Cumulative Lifetime Adversity and Depression Among a National

Cumulative Lifetime Adversity and Depression Among a
National
Sample of U.S. Latinx Immigrants: Within-Group Differences in
Risk and Protective Factors Using Data From the HCHS/SOL
Sociocultural Ancillary Study
Daniel K. Cooper
The Pennsylvania State University
Rahel Bachem
Tel Aviv University
Maya G. Meentken
Erasmus University Medical Center–Sophia
Children’s Hospital, Rotterdam, the Netherlands
Lorena Aceves
The Pennsylvania State University
Ana G. Perez Barrios
Universidad Católica Andres Bello
Latinx immigrants are exposed to multiple stressors before,
during, and after migration.
However, most past research has assumed the effects of these
stressors are uniform across
Latinx groups despite considerable within-group variation. The
purpose of this study was
to (a) assess the moderating effects of several risk and
protective factors on the association

between cumulative lifetime adversity and depression among
U.S. Latinx immigrants and
(b) examine the extent to which risk and protective processes
differed between Latinx
subgroups. Data came from a cross-sectional secondary dataset,
called the Hispanic Com-
munity Health Study/Study of Latinos Sociocultural Ancillary
Study. The sample (N �
2,893) was identified using stratified random probability
sampling in four of the largest
Latinx metropolitan areas: the Bronx, New York; San Diego,
California; Chicago, Illinois;
and Miami, Florida. We included four Latinx subgroups in our
study: Puerto Ricans,
Cubans, Mexicans, and Dominicans. Results from multigroup
regression analyses sug-
gested that social support moderated the association between
cumulative lifetime adversity
and depression. However, further subgroup analyses showed the
moderation effect was
only present for Cuban and Dominican immigrants. We also
found that perceived discrim-
ination moderated the association between lifetime adversity
and depression for Cuban
immigrants and ethnic identity moderated the relationship
between lifetime adversity and
depression for Dominican immigrants. Our results provide
preliminary evidence for the
presence of within-group differences in responses to adverse
events among Latinx immi-
grant groups. Results can be used to inform the development of
mental health interventions
tailored to the specific needs of various Latinx immigrant
populations.
This article was published Online First December 5, 2019.

X Daniel K. Cooper, Methodology Center, The Pennsyl-
vania State University; Rahel Bachem, I-Core Research Cen-
ter for Mass Trauma, Tel Aviv University; Maya G.
Meentken, Department of Child and Adolescent Psychiatry/
Psychology, Erasmus University Medical Center–Sophia
Children’s Hospital, Rotterdam, the Netherlands; Lorena
Aceves, Department of Human Development and Family
Studies, The Pennsylvania State University; Ana G. Perez
Barrios, Universidad Católica Andres Bello.
Funding was provided by Innovatiefonds Zorgverze-
keraars, Stichting Hartekind, and Vereniging EMDR
Nederland (Maya G. Meentken); The Institute of Edu-
cation Sciences, U.S. Department of Education:
R305B090007 (Lorena Aceves); Swiss National Science
Foundation: P00P1_177751 (Rahel Bachem); and Pre-
vention and Methodology Training Program, National
Institute on Drug Abuse (T32 DA017629; Daniel K.
Cooper).
Correspondence concerning this article should be ad-
dressed to Daniel K. Cooper, Methodology Center, The
Pennsylvania State University, 404 HHD, University Park,
PA 16802. E-mail: [email protected]
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Journal of Latinx Psychology
© 2019 American Psychological Association 2020, Vol. 8, No.
3, 202–220
ISSN: 2578-8086 http://dx.doi.org/10.1037/lat0000145
202
https://orcid.org/0000-0002-7144-8406
mailto:[email protected]
http://dx.doi.org/10.1037/lat0000145
Public Significance Statement
This study suggests that the link between risk and protective
factors and depression
may be unique for different Latinx subgroups (e.g., Puerto
Ricans, Dominicans).
These within-group differences may play a role in individuals’
responses to lifetime
adversity. The findings can inform preventive mental health
interventions tailored
to the unique needs of U.S. Latinx populations exposed to
adversity.
Keywords: multigroup regression analysis, discrimination,
acculturation stress,
Latino/a, Hispanic
Supplemental materials:
http://dx.doi.org/10.1037/lat0000145.supp
A wealth of literature indicates that exposure
to adverse events is related to negative mental
health outcomes, such as depression (Edwards,
Holden, Felitti, & Anda, 2003; Ronconi, Shiner,

& Watts, 2015; Ward, Shaw, Chang, & El-
Bassel, 2018). An adverse event is an occur-
rence that will likely cause some form of psy-
chological distress. Adverse events range in
severity and can include a significant life
change such as divorce, serious illness, or in-
carceration or life-threatening experiences such
as physical/sexual abuse or war. Adverse expe-
riences have been linked with numerous health
problems, such as neural impairment, chromo-
somal damage, anxiety, depression, or posttrau-
matic stress disorder (Cicchetti & Rogosch,
2012; Shalev et al., 2013). As individuals are
exposed to higher amounts of adverse life
events, or cumulative lifetime adversity, the
likelihood of developing PTSD, depression, or
other mental health disorders increases (Myers
et al., 2015; Seery, Holman, & Silver, 2010;
Suliman et al., 2009). Therefore, adopting a life
span approach to studying the effects of adverse
events on mental health may be beneficial, es-
pecially when working with populations known
to experience high levels of adversity.
First-generation Latinx immigrants living in
the United States often experience various types
of adverse events before, during, and after mi-
gration (Li, Liddell, & Nickerson, 2016). For
some immigrants, premigration adversity, such
as war-related violence or persecution, can be
the main reason families migrate. During mi-
gration, individuals often experience violence,
discrimination, separation from family mem-
bers, or lack of food and shelter (Bean, Derluyn,
Eurelings-Bontekoe, Broekaert, & Spinhoven,
2007). Finally, there are a number of postmi-

gration challenges that Latinx immigrants face,
such as discrimination, forced detention, unsta-
ble living arrangements, and financial struggles
(e.g., Silove, Austin, & Steel, 2007). Given the
frequent accumulation of numerous types of
adverse events experienced by immigrants, un-
derstanding the cumulative effects of lifetime
adversity is critical when working with immi-
grant populations.
The conservation of resources (COR) theory
(Hobfoll, 1989, 2002) provides a valuable
framework for understanding the effects of cu-
mulative stress on mental health. COR theory
assumes that the primary cause of stress is the
loss of resources and that individuals will go to
great lengths to protect and build upon their
resources. Resources are defined as anything
that a person values, including objects, personal
characteristics, or conditions (Hobfoll, 2001). In
the context of immigrant populations, resources
might include interpersonal relationships, fam-
ily stability, adequate income, health, and well-
being. When these resources are lost or threat-
ened, such as during migration, individuals
experience stress, which may lead to mental
health problems and an increased vulnerability
to future stress (Hobfoll, 2002). This framework
also assumes that stress responses differ based
on the personal and cultural value of a particular
resource.
Past studies have primarily examined risk
and protective factors separately, rather than
testing multiple factors in the same analytical

model (e.g., Huang, Costeines, Kaufman, &
Ayala, 2014). However, risk and protective fac-
tors often co-occur and have overlapping ef-
fects; therefore, including them in the same
statistical model could improve the understand-
ing of mental health processes. Even fewer
203CUMULATIVE LIFETIME ADVERSITY AND
DEPRESSION
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studies have examined potential ethnic sub-
group differences in mental health processes.
Guided by the COR framework, the present
study explored several risk factors (i.e., discrim-
ination, acculturation stress) and protective fac-
tors (i.e., social support, ethnic identity) that
may contribute to how Latinx immigrants re-
spond to adverse events. We also examined how
these risk and protective factors differed across
Latinx subgroups.
Mental Health and U.S. Latinx Populations

Researchers have reported conflicting find-
ings regarding the mental health of U.S. Latinx
populations. Some studies suggest first-
generation Latinx immigrants are at a height-
ened risk for adverse mental health outcomes
compared to second generation Latinxs, family
members that remained in the country of origin,
and non-Latinx Whites (Breslau et al., 2011;
Falcón & Tucker, 2000). Other studies have
reported the opposite trend, or that first-
generation Latinx immigrants display better
mental and physical health compared to Latinxs
who have lived in the United States longer than
a generation (Akresh & Frank, 2008; Alegría et
al., 2008; Shor, Roelfs, & Vang, 2017). Alegría
et al. (2008) referred to this body of conflicting
findings that suggest immigration status is both
a risk and protective factor for negative health
outcomes as the “immigrant paradox.”
There are several possible explanations for
the conflicting findings related to Latinx immi-
grants’ mental health. First, Latinx immigrants
in the United States are a heterogeneous group,
comprised of numerous subethnic groups, each
with a unique migration history and set of life
experiences. For example, Mexicans immi-
grants, the largest U.S. Latinx group, most often
migrate to find employment. Mexican immi-
grants, on average, migrate at a younger age and
with less education than other Latinx immigrant
groups (Alarcón et al., 2016). Mexican immi-
grants tend to experience higher levels of accul-
turation stress, in part due to having one of the
lowest percentages of naturalized citizens, be-
ing most often targeted by immigration author-

ities, and being the least prepared to migrate to
the United States as compared to other Latinx
immigrant groups (Alarcón et al., 2016; Guar-
naccia et al., 2007). A nationally representative
survey of U.S. Latinxs concluded Mexican im-
migrants have lower rates of depression and
other mental health issues as compared to other
subgroups (Alegría et al., 2008). This research
suggests that Mexicans may be more resilient to
life stressors than their Latinx subgroup coun-
terparts.
Cubans often migrate for political reasons
and bring with them considerable social capital,
such as possessing greater levels of education
(Guarnaccia et al., 2007). Cubans were the main
beneficiaries of 1980 Refugee Act and have
historically received greater support from the
United States in seeking asylum and resettling
in the United States (Tienda & Sánchez, 2013).
Cubans are, on average, older when they mi-
grate to the United States, have higher levels of
education, are more financially stable, and are
most likely to be married as compared to other
Latinx subgroups (Alarcón et al., 2016; Guar-
naccia et al., 2007). They also tend to report
having the strongest ethnic identities when
compared to other subgroups (Ai, Carretta, &
Aisenberg, 2017; Guarnaccia et al., 2007). Pos-
sessing a strong ethnic identity and having
greater levels of social capital could promote
resilience to adversity for Cuban immigrants.
Puerto Ricans are unique from other Latinx
subgroups in several ways. Puerto Ricans be-

