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J Lat Psychol. Author manuscript; available in PMC 2017 January 09. Published in final edited form as: J Lat Psychol. 2016 November ; 4(4): 232–247. doi:10.1037/lat0000053.

Trauma-Exposed Latina Immigrants’ Networks: A Social Network Analysis Approach Alejandra Hurtado-de-Mendoza, Georgetown University Medical Center

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Adriana Serrano, Georgetown University Medical Center Felisa A. Gonzales, National Cancer Institute Nicole C. Fernandez, Georgetown University Mark Cabling, and Georgetown University Medical Center Stacey Kaltman Georgetown University Medical Center

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Objective—Trauma exposure among Latina immigrants is common. Social support networks can buffer the impact of trauma on mental health. This study characterizes the social networks of trauma-exposed Latina immigrants using a social network analysis perspective. Methods—In 2011–2012 a convenience sample (n=28) of Latina immigrants with trauma exposure and presumptive depression or posttraumatic stress disorder was recruited from a community clinic in Washington DC. Participants completed a social network assessment and listed up to ten persons in their network (alters). E-Net was used to describe the aggregate structural, interactional, and functional characteristics of networks and Node-XL was used in a case study to diagram one network.

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Results—Most participants listed children (93%), siblings (82%), and friends (71%) as alters, and most alters lived in the US (69%). Perceived emotional support and positive social interaction were higher compared to tangible, language, information, and financial support. A case study

Correspondence concerning this article should be addressed to Alejandra Hurtado-de-Mendoza, Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven St., NW Suite 4100, Washington, DC 20007. [email protected]. Alejandra Hurtado-de-Mendoza, Department of Psychiatry, Georgetown University Medical Center; Adriana Serrano, Department of Psychiatry, Georgetown University Medical Center; Felisa A. Gonzales, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute; Nicole C. Fernandez, Department of Communication, Culture, and Technology, Georgetown University; Mark Cabling, Department of Oncology, Georgetown University Medical Center; Stacey Kaltman, Department of Psychiatry, Georgetown University Medical Center. Alejandra Hurtado-de-Mendoza is now in the Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center. Conflicts of Interest: The authors declare no conflict of interest

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illustrates the use of network visualizations to assess the strengths and weaknesses of social networks. Conclusions—Targeted social network interventions to enhance supportive networks among trauma-exposed Latina immigrants are warranted. Keywords social networks; social support; trauma; Latina immigrants; social network analysis

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The impact of social relationships on health outcomes is profound (Berkman, Glass, Brissette, & Seeman, 2000; Holt-Lunstad, Smith, & Layton, 2010). Among the traumaexposed, the benefit of social support for mental health may be greater (Charuvastra & Cloitre, 2008; Guay, Billette, & Marchand, 2006; Schumm, Briggs-Phillips, & Hobfoll, 2006). In a meta-analysis of 77 studies, lack of social support after trauma was one of the strongest predictors of developing posttraumatic stress disorder (PTSD) (Brewin, Andrews, & Valentine, 2000). Trauma exposure can disrupt social networks and undermine the ability to build/enhance supportive relationships (Flannery, 1990; Charuvastra & Cloitre, 2008), especially if trauma occurs in childhood (Charuvastra & Cloitre, 2008). In a study with trauma-exposed women, those with childhood abuse were twice as likely to report low perceived social support (Schumm et al., 2006). Additionally, PTSD symptoms such as feelings of detachment can impact the ability to relate to others (Guay et al., 2006). Thus, trauma exposure and subsequent PTSD can lead to a “loss spiral,” which in turn hinders the ability to recover from trauma (Schumm et al., 2006).

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This paper focuses on the description of social networks and social support among traumaexposed Latina immigrants (mostly from El Salvador) in the United States (US). Among US immigrants, Latinos are the fastest growing population. Many Latinos are exposed to social stressors and traumas that may impact mental health. A significant percentage (23%) live below the poverty line or have not completed high school (35%). Immigrant Latinos face additional challenges in the US such as finding employment, accessing services, and overcoming language barriers (Menjívar, 2000). Furthermore, prior studies have found a 75% or higher prevalence of trauma exposure in probability and community samples of Latinos (Fortuna, Porche, & Alegría, 2008; Kaltman, Green, Mete, Shara, & Miranda, 2010). Most Latinos who live in the DC Metropolitan area are from El Salvador (32%), Mexico (16%), and Guatemala (7%) (US Census Bureau, 2012). El Salvador has one of the highest rates of violent crimes and continues to suffer the effects of destruction and violence of civil wars and drug-related crimes (Overseas Security Advisory Counsel [OSAC] 2015). Thus, trauma exposure might be particularly high among immigrants from El Salvador. Understanding social support networks among trauma-exposed Latinas will help address the mental health needs of this growing and vulnerable population.

