Crossroads: The Psychology of Immigration in the New Century

value of family interdependence and the broader societal
values of autonomy and independence.
With respect to mental health, the executive summary of
the report of the surgeon general on mental health (U.S.
Department of Health and Human Services, 2001) called
attention to the importance of culture in the clinical context.
Specifically, cultural context shapes the ways in which clients
conceptualize and express psychological distress and resilience,
cope with distress, and seek help. The report further states that
the significance of culture is relevant not only to the client
but also to the mental health professionals who provide help
and the care system in which it is provided.
The societal and local community context can also be
a source of stress for immigrants. One example of the
interaction between macrolevel stressors and mental health
is the intersection of high levels of poverty and a greater
risk for mental disorders in immigrant communities. Other
stressors that can affect immigrants’ mental health and use
of mental health services include the reception by the
mainstream society (macrosystem), policies that restrict
access to health care for immigrants (exosystem), limited
networks of social support and opportunities (microsystem),
and lack of knowledge about mental health services
(mesosystem) (Pumariega & Rothe, 2010). Individual factors
such as exposure to trauma during the migration process
can further shape the ways in which immigrants experience,
express, and cope with psychological distress.
Family cohesion and support from extended family have
been associated with psychological well-being (Lueck
& Wilson, 2010; Masood, Okazaki, & Takeuchi, 2009).
A positive ethnic identity or a sense of belonging and
involvement with one’s ethnic community has also been
associated with self-esteem and general psychological wellbeing
(Phinney & Ong, 2007). Bearing in mind the complex
interplay between person and context, the following sections
describe some major presenting problems experienced by
many immigrants: barriers to treatment, assessment and
diagnosis, and intervention.
Presenting Problems
While most immigrants adapt well to their new lives,
some face considerable psychological distress that may go
unnoticed for various reasons, including cultural differences
in views of psychological distress and coping. Differences in
perceptions of mental health, preferred sources of help, and
Immigrant Populations in Clinical Contexts
alternate coping styles have been thought to contribute to
the underutilization of mental health services by immigrants
(S. R. López & Guarnaccia, 2000). For example, informal
sources of support, such as relatives, authority figures,
community members, friends, or religious leaders, are
an important resource for immigrants from collectivistic
cultures (Yeh, Arora, & Wu, 2006). Further, some immigrants
may express distress through somatic symptoms, which
family and friends may not perceive to be psychologically
driven. In this case, a primary care physician or someone
familiar with traditional Western conceptualizations of
psychological distress may note the individual’s distress.
Many of the mental health problems particular to the
immigrant experience can be linked to experiences of
acculturation, discrimination, and trauma.
Acculturation-Based Presenting Problems
Acculturation is a naturally occurring process that can
result in either positive or negative outcomes, depending
on existing contextual conditions (see Adaptation:
Acculturation, Cultural Identity, and Civic Engagement).
A variety of outcomes can ensue from the process. For
example, acculturation processes can shape the expression of
psychological distress, including culture-bound syndromes.
In other instances, immigrants’ experiences of gender roles
can vary significantly between the country of origin and the
new culture, at times characterized by feelings of increased
sexual freedom and less adherence to traditional roles, and at
other times by feelings of increased oppression and demands.
Changes in gender roles are at times connected with
economic demands in the new environment, presenting
opportunities for improved psychological well-being in
some cases and psychological distress in others (Tummala-
Narra, in press; Vasquez, Han, & De Las Fuentes, 2006). For
example, a woman who might have had limited experience
outside the home in her country of origin may be exposed
to new ideas and gain greater independence now by
working. At the same time, her husband may resent her
freedom and independence and attempt to tighten the reins
of his authority when she returns home. In another case, a
child who immigrates to the United States may suddenly
notice that the parents are working in different roles in
the home when compared with their life in the country
of origin. These shifts in gender roles can contribute to
conflicts within families and affect an individual’s adjustment
to school and workplace.
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