came U.S. citizens in 1917. As a result, they
also tend to have higher English proficiency and
experience less acculturation stress than other
Latinx subgroups (Guarnaccia et al., 2007; Lo-
pez & Patten, 2015). However, at the same time,
they are more likely to experience economic
challenges, such as unemployment (Alarcón et
al., 2016; Lopez & Patten, 2015), and report
greater discrimination and psychological dis-
tress compared to other subgroups (Rivera et al.,
2008).
Dominicans often migrate to the United
States for greater economic opportunities. The
debt crisis of the 1980s led many Dominicans to
migrate in pursuit of work (Zong & Batlova,
2018). Dominicans are more likely to be women
and identify as Black (Dawson, 2009). Studies
suggest that Dominicans are slower to accultur-
ate to U.S. culture than other subgroups, pre-
serving their culture by visiting the Dominican
Republic frequently, speaking in Spanish, and
living in primarily Dominican neighborhoods in
which they can engage in cultural activities
(Dawson, 2009). Possessing a strong orientation
toward Dominican culture may be protective
204 COOPER ET AL.
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against stressful events, such as discrimination.
One study found that having low acculturation
levels was protective against the effects of dis-
crimination on mental health (Dawson, 2009).
These types of within-group differences may
influence Latinx immigrants’ health trajectories
and responses to lifetime adversity (Molina,
Alegría, & Mahalingam, 2013). It is paramount
for researchers to consider within-group vari-
ability when engaging in mental health research
with Latinx immigrants.
Social Support
Individual-level differences in risk and pro-
tective factors may also contribute to the incon-
sistent findings related to Latinx immigrant
mental health. One important resource for im-
migrants is social support (Kinderman, Schwan-
nauer, Pontin, & Tai, 2013). Social support has
been conceptualized in a variety of ways, in-
cluding receiving assistance or affirmation from
others and being liked by others (Gottlieb &
Bergen, 2010). Research has shown that social
support is one of the most significant determi-
nants of how individuals respond to adversity
(e.g., Prati & Pietrantoni, 2010). This may be
particularly true for migrant populations, who
have lost many of their social connections after
moving to a new country, and for whom social

networks may enable access to resources that
would otherwise be unavailable to them (Ward
et al., 2018). Social networks can facilitate
healthy adaptation processes for migrants, such
as finding employment, housing, and access to
education (Anthias & Cederberg, 2009; Bar-
wick, 2017). Studies consistently document that
low social support is associated with higher
depression for Latinxs (e.g., Rivera, 2007). So-
cial support may be particularly salient for Do-
minican immigrants, who often live in Domin-
ican enclaves (Dawson, 2009).
Ethnic Identity
A second resource related to immigrant men-
tal health is possessing a strong ethnic identity,
defined as “the degree to which individuals per-
ceive themselves to be included and aligned
with an ethnic group” (Smith & Silva, 2011, p.
42). Ethnic identity is assumed to be a defining
characteristic for immigrants, particularly those
from minority ethnic/racial groups (Phinney,
2000). A meta-analysis assessed participants
from various ethnic backgrounds, including
Latinx populations, and found that higher levels
of ethnic identity were associated with lower
levels of mental health symptoms, such as de-
pression (Smith & Silva, 2011). However, for
Latinx populations, the literature shows mixed
findings regarding ethnic identity as a resilience
factor. Umaña-Taylor and colleagues (2008)
found that Latinx adolescents’ baseline levels of
ethnic identity were not associated with their
future levels of self-esteem. Although Brittian

and colleagues (2015) identified ethnic identity
as a protective factor in a context of heightened
stress (e.g., when faced with discriminatio n),
studies have found that Latinx groups tend to
differ in their identification with their ethnic
group. For example, Cubans reported a higher
ethnic identity than other Latinx subgroups
(Guarnaccia et al., 2007). These variations in
ethnic identity may lead to differential associa-
tions between ethnic identity and mental health
among different Latinx groups.
Acculturation Stress
There are also various factors that may
threaten migrants’ existing resources and lead to
negative mental health outcomes. The transition
into a new culture often entails various difficul-
ties, such as socioeconomic hardships, language
problems, or social isolation, all of which can
threaten existing resources and prevent the ac-
quisition of additional resources. Such difficul-
ties can be defined as acculturation stress
(Mendoza, Mordeno, Latkin, & Hall, 2017).
Acculturation stress has consistently been
shown to be negatively associated with mi-
grants’ mental health, including increasing de-
pressive symptoms (Chae, Park, & Kang, 2014;
Kartal & Kiropoulos, 2016; Mendoza et al.,
2017; Revollo, Qureshi, Collazos, Valero, &
Casas, 2011). Researchers found that among
refugee populations, postmigration factors such
as acculturation stress were associated with ad-
verse mental health outcomes above and be-
yond the effect of premigration adversity (Li et
al., 2016). Acculturation stress may also differ

between Latinx subgroups (Alegría et al.,
2008). Studies suggest that Mexicans experi-
ence the highest postmigration acculturation
stress as compared with other Latinx subgroups
living in the United States (Guarnaccia et al.,
DEPRESSION
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2007). Puerto Ricans tend to experience lower
levels of acculturation stress than other sub-
groups due to their U.S. citizenship.
Ethnic/Racial Discrimination
A second threat to migrants’ resources is
experiencing ethnic/racial discrimination. The
negative effects of perceived discrimination on
Latinx health have been widely documented in
past literature (Lorenzo-Blanco & Cortina,
2013; Molina et al., 2013; Moradi & Risco,
2006; Umaña-Taylor et al., 2008). Experiencing
greater amounts of discrimination has been

linked with increases in depression symptoms
and a deterioration in physical health for Lat-
inxs (Umaña-Taylor & Updegraff, 2007; Mo-
lina et al., 2013). However, experiences of dis-
crimination may differ depending on a variety
of factors, such as skin tone, English profi-
ciency, or socioeconomic status (Molina et al.,
2013; Zambrana & Dill, 2006). For example,
one study found that the association between
discrimination and depression was higher for
Black Latinas than for other ethnic groups
(Ramos, Jaccard, & Guilamo-Ramos, 2003).
Other research suggests that Puerto Ricans and
Mexicans experience the highest levels of dis-
crimination as compared to other subgroups (Ai
et al., 2017; Molina et al., 2013). Understanding
potential within-group differences in exposure
to various risk and protective factors is critical
for tailoring interventions to meet the needs of
different Latinx populations.
The Present Study
The purpose of this study was to examine risk
and protective processes associated with de-
pression among Latinx subgroups living in the
mainland United States. We examined (a) the
associations between several risk factors (cu-
mulative lifetime adversity, acculturation stress,
discrimination) and protective factors (social
support, ethnic identity), and depression symp-
toms; (b) the extent to which risk and protective
factors moderated the association between cu-
mulative lifetime adversity and depression; and
(c) the extent to which these risk and protective
processes differed between four Latinx sub-

groups.
We hypothesized that, for the full sample, (a)
risk factors will be positively associated with
depression and protective factors will be nega-
tively associated with depression and (b) risk
factors will exacerbate the association between
cumulative lifetime adversity and depression
and protective factors would buffer the associ-
ation between cumulative lifetime adversity and
depression. Based on the extant literature, we
also hypothesized that (c) discrimination will be
most harmful for Puerto Ricans, Dominica ns,
and Mexicans as compared to Cubans, (d) ac-
culturation stress will be most harmful to Mex-
icans and least harmful to Puerto Ricans, (e)
ethnic identity will be most protective for Cu-
bans and Dominicans, and (f) social support
will be most protective for Dominicans. Refer
to Figure 1 for a diagram of the hypothesized
model.
Method
Sample
Data from this study came from the baseline
assessment of an epidemiological survey of Lat-
inx health, called the Hispanic Community
Health Study/Study of Latinos (HCHS/SOL)
Sociocultural Ancillary Study, conducted in
2009 –2011. The HCHS/SOL study used a
household probability sampling procedure to
identify potential participants in four of the larg-
est Latinx metropolitan areas including the

Bronx, New York; San Diego, California; Chi-
cago, Illinois; and Miami, Florida. Based on the
objectives of the original study, researchers
oversampled (a) households in areas with high
concentrations of Latinxs and (b) households
with higher probabilities of having adults over
the age of 45 (LaVange et al., 2010). The orig-
inal study included 4,393 Latinxs; however, for
the purposes of this study, we only included
participants born outside the mainland United
States. For analysis purposes, we only included
Latinxs from locations with at least 100 partic-
ipants, including Mexico (n � 1,353), Cuba
(n � 689), Puerto Rico (n � 402), and the
Dominican Republic (n � 449). Respondents
were adults aged 18 –74. Most participants were
above the age of 45, had at least a high school
degree, and had a yearly household income of
less than $30,000. Participants, on average, ar-
rived in the mainland United States at 28.71
years of age and had lived in the United States
for over 22 years prior to completing the base-
206 COOPER ET AL.
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line survey. See Table 1 for differences in de-
mographics across the four Latinx subgroups.
Refer to Gallo and colleagues (2014) for further
information regarding the study design and pro-
cedure.
Measures
Cumulative lifetime adversity. We as-
sessed cumulative lifetime adversity using 20-
items from two different measures of adversity:
(a) the Adverse Childhood Experiences (ACE)
scale (Felitti et al., 1998) and (b) the Traumatic
Stress Schedule (TSS; Norris, 1990). The ACE
scale is composed of 10 items that assess the
number of adverse and traumatic events people
experienced during childhood, including emo-
tional abuse, sexual abuse, physical abuse, emo-
tional or physical neglect, witnessing female
Figure 1. Hypothesized model: Cumulative lifetime adversity,
risk and protective factors,
and depression. Control variables were omitted for parsimony
(i.e., age, gender, language
preference).
Table 1
Means (Standard Deviations) in Cumulative Lifetime Adversity,
Depression, and Risk and Protective
Factors for Four Latinx Subgroups
Variable Mexican Puerto Rican Cuban Dominican

