Latina/o Children Living with an Immigrant Mother with Depression: Developmental and cultural Nuances in Recognition and Coping.

Abstract

The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers’ mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationships with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths’ attributions and coping strategies. This inquiry involved focus groups with 12 participants ages 9 to 16 years to explore their perspectives on maternal depression. All youth had participated in a 12-week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture-specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.

Economic pressure, anti-immigrant climate, acculturative stress, and exposure to interpersonal trauma can destabilize Latina immigrant mothers’ psychological well-being (Heilemann, Coffey-Love, & Frutos, 2004; Valdez, Abegglen, & Hauser, 2013). These cumulative stressors have been associated with increased risk for depression among women, a concern given the large percentage of children living in immigrant Latina/o households (Falicov, 2007). In spite of the burden on women and the negative effects of maternal depression on youth and family relationships, immigrant Latina/o families report low rates of mental health service utilization (Cabassa, Zayas, & Hansen, 2006). Thus, the needs of youth living with mothers with depression may largely go unaddressed. To promote resilience among youth, we must understand how they experience their home environments, make meaning of their mothers’ condition, and cope with disrupted family life. Our study seeks to fill this gap in the literature by exploring the experiences of youth who had previously participated in a family-focused program for Latina mothers with depression and the family.

Impact of Maternal Depression on Youth

Maternal depression can contribute to poor outcomes for Latina/o children. Corona, Lefkowitz, Sigman, and Romo (2005) found that Mexican-origin youth with mothers with depressive symptoms had higher rates of internalizing and externalizing behavior, and substance abuse than Mexican-origin youth with asymptomatic mothers. Maternal depression has been a more direct and stable predictor of Latina/o youth mental health outcomes than economic pressure (Dennis, Parke, Coltrane, Blacher, & Borthwick-Duffy, 2003) and community violence (Aisenberg, Trickett, Mennen, Saltzman, & Zayas, 2007). Aside from genetic factors, maternal depression largely affects youth through parental modeling of emotion regulation, and disruption in parenting, and family relationships and climate (Morris, Criss, Silk, & Houltberg, 2017). These disruptions may be especially detrimental for Latina/o youth for whom familismo reinforces family cohesion and children’s dependence on mothers (Valdez, Abegglen, & Hauser, 2013; Corona et al., 2005).

If maternal depression harms many preadolescent and adolescent Latina/os, research needs to illuminate the processes by which maternal depression harms youth. The body of literature and our own work with Latina/o families show that youth react to maternal depression with confusion, concern, and fear. They observe their mothers becoming increasingly withdrawn and self-absorbed, and vacillating from nurturing to irritable, warm to hostile (Dunbar et al., 2013; Valdez, Abegglen, & Hauser, 2013). These changes often prompt children to blame themselves and to assume responsibility for the mother and the family’s well-being (Beardslee, Gladstone, Wright, & Cooper, 2003). Unaddressed, these cumulative experiences can strain children’s psychological well-being and generate stressful experiences later in life (Beardslee et al., 2003).

To illustrate how family influences Latina/o youths’ understanding of maternal depression, Aguasaco-Méndez, Albornoz-Salas, and Pérez-Olmos (2010) interviewed youth in Colombia. The authors found youths’ understanding was a function of direct information they received from adults. However, much of that information was inaccurate, such as blaming another adult or an external event for a mother’s depression. Children perceived adults as generally reluctant to discuss a mother’s depression. The study illuminates the importance of accurate information about depression from adults in the meaning making of preadolescent and adolescent youth. Research needs to better understand the experiences of Latina/o youth from immigrant families in the United States and how they cope with maternal depression.

Youth Coping and Maternal Depression

Youth use many strategies to cope with stressful environments with varying degrees of effectiveness based on the level of control they have over the situation and wider environment (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001). Youth use active or primary coping strategies such as support-seeking, self-reliance, and problem solving to manage the environment and internal regulation of their emotions, cognitions, and behavior (Compas et al., 2001; Gonzalez, Tein, Sandler, & Friedman, 2001). Active coping strategies are connected to positive self-efficacy, self-esteem, and perceived competence (Ebata & Moos, 1994; Francisco, Loios, & Pedro, 2015). Conversely, passive or secondary strategies such as disengagement, denial, or avoidance of emotional expression are associated with aversive experiences such as affective and mood problems in youth (Ayers, Sandler, West, & Roosa, 1996; Ebata & Moos, 1994; Jaser, Champion, Dharamsi, Riesing, & Compas, 2011). In a study of maternal depression with a diverse ethnic sample, preadolescents and adolescents with passive coping strategies experienced higher levels of depressive symptoms than children with active strategies (Dunbar et al., 2013). This finding highlights the need to build active coping skills of youth to manage changes associated with maternal depression.

