Addressing Social Isolation and Depression among Women Immigrants from Mexico

Dec 15, 2023 | Arts, Humanities & Social Sciences

Many Mexican women experience social isolation and depression after immigrating to the USA, and they are particularly vulnerable to this if they lack social connections and a support network in their new environment. An innovative research group at the University of New Mexico developed a highly promising intervention called ‘Tertulias’, which is helping to improve the mental health and well-being of female immigrants.

The Social and Psychological Impacts of Immigration

Social isolation, loneliness, depression, and poor mental health, in general, can increase the risk of developing chronic diseases and dying prematurely. Given that millions of people across the globe face these challenges every day, devising effective interventions tailored to the needs of the most affected segments of the population is of crucial importance.

Immigrating to a new country can be extremely difficult, particularly if an individual has few acquaintances, friends, and social connections at their destination. Past research highlights high rates of social isolation and depression among immigrants in the USA, and it is clear that some demographic groups are more impacted than others.

Those who are most impacted include immigrants who leave a country that resonates with their culture and that they know how to navigate, where they can easily communicate with others, feel part of a community, and have solid social connections, to enter an entirely new social and cultural setting. In their new environment, they might face language barriers, stigma, discrimination, and cultural differences, they might be unsure about how to access vital resources, and they feel socially disconnected from others around them.

A significant portion of those immigrating to the USA originate from Latin America, particularly Mexico. Studies investigating the experiences of Mexican immigrants have shown that they are at twice the risk of experiencing depression than Mexicans who stay in Mexico.

Research has also shown that female Mexican immigrants are at a higher risk of being socially isolated than male immigrants, with many of these women experiencing the lack of extended family nearby as a form of ‘cultural bereavement’. Compared to non-Mexican white women, Mexican women living in the USA appear to be more likely to experience depression and yet less likely to be treated for it.

If we can better understand the factors underpinning the high rate of depression among Mexican women who immigrated to the USA, including social isolation, we can develop better ways to do something about it. Identifying new strategies to address social isolation and depression could have numerous benefits, both for the well-being of individual women and their families, and also for the healthcare system. Researchers at the University of New Mexico, in partnership with One Hope Centro de Vida Health Center and Centro Sávila, two health-focused nonprofit organisations in New Mexico, initiated a new research-informed intervention to tackle this health issue. More specifically, they sought to help Mexican women in the USA establish new social ties within their community, reducing their feelings of isolation.

Artist: Laura Venegas

Conversational Gatherings Promoting Peer Support

The intervention designed by the New Mexico-based research team is called ‘Tertulias’, the Spanish word for ‘conversational gatherings.’ As suggested by the name, it is designed to create social support groups that encourage women to share their everyday experiences, thoughts and emotions with each other.

The intervention is based on ‘Structured Dialogues’ – an innovative approach developed by the researchers designed to foster meaningful group conversations on specific topics. A few years ago, the team effectively used this approach to facilitate conversations and the development of relationships between and among Mexican women immigrants attending a support group.

During structured dialogue sessions, attendees share their own powerful life stories and experiences with each other. They read stories from literature, both fiction and nonfiction. They learn about information and stories from outside the group. Stories and information shared fuel constructive discussions and the sharing of even deeper related personal experiences.

Ten years ago, the team conducted a pilot study of this approach. Women participating in the pilot study were asked to complete a health assessment and a survey before and after the study, and were also interviewed individually.

The women attended the structured dialogue-based support group meetings once every week. Women took part in discussions about different topics. For 12 months, researchers joined the meetings once a month and focused the discussion on social isolation, depression, diabetes, nutrition, and food insecurity. At the monthly meetings, the group discussions were recorded, transcribed and later analysed by the researchers to identify common themes and the most prominent ideas shared by participants.

The results of this initial study were very promising, with all the women who attended the support group reporting that it had a huge impact on their lives by allowing them to make new friends and establish new social ties while also reducing their stress, loneliness, and anxiety. In addition, the meetings appeared to increase the women’s knowledge of nutrition and food resources, and to positively impact health challenges like diabetes and food insecurity.

