American Journal of Orthopsychiatry 2015, Vol. 85, No. 1, 23–33

© 2014 American Orthopsychiatric Association http://dx.doi.org/10.1037/ort0000022

Ethnic Identity, Perceived Support, and Depressive Symptoms Among Racial Minority Immigrant-Origin Adolescents Pratyusha Tummala-Narra

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Boston College

Although racial minority immigrant-origin adolescents compose a rapidly growing sector of the U.S. population, few studies have examined the role of contextual factors in mental health among these youth. The present study examined the relationship between ethnic identity and depressive symptoms, the relationship between perceived social support and depressive symptoms, and the relationship between sociodemographic factors (ethnicity, gender, and socioeconomic status) and depressive symptoms, among a culturally diverse group of adolescents. In addition, the potential moderating role of nativity status (U.S. born vs. foreign born) was examined in these associations. Participants were 9th and 10th graders (N ⫽ 341; 141 foreign born and 200 U.S. born, from Asian, Latino(a), and Afro-Caribbean backgrounds), attending an urban high school. Consistent with previous research, ethnic identity was negatively associated with depressive symptomatology in the overall sample. Nativity status did not moderate the relationship between ethnic identity and depressive symptoms. Among the sociodemographic factors examined, only gender was associated with depressive symptoms, with girls reporting higher levels of depressive symptoms compared with boys. Contrary to expectations, there were no differences in the degree of depressive symptomatology between U.S.-born and foreign-born adolescents, and perceived social support was not associated with fewer depressive symptoms. The findings suggest the importance of gender and ethnic identity in mental health and, more broadly, the complexity of social location in mental health outcomes among U.S.-born and foreign-born immigrant-origin adolescents. Implications for research and interventions with immigrant-origin adolescents are discussed.

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sociation, 2012; Cummings & Druss, 2011). Furthermore, although a few studies have noted higher levels of internalizing symptoms (e.g., depression, anxiety) among urban youth when compared with nonurban youth (Carlson & Grant, 2008; Sirin et al., 2013), less is known about potential risk and protective factors in mental health symptomatology among immigrant-origin adolescents in urban settings. Adolescence is a critical developmental stage in which identity issues (e.g., ethnic identity) emerge as a core aspect of well-being, and support systems (e.g., adult and peer support) can play a protective role in mental health (Pahl & Way, 2006). As such, the present study focused on the relationship between ethnic identity and depressive symptoms and the relationship between social support and depressive symptoms among a culturally diverse (e.g., Asian, Latino[a]), Afro-Caribbean) group of adolescents in an urban setting. To understand whether these associations varied between foreign-born or U.S.-born adolescents, I examined nativity status as a moderator of the relationships between ethnic identity and depressive symptoms and between social support and depressive symptoms. Recognizing that different subgroups of racial minority immigrant-origin youth (e.g., different ethnic groups, girls vs. boys, lower socioeconomic status [SES] vs. higher SES) may experience unique stressors, this study also investigated whether ethnicity, gender, and SES predict depressive symptoms and whether nativity status moderates these relationships. The

mmigrant-origin youth are the fastest growing sector of the population in the United States, with the largest number of foreign-born youth arriving from Latin America, Asia, and the Caribbean (Almeida, Johnson, Matsumoto, & Godette, 2012; American Psychological Association, 2012). Latino(a) and Asian populations have increased by 43% in the span of the past decade (U.S. Census Bureau, 2011). Latinos and Asians are expected to compose 25% and 8%, respectively, of the total U.S. population by 2050 (Passel, 2011; Rogers-Sirin & Gupta, 2012). Considering the significant increase of racial minority immigrant (foreign-born) and U.S.-born youth, mental health of this sector of youth is important and relevant to the well-being of the general population (Almeida et al., 2012). Despite a growing prevalence of mental health problems (Sirin, Ryce, Gupta, & Rogers-Sirin, 2013), immigrant-origin youth underuse mental health services when compared with non-Hispanic Whites (American Psychological As-

This article was published Online First October 20, 2014. This research was supported by the Collaborative Fellows Grant, Lynch School of Education, Boston College. Correspondence concerning this article should be addressed to Pratyusha Tummala-Narra, Department of Counseling, Developmental and Educational Psychology, Boston College, Chestnut Hill, MA 02467. E-mail: [email protected] 23

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following sections detail the relevant literature concerning the mental health of immigrant-origin youth across nativity status and sociodemographic correlates (e.g., ethnicity, gender, SES) and the role of ethnic identity and social support in mental health.

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Mental Health Among Immigrant-Origin Adolescents Immigrant youth experience a variety of stressors, such as poverty, limited educational opportunities, discrimination, exposure to violence pre- and postmigration, and language and cultural adjustment challenges, which contribute to mental health problems (American Psychological Association, 2012). Major depression has been found to be a significant mental health problem among Latino and Asian youth, and Asian American youth have the highest risk among ethnic minority groups in the United States for suicide (Centers for Disease Control and Prevention, 2008; Lo, 2010; Potochnick & Perreira, 2010). Differences regarding mental health problems among adolescents across nativity status have been conceptualized primarily in two distinct ways. According to the first conceptualization (acculturation stress hypothesis), foreign-born adolescents experience more acculturative stress than U.S.-born adolescents, contributing to higher levels of mental health symptomatology. The second conceptualization (immigrant optimism hypothesis) focuses on immigrant optimism, or the notion that foreign-born adolescents experience greater optimism that buffers against mental health symptoms (Potochnick, Perreira, & Fuligni, 2012; Suárez-Orozco & Suárez-Orozco, 2001). A majority of research examining the prevalence of mental health problems across immigrant generation among adults suggests an “immigrant paradox,” in which the second generation (U.S. born) has been found to be at a higher risk for mental health concerns, such as depression, anxiety, substance abuse, eating disorders, and suicidal ideation and behavior, compared with the first generation (foreign born), although some studies indicate a different trend with the first generation at a greater risk for mental health problems (American Psychological Association, 2012; García Coll & Marks, 2012; Pumariega, Rothe, & Pumariega, 2005). However, recent research concerning the “immigrant paradox” and internalizing problems (e.g., depression, anxiety) among adolescents indicates mixed findings. For example, consistent with the acculturative stress hypothesis, first-generation adolescents have been found to report more internalizing symptoms (e.g., loneliness, social anxiety) than their second-generation peers (Katsiaficas, Suárez-Orozco, Sirin, & Gupta, 2013; Polo & Lopez, 2009; Potochnick et al., 2012). On the other hand, other studies either have not found a mental health advantage across nativity (Hao & Woo, 2012; Peña et al., 2008) or, consistent with the immigrant optimism hypothesis, have found that U.S.-born adolescents experience more mental health distress (e.g., depression) than foreign-born adolescents (Harker, 2001). Although these studies have examined whether foreign-born versus U.S.-born immigrant-origin youth have higher or lower overall rates of mental health symptomatology, it is not yet clear whether these groups have different risk and protective factors that influence the degree of depressive symptomatology. Several sociodemographic factors, such as ethnicity, gender, and SES, have been thought to account for differences in depressive symptoms across nativity status. Specifically, the prevalence of

