Sunday, October 9, 2011
Hopelessness, family stress, and depression among Mexican-heritage mothers in the Southwest.
Hopelessness, family stress, and depression among Mexican-heritage mothers in the Southwest. The ongoing upsurge of Mexican immigration in the U.S.-Mexicosouthwestern border region and other regions of the United States hasattracted the interest of researchers who are studying how familiesadapt to their new environments and how they cope with the pressuresassociated with immigration. Mexican-heritage immigrants, like otherworking-class immigrants, often encounter institutional patterns ofoppression and discrimination that reduce their likelihood of economicmobility in a host culture (Phinney, 1990). The Southwest region hasbeen identified as a context in which Mexican-heritage residentsexperience high levels of acculturative stress, in part due to ethnicdiscrimination and anti-immigrant sentiments (Guarnaccia et al., 2007).The awareness of these obstacles, plus the constant threat ofdeportation and economic insecurity, can trigger depression and a senseof hopelessness among Mexican-heritage men and women residing in theU.S.-Mexico borderlands (Hancock & Siu, 2009). The present study approached hopelessness as a possible culturallyspecific response to a unique sociopolitical context in whichacculturative stress can surface in relation to, as well as independentof, more traditional psychiatric diagnoses such as depression. To workwith a Mexican-heritage sample is significant, because this groupexperiences great disparity in accessing mental health services comparedwith the non-Hispanic white majority (Blendon et al., 2007).This studyfocused on Mexican-heritage mothers residing in the U.S.-Mexico borderregion because people of Mexican ancestry represent 64 percent of allLatinos and Latinas in the United States (U.S. Census Bureau, 2008).Furthermore, the study focused on female respondents of Mexican ancestrybecause Latinas have higher prevalence rates of psychiatric disordersthan their male counterparts (Alegria, Mulvaney-Day, et al., 2007). Wehypothesized that lack of social support and high parent-child conflictwould be associated with an increased level of hopelessness amongMexican-heritage mothers. We also expected that hopelessness would beassociated with depression among low-income Mexican-heritage women. HOPELESSNESS Hopelessness is conceptualized as an individual's negativeexpectancy regarding the future, and it is characterized by negativeemotions, pessimistic expectations, and loss of pleasure in life (Beck,Weissman Lester, & Trexler, 1974; Heilemann, Coffey-Love, &Frutos, 2004). Hopelessness is the expectation that negative outcomesare inevitable or that positive outcomes will not develop. Theseexpectations are paired with the feeling that one cannot do anything tochange the future (Abela, Gagnon, & Auerbach, 2007). Individuals whoare pessimistic about the causes and consequences of events and who tendto ascribe negative self-characteristics after negative events have beenfound to be more at risk for hopelessness (Brozina & Abela, 2006). The hopelessness theory of depression supports the idea thathopelessness inevitably leads to hopelessness depression (HD) (Abramson,Metalsky, & Alloy, 1989). This approach differentiates HD from themore traditional depression described in the DSM-IV (AmericanPsychiatric Association, 1994).The difference is that the symptoms of HDare evident only in the presence, but not in the absence, of negativelife stress (Abramson et al., 1989), whereas this is not true withdepression. This theory also advances the idea that when faced with anegative life event, a cognitively vulnerable individual will perceivethe event as implying that he or she is unworthy or deficient (Haeffelet al., 2008). Conversely, high levels of self-esteem and self-worth arestrongly negatively correlated with HD and depression and significantlyassociated with happiness (Cheng & Furnham, 2003). Optimism has beenidentified as having a protective effect against hopelessness (Hirsch& Conner, 2006). Optimistic individuals appear to have an active,adaptive set of coping strategies and are able to overcome adversity andstay on target in their efforts to accomplish their goals (Aldwin, 1994;Aldwin & Levenson, 2004; Puskar, Sereika, Lamb, Tusaie-Mumford,& McGuinness, 1999). Immigrants in search of a better future forthemselves and their families tend to fall within this category. The concept of hopelessness has been studied from differentresearch perspectives with clinical and nonclinical adult populations(Dunn, 2005). Regardless of the setting, hopelessness has been found tohave a negative impact on the psychological well-being and physicalhealth of individuals (Haatainen et al., 2004; Johnson et al., 2001;Shek, 2005). For example, a Finnish study found that, after controllingfor other hypertension risk factors, people with high hopelessness werethree times more likely to become hypertensive (Everson, Kaplan,Goldberg, & Salonen, 2000). A similar study conducted with MexicanAmericans did not, however, find hopelessness to predict hypertension(Stern, Dhanda, & Hazuda, 2009). It is important to considercultural and social contextual factors that are social determinants ofhealth (Koh, Oppenhimer, Massin-Short, Emmons, & Geller, 20l0),because racial, ethnic, and cultural groups appear to experiencehopelessness differently because of variation in coping behaviors andcontextual or environmental differences (Mapp & Hudson, 1997). Research on hopelessness among Mexican Americans and other Latinosis scarce, and hopelessness has usually been evaluated together withother psychological disorders (Dey & Lucas, 2006). For example, astudy researching 30-day prevalence rates of serious psychologicaldistress symptoms (for example, hopelessness, sadness, nervousness,restlessness) found a 4.4 percent prevalence rate among U.S.-born Latinoadults and a 3.6 percent prevalence rate among Latino immigrants (Dey& Wilson Lucas, 2006).The reported prevalence rates for Latinos as agroup were higher than those reported by U.S.