State Immigration Policy and Mental Health Outcomes across Immigration Generations: Evidence from National Data

Background/Purpose

Children of immigrants represent a growing population in the United States, with approximately 17.6 million children, or about 26% of all U.S. children, living with at least one foreign-born parent. Despite their growing demographic significance, evidence on their mental health remains mixed, with some studies highlighting resilience and others documenting elevated risks linked to socioeconomic and immigration-related stress. Immigrant-origin youth may face unique stressors related to uncertainty due to family separation, policy uncertainty, and barriers to care. Guided by the social determinants of mental health framework, this study examines the relationship between policy climate and mental health outcomes among different immigrant generations. The study assesses whether policy environments are associated with child mental health and whether they help explain differences across immigration-generation groups.

Methods: This study links the 2023 National Survey of Children’s Health with the Immigration Policy Climate Index, a state-level measure of inclusive versus restrictive immigration policy contexts. Analyses focused on children ages 6 to 17 and compared first-, second-, third-plus-, and other-generation status. Primary outcomes were caregiver-reported anxiety and depression. State policy climate was classified as inclusive, neutral, or exclusive. Some covariates include age, sex, race/ethnicity, poverty ratio, economic strain and insurance status. Survey-weighted logistic regression models were estimated, and poverty was handled using the NSCH federal poverty level implicates with pooled estimates across implicates. Main-effects models tested immigration generation and policy climate simultaneously, and interaction models tested whether the association varied by policy climate.

Results

First- and second-generation children had lower rates of caregiver-reported anxiety and depression diagnoses than third-plus-generation children. Weighted anxiety prevalence was 17.4% among third-plus-generation children, compared with 8.9% among first-generation children and 8.7% among second-generation children. Second-generation children showed lower odds of both anxiety (OR = 0.62) and depression (OR = 0.61) than third-plus-generation children, and first-generation children showed lower odds of depression (OR = 0.37). State immigration policy climate was not independently associated with anxiety or depression after adjustment. Family economic strain and unmet health care needs were the strongest correlates of both outcomes. Children in families experiencing economic strain were about twice as likely to have anxiety and depression diagnoses, and children with unmet health care needs were more than four times as likely to have both outcomes. Poverty was more clearly associated with depression than with anxiety. Evidence that policy climate changed the association between immigration generation and mental health was limited overall, with only one significant interaction emerging for anxiety and no consistent interaction pattern across outcomes.

Conclusions and Implications

The Findings suggest that immigration generation differences in diagnosed anxiety and depression were more salient than state policy climate in this study. The strongest correlates were family economic strain and unmet health care needs, underscoring the importance of addressing material hardship and barriers to care. For social work practice, these findings highlight the need for affordable mental health screening, referral, and treatment, particularly for families facing economic hardship and difficulty obtaining services. Future research should focus on understanding various immigration generations’ mental health outcomes within immigrant populations.