mental health problems among immigrant adolescents has been found to vary across gender, with girls reporting higher degrees of depressive symptoms compared with boys (Céspedes & Huey, 2008; Dawson, Perez, & Suárez-Orozco, 2012). Furthermore, studies (Almgren, Magarati, & Mogford, 2009) have found that this gender difference in mental health symptomatology among adolescents persists across racial and ethnic groups. The research to date suggests a complex picture of mental health of immigrants from different social class backgrounds. Some studies indicate that higher income is not associated with lower risk of mental health problems (Gavin et al., 2010). Other studies have found differential effects of nativity depending on the type of health outcome measured. Specifically, Asian immigrants have been found to be more likely than their U.S.-born peers to rate their mental health as fair to poor but less likely to have a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) mental disorder after accounting for social class (John, de Castro, Martin, Duran, & Takeuchi, 2012). Whereas these sociodemographic variables (e.g., gender, social class) have been studied as risk factors across immigrant-origin youth, to date, few studies have tested whether they are differentially related to depressive symptoms for foreignborn versus U.S.-born adolescents. It is important that, in an increasingly diverse society, the intersection of multiple contextual factors that potentially influence mental health be more closely examined. The present study examined the relationship between these sociodemographic factors and depressive symptoms and the potential moderating role of nativity status in this association.

Ethnic Identity, Social Support, Nativity, and Mental Health Developmental– contextual factors such as ethnic identity and perceptions of social support have been thought to play an important role in the psychological well-being of adolescents. Ethnic identity has been defined as the extent to which an individual views his or her ethnic group positively and experiences a sense of commitment and belonging to his or her ethnic group (Phinney, 1996). Adolescence, in particular, is a developmental period involving the exploration of meanings of ethnic group membership and growth toward a committed ethnic identity (Pahl & Way, 2006). A stronger ethnic identity seems to protect against acculturative stress (Phinney, 1996; Quintana, 2007; Schwartz, Zamboanga, & Jarvis, 2007) and is associated with fewer mental health problems, including depression among immigrant youth (Costigan, Koryzma, Hua, & Chance, 2010; Rogers-Sirin & Gupta, 2012; Smith & Silva, 2011; Tummala-Narra & Claudius, 2013). The relationship between stronger ethnic identity and well-being among people of color has been noted as consistent across race, gender, educational level, and SES (Smith & Silva, 2011). In a recent meta-analytic study, Smith and Silva (2011) found that ethnic identity was consistently associated with measures of self-esteem and well-being, and it was associated with mental health symptoms at a lower magnitude, calling for further study of the ethnic identity–mental health association among diverse populations. Potential differences in the effects of ethnic identity on mental health across nativity status have not been adequately explored. It is possible that U.S.-born adolescents experience their identification with their ethnic groups and heritage culture in ways that are

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IMMIGRANT-ORIGIN ADOLESCENTS AND DEPRESSIVE SYMPTOMS

qualitatively different from their foreign-born peers, and that ethnic identity serves different functions for each subgroup of youth. For example, strongly identifying with one’s heritage culture may pose conflict with adjustment to school, therefore constraining any potential positive effects of ethnic identity on mental health. On the other hand, for foreign-born students, identifying with one’s ethnic group and heritage culture may protect them from potential stressors. In the present study, the association between ethnic identity and depressive symptoms and the potential moderating role of nativity in this relationship were examined as a way to understand how the role of ethnic identity on mental health may vary across these subgroups of immigrant-origin adolescents. While ethnic identity can serve as a protective factor for immigrant-origin youth, a related but distinct construct, perceived social support, or the ability to turn to others for help when facing problems, has been found to be critical to adolescents’ well-being. Research suggests that perceptions of care and support by parents, teachers, and peers are associated with mental health outcomes and well-being among immigrant-origin adolescents from various cultural backgrounds (Cho & Haslam, 2010; Moon & Rao, 2010; Nguyen, Rawana, & Flora, 2011; Potochnick & Perreira, 2010). The role of parental support is thought to be especially important for immigrant-origin youth in facilitating cultural adjustment and negotiating multiple cultural contexts (American Psychological Association, 2012). For immigrant youth who relocate to the United States without immediate family members or who have significant disruptions in their support systems in the country of origin, social support may be of critical importance to their adjustment (Nicolas, Arntz, Hirsch, & Schmiedigen, 2009). Although there have been mixed findings concerning the extent of access to social support for foreign-born and U.S.-born adolescents (Almeida, Subramanian, Kawachi, & Molnar, 2011; Juang & Cookston, 2009), research has not yet adequately examined potential differences in the relationship between social support and depressive symptomatology across foreign-born and U.S.-born adolescents. It is possible, for example, that foreign-born adolescents experience support from their families, teachers, and peers in distinct ways that protect them from emotional distress as compared with U.S.-born adolescents. As such, the present study examined the relationship between perceived social support and depressive symptoms and the potential moderating role of nativity status in this association.

