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Prevalence of Mental Disorder and Service Use by Immigrant Generation and Race/Ethnicity Among U.S. Adolescents

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Objective

To examine differences in lifetime prevalence of mental disorder and service use among U.S. adolescents by both immigrant generation and race/ethnicity.

Method

A total of 6,250 adolescents aged 13 to 18 years in the National Comorbidity Survey Replication Adolescent Supplement were assessed for lifetime prevalence of mood and/or anxiety disorders, behavior disorders, and mental health service use. Twelve groups defined by self-identified race/ethnicity (non-Hispanic white, Hispanic, non-Hispanic black, Asian) and immigrant generation (first, second, third, or more) were compared.

Results

Differences in prevalence of lifetime mental disorder were most apparent when immigrant generation and race/ethnicity were considered jointly. Compared to third+generation non-Hispanic white adolescents, the odds of mood/anxiety disorder were increased among second-generation Asian (adjusted odds ratio [AOR] = 2.51; 95% CI = 1.22−5.17) and third+generation Hispanic (AOR = 1.28; 95% CI = 1.00−1.63) but reduced among first-generation Asian (AOR = 0.27; 95% CI = 0.10−0.71) and second-generation non-Hispanic white adolescents (AOR = 0.50; 95% CI = 0.30−0.81). The odds of behavior disorder were lower among first-generation Asian (AOR = 0.26; 95% CI = 0.09−0.71) and all generations of non-Hispanic black adolescents (AOR range 0.43−0.55). Adjusting for lifetime disorder, first-generation Hispanic and non-Hispanic white adolescents and all generations of non-Hispanic black adolescents were less likely to receive mental health services (AOR range 0.24−0.55).

Conclusions

Variation in risk of disorder by immigrant generation and race/ethnicity underscores the importance of considering social, economic, and cultural influences in etiologic and treatment studies of adolescent psychopathology. Lower rates of service use, particularly among first-generation immigrant adolescents, highlight the need to identify and address barriers to recognition and treatment of mental disorders among adolescents from immigrant and racial/ethnic minority backgrounds.

Section snippets

Sample

The NCS-A is a nationally-representative survey of 10,123 adolescents 13 to 17 years of age in the continental United States that was conducted in 2001 to 2004. Study design, sampling, recruitment, and weighting are described elsewhere.33, 34, 35 Briefly, participants were recruited via a dual-frame sampling strategy that included a household (n = 879) and school-based (n = 9,244) sample, with an overall response rate of 82.9%.34 One parent or parent surrogate provided written informed consent,

Results

Table 1 presents the distribution of sociodemographic/economic characteristics, lifetime mental disorder, and service use by immigrant generation and race/ethnicity. Third+ generation, non-Hispanic white adolescents constituted the largest group (n = 4,006; 64.10%), followed by third+generation non-Hispanic black (n = 999; 15.98%) and third+generation Hispanic (n = 476; 7.62%) adolescents. Parental education, family structure, income to poverty ratio, urbanicity, and region differed across

Discussion

This is the first study of a nationally representative sample to document differences in the lifetime prevalence of mental disorders and mental health service use among U.S. adolescents cross-classified by immigrant generation and race/ethnicity. We found disparities in the prevalence of mood/anxiety and behavior disorders and service use when comparing third+generation non-Hispanic white adolescents to other groups defined by both immigrant generation and race/ethnicity. Many of these

References (53)

  • K.M. Keyes et al.

    Stress, coping, and depression: testing a new hypothesis in a prospectively studied general population sample of U.S.-born whites and blacks

    Soc Sci Med

    (2011)
  • J.S. Passel

    Demography of immigrant youth: past, present, and future

    Future Child

    (2011)
  • D.J. Hernandez et al.

    Diverse Children: Race, Ethnicity, and Immigration in America's New Non-Majority Generation

    (2013)
  • M. Alegría et al.

    Prevalence of mental illness in immigrant and non-immigrant U.S. groups

    Am J Psychiatry

    (2008)
  • J. Breslau et al.

    Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration

    Psychol Med

    (2009)
  • J. Breslau et al.

    Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey−Replication

    J Nerv Ment Dis

    (2007)
  • D.T. Takeuchi et al.

    Immigration-related factors and mental disorders among Asian Americans

    Am J Public Health

    (2007)
  • B.F. Grant et al.

    Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

    Arch Gen Psychiatry

    (2004)
  • R.J. Turner et al.

    Psychiatric and substance use disorders in South Florida: racial/ethnic and gender contrasts in a young adult cohort

    Arch Gen Psychiatry

    (2002)
  • J. Breslau et al.

    Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey

    Soc Psychiatry Psychiatr Epidemiol

    (2006)
  • K. Harker

    Immigrant generation, assimilation, and adolescent psychological well-being

    Social Forces

    (2001)
  • K.M. Harris

    The health status and risk behaviors of adolescents in immigrant families

  • C.G.E. Coll et al.

    The Immigrant Paradox in Children and Adolescents: Is Becoming American a Developmental Risk?

    (2012)
  • K. Georgiades et al.

    Emotional and behavioral problems among adolescent students: the role of immigrant, racial/ethnic congruence and belongingness in schools

    J Youth Adolesc

    (2013)
  • A. Degboe et al.

    Parental immigrant status and adolescent mental health in the United States: do racial/ethnic differences exist?

    Child Adolesc Ment Health

    (2012)
  • G.K. Singh et al.

    Health, chronic conditions, and behavioral risk disparities among U.S. immigrant children and adolescents

    Public Health Rep

    (2013)
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    This work was supported by the David R. (Dan) Offord Chair in Child Studies, a CHIR New Investigator Award, and the Intramural Research Program of the National Institute of Mental Health (ZIAMH002808). The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government. The NCS-A and the larger program of related NCS surveys were supported by the National Institute of Mental Health (UOI-MH60220) and the National Institute on Drug Abuse (ROI DAO 16558) with supplemental support from Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant 044708), and the John W. Alden Trust. The NCS-A was carried out in conjunction with the World Health Organization World Mental Health Survey Initiative. The funding organizations had no further role in the study design; collection, analysis, and interpretation of data; writing of the report; and decision to submit the manuscript for publication.

    Dr. Rudolph served as the statistical expert for this research.

    Disclosure: Drs. Georgiades, Paksarian, Rudolph, and Merikangas report no biomedical financial interests or potential conflicts of interest.

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