Social Networks Social networks are “composed of a set of actors, some of whose members are connected by a set of one or more relations” (Knoke & Yang, 2008, p. 8). Compositional variables include the attribute measures typical to social science and structural variables assess if specific

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types of relationships exist between pairs of people (Wasserman & Faust, 1994). Overall network structure includes characteristics such as network size, the count of relationships each individual has (degree), the types of persons included in the network (composition), and the proportion of existing relationships (density). Interaction and function further describe the network (Gottlieb, 1983). Interactional characteristics may include contact frequency, relationship evaluation and relationship strength. Functional characteristics include the provision of different types of social support. Emotional support (positive affect, empathy, understanding), tangible/pragmatic (material and behavioral aid), informational (information and advice), and positive social interaction (Sherbourne & Stewart, 1991) are of particular relevance.

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Such characteristics are influenced by macro-social factors such as culture, socioeconomic dynamics, and political environment (Berkman et al., 2000). Thus, the benefits of social support networks are not equally distributed (Almeida, Molnar, Kawachi, & Subramanian, 2009). Evidence suggests that people who are less educated or are lower socioeconomically tend to have limited social support networks and social support (Mickelson & Kubzansky, 2003; Small, 2007; Smyth, Siriwardhana, Hotopf, & Hatch, 2014; Uphoff, Pickett, Cabieses, Small, & Wright, 2013). Though evidence is mixed (e.g. Almeida et al., 2009), immigration status has also been associated with limited social support networks. In a London study with ethnically diverse groups, immigrants reported smaller friendship networks and lower tangible support (Smyth et al., 2014) while a Canadian study found that the impact of lower social support was stronger for recently arrived immigrants vs. long-term immigrants and native-born Canadians (Puyat, 2013).

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There is no consensus as to whether Latinos in the US have access to support. Some studies suggest that Latino immigrants have supportive networks (Almeida et al., 2009; Ayón, 2011), while others highlight how immigration can lead to social network disruption and a challenge to building new ties in the US due to economic, legal, environmental, and psychosocial barriers (Hurtado-de-Mendoza, Gonzales, Serrano, & Kaltman, 2014a; Menjívar, 2000; Viruell-Fuentes & Schulz, 2009). Viruell-Fuentes, Morenoff, Williams, and House (2013) found that compared to US-born Latinos, foreign-born Latinos had smaller and less supportive networks.

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Prior research suggests that Latinos tend to have homogenously dense social networks, composed primarily of family members, Spanish-speakers, and women. One of the key components of familismo, a core Latino cultural value, is being able to rely on family members for social support (Sabogal, Marín, Otero-Sabogal, Marín, & Perez-Stable,1987; Villatoro, Morales, & Mays, 2014). The greater reliance on family support (vs. friends) among Latino immigrants (Almeida et al., 2009; Chang, Chen, & Alegría, 2014) may be advantageous as family support has been associated with better self-rated physical/mental health in this population (Mulvaney-Day, Alegría, & Sribney, 2007). Mental health benefits are not limited to social support from family members: connections with one’s community or neighborhood have also been linked to better mental health (Valencia-Garcia, Simoni, Alegría, & Takeuchi, 2012).

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Although prior studies have measured certain aspects of social support networks among Latinos (e.g. Almeida et al., 2009; Mulvaney-Day et al., 2007), no studies have provided a comprehensive description of trauma-exposed Latinos’ social networks using social network analysis (SNA) measures. The goals of the study are to characterize a sample of traumaexposed Latinas with respect to key aspects of social support networks and demonstrate the utility of a visualization tool for assessment of strengths/weaknesses within a network.

Methods Procedures and Participants

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Data were obtained during the baseline interview of an open trial of an intervention designed to address depression and PTSD in a convenience sample of trauma-exposed Latina immigrants. The study was conducted at a primary care clinic in Washington, DC that serves low-income/uninsured patients. Women were eligible if they (1) reported exposure to at least one type of trauma, and (2) met cutoff scores on depression based on the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) and on the PTSD Checklist (PCL) (Weathers, Litz, Herman, Huska, & Keane, 1993). Study procedures were approved by the Georgetown University Institutional Review Board (IRB). Of 62 women screened, 28 women met criteria and were invited to participate in the trial and constitute the study sample (for more details about recruitment see Authors, under review). Measures Socio-demographic factors—We assessed participants’ age, marital and employment status, country of origin, and years in the US.