Present Study The present study examined risk and protective factors associated with depressive symptomatology among foreign-born and U.S.-born immigrant-origin adolescents from diverse cultural and socioeconomic backgrounds (e.g., Latino, Asian, Afro-Caribbean) in an urban setting. Examining the association between sociodemographic factors (e.g., ethnicity, gender, and SES) and depressive symptoms and the association between developmental– contextual factors (e.g., ethnic identity and perceived social support) and depressive symptoms allows for an exploration of both risk and protective factors and unique mental health concerns of immigrant-origin adolescents. In addition, the present study explored the potential moderating role of nativity status (foreign born vs. U.S. born) on the relationships between sociodemographic factors (ethnicity, gender, and SES) and depressive symptoms,

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between ethnic identity and depressive symptoms, and between perceived social support and depressive symptoms. Knowledge concerning these research questions was thought to inform and extend existing views on generation-specific differences among immigrant-origin youth (e.g., acculturative stress hypothesis vs. immigrant optimism hypothesis) and to inform interventions that address the needs of racial minority immigrant-origin adolescents. The following hypotheses were developed based on previous findings concerning relevant variables in the study:

Hypothesis 1: Consistent with findings supporting the immigrant paradox, U.S.-born adolescents will report higher levels of depressive symptomatology compared with foreign-born adolescents. Hypothesis 2: Gender will be associated with depressive symptomatology, with girls reporting higher levels of depressive symptomatology than boys. Hypothesis 3: Stronger ethnic identity will be associated with lower levels of depressive symptomatology. Hypothesis 4: Higher levels of perceived social support will be associated with lower levels of depressive symptomatology. No hypotheses were made regarding the association between ethnicity and depressive symptoms, that between SES and depressive symptoms, and the direction of the moderating role of nativity status in these relationships because of inconclusive findings in previous research. In addition, given the paucity of research concerning how nativity status may play a moderating role in the relationships between ethnic identity and mental health and between social support and mental health, there were no specific hypotheses concerning direction of moderation.

Method Participants Participants attended a public high school in a racially, culturally, and economically diverse urban area in the northeastern part of the United States. Participants were drawn from a larger schoolbased study that included 716 ninth and 10th grade students. Of the total sample, 637 participants are immigrant-origin (U.S.-born or foreign-born) adolescents from a variety of racial and ethnic minority backgrounds. In the present study, analyses focused on Asian, Latino(a), and Afro-Caribbean participants. Multiracial, Native American, Middle Eastern, Black/African American (not of Afro-Caribbean heritage) participants, and participants in the “other” racial/ethnic group were excluded from the sample because of the small numbers of participants in each of these categories. Adolescents who did not indicate their ethnicity or did not provide enough information to determine whether they were U.S. born or foreign born (n ⫽ 79) were excluded from analyses.1 This 1

In addition, White adolescents, adolescents who were born in Puerto Rico, the U.S. Virgin Islands, or Canada, were excluded from the current study to allow for clear examination of the effects of nativity on depression within racial minority immigrant-origin participants.

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was necessary to construct a multigroup model that examined relationships among the variables of interest across U.S.- and foreign-born adolescents (see analytic plan for information on multigroup modeling) and within the current sample of racial minority immigrant-origin adolescents. Three students who identified as transgender were also removed from the sample to allow for examination of gender differences (the extremely small number of transgender students prohibited gender comparisons including transgender students). This left a sample size of 383 participants who identified as Asian, Afro-Caribbean, or Latino(a). Of these adolescents, 42 had missing data across measures of ethnic identity, perceived social support, and depressive symptoms. These students were also excluded from further analyses, leaving a final sample of 341 participants. Chi-square tests were conducted to examine whether participants who were excluded from the sample because of missing data on these three key variables significantly differed from the rest of the sample. Participants who were excluded because of missing data across the three variables of interest did not differ from the rest of the sample by gender, ethnicity, or SES, but they did significantly differ by whether the student was born in the United States or a foreign country. Foreign-born adolescents were more likely to be excluded because of missing data (18% of foreign-born participants were excluded) than U.S.-born adolescents (5% of U.S.-born participants were excluded), ␹2(1) ⫽ 15.96, p ⬍ .001. The final sample of 341 participants consisted of 141 foreignborn adolescents (41.3% of the sample) and 200 U.S.-born adolescents (58.7% of the sample). Participants’ ages ranged from 13 to 18 years (M ⫽ 14.81 years), although the majority of participants (93.8%) were between 14 and 16 years of age. Ninth graders composed 57% (n ⫽ 195) of the sample and 10th graders composed 43% (n ⫽ 146) of the sample. The majority of students identified as Asian (n ⫽ 162; 47.5% of the sample), followed by Latino(a; n ⫽ 100; 29.3%) and Afro-Caribbean (n ⫽ 79; 23.2%). Most foreign-born Asian participants were born in China (n ⫽ 43), Vietnam (n ⫽ 17), the Philippines (n ⫽ 5), or India (n ⫽ 4). Of the foreign-born Latino(a) participants, the most frequent birth countries were Brazil (n ⫽ 26), El Salvador (n ⫽ 4), Colombia (n ⫽ 3), and the Dominican Republic (n ⫽ 3). Finally, the vast majority of Afro-Caribbean participants were born in Haiti (n ⫽ 42). Overall, 52% of the sample was female and 48% was male. SES was indicated by whether or not participants received reduced-fee or free meals (breakfast and/or lunch) at school. The majority of students (71%) received reduced-fee or free breakfast and/or lunch at school. See Results section for demographics by nativity status.

Procedure Prior to data collection, the university’s institutional review board approved the study. Ninth and 10th grade students (total of 923 students) at an urban public high school were invited by the head of guidance and homeroom teachers to participate in a research study examining social and contextual factors in adolescent mental health. Parent and youth consent forms were distributed by the students’ teachers 2 days before a scheduled administration of the survey and were collected prior to survey administration by the teachers. Homeroom teachers administered the survey, and the author and graduate research assistants were

present at the school during the administration to answer any questions from students and teachers. The survey administration lasted approximately 45 min. In total, 716 ninth and 10th grade students completed the surveys (response rate of 78%). Participants’ names were not connected with survey responses to ensure anonymity. No financial incentive was provided to participants for completing the survey.