-born black adults (3.3percent) and white adults (2.7 percent). In the general population, the prevalence of hopelessness appearsto be higher for men than for women. Single/divorced/widowed, lesseducated, rural, and fairly poor men appear to exhibit more hopelessnessthan do women with similar demographic characteristics (Haatainen etal., 2004). Gender differences in levels of hopelessness amongimmigrants differ from those in the dominant population in thathopelessness among female immigrants seems to be higher and related toan increase in levels of stress (Atienza, Stephens, & Townsend,2004; Spitzer, Neufeld, Harrison, Hughes, & Stewart, 2003). Thiscould be attributed to an escalation in domestic responsibilities amongimmigrant women as well as to family fragmentation, lack of socialsupport, and rigid job schedules (Spitzer et al., 2003). This seems tobe particularly true for migrant mothers who often are raising childrenin unfamiliar and challenging environments with limited access toservices and other support systems (Arcury & Quandt, 2007). HOPELESSNESS AND DEPRESSION Cross-sectional studies have found an association betweendepression and hopelessness symptoms (Breitbart et al., 2000). However,hopelessness may also occur independent of depression (Hirsch &Conner, 2006) or as a precursor to depression (Dunn, 2005). Depressionis one of the most common psychological disorders diagnosed amongLatinos (Alegria, Shrout, et al., 2007;Vega et al., 1998). Hopelessnessamong Latino men (Karel & Moye, 2002) and Latinas (Myers et al.,2002) has been identified as a strong predictor of depression. The12-month prevalence of psychiatric disorders (depression, anxiety, andsubstance disorders) among U.S.-born Latinos has been estimated at 19.2percent, whereas the prevalence rates among Latino immigrants whoarrived before age 6 (18.1 percent) and Latino immigrants who arrivedafter age 6 (13.5 percent) were lower (Alegria, Shrout, et al., 2007).In the aggregate, these rates are a source of concern, but the samestudy reported that, after adjusting for immigration status and age,Latinas had 73 percent higher odds of experiencing depression disordersthan did Latino men. Some of the triggers for hopelessness anddepression among low-income Mexican-ancestry women are partner issues;family factors; feelings of being alone; inability to provide formaterial needs; physical symptoms and experiences; and vague,nonspecific reasons (Heilemann et al., 2004). Personal, familial, andsocial-environmental factors in combination may influence the experienceof hopelessness. Socioeconomic status (SES), employment status,education, experiences with discrimination (Durant et al., 2006; Shek,2002), social support (Park, 2000), and the quality of the parent-childrelationship have been identified as possible contributors tohopelessness (Shek, 1998). Small levels of conflict are normative amongfamilies with adolescents. Among some immigrant families, however, thelevels of conflict may be higher when parents and children go throughthe process of acculturating at different paces, and linguistic andcultural gaps ensue (Szapocznik & Williams, 2000). Among Latinofamilies, family unity and family bonding are paramount, andparent--adolescent conflict may be perceived by parents as especiallyproblematic because it implies a lack of respect and consideration fromchildren, which is perceived as a threat to family unity (Knight,Bernal, & Carlo, 1995). Among Mexican-heritage individuals and other Latinos, hopelessnesscan be related to fatalism--the expectation that one will suffer in lifeand that one needs to be stoic about it and, thus, cannot be depressedabout it (Marsiglia & Kulis, 2008). This culturally specific copingstrategy may allow for the presence of hopelessness in the absence ofdepression. In the face of adversity, a lack of social support may lead tohopelessness, and this in turn may accelerate the onset of HD(Gustavsson-Lilius, Julkunen, & Hietanen, 2007). Even the perceptionof support is important. Sometimes the perception that aid and supportare available (the general sense of being cared for by others and theperceived availability of support) contributes to general mental andphysical well-being (Mulvaney-Day, Alegria, & Sribney, 2007). Theimportance of social support lies partly in that it empowers individualsbecause being part of a social network helps people feel less alone andmore in control of events (Cassidy, 1999). This is especially relevantamong Mexican-heritage and other Latinos living in the United States,because they may not have family residing close by because ofimmigration, and they may not find friends who have common beliefs andvalues. Some studies have suggested that women give and receive moresupport than men (House, Umberson, & Landis, 1988). It seems that,in some ways, social support matters more to women. For example, asignificant relationship between low social support and disturbed sleephas been identified among women, but not among men (Nordin, Knuttson,Sundbom, & Stegmayr, 2005). IMMIGRATION, ACCULTURATION, AND HOPELESSNESS Individuals often experience stress due to life events. Oneespecially vulnerable group is the immigrant population. Immigrants havecultural strengths that may protect them from negative outcomes, but atthe same time, they are exposed to a set of stressors (inability to findadequate jobs, housing, and health insurance; challenges associated withlearning a new language and culture; anti-immigrant sentiments andpolicies) that may leave them more vulnerable to other problems,including depression and hopelessness. The act of immigration often hasa negative impact on various health outcomes because of theextraordinary stress-producing situations an immigrant has to endure.Part of this stress derives from separation from loved ones, severancefrom a familiar environment, changes in cultural expectations, andadversity and suffering associated with resettlement in a new land(Warheit, Vega, Auth, & Meinhardt, 1985). Once the immigrant comes in contact with the host culture theacculturation process starts (Williams & Berry, 1991). Berry (1986)defined acculturation as the process of change a group or individualsundergo when in continuous contact with a culture that differs fromtheir own. This process of adjustment has psychological consequencesbecause of the physical, financial, spiritual, social, and linguisticdemands that immigration imposes on the individual (Mui &Kang,2006). While going through this process, individuals may experienceacculturative stress (Berry, 1980), which is conceptualized as "areduction in the health status of individuals that may include physical,psychological and social aspects" (Berry, Kim, Minde, & Mok,1987, p. 493). In time, acculturative stress may result in anxiety,depression, and alienation (Williams & Berry, 1991). Immigrants facestressful life events and daily hassles (common to all populations) inaddition to the stress produced by the process of living in andadjusting to a new culture and environment. The process of acculturationis complex, and both high and low levels of acculturation are associatedwith mental health problems (Organista, Organista, & Kurasaki,2003). The relationship between acculturation and hopelessness has notbeen extensively investigated with Mexican-heritage populations, butstudies conducted with other populations, such as American Indians,suggest that those with bicultural competence (that is, who are adept inboth cultures) have significantly less hopelessness than do those whoare adept in only one or in neither culture (LaFromboise, Albright,& Harris, 2010). APPROACH A risk-and-resilience approach guided our study. Therisk-and-resilience perspective is based on the idea that someindividuals will maintain positive outcomes even when faced