Article citation- ACES
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ACESArticleLatinxImmigrants.pdf
Cumulative Lifetime Adversity and Depression Among a National Sample of U.S. Latinx Immigrants: Within-Group Differences in
Risk and Protective Factors Using Data From the HCHS/SOL Sociocultural Ancillary Study
Daniel K. Cooper The Pennsylvania State University
Rahel Bachem Tel Aviv University
Maya G. Meentken Erasmus University Medical Center–Sophia
Children’s Hospital, Rotterdam, the Netherlands
Lorena Aceves The Pennsylvania State University
Ana G. Perez Barrios Universidad Católica Andres Bello
Latinx immigrants are exposed to multiple stressors before, during, and after migration. However, most past research has assumed the effects of these stressors are uniform across Latinx groups despite considerable within-group variation. The purpose of this study was to (a) assess the moderating effects of several risk and protective factors on the association between cumulative lifetime adversity and depression among U.S. Latinx immigrants and (b) examine the extent to which risk and protective processes differed between Latinx subgroups. Data came from a cross-sectional secondary dataset, called the Hispanic Com- munity Health Study/Study of Latinos Sociocultural Ancillary Study. The sample (N � 2,893) was identified using stratified random probability sampling in four of the largest Latinx metropolitan areas: the Bronx, New York; San Diego, California; Chicago, Illinois; and Miami, Florida. We included four Latinx subgroups in our study: Puerto Ricans, Cubans, Mexicans, and Dominicans. Results from multigroup regression analyses sug- gested that social support moderated the association between cumulative lifetime adversity and depression. However, further subgroup analyses showed the moderation effect was only present for Cuban and Dominican immigrants. We also found that perceived discrim- ination moderated the association between lifetime adversity and depression for Cuban immigrants and ethnic identity moderated the relationship between lifetime adversity and depression for Dominican immigrants. Our results provide preliminary evidence for the presence of within-group differences in responses to adverse events among Latinx immi- grant groups. Results can be used to inform the development of mental health interventions tailored to the specific needs of various Latinx immigrant populations.
This article was published Online First December 5, 2019. X Daniel K. Cooper, Methodology Center, The Pennsyl-
vania State University; Rahel Bachem, I-Core Research Cen- ter for Mass Trauma, Tel Aviv University; Maya G. Meentken, Department of Child and Adolescent Psychiatry/ Psychology, Erasmus University Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands; Lorena Aceves, Department of Human Development and Family Studies, The Pennsylvania State University; Ana G. Perez Barrios, Universidad Católica Andres Bello.
Funding was provided by Innovatiefonds Zorgverze- keraars, Stichting Hartekind, and Vereniging EMDR
Nederland (Maya G. Meentken); The Institute of Edu- cation Sciences, U.S. Department of Education: R305B090007 (Lorena Aceves); Swiss National Science Foundation: P00P1_177751 (Rahel Bachem); and Pre- vention and Methodology Training Program, National Institute on Drug Abuse (T32 DA017629; Daniel K. Cooper).
Correspondence concerning this article should be ad- dressed to Daniel K. Cooper, Methodology Center, The Pennsylvania State University, 404 HHD, University Park, PA 16802. E-mail: [email protected]
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Journal of Latinx Psychology © 2019 American Psychological Association 2020, Vol. 8, No. 3, 202–220 ISSN: 2578-8086 http://dx.doi.org/10.1037/lat0000145
202
Public Significance Statement This study suggests that the link between risk and protective factors and depression may be unique for different Latinx subgroups (e.g., Puerto Ricans, Dominicans). These within-group differences may play a role in individuals’ responses to lifetime adversity. The findings can inform preventive mental health interventions tailored to the unique needs of U.S. Latinx populations exposed to adversity.
Keywords: multigroup regression analysis, discrimination, acculturation stress, Latino/a, Hispanic
Supplemental materials: http://dx.doi.org/10.1037/lat0000145.supp
A wealth of literature indicates that exposure to adverse events is related to negative mental health outcomes, such as depression (Edwards, Holden, Felitti, & Anda, 2003; Ronconi, Shiner, & Watts, 2015; Ward, Shaw, Chang, & El- Bassel, 2018). An adverse event is an occur- rence that will likely cause some form of psy- chological distress. Adverse events range in severity and can include a significant life change such as divorce, serious illness, or in- carceration or life-threatening experiences such as physical/sexual abuse or war. Adverse expe- riences have been linked with numerous health problems, such as neural impairment, chromo- somal damage, anxiety, depression, or posttrau- matic stress disorder (Cicchetti & Rogosch, 2012; Shalev et al., 2013). As individuals are exposed to higher amounts of adverse life events, or cumulative lifetime adversity, the likelihood of developing PTSD, depression, or other mental health disorders increases (Myers et al., 2015; Seery, Holman, & Silver, 2010; Suliman et al., 2009). Therefore, adopting a life span approach to studying the effects of adverse events on mental health may be beneficial, es- pecially when working with populations known to experience high levels of adversity.
First-generation Latinx immigrants living in the United States often experience various types of adverse events before, during, and after mi- gration (Li, Liddell, & Nickerson, 2016). For some immigrants, premigration adversity, such as war-related violence or persecution, can be the main reason families migrate. During mi- gration, individuals often experience violence, discrimination, separation from family mem- bers, or lack of food and shelter (Bean, Derluyn, Eurelings-Bontekoe, Broekaert, & Spinhoven, 2007). Finally, there are a number of postmi-
gration challenges that Latinx immigrants face, such as discrimination, forced detention, unsta- ble living arrangements, and financial struggles (e.g., Silove, Austin, & Steel, 2007). Given the frequent accumulation of numerous types of adverse events experienced by immigrants, un- derstanding the cumulative effects of lifetime adversity is critical when working with immi- grant populations.
The conservation of resources (COR) theory (Hobfoll, 1989, 2002) provides a valuable framework for understanding the effects of cu- mulative stress on mental health. COR theory assumes that the primary cause of stress is the loss of resources and that individuals will go to great lengths to protect and build upon their resources. Resources are defined as anything that a person values, including objects, personal characteristics, or conditions (Hobfoll, 2001). In the context of immigrant populations, resources might include interpersonal relationships, fam- ily stability, adequate income, health, and well- being. When these resources are lost or threat- ened, such as during migration, individuals experience stress, which may lead to mental health problems and an increased vulnerability to future stress (Hobfoll, 2002). This framework also assumes that stress responses differ based on the personal and cultural value of a particular resource.
Past studies have primarily examined risk and protective factors separately, rather than testing multiple factors in the same analytical model (e.g., Huang, Costeines, Kaufman, & Ayala, 2014). However, risk and protective fac- tors often co-occur and have overlapping ef- fects; therefore, including them in the same statistical model could improve the understand- ing of mental health processes. Even fewer
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studies have examined potential ethnic sub- group differences in mental health processes. Guided by the COR framework, the present study explored several risk factors (i.e., discrim- ination, acculturation stress) and protective fac- tors (i.e., social support, ethnic identity) that may contribute to how Latinx immigrants re- spond to adverse events. We also examined how these risk and protective factors differed across Latinx subgroups.
Mental Health and U.S. Latinx Populations
Researchers have reported conflicting find- ings regarding the mental health of U.S. Latinx populations. Some studies suggest first- generation Latinx immigrants are at a height- ened risk for adverse mental health outcomes compared to second generation Latinxs, family members that remained in the country of origin, and non-Latinx Whites (Breslau et al., 2011; Falcón & Tucker, 2000). Other studies have reported the opposite trend, or that first- generation Latinx immigrants display better mental and physical health compared to Latinxs who have lived in the United States longer than a generation (Akresh & Frank, 2008; Alegría et al., 2008; Shor, Roelfs, & Vang, 2017). Alegría et al. (2008) referred to this body of conflicting findings that suggest immigration status is both a risk and protective factor for negative health outcomes as the “immigrant paradox.”
There are several possible explanations for the conflicting findings related to Latinx immi- grants’ mental health. First, Latinx immigrants in the United States are a heterogeneous group, comprised of numerous subethnic groups, each with a unique migration history and set of life experiences. For example, Mexicans immi- grants, the largest U.S. Latinx group, most often migrate to find employment. Mexican immi- grants, on average, migrate at a younger age and with less education than other Latinx immigrant groups (Alarcón et al., 2016). Mexican immi- grants tend to experience higher levels of accul- turation stress, in part due to having one of the lowest percentages of naturalized citizens, be- ing most often targeted by immigration author- ities, and being the least prepared to migrate to the United States as compared to other Latinx immigrant groups (Alarcón et al., 2016; Guar- naccia et al., 2007). A nationally representative survey of U.S. Latinxs concluded Mexican im-
migrants have lower rates of depression and other mental health issues as compared to other subgroups (Alegría et al., 2008). This research suggests that Mexicans may be more resilient to life stressors than their Latinx subgroup coun- terparts.
