The Protective Role of Culture: Familism, Depressive Symptoms, and Stress Among U.S. and Foreign-born Latina Mothers

Abstract

Achieving health equity for U.S. Latinas requires a better understanding of how cultural factors influence mental health, especially during life transitions. This study examined one cultural factor, familism, in relation to depressive symptoms and stress among U.S. and foreign-born Latinas during early parenting. We also tested whether associations varied by nativity. Data were drawn from a sample of 420 U.S.- and foreign-born Latina mothers participating in a large, multisite, community-based study in the US. Familism was measured at 12 months postpartum across three facets: (a) family obligations, (b) family as a source of support, and (c) family as referents. Depressive symptoms and perceived stress were measured at 12 and 18 months after birth using standardized scales. Multiple linear regression analyses indicated that one year after the birth of a child, higher familism was associated with lower depressive symptoms and lower perceived stress. Six months later, only the family support facet of familism remained significantly associated with lower perceived stress, but not with lower depressive symptoms. U.S.-born Latinas endorsed lower levels of familism compared to foreign-born Latinas. Moderation analyses showed that familism was associated with lower perceived stress at 18 months after birth among U.S.-born Latinas, but not among foreign-born Latinas. Familism may play a protective role against depression and stress in the early parenting period, particularly for U.S.-born Latina mothers. These findings highlight the importance of Latinx culture as a potential source of resilience and can inform efforts to improve mental health among childbearing Latinas.

Maternal depression and stress after the birth of a child are common and can severely affect a mother’s well-being, psychosocial functioning, and child development (Glasheen et al., 2015; Obrochta et al., 2020). Approximately 27% of women in the US report symptoms of postpartum depression, anxiety, and stress (Obrochta et al., 2020), with even higher rates among Latinas living in the US (Edwards et al., 2021). In a large study of 3,952 Latina women, 43% of participants had elevated symptoms of depression in the immediate postpartum period, defined as a few days after giving birth (Kuo et al., 2004). In another study of 1,662 Black, Latina, and non-Latina White mothers, 12% of Latina mothers reported postpartum depressive symptoms, compared to 8% in the overall sample (and 7% among non-Latina White mothers; Rich-Edwards et al., 2006). These disparities have been linked to structural and psychosocial stressors, including financial hardship, discrimination, and domestic violence, which disproportionately affect low-income Latinas (Lara-Cinisomo et al., 2016; Ponting et al., 2020a; Ramos et al., 2022). A meta-analysis by Edwards and colleagues (2021) also identified low level of partner or father support as the strongest predictor of postpartum depression among Latinas, along with prenatal depression, intimate partner violence, economic stress, and general social support associated with levels of risk.

Latina women, particularly immigrants, also face significant barriers to detecting and treating postpartum depression (Lara-Cinisomo et al., 2018; Robidoux et al., 2023). Cultural norms surrounding mental health may influence the way that symptoms are recognized and expressed (Forcén et al., 2023). For example, Latina mothers may rely on subjective emotional experiences rather than clinical definitions to identify depression; by contrast, healthcare providers often assess risk using standardized factors such as social support, stress, and maternal age (Chaudron et al., 2005). Many Latinas who report depressive symptoms do not seek formal help, often attributing their distress to situational stressors such as family responsibilities, work demands, or financial pressure (Callister et al., 2011). These perceptions, coupled with stigma, limited social support, and financial constraints, further reduce access to care (Ponting et al., 2020a). Such barriers highlight the importance of identifying protective factors shaped by Latina mothers’ lived experiences.

Perceived Stress in the Postpartum Period

Perceived stress, defined as a person’s appraisal of their life as unpredictable, uncontrollable, and overwhelming, plays a key role in understanding maternal mental health (Cohen et al., 1983). Unlike objective measures of stress (e.g., biomarkers), perceived stress captures a subjective, psychological response that has been shown to predict mental health outcomes (Flores et al., 2008). The postpartum period is a particularly sensitive time during which perceived stress may intensify, especially among mothers facing socioeconomic adversity. For example, younger age, lower educational attainment, and financial strain have all been associated with higher levels of perceived stress and depressive symptoms among new mothers, (Callister et al., 2011). These factors are known to contribute to postpartum depressive symptoms (Edwards et al., 2021); however, fewer studies have explored the role of culturally specific protective factors that may buffer against poor mental health during childbearing.

Role of Familism

Latina mothers may rely on cultural values that promote psychological resilience and offer protection against stress during the perinatal period. One such value is familism, a core cultural value that emphasizes emotional closeness and interdependence and prioritizes family needs over individual ones (Sabogal et al., 1987; Campos & Kim, 2017). Cultural values such as familism shape not only how individuals understand social relationships but also how they perceive and access support (Campos & Kim, 2017). Familism is comprised of three facets: familial obligation (a sense of duty to support family members emotionally and materially), perceived family support (the belief that family members are dependable sources of help), and family as a referent (making decisions around family expectations and values; Sabogal et al., 1987). Together, these facets reflect a collectivistic orientation that contrasts with individualistic norms (Campos & Kim, 2017; Sabogal et al., 1987).

Prior studies have indicated that familism is associated with fewer internalizing symptoms, including lower levels of depression, anxiety, and negative affect, particularly among Latinx adolescents and young adults (Cahill et al., 2021). Among college students, familism is indirectly associated with better psychological health through greater closeness to family and perceived support (Campos et al., 2014); among older Latinx adults, a higher level of familism is linked to fewer depressive symptoms (Chavez-Korell et al., 2014).

