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. Author manuscript; available in PMC: 2026 Jul 11.
Published before final editing as: Child Youth Care Forum. 2025 Jul 11:10.1007/s10566-025-09881-5. doi: 10.1007/s10566-025-09881-5

Depressive Symptoms Over the Course of Adolescence Among Latinx Children of Immigrants and Non-Immigrants and White Youth From Small Towns in the United States

Maria Andrea Oliva 1, Isaac C Rhew 2,3, Anjum Hajat 3, Sabrina Oesterle 4, Katarina Guttmannova 2
PMCID: PMC12372956  NIHMSID: NIHMS2101169  PMID: 40880591

Abstract

Background:

Hispanic/Latinx people comprise 19% of the total United States population and are one of the fastest growing groups in the country. This growth has been particularly notable among youth from rural and small-town communities. Understanding mental health during adolescence in this population can have a significant impact on public health.

Objective:

To compare depressive symptoms during adolescence among Latinx Children of Immigrants (COI), Latinx Children of Non-Immigrants (CONI), and non-Latinx White CONI from small towns in the United States.

Methods:

We used longitudinal data from Grades 6 to 12 from 1,520 youth from 12 rural and small-town communities in seven states. The three study groups were defined by Latinx ethnicity, race, and immigrant generational status based on the child’s and their parents’ country of birth. Using a negative binomial form of the generalized linear mixed model, we evaluated differences in depressive symptoms among the groups and group-by-time interactions to assess whether differences varied across developmental age. Additional models were estimated stratified by sex.

Results:

There were no statistically significant differences in depressive symptoms comparing adolescent Latinx CONI and non-Latinx White CONI to Latinx COI. However, Latinx CONI had significantly elevated depressive symptoms and a steeper decline in symptoms compared to White CONI. Among males, Latino CONI had higher symptom scores than Latino COI and White CONI; however, there were no notable differences among groups in female youth.

Conclusions:

Findings from this study highlight the importance of immigrant generational status when assessing rural and small-town U.S. Latinx youth’s mental health.

Keywords: depressive symptoms, Latinx, Hispanic, adolescents, rural

The United States (U.S.) Latinx/Hispanic population reached 63.76 million in 2022, 19.1% of the total U.S. population, and accounted for 53% of the nation’s growth from 2010 to 2022 (Krogstad et al., 2023; U.S. Census Bureau, Population Division, 2023). Over the last three decades, this growth has been especially rapid among youth from small towns and rural communities (Lichter & Johnson, 2020; Lopez et al., 2018). Understanding Latinx adolescent health and its patterns over time can significantly impact a large portion of the U.S. population and future generations. There is evidence that mental health may be a particular concern in this population, with several studies suggesting that Latinx youth show higher levels of depressive symptoms (Brown et al., 2007; Perry & Frazer, 2020). Nationally, secular trends indicate increases in the prevalence of depression among U.S. adolescents since the early 2000s (Daly, 2022; Mojtabai et al., 2016) with Latinx youth showing a 119.8% increase between 2009 and 2019 (Daly, 2022). Importantly, from 2016 to 2019, Latinx youth had a sharper increase in the prevalence of major depressive disorder compared to other racial and ethnic groups (Substance Abuse and Mental Health Services Administration, 2020a, 2020b, 2020c, 2020d). Within the rural context, Latinx youth may have a higher risk for poor mental health due to higher poverty rates; tight-knit communities that are difficult to integrate into; being a numerical minority and experiencing isolation, discrimination, and marginalization; and a lack of infrastructure and resources to support new arrivals, particularly non-English speaking individuals (Carlo et al., 2016; Crockett et al., 2016; Stein et al., 2016). Moreover, existing research suggests that Latina adolescents experience more depressive symptoms than their male counterparts (Peña et al., 2008) and White, Black, and Asian female adolescents (Brown et al., 2007).

Like other racial and ethnic groups, the Latinx adolescent population is a broad and heterogeneous group with varying backgrounds and experiences. It is important to understand whether certain groups within the Latinx youth population are at greater risk for depression to inform effective, equitable, and culturally applicable prevention strategies. One important characteristic to consider is immigrant generational status, which can serve as a proxy for acculturation (Escobar & Vega, 2000; Peña et al., 2008). We refer to those who were foreign-born or U.S.-born and with at least one foreign-born parent as children of immigrants (COI), such that this term encompasses both first- and second-generation immigrants. Third- and later-generation immigrants, when both parents and child were U.S.-born, are referred to as children of non-immigrants (CONI).

