Discussion
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PUBSTRESSOR.pdf
Culture’s Influence on Stressors, Parental Socialization, and Developmental Processes in the Mental Health of Children of Immigrants
Su Yeong Kim1, Seth J. Schwartz2, Krista M. Perreira3, and Linda P. Juang4
1Department of Human Development and Family Sciences, University of Texas, Austin, Texas 78712, USA
2Department of Epidemiology and Public Health, University of Miami, Miami, Florida 33136, USA
3Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
4Inclusive Education Group, College of Human Sciences, University of Potsdam, 14476 Potsdam, Germany
Abstract
Children of immigrants represent one in four children in the United States and will represent one
in three children by 2050. Children of Asian and Latino immigrants together represent the
majority of children of immigrants in the United States. Children of immigrants may be
immigrants themselves, or they may have been born in the United States to foreign-born parents;
their status may be legal or undocumented. We review transcultural and culture-specific factors
that influence the various ways in which stressors are experienced; we also discuss the ways in
which parental socialization and developmental processes function as risk factors or protective
factors in their influence on the mental health of children of immigrants. Children of immigrants
with elevated risk for mental health problems are more likely to be undocumented immigrants,
refugees, or unaccompanied minors. We describe interventions and policies that show promise for
reducing mental health problems among children of immigrants in the United States.
Keywords
children of immigrants; stressors; transcultural; culture specific; parental socialization; mental health
INTRODUCTION
Migration is a worldwide phenomenon, and the United States is the leading destination of
international migration (Connor & Lopez 2016). Some immigrants arrive alone, and other
immigrants form family units and either arrive with children or have children in the
destination country. This review focuses on the mental health of children with immigrant
HHS Public Access Author manuscript Annu Rev Clin Psychol. Author manuscript; available in PMC 2019 June 23.
Published in final edited form as: Annu Rev Clin Psychol. 2018 May 07; 14: 343–370. doi:10.1146/annurev-clinpsy-050817-084925.
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parents, specifically on the experiences of children of Asian and Latino immigrants in the
United States. We present consistencies as well as differences in the effects of culture on
stressors, parental socialization, and developmental processes, and the effects of these
factors, in turn, on the mental health of adolescents from Asian and Latino immigrant
families. Our spotlight on these pan-ethnic groups is deliberate, as they collectively
represent 77% of immigrants to the United States (26% of US immigrants are of Asian
heritage and 51% are of Latino heritage) (Lopez et al. 2015). This review focuses especially
on children from Chinese and Mexican immigrant families, as they represent the largest
ethnic groups of Asians and Latinos, respectively, in the United States (Lopez et al. 2015).
Understanding the mental health of children of immigrants is important, given the size of the
population and its future growth. Children of immigrants currently represent one in four
children in the United States and are projected to represent one in three children by the year
2050 (Passel 2011). While US-born parents and their children have a share of the US labor
force that is projected to decline by 8.2%, the shares of immigrants and their US-born
children are projected to increase to 4.6% and 13.6% of the labor force, respectively, to
result in a net gain of 10% in the labor force by the year 2035 (Passel & Cohn 2017).
Because immigrants and the children of immigrants will contribute to this projected increase
in the US labor force, understanding their mental health is important for ensuring a healthy
future workforce. Children’s mental health also has important implications for other
outcomes across the life course, including adult educational attainment and adult physical
and mental health functioning (Case et al. 2005)
OVERVIEW
The term children of immigrants encompasses a great deal of complexity and diversity.
Children of immigrants may be immigrants themselves or may have been born in the United
States to foreign-born parents (Hernandez et al. 2011). The first generation refers to foreign-
born children who are themselves immigrants; the second generation refers to US-born
children with one or more immigrant parents; the third or later generation refers to US-born
children with US-born parents (Hernandez et al. 2011). Children of immigrants may come
from legal, undocumented, or mixed-status families; in mixed-status families, at least one
parent (and perhaps some siblings) may be undocumented, whereas at least one child was
born in the United States and is therefore a citizen (Vargas 2015). Children of immigrants
may have parents residing in the United States, have come to the United States as
unaccompanied minors (Huemer et al. 2009), or be part of transnational families in which
parents and children live in different countries but maintain close ties (Dreby & Adkins
2012). Because the focus of the extant literature has been on children with foreign-born
parents who are living in the United States, this review focuses on children of Asian and
Latino descent within this group. Although international migration is not the focus of this
review, we recognize that migration is a worldwide phenomenon (Connor & Lopez 2016)
that is accompanied by a growing literature on immigrants and children of immigrants who
live in Europe and other countries.
The framework guiding this review (Figure 1) considers both transcultural and culture-
specific factors that can be considered stressors. Transcultural stressors can affect any social
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group, regardless of culture or nativity. Culture-specific stressors are more relevant for
minorities and children of immigrants in the United States. We posit that these transcultural
and culture-specific stressors can have a direct, interactive, or indirect impact on the mental
health of children of immigrants through parental socialization, peers, schools,
neighborhoods, and developmental processes. With an empirical understanding of these
processes, policies and interventions can be implemented to improve the mental health of
children of immigrants.
Our review also focuses on adolescence, parental socialization, and two developmental
processes shaping the experience of adolescents from immigrant families, namely
bilingualism (Bialystok 2001) and ethnic identity (Umaña-Taylor et al. 2014b). We focus
more on parental socialization and developmental processes because empirical, evidence-
based interventions targeting these processes are associated with positive mental health
outcomes in children of immigrants (Bacallao & Smokowski 2005, Gonzales et al. 2012,
Lau et al. 2011, Pantin et al. 2003, Umaña-Taylor et al. 2017). We also recognize that child
characteristics and additional proximal and distal factors (e.g., peers, schools, and
neighborhoods) can have a profound influence on the mental health of children of
immigrants (Garcia Coll et al. 1996). With some exceptions (e.g., Kia-Keating & Ellis
2007), there are fewer empirical, evidence-based interventions targeting these other factors.
However, we do reference studies of these other factors when they are relevant to the focus
of our review.
To understand the mental health of children of immigrants of Asian and Latino descent, we
use three theoretical perspectives: two that recognize the culture-specific experiences of
children of immigrants as ethnic minority children (the integrative model of the study of
minority children) (Garcia Coll et al. 1996) growing up with foreign-born parents
(ecodevelopmental theory) (Ortega et al. 2012, Prado et al. 2010) and one that recognizes
transcultural stressors, such as family economic stress, that may disproportionally affect
immigrant families (Conger & Conger 2002, White et al. 2009). The integrative model of
minority child development (Garcia Coll et al. 1996) emphasizes the central role of
discrimination as a stressor among ethnic minorities that can undermine resources and
opportunities, and recognizes that families of minority children create adaptive practices in
response to stressors to develop competence in their children. Complementing this view
within the framework of immigrant families is ecodevelopmental theory (Ortega et al. 2012,
Prado et al. 2010), which recognizes the central role of the parent–child acculturation gap, or
the cultural challenge of orienting toward the heritage and destination cultures at different
rates, as a stressor that has downstream effects on social relationships, such as family and
peer relationships, that influence child mental health. In contrast, family stress theory is a
transcultural theory. Family economic stress is posited, in family stress theory, to be a key
stressor that impairs marital and parent–child relationships and compromises children’s
mental health (Conger & Conger 2002). Our framework therefore includes both culture-
specific and transcultural stressors and examines how they may work in conjunction to
influence the mental health of children of immigrants.
This review focuses heavily on adolescence, a critical developmental period defined by
major physical, cognitive, and social changes occurring at the same time (Blakemore &
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Mills 2014). Specifically, the developing adolescent brain triggers changes that carry
important implications for cognitive function (e.g., executive function) and render
adolescents more sensitive to peer reactions and other environmental cues (Blakemore &
Mills 2014). These major changes may explain why the onsets of psychiatric illnesses often
occur in adolescence (Kessler et al. 2005). Thus, it is important to examine the key processes
that can inform adolescent mental health. In this review, we focus on two key developmental
processes among children of immigrants: bilingualism, which exerts important effects on
cognitive functioning, and ethnic identity, which helps direct social development for
immigrant and minority adolescents. We consider how these developmental processes, along
with parental socialization, may confer both risk and protection in terms of adolescents’
mental health outcomes.
