Rationale: Undocumented Mexican immigrants (UMIs) and their families make up a considerable proportion of the United States (U.S.) population at-risk for psychological distress. Yet, research to inform the mental health of UMIs is scant and existing studies often lack scientific rigor. This study used the Socio-Ecologic Framework and the Minority Stress Model, as well as context-sensitive methodology and Respondent Driven Sampling (RDS) to identify the prevalence of psychological distress,

mental health disorders, and relevant Cultural and Contextual Concepts of Distress, among UMIs living in high-risk neighborhoods near the California-Mexico border region.

Design: This study was a multi-stage project that included formative research, pilot testing, and a cross-sectional study that used Respondent Driven Sampling (RDS) as

a sampling and data analysis methodology. Data for the RDS study was obtained from clinical interviews with 248 UMI adults of Mexican origin residing in North San Diego County. Primary mental health outcome measures included the Mini International Neuropsychiatric Interview (M.I.N.I.), the Brief Symptom Inventory (BSI-53), and the Bradford Symptom Inventory (aBSI). An adapted version of the Diagnostic and Statistical Manual for Mental Disorders (DSM) 5th Edition Cultural Formulation Interview (CFI) was used for the assessment of Cultural and Contextual Concepts of Distress.

Results: Overall, 41% of UMIs met criteria for clinically significant psychological distress, with significant differences found for sex, age, and marital status. Additionally, 22% of UMIs met criteria for one or more mental health disorder based on DSM diagnosis, with the most prevalent disorders being Major Depressive Disorder (MDD: 14%) and Generalized Anxiety Disorder (GAD: 7%). Pertaining to Cultural Concepts of Distress, 24% of UMIs reported a lifetime prevalence of Nervios and 12% reported a lifetime prevalence of Ataque de Nervios, with the most common causal attributions for Nervios and Ataque de Nervios being family conflict (20%). Moreover, 82% of UMIs reported experiencing significant distress as a result of their undocumented status, which was found to be associated with significant migration-related loss, clinically significant psychological and somatic symptoms, and a negative effect on identity and self-esteem.

Conclusions: UMIs are a population at risk of psychological distress given the multiple contextual stressors that these immigrants face. Debates on programs and policies pertaining to UMIs are complex and multifaceted, and divisiveness on immigration and welfare reform in the U.S. is long-standing. Tenacious grassroots efforts, both, in Mexico and in the U.S., are necessary to influence policy aimed to allocate funding to increase access to culturally and contextually responsive interventions aimed to address the complex mental health needs of this vulnerable population. It is the responsibility of both Mexico and the U.S. to work collaboratively in the development of programs and policies to prevent the negative consequences of inadequate access and to protect the human rights of Mexican immigrants looking for more promising futures.

Rationale. Studies demonstrate that acculturation is critical to the understanding of health and well-being among Hispanic Americans. Dependent on how acculturation is measured, however, the relationship between acculturation and health-related quality of life is inconsistent. In addition, studies often use proxy measures of acculturation that preclude an understanding of the complex process of acculturation and its relationship to health. Research using latent variables of acculturation based on several cultural indicators has been suggested as a way to advance the study of acculturation in the field. Furthermore, research is needed that goes beyond studying individual characteristics and their impact on health. Studies have shown that aspects of the neighborhood environment (e.g., park density, access to public transit) impact health-related quality of life, but few of these studies have been conducted in Hispanic Americans, or have considered neighborhood environment in combination with individual cultural variables. Studies that consider both individual cultural and environmental characteristics simultaneously allow for the assessment of interactions. Examination of cross-level interactions may provide information on whether cultural variables are more or less important to health-related quality of life in different contexts.

In an effort to advance the study of acculturation and health-related quality of life, the present study had four aims: 1) derive person-level latent acculturation variables from multiple individual indicators of acculturation using exploratory factor analysis; 2) identify person-level latent acculturation variables that are associated with health-related quality of life; 3) identify neighborhood-related variables (e.g., proximity to open spaces, food environment) that are associated with health-related quality of life; and 4) determine how person-level acculturation variables interact with neighborhood variables to predict health-related quality of life among Hispanic Americans.

Design. Exploratory factor analysis and multi-level modeling were used to explore correlates of mental and physical health-related quality of life in a sample of 383 Hispanic American men and women living in a metropolitan border city. Participants completed health-related questionnaires as part of a larger study developing a clinical trials education program for Hispanic Americans. For this study, person-level acculturation variables were included at the lowest level of the model, and were hierarchically nested within participants’ residential neighborhood data. Neighborhoods were defined using census tracts, considered to be relatively homogeneous units based on population characteristics.  Individual acculturation and health-related quality of life data were gathered from participant responses on measures included in the survey packet from the parent study. Participants’ neighborhood-level data were obtained from the United States Census database, the Healthy Communities Data and Indicators Project, and the California State Board of Equalization.

Results. Exploratory factor analysis showed support for three acculturation latent variables named: Religiosity, Subjective Social Status, and Traditional Acculturation. The Subjective Social Status latent variable was significantly, positively associated with mental and physical health-related quality of life. The Religiosity and Traditional Acculturation latent variables were not significantly associated with mental or physical health-related quality of life. Neighborhoods with a greater percentage of the population within close proximity to an alcohol outlet were associated with better physical health-related quality of life. In addition, the relationship between the Subjective Social Status latent variable and physical health-related quality of life was stronger in neighborhoods with a higher density of tobacco retailers as compared to neighborhoods with a lower density of tobacco retailers.

Conclusions. This study suggests that subjective social status and neighborhood characteristics may play an important role in the health-related quality of life of Hispanic Americans. Subjective social status, or an individual’s belief about where he or she stands in a social hierarchy, was associated with mental and physical health-related quality of life. Findings from the present study suggest that this relationship was stronger in more disadvantaged neighborhoods. Although the study was cross-sectional, the findings identify potentially modifiable individual and neighborhood variables that may play important roles in determining overall quality of life.