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Clinical Factors—Depression. Symptoms were assessed using the PHQ-9 (Kroenke et al., 2001). Presumptive depression was defined by a score of 10 or higher. PTSD. Symptoms were evaluated with the PCL (Weathers et al., 1993). Presumptive PTSD was defined by ascore of 30 or higher. Trauma exposure. Events were assessed with an adapted version of the Stressful Life Events Screening Questionnaire (SLESQ) (Corcoran, Green, Goodman, & Krinsley, 2000) that included 13 items from the original SLESQ (e.g. sexual abuse) and three additional questions based on Kaltman, Hurtado-de-Mendoza, Gonzales, Serrano, and Guarnaccia’s (2011) qualitative research (i.e. witnessing domestic violence as a child, controlling behavior by a partner, and exposure to other traumas that participants were not willing to disclose).

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Social network measures—Egocentric networks were assessed with a modified version of hierarchical mapping technique (Antonucci, 1986; Antonucci & Akiyama, 1987). They illustrate direct relations between a focal person (ego) and persons (alters) in their social network, as well as the direct relations among alters (Knoke & Yang, 2008). The persons in the network are nodes and the relationships are ties or links (Knoke & Yang, 2008). After describing the technique, participants were presented with a diagram with the word “you” surrounded by three concentric circles. Participants were asked to list the closest, most important people in their life in the inner circle. People who were not as close but still important were listed in the intermediate circle, and people close enough to be placed in the

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network were listed in the outer circle. We questioned about each alter to capture structural, interactional, and functional characteristics of the network. Direct relationships between the alters were not assessed. Structural characteristics: Size. Network size corresponds to the number of persons listed by the participants (up to ten). Tie Strength. The circle where participants located each alter in the network (inner, intermediate, or outer circle) represent tie strength. Type of relationship. Nine categories (e.g. parents, siblings) were used to code relationship types. Gender. Though not explicitly asked, gender was coded based on alters’ names.

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Interactional characteristics: Proximity. One item queried whether alters lived in the US or abroad. Frequency of contact. One item assessed the frequency of contact with the alters using a seven-point Likert scale ranging from less than once a year to every day. Quality of the relationship. One item captured the quality of the relationship with each alter on a 5point response scale ranging from very bad (1) to very good (5).

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Functional characteristics: Perceived Social Support. Three items from the Medical Outcomes Study Social Support Survey (MOS-SSS; Sherbourne & Stewart, 1991) captured emotional support (trust to talk about themselves or their problems), positive social interaction (relax or have fun together), and tangible support (help with daily chores if sick). We selected three additional items from the Social Support Scale (SSS; Wong, Yoo, & Stewart, 2007) to capture support domains particularly relevant to low-income immigrants including information support (e.g. how to find a doctor), language support (e.g. reading bills in English), and financial support (e.g. cash for daily expenses). In order to capture more nuanced relationships, an ordinal-level response choice (yes/maybe/no) was used instead of the binary response (yes vs. no) favored by Antonucci and Akiyama (1987). A “non-applicable” response option was used when reported by participants (e.g. alters not living in the US cannot help with daily chores). Data Analysis

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Descriptive statistics for demographic and clinical variables were calculated using SPSS Windows Version 19 for Macintosh. Social network characteristics were analyzed using ENet, specialized software for analyzing egocentric networks (E-Net) (Borgatti, 2006). E-Net can summarize the distributions of egos’ characteristics, alters’ attributes (e.g. gender), as well as the relationship between alters and egos (e.g. frequency of contact) (Borgatti & Halgin, 2012). We used the compositional measures to summarize alters’ characteristics. For instance, if seven out of ten listed alters are female in a participant’s egocentric network, ENet will assign a value of 70% to the variable “female gender” for that participant. To then calculate the percentage of alters who were women for the whole sample (n=28), Excel was used to calculate the average of the percentages assigned to each participant. Data were stratified to allow for calculation of compositional measures for the inner circle, for proximity, and for the five most common alter types (e.g. children). The social network of one participant was selected to be visualized with NodeXL (Milic-Frayling et al., 2010). To contextualize her case, information about her trauma exposure, depression, and PTSD levels are provided. Additionally, study documents were reviewed to capture information she

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shared about her social network during the hierarchical mapping exercise and while participating in the intervention trial. To protect confidentiality, a pseudonym is used and identifiable information is omitted.

