Protective Factors to the Wellbeing of Undocumented Latinx Immigrants in the United States: A Socio-Ecological Approach

Abstract

Undocumented immigrants often experience multiple chronic stressors that over time can increase health risk. This qualitative study used data from 7 focus groups and 15 key informant interviews to identify relevant protective factors to the heath of undocumented immigrants in the U.S. Findings showed that at the individual level, undocumented immigrants rely primarily on motivation to cope with adversity, while also relying on family support and community cohesion at the interpersonal level. At the policy level, safe neighborhoods and non-stigmatizing environments, protection from abuse/exploitation, and activism were identified as protective factors. English proficiency was also identified as important.

Introduction

Undocumented immigration has been a matter of controversy in the United States’ (U.S.) political agenda, particularly in recent years. Polarized views on undocumented immigration, fears of “invasion”, threats of competition for resources, harsh rhetoric, inaccurate and misleading information, and a poor understanding of the immigration experience are factors fueling the current socio-political and anti-immigrant climate in the U.S. Even though undocumented immigration to the U.S. has been moderately stable since 2009, the recent flood of immigrant caravans from Central America and Mexico resulting from the increased instability and dangerous conditions in Latin American countries, is further contributing to fear and a growing anti-immigrant climate (On Immigration Policy & Partisan Differences but Also Some Common Ground, 2016). To develop a more informed and better understanding of the issue, disseminating information to the general public about the experiences of undocumented immigrants in the U.S. and their way of coping with hardship and disadvantage is a necessary first step. In this paper, coping pertains to the cognitive and behavioral strategies that individuals use to deal with adversity.

Undocumented immigrants often experience multiple, complex, and chronic stressors associated with their immigration experience (Garcini et al., 2016; Sullivan & Rehm, 2005). Physical, verbal, psychological, and sexual violence experienced at all different stages of the migration journey are prevalent trauma events associated with distress among undocumented immigrants (Garcini et al., 2017). Discrimination, stigmatization, marginalization, isolation, fear of deportation, exploitability, victimization, living in dangerous neighborhoods, and socioeconomic disadvantage are additional stressors that are also commonly experienced by undocumented immigrants and their families (Garcini et al., 2016; Infante et al., 2012; Sullivan & Rehm, 2005). On top of these stressors, undocumented immigrants frequently endure intrapersonal stressors such as identity shift, deception, and distancing from family, as well as acculturative stress as they try to adjust to a different culture than their own (Garcini et al., 2016; Sullivan & Rehm, 2005). All of the aforementioned stressors, particularly when endured over time and with limited access to resources, can increase health risk and diminish the physical and mental wellbeing of these at-risk immigrants.

Identifying protective factors that may help undocumented individuals cope with the many complex stressors that they face is essential to inform the development of culturally- and contextually-sensitive interventions aimed at reducing health risk. Having essential resources or coping strategies when facing adversity buffers the negative effects of stress on health (Gallo & Matthews, 2003). General protective factors, such as intrapersonal factors (e.g., coping and behavioral strategies), interpersonal factors (e.g., social support), tangible resources (e.g., socioeconomic factors), and culture-specific resources (e.g., cultural values), may facilitate coping in the face of adversity (Gallo et al., 2009b). Among undocumented Latinx immigrants, protective factors, such as strong family connections and social support, have been identified as useful to cope with distress (Ornelas & Perreira, 2011; Potochnick & Perreira, 2010). Likewise, religion and the ability to send remittances to family in the country of origin have been shown to relieve the burden of hardship face while living abroad (Negi, 2013). Nevertheless, research is limited in this area and more investigation is needed to fully identify and contextualize specific aspects of protective factors at different levels of influence that may facilitate coping with the undocumented experience.

Contextualizing protective factors among undocumented Latinx immigrants: the Socio-Ecological framework

A socio-ecological framework was used in this paper as organizing framework (Dahlberg & Krug, 2002). From a socio-ecological perspective, the human experience results from reciprocal interactions between individuals and their environments, varying as a function of different levels of influence including individual characteristics, interpersonal dynamics, community relationships, and the socio-political environment (Dahlberg & Krug, 2002). Individuals facing social disadvantage across multiple levels of influence require greater effort to cope with stress, which over time may take a toll on a person’s health given constant overstimulation of the physiological stress responses on the body (Gallo et al., 2009a). The wear and tear of the stress-response system combined with limited resources and inadequate contextual situations may increase vulnerability for illness and risk of diminished wellbeing (Gallo et al., 2009a). Nonetheless, having a robust set of resources or protective factors is essential to moderate the negative health effects of compounded stress from different levels of influence (Gallo et al., 2009a). Undocumented immigrants experience multiple sources of stress at the individual, interpersonal, community and socio-political levels, which when combined result in compounded stress that can adversely influence their health. Identifying specific protective factors, namely contextual situations and resources, helpful to reduce distress among undocumented immigrants is essential to protect their wellbeing, as well as to inform the development of interventions, advocacy and policy efforts.