Although previous research has primarily focused on youth, college students, and older adults, a small but growing body of literature suggests that familism may also play a role for mothers during pregnancy and after birth (Campos et al., 2008; Luecken et al., 2009). In a study of pregnant Latinas, Campos and colleagues (2008) found that higher levels of familism were associated with greater perceived social support and lower levels of perceived stress and pregnancy anxiety, suggesting that strong family connections can serve as a protective factor. Familism has also been linked to health-promoting behaviors during the perinatal period (Luecken et al., 2009). In a retrospective study of 483 low-income Latina mothers, those endorsing higher levels of familism began prenatal care earlier than those with lower levels of familism, which is associated with better outcomes for both mothers and infants. Together, these findings suggest that familism can support both emotional well-being and healthy behaviors during the perinatal period, making it an important factor to consider when addressing mental health and stress among Latinas following the birth of a child.

Familism is often measured as a single construct, but its facets (i.e., familial obligation, family support, and family as a referent) may influence mental health in different ways. For example, familial obligations may function as stressors rather than buffers (​​Mendez-Luck et al., 2016), especially when mothers are expected to care for extended family members while managing newborn responsibilities. By contrast, perceived family support may be particularly beneficial during postpartum, as families adjust to the arrival of a new child in the home (Corona et al., 2023). Moreover, family as a referent could reinforce identity and belonging during the transition to motherhood (Stein et al., 2014). Separately examining these subcomponents may help clarify the different ways in which familism may influence maternal well-being.

Nativity, Acculturation, and Cultural Adaptation

Nativity status (defined here as being U.S.-born or foreign-born) plays a significant role in shaping how cultural values such as familism are maintained or shift over time. Nativity status is often used as a proxy for acculturation, which refers to a dynamic, bidirectional, and multifaceted process through which individuals adopt, modify, or reject the cultural norms, values, and behaviors of a dominant society, while also retaining aspects of their heritage culture (Berry & Sam, 1997). Foreign-born Latinas are more likely to have been socialized in environments where familism is strongly emphasized, which may at least partially explain their higher endorsement of these values compared to U.S.-born Latinas (Campos et al., 2008). On the other hand, U.S.-born Latinas may be more exposed to individualistic values that can shift traditional family beliefs.

These cultural adaptations can shape how familism influences mental health and may help explain why foreign-born Latinas often demonstrate better health outcomes despite greater socioeconomic disadvantages, a pattern called the Latina Epidemiological Paradox (Abraído-Lanza et al., 2005). Acculturative stress theories also suggest that bicultural identities can create emotional strain, particularly when cultural values such as familism are undervalued in the host country (Schwartz et al., 2010). These frameworks provide context for understanding how familism operates for U.S.- versus foreign-born Latinas in the postpartum period.

The Present Study

This study builds on research suggesting that familism may serve as a cultural protective factor during major life transitions (i.e., motherhood), when emotional challenges are common and support from others is especially important. Although prior studies have linked familism to lower levels of depressive symptoms and stress in youth, college students, and older adults, no studies to date have examined these associations in the postpartum period, particularly among Latinas. Most maternal mental health research focuses on non-Hispanic White, middle-class women, limiting its generalizability to low-income and racially and ethnically diverse populations. The present study addresses these gaps by examining cross-sectional and longitudinal associations between familism, depressive symptoms, and perceived stress in the two years after childbirth among U.S.- and foreign-born Latina mothers living in the US. Familism, depressive symptoms, and perceived stress were measured at 12 months postpartum, with depressive symptoms and stress measured again six months later, when children were 18 months old. These time points¹ were selected based on evidence that elevated levels of maternal stress and depression can persist beyond the first year (Vliegen et al., 2014; Woody et al., 2017) and may continue for up to three years after birth (Marcus & Heringhausen, 2010; Putnick et al., 2020), making them clinically relevant windows for understanding maternal mental health.

Our predictions were as follows: First, we hypothesized that levels of familism (both overall and across subscales) would be higher among foreign-born than U.S.-born Latina mothers, as U.S.-born Latinas are more likely to be acculturated to the American values of individualism and personal achievement over collective responsibilities (Campos et al., 2007). Previous research has suggested that different aspects of familism are retained or diminished at various rates, highlighting the importance of separately examining the subscales (Campos et al., 2019).

Second, we hypothesized that higher levels of familism (both overall and across subscales), irrespective of nativity, would be associated with lower levels of depressive symptoms and perceived stress at both 12 and 18 months postpartum, consistent with prior research highlighting its protective role (Campos et al., 2008; Cahill et al., 2021; Chavez-Korell et al., 2014). Individually examining the subscales allows us to examine whether certain aspects of familism (e.g., family support vs. familial obligation) drive these associations.

Third, we predicted that the protective effects of familism would be stronger among foreign-born Latina mothers than for U.S.-born Latinas at both time points. Familism may be more beneficial in contexts where it is normative, which may be the case for foreign-born Latinas, compared to U.S.-born Latinas who may experience tension between holding familial values and the dominant American value of independence (Diaz & Niño, 2019). By separately analyzing subscales, we can explore whether certain aspects of familism are more protective for foreign-born Latinas relative to their U.S.-born counterparts.