Compared to CONI, children of immigrants tend to have better physical health; however, it is unclear whether this trend holds for mental health (Perreira & Ornelas, 2011). Being a child from a family with mixed immigration status, a possibility specific to COI, may impact mental health outcomes (Eskenazi et al., 2019; Gulbas et al., 2015; Landale et al., 2015; Perreira & Ornelas, 2011). Findings on depression by immigrant generational status among Latinx youth are inconclusive. For example, Peña et al. (2008) studied a nationally representative sample of seventh through 12th-grade students who attended public or private schools in 1995 and found no statistically significant differences in depressive symptoms among first-, second-, and third-generation Latinx youth. Even so, Peña and colleagues note a nonsignificant trend that suggests second-generation Latinx youth had higher levels of depressive symptoms compared to later generations and call for further research into this possible relation. In contrast, another study that focused on youth residing in Chicago neighborhoods between the mid-to-late 1990s found that COI Latinx youth showed higher levels of internalizing symptoms (i.e., depression, anxiety) than CONI (Lara-Cinisomo et al., 2013). Similarly, Kim et al. (2018) found that Latinx COI had significantly higher levels of depressive symptoms than CONI in a 2001 to 2004 sample of sixth-grade students from an urban public school district. However, another study, based on a nationally representative sample from 2007 to 2008, found that Hispanic COI had a lower prevalence of depression compared to Hispanic CONI (Singh et al., 2013). Thus, the role of generational status in depression among Latinx youth requires further investigation. Moreover, to the best of our knowledge, no studies have assessed this relationship across adolescence in a longitudinal cohort (i.e., using repeated measures of an individual at multiple time points) within a rural- and small-town context.

Different theoretical frameworks have been used to inform opposing hypotheses regarding the mental health of children growing up in immigrant families. On the one hand, the acculturative stress framework and the intergenerational acculturation conflict (IAC) model would imply worse outcomes for COI than for CONI. In the acculturative stress framework, COI are believed to have a higher risk of mental health problems than non-immigrant peers (Berry, 1997) because of factors like disrupted social connections, economic disadvantage, and discrimination (Kim et al., 2018). The IAC model posits that when the gap in acculturation between a child and a parent is large, which may be the case for COI, intergenerational conflict or problematic family dynamics can occur, resulting in distress among youth (Peña et al., 2008). For instance, acculturation-related intergenerational and language conflicts have been identified as a primary stressor for COI and their parents (Perreira et al., 2019). The acculturative stress and the IAC models may suggest, then, that COI may be at higher risk of poor mental health than CONI.

On the other hand, the immigrant health paradox framework would suggest worse outcomes for CONI compared to COI. This immigrant health framework posits that those individuals who leave their country of birth and immigrate to a new country have better health outcomes compared to native-born individuals in the receiving country, even though they often face poorer socioeconomic conditions, have less social and material resources, and experience stress related to migration and acculturation (Kim et al., 2018; Oh et al., 2021; Perreira & Ornelas, 2011). This health advantage, though, is thought to dissipate over time and generations (Acevedo-Garcia et al., 2010; Perreira & Ornelas, 2011).

Using longitudinal data collected over 7 years among youth residing in rural and small towns, this study examined depressive symptoms from Grades 6 to 12 (approximately ages 12 – 18) among U.S. Latinx and non-Latinx White adolescents. The primary aim of this study was to examine whether there were differences in depressive symptoms over time (both in terms of overall level as well as trajectory) during adolescence among Latinx children of immigrants (COI), Latinx children of non-immigrants (CONI), and non-Latinx White CONI. Consistent with the acculturative stress framework and IAC model and consistent with the evidence as mentioned earlier that rural context may pose an additional risk for Latinx COI youth (Carlo et al., 2016; Crockett et al., 2016; Stein et al., 2016), we hypothesized that this sample of rural/small-town COI Latinx adolescents would report more depressive symptoms and experience a greater increase in symptoms across adolescence than Latinx and non-Latinx White CONI. As a secondary aim, we explored whether the differences in depressive symptoms between the three groups varied by sex descriptively in stratified analyses.