Cubans often migrate for political reasons and bring with them considerable social capital, such as possessing greater levels of education (Guarnaccia et al., 2007). Cubans were the main beneficiaries of 1980 Refugee Act and have historically received greater support from the United States in seeking asylum and resettling in the United States (Tienda & Sánchez, 2013). Cubans are, on average, older when they mi- grate to the United States, have higher levels of education, are more financially stable, and are most likely to be married as compared to other Latinx subgroups (Alarcón et al., 2016; Guar- naccia et al., 2007). They also tend to report having the strongest ethnic identities when compared to other subgroups (Ai, Carretta, & Aisenberg, 2017; Guarnaccia et al., 2007). Pos- sessing a strong ethnic identity and having greater levels of social capital could promote resilience to adversity for Cuban immigrants.
Puerto Ricans are unique from other Latinx subgroups in several ways. Puerto Ricans be- came U.S. citizens in 1917. As a result, they also tend to have higher English proficiency and experience less acculturation stress than other Latinx subgroups (Guarnaccia et al., 2007; Lo- pez & Patten, 2015). However, at the same time, they are more likely to experience economic challenges, such as unemployment (Alarcón et al., 2016; Lopez & Patten, 2015), and report greater discrimination and psychological dis- tress compared to other subgroups (Rivera et al., 2008).
Dominicans often migrate to the United States for greater economic opportunities. The debt crisis of the 1980s led many Dominicans to migrate in pursuit of work (Zong & Batlova, 2018). Dominicans are more likely to be women and identify as Black (Dawson, 2009). Studies suggest that Dominicans are slower to accultur- ate to U.S. culture than other subgroups, pre- serving their culture by visiting the Dominican Republic frequently, speaking in Spanish, and living in primarily Dominican neighborhoods in which they can engage in cultural activities (Dawson, 2009). Possessing a strong orientation toward Dominican culture may be protective
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against stressful events, such as discrimination. One study found that having low acculturation levels was protective against the effects of dis- crimination on mental health (Dawson, 2009). These types of within-group differences may influence Latinx immigrants’ health trajectories and responses to lifetime adversity (Molina, Alegría, & Mahalingam, 2013). It is paramount for researchers to consider within-group vari- ability when engaging in mental health research with Latinx immigrants.
Social Support
Individual-level differences in risk and pro- tective factors may also contribute to the incon- sistent findings related to Latinx immigrant mental health. One important resource for im- migrants is social support (Kinderman, Schwan- nauer, Pontin, & Tai, 2013). Social support has been conceptualized in a variety of ways, in- cluding receiving assistance or affirmation from others and being liked by others (Gottlieb & Bergen, 2010). Research has shown that social support is one of the most significant determi- nants of how individuals respond to adversity (e.g., Prati & Pietrantoni, 2010). This may be particularly true for migrant populations, who have lost many of their social connections after moving to a new country, and for whom social networks may enable access to resources that would otherwise be unavailable to them (Ward et al., 2018). Social networks can facilitate healthy adaptation processes for migrants, such as finding employment, housing, and access to education (Anthias & Cederberg, 2009; Bar- wick, 2017). Studies consistently document that low social support is associated with higher depression for Latinxs (e.g., Rivera, 2007). So- cial support may be particularly salient for Do- minican immigrants, who often live in Domin- ican enclaves (Dawson, 2009).
Ethnic Identity
A second resource related to immigrant men- tal health is possessing a strong ethnic identity, defined as “the degree to which individuals per- ceive themselves to be included and aligned with an ethnic group” (Smith & Silva, 2011, p. 42). Ethnic identity is assumed to be a defining characteristic for immigrants, particularly those from minority ethnic/racial groups (Phinney,
2000). A meta-analysis assessed participants from various ethnic backgrounds, including Latinx populations, and found that higher levels of ethnic identity were associated with lower levels of mental health symptoms, such as de- pression (Smith & Silva, 2011). However, for Latinx populations, the literature shows mixed findings regarding ethnic identity as a resilience factor. Umaña-Taylor and colleagues (2008) found that Latinx adolescents’ baseline levels of ethnic identity were not associated with their future levels of self-esteem. Although Brittian and colleagues (2015) identified ethnic identity as a protective factor in a context of heightened stress (e.g., when faced with discrimination), studies have found that Latinx groups tend to differ in their identification with their ethnic group. For example, Cubans reported a higher ethnic identity than other Latinx subgroups (Guarnaccia et al., 2007). These variations in ethnic identity may lead to differential associa- tions between ethnic identity and mental health among different Latinx groups.
Acculturation Stress
There are also various factors that may threaten migrants’ existing resources and lead to negative mental health outcomes. The transition into a new culture often entails various difficul- ties, such as socioeconomic hardships, language problems, or social isolation, all of which can threaten existing resources and prevent the ac- quisition of additional resources. Such difficul- ties can be defined as acculturation stress (Mendoza, Mordeno, Latkin, & Hall, 2017). Acculturation stress has consistently been shown to be negatively associated with mi- grants’ mental health, including increasing de- pressive symptoms (Chae, Park, & Kang, 2014; Kartal & Kiropoulos, 2016; Mendoza et al., 2017; Revollo, Qureshi, Collazos, Valero, & Casas, 2011). Researchers found that among refugee populations, postmigration factors such as acculturation stress were associated with ad- verse mental health outcomes above and be- yond the effect of premigration adversity (Li et al., 2016). Acculturation stress may also differ between Latinx subgroups (Alegría et al., 2008). Studies suggest that Mexicans experi- ence the highest postmigration acculturation stress as compared with other Latinx subgroups living in the United States (Guarnaccia et al.,
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2007). Puerto Ricans tend to experience lower levels of acculturation stress than other sub- groups due to their U.S. citizenship.
Ethnic/Racial Discrimination
A second threat to migrants’ resources is experiencing ethnic/racial discrimination. The negative effects of perceived discrimination on Latinx health have been widely documented in past literature (Lorenzo-Blanco & Cortina, 2013; Molina et al., 2013; Moradi & Risco, 2006; Umaña-Taylor et al., 2008). Experiencing greater amounts of discrimination has been linked with increases in depression symptoms and a deterioration in physical health for Lat- inxs (Umaña-Taylor & Updegraff, 2007; Mo- lina et al., 2013). However, experiences of dis- crimination may differ depending on a variety of factors, such as skin tone, English profi- ciency, or socioeconomic status (Molina et al., 2013; Zambrana & Dill, 2006). For example, one study found that the association between discrimination and depression was higher for Black Latinas than for other ethnic groups (Ramos, Jaccard, & Guilamo-Ramos, 2003). Other research suggests that Puerto Ricans and Mexicans experience the highest levels of dis- crimination as compared to other subgroups (Ai et al., 2017; Molina et al., 2013). Understanding potential within-group differences in exposure to various risk and protective factors is critical for tailoring interventions to meet the needs of different Latinx populations.
The Present Study
The purpose of this study was to examine risk and protective processes associated with de- pression among Latinx subgroups living in the mainland United States. We examined (a) the associations between several risk factors (cu- mulative lifetime adversity, acculturation stress, discrimination) and protective factors (social support, ethnic identity), and depression symp- toms; (b) the extent to which risk and protective factors moderated the association between cu- mulative lifetime adversity and depression; and (c) the extent to which these risk and protective processes differed between four Latinx sub- groups.
We hypothesized that, for the full sample, (a) risk factors will be positively associated with
depression and protective factors will be nega- tively associated with depression and (b) risk factors will exacerbate the association between cumulative lifetime adversity and depression and protective factors would buffer the associ- ation between cumulative lifetime adversity and depression. Based on the extant literature, we also hypothesized that (c) discrimination will be most harmful for Puerto Ricans, Dominicans, and Mexicans as compared to Cubans, (d) ac- culturation stress will be most harmful to Mex- icans and least harmful to Puerto Ricans, (e) ethnic identity will be most protective for Cu- bans and Dominicans, and (f) social support will be most protective for Dominicans. Refer to Figure 1 for a diagram of the hypothesized model.
Method
Sample
Data from this study came from the baseline assessment of an epidemiological survey of Lat- inx health, called the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study, conducted in 2009 –2011. The HCHS/SOL study used a household probability sampling procedure to identify potential participants in four of the larg- est Latinx metropolitan areas including the Bronx, New York; San Diego, California; Chi- cago, Illinois; and Miami, Florida. Based on the objectives of the original study, researchers oversampled (a) households in areas with high concentrations of Latinxs and (b) households with higher probabilities of having adults over the age of 45 (LaVange et al., 2010). The orig- inal study included 4,393 Latinxs; however, for the purposes of this study, we only included participants born outside the mainland United States. For analysis purposes, we only included Latinxs from locations with at least 100 partic- ipants, including Mexico (n � 1,353), Cuba (n � 689), Puerto Rico (n � 402), and the Dominican Republic (n � 449). Respondents were adults aged 18 –74. Most participants were above the age of 45, had at least a high school degree, and had a yearly household income of less than $30,000. Participants, on average, ar- rived in the mainland United States at 28.71 years of age and had lived in the United States for over 22 years prior to completing the base-
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line survey. See Table 1 for differences in de- mographics across the four Latinx subgroups. Refer to Gallo and colleagues (2014) for further information regarding the study design and pro- cedure.
