The Role of Migration-Related Stress in Depression Among Haitian Immigrants in Florida: A Mixed Method Sequential Explanatory Approach

Recognizing, appropriately treating depression, and meeting the mental health needs of the growing number of Haitian immigrants in the United States (US), continue to pose a challenge because of differences in culture, beliefs, idiom of distress, expression of depression as well as specific stressors associated with the migration process. Previous studies, while limited, document high levels of depression among Haitian migrants, and postulated that migration-related stress (MRS) may play a significant role. Aspects of the migration process, more specifically stressors endured during settlement in the US may negatively precipitate the development of depression. This study used a mixed method sequential explanatory approach to pursue the following specific aims: Aim 1: to identify demographic factors associated with MRS; Aim 2: to identify demographic factors associated with depression; Aim 3: to examine the relationship between MRS and depression overall and the extent to which this relationship is modified by other factors; and Aim 4: to provide an in depth overview of the most significant migration-related stressors experienced by first generation Haitian migrants with high scores of MRS. Seventy-six first generation Haitian migrants were recruited from the southeast region of Florida through three purposive sampling methods: venue-­based sampling, snowball sampling, and convenience sampling. Among participants who consented and completed quantitative data, eight with high MRS scores (\u3e 25 on the Demands of Immigration Scale, DIS) completed an in-­depth interview about MRS. Descriptive statistics, Analysis of Variance, Chi-square, Pearson correlations and multiple linear regressions were utilized to assess MRS (DIS), depression (Center for Epidemiological Studies Depression (CESD) and Zanmi Lasante Depression Symptom Inventory (ZLDSI)) and demographic variables. Qualitative interviews were analyzed using a double-coding approach. While MRS significantly correlated with gender, age, English language fluency, and age at migration; only gender ( = -.280, p = .011) and English language frequency ( = -.264, p = .017) emerged as significant predictors of MRS. Findings showed a strong positive linear relationship between MRS and depression (CESD (r =.606, p \u3c.000) and ZLDSI (r = .624, p \u3c .000)) and between CESD and ZLDSI (r =.738, p \u3c.000). MRS remained the strongest predictor of depression when controlling for all other significant predictors of depression (CESD: gender, income, education and direct impact from the 2010 earthquake; ZLDSI: in Haiti during the 2010 earthquake and moving to the U.S. during the first visit). Being in Haiti during the 2010 earthquake moderated the relationship between MRS and depression (ZLDSI), showing an amplifying effect for depression between MRS and reported 2010 earthquake exposure. Findings from the in-depth interviews revealed five migration-related stressors to be of most significance to the development of mental illness among Haitian migrants: language barriers, financial strains, loss of social networks, family conflicts and exposure to discrimination and stigma. Moreover, findings provided information to explain why Haitian migrants found each high-ranking migration-related stressor stressful. This study made unique and innovative contributions to the migrant stress literature and shed light on the mental health of Haitian migrants and risk factors long implicated in MRS and depression. Health care providers should work with Haitian migrants when diagnosing and treating depression to facilitate the consideration of both the unique migration stressors and risk factors Haitian migrants may face, and the ethnic differences in their expression of depression. The use of culturally appropriate and validated measures is instrumental to better capture depression among Haitians