Methods

Study Population and Procedures

Data were from the Community Youth Development Study (CYDS), a community-randomized controlled trial of the Communities that Care (CTC) prevention system in seven states (Colorado, Illinois, Kansas, Maine, Oregon, Utah, and Washington). Participating communities were rural or small towns (populations between 1,578 and 40,787; Hawkins et al., 2008). This longitudinal cohort study used data from 12 communities in the control arm of the CYDS to avoid potential differences in depressive symptomology due to youth in the experimental condition being exposed to the CTC intervention. Study procedures were approved by the University of Washington’s Institutional Review Board. Written informed consent from parents and written informed assent from minor students were obtained.

The 2003–2004 Grade 5 cohort of public school students from each community was enrolled and prospectively followed over time. Of 2,611 youths eligible to participate, 76.6% (N = 2,002) were enrolled. Of those, 26.6% (n = 532) were Latinx, and 57.4% (n = 1,150) were non-Latinx White. Although children of other racial and ethnic groups participated in the CYDS, their numbers were smaller. Thus, only those who self-identified as Latinx (of any race) or as non-Latinx White CONI were included in this study. Of the Latinx youth, 59.6% were COI (18.4% [n = 98] were first-generation immigrants; 41.2% [n = 219] were second-generation immigrants), and 31.2% (n = 166) were CONI. The vast majority (about 80%) of the Latinx youth reported being of Mexican origin. Latinx participants missing information about immigrant generational status were excluded (9.2%, n = 49). Among the non-Latinx White participants, less than 1% identified as first-generation and 2.6% as second-generation immigrants. These participants (n = 31) were excluded due to the small sample size and considerable variability in their country of origin. Non-Latinx White participants missing information about immigrant generational status were also excluded (n = 72). Thus, all the non-Latinx White participants included in this study were CONI. The final analytic sample included 1,520 participants (n = 313 Latinx COI; n = 166 Latinx CONI; n = 1,041 non-Latinx White CONI).

Primary data for this study were gathered during the participants’ adolescence. Specifically, participants were surveyed every year from Grade 6 (collected in 2005; mean age = 12.1, standard deviation [SD] = 0.4, range: 11 – 14) to Grade 12 (2011), except for Grade 11. Participants were followed even if they left school before graduating or moved away from their original study community. Participants completed a modified version of the Communities That Care Youth Survey (Glaser et al., 2005). For middle and high school study assessments, most youth completed the surveys in class during the school year. If participants were absent, inaccessible, or had moved, alternative administration options were provided (e.g., make-ups, questionnaires sent to new schools, in-person or telephone administration outside of school). The survey was made available online during the 12th-grade wave for participants who had moved or left school before graduating. The study achieved a 90% survey response rate at Grade 12 and higher rates during preceding waves of data collection (ranging between 93% and 96% for Grades 7 to 10).

Measures

Latinx Ethnicity and Immigrant Generation

Latinx ethnicity was assessed by asking participants, “Are you Spanish/ Hispanic/ Latino?” and their race by asking, “What is your race?” in Grade 8. Immigrant/generational status variables were based on the following questions: “In what country were you born?”, “In what country was your mother[/father] born?” which were asked in 2014 (~ age 21) and, if missing, in 2016 (~age 23). If participants indicated they had at least one foreign-born parent, they were categorized as COI. Individuals were characterized as CONI if they indicated that they and their parents were U.S.-born. For Latinx COI and CONI groups, youth of any race category were included, even if missing. However, for the non-Latinx White CONI group, if race was missing, they were excluded (Humes et al., 2011; Parker et al., 2015; Tafoya, 2004).

Depressive Symptoms

To assess depressive symptoms, the four-item Communities That Care Brief Depression Scale (BDS) was administered in Grades 6 to 12. It consists of the following four items: “Sometimes I think that life is not worth it”; “At times I think I am no good at all”; “All in all, I am inclined to think that I am a failure”; “In the past year (12 months), have you felt depressed or sad MOST days, even if you felt OK sometimes?” Participants were asked to rate their agreement with each statement using the following 4-point Likert scale: NO! (0); no (1); yes (2); YES! (3). Item scores were summed to a total symptom score (range: 0 – 12). The BDS has been found to have strong construct and criterion validity (Monahan et al., 2014; Rhew et al., 2016). The BDS showed high internal consistency in this study sample (Cronbach’s alpha > 0.8 across groups at each grade). Furthermore, confirmatory factor analysis indicated that the scale demonstrated measurement equivalence (e.g., no evidence for significant differences in factor structure, item factor loadings, or intercepts) across the three racial-ethnic immigrant generation groups of interest (Delawalla et al., 2025).

