Crossroads: The Psychology of Immigration in the New Century

Immigrant Populations in
Clinical Contexts
a resilience Perspective
Many immigrants adapt well to and thrive in their new
living circumstances. They do so by navigating multiple
sociocultural contexts in positive ways that contribute to
their well-being and success in the United States. Studies
suggest that first-generation immigrants may actually
experience less psychological
distress than second-
generation immigrants
(Alegría, Canino, Stinson,
& Grant, 2006). While the
“immigrant paradox” (see the
Introduction) may lead to
the conclusion that the first
generation has reported lower
than expected negative mental
health outcomes, several caveats should be considered. It
may be that the first generation is healthier than subsequent
generations, but it may also be that several different issues are
artificially deflating or confounding these prevalence rates. It
may be possible that first-generation persons
• experience different disorders than ones included
in Western psychiatric classification systems (e.g.,
neurasthenia) (S. Sue & Chu, 2003);
• have different idioms of distress (e.g., ataque de nervios)
(Guarnaccia et al., 2007; I. López, Dent, et al., 2011);
• experience their symptoms in culturally different
ways (e.g., fatigue or malaise instead of “depression”)
(Pumariega, Rothe, & Pumariega, 2005);
• are less likely to report their symptoms if they feel selfconscious
about doing so (Nadeem et al., 2007); and
• are less likely to avail themselves of services either
because this is not a culturally normative practice or
because they simply do not trust outsiders (Whaley,
2001).
Immigrant Populations in Clinical Contexts
The tools used to assess clinical
symptomatology are usually not
calibrated for immigrant populations
either linguistically or culturally.
In addition, the tools used to assess clinical symptomatology
are usually not calibrated for immigrant populations either
linguistically or culturally (Dana, 2005).
It is important to note that while those who immigrate
voluntarily may, on the whole, be hardier or more resilient
than nonimmigrant comparison populations, there are
particularly vulnerable
immigrant subpopulations
(e.g., refugees, older adults,
and LGBT populations)
that are likely to constitute
a very different profile with
additional stressors that can
have a negative impact on
their mental health. Whether
there is evidence to support
the notion that immigrants are less likely than U.S.-born
populations to experience mental illness, there is no
evidence in the literature that immigrants are any more
likely to experience mental illness or psychological distress
than nonimmigrants, taking into account who does and does
not seek treatment.
When immigrants do experience mental health difficulties,
however, many are particular to the immigration experience.
A wide range of mental health problems, including anxiety,
depression, PTSD, substance abuse, and higher prevalence
of severe mental illness and suicidal ideation, have been
observed among immigrant populations in the United States
(Desjarlais et al., 1995; Duldulao et al., 2009). Recent studies
have also noted the unique presentation of psychological
problems among immigrant children, such as a relationship
between ataques de nervios and somatic complaints (I. López,
Ramirez, Guarnaccia, Canino, & Bird, 2011).
The immigration process has the potential to serve
as a catalyst for the development of a great variety of
psychological problems and has been conceptualized as
consisting of different phases (Akhtar, 2010; Tummala-Narra,
2009). Each of these phases involves negotiating loss and
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