Conversations about caring for parents generally begin later in life. However, most children of immigrants care across generations and life stages. As the United States is a nation of immigrants—where immigrants comprise one-eighth of the U.S. population and children of immigrants represent one in four children in the country—it is important to understand the enormous barriers that immigrants and their children face when trying to access mental health care in the United States.

The daily struggles of being an immigrant in the U.S. are a burden both to immigrant parents and their children

These very barriers have been exposed and exacerbated by the COVID-19 pandemic, compounding mental health problems for many of these children as financial and health trauma worsens and access to social support is limited. The generational effects of social inequities in this population demand policy reform and targeted support. While the children of immigrants may not have to endure the traumas of migration their parents experienced, the financial, cultural, and emotional caregiving responsibilities they assume for their parents nevertheless exact an enormous toll on their mental well-being. The daily struggles of being an immigrant in the U.S. are a burden both to immigrant parents and their children.

The photo shows a family walking through a field at dusk. The father has a small child on his shoulders. — A family from Guatemala seeking asylum, walks northbound through farmland after traveling across the Rio Grande river into the United States from Mexico, near Penitas, Texas, U.S., March 22, 2019. REUTERS/Adrees Latif

Children of immigrants often financially and emotionally support their parents during difficult situations in an unforgiving U.S. system that leaves them without a federally mandated living wage, accessible health care, and affordable housing. They often serve as cultural and language brokers for their families’ collective survival at home and at work. Parents also often set high expectations on their children to succeed, given their own incredible sacrifices, including migration. So the children of immigrants often feel an incredible pressure to elevate their families and themselves to a better life with limited or nonexistent support from the state.

Children of Asian, Pacific Island, and Latinx immigrants have significantly higherrates of depression, anxiety, and post-traumatic stress disorder

This multifaceted identity of caretaker/child increases anxiety, stress, and depression in children of immigrants compared to their parents. In fact, the prevalence of psychological distress (defined as feeling nervous, hopeless, restless or fidgety, worthless, depressed, and/or that everything was an effort) of children of immigrants is nearly double (10.1 percent) that of their first-generation immigrant parents (5.9 percent). These problems vary by ethnicity and gender—and especially by race, financial status, and familial legal status. The vast majority of new immigrants to the United States are people of color, and both children and parents must navigate structural and explicit racism in the United States. The children of Asian Americans, Pacific Islanders, and Latinx immigrants have significantly higher rates of depression, anxiety, and post-traumatic stress disorder compared to the children of white European immigrants.

The photo shows Irma laughing with her kids. — Irma Rivera, an asylum-seeker from Honduras, with her children Jesus and Suany in Fort Worth, Texas, on June 6, 2019. Happy scenes like this belie the burden of depression in children of immigrants. REUTERS/Loren Elliott

Complexity of the Problem

Immigration itself is complicated, presenting unique and dynamic repercussions for individuals and families. The hardships of immigrant parents in one generation, experienced through social inequality and cultural barriers, influence the struggles and successes of the next generation. The passage of parental hardship from immigrants to their children leaves the latter especially susceptible to mental health issues, particularly during the pandemic.

The pressures of caregiving can lead directly to mental health conditions in those children

Immigrants to the United States do not receive coordinated support as they integrate and build lives in the country. Religious groups and non-profit organizations provide aid to immigrants and their families, but the demand for resources is often generational and the aid insufficient to meet complicated needs. That leaves the children of immigrants to fill the support roles essential to the social, financial, and emotional well being of their parents, particularly for the more than 5.5 million American-born children of undocumented parents. The pressures of caregiving can then lead directly to mental health conditions in those children.

The photo shows three people holding handmade signs in a protest. The sign in the middle reads: "No human being is illegal." — People hold signs as they take part in a rally for “Justice Everywhere” to celebrate a U.S. Supreme Court ruling on a federal immigration program, in San Diego, California, U.S., June 18, 2020. REUTERS/Mike Blake

Immigrants and their children then face financial, logistical, and cultural challenges when accessing care. These challenges are an insurmountable barrier to many who worry about costly doctor’s visits and subsequent medical interventions, and the barriers they create keep people from accessing care and contribute to poor health outcomes. According to a Kaiser Family Foundation analysis, roughly 23 percent of lawfully present immigrants and 45 percent of undocumented immigrants are uninsured. Moreover, about one quarter (11.3 million individuals) of the U.S. foreign-born population is undocumented, leaving them ineligible for Medicaid or government benefits and nervous about the implications on their living situations should they seek coverage.

1 Quarter

About one quarter (11.3 million individuals) of the U.S. foreign-born population is undocumented

Cultural barriers also hinder children of immigrants from acquiring needed support. Many communities are uninformed about their options for formal, affordable mental health care. Children of immigrants may hold misconceptions about care, face stigma for needing support, and struggle to comprehend availability of and access to resources. Cultural traditions of privacy, proud self-reliance, a preference for non-Western medicine, and uneasiness with American health care leave certain immigrants less likely to seek care on their own. Moreover, many children of immigrants believe that their mental health needs cannot or should not be validated as their trauma seems trivial compared to what their parents went through. Often, children of immigrants are experiencing a full-blown mental health crisis by the time they seek care, which complicates treatment. Despite their rising to meet the multifaceted challenges of caregiving for their parents, the children of immigrants rarely seek help for themselves by obtaining professional mental health care to manage this stress.