Cumulative lifetime adversity 4.38 (3.31) 5.00 (3.59) 3.83
(3.21) 3.83 (2.93)
Depression 7.22 (5.67) 8.70 (6.39) 8.36 (6.71) 7.43 (6.19)
Ethnic identity 3.51 (.46) 3.72 (.46) 3.68 (.47) 3.73 (.45)
Social support 25.72 (6.48) 24.67 (7.13) 27.07 (6.61) 25.40
(6.66)
Discrimination 24.89 (8.07) 26.24 (9.80) 22.45 (6.39) 23.49
(8.10)
Acculturation stress 14.91 (14.04) 10.59 (11.31) 14.83 (12.61)
15.10 (13.50)
Age 47.39 54.61 50.89 47.52
Years in United States 20.75 35.57 12.53 17.50
Language preference (% Spanish preference) 94% 71% 97%
93%
Gender (% Male) 35% 41% 45% 32%
Race (% White) 37% 30% 75% 9%
Income (% families making � $30,000/year) 65% 76% 75%
71%
Marital status (% married) 65% 34% 49% 43%
DEPRESSION
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parent being abused, parental separation or di-
vorce, living with someone abusing substances
or who has a mental illness, and imprisonment
of a household member. The TSS is a brief
10-item assessment of lifetime trauma that in-
cludes events commonly experienced by the
general public, such as experiencing a mugging,
physical attack, unwanted sexual activity, unex-
pected death of a friend or loved one, house fire,
natural disaster, forced evacuation of home, ex-
posure to war/combat, motor vehicle accident,
or other terrifying experience. Participants indi-
cated the number of events they had experi-
enced on a dichotomous scale (0 � no, 1 �
yes). Scores ranged from 0 to 20, with higher
scores representing a higher frequency of expo-
sure to adverse events. Refer to Supplemental
File 1 for a complete list of the ACE and TSS
items.
Acculturation stress. We assessed accul-
turation stress using an abbreviated 17-item ver-
sion of the Hispanic Stress Inventory (Cavazos-
Rehg, Zayas, Walker, & Fisher, 2006). Likert-
type items in this scale focused on various
stressful experiences associated with transition-
ing into living in a new culture, such as occu-
pational/economic stress, immigration stress,
parental stress, and familial stress. Participants
first indicated if they experienced a particular
type of acculturation stress (0 � no, 1 � yes),
then rated the level of stress that item caused on
a range of 1 (not at all worried/tense) to 5
(extremely worried/tense). The total score was
based on a sum of the 17 items and ranged from
0 to 85, with higher scores representing higher

levels of acculturation stress. The internal con-
sistency of the scale was � � .83 for this
sample.
Perceived ethnic discrimination. We as-
sessed perceived discrimination using a 17-item
Brief Perceived Ethnic Discrimination Ques-
tionnaire–Community Version (PEDQ). Items
assess lifetime experiences of discrimination
based on race and ethnicity in various areas of
life, including the workplace and other social
contexts. The PEDQ examines four dimensions
of perceived ethnic discrimination: exclusion/
rejection, stigmatization/evaluation, work/
school discrimination, and threat/aggression
(Gallo et al., 2014). Participants were asked to
respond to how often they had been discrimi-
nated against because of their race or ethnicity
from 1 (never) to 5 (very often). Total scores
ranged from 17 to 85, with higher scores indi-
cating higher levels of perceived discrimination.
This scale has been widely used Latinx popula-
tions (Molina et al., 2013). The internal consis-
tency in the current sample was � � .87.
Social support. We measured social sup-
port using a brief 12-item version of the Inter-
personal Support Evaluation List (ISEL; Merz
et al., 2014), which evaluates the perceived
availability of potential sources of social sup-
port. Items are scored on a 4-point Likert-type
scale, ranging from 0 (definitely false) to 3
(definitely true). The ISEL includes positive and
negative statements assessing three types of so-
cial support: appraisal (advice or guidance), tan-

gible (help or assistance), and sense of belong-
ing (empathy or acceptance). Example items
include “If I were sick, I could easily find some-
one to help me with my daily chores” (tangible)
and “When I need suggestions on how to deal
with a personal problem, I know someone I can
turn to” (appraisal). After reverse scoring the
negatively worded items, the 12 items were
summed to create a composite scale ranging
from 0 to 36. Higher scores represented higher
perceived social interpersonal support. This
scale has been validated with Latinx popula-
tions (Merz et al., 2014) and the internal con-
sistency was � � .82 for our sample.
Ethnic identity. We assessed ethnic iden-
tity using a 12-item subscale from the Scale of
Ethnic Experiences (SEE; Malcarne, Chavira,
Fernandez, & Liu, 2006). Items are scored on a
five-point Likert-type scale asking about
thoughts and feelings surrounding ethnic group
membership. Example items include “I believe
it is important to take part in holidays that
celebrate my ethnic group,” “I have a strong
sense of myself as a member of my ethnic
group,” and “I do not feel it is necessary to learn
about the history of my ethnic group.” Six items
were reverse scored. The following item was
removed due to poor internal consistency: “My
ethnic background plays a very small role in
how I live my life.” The scale was created by
calculating the mean of the remaining 11 items,
with higher scores reflecting higher ethnic iden-
tity. The internal consistency was � � .70 for
our sample.

Depression. To assess depression, we used
a 10-item scale from the Center of Epidemio-
logic Studies Scale (CES-D; Björgvinsson,
Kertz, Bigda-Peyton, McCoy, & Aderka, 2013).
208 COOPER ET AL.
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The CES-D is a brief, widely used measure that
identifies the level of depression symptoms ex-
perienced over the past week. It includes posi-
tive and negative items scored on a 4-point
Likert-type scale from 0 (less than one day) to
3 (5–7 days). Example positive items include “I
felt hopeful about the future and I was happy.”
Example negative items include “I was both-
ered by things that do not usually bother me”
and “I felt depressed.” After reverse scoring the
two positively worded items, we calculated the
sum score for the 10 items (ranged from 0 to
30), with higher scores indicating greater levels
of depression. The criteria for clinical depres-

sion is met when individuals score above 10 on
the CES-D scale. The CES-D has been vali-
dated with Latinx populations (González et al.,
2017). The internal consistency was � � .84 for
this sample.
Data Analysis
We used Mplus 8 (Muthén & Muthén, 2017)
to test all aims of this study. We conducted
preliminary analyses to examine item and vari-
able distribution, internal consistency, bivariate
correlations, and verified that our data met the
assumptions required for conducting multi-
group regression analyses. To test the associa-
tions between cumulative lifetime adversity,
risk factors, protective factors, and depression,
we used multivariate regression. We used ro-
bust maximum likelihood estimation, which is
better at handling nonnormal distributions
(Maydeu-Olivares, 2017).
To test the moderation effects of cultural risk
and protective factors on the relationship be-
tween cumulative lifetime adversity and depres-
sion, we conducted a moderation regression
analysis. Moderators change the relationships
that two variables have with one another. Re-
searchers often use moderation analyses to de-
termine for whom or under which conditions an
association between two variables exists. We
calculated interaction terms by (a) standardizing
the independent and moderating variables and
(b) calculating the product of these two vari-
ables (Kline, 2016). We then added these inter-
action terms to the main effects model and

conducted a R2 change test to determine the
extent to which the moderators improved the
model. To determine whether moderation ef-
fects were significant, we examined unstandard-
ized and standardized regression coefficients
(p � .05).
To test the subgroup differences in risk and
protective processes, we used multigroup re-
gression analyses. Multigroup analysis deter-
mines whether the constructs in the model are
associated with one another in the same way in
each group. Multigroup analysis involves com-
paring a model in which all the parameters are
freely estimated to a model in which all the
parameters are constrained to equal across
groups. Equality constraints do not allow esti-
mates to vary across groups, consistent with the
null hypothesis that no group differences exist
(Kline, 2016). If model fit significantly worsens
after setting equality constraints, this would in-
dicate that the model’s fit to the data depends on
ethnic group membership.
We compared two nested models: (a) a base-
line model with all parameters freely estimated,
and (b) a model with all parameters constrained
to be equal across groups. The two models were
compared using a Satorra-Bentley �2 difference
test, where a significant �2 value indicated a
significantly worse fit for the constrained mod-
el. We also tested alternative models using the
same variables to avoid confirmation bias (as-
suming the hypothesized model is the best fit to
the data). The proportion of missing data in our

study ranged from between 0% and 1% of the
cases. Based on missing data analysis, we as-
sumed that our missing data were missing at
random and handled missing data using listwise
deletion. Power analyses demonstrated that we
had adequate statistical power to detect small to
moderate effect sizes.
Results
Preliminary Analysis
We calculated descriptive statistics to assess
item means, standard deviations and test the
assumptions required for conducting multivari-
ate regression analysis. We assessed demo-
graphic differences between Latinx subgroups
by conducting analyses of variance (ANOVAs).
We found that there were significant group dif-
ferences in gender, age, years lived in the
United States, race, language preference, in-
come level, and marital status (p � .05). There-
fore, we controlled for these variables in subse-
quent analyses.
DEPRESSION
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y.
The mean cumulative lifetime adversity for
the full sample was 4.25 (SD � 3.30) and the
mean depression score was 7.73 (SD � 6.14).
The most common types of lifetime adversities
were unexpected death of a friend or loved one,
parents separated or divorced, mugging, and
physical assault. About 31% of the sample met
criteria for depression. See Table 1 for descrip-
tive statistics for each Latinx subgroup. We also
calculated bivariate correlations between focal
constructs. Cumulative lifetime adversity was
significantly associated with depression, r �
.27, p � .05. The associations between the four
moderating variables (discrimination, accultur-
ation, social support, and ethnic identity), de-
pression, and our control variables were small
to moderate and all were statistically significant.
See Table 2 for all bivariate correlations for the
full sample.
Main Effects for Total Sample
We tested the main effects of cumulative
lifetime adversity, social support, ethnic iden-
tity, discrimination, and acculturation stress on
depression for the full sample using a multivar-
iate regression. We controlled for the effects of
age at the time of the survey, years lived in the
United States, gender, language preference,
marital status, and income level. We selected
these control variables because they have been

shown to contribute to mental health problems
for Latinxs (e.g., Alegría & Woo, 2009; Smith
& Silva, 2011). However, three control vari-
ables (i.e., marital status, years lived in the
United States, and income level) were removed
from the main effects model (and all subsequent
models) because they were not associated with
depression and did not improve model fit.
We found that cumulative lifetime adversity
was significantly associated with depression
scores (b � .15, p � .001). Two of the four
moderator variables were also significantly as-
sociated with depression scores, including so-
cial support (b � �.29, p � .001) and
acculturation stress (b � .26, p � .001). Dis-
crimination (b � .02, p � .05) and ethnic iden-
tity (b � .00, p � .05) were not associated with
depression. In addition, we found that our three
control variables were significantly associated
with depression: age (b � .06, p � .001), lan-
guage preference (b � .07, p � .001), and
gender (b � �.08, p � .001). The main effects
model accounted for 27% of the variance in
depression scores for the full sample.
Moderation Model for Total Sample
We tested the extent to which discrimination,
acculturation stress, ethnic identity and social
support moderated the association between cu-
mulative lifetime adversity and depression, con-
trolling for gender, age at time of survey, and
language preference. Specifically, we examined
whether ethnic identity and social support

