SOC.Sci. Med. Vol. 22, No. 6. pp. 645-652.

1986

0177.9536
86 53.00+ 0.00
Copyright

Pnnted in Great Britain. All rights reserwd

1 1956 Pe&mon

Press Ltd

DEPRESSIVE SYMPTOMS AND THEIR CORRELATES

AMONG IMMIGRANT
MEXICAN WOMEN IN THE
UNITED STATES
WILLIAM

A. VEGA, BOHDAN KOLODY, RAWON VALLE and RICHARD HOUGH

San Diego State

University,

San Diego,

CA 92182,

U.S.A.

Abstract-Correlates
of depressive symptomatology
and caseness are examined for a survey sample of
N = 1825 poor Mexican immigrant
women in San Diego County,
California.
The Center for Epidemiologic Studies-Depression
(CES-D)
checklist is tested against a variety of demographic
variables
as well as health status and service utilization
rates. Statistically
significant
associations
were found
between CES-D
and education, years in the United States, income, marital status and number of adults
in household.
Also significant
were associations
with health status, confidant
support
and recent,
traumatic
life event. Utilization rates point to medical doctors as the major source of formal treatment
and a heavy reliance on family and friends. The implications
of the high disorder rates for diagnosis and
treatment among immigrants
are discussed.

The phenomenon
of world wide immigration in the
twentieth century has been a focal point of research
and a concern of health planners for some time, and
broad speculation has taken place regarding the
relationship of migration to mental disorder. Conclusive evidence on this issue has not been forthcoming,
and studies have appeared that both support and
refute [l-3] the assertion that migrants and imrqigrants are more likely to suffer from mental disorders
and related symptomatology. However, to date, most
of the research concerning levels of psychiatric disorders among immigrants has been based on treatment
data which inherently limits its generalizability. The
data reported herein describes the prevalence of
depressive symptoms in a cohort of Mexican immigrant women residing in a metropolitan community
in the United States, examines the relationship between these symptoms and a number of factors that
have been identified in the epidemiological literature
as salient predictors of psychopathology
[4], and
looks at help-seeking patterns of depressive women.
Mexican immigration to the United States constitutes one of the largest sustained migratory movements in the world. The economic disparity that
distinguishes the United States and Mexico is
reflected in the incessant flow of undocumented aliens
as well as legal migrants and temporary visitors. By
1980, there were 4S43.770 Hispanic heritage people
in California (U.S. Census), not counting illegal
aliens, and this population is characterized by high
fertility rates, low median age and far lower levels of
educational
and economic attainment.
In other
words, the structure of the Hispanic population
resembles that of a developing country, in contrast to
the socioeconomic characteristics of the general population in California. Nowhere else in the world can
such a differential in standards of living be found
distinguishing two nations sharing a common border.
Furthermore, no single area better exemplifies the
The research described in this paper is supported
the Center for Prevention
Research, National
of Mental Health-M.H.
No. 38745-OIAI.

in part by
Institute

645

abruptness of the transition from underdevelopment

to affluence than the San Diego-Tijuana urban corridor which transcends the international boundary.
The traffic through this region is impressive and
illustrates both the degree of geographic mobility and
the permeability of the international border. According to the Mexican Tourist Authority in Tijuana,
Mexico, approximately
38 million people legally
crossed the San Diego-Tijuana
border (in either
direction) at San Ysidro, and that an additional
405,000 were apprehended at the same border crossing attempting to enter without documentation, during the 1984 calender year. Although these figures
include tourism and commuters working in San
Diego but residing in Mexico (including multiple
crossings), it also includes numerous short stay and
long stay immigrants. This drama of human migration serves as a backdrop for the study reported
below, since the cross-sectional data was collected in
communities contiguous to the international border.
This paper reports data from a cross sectional
survey conducted in San Diego County, Calif., which
included 1825 immigrant women of Mexican descent.
The survey was part of the enumeration phase of a
multi-year prospective preventive intervention study
[5] targeting depressive symptoms among Mexican
American women. The goal of the enumeration phase
was to identify a large number of low income Mexican American women who were neither seriously
depressed nor demoralized, and to develop a sample
suitable for a community based randomized trial. In
the course of the enumeration, several types of information were gathered, including: (a) the prevalence of
depressive symptoms, (b) demographic factors, (c)
health status-including symptom chronicity, (d) services utilization, (e) family structure, (f) life events
and (g) social support.
Three California studies [6-81 have reported prevalence data about depressive symptoms among Mexican Americans, and their findings are in accord:
Mexican Americans have higher uncontrolled rates
when compared with non-Hispanic whites. TWO of
these used the same checklist reported on in this