There are at least four ways in which culture-specific and transcultural factors can influence
the mental health of children of immigrants (Figure 2). Culture-specific and transcultural
factors can make separate and distinct contributions (Figure 2a), fuse to make an
independent contribution (Figure 2b), make interactive contributions (Figure 2c), or be
represented by multiple dimensions of each factor (Figure 2d) to influence mental health in
children of immigrants.
Culture-specific and transcultural factors can make independent contributions, and one
factor may be more influential than others when accounting for influence on mental health
(Figure 2a). For example, White et al. (2009) found that pressure to speak English (a culture-
specific stressor) and economic pressure (a transcultural stressor) additively made
independent contributions to depressed mood in a sample of Mexican American parents.
However, multiple factors can be considered together, and one factor may emerge as a
significant contributor to mental health in children of immigrants. For example, using the
Hispanic Stress Inventory, a measure that includes a number of culture-specific factors,
Goldbach et al. (2015) found that acculturation gap between parents and children emerged as
a culturally significant predictor of alcohol use, after accounting for discrimination, in
Latino adolescents.
Culture-specific and transcultural factors can also fuse to influence the mental health of
children of immigrants (Figure 2b). In acculturation research, the creation of a new cultural
identity that fuses elements of the heritage and destination cultures can result in a cultural
orientation that is greater than the sum of its parts (Flannery et al. 2001). For example, a
Mexican American child may identify as Mexican, as American, or as Mexican American (a
hybrid identity that is more than the sum of its parts). Although a hybrid identity reflecting
biculturalism tends to facilitate positive mental health outcomes (Nguyen & Benet-Martínez
2013), children of immigrants may also adopt negative or oppositional cultural identities,
such as cholo or la raza (Unger et al. 2014). Specifically, cholo is a term used to describe gang members, and la raza is a cultural identity that represents resistance to discrimination by the dominant group (Unger et al. 2014). Identifying with oppositional cultural labels may
promote more risky behaviors, such as substance use (Unger et al. 2014).
Interactions between culture-specific and transcultural factors can also be tracked using the
statistical interactions approach in social science research (Aiken & West 1991) to
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understand the influences of these factors on the mental health of children of immigrants
(Figure 2c). For example, for Mexico-born adolescents living in the United States, language
hassles (a culture-specific factor) may predict more externalizing symptoms, especially
when accompanied by low levels of family cohesion (a transcultural factor) (Nair et al.
2013). Language hassles refer to negative events related to using either the heritage language
or the language of the destination country, such as being criticized for speaking Spanish or
being put down by a teacher for not speaking English well.
Culture-specific and transcultural factors can also be viewed as multidimensional and used
in statistical approaches, such as latent profile analysis (Collins & Lanza 2010), or as latent
factors in structural equation modeling (Kline 2016) to understand the mental health of
children of immigrants (Figure 2d). For example, both culture-specific dimensions
(discrimination and language hassles as stressors) and transcultural dimensions (maternal
depression, economic hardship, parent–child conflict, deviant peers, and peer conflict as
stressors) were used to conduct latent profile analysis, producing three types of risk profiles
in Mexican American adolescents (Zeiders et al. 2013). Adolescents with the highest risk
(highest levels of stressors across multiple dimensions) reported the most problematic
mental health symptoms (Zeiders et al. 2013). In a structural equation modeling framework,
a latent factor comprised of culture-specific factors (perceived discrimination, bicultural
stress, and negative context of reception in the destination culture) was found to predispose
Latino adolescents toward depressive symptoms, substance use, and aggressive and rule-
breaking behaviors (Schwartz et al. 2015b).
Against the backdrop of the theories and methods reviewed above, we highlight the various
ways that culture-specific and transcultural stressors directly, interactively, or indirectly
influence parental socialization and developmental processes to affect the mental health of
children of immigrants. Before doing so, however, we first review the extent of mental
health problems in children of immigrants.
PREVALENCE OF MENTAL HEALTH PROBLEMS IN CHILDREN OF
IMMIGRANTS
The mental health of immigrants has most often been framed in terms of the immigrant
paradox, in which immigrants experience better mental health than their native-born
counterparts despite the lower socioeconomic status of immigrants (Marks et al. 2014). This
paradox has also been termed the healthy immigrant effect (Castañeda et al. 2015). The
assumption is that the most healthy immigrants are selecting themselves to migrate, and
unhealthy immigrants are returning to their country of origin (salmon bias) (Arenas et al.
2015), thus making the immigrant pool more healthy overall. At present, though, due to lack
of cross-country data, a full and rigorous test of these assumptions has not been fully
realized. Moreover, we currently lack a national epidemiological study to ascertain levels of
psychiatric diagnoses by nativity for children of immigrants. We therefore use national
epidemiological data sets on adults, along with data related to nativity, age of arrival, and
years of residence in the United States, to ascertain information relevant for understanding
mental health functioning in children of immigrants. We also turn to prominent studies that
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have sampled adolescents in the United States and have also included an assessment of
nativity to make more direct inferences about the mental health of children of immigrants,
acknowledging that such studies typically assess mental health functioning in terms of
symptoms rather than as psychiatric diagnoses.
Large-scale epidemiological surveys generally support the notion of an immigrant paradox
for psychiatric diagnoses among adults, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (Am. Psychiatr. Assoc. 1994). Using DSM-IV criteria, Breslau et al. (2007) found a health advantage for adult immigrants
relative to native-born individuals for various classes of psychiatric disorders in the National
Comorbidity Survey Replication (NCS-R). Also using DSM-IV criteria, Alegría et al. (2007)
and Takeuchi et al. (2007) found that this nativity advantage was replicated in the National
Latino and Asian American Study (NLAAS) for lifetime prevalence of psychiatric diagnoses
(depressive disorders, anxiety disorders, substance use disorders) among Latinos and Asian
Americans in the United States.
The age of an immigrants’ arrival can provide information on whether developmental status
at the time of migration can influence immigrants’ future mental health. The NCS-R and
NLAAS on adults suggest that migration before adolescence puts immigrants at a risk level
for psychiatric diagnoses similar to that of native-born individuals, whereas migration as an
adult provides a mental health advantage (Alegría et al. 2007, Breslau et al. 2007, Takeuchi
et al. 2007).
Acculturation is a construct that is central to understanding the mental health of immigrants
(Schwartz et al. 2010). Acculturation refers to the culture change that occurs when
immigrants settle in a destination culture. In large epidemiological studies, acculturation is
often studied using English fluency or years of residence in the United States as a proxy
(Schwartz et al. 2010). Whether acculturation relates to better or worse mental health is
unclear, as findings have been generally inconsistent. In the NLAAS, for example, higher
English proficiency related to disadvantaged mental health status in Latinos, whereas the
pattern was the opposite for Asian American men (Alegría et al. 2007, Takeuchi et al. 2007).
The evidence is also mixed on whether the initial immigrant mental health advantage
dissipates over time. The NCS-R showed that the incidence of psychiatric disorders among
immigrants increased with longer time spent in the United States, until levels of impulse
control, substance use, and mood disorders reached those seen among native-born
individuals (Breslau et al. 2007). In contrast, the NLAAS showed no consistent pattern and
no significant effect of longer time spent in the United States on psychiatric diagnoses after
accounting for age (Alegría et al. 2007, Takeuchi et al. 2007). However, because the NLAAS
was conducted in 2002-2003, more recent statistics are needed. The Hispanic Community
Health Study/Study of Latinos (HCHS/SOL), conducted between 2008 and 2011, provides
more recent data on the mental health of immigrants, but it does not include measures of
psychiatric disorders (Perreira et al. 2015). Nonetheless, the HCHS/SOL does find evidence
that, among Latinos, there are higher rates of moderate to severe psychological distress,
depression, and anxiety with longer exposure to US culture (Perreira et al. 2015).
