Rates of mental disorders and service use differ by immigration status and ethnicity of American adolescents

Immigrant youth from specific racial-ethnic groups in the USA tend to have lower rates of certain mental disorders compared to their non-immigrant peers, reports a study published in the April 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

The study was conducted by a team of epidemiologists from the National Institute of Mental Health (NIMH), part of the National Institutes of Health in the US and the Offord Center for Child Studies at McMaster University in Canada. They examined the lifetime prevalence of mood, anxiety, and behavior disorders (attention deficit, oppositional defiant, conduct, and substance use disorders), as well as mental health service use in 6,250 adolescents aged 13 to 18 years who were part of a national database. Youth were classified by both self-identified race-ethnicity (non-Hispanic white, Hispanic, non-Hispanic black, Asian) and immigrant generation (first, second, third, or greater).

The authors found that prevalence rates of mental disorders among immigrant youth differed by immigrant generation and by racial-ethnic group. Consistent with the "immigrant paradox" in earlier studies, foreign-born Asian youth had lower rates of both emotional and behavior disorders, but by the second generation, they had significantly higher rates of mood and anxiety disorders compared to non-immigrant white youth. The authors also report a general trend for lower rates of behavior disorders among foreign-born Asian and Hispanic youth, and among both immigrant and non-immigrant black youth compared to non-immigrant white youth.

"Many of these differences were not apparent when immigrant generation and race-ethnicity were considered separately," said lead author Dr. Katholiki Georgiades, an Associate Professor and the David R. (Dan) Offord Chair in Child Studies at the Department of Psychiatry and Behavioral Neuroscience at McMaster University and the Offord Centre for Child Studies. "This underscores the importance of joint consideration of these characteristics in studies of disparities in adolescent mental disorders and service use."

"One of the most concerning findings was that most immigrant youth with mental disorders were significantly less likely to receive mental health services than their non-immigrant peers" said senior author Dr. Kathleen Merikangas, Senior Investigator and Chief of the Genetic Epidemiology Research Branch in the NIMH Division of Intramural Research Programs. "This finding highlights the need to address cultural and economic barriers to mental health service use for youth with mental disorders from immigrant families, particularly those from ethnic minority backgrounds."

These findings could have major public health implications because children living in families with at least one foreign-born parent represent the fastest growing segment of the US population and are projected to represent up to one-third of the child population in the next few decades, according to the US Census Bureau. Identifying barriers to recognition of mental disorders and access to treatment for these youth will therefore be of increasing importance.