646

WILLIAM

A.

paper:
the Center
for Epidemiologic
StudiesDepression (see discussion of the depression checklist
in Methods
section).
For example,
Vernon
and
Roberts [6] found a caseness of 28.5% for Mexican
Americans, 18. I % for Blacks and 14.6% for Angles;
and Frerichs er al. [7] reported 27.4% for Hispanics,
21.4% for Blacks and 21.8% for Angles, in two
California studies which did not publish discrete rates
for immigrants.
Vega er al. [S] did find significantly
higher prevalence of depressive symptoms for a small
sample of immigrants, when compared to native born
Mexican Americans or non-hispanic
whites in Santa
Clara County, Calif.; however since a different depression checklist was used to determine rates, the
results are not comparable to the present research, or
the studies cited above.
These epidemiological
studies contradict the earlier
body of research literature [9, 101 which suggested
that Mexican Americans had lower levels of psychopathology due to the cohesive and nurturing qualities
of their social support systems. Indeed, the persistent
underutilization
of mental health servcies by this
ethnic group was seen as verification of this supposed
resistance to psychopathology.
In part this discrepancy in findings may well be due to the use of
disparate theoretical and methodological
designs, including the use of anthropological
observation
and
treatment data in the earlier studies.
The data below represents
the most significant
sample of immigrants
yet reported
in a crosssectional study of depression
in the United States.
This paper will contribute
new information
to the
data base concerning
the prevalence
of depressive
symptoms among Hispanic immigrants, and perhaps
shed some light on associated issues of risk factors
and help-seeking
patterns among depressed women,
and immigrants
more generally.

METHODS

The survey was conducted

in San Diego County,
Calif., which was estimated to have a population
in
1985 of 2,041,300. Approximately
14.8% of the population is Hispanic,
or about 302,112 persons. Of
course. these estimates are based on United States
and California State Census projections which do not
include undocumented
aliens. The exact number of
such people are not known, but estimates [I I] range
from 25 to 48 thousand
undocumented
Mexican
immigrants living in San Diego County.
Since the target group for the parent study are low
income women of Mexican descent between 35 and
50 years of age, the sampling
plan called for a
virtually total enumeration
of women in all block
groups with a proportion
of Mexican Americans
ranging from 25 to 76% (the upper limit). These
residential
zones were uniformly
low income and
characterized
by housing ranging from modest to
very crude. the latter exemplified by such things as
large families living in small one-room trailers. The
interviewers
were Mexican American
women who

*Copies are available

from

the senior

author

VEGA

el

a/

were fully bilingual. and trained and supervised by

the research team. Since the survey was used as a
combination
enumeration
and screen. the interviews
were quite short. lasting an average of only fifteen
minutes. Efforts were made to contact households
with no responses either in person or by telephone
using a reverse telephone
directory.
High density
areas were covered twice to provide better assurance
that all eligible respondents
were being identified.
Interviewing was done face-to-face after ascertaining
the eligibility
of the respondent
with regards to
ethnicity and age. If a respondent could not take the
interview at the time of initial contact. arrangements
were made for another appointment.
Respondents
were informed
that the interview was part of a
university based health promotion
study concerned
with their health and psychological
well being. Approximately 40,000 residences were screened in order
to gather a sample of 2600 respondents.
with a refusal
rate under 10%. This paper is limited to reporting
data
on the subsample
of immigrant
women
(X = 1825).
The interview instrument
included the Center for
Epidemiological
Studies-Depression
measure
(CES-D)
[12], a non-diagnostic
screening measure,
which has been tested for validity and reliability and
found to be acceptable for use in community studies
[13], as well as cross-ethnically
for use with Mexican
heritage Hispanics [14]. In addition, the CES-D
has
been used in numerous studies throughout the United
States so that a large comparative
data base is
available. The CES-D
is a 20 item inventory* which
includes a range of symptoms covering mood, feelings and perceptions-including
vegetative
motor
indicators associated with depression [ 15Z_as well as
their relative duration
during the past week. The
scoring range is O-60, with higher scores indicating
greater
symptomatology.
The accepted
caseness
which
emerged
from
studies
with
threshold,
psychiatric
patient populations,
is a score of 16 or
over. This threshold
represents
the upper 20% of
mean scores in previous community
studies.
Although the CES-D
is not a diagnostic instrument, it was found to have a concordance
of approximately 85% for current major depression
using a
diagnostic protocol, the Diagnostic Interview Schedule (DIS) [16]. In other words, of those identified as
cases on the DIS, 85% reached or surpassed the
threshold of 16 on the CES-D.
On the other hand,
of those scoring 16 or over on CES-D,
60% were
found to reach caseness criteria on the DIS [ 161 which
indicates that the CES-D
has acceptable predictive
validity
as a community
screen for depression,
though it does not purport to be measuring a clinically verifiable syndrome(s)
as does the DIS. Moreover, the type of symptoms
found in the CES-D
have been found to be good predictors
of mental
health services utilization, even better than diagnostic
measures such as the DIS [ 171. It is well suited for use
in poorly educated populations
because of very short
administration
time and simple wording of questions.
Furthermore,
this depression checklist, perhaps more
than any other, minimizes the confounding
effects of
somatic compiaints
since the tendency to present
physical health problems rather than psychological
ones is well established
for Hispanic populations.