Measures Cumulative lifetime adversity. We as-
sessed cumulative lifetime adversity using 20-
items from two different measures of adversity: (a) the Adverse Childhood Experiences (ACE) scale (Felitti et al., 1998) and (b) the Traumatic Stress Schedule (TSS; Norris, 1990). The ACE scale is composed of 10 items that assess the number of adverse and traumatic events people experienced during childhood, including emo- tional abuse, sexual abuse, physical abuse, emo- tional or physical neglect, witnessing female
Figure 1. Hypothesized model: Cumulative lifetime adversity, risk and protective factors, and depression. Control variables were omitted for parsimony (i.e., age, gender, language preference).
Table 1 Means (Standard Deviations) in Cumulative Lifetime Adversity, Depression, and Risk and Protective Factors for Four Latinx Subgroups
Variable Mexican Puerto Rican Cuban Dominican
Cumulative lifetime adversity 4.38 (3.31) 5.00 (3.59) 3.83 (3.21) 3.83 (2.93) Depression 7.22 (5.67) 8.70 (6.39) 8.36 (6.71) 7.43 (6.19) Ethnic identity 3.51 (.46) 3.72 (.46) 3.68 (.47) 3.73 (.45) Social support 25.72 (6.48) 24.67 (7.13) 27.07 (6.61) 25.40 (6.66) Discrimination 24.89 (8.07) 26.24 (9.80) 22.45 (6.39) 23.49 (8.10) Acculturation stress 14.91 (14.04) 10.59 (11.31) 14.83 (12.61) 15.10 (13.50) Age 47.39 54.61 50.89 47.52 Years in United States 20.75 35.57 12.53 17.50 Language preference (% Spanish preference) 94% 71% 97% 93% Gender (% Male) 35% 41% 45% 32% Race (% White) 37% 30% 75% 9% Income (% families making � $30,000/year) 65% 76% 75% 71% Marital status (% married) 65% 34% 49% 43%
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parent being abused, parental separation or di- vorce, living with someone abusing substances or who has a mental illness, and imprisonment of a household member. The TSS is a brief 10-item assessment of lifetime trauma that in- cludes events commonly experienced by the general public, such as experiencing a mugging, physical attack, unwanted sexual activity, unex- pected death of a friend or loved one, house fire, natural disaster, forced evacuation of home, ex- posure to war/combat, motor vehicle accident, or other terrifying experience. Participants indi- cated the number of events they had experi- enced on a dichotomous scale (0 � no, 1 � yes). Scores ranged from 0 to 20, with higher scores representing a higher frequency of expo- sure to adverse events. Refer to Supplemental File 1 for a complete list of the ACE and TSS items.
Acculturation stress. We assessed accul- turation stress using an abbreviated 17-item ver- sion of the Hispanic Stress Inventory (Cavazos- Rehg, Zayas, Walker, & Fisher, 2006). Likert- type items in this scale focused on various stressful experiences associated with transition- ing into living in a new culture, such as occu- pational/economic stress, immigration stress, parental stress, and familial stress. Participants first indicated if they experienced a particular type of acculturation stress (0 � no, 1 � yes), then rated the level of stress that item caused on a range of 1 (not at all worried/tense) to 5 (extremely worried/tense). The total score was based on a sum of the 17 items and ranged from 0 to 85, with higher scores representing higher levels of acculturation stress. The internal con- sistency of the scale was � � .83 for this sample.
Perceived ethnic discrimination. We as- sessed perceived discrimination using a 17-item Brief Perceived Ethnic Discrimination Ques- tionnaire–Community Version (PEDQ). Items assess lifetime experiences of discrimination based on race and ethnicity in various areas of life, including the workplace and other social contexts. The PEDQ examines four dimensions of perceived ethnic discrimination: exclusion/ rejection, stigmatization/evaluation, work/ school discrimination, and threat/aggression (Gallo et al., 2014). Participants were asked to respond to how often they had been discrimi- nated against because of their race or ethnicity from 1 (never) to 5 (very often). Total scores
ranged from 17 to 85, with higher scores indi- cating higher levels of perceived discrimination. This scale has been widely used Latinx popula- tions (Molina et al., 2013). The internal consis- tency in the current sample was � � .87.
Social support. We measured social sup- port using a brief 12-item version of the Inter- personal Support Evaluation List (ISEL; Merz et al., 2014), which evaluates the perceived availability of potential sources of social sup- port. Items are scored on a 4-point Likert-type scale, ranging from 0 (definitely false) to 3 (definitely true). The ISEL includes positive and negative statements assessing three types of so- cial support: appraisal (advice or guidance), tan- gible (help or assistance), and sense of belong- ing (empathy or acceptance). Example items include “If I were sick, I could easily find some- one to help me with my daily chores” (tangible) and “When I need suggestions on how to deal with a personal problem, I know someone I can turn to” (appraisal). After reverse scoring the negatively worded items, the 12 items were summed to create a composite scale ranging from 0 to 36. Higher scores represented higher perceived social interpersonal support. This scale has been validated with Latinx popula- tions (Merz et al., 2014) and the internal con- sistency was � � .82 for our sample.
Ethnic identity. We assessed ethnic iden- tity using a 12-item subscale from the Scale of Ethnic Experiences (SEE; Malcarne, Chavira, Fernandez, & Liu, 2006). Items are scored on a five-point Likert-type scale asking about thoughts and feelings surrounding ethnic group membership. Example items include “I believe it is important to take part in holidays that celebrate my ethnic group,” “I have a strong sense of myself as a member of my ethnic group,” and “I do not feel it is necessary to learn about the history of my ethnic group.” Six items were reverse scored. The following item was removed due to poor internal consistency: “My ethnic background plays a very small role in how I live my life.” The scale was created by calculating the mean of the remaining 11 items, with higher scores reflecting higher ethnic iden- tity. The internal consistency was � � .70 for our sample.
Depression. To assess depression, we used a 10-item scale from the Center of Epidemio- logic Studies Scale (CES-D; Björgvinsson, Kertz, Bigda-Peyton, McCoy, & Aderka, 2013).
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The CES-D is a brief, widely used measure that identifies the level of depression symptoms ex- perienced over the past week. It includes posi- tive and negative items scored on a 4-point Likert-type scale from 0 (less than one day) to 3 (5–7 days). Example positive items include “I felt hopeful about the future and I was happy.” Example negative items include “I was both- ered by things that do not usually bother me” and “I felt depressed.” After reverse scoring the two positively worded items, we calculated the sum score for the 10 items (ranged from 0 to 30), with higher scores indicating greater levels of depression. The criteria for clinical depres- sion is met when individuals score above 10 on the CES-D scale. The CES-D has been vali- dated with Latinx populations (González et al., 2017). The internal consistency was � � .84 for this sample.
Data Analysis
We used Mplus 8 (Muthén & Muthén, 2017) to test all aims of this study. We conducted preliminary analyses to examine item and vari- able distribution, internal consistency, bivariate correlations, and verified that our data met the assumptions required for conducting multi- group regression analyses. To test the associa- tions between cumulative lifetime adversity, risk factors, protective factors, and depression, we used multivariate regression. We used ro- bust maximum likelihood estimation, which is better at handling nonnormal distributions (Maydeu-Olivares, 2017).
To test the moderation effects of cultural risk and protective factors on the relationship be- tween cumulative lifetime adversity and depres- sion, we conducted a moderation regression analysis. Moderators change the relationships that two variables have with one another. Re- searchers often use moderation analyses to de- termine for whom or under which conditions an association between two variables exists. We calculated interaction terms by (a) standardizing the independent and moderating variables and (b) calculating the product of these two vari- ables (Kline, 2016). We then added these inter- action terms to the main effects model and conducted a R2 change test to determine the extent to which the moderators improved the model. To determine whether moderation ef- fects were significant, we examined unstandard-
ized and standardized regression coefficients (p � .05).
To test the subgroup differences in risk and protective processes, we used multigroup re- gression analyses. Multigroup analysis deter- mines whether the constructs in the model are associated with one another in the same way in each group. Multigroup analysis involves com- paring a model in which all the parameters are freely estimated to a model in which all the parameters are constrained to equal across groups. Equality constraints do not allow esti- mates to vary across groups, consistent with the null hypothesis that no group differences exist (Kline, 2016). If model fit significantly worsens after setting equality constraints, this would in- dicate that the model’s fit to the data depends on ethnic group membership.