Measures Participants completed a background form that included questions about age, sex, grade, racial background, whether or not they received reduced-fee or free breakfast and/or lunch at school, whether they were born in the United States, and their parents’ countries of origin. Participants who were born outside of the United States were asked to indicate their countries of origin. Gender was indicated by one dichotomous item that represented whether the participant identified as male or female (0 ⫽ male, 1 ⫽ female), and nativity status was indicated by one dichotomous item that represented whether the participant was born in the United States or outside the United States (0 ⫽ U.S. born, 1 ⫽ foreign born). SES was measured by one dichotomous item that represented whether the participant received reduced-fee or free breakfast and/or lunch at school (0 ⫽ no, 1 ⫽ yes). In addition to the background questions, participants provided responses to measures assessing ethnic identity, perceived social support, and depressive symptomatology. All of the measures were conducted in English. Ethnic identity. The Multigroup Ethnic Identity Measure (MEIM; Phinney, 1992) was used to measure participants’ ethnic identity. Participants rated 12 statements about their feelings and reactions concerning their ethnicity or ethnic groups on a Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The following are sample items: “I feel good about my cultural or ethnic background” and “I have a strong sense of belonging to my own ethnic group.” A total scale score was used, with higher scores indicating higher levels of ethnic identity. The MEIM has been widely used with both adolescents and adults, and has consistently demonstrated strong reliability, most often with alphas above .80. The MEIM has been validated with adolescents and young adults from a variety of ethnic and racial backgrounds in the United States and across different countries (Dandy, Durkin, McEvoy, Barber, & Houghton, 2008; Phinney, 1992). Similar to previous studies, the internal consistency of the MEIM in the present study was strong (␣ ⫽ .91). Perceived social support. The social support component of the Polling for Justice Survey (Fox et al., 2010) was used to assess perceptions of support from adults (e.g., parents, teachers) and peers. The Polling for Justice Survey was created in New York City as a part of a participatory action research project and involved a collaboration of university-based researchers and students, public health professionals, and youth researchers from culturally, racially, and economically diverse backgrounds “to document and create policy action around youth experiences with health, education and criminal justice” (Fox et al., 2010, p. 7). A series of focus groups and informal meetings with youth researchers guided the development of the survey. The survey includes

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IMMIGRANT-ORIGIN ADOLESCENTS AND DEPRESSIVE SYMPTOMS

questions concerning the areas of health, education, and interactions with adults and peers. The questions concerning social support from this survey are especially relevant to the present study as they reflect perspectives of youth from diverse racial and cultural backgrounds living in an urban setting. Furthermore, the social support measure was thought to closely reflect the experiences of youth from immigrant and racial minority backgrounds as it was derived from collaboration with diverse youth communities (Torre & Fine, 2011). The social support measure in the Polling for Justice Survey includes seven items. Sample items include the following: “When you are going through a hard time, how often do you turn to adult family members (like: my mother, father, grandparent, guardian)?”; “When you are going through a hard time, how often do you turn to adults at school (like: teachers, guidance counselor)?”; “When you are going through a hard time, how often do you turn to friends (including boyfriend/girlfriend)?” Responses to the questions are based on a 4-point Likert scale from 1 (always) to 4 (never). In the present study, responses were recoded such that higher scores on the scale indicated higher levels of perceived social support to facilitate interpretation from 1 (never) to 4 (always). Internal consistency for the measure was adequate (␣ ⫽ .71). Depressive symptoms. The Center for Epidemiological Studies Depression Scale for Children (CES-DC; Faulstich, Carey, Ruggiero, Enyart, & Gresham, 1986) was used to measure depressive symptoms. The CES-DC is a commonly used instrument for assessing self-reported depressive symptoms in adolescents. Participants were asked to indicate the frequency of depressive symptoms over the past week on a 20-item 4-point scale from 0 (not at all) to 3 (a lot). Sample items include the following: “I felt lonely, like I didn’t have any friends” and “I felt down and unhappy.” A mean score was used, with higher scores indicating higher levels of depressive symptomatology. The CES-DC has adequate test–retest reliability (r ⫽ .51), strong internal consistency (␣ ⫽ .84, Faulstich et al., 1986; ␣ ⫽ .88, Hudson, Elek, & Campbell-Grossman, 2000), and has been found to be a valid instrument in measuring depression among adolescents (Faulstich et al., 1986). The internal consistency of the CES-DC in the present study was strong (␣ ⫽ .88).

Results Data Analysis A multigroup path model was conducted to examine the relationships among the variables of interest. Multigroup analysis is a type of structural equation modeling. This approach allowed testing whether modeled relationships differed between subgroups in the sample. In this study, this allowed testing of whether U.S.-born (n ⫽ 200) and foreign-born (n ⫽ 141) adolescents exhibited different relationships among the variables of interest. This was a reasonable sample size for examining model fit, testing relationships among the variables of interest, and conducting the multigroup analysis (Jaccard & Wan, 1996; Tabachnick & Fidell, 2007). Prior to modeling, data were screened for skewness and kurtosis. The perceived social support scale exhibited a high degree of kurtosis (3.03). Therefore, a square-root transformation was con-

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ducted on this variable in preparation for analyses. Results are based on this transformed variable. The sample also had a moderate amount of missing data on the measure of ethnic identity (24%), a fair amount of missing data on the measure of depressive symptoms (12%), and a negligible amount of missing data on the measure of social support (less than 1%). To address this, expectation maximization was used to impute missing data on the variables of interest. Expectation maximization is preferable to other methods of addressing missing data, such as pairwise and listwise deletion, which can create biased results (Schafer & Graham, 2002). All modeling was conducted in AMOS 20.0. Model fit was assessed by the root mean square error of approximation (RMSEA) and comparative fit index (CFI; CFI of 0.90 – 0.95 ⫽ adequate fit; CFI ⬎ 0.95 ⫽ good fit; RMSEA of 0.06 – 0.08 ⫽ adequate fit; RMSEA ⬍.06 ⫽ good fit; Hu & Bentler, 1998). The chi-square index of misfit is also reported, and likelihood ratio tests were used to evaluate differences in model fit between nested models.