weakened the association between cumulative
Table 2
Bivariate Correlations for the Full Sample (N � 2,893)
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Cumulative lifetime
adversity —
2. Depression .27�� —
3. Acculturation stress .25�� .38�� —
4. Discrimination .41�� .25�� .45�� —
5. Social support �.12 �.39�� .27�� .20�� —
6. Ethnic identity �.04 �.09�� .06�� .01 .23�� —
7. Age �.03 .05�� .10�� .10�� .07�� .03 —
8. Years lived in United
States .08�� .04�� .16�� .11�� .07�� .02 .43�� —
9. Gender .02 �.10�� .06�� .13�� .04� �.03 �.03 .03 —
10. Language preference .11�� .03�� .11�� .11�� .07��
.05�� .08�� .32�� .06�� —
11. Race .02 �.01�� .03 .07�� .07�� .02 �.07�� .08��
�.05�� .03 —
12. Marital status .01 .00 .02 �.02 .01 �.03 .30�� .08��
�.11�� .10�� .01 —
13. Income �.04�� .06�� .09�� .07�� .10�� .03
�.05�� .02 .01 .05�� .00 �.01 —
� p � .05. �� p � .01.
210 COOPER ET AL.
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lifetime adversity and depression and whether
discrimination and acculturation stress strength-
ened the association between cumulative life-
time adversity and depression. Our results sug-
gested that the moderation effects model was
superior to the main effects model, F � 2.63,
p � .05. We found that only social support
significantly moderated the relationship be-
sion, � � �.30, p � .01. This means that the
strength of the association between cumulative
lifetime adversity and depression depended on
individuals’ levels of social support (see Figure
2 for a graph of the interaction). None of the
other moderators were significant. The moder-
ation model accounted for 28% of the variance
in depression scores for the full sample.
Multigroup Analysis: Comparing Latinx
Subgroups
We conducted multigroup analyses to deter-
mine the extent to which our hypothesized main
effects and moderation models differed between
four Latinx subgroups. For the freely estimated

models, we selected one parameter that was
relatively equivalent across groups to constrain
to equal (for model identification purposes). We
conducted ANOVAs to make sure these con-
straints did not affect model fit.
The main effects model with all the parame-
ters constrained to equal fit the data significantly
worse than the freely estimated model (robust
�2 � 101.54, p � .001), rejecting the hypoth-
esis that all parameters were the same across the
four Latinx subgroups. Results of the multi-
group main effects model showed that the as-
sociation between discrimination and depres-
sion was only significant for Mexican
immigrants (b � .07, p � .01). The moderation
model with all parameters constrained fit the
data significantly worse than the freely esti-
mated model (robust �2 � 125.11, p � .001),
meaning the moderating effects were not con-
sistent across the four subgroups. First, we
found that social support only moderated the
association between cumulative lifetime adver-
sity and depression for Cuban (� � �.79, p �
.01) and Dominican (� � �.78, p � .01) im-
migrants. Second, we found that discrimination
significantly moderated the association between
for Cuban immigrants (� � �.68, p � .05).
However, this association was in the opposite
direction than expected. Third, we found that
Figure 2. Moderation effect of social support for the full sample
(N � 2,896). Moderation
effect was significant at the p � .01 level. The cutoff score to

meet the criteria for significant
depression symptoms is 10.
DEPRESSION
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ethnic identity moderated the association be-
sion for Dominican immigrants (� � .66, p �
.05). This association was also in the opposite
direction than we predicted. See Table 3 for the
main and interaction effects for each of the four
Latinx subgroups. Refer to Table 3 and Table 4
for results of the multigroup analyses.
Discussion
This study investigated the association be-
tween cumulative lifetime adversity and de-
pression in a diverse sample of Latinx immi-
grants living in the United States. Based on
the COR theory (Hobfoll, 1989), which sug-
gests that cultural resources are critical in

determining responses to stress, we examined
the extent to which several risk and protective
factors moderated the relationship between
controlling for several demographic charac-
teristics. We also examined the extent to
which these risk and protective processes dif-
fered across four Latinx subgroups. Our find-
ings provide important direction for future
intervention work with Latinx immigrants liv-
ing in the United States.
Associations Between Risk and Protective
Factors and Depression
Prior to testing moderation effects, we tested
a main effects model that examined the associ-
ations between cumulative lifetime adversity,
our four moderating variables (i.e., social sup-
port, ethnic identity, acculturation stress, dis-
crimination), control variables, and depression.
Consistent with our hypotheses, we found that
higher levels of cumulative lifetime adversity
and acculturation stress were linked with higher
levels of depression and that higher levels of
social support were linked with lower depres-
sion symptoms for the full sample. These find-
ings are consistent with past research linking
these constructs with depression (Hammen,
2005; Kinderman et al., 2013; Muscatell, Slav-
ich, Monroe, & Gotlib, 2009; Paykel, 2003;
Revollo et al., 2011). Contrary to expectations,
discrimination was not associated with depres-
sion for the full sample of Latinx immigrants.
This finding is inconsistent with past research
documenting the negative association between

discrimination and the well-being of minority
populations (Ellis, MacDonald, Lincoln, &
Cabral, 2008; Lorenzo-Blanco & Unger, 2015;
Torres & Ong, 2010). Although discrimination
was not significantly associated with depression
Table 3
Standardized and Unstandardized Path Coefficients From
Unconstrained Multigroup Main Effects and
Moderation Effects Models by Latinx Subgroup (N � 2,808)
Latinx subgroups Mexican Cuban PR DR
Standardized main effects
Cumulative lifetime adversity .14�� .16�� .11��
.18��
Acculturation stress .33�� .24�� .21�� .21��
Discrimination .07�� .01 .03 �.04
Social support �.25�� .32�� .38�� .28��
Ethnic identity �.02 �.01 .00 �.05
Age .02 .12�� .07 �.03
Language preference .07� .01 .13�� .04
Gender �.03 �.15�� .11�� .17��
Model R2 .30 .30 .29 .27
Unstandardized moderation effects
CLA
Acculturation Stress .11 �.06 �.25 �.05
CLA
Discrimination �.04 �.68� �.02 �.08
CLA
Social Support .03 �.79�� .24 �.78��

CLA
Ethnic Identity �.09 .25 .33 .66�
Model R2 .30 .32 .29 .29
Note. PR � Puerto Rican; DR � Dominican; CLA � cumulative
lifetime adversity.
� p � .05. �� p � .01. �� p � .001.
212 COOPER ET AL.
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for the full sample, our multigroup analysis
(explained below) provide some support for our
hypothesis that discrimination is a risk factor for
developing depression.
Contrary to our hypothesis, we did not find an
association between ethnic identity and depres-
sion. This is surprising as meta-analytic findings
suggest a negative association between ethnic
identity and depression among ethnic minority
individuals (e.g., Smith & Silva, 2011). How-

ever, not all studies have shown ethnic identity
to be linked with positive mental health out-
comes (Kiang, Yip, Gonzales-Backen, Witkow,
& Fuligni, 2006; Umaña-Taylor et al., 2009). In
recent years, scholars have come to recognize
that migrant’s ethnic identity is a dynamic, mul-
tidimensional concept; it likely changes as im-
migrants acculturate to their host societies (e.g.,
Schwartz, Montgomery, & Briones, 2006). In-
dividuals in the current study may have been in
different stages of the acculturation process and,
consequently, their ethnic identity may not have
been associated with depression in a unified
manner. It is also possible that different dimen-
sions of ethnic identity (i.e., exploration, reso-
lution, affirmation) may be associated with dif-
ferent mental health outcomes (Umaña-Taylor
et al., 2008). Future studies could benefit from
assessing the associations between each compo-
nent of ethnic identity and mental health.
Moderating Effects of Social Support for
the Full Sample
Social support was the only significant mod-
erator of the relationship between cumulative
lifetime adversity and depression for the full
sample. This suggests that social support is pro-
tective for Latinx immigrants exposed to ad-
verse events. This finding corresponds with past
research and theory suggesting that social sup-
port buffers the effects of lifetime adversity on
depression (Arnberg, Hultman, Michel, & Lun-
din, 2012; Cohen & Wills, 1985; Ward et al.,
2018). According to the COR theory, social

support is a major resource for individuals ex-
posed to adverse events and can facilitate the
preservation of other resources, such as having
a sense of well-being or a strong ethnic identity
(Hobfoll, 1989). This finding provides impor-
tant information about the potential buffering
effect social support can have for those who
have experienced high levels of lifetime adver-
sity.
Contrary to our hypotheses and COR theory,
ethnic identity, discrimination, and accultura-
tion stress did not moderate the relationship
between cumulative lifetime adversity and de-
pression in the full sample. According to COR
theory, experiencing multiple threats to existing
resources (e.g., acculturation stress and discrim-
ination) will have a cumulative effect, exacer-
bating the effects of adversity on mental health.
Past research suggests that these types of stres-
sors can have overlapping effects and nega-
tively influence Latinx mental health (Torres,
Driscoll, & Voell, 2012). COR theory also as-
sumes that increasing resources, such as by im-
proving one’s ethnic identity, will improve
mental health and protect against future losses
of resources. Similarly, past literature indicates
that components of ethnic identity can be pro-
tective against developing mental health disor-
ders (Smith & Silva, 2011). Our unexpected
findings may be a result of the large amount of
Table 4
Multigroup Analyses for Main Effects and Moderation Effects
Models (N � 2,808)