Depressive
Table

among

immigrant

Mexican

women

mean scores and caseness rates for demoerauhc

641

variables

In
category

Mean

SD

I825

100.0

15.71

Il.46

603
558
664

33.0
30.6
36.4

15.56
15.43
16.09

II.16
11.09
12.03

O.j80t

805
5x5
228
184

44.7
32.5
12.1
IO.?

17.13
15.25
I-l.14
12.57

II.56
II.25
Il.73
IO.21

10.68**?
25.69***:
O.Zl$

48.0
39.3
31.1
32.1

32.32

26.7
20.9
IS.1
11.7

251
395
401
379
386

13.9
21.8
22. I
20.9
21.3

17.79
15.74
14.33
16.20
15.03

12.17
II.27
10.66
I I.50
I I .67

1.07**t
6.26.:
3.94J

47.4
42.3
36.9
44.1
37.8

10.33

29. I
21.8
19.2
23.7
21.0

9.72

270
209
81
1229

15.1
I I.7
4.5
68.7

15.61
14.62
17.23
15.84

I I.51
IO.51
Il.75
I I.67

1.17t

41.1
36.1
48.1
42.3

4.06

?1.9
IS.?
22.2
23.5

3.01

428
678
409
I67
48

24.1
39.2
23.6
9.7
2.8

17.84
16.27
13.70
13.38
il.88

11.76
II.36
II.01
Il.43
9.57

10.53***t
17.06:
0.86:

50.5
43.7
33.5
29.9
27. I

39.8.;

29.4
23.6
15.9
18.0
6.3

31.95***

1318
95
65
I79
IS3

72.8
5.2
3.6
9.9
8.5

14.96
14.71
17.52
18.82
18.61

I I.18
9.29
II.46
13.15
12.04

7.54***+

38.6
41.1
47.7
50.8
54.2

22.19***

20.9
12.6
27.7
33.0
29.4

7: &$*.*
_.

N
Total
A8e
35-39
40-u
45-50
Education
0-j kr
68 kr
9-11 >r
I?+
Years in U.S.
&5 ?r
&IO )r
I I-15 )r
I&?0 yr
II T
Employment status
Full time
Pars lime
Unemployed
Housewife
Income (monthly)
< 5600
60&999
1000-1399
1400-1999
2000 +
Manta1 swtus
Marncd
Never mar.
Widoued
Separated
Divorced

I. CES-D

symptoms

% CES-DB

16

x!

41.5

0.671:
0.4599

10.6
II 1
42.5

C CES-D

5 4

%=

22.6
0.45

~1.6
21.1
24.8

1.96

17.;0***

*P c 0.05; l*P < 0.01: +**p < 0.001.

tBetvecn groups.
:Linear F.
SAdditional non-linear f.

