Latinx Youth's Mental Health Needs and Socioeconomic Factors Associated with Service Utilization.

This study examined mental health needs and risk factors associated with service use among Latinx high school students in two cities in the United States. We explored how socioeconomic characteristics, school location, youth and parental nativity, and self-perceived clinical needs were associated with the odds of youths seeing a mental health provider. Data were collected from 306 Latinx youths during the 2018-19 school year. Most youths (78%) self-reported symptoms of anxiety, trauma, or depression above the clinical range. None of these clinical needs predicted service utilization. Youth experiencing less economic hardship and having a mother from South America were almost five times more likely to use services than their counterparts. Similarly, males and older respondents were more likely to be underserved than females and younger respondents. Implications to ensure equitable access to services among older, low-income Latinx youth, particularly those from Central America, the Caribbean, and Mexico, are discussed.

Evaluating the Role of Anxiety Sensitivity on Behavioral Health Outcomes among Latinx Persons.

Background: Mexican Americans represent the largest subpopulation among Latinx persons and experience numerous health inequalities for psychological symptoms and behavioral health problems. First generation Mexican Americans are particularly vulnerable to such disparities and past work suggests that the experience of acculturative stress may play a vital role in terms of mental and physical health problems among this population. The current study sought to bridge past work on acculturative stress among first-generation Mexican Americans by exploring the role of anxiety sensitivity (AS; fear of the negative consequences of internal sensations) as a potential mediational factor in terms of psychological and behavioral health problems among this group. Methods: The current study consisted of 369 first generation Mexican American persons (86.2% female, 40.1 years of age (SD = 11.1) years in the U.S. attending a Federally Qualified Healthcare Center located in an urban southwestern community. We explored whether AS served as a mediator between acculturative stress and some of the most common and disabling clinical problems among this group, including social anxiety, anxious arousal, general depression, insomnia and pain intensity and disability. Result: Consistent with prediction, there was a statistically significant indirect effect of acculturative stress via AS across all criterion variables apart from pain intensity (depression [ab = - 0.17, SE = 0.05, 95% CI [0.08, 0.26]], insomnia [ab = 0.07, SE = 0.02, 95% CI [0.03, 0.10]], social anxiety [ab 0.05, SE = 0.02, 95% CI [0.02, 0.08]], anxious arousal [ab = 0.08, SE = 0.03, 95% CI [0.03, 0.12]], pain disability [ab = 0.05, SE = 0.02, 95% CI [0.02, 0.09]]). Comparative models were run to evaluate the specificity of hypothesized statistically significant models. For all models except anxious arousal and general depression, the alternative model was rejected, adding support to the hypothesized pathway. Conclusion: Overall, this work provides initial support for the role of AS in terms of the relation between acculturative stress and numerous psychological and behavioral health problems among Mexican American adults in a clinical setting.

Psychological Distress and Physical Health Symptoms in the Latinx Population During the COVID-19 Pandemic: Exploring the Role of Anxiety Sensitivity.

OBJECTIVE: The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial physical and mental health consequences. Rates of mortality and hospitalization are highest among those of racial and ethnic minority persons, including Latinx persons. Further, Latinx persons have been experiencing elevated mental health problems in response to the pandemic compared to non-Latinx Whites. The current study examined whether individual differences in anxiety sensitivity (AS) related to more severe emotional distress associated with social distancing, financial strain, fear of COVID-19, and physical health symptoms stemming from the COVID-19 pandemic among Latinx adults. METHODS: Participants included 188 Latinx persons (31.4% female, M age = 34.1 years, SD = 8.16) recruited via an online survey panel program. RESULTS: Results indicated that AS significantly contributed to increased severity of the emotional stress response associated with social distancing (ΔR 2 = 0.15, p < 0.001), financial strain (ΔR 2 = 0.15, p < 0.001), physical health symptoms (ΔR 2 = 0.03, p = 0.006), and fear of COVID-19 (ΔR 2 = 0.15, p < 0.001). These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and work and home life COVID-19-related stress. CONCLUSIONS: These cross-sectional findings suggest AS may be an important individual difference factor for better understanding mental health among Latinx persons in the context of the COVID-19 pandemic.

