Puerto Rican crisis migrants who relocated to the US mainland after Hurricane Maria. METHOD: Participants were 319 adult (Mage = 39 years; 71% female; 90% arriving in 2017-2018) Hurricane Maria survivors surveyed on the US mainland. Latent profile analysis was used to model acculturation subtypes. In turn, ordinary least squares regression was executed to examine the associations of cultural stress and hurricane trauma exposure with behavioral health while stratifying by acculturation subtype. RESULTS: Five acculturation orientation subtypes were modeled, three of which-Separated (24%), Marginalized (13%), and Full Bicultural (14%)-align closely with prior theorizing. We also identified Partially Bicultural (21%) and Moderate (28%) subtypes. Stratifying by acculturation subtype, with behavioral health (depression/anxiety symptoms) specified as the dependent variable, hurricane trauma and cultural stress accounted for only 4% of explained variance in the Moderate class, a somewhat greater percentage in the Partial Bicultural (12%) and Separated (15%) classes, and substantially greater amounts of variance in the Marginalized (25%) and Full Bicultural (56%) classes. CONCLUSION: Findings underscore the importance of accounting for acculturation in understanding the relationship between stress and behavioral health among climate migrants.

Hurricane stress, cultural stress, and mental health among hurricane Maria migrants in the U.S. mainland.

Hurricane Maria (2017) caused great damage to Puerto Rico, undermining people's quality of life and forcing thousands to migrate to the U.S. mainland. Identifying individuals at elevated risk of suffering mental health problems as a function of being exposed to hurricane and cultural stress is crucial to reducing the burden of such health outcomes. The present study was conducted in 2020-2021 (3-4 years postdisaster) with 319 adult Hurricane Maria survivors on the U.S. mainland. We aimed to (a) identify latent stress subgroups, as defined by hurricane stress and cultural stress, and (b) map these latent stress subgroups or classes onto sociodemographic characteristics and mental health indicators (i.e., symptoms of posttraumatic stress disorder, depression, and anxiety). We used latent profile analysis and multinomial regression modeling to accomplish the study aims. We extracted four latent classes: (a) low hurricane stress/low cultural stress (44.7%), (b) low hurricane stress/moderate cultural stress (38.7%), (c) high hurricane stress/moderate cultural stress (6.3%), and (d) moderate hurricane stress/high cultural stress (10.4%). Individuals in the low hurricane stress/low cultural stress class reported the highest household incomes and levels of English-language proficiency. The moderate hurricane stress/high cultural stress class reported the worst mental health outcomes. While postmigration cultural stress, as a chronic stressor, emerged as the most important predictor of poor mental health, hurricane stress, as an acute stressor that occurred several years earlier, emerged as less influential. Our findings might be used to inform mental health prevention experts who work with natural disaster survivors forced to migrate. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents.

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

After Hurricane Maria: Effects of disaster trauma on Puerto Rican survivors on the U.S. mainland.

PURPOSE: In September 2017, Hurricane Maria devastated Puerto Rico. Houses were destroyed, millions of people lost power and access to clean water, and many roads were flooded and blocked. In the years following the storm, hundreds of thousands of people have left Puerto Rico and settled on the U.S. mainland. The purpose of this study is to examine the impact of disaster trauma among Puerto Rican adults who moved to the U.S. mainland after Hurricane Maria. METHOD: Participants were 319 adult Puerto Rican Hurricane Maria survivors on the U.S. mainland. Women comprised 71.2% of the sample. Data were collected between August 2020 and October 2021. Participants completed Spanish-language measures of hurricane-related trauma, perceived ethnic discrimination and negative context of reception on the U.S. mainland, language stress, depressive symptoms, anxiety, optimism, life satisfaction, and problem drinking. RESULTS: We estimated a structural equation model where hurricane trauma predicted cultural stress, which in turn predicted internalizing symptoms, optimism, and life satisfaction. Internalizing symptoms, optimism, and life satisfaction were specified as predictors of problem drinking. Results indicated that hurricane trauma predicted cultural stress. Cultural stress predicted internalizing symptoms, optimism, and life satisfaction. Internalizing symptoms predicted problem drinking. Hurricane trauma indirectly predicted internalizing symptoms through cultural stress and indirectly predicted problem drinking through cultural stress and internalizing symptoms. CONCLUSIONS: Traumatic experiences from the storm may predispose Puerto Rican Hurricane Maria survivors to perceive cultural stress on the U.S. mainland. In turn, cultural stressors may be associated with internalizing symptoms and alcohol problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Venezuelan diaspora: Migration-related experiences and mental health.

