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The British Journal of Occupational Therapy logoLink to The British Journal of Occupational Therapy
. 2021 May 29;85(5):332–340. doi: 10.1177/03080226211022962

Adult attachment, stress-coping, and resilience in first-generation immigrants in the United States

Chiao-Ju Fang 1,✉, Nenette Tong 1, Rosely J Villa 1, Ana M Flores 1, Elaine Lim 1, Alexandria Tu 1
PMCID: PMC12033741  PMID: 40337668

Abstract

Introduction

Previous studies have shown correlations between adult attachment, stress-coping, and resilience, but little is known about how attachment and stress-coping affect resilience, particularly among first-generation immigrants. This study explored relationships among adult attachment, stress-coping, and resilience for first-generation immigrants.

Method

A quantitative cross-sectional design was used to assess associations between adult attachment and stress-coping with resilience among first-generation immigrants. Thirty-five participants answered an online Qualtrics survey. A simple linear regression analysis was conducted to analyze the results.

Results

The results indicated statistically significant correlations between avoidance scores and annual household income but not between resilience and education, resilience and income, and stress-coping scores and education and income. Positive reinterpretation growth was positively correlated with resilience, while denial and behavioral disengagement were negatively correlated. Adult attachment and number of years in the United States were not significantly statistically related to resilience.

Conclusion

The findings indicate high income may be associated with attachment avoidance, and increases in positive coping strategies and decreases in negative coping strategies are associated with resilience among first-generation immigrants. Understanding influences on first-generation immigrants to engage in stress-coping skills may inform the development and implementation of occupational therapy, including programs and interventions for successful client-centered outcomes.

Keywords: Adult attachment, stress, stress-coping, resilience, first-generation immigrants, occupational therapy

Introduction and literature review

In 2020, 281 million people were living as foreign-born immigrants worldwide. Currently, international migrants compose 3.6% of the global population, compared to 2.8% in 2000. While international migration is a global phenomenon, most movements involve a limited number of countries. The second largest number of migrants resided in the United States (US), which hosted 59 million migrants in 2020 (21% of the world’s total) (United Nations, International Migration Report, 2020). The US has become more ethnically diverse as the population of immigrants has increased. According to the US Census Bureau (2020) Current Population Survey, immigrants make up 26% of the American population (US Census Bureau, 2020). For first-generation immigrants, migration is not just about moving from one country to another but also trying to adopt new and unfamiliar occupations in an attempt to adapt to their new culture (Berry, 1997; Bennett et al., 2012). Occupations provide a means for participation in the host country and play a significant role in habits and routines in many settings including home, school, workplace, and community (American Occupational Therapy Association, 2014; Bennett et al., 2012). There has been some research on immigrants and health, both in the field of occupational therapy (OT) and in health sciences in general, and it has tended to focus on second-generation individuals. To the best of the researchers’ knowledge, research focusing on the attachment and stress-coping for the resilience of the first-generation immigrants is still lacking.

The way a person behaves in response to relationships and bonds with others has been conceptualized as attachment, a concept initially described by Bowlby (1960). Analysis of infant behavior in relation to a mother and a stranger by Ainsworth and Wittig (1969) led to categorization of attachment into three styles: secure, anxious avoidant, and anxious defiant, with a fourth category—disorganized—added later by Main and Solomon (1986). Of the four styles, secure attachment sets the stage for the development of healthy, positive ability to relate to others. The adult attachment has been defined along two dimensions: Anxiety that involves a fear of interpersonal rejection or abandonment, an excessive need for approval from others, and distress when one’s partner is unavailable or unresponsive and attachment avoidance involves fear of dependence and interpersonal intimacy, an extreme need for self-reliance, and reluctance to self-disclose (Brennan et al., 1998; Lopez and Brennan, 2000; Mikulincer et al., 2003). Research among adults has found clear, positive associations between secure attachment and resilience (Rasmussen et al., 2019; Terzi, 2013). Moreover, people with secure attachment styles have more self-confidence and utilize effective stress-coping strategies, demonstrating their resilience (Mikulincer and Florian, 1995). In contrast, having an insecure attachment style is associated with experiences of negative emotions and maladaptive stress-coping strategies, which are not conducive to one’s well-being (Caltabiano and Grosset, 2009; Simonelli et al., 2004).

