As a teenager working as a cashier at Target during rush hour, Cindy Portillo would struggle to catch her breath as her palms became sweaty and her heart raced. At the time, she could not name what was happening: an anxiety-induced panic attack. It was only at 21, after years of feeling this way and doing her own research that a doctor diagnosed her with anxiety disorder. “I feel like I'm the only one in my family who has ever experienced anxiety,” Portillo tells Refinery29 Somos. “Within my family, they didn't really know how to help me, besides telling me that I needed to go to church more, or get closer to God and that would help. But it didn't. I just needed more support.”
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Going to talk therapy, Portillo learned to manage her anxiety symptoms, as well as the root causes behind her disorder: suppressed trauma and high expectations from her immigrant family. As a first-generation American, Portillo is more likely to develop an anxiety disorder than her parents, according to a new study that states that immigrants have lower rates of anxiety disorders than U.S.-born adults across most racial-ethnic backgrounds.
These findings align with the immigrant paradox, a phenomenon experts and researchers have observed about recent immigrants to the U.S. outperforming children of immigrants on health, education, and crime-related outcomes. According to licensed therapist Stephanie Contreras, whose clinical work focuses on immigrant youth, there’s no current answer for the incongruity.
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"As a first-generation American, Portillo is more likely to develop an anxiety disorder than her parents, according to a new study that states that immigrants have lower rates of anxiety disorders than U.S.-born adults across most racial-ethnic backgrounds."
nicole froio
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“The data does show that progressively, as generations stay in the U.S. context, these psychological outcomes, like anxiety and depression, worsened, and I think it’s important to name this paradox,” Contreras says. “I do think this conversation needs to happen, and we have to ask: What are the protective elements and the risk factors for recent immigrants? How do their experiences in their native country protect them, or not, from what they're going to experience in the U.S.?”
Contreras adds that, in her clinical work, she has observed that children of immigrants have different developmental tasks from their parents because they must learn the social patterns of two countries. “Children of immigrants have an additional burden of learning about their home context and the context of the country of reception, in this case, the U.S., which is a kind of literacy these children must have,” Contreras says. “And then how do they learn it? There isn’t a curriculum for teaching your children to protect themselves against these things that you might not be aware of as a parent with an immigrant background.”
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For Portillo, the oldest daughter of a Guatemalan family in the U.S., these findings make sense. However, Portillo asserts that Latine families’ lack of knowledge about mental health might be skewing the results. She believes people in her family do suffer from mental health conditions but don’t have the resources or time to get the care they need. “They didn't know that what I had was anxiety,” Portillo says. “When it comes to mental health, I feel like there are signs and symptoms in certain family members, but because they've never actually done anything about it, they don't believe that there’s anything wrong with them.”
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"Children of immigrants have an additional burden of learning about their home context and the context of the country of reception, in this case, the U.S., which is a kind of literacy these children must have. And then how do they learn it? There isn’t a curriculum for teaching your children to protect themselves against these things that you might not be aware of as a parent with an immigrant background."
Stephanie Contreras
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For licensed therapist Valerie Labanca, who works with Latine patients at Octave in Pasadena, California, the study also doesn’t seem to account for a normalization of mental health disorders in older populations. “It mentions in the study that some folks that don't leave their country, that they might have less anxiety disorders, and I don’t know if that’s necessarily true,” Labanca says. ‘Especially for older generations, [mental health] is not talked about. Especially if we are talking about the Latine community, feelings, emotions, mental health — these are not topics of discussion when we think about older generations, and they're not seeking mental health services. They're not getting diagnosed. They sometimes normalize it in terms of their feelings and just think that that's just part of life.”
Juliana* was diagnosed with anxiety and mild depression at 18. Similar to Portillo, she recognized symptoms at an earlier age but thought it was normal until she started feeling consistently low and on-edge all the time. Getting a diagnosis and subsequent treatment was extra difficult because Juliana’s parents didn’t believe anything was wrong.
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“My dad just brushed it all off,” she says. “My mom was like, ‘No you don't need therapy. You've lived a perfectly good life. Nothing super dramatic has ever happened to you. Why do you need to go to therapy?’” Juliana’s mother thought she was overreacting, but later, her mother admitted that a pediatrician had flagged possible anxiety symptoms when Juliana was 10 years old.
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"When it comes to mental health, I feel like there are signs and symptoms in certain family members, but because they've never actually done anything about it, they don't believe that there’s anything wrong with them."