As youth age and develop their emotional, cognitive, and behavioral capacities, they can expand their repertoire and effectiveness of coping strategies in the face of stress (Francisco et al., 2015; Hoffman, 2016). However, older adolescents may implement fewer effective strategies than their younger counterparts because of employment and educational responsibilities (Allen & Hiebert, 1991). Adolescents also have increased exposure to stressors related to social context, including underresourced schools, anti-immigrant climate, and community violence and discrimination (Gonzalez et al., 2001). As adolescents become less reliant on parents for validation and support (Klimes-Dougan & Bolger, 1998), maternal depression coupled with social stressors may underscore the need for continued parent involvement and emotional coaching to support emotion regulation in adolescence (Morris et al., 2017).

Cultural and Contextual Influences on Family Life and Youths’ Coping

The strategies of preadolescent and adolescent youth in Latina/o families facing maternal depression cannot be studied without proper attention to culture. In response to maternal depression, youth may attempt to support the mother and the family by assuming greater caregiving responsibilities. These responsibilities may exceed already high expectations for family obligations among many Latina/o families, which may make it more difficult for youth to feel independent from their families’ problems and threaten youths’ achievement of autonomy (Valdez, Abegglen, & Hauser, 2013; Zayas, Lester, Cabassa, & Fortuna, 2005). The traditional value of familismo in Latina/o families may lead their children to feel particularly distressed when they perceive family discord (Duarté-Vélez & Bernal, 2007). The intersection of traditional gender roles with acculturative pressures may contribute to family burden and psychological stress, including patterns of suicidality among Latina/o youth in the United States (Baumann, Kuhlberg, & Zayas, 2010; Duarté-Vélez & Bernal, 2007; Zayas, 1987; Zayas et al., 2005). Expectations among offspring traditionally vary by gender among Latina/o families, and authoritarian parenting tends to be applied particularly to girls (Zayas et al., 2005), who are expected to be dependent, obedient, and respectful of family hierarchy (Lopez-Baez, 2006; Raffaelli & Ontai, 2004). Moreover, research shows that Latina adolescents who experience greater disconnection from their mothers, as can happen with maternal depression, also feel less supported in the family (Baumann et al., 2010). On the other hand, the cultural value of machismo among Latinos emphasizes expectations of male family figures to fulfill roles of providers, protectors, and figures of authority (Bronte-Tinkew, Moore, Mathews, & Carrano, 2007), which may harm male adolescents’ and preadolescents’ perceptions of viable coping mechanisms for family stressors (Duarté-Vélez & Bernal, 2007). Thus, family and cultural dynamics can alter the efficacy with which adolescents cope with maternal depression and manage their environments.

Latina/o youth stress may be buffered through resources and adaptive qualities that immigrant families often possess, including father involvement and co-parenting, cultural values of family togetherness, and religion and spirituality (Falicov, 2007; Valdez, Ramirez Stege, Martinez, D’Costa, & Chavez, 2018). Landale and Oropesa (2007) noted many Latina/o immigrants have extended families and support networks that offer instrumental and emotional support. Seeking help from religion and extended family relationships may be common coping responses among Latina/o youth (Epstein-Ngo, Maurizi, Bregman, & Ceballo, 2013). Finally, youth with greater bilingual language fluency may be better able to communicate with parents about depression than children who speak the parents’ language minimally or only instrumentally (D’Angelo et al., 2009). Exploring whether and how youth of immigrant parents in the United States use these resources is warranted to understand Latina/o youths’ responses to family stress when they have a parent with depression.

Structural context of Latina/o families.

Epidemiological data starkly illustrate disparity between Latina/os and non-Latina/o Whites when it comes to healthcare access. In general, Latina/o adults are less likely to access mental health services and tend to receive lower quality of specialty services on average than White, non-Latina/o adults (Cabassa et al., 2006; National Institute of Mental Health, 2015), particularly for depression and substance use (U.S. Department of Health and Human Services, 2013). Despite lower rates of healthcare utilization, U.S. Latina/os tend to have similar rates of lifetime psychiatric prevalence rates compared to non-Latina/o Whites (Cabassa et al., 2006), though psychiatric disorder prevalence tends to increase with time spent in the U.S. for Latina/os (Alegría et al., 2007; Cabassa et al., 2006). We have aimed to reduce some of these disparities by developing a culturally grounded program that addresses the mechanisms affecting youth and families when a mother has depression, and by implementing the program in settings such as mental health clinics and schools (Valdez et al., 2018). Exploring the experiences of youth, fathers, and mothers has been critical to understand the shared and the unique burdens and resources available to support the family.

Compounding these stressors is documentation status among immigrant Latina/o families in the United States. Because the uncertain yet consequential threat of deportation is a primary concern for many with undocumented status (Gonzalez, 2015), these individuals experience higher levels of adverse physical (Cavazos-Rehg et al., 2007) and mental health (Perez & Fortuna, 2005), compared to Latina/os who are U.S. citizens. Among emotional burdens are anxiety, adjustment disorder, alcohol abuse, and higher subjective ratings of distress (Perez & Fortuna, 2005). The added stress of being undocumented can reinforce isolation, and barriers to mental health and physical health services. Collectively, these stressors and barriers may restrict coping strategies and perceived resilience of Latina/o children of mothers with depression.