A key concept used to understand coping with stress is resilience, which is defined as an individual’s capacity for positive adaptation in response to stress (Carver, 1998; Tugade and Fredrickson, 2004), the ability to adapt positively to adversity (Luthar et al., 2000), and the ability to maintain equilibrium during stressful events (Bonanno, 2004). Previous studies showed that better stress-coping strategies are linked to decreased negative feelings, resulting in stronger resilience (Marsiglia et al., 2013; Straiton et al., 2017). A common stressor is how the immigrants adapt in the new context. The experience of leaving a home country to join a host country often results in an increase in this type of stress among first-generation immigrants, which can negatively impact their mental well-being and lead to depression and anxiety (Yakushko et al., 2008). Factors that lead to an increase the stress include coping with the separation from family, discrimination, and loss of social status (Finch et al., 2000). While many immigrants experience a number of the aforementioned stressors, some of them are more resilient than others and thus experience a smoother, more successful resettlement. However, to date, little is known about what accounts for this difference in resilience among first-generation immigrants.

Previous studies have emphasized factors such as an individual’s education (Azmitia et al., 2018; Cavazos et al., 2010), income level (Schwartz et al., 2019), and length of stay (Klokgieters et al., 2020) as possible contributors to resilience. With the immigrant population specifically, the education in a new home country may influence their ability to overcome the various adversities related to the migration process. Individuals with high resilience are known to more likely persist through the stressful demands of college and reach greater academic heights than those who are not as resilient (De la Fuente et al., 2017; Hartley, 2011). In addition, people with higher incomes are more likely to engage in “reserve-building activities” that are intellectually stimulating, health-promoting, and capable of improving one’s flexibility to cope with and withstand stress (Schwartz et al., 2019). Moreover, children from higher-income households are better able to vent emotions to their family members, something considered a factor in a family’s resilience (Radetić-Paić and Černe, 2020). Last, there is evidence supporting the relationship between the length of stay and adaptation within the immigrant population. Miglietta and Tartaglia (2009) found that the longer immigrants in Italy live in the country, the better their linguistic competence with the host language is, which assists with their adaptation. Similar findings were reported with immigrants in Greece and Belgium, where the mediating effects of acculturative variables like integration, assimilation, and separation aid in their adaptation (Besevegis and Pavlopoulos, 2008; Grigoryev and Van de Vijver, 2017). Current literature on the experiences of immigrants to the US shows that length of time in the new country is positively related to immigrants’ acculturation and the maintenance of social supports (Ando, 2014; Dow, 2011).

Occupational therapists have a unique role in the healthcare system, implementing interventions that promote the therapeutic use of occupations to enhance and enable participation (American Occupational Therapy Association, 2014). A deeper understanding of the dynamical interaction among person, occupation, and environment has implications for many professions including occupational therapists whom may look to occupational science for a way of understanding and resolving client-based problems (Whitcomb, 2012). As the US population becomes increasingly multicultural, OT practitioners must be adept at working with people from diverse backgrounds, including first-generation immigrants. In addition, occupational therapists need to develop cultural humility—defined by flexibility; awareness of bias; a lifelong, learning-oriented approach to working with diversity; and a recognition of the role of power in healthcare interactions (Tervalon and Murray-Garcia, 1998)—to improve understanding of and practice with immigrant populations. Obtaining more knowledge about the experiences of adult first-generation immigrants in the US and strategies used to overcome their circumstances may assist in building the cultural humility of occupational therapists and other healthcare professionals. Additionally, this information can inform researchers and clinicians of better practices and help them better understand the experiences of this vulnerable, fast-growing population.

Last, understanding the impact of the transition process adult first-generation immigrants experience may help therapists develop more holistic, client-centered interventions to promote engagement in meaningful occupations (Ashby et al., 2013; Bowden et al., 2018; Oliver et al., 2006). Among first-generation immigrants, the trait of resilience can have a considerable effect on their occupational participation and performance during the transition to a new country (Horowitz et al., 2018). Given the differences in the acquisition of resilience that exist within this population, the current body of evidence is lacking in providing explanations for why these differences occur. This study investigated whether adult attachment and stress-coping mechanisms lead to greater resilience in first-generation immigrants in the US and how the factors of age, education, income, and length of stay contribute to resilience. The research question of this study was, “To what extent do adult attachment styles and stress-coping strategies influence resilience in first-generation immigrants living in the US?” An understanding of how the two factors, adult attachment styles and stress-coping strategies, influence resilience acquisition is essential for expanding the knowledge base, so clinicians, including OT practitioners, can provide the best clinical services when working with this population.