Results Demographic and Clinical Factors

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On average, women were 48 years old (M=48.2, SD=10.1) and had arrived in the US an average of 15 years prior (M=15.3, SD=7.8). The greatest proportion of women was from Central America (60.7%). Past-year household income was less than $20,000 for the majority of participants. Approximately one-third of the participants were married or living with a partner and all had children (M=2.54, SD=1.10), with slightly more than half (53.6 %) living with one or more of their children. All participants were exposed to more than one trauma event. On average, participants reported 7.3 types of trauma exposure (SD=3.4) and the most common types were childhood physical abuse, emotional abuse, and “other type of horrifying and helpless situation.” Most participants met presumptive criteria for PTSD and depression (see Table 1). Social Network Measures

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Structural characteristics—Participants listed an average of 8 alters (M=8.71, SD=2.11). Around two thirds of the women (67.9%) included ten persons in their networks, 21.4% listed between six and eight alters, and 10.7% named between three and five network members. The majority of alters were family members (75%), and more than half were female (56%). Approximately half of alters were included in the inner circle (46%), 96% of which were relatives (Table 2). The relationship types listed most frequently were children (93 %), siblings (82%), and friends (71%) (see Figure 1). All children (100%) and most parents (62%) tended to be listed in the inner circle, whereas the majority of partners (57%), siblings (63%), and friends (61%) were placed in the intermediate circle.

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Interactional characteristics—Participants reported having contact with an average of 67.5% of their alters at least once a week or more frequently. The majority of alters (69.0%) lived in the US. Participants reported a positive evaluation (very good/good) of the relationship with most alters in the network (76.8%). Analysis stratified by country of residence showed that women had contact at least once a week or more with 72.7% of the alters who lived in the US versus 55.1% of those who resided in home countries. Analyses stratified by type of alter revealed that most partners (93%), friends (90%), children (71%), and siblings (59%) lived in the US whereas the majority of parents (62%) lived in their countries of origin. Approximately a third of children remained in home countries. Relationships with children had the most positive evaluation (M=4.58, SD=0.52), followed by relations with friends (M=4.25, SD=0.62), parents (M=3.96, SD=1.13), siblings (M=3.91, SD=0.82), and lastly partners (M=3.36, SD=1.08). Functional characteristics—Emotional support was perceived as available from the highest percentage of sources within the networks (47.1%), followed by positive social interaction (42.5%), information support (36.5%), language support (31.6%), tangible

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support (26.6%), and financial support (25.4%) (see Table 2). The most common providers of emotional support were friends (52%), siblings (52%), and partners (43%). Children (58%), partners (43%), and friends (39%) tended to provide positive social interaction. Partners (64%) and children (41%) were perceived as the main providers of tangible support, while children (46%), friends (43%), and partners (36%) were listed as the main sources of information. Moreover, children (46%) and partners (43%) appeared as main sources of language support, and partners (50%) as the main source of financial support (see Figure 2). Social Network Analysis Case Study

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The following case was chosen because it exemplifies facets of social support networks, including aspects related to trauma, immigration, and reunification. Tatiana migrated to the US when she was in her 20s. She came from a large family. When her parents divorced, she became the main source of support to her mother and siblings. In her country of origin, she was exposed to various traumas. As a child, she experienced physical and emotional abuse. As an adult, she was a victim of political violence, witnessed domestic abuse, and suffered the violent loss of a relative. In the US she was exposed to domestic and community violence. She had a moderate-severe level of depression (15 on PHQ-9), and met the cutoff for PTSD (46 on PCL). Figure 3 displays Tatiana’s egocentric network. Each listed alter is represented by a node. The node’s shape indicates the country where alters lived (filled squares=US, open circle=country of origin). Tie strength is depicted by the length of the lines (shorter ties=inner circle). The evaluation of the quality of relationship with each alter is captured by the color and by the width of the lines (the thicker and darker, the better the relationship).

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Nine out of Tatiana’s ten listed alters were relatives. In the inner circle, Tatiana listed a teenaged daughter and four-year-old son. The remaining relatives and one friend were placed within the intermediate circle. Tatiana reported having a very good relationship with her son. Her daughter had recently migrated to the US to reunite with her after 11 years of separation and the reunification process was challenging. Tatiana felt that her daughter did not respect her and their relationship deteriorated to the point that Tatiana considered sending her back. Tatiana had a trustworthy relationship with a friend from work but relationships with other members of her family, such as her husband, mother, and some siblings, were not as positive. Indeed, she was experiencing a strained and violent relationship with her separated husband whom she had requested a restraining order against due to his physical abuse against her.