Model
Robust
�2(df) CFI RMSEA SRMR
Robust
�2( df) CFI RMSEA SRMR Decision
Main effects
M0: Freely estimated 2.22 (4) 1.00 .00 .00 — — — — —
M1: Constrained 102.41�� (27) .92 .06 .02 101.54�� (23)
�.08 .06 .02 Reject
Moderation effects
M0: Freely estimated 1.73 (4) 1.00 .00 .00 — — — — —
M1: Constrained 124.76�� (40) .91 .06 .02 125.11�� (36)
�.09 .06 .02 Reject
Note. CFI � comparative fit index; RMSEA � root mean square
error of approximation; SRMR � square root mean
residual. Estimates were generated using robust maximum
likelihood (MLR) estimation.
�� p � .001.
DEPRESSION
T
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within-group variation in our sample. As sug-
gested by our subgroup analyses (explained be-
low), the moderating effects may not be consis-
tent across all groups of Latinx immigrants.
Differences in Risk and Protective
Processes Across Latinx Subgroups
Past research suggests that associations be-
tween life stressors and psychological health
can vary between Latinx subgroups (Ai et al.,
2017; Molina et al., 2013; Rivera et al., 2008).
We found several differences in risk and pro-
tective processes across Latinx subgroups in our
sample. First, from our main effects multigroup
analysis, we found discrimination was signifi-
cantly linked with depression only for Mexican
immigrants. This finding supported our hypoth-
esis that the association between discrimination
and depression would be particularly high for
Mexican immigrants. Ai and colleagues (2017)
found that Mexican immigrants reported higher
levels of discrimination compared to their Cu-
ban counterparts. In addition, prior studies have
shown that Mexicans often have less social cap-
ital (e.g., education) at the time of arrival in the
United States and have experienced higher lev-
els of deprivation and inequality in their home
country compared to other Latinx subgroups
(Alegría et al., 2008; Guarnaccia et al., 2007;
Torres, 2004). These factors may make Mexi-
can immigrants particularly vulnerable to dis-
crimination. However, we also hypothesized

that discrimination would be associated with
depression for other subgroups, considering
past research documenting the negative effects
of discrimination across Latinx populations (Ai
et al., 2017; Molina et al., 2013). Without other
covariates in the model, discrimination was as-
sociated with depression for all subgroups. This
suggests that although discrimination may
be significantly related to depression when
assessed alone, discrimination may not be
associated with depression above and beyond
the effects of cumulative lifetime adversity,
acculturation stress, social support, ethnic
identity, age, gender, and language prefer-
ence.
Second, we found that social support only
moderated the association between cumulative
lifetime adversity and depression for Cuban and
Dominican immigrants. This finding supported
our hypothesis that social support would be
most protective for Dominican immigrants. Do-
minican immigrants tend to have lower educa-
tion, household income, and are the least likely
Latinx subgroup to be married (Alarcón et al.,
2016; Zong & Batlova, 2018). Hence, social
support may be more protective for Dominicans
than other Latinx subgroups. In addition, many
Dominicans live in ethnically homogenous
neighborhoods in which they have the opportu-
nity to engage in Dominican cultural activities
and social gatherings to build their sense of
community (Dawson, 2009). Cubans’ social ties
are more likely to be with other Spanish speak-
ers based on their lower levels of English pro-

ficiency compared to other subgroups (Guar-
naccia et al., 2007). This may explain the
particular importance of social support in pro-
tecting against depression for Cuban immi-
grants. Further research is needed with these
groups before these explanations can be gener-
alized across all Cuban and Dominican immi-
grant populations.
Third, we found discrimination moderated
the association between cumulative lifetime ad-
versity and depression for Cubans. However,
the moderation was not in the direction that we
expected. Cumulative lifetime adversity seemed
to be more strongly associated with depression
for those who had experienced low levels of
discrimination compared to those who had ex-
perienced high levels of discrimination. This
goes against past literature and theory docu-
menting the cumulative effects of stress, or that
experiencing multiple stressors at the same time
is especially harmful to mental health (e.g.,
Seery et al., 2010).
Finally, we found that ethnic identity moder-
ated the association between cumulative life-
time adversity and depression for Dominican
immigrants. However, the moderation effect
was in the opposite direction than we predicted.
Based on the literature, we predicted that ethnic
identity would be protective for all subgroups
with particular importance for Cuban immi-
grants. Conversely, we found that having high
levels of ethnic identity had an exacerbating
effect on the association between lifetime ad-
versity and depression. Although this result in

part supports our hypothesis that there would be
subgroup differences in the role of ethnic iden-
tity in protecting against depression, this finding
contradicts ample past literature suggesting a
significant positive link between ethnic identity
214 COOPER ET AL.
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and well-being (Iturbide, Raffaelli, & Carlo,
2009). However, some studies suggest that hav-
ing a strong ethnic identity is not always bene-
ficial to psychological health (Umaña-Taylor et
al., 2008). Smith and Silva (2011) stated that
individuals living in ethnic enclaves, such as
many Dominican immigrants, “may not initially
activate ethnic identity as a coping strategy” (p.
21). Additional research is needed to explore
the role of ethnic identity in mental health out-
comes for Dominican immigrants.
Overall, these findings provide evidence for
the large within-group diversity that exists
among U.S. Latinx immigrant populations. Past

theory and research highlight the importance of
culture and life experiences in shaping risk and
resilience processes (Miranda, Estrada, &
Firpo-Jimenez, 2000). Our results also provide
a potential explanation for the conflicting find-
ings related to Latinx immigrant mental health
(e.g., the immigrant paradox). We found that for
the full sample, social support was the only
moderator of the association between cumula-
tive lifetime adversity and depression. How-
ever, the results were very different when ex-
amining each subgroup separately. Without
doing subgroup analyses, these complexities are
lost, and the conclusion validity is compro-
mised. The inconsistent findings in the literature
related to Latinx immigrant mental health could
be due to the large within-group variability
among the Latinx populations assessed (e.g.,
Leong, Park, & Kalibatseva, 2013). Most past
research has focused on Mexican samples and
has not tested subgroup differences in responses
to adverse events. Additional research is needed
to further explore subgroup differences in men-
tal health processes.
Limitations
There are several limitations worth noting in
this study. First, our data came from a cross-
sectional study. This means that the relation-
ships between variables in the study are associ-
ations, and we cannot infer causation or the
direction of these associations. Future research-
ers will need to replicate the results with longi-
tudinal data. Second, our assessment of cumu-
lative lifetime adversity did not account for the

duration of the adverse events. This is an im-
portant element to consider because research
has shown that exposure to long periods of
adversity can be particularly detrimental (Suli-
man et al., 2009). Third, our assessment of
cumulative lifetime adversity was not exhaus-
tive. Although we included many of the most
commonly experienced adverse events, we did
not include all possible forms of lifetime adver-
sity. Fourth, there may have been some level of
overlap in the constructs in our model, such as
cumulative lifetime adversity, discrimination,
and acculturation stress. For example, past the-
ory and research suggest that discrimination and
acculturation stress may be closely related
(Lorenzo-Blanco & Unger, 2015) and certain
types of discrimination can classify as traumatic
events (Ellis et al., 2008). Therefore, some of
the variance in discrimination may have been
accounted for by other constructs in our model.
We chose to conceptualize cultural stressors
(discrimination and acculturation stress) as dis-
tinct from general lifetime adversities (per-
ceived stress, chronic stress, ACEs) to test the
exacerbating effects of experiencing cultural
and general stressors. Fourth, although random
sampling procedures were used to identify par-
ticipants, they were not representative of all age
groups or geographic areas of the United States.
Finally, although we found differences in men-
tal health processes between Latinx subgroups,
we do not know why these differences exist.
Future studies could examine what life events,
beliefs, or values are driving these subgroup
differences.

Conclusion
Despite these limitations, this study repre-
sented the first effort to examine culture-specific
risk and resilience processes across multiple
Latinx subgroups in a national epidemiological
sample of U.S. Latinx immigrants. Few studies
have used multigroup analyses to examine the
mental health trajectories of populations with
high levels of within-group diversity. The pres-
ent study serves as an example of the rich in-
formation that can be obtained by using sub-
group analyses. Our findings have implications
for tailoring mental health interventions for spe-
cific Latinx immigrant groups, as different Lat-
inx immigrant groups may need different inter-
ventions. Factors that may be protective for
some Latinx groups might not be protective for
others. For example, our results indicate that
Cuban and Dominican immigrants exposed to
DEPRESSION
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lifetime adversity could benefit from interven-
tions focused on building social support. More-
over, discrimination seems to be a significant
issue for Mexican and South American immi-
grants and may be a worthwhile target for men-
tal health interventions with these populations.
Health professionals face the risk of making
inaccurate assessments about Latinx immi-
grants’ mental health if they assume all Latinx
immigrants are similar to one another. Future
studies examining risk and protective factors
related to mental health could be strengthened
by further assessing within-group differences
and could increase our understanding of Latinx
mental health.
Resumen
Los inmigrantes Latinx están expuestos a varios facto-
res que les causan estrés antes, durante, y después de
migrar. Sin embargo, casi todas las investigaciones pre-
vias han asumido que los efectos de estos factores que
causan estrés son uniformes entre todos los grupos
inmigrantes Latinx, a pesar de variación considerable
dentro del grupo. El propósito de esta investigación fue
(a) evaluar los efectos moderativos de los varios facto-
res riesgosos y protectores en la relación entre la adver -
sidad acumulativa de la vida y la depresión entre los
inmigrantes Latinx en los estados unidos y (b) examinar
hasta qué punto los procesos riesgosos y protectores se
distinguían entre los subgrupos Latinx. Los datos vini-
eron de un conjunto de datos secundarios transversales
llamados el HCHS/SOL Estudio Sociocultural Ancilar.
La muestra de personas (N � 2893) fue identificada

usando un muestreo aleatorio proporcionalmente es-
tratificado en cuatro de las áreas metropolitanas más
grandes de gente Latinx: El Bronx en New York, San
Diego, California, Chicago, Illinois, y Miami, Florida.
Hemos incluyendo cuatro subgrupos Latinx en nuestra
investigación: puertorriqueños, cubanos, mexicanos, y
dominicanos. Resultados del análisis de regresión mul-
tigrupo sugirieron que el apoyo social moderó la rel -
ación entre la adversidad acumulativa de la vida y la
depresión. Sin embargo, análisis más a fondo de sub-
grupos demostraron que el efecto de moderación solo
estaba presente para los inmigrantes cubanos y domini-
canos. También descubrimos que la discriminación
moderó la relación entre la adversidad acumulativa de la
vida y la depresión para los inmigrantes cubanos y que
la identidad étnica moderó la relación entre la adversi -
dad acumulativa de la vida y la depresión para los
inmigrantes dominicanos. Nuestros resultados proveen
evidencia preliminar de la presencia de diferencias den-
tro del grupo en las repuestas a los eventos adversos
entre los subgrupos de inmigrantes Latinx. Los resulta-
dos pueden informar el desarrollo de intervenciones de
salud mental personalizadas para las necesidades espe-
cíficas de varias poblaciones de inmigrantes Latinx.
References
Ai, A. L., Carretta, H. J., & Aisenberg, E. (2017).
Cultural strengths of Latino-American subgroups:
Differential associations with their self-rated men-
tal and physical health. Journal of Cross-Cultural
Psychology, 48, 1349–1368. http://dx.doi.org/10
.1177/0022022117723528
Akresh, I. R., & Frank, R. (2008). Health selection