Purpose of study

Guided by the Socio-Ecological Framework, the overall goal of this paper is to identify protective factors relevant to the undocumented immigrant experience at multiple levels of influence (i.e., individual, interpersonal, community, political), which promote wellbeing and facilitate coping with adversity. In this study, protective factors are defined as aspects that buffer the effects of individual vulnerabilities or threatening environments to facilitate the functioning of undocumented immigrants, their social interactions, and their social exchanges within communities (Shonkoff & Meisels, 2011). The aforementioned framework and its emphasis on different levels of influence is particularly useful to identify and contextualize protective factors to the undocumented experience from a multidimensional perspective. This contextualization is essential to inform the development of culturally- and contextually-sensitive interventions, advocacy, policy efforts and best practices among providers and organizations that come into contact with this population.

Methods

From its inception, the development of this project relied on shared cultural and contextual knowledge about undocumented Latinx immigrants in the U.S. from collaborating community and academic partners. For instance, the primary investigator is a Latina immigrant of Mexican origin with more than decade of clinical and research experience working to inform the mental health needs of undocumented immigrant families. Similarly, all members of the research team were of immigrant background and had personal experience and knowledge about the target population. Indeed, some of the members of the research team were or have been undocumented. The collaborative process with local community partners began a year prior to the launching of this study; this time was used by the principal investigator to establish trusting relationships with local faith-based leaders and community advocates. This was primarily achieved by attending local advocacy events, serving on relevant community boards, and conducting relevant psychoeducational presentations for the community pertaining to the health needs of undocumented immigrants. Upon building an established network of collaborators, the next step in the research process involved conducting extensive formative research with community members to identify salient mental health needs among undocumented immigrants, along with relevant barriers for accessing services. A primary barrier that emerged from formative research was the need for culture and context sensitive mental health services and providers familiar with the undocumented experience. This included the need for building interventions focusing on building resilience and strengths in this population, rather than approaches that may further stigmatize this community. Resilience refers to an individual’s ability to adapt well to his/her environment or living conditions in the face of adversity. As a result, and in collaboration with our community partners, we created a line of research and community efforts named Voces (Voices) aimed at informing and addressing the mental health needs of undocumented immigrants from a strength-based approach. This qualitative study was among the first studies to take place in our line of research, which is currently on its sixth phase.

Participants and recruitment for focus groups and key informant interviews

Purposeful sampling was used to recruit participants for focus groups to facilitate greater group discussions (Palinkas et al., 2015). In collaboration with our community partners, participants were recruited using networks-based referrals. Specific strategies used in recruitment included active approaches (i.e., electronic mailing lists, snowball sampling, social networks, venue-based recruitment), as well as passive approaches (i.e., newsletters). Participant inclusion criteria for the focus groups was: (1) at least 18 years of age; (2) able to speak Spanish given that the groups were conducted in Spanish; (3) self-identified as Latinx; and (4) having an undocumented status as determined by participant’s responses to a series of yes/no questions regarding possible immigration legal statuses. Key informants for the in-depth interviews included informants referred to us by our community and academic partners; although several of our community partners participated as key informants themselves (n = 15). This approach provided a diversity in the backgrounds of key informants knowledgeable about the target population, which included health providers (i.e., physicians, community health workers), mental health specialists, faith-based and indigenous leaders, legal and political experts, employers, researchers, and community advocates. Recruitment for focus group participants took place locally in a region near the U.S.-Mexico border, while key informants were recruited nationwide.

Data collection

Informed by results of formative research conducted in collaboration with our community partners, we conducted the focus groups at locations that were previously identified as safe by our community partners. This was essential to ensure the security of participants. In-depth interviews with key informants were held at private locations convenient to the key informant or via teleconference for key informants who resided away from the study location. All participants filled out a brief demographic questionnaire prior to participation in a focus group or an in-depth interview. For participants unable to read and/or write, the questionnaire was read to the participant in private by a member of the research team. As recommended by our community partners and to protect the confidentiality of participants, we audiotaped the sessions rather than video recorded, as well as obtained verbal rather than written consent. The consent was carefully drafted and adapted in collaboration with our community partners to make it brief (one-page) and to ensure that participants would understand the information provided. The principal investigator with two additional members of the research team conducted the focus groups. The focus groups lasted between 2 to 3 hours, and the key to their success was flexibility in adapting the format of the group to recommendations provided by our community collaborators. For instance, these included offering and sharing a meal with the participants during the discussion to help participants feel more relaxed, facilitating childcare during the groups, and having open groups to allow for participants to bring a companion to increase their sense of safety. Key informant interviews were on average an hour long. All participants received a $20 incentive for participation, which was informed by results of formative research. Questions for the focus groups were developed in collaboration with our community partners. The questions were semi-structured and were aimed at fostering discussion pertaining to: (a) the experiencing of distress and related mental health concerns among undocumented Latinx immigrants (e.g., what do you think are some relevant mental health issues for undocumented immigrants in your community?), and (b) the identification of risk and protective factors to the wellbeing of undocumented immigrants (e.g., what do you think are some situations or things that increase stress among undocumented immigrants in your community? what are some things or resources that help undocumented immigrants cope with stress? what are some community resources that are helpful to the wellbeing of undocumented immigrants?). As recommended by our community partners, at the end of each group or interview, we provided participants with an opportunity to provide us with anonymous feedback using a comments and suggestion sheet. This was extremely helpful and provided us with knowledge that we incorporated into subsequent groups (e.g., provide information about resources for local mental health and legal services; explain the importance of research; schedule future talks in the community; longer duration of the groups to allow for more in-depth discussion). The San Diego State University/University of California San Diego Institutional Review Board (IRB) provided approval for this study.