Descriptives and Bivariate Relationships Descriptives are presented by nativity status in Table 1. Chisquare and analysis of variance tests were conducted to examine differences between U.S.- and foreign-born participants on gender, ethnicity, SES, ethnic identity, perceived social support, and depressive symptoms (see Table 1). There were no statistically significant differences on these variables between U.S.- and foreign-born participants. It is worth noting that 24% (n ⫽ 82) of participants (both U.S. born and foreign born) indicated that they never turn to adult family members, 28% (n ⫽ 97) never turn to peer family members, 13.2% (n ⫽ 45) never turn to friends, 57.2% (n ⫽ 195) never turn to adults at school, and 78.9% (n ⫽ 269) never turn to mental health professionals when dealing with a difficult time. Table 2 presents bivariate correlations among the variables of interest within U.S.-born versus foreign-born participants.

Multigroup Analysis Results: Predictors of Depressive Symptoms and Nativity Status as a Moderator In structural equation modeling, multiple alternative models are tested to obtain a parsimonious model that is consistent with the observed data (i.e., a well-fitting model). An initial (saturated) model was constructed with gender, ethnicity, SES, ethnic identity, and (transformed) perceived social support modeled as correlated predictors of the dependent variable: depressive symptoms. Ethnicity was coded with two dummy codes representing AfroCaribbean and Latino(a) adolescents, with Asian adolescents (the largest group) as the reference group. First, this model was tested as an ungrouped model, in which all relationships were constrained to be equivalent across U.S.-born and foreign-born participants. Next, an unconstrained, grouped model was tested in which all modeled relationships were allowed to differ between U.S.-born and foreign-born participants. To reduce model complexity and improve parsimony, I sequentially constrained relationships that were neither significant in the ungrouped model (all relationships

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Table 1. Variables of Interest by Nativity Status (Foreign vs. U.S. Born)

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Variable Ethnicity, n (%) Afro-Caribbean Latino(a) Asian Gender, n (%) Male Female Socioeconomic status, n (%) Received free/reduced-fee meals No free/reduced-fee meals Mean (SD) ethnic identity Mean (SD) social support (transformed) Mean (SD) depressive symptoms

Full sample (N ⫽ 341)

Foreign born (n ⫽ 141)

U.S. born (n ⫽ 200)

79 (23) 100 (29) 162 (48)

30 (21) 42 (30) 69 (49)

50 (25) 58 (29) 94 (47)

163 (48) 178 (52)

73 (52) 68 (48)

90 (45) 110 (55)

243 (71) 98 (29) 2.94 (0.55) 1.33 (0.20) 0.70 (0.50)

105 (75) 36 (26) 2.99 (0.53) 1.33 (0.22) 0.68 (0.44)

138 (69) 62 (31) 2.91 (0.56) 1.33 (0.18) 0.72 (0.50)

Significance tests ␹2(2) ⫽ 0.49, ns

␹2(1) ⫽ 1.52, ns ␹2(1) ⫽ 1.21, ns t(339) ⫽ ⫺1.39, ns t(339) ⫽ ⫺0.22, ns t(339) ⫽ 0.76, ns

Note. Ethnic identity: 1 ⫽ strongly disagree to 4 ⫽ strongly agree; square-root transformed social support: 1 ⫽ never to 2 ⫽ always; depressive symptoms: 0 ⫽ not at all to 3 ⫽ a lot. Percentages were rounded up, absolute numbers are accurate.

treated as equivalent across both groups) nor significant in either of the groups (U.S.-born and foreign-born students) in the unconstrained grouped model to zero. This process was applied to both covariances among the independent variables and relationships between the independent variables and the dependent variables. Ethnicity, SES, and (transformed) perceived social support were not significantly associated with depressive symptoms in either the U.S.-born or foreign-born groups, and were not significantly associated with depressive symptoms in the combined sample; therefore, the effects of these predictors on depressive symptomatology were constrained to zero in the remaining analyses. In addition, several covariances between the independent variables were not significant in either the U.S.-born or foreign-born groups; they were also constrained to zero in further analyses. This modeltrimming process did not result in a statistically significant introduction of misfit into the model, based on the likelihood ratio test, change in ␹2(28) ⫽ 23.61, ns. The trimmed, unconstrained grouped model, in which all relationships between the independent and dependent variables were free to differ between U.S.-born and foreign-born participants, resulted in excellent model fit: ␹2(28) ⫽ 23.61, ns; CFI ⫽ 1.00; RMSEA ⫽ 0.00. An alternative and more parsimonious structural weights version of the trimmed model was then tested. In this model, the paths representing the effects of the independent variable on the dependent variable were constrained to be equal, but other parameters (e.g., correlations among the independent variables, variable variances, and residuals) were still allowed to vary across the two groups, ␹2(30) ⫽ 26.16, ns; CFI ⫽ 1.00; RMSEA ⫽ 0.00. By comparing the fit of these two models, it was possible to test whether nativity (U.S. born vs. foreign born) moderated the predictive relationships between the independent and dependent variables. A likelihood ratio test (comparing the fits of the trimmed, unconstrained grouped model and the trimmed structural weights model) showed that constraining these paths to be equivalent across did not introduce a significant amount of misfit, ␹2(2) ⫽ 2.55, ns. In other words, forcing those relationships to be the same across U.S.-born and foreign-born participants did not result in significantly worse model fit between the model and observed data than allowing the relationships to vary across the groups. There-

fore, there was no evidence to suggest that nativity status moderated the relationships between the independent variables and the dependent variable. In light of this finding, the more parsimonious structural weights model, in which paths between the independent variables and the dependent variable were constrained to be equal, was chosen as the final model.2 In the final model, relationships between the independent variables were still allowed to vary between U.S.-born and foreign-born participants (i.e., nativity status did moderate the relationships among the independent variables). The final model exhibited excellent fit: ␹2(30) ⫽ 26.16, ns; CFI ⫽ 1.00; RMSEA ⫽ 0.00. The final model tested the associations between the remaining independent variables and depressive symptoms across U.S.-born and foreign-born adolescents. The results of the final model are provided in Figure 1. After controlling for gender, ethnic identity was negatively associated with depressive symptoms, such that students with higher ethnic identity reported fewer depressive symptoms (b ⫽ ⫺.107, p ⬍ .05). After controlling for ethnic identity, gender was related to depressive symptomatology such that girls reported more depressive symptoms than boys (b ⫽ .242, p ⬍ .001). As noted earlier, nativity status did not moderate the relationships between the independent variables and the dependent variable, and ethnicity, SES, and perceived social support were not significant predictors of depressive symptoms.

