Elsevier

Social Science & Medicine

Volume 66, Issue 5, March 2008, Pages 1152-1164
Social Science & Medicine

The association between subjective social status and mental health among Asian immigrants: Investigating the influence of age at immigration

https://doi.org/10.1016/j.socscimed.2007.11.028Get rights and content

Abstract

This paper examines how age at immigration influences the association between adult subjective social status and mental health outcomes. The age when people immigrate shapes the capacity and efficiency at which they learn and use a new language, the opportunities to meet and socialize with a wide range of people, and respond to healthy or stressful environments. We hypothesize that adult subjective social status will be more predictive of health outcomes among immigrants who arrive in the US in mid- to late-adulthood compared with immigrants who arrive earlier. To investigate this hypothesis, data on immigrants are drawn from the US first national survey of mental health among Asian Americans (N = 1451). Logistic regression is used to estimate the relationships between adult subjective social status and mood dysfunction, a composite of anxiety and affective disorder symptoms. As predicted, age at immigration moderated the relationship between adult subjective social status and mood dysfunction. Adult subjective social status was related to health among immigrants arriving when they were 25 years and older, but there was no association between subjective social status and mental health among immigrants arriving before the age of 25 years.

Introduction

Past studies on the mental health of immigrants find that foreign-born Asians and Latinos report better mental health than their US-born counterparts (Alegría et al., 2007, Breslau and Chang, 2006, Burnham et al., 1987, Takeuchi et al., 2007, Williams et al., 2007). Socioeconomic status (SES) may be an important determinant of mental health among immigrants. SES is often linked to adaptation and social mobility which are frequently related to various quality of life indicators (Evans-Campbell et al., 2007, Franzini and Fernandez-Esquer, 2006, Rumbaut, 1991). However, empirical studies often treat immigrants as a homogenous group without considering the social factors that may influence the association between SES and mental health. One such factor that captures the heterogeneity of the immigration experience is the developmental context of immigration or the age when immigrants first arrive in a country. Immigrating during childhood, adolescence, or early adulthood, which are formative periods of life, can expose individuals to a particular set of risks with long-ranging consequences for the relationship between adult SES and mental health in adulthood. In this paper, we specifically examine whether age at immigration is a potential moderator in the relationship between adult SES and mental health among a nationally representative sample of Asian immigrants.

Immigration has increased substantially over the past three decades. While the annual naturalization of immigrants peaked at 1 million in 1996, current numbers are still well over the levels of the 1980s (Fix, Passel, & Sucher, 2003). A large share of this immigration has come from Mexico, China, the Philippines, and other Asian and South American countries. The large numbers of immigrants from these diverse countries have radically changed the racial and ethnic profile in the US. Latino Americans are now the largest minority group in America, comprising 13% of the US population (U.S. Census Bureau, 2003). While Asian Americans are not as large as the Latino population, they experienced the largest percentage increase of the major ethnic categories. Since the 2000 U.S. Census allowed respondents to check more than one racial category, there are at least two ways to mark the growth of Asian Americans. Asian Americans grew by 48% (or 3.3 million) if the Asian alone category in the 2000 U.S. Census is used. If multiracial Asians are counted in the Asian category, Asians grew by 5 million or 72%. By comparison, the population of the U.S. in its entirety increased by only 13% (Barnes & Bennett, 2002). Given that 25% of immigrants who come to the US are from Asia, Asian Americans represent an important group to examine how age at immigration influences the association between SES and mental health. Studying Asian Americans is especially important in understanding the development of American children. Nearly one quarter (23%) of all American children under the age of 6 years have parents who were born in Asia (Capps, Fix, Ost, Reardon-Anderson, & Passel, 2004).