withdifficult personal or environmental circumstances (Rutter, 1985). Theseadverse circumstances are conceptualized as risks (or vulnerabilities)and may include poverty, family conflict, exposure to violence,substance use, and other challenging experiences (Kaplan, 1999).Resiliency is the ability to cope positively with adverse situations orthe ability to bounce back after experiencing an adverse situation(Marsiglia & Kulis, 2008). Resiliency helps individuals to resistadversity successfully as they develop positive coping strategies thathelp them experience adverse circumstances without succumbing to them(Masten, Morison, Pellegrini, & Tellegen, 1990). Resiliency canemerge from the individual, familial, and environmental ecosystems(Newman & Blackburn, 2002). An individual's relationships appear to play a key role inunderstanding the emergence of resiliency (Luthar & Brown, 2007).Supportive relationships provide individuals with the strength to keephope alive even when confronted with very stressful, oppressive, andchallenging circumstances (Graziano, 2004). Individuals from societiesthat tend to be collectivistic in nature may benefit especially frombeing part of a network in which they find positive relationships. It ishuman nature to seek a sense of community, and this is most often foundamong family members who have some common beliefs and values thatprovide a type of cohesiveness and support (Mulvaney-Day et al.,2007).Within families, the quality of the parent-child relationship andthe support drawn from other family members are very important andcontribute to resiliency. Families that are resilient enjoy healthierparent-child relationships and less parent-child conflict (Miranda,Estrada, & Firpo-Jimenez, 2000). Among female adolescents, aweakening of the parent-child relationship is associated with higherlevels of distress, depression, and feelings of exclusion (Fischer,Munsch, & Greene, 1996). The present study examined the role of family support andparent-child conflict in women's self-reported hopelessnesssymptoms. From a risk-and-resiliency perspective, we hypothesized thatlack of social support and high parent-child conflict would beassociated with increased levels of hopelessness among mothers. We alsoexpected that hopelessness would be associated with depression. Thisresearch aimed to fill a gap in the literature by exploring how familialsupport and parent-adolescent conflict relate to Mexican-heritagemothers' sense of hopelessness, after controlling for levels ofdepression and demographic variables. METHOD Data Data for the study came from the Latino Acculturation and HealthProject, a longitudinal study of acculturation and health outcomes amongLatino families living in Arizona and North Carolina (Smokowski, Rose,& Bacallao, 2006). The project was reviewed and approved by theArizona State University institutional review board in the fall of2004.The present study used wave 1 data collected during the spring of2005 in Arizona. The Arizona sample comprised 151 Latino families, withone parent and one adolescent participating in the study from eachfamily. The adolescent data were not used in this study. This study wasrestricted to adult female participants of Mexican origin (N = 136). Avery small number of participants were excluded from the analysis--ninefathers and six mothers who had migrated from Latin American countriesother than Mexico. The analysis focused on Mexican-heritage mothers toensure that there was consistency among the respondents in cultural andnational background and because Mexicans represent the great majority ofLatinos in the United States. Participants Participants were recruited from adult English as a second languageclasses, community centers, local churches, and community fairs.Participation in the study was open to anyone meeting the selectioncriteria, and this is therefore a sample of convenience. Criteria forparticipation included being Latino or Latina and a parent or guardianof an adolescent 14 to 18 years of age. Participation in the study was confidential and voluntary. Writtenconsent was provided by each participant, and participants received $20each as a token of appreciation for their time and for opening theirhomes to the interviewers. Questionnaires were available in both Spanishand English. Participants chose to answer the questions on their own orto have interviewers read the questions to them. In most cases,information was gathered through face-to-face interviews. Baselinesurvey data on the female adults were used in this study. Interviewers Graduate students were hired and trained as interviewers; all werefluent in Spanish and English. Interviews were conducted inparticipants' homes and lasted between one-and-a-half and twohours. All interviews were completed in person. Measures Outcome Variable. The outcome variable hopelessness was measured bynine items from Beck et al.'s (1974) Hopelessness Scale.Participants were asked to respond to statements such as "Thefuture seems dark to me" and "My future is uncertain."Participants responded "true" or "false" to eachitem, and the score was calculated by counting the number of"true" responses. The scale had acceptable reliability(Cronbach's [alpha] = .77). Although the scale had an originalpotential range of 0 to 9, only one person reached the high levels ofhopelessness, and 10 more had scores of 6. For that reason, the highestvalues were collapsed, and the scale was recoded to range from 0 to 4. Independent Variables. Depression was measured with the Center forEpidemiologic Studies Depression Scale (CES-D) (Radloff, 1977).Thisscale has been found to be acceptable for use with subjects of Mexicanheritage (Roberts, 1980). In this study, depression was assessed using a12-item CES-D. Shorter versions of the scale have also been used inothers studies (Andresen, Malmgren, Carter, & Patrick, 1994; Cole,Rabin, Smith, & Kaufman, 2004). Our shortened scale demonstratedadequate reliability ([alpha] =.76). Parent-adolescent conflict was measured with the Conflict BehaviorQuestionnaire for parents (Robin & Foster, 1989), which consists of20 questions containing positive and negative statements concerning achild's social competence and conflict behaviors. Items are ratedas "false" (0) or "true" (1). After recoding ofquestions to the same valence, high scores indicated a great amount ofconflict between parents and adolescents. In this study, one questionwas eliminated (number 10) because more than 5 percent of the cases weremissing. This scale was highly reliable ([alpha] = .92). Demographic Variables. Participants' age was assessed as acontinuous variable (range = 24 to 57 years). SES was calculated on thebasis of family income, adjusted for the number of people in thehousehold and official poverty thresholds. Following the U.S. Departmentof Health and Human Services federal poverty guidelines (FPG), wecreated a new dichotomous variable: FPG. The FPG takes intoconsideration