Method

Participants

This study utilized data collected by the Community Child Health Network (CCHN), a community-based participatory research network study. Data and study materials for the CCHN study are available on the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Data and Specimen Hub (DASH): https://dash.nichd.nih.gov/study/1649. Data collection took place from 2003 to 2008 in five U.S. sites (Baltimore, Chicago, Los Angeles, North Carolina, and Washington, DC). A total of 2,510 mothers met the criteria for inclusion in the CCHN cohort. Study eligibility criteria were as follows: mothers (a) self-identify as African American, Hispanic, or non-Hispanic White; (b) are between 18 and 40 years of age; (c) are willing to complete interviews in either English or Spanish; (d) are residents in one of the identified communities for at least six months; and (e) have given birth to four or fewer children (including the new infant), with no immediate intention to be surgically sterilized following birth. Interested mothers were provided with study information by trained research staff, and informed consent was obtained for those who agreed to participate (see O’Campo et al. (2016) for additional recruitment details).

The current study included a subset of participants enrolled in the CCHN maternal cohort who self-identified as Latina and completed an interview one year after the birth of a child (12 months postpartum) and six months later (18 months after birth). The original CCHN maternal cohort included 607 participants who self-identified as Latina, of which 420 completed interviews at 12 and 18 months after birth; therefore, the present analytic sample included 420 participants. ​​Regarding the differences between the current analytic sample (n = 420) and the full sample of Latinas in the CCHN cohort (n = 607), participants in this sample were older, had completed more years of education, and reported higher income than the full sample. No other sociodemographic differences emerged between the two samples.

Procedure

The Institutional Review Board of each site approved all protocols and study procedures. Women were recruited in the hospital after birth in four sites (Baltimore, Chicago, Los Angeles, and Washington, DC) and in prenatal clinics in one site (North Carolina). Community members who were bilingual and experienced or trained in community research or clinical service delivery conducted face-to-face interviews in participant homes at three time points following the birth of a child, at one month, six months, and 12 months, and by telephone at 18 months after birth. Familism was measured at 12 months. Participants were interviewed in the language of their choice; 59.5% of the women (n = 250) completed the survey in Spanish and 40.5% completed the survey in English (n = 170). Participants completed questionnaires with the assistance of a trained interviewer. Questionnaires were completed either over the phone or during home visits, with the data collected via paper-and-pencil format. This study used data collected at the 12-month (T1) and 18-month (T2) time point visits.

Measures

Demographics

In the first interview, participants reported their age, self-identified ethnicity/race, birthplace, age when they moved to the US, and number of years that they had lived in the US at one month after the birth of a child. Race and ethnicity were not assessed separately. Data assessing whether mothers were first- or second-generation immigrants were not collected. Education was assessed at the first study visit by asking participants an open-ended question: “How many years of education have you completed?”

At Time 1, annual household income was assessed by asking participants to report the “total income from all sources” before taxes in the previous year using the following scale: (1) less than $0 (loss), (2) $0 (none), (3) $1–$999, (4) $1,000–$1,999, and so on to (36) $1,000,000 or more. The income transformation is described in detail in Hooker et al. (2023). To create a continuous gross household income variable, the midpoint of each of the 36 categories was used (O’Campo et al., 2016). In addition, per capita household income was computed by dividing gross household income by the number of household members. Per capita household income was adjusted for variability in the regional cost of living using indices from the Council for Community and Economic Research. The Data Coordination and Analysis Center at Pennsylvania State University imputed missing data for the income variable and adjusted for household size and cost of living. Household income adjusted for cost of living was positively skewed, the bottom and top 5% in the data were transformed to be equal to the 5th and 95th percentile values, respectively. Higher values represented higher income.

Participant Characteristics

Approximately 72% of the sample was born outside of the US (n = 304). The most commonly reported countries of origin were Mexico (64%), El Salvador (18%), and Honduras (6%). The average age when foreign-born participants moved to the US was 16.8 years old with a wide range (SD = 7.0, range: < 1–35), and they had been living in the US for an average of 9.6 years again with a wide range (SD = 6.6, range: < 1–35). In addition, tests of differences between those who were U.S.-born or not revealed that women who were born outside the US were significantly older, had a lower average per capita household income, and had fewer years of education. On average, U.S.-born Latinas were 23.58 years old (SD = 4.76) compared to foreign-born Latinas who were 26.49 years old (SD = 5.14). The average income was $10,503.15 (SD = 14320.54) for U.S.-born Latinas and $7,440.22 (SD = 9171.08) for foreign-born Latinas. Mean years of education for U.S.-born women was 12.22 (SD = 2.11) and 10.83 (SD = 2.81) for foreign-born women.

Familism

The 14-item Familism Scale (Sabogal et al., 1987) was used for measuring the participants’ familial orientation in terms of (a) responsibilities within the family (familial obligation), (b) family as a source of support (support from family), and (c) family as a referent (family as a referent). Participants completed the familism scale 12 months after the birth of their child. Items included “One should make great sacrifices to guarantee a good education for his/her children;” “When one has problems, one can count on the help of relatives;” and “Much of what a son or daughter does should be done to please the parents.” Consistent with prior work (Hooker et al., 2023), the item “One can count on help from relatives to solve most problems” was omitted due to a low factor loading and a translation error that may have altered its intended meaning. Removing this item improved the scale’s reliability and cultural validity for our sample. While this may slightly reduce overall scores, it improves the scale’s internal consistency and cultural validity for our sample. Participants rated each item on a 5-point Likert scale to indicate agreement or disagreement (1 = strongly agree; 5 = strongly disagree).