The photo shows a row of children seated and leaning on one another. — Children often help family members but rarely seek mental health help for themselves—and may not feel the same support as these children at a memorial service in Springfield, Ohio, on August 5, 2019. REUTERS/Bryan Woolston

Heightened Challenges due to the COVID-19 Pandemic

During the COVID-19 pandemic, immigrant families have faced heightened difficulties with their physical and mental health, which underscores the need for expanded support and targeted intervention.

Reluctant to seek care for fear of exposing themselves to detainment

Immigrants are more prone to infection by COVID-19 and worse outcomes from the disease because of systemic inequities in their living and working situations. They tend to live in multi-generational households—crowded housing circumstances conducive to disease spread. They are more likely to hold essential worker jobs, leaving them at risk for exposure to the virus. Those jobs often leave them uninsured or underinsured, preventing them from accessing care if needed. And undocumented immigrants may be reluctant to seek care for fear of exposing themselves to detainment by customs enforcement officer.

The photo shows a group of small children standing amid black lives matter signs. — There are racist burdens to bear as the pandemic unfolds as well, the authors write. Shown here is a group of children in front of a Black Lives Matter sign in Washington, DC, on June 7, 2020. REUTERS/Joshua Roberts

There are racist burdens to bear as the pandemic unfolds as well. The United States has witnessed increased hostility toward certain immigrant groups in the last six months. The mistreatment and exploitation of Central American and Mexican immigrants at the southern border and derogatory language toward Chinese Americans regarding the virus’ origin in China reflect these anti-immigrant sentiments.

Many immigrants rely on one another for social support

Social isolation has also worsened mental health in immigrant communities. Many immigrants rely on one another for social support. Physical distancing measures designed to curb the outbreak prevent individuals from engaging in person. Moreover, insufficient health illiteracy in immigrant populations can result in fears regarding needed social services and health care. Individuals worry about the public charge rule, which says that seeking certain public benefits can disqualify an immigrant from securing a visa, and they may be unsure about permitted supports and potential obstacles to securing permanent status in the United States.

The photo shows the woman in her living room with her two daughters. — Silvia Sanchez, an undocumented immigrant in North Carolina, with her daughters Jessica and Lucy, speaks by video feed during the virtual 2020 Democratic National Convention on August 19, 2020. REUTERS/Pool

Where Do We Go From Here?

Addressing the mental health of children of immigrants demands a multifaceted approach. Culturally competent, thoughtful initiatives can rectify social inequities through expanded access to health care, engagement with immigrant communities, and formation of support networks. Understanding why the linkages to care are often broken is a good place to start.

Children of immigrants often do not seek health care for a variety of reasons. Cost alone can be an insurmountable barrier such that care is only sought in situations of extreme crisis. A wider safety net system would address the prohibitive nature of insurance for equitable physical and mental health care.

The photo shows a man outside in a snowy field. — Norway does some things well. Here a Syrian commercial airline pilot named Muaz—in Naerboe, Norway, on January 19, 2016—at a workshop that treats attendees as future members of Norwegian society. REUTERS/Gwladys Fouche

It’s worth looking at other countries to find best practices and potential challenges in addressing the needs of immigrants and their children. In Norway, immigrants can receive assistance with securing employment from a designated government worker, alleviating stress for the children and promoting the parents’ financial stability.

This estrangement from peers and families further exacerbates the trauma of migration, racism, and xenophobia

Some countries offer free language classes in both the language of the state and the various mother tongues of immigrants, improving communication within families and encouraging parental self-reliance. Some countries have poor practices that may be worth avoiding. Denmark’s assimilationist model, for instance, fails to support immigrants for who they are, forcing integration into the existing culture through mandatory specialized education on “Danish” values. In Denmark, the children of immigrants are required to attend separate language classes and receive education on Christian traditions. By separating children of immigrants from their peers and choosing to not reciprocate an understanding of faiths and cultures, the Danish government effectively denies Danish-children of immigrants both their familial and national identities by establishing a state of existence between paradoxical sites of identification and alienation. This estrangement from peers and families further exacerbates the trauma of migration, racism, and xenophobia.

The photo shows a massive crowd of people marching through the streets. — People participate in a torchlight procession to show their support for migrants and refugees after the Danish government tightened rules for asylum seekers in Copenhagen, Denmar, on October 6, 2015. REUTERS/Soeren Bidstrup/Scanpix Denmark

Cultural competency is crucial for creating new initiatives to address the unique mental health challenges that children of immigrants face, and this suggests one approach is to partner with institutions that are already sensitive to the needs of particular immigrant communities—like schools or religious organizations.

Children of immigrants are America’s future—we should promote their health through comprehensive, accessible, and respectful initiatives

But that’s not enough. Mental health professionals also need culturally competent training on the unique circumstances of children of immigrants and how to help them know how and where to seek support. Networks of support for these children can foster trust and resilience in this population. Such networks may appear naturally, but formal structures could support children of immigrants isolated due to geographic constraints or informal gatekeeping mechanisms such as linguistic ability, age, or financial resources. Children of immigrants are America’s future. We should promote their health through comprehensive, accessible, and respectful initiatives to meet their unique needs.

The photo shows a group of children, all with orange hats, standing in a line. — Children of immigrants are America’s future, the authors write. Here children who have been incarcerated by Homeland Security are housed in tents in Homestead, Florida, U.S., June 26, 2019. REUTERS/Carlo Allegri

In doing so, we not only serve the needs of individuals in our society, we also foster a more productive, stronger, and healthier nation—one supported, as it always has been, on the hard work and resiliency of immigrants.

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Children of Immigrants and Their Mental Health Needs

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