a family's annual income and the household size tocalculate whether a family is below or above the poverty level. Thisvariable was coded 1 for families with incomes below the poverty leveland 0 for families with incomes above the poverty level. Themother's working status was coded 0 for those not currently workingand 1 for those currently employed. Family support was measured using four items: (1) "Familymembers are supportive of each other during difficult times," (2)"Family members discuss problems and feel good about thesolutions," (3) "Family members consult other family memberson personal decisions," and (4) "Family members feel veryclose to each other." Participants responded on a Likert-type scaleranging from 1 (not at all) to 5 (all the time). The four items weresummed, and the scale ranged from 0 to 20. Finally, we used two measures of acculturation. One was based onthe Bicultural Involvement Questionnaire (Szapocznik, Kurtines, &Fernandez, 1980). This was created from 33 items, responded to on afive-point Likert-type scale, with separate questions measuring Hispanicand American orientations. We added the Hispanicism and Americanismsubscales together, resulting in a biculturalism score that ranged fromcultural marginality (lowest scores) to monoculturalism to biculturalism(highest scores).The second measure was the respondent's durationof residence in the United States. Participants' length of timeresiding in the United States has been used previously as a proxy foracculturation (Coonrod, Balcazar, Brady, Garcia, & Van Tine, 1999).This variable was measured in years. ANALYSIS The objective of this study was to examine factors contributing tohopelessness among Mexican-origin mothers living in the United States,controlling for levels of depression. Variables possibly associated withhopelessness were identified through a literature review. We proceededwith analysis by first exploring descriptive statistics to assess thedistribution of the variables, with the goal of determining whether andhow to include them in multivariate analyses. Second, we reduced thenumber of variables to be considered in regression analyses, usingPearson correlation coefficients to select as predictors only thevariables that were significantly associated with hopelessness. Third,we examined each of the selected predictors in separate multipleregressions, with hopelessness as the dependent variable and thepotential effects of depression controlled for. Fourth, we entered allsignificant predictors of hopelessness from the previous regressions ina final simultaneous multiple regression model to assess the relativestrength of their relationship to hopelessness, net of the otherfactors. Variables in this model were examined for possiblemulticollinearity, and all variance inflation factors were withinacceptable ranges (<4). RESULTS The first set of results is descriptive and provides a profile ofthe respondents. Descriptive statistics for all variables (means andstandard deviations for continuous variables and percent non-zero fordummy variables) and their correlations with hopelessness are depictedin Table 1. The mean family support score was high, 17, within onestandard deviation of the maximum value. Most participants reported highlevels of perceived social support (56 percent scoring 18 or above), buta sizable group reported low social support (44 percent scoring 9 orless). About 40 percent of participants reported "nohopelessness," 30 percent scored 1 on the hopelessness scale, and30 percent reported hopelessness on more than one of the nineindicators. In a study of depression with Mexican-heritage respondentsin San Diego, Vega, Kolody, Valle, and Hough (1986) used the CES-D and athreshold of 16 to indicate depression. Because our scale used only 12items, we recalculated the corresponding threshold to be at 9.6. About52 percent of respondents scored above that cutoff point for depression. Significant negative correlations (depicted in Table 1) were foundbetween the dependent variable, hopelessness, and three of thepredictors. Participants reported less hopelessness when they werecurrently working, when they were more educated, and when they hadhigher levels of family support (p < .001). Hopelessness wassignificantly higher among participants who were more depressed, livingin larger households, and experiencing more parent-adolescent conflict.All other variables were not significantly correlated with hopelessnessand, therefore, were excluded from further analysis. In the next step, we tested five separate linear multipleregression models. Results of the analyses are presented in Table 2.Depression was entered first, followed separately by each of thevariables that were correlated with hopelessness. After controlling forthe effects of depression, we found that all predictors remainedsignificant, with the exception of the mother's education. In the final model, depicted in Table 3, all the significantpredictors from Table 2 were entered simultaneously. The linearcombination of working status, household size, family support,parent-adolescent conflict, and depression were significant inpredicting hopelessness [F(5, 142) = 10.48, p < .000].The magnitudeof the relationship was moderate ([r.sup.2] = .29). Similar to previousfindings (Haatanien et al., 2004), working women were substantially lesslikely to experience hopelessness than women not currently working (p< .05), and the standardized coefficient of this predictor was quitelarge. Participants who reported living in households with a largernumber of people also reported more hopelessness (p < .05). Women whohad more support from their families were less likely to reporthopelessness (p < .05). Depression was associated with morehopelessness (p < .01), but its standardized effect was the smallestof those for all significant predictors. Mothers who reported moreconflict with their adolescents also reported higher levels ofhopelessness, but this was nonsignificant after the effects of the otherpredictors were controlled for. DISCUSSION The risk-and-resilience framework (Rutter, 1985) suggests thatindividuals' exposure to risk and protective factors may affectphysical and mental outcomes. Hopelessness is one salient mental outcomethat is particularly important given that previous research hasuncovered a connection between hopelessness and depression. The presentstudy sought to identify factors for Mexican-heritage mothers thatprotect from or contribute to hopelessness. The overall hypothesis thatlack of social support and high parent-adolescent conflict would beassociated with an increased level of hopelessness among the mothers waspartially confirmed. As predicted, a lack of social support wasassociated with hopelessness. Parent-adolescent conflict was moderatelyassociated with hopelessness, but it became nonsignificant after wecontrolled for other predictors. The relationship between hopelessnessand depression within this