We compared two nested models: (a) a base- line model with all parameters freely estimated, and (b) a model with all parameters constrained to be equal across groups. The two models were compared using a Satorra-Bentley �2 difference test, where a significant �2 value indicated a significantly worse fit for the constrained mod- el. We also tested alternative models using the same variables to avoid confirmation bias (as- suming the hypothesized model is the best fit to the data). The proportion of missing data in our study ranged from between 0% and 1% of the cases. Based on missing data analysis, we as- sumed that our missing data were missing at random and handled missing data using listwise deletion. Power analyses demonstrated that we had adequate statistical power to detect small to moderate effect sizes.
Results
Preliminary Analysis
We calculated descriptive statistics to assess item means, standard deviations and test the assumptions required for conducting multivari- ate regression analysis. We assessed demo- graphic differences between Latinx subgroups by conducting analyses of variance (ANOVAs). We found that there were significant group dif- ferences in gender, age, years lived in the United States, race, language preference, in- come level, and marital status (p � .05). There- fore, we controlled for these variables in subse- quent analyses.
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The mean cumulative lifetime adversity for the full sample was 4.25 (SD � 3.30) and the mean depression score was 7.73 (SD � 6.14). The most common types of lifetime adversities were unexpected death of a friend or loved one, parents separated or divorced, mugging, and physical assault. About 31% of the sample met criteria for depression. See Table 1 for descrip- tive statistics for each Latinx subgroup. We also calculated bivariate correlations between focal constructs. Cumulative lifetime adversity was significantly associated with depression, r � .27, p � .05. The associations between the four moderating variables (discrimination, accultur- ation, social support, and ethnic identity), de- pression, and our control variables were small to moderate and all were statistically significant. See Table 2 for all bivariate correlations for the full sample.
Main Effects for Total Sample
We tested the main effects of cumulative lifetime adversity, social support, ethnic iden- tity, discrimination, and acculturation stress on depression for the full sample using a multivar- iate regression. We controlled for the effects of age at the time of the survey, years lived in the United States, gender, language preference, marital status, and income level. We selected these control variables because they have been shown to contribute to mental health problems for Latinxs (e.g., Alegría & Woo, 2009; Smith
& Silva, 2011). However, three control vari- ables (i.e., marital status, years lived in the United States, and income level) were removed from the main effects model (and all subsequent models) because they were not associated with depression and did not improve model fit.
We found that cumulative lifetime adversity was significantly associated with depression scores (b � .15, p � .001). Two of the four moderator variables were also significantly as- sociated with depression scores, including so- cial support (b � �.29, p � .001) and acculturation stress (b � .26, p � .001). Dis- crimination (b � .02, p � .05) and ethnic iden- tity (b � .00, p � .05) were not associated with depression. In addition, we found that our three control variables were significantly associated with depression: age (b � .06, p � .001), lan- guage preference (b � .07, p � .001), and gender (b � �.08, p � .001). The main effects model accounted for 27% of the variance in depression scores for the full sample.
Moderation Model for Total Sample
We tested the extent to which discrimination, acculturation stress, ethnic identity and social support moderated the association between cu- mulative lifetime adversity and depression, con- trolling for gender, age at time of survey, and language preference. Specifically, we examined whether ethnic identity and social support weakened the association between cumulative
Table 2 Bivariate Correlations for the Full Sample (N � 2,893)
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Cumulative lifetime adversity —
2. Depression .27�� — 3. Acculturation stress .25�� .38�� — 4. Discrimination .41�� .25�� .45�� — 5. Social support �.12 �.39�� �.27�� �.20�� — 6. Ethnic identity �.04 �.09�� �.06�� �.01 .23�� — 7. Age �.03 .05�� �.10�� �.10�� �.07�� .03 — 8. Years lived in United
States .08�� .04�� �.16�� .11�� �.07�� �.02 .43�� — 9. Gender .02 �.10�� �.06�� .13�� .04� �.03 �.03 .03 —
10. Language preference .11�� .03�� �.11�� .11�� .07�� .05�� �.08�� .32�� .06�� — 11. Race .02 �.01�� .03 .07�� �.07�� �.02 �.07�� .08�� �.05�� .03 — 12. Marital status .01 .00 .02 �.02 .01 �.03 .30�� .08�� �.11�� �.10�� �.01 — 13. Income �.04�� �.06�� �.09�� �.07�� .10�� .03 �.05�� �.02 .01 .05�� .00 �.01 —
� p � .05. �� p � .01.
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lifetime adversity and depression and whether discrimination and acculturation stress strength- ened the association between cumulative life- time adversity and depression. Our results sug- gested that the moderation effects model was superior to the main effects model, F � 2.63, p � .05. We found that only social support significantly moderated the relationship be- tween cumulative lifetime adversity and depres- sion, � � �.30, p � .01. This means that the strength of the association between cumulative lifetime adversity and depression depended on individuals’ levels of social support (see Figure 2 for a graph of the interaction). None of the other moderators were significant. The moder- ation model accounted for 28% of the variance in depression scores for the full sample.
Multigroup Analysis: Comparing Latinx Subgroups
We conducted multigroup analyses to deter- mine the extent to which our hypothesized main effects and moderation models differed between four Latinx subgroups. For the freely estimated models, we selected one parameter that was relatively equivalent across groups to constrain to equal (for model identification purposes). We
conducted ANOVAs to make sure these con- straints did not affect model fit.
The main effects model with all the parame- ters constrained to equal fit the data significantly worse than the freely estimated model (robust �2 � 101.54, p � .001), rejecting the hypoth- esis that all parameters were the same across the four Latinx subgroups. Results of the multi- group main effects model showed that the as- sociation between discrimination and depres- sion was only significant for Mexican immigrants (b � .07, p � .01). The moderation model with all parameters constrained fit the data significantly worse than the freely esti- mated model (robust �2 � 125.11, p � .001), meaning the moderating effects were not con- sistent across the four subgroups. First, we found that social support only moderated the association between cumulative lifetime adver- sity and depression for Cuban (� � �.79, p � .01) and Dominican (� � �.78, p � .01) im- migrants. Second, we found that discrimination significantly moderated the association between cumulative lifetime adversity and depression for Cuban immigrants (� � �.68, p � .05). However, this association was in the opposite direction than expected. Third, we found that
Figure 2. Moderation effect of social support for the full sample (N � 2,896). Moderation effect was significant at the p � .01 level. The cutoff score to meet the criteria for significant depression symptoms is 10.
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ethnic identity moderated the association be- tween cumulative lifetime adversity and depres- sion for Dominican immigrants (� � .66, p � .05). This association was also in the opposite direction than we predicted. See Table 3 for the main and interaction effects for each of the four Latinx subgroups. Refer to Table 3 and Table 4 for results of the multigroup analyses.
Discussion
This study investigated the association be- tween cumulative lifetime adversity and de- pression in a diverse sample of Latinx immi- grants living in the United States. Based on the COR theory (Hobfoll, 1989), which sug- gests that cultural resources are critical in determining responses to stress, we examined the extent to which several risk and protective factors moderated the relationship between cumulative lifetime adversity and depression controlling for several demographic charac- teristics. We also examined the extent to which these risk and protective processes dif- fered across four Latinx subgroups. Our find- ings provide important direction for future intervention work with Latinx immigrants liv- ing in the United States.
Associations Between Risk and Protective Factors and Depression
Prior to testing moderation effects, we tested a main effects model that examined the associ- ations between cumulative lifetime adversity, our four moderating variables (i.e., social sup- port, ethnic identity, acculturation stress, dis- crimination), control variables, and depression. Consistent with our hypotheses, we found that higher levels of cumulative lifetime adversity and acculturation stress were linked with higher levels of depression and that higher levels of social support were linked with lower depres- sion symptoms for the full sample. These find- ings are consistent with past research linking these constructs with depression (Hammen, 2005; Kinderman et al., 2013; Muscatell, Slav- ich, Monroe, & Gotlib, 2009; Paykel, 2003; Revollo et al., 2011). Contrary to expectations, discrimination was not associated with depres- sion for the full sample of Latinx immigrants. This finding is inconsistent with past research documenting the negative association between discrimination and the well-being of minority populations (Ellis, MacDonald, Lincoln, & Cabral, 2008; Lorenzo-Blanco & Unger, 2015; Torres & Ong, 2010). Although discrimination was not significantly associated with depression
Table 3 Standardized and Unstandardized Path Coefficients From Unconstrained Multigroup Main Effects and Moderation Effects Models by Latinx Subgroup (N � 2,808)
Latinx subgroups Mexican Cuban PR DR
Standardized main effects Cumulative lifetime adversity .14��� .16��� .11�� .18���
Acculturation stress .33��� .24��� .21��� .21���
Discrimination .07�� .01 .03 �.04 Social support �.25��� �.32��� �.38��� �.28���
Ethnic identity �.02 �.01 .00 �.05 Age .02 .12��� .07 �.03 Language preference .07� .01 .13�� .04 Gender �.03 �.15��� �.11�� �.17���
Model R2 .30 .30 .29 .27 Unstandardized moderation effects
CLA Acculturation Stress .11 �.06 �.25 �.05 CLA Discrimination �.04 �.68� �.02 �.08 CLA Social Support .03 �.79�� �.24 �.78��
CLA Ethnic Identity �.09 .25 .33 .66�
Model R2 .30 .32 .29 .29
Note. PR � Puerto Rican; DR � Dominican; CLA � cumulative lifetime adversity. � p � .05. �� p � .01. ��� p � .001.
