ABSTRACT

Objective

There are approximately 11 million undocumented immigrants in the US, including 1.3 million young adults who are eligible for the Deferred Action for Childhood Arrivals (DACA) program. It is unclear how DACA influences engagement in healthcare or depressive symptoms, and the role of discrimination, medical mistrust, and stigma in healthcare settings. This study assesses the association of DACA on undocumented young adults’ engagement with health care and depressive symptoms.

Design

We conducted an internet-based survey examining the health-related experiences of undocumented Latino and Asians and Pacific Islander (API) young adults in California (n = 218) between June and August 2017. Multivariable logistic regressions were conducted to assess the influence of DACA, discrimination, medical mistrust, and stigma on healthcare engagement and depressive symptoms.

Results

Approximately 78% of respondents had a gap in healthcare, and about 31% reported high levels of depressive symptoms. Controlling for demographic characteristics, compared to those without DACA, DACA-recipients had lower odds of reporting gaps in healthcare engagement (aOR = 0.270, p < 0.05) and depressive symptoms (aOR = 0.115, p < 0.01). Those facing discrimination, medical mistrust, and stigma in healthcare settings were less likely to have a healthcare visit and more likely to have higher depressive symptoms.

Conclusions

DACA is a potential strategy to improve healthcare access and address the mental health of undocumented populations. In particular, issues of discrimination, stigma by healthcare providers, and medical mistrust need to be addressed.

中文翻译：

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儿童入境延期行动、健康获取和心理健康之间的关联：歧视、医疗不信任和污名的作用

摘要

客观的

美国约有 1100 万无证移民，其中包括 130 万符合儿童入境暂缓遣返 (DACA) 计划的年轻人。目前尚不清楚 DACA 如何影响医疗保健或抑郁症状的参与，以及歧视、医疗不信任和污名在医疗保健环境中的作用。本研究评估了 DACA 与无证青年参与医疗保健和抑郁症状的关系。

设计

我们进行了一项基于互联网的调查，调查了 2017 年 6 月至 8 月期间加利福尼亚州无证拉丁裔和亚洲人和太平洋岛民 (API) 年轻人 ( n  = 218) 的健康相关经历。进行了多变量逻辑回归以评估 DACA 的影响、歧视、医疗不信任以及对医疗保健参与和抑郁症状的污名。

结果

大约 78% 的受访者在医疗保健方面存在差距，约 31% 的受访者报告有高水平的抑郁症状。控制人口学特征，与没有 DACA 的人相比，DACA 接受者报告医疗保健参与（aOR = 0.270，p  < 0.05）和抑郁症状（aOR = 0.115，p  < 0.01）的差距的几率较低。那些在医疗保健环境中面临歧视、医疗不信任和污名的人不太可能进行医疗保健就诊，更有可能出现更高的抑郁症状。

结论

DACA 是改善医疗保健可及性和解决无证人群心理健康问题的潜在战略。尤其需要解决歧视、医疗保健提供者的污名和医疗不信任的问题。