Tuesday, March 14, 2017

"Dreamers" policy may have reduced depression in eligible individuals

Study finds reduced levels of depression in Hispanic non-citizens who may be eligible for Deferred Action for Childhood Arrivals (DACA) program

A team of researchers from Massachusetts General Hospital (MGH) and the Harvard T.H. Chan School of Public Health reported that the Deferred Action for Childhood Arrivals (DACA) program appears to have reduced depression among eligible undocumented immigrants, often referred to as the “Dreamers.” These timely findings come on the heels of ongoing debates around the future under the Trump Administration of immigration policies, including the DACA program, which provides renewable, temporary work permits to undocumented immigrants who arrived in the United States as children. Thus far, over 750,000 individuals have been enrolled.

“It is well known that economic circumstances affect mental health,” says lead researcher Atheendar Venkataramani, MD, PhD, of the MGH Division of General Medicine. “The DACA program increased access to the US labor market for these individuals and raised hopes for a better economic future. The large mental health benefits we found likely reflect these positive changes.”

The current study, published in the latest issue of The Lancet Public Health, examined data submitted from 2008 to 2015 by more than 14,000 non-citizen Hispanic adults through the U.S. National Health Interview Survey. The researchers used respondents’ age, timing of immigration and other criteria to identify potentially DACA-eligible persons. They then compared changes in respondents’ overall self-reported health and depression symptoms before and after the 2012 implementation of DACA between those who might be eligible – the survey did not ask about immigration status – and those definitely not eligible for DACA.

Overall, the study found that DACA-eligible persons were 50 percent less likely to report symptoms consistent with major depression at the time they completed the survey. No association was found between DACA eligibility and self-reported overall health, which the authors noted is likely due to the relative youth of participants and the fact that physical health symptoms may take longer to evolve in response to policy changes. Because neither immigration status nor DACA enrollment were directly elicited in these surveys, the authors also noted that estimates from their analysis likely understate the true impacts of the DACA program on mental health.

“Our statistical estimates are averaged over a large group of people who reported that they are non-citizens. Estimates are that close to 60 percent of self-reported non-citizens in large U.S. surveys are undocumented, and a smaller fraction of that group may have been signed up for DACA,” says Venkataramani. “It is possible that mental health benefits would be much larger for persons directly affected by the policy.”

Study co-author Ichiro Kawachi, MBChB, PhD, the John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology and Chair of the Department of Social and Behavioral Sciences at the Harvard Chan School, says “Our study reveals the potentially large consequences of changes in immigration policy on important health outcomes. Policymakers have traditionally not taken health impacts into account when debating immigration. While our results are specific to the DACA program, we hope they may better inform decisions around immigration policy more generally.”

Alexander C. Tsai, MD, of the Chester M. Pierce Division of Global Psychiatry at MGH, the senior author of the study, adds that the findings reveal the importance of economic opportunities for health. “As the current political climate has demonstrated, there has been a lot of anxiety about how there no longer seems to be equal opportunities to share in prosperity through hard work – that’s the American Dream, and it’s fading.” Referring to companion studies from his group, published recently in the American Journal of Public Health and The Lancet Public Health, he said, “Our research program has shown that there is a strong and meaningful link between the prospects for upward social mobility and good health. The current work really underscores that point – giving people access to the American Dream improves their mental health in a substantial way.”

Tsai is an assistant professor of Psychiatry and Venkataramani an assistant professor of Medicine at Harvard Medical School. Additional co-authors of The Lancet Public Health paper are Sachin Shah, MD, MGH Department of Medicine, and Rourke O’Brien, PhD, University of Wisconsin – Madison.

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators and students, we work together to take innovative ideas from the laboratory to people’s lives – not only making scientific breakthroughs, but also working to change individual behaviors, public policies and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the school is recognized as America’s oldest professional training program in public health.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2016 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America’s Best Hospitals."

media contact: Noah Brown, nbrown9@partners.org, 617 643-3907

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