Discussion The present study examined potential risk and protective factors in depressive symptomatology among racial minority U.S.-born and foreign-born immigrant-origin adolescents in an urban setting. Contrary to findings supporting the immigrant paradox, there were

2

A structural covariances model was also tested, in which covariances between the variables were also constrained to be equal across U.S.-born and foreign-born students. In comparison to the structural weights model, the structural covariances model introduced a significant amount of misfit and was therefore rejected in favor of the structural weights model, ␹2(11) ⫽ 21.09, ns.

IMMIGRANT-ORIGIN ADOLESCENTS AND DEPRESSIVE SYMPTOMS

29

Table 2. Correlations Among Modeled Variables by Nativity Status Variable

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1. 2. 3. 4. 5. 6. 7. 8.

Ethnicity: Afro-Caribbean Ethnicity: Latino(a) Ethnicity: Asian Gender Socioeconomic status Ethnic identity Social support Depressive symptoms

1

2

3

4

5

6

7

8

— ⴚ.364ⴱⴱ ⫺.531ⴱⴱ .025 .130 .063 .103 ⫺.075

⫺.339ⴱⴱ — ⴚ.596ⴱⴱ .047 ⫺.024 .053 .071 .044

⫺.509ⴱⴱ ⫺.638ⴱⴱ — ⴚ.063 ⫺.090 ⫺.103 ⫺.154ⴱ .025

⫺.016 .023 ⫺.008 — .002 .105 .084 .239ⴱⴱ

⫺.093 ⫺.152 .215ⴱ ⫺.184ⴱ — .094 .042 ⫺.048

⫺.028 .024 .001 ⫺.045 ⫺.018 — .285ⴱⴱ ⫺.019

⫺.211ⴱ .054 .123 ⫺.086 ⫺.025 .441ⴱⴱ — ⴚ.013

⫺.108 .001 .087 .265ⴱⴱ ⫺.003 ⫺.232ⴱⴱ ⫺.093 —

Note. Correlations among foreign-born participants appear above the diagonal; correlations within U.S. born participants are presented below the diagonal (bold cells); Gender coded 0 ⫽ male, 1 ⫽ female; socioeconomic status coded 0 ⫽ did not receive free/reduced-fee meals, 1 ⫽ received free/reduced-fee meals. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.

no differences in the degree of depressive symptomatology between U.S.-born and foreign-born adolescents. Furthermore, contrary to expectations, perceived social support was not associated with fewer depressive symptoms both in the overall sample and within subgroups of adolescents (U.S. born and foreign born). Youth seemed most likely to seek help from friends and family members and less likely to seek help from adults at school and mental health professionals. Consistent with the hypotheses, in the overall sample, youth with higher levels of ethnic identity reported fewer depressive symptoms. Nativity status did not moderate the relationship between ethnic identity and depressive symptoms. Multigroup models test for moderation by examining whether constraining the paths to be equal across the two groups introduces a statistically significant amount of misfit, which is a relatively stringent requirement for moderation. Although the study did not meet this test of moderation, inspection of the coefficients in the unconstrained model suggested that the possibility of differences between the two groups (U.S. born and foreign born) were not sufficient to introduce a statistically significant amount of model misfit at p ⬍ .05. Specifically, within the U.S.-born adolescent group, having a stronger ethnic identity did not predict fewer depressive symptoms, whereas within the foreign-born adolescent group, having a stronger ethnic identity predicted less depressive symptomatology. Therefore, further study of moderation is warranted. Among the sociodemographic factors examined in the study, only gender was associated with depressive symptoms, with girls reporting higher levels of depressive symptoms compared with boys in the overall sample and within the U.S.-born adolescent group and the foreign-born adolescent group. The particular ethnicity or SES of youth did not predict depressive symptomatology in neither the combined sample nor within U.S.-born or foreign-born adolescent subgroups. This research is among the few studies examining risk and protective factors in mental health of a culturally and socioeconomically diverse group of urban racial minority immigrant-origin adolescents. It is also worth noting that Afro-Caribbean adolescents, a growing sector of the immigrant population in the United States, in particular, have rarely been included in previous studies of depressive symptomatology across nativity. The study underscores the importance of gender and ethnic identity and the comparable prevalence of depressive symptomatology across ethnicity, SES, and nativity among immigrant-origin youth. The following

sections provide a more detailed discussion of the findings and implications for future research and practice.

Social Location and Depressive Symptomatology Recent studies (Alegría et al., 2008; John et al., 2012) have raised concerns over the overgeneralization and oversimplification of the immigrant paradox, which can contribute to masking mental health distress among subgroups of immigrant-origin individuals. Alegria and colleagues (2008), for example, cautioned against the generalization of the protective effects of foreign-born nativity status. The findings in the present study support neither the acculturative stress hypothesis nor the immigrant optimism hypothesis, but instead underscore the importance of attending to the complexity of social location in mental health outcomes among racial minority immigrant-origin adolescents. Social location refers to one’s position in society with respect to factors such as gender, race, social class, and immigration, and to the social, economic, and political conditions connected with this position (Fuller & Vosko, 2008; Zavella, 1997). Not only were there no significant differences in depressive symptoms across nativity, there were also no significant differences between SES, ethnic identity, and perceived social support across nativity. The lack of difference in depressive symptoms across nativity has been noted in previous studies (Hao & Woo, 2012; Polo & Lopez, 2009), suggesting that foreign-born nativity may not be a protective factor in depression. Furthermore, belonging to a particular SES and ethnic background did not predict depressive symptoms, suggesting that these sociodemographic variables in themselves may not be risk factors for mental health problems, and more specifically, depressive symptoms may be relatively stable across different immigrant generations from diverse ethnic and social class backgrounds. The findings also suggest that U.S.-born and foreign-born adolescents may experience similar or comparable levels of ethnic identity and perceived social support. These findings are contrary to research supporting the acculturative stress hypothesis, indicating that foreign-born immigrants have fewer social networks, and to other research supporting the immigrant optimism hypothesis, which suggests that immigrants have more access to support from family than U.S.-born immigrant-origin individuals (Potochnick et al., 2012).

