Introduction
The Covid-19 pandemic heightened levels of mental distresses in the US. While foreign-born (FB) Americans faced additional stressors compared to their US-born counterparts, they may have experienced fewer mental distresses, suggested by the Healthy Immigrant Paradox. However, it remains unclear whether this paradox extends after the global pandemic among middle aged adults who might have experienced greater mental distresses as sandwich generation, caring for both their aging parents and their own children. This study sought to describe the mental health disparity by immigrant generation among middle aged US adults.
Methods
This study design was cross-sectional and used the latest data (wave 6) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The data were collected in 2022-2025 immediately after the pandemic. Three immigrant generation was defined as: 1) first – FB to FB parents, 2) second: US-born to FB parents, and 3) third: US-born to US-born parents. Depressive symptom was measured using the Center for Epidemiologic Studies-Depression Scale and anxiety was measured using the General Anxiety Disorder-7.
Results
Among 11,727 participants included, the average age was 44 years old. Majority were third generation (83%), followed by first (10%), and second (6%). The average depressive symptoms and anxiety scores were (3.10, SD = 0.05) and (3.95, SD = 0.07), respectively. First generation immigrant reported the lowest depressive symptom (2.64, SD = 0.11) compared to second (3.18, SD = 0.19) and third (3.13, Sd = 0.06). Similarly, the lowest anxiety was reported among the first generation (2.90, SD = 0.21) compared to second (3.90, SD = 0.30), and third (3.99, SD = 0.09).
Conclusion
Despite additional stressors faced by FB middle-aged adults, their immigrant status protected them from experiencing depressive symptom and anxiety compared to US-born counterparts. Investigation into potential socio-political factors of this paradox might explain the Healthy Immigrant Paradox.