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for the full sample, our multigroup analysis (explained below) provide some support for our hypothesis that discrimination is a risk factor for developing depression.
Contrary to our hypothesis, we did not find an association between ethnic identity and depres- sion. This is surprising as meta-analytic findings suggest a negative association between ethnic identity and depression among ethnic minority individuals (e.g., Smith & Silva, 2011). How- ever, not all studies have shown ethnic identity to be linked with positive mental health out- comes (Kiang, Yip, Gonzales-Backen, Witkow, & Fuligni, 2006; Umaña-Taylor et al., 2009). In recent years, scholars have come to recognize that migrant’s ethnic identity is a dynamic, mul- tidimensional concept; it likely changes as im- migrants acculturate to their host societies (e.g., Schwartz, Montgomery, & Briones, 2006). In- dividuals in the current study may have been in different stages of the acculturation process and, consequently, their ethnic identity may not have been associated with depression in a unified manner. It is also possible that different dimen- sions of ethnic identity (i.e., exploration, reso- lution, affirmation) may be associated with dif- ferent mental health outcomes (Umaña-Taylor et al., 2008). Future studies could benefit from assessing the associations between each compo- nent of ethnic identity and mental health.
Moderating Effects of Social Support for the Full Sample
Social support was the only significant mod- erator of the relationship between cumulative lifetime adversity and depression for the full sample. This suggests that social support is pro-
tective for Latinx immigrants exposed to ad- verse events. This finding corresponds with past research and theory suggesting that social sup- port buffers the effects of lifetime adversity on depression (Arnberg, Hultman, Michel, & Lun- din, 2012; Cohen & Wills, 1985; Ward et al., 2018). According to the COR theory, social support is a major resource for individuals ex- posed to adverse events and can facilitate the preservation of other resources, such as having a sense of well-being or a strong ethnic identity (Hobfoll, 1989). This finding provides impor- tant information about the potential buffering effect social support can have for those who have experienced high levels of lifetime adver- sity.
Contrary to our hypotheses and COR theory, ethnic identity, discrimination, and accultura- tion stress did not moderate the relationship between cumulative lifetime adversity and de- pression in the full sample. According to COR theory, experiencing multiple threats to existing resources (e.g., acculturation stress and discrim- ination) will have a cumulative effect, exacer- bating the effects of adversity on mental health. Past research suggests that these types of stres- sors can have overlapping effects and nega- tively influence Latinx mental health (Torres, Driscoll, & Voell, 2012). COR theory also as- sumes that increasing resources, such as by im- proving one’s ethnic identity, will improve mental health and protect against future losses of resources. Similarly, past literature indicates that components of ethnic identity can be pro- tective against developing mental health disor- ders (Smith & Silva, 2011). Our unexpected findings may be a result of the large amount of
Table 4 Multigroup Analyses for Main Effects and Moderation Effects Models (N � 2,808)
Model Robust �2(df) CFI RMSEA SRMR
Robust �2( df) CFI RMSEA SRMR Decision
Main effects M0: Freely estimated 2.22 (4) 1.00 .00 .00 — — — — — M1: Constrained 102.41��� (27) .92 .06 .02 101.54��� (23) �.08 .06 .02 Reject
Moderation effects M0: Freely estimated 1.73 (4) 1.00 .00 .00 — — — — — M1: Constrained 124.76��� (40) .91 .06 .02 125.11��� (36) �.09 .06 .02 Reject
Note. CFI � comparative fit index; RMSEA � root mean square error of approximation; SRMR � square root mean residual. Estimates were generated using robust maximum likelihood (MLR) estimation. ��� p � .001.
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within-group variation in our sample. As sug- gested by our subgroup analyses (explained be- low), the moderating effects may not be consis- tent across all groups of Latinx immigrants.
Differences in Risk and Protective Processes Across Latinx Subgroups
Past research suggests that associations be- tween life stressors and psychological health can vary between Latinx subgroups (Ai et al., 2017; Molina et al., 2013; Rivera et al., 2008). We found several differences in risk and pro- tective processes across Latinx subgroups in our sample. First, from our main effects multigroup analysis, we found discrimination was signifi- cantly linked with depression only for Mexican immigrants. This finding supported our hypoth- esis that the association between discrimination and depression would be particularly high for Mexican immigrants. Ai and colleagues (2017) found that Mexican immigrants reported higher levels of discrimination compared to their Cu- ban counterparts. In addition, prior studies have shown that Mexicans often have less social cap- ital (e.g., education) at the time of arrival in the United States and have experienced higher lev- els of deprivation and inequality in their home country compared to other Latinx subgroups (Alegría et al., 2008; Guarnaccia et al., 2007; Torres, 2004). These factors may make Mexi- can immigrants particularly vulnerable to dis- crimination. However, we also hypothesized that discrimination would be associated with depression for other subgroups, considering past research documenting the negative effects of discrimination across Latinx populations (Ai et al., 2017; Molina et al., 2013). Without other covariates in the model, discrimination was as- sociated with depression for all subgroups. This suggests that although discrimination may be significantly related to depression when assessed alone, discrimination may not be associated with depression above and beyond the effects of cumulative lifetime adversity, acculturation stress, social support, ethnic identity, age, gender, and language prefer- ence.
Second, we found that social support only moderated the association between cumulative lifetime adversity and depression for Cuban and Dominican immigrants. This finding supported our hypothesis that social support would be
most protective for Dominican immigrants. Do- minican immigrants tend to have lower educa- tion, household income, and are the least likely Latinx subgroup to be married (Alarcón et al., 2016; Zong & Batlova, 2018). Hence, social support may be more protective for Dominicans than other Latinx subgroups. In addition, many Dominicans live in ethnically homogenous neighborhoods in which they have the opportu- nity to engage in Dominican cultural activities and social gatherings to build their sense of community (Dawson, 2009). Cubans’ social ties are more likely to be with other Spanish speak- ers based on their lower levels of English pro- ficiency compared to other subgroups (Guar- naccia et al., 2007). This may explain the particular importance of social support in pro- tecting against depression for Cuban immi- grants. Further research is needed with these groups before these explanations can be gener- alized across all Cuban and Dominican immi- grant populations.
Third, we found discrimination moderated the association between cumulative lifetime ad- versity and depression for Cubans. However, the moderation was not in the direction that we expected. Cumulative lifetime adversity seemed to be more strongly associated with depression for those who had experienced low levels of discrimination compared to those who had ex- perienced high levels of discrimination. This goes against past literature and theory docu- menting the cumulative effects of stress, or that experiencing multiple stressors at the same time is especially harmful to mental health (e.g., Seery et al., 2010).
Finally, we found that ethnic identity moder- ated the association between cumulative life- time adversity and depression for Dominican immigrants. However, the moderation effect was in the opposite direction than we predicted. Based on the literature, we predicted that ethnic identity would be protective for all subgroups with particular importance for Cuban immi- grants. Conversely, we found that having high levels of ethnic identity had an exacerbating effect on the association between lifetime ad- versity and depression. Although this result in part supports our hypothesis that there would be subgroup differences in the role of ethnic iden- tity in protecting against depression, this finding contradicts ample past literature suggesting a significant positive link between ethnic identity
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and well-being (Iturbide, Raffaelli, & Carlo, 2009). However, some studies suggest that hav- ing a strong ethnic identity is not always bene- ficial to psychological health (Umaña-Taylor et al., 2008). Smith and Silva (2011) stated that individuals living in ethnic enclaves, such as many Dominican immigrants, “may not initially activate ethnic identity as a coping strategy” (p. 21). Additional research is needed to explore the role of ethnic identity in mental health out- comes for Dominican immigrants.
Overall, these findings provide evidence for the large within-group diversity that exists among U.S. Latinx immigrant populations. Past theory and research highlight the importance of culture and life experiences in shaping risk and resilience processes (Miranda, Estrada, & Firpo-Jimenez, 2000). Our results also provide a potential explanation for the conflicting find- ings related to Latinx immigrant mental health (e.g., the immigrant paradox). We found that for the full sample, social support was the only moderator of the association between cumula- tive lifetime adversity and depression. How- ever, the results were very different when ex- amining each subgroup separately. Without doing subgroup analyses, these complexities are lost, and the conclusion validity is compro- mised. The inconsistent findings in the literature related to Latinx immigrant mental health could be due to the large within-group variability among the Latinx populations assessed (e.g., Leong, Park, & Kalibatseva, 2013). Most past research has focused on Mexican samples and has not tested subgroup differences in responses to adverse events. Additional research is needed to further explore subgroup differences in men- tal health processes.