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The national epidemiological studies we review above were based on information provided
by adult participants; however, it is also important to examine the rates of mental health
problems in child and adolescent populations directly. We anchor our review using data from
the National Longitudinal Study of Adolescent to Adult Health (Add Health), one of the
most prominent national studies of adolescents in the United States. Across studies, there is
evidence for both immigrant advantage and disadvantage in internalizing problems, whereas
our review on suicidal behaviors, externalizing problems, and substance use generally points
to immigrant advantage among children of immigrants.
For internalizing problems, the evidence for immigrant advantage in children of immigrants
is mixed. The Add Health study found that the adolescent immigrant health advantage of
lower depressive symptoms was initially not apparent but became apparent after accounting
for protective factors such as family support and parental supervision (Harker 2001).
Another prominent study, the Project on Human Development in Chicago Neighborhoods,
found an opposite pattern, in which first- and second-generation Latino children had higher
levels of internalizing problems relative to third-generation children, but this disadvantage
was no longer significant after accounting for neighborhood characteristics (Lara-Cinisomo
et al. 2013). In a review of 35 studies published between the years 2009 and 2013, Kouider
et al. (2015) identified children of immigrants in the United States with an Asian
background as being particularly at risk for internalizing problems.
For suicidal behavior, the immigrant health advantage is more apparent. The risk of suicide
is lower in the first generation and increases in second- and third-generation adolescents in
both the Latino and the Asian American samples of Add Health (Duldulao et al. 2009, Peña
et al. 2008). Although the risk of suicidal behavior is lower among first-generation children,
a review of 18 studies showed that immigrant children were at greater risk of being victims
of bullying, peer aggression, and violence; the risk was especially high among those whose
heritage language was not English (Pottie et al. 2015).
For externalizing problems and substance use, we again find a consistent pattern: an
immigrant advantage that dissipates over time spent living in the United States. The National
Survey on Drug Use and Health found evidence of an immigrant health advantage,
especially among 15- to 17-year-olds, for externalizing problems such as crime, violence,
and drug misuse (Salas-Wright et al. 2016). They also found that later age of arrival and
fewer years spent in the United States functioned as protective factors for externalizing
problems. Such findings were replicated in two other national studies, for alcohol use among
Latinos in Add Health (Bacio et al. 2013) and for substance use in the National Household
Survey on Drug Abuse (Gfroerer & Tan 2003).
The mental health of undocumented children, unaccompanied minors, and refugee children
deserves special mention because of the often traumatic circumstances, such as war,
violence, or other natural disasters, that they face both before migration and in their transit to
the United States and because of the lack of legal status that can continually undermine
children’s mental health. Despite some evidence of first-generation children in the United
States having an advantage in terms of their mental health, children who are undocumented,
unaccompanied, or refugees are at elevated risk for mental health problems (Takeuchi 2016).
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Indeed, in a survey of first-generation immigrant adolescents, relative to documented
adolescents, undocumented adolescents were at elevated risk for anxiety, and adolescents in
mixed-status families showed both greater anxiety and marginally greater risk for depressive
symptoms (Potochnick & Perreira 2010). Undocumented parental legal status can be
particularly detrimental; for example, relative to those with documented parents, Mexican
children in Los Angeles with mothers who were unauthorized showed elevated rates of
internalizing and externalizing problems (Landale et al. 2015). Another special case in
which children are at higher risk of mental health problems occurs when the family is
involuntarily transnational, and children are maintaining contact with parents who lack legal
status and have therefore been deported from the United States back to their country of
origin (Dreby 2012a).
The number of unaccompanied minors has grown precipitously in the United States in recent
years, swelling from 24,000 in 2012 to over 67,000 in 2014; this growth is mostly
attributable to the northern triangle consisting of El Salvador, Guatemala, and Honduras
(Roth & Grace 2015). Unaccompanied minors are often fleeing gang violence in their
country of origin and show high rates of mental health problems because of the trauma that
they experienced in their country of origin as well as during their journey to the United
States (Ciaccia & John 2016). Refugee children also show high rates of posttraumatic stress
disorder, both on arrival and in the United States postmigration, due to the continuing
acculturative stressors they face (Lincoln et al. 2016).
Studies on the mental health of immigrants often argue that accounting for stressors, such as
the discrimination facing immigrants, may explain nativity differences found in mental
health (e.g., Lau et al. 2013, Perreira et al. 2015). It is therefore important to understand the
predictors, mechanisms, and conditions through which such stressors affect the mental
health of children of immigrants. In the next section, we review how both culture-specific
and transcultural stressors influence the mental health of children of immigrants.
TRANSCULTURAL AND CULTURE-SPECIFIC STRESSORS
Children of immigrants experience both transcultural stressors and culture-specific stressors
related to their minority and immigrant status; both types of stressors influence their mental
health. Although transcultural stressors, such as economic stressors and neighborhood
disadvantage, are not unique to children of immigrants, this population may be more likely
to experience them due to disadvantages associated with being a member of an ethnic
minority group and/or the immigrant status of their parents. For example, for immigrant
parents with limited income, education, and English skills, the most viable housing options
may be in low-rent neighborhoods with high crime rates (Pumariega et al. 2005). We
therefore highlight two stressors, economic pressure (Mistry et al. 2009) and neighborhood
disadvantage (White et al. 2016), as transcultural stressors that influence the mental health
of children of immigrants.
There are also culture-specific stressors that may be unique to children of immigrants; these
include stressors experienced prior to migration and during transit to their destination
(Drachman 1992). Once in the United States, regardless of whether they are first or second
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generation, children of immigrants may experience a range of acculturative stressors.
Acculturative stressors have been conceptualized to include a multitude of factors, including
perceived discrimination and cultural conflicts (Gil et al. 2000). One of the most unhealthy
stressors is discrimination (Armenta et al. 2013, Garcia Coll et al. 1996, Lewis et al. 2015),
and its effects on the mental health of children of immigrants can vary by source, timing,
and context. In the process of resettlement, acculturative stressors can influence the mental
health of children of immigrants whether these stressors are experienced by the children
themselves or by their parents.
Transcultural Stressors
Transcultural stressors, such as economic pressure and neighborhood disadvantage, have
been shown to have both direct and indirect links to adolescent mental health among Asian
and Latino children of immigrants. Gonzales et al. (2011) and White et al. (2015) extended
family stress theory’s (Conger & Conger 2002) focus on economic stress to include
neighborhood disadvantage as an environmental stressor facing Mexican American families.
They found that both economic stress and neighborhood disadvantage undermined maternal
warm parenting and/or increased harsh parenting, which, in turn, led to more externalizing
problems in Mexican American adolescents (Gonzales et al. 2011, White et al. 2015).
Consistent with Garcia Coll et al.’s (1996) notion of adaptive cultures in minority and
immigrant families, White et al. (2015) identified familism (reciprocity among family
members) as an adaptive resilience factor that would be valuable to retain and promote in
Mexican American mothers, as mothers with high levels of familism were protected from
disruptions that link economic stress with low levels of warm parenting.
Family stress theory (Conger & Conger 2002) is also supported by research on Chinese
American families. There is evidence of an indirect process from parent reports of economic
stress to Chinese American adolescent mental health. Parent reports of economic stress
(making financial adjustments, economic strain, and difficulty making ends meet) indirectly
led to Chinese American adolescent depressive symptoms through adolescent reports of
economic stress and financial constraints (Mistry et al. 2009). There is also evidence that a
greater degree of neighborhood disadvantage leads to erosion of positive parenting practices,
such as maternal monitoring in Chinese Americans (Liu et al. 2009). However, the indirect
pathway was different, as neighborhood economic disadvantage related to externalizing
problems in Chinese American children, which in turn led to erosion of positive parenting
(Lee et al. 2014).