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Figure 4 presents the different types of social support Tatiana perceived she had received from each alter. Similar to Figure 3, the color of the lines represents the evaluation of the relationship. However, in Figure 4 the thickness and pattern of the lines indicate the extent of perceived support. Alters who were not perceived as potential sources of support (including the non-applicable ones) are not connected to Tatiana. Persons who were perceived as potential sources of support are connected to Tatiana by thinner, dashed links whereas persons who were strongly perceived as potential sources of support are connected with thicker, solid lines.

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Tatiana’s son was the person with whom she felt the most connected and whom provided mostly positive interaction. Due to his young age, he was not a source of other support. While several members of Tatiana’s network were listed as sources of emotional support and positive social interaction, fewer alters were available to provide tangible, language, information, and financial support. Tatiana perceived she could rely only on her husband and daughter for tangible support. The only person she felt she could rely on for financial support was her estranged husband. Tatiana’s friend was a key source for obtaining information/language support.

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Although the survey did not capture support that participants provided to others, Tatiana reported challenges and strains associated with being the supporter for most relatives. After her parents’ divorce, she believed her mother and siblings had become very dependent on her. She reported feeling pressure to provide financial support (e.g., sending money home). At the same time, she thought she could not rely on them for support. Tatiana reported feeling very stressed with her limited resources and was considering lifting the restraining order against her husband because he was the only provider of tangible and financial support.

Discussion

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This study provides an in-depth characterization of the social networks of trauma-exposed Latina immigrants in the US. Networks were primarily comprised of family members, females, and persons living in the US. Participants had a large percentage of alters available to provide emotional support and positive social interaction. Other types of support that have been deemed important for immigrants (e.g. language, information, financial) (Wong et al., 2007) were not perceived to be as readily available from the women’s networks. Tatiana’s case study illustrated the challenges of limited social support and its interplay with migration and trauma. Structural characteristics

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The average network size in our sample was 8.7 alters, which is lower than the average network size (14–15 alters) reported in prior studies that used the hierarchical mapping technique and included Latino samples (Levitt, Weber, & Guacci, 1993; MacPhee et al., 1996). As we only asked participants to list up to ten alters, our network size results cannot be directly compared to these studies. It is still noteworthy that a third of our sample listed less than ten alters in the network and around ten percent only mentioned five or less. Networks usually have 20–30 persons whereas those of persons with mental disorders tend to have 4–5 persons (Pattison, Defrancisco, Wood, Frazier, & Crowder, 1975). The fact that our sample was trauma-exposed and had presumptive depression and/or PTSD may explain the small network size of some participants. Further research comparing the network of trauma-exposed versus non-trauma-exposed women is needed. Although we did not capture the ethnic identity of alters or the direct relations between alters, the finding that 75% of persons listed were relatives aligns with prior studies describing Latino networks as close-knit, homogeneous family networks (MacPhee et al., 1996; Marquez et al., 2014). The prevalence of females and percentage of alters listed in

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each circle resembles Antonucci and Akiyama’s (1987) study on an elderly sample. Our finding that children were cited in the inner circle also echoes their research. Partners were typically located in the intermediate circle in our study (vs. the inner circle as found by Antonucci and Akiyama). The partner relationship quality received the worst evaluation, which may explain that finding. Interactional Characteristics

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Though participants had more contact with alters living in the US, they maintained close contact with relatives in their home country, which is common for Latina immigrants, who tend to maintain translational relations (Viruell-Fuentes & Schulz, 2009). Participants reported having good relationships with most alters in the network but it is noteworthy that they evaluated the relationship with almost a quarter as “neither good nor bad/bad/very bad”). Negative evaluations of a relationship may be an indicator of conflicts. It is important to consider both positive and negative aspects of relationships, as research suggests that negative relationships have a stronger association with PTSD than positive ones (e.g. Andrews, Brewin, & Rose, 2003). Functional Characteristics

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Emotional support was the most common support that was perceived to be available. This is important as some research suggests that emotional support is a stronger predictor of mental health than tangible support (Falcon, Todorova, & Tucker, 2009; Smyth et al., 2014). Having several types of network members to potentially provide emotional support makes the network flexible: participants could still obtain emotional support even if some of alters became unavailable. The availability of other types of support (tangible, language, information, and financial) was lower. This may be due to the limited diversity in the participants’ networks. Indeed, previous research has indicated that dense, undifferentiated networks lack experts who can provide information and opportunities (Cornwell & Cornwell, 2008; MacPhee, Fritz, & Miller-Heyl, 1996; Marquez et al., 2014; Mollica, Gray, & Trevino, 2003). Additionally, approximately a third of the alters lived in their home countries and some of the support types captured were geographically dependent (e.g. tangible support operationalized as receiving help with daily chores when sick).