Purpose of the Study

Our primary objective is to understand the experiences of youth whose mothers have depression. More broadly stated, we seek to explore (a) how youth understand their mothers’ depression, (b) how they explain the effects of her illness on them and their families, and (c) how they cope with the depression and find support within and outside the family. All of these youth participated in a family intervention 12 months prior, which allowed them to gain awareness and reflectivity about their lived experience. We targeted youth in preadolescence and adolescence because of their increasing cognitive capacity to think about family life, relative to younger children. Our secondary objective is to explore perceived differences in experiences of maternal depression between these two cohorts. Our tertiary objective is to capture cultural and contextual nuances in youths’ experiences. Because most research with offspring of mothers with depression is quantitative and focused on functioning, we use qualitative methods to gain a deeper understanding of youth’s subjective experiences, with an emphasis on meaning making and family process. Our qualitative approach provides insight about the day-to-day experiences of Latina/o youth living with mothers with depression in the U.S. By presenting a personal account of Latina/o adolescents and preadolescents experiences of maternal depression, we may be better equipped to promote resilience among this population.

Method

We adapted a phenomenological approach to a focus group format (Wertz, 2005) to illuminate day-to-day lived experiences of preadolescent and adolescent Latina/os with mothers living with depression. We chose this methodological tradition because it guides the following questions, which we apply here to our research: (a) What is it like to have a mother with depression?, (b) Which elements of the experience are essential for all youth?, (c) What are the nuances in the experiences between preadolescents and adolescents?, and (d) How do culture and context influence youths’ experiences of maternal depression? In phenomenology, participants often reflect on their lived experience in disjointed ways, and the researcher embarks on an iterative process of analysis to give order and sequence to the experience. Thus, we organized themes first related to how youth recognized and understood depression; second by their perceptions of how maternal depression affected them and family relations; finally, by how youth coped and sought support for these perceived impacts.

Participants

Participants (N = 12) were part of a study of Fortalezas Familiares (Family Strenghts), a family-focused intervention for Latina mothers in treatment for depression. The goals of the intervention are for parents and children to understand depression and its impact on family, and to engage in stable, positive, and nurturing experiences. Children participate in concurrent but separate meetings where they discuss similar topics as their parents, and learn about active coping strategies to manage stress and to seek positive support. The intervention addresses stressors that parents and youth face as part of their family life cycle and acculturative experience in the U.S. (Valdez, Abegglen, & Hauser, 2013; Valdez et al., 2018). Youth meetings are conducted in English.

Focus group participants were six preadolescent children 9 to 11 years old and six adolescents 12 to 16 years old who participated in one of three focus groups (two preadolescent and one adolescent). Half the sample was female, and all were children of undocumented parents born in Mexico (n = 11) and Honduras (n = 1). All but one participant were born in the U.S. All children were bilingual in English and Spanish. Participants were children from 10 families who completed the program, that is, they participated in at least 11 out of 12 program meetings. Nine families had one child and one family had three children in that age range. Families were recruited into the intervention through mental health clinics where the mothers received depression treatment. Sixty percent of these families had a mother and father living in the home. Ninety percent of families had annual household incomes of $30,000 or less. Thirteen families completed the program, but three of those families were unavailable for focus groups 12 months later. There were no differences between non-participating and participating families based on socioeconomic status, documentation status, or any other social demographic.

Sampling was purposeful and followed standard guidelines for qualitative research. We targeted preadolescent and adolescent children of mothers with depression to study the central phenomenon of maternal depression for children, with interest in developmental and cultural/contextual nuances in children’s experience. The intent was to gather a sample size that delivers rich information to describe, explain, and interpret the phenomenon rather than to generalize to the population. Leading qualitative methodologists recommend sample sizes of three to 12 participants for phenomenological research to reach saturation (Creswell, 2013; Morse, 1994; Ray, 1994). Saturation is achieved when participants’ responses become redundant and no longer yield new themes (Wertz, 2005). We reached saturation among the 12 participants when each question was exhausted and redundant information remained with continued probing.

Procedures

Our university’s institutional review board (IRB) approved the study. Because we planned to engage children in potentially difficult conversations, the IRB asked us to take more precautions than would be expected with adults. First, the IRB asked us to word our focus group questions in third person and in general terms (e.g., “What do children worry about when their mom has depression?”) to avoid burdening children with intense personal experiences. Second, because children may not fully understand or feel comfortable talking about their mothers’ depression, the IRB requested we begin with general questions about family stress. Similarly, we were to use the words youth produced to describe their mother’s condition or distress. Finally, because youth were part of mixed-status families, with at least one undocumented relative, the IRB directed us to refrain from asking youth about their family’s documentation status to avoid undue disclosure, and hence risk protection to confidentiality, in a focus group setting.

We recruited participants from a medium-sized city in Wisconsin with a relatively small but rapidly growing Latina/o population (the second fastest growing population from 2010 to 2014). For the larger study, we established contact with families via referral from area mental health clinicians. We conducted screenings for study involvement in families’ homes. Parents provided consent, and youth assented to participate in the intervention and, subsequently, in the focus groups. Twelve months after the intervention, we contacted the mother by phone to explain the purpose of the focus group for youth. We scheduled the focus groups at times convenient for families in a community center where the intervention had taken place. Graduate students from a counseling psychology department who had training in qualitative research, and with Latina/o youth and families representative of our study (i.e., low-income, undocumented status of Mexican and Central American origin) facilitated the 1-hour focus groups. Facilitators were bilingual in English and Spanish, and most were native Spanish-speakers who identified as Latina/o immigrants. Each focus group had two bilingual facilitators.