Culture-Specific Stressors
Culture-specific stressors related to the context of exit (premigration and during migration)
to the United States have been studied in reference mostly to refugees and unaccompanied
minors (Pumariega et al. 2005). Traumatic experiences in the country of origin (e.g., war,
trauma, violence, famine) can prompt children to make the journey to the United States, and
the journey itself can be traumatic (e.g., crossing rivers, witnessing deaths, and experiencing
physical violence or sexual exploitation) (Chan et al. 2009, Pumariega et al. 2005). The
transit is often undertaken without caregivers and can also entail detention or asylum
hearings that can take 2 years or longer (Lustig et al. 2004). Upon arrival, postmigration
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stressors, including experiences of discrimination and other acculturative stressors, ensue
(Ellis et al. 2010). Of course, these stressors are not limited to refugees and unaccompanied
minors—they are relevant to children of immigrants more generally.
Discrimination.—One of the most prominent culture-specific stressors relevant to the mental health of children of immigrants is discrimination (Berry et al. 2006, Garcia Coll et
al. 1996). Studies vary in the way discrimination is assessed, and they may include everyday
discrimination as a measure of overall mistreatment (Lewis et al. 2015), discrimination
based on one’s race or ethnicity (Greene et al. 2006), or discrimination based on an
assumption that children of immigrants are all foreigners even if they are born in the United
States (Armenta et al. 2013). Of these three types of discrimination, everyday and racial
discrimination are the two that are most likely to be measured in studies of children of
immigrants, with fewer studies focusing on foreigner stereotype. Regardless of the type of
measure used, discrimination experiences are significantly linked to mental health problems
(Lewis et al. 2015, Pascoe & Smart Richman 2009) and to substance use in children of
immigrants (Unger et al. 2014). In this section, we review studies of children of immigrants
to demonstrate the importance of considering the source, timing, and context of
discrimination experiences and their links to mental health.
The sources of discrimination experiences can vary: Adolescents may experience
discrimination from peers or adults, or they may experience discrimination vicariously
through their parents’ experiences, either of which can influence their mental health.
Differential experiences of peer versus adult discrimination were demonstrated by Greene et
al. (2006). Using a sample of high school students that included Asian and Latino children
of immigrants, they found an increase in perceptions of discrimination coming from adults
during high school, whereas perceptions of discrimination coming from peers remained
stable. In addition, Rosenbloom & Way (2004) found that, when adolescents are members of
an ethnic group that is more likely to be foreign-born at their high school (Chinese
Americans and Dominicans, in their study), they report higher levels of peer or adult
discrimination depending on their ethnic group membership. Specifically, Chinese American
adolescents are more likely to experience peer discrimination and Dominican adolescents
more likely to experience adult discrimination (Rosenbloom & Way 2004). Both peer and
adult discrimination led to increases in depressive symptoms over time in children of
immigrants (Greene et al. 2006).
There is also evidence that parental experiences of discrimination influence the mental
health of children of immigrants. The intergenerational transmission of parents’
discrimination experiences can have an indirect influence on adolescent mental health
through erosion of family processes. Hou et al. (2017) demonstrated an indirect process in
Chinese American families, in which paternal experiences of discrimination led to
adolescent delinquency and depressive symptoms via increased paternal depressive
symptoms and maternal hostility toward adolescents. The intergenerational transmission of
parents’ discrimination experiences can also be interactive with other family members.
Specifically, Crouteretal. (2006) found that Mexican-origin fathers’experiences of workplace
racism led to more depressive symptoms among family members, including the child’s
depressive symptoms, when mothers were low in acculturation toward US culture (Crouter
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et al. 2006). Taken together, these studies highlight the important role of fathers’
discriminatory experiences and their intergenerational influence on the mental health of
children of immigrants.
The timing of discrimination experiences is another important consideration for the mental
health of children of immigrants. Although the pernicious effect of discrimination on mental
health is often considered to be a contemporaneous process, its long-term implications can
go beyond mental health to influence academic outcomes, as well. Specifically, Benner &
Kim (2009a) found that contemporaneous experiences of discrimination were more likely to
relate to depressive symptoms, whereas early discrimination experiences were more likely to
relate to worse later academic outcomes, in Chinese American adolescents. Corroborating
this finding, another study that sampled Asian and Latino children of immigrants found that
high school discrimination experiences related to later academic outcomes, specifically
college persistence (Witkow et al. 2015).
The context of discrimination experiences is also important to consider. The literature on this
topic considers the ways in which discrimination interacts with health behaviors, the
multiple influences of discrimination in combination with other psychosocial experiences,
and resources for coping with discrimination experiences. For example, Yip (2015) found
that high levels of discrimination, coupled with poor sleep (health behavior), predicted
increases in depressive symptoms in a sample that included children of immigrants. In
addition, a host of psychosocial experiences, including discrimination, can work in
conjunction with one another to influence the mental health of children of immigrants.
Lorenzo-Blanco et al. (2016) found that Latino adolescents that belonged to a profile
characterized by a high level of ethnic discrimination, high bullying victimization, and few
positive experiences in social support and perceived school safety were at the highest risk of
depressive symptoms and smoking (Lorenzo-Blanco et al. 2016). On a more positive note,
adolescents can cope with discrimination by seeking out family support. Specifically,
discrimination’s link to externalizing problems in Mexican American adolescents was
weaker among individuals with high levels of family support (Park et al. 2017). Together,
these studies suggest that the context of discrimination experiences can either exacerbate or
mitigate the link between discrimination and poorer mental health in children of immigrants.
In studying the discrimination experiences of children of immigrants, another relevant factor
to consider is stress related to being perceived as a foreigner. Asian and Latino children of
immigrants in the United States may consider themselves to be just as American as their
European American counterparts but may be more likely to be stereotyped as foreigners
because of their physical appearance and minority background (Armenta et al. 2013).
Armenta et al. (2013) found a direct link between being perceived as a foreigner and lower
life satisfaction and more depressive symptoms, particularly among US-born Asians and
Latinos, even after accounting for ethnic discrimination. Kim et al. (2011) found an indirect
pathway that predicted being perceived as a foreigner, through which self-reported low
levels of English fluency led to reports of speaking English with an accent, which then led to
being perceived as a foreigner. Being perceived as a foreigner led to more discrimination
experiences and, in turn, to more depressive symptoms in Chinese American adolescents.
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These studies underscore the need to recognize that foreigner discrimination plays a role in
the mental health of children of immigrants.
Acculturative stressors.—Acculturation is a multidimensional process involving heritage culture and destination culture values, practices, and identifications (Schwartz et al.
2010). In the process of adjusting to a new culture, acculturative stressors can arise.
Acculturative stress chiefly involves language difficulties and the conflicts that occur when
balancing between one’s heritage and destination cultural orientations (Torres et al. 2012). In
this section, we present studies that examine acculturative stressors, as experienced by
adolescents and their parents, and their role in the mental health of children of immigrants.
Romero & Roberts (2003) conceptualize acculturative stress as bicultural stress in children
of immigrants, or the pressure to adhere to both heritage and US cultures. Bicultural stress is
a proximate life stressor that affects bilingual and bicultural youth in school, peer, and
family contexts (Romero & Roberts 2003). Bicultural stress is composed of family stressors
(e.g., family conflict related to family traditions), discrimination stressors (e.g., worry about
immigration), monolingual stressors (e.g., problems with poor English), and peer stressors
(e.g., not feeling accepted because of ethnicity) (Romero & Roberts 2003). Romero &
Roberts (2003) found that US-born youths were more likely to report stress related to
needing to speak better Spanish, whereas immigrant youths reported more stress regarding
needing to be more proficient in English in school. As expected, a higher level of bicultural
stress was related to more risk behaviors and depressive symptoms in both US-born and
immigrant adolescents (Romero & Roberts 2003, Romero et al. 2007).
In the current US political climate, which is characterized by high anti-immigrant sentiment,
the perception of hostility from the receiving community is another source of acculturative
stress facing children of immigrants (Schwartz et al. 2014). Even after accounting for ethnic
discrimination, a negative context of reception predicted more depressive symptoms in
Latino adolescents (Schwartz et al. 2014).
