(PS4-43) Applying Social Determinants and the Family Stress Model to Latinx Families: The Roles of Context of Immigration and Systemic Disinvestment

Abstract Text: There is an urgent need to understand how inequities in mental health awareness, service access, and delivery influence Latinx families in the United States. Social Determinants of Health (SDH) – macro-level structural conditions (e.g., public policy) that shape income, education, discrimination, and working life conditions – may constitute a fundamental context that adversely influences Latinx family functioning through the perpetuation of large-scale structural inequities (Alegría et al., 2018; Braveman & Gottlieb, 2014). The Family Stress Model (FSM; Conger et al., 2010) connects stressors associated with economic inequality with decreased quality of familial relationships through emotional and behavioral problems. This qualitative study used FSM to examine the perception of social determinants on family functioning.

Four focus groups were conducted with promotores de salud (n = 21), or community health workers, in the Latinx community in a large, urban midwestern city. The sample had a mean age of 49.45 years old (SD = 9.87), was 85.71% female, and 95% first-generation Mexican immigrant. Semi-structured interviews were conducted for participants beliefs about: 1) ethnic-racial identity; 2) defining good versus poor mental health; 3) how promotores provide support to community members; 4) how ethnic-racial identity influences mental health; 5) how emotional issues are addressed; 6) how ethnic-racial identity impacts the method and reception of support offered to community members.

Qualitative data analysis of participant responses was analyzed using ground theory (Corbin & Strauss, 2008). Three main themes within the data were identified across 19 different code categories. The first theme, General Family Impact (35 references, percent coverage: 0.40-21.54%), addresses the relationship between economic stressors and family conflict. Notably, participants associated less parental presence in the home with family conflict. The second theme, Context of Immigration, (13 references, percent coverage: 0.67-8.77%), identified the relationship between immigration status and employment opportunity. This theme incorporated observations regarding undocumented status, societal reception of Latino immigrants, and policies perceived as engendering fear within the community. The final theme, Systemic Disinvestment (46 references, percent coverage: 0.90-11.16%), reflected the association between historical oppression towards Latinx communities with the current sociocultural environment. Promotores referenced insufficient resource allotment, violence, and crime within this category. These major themes in participant responses provide support that Social Determinants related to immigration public policy and job opportunity create and/or perpetuate inequities that substantially influence family stress in Latinx families and, in turn, subsequently adverse influence mental. Results are further discussed in the context of expanding FSM to incorporate social determinants, and implications for clinicians treating Latinx families.