Discrimination and PTSD among Latinx immigrant youth: The moderating effects of gender.

OBJECTIVE: Discrimination is a minority-related stressor that contributes to mental health disparities between Latinx youth and their racial/ethnic peers. Discrimination activates the body's stress response system, resulting in a higher allostatic load that can cause mental health problems such as PTSD. We explored 1) the relation between perceived discrimination and PTSD symptoms among Latinx immigrant youth, and 2) how gender moderates this relation. METHODS: We conducted surveys with 306 Latinx first- and second-generation immigrant youth during the 2018-19 school year in Harris County, Texas and Rhode Island. RESULTS: We found that youth who perceived more discrimination were more likely to report PTSD symptoms. Female participants reported higher levels of PTSD symptoms than males, including higher levels of avoidance and reexperiencing symptoms. Perceived discrimination was associated with increased PTSD symptoms, including hypervigilance and avoidance symptoms, for female participants but not males. These interactions did not differ by location. CONCLUSION: These results further provide support for research into discrimination as a potentially traumatic experience linked to PTSD and underscore the importance of including discrimination in assessments of trauma and adverse childhood outcomes among Latinx immigrant youth. Results further suggest the importance of an intersectional approach to understanding how discrimination relates to PTSD among Latinx immigrant youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Immigration Enforcement Fear and Anxiety in Latinx High School Students: The Indirect Effect of Perceived Discrimination.

PURPOSE: Immigration enforcement policies and negative rhetoric about immigrants harm the psychological well-being of Latinx youth in immigrant families, particularly those who are most vulnerable because of their own or their loved ones' legal status. According to the Integrative Model for the Study of Developmental Competencies among Minority Children, discrimination may be one pathway to explain how vulnerability to restrictive immigration policies affects Latinx youth mental health. METHODS: We collected data from 306 Latinx high school students from immigrant families in Harris County, Texas, and Rhode Island to (1) determine the direct effect of immigration enforcement fear (a proxy for the social position of vulnerable legal status) on adolescents' anxiety; (2) explore the effect of immigration enforcement fear on anxiety through the pathway of perceived discrimination; and (3) test whether the different enforcement climates in the two study sites moderate these pathways. Total anxiety and subscales measuring separation, social, school, generalized, and somatic anxiety subtypes were analyzed. RESULTS: Immigration enforcement fear was related to increased somatic and separation anxiety in both first- and second-generation Latinx adolescents. Perceived discrimination partially mediated the association between immigration enforcement fear and separation and somatic anxiety; data collection site did not moderate these effects. CONCLUSIONS: Immigration policies and rhetoric have psychological consequences. Although the adolescents in our study face multiple stressors, immigration enforcement fear may heighten their perception of discrimination, in turn, likely elevating their physiological and family separation anxiety.

Association between generational status and smoking behaviors before and during pregnancy among Hispanic women.

BACKGROUND: Evidence is limited on the risk of maternal smoking before and during pregnancy across generations of Hispanic immigrants. PURPOSE: The aim of this study was to determine whether immigration generational status predicts maternal smoking behaviors before and during pregnancy among Hispanic women. METHODS: Data on pregnancies in National Longitudinal Survey of Youth 1979 were used. Current study sample consists of Hispanic women (15-24 years) reporting pregnancy between 1979 and 2014 (n = 616). Data on birthplaces of the respondent and their parents were used to determine generation status. Maternal smoking behaviors before and during pregnancy were self-reported. Data were analyzed using weighted covariate-adjusted logistic regression models. RESULTS: There were 24% first-generation, 20% second-generation, and 56% third or higher generation Hispanic women in the sample. Majority of participants were married (72%), with a high school degree or more (69%), and of Mexican origin (56%). After controlling for covariates, first generation Hispanic women had lower likelihood of smoking prior to (OR = 0.40, p = 0.009) and during pregnancy (OR = 0.35, p = 0.007) compared to third or higher generation women. The second-generation women had lower likelihood of smoking during pregnancy (OR = 0.46, p = 0.038) compared to third or higher generation women. CONCLUSIONS: First generation Hispanic women are at lower risk of smoking both prior to and during pregnancy. Identification of cultural factors discouraging smoking during pregnancy among first/second generation Hispanic women and incorporating in smoking prevention interventions targeting Hispanic women could benefits the later generations of Hispanic immigrants.