among new immigrants. American Journal of Pub-
lic Health, 98, 2058–2064. http://dx.doi.org/10
.2105/AJPH.2006.100974
Alarcón, R. D., Parekh, A., Wainberg, M. L., Duarte,
C. S., Araya, R., & Oquendo, M. A. (2016). His-
panic immigrants in the USA: Social and mental
health perspectives. The Lancet Psychiatry, 3,
860– 870. http://dx.doi.org/10.1016/S2215-0366
(16)30101-8
Alegría, M., Canino, G., Shrout, P. E., Woo, M.,
Duan, N., Vila, D., . . . Meng, X. L. (2008).
Prevalence of mental illness in immigrant and non-
immigrant U.S. Latino groups. The American
Journal of Psychiatry, 165, 359–369. http://dx.doi
.org/10.1176/appi.ajp.2007.07040704
Alegría, M., & Woo, M. (2009). Conceptual issues in
Latino mental health. In F. A. Villarruel, G. Carlo,
J. M. Grau, M. Azmitia, N. J. Cabrera, & T. J.
Chahin (Eds.), Handbook of U.S. Latino psychol-
ogy: Developmental and community-based per-
spectives (pp. 15–30). Thousand Oaks, CA: SAGE
Publications.
Anthias, F., & Cederberg, M. (2009). Using ethnic
bonds in self-employment and the issue of social
capital. Journal of Ethnic and Migration Studies,
35, 901–917. http://dx.doi.org/10.1080/1369183
0902957692
Arnberg, F. K., Hultman, C. M., Michel, P. O., &
Lundin, T. (2012). Social support moderates post-
traumatic stress and general distress after disaster.
Journal of Traumatic Stress, 25, 721–727. http://

dx.doi.org/10.1002/jts.21758
Barwick, C. (2017). Are immigrants really lacking
social networking skills? The crucial role of reci -
procity in building ethnically diverse networks.
Sociology, 51, 410– 428. http://dx.doi.org/10.1177/
0038038515596896
Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broe-
kaert, E., & Spinhoven, P. (2007). Comparing psy-
chological distress, traumatic stress reactions, and
experiences of unaccompanied refugee minors
with experiences of adolescents accompanied by
parents. Journal of Nervous and Mental Disease,
195, 288–297. http://dx.doi.org/10.1097/01. nmd
.0000243751.49499.93
216 COOPER ET AL.
T
hi
s
do
cu
m
en
t
is
co
py
ri

gh
te
d
by
th
e
A
m
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on

or
on
e
of
it
s
al
li
ed
pu
bl
is
he
rs
.
T
hi
s
ar
ti
cl
e
is
in

te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on
al
us
e
of
th
e
in
di
vi
du
al

us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
http://dx.doi.org/10.1177/0022022117723528
http://dx.doi.org/10.2105/AJPH.2006.100974
http://dx.doi.org/10.2105/AJPH.2006.100974
http://dx.doi.org/10.1016/S2215-0366%2816%2930101-8

http://dx.doi.org/10.1176/appi.ajp.2007.07040704
http://dx.doi.org/10.1176/appi.ajp.2007.07040704
http://dx.doi.org/10.1002/jts.21758
http://dx.doi.org/10.1097/01.nmd.0000243751.49499.93
http://dx.doi.org/10.1097/01.nmd.0000243751.49499.93
Björgvinsson, T., Kertz, S. J., Bigda-Peyton, J. S.,
McCoy, K. L., & Aderka, I. M. (2013). Psycho-
metric properties of the CES-D-10 in a psychiatric
sample. Assessment, 20, 429– 436. http://dx.doi
.org/10.1177/1073191113481998
Breslau, J., Borges, G., Tancredi, D., Saito, N., Krav-
itz, R., Hinton, L., . . . Aguilar-Gaxiola, S. (2011).
Migration from Mexico to the United States and
subsequent risk for depressive and anxiety disor-
ders: A cross-national study. Archives of General
Psychiatry, 68, 428– 433. http://dx.doi.org/10
.1001/archgenpsychiatry.2011.21
Brittian, A. S., Kim, S. Y., Armenta, B. E., Lee,
R. M., Umaña-Taylor, A. J., Schwartz, S. J., . . .
Hudson, M. L. (2015). Do dimensions of ethnic
identity mediate the association between perceived
ethnic group discrimination and depressive symp-
toms? Cultural Diversity and Ethnic Minority Psy-
chology, 21, 41–53. http://dx.doi.org/10.1037/
a0037531
Cavazos-Rehg, P. A., Zayas, L. H., Walker, M. S., &

Fisher, E. B. (2006). Evaluating an abbreviated
version of the hispanic stress inventory for immi-
grants. Hispanic Journal of Behavioral Sciences,
306291740
Chae, S. M., Park, J. W., & Kang, H. S. (2014).
Relationships of acculturative stress, depression,
and social support to health-related quality of life
in Vietnamese immigrant women in South Korea.
Journal of Transcultural Nursing, 25, 137–144.
Cicchetti, D., & Rogosch, F. A. (2012). Neuroendo-
crine regulation and emotional adaptation in the
context of child maltreatment. Monographs of the
Society for Research in Child Development, 77,
87–95. http://dx.doi.org/10.1111/j.1540-5834
.2011.00666.x
Cohen, S., & Wills, T. A. (1985). Stress, social
support, and the buffering hypothesis. Psycholog-
ical Bulletin, 98, 310–357. http://dx.doi.org/10
.1037/0033-2909.98.2.310
Dawson, B. A. (2009). Discrimination, stress, and
acculturation among Dominican immigrant wom-
en. Hispanic Journal of Behavioral Sciences, 31,
96–111. http://dx.doi.org/10.1177/07399863083
27502
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda,
R. F. (2003). Relationship between multiple forms
of childhood maltreatment and adult mental health
in community respondents: Results from the ad-
verse childhood experiences study. The American

Journal of Psychiatry, 160, 1453–1460. http://dx
.doi.org/10.1176/appi.ajp.160.8.1453
Ellis, B. H., MacDonald, H. Z., Lincoln, A. K., &
Cabral, H. J. (2008). Mental health of Somali
adolescent refugees: The role of trauma, stress, and
perceived discrimination. Journal of Consulting
and Clinical Psychology, 76, 184–193. http://dx
.doi.org/10.1037/0022-006X.76.2.184
Falcón, L. M., & Tucker, K. L. (2000). Prevalence
and correlates of depressive symptoms among His-
panic elders in Massachusetts. The Journals of
Gerontology: Series B: Psychological Sciences
and Social Sciences, 55(2), S108–S116. http://dx
.doi.org/10.1093/geronb/55.2.S108
Felitti, V. J., Anda, R. F., Nordenberg, D., William-
son, D. F., Spitz, A. M., Edwards, V., . . . Marks,
J. S. (1998). Relationship of childhood abuse and
household dysfunction to many of the leading
causes of death in adults: The Adverse Childhood
Experiences (ACE) Study. American Journal of
Preventive Medicine, 14, 245–258. http://dx.doi
.org/10.1016/S0749-3797(98)00017-8
Gallo, L. C., Penedo, F. J., Carnethon, M., Isasi, C. R.,
Sotres-Alvarez, D., Malcarne, V. L., . . . Talavera,
G. T. (2014). The Hispanic community health study/
study of Latinos sociocultural ancillary study: Sam-
ple, design, and procedures. Ethnicity & Disease, 24,
77– 83. Retrieved from https://www.ncbi.nlm.nih
.gov/pmc/articles/PMC3986116/
González, P., Nuñez, A., Merz, E., Brintz, C., Weitz-

man, O., Navas, E. L., . . . Gallo, L. C. (2017).
Measurement properties of the Center for Epide-
miologic Studies Depression Scale (CES-D 10):
Findings from HCHS/SOL. Psychological Assess-
ment, 29, 372–381. http://dx.doi.org/10.1037/
pas0000330
Gottlieb, B. H., & Bergen, A. E. (2010). Social
support concepts and measures. Journal of Psy-
chosomatic Research, 69, 511–520. http://dx.doi
.org/10.1016/j.jpsychores.2009.10.001
Guarnaccia, P. J., Martínez Pincay, I., Alegria, M.,
Shrout, P., Lewis-Fernandez, R., & Canino, G.
(2007). Assessing diversity among Latinos: Re-
sults from the NLAAS. Hispanic Journal of Be-
havioral Sciences, 29, 510–534. http://dx.doi.org/
10.1177/0739986307308110
Hammen, C. (2005). Stress and depression. Annual
Review of Clinical Psychology, 1, 293–319. http://
dx.doi.org/10.1146/annurev.clinpsy.1.102803
.143938
Hobfoll, S. E. (1989). Conservation of resources. A
new attempt at conceptualizing stress. American
Psychologist, 44, 513–524. http://dx.doi.org/10
.1037/0003-066X.44.3.513
Hobfoll, S. E. (2001). The influence of culture, com-
munity, and the nested-self in the stress process:
Advancing conservation of resources theory. Ap-
plied Psychology: An International Review, 50,
337– 421. http://dx.doi.org/10.1111/1464-0597
.00062

Hobfoll, S. E. (2002). Social and psychological re-
sources and adaptation. Review of General Psy-
chology, 6, 307–324. http://dx.doi.org/10.1037/
1089-2680.6.4.307
DEPRESSION
T
hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A

to
be
di
ss
em
in
at
ed
br
oa
dl
y.
http://dx.doi.org/10.1001/archgenpsychiatry.2011.21
http://dx.doi.org/10.1001/archgenpsychiatry.2011.21
http://dx.doi.org/10.1037/a0037531
http://dx.doi.org/10.1111/j.1540-5834.2011.00666.x
http://dx.doi.org/10.1037/0033-2909.98.2.310
http://dx.doi.org/10.1176/appi.ajp.160.8.1453
http://dx.doi.org/10.1176/appi.ajp.160.8.1453

http://dx.doi.org/10.1037/0022-006X.76.2.184
http://dx.doi.org/10.1093/geronb/55.2.S108
http://dx.doi.org/10.1093/geronb/55.2.S108
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986116/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986116/
http://dx.doi.org/10.1037/pas0000330
http://dx.doi.org/10.1037/pas00003 30
http://dx.doi.org/10.1016/j.jpsychores.2009.10.001
http://dx.doi.org/10.1016/j.jpsychores.2009.10.001
http://dx.doi.org/10.1146/annurev.clinpsy.1.102803.143938
http://dx.doi.org/10.1111/1464-0597.00062
http://dx.doi.org/10.1111/1464-0597.00062
Huang, C. Y., Costeines, J., Kaufman, J. S., & Ayala,
C. (2014). Parenting stress, social support, and
depression for ethnic minority adolescent mothers:
Impact on child development. Journal of Child
and Family Studies, 23, 255–262. http://dx.doi
.org/10.1007/s10826-013-9807-1
Iturbide, M. I., Raffaelli, M., & Carlo, G. (2009).
Protective effects of ethnic identity on Mexican
American college students’ psychological well-
being. Hispanic Journal of Behavioral Sciences,