Analyses by Campos et al. (2019) supported the psychometric properties of the three subscales in U.S. Latinxs (in both English and Spanish), and their analytic recommendations were followed in the present study. Each subscale and the total score (family total) were averaged, with higher scores indicating higher familism values. Cronbach’s coefficient alphas for the familism subscale ranged from .53 to .82 for foreign-born mothers and from .48 to .74 for U.S.-born mothers. For the total familism scale, Cronbach’s alpha was .67 among foreign-born mothers and .65 among U.S.-born mothers. For the subscales, Cronbach’s alpha scores were as follows: familial obligation (.66 for foreign-born and .67 for U.S.-born mothers), family support (.82 for foreign-born and .74 for U.S.-born mothers), and family as a referent (.53 for foreign-born and .48 for U.S.-born mothers).

Depressive Symptoms

Two measures assessed symptoms of depression, chosen to be appropriate for the time periods administered. Interviews included the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) at all time points (i.e., one, six, and 12 months after birth). This scale consists of 10 items regarding the severity of common depressive symptoms on a 0–3 scale. Respondents were asked to select one option out of four for each item, which best describes how they have been feeling in the past seven days. An example item was, “I have blamed myself unnecessarily when things went wrong.” The Cronbach’s coefficient alpha was .78 for foreign-born mothers and .84 for U.S.-born mothers at 12 months postpartum. This instrument is validated for use within one year postpartum in English (Smith-Nielson 2018) and Spanish (Garcia Esteves et al., 2003).

At 18 months after birth, participants completed the nine-item version of the Center for Epidemiological Studies Depression Scale (CES-D; Santor & Coyne, 1997), a widely utilized self-report measure in the general population. The CES-D scale consists of nine items that measure depressive symptoms during the past seven days. Participants were asked to rate on a 4-point response scale (1 = rarely or none of the time; 4 = most or all of the time) how often they felt depressive symptoms. Sample items included “I felt sad” and “I felt depressed.” The Cronbach’s alpha was .87 for foreign-born mothers and .83 for U.S.-born mothers. This measure is well-validated and commonly adopted in community studies (Mohebbi et al., 2018) with a validated Spanish translation (Soler et al., 1997). Based on past studies in perinatal samples, there is substantial overlap between the EPDS and CES-D (Tandon et al., 2012).

Perceived Stress

The Perceived Stress Scale (PSS; Cohen et al., 1983) was used to measure the degree to which participants felt that the demands of their life exceeded their available resources to cope with those demands at every time point of the study. This measure is most commonly used for appraising stress, with extensive validation information in general populations and in pregnant and postpartum samples (Guardino et al., 2018; Kaufman-Shriqui et al., 2020) and is validated in Spanish (Remor et al., 2006). Using a 5-point Likert scale (1 = never; 5 = almost always), each of the 10 items asked participants to rate the frequency with which they perceived feeling overwhelm, inability to cope, uncontrollability, or other aspects of demands that exceed resources. At 12 months postpartum, Cronbach’s alpha was .82 for foreign-born mothers and .86 for U.S.-born mothers; at 18 months, the values were .84 and .87, respectively.

Data Analysis Strategy

First, we calculated the frequencies for categorical variables and means, standard deviations, and ranges for continuous variables. We then used t-tests to determine the differences between the U.S.- and foreign-born mothers’ age, education, and income. The U.S.- and foreign-born Latina mothers significantly differed in age, education, and income; thus, these demographic variables were included as covariates in all analyses. Age, education, and income were selected as covariates in the analyses based on prior work suggesting a possible relationship to familism (Fuller-Iglesias & Antonucci, 2016). Consistent with the models of the social determinants of health, stressful conditions, including financial stress, may cause disparities in health and health behaviors in vulnerable populations (Guardino et al., 2018; Dunkel Schetter et al., 2013). Hypotheses about differences in familism, depressive symptoms, and perceived stress between U.S.- and foreign-born mothers were also tested using independent sample t-tests. We used Pearson’s correlations to ascertain whether a higher level of familism was correlated with lower levels of depressive symptoms and perceived stress in both U.S.-born and foreign-born mothers concurrently and six months later.

Finally, to test whether the associations were stronger in U.S.- or foreign-born mothers, we grand mean centered the familism variables and created interactions between the place of birth and familism (Aiken & West, 1991). Eight separate regressions were run to test the interactions between familism and nativity (familism total X place of birth, family obligation X place of birth, support from family X place of birth, and family as a referent X place of birth) with depressive symptoms and perceived stress. If the interactions were significant, then we conducted simple slope analyses to determine the strength of the associations for U.S.- and foreign-born Latinas. The variables used for regression imputation were date of birth; language preferred for the study; ethnic/racial group; whom the individual lives with; relationship status; type of health care; sources of income; number of people in or financially contributing to the household; place of birth; years of education; employment; and hours worked per week. Statistical analyses were conducted using Stata 18 (StataCorp, 2023).

No formal power analysis was performed prior to data collection. The sample size was based on available resources and broader project goals. However, our final sample size (N = 420) was consistent with prior studies in this area (Guardino et al., 2018; Campos et al., 2008; Lara Cinisomo et al., 2019b; Luis Sanchez et al., 2020). Additionally, a post-hoc power analysis was conducted to determine achieved power, calculated in G*Power. These analyses indicated that all analyses achieved a recommended 0.80 power, based on obtained effect sizes, number of predictors, and sample size (Faul et al., 2007). By default, Stata handles missing data through a listwise deletion of missing values, such that only cases with non-missing values for the main variables were included in the analyses. No missing data were imputed. Two sites did not conduct the 18-month interview and three others participated by phone, which contributed to missing data on key variables. Table 1 shows the missing values on the variables of interest and attrition rates at 12 months postpartum and 18 months postpartum.

Table 1.