population appears to be a complex one thatmerits further study before any definitive conclusion is drawn. Familial support was found to be protective against hopelessness(Bayat, Erdem, & Gul Kuzucu, 2008; Beedie & Kennedy, 2002).Familial support may be especially important within this group as itrelates to the strong sense of duty and responsibility toward thefamily, or "familism" (Coohey, 2001). Supportive relationshipsappeared to be a source of strength and resilience for the participantsand helped them to maintain hope (Graziano, 2004). Although parent-adolescent conflict was moderately correlated withhigher levels of hopelessness, this relationship was nonsignificantafter the other predictors were controlled for. Parent-adolescentconflict may not be as important as other variables (such as working andfamily support) in the context of immigration. Parent-adolescentconflict may undermine perceived family support, which emerged as a morepotent predictor of hopelessness. This interpretation is generally inline with previous findings showing that family conflict is associatedwith increased risk of depression in Latino families because it erodesfamily harmony, which is an especially important cultural value for thispopulation (Alegria, Mulvaney-Day, et al., 2007). The model predicting hopelessness while depression was controlledfor needs further exploration. The present findings do not necessarilymatch the causal understanding of this relationship whereby depressionand hopelessness are closely linked (Abramson et al., 1989). It ispossible that in a Mexican-immigrant context, hopelessness anddepression are differentiated, and one does not inevitably lead to theother (Abela et al., 2007).These two constructs appear to be different,suggesting that in this Mexican, female, low-income immigrantpopulation, an individual can feel hopeless but not depressed. Furtherresearch is needed to clarify the possible effects of culturaldeterminants on mental health outcomes of Mexican immigrants. Forexample, hopelessness can be related to fatalism, the expectation thatone will suffer in life and that one needs to be stoic about it and,thus, cannot be depressed about it (Marsiglia & Kulis, 2008).Thisconstruct may have a culturally protective dimension. The partialindependence of hopelessness from depression could also be related tothe immigration experience. The participants were resilient individualswho endured the immigration experience, so they may, on that basis, havebeen optimistic about the long-term future and opportunities ahead. Whenconfronting hard times or rejection, they may have experienced a senseof diminished hope without internalizing it into the feelings ofinadequacy linked to depression. Although a moderate association betweenhopeless-ness and depression was found (r = .40), given the limitationsof our cross-sectional analysis we are not able to determine the degreeto which depression explains hopelessness or hopelessness explainsdepression. We know that in many cases, individuals who are depressedhave feelings of hopelessness, sadness, and loneliness. Other variables of interest in the model, such as low SES andacculturation, did not predict hopelessness in this population. Mostparticipants in the study lived under the federal poverty line, had lowlevels of education, and were first-generation immigrants. Contrary toour expectations, low SES and acculturation levels were notsignificantly associated with hopelessness. There are several potentialexplanations for this finding. Some individuals adapt successfully tochallenging or stressful situations. Some resilience researchers havediscussed the idea that challenging circumstances (such as poverty andacculturation stress) have the potential to enhance an individual'sfunctioning (Aldwin & Levenson, 2004; Puskar et al., 1999). This mayoccur when the individual puts in perspective the challenging event orcircumstances and develops a plan of action (Aldwin, 1994). Thus, thefirst explanation may be that this group of Mexican-heritage mothersrose above the challenges of poverty and acculturation and therefore didnot experience high levels of hopelessness. The second explanation isthat individuals usually migrate in pursuit of a better life, andimmigrants may see the fact that they are settled in their country ofchoice as an already important accomplishment that keeps them fromhaving a negative outlook. The third explanation involves the concept ofoptimism and the use of active coping strategies such as seeking socialsupport (Hirsch & Conner, 2006). Although this study did not measureoptimism, it is possible that these immigrant mothers were high inoptimism and active coping. Future research should investigate thispossibility. The bicultural orientation that typified many respondentsmay have contributed further to the mothers' ability to functionwell within domains of their culture of origin (for example, family,community) as well as within domains of the majority culture, such astheir places of employment (LaFromboise et al., 2010). Current employment was found to be protective against hopelessness,and the size of this effect was far larger than that of any other. Inpoor households, having a job may be an important source of hope. A jobmay increase mothers' positive expectations about the future inmultiple ways. Working mothers may be able to contribute to thehousehold finances, and this, in turn, may have a positive impact on howthey perceive their leadership role and relative status and power withinthe family. A job also gives an opportunity to meet otherMexican-heritage women, which may provide an additional family-likesource of support to the individual. This result may indicate that thestrong effect of current employment status is more important to thesubjective sense of hopelessness than are two other socioeconomicindicators, income and education. For the Mexican-heritage mothers inthis study, in other words, working outside the home may have been moreimportant than their level of socioeconomic attainment. Alternatively, women living in large households, and thoseexperiencing parent-adolescent conflicts, reported higher levels ofhopelessness, although the latter relationship was nonsignificant in thefinal model. Households that include larger numbers of people are morecostly to maintain and may be a source of distress and hopelessness forparents who are struggling financially. In the current study, perceivedfamily support may have been an indirect gauge of respondents'sense of family harmony. These possible relationships deserve moredetailed examination in future research. In conclusion, for this sample of Mexican-heritage immigrantmothers, receiving familial support emerged as an important protectivefactor against hopelessness, and parent-child conflict was not asimportant as other predictors. Hopelessness sometimes was presentindependent of depression, calling attention to the need for theimplementation