Since 2015, the Venezuelan diaspora has poured forth from the Venezuelan sending context into an array of (mostly) middle-income receiving countries and into the United States (US) as well. For many Venezuelan migrants, post-migration reception has been mixed, and multiple studies suggest that mental health is an important challenge with discrimination and negative context reception contributing to mental health burden in terms of depression, anxiety, and posttraumatic stress. Cross-national research points to important sociodemographic differences between Venezuelan migrants resettled in South American contexts and in the US, and suggests that-on average-migration-related cultural stress is lower and mental health outcomes are better among those resettling in South Florida and elsewhere in the US.

Cultural Stress Theory in the Context of Family Crisis Migration: Implications for Behavioral Health with Illustrations from the Adelante Boricua Study.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico as a Category 4 hurricane with sustained winds of 155 miles per hour and torrential rains that ravaged the United States territory. In the midst of the crisis, several hundred thousand Maria survivors boarded humanitarian flights and cruise ships, seeking refuge on the United States mainland. More than three years later, tens of thousands of post-Maria migrants remain on the mainland as long-term emigres. In this article, we lay the theoretical/conceptual groundwork for researchers and practitioners interested in understanding the experiences of post-Maria migrants. Specifically, we aim to assist readers in thinking deeply about: [1] why many Puerto Ricans relocated, [2] the experiences of post-Maria migrants en movimiento, and [3] how such experiences shape their lives, behavior, and well-being. In understanding the experiences of post-Maria migrants, several theories/constructs emerge as especially salient. These include "push and pull" models, cultural stress theory and its transnational variants, the concept of crisis migration, and models of cumulative risk. We provide a succinct overview of each of these theories/constructs and describe the broad perspectives that serve as a foundational or orienting paradigm for our work (i.e., the life course perspective, the strengths perspective, and an ecodevelopmental framework). Finally, we provide illustrations of how these theories/concepts apply to emerging data from the Adelante Boricua study, an ongoing research project with post-Maria migrant youth and their parents, supported by funding from the National Institute on Minority Health and Health Disparities.

The family crisis migration stress framework: A framework to understand the mental health effects of crisis migration on children and families caused by disasters.

Crisis migration refers to displacement of large numbers of individuals and families from their home countries due to wars, dictatorial governments, and other critical hazards (e.g., hurricanes). Although crisis migration can adversely influence direct and indirect effects on the mental health of adults and their children collectively as families, there is a deficiency in theory that addresses family level processes in this crisis migration context. We propose the Family Crisis Migration Stress Framework, which consolidates what is known about the multiple factors affecting mental health outcomes of crisis migrants into one cohesive model. In our article, we synthesize relevant theories and models of disaster, migration, and family resilience in order to create a framework in which to organize the complex processes that occur within families as a result of migration and that affect the mental health of children. We include examples from various national settings to illustrate the tenets of our framework. Future policy and intervention for crisis migrant should focus on the family as a unit, instead of parents and children as individual entities.

Health risk behavior and cultural stress among Venezuelan youth: a person centered approach.

BACKGROUND: In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited. OBJECTIVES: Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support). METHOD: Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male). RESULTS: We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US. CONCLUSION: It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.

Cultural Stress and Substance Use Risk among Venezuelan Migrant Youth in the United States.

BACKGROUND: Since 2015, more than four million Venezuelans have fled their once prosperous nation, prompting an ever-intensifying refugee crisis. Recent research with Venezuelan parents suggests that many are exposed to elevated migration-related stress, experience behavioral health problems, and express profound concern for their children's post-migration wellbeing. We examine the relationships between stress, family functioning, and substance use risk with a cultural stress theoretical lens. Methods: Survey data were collected between November 2018 and June 2019 from 402 recently-arrived Venezuelan immigrant youth ages 10-17. Outcomes include perceived discrimination, negative context of reception, family support/communication, and substance use intentions and normative beliefs. Structural equation modeling was used to examine the relationships between variables. Results: Structural equation modeling results indicated that negative context of reception was associated with permissive substance use norms (via family communication; B = 0.070, p < .01) and intentions to use (via family support; B = 0.051, p < .01). Discrimination was not mediated by family functioning, rather it exerted a direct effect on substance use norms (ß = 0.20, p < .01) and intentions (ß = 0.33, p < .001). Discussion: We see clear evidence that negative context of reception and discrimination are related to substance use risk, both directly (in the case of discrimination) and indirectly (in the case of negative context of reception). Given the manifold stressors faced by Venezuelan immigrants both prior to migration and in the process of resettling in the US, it is critical that practitioners and policymakers support this rapidly-growing population.

Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force.

Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.