Focus group protocols consisted of six main questions to explore participants’ perspectives about the day-to-day experience of life with mothers with depression, coping, and the need for family support: (1) “How can kids tell when their mother has depression?” (2) “What do kids need to know about their mother’s depression?” (3) “What are some things that kids worry about when a mother has depression?” (4) How are kids affected by their mother’s depression?” (5) “What helps kids when a mother is depressed?” and (6) “How do kids and families who have a mother with depression get strong?” Focus groups with preadolescents were the same amount of time and contained the same questions as the focus group with adolescents, but added a 10-minute break to maximize children’s attention. Facilitators also checked preadolescents’ understanding of concepts and enhanced reflection by offering youth the option to first draw some of their responses. Youth accepted these strategies, which allowed us to account for developmental constrains of the younger children, thereby optimizing the quality of data collection. We recorded and transcribed verbatim all focus groups.

Data Analysis

Coders were a faculty member (first author) and two graduate students (second and fourth authors). The faculty member trained the students in phenomenology. In the initial coding phase, student researchers read and reread the focus group transcripts to become immersed in the focal components and complexity of each group’s responses (Wertz, 2005). During this phase, they approached transcripts with empathy and suspension of judgement and theory, also known as epoché in phenomenology (Wertz, 2005). This stance honors participants’ meanings and expression, whether rudimentary and disjointed, or sophisticated and integrated. The second phase involved the two student researchers independently coding transcripts to highlight significant statements that reflected participants’ experiences (Krueger & Casey, 2009). To preserve developmental and cultural nuances in youth’s narrative, statements were coded nearly verbatim. The three coders compared coding schemes to reach consensus on the statements.

The third and final phase involved integrating descriptive statements into shared and unique themes across focus groups (Wertz, 2005), based on preadolescent and adolescent stages. We identified themes that highlight the essential experiences of participants, with recognition of shifts and developments in the experiences (Ashworth, 2003; Wertz, 2005). The first author ensured trustworthiness in the data by (a) auditing the coding for theme stability, (b) comparing results from the focus groups with interviews conducted individually with youth prior to the intervention, (c) comparing results from the youth focus groups with focus groups conducted with mothers and fathers (reported elsewhere), and (d) ensuring consistency with the theoretical and empirical literature with similar populations (Krueger & Casey, 2009).

Researcher Positionality

Carmen, a faculty member in counseling psychology at a large university in the Midwestern U.S. for 12 years, is beginning a position focused on community-based research at a Southern university. Originally from El Salvador, Carmen draws on her experiences as a U.S. immigrant and community engaged scholar to explore the collective and unique family processes of Latina/o youth and their foreign-born parents. Christo and Kevin are U.S. graduate students who identify as White men, originally from the Northwest and Midwest, respectively. Christo’s research focuses on cultural and identity-based factors that influence coping, understanding of, and response to mental illness. Kevin is interested in supporting development of culturally tailored approaches to mental-health services so providers may better engage with underserved populations. Stephanie is an Indian-American child psychologist. As an immigrant to the United States, she explores cultural and linguistic adaptations to current mental health, behavioral, and academic practices. Her research and clinical practice focuses on community mental health and school-based services for underserved families. Authors discussed their backgrounds and interests, and the potential for these to inform and influence data coding and interpretation.

Results

Our analyses revealed seven themes within three major overarching categories: (a) youths’ understanding of depression, (b) effects of maternal depression on youth, and (c) ways in which youth and families cope with depression. Given the overlap between preadolescents and adolescents, we describe each theme, beginning with the essential elements of the theme for all youth. This approach is consistent with phenomenology’s focus on the essential experiences of a phenomenon. Then we highlight differences in experience between preadolescents and adolescents, and note cultural/contextual nuances. We illustrate themes with participant quotes.

Youths’ Understanding of Maternal Depression

The youth used their lived experiences to define the appearance, behaviors, and feelings they associated with mothers with depression. They also discussed the potential causes of their mothers’ depression and their perceived role in the illness. Last, the youth explored lingering questions they had about their mothers’ depression.

Description of mother’s depression.

Preadolescent and adolescent youth created a working definition of mothers living with depression that included expression of feelings and behaviors. For example, all youth noted mothers with depression are sad all the time and lack interest in activities they once enjoyed. Preadolescents noted their attentiveness to maternal facial expressions that helped them recognize when a mother was sad, using visual cues such as the look in her eyes and mouth. Preadolescents readily identified specific actions of their mothers that clued them in to her having depression. These depressive behaviors were usually self-directed and involved withdrawing from the family. Descriptions included a mother “being in her room … sleeping” or “… crying,” “watching TV or with the lights turned off and lying in bed,” and “[not eating], even if she cooked.” In addition, a couple of preadolescent males described their mothers’ actions resulting from depression as hostile toward others, as in, “When my mom is depressed she gets mad at everything, even my dad” and “I can tell [she is depressed] because she is cranky and yells.” Adolescents were also aware of clinically concerning factors related to depression, as stated by a female adolescent: “[Mothers] would think about killing themselves”

Causes of maternal depression.