of culturally specific research about the phenomenon. Anadditional key protective factor against hopelessness was employmentoutside of the home, and size of household emerged as a main risk factorfor hopelessness. Implications for Practice The present findings provide knowledge to inform the development ofinnovative interventions and services to better integrate the uniquestrengths and address the distinct challenges of low-incomeMexican-heritage immigrant mothers. Some specific implications forpractice are the following: * Practitioners should design and test prevention interventionsthat strengthen families of origin and families of choice when familiesof origin are not available due to immigration. * Practitioners should support female employment and relatedsupport networks (for example, social services, mental health services,religious communities). * Practitioners should refine mental health assessment tools tomore effectively diagnose and treat hopelessness and depressionseparately. * Practitioners should identify and reduce additional risk factorsand strengthen protective factors related to hopelessness from aculturally specific perspective. * Practitioners should be aware that some individuals experiencinghopelessness may be at risk for other problems including depression, andthey should be proactive in terms of assessment and treatment. * Because the stress of immigration may be accompanied by a senseof hopelessness and a sense of optimism, health professionals shouldapply a risk-and-resiliency approach to work with the whole experienceof Latina clients who display elevated stress. * In some Latino cultures, talking about depression (depresion) maybe taboo. Hopelessness (desanimo) may be understood differently byclients of various cultural backgrounds and may have a more normativeand culturally specific, comfortable sound for clients. * There is a need for ongoing appraisal of the political and socialenvironment surrounding community members. They are the experts, andtheir stories of success and struggles are the best source ofinformation to keep services responsive and culturally competent. Limitations and Future Research This study used a convenience sample, and its generalizability istherefore limited. A finer analysis of different aspects ofacculturation--such as linguistic acculturation, acquisition ofmainstream cultural values, and entry into social networks of themainstream society--might reveal that acculturation is implicated inhopelessness, but such an investigation would require a larger samplethan was available for the present study. A qualitative component infuture research could contribute needed in-depth knowledge about themeaning of hopelessness and why it emerges among different individualsand in different social contexts. Even taking into consideration theselimitations, the present findings make a significant contribution to thehopelessness literature, because they address the experience of anunderstudied and underserved growing group of Latinos living in theUnited States. Original manuscript received October 7, 2008 Final revision received September 28, 2009 Accepted January 25, 2010 REFERENCES Abela, J.R.Z., Gagnon, H., & Auerbach, R. P. (2007).Hopelessness depression in children: An examination of the symptomcomponent of the hopelessness theory. Cognitive Therapy and Research,31, 401-417. Abramson, L.Y., Metalsky, G., & Alloy, L. (1989). Hopelessnessdepression: A theory-based subtype of depression. Psychological Review,96, 358-372. Aldwin, C. M. (1994). Stress, coping, and development: Anintegrative perspective. New York: Guilford Press. Aldwin, C. M., & Levenson, M. R. (2004). Posttraumatic growth:A developmental perspective. Psychological Inquiry, 15, 19-22. Alegria, M., Mulvaney-Day, N., Torres, M., Polo, A, Cao, Z., &Canino, G. (2007). Prevalence of psychiatric disorders across Latinosubgroups in the United States. American Journal of Public Health, 97,68-75. Alegria, M., Shrout, P. E., Woo, M., Guarnaccia, P., Sribney, W.,Vila, D., et al. (2007). Understanding differences in past yearpsychiatric disorders for Latinos living in the US. Social Science &Medicine, 65, 214-230. American Psychiatric Association. (1994). Diagnostic andstatistical manual of mental disorders (4th ed.). Washington, DC:Author. Andresen, E. M., Malmgren, J.A., Carter, W B., & Patrick, D. L.(1994). Screening for depression in well older adults: Evaluation of ashort form of the CES-D (Center for Epidemiologic Studies DepressionScale). American Journal of Preventive Medicine, 10, 77-84. Arcury, T. A., & Quandt, S.A. (2007). Delivery of healthservices to migrant and seasonal farm workers. Annual Review of PublicHealth, 28, 345-363. Atienza, A. A., Stephens, M.A.P., & Townsend, A. L. (2004).Role stressors as predictors of changes in women's optimisticexpectations. Personality and Individual Differences, 37, 471-484. Bayat, M., Erdem, E., & Gul Kuzucu, E. (2008). Depression,anxiety, hopelessness, and social support levels of the parents ofchildren with cancer. Journal of Pediatric Oncology Nursing, 25,247-253. Beck, A.T., Weissman, A., Lester, D., & Trexler, L. (1974). Themeasurement of pessimism: The Hopelessness Scale. Journal of Consultingand Clinical Psychology, 42, 861-865. Beedie, A., & Kennedy, P. (2002). Quality of social supportpredicts hopelessness and depression post spinal cord injury. Journal ofClinical Psychology in Medical Setting, 9, 227-234. Berry, J.W (1980). Social and cultural change. In H. C. Triandis& R.W Brislin (Eds.), Handbook of cross-cultural psychology, vol. 5:Social psychology (pp. 211-279). Boston: Allyn & Bacon. Berry, J.W. (1986).The acculturation process and refugee behavior.In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health inresettlement countries (pp. 25-37).Washington, DC: Hemisphere. Berry, J.W., Kim, U., Minde, T., & Mok, D. (1987). Comparativestudies of acculturation stress. International Migration Review, 21,491-511. Blendon, R.J., Buhr, T., Cassidy, E. F., Perez, D.J., Hunt, K.A.,Fleischfresser, C., et al. (2007). Disparities in health: Perspectivesof a multi-ethnic, multi-racial America. Health Affairs, 26, 1437-1447. Breitbart, W, Rosenfeld, B., Pessin, H., Kaim, M., FunestiEsch, J.,Galietta, M., et al. (2000). Depression, hopelessness, and desire forhastened death in terminally ill patients with cancer. JAMA, 284,2907-2911. Brozina, K., & Abela, J.R.Z. (2006). Symptoms of depression andanxiety in children: Specificity of the hopelessness theory. Journal ofClinical Child and Adolescent Psychology, 35, 515-527. Cassidy, T. (1999). Stress, cognition and health. New York:Routledge. Cheng, H., & Furnham, A. (2003). Personality, self-esteem, anddemographic predictions of happiness and depression. Personality andIndividual Differences, 34, 921-942. Cole, J. C., Rabin, A. S., Smith, T. L., & Kaufman, A. S.