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The finding that participants had higher levels of emotional support compared to information support is in line with the theory that dense homogeneous networks tend to be limited in the provision of information support (Granovetter, 1983). Friends were perceived as sources of information support. However, they only constituted 22% of the listed alters with 30% of the participants not including any friends in their network. Higher levels of friend support have been linked to increased likelihood of using mental health services (Chang et al., 2014; Sousa & Frizzell, 2005), which is particularly important to this sample. Financial support was the least accessible. One potential reason could be that most participants were below the poverty line and low socioeconomic status has been associated with lower support (e.g. Smyth et al., 2014). Although we did not assess alters’ socioeconomic status, it is possible that they face similar financial struggles thereby precluding them from providing financial support. Additionally, research with Salvadorian

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immigrants has found that migrant mothers, compared to fathers, tend to have lower-wage jobs and limited opportunities for upward mobility but they send more remittances to their children to fulfill the social expectations related to motherhood (Abrego, 2009). Thus, as shown in the case study, women may face the double challenge of having limited financial support while expected to provide financial aid to relatives. Partners were perceived as important sources of all types of support, but their perceived contribution was greatest for tangible and financial support, which is significant given that these types of support were the least available. In Tatiana’s case, she could only access financial support from her abusive husband. This type of support was so essential to her that she was considering revoking the restraining order against him. Thus, overreliance on partners for certain types of support can be risky, especially in the case of domestic violence.

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As nearly all participants listed children in the social network and all children were placed within the inner circle, their role as providers of social support merit special attention. Children were perceived to be the providers of most types of support. This reliance may be unique in immigrant populations. For example, children function as culture/language brokers by interpreting situations and translating in different contexts (e.g. medical settings) (Villanueva & Buriel, 2010). In some cases, a child’s ability to speak English with greater ease than their parents can lead to power reversals in the parent-child relationship (Leidy, Guerra, & Toro, 2012). However, the evidence is inconclusive as to whether language brokering has a positive or negative effect in parent-children relationships (Morales & Hanson, 2005) and numerous strategies to navigate both healthy and harmful acculturation gaps have been documented among Latino families struggling with these issues (Buckingham & Brodskey, 2015). Future research should explore children’s perceptions of perceived and provided support. Additionally, in our sample, approximately a third of children lived in their home countries. Prior research suggests that family reunification can be challenging after extended separation (Zentgraf & Chinchilla, 2012), as illustrated in Tatiana’s case. When children feel abandoned by migrant parents, they often face difficulties reestablishing trusting relationships upon reunification (Hurtado-de-Mendoza, Gonzales, Serrano, & Kaltman, 2014b). Parents also have a difficult time establishing themselves as respected authority figures (Menjívar & Abrego, 2009). Revealed in the case study with Tatiana, overreliance on children may become difficult if relationships are strained. Relevance of Trauma Exposure

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Studies show that social support can buffer the impact of trauma (Berkman et al., 2000). All participants were exposed to trauma, childhood trauma being the most common. Trauma exposure is related to lower perceived social support (e.g. Schumm et al., 2006). Childhood trauma in particular has been associated with lower informal/formal help-seeking in Latinas (Sabina, Cuevas, & Schally, 2012). Latinas also face several barriers to seeking help from formal services (Kaltman, Hurtado-de-Mendoza, Gonzales, & Serrano, 2014) that may mitigate the overreliance on unhealthy relationships. Tatiana’s case illustrates how limited social support can exacerbate violence if women cannot rely on a diverse network for multiple types of support. Latinas constitute an especially vulnerable population that could benefit from social support network interventions due to trauma exposure (Fortuna et al.,

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2008) and barriers to seeking formal (e.g. Kaltman et al., 2014) and informal support (e.g. Hurtado-de-Mendoza et al., 2014a). Future Directions

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Despite calls to assess and develop interventions and services that specifically target social networks and social support (Holt-Lunstad et al., 2010), especially among vulnerable populations (e.g. Smyth et al., 2014; Viruell-Fuentes et al., 2013), there are few mental health interventions designed to strengthen the social support networks of low-income populations (Goodman, Smyth, & Banyard, 2010). Social network interventions use social network maps that capture a large amount of information about different relationships, such as the ones presented. These visualizations can facilitate the discussion of social support, enhance awareness about the social networks’ strengths and weakness, and inform tailored action steps to strengthen networks (Domínguez & Arford, 2010). For instance, Biegel, Tracy, and Corvo (1994) proposed a framework for developing intervention strategies that consists of building new ties with clusters (e.g. linking the client with community groups), strengthening existing ties (e.g. communication skills), and enhancing family ties (e.g. family interventions to decrease conflict).