Method

Participants

Participants in this study were first-generation immigrant adults living in the US. The first inclusion criterion was being between the ages of 20–55, chosen as a representative sample because more than half of the foreign-born population in US are in this age range (US Census Bureau, 2020). Second, participants must have been at least 12 years of age or older at the time of immigration to the US. This is important because children who immigrate during later stages of childhood experience more lasting impacts on socioeconomic outcomes later in life compared to children who immigrate at earlier stages of childhood (Hermansen, 2017).

According to sample size estimation with G*Power version 3.1.9.2 (Faul et al., 2007), for linear regression analyses of research questions, a sample of 35 participants was necessary to detect a medium effect and a statistical power of 0.95. Of the 51 people who answered the survey questions, the working sample of this present study comprised 35 participants who answered all of the questions. As shown in Table 1, out of the 35 participants who completed the survey, 26 (74.3%) were between 20 and 39 years old. Fourteen (46.50%) speak English at home, while 16 (53.30%) speak another language. Seven (20%) have an annual household income below US$50,000, eight (22.9%) between US$50,000 and US99,000, and 20 (57.1%) above US$100,000. With respect to education level, 19 participants (54.3%) graduated from a college or university, and 12 (34.3%) graduated from graduate-level schooling. The range of years in which the participants immigrated to the US was between 1983 and 2017, with 30% immigrating between 2006 and 2009. The minimum number of years a participant has lived in the US was 3, and the maximum was 37. On average, the participants had lived in the US for 17.1 years (SD = 10.76).

Table 1.

Demographic data: Participants’ ages, education, annual household income, and languages spoken most at home (N = 35).

Variable n %
Age
 20–29 14 40
 30–39 12 34.4
 40–49 2 5.7
 50–59 7 23.3
Education
 High school or less 2 5.7
 College/university/technical training 2 5.7
 Graduated college/university 19 54.3
 Graduate degree 12 34.3
Annual household income
 Less than US$10,000 1 2.9
 US$10,000–US$49,999 6 17.1
 US$50,000–US$99,999 8 22.9
 US$100,000–US$149,999 6 17.1
 US$150,000–US$199,999 7 20
 Above US$200,000 7 20
Language
 English 14 46.7
 Other 16 53.3
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Instruments

Three self-report instruments for data collection were utilized through Qualtrics: The Experiences in Close Relationship Scale–Short Form (ECR–S), the Coping Orientation to Problems Experienced (COPE) Inventory, and the 14-item Resilience Scale (RS14). The ECR–S (Wei et al., 2007) is a 12-item questionnaire designed to assess a general pattern of adult attachment, which scores for anxiety and avoidance. Participants scored each of these items according to how characteristic it was of them, using a 7-item Likert-type scale with values ranging from strongly disagree to strongly agree. Participants who scored high on either or both of these dimensions were assumed to have an insecure adult attachment style. By contrast, people with low levels of attachment anxiety and avoidance can be viewed as having a secure adult attachment style (Brennan et al., 1998). The ECR–S has been found to possess a stable factor structure and acceptable internal consistency (anxiety, 0.78; avoidance, 0.84), test–retest reliability (anxiety, 0.80; avoidance, 0.83), and construct validity (Wei et al., 2007).

The COPE Inventory is a 60-item measure designed to assess the use of functional and dysfunctional coping strategies (Carver et al., 1989). Participants indicated how often they utilized each presented coping strategy on a 4-point Likert-type scale (1 = I usually don't do this at all; 4 = I usually do this a lot). COPE items can be used to create 15, 4-item subscales: (Positive Reinterpretation and Growth, Mental Disengagement, Focus On and Venting of Emotions, Use of Instrumental Social Support, Active Coping, Denial, Religious Coping, Humor, Behavioral Disengagement, Restraint, Use of Emotional Social Support, Substance Use, Acceptance, Suppression of Competing Activities, and Planning). All subscales are scored such that higher values indicate increased use of particular coping strategy. The COPE has demonstrated acceptable internal consistency ranged from 0.54 to 0.92.

