Immigration and Stress: The Relationship Between Parents' Acculturative Stress and Young Children's Anxiety Symptoms

Previous research suggests that several developmental risk factors in early childhood are associated with the manifestation of anxiety symptoms and anxiety disorders in children. Acculturative stress and other risk factors related to immigration have been related to anxiety in adolescents and adults. However, minimal research has focused on the relation between parental acculturative stress and young children’s anxiety symptoms. Furthermore, research on the psychological outcomes of immigration has been disproportionately limited to samples that do not include young children. There is substantial evidence suggesting that a withdrawn temperament is a significant predictor of anxiety in early childhood. However, temperament has been understudied in ethnic and racial minority groups, leaving us with insufficient data on the predictors for anxiety in young immigrant children. Thus, the present study aims to identify and explain predictors of anxiety symptoms in young immigrant children; specifically, parent acculturative stress as a predictor of child anxiety symptoms. The goal of the present study is to explore the relationship between stress levels related to acculturation in the parent and anxiety levels in the child. A significant relationship here would broaden our understanding of anxiety in young immigrant children.

Prevalence, Comorbidity, and Costs of Anxiety

In the United States, an estimated 28 percent of the population will suffer from anxiety disorders in their lifetime (Kessler, 2005). Anxiety disorders are the most common class of psychological disorders, the most prevalent among which is specific phobia (Kessler, Ruscio, Shear, & Wittchen, 2009). Anxiety disorders are also quite common during the preschool age. Egger and Angold (2006) found that the prevalence of preschool children meeting criteria for any anxiety disorder was 9.4 percent; greater than the prevalence for oppositional defiant disorder (ODD; 6.6%), attention deficit hyperactivity disorders (ADHD; 3.3%) and conduct disorder (CD; 3.3%). The prevalence for any anxiety disorder was also higher than the prevalence for any behavioral disorder (9.0%; Egger & Engold, 2006). It is also evident that there is high comorbidity among types of anxiety disorders and between anxiety disorders and other disorders in preschool children. Egger and Engold (2006) found that specific phobias, post-traumatic stress disorder (PTSD), and selective mutism were closely linked with depression, whereas, separation anxiety disorder (SAD) and generalized anxiety disorder (GAD) were closely linked with ODD. In older children, there is also high comorbidity among types of anxiety disorders. In children of ages 9, 11, and 13 diagnosed with GAD, 48% also met criteria for either overanxious disorder (OAD), SAD, or social phobia (Bittner et al., 2007). In addition, the likelihood that a preschooler is impaired is significantly greater if they meet current DSM-IV diagnostic criteria for an anxiety disorder than if they did not meet criteria for any anxiety disorder (Egger & Angold, 2006).

Also, the development and manifestation of subsequent mental and substance abuse disorders are strongly predicted by the presence of anxiety disorders in early and middle childhood (Kessler et al., 2009). In a study of children at ages 9, 11, and 13 years of age, anxiety disorders predicted a range of psychiatric disorders in adolescence (Bittner et al., 2009). It was found that childhood OAD predicted adolescent OAD, panic attacks, depression, and CD, while childhood social phobia strongly predicted adolescent OAD, social phobia, and ADHD (Bittner et al., 2009). Furthermore, anxiety disorders in young adulthood have been associated with childhood and adolescent OAD (Copeland, Shanahan, Costello, & Angold, 2009).

This research suggests that preventing anxiety at an early age may be a crucial step towards preventing anxiety disorders and other mental disorders later in life. Anxiety disorders have proven costly to society, primarily through reduced productivity, absenteeism from work, and suicide (Lepine, 2002). Negative life outcomes linked to anxiety disorders have been identified by Lepine (2002), including reduced educational attainment, early marriage, marital instability, and low occupational and financial status. Furthermore, the societal costs of anxiety disorders produce a very significant financial burden. An approximation made by Greenberg et al. (1999), showed that over $42 billion were accounted for by active anxiety disorders in the U.S. during the 1990s. In Australia, the cost of generalized anxiety disorder and social phobia together has been found to be greater than HIV/AIDS, cirrhosis of the liver, or melanoma (Mathers, Theo Vos, Stevenson, & Begg, 2001).