Youth had a broad understanding of the causes behind their mothers’ depression. Some youth mentioned their mothers’ excessive workloads, while others referenced stressful extrafamilial events, such as transnational family separation and inability to travel. One preadolescent male noted about his mother:

She got stressed out because my uncle [in Mexico] has diabetes and he has to have help to do a lot of things. So my mom wanted to go help him because my mom’s mom died and she couldn’t help him anymore. They lived in Mexico. My dad said “no” because she had a family to take care of too here. So my dad said maybe later in the future.

This child sees a confluence of family and cultural factors including the mother’s sense of duty to her extended family, fear of and anticipated grief over not being able to care for her sibling, and the father as primary decision-maker in the family.

A common theme for all youth was self-attributions for their mothers’ depressive symptoms. Youth explained why they may feel as though their mother’s condition was their fault, including this preadolescent female: “When my mom comes home she is depressed from work, and me and my sister just make it worse because we fight and stuff. So that’s why I think it’s my fault.” Several preadolescent children talked about fighting with siblings as a source of their mothers’ depression. For other youth in this age group, not helping around the house or creating more work for the mother was seen as a source of her depression. Adolescents also talked about interpersonal conflicts as a cause of the mothers’ depression, but their examples of conflict referenced their own interactions with the mother rather than conflict between siblings.

While self-attributions occurred across groups, some children discussed ways to combat this cognition. Adolescents talked about thinking positively, telling themselves that they were not to blame, and they engaged in outside activities to distract them. Preadolescents were more inclined to talk to their mothers directly, as this male indicated: “Kids should talk to their mom to see if it is their fault … then if she says ‘no, it’s not your fault,’ it is another reason.” Other preadolescents suggested talking to another family member, such as their father or an aunt or grandparent, about the cause of the mother’s depression or about their feelings.

Questions youth have about depression.

The youth reflected on their questions about their mothers’ depression. They wanted to understand the causes in general and more specifically as depression affected their mothers. A female adolescent reflected: “[I want to know] why she is always mad or sad.” Although all youth had this question, preadolescents felt more comfortable asking their mothers directly about the cause than adolescents did. The younger youth also wanted to know how they could support a person with depression.

Effects of Maternal Depression on Youth

Youth described being embarrassed, lonely, angry, confused, and sad in response to their mothers’ depression, but worry was the paramount feeling. Most adolescents worried primarily about their relationship with their mothers. Preadolescents described safety as the primary concern, as stated by this female: “[I worry that] she might do something extreme … like start a fight for no reason. Like somebody is going to get hurt.” A preadolescent male said, “One of my friends had a depressed mom, and he said that he was worried that she was going to get a knife or something and hurt herself.” A year prior to this focus group, this child witnessed his mother pull a kitchen knife during an altercation with his father. His comment about a friend’s mother suggests difficulty in talking about the incident and the continued worry for his family.

Youth described ways their mothers’ depression affected their own moods, behaviors, and activities. Many preadolescents talked about crying and constantly thinking about their mothers. “I couldn’t take my mind off it,” a preadolescent male noted. “[In school] I could answer some questions in math but not other ones because I couldn’t pay attention.” Another talked about not playing as much with siblings because “when [mother] has depression, it’s not a good time to be messing around … or [she] might get even more depressed.” Adolescents described how they took on more responsibility by cooking, doing laundry, or caring for siblings. These responsibilities appeared to be equally assumed by male and female youth.

Ways Youth and Families Cope with Maternal Depression

Youth talked about personal and family ways of coping with maternal depression. The role of families was a source of strength for youth, with different relatives playing different roles. Youth described behaviors and activities (i.e., communication, enjoyable family activities, and supporting each other) they perceived as important for families to succeed in difficult times.

Ways of coping.

Responses to stress vary by individual, yet many youth described overlapping active and passive coping strategies in response to maternal depression. First, they utilized distractions outside the home to alleviate some of their strong feelings about their mothers’ depression and home environments. All youth talked about playing sports, going biking or to the movies, or participating in after-school activities. Adolescents said they spent more time with friends. A male adolescent described how he supports his friends whose mothers have depression: “Get them distracted. Get them involved in sports [or] stay after school to get help with homework.” This theme of distraction is one of many ways youth described coping.

Second, youth sought support as an active way to manage stress. Engaging in conversations about their mothers’ depression with peers was a way that youth found helpful for processing some of their strong feelings. And if peer support was unavailable, the preadolescent children brought up the need to express their emotions to a toy, pet, or imaginary friend. A female preadolescent explained this source of coping: “When I was sad in the morning. I used to get my bunny out of his cage and I used to put it on the couch and talk to it and kiss it … he’s cuddly and soft. [I talked to it] because it doesn’t talk, it can keep my secrets.”