Acculturative stress as experienced by parents can also indirectly influence the mental health
of children of immigrants. For example, in Chinese American families, Hou et al. (2016)
found that parental acculturative stressors, as represented by both bicultural management
difficulty (challenges related to balancing between heritage and destination cultural
orientations) and perpetual foreigner stress, led to interparental conflict, parent–child
conflicts, and adolescents’ sense of alienation from their parents. In turn, these factors led to
more adolescent depressive symptoms, more delinquent behaviors, and lower academic
performance.
Together, the studies reviewed above suggest that the risks associated with both transcultural
and culture-specific stressors work in isolation or together as multiple risk factors affecting
the mental health of children of Asian and Latino immigrants. These studies also
consistently emphasize the role of parental support in mitigating the negative effects of
stressors on the mental health of children of immigrants (Juang & Alvarez 2010, Trentacosta
et al. 2016). In the next section, we present studies on parental socialization patterns in
children of Asian and Latino immigrants and discuss how parenting behaviors (e.g.,
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parenting, ethnic–racial socialization) and parent–child relationships as influenced by
acculturation (e.g., acculturation gap, language brokering) both function as forms of risk and
protection for children of immigrants.
PARENTAL SOCIALIZATION
Parental socialization traditionally encompasses general parenting behaviors, such as
parenting styles (Darling & Steinberg 1993). For Asian and Latino immigrant parents, it can
also include teaching children about what it means to be an ethnic minority through ethnic–
racial socialization (Hughes et al. 2006, Juang et al. 2016). For children in immigrant
families, parental socialization is also influenced by acculturation. The parent–child
acculturation gap refers to potentially discrepant acculturation levels between parents and
children. This gap can result in language brokering, whereby children translate between the
heritage language and English for their English-limited parents. Together, these parental
socialization practices and parent–child relationships, as influenced by acculturation, have
direct, interactive, and indirect effects, as well as promotive and inhibiting effects, on the
mental health of children of immigrants.
Parenting
Parental socialization of children is typically studied by identifying parenting styles, which
are composed of parenting practices (Darling & Steinberg 1993). The two most commonly
studied styles are authoritative and authoritarian parenting, with authoritative parenting
generally relating to positive mental health outcomes and authoritarian parenting generally
relating to more negative mental health outcomes in children (Darling & Steinberg 1993).
Because these effects are not as robust for Asian and Latino children of immigrants as they
are for European American children (Calzada et al. 2012, Chao 1994), more recent
scholarship has called for the consideration of the role of cultural values in understanding
parenting behaviors and in identifying parenting styles that may be unique to these groups.
For example, in Chinese American families, supportive parenting, which resembles
authoritative parenting, is distinguished by high levels of positive (e.g., warmth, monitoring)
and low levels of negative (e.g., hostility) parenting, as well as a moderate level of shaming,
a culturally informed parenting behavior (Kim et al. 2013b). Similarly, in Mexican American
parents, cultural values of respeto (respect for authority) and familism (reciprocity among family members) relate to authoritative parenting (White etal.2013). There is also evidence
of parenting styles that are unique to each group. In Chinese Americans, tiger parenting is
characterized by high levels of shaming along with high levels of both positive and negative
parenting (Kim et al. 2013b). For Mexican American families with adolescents, White et al.
(2013) found no-nonsense parenting to be a unique parenting style characterized by
moderate levels of harsh parenting with elements of authoritative parenting (high levels of
both responsiveness and demandingness).
These unique parenting profiles may represent adaptive parenting strategies in response to
the environmental demands of living as ethnic minorities and as immigrants (Garcia Coll et
al. 1996). According to Sue & Okazaki (1990), Asian Americans see academic achievement
as a form of relative functionalism. That is, achieving academically is seen as an important
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avenue to achieving upward mobility. For this reason, Chinese American parents may adopt
a parenting strategy such as tiger parenting with the goal of high academic achievement for
their adolescents (Kim et al. 2013b). Such a strategy, however, often results in adolescents
who are paradoxically adjusted (high levels of academic achievement, low levels of mental
health) (Kim et al. 2015). Therefore, although tiger parenting can result in high academic
achievement for adolescents, this may come at the cost of their mental health. For Mexican
American families, White et al. (2016) found that, for those living in high-adversity
neighborhoods, no-nonsense parenting is an adaptive strategy for fathers. This type of
parenting allows fathers to recognize the environmental demands of their neighborhoods and
adapt their parenting accordingly, resulting in declines in internalizing problems across the
course of adolescence in their children. Studies of parenting among the families of Mexican
American and Chinese American adolescents highlight the importance of going beyond
transcultural parenting dimensions to consider culture-specific dimensions (such as shaming
in Chinese Americans) and contextual demands (such as high-adversity neighborhoods) to
understand adaptive parenting among Asian and Latino immigrant parents.
Ethnic–Racial Socialization
Asian and Latino immigrant parents also socialize their children about race, culture, and
ethnicity (Hughes et al. 2006, Umaña-Taylor et al. 2014a). Ethnic–racial socialization
encompasses multiple domains. In immigrant families, parents’ discriminatory experiences
serve as a catalyst for initiating discussions about racial bias or practicing racial socialization
with their children (Benner & Kim 2009b). We focus on two of the more widely studied of
these domains: ethnic and cultural socialization, where parents teach their children about
their heritage and history, pass on customs, and promote ethnic pride (Umaña-Taylor et al.
2014a); and preparation for bias, where parents teach their children about how to be aware
of and cope with discrimination (Hughes et al. 2006) (see the sidebar titled Ethnic–Racial
Socialization in Asian Children of Immigrants).
In both Asian and Latino children of immigrants, ethnic and cultural socialization relates to
better mental health. Mechanisms underlying the positive effect of ethnic and cultural
socialization include engendering a stronger sense of ethnic identity and instilling a sense of
optimism, ultimately predicting positive mental health in adolescents (Gartner et al. 2014,
Liu & Lau 2013, Umaña-Taylor et al. 2014a). On the other hand, preparation for bias relates
to negative mental health outcomes in children of Asian and Latino immigrants.
Mechanisms underlying the negative effect of preparation for bias can include negative
perceptions of one’s ethnic group, especially when accompanied by perceptions of adult
discrimination, feeling like a misfit, and higher levels of pessimism, ultimately relating to
more depressive symptoms in adolescents (Benner & Kim 2009b, Liu & Lau 2013, Rivas-
Drake et al. 2009). However, there is also evidence that preparation for bias can relate to a
stronger sense of ethnic identity in Asian and Latino adolescents (Hughes et al. 2009),
suggesting the need for additional research to untangle the conditions under which
preparation for bias can relate to a positive versus a negative sense of ethnic identity and to
predict mental health outcomes.
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Parent–Child Acculturation Gap
According to ecodevelopmental theory (Prado et al. 2010), an acculturation gap is a
hallmark of immigrant families that affects developmental outcomes among children of
immigrants. Acculturation gap refers to a mismatch in levels of cultural orientation to the
heritage and destination cultures between parents and children in immigrant families (Telzer
2011). A meta-analysis finds that, among children of Asian and Latino immigrants,
acculturation gap can have deleterious effects on mental health, particularly in the US-born
second generation (Lui 2015). The findings on acculturation gap and mental health
outcomes, which we review below, are complex and nuanced: Some types of acculturation
gap show protective effects, whereas other types seem to be risk factors for mental health
problems.
The longstanding acculturation gap–distress model proposes that high levels of parent–child
acculturation discrepancy represent a risk factor for poor mental health in children (Kim et
al. 2013a, Schofield et al. 2008). This model suggests that parent–child acculturation
discrepancies erode the quality of family relationships and predict child mental health
problems. For example, higher levels of father–child acculturation gap were related to more
externalizing problems in Mexican American adolescents, especially when the father–
adolescent relationship quality was poor (Schofield et al. 2008). Moreover, in Chinese
American families, higher levels of father–child acculturation gap, particularly in orientation
toward US culture, is detrimental in that it predicts parents’ lower use of warmth,
monitoring, and reasoning with their adolescents and increases adolescents’ sense of
alienation from parents, resulting in more adolescent depressive symptoms (Kim et al.