Additional Covariates

The following were included as covariates in the final adjusted models: age at Grade 6, study wave as an indicator for developmental age, sex, and parents’ highest level of education. The study wave was coded as an integer from zero to five5, with Wave 0 denoting Grade 6 and Wave 5 denoting Grade 12. Age was measured as a continuous variable in years and transformed such that the minimum age in the sample was set as zero. Sex was self-reported as either male or female. Participants were asked about the highest level of education completed by their father and mother, and the highest of the two was used in analyses (less than high school [0], completed high school [1], some college [2], completed college, graduate or professional degree [3]). This parental education variable was used as a proxy for socioeconomic status (Liberatos et al., 1988). Individuals missing any of these covariates (0.7%, n = 10) were excluded from analyses, and other forms of missingness are addressed below.

Analytic Plan

For our primary analytic approach, we used generalized linear mixed models (GLMMs) with a random intercept, which accounted for the potential correlation of repeated measures within an individual over time. Because GLMMs with maximum likelihood estimation allow for incomplete outcome data across repeated assessments, all participants with at least one wave of data were included in the analyses. GLMMs provide unbiased estimates in the presence of missing data over time, assuming data are missing at random or missing completely at random (Atkins et al., 2013). Because the BDS score is a non-negative integer and it showed a strong positive skew at all waves that followed a count distribution with evidence of overdispersion, we used a negative binomial count regression form of the GLMM (Atkins et al., 2013; Atkins & Gallop, 2007). The negative binomial model connects covariates to the outcome via a natural log link function. As is common with count regression, we exponentiated coefficients to yield count ratios (also called rate ratios), which describe the proportional change in the count associated with a 1-unit increase in the covariate (Atkins & Gallop, 2007).

The model included racial-ethnic immigrant generation as an indicator variable, with Latinx COI as the reference group in primary models. This allowed for comparisons of Latinx CONI and non-Latinx White CONI with Latinx COI, consistent with hypotheses. We also compared Latinx CONI and non-Latinx White CONI in additional models by switching the reference group to Latinx CONI. All models were adjusted for study wave, age, sex, and parents’ highest education. In sensitivity analysis, we included the study community at enrollment as 11 indicator (also known as dummy-coded) variables in the statistical models to account for potential clustering (Online Resource 1). Substantive results remained unchanged relative to models without their inclusion. However, sex-stratified models did not converge when the community variables were included, likely due to the reduced sample size. To compare slopes of depressive symptoms over time, we included a COIstatus-x-time (study wave) interaction. As additional sensitivity analyses, we explored the inclusion of a random effect for time to allow the effect of time to vary by participant. However, this did not result in significantly improved model fit, and we present results from models with only the random intercept. To explore whether sex modified the differences in depression symptoms among these three immigrant generational status groups, the fully adjusted GLMMs were estimated separately by sex. Interaction terms were not tested due to limited statistical power and challenges with interpretation. Thus, the results of the stratified analyses were intended to be descriptive. All GLMMs were run with R statistical software, version 3.6.1, using the “lme4” package, and the figure was created in R using the “sjPlot” package (Bates et al., 2015; Lüdecke et al., 2023).

Results

All racial-ethnic immigrant generation groups had a similar mean age at Grade 6 of approximately 12 years (Table 1). Overall, the groups had a similar proportion of males and females. While approximately two-thirds of the full sample had a parent with at least some college education, the distribution of parents’ highest education differed across groups. Among the Latinx COI group, 36% had parents with less than a high school education, and only 15% had a parent who completed a college degree. Approximately 18% of the Latinx CONI group’s parents had less than a high school education, but about one-third of them had a college graduate parent. The White CONI group had the smallest proportion (4%) of parents with less than a high school education and the largest proportion (50%) of parents with a college-level education. Unadjusted mean BDS scores and standard deviations for each group at each grade are shown in Table 2.

Table 1.

Distribution of Participant Characteristics by Racial-Ethnic Immigrant Generation Group and Full Sample

Characteristic Latinx children of immigrants
n = 313		 Latinx children of non-immigrants
n = 166		 White children of non-immigrants
n = 1,041		 Full sample
N = 1,520
Grade 6 age in years, mean (SD) 12.1 (0.4) 12.1 (0.4) 12.1 (0.4) 12.1 (0.4)
Female sex, n (%) 164 (52.4%) 85 (51.2%) 517 (49.4%) 766 (50.4%)
Parents’ highest education, n (%)
 Less than high school 113 (36.1%) 29 (17.5%) 46 (4.4%) 188 (12.4%)
 High school 96 (30.7%) 36 (21.7%) 200 (19.2%) 332 (21.9%)
 Some college 56 (17.9%) 46 (27.7%) 266 (25.6%) 368 (24.2%)
 ≥ College graduate 48 (15.3%) 55 (33.1%) 529 (50.8%) 632 (41.6%)
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Note. SD: Standard deviation

Table 2.

