Mental and Behavioral Health Access and Outcome Disparities for Children in Immigrant Families

Background: With immigrants and children in immigrant families (CIF) representing 24% of the US population, their mental health status has major implications for the overall health of the nation. Stressors unique to the CIF population (e.g., family separation, cultural and language barriers, xenophobia) may create or exacerbate mental health concerns. In addition, CIF are less likely to receive treatment for mental health problems. The potential disparities to mental health care access and health outcomes between CIF and non-CIF are less well understood.

Methods: The nationally-representative 2016-2017 National Survey of Children’s Health was used to compare children with at least one mental or behavioral health disorder in CIF (n=1,159) and non-CIF (n=9,264) across various outcomes, including population demographics, health care access, and health outcomes. After applying survey weights, multivariate logistic regression analysis was used to compare the populations, controlling for age, race, poverty status, parental education, parental age, household structure, state of residence, and survey year.

Results: CIF, as compared to non-CIF, were more Hispanic (57.3% CIF vs. 13.9% non-CIF, P < 0.01), were more likely to have public health care insurance (adjusted odds ratios, AOR 1.46, 95% confidence interval, CI 1.05-2.03), more likely to have an autism spectrum disorder (ASD) diagnosis (AOR 1.77, 95% CI 1.25-2.51), less likely to have a depression diagnosis (AOR 0.65, 95% CI 0.43-0.97) and less likely to have an attention deficit hyperactivity disorder (ADHD) diagnosis (AOR 0.55, 95% CI 0.42-0.73).

Conclusion: Of children with a mental or behavioral health disorder, CIF, as compared to non-CIF, are more likely to have public health insurance and have a diagnosis of ASD, and are less likely to have a diagnosis of depression and ADHD. These mental health care access and outcome disparities may be the result of a combination of over and underdiagnosis in the CIF population and demonstrate need for population-level health system and policy interventions.