TUMMALA-NARRA

30 Social Support

Ethnic Id

ty

e b = -.107* Depressive Symptoms

Gender b = .242***

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Socioeconomic Status

Ethnicity Dummy Code: AfroCaribbean Ethnicity Dummy Code: La no(a)

Figure 1. Predictors of depressive symptoms in the final, trimmed, structural weights multigroup model. The structural equation model is grouped by nativity status (U.S.- vs. foreign-born participants). One-headed arrows represent directional, predictive relationships between the independent variables and the dependent variable; double-headed arrows represent covariances among the independent variables. Relationships that were constrained to be equal across the two groups are shown as solid arrows; relationships that were allowed to vary between U.S.- and foreign-born participants are represented by dashed arrows. Relationships between the independent variables and the dependent variables were constrained to be equal across the two groups; relationships among the independent variables were allowed to vary across U.S.- and foreign-born participants. The model was arrived at after a trimming process whereby relationships that were not significant among either U.S.- or foreign-born participants were constrained to zero. Therefore, these arrows are not depicted. Coefficients and significance levels are not provided for the covariances between the independent variables because they were allowed to vary across the two groups, and space prohibits displaying all 10 covariances. Gender coded 0 ⫽ male, 1 ⫽ female; socioeconomic status coded 0 ⫽ did not receive free or reduced-fee meals, 1 ⫽ received reduced-fee or free meals; reference group for ethnicity dummy codes ⫽ Asian. ⴱ p ⬍ .05. ⴱⴱⴱ p ⬍ .001.

It is possible that the lack of differences in depressive symptoms, ethnic identity, and perceived social support across nativity reflect shared challenges of immigrant-origin youth that are more closely related to adjustment issues during early and midadolescence. For example, U.S.-born and foreign-born adolescents may cope with similar stressors, such as intergenerational conflicts at home and discrimination at school, which can contribute to their construction of ethnic identity, perceptions of support, and emotional distress. It is also worth noting that the present study did not include measures of acculturation, acculturative stress, cultural values, English proficiency, or discrimination, all of which may be important factors that differentially influence mental health of first- and second-generation immigrant-origin youth (Katsiaficas & Suárez-Orozco, 2013). The findings call for further research that examines the association between such factors and depressive symptomatology. Consistent with previous research (Céspedes & Huey, 2008; Dawson et al., 2012), the present study raises attention to the role of gender in depressive symptomatology. Although some recent

studies (Sirin et al., 2013; Takeuchi et al., 2007) have suggested that gender differences in mental health symptomatology may vary by nativity status, the present study indicates that both U.S.-born and foreign-born girls report higher levels of depressive symptoms compared with boys. It is possible that girls are more likely than boys to be socialized to internalize distress, and therefore are more likely to report symptoms of depression and other internalizing disorders (Dawson et al., 2012). Furthermore, gender-based socialization, the challenging task of negotiating mixed societal messages concerning gender, and the experience of rejection among girls who do not meet gender-based societal expectations have all been thought to contribute to higher levels of depressive symptomatology among girls when compared with boys (Barrett & White, 2002; Wisdom, Rees, Riley, & Weis, 2007). It has also been suggested that gender differences in depression may relate to gender-based socialization and family conflict (Almgren et al., 2009; Dawson et al., 2012). Specifically, differences in gender role beliefs and expectations between adolescents and their parents may contribute to higher levels of depressive symptoms among U.S.-born and foreign-born immigrant-origin girls (Céspedes & Huey, 2008).

Revisiting Ethnic Identity and Social Support The findings support previous research concerning the protective role of ethnic identity in mental health among immigrant adolescents (Costigan et al., 2010; Smith & Silva, 2011). Whereas nativity status was not found to be a moderator in the negative relationship between ethnic identity and depressive symptoms, the protective role of ethnic identity was evident only in the foreignborn adolescent group even though there were no significant differences in the degree of ethnic identity reported by U.S.-born and foreign-born adolescents. The present study supports previous research (Smith & Silva, 2011) that suggests that ethnic identity does not differ significantly across social location (e.g., gender, ethnicity, and SES). At the same time, the findings raise attention to the possibility of differences concerning the meaning of ethnic identity across youth who are born in the United States and those born outside of the United States. Specifically, factors such as socialization and discrimination may be more relevant than ethnic identity for depressive symptoms among U.S.-born or secondgeneration immigrant-origin adolescents. Furthermore, different dimensions of ethnic identity (e.g., ethnic identity affirmation, belonging, and commitment) may have unique relevance for each adolescent subgroup. Surprisingly, contrary to previous research (Cho & Haslam, 2010; Katsiaficas et al., 2013), youth’s perceptions of social support were not associated with depressive symptoms in neither the overall sample nor each of the adolescent subgroups (U.S. born and foreign born). Perceived social support or the likelihood of turning to others (e.g., parents, teachers, peers) during a difficult circumstance or situation does not appear to be a protective factor in depressive symptomatology for this sample of immigrant-origin adolescents. The present study focused on the ability to turn to others for help, and participants were not asked about how satisfied they were with the help that they may have received from others. The degree of satisfaction in seeking support may be more important to assess in learning about risk and protective factors in future research (Cho & Haslam, 2010). Information regarding the spe-