Developmental Factors: Temperamental Risk in Early Childhood

A common construct in studying young children’s risk for psychopathology is temperament. Temperament is commonly described as the factor that accounts for differences between individuals in their responses to situational and environmental stimuli. While consensus in defining temperament does not exist, Goldsmith and colleagues (1981) provided an overview of key theories proposed by Buss, Plomin, Rothbart, Thomas, Chess, Hinde, and McCall attempting to describe temperament. Combining the work of these researchers, a synthesis of key theories emerged. McCall (1981) concluded that “temperament consists of relatively consistent, basic dispositions inherent in the person that underlie and modulate the expression of activity, reactivity, emotionality, and sociability.” Rapee‘s (2002) review of previous research suggests that the nature and degree of temperamental responses in individuals remain fairly constant across situations. This ‘individual-difference’ factor is typically called personality, but is referred to as temperament in younger populations (Prior, 1992). Although there is much debate over how much genetic influence there is on temperament, only 30%-50% of the difference in temperament or personality has been attributed to genetic factors (Goldsmith & Gottesman, 1981; Robinson, Kagan, Reznick, & Corley, 1992).

Research suggests that a withdrawn temperament, or behavioral inhibition, in preschool aged children is a significant risk factor for the development of anxiety and anxiety disorders (Kagan, Snidman, Zentner, & Petersen, 1999; Rapee, 2002). Withdrawn temperament is characterized by excessive apprehension to novel people, objects, or situations; commonly observed through “reduced approach to strangers, distress in new or novel environments, reduced smiling and interaction with others, and being slow to warm up in social situations” (Kagan, Snidman, Kahn & Towsley, 2007; Rapee, 2002). Furthermore, high reactivity in infancy is a strong predictor of a withdrawn temperament in middle childhood (Kagan et al., 1999). In a retrospective questionnaire conducted by Rapee and Szollos (2002), mothers of anxious children (age 0-1) reported significantly higher levels of sleep difficulties, crying, and activity in their child than did mothers of nonclinical children. In infants, crying reactivity to novel stimuli at 4 months was found to be a significant predictor of behavioral inhibition at 14 months (Moehler et al., 2008). In longitudinal data, three-month old infants who displayed the most crying and motor movement in response to visual, auditory, and olfactory stimuli were the most likely to be categorized as behaviorally inhibited at 14 and 21 months of age (Kagan & Snidman, 1999). These high reactive infants were also more likely to report anxious symptoms at 7 years of age (Kagan et al., 1999). In a 6-year longitudinal study conducted by Engfer (1993), difficult soothability, crying, and restlessness in 4-month-old infants were predictive of shyness at 6 years of age (as cited in Rapee, 2002). Additionally, risk for anxiety has been linked to toddlers who display high levels of fear in low-threat contexts. Buss (2011) found that high fear response in low-threat situations at age two was predictive of higher anxiety behaviors in preschool and kindergarten. Buss (2011) categorizes these high fear patterns as dysregulated fear, which is constant across situations that are low in threat. However, there is still insufficient data to prove a causal relationship between a dysregulated fear profile and clinically significant anxiety symptoms and disorder in children (Buss, 2011).

One must bear in mind that the present study and many other studies are limited by the accuracy of parental reports. Questionnaire assessment may be biased by parental perceptions or motivations since it relies on the insight, child development knowledge, and honesty of parents (Rapee, 2002). Additionally, much of the previous research on temperamental risk for anxiety and anxiety disorders has been limited to samples of White/European American children. There is insufficient data on risk factors for ethnic and racial minority children, apart from those related to immigration. Thus, further research with ethnic and racial minority children is needed in order to expand our understanding of anxiety in first and second-generation immigrant children.

