Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

New Hispanic Migration and HIV Risk in New York

Abstract

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PWAs and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experience and knowledge of HIV care issues and the issues affecting health-seeking behavior. Among the data collected to provide context, depth and detail to the issue of access and utilization of services, was the detailed information on migration and HIV risk reported here.

A total of 57 men and women participated, ranging in age from 19-61. Results included information on migration patterns, obstacles for Latino immigrants living in the U.S., social networks, community resources, knowledge of HIV/AIDS, risk behavior and access to information. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty; repressive governments; lack of education/literacy; ethnicity, class; color-based stigma; and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behavior. The key elements for the provision of services to this population appear to be those which build on cultural norms and which network human and institutional resources.     

Surviving Chernobyl in America

Abstract

This paper fills an informational gap for multidisciplinary providers of services to the former Soviet Union (FSU) immigrants in the United States, highlighting the long-term medical and mental health consequences of this group's pre-migration exposure to the 1986 Chernobyl nuclear disaster. The international literature is selectively presented together with recent findings of Chernobyl mental health sequelae in a cohort residing in the United States. Guidelines for service providers, as well as Russian language health service resources in US cities populated by significant FSU communities, are also furnished.     

Immigration in the Life Histories of Women Living in the United States-Mexico Border Region

Abstract

This paper focuses on the role that immigration plays in the lives of very low-income women living along the United States-Mexico border. Life here is distinct from that in any other part of the United States, due to the international, social, political, and economic interdependence that characterizes this region. Thus, from the perspective of migration as a social process, this “contact zone” can provide insight on migration issues that occur within a transborder context. Based on life history interviews and focus groups with women living in two adjoining border cities, Brownsville, Texas and Matamoros, Tamaulipas, we observed the trajectories of women at two points of the migration course: (a) migration from the interior of Mexico to the northern border and (b) emigration across the international boundary to the United States. The study shows that although these women held expectations that migration would improve their lives and the lives of their families, their social and economic integration in the border region met with limited success.     

跨国主义视阈下北美一代半华人新移民发展探究

本文从跨国主义的理论框架出发,对北美一代半新移民的特点进行分析,指出其跨国发展中的优势与劣势,认为这一群体是跨国主义的典型践行者,本文提出应密切关注北美一代半新移民在移入国的活动,并为其回归祖国发展提供更加优质的环境。     

From Dictatorship to Democracy: Crime and Policing in Contemporary Spain

Francisco Franco's death in 1975 ended nearly forty years of fascist dictatorship in Spain. In the next decade the country underwent substantial and dramatic change: The political structure was democratized under King Juan Carlos. Rapid industrialization and commercial development, especially on the northeastern areas, altered the economic nature of Spain. Internal migration, particularly from the more impoverished South to Madrid and Barcelona, altered social arrangements as well.

Crime and disorder also increased rapidly. All crime rates and imprisonment rates grew. Drug use and abuse became a major problem. Basque pressure for a separate state often resulted in a terrorist war in which the main casualties were policemen.

Attempts at reforming the police occurred almost immediately after Franco's death. The old Armed Police—a repressive agency that policed cities over 20,000 populations-was substantially demilitarized and became the National Police. Although transformations are incomplete, the National Police can be seen as a symbol of the new era. The more rural police, the Civil Guard, has been less responsive to change and may be seen as a symbol of the old dictatorship.     

Parental Self-Efficacy and Social Support as Predictors of Parenting Practices and Children's Socioemotional Adjustment in Mexican Immigrant Families

SUMMARY

The current study examined the hypotheses that (1) parental self-efficacy partially mediates the relationships between social support and both parental warmth and control, and (2) these parenting variables relate positively to children's socioemotional adjustment. First-generation, Mexican immigrant mothers were interviewed regarding social support, parental self-efficacy, parenting practices, and their child's socioemotional adjustment. Overall, results from path analyses suggest that, for Mexican immigrant families, social support relates to parenting practices partly because those with greater social support feel more efficacious as parents. Findings also showed that parenting characterized by warmth or control is associated with greater socioemotional adjustment among children. This research supports the idea that, for programs designed to influence parenting practices, simply providing social support may be less important than taking steps to enhance parental self-efficacy.     

Migrants' remittances and economic voting in the Mexican countryside

This study advances and tests hypotheses about the effects of migrants' remittances on political behavior. Analyzing new survey data from Mexico, I find that despite being very poor, respondents who receive remittances tend to view their income as more stable than neighbors who do not receive this money. As a result, remittance recipients have relatively fewer economic grievances and tend to feel more optimistic about economic matters than neighbors who do not receive remittances. According to the economic voter thesis, citizens who are more satisfied with the economy are also less likely to pressure and oppose politicians, particularly incumbents. Analyses indicate that respondents in this sample who receive remittances are indeed less likely to lobby local officials for economic assistance. They were also less likely to mobilize against and punish the incumbent party in the 2006 Mexican presidential election.     

Immigrant-Serving Non-profit Voter Mobilization in Off-Cycle Elections: An Institutional Explanation of Differential Political Participation Patterns

Abstract

Immigrants in the USA tend to vote less than other groups, and immigrants vote at even lower levels during off-cycle elections. The aim of this article is to analyse whether these same patterns can be observed in the electoral activities of non-profit organizations that represent immigrants. I argue for a theory of reflective non-profit representation to explain how immigrant-serving organizations make decisions about electoral activities. By analysing original survey data collected in 2012 and 2013, the article finds that immigrant-serving non-profits are less likely to mobilize immigrants in off-cycle compared to on-cycle elections, and less likely to mobilize voters than organizations serving other communities. These findings suggest that immigrant voting could increase if non-profits increased their political involvement, reimagined their identities to include politics as a part of their mission, and generated new revenues to support these activities.