Mean and Standard Deviation of Brief Depression Scale (BDS) Score at Each Wave by Racial-Ethnic Immigrant Generation Group and Full Sample

mean (SD)
Grade Latinx children of immigrants Latinx children of non-immigrants White children of non-immigrants Full sample
Grade 6 4.5 (3.2) 4.6 (3.2) 3.9 (3.3) 4.1 (3.3)
Grade 7 3.9 (3.3) 4.6 (3.8) 3.6 (3.3) 3.8 (3.3)
Grade 8 4.5 (3.5) 4.9 (3.6) 3.8 (3.5) 4.1 (3.5)
Grade 9 4.2 (3.6) 4.1 (3.6) 3.6 (3.3) 3.8 (3.4)
Grade 10 3.6 (3.4) 3.5 (3.3) 3.4 (3.3) 3.5 (3.3)
Grade 12 3.5 (3.3) 3.0 (2.9) 3.1 (3.1) 3.1 (3.1)
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Note. SD: Standard deviation

When comparing BDS scores across groups in adjusted models, before the inclusion of interactions with time, there was little evidence for differences in depressive symptoms across adolescence among Latinx CONI or White CONI compared to Latinx COI (Table 3). However, when we compared White CONI to Latinx CONI (Table 4), White CONI had a statistically significant 13% lower symptom score than Latinx CONI (CR = 0.87; 95% CI: 0.76, 0.99). Further, adolescents showed a 5% decrease in depressive symptoms per year (“study wave”; CR = 0.95, 95% CI: 0.94, 0.96).

Table 3.

Negative Binomial Generalized Linear Mixed Model Results for Association of Racial-Ethnic Immigrant Generation Group With Depressive Symptoms With Latinx COI as the Reference Group, Adjusted for Covariatesa

Variable Count ratio (95% CI)
COI status
 Latinx COI (ref.) --
 Latinx CONI 1.11 (0.95, 1.30)
 White CONI 0.96 (0.86, 1.08)
Study wave 0.95 (0.94, 0.96)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for sex, age at Grade 6 (years) and parent’s highest education.

Table 4.

Negative Binomial Generalized Linear Mixed Model Results for Association of Racial-Ethnic Immigrant Generation Group With Depressive Symptoms With Latinx CONI as the Reference Group, Adjusted for Covariatesa

Variable Count ratio (95% CI)
COI status
 Latinx CONI (ref.) --
 Latinx COI 0.90 (0.77, 1.05)
 White CONI 0.87 (0.76, 0.99)
Study wave 0.95 (0.94, 0.96)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for study wave, sex, age at Grade 6 (years) and parent’s highest education.

We next examined whether the change in depressive symptoms over time (slopes) differed by immigrant generational status (Table 5). We did not find strong evidence for differences in change in depressive symptoms over time when comparing the Latinx CONI or White CONI youth to Latinx COI youth. However, when comparing Latinx CONI to White CONI (Table 6), we observed a statistically significant interaction between White CONI status and time (CR = 1.04; 95% CI: 1.00, 1.07). To visualize the interaction, model-predicted BDS scores over time and by racial-ethnic immigrant generation status are shown in Figure 1. Latinx CONI (green line) showed higher initial BDS scores than White CONI (blue line) and then decreased at a greater rate from Grade 6 to 12 such that the difference between Latinx CONI and White CONI became attenuated over time.

Table 5.

Adjusteda Negative Binomial Generalized Linear Mixed Model Results for Interactions of Racial-Ethnic Generation Group by Study Wave With Latinx COI as the Reference Group

Variable Count ratio (95% CI)
COI status
 Latinx COI (ref.) --
 Latinx CONI 1.17 (0.98, 1.40)
 White CONI 0.94 (0.83, 1.06)
Study wave 0.94 (0.92, 0.96)
 Latinx CONI-x-study wave 0.98 (0.94, 1.01)
 White CONI-x-study wave 1.01 (0.99, 1.04)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for sex, age at Grade 6 (years) and parent’s highest education.

Table 6.