The RS14 (Wagnild, 2009) was used to measure levels of resilience for the first-generation immigrants. This scale consists of 14 items, and each item is answered using a 7-point Likert scale ranging from strongly disagree to strongly agree. The total score is obtained by summing all items, which can range from 14 to 98 points. The higher scores indicate higher resilience. The reliability ranges from 0.89 to 0.96, and construct validity has been supported by positive associations between resilience and self-esteem, active coping, health promotion, psychological well-being, sense of community, social support, purpose in life, optimism, high physical function, goal achievement, and other qualities.

Procedure

Prior to data collection, institutional review board approval for human subjects research was obtained. The researchers created a survey on Qualtrics using questions from the ECR–S, the COPE Inventory, and the RS14. The survey also included questions to gather information about participants’ backgrounds and demographics (age, education, income, how long they have lived in the US, and which year they came to the US). To recruit participants, the researchers created a flyer containing a brief description of the study, the criteria to participate, the invitation link, the QR code to the Qualtrics survey, and the primary investigator’s contact information for any questions. A digital version of the flyer was posted on the social media accounts of the contributing researchers (Facebook, Instagram, Twitter, etc.). Hard copies of the flyer were posted around the Bay area in California and dispatched to people who may be familiar with the immigrant communities. The researchers utilized convenience and snowball sampling and encouraged participants and those who viewed the flyer to share the survey with people fitting the inclusion criteria.

Data analysis

A cross-sectional, descriptive design was used in this study. To answer the research question, the one-way analysis of variance (ANOVA) and simple linear regression analysis were conducted with SPSS 26. To investigate the difference in the attachment, stress-coping, and the resilience between the education level and annual household income, one-way ANOVA was performed to analyze these scores that were rated by the first-generation immigrants. Univariate and bivariate analyses were conducted prior to using simple linear regression for addressing the research question. The dependent variable was the total resilience scores as measured by RS14. The covariate to be controlled included the length the participants lived in the US, and the research variables of interest were three scores from COPE Inventory: positive reinterpretation and growth, denial, and behavioral disengagement.

Findings

In Table 2, the minimums, maximums, means, and standard deviations for the attachment, stress-coping, and resilience items are shown. The skewness statistics are also included.

Table 2.

Attachment, stress-coping, and resilience minimums, maximums, means, and standard deviations (N = 35).

Scale items Minimum Maximum Mean SD Skewness
Anxiety 5 15 9.37 2.47 0.44
Avoidance 12 31 24.31 4.07 −1.37
Positive reinterpretation growth 8 16 12.80 2.26 −0.59
Mental disengagement 5 15 9.37 2.47 0.44
Focus on venting emotions 4 15 9.46 2.79 0.02
Use of instrumental social support 5 16 11.49 2.85 −0.23
Active coping 7 16 12.66 2.66 −0.54
Denial 4 13 5.86 2.53 1.56
Religious coping 4 16 9.91 4.31 −0.14
Humor 4 16 8.17 3.35 0.42
Behavioral disengagement 4 14 6.43 2.54 1.31
Restraint 6 14 10.51 1.96 −0.23
Use of emotional social support 6 16 10.68 2.83 0.22
Substance use 4 12 4.97 2.08 2.23
Acceptance 5 16 11.11 2.10 −0.34
Suppression of competing activities 6 15 10.08 2.22 0.31
Planning 7 16 12.60 2.30 −0.36
Total resilience 33 98 78.94 13.34 −1.37
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One-way ANOVA revealed that there was a statistically significant difference between the avoidance scores and the annual household income (F = 4.28; p = 0.005). Details regarding the avoidance scores are presented in Table 3. The lowest income indicated the lowest avoidance scores. On the other hand, no differences were observed in the resilience and education (F = 2.01; p = 0.13); the resilience and income (F = 1.49; p = 0.22), and all stress-coping scores and education and income.

Table 3.

Means and standard deviation of the mean of the avoidance scores (N = 35).

Statistics
Income Mean (SD) F p
Less than US$10,000 12 (4.1) 4.28 0.005
US$10,000–US$49,999 23.67 (4.5)
US$50,000–US$99,999 26.62 (2.77)
US$100,000–US$149,999 22.83 (4.21)
US$150,000–US$199,999 25.42 (1.81)
Above US$200,000 24.14 (2.34)
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A correlation analysis was performed (see Table 4), focusing on the dependent variable (total resilience), the control variable (years in the US), and the research variables of attachment and coping. The results indicate that the number of years in the US is not significantly related to the total resilience score. In addition, the two attachment scores for anxiety and avoidance from the ECR–S items were not statistically significant in relation to the total resilience score. Therefore, the researchers removed these two factors from the simple linear regression model. Finally, the three scores from the COPE Inventory items (positive reinterpretation growth (r = 0.57, p < 0.05), denial (r = −0.49, p < 0.05), and behavioral disengagement (r = −0.67, p < 0.05)) were significantly statistically related to total resilience. Because of the results of the bivariate analyses of variables, the researchers then moved the three variables of positive reinterpretation growth, denial, and behavioral disengagement in the simple linear regression model.