Third, youth noted family prayer relieved their personal feelings of sadness or stress and their families’ stress as a whole. One preadolescent male noted in response to a peer describing prayer, “When I am sad I also pray.” Another preadolescent male described the function in his family of praying, “[When] my grandma died, [my mom] started getting depressed … and my dad would pray. And he would pray to my mom’s mom. … My whole family would come and pray with [my mom] and that would make her feel better.”

A passive way in which youth cope with maternal depression is by providing the mothers with space. Preadolescents emphasized the importance of physical and emotional space for mothers to rest, but they also expressed being comfortable with entering their mothers’ space to have some of their own needs met. As this preadolescent male noted, “I go to my mom’s room and talk about stuff … stuff about [her] and my family.” Adolescents also valued providing their mother with space, but described this space as a form of emotional distance, as this male indicated: “She’s a grown woman and will figure it out … that way it won’t get to you.”

Role of the family as a support.

Youth identified multiple layers of support from extended family, siblings, and fathers when their mothers experienced depression. Extended families provided safety, love, and kindness to children during difficult moments. Preadolescents described involvement with extended family, through staying with relatives or family members coming to support the youth and their mothers at home. This preadolescent female shared:

When my mom first got depressed, we had to go to my aunt’s house, and my grandma came to my aunt’s house because we lived in the same apartment building. My mom was crying in her room, and my grandma and my aunt tried to calm her down.

Youth reported different types of support by siblings depending on whether they are older or younger than themselves. Older siblings tended to comfort those in our focus group by offering hugs, processing what was happening, and taking them out of the house. Key for youth was having a sibling who understood the family challenges and whom they considered a trusting friend. A preadolescent female recalled an incident in which she was feeling sad about her mother: “If [older sibling] thought that something is wrong they’ll say like ‘It wasn’t your fault.’” Another preadolescent felt better when his older sister bought him things to cheer him up, while yet another appreciated her older sister putting her to bed every night. One of our youngest female participants described being cautious about how much she relied on her oldest siblings because she did not want her mother to feel sad about not being a good caretaker.

Youth felt responsibility to take care of younger siblings by distracting them or giving them advice on how to cope with the familial stress. One of our younger preadolescent male participants, for whom giving advice may have been difficult, found other ways to support his younger sister, “When my mom is depressed she gets mad at everything, even my dad. And my sister comes to me and hugs me and sometimes she cries.” These ways of supporting one another deepened sibling friendships and bonds. One adolescent male, who found himself often caring for his younger siblings, sought refuge with his college-age sibling, “[the stress of taking care of younger siblings] made me grateful to have my big brother to talk to.”

Fathers played an important role in supporting youth, distracting them with fun outside activities. These female and male preadolescents, respectively, described the fathers’ support in this way, “Sometimes when my mom is depressed, my dad will let her sleep and calm down,” and “My dad takes us to the park and we forget all about it.” Youth described how fathers took them out on visits with their extended family, talked to youth about the family, and emphasized that the mother’s depression is not the child’s fault.

Support families need to get through tough times.

Youth discussed the importance for immediate and extended family members to learn about depression. They stated that this knowledge was important for youth to recognize when their mother was depressed and to understand positive ways to react. Youth talked about how this knowledge would equip them to help other youth in similar situations, as one preadolescent female noted:

They can learn from things that we feel. They see us every time; they notice that we are changing. Like sad or happy … [We] can tell them that my mom has depression and then they can know what to do.

The youth recommended coping strategies for the whole family. They stressed the importance of sharing feelings and allowing time to see what would happen. For preadolescents, talking with their mothers was important, but conversations needed to be at their level of understanding and account for language differences between parents and youth. As this female participant stated: “Like when I tried to talk to my mom, she tried to explain, but I don’t really understand … some of the words I don’t understand because they’re in Spanish.” Moreover, youth recommended that parents be taught to monitor their reactions (e.g., anger, defensiveness) when youth approach them with questions about depression. Some skills learned in the family program that resonated with youth were to remain calm, find the right time for conversations, and to brainstorm how to handle parent responses. Last, youth said family time was important in alleviating tough times. They said activities such as exercising, going to the movies and playing board games enabled the family to have fun and bond.

Discussion

In the present study we interviewed preadolescent and adolescent Latina/o youth from immigrant families about their experiences with their mothers’ depression. Youth were recruited after they and their parents completed participation in a family-focused intervention for maternal depression 12 months earlier. Analysis of qualitative interviews revealed three categories: (a) recognition of their mothers’ depression and understanding of its causes, (b) effects of maternal depression on youth, and (c) ways in which youth and families cope with maternal depression and its associated changes. Although these categories and their themes emerged in both age groups, they manifested differently for preadolescent and adolescent youth, underscoring the importance of considering developmental progression in internal capacity and external resources in resilience-based interventions. We discuss these differences, and the influence of culture and contextual factors in youths’ experience of maternal depression.

Recognition and Understanding of Maternal Depression

Recognition.