Analyses

As recommended we have revised the data analyses section to provide a step by step description of our process. The revised paragraph reads: “All audiotapes were transcribed to facilitate the analysis of data. Quantitative data from the demographic questionnaires were analyzed using descriptive statistics (i.e., frequencies, measures of central tendency) to develop a demographic profile for participants in this study. Qualitative data from the focus groups and key informant interviews were analyzed through systematic methods outlined by Miles and Huberman (1994), including starting with specific questions previously developed and then proceed through the steps of data categorization, data reduction, data display, and conclusion drawing and confirmation. More specifically, we began by using the socio-ecological framework as template to categorized data into themes, specifically (a) motivators, (b) resources, and (c) contextual situations, that are helpful to promote the wellbeing of undocumented immigrants at different levels of influence (i.e., individual, interpersonal/community, and policy). Over a six-month period, weekly group meetings with the principal investigator, research assistants, and community representatives were scheduled to read, reread, discuss and categorize the data. To further reduce the data into primary codes and subcodes, we used a table displaying the aforementioned themes at each level of influence. To confirm the categorization and validity of the definitions given for each of theme, primary code and subcode, we engaged in data triangulation. This was done by comparing data from the focus groups with undocumented immigrants to that generated by key informant interviews. We also used field notes and observations taken by the principal investigator and research assistants during the groups and interviews to confirm the themes and codes identified, as well as the definitions generated. Convergence of all of the aforementioned data sources was used to enhance the trustworthiness of our findings.”

Results

Participants

The study sample was comprised of 35 participants, including 20 undocumented Latinx immigrants and 15 key informants. Among undocumented immigrants, the majority were women (74%), married (79%), and had an average age of 44 years (SD = 12.5). Most had a lower than high school education (54%) and approximately half were working (49%). On average, undocumented immigrant participants had lived in the U.S. for approximately 21 years (SD = 9.9). Also, participants reported that more than half of the size of their social network was undocumented (59%). (See Table 1). Among key informants, half were women (50%), most were married (65%), and had an average age of 42 years (SD = 12.9). In contrast to undocumented immigrant participants, most key informants had a greater than high school education (85%), with approximately 34% being community leaders (i.e., faith-based, indigenous, activists), 27% health providers to undocumented immigrants, 20% research experts on the health of undocumented immigrants, 13% legal experts or attorneys, and 7% employers. On average, key informants reported working with undocumented immigrants almost every day of the week (M = 5 days/week; SD = 1.5) for approximately the past 13 years (SD = 11) (See Table 2).

Table 1.

Characteristics of participants in focus groups.

Characteristics Focus Groups = 7 (n = 20)
Sex
% Women	74
Age (M, SD)	43.5 (12.5)
Marital Status
% Married	79
Education
% Below HS	54
Employment
% Working	49
Age of Arrival to the U.S. (M, SD)	22.2 (9.1)
Years in the U.S. (M, SD)	21.4 (9.9)
Social Network
% Social network that is undocumented	59

Table 2.

Characteristics of key informants.

Characteristics	n = 15
Sex
% Women	50
Age (M, SD)	42.0 (12.9)
Marital Status
% Married/all other	65
Education
% Below HS	15
Key informant role/work
% Research	20
% Health service provider (CHW)	7
% Mental health provider	20
% Spiritual/religious leader	20
% Indigenous leader	7
% Legal/Political expert	13
% Employer	7
% Community activist	6
Knowledge of undocumented community
Years serving the undocumented (M, SD)	13 (11)
Days per week interacting with the undocumented (M, SD)	5 (1.5)
% of undocumented immigrants served	73

Protective factors at the individual level

At the personal or individual level, two primary themes emerged for the classification of factors protective to the wellbeing of undocumented Latinx immigrants. These included motivation and resources, with each of these themes having specific primary codes and subcodes (See Table 3). Motivation. This pertains to reasons that inspire, encourage, or help undocumented immigrants endure and overcome hardship to achieve a desired goal. A primary source of motivation identified was the family unit, which motivates immigrants to behave in ways that facilitate better opportunities for the advancement and wellbeing of their loved ones, primarily their children. The majority of key informants emphasized concern for family wellbeing as the primary motivator that helps undocumented immigrants face hardship. For instance, a prominent community advocate emphasized that “what keeps these immigrants strong is their love for their family, their desire to give [their children] a better life; that is what they come here for … They hope that [their children] can have better jobs than they do, so that they don’t have to face similar hardship.” Similarly, an immigrant declared, “[our motivation] can be a job or money, but the most important thing is to give a better future to our children.” As such, employment and income are secondary motivators or tools that facilitate opportunities for advancing up the social ladder, which in turn can again serve to protect the wellbeing of their families. Of note, the desire to take care of family members in their country of origin, primarily ill or elderly parents, by sending money back home was also identified as an important motivator. In this regard, a young immigrant stated, “I work to send money to my mom, even if I don’t have any money left to eat. I feel good because my mom will eat regardless of what I have to go through.” It is through self-sacrifice and selflessness that these immigrants find meaning to their undocumented experience, with the ultimate goal of providing a better life for their loved ones.