Artist: Blanca Vela

Evaluating Tertulias

The Tertulias team received funding to replicate the peer support groups on a larger scale to further evaluate the impact of the intervention on social isolation and depression. Preliminary results are under review for publication. For this new study, the team recruited 252 female Mexican immigrants in four groups of sixty to sixty-five women a year for four years. The participants were divided into two groups; one cohort became the intervention group, the Tertulias weekly session group, while the other cohort, the control group, did not take part in any support group meetings and only received bi-monthly phone calls. The intervention group was further divided into three smaller groups based on participants’ schedules—morning, afternoon, or evening.

The group sessions were originally supposed to be in-person, but due to COVID-19 restrictions, they had to be held remotely using the communication platform Zoom. Participants completed pre- and post-study surveys, and a subset were interviewed individually by the researchers. They were also asked to provide a sample of their hair to measure the level of the stress-related hormone cortisol at the beginning and end of their participation in the study.

Like in the pilot study, the team evaluated the effects of the Tertulias meetings using both pre- and post-study survey responses, and by asking participants about their experiences through interviews and group discussions.

They also used an innovative evaluation tool called ‘Ripple Effects Mapping’ (REM), which relies on the XMind 8 Pro Mind Mapping Software. Using this software, the team created visual map-like representations summarising the impact of their intervention and how the lives of participants and their social interactions had changed over time while also unveiling connections between different activities and elements of their approach. Participants said that being able to see this visual representation of their own participation in the study was extremely powerful and helped them understand how the research was impacting their lives and the lives of other participants.

Preliminary results of this evaluation are highly promising, as the Tertulias team has found that their intervention is positively impacting the lives of participants in various ways. Most notably, the women who attended the Tertulias meetings reported that they felt safe and listened to among other group members, that they could freely share their experiences and emotions, and that they were happy to meet others with the same cultural background who were experiencing similar things.

The researchers found that the meetings helped to strengthen and broaden the social network of participating women and that women made friends in the groups. But the groups also broadened their knowledge of available resources, put them in tune with their own power, and offered them emotional support during hard times. In the groups, the participants shared their own personal life stories, and many mentioned learning from others, feeling part of a community, and finding strength, lightness, joy, and empathy in these mutual exchanges.

In the Tertulias meetings, the participants also shared their creative projects, including stories, poems, paintings, photographs, recipes, and images of items they had handcrafted. Records of these projects, along with transcripts of group evaluation sessions and individual interviews, were used to track the overall impact of the intervention.

‘Meeting like this as a group and knowing the situations that each one of us is experiencing strengthens us, in the sense of being strong ourselves and of also having the strength to support with our words those who are going through a difficult situation’, explained one of the participants.

Artist: Angélica Borja Holguín

Leveraging Online Communication Platforms

Restrictive measures on social interaction put in place during the pandemic forced the researchers to conduct the Tertulias group meetings online through Zoom and WhatsApp chat groups. This offered a valuable opportunity to assess the effectiveness of the intervention when implemented via digital information and communication technologies rather than face-to-face as it was originally meant to be delivered.

The Tertulias team decided to conduct the group meetings and interviews via Zoom while also creating a WhatsApp chat for each Tertulias group where the women could freely communicate and interact with each other outside of the group sessions. They hoped that this group chat would offer them greater opportunities to bond and establish new friendships outside of the Zoom meetings, which appeared to gradually happen over time.

While initially, the women appeared to primarily use the chat to report issues with signing into meetings or their inability to attend on a specific date, over time, they also started using them to greet the group, provide information about and connection to resources, share their emotions, offer emotional support to each other, and even arrange face-to-face gatherings.

Although most of the participants mentioned that they would have preferred to have more in-person, face-to-face interactions, and some of them experienced difficulties with accessing Wi-Fi or other technical issues while using Zoom or WhatsApp, the intervention appeared to be overwhelmingly positive. By the end of the study, most participants felt that the technologies not only offered a beneficial virtual space where they could connect with others in their community in real time and support each other in meaningful ways but that the technology actually improved the experience because it made it more likely for them to participate.

A Highly Impactful Intervention

Overall, the Tertulias intervention is proving to be highly beneficial and empowering, highlighting the key role of peer support and meaningful connections in promoting mental health and well-being. The women who are taking part in the groups are responding remarkably well. The meetings have reduced participants’ stress levels and feelings of isolation while increasing their confidence, social ties, and knowledge of resources in their environment.