Youth used social cues such as facial expression, affect, and behavior to recognize their mothers’ depression. Youth perceived these cues as aversive, in that they described their mothers as typically sad, absent, or angry, and their interactions with family members as distant or irritable. While some research suggests Latina/o youth may be less likely to detect maternal depression than non-Latina/o youth because symptoms among Latina mothers may manifest as somatic rather than emotional (Corona et al., 2005), we did not find that. Our findings imply that even when parents wish to hide depression from their children, they model it through emotion regulation and interpersonal interactions, as found in studies with non-Latina/o samples (Morris et al., 2017; Tsypes, Burkhouse, & Gibb, 2016). Children perceiving mothers’ social cues of depression is concerning because parental social cues influence emotion regulation in youth, which has been associated with depression, suicidality, and substance use among non-Latina/o and Latina/o youth (Baumann et al., 2010; Corona et al., 2005; Tsypes et al., 2016).

Adolescents in our study were also aware that suicidality was part of the mothers’ condition. A few participants worried about the mother’s safety but felt they could not openly talk about it with their parents. Parents should learn how to initiate difficult conversations about their suicidality with youth, and to provide realistic reassurance of how they and other adults are monitoring and addressing safety issues. To our knowledge, none of our participant youth had suicidal ideation or intent, but preadolescent and adolescent girls within Latina/o families are at elevated risk for suicidality (Baumann et al., 2010; Duarté-Vélez & Bernal, 2007; Zayas et al., 2005). Although preadolescents did not mention suicidality, they did voice concerns about their mothers’ erratic behaviors that could result in a family member’s injury or harm. Thus, all youth could benefit from having a safe space where they and their parents could discuss their concerns.

Understanding.

If youth in our study accurately detected their mothers had depression, they only partly understood factors contributing to the condition. Collectively, youth had some grasp of family and marital dynamics that weighed on their mothers, such as spousal or family conflict. Preadolescents mentioned daily hassles, with many attributing the mother’s depression to sibling arguments and noise, and youths’ lack of cooperation with housework. Adolescents also discussed parent-child conflict, possibly reflecting greater separation and autonomy of youth from parents during adolescence, and the acculturative struggles that are heightened during this phase of development (Zayas et al., 2005). That youth blame their own behavior for their mothers’ depression has been widely found in research with non-Latina/os (see Beardslee, 2002). Our study findings were consistent with other research that posits that familismo, a cultural value on family cohesion and obligation, may heighten these self-attributions and make it more difficult for youth to see their mothers’ well-being as separate from theirs (Corona et al., 2005).

Our participants’ families grappled with structural factors that typically affect low-income immigrant families, such as undocumented immigration status (Hoffman, 2016). These factors seemed beyond youths’ awareness as they tried to explain their mothers’ depression. The youth who recognized and attributed their mother’s stress to not being able to travel to Mexico to support a family member did not recognize that travel was too risky and instead noted the mother could not travel due to other household responsibilities. Although the children simply may not have disclosed their thoughts about these factors to protect their families, their parents may have withheld information about immigration status from their children (Valdez, Padilla, Lewis Valentine, 2013b). Documentation status has significant health impacts on parents (Cavazos-Rehg, Zayas, & Spitznagel, 2007) but also impacts the developmental well-being of children within undocumented families (Gonzalez, 2015). Parents not incorporating immigration stress as part of the family’s narrative may inhibit youth from learning to manage shame and discrimination (Gonzalez, 2015). Interventions to target such social factors should equip parents to converse with children about discrimination and shame. These exchanges can help parents socialize and prepare their children for when they encounter bias and shame (Smokowski & Bacallao, 2011). The more information youth can receive about their families and community life, the more internal and external resources they will have available to cope with stressful environments (Aguasaco-Méndez et al., 2010). More research is needed to explore the unique impact that immigration status plays on families’ psychological well-being.

Effects of Maternal Depression on Youth

Maternal depression is particularly harmful for Latina/o families given a cultural emphasis on familial interdependence (Falicov, 2007). Unaddressed mental health symptoms can fuel interfamilial conflict and lead to distance. The perspectives of youth in our study underscore the importance of strengthening relationships between Latina/o adolescents and their mothers as part of mental health services (Corona et al., 2005; Zayas et al., 2005). Although adolescents in our study worried about their mothers, they also felt emotionally distant from them, which kept them from having meaningful family-wide conversations about depression and family life. That adolescents avoided seeking support from their mothers is concerning because family harmony is central to Latina/o youth well-being (Zayas et al., 2005). Thus, the value of trust, warmth, and positive exchanges between mothers and adolescents should not be underestimated (D’Angelo et al., 2011) and should be a central component of family interventions for Latina/o families.

It is not clear whether adolescents’ physical and emotional distance to their mothers in our study is due to acculturative incongruence between immigrant parents and their more acculturated children (Baumann et al., 2010; Smokowski & Bacallao, 2011) or to typical parent-child separation during adolescence (Zimmer-Gembeck & Skinner, 2011). Latina/o adolescents often feel angry and resentful due to their substantial caregiving roles when depression incapacitates mothers. As adolescents take on more responsibilities at home, they feel burdened and deprived of activities with peers (Valdez, Abegglen, & Hauser, 2013). Feeling deprived of a “normal childhood,” coupled with mothers’ difficulty expressing warmth and mutuality to their children, may contribute to emotional distance, and should be examined in future research. Interventions should facilitate youths’ connections to positive peers, and to adults within and outside the family (Dunbar et al., 2013, Valdez, Abegglen, & Hauser, 2013).