Table 3.

Protective Factors to the wellbeing of undocumented immigrants at different levels of influence: Themes, primary codes, and subcodes.

Level of Influence	Themes	Primary Codes	Subcodes
Individ ual
	1.Motivation	1.Family	1.Opportunities for children
			•1. 2.Providing for family abroad
	•1. b.Resources	1.English proficiency
		•1. b.Employment
		•1. c.Diverse job skills
		•1. d.Transportation
Interpersonal and Community	1.Contextual situations	1.Family environment	•1. 1.Family unity •2. 2.Family harmony •3. 1.Trusting networks •4. 2.Prevent discrimination within group •5. 1.Structure/Sources •6. 2.Function/Type
	•1. b.Resources	•1. b.Community cohesion
		•1. a.Social Support
Policy	1.Contextual situations	1.Protected neighborhoods	•1. 1.Low crime •2. 2.Less persecution •3. 1.Protection from work exploitation •4. 2.Prevent abuse from services •5. 3.Prevent domestic violence •6. 1.Loans/scholarships •7. 1.Ability to purchase health insurance
	1.Resources	•1. b.Non-stigmatizing environments
		•1. c.Protection from abuse/exploitation
		•1. d.Activism
		•1. a.Educational opportunities
		•1. b.Health-care access

Resources

These are tools or sources that facilitate an immigrant’s ability to function effectively in the midst of chaos. Resources identified included English proficiency, employment, acquisition of diverse job skills, and transportation. An immigrant emphasized the importance of being proficient in English by saying, “If you don’t speak English, you are nothing. Speaking English is necessary to get a job and to defend yourself,” while another asserted that “speaking English opens many doors. If people try to speak English and be bilingual, this helps a lot.” English proficiency was emphasized as essential to reduce discrimination, important to advance the social ladder, necessary to facilitate access to resources (i.e., jobs, health services, legal assistance), and crucial to improve interpersonal communication, including bridging the acculturation gap among family members varying in generation status. This is important for families in which the parents have limited English proficiency and the children become their cultural brokers, which can be quite distressing and disrupting for both parties. An immigrant commented that “not speaking English is a big stressor … if the children speak English and the parents don’t, this puts a lot of stress on the kids who have to do things that are not their responsibility.” English proficiency was also emphasized as a gateway to better employment and less hazardous jobs, as well as an initial step to become self-employed. An immigrant stated, “after many years, I am doing better … I speak English, and now I work on my own after having to beg for jobs. I am self-employed and I have learned a lot of things that have helped me move forward.” The ability to become self-employed provides undocumented immigrants with many benefits, including an increased sense of control over their life, opportunities for creativity and decision-making, and the ability to build a desirable social network. Acquiring diverse job skills, such as reading and writing, learning to use a computer, learning how to operate complex machinery, learning an art (e.g., carpentry, construction, painting), was also identified as a particularly helpful resource to secure job placements and escalate the social ladder. Finally, transportation, specifically learning to use public transportation and having the ability to obtain a driver’s license, was identified as essential for job stability and access to services, which helps to reduce stress.

Protective factors at the interpersonal and community level

At the interpersonal or community level, two primary themes emerged. These included contextual situations and resources, with each of these having specific primary codes and subcodes (See Table 3).