FIXDINGS

Table 1 reports the demographic

characteristics
of
the cohort. They have very low levels of educational
attainment,
over half are in the lowest quartile of
family income for the County, and most are housewives. In addition,
most are married (72.8%) and
average about three children still living in the household. Overall, the respondents
are long stay immigrants since only 13.9% have been in the United
States for five years or less. The cohort is quite
homogenous,
as could be expected given the selection
criteria.
The distributions
of depressive symptoms by demographic variables are presented in Table I. Subgroup N. mean and standard deviation are given as
well as subgroup proportions
falling at or above two
selected CESD cutpoints;
16 which is the customary
caseness cutpoint, or. 24 which represents the upper
quintile of scores and is used to represent very high
risk for caseness.
For each variable
a one-way
ANOVA was performed
to test differences among
means. A test for linearity followed by one for
non-linearity
was added for ordered or continuous
variables. F ratios for these tests are reported as are
x test outcomes
for differences among subgroup
proportions
falling above the selected cutpoints.
The most impressive finding is the very high prevalence of symptoms as illustrated in the 15.71 grand
mean reported for the cohort. Using the probable
case standard of 16 on the CES-D,
41.53% of the

cohort reaches or exceeds this threshold, and approximately 22.63% of the total sample reaches 24 on the
CES-D.
These caseness rates are twice the average
reported in previous community
studies. Furthermore, they also surpass the caseness rates of 28.5%,
reported by Vernon and Roberts in Alameda County,
and 27.4%, reported by Frerichs er al. in Los Angeles
County, for community
samples of adult Mexican
Americans who were interviewed using the CES-D.

DE.MOGRAPHIC

VARIABLES

A statistically significant (P cc 0.001) negative linear association

was found between educational
attainment and depression scores, and a similar result
obtained for income level. In fact, of those with less
than 5 years of education 48.1 reach caseness criteria
and, for those with a monthly income of less than
5600.00 a month 50.5% reach criteria. On the other
hand, those respondents
with income in excess of
SZOOOper month had much lower mean scores. with
only 6.3% reaching or surpassing the 24 cutpoint.
Although extraordinarily
pronounced
in this cohort,
this patterning
has been reported in numerous epidemiological
studies
of depressive symptoms
for
both income and education
in the United States
[18-221.
Marital status also has the expected relationship,
with those in disrupted
marital statuses
having
significantly higher symptom levels than the married

6-e

WILLl4Sl

the never married. Those respondents

who were
currently. separated
were highest however there is
little vacation in mean scores for those in disrupted
marital statuses. and those reaching criteria range
from 47.7 to 54.2%. This relationship
between marital status and depressive symptoms
has also been
widely reported [23-X].
Years
in the United
States
was significant
(P < 0.01) with respondents
reporting five or fewer
years of residence having the highest mean scores.
caseness rates and percentages
reaching 24 or over.
However. beyond this marked association there is no
consistent relationship
between depressive symptoms
and time in country. These data suggest a higher lev$el
of stress is being experienced
by the more recent
arrivals reflected in significantly higher percentages at
both symptom cutpotnts.
Neither age nor employment
status demonstrated
any remarkable predictive value ris-Li-ris depressive
symptoms. although subtle trends are present in both
cases. For example, older respondents are more likely
to be symptomatic
and meet criteria. Similarly. the
unemployed
also had higher symptom mean scores
and caseness rates but the small number
of respondents
in the cell precludes
finding statistical
significance.
or

Table

Total
Children
None

e: al.

If we use the cutpoint

of 2-I or higher as our
standard for very high risk of being a case, rather
than the 16 cutpoint which represents a probable
case, we find the following demographic
variables to
be highly associated with depressive symptoms in this
immigrant
population.
Note that the variables are
arranged according
to their respective values from
high to love. The most important are: (I) separation;
(2) family income under 5600 per month; (3) divorced; (4) 5 years or fewer in the U.S.; (5) widowed
and (6) 5 years or less of educational
attainment.
Note that three of the six variables are disrupted
marital statuses, and that items (2) and (3) have
identical rates meeting criteria.
PSYCHOSOCI.AL

CORRELATES

Table 2 presents data covering five factors that are

frequently
associated
with v-ariations
in psychopathology.
These five factors are household
composition, health status and services utilization,
life
events and confidant social support.
Social indicators used as proxy measures of need
for mental health services, such as the Mental Health
Demographic
Profile System [27], often include family composition;
especially items identifying
single