Table 4.

Correlation matrix of total resilience, number of years in the US, attachment scores from ECR–S, and coping scores from COPE (N = 35).

Variables TR # Yrs in the US AN AV PRG MD FVE ISS AC D RC H BD R ESS SA A SCA P
TR 1 0.24 0.57* −0.24 −0.20 −0.13 0.29 −0.49* 0.07 −0.07 −0.67* 0.04 0.01 0.02 −0.18 0.07 0.35
# Yrs in the US 0.24 1
AN −0.24 1 0.36
AV −0.17 0.17 1
PRG 0.57* 1 −0.04 −0.11 0.06 0.48* −0.31 0.15 0.28 −0.30 0.29 0.28 0.05 −0.04 0.22 0.28
MD −0.24 −0.04 1 0.40* 0.41* −0.05 0.48* 0.07 0.07 0.28 0.45* 0.26 0.31 0.13 0.12 0.05
FVE −0.20 −0.11 0.40* 1 0.43* 0.17 0.21 0.14 0.01 0.03 0.18 0.30 0.17 0.06 0.50* 0.28
ISS −0.13 0.06 0.41* 0.43* 1 0.19 0.13 0.07 0.30 0.12 0.30 0.85* 0.08 0.07 0.11 0.23
AC 0.29 0.48* −0.05 0.17 0.19 1 −0.17 0.31 −0.08 −0.31 0.35 0.17 0.03 0.17 0.42* 0.72*
D −0.49* −0.31 0.48* 0.21 0.13 −0.17 1 −0.13 0.04 0.73* 0.19 0.03 0.54* 0.19 0.17 −0.21
C 0.07 0.15 0.07 0.14 0.07 0.31 −0.13 1 −0.23 −0.36* 0.05 0 −0.12 0.08 0.24 0.29
H −0.07 0.28 0.07 0.01 0.30 −0.08 0.04 −0.23 1 0.37* 0.06 0.37* 0.15 0.30 −0.24 −0.16
BD −0.67* −0.30 0.28 0.03 0.12 −0.31 0.73* −0.36* 0.37* 1 0.12 0.09 0.35 0.21 −0.07 −0.43*
R 0.04 0.29 0.45* 0.18 0.30 0.35 0.19 0.05 0.06 0.12 1 0.35 0.11 0.17 0.19 0.42*
ESS 0.01 0.28 0.26 0.30 0.85* 0.17 0.03 0 0.37* 0.09 0.35 1 −0.06 −0.26 0.22 0.29
SU 0.02 0.05 0.31 0.17 0.08 0.03 0.54* −0.12 0.15 0.35 0.11 −0.06 1 0.21 0.07 −0.07
A −0.18 −0.04 0.13 0.06 0.07 0.17 0.19 0.08 0.30 0.21 0.17 −0.26 0.21 1 −0.34 −0.20
SCA 0.07 0.22 0.12 0.50* 0.11 0.42* 0.17 0.24 −0.24 −0.07 0.19 0.22 0.07 −0.34 1 0.54*
P 0.35* 0.28 0.05 0.28 0.23 0.72* −0.21 0.29 −0.16 −0.43* 0.42* 0.29 −0.07 −0.20 0.54* 1
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TR: total resilience; Yrs: years; AN: anxiety; AV: avoidance; PRG: positive reinterpretation growth; MD: mental disengagement; FVE: focus on venting emotions; ISS: instrumental social support; AC: active coping; D: denial; RC: religious coping; H: humor; BD: behavioral disengagement; R: restraint; ESS: emotional social support; SU: substance use; A: acceptance; SCA: suppression of competing activities; and P: planning.

*Correlation is significant at the 0.05 level (two-tailed).