Limitations
There are several limitations worth noting in this study. First, our data came from a cross- sectional study. This means that the relation- ships between variables in the study are associ- ations, and we cannot infer causation or the direction of these associations. Future research- ers will need to replicate the results with longi- tudinal data. Second, our assessment of cumu- lative lifetime adversity did not account for the duration of the adverse events. This is an im- portant element to consider because research has shown that exposure to long periods of
adversity can be particularly detrimental (Suli- man et al., 2009). Third, our assessment of cumulative lifetime adversity was not exhaus- tive. Although we included many of the most commonly experienced adverse events, we did not include all possible forms of lifetime adver- sity. Fourth, there may have been some level of overlap in the constructs in our model, such as cumulative lifetime adversity, discrimination, and acculturation stress. For example, past the- ory and research suggest that discrimination and acculturation stress may be closely related (Lorenzo-Blanco & Unger, 2015) and certain types of discrimination can classify as traumatic events (Ellis et al., 2008). Therefore, some of the variance in discrimination may have been accounted for by other constructs in our model. We chose to conceptualize cultural stressors (discrimination and acculturation stress) as dis- tinct from general lifetime adversities (per- ceived stress, chronic stress, ACEs) to test the exacerbating effects of experiencing cultural and general stressors. Fourth, although random sampling procedures were used to identify par- ticipants, they were not representative of all age groups or geographic areas of the United States. Finally, although we found differences in men- tal health processes between Latinx subgroups, we do not know why these differences exist. Future studies could examine what life events, beliefs, or values are driving these subgroup differences.
Conclusion
Despite these limitations, this study repre- sented the first effort to examine culture-specific risk and resilience processes across multiple Latinx subgroups in a national epidemiological sample of U.S. Latinx immigrants. Few studies have used multigroup analyses to examine the mental health trajectories of populations with high levels of within-group diversity. The pres- ent study serves as an example of the rich in- formation that can be obtained by using sub- group analyses. Our findings have implications for tailoring mental health interventions for spe- cific Latinx immigrant groups, as different Lat- inx immigrant groups may need different inter- ventions. Factors that may be protective for some Latinx groups might not be protective for others. For example, our results indicate that Cuban and Dominican immigrants exposed to
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lifetime adversity could benefit from interven- tions focused on building social support. More- over, discrimination seems to be a significant issue for Mexican and South American immi- grants and may be a worthwhile target for men- tal health interventions with these populations. Health professionals face the risk of making inaccurate assessments about Latinx immi- grants’ mental health if they assume all Latinx immigrants are similar to one another. Future studies examining risk and protective factors related to mental health could be strengthened by further assessing within-group differences and could increase our understanding of Latinx mental health.
Resumen
Los inmigrantes Latinx están expuestos a varios facto- res que les causan estrés antes, durante, y después de migrar. Sin embargo, casi todas las investigaciones pre- vias han asumido que los efectos de estos factores que causan estrés son uniformes entre todos los grupos inmigrantes Latinx, a pesar de variación considerable dentro del grupo. El propósito de esta investigación fue (a) evaluar los efectos moderativos de los varios facto- res riesgosos y protectores en la relación entre la adver- sidad acumulativa de la vida y la depresión entre los inmigrantes Latinx en los estados unidos y (b) examinar hasta qué punto los procesos riesgosos y protectores se distinguían entre los subgrupos Latinx. Los datos vini- eron de un conjunto de datos secundarios transversales llamados el HCHS/SOL Estudio Sociocultural Ancilar. La muestra de personas (N � 2893) fue identificada usando un muestreo aleatorio proporcionalmente es- tratificado en cuatro de las áreas metropolitanas más grandes de gente Latinx: El Bronx en New York, San Diego, California, Chicago, Illinois, y Miami, Florida. Hemos incluyendo cuatro subgrupos Latinx en nuestra investigación: puertorriqueños, cubanos, mexicanos, y dominicanos. Resultados del análisis de regresión mul- tigrupo sugirieron que el apoyo social moderó la rel- ación entre la adversidad acumulativa de la vida y la depresión. Sin embargo, análisis más a fondo de sub- grupos demostraron que el efecto de moderación solo estaba presente para los inmigrantes cubanos y domini- canos. También descubrimos que la discriminación moderó la relación entre la adversidad acumulativa de la vida y la depresión para los inmigrantes cubanos y que la identidad étnica moderó la relación entre la adversi- dad acumulativa de la vida y la depresión para los inmigrantes dominicanos. Nuestros resultados proveen evidencia preliminar de la presencia de diferencias den- tro del grupo en las repuestas a los eventos adversos entre los subgrupos de inmigrantes Latinx. Los resulta- dos pueden informar el desarrollo de intervenciones de
salud mental personalizadas para las necesidades espe- cíficas de varias poblaciones de inmigrantes Latinx.
References
Ai, A. L., Carretta, H. J., & Aisenberg, E. (2017). Cultural strengths of Latino-American subgroups: Differential associations with their self-rated men- tal and physical health. Journal of Cross-Cultural Psychology, 48, 1349–1368. http://dx.doi.org/10 .1177/0022022117723528
Akresh, I. R., & Frank, R. (2008). Health selection among new immigrants. American Journal of Pub- lic Health, 98, 2058–2064. http://dx.doi.org/10 .2105/AJPH.2006.100974
Alarcón, R. D., Parekh, A., Wainberg, M. L., Duarte, C. S., Araya, R., & Oquendo, M. A. (2016). His- panic immigrants in the USA: Social and mental health perspectives. The Lancet Psychiatry, 3, 860– 870. http://dx.doi.org/10.1016/S2215-0366 (16)30101-8
Alegría, M., Canino, G., Shrout, P. E., Woo, M., Duan, N., Vila, D., . . . Meng, X. L. (2008). Prevalence of mental illness in immigrant and non- immigrant U.S. Latino groups. The American Journal of Psychiatry, 165, 359–369. http://dx.doi .org/10.1176/appi.ajp.2007.07040704
Alegría, M., & Woo, M. (2009). Conceptual issues in Latino mental health. In F. A. Villarruel, G. Carlo, J. M. Grau, M. Azmitia, N. J. Cabrera, & T. J. Chahin (Eds.), Handbook of U.S. Latino psychol- ogy: Developmental and community-based per- spectives (pp. 15–30). Thousand Oaks, CA: SAGE Publications.