mean scores and caseness rates for psychosocial

correlales

,Y

Sb In
category

1825

100.0

15.71

1 I .16

204

I I.2
16.5
20.4
22.2
16.2
13.4

15.70
I5 31
15.53
15.31
16.68
16.00

II.67
Il.63
Il.57
II.17
I I.51
II.37

0.65+
0.77:
0.57%

42.2
39. I
39.5
41.1
45.6
42.9

3.64

22. I
23.5
21.2
20.0
26.0
24.5

4.67

302
372
406
296
245
201
770
417
267
170

Il.0
42.2
28.8
14.6
9.3

18.54
15.29
15.06
15.85
15.68

Il.64
10.92
II.85
II.75
Il.53

3.69**+
4,lSt
4.2Y.P

52.2
39.7
37.4
44 2
42.9

14.34

30.3
21.2
21.3
23.2
22.4

8.23

248
699
626
237

13.7
38.6
34.6
13.1

9.17
12.16
18.77
24.74

7.65
9.04
Il.55
12.65

139,40***t
344.w**:
6.3 I5

15.3
27.8
55.0
73 0

268.12*

5.2
I I.6
30.04
52.3

232.78

1477
321

82. I
Il.9

14.34
22.21

IO.71
12.64

132.90***t

36.4
65.1

88.16***

17.9
44.5

103.90***

512
400
376
I64
II5
229

28.7
22.2
20.9
9.1
6.4
12.7

13.77
13.87
16.04
lb.91
17.83
20.47

10.96
IO.95
II.09
II.17
10.95
12.74

14.72***t
63.56***:
0.99s

34.5
32.5
43. I
48.2
52.2
59.4

62.79

19.2
16.5
22.9
23.5
27.8
35.8

36.88

722
986

42.3
57.1

II.91
18.40

9.15
Il.98

148.42***+

27.6
51.4

96.85***

12.5
29.4

68.22

560
I257

30.8
69.2

10.28
13.69

12.05
IO.56

l38.08***

60.2
33.3

I IJ.53**

36.6
lb.4

89.33

Mean

SD

% CES-D

> 6

%:

41.5

0 CES-D

> 24

1:

22.6

,n home

j+
Adults

2. CES-D

VEGA

in home

Health in
last I2 months
Excellent
Good
Fair
Poor bad
Illness or
disability
NO

Yes
M.D. visits
last I2 months
None
2-3
tj
6-9
lot
Life event
last I? months
No
Yes

Confidant
ruppor1
NO
Yes

P < 0.05: l*P <0.01:

+Between groups.
:Linear F.
ZAdditional
non-linear

***p

F.

<O.OOl.

Depressive

symptoms

among

heads of families in poverty and the number of adults

and children present in such households.
Using the
family data collected in this survey we were able to
test some of these suspected associations.
In contrast
to the expected relationships,
we found that the
number of children and adults in the household was
not related to depressive symptoms or caseness rates.
However, being a single head of household
was
strongly
associated
with
higher
mean
scores
(P < 0.001) and rates above the two cutpoints.
Three items were used to tap health status, and all
have a strong association
with mean scores and
caseness rates. The self-perception
of health in the
previous I2 months is a dramatic indicator of psychological distress, with 73% of those describing their
health as poor or very bad scoring above the
caseness threshold,
and 52.3% scoring at 24 or
higher. The items identifying disabilities and M.D.
visits also produce
very strong associations.
The
associations between health status or health behavior
and symptomatology
are in the direction predicted by
the literature
[28, 291, and these are probably
magnified because of the homogenous
nature of the
sample. i.e. low income, immigrant, middle aged and
female. Link and Dohrenwend
[30] believe health
problems are an important
antecedent of demoralization, which is perhaps one of the most prevalent
maladies in urban society requiring medical services.
A large literature has chronicled the importance of
life events in the onset of psychological
distress,
especially depression [3 I, 321. Although the nature of
the etiological relationships
and temporal sequencing
is poorly understood,
life events remain a viable
predictor of symptomatology.
In this study our respondents
were asked if they had experienced
an
upsetting event (death of family member,
serious
injury, loss of job, etc.) during the preceding
12
months.
The
results
were
highly
statistically
significant
in the expected direction.
In fact, respondents reporting a life event had rates approximately twice as high at both symptom cutpoints than
those who had not experienced an event.
Perhaps the single most reliable predictor of psychological well being found in the social support
research is the presence of a confidant. In this case,
respondents
were asked if they had anyone with
whom they could share their innermost thoughts and
feelings? The results clearly mark the trend for
psychological
well-being
among respondents
who
have such support. with twice as many respondents
lacking confidant support meeting caseness criteria or
scoring at the cutpoint of 24, or above it. Again the

Family
Friends
Clergy
Hum. ser. prov.
!vledical doctor
bkntal
health
T01al

,v

I32
122
67
16
9j
47
479

27.6
2j.j
11.0
3.3
19.8
9.8
100.0

mean'
17.61
18.47
19.31
?j.?j
2 I .95
?9.Sj
20.39

*ANOVA: F = 9.85. d.f. = j: P < 0.000.