Adult SES is associated with the risk for different physical diseases even among individuals who live above the poverty line (Adler et al., 1994, Marmot et al., 1984). While conventional SES measures such as education, income, and occupation are often important predictors of health, subjective social status has increasingly been shown to be an equally critical determinant of physical and mental health among adults (Wilkinson, 1999). In a study by Adler, Epel, Castellazzo, and Ickovics (2000), a new subjective social status measure was demonstrated as significantly related to adult physical and mental health outcomes. Subjective social status was measured using a symbolic ladder with 10 rungs that asked participants to place themselves in comparison with others in the US in relation to common aspects of what it means to be at the top and bottom of society (e.g., the top have the most money and education and the best jobs). This subjective social status measure has been demonstrated to be significantly related to adult physical health outcomes, even after controlling for traditional SES measures among British civil servants, low-income Mexican Americans, ethnically diverse pregnant women, and older Taiwanese (Franzini and Fernandez-Esquer, 2006, Hu et al., 2005, Ostrove et al., 2000, Singh-Manoux et al., 2003). A second measure of subjective social status (csubjective social status) asks participants to place themselves in comparison with others in the community that is most important to them. Few studies have reported the association between csubjective social status and health. Despite the substantive increase of research on subjective social status and health, it is only recently that empirical studies have begun to focus on whether subjective social status and csubjective social status operate similarly or differently across a range of groups based on race, ethnicity, nativity, and traditional measures of SES.

The meaning of subjective social status has been debated with some scholars suggesting that subjective social status measures the psychosocial correlates of health inequalities such as relative social rank (Macleod, Davey Smith, Metcalfe, & Hart, 2005). However, subjective social status may be a more nuanced measure of socioeconomic status than current “crude” measures of education, occupation, and income (Adler et al., 1994, Adler et al., 2000). As a predictor of health, measures of subjective social status deserve more research attention as they have demonstrated predictive power when traditional SES measures have not (Adler et al., 1994, Adler et al., 2000).

We propose that the developmental context, or the age when an immigrant arrives in a new country, may be a critical factor that moderates the association between subjective social status and mental health. The age when people immigrate shapes the capacity and efficiency at which immigrants learn and use a new language, the opportunities to meet and socialize with a wide range of people, and the exposure to healthy or stressful environments. This context may lead to different life course trajectories because the social institutions that affect people's lives, such as schools, families, and workplaces, vary by age at immigration (Fuligni, 2004, Rumbaut, 2004).

Developmental context can affect SES, subjective social status and mental health in at least two distinct but seemingly paradoxical ways. First, age at immigration can affect SES by influencing the sort of educational experience a person receives. Immigrants who arrive as children or young adults have an easier time than older immigrants learning English and becoming established in US-born peer networks. While their education trajectories may not be identical to US-born individuals, immigrants who come at younger ages are most likely among all immigrant generations to accrue similar rewards and resources from their educational experiences as U.S.-born children. For older immigrants, education may not lead to the same personal, economic and social benefits as for U.S.-born individuals, especially if they are schooled in another country (Zeng & Xie, 2004). Their foreign educational credentials and overseas networks often do not secure as much career advancement as those of U.S.-born residents.

Accordingly, conventional measures of SES may be a more important marker of health among immigrants who arrive as children or young adults and less important for immigrants who arrive as older adults. Education consistently demonstrates a stable direct association with positive health (Williams & Collins, 1995). In many respects, education is considered the causal mechanism that leads to economic and social rewards. Progression through the educational pipeline is seen as leading to higher cognitive abilities, better quality and more secure jobs in safe work environments, more opportunities to enhance income, greater capacity to increase wealth, and a wider range of social networks that provide instrumental and emotional support (Mirowsky & Ross, 1998). All these factors are linked to better mental health.

On the other hand, the salutary effects of social mobility may be less pronounced among immigrants who arrive at early ages. In fact, some evidence shows that the earlier timing of immigration can actually increase an adult's risk for psychiatric disorders among Asian Americans. Immigration during childhood and adolescence, for example, coincides with the risk period for the onset of affective and anxiety disorders. Takeuchi, Hong, Gile, & Alegría (2007) found that age at immigration was linked to lifetime and adult 12-month prevalence of psychiatric disorders. Adult US-born and immigrant Asian Americans who arrived earlier in life were more likely to have both lifetime and 12-month mental disorders compared with immigrants who arrived at later developmental periods in life.