Integration of Unaccompanied Migrant Youth in the United States: A Call for Research.

Between October 2013 and July 2016, over 156,000 children traveling without their guardians were apprehended at the US-Mexico border and transferred to the care of the Office of Refugee Resettlement (ORR). During that same period, ORR placed over 123,000 unaccompanied migrant youth-predominantly from Central America-with a parent or other adult sponsor residing in the US. Following placement, local communities are tasked with integrating migrant youth, many of whom experience pre- and in-transit migration traumas, family separation, limited/interrupted schooling, and unauthorised legal status, placing them at heightened risk for psychological distress, academic disengagement, maltreatment, and human trafficking. Nonetheless, fewer than 10% of young people receive formal post-release services. This paper addresses the paucity of research on the experiences of the 90% of children and youth without access to post-release services. To bridge this gap, this article: (a) describes the post-release experiences of unaccompanied youth, focusing on legal, family, health, and educational contexts; (b) identifies methodological and ethical challenges and solutions in conducting research with this population of young people and their families; and (c) proposes research to identify structural challenges to the provision of services and to inform best practices in support of unaccompanied youth.

Anxiety sensitivity and acculturative stress among trauma exposed Latinx young adults.

There are elevated rates of trauma exposure, posttraumatic stress symptoms, and greater conditional risk of posttraumatic stress disorder among Latinx relative to other racial/ethnic groups. Such trauma-related health disparities serve to exacerbate or maintain acculturative and other types of stress among the Latinx population. Yet, little research has explored what types of individual difference factors may undergird variability in acculturative stress among trauma-exposed Latinx persons. Accordingly, the present investigation examined individual differences in anxiety sensitivity (fear of the negative consequences of stress sensations) in relation to acculturative stress among a large sample of trauma-exposed Latinx young adults (n = 1,377 persons; Mage = 21.01; SD = 2.50; age range: 18-29 years; 76.7% female). Results demonstrated that anxiety sensitivity explained 10.2% of unique variance in acculturative stress (p < .001, adjusted R² = .188) after accounting for age, sexual minority status, history of trauma exposure, and posttraumatic stress symptom severity. Additionally, each of the 3 subfactors of anxiety sensitivity (Physical, Cognitive, and Social) were directly related to acculturative stress despite sharing variance with one another. Overall, the current findings suggest that anxiety sensitivity may be a heretofore underrecognized individual difference factor that is related to more severe acculturative stress among trauma-exposed Latinx young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Acculturative stress, emotion regulation, and affective symptomology among Latino/a college students.

Although recent work has highlighted the relation of acculturative stress with depression and anxiety symptoms specifically among Latino/a university students, the potential mechanisms underlying these associations remain relatively unknown. The present study aims to examine difficulties in emotion regulation as an explanatory factor in the relation of acculturative stress with symptoms of depression, suicidality, social anxiety, and anxious arousal. A sample of 448 Latino/a college students (Mage = 20.67 years, SD = 1.96; 78.3% female) were recruited from a southwestern public university through an online, self-report survey. Indirect effects of acculturative stress via difficulties in emotion regulation on all outcomes were observed among males and females. Follow-up analyses showed the indirect effect on all dependent variables among Latino men occurred exclusively through lack of access to emotion regulation strategies, whereas the indirect effects among Latina women occurred through a different subfactor of difficulties in emotion regulation for each dependent variable. These findings suggest the potential clinical utility of assessing and targeting acculturative stress and difficulties in emotion regulation in the treatment of depression and anxiety problems among Latino/a college students. (PsycINFO Database Record

Acculturative stress and mental health among economically disadvantaged Spanish-speaking Latinos in primary care: The role of anxiety sensitivity.