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This type of intervention could be targeted to address specific barriers to building and maintaining supportive networks among trauma-exposed Latinas. Latinas may experience socioeconomic barriers to develop and maintain supportive relationships due to the time limitations of working many hours to cover basic living expenses and due to the challenges of reciprocating help with limited finances (Hurtado-de-Mendoza et al., 2014a). Thus, time management skills and reciprocity discussions may be helpful. Psychosocial barriers such as difficulty building trust (Hurtado-de-Mendoza et al., 2014a) and the impact of trauma on social relationships (e.g. Charuvastra & Cloitre, 2008) should also be considered when designing targeted interventions. Strategies to connect women with formal services would need to take access barriers into account (e.g. payment). Interventions that address family reunification challenges and strategies to maintain and enhance transnational relationships could strengthen family ties. In Tatiana’s case, potential action steps to diversify and strengthen her network could include linking her with formal support to prevent her from relying on her abusive husband, connecting her with community groups that may lead to the development of new friendships, and providing family therapy to facilitate the reunification process with her teenage daughter.

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Findings from this study illustrate how SNA can be a useful research tool and provide insights to inform practice. Valente (2012) identified four types of network interventions (i.e. individual, segmentation, induction, and alteration) that use social network data to promote behavior change among individuals, organizations, communities, or populations that could provide different avenues for research in the Latino mental health field. Mapping Latino immigrant communities can help identify individuals or groups to be reached as agents of change or as targets of interventions based on their position within the network. For instance, individuals who connect groups that are disconnected or loosely connected (bridges, e.g. connected with the Latino community and to formal services) (Knoke & Yang, 2008) can be mobilized to enhance the use of formal services among Latina immigrants and

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reduce the overreliance on potentially abusive partners. Identification of individuals or groups with few connections (isolates) can inform outreach efforts to target specific segments of the community that may benefit from social support interventions and strategies on how to reach them. From a research perspective, identifying which aspects of the network (e.g. size, density, centrality) are more conducive to enhanced mental health in Latino immigrants would be important in informing future network interventions that may consist of adding new connections or rewiring existing ones.

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Integrating a social network perspective into formal services that serve Latino immigrants and training practitioners (e.g. social workers) in the use of SNA tools can be an important first step. Goodman and colleagues (2015) recently demonstrated that Domestic Violence Services lack a systemic approach that draws on abused women’s informal sources of support and that social workers lack the skills to reach out to these informal networks. This example suggests that adding a social network perspective in Latina mental health research and practice may be able to shed light on ways to capitalize on the benefits of social support networks in mental health among trauma-exposed individuals. Strengths and Limitations

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This study had several strengths. The sample included trauma-exposed Latinas from diverse countries in Latin America. SNA techniques captured a large number of social network characteristics. The assessment of different types of support by specific types of alters that do not tend to be included in prior studies (e.g. children, parents) and the adaptation of the hierarchical mapping technique to include items deemed to be relevant for immigrants is also innovative. However, some caveats are noteworthy. The adapted hierarchical mapping technique did not capture some characteristics of alters (e.g. income), the direct connections between alters (e.g. density), or reciprocity (participant’s perceptions of social support that they provided to alters). Findings from this study may not be applicable to the population of Latina women who have not been exposed to trauma, Latino men and Latinas living in other parts of the US. Given that our sample included women predominantly from El Salvador, findings may not apply to Latinas from other countries. The limited sample size and that this was a convenience sample prevented testing specific hypotheses. Future studies with larger samples are needed to test whether there are differences in the social networks of Latina immigrants who differ in various characteristics including trauma exposure, marital status, immigration status, or settlement patterns. This study provided a comprehensive description of the social support networks of a sample of trauma-exposed Latina immigrants that provided insights for future hypotheses testing and development of interventions to enhance social support networks in this vulnerable and underserved population.