Youth Coping Strategies for Maternal Depression

Youth described active and passive coping strategies to manage stressful environments. Distraction was one way preadolescents and adolescents said they coped. Although distraction could be an escape, and thus viewed as passive, it may have contributed to youth feeling efficacious, self-reliant, and connected to positive relationships. In addition, preadolescents managed stress associated with maternal depression by “confiding” in a family pet, a toy, or an imaginary friend as an active means of coping. This behavior is consistent with their developmental capacities and external resources, which are largely limited to the home (Zimmer-Gembeck & Skinner, 2011). These younger participants also found comfort in talking directly with their mothers. Adolescents managed stress by discussing their concerns with friends. However, they avoided seeking this type of support from their mothers directly. Having peer confidants outside of the family is adaptive because it allows adolescents to express their feelings and seek validation for them, and reflects adolescents’ increasing reliance on external supports. Ensuring adolescents have access to positive peer or adult role models outside of the family protects children from effects of maternal depression and should be considered an important source of support (Beardslee, 2002). In addition to peers, our findings highlighted how fathers, extended family, and siblings support youth.

Father relationships.

Youth experiences intersected with culture and social context to facilitate and challenge the resources and supports they needed to manage family life. A primary resource for youth was their father’s involvement, which provided a healthy parental figure to maintain stable routines and address concerns about the mother. Father involvement is a key resource among immigrant families, with over 80% of Mexican-born immigrant families in the U.S. living in two-parent homes (Falicov, 2007). Including fathers in mothers’ recovery and the resilience of the family can benefit children as they attempt to manage stress associated with maternal depression (Valdez et al., 2018). Challenging notions of masculinity and lack of father involvement in Latina/o culture (Bronte-Tinkew et al., 2007), youth in our study described ways their fathers were present physically and emotionally for them, and engaged in restorative parenting. Perhaps Latino fathers in the U.S. adapt to different social expectations about men’s familial roles (Updegraff, Crouter, Umaña-Taylor, & Cansler, 2007) or they increase involvement when they perceive mothers to be impaired (Bronte-Tinkew et al., 2007). Recognizing fathers’ commitment to children and their potential role in children’s lives supports use of family-focused interventions for maternal depression (D’Angelo et al., 2011; Valdez, Abegglen, & Hauser, 2013) where fathers can learn to recognize maternal depression and attend to children’s needs, while having space to process their own concerns (Valdez et al., 2018).

Extended family relationships.

Youth participants also described extended family members as a resource in managing stress related to maternal depression. Grandparents and aunts supported youth by taking care of the mother and comforting children during crisis. Extended family created positive experiences, and exposed youth and fathers to traditional coping practices, such as prayer. Not all youth in our study, however, had access to extended family where they resided. Thus, promoting transnational support and connection with many relatives is not only critical for preventing mothers’ distress and isolation, but also for strengthening bonds between youth and traditional practices that shape family health and healing (Falicov, 2007).

Sibling relationships.

Finally, close ties with siblings were a significant cultural resource for youth in our study. Participants received and provided support to siblings; this type of support is especially valued in a context in which interdependence and family obligation and unity override individual interests (Corona et al., 2005). Although sibling relationships may be valuable for Latina/o immigrant youth facing maternal depression, youth may feel burdened by their caregiving of siblings. Parentification of youth is common with maternal depression (Beardslee, 2002) and may be heightened among immigrant families that reinforce children’s involvement in caregiving as a family obligation. This burden may reflect anxiety about what actions youth have to take to support the family while the mother has depression and resentment about how this responsibility interferes with childhood activities (Valdez, Abegglen, & Hauser, 2013). Research needs to examine the extent to which caregiving of siblings is experienced as a burden among Latina/o youth in immigrant families, or whether the benefits and norms around familismo protect these youth from potential negative consequences. Programs could explore how familismo supports and challenges youth facing maternal depression in immigrant families.

Limitations

One potential limitation is that the children in our study had participated in our family-focused intervention 12 months prior to our focus groups. Thus, participation in the program possibly influenced their recognition, understanding, effects, and ways of coping. Specifically, our participants may have thought and learned more about maternal depression and its impact in their family. Nevertheless, our findings illustrate the perceived effect of maternal depression on youth, and how youth explain and respond to stress. Second, our study occurred at a single time point, and although we noted developmental differences among youth, we cannot confirm that differences in understanding are due to children’s maturation from one age group to another. Third, our study explored experiences of predominantly Mexican immigrants living in the Midwest. While these experiences may be common in other contexts, youth across the Latina/o diaspora may have different cultural risk and resilience factors that would impact their impressions of maternal depression. Finally, although much research suggests that gender socialization influences coping strategies and family burden, we did not observe gender differences. Future research could directly elicit information about gender to understand nuances in experience. Limitations notwithstanding, our study captured perceived impacts of maternal depression on children in Latina/o immigrant families, how youth coped and how they perceived culture supporting them, and possible developmental nuances in experience.