The present study examined the role of anxiety sensitivity in the relation between acculturative stress and mood and anxiety symptoms and disorders among Latinos seeking health services at a primary healthcare facility. Participants included 142 adult Latinos (86.6% female, Mage = 39.05 years, SD = 12.46%, and 96.3% reported Spanish as their first language). Results indicated that acculturative stress was indirectly related to the number of mood and anxiety disorders, anxious arousal, social anxiety, and depressive symptoms through anxiety sensitivity. The observed effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and negative affectivity. Overall, the present findings suggest that there is merit in focusing further scientific attention on the interplay between acculturative stress and anxiety sensitivity to better understand and inform interventions to reduce anxiety/depressive vulnerability among Latinos in primary care.

General and Ethnic-Biased Bullying Among Latino Students: Exploring Risks of Depression, Suicidal Ideation, and Substance Use.

Using a cross-sectional sample of 534 Latino students from middle and high schools in a large North Carolina school district, we examined the relation of general and ethnic-biased bullying to depression and the indirect pathways through depression to suicidal ideation and substance use outcomes. A structural equation model tested the direct and indirect paths. The final model fit was excellent, χ2(90) = 127.6, p = .0056, RMSEA = 0.028, CFI = 0.974, TLI = 0.961. Ethnic-biased and verbal or relational bullying had a direct effect on depression, but general and physical bullying did not. Indirect effects through depression were found for ethnic-biased and verbal or relational bullying in relation to suicidal ideation, alcohol, and illicit drug use. Child nativity was marginally associated with ethnic-biased bullying, indicating foreign-born students may experience greater ethnic-biased bullying. Implications for future research and bullying prevention are discussed.

Clarifying the relation of acculturative stress and anxiety/depressive symptoms: The role of anxiety sensitivity among Hispanic college students.

OBJECTIVES: Recent work has highlighted the link between acculturative stress and depression/anxiety symptoms among Hispanic young adults, but the nature of these relations is not well understood. The present study aimed to clarify the relation between acculturative stress and depression/anxiety symptoms by examining anxiety sensitivity, globally and via subfactors, as an explanatory variable. METHOD: A cross-sectional sample of 788 Hispanic college students (80.8% female; Mage = 20.83 years, SD = 1.93) was recruited from a southwestern public university and completed an online self-report assessment battery. RESULTS: Acculturative stress exerted an indirect effect, via the global construct of anxiety sensitivity, on depression symptoms, suicidality, anxious arousal, and social anxiety symptoms. Follow-up simultaneous analytic models demonstrated indirect effects via the anxiety sensitivity subfactors that were pathognomonic with each of the specific affective outcomes. CONCLUSIONS: These findings suggest the utility of assessing and targeting anxiety sensitivity in the treatment of acculturative stress-related depression/anxiety problems among Hispanic college students. (PsycINFO Database Record

Rumination and PTSD symptoms among trauma-exposed Latinos in primary care: Is mindful attention helpful?

The present investigation examined the moderating role of mindful attention in the relation between rumination and posttraumatic stress (PTS) symptoms (i.e., re-experiencing, avoidance, arousal, and total PTSD symptoms) among trauma-exposed Latinos in a primary care medical setting. It was hypothesized that mindful attention would moderate, or lessen, the relation between rumination and all facets of PTS, even after controlling for clinically relevant covariates. Participants included 182 trauma-exposed adult Latinos (89.0% female; Mage = 37.8, SD = 10.6% and 95.1% reported Spanish as their first language) attending a community-based integrated healthcare clinic in the Southwestern United States. Mindful attention was a significant moderator of relations between rumination and all PTS facets. Specifically, rumination and PTSD symptoms were significantly related yet only in the context of low (vs. high) levels of mindful attention. Mindfulness-based skills may offer incremental value to established treatment protocols for traumatic stress, especially when high levels of rumination are present. Rumination may also serve to identify those who are at greatest risk for developing PTSD after trauma exposure and, therefore, most likely to benefit from mindfulness-based strategies.

Emotional nonacceptance within the context of traumatic event exposure: The explanatory role of anxiety sensitivity for traumatic stress symptoms and disability among Latinos in a primary care setting.

