May is Mental Health Awareness Month. In this article, we highlight aspects of the mental health of immigrants based on a Stress & Trauma Toolkit for Treating Undocumented Immigrants in a Changing Political and Social Environment from the American Psychiatric Association.

Mental health risk factors
Immigrants experience trauma and stressors before, during, and after immigration. Undocumented immigrants often experience the following trauma at various stages of the migration process:
•Before: Financial issues, sense of failure, escape from violence, poverty, political oppression, threats or disasters
•During: Violence, environmental hazards, abandonment/separation, witnessing death
•After: Limited resources given their status, intra- and interpersonal conflict, stress from adjusting to their new environment, exploitation, fear of deportation

Treatment in school and the workplace
Research suggests that low-income, immigrant, and racial/ethnic minority children are disproportionately placed in low-ability groups early in their education, while adults experience discrimination and stigma in the workplace.

•Stigma: Undocumented immigrants are often subjected to stigma at work, in school, and by society.

Shifting family structures and dynamics
Undocumented immigrants have varying family situations and mixed-status families are common. Some individuals are in the U.S. alone; others have large families, and some have children who are citizens. This can create strained family situations, including varying levels of inclusion, exclusion, acculturation, and desires for assimilation among family members. These shifting and potentially disparate priorities often lead to increased intergenerational conflicts.

•Social isolation: Stigma often leads to social isolation and a decreased level of support in the community. Isolation can be a risk factor for mental health disorders.

Fear and distrust
•Distrust of the U.S. legal system: Studies show that undocumented immigrants have increased rates of fear and distrust of the U.S. legal system, causing decreased participation in civic life, including advocacy efforts. They also have a decreased likelihood of using the legal system even when they are victims of illegal activities. This distrust can extend to the health care system and act as a barrier to care. •Fear of deportation: Given the current political climate, undocumented immigrants live in widespread fear of deportation, which limits their use of health care and social services and prevents social integration.

Higher overall risk for mental health issues for some undocumented immigrants:
•Undocumented immigrants who have had exposure to violent trauma are at high risk for depressive disorders, posttraumatic stress disorder (PTSD), and substance use disorders.
•Unaccompanied minors have a higher number of traumatic exposures on average than minors who migrate accompanied by family, which increases their risk for mental health problems like PTSD.
•Compared to U.S.-born Latinos, Latinos who are undocumented immigrants are more likely to have multiple psychosocial problems, including those related to employment, access to health care and the legal system. However, undocumented immigrant Latinos use fewer mental health services use than U.S.-born Latinos do.
•Immigration-related stressors can increase suicidal ideation and risk due to the distress associated with cultural stress, social marginalization and intergenerational conflicts in addition to PTSD and other psychological disorders.

Separation from family: Undocumented immigrants can be separated from family and children may be placed in foster homes or other custodial arrangements. Separation from family can be traumatic, especially for children, and can lead to mental health symptoms. In addition, studies have shown that young children entering foster families may avoid engaging with a new caregiver and, even if reunited with their parents, may respond to feelings of abandonment by rejecting them. This can create a self-perpetuating cycle that prevents nurturing and responsive care and ultimately exacerbate dysfunctional family dynamics.

Available support
Help is available regardless of your immigration status. NYC Well: If symptoms of stress become overwhelming for you, you can connect with trained counselors at NYC Well, a free and confidential mental health support service that can help New Yorkers cope. NYC Well staff are available 24 hours a day, seven days a week, and can provide brief counseling and referrals to care in over 200 languages. For support, call 888-NYCWELL (888-692-9355), text “WELL” to 65173 or chat online.

  immigrants, mental health, undocumented, undocumented immigrants