Lifetime Psychiatric Diagnoses Among NESARC-III Hispanic Participants: A Relative Importance Analysis of Sociodemographic and Social Determinants of Health.

Abstract

Hispanic/Latin American people comprise a health disparity population, in part due to having higher rates of mental illness relative to White counterparts. Much of the extant literature on understanding Hispanic mental health has focused on single outcomes (e.g., substance use, depression) or single indicators (e.g., adverse childhood experiences). However, given the multifinality of mental health outcomes and their predictors, research is needed to understand how protective and risk factors relate to mental health more broadly (i.e., internalizing and externalizing symptomology). Using a sample of Hispanic adults (N = 7037) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-III, we used structural equation modeling to estimate a correlated common factors model with latent variables for lifetime externalizing and internalizing disorders. Using the discrimination stress, coping, and mental health framework as guide, we examined the associations between latent factor scores, sociodemographic characteristics, and social determinants of health (SDOH). The SDOH included adverse childhood experiences (ACEs), nativity status, ethnic discrimination, ethnic identity, and religiosity/spirituality. Finally, we employed relative importance analyses to assess the comparative importance of significant correlates of psychopathology. ACE was the strongest correlate of both internalizing and externalizing psychopathology, underscoring the importance of prevention and ACEs screening to mitigate adverse mental health outcomes. Discrimination and being US born were the next strongest correlates of having internalizing and externalizing psychopathology. Ethnic identity emerged as the strongest negative correlate of both psychopathology factors. The findings are important for improving Hispanic mental health and informing healthcare policy.