Anthias, F., & Cederberg, M. (2009). Using ethnic bonds in self-employment and the issue of social capital. Journal of Ethnic and Migration Studies, 35, 901–917. http://dx.doi.org/10.1080/1369183 0902957692
Arnberg, F. K., Hultman, C. M., Michel, P. O., & Lundin, T. (2012). Social support moderates post- traumatic stress and general distress after disaster. Journal of Traumatic Stress, 25, 721–727. http:// dx.doi.org/10.1002/jts.21758
Barwick, C. (2017). Are immigrants really lacking social networking skills? The crucial role of reci- procity in building ethnically diverse networks. Sociology, 51, 410– 428. http://dx.doi.org/10.1177/ 0038038515596896
Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broe- kaert, E., & Spinhoven, P. (2007). Comparing psy- chological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. Journal of Nervous and Mental Disease, 195, 288–297. http://dx.doi.org/10.1097/01.nmd .0000243751.49499.93
216 COOPER ET AL.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
Björgvinsson, T., Kertz, S. J., Bigda-Peyton, J. S., McCoy, K. L., & Aderka, I. M. (2013). Psycho- metric properties of the CES-D-10 in a psychiatric sample. Assessment, 20, 429– 436. http://dx.doi .org/10.1177/1073191113481998
Breslau, J., Borges, G., Tancredi, D., Saito, N., Krav- itz, R., Hinton, L., . . . Aguilar-Gaxiola, S. (2011). Migration from Mexico to the United States and subsequent risk for depressive and anxiety disor- ders: A cross-national study. Archives of General Psychiatry, 68, 428– 433. http://dx.doi.org/10 .1001/archgenpsychiatry.2011.21
Brittian, A. S., Kim, S. Y., Armenta, B. E., Lee, R. M., Umaña-Taylor, A. J., Schwartz, S. J., . . . Hudson, M. L. (2015). Do dimensions of ethnic identity mediate the association between perceived ethnic group discrimination and depressive symp- toms? Cultural Diversity and Ethnic Minority Psy- chology, 21, 41–53. http://dx.doi.org/10.1037/ a0037531
Cavazos-Rehg, P. A., Zayas, L. H., Walker, M. S., & Fisher, E. B. (2006). Evaluating an abbreviated version of the hispanic stress inventory for immi- grants. Hispanic Journal of Behavioral Sciences, 28, 498–515. http://dx.doi.org/10.1177/0739986 306291740
Chae, S. M., Park, J. W., & Kang, H. S. (2014). Relationships of acculturative stress, depression, and social support to health-related quality of life in Vietnamese immigrant women in South Korea. Journal of Transcultural Nursing, 25, 137–144. http://dx.doi.org/10.1177/1043659613515714
Cicchetti, D., & Rogosch, F. A. (2012). Neuroendo- crine regulation and emotional adaptation in the context of child maltreatment. Monographs of the Society for Research in Child Development, 77, 87–95. http://dx.doi.org/10.1111/j.1540-5834 .2011.00666.x
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psycholog- ical Bulletin, 98, 310–357. http://dx.doi.org/10 .1037/0033-2909.98.2.310
Dawson, B. A. (2009). Discrimination, stress, and acculturation among Dominican immigrant wom- en. Hispanic Journal of Behavioral Sciences, 31, 96–111. http://dx.doi.org/10.1177/07399863083 27502
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the ad- verse childhood experiences study. The American Journal of Psychiatry, 160, 1453–1460. http://dx .doi.org/10.1176/appi.ajp.160.8.1453
Ellis, B. H., MacDonald, H. Z., Lincoln, A. K., & Cabral, H. J. (2008). Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination. Journal of Consulting
and Clinical Psychology, 76, 184–193. http://dx .doi.org/10.1037/0022-006X.76.2.184
Falcón, L. M., & Tucker, K. L. (2000). Prevalence and correlates of depressive symptoms among His- panic elders in Massachusetts. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 55(2), S108–S116. http://dx .doi.org/10.1093/geronb/55.2.S108
Felitti, V. J., Anda, R. F., Nordenberg, D., William- son, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245–258. http://dx.doi .org/10.1016/S0749-3797(98)00017-8
Gallo, L. C., Penedo, F. J., Carnethon, M., Isasi, C. R., Sotres-Alvarez, D., Malcarne, V. L., . . . Talavera, G. T. (2014). The Hispanic community health study/ study of Latinos sociocultural ancillary study: Sam- ple, design, and procedures. Ethnicity & Disease, 24, 77– 83. Retrieved from https://www.ncbi.nlm.nih .gov/pmc/articles/PMC3986116/
González, P., Nuñez, A., Merz, E., Brintz, C., Weitz- man, O., Navas, E. L., . . . Gallo, L. C. (2017). Measurement properties of the Center for Epide- miologic Studies Depression Scale (CES-D 10): Findings from HCHS/SOL. Psychological Assess- ment, 29, 372–381. http://dx.doi.org/10.1037/ pas0000330
Gottlieb, B. H., & Bergen, A. E. (2010). Social support concepts and measures. Journal of Psy- chosomatic Research, 69, 511–520. http://dx.doi .org/10.1016/j.jpsychores.2009.10.001
Guarnaccia, P. J., Martínez Pincay, I., Alegria, M., Shrout, P., Lewis-Fernandez, R., & Canino, G. (2007). Assessing diversity among Latinos: Re- sults from the NLAAS. Hispanic Journal of Be- havioral Sciences, 29, 510–534. http://dx.doi.org/ 10.1177/0739986307308110
Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319. http:// dx.doi.org/10.1146/annurev.clinpsy.1.102803 .143938
Hobfoll, S. E. (1989). Conservation of resources. A new attempt at conceptualizing stress. American Psychologist, 44, 513–524. http://dx.doi.org/10 .1037/0003-066X.44.3.513
Hobfoll, S. E. (2001). The influence of culture, com- munity, and the nested-self in the stress process: Advancing conservation of resources theory. Ap- plied Psychology: An International Review, 50, 337– 421. http://dx.doi.org/10.1111/1464-0597 .00062
Hobfoll, S. E. (2002). Social and psychological re- sources and adaptation. Review of General Psy- chology, 6, 307–324. http://dx.doi.org/10.1037/ 1089-2680.6.4.307
217CUMULATIVE LIFETIME ADVERSITY AND DEPRESSION
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
Huang, C. Y., Costeines, J., Kaufman, J. S., & Ayala, C. (2014). Parenting stress, social support, and depression for ethnic minority adolescent mothers: Impact on child development. Journal of Child and Family Studies, 23, 255–262. http://dx.doi .org/10.1007/s10826-013-9807-1
Iturbide, M. I., Raffaelli, M., & Carlo, G. (2009). Protective effects of ethnic identity on Mexican American college students’ psychological well- being. Hispanic Journal of Behavioral Sciences, 31, 536–552. http://dx.doi.org/10.1177/07399863 09345992
Kartal, D., & Kiropoulos, L. (2016). Effects of acculturative stress on PTSD, depressive, and anxiety symptoms among refugees resettled in Australia and Austria. European Journal of Psy- chotraumatology, 7, 28711. http://dx.doi.org/10 .3402/ejpt.v7.28711
Kiang, L., Yip, T., Gonzales-Backen, M., Witkow, M., & Fuligni, A. J. (2006). Ethnic identity and the daily psychological well-being of adolescents from Mexican and Chinese backgrounds. Child Devel- opment, 77, 1338–1350. http://dx.doi.org/10.1111/ j.1467-8624.2006.00938.x
Kinderman, P., Schwannauer, M., Pontin, E., & Tai, S. (2013). Psychological processes mediate the impact of familial risk, social circumstances and life events on mental health. PLoS ONE, 8(10), e76564. http://dx.doi.org/10.1371/journal.pone .0076564
Kline, R. B. (2016). Principles and practice of struc- tural equation modeling (4th ed.). New York, NY: Guilford Press.
LaVange, L. M., Kalsbeek, W. D., Sorlie, P. D., Avilés-Santa, L. M., Kaplan, R. C., Barnhart, J., . . . Elder, J. P. (2010). Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos. Annals of Epidemiology, 20, 642– 649. http://dx.doi.org/10.1016/j.annepi- dem.2010.05.006
Leong, F., Park, Y. S., & Kalibatseva, Z. (2013). Disentangling immigrant status in mental health: Psychological protective and risk factors among Latino and Asian American immigrants. American Journal of Orthopsychiatry, 83, 361–371. http://dx .doi.org/10.1111/ajop.12020
Li, S. S. Y., Liddell, B. J., & Nickerson, A. (2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18, 82. http:// dx.doi.org/10.1007/s11920-016-0723-0
Lopez, G., & Patten, E. (2015). Hispanics of Puerto Rican origin in the United States, 2013. Retrieved from https://www.pewresearch.org/hispanic/2015/ 09/15/hispanics-of-puerto-rican-origin-in-the- united-states-2013/
Lorenzo-Blanco, E. I., & Cortina, L. M. (2013). Towards an integrated understanding of Latino/a
acculturation, depression, and smoking: A gen- dered analysis. Journal of Latina/o Psychology, 1, 3–20. http://dx.doi.org/10.1037/a0030951
Lorenzo-Blanco, E. I., & Unger, J. B. (2015). Ethnic discrimination, acculturative stress, and family conflict as predictors of depressive symptoms and cigarette smoking among Latina/o youth: The me- diating role of perceived stress. Journal of Youth and Adolescence, 44, 1984–1997. http://dx.doi .org/10.1007/s10964-015-0339-4
Malcarne, V. L., Chavira, D. A., Fernandez, S., & Liu, P. J. (2006). The Scale of Ethnic Experience: Development and psychometric properties. Jour- nal of Personality Assessment, 86, 150–161. http:// dx.doi.org/10.1207/s15327752jpa8602_04
Maydeu-Olivares, A. (2017). Maximum likelihood estimation of structural equation models for con- tinuous data: Standard errors and goodness of fit. Structural Equation Modeling, 24, 383–394. http:// dx.doi.org/10.1080/10705511.2016.1269606
Mendoza, N. B., Mordeno, I. G., Latkin, C. A., & Hall, B. J. (2017). Evidence of the paradoxical effect of social network support: A study among Filipino domestic workers in China. Psychiatry Research, 255, 263–271. http://dx.doi.org/10 .1016/j.psychres.2017.05.037