Proportion of Missing Data and Attrition on Primary Study Variables

Variable	N (Total)	Missing (n)	Missing (%)
[1] Familism Total	420	0	0
Family as Referents	420	0	0
Family Obligations	420	0	0
Support from Family	420	0	0
[2] Depressive Symptoms 12 Mo PP (T1)	420	0	0%
[3] Depressive Symptoms 18 Mo PP (T2)	325	95	22.6%
[4] Perceived Stress 12 Mo PP (T1)	419	1	.2%
Perceived Stress 18 Mo PP (T2)	325	95	22.6%

Note. N (Total) reflects the number of participants in the full sample. Missing (%) was calculated as (Missing n / N Total) × 100. [1] The 14-item Familism Scale (Sabogal et al., 1987) assesses cultural values related to familial obligation, support, and referents, using items rated on a Likert-type scale. Higher scores indicate stronger familistic values. The Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987) is a 10-item screening tool for postpartum depressive symptoms, with higher scores indicating greater symptom severity. [3] The Brief Center for Epidemiologic Studies Depression Scale (CES-D; Santor & Coyne, 1997) is a 10-item self-report measure assessing depressive symptoms experienced in the past week. [4] The Perceived Stress Scale (PSS; Cohen et al., 1983) is a widely used 10-item measure evaluating the degree to which situations in one’s life are appraised as stressful.

Results

Is place of birth associated with depressive symptoms and perceived stress?

As shown in Table 2, t-tests comparing U.S.- to foreign-born mothers showed no significant difference between U.S-born (M = 5.30, SD = 4.8) and foreign-born mothers (M = 5.53, SD = 4.21) in terms of depressive symptoms 12 months after a birth. At 18 months, no significant difference was found between U.S.-born (M = 9.51, SD = 3.47) and foreign-born mothers (M = 8.84, SD = 3.37) in terms of depressive symptoms. Meanwhile, there was a significant difference in perceived stress at 12 months after birth. Foreign-born mothers (M = 14.46, SD = 6.04) reported a higher level of perceived stress compared to U.S.-born mothers (M = 13.14, SD = 6.33). However, no significant difference were found between U.S.-born (M = 12.76, SD = 6.47) and foreign-born Latinas (M = 12.82, SD = 6.06) perceived stress at 18 months after birth.

Table 2.

Main Variable t-tests for U.S.-Born and Foreign-Born Mothers

	U.S. Born		Foreign-born
	M	SD	M	SD	t-test	p	df	Cohen’s d
Depressive Symptoms 12 Mo PP	5.30	4.8	5.53	4.21	−.47	.64	418	4.39
Depressive Symptoms 18 Mo PP	9.51	3.47	8.84	3.37	1.55	.12	323	3.40
Perceived Stress 12 Mo PP	13.14	6.33	14.46	6.04	−1.96	.05*	417	6.12
Perceived Stress 18 Mo PP	12.76	6.47	12.82	6.06	−.08	.94	323	6.17
-	-		-		-

Do familism levels vary by place of birth?

As presented in Table 3, foreign-born mothers had higher levels of familism (M = 50.49, SD = 5.60) than U.S.-born mothers (M = 49.17, SD =5.48). Foreign-born Latinas also had higher subscale scores on family as a referent (M = 15.12, SD = 3.05) compared to the U.S.-born group (M = 13.96, SD = 2.83). However, no significant difference in familial obligation emerged between foreign-born (M = 24.45, SD = 2.71) and U.S.-born Latinas (M = 24.09, SD = 2.81). Furthermore, no significant difference in support from family emerged between foreign-born (M = 10.92, SD = 1.86) and U.S.-born Latinas (M = 11.12., SD = 2.05).

Table 3.

Main Variable t-tests for U.S.-Born and Foreign-Born Mothers

	U.S. Born		Foreign-born
	M	SD	M	SD	t-test	p	df	Cohen’s d
Familism Total	49.17	5.48	50.49	5.60	−2.16	.032*	418	5.57
Family as Referents	13.96	2.83	15.12	3.05	−3.55	.001***	418	2.99
Family Obligations	24.09	2.81	24.45	2.71	−1.20	.23	418	2.74
Support from Family	11.12	2.05	10.92	1.86	.99	.32	418	1.91

Are familism levels associated with depressive symptoms and perceived stress?

Table 4 shows the correlations between familism (total and subscales) and depressive symptoms and perceived stress at 12 and 18 months postpartum. Higher familism total and subscale scores on familial obligation and support from family were associated with lower levels of depressive symptoms and perceived stress in U.S.-born mothers (see Figure 1 for the associations between total familism score and depressive symptoms and perceived stress at 12 months postpartum). In foreign-born mothers, support from family was associated with lower levels of depressive symptoms.

Table 4.

Correlations among Demographics, Familism, Depressive Symptoms and Perceived Stress

Variables	1. Age	2. Education	3. Income	4. Familism Total	5. Family Obligations	6. Support from Family	7. Family as Referents	8. EPDS PP 12 Mo	9. PSS PP 12 Mo	10. CESD PP 18 Mo	11. PSS PP 18 Mo
1. Age	-	.30*	.30*	.02	.02	.02	.00	.04	.02	.07	−.07
2. Education	.08	-	.26*	−.02	.12	.10	−.20*	−.15	−.15	−.11	−.04
3. Income	.27***	.23***	-	−.18†	−.13	−.02	−.19*	.15	.06	.01	−.03
4. Familism Total	.07	−.11†	.02	-	.77***	.65**	.64***	−.20*	−.23*	0.06	−.22†
5. Family Obligations	.08	−.02	.01	.76*	-	.51***	.07	−.27**	−.19*	0.13	−0.19
6. Support from Family	.05	−.01	.06	.55***	.40***	-	.09	−.31***	−.31***	−0.05	−.22*
7. Family as Referents	.03	−.15*	.00	.74***	.20***	.11†	-	.08	−.04	−0.01	−0.09
8. EPDS T3	−.06	−.02	.07	−.06	−.04	−.15*	.01	-	.71***	.33*	.50***
9. PSS T3	−.20	−.00	.03	−.11*	−.12*	−.24**	.02	.61***	-	.32*	.53***
10. CESD T4	−.02	−.04	−.04	−.04	−0.04	−0.13*	0.04	.36***	.27***	-	.36*
11. PSS T4	−.09	.03	−.08	0.00	−0.03	−0.16*	0.10	.42***	.49***	.53***	-