Cindy Portillo
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The only way to persuade her parents that she had a mental health condition that needed attention was by going through the treatment process and showing results. “Over the past couple years, she's been accepting it more just because of how I've been dealing with it, but also how she has seen that I've been progressing,” Juliana says, two years after her diagnosis.
Like Portillo, Juliana believes her parents have a lot of unresolved trauma that results in mental health conditions like anxiety and depression. Though Juliana’s father is Cuban and her mother is Puerto Rican, they approach feelings and mental health in the same way: They don’t talk about it. “Both of my parents don't talk a lot about their upbringing, but what I do know about it — they've gone through some serious stuff,” she says. “And my dad did not see a therapist until my mom basically forced him to do couples counseling after he had an affair.”
When older generations don’t recognize mental health issues in themselves, they affect the younger generations who want to heal. Additionally, Labanca says that while older generations from Latin American countries might have undiagnosed anxiety disorders, the reasons for their anxiety are different from what their children experience. The older generations might have more trauma than their U.S.-born children, which makes it difficult to find common ground between the two parties.
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"When older generations don’t recognize mental health issues in themselves, they affect the younger generations who want to heal."
nicole froio
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For Contreras, the immigrant paradox theory points to a gap in literature — a lack of input from older generations of immigrants in these kinds of studies and wider conversations about mental health. Inviting older immigrants to speak about their feelings and their coping mechanisms would clarify what we’re losing over generations of Latine immigration and clarify if and how they experience anxiety.
“We understand that with generations assimilating the longer they're here, the worse they fare, so what is the bridge that we can build between the protective factors of recent immigrants and their children,” Contreras adds. “It's also important to theorize around what our parents inherently do; what is the cultural inheritance that they can bring to this conversation? It could be that they’re better adjusted, or it could be that we're just not measuring their anxiety in the same way. Either way, I think it'd be interesting to just take inventory. What are parents or recent immigrants doing well that keeps them protected? And what they could mindfully inculcate in their children so that we, too, can have their support in those [developmental] processes. So I think bringing recent immigrants into these conversations and being curious about what works is also important.”
Immigration is often traumatic, but as Labanca points out, not all immigrant stories are the same. For example, if someone moves to the U.S. with a visa for a specific professional opportunity, they might have a better support system to fall back on than someone entering the U.S. undocumented. Still, in cases where someone enters with permission, U.S.-born children of families with green cards might develop anxiety due to a lack of community. So while immigrants’ mental health issues might be due to the particularities of moving to the U.S. — the study cites assimilation into U.S. culture, stress, social ties, and sociodemographics — their U.S.-born children are dealing with the aftermath of their family’s immigration.
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"We understand that with generations assimilating the longer they're here, the worse they fare, so what is the bridge that we can build between the protective factors of recent immigrants and their children."
Stephanie Contreras
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“In those cases, I would say that U.S.-born children might actually have [a] higher risk of anxiety disorders because they're born in a country where they don't have the access to their grandparents, their uncles, their cousins and that sense of family when they're growing up,” Labanca says. “Whereas maybe the parents did have that experience, and then came [to the U.S.] as adults, right? I would say that's where the percentage of anxiety disorders in the U.S.-born community comes from.”
The children of immigrants might also experience more pressure to succeed academically and professionally because of their families’ sacrifices for better lives. “There’s a sense of, ‘we came to this country for you to get an education, for you to have better opportunities,’ so this creates an internalized pressure to succeed,” she says. “But they don’t have the same resources as others who have multiple generations of family members in the United States, people who’ve gone to college before and can support them, and offer resources — things a first-generation Latine might not get from their parents. So you're having to figure things out without that same community support, which can also trigger anxiety.”
Almost 13 years after her anxiety disorder diagnosis, Portillo, now 32, can safely say she is part of the solution for the unspoken mental health issues within the Latine community. Now the mother of a son, she believes the work she did to cope with her anxiety and the knowledge she has about mental health more generally will help her be more understanding if her son ever struggles with anxiety.
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"U.S.-born children might actually have [a] higher risk of anxiety disorders because they're born in a country where they don't have the access to their grandparents, their uncles, their cousins and that sense of family when they're growing up. Whereas maybe the parents did have that experience."
Valerie Labanca
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“I feel like [my generation] is more aware of our emotions and we prioritize mental health,” Portillo says. “We're able to help if our children are ever to deal with something similar. We know exactly what to do or how to be more compassionate toward the situation. I think that, as far as mental health is concerned, the future generations will be at a better advantage, and there'll be more awareness around it.”
*Editor's note: Some sources have decided to remain anonymous for privacy.