2013a). In Latino families, though, it is the discrepancy in heritage orientation, where
adolescents endorse Latino cultural values, practices, and identity less than their parents do,
that puts them at risk of poor family functioning and poor mental health (Schwartz et al.
2016).
Weaver & Kim (2008) identified a specific type of parent–child acculturation gap that relates
to risk for poor family functioning and mental health in Chinese Americans. They described
three profiles of acculturation in a Chinese American sample (bicultural, more American,
and more Chinese). Relative to other combinations, parent–child dyads with an acculturation
match—specifically, bicultural adolescents with bicultural parents—reported more
supportive parenting, which then led to fewer adolescent depressive symptoms. Consistent
with the acculturation gap–distress model, adolescents with an acculturation mismatch (or
acculturation gap)—specifically, American-oriented adolescents with Chinese-oriented
parents—reported the least supportive parenting and the most depressive symptoms.
Lau et al. (2005) identified a different type of acculturation gap that related to mental health
functioning in Mexican Americans. An acculturation gap in the unexpected direction, such
that adolescents are more oriented toward the heritage culture than their parents are, was
associated with more conduct problems, whereas an acculturation gap in the expected
direction (adolescents more oriented to the destination culture than the parents) did not lead
to the expected positive relationship to family conflict and conduct problems. In fact, Telzer
(2011) contends that the expected acculturation gap between parents and children (where
children are more oriented to the destination culture than their parents are) is considered
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normative, as it allows children to facilitate immigrant families’ adjustment to the cultural
values and customs of the destination society. Consistent with this view, Schwartz et al.
(2016) found that parent–child gaps in the individualist values of US culture were actually
predictive of positive functioning and positive mental health outcomes in Latino children.
Language Brokering
Children may assist in the resettlement process of their immigrant families by functioning as
language brokers. Language brokers are children who translate, both linguistically and
culturally, for their English-limited parents, thereby playing an important role as
intermediaries between their parents and the larger society (Kim et al. 2017). Language
brokering is a common activity performed by 71-89% of children in immigrant families
(Chao 2006).
Language brokering can have both positive and negative consequences for adolescent mental
health. When adolescents perceive their language brokering experience as a burden, this
stressor may predict more depressive symptoms in Chinese American adolescents (Kim et
al. 2014) and more substance use in Mexican American adolescents (Kam & Lazarevic
2014) through increased family-based acculturation stressors. However, language brokering
can also be protective, especially in the presence of risk. Specifically, Mexican American
adolescents who appraise their language brokering experience as more efficacious are less
likely to experience depressive symptoms when they are more at risk (i.e., when they have a
high sense of alienation with regard to their parents or a low sense of personal resilience)
(Kim et al. 2017).
There is also evidence that the configuration of language brokering experiences matters in
predicting positive or negative consequences on adolescent mental health. Kam et al. (2017)
identified three types of Latino adolescent language brokers: infrequent–ambivalents (least
likely to language broker, with low positive and negative feelings about language brokering
and low levels of parentification, which refers to parents relying on their children),
occasional–moderates (moderate language brokering with moderate positive and low
negative feelings about language brokering and low levels of parentification), and
parentified–endorsers (most likely to language broker, with high positive and low negative
feelings about language brokering and high levels of parentification). Kam et al. found that
occasional–moderates showed the most positive outcomes, as this profile membership did
not predict discrimination, depressive symptoms, or risky behaviors. Parentified–endorsers
were most at risk for discrimination and depressive symptoms, while infrequent–ambivalents
were less engaged in risky behaviors (Kam et al. 2017). These results suggest that assessing
the context in which language brokering occurs may be more important than simply
assessing the feelings surrounding it to understand its protective and risk functions in
children of immigrants.
DEVELOPMENTAL PROCESSES
Children of Asian and Latino immigrants are likely to be exposed to a heritage language
other than English at home, and a body of research has identified a bilingual advantage for
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these children, as well as development processes, such as ethnic identity, that can be a source
of both risk and protection in terms of the mental health of children of immigrants.
The term bilingual advantage refers to cognitive advantages that come with being proficient
in two or more languages (Bialystok 2015). Bilingualism comes with some costs, such as
smaller receptive vocabulary (Luk & Bialystok 2013). However, bilingualism generally
confers advantages across the life span when it comes to nonverbal executive functioning
cognitive tasks, such as superior performance in working memory and sometimes in
inhibitory control relative to mono-linguals (Bialystok 2011, Luk & Bialystok 2013).
Studies with adults indicate that being bilingual is associated with better physical and mental
health relative to those who are proficient only in English or proficient only in the heritage
language (Schachter et al. 2012). The positive effect of bilingualism on mental health can be
partially explained by socioeconomic status and family support but not by acculturation,
discrimination, or health behaviors (Schachter et al. 2012). Studies with children also
demonstrate a bilingual advantage for mental health. Relative to monolinguals, who show
faster growth in problem behaviors, Asian bilingual children of immigrants show low levels
of growth in externalizing and internalizing behaviors over time (Han & Huang 2010).
A central developmental task of adolescence is developing a sense of identity. Research on
identity in children of Asian and Latino immigrants in the United States has largely focused
on the role of ethnic identity in their mental health. A strong sense of ethnic identity among
children of immigrants is generally considered to be a protective factor for adolescent mental
health. Ethnic identity affect (positive feelings about one’s ethnicity), in particular, is linked
with robust positive effects on a range of mental health outcomes (e.g., depressive
symptoms, internalizing and externalizing problems) among children of immigrants (Neblett
et al. 2012, Rivas-Drake et al. 2014). However, there is some research indicating that there
exist conditions under which ethnic identity may also function as a risk factor. In fact, a
stressor such as discrimination relates to more delinquent behaviors, and this relationship
can be exacerbated or mitigated depending on the dimension of ethnic identity under
examination. In a sample that included low-income Latino boys, Williams et al. (2014)
found that, when adolescents are faced with discrimination, high ethnic identity affirmation
(sense of belonging to one’s ethnic group) can be a protective factor, as it does not relate
significantly to delinquency, whereas low ethnic identity affirmation is significantly related
to delinquency. However, ethnic identity achievement (exploring and committing to one’s
ethnic identity) can be a risk factor exacerbating the link between discrimination and
delinquency (Williams et al. 2014).
One construct related to ethnic identity in children of Asian and Latino immigrants is
bicultural identity integration, which refers to the degree to which individuals living in a
bicultural setting perceive their two cultural identities as compatible rather than as
oppositional (Benet-Martínez & Haritatos 2005). Bicultural identity integration relates to
positive mental health (Chen et al. 2008) and positive youth development (self-esteem,
optimism, prosocial behaviors, parental involvement, parent–adolescent communication, and
family communication) (Schwartz et al. 2015a) in both Asians and Latinos (see the sidebar
titled The Role of Physiology in the Mental Health of Children of Immigrants).
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EVIDENCE-BASED INTERVENTIONS FOR CHILDREN OF IMMIGRANTS
The studies reviewed above highlight the risk and protective factors that can impact the
mental health of children of immigrants. Identification of such factors is important, as they
can represent key program components in interventions. In this section, we highlight various
types of evidence-based intervention programs (family-based interventions, a
developmentally focused intervention on ethnic identity, and an intervention specific to
refugee children) that show efficacy in reducing mental health problems in children of
immigrants.
