There is an increasing body of literature exploring the mental health of Latinx youth. However, the extent to which geographic contexts affect internalizing and externalizing symptoms has received little attention. Understanding Latinx youth's mental health needs will enable services and interventions appropriate to multiple contexts and tailored to their community's needs. This study assessed whether Latinx children aged 8–11 from rural farmworker families and urban non-farmworker families in North Carolina had measurable differences in anxious/depression (internalized symptoms) and aggression (externalized symptoms) across time. These findings suggest that urban children were more likely to experience internalized emotional problems than those from rural farmworker families. Internalized results for the rural sample remained unchanged and were not statistically significantly different. Other PACE 5 studies with a similar population of Latinx urban children reported more adverse childhood experiences [23] and lower WISC-V scores [26]. Adolescents with depression have lower full-scale, verbal, and performance IQs, lower working memory, organization ability, verbal fluency, and concentration than non-depressed adolescents [35]. Dobbins et al. (2021) found urban children are twice as likely as rural children to have at least one adverse childhood experience (ACE). Stresses from disadvantages may explain why urban children had higher baseline scores on anxious/depression CBCL scores than rural children.
In addition, the results compared the initial and follow-up evaluations approximately one and two years after the first initial assessment to determine whether CBCL outcomes changed over time. The externalized, aggressive symptoms of Latinx children in rural and urban environments increased over time. Urban children's baseline aggression scores were higher than the rural children's initially. Still, the rural children's aggression scores increased more rapidly, resulting in diminished differences between the two groups two years later. Externalizing aggressive behaviors contributes to the risk of adolescent deviant behaviors like delinquency, substance use, parent-child conflict, and negative peer relationships [35]. Additionally, longitudinal studies have shown a reciprocal relationship between internalized emotional problems and externalized aggression among youth, in which aggressive behavior is likely to be accompanied by depression and anxiety and vice versa [35–37].
Although the results of this study cannot explain why Latinx children who live in rural and urban areas experience different ranges of mental health symptoms, evidence suggests that different environmental contexts may play a role. Poor and marginalized communities often experience differences ranging from targeted prejudice to structural racism. According to Cano et al. [38], discrimination or racism, which is uniquely experienced by minority groups, can contribute to Latinx youths' externalizing aggressive behavior. Latinx face discrimination, limiting their access to opportunities and resources. This study consists of Latinx children whose families earn less than 200% of the federal poverty level. Growing up in oppressive, impoverished, unstable, or dire living conditions can cause any child, regardless of age, to exhibit aggression. Identifying contextual factors may help inform prevention and intervention strategies for Latinx youth. Understanding the specific factors contributing to mental health issues among Latinx youth is vital to developing and implementing evidence-based and culturally appropriate mental health services [39].
To provide culturally competent care, mental health providers and healthcare workers must recognize how relationships, circumstances, stress, culture, and transitions affect Latinx children. Furthermore, public policy must consider how exposure to risk affects Latinx psychological well-being [40]. Understanding the specific factors contributing to mental health issues among Latinx youth is vital to developing and implementing evidence-based and culturally appropriate mental health services [41]. Sociopolitical history, ethnic density, public policies, and resource inaccessibility also contribute to mental illness [42]. Specifically, Latinx youth living in urban areas receive less mental health care than their peers from other ethnic and racial backgrounds and suffer from more mental health disparities as a result of low academic performance, physical and sexual abuse, adjustment difficulties, relocation due to temporary/seasonal migration, and deportation fears [43].
Despite meaningful, statistically significant changes in mental health symptoms over time, t-score thresholds for this population of children did not reach clinically significant levels. According to the immigrant paradox, even when children of immigrants face adverse conditions due to socioeconomic conditions and discrimination, they continue to succeed, remain resilient, and have protective health indicators. Nevertheless, because Latinx populations suffer from lower rates of psychiatric disorders, research and treatment interventions often overlook Latinx mental health concerns [44]. It is essential to investigate subclinical symptoms since they may develop into clinically significant symptoms over time.