How is immigration at early ages linked to poorer mental health outcomes? Converging findings show that early socioeconomic developmental contexts have a “long reach” and affect the development of biological mechanisms that underlie the ability to regulate stress as adults (Hayward & Gorman, 2004). Emotional and cognitive development matures in early adulthood (Giedd, 2004, Gogtay et al., 2004), so it is likely that disruption during childhood, adolescence, and early adulthood will influence mental health in middle- and late-adulthood. McLoyd (1990) suggests that families experiencing economic stress may produce a greater risk for socioemotional problems among children because poverty and few economic resources limit the capacity for supportive, consistent, and involved parenting. Psychological studies of adolescents and young adults also suggest that young immigrants may face unique psychosocial stressors that may influence later-adult mental health. For example, they simultaneously negotiate dominant US values expressed in peer groups, school, and society with competing dominant values of their home country expressed in their families and communities (Benet-Martinez et al., 2002, Fuligni, 2004, Hong et al., 2000). These stressors may result in enduring family cultural conflict in adulthood (Leu et al., in preparation).

We build on past studies to examine how age at immigration shapes the relationship between adult subjective social status measures and mental health among Asian immigrants in the US. Immigrants who arrive in middle- and late-adulthood are less likely to have experienced sociocultural disruption and economic instability while growing up, compared with those who immigrate as children, adolescents, or young adults. If this is true, adult measures of subjective social status may be more relevant to adult mental health outcomes among immigrants who arrived in middle to late adulthood, compared with those who arrived at an earlier age. Stressful early developmental contexts, such as the cultural and socioeconomic challenges that accompany immigration, may be so powerful that they are more predictive of adult mental health outcomes than even subjective social status in adulthood. We test our prediction by using age at immigration as a proxy for the developmental context of immigration.

Hypothesis 1

We examine age at immigration as a moderator in the relationship between adult subjective social status and mental health outcomes. We expect to find a stronger relationship between adult subjective social status and mental health among Asian American immigrants who arrived as mid- to late-adults, compared with those who arrived at an earlier age.

Hypothesis 2

We also test whether the moderation replicates when using the community subjective social status measure (csubjective social status). The csubjective social status measure allows participants to compare themselves with any community.

Section snippets

Methods

We selected Asian American data from the National Latino and Asian American Survey, which used a multi-frame, stratified probability sampling scheme. The scheme has been described in detail elsewhere (Heeringa et al., 2004), but a summary follows. Samples were drawn using three methods. In the first, participants were recruited with a multistage stratified area probability sampling design: (a) city or contiguous census blocks were sampled based on population density in each neighborhood; (b)

Descriptive statistics

We limited data to foreign-born participants aged 25 years and older (N = 1451). Eleven percent of the sample reported mood dysfunction in the past 12 months (see Table 1). Weighted 12-month period prevalence was based on the presence of at least one clinical or sub-threshold report of an anxiety disorder in the past 12 months (5.2% clinical and 5.0% sub-threshold panic disorder, agoraphobia, social phobia, post-traumatic stress disorder, and generalized anxiety disorder). It was also based on

Discussion

Our data demonstrate worse mental health among Asian immigrants who arrived before age 25 years, despite greater educational and income gains at the time of the survey, compared with immigrants who arrived later.

There was a reliable association between mood dysfunction and adult subjective social status, which provides further evidence that subjective social status may be as or more important in predicting immigrant health as traditional measures of socioeconomic status. Education and income

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    This project was funded by the Robert Wood Johnson Foundation to understand the social determinants of health in diverse populations from an interdisciplinary perspective.

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