Contextual situations

These refer to conditions in the immediate and community environment in which an immigrant lives that makes it more bearable for the immigrant to cope with being undocumented and that facilitate adaptation or adjustment to change over time. Relevant contextual situations identified included: (a) having an adequate family environment and (b) community cohesion. Regarding family environment, two subcodes emerged: unity and harmony. Family unity refers to preservation of the family intactness to avoid disruption in family dynamics. This includes preventing family separation, particularly as a result of deportation or leaving family or children in the country of origin. An immigrant stated, “[family separation] destroys the most important thing that we have, it breaks our spirit in half, and this definitively affects our health.” Another detrimental type of family separation identified was divorce and single parenting. In this regard, a mental health provider emphasized that “the involvement of the fathers helps a lot … when the father is involved, things get done a lot faster and with less distress … undocumented women who are single mothers have a heavy load that is hard to endure.” In addition to highlighting the detrimental effects of family separation on an immigrant’s wellbeing, participants identify that family unity is essential to building the secure attachments needed to maintain good interpersonal relationships. In addition to family unity, harmony within the family, or the ability of families to minimize interpersonal conflict, was an important protective factor. This includes bridging the intergenerational gap between children and parents and diminishing acculturative stress within the family. A mental health provider stated that “having children that may be more acculturated than the parents… having that acculturation gap and not knowing how to handle it is very difficult, these families need to learn how to navigate differences between first and second generation to prevent conflict … [the parents] perceive themselves as the guardians of tradition and cultural values, while [the children] are cultural brokers.” Another important issue pertaining to family harmony was improving family communication and learning to be more sensitive to the challenges faced by family members varying in immigration legal status, such as in mixed-status families. Complex dynamics identified in mixed status families included difficulty bonding between family members, difficulties empathizing and understanding the hardship faced by undocumented family members, and facing unequal opportunities for education, employment, and social advancement. For instance, a community health worker commented that “family members who have a [legal immigration status] sometimes do not understand the struggles of family members who are undocumented. They do not understand why [undocumented family members] may be so depressed … They do not realize that those with [a documented status] have privileges and can do many things that an undocumented person cannot do. It is hard for them have compassion or understanding.” Another emphasized that “family members who are documented often feel frustrated because they can’t help their loved ones who are undocumented … they may want to help, but they don’t know how.” Also, upon reflecting on her story, an immigrant woman said, “if some of your children are documented and others are not, it is very difficult … you can find health services for the documented ones, but not for the others, or some can go to school but not others.” Another aspect of family harmony that was emphasized was preventing domestic violence. A legal expert acknowledged that “there is a good amount of domestic violence among undocumented families, and this includes intimidation, manipulation, coercion, and extortion, which causes a lot of damage.” Educating the undocumented community about the negative effects of domestic violence, the identification of symptoms, and devising ways to prevent domestic violence were identified as important protective factors.

Community cohesion or residence in areas where there are trusting networks or relationships that share similar values and norms was identified as another relevant contextual situation for protecting the wellbeing of undocumented immigrants, with two subcodes of interest: a) building trusting networks, and b) preventing discrimination from other Latinxs. An immigrant reflected, “having a sense of community carries a sense of hope … being connected to community groups and local traditional groups brings us happiness … it helps us to not feel alone. It helps us learn that we are not the only undocumented person, and that there are a lot of undocumented people around.” Also, the relevance of community cohesion, particularly the need for building trusting networks, was summarized by an immigrant who declared that “there are not many spaces where [they] feel comfortable saying that [they] are undocumented. This can cause a lot of pain and trauma.” He emphasized that a high degree of trustworthiness and solidarity within communities are helpful ways for undocumented immigrants to relax away from the difficulties of their everyday lives, which helps immigrants feel less alone knowing that they are not the only ones going through similar hardships. An important aspect that was brought up as interfering with community cohesion was discrimination from other Latinxs, which was described as distressing. For instance, a male immigrant stated, “the rejection from my own people hurts, it is the rejection from other Latinxs that is most damaging. They often ignore us. It is very sad because instead of finding help in them, they don’t support or help us.”

Resources

The primary interpersonal or community resource identified as a protective factor was social support. Social support refers to the network of family, friends, neighbors, and community members that is available to provide the immigrant with help and relief in times of need. Within social support, two different subcodes were identified: (a) structural features and (b) functional characteristics. Structural features refer to the sources of social support available to the immigrant, which included family, community, and employers. Family sources of social support included the nuclear and extended family, as well as in-laws and adopted relatives such as close friends of the family or familial relationships created through ritual kinship such as compadres/comadres or padrinos/madrinas. Participants also emphasized that the aforementioned ties need to be strong and numerous in both the U.S. and in their country of origin. A mental health provider asserted that “having a large extended family, including siblings, cousins, grandparents, is definitively helpful because family members rely on each other and this helps them cope with stress.” Likewise, an immigrant commented, “having a large family helps share responsibilities, because then you know that if you don’t have a place to live you can go with one or another member of your family.”

Community sources of support identified included: (a) support from compatriot networks or groups of immigrants from the same country of origin, (b) social clubs or places of gathering that are endogenous to the Latinx culture, and (c) religious institutions. Regarding religious institutions as sources of support, a young undocumented immigrant stated that “churches provide a lot of services and outreach to our community that the government at large does not provide. Churches provide an environment where we feel supported, valued, useful, respected, and where our stories can be heard, which is of an incredible value.” Other sources of support provided by religious institutions that were identified included workshops for legal aid, English classes, skills building workshops, mental and physical health seminars, support groups, spiritual retreats, leadership opportunities, and food/financial assistance programs. Another relevant source of social support were employers. In reflecting upon his employer, an immigrant commented, “having an employer that understands our problems and the situation that we face [as undocumented], and who is willing to lend us a hand, makes us feel good and helps a lot.”