^***p < .001;

^**p < .01;

^*p < .05;

^†p < 0.10

Note. Correlations above the diagonal are for U.S.-born women. Correlations below the diagonal are for foreign-born women.

Figure 1.

Scatterplots of associations between total familism score and depressive symptoms (A) and perceived stress (B) at 12 months postpartum.

Regarding perceived stress, higher familism total, familial obligation, and support from family scores were associated with a lower level of perceived stress in foreign-born mothers at 12 months after the birth. Six months later, when children were 18 months old, familism total and support from family were associated with lower perceived stress scores in U.S.-born mothers (see Figure 2). However, for foreign-born mothers, only support from family was associated with lower levels of perceived stress and depressive symptoms.

Figure 2.

Scatterplot of correlation between total familism score and perceived stress at 18 months postpartum among U.S. born mothers.

Do associations between familism with depressive symptoms and perceived stress vary by place of birth?

As shown in Table 5, regression analyses at 12 months postpartum indicated a marginally significant place of birth X familial obligation interaction in predicting depressive symptoms. Higher levels of familial obligation were associated with lower levels of depressive symptoms for U.S.-born (b = ˗.43, p = .01) but not for foreign-born women (b = ˗.07, p = .46). No interactions were found between place of birth X familism subscales predicting depressive symptoms (see Table 4 for the main effects models). At 18 months after birth, the interactions between place of birth X familism total (β = .03, t(321) = .44, p = .66), familial obligation (β = .08, t(321) = 1.10, p = .27), support from family (β = ˗.003, t(321) = ˗.04, p = .97), and family as a referent (β = ˗.02, t(321) = ˗.20, p = .84) predicting CES-D scores² were not significant.

Table 5.

Linear Regressions for Familism and Place of Birth Predicting Depressive Symptoms at 12 Months PP

	U.S.-born	Foreign-born	U.S.-born	Foreign-born	U.S.-born	Foreign-born	U.S.-born	Foreign-born
	b (β)
Age	−.05 (−.06)	−.05 (−.05)	−.04 (−.05)	−.05 (.05)	−.06 (−.07)	−.05 (−.06)	−.05 (−.06)	−.05 (−.06)
Education	−.14 (−.09)	−.14 (−.08)	−.13 (−.08)	−.12 (−.07)	−.14 (−.09)	−.13 (−.08)	−.12 (−.08)	−.13 (−.08)
Income	.00* (.13)	.00* (.12)	.00* (.12)	.00* (.12)	.00* (.14)	.00* (.12)	.00* (.13)	.00* (.14)
Familism Total	−.07† (−.09)	−.04 (−.05)	-	-	-	-	-	-
Family Obligations	-	-	−.1* (−.10)	−.07 (−.04)	-	-	-	-
Support from Family	-	-	-	-	−.34** (−.15)	−.18 (−.08)	-	-
Family as Referents	-	-	-	-	-	-	.03 (.02)	−.00 (−.00)
Place of birth	−.32 (−.03)	−.40 (−.04)	−.31 (−.03)	−.39 (−.04)	−.21 (−.02)	−.17 (−.02)	−.23 (−.02)	−.15 (−.02)
Familism * Place of birth	−.13 (−.08)		−.36† (−.12)		−.50 (−.12)		.16 (.06)
Constant	7.97	7.89	7.74	7.67	8.09	8.00	7.84	7.89
R 2	0.03	0.03	0.03	0.04	0.04	0.05	0.02	0.02
F	1.82	1.76	2.20	2.58	2.92	2.76	1.45	1.45
R2 change	0.00		0.01		0.00		0.00

^*p < 0.05;

^†p < 0.10

There were no significant place of birth X familism total or subscale interactions in predicting perceived stress at 12 months postpartum (see Table 6). However, at 18 months after birth, a significant interaction occurred between place of birth X familism total (β = ˗.16, t(321) = ˗2.50, p = .01) in predicting a higher level of perceived stress. Higher scores for familism total were associated with lower levels of perceived stress for U.S.-born women (β = ˗.30, p = .02) but not for foreign-born Latinas (β = .02, p = .80). Additionally, a marginal interaction emerged between place of birth X family as a referent (β = ˗.13, t(321) = ˗1.95, p = .05). Higher family as referents were marginally associated with a higher level of perceived stress for foreign-born (b = .23, p = .09) but not for U.S.-born women (b = ˗.31, p =.20). In terms of perceived stress 18 months after birth, the interactions between place of birth X familial obligation (β = ˗.10, t(321) = ˗1.35, p = .18) and support from family (β = ˗.11, t(321) = ˗1.78, p = .08) were not significant.

Table 6.

