PM3019: Adverse Childhood Experiences in Children in Immigrant Families: Better If None, Worse If Even One

Background: Exposure to adverse childhood experiences (ACEs) is linked to poorer mental health outcomes. Children in immigrant families (CIF) are children born outside the United States(US) or who have 1 or more foreign-born parents. Previous research has shown CIF are reported to have lower ACE exposures. It is unknown to what extent CIF who have ACE exposure are at increased risk for externalizing (attention deficit hyperactivity disorder(ADHD) and behavior/conduct problems) and internalizing (anxiety and depression) conditions and if ACE exposure worsens severity. We aimed to examine associations between exposure to ACEs and the reported diagnosis and severity of externalizing or internalizing conditions in CIF using nationally representative data.

Methods: The National Survey of Children’s Health (NSCH) provides data on the health of non-institutionalized children in the US. Children were considered to be CIF if they had at least 1 foreign born parent. ACE studied were exposure to household substance abuse problems, mental illness, domestic/neighborhood violence, parental divorce/death/incarceration, or race/ethnicity-based discrimination, and economic hardship. Using combined NSCH datasets from 2016 to 2019, logistic regression was performed to compute the relevant odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (95% CI), with adjustment for potential sociodemographic confounders.

Results: The total eligible sample included 13,477 children, of which 3,596 had 1 foreign born parent and 9,881 had 2 foreign born parent. ACE exposure in CIF led to a higher likelihood of being diagnosed with anxiety, depression, and behavioral or conduct disorder (Table 1). They were almost 3 times more likely to be diagnosed with anxiety (aOR=2.97, 95% CI: [1.88, 4.67]) and more than 7 times more likely to be diagnosed with depression (aOR=7.73, 95% CI: [3.55, 16.84]). We did not find a similar increased likelihood with ADHD(Table 1). In addition, there was no significant association between exposure to ACEs and severity of the conditions (Table 2).

Conclusion: While previous research has found that children in immigrant families are exposed to fewer ACEs, we found that any ACE exposure significantly increased the risk for a diagnosis of a mental or behavioral health disorder. ACE exposure however did not have a significant impact on the severity of the condition. It is imperative that CIF be screened for ACEs, and children identified as having ACE exposure are referred for appropriate care. It is worthy to note that traditional measures of ACEs may not fully encapsulate the adversity that CIF face due to immigration and this needs to be explored further.