In order to answer the research question, a simple linear regression analysis of the dependent variable (total resilience) was conducted. The control variables (years stay in the US) and the indicator variables (positive reinterpretation growth, denial, and behavioral disengagement) were entered into the regression model. This approach allowed a determination of whether the stress-coping indicator variables significantly related to the resilience scores of the first-generation immigrants. The regression coefficient (b) estimated for the resilience total score in this model was 60.94, with a standard error of 14.32 and a significance of p < 0.05. The 95% confidence interval for b was calculated as 31.7 to 90.18. The results for the regression model also showed that the R2 associated with this model equals 0.59, suggesting that all variables included explain 59% of the variance in resilience scores and can fit within this model.

Discussion and implications

The purpose of this study was to explore the relationship between adult attachment, stress-coping, and resilience among first-generation immigrants in the US after controlling for length of stay. Previous studies indicated that education, income, and length of time spent in the US should be considered when measuring resilience (Hartley, 2011; Klokgieters et al., 2020; Schwartz et al., 2019). However, the findings of this present study reveal inconsistent results in that education and income were not correlated with resilience. According to the United Census Bureau (2020), median household income was US$68,703. Most of the previous studies have focused on families of low-income and lower-education levels (Bhandari and Alonge, 2020; Meyer, 2020); however, the populations of the present study were involved individuals of higher education and income levels. Therefore, this may explain why there were no significant differences between the resilience and the education and income. On the other hand, the results indicated that the income of the participants may associate with attachment avoidance. The results showed that the participants with higher income may have more fear of dependence and interpersonal intimacy, an excessive need for self-reliance, and reluctance to self-disclose—results consistent with previous studies that showed an association of higher income with people’s anxious avoidant style (Zelekha and Yaakobi, 2020). Last, length of time spent in the US was not significantly correlated with resilience. This differs from previous studies reporting that, over time, immigrants build resilience through the ability to find and utilize resources and adaptive strategies (Dow, 2011; Klokgieters et al., 2020). This discrepancy may be explained by this study’s small sample size and large length of time spent in the US.

In addition, “anxiety” and “avoidance” from the attachment items were found to have no significant relationship with resilience among the first-generation immigrants, which is not congruent with the existing literature (Rasmussen et al., 2019). This study found that adult attachment to romantic partners in first-generation immigrants was not associated with resilience. A factor that may have caused this result is that the participants fall into the young adult age range. When measuring attachment in romantic partnerships, age may be relevant as it is during young adulthood that one begins to have supportive interchanges in such relationships, something that is especially true among immigrants (Chopik et al., 2013; Lantagne and Furman, 2017). Since adult attachment in a romantic partnership varies by age, the findings of this study suggest that the attachment styles of first-generation immigrants may need to be explored in the wider ages range in the future studies.

Further, the findings of this study indicate that the stress-coping strategies of positive reinterpretation growth, behavioral disengagement, and denial are significantly statistically related to resilience. Specifically, the results show that the constructive coping strategy, positive reinterpretation, is positively correlated with resilience, while the negative coping strategies, denial and behavioral disengagement, are negatively correlated with resilience. Lazarus and Folkman (1984) regarded positive reinterpretation as a type of emotion-focused coping aimed at managing distress emotions rather than at dealing with the stressor per se. Denial is a somewhat controversial response that sometimes emerges in primary appraisal, yet it may be useful, minimizing distress and thereby facilitating coping (Breznitz, 1983; Wilson, 1981). Behavioral disengagement involves reducing one’s effort to deal with the stressor, even to the point of giving up the attempt to attain goals with which the stressor is interfering. Behavioral disengagement is identified with terms such as helplessness and in theory is most likely to occur when people expect poor coping outcomes (Carver et al., 1989). These results are congruent with previous work regarding the association between positive stress-coping strategies and increased resilience, as well as positive personal development in the face of stress (e.g., learning the host country’s language or pursuing higher education) to produce positive stress-coping patterns, resulting in resilience (Dow, 2011; Marsiglia et al., 2013; Straiton et al., 2017; Yakushko, 2010).

Zuniga (2002) indicated that positive reinterpretation growth may be applied to the way first-generation immigrants respond to stressors outside of their control (e.g., lack of documentation, language barriers, death of a family member, etc.), and this is consistent with the present study. To employ positive reinterpretation growth, individuals can assess the factors over which they do have control, like emotional responses to stressors that allow them to cope with stressful situations. Similarly, Jones et al. (2002) reported that many immigrants perceive the struggle of migration as a positive event. The ability to reflect on past experiences and identify growth from surviving challenges may improve self-efficacy for overcoming new stressors and challenges, in turn improving resilience (Morland et al., 2008).