Linear Regression for Familism and Place of Birth Predicting Perceived Stress at 12 Months PP

	U.S.-born	Foreign-born	U.S.-born	Foreign-born	U.S.-born	Foreign-born	U.S.-born	Foreign-born
	b (β)
Age	−.01 (−.01)	−.01 (−.01)	−.01 (−.01)	−.05 (.05)	−.03 (−.03)	−.03 (−.02)	−.02 (−.02)	−.02 (−.02)
Education	−.13 (−.06)	−.13 (−.06)	−.10 (−.04)	−.12 (−.07)	−.12 (−.05)	−.12 (−.05)	−.10 (−.05)	−.10 (−.05)
Income	.00 (.04)	.00 (.04)	.00 (.04)	.00* (.12)	.00 (.05)	.00 (.04)	.00 (.05)	.00 (.04)
Familism Total	−.16* (−.14)	−.11† (−.10)	-	-	-	-	-	-
Family Obligations	-	-	−.30* (.13)	−.07 (−.04)	-	-	-	-
Support from Family	-	-	-	-	−.70*** (−.22)	−.55*** (−.17)	-	-
Family as Referents	-	-	-	-	-	-	−.00 (−.00)	.03 (.02)
Place of birth	−1.32† (.10)	−.143† (−.10)	−1.27† (−.09)	−.39 (−.04)	−1.07† (−.08)	−1.03† (−.07)	−1.19 (−.09)	−1.26† (−.09)
Familism * Place of birth	−.16 (−.10)		−.13 (−.03)		−.48 (−.08)		−.15 (−.04)
Constant	16.13	16.02	15.66	15.64	16.35	16.28	15.95	15.91
R 2	0.03	0.03	0.03	0.03	0.06	0.06	0.01	0.01
F	2.95	2.69	2.88	2.43	5.85	5.28	.87	.80
R2 change	0.00		0.00		0.00		0.00

^***p < .001;

^*p < 0.05;

^†p < 0.10.

Note. Four separate linear regression models to test interactions between nativity x familism with perceived stress reported.

Discussion

This study examined the associations between a cultural value, familism, with measures of depressive symptoms and perceived stress during the early parenting period in a large sample of 420 U.S.-born and foreign-born Latinas living in multiple locations around the US. Our first hypothesis was partially supported. As expected, foreign-born Latinas reported higher levels of familism compared to U.S.-born Latinas, particularly on the referent subscale, which reflects the extent to which individuals look to relatives as behavioral and attitudinal referents. These findings suggest that family cultural values may be especially important in the years following childbirth. Our results are consistent with Hooker et al. (2023), finding that although scores for familial obligation and family support were similar across foreign-born Latinxs, U.S.-born Latinxs, and European Americans, foreign-born Latinxs endorsed significantly higher values of family as a referent in a larger sub-sample of mothers and fathers from the CCHN study. In our study, however, U.S.- and foreign-born Latinas did not differ in their endorsement of familial obligation or support from family, suggesting that these facets do not change with US acculturation.

Our second hypothesis was also partially supported. In the overall sample of U.S.- and foreign-born Latinas, familism was associated with lower levels of depressive symptoms and perceived stress at 12 months after birth. However, by 18 months, only one facet of familism, support from family (defined as viewing family members as reliable providers of help and support) remained significantly associated with lower levels of perceived stress. This pattern may suggest that familism plays a salient role in the first year after childbirth, when family involvement is closely tied to both childcare and cultural traditions that celebrate motherhood in communities where this role is highly valued (Lucas, 2010).

These results also highlight the need to examine possible boundary conditions and effect sizes of familism’s protective outcomes during this life transition. Previous research has shown that Latinas at higher risk for postpartum depression report a lower level of satisfaction with family support one month after birth, but not during pregnancy, emphasizing the postpartum period as a particularly sensitive time for social support (Sheng et al., 2010). Future studies should explore the issue of whether the influence of familism on depressive symptoms and stress is strongest immediately after childbirth, especially among women from cultural backgrounds that hold strong values towards childbearing and the maternal role (Durand, 2011).

Our third hypothesis was not supported. We found only one marginally significant interaction: familial obligation predicted lower levels of depressive symptoms one year after birth for U.S.-born, but not for foreign-born, Latinas. This finding is interesting, given that foreign-born Latinas reported higher levels of familism, and they did not differ from U.S.-born women in endorsing familial obligation. The use of nativity status, defined by place of birth, may have overlooked heterogeneity in migration experiences (Kirby et al., 2011; Urquia et al., 2010). Factors such as age at migration, reason for migration (e.g., economic opportunity, family reunification, escape from violence, or political persecution), and whether family members supported migration could shape the way that familism is internalized and expressed (Lara Cinisomo et al., 2019a; Pew Research Center, 2024a; Park & Kim, 2019). These contextual factors may help explain why foreign-born Latinas, despite endorsing higher levels of familism overall, did not show the expected protective associations with depressive symptoms.

Another possible explanation relates to timing. Familism was measured one year after childbirth, when mothers may have returned to employment outside the home. Foreign-born Latinas, who may adhere more strongly to traditional gender roles (Albuja et al., 2017; Pew Research Center, 2024b), could experience guilt or conflict about working outside the household. Future research should examine traditional gender roles as a possible explanation for this finding and their broader influence during the postpartum period.

Consistent with our findings at one year after birth, the support from family subscale was associated with depressive symptoms among both U.S.- and foreign-born Latinas at one year and again at 18 months following birth. These results are consistent with prior research indicating that family support is associated with lower levels of depressive symptoms among Latinas (Albuja et al., 2017; Edwards et al., 2021; Kuo et al., 2004). We also found a significant interaction between overall familism and place of birth in terms of predicting stress, and a marginally significant interaction for the family as a referent subscale. However, these associations were not as expected. Familism was a stronger protective factor against stress for U.S.-born Latinas than for Latinas born outside the US.

