- The association between minority group status and mental health problems is well documented, but few prospective studies have attempted to determine what leads to this elevated risk
- This longitudinal study constituted four waves of interviews comparing children of Puerto Rican descent raised in the South Bronx, where they are a minority, with youth raised on the island of Puerto Rico
- By young adulthood, rates of all psychological disorders and symptoms examined, major depressive disorder, generalized anxiety disorder, depressive/anxiety symptoms and psychological distress, were higher among the South Bronx youth
- The effect of minority status on mental health outcomes in young Puerto Ricans living in the South Bronx was partially explained by social relationships in childhood and discrimination and unfair treatment in young adulthood
The association between racial/ethnic minority group status and mental health problems has been documented in multiple studies, yet few prospective longitudinal studies with a homogenous ethnic group have attempted to determine what specific factors lead to this elevated risk. Can minority status environments impact one's social interactions and exacerbate stressors so much that mental health is negatively affected?
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Margarita Alegria, PhD, chief of the Disparities Research Unit at Massachusetts General Hospital, Cristiane Duarte, PhD, MPH, at Columbia University - New York State Psychiatric Institute, Glorisa Canino, PhD, at the University of Puerto Rico Medical School, and colleagues noticed that Puerto Ricans have the highest rates of mental disorders among all Latino subgroups in the mainland United States, where they are a minority, but low rates on the island of Puerto Rico. This suggests that the experiences that accompany minority status might lead to psychopathology.
In World Psychiatry, these researchers document that among Puerto Rican youth growing up in the South Bronx as part of an ethnic minority group, perceptions of intercultural conflict, discrimination, unfair treatment and low social support increased the risk of developing depression and/or anxiety by young adulthood.
The research team drew on data from the Boricua Youth Study carried out by researchers at Columbia University, New York State Psychiatric Institute, University of Puerto Rico Medical School and Mass General. The study was representative of the youth of Puerto Rican descent in both the South Bronx in New York City and the San Juan Metropolitan Area of Puerto Rico in 2000. This longitudinal study had four waves:
- Wave 1: 2,491 participants 5 to 13 years old were interviewed in 2000
- Waves 2 and 3: Each youth participant and one parent were assessed twice more by 2003
- Wave 4: Interviews were conducted between April 2013 and August 2017 with 2,004 young adults ages 15 to 29 (921 in South Bronx, 1,083 in Puerto Rico) and 1,180 parents (490 in South Bronx, 690 in Puerto Rico)
During the study period, the two cities had similar levels of poverty. For the present analysis, youth who met criteria for depression and/or anxiety in any of the first three assessments were excluded from further study.
Mental Health Outcomes
By young adulthood (wave 4), rates of all psychopathologies studied were higher among the South Bronx youth than the island Puerto Rican youth. Most differences were either statistically significant or marginally significant, even after the groups were matched for gender, age at baseline, maternal age and maternal education:
- Lifetime diagnosis of major depressive disorder (MDD) — 16.2% in South Bronx vs. 11.9% in Puerto Rico, P = 0.059
- Lifetime diagnosis of generalized anxiety disorder (GAD) — 5.9% vs. 2.4%, P < .001
- Diagnosis of MDD within last 12 months — 9.6% vs. 6.9%, P = 0.084
- Diagnosis of GAD within last 12 months — 3.6% vs. 1.0%, P = .001
- Average number of depressive and anxiety symptoms — 5.7 vs. 4.1, P = .005
- Average number of symptoms of psychological distress in the last 30 days — 15.9 vs. 14.3, P < .001
Potential Factors Underlying Site Differences
Of 35 variables tested in the study, the South Bronx differed significantly from Puerto Rico on 23, including:
- Government statistics at wave 3 (childhood and early adolescence) — The South Bronx had greater residential mobility (perhaps related to increasing cost of living/gentrification), a higher number of female-headed households with children and a lower average proportion of Latino residents at the census block group level than Puerto Rico. they also had a lower murder rate per crime data
- Social context at wave 3 — Youth in the South Bronx reported lower social support (from family and friends) and poorer peer relationships compared with youth in Puerto Rico; parents also reported lower social support
- Cultural context at wave 3 — Youth in the South Bronx reported greater societal cultural stress (having problems due to being Puerto Rican or not speaking English well; feeling that they didn't belong in either Puerto Rico or the U.S.) and greater acculturation; parents reported more discrimination, greater family cultural stress and lower levels of familism (a cultural value placed on family cohesion and togetherness)
- Neighborhood description at wave 3 — Youth in the South Bronx reported more exposure to violence; parents reported more adverse neighborhood characteristics (such as vacant lots, crime and pollution), less neighborhood monitoring (extent to which neighbors monitor and intervene in situations where safety concerns might affect children) and more monitoring by parents of their own children
- Cultural context at wave 4 (young adulthood) — Youth in the South Bronx reported lower ethnic identity, lower levels of familism, more neighborhood discrimination, more minority stress (neighbors' negative attitudes toward/treatment of minorities), more unfair treatment and more intercultural conflict (between Puerto Rican/Latino and American customs)
Links Between Social/Cultural Factors and Psychopathology
Based on statistical analyses, the differences between the South Bronx and Puerto Rico regarding depression and anxiety at wave 4, a proxy for the effect of minority status on mental health outcomes in young adults, were explained by certain social and cultural differences identified at wave 3. The following factors were mediators of the effect of site on various outcomes:
- The lower social support in the South Bronx at wave 3 was a mediator for MDD diagnosis and depressive/anxiety symptoms
- The poorer peer relationships were a mediator for past-year MDD diagnosis, depressive/anxiety symptoms and past 30-day psychological distress
- The greater exposure to violence and greater residential mobility was a mediator for levels of psychological distress
- The greater intercultural conflict and neighborhood discrimination at wave 4 was a mediator for all outcomes
In addition, minority stress and ethnic identity at wave 4 mediated the effect of site on lifetime and past-year MDD, depressive/anxiety symptoms and psychological distress. Minority stress additionally mediated the effect of site on past-year GAD. Unfair treatment at wave 4 mediated the effect of site on depressive and anxiety symptoms and psychological distress.
Need for a New Paradigm
Puerto Rican young adults who grew up as minorities in the South Bronx were at higher risk of depression and anxiety than those who grew up in San Juan despite similar levels of poverty. This suggests that social and cultural context plays a prominent role in the development of depression and anxiety in these youth.
Parental and peer supports appear to be stress-buffering mechanisms that can alleviate the toxic experiences of discrimination and worries about rejection in children growing up as minorities. Cultural factors also require attention, since intercultural conflict with family can be harmful where other sources of assistance are limited.
Public health approaches that target social interactions rather than individual clinical treatment should be more successful in addressing the "othering" that jeopardizes the mental health of minority youth.
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