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IMMIGRANT-ORIGIN ADOLESCENTS AND DEPRESSIVE SYMPTOMS

cific type of support that was received by participants and the degree to which the support aligned with the support needed or desired by participants would be helpful in gaining more insight about the relationship between social support and mental health. It may be important to differentiate instrumental and emotional support, as distinct types of support may be associated with depressive symptomatology (Ajrouch, Reisine, Lim, Sohn, & Ismail, 2010). It is also possible that although there are no direct effects of perceived social support on depressive symptomatology, mediating factors such as experiences of discrimination, peer relationships, intergenerational conflicts, or family dysfunction may have more direct associations with depressive symptoms. Nonetheless, it is of concern that a greater perception of support does not appear to protect against depressive symptoms for U.S.born and foreign-born adolescents, considering the potentially important role of family, peers, and adults at school as adolescents cope with stress. In addition, it is important to note that the degree of perceived social support did not vary across nativity, and that over half of the participants reported that they never seek help from adults at school (e.g., teachers, guidance counselor) and over three quarters of the participants reported that they never seek help from mental health professionals when they experience a difficult situation. It appears that immigrant-origin adolescents are more likely to seek help from friends and family members who may or may not recognize mental health concerns. It is possible that youth tend not to seek help from adults at school or mental health professionals because of cultural beliefs, stigma against mental illness, or a lack of knowledge about available resources.

Limitations and Implications for Research and Practice Several limitations in the present study should be noted. The representativeness of our sample across different geographic regions cannot be assumed, as the sample included adolescents attending an urban high school in the northeastern part of the United States, with the majority receiving reduced-fee or free meals at school. The surveys in the study were conducted in English, and as such, excluded non–English-proficient adolescents. In fact, there was a notable difference in the amount of missing data between foreign-born students and U.S.-born students. There was also a moderate amount of missing data on the measure of ethnic identity. Furthermore, data analysis from the Polling for Justice Survey is ongoing and, therefore, psychometric information on the survey was unavailable at the time of the study. Future empirical study of the survey is necessary to establish further validity and reliability. Only one indicator of SES (receiving reduced-fee or free meals at school) was included in the present study, which may not have captured other potentially adverse circumstances associated with low-income conditions. In addition, adolescents from other immigrant backgrounds, such as Middle Eastern and African, and multiracial participants were not included in the study because of their relatively small numbers in the broader sample. The cross-sectional design of the study limits the ability to interpret the association between ethnic identity and depressive symptoms and the role of gender in depressive symptoms across time and developmental stage (e.g., early adolescence vs. late adolescence).

31

However, the findings in the present study have important implications for mental health professionals in designing and implementing research and interventions with racial minority immigrant-origin youth. Although nativity status did not moderate the relationship between ethnic identity and depressive symptomatology, it is possible that nativity status may contribute to other types of mental health symptoms, such as anxiety or substance abuse. As such, future research should further explore mental health symptomatology across nativity. The finding that U.S.-born and foreign-born girls appear to be more vulnerable to depressive symptoms compared with boys calls for further inquiry concerning cultural beliefs, gender role expectations, and gender-based family and peer conflict that may contribute to mental health distress among girls. In addition, the ways in which boys and girls are socialized to express and report mental health concerns should be explored. Future research should extend the present study’s focus on social location and depressive symptomatology by further exploring intersections of identity (e.g., Gender ⫻ SES, Ethnicity ⫻ Sexual Orientation) across nativity status. The present study did not inquire about sources of social support such as ethnic and/or religious community members and extended family members, which may be important to both U.S.-born and foreign-born adolescents. Future research can examine salient sources of support within and across subgroups of adolescents from different ethnic and religious backgrounds. There are several implications of the present study for interventions and practice. A socioecological framework (Bronfenbrenner & Morris, 2006) that considers both stress and resilience experienced by immigrant-origin youth and a variety of different settings for interventions (e.g., schools, mental health clinics, communitybased services) can be especially important (American Psychological Association, 2012). For example, school-based interventions that promote positive messages about immigrant-origin students’ ethnic heritage and provide opportunity for discussion and exploration of ethnic identity may be especially helpful. Schools can initiate community-building efforts that engage students and parents in panel or roundtable discussions about the role of cultural heritage in school adjustment and emotional well-being and initiate awareness building campaigns that offer clear and accurate information about different cultures. Festivals and celebrations of various cultures can facilitate a sense of pride in students’ cultural heritage, an opportunity for students, teachers, and parents to collectively recognize and appreciate the strengths of a multicultural school community, and foster a sense of connection across the school community. Schools can also collaborate with cultural and religious communities to create educational workshops for parents and students concerning the prevalence of mental health problems, such as depression, particularly when considering the underutilization of traditional mental health services among immigrant populations (American Psychological Association, 2012; Cummings & Druss, 2011). These workshops can provide instrumental support to parents and students as they navigate resources at school and in the mental health care system. They can also provide an opportunity to address parents’ and students’ apprehension concerning the misconstrual or pathologization of their cultural values, beliefs, or practices, and the safeguarding of privacy and confidentiality. Such outreach and education can help promote early identification of mental health concerns and help-seeking, access to mental

TUMMALA-NARRA

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32

health education for parents and caregivers (Santiago & Wadsworth, 2011), and the development of culturally competent practices in school and mental health settings. In fact, prior research suggests that immigrant youth may be willing to seek professional help for mental health problems if they are aware of available resources and have reasonable access to services (García, Gilchrist, Vazquez, Leite, & Raymond, 2011). Clinicians working with immigrant-origin youth and their families should strongly consider the heterogeneity of experiences with ethnic identification among subgroups of youth (e.g., U.S. born vs. foreign born). The findings in the present study further support the importance of clinical and community-based interventions focused on the specific mental health needs of immigrant-origin girls and boys and distinct interactions and dynamics with family, peers, teachers, and significant others that contribute to mental health trajectories. Finally, interventions should focus on increasing access to formal and informal support systems that youth experience as helpful and effective in coping with emotional stress and address potential sources of acculturative stress (e.g., discrimination, language barriers). Informal community-based resources, such as cultural organizations and places of worship (e.g., temples, mosques, churches), are among the most salient sources of support for many immigrant families (American Psychological Association, 2012), and as such, youth may especially benefit from increased dialogue on their experiences of stress and adjustment within these community settings. Keywords: immigration; adolescents; depression; ethnic identity; nativity

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