Future Research
This descriptive analysis aims to present geographical influences on Latinx children's mental health; however, it does not distinguish the other factors that may cause or contribute to symptoms. Trauma and discrimination can also play an essential role in affecting their emotional well-being. The challenges associated with adjusting to a new country, when combined with previous stressful experiences, can lead to anxiety symptoms and other mental illnesses [40–42]. Migrants often experience trauma due to political unrest, forced disappearances, sexual abuse, and being witnesses to violence in their countries of origin [39]. In Latinx communities, immigration remains a particularly prominent issue because many Latinx know undocumented immigrants, and a substantial percentage know someone incarcerated or deported personally. It is important to note that children with US citizenship may lose a parent or caregiver, experience environmental or community changes, and cope with stress and trauma without adequate mental health services [45]. The risks associated with undocumented and illegal status can lead to anxiety, insecurity, trauma, and exploitation [46]. Mixed-status families with native and foreign-born family members and migration-related discrimination can also suffer from emotional distress, depression, anxiety, panic attacks, attention deficit hyperactivity disorder, conduct problems, and post-traumatic stress disorder [2].
According to recent data on healthcare disparities, where people live affect their health. Some communities have a shorter average life expectancy than those mere miles away. Generally, health disparities reflect a complex interaction between racial, economic, educational, and other factors [47]. A separate inquiry found that lower externalizing problems among youth were associated with different neighborhood SES and immigrant concentrations. Latinx children living in neighborhoods with high concentrations had a lower risk of externalizing problems, while non-Latinx youth in these neighborhoods had the opposite effect [46]. Most of the urban children in this study lived near Winston-Salem, North Carolina, in Forsyth County. Based on census data, the United Way of Forsyth County [48] found that the average household income of a child of low-income parents residing in the 27104-zip code, now in their mid-30s, is $45,000 per year. The average income of children in their mid-thirties who grew up in the 27105-zip code is $17,000. The distance between these two zip codes is just five miles. Mortality and morbidity disparities exist throughout the country, even within small areas near each other [49]. Comparing zip codes with various social determinants of health datasets could help identify whether children living in specific areas are more susceptible to disparities such as economic stability, environmental injustice, and neighborhood safety than other children within the comparison groups [50].
While the study did not examine gender differences, its evaluation could provide gender-informed cultural information. Traditional Latinx gender roles involve different social expectations for males and females and adhere to a patriarchal order [39]. Gender-specific cultural norms and behaviors influence the development of a Latinx child. In addition, gender plays a vital role in how children interact socially [51]. As a result of gender roles conflicting with mainstream American cultural norms, Latinx females may be more likely to develop depression symptoms during adolescence. Latinx cultures place importance on the family, and females must behave passively, give precedence to family needs, and sacrifice their own well-being for family unity. Latinx males traditionally adhere to strict, masculinized roles and attitudes associated with aggressive behavior and male honor [52]. Differentiating gender-cultural outcomes between rural and urban comparison groups could provide a means to moderate and define significance levels in outcomes between this study's rural and urban comparison groups.
Although this longitudinal study followed this group of children for two years during middle childhood, longitudinal data through adolescence may help identify crucial times during a child's life when intervention is needed or to maximize protective safeguards. Adolescence is a pivotal developmental period marked by profound physical, cognitive, and social adjustment. Therefore, analyzing the socio-emotional factors influencing childhood development provides insight into future mental health outcomes.
Limitations
The current study is not without limits. Specifically, the study evaluated the mental health of Latinx youth in rural and urban environments without comparing them to the youth of other races in similar residential settings. Since only Latinx children living in specific rural and urban areas in North Carolina participated in the study, the findings might not generalize to other regions across the country. Reporting bias may have affected the results as parents may not have been aware of experiences outside their homes, such as discrimination in schools or communities. Social desirability may also be a factor, especially among rural mothers who reported sub-clinical mental health symptoms affecting their children. It is imperative to consider the unique protective and risk factors of Latinx subgroups when understanding and treating psychological distress [53]. Barragán et al. (2020) found that the Spanish language buffered psychological distress in Mexican Americans; however, this resulted in higher rates of psychological distress among Latinx people of Central and South America, Puerto Rico, and Cuba. Understanding cultural differences among Latinx subgroups, like the urban and rural comparison groups, may be helpful and contribute to understanding intragroup differences.