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Acknowledgments This research was supported by a grant from the National Institute of Mental Health (K23MH077071) to Dr. Kaltman.

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Figure 1.

Network Composition: Percentage of Participants who Listed Type of Alter at Least Once

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Figure 2.

Perceived Social Support Types by Source of Support Percentages represent the percentage within each source that is perceived as a source of support (“yes”). For instance 43% of partners are perceived to be available to provide emotional support. Scaled to 100%.

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Figure 3.

Visualization of Tatiana’s Ego-centric Network The nodes closer to the center represent the nodes in the inner circle. Darker edges indicate better quality of relationships.

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Visualization of the Functional Characteristics of Tatiana’s Ego-Centric Network

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Table 1

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Socio-demographic and Clinical Characteristics (N=28) Demographic and Clinical Characteristics

N (Valid Percentage)

Education < High School

13 (46.4%)

≥ High School

15 (53.6%)

Marital Status Married/Living with partner

9 (32.1%)

Single, divorced, separated

19 (67.9%)

Annual income ≤20,000

23 (85.2%)

>20,000

4 (14.8%)

Employment Status

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Full-time

10 (35.7%)

Part-time

11 (39.3%)

Unemployed

7 (25.0%)

Country of Origin El Salvador

13 (46.4%)

Bolivia

4 (14.3%)

Peru

3 (10.7%)

Argentina

3 (10.7%)

Guatemala

2 (7.1%)

Honduras

1 (3.6%)

Nicaragua

1 (3.6%)

Brazil

1 (3.6%)

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Trauma Exposure

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Childhood physical abuse

21 (75.0%)

Emotional abuse

20 (71.4%)

Other type of horrifying situation

20 (71.4%)

Adult physical violence

18 (64.3%)

Controlled daily activities

14 (50.0%)

Witness killing/harm to another

14 (50.0%)

Violent loss

13 (46.4%)

Witness domestic violence

13 (46.4%)

Robbert/mugging

13 (46.4%)

Life threatening illness

11 (39.3%)

Other dangerous situations

11 (39.3%)

Rape

10 (35.7%)

Inappropriate sexual touching

9 (32.1%)

Threatened with weapon

7 (25.0%)

Life threatening accident

6 (21.4%)

Other, would prefer not to disclose

5 (17.9%)

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Demographic and Clinical Characteristics

N (Valid Percentage)

Presumptive Diagnosis

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Depression only

2 (7.1%)

PTSD only

10 (35.7%)

Depression and PTSD

16 (57%)

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Table 2

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Structural, Interactional, and Functional Characteristics of the Social Network SN Characteristics

Average Percentage

Structural Characteristics Tie Strength Inner Circle

46.2%

Intermediate Circle

39.0%

Outer Circle

14.8%

Role Composition

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Partner

6.5%

Parents

5.5%

Child

27.2%

Siblings

24.8%

Other relatives

10.9%

Friends

22.3%

Godparents (Compadres)

0.9 %

Co-workers

1.6%

Neighbors

0%

Other

0.4%

Gender Composition Male

44.0%

Female

56.0%

Interactional Characteristics Frequency of contact

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Less than once a year

3.9%

Several times per year

5.4%

Once a month

8.8%

Several times per month

14.5%

At least once a week

28.6%

Almost every day

11.4%

Every day

27.5%

Proximity US

69.0%

Country of Origin

31.0%

Evaluation of relationship

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Very bad

1.2%

Bad

2.1%

Neither good nor bad

20.0%

Good

35.6%

Very good

41.2%

Functional Characteristics Emotional Support

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SN Characteristics

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Average Percentage

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Yes

47.1%

Maybe

24.9%

No

25.5%

N/A

2.5%

Positive Social Interaction Yes

42.5%

Maybe

14.0%

No

25.3%

N/A

18.2%

Tangible Support

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Yes

26.6%

Maybe

11.2%

No

31.2%

N/A

31.0%

Information Support Yes

36.5%

Maybe

10.4%

No

28.3%

N/A

24.9%

Language Support Yes

31.6%

Maybe

7.5%

No

37.4%

N/A

23.4%

Financial Support

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Yes

25.4%

Maybe

6.7%

No

57.1%

N/A

10.8%

Note: Average of the percentage of participant’s alters structural, interactional, and functional characteristics

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Trauma-Exposed Latina Immigrants' Networks: A Social Network Analysis Approach.

Trauma exposure among Latina immigrants is common. Social support networks can buffer the impact of trauma on mental health. This study characterizes ...
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