'Dreamers' policy may have reduced depression in eligible individuals

A team of researchers from Harvard T.H. Chan School of Public Health and Massachusetts General Hospital (MGH) reported that the Deferred Action for Childhood Arrivals (DACA) program appears to have reduced depression among eligible undocumented immigrants, often referred to as the "Dreamers." These timely findings come on the heels of ongoing debates around the future under the Trump Administration of immigration policies, including the DACA program, which provides renewable, temporary work permits to undocumented immigrants who arrived in the United States as children. Thus far, over 750,000 individuals have been enrolled.

"It is well known that economic circumstances affect mental health," said lead researcher Atheendar Venkataramani, MD, PhD, of the MGH Division of General Medicine. "The DACA program increased access to the U.S labor market for these individuals and raised hopes for a better economic future. The large mental health benefits we found likely reflect these positive changes."

The current study, published in the latest issue of The Lancet Public Health, examined data submitted from 2008 to 2015 by more than 14,000 non-citizen Hispanic adults through the U.S. National Health Interview Survey. The researchers used respondents' age, timing of immigration and other criteria to identify potentially DACA-eligible persons. They then compared changes in respondents' overall self-reported health and depression symptoms before and after the 2012 implementation of DACA between those who might be eligible - the survey did not ask about immigration status - and those definitely not eligible for DACA.

Overall, the study found that DACA-eligible persons were 50% less likely to report symptoms consistent with major depression at the time they completed the survey. No association was found between DACA eligibility and self-reported overall health, which the authors noted is likely due to the relative youth of participants and the fact that physical health symptoms may take longer to evolve in response to policy changes. Because neither immigration status nor DACA enrollment were directly elicited in these surveys, the authors also noted that estimates from their analysis likely understate the true impacts of the DACA program on mental health.

"Our statistical estimates are averaged over a large group of people who reported that they are non-citizens. Estimates are that close to 60% of self-reported non-citizens in large U.S. surveys are undocumented, and a smaller fraction of that group may have been signed up for DACA," said Venkataramani. "It is possible that mental health benefits would be much larger for persons directly affected by the policy."

Study co-author Ichiro Kawachi, MBChB, PhD, the John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology and chair of the Department of Social and Behavioral Sciences at Harvard Chan School, said, "Our study reveals the potentially large consequences of changes in immigration policy on important health outcomes. Policymakers have traditionally not taken health impacts into account when debating immigration. While our results are specific to the DACA program, we hope they may better inform decisions around immigration policy more generally."

Alexander C. Tsai, MD, of the Chester M. Pierce Division of Global Psychiatry at MGH, the senior author of the study, adds that the findings reveal the importance of economic opportunities for health. "As the current political climate has demonstrated, there has been a lot of anxiety about how there no longer seems to be equal opportunities to share in prosperity through hard work—that's the American Dream, and it's fading." Referring to companion studies from his group, published recently in the American Journal of Public Health and The Lancet Public Health, he said, "Our research program has shown that there is a strong and meaningful link between the prospects for upward social mobility and good health. The current work really underscores that point —giving people access to the American Dream improves their mental health in a substantial way."