The other aspect of social support that emerged as important is functional characteristics, which are the types of support available. Specifically, three different types of support were identified: (a) tangible, (b) informational, and (c) affectionate. Tangible support includes assistance with practical help, such as loans of money, assistance with daily needs, housing, transportation, food, translation, and transitioning to the U.S. culture. For instance, an immigrant illustrated the role of tangible support by reflecting on her daughter’s story. She said, “If someone needs something, [undocumented immigrants] unite, and cook or sell stuff to gather money to help each other in whatever is needed… It happened with my daughter, we needed fourteen thousand dollars for her radiation and we didn’t have the money … in three days we gathered the money in our community.” The second type of support identified was affectionate or emotional support, which pertains to receiving love and empathy from others, being listened to, and being given displays of affection. An immigrant described his primary sources of affectionate support by saying, “I talk with my wife, she supports me, listens to me, and tells me to take it easy, she tells me relax and not worry.” In reflecting how to provide emotional support to undocumented immigrants, an expert community health worker commented, “you have to open yourself a lot and show [them] your vulnerability, so that they can open themselves to you.” Overall, participants emphasized that affectionate support can be provided by using eye contact to convey love and care, attentiveness, good listening skills, and non-judgment. An immigrant stated that, “we need to feel understood and not ignored … no one likes to be ignored.” The third type of support identified was informational support, that is, having assistance to access information and community resources, such as health advice, tips for job search and referrals, and access to other needed services, such as legal and social services. An immigrant emphasized that “having resources handy and references for places that [they] can go seek help is essential. [They] need someone that can give [them] advice and can tell [them] how to keep moving forward or how to overcome a problem that [they] may have.” Nonetheless, most participants agreed that informational support needs to be provided without passing judgment or lecturing the person.

Protective factors at the policy level

At the policy level, two primary themes emerged for classification of protective factors. These included contextual situations and resources, with each of these having specific codes and subcodes (See Table 3).

Contextual situations

Similar to the description at the interpersonal level, contextual situations are environments in which an immigrant can thrive and be safe. At the policy level, four primary contextual situations were identified: (a) protected neighborhoods, (b) non-stigmatizing environments, (c) protection from abuse and/or exploitation, and (d) activism involvement. Being in protected neighborhoods was described as the ability to live in neighborhoods with low crime and places where undocumented immigrants do not have to be constantly afraid of being detained. In this regard, an expert researcher mentioned that “living in safe neighborhoods is helpful to [undocumented immigrants] … the situation is more difficult in [neighborhoods] where the undocumented population is very small and there are only a few of them, which leads to isolation.” Indeed, a community health worker commented that “many [undocumented immigrants] live in places in which they feel vulnerable and unsafe. They worry about how others would look at them. They ask themselves, would they accept me? Would they discriminate against me? Will there be any legal consequences? This creates a lot of social anxiety, maybe even agoraphobia, because it feels safer for them to be at home than in the streets.” In addition, the need to build safe spaces in which these immigrants can feel free to denounce crime was identified as necessary. In this regard, a legal expert mentioned, “people are afraid to ask for help because they think that they are going to be deported, and this is particularly pronounced in rural communities.” The ever-present fear of being detained or separated from their families was highlighted as a prevalent stressor in neighborhoods described as “unsafe.”

A non-stigmatizing environment was identified as another contextual situation needed to protect the wellbeing of undocumented immigrants, particularly their mental health. To illustrate some common stereotypes surrounding undocumented immigrants, an immigrant declared, “there is a lot of stigma that is placed on undocumented people. Just by being called undocumented makes you feel uncomfortable and that is because people have always associated us with negative [attributes]. [Being undocumented] is made out to be something you should be ashamed of. People often associate us with high crime [and] poverty, not understanding our lives and our needs. They think of us as a drain to society.” Several participants denounced stereotypes that portray undocumented immigrants as undesirable members of society as “wrong,” “cruel,” and “inhumane.” In describing the negative effects of stereotyping on their health, an immigrant expressed, “we don’t have a face, we are perceived as not having feelings, we don’t exist. People don’t know the effects that [stereotyping] has on us. This creates a lot of stress.” Also, to highlight the damaging effects of stereotyping, a community health provider emphasized, “[undocumented immigrants] are dehumanized to the point that they may want to kill themselves. If we are going to try and treat immigrants better, we need to learn and understand the effects of migration on them better.” This includes the general history of immigration, current immigration trends, reasons for migration, challenges that immigrants face across different stages of the immigration process, and the resilience of immigrants, among others.

Also, protection from exploitation or abuse was identified as an important primary code. Most participants highlighted that undocumented immigrants have limited civil and labor protections, which can result in exploitation and exposure to unsafe conditions, compromising their health and even leading to death. Primary factors identified as preventing undocumented immigrants from denouncing exploitation or abuse included fear of deportation, limited knowledge of rights, and lack of knowledge about courses of action (e.g., where and how to denounce exploitation or abuse). A mental health professional emphasized that “because of fear of deportation, [undocumented immigrants] don’t seek help, they don’t know how to defend themselves, they don’t know what to do if they are abused.” Pertaining to exploitation or abuse, the need for protection at three levels emerged: (a) work exploitation, (b) services provided (i.e., purchasing a car or house at high interest rates), and (c) domestic violence. Within work exploitation, examples of common abuses from which undocumented immigrants need to be protected from included: (a) sexual harassment, (b) physical abuse, (c) low pay, (d) long hours, and (e) deception. For instance, an immigrant commented, “our bosses sometimes take advantage of us and make us work longer times or asks us to do things that were not part of our job and that we didn’t expect. They ask us to do it because they know we need the job and we don’t have time to look for another job.”

