Mental health disparities in Latinx immigrant communities residing in the United States during COVID-19: Implications for policy and practice

A Scoping Review to Explore the Intersection of Immigration-Related Policies and Immigrants' Health Access and Outcomes During the COVID-19 Pandemic

The COVID-19 pandemic may have exacerbated existing health inequities in the U.S., disproportionately affecting marginalized groups, particularly immigrants. Structural barriers, institutional inequalities, and exclusion from relief measures may have worsened these communities' health outcomes. Additionally, anti-immigrant rhetoric, restrictive policies, and fear of deportation may have deterred many immigrants from accessing essential services, affecting both their physical and mental health. This scoping review examines immigrant health access, outcomes, and relevant policies during the pandemic using the Arksey and O'Malley framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews) guidelines. Key findings highlight widespread distrust in government, limited healthcare access, and significant adverse mental health challenges among immigrants during the pandemic, which may be worsened by restrictive immigration policies such as revisions to the public charge rule.

Perceptions and Experiences of Uninsured Latinx Adult Participants in a Community Health Worker-Delivered Intervention to Address Depression

Latinx immigrants have an increased risk of depression and other negative mental health problems. Community health workers (CHWs) have a history of bridging the divide between marginalized communities and health care systems. Since 2019, we have been implementing and evaluating a ten 1-hour-sessions intervention delivered by a CHW and adapted from cognitive behavioral therapy, mindfulness exercises, and behavioral activation to treat mild to severe depressive symptoms and anxiety. There has been little research on the subjective experiences of the participants receiving mental health services delivered by CHW. Our study's purpose was to explore the perceptions and experiences of participants in the intervention. To better understand the experiences of Latinx participants in the intervention, we conducted in-depth 1-hour interviews with participants who completed the 10 intervention sessions. Twenty-nine participants provided responses. Participant discussions about their experience with the intervention centered around three main themes: desperation as a motivator to accept the intervention, changed perceptions of self, and feelings of support. Results show that participants perceived the program as beneficial for their mental health and well-being by influencing their sense of self and self-worth and by feeling supported by the CHW. CHWs have the potential to address gaps in mental health service access experienced among Latinx immigrants. However, more research needs to continue investigating effective engagement strategies for treating depression and anxiety among Latinx immigrant patients.

Centering Latinx immigrant knowledge for wellbeing, liberation, and justice in community-university research partnerships

Structural inequities impacting immigrant health in the United States were intensified during two recent time periods-the anti-immigrant socio-political context of 2017-2021 and the COVID-19 pandemic beginning in 2020. Our community-university research team adapted and implemented a community-based mental health intervention with Latinx immigrants during these periods, which allowed us to reflect on the role of our community-based participatory research (CBPR) partnership in addressing the disparate impacts of these events on Latinx immigrants. We documented the factors and processes that enabled our partnership to navigate crises, address immediate needs, and promote long-term social change. We analyzed focus groups with community-based organization staff, research team meetings, retreat notes, and interviews with Latinx immigrants. Exacerbated challenges included fear, uncertainty, limited resources, and restricted mobility and isolation. By prioritizing immigrant individual, community, and organizational knowledge and epistemologies, our team built upon immigrants' experiences of survival and resistance in the face of ongoing exclusion to navigate the difficulties of both periods. Instead of developing reactive processes, our partnership centered on immigrants' existing strategies, ensuring responses were rapid, effective, and aligned with community needs. These findings highlight that immigrant communities survive continual "crises" and engage in ongoing resistance and survival strategies that can provide the basis for effective CBPR and other social change efforts.

Remote school instruction in Fall 2020 and psychiatric emergencies among adolescents in Los Angeles County

OBJECTIVE

Schools play an essential role in providing mental health care for adolescents. School closures during COVID-19, as well as re-opening to remote-only instruction in Fall 2020, may indirectly affect the utilization of emergency psychiatric care. We examine COVID-19-related changes in emergency psychiatric care among youth during the school closure and after school reopening (with remote instruction).

METHODS

We use Box-Jenkins interrupted time series methods to analyze psychiatric emergency department (ED) visits among patients 10-19 years at LAC + USC Medical Center (LAC + USC) between January 5th, 2018, and December 31st, 2020. We control for the 1st societal shutdown in LA County (i.e., the nine weeks from March 13 to May 14, 2020) when analyzing the potential "return to remote school" shock.

RESULTS

Youth psychiatric ED visits fell by 15.3 per week during the Spring 2020 school closure (p < .05). The "return to remote school" coefficient (i.e., August 14th to September 10, 2020), by contrast, is positive but does not reach statistical detection above expected values (p = .11). However, the proportion of psychiatric ED visits rises 38% among youth during the "return to remote school" period (p = 0.006).

CONCLUSION

The initiation of Fall 2020 remote instruction corresponded with a greater proportion of youth ED visits that are classified as psychiatric.

COVID-19 Deaths in Transnational Settings: Disrupted Bereavement and Pandemic-Related Prolonged Grief Disorder in the Latinx Immigrant Population

The Latinx immigrant population experienced one of the highest COVID-19 death rates. Those left behind have exhibited rising rates of mental illness, particularly, pandemic-related prolonged grief disorder. The Latinx immigrant population is uniquely vulnerable to this disorder as a result of disrupted culturally appropriate bereavement practices, constrained social support, and concurrent COVID-19 stressors and immigration-related trauma. Despite a rising call for research on pandemic-related prolonged grief disorder, little is known about the true prevalence, cause, and appropriate treatment protocol behind this disorder in the Latinx immigrant population. Four areas of research critical to the identification and understanding of pandemic-related prolonged grief disorder in this population are recommended: 1) death and bereavement in transnational settings, 2) immigrant social networks and disrupted bereavement, 3) COVID-19 stressors and grieving, and 4) prolonged grief disorder and mental illness comorbidities. An understanding of these four contributing areas to Latinx immigrants' vulnerability to prolonged grief disorder is imperative to providers' development of assessments and treatment protocols needed to identify and treat prolonged grief disorder in this population.

Mental health among rural Latino immigrants during the COVID-19 pandemic

The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n ​= ​12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.