OBJECTIVE: Research has found that Latinos (versus non-Latino Whites) evince higher rates of posttraumatic stress symptoms (PTS) and posttraumatic stress disorder (PTSD), yet little attention has been given to intra-individual, emotion-related processes to explicate the higher incidence of these symptoms among Latinos. METHOD: Participants included 183 trauma-exposed adult Latinos (88.5% female; Mage=37.7, SD=10.7 and 93.4% reported Spanish as their first language) who attended a community-based primary healthcare clinic in Houston. It was hypothesized that anxiety sensitivity would explain the relation between emotional nonacceptance and traumatic stress symptoms, namely re-experiencing, avoidance, and arousal difficulties as well as overall disability. Additionally, it was expected that the observed effects would be evident above and beyond the variance accounted for by number of traumas reported, gender, age, marital status, educational status, years living in the U.S., and negative affectivity. RESULTS: Consistent with our hypotheses, difficulties accepting negative emotions were associated with increased trauma-related re-experiencing, avoidance, and arousal difficulties. Additionally, anxiety sensitivity was an underlying mechanism in the association between emotional nonacceptance and all but one facet of traumatic stress symptoms (i.e., re-experiencing symptoms) and disability. Alternative models yielded no significant effects, providing greater confidence in the direction of the hypothesized effects. CONCLUSION: Findings are discussed in the context of their significance for informing the development of specialized intervention strategies that target anxiety sensitivity for Latinos in primary care with elevated risk for PTS and PTSD by their heightened levels of emotional nonacceptance.

Stress and Multiple Substance Use Behaviors Among Hispanic Adolescents.

Hispanic adolescents reported a higher annual prevalence of use of nearly all major drugs compared to non-Hispanic White and African American adolescents. Cultural or minority stressors, such as those related to the acculturation process, discrimination, immigration, poverty, and community violence, have been implicated in these outcomes. Unfortunately, few studies have examined how these stressors may have a differential or additive effect when considered simultaneously. The current study examined the relation between stress and multiple substance use behaviors in a sample of Hispanic adolescents (n = 1036), age 11-19 years old. Latent class analysis identified subgroups of Hispanic adolescents based on combinations of substance use behaviors. General linear models were used to examine mean differences by class among the eight domains of stress. Fit statistics revealed a six-class structure: no substance use risk, predominately alcohol use, low polysubstance use, high polysubstance use, illicit drug use, and predominately marijuana use. Differences in stress across the six classes were identified for four of the eight domains: family economic, acculturation gap, community and gang, and family and drug stress. The effect sizes revealed the largest mean differences in stress between the no substance use group and the two polysubstance use groups and between the no risk group and alcohol use group. The findings from this study support the use of interventions that target stress to affect multiple substance use behaviors in Hispanic adolescents.

Effects of Parent Immigration Status on Mental Health Service Use Among Latino Children Referred to Child Welfare.

OBJECTIVE: Latino families may be at risk of experiencing stressors resulting from the immigration process, such as those related to documentation status and acculturation, that may increase their need for mental health services. However, little research exists on the mental health needs and service use of Latino children. This study examined how parental nativity and legal status influence mental health needs and service utilization among children in Latino families investigated by child welfare. METHODS: Data from the second National Survey of Child and Adolescent Well-Being, a nationally representative, prospective study of families investigated by child welfare agencies for maltreatment, were used to examine mental health need and service use in a subset of Latino children who remained in the home following a maltreatment investigation (N=390). RESULTS: Although children of immigrants did not differ from children of U.S.-born parents in levels of clinical need, they had lower rates of mental health service receipt. After the analyses accounted for other relevant variables, the odds of receiving services were significantly lower (odds ratio=.09) for children whose parents were undocumented compared with children whose parents were U.S. citizens. CONCLUSIONS: This study contributes to growing discourse on Latino family needs within the child welfare system. Analyses support earlier research regarding the effects of parent nativity on mental health service use and advance the literature by identifying parent legal status as a unique barrier to child service receipt.

Examining differences in culturally based stress among clinical and nonclinical Hispanic adolescents.

