Margarita Alegría, Glorisa Canino, Patrick Shrout, Meghan Woo, Naihua Duan, Doryliz Vila, Maria Torres, Chih-nan Chen, and Xiao-Li Meng, write:
Although widely reported among Latino populations, contradictory evidence exists regarding the generalizability of the immigrant paradox, i.e., that foreign nativity protects against psychiatric disorders. The authors examined whether this paradox applies to all Latino groups by comparing estimates of lifetime psychiatric disorders among immigrant Latino subjects, U.S-born Latino subjects, and non-Latino white subjects.
The authors combined and examined data from the National Latino and Asian American Study and the National Comorbidity Survey Replication, two of the largest nationally representative samples of psychiatric information.
In the aggregate, risk of most psychiatric disorders was lower for Latino subjects than for non-Latino white subjects. Consistent with the immigrant paradox, U.S.-born Latino subjects reported higher rates for most psychiatric disorders than Latino immigrants. However, rates varied when data were stratified by nativity and disorder and adjusted for demographic and socioeconomic differences across groups. The immigrant paradox consistently held for Mexican subjects across mood, anxiety, and substance disorders, while it was only evident among Cuban and other Latino subjects for substance disorders. No differences were found in lifetime prevalence rates between migrant and U.S.-born Puerto Rican subjects.
Caution should be exercised in generalizing the immigrant paradox to all Latino groups and for all psychiatric disorders. Aggregating Latino subjects into a single group masks significant variability in lifetime risk of psychiatric disorders, with some subgroups, such as Puerto Rican subjects, suffering from psychiatric disorders at rates comparable to non-Latino white subjects. Our findings thus suggest that immigrants benefit from a protective context in their country of origin, possibly inoculating them against risk for substance disorders, particularly if they emigrated to the United States as adults.
This is really important stuff, and it’s a big contribution to put all these data in the same place. That said, I have a couple of problems with the article. I actually know several of the authors, so maybe they can help me out with this. Anyway, here are my questions:
1. Why is this called a “paradox”? For something to be a paradox, don’t you need some sort of apparent contradiction? X, but also Y? Here, X is the lower rate of psychiatric disorders among foreign-born Latinos, but what’s Y? I’d have a better appreciation for the paradox if I understood why it was called a paradox. As they write, “These higher rates are not surprising, given that psychiatric disorders are more prevalent in the United States than in many other parts of the world.”
2. The difference between “significant” and “not significant” is not itself statistically significant. With that in mind, I’m skeptical of claims made in the article such as:
Overall, the immigrant paradox was only reliably observed for Mexican subjects, and only evident for depressive and anxiety disorders. However, the paradox was consistently observed among Mexican, Cuban, and other Latino subjects for substance disorders. No evidence for the immigrant paradox was found among Puerto Rican subjects.
The graph above (as well as the other graph shown in the paper) shows differences in a consistent direction for all groups. The differences are of different sizes, and maybe some are statistically significant and some are not, but, remember, the difference between . . .
3. Given the sample size, could they also disaggregate non-Latino whites? If not by ethnicity (maybe such information is unavailable from the survey), at least by state or region of the country, or urban/rural? Also blacks, no?
4. They used the National Latino and Asian American Study, so could they display results for Asians as well?
5. I expect that researchers in mental health would have other breadowns they’re interested in. I understand that it is not the responsibility of Alegria et al. to show all possible subsets of the population–their article is focused on the differences between U.S.-born and other Latinos, which is an important issue in its own right–but showing a few other groups might help put this into perspective, especially if it doesn’t really take much work. Maybe this can be done in the next article.
6. I wish they’d talked to me before making the final version of their graph above. The right way to do this is to label the lines directly rather than using a color code. I’d also zero the graph, but that’s a judgment call. Otherwise, the graph is pretty good.
Finally, let me emphasize that I’m not criticizing Alegria et al. for only presenting data without explanation. As a data-presenter myself, I have a lot of respect for work where researchers clearly describe what’s happening, providing a solid foundation so that they and others can dig deeper.