09345992
Kartal, D., & Kiropoulos, L. (2016). Effects of
acculturative stress on PTSD, depressive, and
anxiety symptoms among refugees resettled in
Australia and Austria. European Journal of Psy-
chotraumatology, 7, 28711. http://dx.doi.org/10
.3402/ejpt.v7.28711
Kiang, L., Yip, T., Gonzales-Backen, M., Witkow,
M., & Fuligni, A. J. (2006). Ethnic identity and the
daily psychological well-being of adolescents from
Mexican and Chinese backgrounds. Child Devel-
opment, 77, 1338–1350. http://dx.doi.org/10.1111/
j.1467-8624.2006.00938.x
Kinderman, P., Schwannauer, M., Pontin, E., & Tai,
S. (2013). Psychological processes mediate the
impact of familial risk, social circumstances and
life events on mental health. PLoS ONE, 8(10),
e76564. http://dx.doi.org/10.1371/journal.pone
.0076564
Kline, R. B. (2016). Principles and practice of struc-
tural equation modeling (4th ed.). New York, NY:
Guilford Press.
LaVange, L. M., Kalsbeek, W. D., Sorlie, P. D.,
Avilés-Santa, L. M., Kaplan, R. C., Barnhart, J.,
. . . Elder, J. P. (2010). Sample design and cohort
selection in the Hispanic Community Health
Study/Study of Latinos. Annals of Epidemiology,
20, 642– 649. http://dx.doi.org/10.1016/j.annepi-
dem.2010.05.006

Leong, F., Park, Y. S., & Kalibatseva, Z. (2013).
Disentangling immigrant status in mental health:
Psychological protective and risk factors among
Latino and Asian American immigrants. American
Journal of Orthopsychiatry, 83, 361–371. http://dx
.doi.org/10.1111/ajop.12020
Li, S. S. Y., Liddell, B. J., & Nickerson, A. (2016).
The relationship between post-migration stress and
psychological disorders in refugees and asylum
seekers. Current Psychiatry Reports, 18, 82. http://
dx.doi.org/10.1007/s11920-016-0723-0
Lopez, G., & Patten, E. (2015). Hispanics of Puerto
Rican origin in the United States, 2013. Retrieved
from https://www.pewresearch.org/hispanic/2015/
09/15/hispanics-of-puerto-rican-origin-in-the-
united-states-2013/
Lorenzo-Blanco, E. I., & Cortina, L. M. (2013).
Towards an integrated understanding of Latino/a
acculturation, depression, and smoking: A gen-
dered analysis. Journal of Latina/o Psychology, 1,
3–20. http://dx.doi.org/10.1037/a0030951
Lorenzo-Blanco, E. I., & Unger, J. B. (2015). Ethnic
discrimination, acculturative stress, and family
conflict as predictors of depressive symptoms and
cigarette smoking among Latina/o youth: The me-
diating role of perceived stress. Journal of Youth
and Adolescence, 44, 1984–1997. http://dx.doi
.org/10.1007/s10964-015-0339-4
Malcarne, V. L., Chavira, D. A., Fernandez, S., &
Liu, P. J. (2006). The Scale of Ethnic Experience:

Development and psychometric properties. Jour-
nal of Personality Assessment, 86, 150–161. http://
dx.doi.org/10.1207/s15327752jpa8602_04
Maydeu-Olivares, A. (2017). Maximum likelihood
estimation of structural equation models for con-
tinuous data: Standard errors and goodness of fit.
Structural Equation Modeling, 24, 383–394. http://
dx.doi.org/10.1080/10705511.2016.1269606
Mendoza, N. B., Mordeno, I. G., Latkin, C. A., &
Hall, B. J. (2017). Evidence of the paradoxical
effect of social network support: A study among
Filipino domestic workers in China. Psychiatry
Research, 255, 263–271. http://dx.doi.org/10
.1016/j.psychres.2017.05.037
Merz, E. L., Roesch, S. C., Malcarne, V. L., Penedo,
F. J., Llabre, M. M., Weitzman, O. B., . . . Gallo,
L. C. (2014). Validation of interpersonal support
evaluation list-12 (ISEL-12) scores among Eng-
lish- and Spanish-speaking Hispanics/Latinos from
the HCHS/SOL Sociocultural Ancillary Study.
Psychological Assessment, 26, 384–394. http://dx
.doi.org/10.1037/a0035248
Miranda, A. O., Estrada, D., & Firpo-Jimenez, M.
(2000). Differences in family cohesion, adaptabil-
ity, and environment among Latino families in
dissimilar stages of acculturation. The Family
Journal, 8, 341–350. http://dx.doi.org/10.1177/
1066480700084003
Molina, K. M., Alegría, M., & Mahalingam, R.
(2013). A multiple-group path analysis of the role
of everyday discrimination on self-rated physical

health among Latina/os in the USA. Annals of
Behavioral Medicine, 45, 33– 44. http://dx.doi.org/
10.1007/s12160-012-9421-2
Moradi, B., & Risco, C. (2006). Perceived discrimi-
nation experiences and mental health of Latina/o
American persons. Journal of Counseling Psychol-
ogy, 53, 411– 421. http://dx.doi.org/10.1037/0022-
0167.53.4.411
Muscatell, K. A., Slavich, G. M., Monroe, S. M., &
Gotlib, I. H. (2009). Stressful life events, chronic
difficulties, and the symptoms of clinical depres-
sion. Journal of Nervous and Mental Disease, 197,
154–160. http://dx.doi.org/10.1097/NMD.0b013
e318199f77b
218 COOPER ET AL.
T
hi
s
do
cu
m
en
t
is
co
py
ri

us
er
an
d
is
no
t
to
be
di
ss
em
in
at
ed
br
oa
dl
y.
http://dx.doi.org/10.1007/s10826-013-9807-1
http://dx.doi.org/10.3402/ejpt.v7.28711
http://dx.doi.org/10.3402/ejpt.v7.28711

http://dx.doi.org/10.1371/journal.pone.0076564
http://dx.doi.org/10.1371/journal.pone.0076564
http://dx.doi.org/10.1016/j.annepidem.2010.0 5.006
http://dx.doi.org/10.1016/j.annepidem.2010.05.006
http://dx.doi.org/10.1111/ajop.12020
http://dx.doi.org/10.1111/ajop.12020
https://www.pewresearch.org/hispanic/2015/09/15/hispanics-of-
puerto-rican-origin-in-the-united-states-2013/
http://dx.doi.org/10.1207/s15327752jpa8602_04
http://dx.doi.org/10.1207/s15327752jpa8602_04
http://dx.doi.org/10.1080/10705511.2016.1269606
http://dx.doi.org/10.1016/j.psychres.2017.05.037
http://dx.doi.org/10.1016/j.psychres.2017.05.037
http://dx.doi.org/10.1097/NMD.0b013e318199f77b
http://dx.doi.org/10.1097/NMD.0b013e318199f77b

Muthén, L. K., & Muthén, B. O. (2017). Mplus user’s
guide (8th ed.). Los Angeles, CA: Author. (Orig-
inal work published 1998)
Myers, H. F., Wyatt, G. E., Ullman, J. B., Loeb,
T. B., Chin, D., Prause, N., . . . Liu, H. (2015).
Cumulative burden of lifetime adversities: Trauma
and mental health in low-SES African Americans
and Latino/as. Psychological Trauma: Theory, Re-
search, Practice and Policy, 7, 243–251. http://dx
.doi.org/10.1037/a0039077
Norris, F. H. (1990). Screening for traumatic stress: A
scale for use in the general population. Journal of
Applied Social Psychology, 20, 1704–1715. http://dx
.doi.org/10.1111/j.1559-1816.1990.tb01505.x
Paykel, E. S. (2003). Life events and affective disor-
ders. Acta Psychiatrica Scandinavica, 108, 61– 66.
http://dx.doi.org/10.1034/j.1600-0447.108.s418
.13.x
Phinney, J. S. (2000). Ethnic and racial identity:
Ethnic identity. In A. E. Kazdin (Ed.), Encyclope-
dia of psychology (Vol. 3, pp. 254–259). Washing-
ton DC: American Psychological Association.
http://dx.doi.org/10.1037/10518-122
Prati, G., & Pietrantoni, L. (2010). The relation of
perceived and received social support to mental
health among first responders: A meta-analytic re-
view. Journal of Community Psychology, 38, 403–
417. http://dx.doi.org/10.1002/jcop.20371
Ramos, B., Jaccard, J., & Guilamo-Ramos, V.

(2003). Dual ethnicity and depressive symptoms:
Implications of being Black and Latino in the
United States. Hispanic Journal of Behavioral Sci-
ences, 25, 147–173. http://dx.doi.org/10.1177/
0739986303025002002
Revollo, H. W., Qureshi, A., Collazos, F., Valero, S.,
& Casas, M. (2011). Acculturative stress as a risk
factor of depression and anxiety in the Latin Amer-
ican immigrant population. International Review
of Psychiatry, 23, 84–92. http://dx.doi.org/10
.3109/09540261.2010.545988
Rivera, F. I. (2007). Contextualizing the experience
of young Latino adults: Acculturation, social sup-
port and depression. Journal of Immigrant and
Minority Health, 9, 237–244. http://dx.doi.org/10
.1007/s10903-006-9034-6
Rivera, F. I., Guarnaccia, P. J., Mulvaney-Day, N.,
Lin, J. Y., Torres, M., & Alegria, M. (2008).
Family cohesion and its relationship to psycholog-
ical distress among Latino groups. Hispanic Jour-
nal of Behavioral Sciences, 30, 357–378. http://dx
.doi.org/10.1177/0739986308318713
Ronconi, J. M., Shiner, B., & Watts, B. V. (2015). A
meta-analysis of depressive symptom outcomes in
randomized, controlled trials for PTSD. Journal of
Nervous and Mental Disease, 203, 522–529. http://
dx.doi.org/10.1097/NMD.0000000000000322
Schwartz, S. J., Montgomery, M. J., & Briones, E.
(2006). The role of identity in acculturation among
immigrant people: Theoretical propositions, em-

pirical questions, and applied recommendations.
Human Development, 49, 1–30. http://dx.doi.org/
10.1159/000090300
Seery, M. D., Holman, E. A., & Silver, R. C. (2010).
Whatever does not kill us: Cumulative lifetime
adversity, vulnerability, and resilience. Journal of
Personality and Social Psychology, 99, 1025–
1041. http://dx.doi.org/10.1037/a0021344
Shalev, I., Moffitt, T. E., Sugden, K., Williams, B.,
Houts, R. M., Danese, A., . . . Caspi, A. (2013).
Exposure to violence during childhood is associ-
ated with telomere erosion from 5 to 10 years of
age: A longitudinal study. Molecular Psychiatry,
18, 576–581. http://dx.doi.org/10.1038/mp
.2012.32
Shor, E., Roelfs, D., & Vang, Z. M. (2017). The
“Hispanic mortality paradox” revisited: Meta-
analysis and meta-regression of life-course differ-
entials in Latin American and Caribbean immi-
grants’ mortality. Social Science & Medicine, 186,
20–33. http://dx.doi.org/10.1016/j.socscimed.2017
.05.049
Silove, D., Austin, P., & Steel, Z. (2007). No refuge
from terror: The impact of detention on the mental
health of trauma-affected refugees seeking asylum
in Australia. Transcultural Psychiatry, 44, 359–
393. http://dx.doi.org/10.1177/1363461507081637
Smith, T. B., & Silva, L. (2011). Ethnic identity and
personal well-being of people of color: A meta-
analysis. Journal of Counseling Psychology, 58,
42– 60. http://dx.doi.org/10.1037/a0021528

Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed,
R., Stein, D. J., & Seedat, S. (2009). Cumulative
effect of multiple trauma on symptoms of posttrau-
matic stress disorder, anxiety, and depression in
adolescents. Comprehensive Psychiatry, 50, 121–
127. http://dx.doi.org/10.1016/j.comppsych.2008
.06.006
Tienda, M., & Sánchez, S. (2013). Latin American
Immigration to the United States. Daedalus, 142,
48– 64. http://dx.doi.org/10.1162/DAED_a_00218
Torres, L., Driscoll, M. W., & Voell, M. (2012).
Discrimination, acculturation, acculturative stress,
and Latino psychological distress: A moderated
mediational model. Cultural Diversity and Ethnic
Minority Psychology, 18, 17–25. http://dx.doi.org/
10.1037/a0026710
Torres, L., & Ong, A. D. (2010). A daily diary
investigation of Latino ethnic identity, discrimina-
tion, and depression. Cultural Diversity and Ethnic
Minority Psychology, 16, 561–568. http://dx.doi
.org/10.1037/a0020652
Torres, V. (2004). The diversity among us: Puerto
Ricans, Cuban Americans, Caribbean Americans,
and Central and South Americans. New Directions
for Student Services, 2004, 5–16. http://dx.doi.org/
10.1002/ss.112
DEPRESSION
T

hi
s
do
cu
m
en
t
is
co
py
ri
gh
te
d
by
th
e
A
m
er
ic
an
P
sy

ch
ol
og
ic
al
A
ss
oc
ia
ti
on
or
on
e
of
it
s
al
li
ed
pu
bl
is
he

rs
.
T
hi
s
ar
ti
cl
e
is
in
te
nd
ed
so
le
ly
fo
r
th
e
pe
rs
on

al
us
e
of
th
e
in
di
vi
du
al
us
er
an
d
is
no
t
to
be
di
ss
em
in

at
ed
br
oa
dl
y.
http://dx.doi.org/10.1111/j.1559-1816.1990.tb01505.x
http://dx.doi.org/10.1111/j.1559-1816.1990.tb01505.x
http://dx.doi.org/10.1034/j.1600-0447.108.s418.13.x
http://dx.doi.org/10.1034/j.1600-0447.108.s418.13.x
http://dx.doi.org/10.1037/10518-122
http://dx.doi.org/10.1002/jcop.20371
http://dx.doi.org/10.1097/NMD.0000000000000322
http://dx.doi.org/10.1097/NMD.0000000000000322
http://dx.doi.org/10.1038/mp.2012.32
http://dx.doi.org/10.1038/mp.2012.32
http://dx.doi.org/10.1016/j.socscimed.2017.05.049
http://dx.doi.org/10.1016/j.socscimed.2017.05.049
http://dx.doi.org/10.1177/1363461507 081637

http://dx.doi.org/10.1016/j.comppsych.2008.06.006
http://dx.doi.org/10.1016/j.comppsych.2008.06.006
http://dx.doi.org/10.1162/DAED_a_00218
http://dx.doi.org/10.1002/ss.112
http://dx.doi.org/10.1002/ss.112
Umaña-Taylor, A. J., Gonzales-Backen, M. A., & Gui-
mond, A. B. (2009). Latino adolescents’ ethnic iden-
tity: Is there a developmental progression and does
growth in ethnic identity predict growth in self-
esteem? Child Development, 80, 391– 405. http://dx
.doi.org/10.1111/j.1467-8624.2009.01267.x
Umaña-Taylor, A. J., & Updegraff, K. A. (2007).
Latino adolescents’ mental health: Exploring the
interrelations among discrimination, ethnic iden-
tity, cultural orientation, self-esteem, and depres-
sive symptoms. Journal of Adolescence, 30, 549–
567. http://dx.doi.org/10.1016/j.adolescence.2006
.08.002
Umaña-Taylor, A. J., Vargas-Chanes, D., Garcia, C. D.,
& Gonzales-Backen, M. (2008). A longitudinal ex-
amination of Latino adolescents’ ethnic identity, cop-
ing with discrimination, and self-esteem. The Journal
of Early Adolescence, 28, 16–50. http://dx.doi.org/10
.1177/0272431607308666
Ward, K. P., Shaw, S. A., Chang, M., & El-Bassel, N.
(2018). Social support moderates the association

between traumatic life events and depression
among migrant and nonmigrant men in Almaty,
Kazakhstan. Journal of Traumatic Stress, 31, 698–
707. http://dx.doi.org/10.1002/jts.22324
Zambrana, R. E., & Dill, B. T. (2006). Disparities in
Latina health: An intersectional analysis. In A.
Schultz & L. Mullings (Eds.), Race, class, gender
and health (pp. 192–227). San Francisco, CA:
Jossey-Bass.
Zong, J., & Batlova, J. (2018). Dominican immi-
grants in the United States. Retrieved from https://
www.migrationpolicy.org/article/dominican-
immigrants-united-states
Received February 17, 2019
Revision received October 10, 2019
Accepted October 18, 2019 �
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220 COOPER ET AL.
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http://dx.doi.org/10.1016/j.adolescence.2006.08.002
https://www.migrationpolicy.org/article/dominican-immigrants-
united-states
united-states
united-statesCumulative Lifetime Adversity and Depression
Among a National Sample of U.S. Latinx Immigrants: ...Mental
Health and U.S. Latinx PopulationsSocial SupportEthnic
IdentityAcculturation StressEthnic/Racial DiscriminationThe
Present StudyMethodSampleMeasuresCumulative lifetime
adversityAcculturation stressPerceived ethnic
discriminationSocial supportEthnic identityDepressionData
AnalysisResultsPreliminary AnalysisMain Effects for Total
SampleModeration Model for Total SampleMultigroup Analysis:
Comparing Latinx SubgroupsDiscussionAssociations Between
Risk and Protective Factors and DepressionModerating Effects
of Social Support for the Full SampleDifferences in Risk and
Protective Processes Across Latinx
SubgroupsLimitationsConclusionReferences
MODULE 2 2

Module 2 Reflections
Your Name
Texas A&M University-Commerce
Running head: MODULE 2 1
Module 2 Reflections
The reflections can be about what you found new,
intriguing, puzzling, and etcetera, for the assigned reading in
the textbook, assigned videos, and articles. The journal
reflections can also include what you found interesting in some
of the classmate's discussion board "post" comments. Do not
repeat your discussion board "post" responses in the reflections.
Label Reflections entry title as Module 2
Reflections: Reflections are to be in a double-spaced paragraph
format and consist of a minimum of 250 words for each module
reflections entry. Review the reflections content for correct
grammar and spelling.
NOTE: Reflection assignment is to be submitted toward the end

of the module so that any reflections pertaining to the
assignment, discussion board, lecture, and/or videos can be
included. Delete the instructional paragraphs from this template
before submitting the assignment file to a module reflections
folder. You will need to make necessary changes to page
headers, title page title, headings, and/or subheadings when
using this template for future module reflections.
Jovanka Perez February 18,
2021
Article citation- ACES
Topic: Cumulative lifetime adversity and depression among a
national sample of U.S. Latinx immigrants: Within-group
differences in risk and protective factors using data from the
HCHS/SOL sociocultural ancillary study.
Reference:
Cooper, D. K., Bachem, R., Meentken, M. G., Aceves, L., &
Perez Barrios, A. G. (2020). Cumulative lifetime adversity and
depression among a national sample of US Latinx immigrants:
Within-group differences in risk and protective factors using
data from the HCHS/SOL sociocultural ancillary study. Journal
of Latinx Psychology, 8(3), 202–220. https://doi-org.rdas-
proxy.mercy.edu/10.1037/lat0000145.supp (Supplemental)
Abstract (English):

Latinx immigrants are exposed to multiple stressors before,
during, and after migration. However, most past research has
assumed the effects of these stressors are uniform across Latinx
groups despite considerable within-group variation. The purpose
of this study was to (a) assess the moderating effects of several
risk and protective factors on the association between
cumulative lifetime adversity and depression among U.S. Latinx
immigrants and (b) examine the extent to which risk and
protective processes differed between Latinx subgroups. Data
came from a cross-sectional secondary dataset, called the
Hispanic Community Health Study/Study of Latinos
Sociocultural Ancillary Study. The sample (N = 2,893) was
identified using stratified random probability sampling in four
of the largest Latinx metropolitan areas: the Bronx, New York;
San Diego, California; Chicago, Illinois; and Miami, Florida.
We included four Latinx subgroups in our study: Puerto Ricans,
Cubans, Mexicans, and Dominicans. Results from multigroup
regression analyses suggested that social support moderated the
association between cumulative lifetime adversity and
depression. However, further subgroup analyses showed the
moderation effect was only present for Cuban and Dominican
immigrants. We also found that perceived discrimination
moderated the association between lifetime adversity and
depression for Cuban immigrants and ethnic identity moderated
the relationship between lifetime adversity and depression for
Dominican immigrants. Our results provide preliminary
evidence for the presence of within-group differences in
responses to adverse events among Latinx immigrant groups.
Results can be used to inform the development of mental health
interventions tailored to the specific needs of various Latinx
immigrant populations. (PsycInfo Database Record (c) 2020
APA, all rights reserved)

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