Immigration-Related Risk:

Acculturation

The term acculturation is traditionally defined as “those phenomena that result when groups of individuals having different cultures come into continuous first-hand contact, with subsequent changes in the original cultural patterns of either or both groups” (Redfield, Linton, & Herskovits, 1936). Usually, there is less change in the cultural patterns of the dominant group (Redfield et al., 1936). Thus, acculturation is characterized by the intercultural relations that occur between individual groups. Berry (1998) provides a theoretical framework to describe the various processes underlying acculturation. Within his model, the dynamics of such intercultural relations are mediated by two governing concepts; cultural maintenance and contact-participation. Cultural maintenance denotes the degree to which individuals both value and strive to keep cultural identity and behavior. On the other hand, contact-participation refers to how much importance and effort individuals place on interacting with others’ cultural groups and larger society. Whether or not an individual in a non-dominant group exerts cultural maintenance or contact-participation depends on which strategies they use during acculturation. Berry also proposed four key strategies that non-dominant groups employ when addressing intercultural relations; assimilation, separation, integration, and marginalization. In assimilation, individuals strive to interact with other cultures on a daily basis while neglecting their own. The opposite is separation, where individuals refrain from contact with other cultures while they strive to keep their own In integration, individuals strive to become part of other groups and hold on to their own culture at the same time . Finally, marginalization is defined by failure to maintain any culture due to individuals not seeking contact with other cultures and not keeping their own. It is important to note that members of non-dominant groups are not always entirely free to employ these strategies because the dominant group can enforce or constrict the acculturation of non-dominant groups. Thus, acculturation strategies can only take place when the host culture welcomes cultural diversity (Berry, 1997).

Acculturative stress

Stressful experiences that are associated with acculturation are referred to as acculturative stress. Acculturative stress can be described as the stressful experiences and reactions involved in the process of adjustment and acculturation (De Las Fuentes, 2003; Berry, 2006). Thus, acculturative stress is a result of stress factors related to the process of acculturation. While a direct relationship between immigration and psychopathology is still unclear, acculturative stressors are commonly identified as risk factors and have become increasingly related to the appearance of mental disorders. Some of the significant stressors linked to acculturative stress and the appearance of mental disorders are barriers to social acceptance, cultural difference, scarce ethnic and cultural resources, stress related to immigration and migration issues, and prejudice and discrimination (De Las Fuentes, 2003; Collazos, Qureshi, Antonin, & Tomás-Sabádo, 2008). The degree of acculturative stress experienced is linked to the strategy of acculturation that is chosen by an individual. Berry (1997) suggests that integration and assimilation strategies facilitate acculturation and lead to healthier psychological adjustment, whereas marginalization and separation are associated with patterns of conflict, resulting in acculturative stress and psychopathology. Members of non-dominant groups who employ the integration strategy tend to experience the least amount of stress (as measured by the degree of negative immediate effects involving self-reported anxiety and depression) when acculturating (Berry, 1998). In contrast, members of non-dominant groups who employ the marginalization strategy tend to experience the most amount of stress (Berry, 1998).

It is important to note that the level of stress one experiences largely depends on how one copes with the acculturative stressors presented (Lara, Gamboa, Kahramanian, Morales, & Hayes Bautista, 2005). When an individual faces overwhelming acculturative stressors, they might fail to cope with them in a successful way. In turn, they can experience severely negative immediate effects and debilitating stress, including personal crises such as anxiety and depression (Berry, 1997). In a study of Turkish college students in the US, a positive correlation was found between acculturative stress and adjustment difficulties while a negative correlation was found between acculturative stress and social connectedness (Duru & Poyrazli, 2007). In addition, research suggests that differences between societal values and individual values are predictive of social anxiety and other psychopathology. Individualistic values involve competition, hedonism, and prioritizing personal values above group harmony, opposite to collectivistic values which increase dependency and decrease autonomy and prioritize group goals over personal ones (Caldwell-Harris & Ayçiçegi, 2006). In a study examining students living in individualistic societies, Caldwell-Harris & Ayçiçegi (2006) found a positive correlation between students’ collectivism scores and social anxiety and other mental health problems. Conversely, a positive correlation was found in collectivistic societies between individualistic students and mental health problems (Caldwell-Harris & Ayçiçegi, 2006). Although research on the psychological impact of differing societal and individual values in acculturating individuals is still inconclusive, it is possible that most immigrants acculturating in the US possess values that are more collectivistic than the individualistic values evident in the US.Continued on Next Page »