(2004). Development and validation of a Rasch-derived CES-D short form.Psychological Assessment, 17, 360-372. Coohey, C. (2001). The relationship between familism and childmaltreatment in Latino and Anglo families. Child Maltreatment, 6,130-142. Coonrod, D.V., Balcazar, H., Brady, J, Garcia, S., &Van Tine,M. (1999). Smoking, acculturation and family cohesion inMexican-American women. Journal of Ethnicity and Disease, 9, 434-440. Dey, A. N., &Wilson Lucas, J. (2006, March 1). Physical andmental health characteristics of U.S. and foreign-born adults: UnitedStates, 1998-2003 (Advance Data No. 369). Hyattsville, MD: NationalCenter for Health Statistics. Dunn, S. L. (2005). Hopelessness as a response to physical illness.Journal of Nursing Scholarship, 37, 148-155. Durant, T., Mercy, J., Kresnow, M., Simon, T., Potter, L., &Hammond, W. R. (2006). Racial differences in hopelessness as a riskfactor for a nearly lethal suicide attempt. Journal of Black Psychology,32, 285-302. Everson, S.A., Kaplan, G.A., Goldberg, D. E., & Salonen, J.T.(2000). Hypertension incidence is predicted by high levels ofhopelessness in Finnish men. Hypertension, 35, 561-567. Fischer, J. L., Munsch, J., & Greene, S. M. (1996). Adolescenceand intimacy. In G. R. Adams, R. Montemayor, & T. P. Gullotta(Eds.), Psychosocial development during adolescence (pp. 95-129).Thousand Oaks, CA: Sage Publications. Graziano, K.J. (2004). Oppression and resiliency in apost-apartheid South Africa: Unheard voices of black gay men andlesbians. Cultural Diversity and Ethnic Minority Psychology, 10,302-316. Guarnaccia, P. J., Pincay, I. A., Alegria, M., Shrout, P. E.,Lewis-Fernandez, R., & Canino, G.J. (2007). Assessing diversityamong Latinos: Results from NLAAS. Hispanic Journal of BehaviorSciences, 29, 510-534. Gustavsson-Lilius, M., Julkunen, J., & Hietanen, P. (2007). Quality of fife in cancer patients: The role of optimism,hopelessness, and partner support. Quality of Life Research, 16, 75-87. Haatainen, K. M., Tanskanen, J. K., Kylma, J., Honkalampi, K.,Koivumaa-Honkanen, H., Hintikka, J., & Viinamaki, H. (2004). Factorsassociated with hopelessness: A population study. International Journalof Social Psychiatry, 50, 142-152. Haeffel, G.J., Gibb, B. E., Metalsky, G. I., Alloy, L. B.,Abramson, L.Y., Hankin, B. L., et al. (2008). Measuring cognitivevulnerability to depression: Development and validation of the cognitivestyle questionnaire. Clinical Psychology Review, 28, 824-836. Hancock, T. U., & Siu, K. (2009). A culturally sensitiveintervention with domestically violent Latino immigrant men. Journal ofFamily Violence, 24, 123-132. Heilemann, M., Coffey-Love, M., & Frutos, L. (2004). Perceivedreasons for depression among low income women of Mexican descent.Archives of Psychiatric Nursing, 18, 185-192. Hirsch, J. K., & Conner, K. R. (2006). Dispositional andexplanatory style optimism as potential moderators of the relationshipbetween hopelessness and suicidal ideation. Suicide and Life-ThreateningBehavior, 36, 661-670. House, J. S., Umberson, D., & Landis, K. R. (1988). Structuresand processes of social support. In W. R. Scott & J. Blake (Eds.),Annual review of sociology (Vol. 14, pp. 293-318). Palo Alto, CA: AnnualReviews. Johnson, J. G., Alloy, L. B., Panzarella, C., Metalsky, G. I.,Rabkin, J. G., Williams, J.B.W., et al. (2001). Hopelessness as a mediator of the association between socialsupport and depressive symptoms: Findings of a study of men with HIV.Journal of Consulting and Clinical Psychology, 6, 1056-1060. Kaplan, H. B. (1999). Toward an understanding of resilience: Acritical review of definitions and models. In M. D. Glant & J. L.Johnson (Eds.), Resilience and development: Positive life adaptations(pp. 17-83). New York: Kluwer/Plenum. Karel, M.J., & Moye, J. (2002). Assessing depression inmedically ill elderly male veterans: Item--scale properties across andwithin racial groups. Journal of Mental Health and Aging, 8, 121-138. Knight, G. P., Bernal, M. E., & Carlo, G. (1995). Socializationand the development of cooperative, competitive, and individualisticbehaviors among Mexican American children. In E. E. Garcia & B.McLaughlin (Eds.), Meeting the challenge of linguistic and culturaldiversity in early childhood education (pp. 85-102). New York: TeachersCollege Press. Koh, H. K., Oppenhimer, S. C., Massin-Short, S. B., Emmons, K. E.,& Geller, A. C. (2010). Translating research evidence into practiceto reduce health disparities: A social determinants approach. AmericanJournal of Public Health. Advance online publication.doi:10.2105/AJPH.2009.167353 LaFromboise, T. D., Albright, K., & Harris, A. (2010). Patternsof hopelessness among American Indian adolescents: Relationships bylevels of acculturation and residence. Cultural Diversity and EthnicMinority Psychology, 16, 68-76. Luthar, S. S., & Brown, P.J. (2007). Maximizing resiliencethrough diverse levels of inquiry: Prevailing paradigms, possibilities,and priorities for the future. Development and Psychopathology, 19,931-955. Mapp, I., & Hudson, R. (1997). Stress and coping amongAfrican-American and Hispanic parents of deaf children. American Annalsof the Deaf, 142, 48-56. Marsiglia, F. F., & Kulis, S. (2008). Diversity, oppression,and change: Culturally grounded social work. Chicago: Lyceum Books. Masten, A. S., Morison, P., Pellegrini, D., & Tellegen, A.(1990). Competence under stress: Risk and protective factors. In J.Rolf, A. Masten, D. Cicchetti, K. Neuchterlein, & S. Weintraub(Eds.), Risk and protective factors in the development ofpsychopathology (pp. 236-256). Cambridge, England: Cambridge UniversityPress. Miranda, A. O., Estrada, D. & Firpo-Jimenez, M. (2000).Differences in family cohesion, adaptability, and environment amongHispanic families in dissimilar stages of acculturation. Family Journal:Counseling and Therapy for Couples and Families, 8, 341-350. Mui, A. C., & Kang, S.-Y. (2006). Acculturation stress anddepression among Asian immigrant elders. Social Work, 51, 243-255. Mulvaney-Day, N. E., Alegria, M., & Sribney, W. (2007). Socialcohesion, social support, and health among Latinos in the United States.Social Science & Medicine, 64, 477-495. Myers, H. F., Lesser, I., Rodriguez, N., Mira, C. B., Hwang, W. C.,Camp, C., et al. (2002). Ethnic differences in clinical presentation ofdepression in adult women. Cultural Diversity and Ethnic MinorityPsychology, 8, 138-156. Newman, T., & Blackburn, S. (2002). Transitions in the lives ofchildren and young people: Resilience factors (Interchange No. 78).Edinburgh: Scottish Executive Education Department. Nordin, M., Knuttson, A., Sundbom, E., & Stegmayr, B. (2005).Psychosocial factors, gender, and sleep. Journal of Occupational HealthPsychology, 10, 54-63. Organista, P. B., Organista, K. C., & Kurasaki, K. (2003). Therelationship between acculturation and ethnic minority mental health. InK. M. Chun, P. B. Organista, & G. Matin (Eds.), Acculturation:Advances in theory, measurement, and applied research (pp. 112-126).Washington, D C: American Psychological Association. Park, J. (2000).The