Undocumented Mexican immigrants plagued by loss and distress

Approximately 18 years ago, a little boy and his mother entered the United States illegally. The young boy suffered from congenital heart disease and needed a new heart. His mother, fleeing severe domestic abuse, hoped they could build a new life in America and that she could get her small son the specialized medical care he so desperately needed.

Years passed, but the undocumented boy was never considered for the transplant list. His condition progressively worsened until he was finally placed in palliative care. Today, he relies on morphine to control the pain that pulses throughout his body. His mother remains by his side, but she, too, is dying—waiting for a liver transplant that will never come.

This story was collected in clinical interviews that took place between Nov. 2014 and Jan. 2015. In all, 248 undocumented Mexican immigrants residing near the California-Mexico border were interviewed by researchers who wanted to examine the prevalence of migration-related loss and its association with ongoing trauma and psychological distress. Results of the study appeared in a paper titled “A High Price Paid: Loss and Distress Among Undocumented Mexican Immigrants,” published by the Journal of Latinx Psychology.

Luz Garcini, Ph.D., a postdoctoral research fellow in Rice University’s department of psychological sciences and the study’s lead author, stressed the importance of these interviews in collecting her data.

“If we were to do the clinical interview using traditional measures and with a traditional diagnosis—without really knowing the context of how this young adult was living—he would come out as a drug addict,” said Garcini, who also serves as a faculty scholar at the Baker Institute for Public Policy at Rice and will soon join the The University of Texas Health Science Center in San Antonio as an assistant professor at The Center for Research to Advance Community Health. “The stress and the high level of depression and anxiety and the constant amounts of medically related drugs that he was consuming—he would have come out of the study as someone with substance abuse, which is the stereotype that is so prevalent in this community. That’s why it is so important to get the story, to find out who these people really are.”

Loss and trauma

Garcini, who worked alongside colleagues at Rice as well as researchers at the University of Denver, the University of New Mexico, the University of Central Florida and The University of Texas at Austin, discovered that the rate at which undocumented Mexican immigrants suffer psychological and physical losses related to their migration was much higher than previously understood.

“We knew there was a high prevalence of loss and trauma in this population—we expect it because we know the many challenges they face. However, they were so much higher than I could even imagine, particularly in terms of repeated exposure or multiple losses,” Garcini said.

The study’s participants were mostly female, married and living on a household income of less than $2,000 a month. The majority had been in the U.S. for more than 10 years.

Researchers divided the different types of losses into separate categories, including the symbolic self, interdependence, home, interpersonal relationships and interpersonal integrity. They found that migration-related loss was high across all categories. Even more, these losses were linked to clinically significant psychological stress—especially loss of interdependence related to being treated differently by others for not having a visa.

Yet despite what seemed to be endless suffering, the people who shared their stories were remarkably strong, Garcini said.

“One of the most striking things is that, regardless of the amount of loss and trauma, they are very resilient,” she said. “I would say, ‘It seems like you’ve endured a lot in your life and you have lost a lot. How are you doing? How would you describe your life here?’ And they would say, ‘It’s very good.’ And I would say, ‘But you’re struggling. You’re facing loss and trauma,’ and they would say, ‘Yes, but you don’t know where I come from. This is much better than what I left behind.’”

Individuals who seemed most resilient, she said, often had three things in common: a focus on family, a job and strong spirituality.

Living in fear

The Pew Research Center estimates that 10.7 million undocumented immigrants resided in the U.S. in 2016, half of whom originated from Mexico. Approximately one-quarter of the U.S. foreign-born population is unauthorized immigrants.

Garcini hopes that the results of this study will help her and others identify new strategies to reduce the negative effects and mental health concerns among this at-risk population and start implementing intervention, policy and advocacy efforts. She is now involved in studies that take this data a step forward by using blood tests to assess how stress and trauma affect physical health and physiological function.

“The purpose is to also identify some of the protecting factors that could lessen that impact on their health,” Garcini explained. “Once we identify that, we’ll be able to develop and build interventions that could be disseminated to the community through collaboration with social agencies or faith-based communities.”

Some of the most important collaborators, Garcini said, are clinicians.

“We hope these results will raise awareness among providers to develop best practices with these populations,” Garcini said. “It’s always important when you see these families that you have in the back of your mind that there’s a very high possibility that they might have experienced trauma, or they might not disclose certain health conditions because of fear.”

That fear has been compounded in recent years amid a political and social climate that has grown increasingly hostile toward undocumented immigrants.

“The rhetoric has escalated against immigrants, particularly undocumented and particularly people of Mexican origin,” Garcini said. “We have seen increased discrimination, threats— you can imagine that the loss and the trauma is going to be much, much higher.”

Interviewees who had been eager to speak with Garcini in 2014 were afraid to speak with her when she returned this past December.

“People didn’t want to talk,” Garcini said, “and these people know me.”

Beyond mental health

A constant state of anxiety keeps many undocumented immigrants from receiving sufficient care for mental and physical health issues. Further complicating the situation is the fact that this population is almost always uninsured.

“Generally, these patients are able to get some care at these federally qualified health centers that see patients regardless of citizenship and regardless of insurance, but these centers don’t have all the specialists that are required,” said Rajeev Raghavan, M.D., an associate professor of nephrology at Baylor College of Medicine who sees many undocumented patients in renal failure who are in need of dialysis or a transplant. “Oftentimes these patients really go untreated and the disease becomes quite severe.”

Raghavan believes that policy change on a federal level is critical.

“This patchwork of solutions where one state does one thing and one state does another is not fair to the patients and it makes it much more complicated for the health care system to provide care when it’s fragmented,” Raghavan said. “This is really a national problem … so having some uniform policy makes sense.”

For now, though, federal policy seems to be moving in the opposite direction. On Oct. 10, 2018, the Trump administration proposed a change to what is known as the “public charge” rule. According to U.S. Citizenship and Immigration Services: “Any individual who is likely at any time to become a public charge is inadmissible to the United States and ineligible to become a legal permanent resident. However, receiving public benefits does not automatically make an individual a public charge.”

Trump’s proposed change adds more programs to be considered when determining if a person is likely to become a public charge, including health care organizations previously considered “off-limits” because of the essential services they provide, such as Medicaid, Medicare Part D, housing assistance and the Supplemental Nutrition Assistance Program (SNAP). Although these changes have yet to be implemented, misinformation and rumors have sent ripples of fear throughout immigrant communities.

“People are really afraid. It’s created a lot of misconceptions and misunderstanding,” said attorney Wafa Abdin, executive director of Houston Volunteer Lawyers, which provides pro bono legal aid. Abdin said she’s even seen immigrants who are excluded from the public charge rule avoid accessing services because of it.

“There are families that don’t really know how much it will affect them, so they are starting to stop asking for these benefits,” Abdin said.

Living in fear is the status quo for many undocumented immigrants.

“They’re not sure when they drop their kids at school whether they’ll be able to pick up the kids because every undocumented immigrant has become a priority with the change of priorities as a result of the executive orders,” Abdin said. “There is this atmosphere of fear added to those who even have hope of getting some kind of status. They really don’t want to even touch anything that might jeopardize them.”

For those who work most closely with this population, the current patchwork of solutions and the threat of even more stringent guidelines for aid is devastating, Garcini said.

“When you study the context and you learn the story, you realize that the majority of these people are struggling, that they come here with a purpose, that they want to work, they want to better their lives,” she said.