Examples of efficacious family-based interventions have core program components that are
culture specific or are both culture specific and transcultural. Entre Dos Mundos is a culture-
specific bicultural skills training program designed for Latino adolescents and parents. The
program focuses on mediating the negative impact of parent–child conflict and perceived
discrimination while increasing familism and biculturalism in parents and adolescents
(Bacallao & Smokowski 2005). Attending more sessions was predictive of fewer
externalizing problems, such as child aggression and oppositional defiant disorder, along
with gains in family adaptability and bicultural identity integration (Smokowski & Bacallao
2009). Familias Unidas is another family-based intervention program that includes culture-
specific components such as educating parents about US culture and biculturalism (Pantin et
al. 2003). The program also includes transcultural elements, such as increasing
communication and negotiation skills to reduce family conflict and distance and fostering
connections between the family and other important systems, such as peers and schools, to
improve Latino parents’ investment in their adolescents’ lives (Pantin et al. 2003). Program
effects indicate increases in parental investment and decreases in adolescent problem
behaviors, although there were no significant program effects for school achievement
(Pantin et al. 2003).
Examples of efficacious family-based interventions can also have core program components
that are more transcultural in focus, but with culturally responsive adaptations. Parent
Training (PT) is a program for high-risk Chinese immigrant parents that augments content
by addressing the cultural challenges facing these parents (Lau et al. 2011). Sessions target a
transcultural component, namely improving multiple parenting skills (e.g., logical
consequences, cognitive restructuring, communication training, positive and proactive
parental involvement) (Lau et al. 2011). Examples of cultural adaptations in these sessions
would be group leaders eliciting parental views on potential cultural and practical barriers to
implementing the skills being taught in the sessions or facilitating a discussion with parents
about the identified barriers and how the skills being taught can achieve parenting goals. PT
has been shown to be effective in reducing negative discipline and increasing positive
parenting in Chinese American families and in reducing externalizing and internalizing
problems in Chinese American children (Lau et al. 2011).
Another family-based intervention, Bridges, has core program components that are
transcultural and is also culturally responsive to Mexican American families (Gonzales et al.
2014). The program has three components: parent sessions (emphasizing effective parenting
practices), adolescent sessions (emphasizing coping efficacy), and family sessions
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(emphasizing family cohesion). It is culturally responsive because its core program
components were adapted to recognize the processes more germane to low-income Mexican
American families. For example, given that low-income Mexican American parents may
have a poor understanding of US schools and may be less prepared to monitor their
children’s academic challenges, parenting sessions emphasize positive parenting practices,
such as monitoring of schoolwork (Gonzales et al. 2014). Bridges is delivered in middle
school and has been shown to be effective in increasing school engagement as a primary
mediating mechanism to reduce internalizing symptoms, substance use, and school dropout
(Gonzales et al. 2014).
The Identity Project is an evidence-based identity intervention that focuses on increasing
adolescents’ identity exploration and resolution, based on empirical evidence for the positive
impact of ethnic identity on adolescent mental health (Umaña-Taylor et al. 2017). It is
designed as an 8-week intervention for delivery in a school-based setting. Initial results
indicate that increasing exploration of adolescents’ ethnic identity improves ethnic identity
resolution for youths in the treatment condition. Because ethnic identity resolution can relate
to positive mental health, the initial results of this intervention suggest that it shows promise
as an evidence-based intervention to reduce mental health problems in children of
immigrants.
Because refugees are a special population, we also highlight an intervention that may
specifically reduce mental health problems in children in this population. Project SHIFA
(Supporting the Health of Immigrant Families and Adolescents) is a multitiered intervention
program for Somali refugee youth. It has three main components: resilience building in the
community, school-based intervention for those at risk, and direct trauma therapy for those
reporting significant levels of psychological distress (Ellis et al. 2013). Program results
showed effectiveness in reducing symptoms of depression and post-traumatic stress disorder
among refugee adolescents.
POLICIES FOR CHILDREN OF IMMIGRANTS
Government policies and programs are one way to reduce mental health problems in
children of immigrants. Programs such as Medicaid, Children’s Health Insurance Program
(CHIP), Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance to
Needy Families (TANF) provide important financial, health, and nutritional assistance for
low-income families in the United States (Perreira et al. 2012). Despite their greater need for
these services, low-income immigrant families have less access to these programs because of
strict eligibility requirements and barriers that result in lower usage of these benefits
(Perreira et al. 2012). These barriers include the complexity of the application and eligibility
rules, administrative burdens, language and cultural barriers, transportation and other
logistical issues, and fear and mistrust of government authorities (Perreira et al. 2012).
Moreover, although many children in immigrant families are US-born and are thus eligible
for government services, many do not access them, especially when parents are
undocumented (Torres & Young 2016). In addition, increased risk of deportation can
decrease use of public services such as Medicaid (Vargas 2015).
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Lack of legal status is a major obstacle to being eligible for government programs.
Government policies such as the 2012 Deferred Action for Child Arrivals (DACA), which
provided temporary relief from deportation and renewable work permits for undocumented
children of immigrants, have shown positive consequences for mental health (Venkataramani
et al. 2017). Specifically, relative to DACA-ineligible individuals, those who were DACA
eligible showed lower levels of psychological distress (Venkataramani et al. 2017). For this
reason, it is important to implement programs such as DACA to improve the mental health
of children of immigrants in the future.
Despite some favorable government policies (e.g., DACA) for undocumented children in the
United States, between 2003 and 2013, over 3.7 million immigrants were deported from the
United States (Koball et al. 2015). The majority (91%) of these deportees were men, and up
to 25% were parents of US-born children (Koball et al. 2015). Deportation of undocumented
immigrant parents can have disastrous consequences for families. For example, children may
be left in foster care, mothers may become single parents if fathers are deported, parents
may lose custody of their US-born children, children may begin to fear law enforcement,
children may begin to view being an immigrant as the same as being illegal, and children
may begin to associate their immigrant and heritage background with stigma (Dreby 2012b).
Among other recommendations, government policies to improve access to benefits, better
coordination with child welfare caseworkers, and short-term financial assistance are useful
strategies for improving the lives of families affected by the deportation of a family member
(Koball et al. 2015).
Unaccompanied minors, in particular, are a group of undocumented immigrant children who
have received recent media attention. The peak of arrivals of unaccompanied minors to the
United States occurred in 2014, with the largest number coming from Honduras, followed
by Guatemala, El Salvador, and Mexico. These children are often apprehended and detained
at the border (Am. Immigr. Counc. 2015). The Office of Refugee Resettlement, an agency of
the US Department of Health and Human Services, is then responsible for finding them
shelter and directing their legal proceedings (Pierce 2015). The vast majority of
unaccompanied minors stay with a parent, relative, or friend in the United States while
awaiting the settlement of their cases in the US immigration courts (Pierce 2015). The length
of the process, which can take years, means that unaccompanied minors become further
integrated into the United States while awaiting the results of their court proceedings.
Typically, after their cases are heard, 97% of unaccompanied minors remain unauthorized
(Pierce 2015). They may be given informal relief but not legal status in the United States,
which means they have limited access to social programs. Given the strong link between
undocumented status and poor mental health (Potochnick & Perreira 2010), providing a
better avenue for achieving legal status may go a long way toward improving the mental
health of unaccompanied minors.
CONCLUSION
The United States is a country founded by immigrants and is expected to increase its
immigrant population, from today’s 14% of the US population to 18% in 2065. In fact,
immigrants and their children are projected to comprise 36% of the US population in 2065
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(Pew Res. Cent. 2015). With these future trends in mind, we have reviewed the ways in
which transcultural and culture-specific stressors, parental socialization, and developmental
processes influence the mental health of children of immigrants. We have also identified risk
factors that can be reduced, and protective factors that can be promoted, to improve the
mental health of children of immigrants. Given the many obstacles immigrants and their
children face, implementing the evidence-based interventions and policies identified in this
review would go a long way toward bolstering the mental health of a growing population,
specifically children of immigrants, who represent a large proportion of the US population
and our future workforce.
ACKNOWLEDGMENTS
This work was supported by grants to S.Y.K. from the National Science Foundation, Division of Behavioral and Cognitive Sciences (1651128 and 0956123), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R03HD060045-02 and 5R03HD051629-02), and by grants to the Population Research Center at the University of Texas at Austin from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (2P2CHD042849-16).