The purpose of the current study was to determine if, and how, Hispanic adolescents receiving clinical treatment differ from their peers who are not in treatment on the 8 domains (family economic stress, cultural or educational stress, acculturation-gap stress, immigration stress, discrimination stress, family immigration stress, community or gang-related stress) of cultural stress (HSI-A), and if the relation between cultural stress domains and depressive symptomology differed by group membership (clinical vs. nonclinical). The sample included 1,254 Hispanic adolescents. The clinical sample had significantly higher scores of cultural stress (p < .05) and mean depression scores (< .001). All 8 domains of HSI-A stress were correlated with depression (p < .05). In the general linear models (GLM), only family economic, acculturation gap, family immigration, discrimination, and family drug stress had a unique effect on depression and effect varied by group. Acculturation gap stress was associated with depression for the nonclinical group but not the clinical group (p < .001) and community gang stress was more strongly related to depression for the clinical group (p < .05).

An examination of the path between recent sexual violence and sexually transmitted infections.

PURPOSE: Sexually transmitted infections (STIs) are among the most common infections in the United States and are particularly prevalent in survivors of sexual violence. The purpose of this study is to examine co-occurring risk factors for sexual violence and STIs including mental health, alcohol use, drug use, and multiple partners as intersecting pathways to STIs for women who experienced sexual abuse in the past year. METHODS: Secondary analyses were conducted on cross-sectional data from women originally recruited as respondents for an epidemiologic survey funded by the Centers for Disease Control and Prevention (CDC): Project CHOICES. The survey was administered to 2,672 women in six settings: A large, urban jail and residential alcohol and drug treatment facilities (Texas); a gynecology clinic (Virginia); two primary care clinics (Virginia and Florida); and media solicitation (Florida). Women were included in the current study if they were fertile, sexually active, and not pregnant or trying to get pregnant (n = 1,183). Structural equation modeling (SEM) was used to test the conceptual path model between sexual violence and STI occurrence. RESULTS: In the SEM, there were no significant paths from mental health, alcohol severity, or drug use to STI occurrence contrary to the results of the initial bivariate analyses. Multiple sexual partners significantly mediated the relationship between sexual violence and STIs and between mental health and drug use and STIs. CONCLUSION: This study highlights the importance of providing effective treatment to survivors of sexual violence, which includes addressing risky sexual behaviors to reduce STI occurrence.

Racial and ethnic variation in the predictors of maternal parenting stress.

Little is known about the causes of maternal parenting stress in the Mexican American population. We examine determinants of parenting stress among Mexican American mothers in comparison to non-Hispanic white and non-Hispanic black mothers. We base our analysis on Belsky's conceptual model (1984), which specifies predictors of parenting stress in three domains: maternal characteristics, child characteristics, and social context. Using data from the Fragile Families and Child Wellbeing Study, a national survey of new mothers conducted in large cities beginning in 1998, we draw a sample of 2,898 mothers from diverse racial and ethnic backgrounds. Our findings suggest differences in the determinants of parenting stress by racial or ethnic group. Overall, the patterns of parenting stress for non-Hispanic white and non-Hispanic black mothers are fairly consistent with Belsky's parenting model. However, for Mexican American mothers social support, but not partner support, ameliorate parenting stress and depression is not associated with parenting stress. Importantly as well, despite significant social disadvantage, the levels of parenting stress in Mexican American mothers does not significantly differ from those of non-Hispanic whites. Specific recommendations are made to practitioners for culturally competent responses to parenting stress in the provision of social services to Mexican American families. Implications for future research are twofold: our study calls for the incorporation of diverse samples when examining the determinants of parenting stress and for the development of theoretical frameworks that reflect the unique aspects of psychosocial well-being among Mexican Americans.

What happens when family resources are across international boundaries? An exploratory study on kinship placement in Mexican immigrant families.

Children in Latino immigrant families are significantly less likely to be placed in kinship care than other children are. Using grounded theory, the researchers conducted focus groups and individual interviews with child welfare workers working with Mexican origin families in south Texas to study the extent to which they use international kin placement resources. Key barriers to international kinship placement include lack of accurate information concerning international placements and conflicting agency mandates. Lack of child protective services policy enforcement also plays a role. Recommendations for practice and agency policy are discussed.