effect of multiple roles of South Koreanmarried women professors: Role changes and the factors which influencepotential role gratification and strain. Sex Roles, 43, 571-591. Phinney, J. S. (1990). Ethnic identity in adolescents and adults:Review of research. Psychological Bulletin, 108, 499-514. Puskar, K. R., Sereika, S. M., Lamb, J., Tusaie-Mumford, K., &McGuinness, T. (1999). Optimism and its relationship to depression,coping, anger, and life events in rural adolescents. Issues in MentalHealth Nursing, 20, 115-130. Radloff, L. S. (1977).The CES-D Scale: A self-report depressionscale for research in the general population. Applied PsychologicalMeasurement, 1, 385-401. Roberts, R. (1980). Reliability of the CES-D in different ethniccontexts. Psychiatry Research, 2, 125-134. Robin, A. L., & Foster, S. L. (1989). Negotiatingparent-adolescent conflict: A behavioral-family systems approach. NewYork: Guilford Press. Rutter, M. (1985). Family and school influences on cognitivedevelopment. Journal of Child Psychology and Psychiatry, 26, 683-704. Shek, D.T.L. (1998). A longitudinal study of the relations betweenparent-adolescent conflict and adolescent psychological well-being.Journal of Genetic Psychology, 159, 53-68. Shek, D.T.L. (2002). Family functioning and psychologicalwell-being, school adjustment, and problem behavior in Chineseadolescents with and without economic disadvantages. Journal of GeneticPsychology, 163, 497-502. Shek, D.T.L. (2005). Perceived parental control processes,parent-child relational qualities, and psychological well-being inChinese adolescents with and without economic disadvantage. Journal ofGenetic Psychology, 166, 171-189. Smokowski, P. R., Rose, R., & Bacallao. M. L. (2006).Acculturation and Latino family processes: How cultural involvement,biculturalism, and acculturation gaps influence family dynamics. FamilyRelations, 57, 295-308. Spitzer, D., Neufeld, A., Harrison, M. J., Hughes, K., &Stewart, M.J. (2003). Caregiving in transnational context: "Mywings have been cut; where can I fly?" Gender and Society, 17,267-286. Stern, S. L., Dhanda, R., & Hazuda, H. P. (2009). Helplessnesspredicts the development of hypertension in older Mexican and EuropeanAmericans. Journal of Psychosomatic Research, 67, 333-337. Szapocznik, J., Kurtines, W., & Fernandez, T. (1980).Biculturalism and adjustment among Hispanic youths. InternationalJournal of Intercultural Relations, 4, 353-375. Szapocznik, J., & Williams, R.A. (2000). Brief strategic familytherapy: Twenty-five years of interplay among theory, research andpractice in adolescent behavior problems and drug abuse. Clinical Childand Family Psychology Reviews, 3, 117-134. U.S. Census Bureau. (2008, July 9). Factors for features:Populations estimates [Press release].Washington, DC: Author. Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E.,Catalana, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence ofDSM-III-R psychiatric disorders among urban and rural Mexican Americansin California. Archives of General Psychiatry, 55, 771-778. Vega, W. A., Kolody, B., Valle, R., & Hough, R. (1986).Depressive symptoms and their correlates among immigrant Mexican womenin the United States. Social Science Medicine, 22, 645-652. Warheit, G.J., Vega, W.A., Auth, J., & Meinhardt, K. (1985).Mexican-American immigration and mental health. In W.A. Vega & M. R.Miranda (Eds.), Stress and Hispanic mental health (pp. 89-110).Rockville, MD: National Institute of Mental Health Press. Williams, C. L., & Berry, J.W. (1991). Primary prevention ofacculturative stress among refugees: Application of psychological theoryand practice. American Psychologist, 46, 632-641. Flavio F. Marsiglia, PhD, is professor, School of Social Work, anddirector of the Southwest Interdisciplinary Research Center (SIRC),Arizona State University, Phoenix. Stephen Kulis, PhD, is professor,School of Social and Family Dynamics, and director of research, SIRC,Arizona State University, Phoenix. Hilda Garcia Perez, PhD, is assistantprofessor, Department of Transborder Chicana/o and Latina/o Studies, anda faculty research affiliate, SIR C, Arizona State University, Phoenix.Monica Bermudez-Parsai, PhD, is assistant research professor, School ofSocial Work, and assistant director of family intervention research,SIRC, Arizona State University, Phoenix. Address correspondence toFlavio F. Marsiglia, Southwest Interdisciplinary Research Center,Arizona State University, 411 North Central Avenue, Suite 720, Phoenix,AZ 85004-0963;e-mail: firstname.lastname@example.org. Data collection was supportedby awards from the Center for Disease Control and Prevention's(CDC) National Injury Prevention Center (R49/CCR42172 and 1K01CE000496;Paul Smokowski, principal investigator). Data analysis and manuscriptdevelopment were supported by a National Center on Minority Health andHealth Disparities (NCMHHD)/National Institutes of Health (NIH) award(P20MD002316-03; Flavio F. Marsiglia, principal investigator). Thecontent of this article is solely the responsibility of the authors anddoes not necessarily represent the official views of the CDC, theNCMHHD, or the NIH.Table 1: Sample Characteristics (N = 136)Variable M (SD) Range %Age (years) 39.42 (6.16) 24-57Education (0 = <HS, 1 = HS+) 64Living with spouse or partner 82 (0 = no, 1 = yes)Household size 5.22 (1.53) 2-11Working status (0 = not 55 working, 1 = working)FPG (% under poverty level) 79Acculturation (biculturalism 1.26 (1.32) -3-3 score)Time in United States (years) 16.12 (11.48) 0.25-27.00Family support 17.03 (3.15) 0-20Hopelessness 1.20 (1.34) 0-4Parent-adolescent conflict 5.94 (5.07) 0-20Depression 10.86 (6.90) 0-33 Correlation withVariable HopelessnessAge (years) -.01Education (0 = <HS, 1 = HS+) -.17 *Living with spouse or partner .03 (0 = no, 1 = yes)Household size .20 *Working status (0 = not -.32 *** working, 1 = working)FPG (% under poverty level) -.09Acculturation (biculturalism .03 score)Time in United States (years) -.07Family support -.27 ***Hopelessness 1.00Parent-adolescent conflict .30 ***Depression .40 ***Note: HS = high school.* p<.05. ** p<.001.Table 2: Multiple Regression Analyses for All VariablesAssociated with Hopelessness Step and Predictor B SE B [beta] t1 Depression .39 *** .01 .07 4.86 Mother's education -0.10 .10 -.12 -1.202 Depression .39 *** .01 .08 5.12 Household size 0.18 .07 .16 2.30 *3 Depression .34 *** .02 .07 4.18 Working status -.56 ** .22 -.21 -2.584 Depression .36 *** .02 .07 4.44 Family support -.18 * .03 -.07 -2.205 Depression .34 *** .16 .07 4.14 Parent-adolescent .18 * .02 .05 2.22 conflict* p < .05. ** p <.01. *** p <.001.Table 3: Multiple Regression Analysis:Standardized CoefficientsPredictor B SE [beta] tWorking status -.197 * .21 -0.53 -2.53Household size .188 * .07 0.16 2.52Family support -.160 * .03 -0.07 -1.99Parent-adolescent conflict .145 .02 0.04 1.78Depression .238 ** .01 0.04 2.85* p < 05. ** p <.01.
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