Date of Award
Spring 2025
Language
English
Embargo Period
5-1-2025
Document Type
Master's Thesis
Degree Name
Master of Science (MS)
College/School/Department
Department of Epidemiology and Biostatistics
Program
Epidemiology
First Advisor
Melissa Tracy
Committee Members
Eric Rose
Keywords
Immigrant, mental health, rural, urban
Subject Categories
Community Health and Preventive Medicine | Epidemiology | Public Health
Abstract
Background
The immigration process to the United States creates distinct mental stressors. These stressors are influenced by socioeconomic factors including income, education level and insurance status. In rural America, these factors are intensified due to a poor healthcare infrastructure that is limited. This study examines the relationship between urban-rural residence and mental health outcomes among immigrants vs. native-born residents in the United States.
Methods
Data from the National Health Interview Survey (NHIS) from 2019 and 2022 were used to examine the relationship. The exposure of interest was place of birth, and the outcome of interest was the presence of clinically significant mental health symptoms. Potential confounders were the ratio of family income to the federal poverty level, education level, region, sex, age, health insurance status, and race/ethnicity. Descriptive statistics were examined, and then bivariate analysis and an adjusted multiple logistic regression model were fitted to understand the relationship between exposure and outcome. Stratified analysis by urban-rural classification and poverty status was considered for effect measure modification.
Results
Based on the results, residents in nonmetropolitan areas reported the highest prevalence of clinically significant mental health symptoms (10.8%) compared to residents in large central metropolitan areas (8.6%). However, this trend was reversed in adjusted logistic regression models, with residents of non-metropolitan areas exhibiting significantly lower odds of clinically significant mental health symptoms (OR= 0.85, 95% CI = 0.75-0.97), compared to those living in large central metro areas. Furthermore, NHIS participants born outside the US had significantly lower odds of clinically significant depression or anxiety (OR = 0.41, 95% CI = 0.36-0.48) compared to U.S.-born residents. These findings highlight mental health disparities by geographic residence and nativity status and highlight the need for further research to better understand mental health disparities based on duration of residence in the U.S. and within certain geographic regions of the country
Conclusion
This study found that poverty and lower education level were associated with higher levels of clinically significant mental health symptoms; these relations were stronger among U.S.-born adults. Foreign-born adults in the United States had lower odds of reporting clinically significant mental health symptoms compared to U.S.-born individuals after adjusting for socioeconomic and geographic factors. These findings highlight the need for mental health interventions that address socioeconomic-related stressors among U.S.-born populations while ensuring culturally responsive approaches to treat the unique stressors of the immigration process. Future studies should examine how the length of U.S. residence affects mental health outcomes and explore regional differences, particularly in the southern U.S.
License
This work is licensed under the University at Albany Standard Author Agreement.
Recommended Citation
Gentles, Zoë, "Differences in Mental Health Outcomes in Immigrant vs. U.S.-Born Populations in Urban vs. Rural Areas in the United States" (2025). Electronic Theses & Dissertations (2024 - present). 194.
https://scholarsarchive.library.albany.edu/etd/194