Finally, involvement in activism, or having the ability to participate in efforts aimed at promoting social, political, economic, or environmental changes to achieve social justice, was also identified as a valuable contextual situation. A legal expert referred to activism as a way for immigrants to derive a sense of empowerment and identity beyond their legal status, which prevents them from succumbing to the oppressive situations that they face. He commented that “sometimes the parents become empowered by their kids and you see families of activists … this gives them hope and motivation to keep going.”

Resources

At the policy level, resources refer primarily to opportunities that provide better quality of life and social advancement for undocumented immigrants. Important resources identified included: (a) educational opportunities and (b) healthcare access. Regarding educational opportunities, creating programs for scholarship or financial assistance would allow immigrants to continue advancing their education, which in turn opens doors to better jobs and more income. A young immigrant commented, “I did not know that I was undocumented until I was in high school when it was time to apply for college and financial aid. I realized I did not have a Social Security Number so I worried that I was not going to be able to go to college. I got very depressed.” Along those lines, another young immigrant mentioned, “there are a lot of things that you have to overcome, but at the same time [not having access to education] holds you down because you can’t be what you want to be.” Pertaining to healthcare access, participants emphasized the need for access to purchasing health insurance so that undocumented immigrants can receive needed health services. Reflecting on her experience, an immigrant asserted, “we do not ask for free things. We simply ask for access to purchase health insurance. I need medical care because I got ran over and they don’t give me medical attention or any therapy.” Similarly, a mental health provider said that “there is a need for a policy that gives access to undocumented immigrants to purchase health insurance. Many of them have economic power to purchase insurance and they are willing to do it.”

Discussion

To fill an existing gap in the literature and to provide a portrait of aspects that facilitate resilience among undocumented Latinx immigrants, this study identified protective factors at different levels of influence that help these immigrants cope with adversity and protect their wellbeing. At the individual level, our findings identified dispositional attributes that undocumented immigrants use day-to-day to overcome hardship, including building optimism, focusing on the impermanence of an adverse event, using creativity to solve problems, believing in God’s protection, remaining flexible or open to new ways of doing things, and building tenacity or persistence. Similarly, consistent with prior research on the relevance of familismo to Latinx mental health, which is the deep feelings of dedication, commitment, and loyalty to the family that brings about positive feelings, our study showed that bettering the life of family members is a primary motivation that helps undocumented immigrants overcome the many challenges that they face (Valdivieso-Mora et al., 2016). The aforementioned cognitive and behavioral skills, as well as having family as a primary motivation to move forward despite adversity, provide crucial knowledge that should be incorporated in the development of context-sensitive interventions framed within a strength-based approach. Strength-based approaches focus on developing and building upon a person’s strengths, qualities, and motivation to foster a positive self-image (Smith, 2006). Preliminary studies support the effectiveness of strength-based approaches in increasing positive feelings (i.e., happiness) and diminishing negative affectivity (i.e., depression) (Tayyab, 2015). Facilitating ways for undocumented immigrants to build on the aforementioned attributes and motivation could be helpful to increase perceptions of resourcefulness, strength, and resilience, which is needed to endure hostile environments and the daily challenges of living undocumented.

At the interpersonal and community level, our findings identified specific contextual situations within the family and in the community that are protective to the mental health of undocumented immigrants. Consistent with prior research on family connectedness, our study showed the vital need for family unity and harmony, including keeping the family intact by preventing family separation, to foster an environment for undocumented immigrants to thrive in (Berger Cardoso & Thompson, 2010). Moreover, our findings on the relevance of family harmony to the wellbeing to undocumented immigrants support the need for psychoeducational interventions aimed at promoting effective communication and problem-solving skills within families, including learning to navigate the acculturation gap between parents and children and developing ways to improve family dynamics for mixed-status families. For instance, members of mixed status families could benefit from learning techniques to help cope with distressing emotions such as guilt, fear, uncertainty, and anger that are often prevalent in families in which not all members are undocumented (Romero Morales & Consoli, 2020). Similarly, interventions aimed to minimize interpersonal family conflict and to prevent domestic violence would be beneficial (Raj & Silverman, 2002). Of note, our findings also support the importance of building community cohesion in undocumented communities, particularly building trusting networks where immigrants can feel supported and respected. Unfortunately, our findings showed that discrimination from other Latinxs often interferes with building community cohesion; thus, the need for prevention programs and educational campaigns aimed at raising awareness on the detrimental effects of within group discrimination and how it interferes with building cohesive communities and more tolerant environments. Given the limited access to health services and prevalent stigma that surrounds mental health in the Latinx community, nontraditional sources of service delivery such as faith-based organizations, advocacy agencies, or media campaigns could be ideal ways for the dissemination of the aforementioned family and community interventions.