+Chi-squared:
r = 27.87. d.f. = j: P < 0.000.
:Chl-squared:
% = 30.11. d.f. = j: P -z 0.000.

immigrant

hlexicar,

women

649

results were very significant for all three associations

tested in Table 2.
Summarizing these results using the 24 cutpoint as
the threshold of very high distress, the ordering of
variables is as follows: (I) poor health; (2) suffering
from a disability: (3) no confidant support; (4) ten or
more M.D. visits: (5) fair physical health; (6) single
head of household and (7) upsetting life event. Of the
five factors assessed. health status clearly predominates as the most salient predictor
of depressive
symptoms.
However,
the other factors identified.
confidant support and negative life events. clearly
discriminate between high and low symptom cohorts
as well.
SY\IPTO>l
SEVERITY
HELP SEEKING

AND

During
the course of the interview, and the conclusion of the symptom
checklist. respondents
were
asked some questions about the severity and extent to
which these symptoms had disturbed their normal life
functioning.
In those cases where the respondent
indicated being bothered by their depressive symptoms. they were asked about help-seeking behavior in
terms of the type of provider sought for relief of
symptomatology.
The results are presented in Table
3, and include both informal sources of social support
and direct services.
Mean CES-D
scores were lowest for those immigrant women who sought help from informal sources
such as family, friends, and clergy than for those
seeking more formal help. However,
of the 479
women who reported being bothered by symptoms
and who tried to talk to someone about them. about
67% used informal resources. Those seeking help
from mental health providers had the highest mean
CES-D
scores (29.85), followed by users of human
services
providers
(25.25) and medical
doctors
(21.98). However. medical doctors were the formal
resource most likely to be used (19.9%). Obv-iously,
women who were more depressed were much more
likely to seek services from formal providers.
and
among these, the most depressed were likely to seek
services from a mental health provider (P < 0.000).
In Table 3, x were used to test for the significance
of the differences between the proportions
using any
of the informal or formal resources and the proportions using no resources. The tests were run for
women scoring at or above the two CES-D
cutpoints; the usual I6 caseness threshold, and a higher
threshold of 24. Of those who turned to informal

SD
IO.05
10.67
13.28
12.80
II.60
12.75
II.89

CES-D
49.2
16.7
j3.7
7j.0
69-j
80.9
j7.2

> 16+

CES-D
2j.X
25.7
29.9
50.0
40.0
66.0
34.7

3 14:

650

WILLLM

resouces. about half were cas2s (16 or above) and half

were not. However. those using formal providers
were much more likely to bc cases or meet ths
threshold of 24 or above (P < 0.000). Examining thz
patterns in a different way, about half of those who
sought help from family, friends and clergy met
caseness criteria. The rates were substantially
higher
for those women who saw a medical doctor, human
services provider.
or mental health spscialist.
The
highest rate (80.9%) was for mental health utilization. The pattern is repeated when using the cutpoint
of 24 and becomes even more pronounced.
Therefore.
it would appear that as the threshold of symptom
severity increases so does the likelihood of seeking
services from a general medical or speciality mental
health provider.
DISCUSSION ASD CONCLLSIOS
Our findings have important ramifications
for the
assessment
of risk and delivery of mental health
services. Mexican female immigrants
interviewed in
the course of this research have extraordinarily
high
rates of depressive
symptoms
as well as caseness
prevalence.
The analyses identify several powerful
associations
between demographic
variables and/or
help-seeking with depressive symptoms in this population. Overall, many of these associations
pattern
like those reported in other epidemiological
studies
but at exceedingly high levels of symptomatology.
The finding which was not anticipated
is that
household composition
did not have a remarkable
relationship to symptomatology.
Neither the number
of children nor adults in a household seem to make
an important difference in prognosticating
symptom
levels. However. the immigrant
women who were
single heads of households
were, as expected, more
likely to be designated as at risk for caseness.
The relationship
between time in country
and
depressive symptoms provides the most direct evidence of psychological
distress associated
with the
immigrant experience. Respondents with five or fewer
years in country have higher levels of symptoms.
Moreover, time in country has no consistent association with symptoms for respondents who have been
in the United States over 5 years, although the mean
scores remain high overall.
The data do not confirm the observations
that
immigrants have low symptomatology.
or that mental health providers will not be used by Mexican
Americans. Although it is probable that unmet need
continues to exist in this ethnic cohort. which is the
case in the general population
as well. our survey
results indicate that both formal and informal support providers
are operating
to provide
help in
overcoming
the dslsterious
effects of depressive
symptomatology.
Prrhaps as reported by Lopez [33],
the problem of utilization among Mexican Americans
(and possibly other subpopulations
with substantial
immigrant
representation)
is neither as monolithic
nor as widespread as is currently believed, and when
appropriately
staffed bicultural and bilingual clinics
are available, as they are in San Diego County, they
will be used.
The findings lend further support
to what investigators
in the mental health field have been