Strengths

A key strength of this study is its focus on Latina mothers, a population that remains underrepresented in maternal and child health research, especially those from low-income backgrounds (Lara-Cinisomo et al., 2015; Lebron et al., 2023). The literature on maternal mental health has largely focused on non-Hispanic White, middle-class, well-educated samples, thereby limiting the generalizability of findings to more diverse populations. This is especially concerning given that Latinas may experience challenges such as immigration-related stress, language barriers, discrimination, financial hardship, and limited access to culturally congruent care, all of which can shape both risk and resilience during the transition to motherhood (Cervantes et al., 2020; Lara Cinisomo et al., 2016; Torche & Sirois, 2019; Wiley et al., 2023).

The current study points to the importance of culturally-specific protective factors (i.e., familism) in shaping maternal mental health among Latina mothers. Our findings suggest that familism may buffer against depressive symptoms and stress, particularly among women who have been found to be more likely to attribute their depressive symptoms to external stressors such as work and family responsibilities (Callister et al., 2011). By highlighting the role of familism, the present study contributes to ongoing efforts towards a more nuanced, culturally responsive approach to maternal mental health research and care.

Limitations

The limitations of this study should also be noted. Future research should examine whether the different measures of familism, as well as broader collectivist values, may influence maternal health outcomes during the sensitive childbearing years. We were also unable to determine whether the associations we observed were specific to mothers who not only reported depressive symptoms but also received a clinical diagnosis of depression. Attrition across time points was also limitation, as the sample size decreased (two sites did not conduct the 18-month interview and three others used phone-only participation), resulting in missing data on key variables (see the Methods for details). Additionally, we used listwise deletion to handle missing data, which may reduce statistical power and potentially bias results if data are not missing completely at random. We also did not adjust for multiple comparisons as doing so would reduce statistical power and likely increase the risk for Type II error (Nakagawa, 2004). We acknowledge the importance of replicating these findings using correction procedures to reduce the likelihood of error rates.

Another limitation was the lack of more nuanced measures of US acculturation. It is possible that both U.S.- and foreign-born Latina mothers may emphasize interdependence, in contrast to the individualism that is often observed among U.S.-born women of European descent. With more extensive measures of behavioral and attitudinal acculturation, different patterns that are relevant to the improved understanding of cultural adaptations may have emerged. Similarly, having data on whether U.S.-born participants were first, second, or third generation would have provided insight into how generational status shapes familism and postpartum health. The original study also did not distinguish between race and ethnicity, limiting our ability to examine differences in experiences across subgroups.

In addition, depression was measured using two different instruments across study time points. Each instrument was appropriate for its timing, and the measures demonstrated an overlap (Tandon et al., 2012); however, using multiple tools might have contributed to variability in our findings. Moreover, the internal consistency of the 14-item Familism Scale was relatively low. Although the scale has been validated in prior studies with Latinx populations (Campos et al., 2019), our findings suggest that certain items may have been interpreted differently or were less salient among participants. Future research should assess measurement performance across diverse subgroups within broader ethnic categories through item-level analysis, measurement invariance testing, or qualitative studies.

Finally, this study relied on an older dataset. Nonetheless, the data come from a large, nationally representative sample of Latina mothers, a population that is both diverse and difficult to reach, particularly low-income Latinas. Given the challenges of recruiting this population and the depth of data collected, this dataset offers insights that are rarely captured in more recent, smaller studies. As such, the findings remain highly relevant and contribute meaningful knowledge to an understudied area of maternal and child health research.

Implications

These findings have implications for policy, clinical practice, and future research. At the policy level, interventions supporting postpartum Latinas may benefit from tailoring content to address both shared cultural values such as familism and differences by nativity (Ponting et al., 2020a). For example, public health campaigns could emphasize the value of family support while also recognizing barriers that U.S.-born Latinas may encounter in accessing it. Understanding these experiences is important for developing interventions that address the specific needs of Latina mothers (Ponting et al., 2020a). For clinical practice, assessing familism-related values during perinatal care may help providers identify gaps in support as their patients transition to motherhood (Lara Cinisomo et al., 2010). For future research, replication in diverse Latina samples, with more detailed information about migration history and acculturative stressors, can help clarify the ways in which cultural values may shift across generations.

Conclusions

Our findings add to the growing literature showing that familism is a beneficial cultural value for both U.S.- and foreign-born Latina women living in the US. This study provides new evidence of the importance of familism during the early parenting period and highlights implications for maternal mental health. Although U.S.-born Latinas reported lower levels of familism on average compared to their foreign-born counterparts, familism still appeared to operate as a protective factor for psychological well-being among U.S.-born Latinas. Further research should determine whether familism and related cultural values have the same effects across subgroups of Latinas, especially as the heterogeneity within this population is increasingly acknowledged (Carvajal et al., 2024; Mitsdarffer et al., 2024). Focusing on cultural values may offer an effective entry point for improving the way that distress is recognized and addressed during early parenting. Latinas have been historically unrepresented in maternal and child health research; thus, continued efforts are required to understand both the onset and long-term course of depressive symptoms in this growing population.

What is the public significance of this article?

Understanding how cultural values like familism support mental health during early parenting can help identify strengths within the Latina community. This study shows that feeling supported by family may help reduce stress and depressive symptoms among Latina mothers, especially those born in the United States, highlighting the importance of culture in maternal mental health.