At the policy level, our findings also identified contexts that are essential to safeguarding the wellbeing and human rights of undocumented immigrants, including protecting the neighborhoods where these immigrants reside, stopping rhetoric that stigmatizes the undocumented community, and putting in place legal protections to prevent these immigrants from being abused or exploited. Research shows that undocumented immigrants often choose to live in segregated neighborhoods not only because of financial constraints but primarily to avoid punitive contact with law enforcement that could result in deportation and family separation (Asad & Rosen, 2019). As a result, these immigrants must often learn to leverage long-existing ethno-racial hierarchies to conceal their undocumented status, while having to find ways to cope with discrimination and stigmatization (Asad & Rosen, 2019). It is often the case that in these neighborhoods, undocumented immigrants fall prey to crime, high housing costs, neglect and/or exploitation from landlords or lending practices, as well as limited access to needed resources, healthcare, and social services (Asad & Rosen, 2019). Similar situations often take place in job settings in which immigrants fall prey to wage theft, long work shifts, harassment, unsafe working conditions, and lack of benefits (Clibborn, 2015). Unfortunately, given fear of deportation, family separation, and job loss, most undocumented immigrants avoid reporting criminal activity, abuse, or exploitation to the appropriate authorities, and instead continue to endure abuse (Fussell, 2011). The risk of living and working in these detrimental environments calls for the need to advocate for the creation of safe spaces where undocumented immigrants may no longer need to make significant tradeoffs between neighborhood, job safety, and their legal risk. Safe spaces are places or environments where immigrants can feel supported, respected, and secure from discrimination, harm, abuse, and exploitation, as well as places where immigrants feel safe to denounce crimes without repercussion (Safe Space, n.d.). Faith-based organizations and academic institutions have been at the forefront of building safe spaces for undocumented immigrants; however, an expanded conceptualization is needed to facilitate the building of safe spaces beyond the aforementioned settings to encompass public places, healthcare settings, legal aid centers, law enforcement, workforce organizations, media, and the internet (Vannini et al., 2018).

Other important findings from our study were the identification of resources at different levels of influence that facilitate the advancement of undocumented immigrants and make it easier for them to overcome the obstacles that they face. For instance, at the individual and policy level, facilitating access to educational opportunities such as classes for English as a Second Language (ESL), workshops to learn and develop job-related skills (e.g., computer, administration/finances, leadership), and availability of loans and programs to pay for higher education is important to help these immigrants advance in society. Likewise, finding avenues to make transportation safe and accessible, which includes allowing undocumented immigrants to obtain driving permits or licenses, is essential. Obtaining a driver’s license is important to increasing their safety by (a) ensuring that these immigrants pass a driving test to determine their capability, (b) allowing identification by emergency personnel in case of an accident, (c) facilitating access to purchase car insurance to comply with the law, and (d) having access to an official identification document that can verify the person’s identity. Currently, there are only 14 U.S. states that allow undocumented immigrants to obtain driver’s licenses. Research to identify the potential personal and community benefits of allowing undocumented immigrants to obtain a driver’s license is essential to motivate additional states to endorse such policy.

Another necessary resource that was identified at the policy level was healthcare access. Undocumented immigrants have limited access to health services and are unable to purchase health insurance in the exchanges; thus, they often rely on cash to pay for services or neglect their care due to cost (Wallace et al., 2013). This is particularly problematic given that many undocumented immigrants live in poverty and lack means to afford prevention and treatment services. Two possible ways to facilitate access to healthcare for these immigrants could be to allow them to purchase health insurance in the exchanges at their personal expense or to compel employers of undocumented immigrants to provide health insurance. Providing access to the aforementioned resources is crucial to protecting the human rights of these immigrants and to increase their safety and opportunities in our communities.

Lastly, consistent with a broad body of research, our study showed that social support is a vital resource that helps undocumented immigrants cope with adversity (Mulvaney-Day et al., 2007). Indeed, this study identified not only sources, but also specific types of social support, such as receiving help with daily hassles, gaining affection and empathy from others, and having assistance in learning and identifying community resources, as helpful to ameliorate distress. A deeper understanding of the mechanisms through which the aforementioned types of social support buffer the negative effects of stress in this population is needed to increase cultural competence in the organizations, agencies, healthcare settings, and law enforcement agencies that come into contact with this immigrant population.

Limitations

This study has some limitations. First, we used a convenience sample recruited through community networks that may have influenced participants’ responses. However, it is likely that this approach may have empowered participants to provide honest answers. Second, all participants in the focus groups resided near the U.S.-Mexico border region, which may have implications for the generalizability of findings. Nonetheless, efforts were made to ensure that the focus groups included diverse participants, while key informants had extensive exposure and expertise in working or interacting with different undocumented communities nationwide. Additional studies are needed with undocumented communities located across diverse regions in the U.S.

Conclusion

This study adds to the literature by highlighting relevant protective factors to the wellbeing of undocumented Latinx immigrants in the U.S. Overall, our study identifies specific resources such as the provision of relevant educational, social and employment opportunities, along with healthcare access and transportation as essential to better the lives of this vulnerable population. In addition, facilitating contextual situations such as creating safer and trusting environments at the individual, community and policy levels is essential to reduce risk and prevent further harm. Despite the high resilience of undocumented immigrants, the current socio-political climate in the U.S. poses a serious threat to the health and wellbeing of this marginalized population. Now more than ever, the need for advocacy efforts and the adoption of immigrant-friendly policies are critical to protect the human rights of undocumented immigrants, their U.S.-born families, and their communities.