A.

VEGA

ef

al.

reporting
for some time; that most of the formal
services for treating signs of psychological distress are
being delivered by msdical doctors. ahich obscures
the evaluation of rates-in-treatment
and underscores
the importance
of appropriate
diagnoses and treatment in general medical care settings.
The findings reported in this paper depict a poor.
minimally acculturated
cohort of women who ar2
socially isolated and have levels of sducational
attainment that are far below what is considered normative in the United States, Cert;tinly.
from the
perspective of social psychological
stress theory [34],
these women are at far greater risk for depression
than better integrated members of ths general population. However, there are other socially marginal
groups subjected
to multiple
stressors
in North
America. and studies exist documenting
their correspondingly
high levels of psychopathology
[3j-371.
Indeed. it will be interesting to compare the symptom
levels reported
in this study, indexed for socioeconomic status, with the CES-D
data forthcoming
from the Epidemiological
Catchment Area Program
[38] and the Hispanic Health and Sutrition
Examination which include large multiregional
samples,
including Mexican Americans, encompassing
the major sociodemographic
groups found in the United
States. It is our belief that when the major demographic
variables
are taken
into
account,
differences in symptom counts between immigrants
and native born American citizens will be greatly
attenuated.
although they probably will not disappear altogether.
Further, the cohort of women we
have assessed are in middle age, which appears to be
a special risk group within the Mexican American
population.
It will be interesting
to see whether
diagnostic rates for minor depressive disorders also
accentuate the risk proneness of Me.xican immigrant
women over 40 when such data become available.
We would conjecture
that the reasons for the
extraordinary
levels of depressive symptoms in this
cohort of women has its basis in a combination
of
cultural and socioeconomic
factors which may personify poor immigrants
more broadly, but which
focus with particular
intensity on ths middle aged
woman. Family structure and normative expectations
are unstable and deeply conflicted for women undergoing the transitional
processes implicit in the immigration experience. The effort to maintain traditional
cultural role expectations
within the context of highly
urbanized and affluent social systems could be expected to increase stress, and economic marginality
combined with lessened social support compound the
severity of perceived stress and narrow the range of
coping alternatives. Our measure of depressive symptoms, the CES-D,
is known to be v2ry sensitive to
situational stress. This context of high risk for depression should also be prevalent in populations
with
similar demographic
and cultural diff2rences, such as
the Turkish immigrants
in Germany and Sweden.
Perhaps the most intriguing question suggested by
this research but fundamentally
unansvverable using
cross-sectional
data, is the potential for identifying
factors that distinguish successful copsrs within the
immigrant
cohort.
Given the homogeneity
of the
sample, many types of life stressors encountered
by
poor immigrant
women are expected to be nearly

Depressive symptoms among immigrant Mexican women

universal. thus permitting an assessment of psychological coping processes and related behaviours in the
various domains of life experience; i.e. marital relationships, parenting, work. economic, legal, etc. We
are currently
conducting
such a prospective
investigation
during
the second
and subsequent
waves
of interviews
with this cohort
using scales designed
by
Pearlin
[39], as well as others,
to assess these interactions within a causal model. We are also testing the

construct of migration and stress developed by Fabrega [-lo] in order to determine if the factors have
any predictive value for depressive symptoms within
this immigrant
cohort.
Ideally,
the information
gleaned will better explain differences in immigrant
adjustment
and related social processes that affect
health and psychological
well being.
The tindings in this paper forcefully suggest the
importance of intervening with new immigrant populations using broad educational approaches as well as
targeted public health interventions.
The finding that
respondents
are very sensitive to the impact of depressive symptoms on their functioning is important
evidence supporting
the viability of public health
interventions
with this population.
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