Adjusteda Negative Binomial Generalized Linear Mixed Model Results for Interactions of Racial-Ethnic Generation Group by Study Wave With Latinx CONI as the Reference Group

Variable Count ratio (95% CI)
COI status
 Latinx CONI (ref.) --
 Latinx COI 0.85 (0.71, 1.02)
 White CONI 0.80 (0.68, 0.93)
Study wave 0.92 (0.89, 0.95)
 Latinx COI*study wave 1.02 (0.99, 1.06)
 White CONI*study wave 1.04 (1.00, 1.07)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for sex, age at Grade 6 (years) and parent’s highest education.

Fig 1.

Fig 1

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Model-Predicted Depressive Symptom Score and 95% Confidence Interval Over Time by Racial-Ethnic Immigrant Generation Group

The results of the adjusted models comparing overall levels of depressive symptoms across racial-ethnic immigrant generation groups stratified by sex are shown in Table 7. Among female youth, we did not find statistically significant differences in depressive symptoms when comparing Latinx CONI and White CONI to Latinx COI. Nor did we find a statistically significant difference when comparing female White CONI to female Latinx CONI. Similarly, when examining males there was no significant difference between male White CONI and male Latinx COI. However, there was a significant difference in depressive symptoms between Latinx CONI and Latinx COI, with male Latinx CONI showing a 33% higher symptom score than Latinx COI across study waves (CR = 1.33; 95% CI: 1.04, 1.70). There was also a statistically significant difference when comparing male White CONI to male Latinx CONI, where White CONI had a 21% lower symptom score (CR = 0.79; 95% CI: 0.64, 0.97).

Table 7.

Sex-Stratified Adjusteda Negative Binomial Generalized Linear Mixed Model Results With Latinx COI as the Reference Group

Female Male
Variable Count ratio (95% CI) Count ratio (95% CI)
COI status
 Latinx COI (ref.) -- --
 Latinx CONI 0.96 (0.79, 1.17) 1.33 (1.04, 1.70)
 White CONI 0.90 (0.78, 1.04) 1.05 (0.88, 1.25)
Study wave 0.96 (0.95, 0.98) 0.93 (0.91, 0.94)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for study wave, sex, age at Grade 6 (years) and parent’s highest education.

There was no statistically significant interaction between immigrant generational status and time in either male or female subgroups when comparing the Latinx CONI or White CONI to Latinx COI (Table 8). Likewise, we did not observe a significant interaction with time when comparing White CONI to Latinx CONI in either male (CR = 1.05; 95% CI: 1.00, 1.11) or female youth (CR = 1.02; 95% CI: 0.98, 1.07). Thus, when stratified by sex, the change over time in depressive symptoms did not appear to differ significantly in the Latinx CONI and White CONI when compared to the Latinx COI or in the White CONI when compared to the Latinx CONI.

Table 8.

Sex-Stratified Adjusteda Negative Binomial Generalized Linear Mixed Model Results for Interaction of Racial-Ethnic Generation Group by Study Wave With Latinx COI as the Reference Group

Female Male
Variable Count ratio (95% CI) Count ratio (95% CI)
COI status
 Latinx COI (ref.) -- --
 Latinx CONI 0.96 (0.77, 1.21) 1.47 (1.12, 1.95)
 White CONI 0.86 (0.73, 1.01) 1.04 (0.85, 1.27)
Study wave 0.95 (0.93, 0.98) 0.93 (0.90, 0.97)
 Latinx CONI*study wave 1.00 (0.95, 1.04) 0.95 (0.90, 1.01)
 White CONI*study wave 1.02 (0.99, 1.05) 1.00 (0.96, 1.05)
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Note. CI: Confidence interval; COI: Children of immigrants; CONI: Children of non-immigrants.

a

Model adjusted for sex, age at Grade 6 (years) and parent’s highest education.

Discussion

This longitudinal cohort study of youth growing up in rural communities or small towns compared overall levels and changes in depressive symptoms over the course of adolescence among Latinx children of immigrants (COI), Latinx children of non-immigrants (CONI), and non-Latinx White CONI. We did not find evidence to support our primary study hypothesis that adolescent Latinx COI would endorse more depressive symptoms. However, when compared to Latinx CONI, we observed a significantly lower depressive symptom score among White CONI across adolescence. Our finding of non-Latinx White adolescents reporting fewer depressive symptoms than Latinx CONI is consistent with results from other studies on U.S. youth. Overall, ethnically and racially minoritized youth residing in the United States appear to show a higher prevalence of depression than White youth (Anderson & Mayes, 2010). Another study that used data from a nationally representative longitudinal sample found that White adolescents showed the lowest levels of depressive symptoms relative to Hispanic, Black, and Asian adolescents across adolescence into young adulthood (Brown et al., 2007). Although model-predicted values suggested a relatively modest difference of 0.4 in the CTC-BDS score between groups, this could translate to an important difference in the number of cases within populations (Carey et al., 2023), which would have important implications for allocating resources for intervention and prevention.

