title: Effects of Nativity, Length of Residence, and County-Level Foreign-Born Density on Mental Health Among Older Adults in the U.S.
abstract: Using the 2004-2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals' mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults' immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.-born individuals (n = 24,225), earlier immigrants (≥15 years in the U.S.; n = 3866), and recent immigrants (<15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities.
authors.affiliation: College of Social Work, The University of Tennessee, Knoxville, TN, USA.
authors.forename: Sunha
authors.initials: S
authors.lastname: Choi
authors.affiliation: Alabama Research Institute on Aging and Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
authors.forename: Giyeon
authors.initials: G
authors.lastname: Kim
authors.affiliation: School of Social Welfare, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Korea. slee90@utk.edu.
authors.forename: Sungkyu
authors.initials: S
authors.lastname: Lee
mesh_terms: D000368:Aged; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011156:Population Density; D012111:Residence Characteristics; D013315:Stress, Psychological / Q000523:psychology*; D013997:Time Factors; D014481:United States
keywords: Depression; Ethnic density effect; Health immigrant effect; Psychological distress