This study also found two negative coping strategies, behavioral disengagement and denial, to be negatively correlated with resilience, which is congruent with previous studies. Negative or avoidant coping strategies prevent individuals from addressing stressful events directly, causing them instead to develop helplessness and engage in behaviors such as alcohol use, withdrawal (disengagement), and denial (Holahan and Moos, 1987). Although there is limited research on negative coping strategies and their relationships with immigrant resilience, the findings from the present study align with previous studies indicating that engaging in negative coping strategies can cause detrimental effects. For instance, multiple studies have found that negative coping strategies can impair recovery from mental and physical health challenges (Arraras et al., 2002; González-Freire et al., 2010; Riolli and Savicki, 2010). And first-generation immigrants who have difficulty coping with acculturative stress have been found to engage in detrimental or harmful stress-coping strategies (Yakushko, 2010).

Clinical implications

The findings of this study have several implications for OTs, educators, and clinicians working with first-generation immigrants in the US. The results reveal that positive and negative coping strategies may be linked with resilience. By identifying positive and negative trends between stress-coping strategies and resilience in first-generation immigrants, professionals may address the promotion of positive stress-coping strategies to improve with the resilience, as well as health and wellness, in this population. More specifically, OTs can create health-promoting and client-centered stress management programs that encourage positive reinterpretation growth. Occupational therapists must also be aware that behavioral disengagement and denial may cause negative implications in terms of resilience. They should assist clients in identifying which stress-coping strategies support, and which cause barriers to, resilience. The findings suggest that OTs, educators, and clinicians must collaborate closely with first-generation immigrants to develop individualized treatment plans that stress coping strategies such as positive reinterpretation growth and other constructive stress-coping.

Limitations and future research

Several limitations need to be taken into consideration when interpreting the findings of this study. The sample size was small and so may not be representative of the larger population. The study also utilized convenience and snowball sampling, which may limit the range of the sample’s age-groups, communities, states, languages, incomes, occupations, and educational backgrounds. Further, despite the researchers’ best efforts to minimize the challenges that come with questionnaires, only 35 of the 51 initial respondents fully completed the Qualtrics survey. The entire survey may take up to 60 min to complete and therefore presented a challenge to the participants. Of those who completed it, 53% of them speak a language other than English at home. This may have impacted data collection from recent immigrants, immigrants still learning English, and immigrants unable to read English text.

Finally, the recruitment strategies implemented could have contributed to a low response rate and sample bias. Approximately 68.6% of the initial group of participants completed the survey, with most being from California. Also, the cross-sectional design only informs the researchers about a point in time and limits inference to a causal relationship between adult attachment, stress-coping, and resilience. It is recommended that a longitudinal study be conducted to verify the results of this study. To increase survey response rates, future studies can provide the option of either online or paper survey approach (Pit et al., 2014).

Conclusion

The aim of this study was to investigate the extent to which attachment styles and stress-coping are associated with resilience in first-generation immigrants in the US. This study indicates that having a high income may associate with attachment avoidance in the first-generation population. In addition, after controlling for the length of the first-immigrants’ time in the US, the results indicate that positive reinterpretation growth is positively correlated with resilience, while denial and behavioral disengagement are negatively correlated with it. No significant relationship was found between the two attachment items, anxiety and avoidance, and resilience. The findings suggest that OTs, researchers, and clinicians should build cultural humility to improve understanding of and practice with immigrant populations—especially first-generation immigrants. This study may be used as the basis for further research when addressing resilience in first-generation immigrants and when developing treatment plans containing stress-coping strategies to promote resilience in this population.

Acknowledgements

We would like to thank the participants who took part in this study. We appreciate them contributing their time, thoughts, experiences, and suggestions to make our work better. We would also like to thank our friends and family for their help with the recruitment of participants.

Footnotes

Research ethics: Full ethics approval with IRB Protocol Tracking Number 20016 by San José State University Human Subjects Institutional Review Board.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Contributorship: CF was the main author and principle investigator to write the first draft of the manuscript. CF researched literature, conceived the study, and finalized the topic and research design. All authors were involved in protocol development, gaining ethical approval, patient recruitment, and data analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

ORCID iD

Chiao-Ju Fang https://orcid.org/0000-0002-2229-2556

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