Contrary to our expectations, however, we did not find evidence for elevated depressive symptoms across time among Latinx COI compared to Latinx CONI. If anything, findings suggest that depressive symptoms were higher among the Latinx CONI, although these results were not statistically significant at p < .05. These findings may be consistent with the immigrant health paradox framework (Kim et al., 2018; Oh et al., 2021; Perreira & Ornelas, 2011). Explanations for this health advantage among immigrants include that those who emigrate tend to be a self-selected healthier group to begin with, that foreign-born immigrants may practice healthier behaviors than their U.S.-born counterparts, that foreign-born immigrant children may have lower levels of acculturation and a stronger ethnic identity, and that children of immigrants live within a protective environment of two-parent families, multigenerational households, strong social support, familism, and other cultural values and traditions (Harker, 2001; Landale et al., 2011; Perreira & Ornelas, 2011; Piña-Watson et al., 2019; Potochnick & Perreira, 2010; Teruya & Bazargan-Hejazi, 2013; Velasco-Mondragon et al., 2016). More research is needed to explore whether the immigrant health paradox also applies to mental health outcomes, as most studies that support this framework focus on physical health outcomes, externalizing psychological outcomes, risk behaviors, and academic outcomes (Sirin et al., 2013). Additionally, most studies on Latinx immigrants that support the immigrant health paradox with respect to depression have been conducted in adults (Lara-Cinisomo et al., 2013; Peña et al., 2008).

We observed some differences in associations when stratifying results by sex. Among males, Latinx CONI had a higher symptom count than Latinx COI and White CONI. In our rural and small-town sample of Latina youth, we did not find notable differences in depressive symptom scores in any of the group comparisons. This was contrary to what was found in nationally representative samples (Brown et al., 2007; Peña et al., 2008). Most sex-stratified analyses yielded nonsignificant results, except for two comparisons. First, male Latinx CONI had a higher symptom score than male White CONI, which is consistent with Brown and colleagues’ (2007) finding that White males had the lowest depressive symptom levels in their nationally representative longitudinal sample of White, Black, Hispanic, and Asian adolescents. Second, male Latinx CONI had a higher symptom count than male Latinx COI across adolescence, possibly indicating that the gendered rules and expectations for children that have been observed in Latinx families may play a role (Goldston et al., 2008; Ramirez et al., 2017; Umaña-Taylor & Updegraff, 2007). Additionally, dissonant views between Latinx generations (i.e., children and caregivers) about gender roles may lead to family conflict, resulting in more distress (Céspedes & Huey, 2008). Future studies are needed to better understand potential differences across the groups, by sex, and their underlying mechanisms.

There are several important limitations to this study that should be considered. The results are based on older data gathered between 2005 and 2011, which can impact external validity. However, this study captures an important period of secular increases in the prevalence of depression among U.S. adolescents that may have begun during this time (Daly, 2022; Mojtabai et al., 2016) and continued beyond these years (Goodwin et al., 2022). Since most of the Latinx study participants were of Mexican origin, our results may not be generalizable to U.S. Latinx groups originating from other Latin American countries. Additionally, we could not examine differences by country of origin, which may have masked significant subgroup differences. This hindered our ability to assess heterogeneity within the Latinx population, which is often viewed as monolithic (Umaña-Taylor & Fine, 2001; Weinick et al., 2004). While the focus on rural and small-town communities is important, it is also important to note that our data were collected from 12 small towns in seven different U.S. states, and the experience of immigrant families in each of these communities can vary considerably. For instance, social networks, acceptance of immigrants in the community, healthcare access, linguistically concordant resources or services, type and degree of discrimination, education and employment opportunities, or sanctuary laws may vary by community (Hainmueller et al., 2017; Immigrant Legal Resource Center, 2023; Perreira & Ornelas, 2011; Schumacher et al., 2023), and their specific effects could be examined in future studies. Due to the small sample size (n = 98) of the first-generation immigrant group and because, by study design, all participants had to have arrived in the United States by the time they were 11 years of age, we categorized first- and second-generation Latinx immigrant youth as children of immigrants. This precluded our understanding of the variability between the first- and second-generation groups. Although our overall sample was large (N = 1,520), the Latinx COI (n = 313) and Latinx CONI (n = 166) groups were relatively small compared to the White CONI group (n = 1,041). Lastly, we may not have been able to detect statistically significant changes over time and differences in sex-stratified analyses due to limited statistical power. Finally, the depressive symptom measure used in this study consisted of only four items and did not capture common symptoms, including somatic complaints and anhedonia. However, this measure was intended for use in a survey consisting of numerous behavioral measures for communities to capture as a general indicator of depressive symptoms in their youth populations. Thus, lengthier measures were not feasible. Further, it should be noted that three of the four items used in the CTC-BDS focused on symptoms related to negative cognitions, which have been shown to have particularly strong discriminatory properties in research of other youth depressive symptom scales (Sharp et al., 2006).