Merz, E. L., Roesch, S. C., Malcarne, V. L., Penedo, F. J., Llabre, M. M., Weitzman, O. B., . . . Gallo, L. C. (2014). Validation of interpersonal support evaluation list-12 (ISEL-12) scores among Eng- lish- and Spanish-speaking Hispanics/Latinos from the HCHS/SOL Sociocultural Ancillary Study. Psychological Assessment, 26, 384–394. http://dx .doi.org/10.1037/a0035248
Miranda, A. O., Estrada, D., & Firpo-Jimenez, M. (2000). Differences in family cohesion, adaptabil- ity, and environment among Latino families in dissimilar stages of acculturation. The Family Journal, 8, 341–350. http://dx.doi.org/10.1177/ 1066480700084003
Molina, K. M., Alegría, M., & Mahalingam, R. (2013). A multiple-group path analysis of the role of everyday discrimination on self-rated physical health among Latina/os in the USA. Annals of Behavioral Medicine, 45, 33– 44. http://dx.doi.org/ 10.1007/s12160-012-9421-2
Moradi, B., & Risco, C. (2006). Perceived discrimi- nation experiences and mental health of Latina/o American persons. Journal of Counseling Psychol- ogy, 53, 411– 421. http://dx.doi.org/10.1037/0022- 0167.53.4.411
Muscatell, K. A., Slavich, G. M., Monroe, S. M., & Gotlib, I. H. (2009). Stressful life events, chronic difficulties, and the symptoms of clinical depres- sion. Journal of Nervous and Mental Disease, 197, 154–160. http://dx.doi.org/10.1097/NMD.0b013 e318199f77b
218 COOPER ET AL.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
Muthén, L. K., & Muthén, B. O. (2017). Mplus user’s guide (8th ed.). Los Angeles, CA: Author. (Orig- inal work published 1998)
Myers, H. F., Wyatt, G. E., Ullman, J. B., Loeb, T. B., Chin, D., Prause, N., . . . Liu, H. (2015). Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. Psychological Trauma: Theory, Re- search, Practice and Policy, 7, 243–251. http://dx .doi.org/10.1037/a0039077
Norris, F. H. (1990). Screening for traumatic stress: A scale for use in the general population. Journal of Applied Social Psychology, 20, 1704–1715. http://dx .doi.org/10.1111/j.1559-1816.1990.tb01505.x
Paykel, E. S. (2003). Life events and affective disor- ders. Acta Psychiatrica Scandinavica, 108, 61– 66. http://dx.doi.org/10.1034/j.1600-0447.108.s418 .13.x
Phinney, J. S. (2000). Ethnic and racial identity: Ethnic identity. In A. E. Kazdin (Ed.), Encyclope- dia of psychology (Vol. 3, pp. 254–259). Washing- ton DC: American Psychological Association. http://dx.doi.org/10.1037/10518-122
Prati, G., & Pietrantoni, L. (2010). The relation of perceived and received social support to mental health among first responders: A meta-analytic re- view. Journal of Community Psychology, 38, 403– 417. http://dx.doi.org/10.1002/jcop.20371
Ramos, B., Jaccard, J., & Guilamo-Ramos, V. (2003). Dual ethnicity and depressive symptoms: Implications of being Black and Latino in the United States. Hispanic Journal of Behavioral Sci- ences, 25, 147–173. http://dx.doi.org/10.1177/ 0739986303025002002
Revollo, H. W., Qureshi, A., Collazos, F., Valero, S., & Casas, M. (2011). Acculturative stress as a risk factor of depression and anxiety in the Latin Amer- ican immigrant population. International Review of Psychiatry, 23, 84–92. http://dx.doi.org/10 .3109/09540261.2010.545988
Rivera, F. I. (2007). Contextualizing the experience of young Latino adults: Acculturation, social sup- port and depression. Journal of Immigrant and Minority Health, 9, 237–244. http://dx.doi.org/10 .1007/s10903-006-9034-6
Rivera, F. I., Guarnaccia, P. J., Mulvaney-Day, N., Lin, J. Y., Torres, M., & Alegria, M. (2008). Family cohesion and its relationship to psycholog- ical distress among Latino groups. Hispanic Jour- nal of Behavioral Sciences, 30, 357–378. http://dx .doi.org/10.1177/0739986308318713
Ronconi, J. M., Shiner, B., & Watts, B. V. (2015). A meta-analysis of depressive symptom outcomes in randomized, controlled trials for PTSD. Journal of Nervous and Mental Disease, 203, 522–529. http:// dx.doi.org/10.1097/NMD.0000000000000322
Schwartz, S. J., Montgomery, M. J., & Briones, E. (2006). The role of identity in acculturation among
immigrant people: Theoretical propositions, em- pirical questions, and applied recommendations. Human Development, 49, 1–30. http://dx.doi.org/ 10.1159/000090300
Seery, M. D., Holman, E. A., & Silver, R. C. (2010). Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience. Journal of Personality and Social Psychology, 99, 1025– 1041. http://dx.doi.org/10.1037/a0021344
Shalev, I., Moffitt, T. E., Sugden, K., Williams, B., Houts, R. M., Danese, A., . . . Caspi, A. (2013). Exposure to violence during childhood is associ- ated with telomere erosion from 5 to 10 years of age: A longitudinal study. Molecular Psychiatry, 18, 576–581. http://dx.doi.org/10.1038/mp .2012.32
Shor, E., Roelfs, D., & Vang, Z. M. (2017). The “Hispanic mortality paradox” revisited: Meta- analysis and meta-regression of life-course differ- entials in Latin American and Caribbean immi- grants’ mortality. Social Science & Medicine, 186, 20–33. http://dx.doi.org/10.1016/j.socscimed.2017 .05.049
Silove, D., Austin, P., & Steel, Z. (2007). No refuge from terror: The impact of detention on the mental health of trauma-affected refugees seeking asylum in Australia. Transcultural Psychiatry, 44, 359– 393. http://dx.doi.org/10.1177/1363461507081637
Smith, T. B., & Silva, L. (2011). Ethnic identity and personal well-being of people of color: A meta- analysis. Journal of Counseling Psychology, 58, 42– 60. http://dx.doi.org/10.1037/a0021528
Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed, R., Stein, D. J., & Seedat, S. (2009). Cumulative effect of multiple trauma on symptoms of posttrau- matic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50, 121– 127. http://dx.doi.org/10.1016/j.comppsych.2008 .06.006
Tienda, M., & Sánchez, S. (2013). Latin American Immigration to the United States. Daedalus, 142, 48– 64. http://dx.doi.org/10.1162/DAED_a_00218
Torres, L., Driscoll, M. W., & Voell, M. (2012). Discrimination, acculturation, acculturative stress, and Latino psychological distress: A moderated mediational model. Cultural Diversity and Ethnic Minority Psychology, 18, 17–25. http://dx.doi.org/ 10.1037/a0026710
Torres, L., & Ong, A. D. (2010). A daily diary investigation of Latino ethnic identity, discrimina- tion, and depression. Cultural Diversity and Ethnic Minority Psychology, 16, 561–568. http://dx.doi .org/10.1037/a0020652
Torres, V. (2004). The diversity among us: Puerto Ricans, Cuban Americans, Caribbean Americans, and Central and South Americans. New Directions for Student Services, 2004, 5–16. http://dx.doi.org/ 10.1002/ss.112
219CUMULATIVE LIFETIME ADVERSITY AND DEPRESSION
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
Umaña-Taylor, A. J., Gonzales-Backen, M. A., & Gui- mond, A. B. (2009). Latino adolescents’ ethnic iden- tity: Is there a developmental progression and does growth in ethnic identity predict growth in self- esteem? Child Development, 80, 391– 405. http://dx .doi.org/10.1111/j.1467-8624.2009.01267.x
Umaña-Taylor, A. J., & Updegraff, K. A. (2007). Latino adolescents’ mental health: Exploring the interrelations among discrimination, ethnic iden- tity, cultural orientation, self-esteem, and depres- sive symptoms. Journal of Adolescence, 30, 549– 567. http://dx.doi.org/10.1016/j.adolescence.2006 .08.002
Umaña-Taylor, A. J., Vargas-Chanes, D., Garcia, C. D., & Gonzales-Backen, M. (2008). A longitudinal ex- amination of Latino adolescents’ ethnic identity, cop- ing with discrimination, and self-esteem. The Journal of Early Adolescence, 28, 16–50. http://dx.doi.org/10 .1177/0272431607308666
Ward, K. P., Shaw, S. A., Chang, M., & El-Bassel, N. (2018). Social support moderates the association between traumatic life events and depression among migrant and nonmigrant men in Almaty, Kazakhstan. Journal of Traumatic Stress, 31, 698– 707. http://dx.doi.org/10.1002/jts.22324
Zambrana, R. E., & Dill, B. T. (2006). Disparities in Latina health: An intersectional analysis. In A. Schultz & L. Mullings (Eds.), Race, class, gender and health (pp. 192–227). San Francisco, CA: Jossey-Bass.
Zong, J., & Batlova, J. (2018). Dominican immi- grants in the United States. Retrieved from https:// www.migrationpolicy.org/article/dominican- immigrants-united-states
Received February 17, 2019 Revision received October 10, 2019
Accepted October 18, 2019 �
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en t
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- Cumulative Lifetime Adversity and Depression Among a National Sample of U.S. Latinx Immigrants: ...
- Mental Health and U.S. Latinx Populations
- Social Support
- Ethnic Identity
- Acculturation Stress
- Ethnic/Racial Discrimination
- The Present Study
- Method
- Sample
- Measures
- Cumulative lifetime adversity
- Acculturation stress
- Perceived ethnic discrimination
- Social support
- Ethnic identity
- Depression
- Data Analysis
- Results
- Preliminary Analysis
- Main Effects for Total Sample
- Moderation Model for Total Sample
- Multigroup Analysis: Comparing Latinx Subgroups
- Discussion
- Associations Between Risk and Protective Factors and Depression
- Moderating Effects of Social Support for the Full Sample
- Differences in Risk and Protective Processes Across Latinx Subgroups
- Limitations
- Conclusion
- References