DISCLOSURE STATEMENT
K.M.P. is a board member of the Population Association of America and a coinvestigator of the Hispanic Community Health Study, supported by the National Heart, Lung, and Blood Institute (contract N01-HC65233).
Glossary
First generation individuals who are foreign born; also known as immigrants
Second generation individuals who are US born, with at least one foreign-born parent
Third or later generation individuals who are US born, with US-born parents
Mixed-status families families with some members who are undocumented and other members who have legal
status
Unaccompanied minors children who migrate to the United States without their caregivers
Transnational families families whose members maintain relationships across one or more countries
Transcultural factors that can be applied generally to any ethnic, racial, or nativity group
Culture specific factors that are more relevant to ethnic/racial minorities and immigrant groups
Immigrant paradox
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refers to evidence indicating that immigrants have better health despite their lower
socioeconomic status relative to those who are native born
NLAAS National Latino and Asian American Study
Add Health National Longitudinal Study of Adolescent to Adult Health
Language brokers children who act as intermediaries and translators for English-limited individuals
DACA Deferred Action for Child Arrivals
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RELATED RESOURCES
Migration Policy Institute website: http://www.migrationpolicy.org/. Provides up-to-date information on migration policy and its impact on Americans
Pacione L, Measham T, Rousseau C. 2013 Refugee children: mental health and effective interventions. Curr. Psychiatry Rep. 15:341 [PubMed: 23307563]
Pew Research Center Hispanic Trends website: http://www.pewhispanic.org/. Provides timely information on a wide range of social issues facing US Latinos
Weisskirch RS. 2017 Language Brokering in Immigrant Families: Theories and Contexts New York: Routledge
Yoshikawa H, Suárez-Orozco C, Gonzales RG. 2017 Unauthorized status and youth development in the United States: consensus statement of the Society for Research on Adolescence. J. Res. Adolesc. 27:4–19 [PubMed: 28498536]
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Zhou Q, Tao A, Chen SH, Main A, Lee E, et al. 2012 Asset and protective factors for Asian American children’s mental health adjustment. Child Dev. Perspect. 6:312–19
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ETHNIC–RACIAL SOCIALIZATION IN ASIAN CHILDREN OF IMMIGRANTS
Asian Americans make up the second-largest ethnic group of immigrants in the United
States. Asian immigrant parents see their status as members of a majority group
disappear upon migrating to the United States (Kim et al. 2006). As new minorities, they
may lack the experience necessary to teach their children about coping with
discrimination. The ethnic–racial socialization scale (Juang et al. 2016) assesses how
Asian American parents prepare their children to cope with the challenges of
interpersonal and societal discrimination while also socializing their children to embrace
diverse perspectives. They found that increasing diversity and cultural awareness related
to stronger ethnic identity as well as to greater perceived discrimination, suggesting that
ethnic–racial socialization can be both a risk and protective factor for adolescent
development in Asian Americans. Wang & Benner (2016) extended this work to examine
how socialization toward the mainstream society and socialization about one’s ethnicity
are both practiced by multiple agents (not only by parents, but also by peers). Using a
diverse sample of adolescents that included children of immigrants, they found that
congruity in mainstream and ethnic socialization from parents and peers resulted in more
positive adolescent mental health.
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THE ROLE OF PHYSIOLOGY IN THE MENTAL HEALTH OF CHILDREN OF IMMIGRANTS
The current research on the mental health of children of immigrants has relied mainly on
reports of perceived stressors, especially discrimination. An emerging body of research is
demonstrating the ways in which such stressors can get under the skin to influence
physiological changes, such as changes in hypothalamic-pituitary-adrenal axis
functioning. Perceived discrimination related to greater overall cortisol output in a sample
of Mexican American adolescents (Zeiders et al. 2012), and it also related to flatter
diurnal slope in ethnic minority young adults, both of which indicate more dysfunctional
cortisol rhythms (Zeiders et al. 2014). Psychological stressors experienced early in the
life course (e.g., poverty, discrimination) can also result in inflammation, as evidenced by
elevated levels of C-reactive protein, which is considered a precursor of depression and
cardiovascular disease (Goosby et al. 2015, Miller et al. 2011). As dysregulated cortisol
functioning and inflammation can relate to a range of health disparities, including in
mental health functioning, an important avenue for future research would be
understanding the physiological underpinnings of stressors commonly experienced by
children of immigrants to deliver the most effective interventions (McEwen 2004, Miller
et al. 2011).
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SUMMARY POINTS
1. Among both Asian Americans and Latinos, individuals who migrate before adolescence are at similar risk for psychiatric disorders as US-born
individuals.
2. Asian children of immigrant backgrounds in the United States are particularly at risk for internalizing problems.
3. Relative to documented adolescents, undocumented adolescents and children in mixed-status families are at elevated risk for anxiety.
4. Parental experiences of discrimination relate to adolescent delinquency and depressive symptoms via increased paternal depressive symptoms and
parental hostility toward adolescents.
5. Parent–child dyads with matching acculturation levels experience more supportive parenting and fewer adolescent depressive symptoms, whereas
dyads with mismatched acculturation report less supportive parenting and
more depressive symptoms.
6. Asian bilingual children of immigrants show slower growth in internalizing and externalizing problems over time relative to monolingual children.
7. Ethnic identity affirmation has a robust relationship with positive mental health and can mitigate the negative effects of discrimination.
8. Relative to DACA-ineligible individuals, those who were DACA eligible showed lower levels of psychological distress.
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FUTURE ISSUES
1. An up-to-date national study to ascertain the prevalence of psychiatric diagnoses in a US adolescent sample by nativity is needed.
2. Relative to studies of Latino children of immigrants, there are fewer studies of Asian children of immigrants in the United States. As the number of Asian
Americans is expected to surpass the number of Latino immigrants in the
future, more research attention to this population is needed.
3. Migration stressors related to the context of exit from the country of origin and entrance into the United States have been studied in reference to refugee
children and unaccompanied minors, but we know less about the role of these
experiences in the development of immigrant children more generally.
4. Children of immigrants are faced with both transcultural and culture-specific challenges, and real-time interventions targeting changes in these stress
responses may be most fruitful in improving their mental health.
5. The exact mechanisms through which bilingual advantage, characterized by enhanced executive functioning, relates to better mental health need to be
identified.
6. Longitudinal studies that follow immigrant children from their experiences in their countries of origin, to their experiences journeying to the United States,
to their post-settlement experiences are needed to understand their mental
health prospectively.
7. More long-term follow-up is needed for intervention studies that have targeted children of immigrants into adulthood to incorporate life-course perspectives
on health and the potential cumulative impact of interventions over time on
the mental health of children of immigrants.
8. An immigration policy allowing a path to citizenship in the United States for undocumented children and their parents will allow them to realize a more
secure future, free from the fear of deportation, and will improve their long-
term mental health.
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Figure 1. Model of mental health outcomes in children of immigrants.
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Figure 2. Processes of interaction between transcultural and culture-specific factors of mental health
in children of immigrants. (a) Separate and distinct processes. (b) Culture-infused processes. (c) Interactive processes. (d) Multidimensional processes.
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- Abstract
- INTRODUCTION
- OVERVIEW
- PREVALENCE OF MENTAL HEALTH PROBLEMS IN CHILDREN OF IMMIGRANTS
- TRANSCULTURAL AND CULTURE-SPECIFIC STRESSORS
- Transcultural Stressors
- Culture-Specific Stressors
- Discrimination.
- Acculturative stressors.
- PARENTAL SOCIALIZATION
- Parenting
- Ethnic–Racial Socialization
- Parent–Child Acculturation Gap
- Language Brokering
- DEVELOPMENTAL PROCESSES
- EVIDENCE-BASED INTERVENTIONS FOR CHILDREN OF IMMIGRANTS
- POLICIES FOR CHILDREN OF IMMIGRANTS
- CONCLUSION
- References
- References
- Figure 1
- Figure 2