However, our project adds to the body of research focused on immigrant generational status and adolescent depression in important ways. First, most research on depression and other internalizing problems among immigrant youth has focused on early adolescence and has used cross-sectional data (Sirin et al., 2013). The longitudinal data enabled us to investigate differences in depressive symptoms across six time points, spanning from early to late adolescence. Second, the small-town context of our project contributes evidence toward the knowledge gap of depression among Latinx youth in rural areas of the United States. Rural populations tend to be marginalized, understudied, and underserved. Accordingly, there is a paucity of research on rural Latinx youths’ mental health (Crockett & Carlo, 2016). Furthermore, during the time frame of this study, the Latinx population in rural and small towns in the United States doubled (Taylor & Jones, 2020). Moreover, the secular trends in the prevalence of adolescent depression continued to rise during and beyond the study period (Daly, 2022; Goodwin et al., 2022; Mojtabai et al., 2016), underscoring the importance of focusing on this mental health outcome. Third, we considered the intersectionality of sex, ethnicity, and immigrant generational status. We found more depression symptoms among Latinx children of non-immigrants (CONI), particularly among males, when compared to Latinx children of immigrants (COI) and non-Latinx White CONI.

Thus, results from this longitudinal study of rural and small-town U.S. Latinx COI, Latinx CONI, and non-Latinx White CONI suggest that prevention and intervention efforts in early adolescence may be needed, particularly for Latinx CONI youth. Culturally relevant programs have been developed and shown to work either by addressing internalizing symptoms directly (Borrero & Przeworski, 2024; Pina et al., 2019) or by affecting risk factors common to a broad spectrum of co-occurring mental and behavioral health issues (Perrino et al., 2014; Pina et al., 2019). For example, Familias Unidas, an evidence-based Latinx parent and family-centered intervention created initially to address adolescent externalizing behavior problems (Pantin et al., 2009; Prado et al., 2012), has also been found efficacious in reducing internalizing symptoms, including depression, among Latinx adolescents by addressing parent-child communication (Perrino et al., 2014). Moreover, culturally suitable screening, prevention, and treatment strategies aimed to address stressors that are specific to Latinx CONI youth could help improve their mental health and well-being. To that end, this line of work could be further informed by qualitative data from interviews or focus groups with Latinx youth, allowing them to describe their experiences in their own voice, an important area of future research.

Supplementary Material

Oliva_et_al_2025_supplementary_materials

Acknowledgements:

The authors gratefully acknowledge CYDS panel participants for their continued contribution to the longitudinal study. We also acknowledge the Social Development Research Group (SDRG) Survey Research Division for their hard work maintaining high panel retention, and Mr. John Briney for his data management support.

Funding:

This work was supported by the National Institute on Drug Abuse of the National Institutes of Health [R01DA048827]. The data was collected with funding from the National Institute on Drug Abuse of the National Institutes of Health [R01DA015183, R01DA044522]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. These organizations had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Footnotes

Competing Interests: The authors have no relevant financial or nonfinancial interests to disclose.

Compliance with Ethical Standards: Study procedures were approved by the University of Washington’s Institutional Review Board.

Consent to Participate: Written informed consent was obtained from the parents of the panel students for the participation of their child in the study. Students were provided with assent statements outlining their rights as research participants in the study and they signed if they agreed to participate.

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Supplementary Materials

Oliva_et_al_2025_supplementary_materials
NIHMS2101169-supplement-Oliva_et_al_2025_supplementary_materials.pdf (156.4KB, pdf)

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