This intervention, whilst initially designed for female Mexican immigrants, could be adapted to support other immigrants and groups who are experiencing social isolation, loneliness and depression. This could, in turn, help to improve the quality of life of many people across the USA while also reducing the risk that they will develop chronic illnesses or die prematurely.

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REFERENCE

https://doi.org/10.33548/SCIENTIA971

MEET THE RESEARCHERS

The Tertulias Study Team

Some women in a Tertulias group with some members of the Tertulias team. Credit: Janet Page-Reeves.

Unlike most research studies that are entirely conducted by university researchers, Tertulias uses an uncommon community-driven, community-engaged approach. Members of the community came up with the idea for the study, and they have been involved in designing the research, obtaining the funding, and doing the on-the-ground work to make the study happen. The 16-member Tertulias Research Team includes a diverse group of key collaborators, many of whom are themselves female Mexican immigrants or from Mexican immigrant families:

Lidia Regino is a female Mexican immigrant (FMI) with a long career working with the immigrant community and advocating for immigrant health issues. She was previously the Clinic Director at One Hope Centro de Vida Health Center. She is the Research Director for the Tertulias project and is a Co-Facilitator of two of the Tertulias groups that operate out of One Hope.

Maria Tellez, the project Research Manager, is an FMI who has also worked for many years promoting healthful solutions to challenges faced by immigrant families. She is a Co-Facilitator of two Tertulias groups with Lidia Regino.

Jackie Perez, a Clinical Social Worker who provides mental health counselling primarily to immigrant families through Centro Sávila, is an FMI. She was a collaborator on the previous pilot study and is a Co-Facilitator of the Centro Sávila Tertulias group.

Dulce Medina, also a Clinical Social worker and counsellor at Centro Sávila, is an FMI. She is a Co-Facilitator of the Centro Sávila Tertulias group with Jackie Perez.

Virginia Sandoval works at One Hope Centro de Vida Health Center as a Community Health Worker and an FMI. She serves as the Tertulias Site Coordinator for One Hope.

Camille Vasquez serves as the Tertulias Site Coordinator for Centro Sávila. Her father is a Mexican immigrant.

Daniel Perez Rodriguez is a Mexican immigrant and the Tertulias Data Manager.

Cristina Murra-Krezan is the Tertulias Senior Biostatistician. She designed and leads the statistical analysis of the survey data.

Reuben ‘Jack’ Thomas is a Sociologist and the Tertulias Social Network Scientist. He leads the project social network analysis to understand how social relationships between people are affected by participation in the groups.

Elaine Bearer is a Pathologist and is leading the analysis of cortisol levels taken from hair samples.

Alejandro Aragon is the Project Statistician.

Bill Wagner is a Cultural Anthropologist and a Clinical Social Worker. He is the Tertulias Policy Analyst.

Pachely Mendivil Aguayo, Megan Rivera, and Evelyn Lozano are Medical Students at the University of New Mexico and work as Research Assistants on the project. Pachely and Evelyn are both from Mexican immigrant families.

Janet Page-Reeves is a Cultural Anthropologist and the Principal Investigator for the study. She participates in all of the Tertulias group sessions and leads analysis of parts of the study that do not involve surveys and statistics.

Dr Page-Reeves is a Professor and Vice Chair for Research in the Department of Family & Community Medicine, and the Director of Research for the Office for Community Health at the University of New Mexico. She holds a BA in History and International Development from Washington University and an MA and PhD in Cultural Anthropology from the City University of New York. During her studies, she learned Spanish and travelled across South America, conducting her doctoral thesis on the internal dynamics of a women’s sweater knitting cooperative in Bolivia. Dr Page-Reeves has written two book collections and conducted several studies on health and equity issues in the USA and South America. She is dedicated to better understanding and addressing the root causes and consequences of poverty, the social drivers of health, and promoting health equity. Dr Page-Reeves’ efforts in designing patient-engaged research approaches have attained national recognition and prestigious funding. She collaborates with the Tertulias Study Team to evaluate interventions to reduce feelings of social isolation and depression among immigrant Mexican women in the USA.

 

CONTACT

E: JPage-Reeves@salud.unm.edu

W: https://hsc.unm.edu/directory/page-reeves-janet.html

 

FUNDING

This research was funded by the National Institute of Minority Health and Health Disparities, grant number #1R01MD014153-01, and supported by an award from the National Center for Advancing Translational Sciences, National Institutes of Health under grant number UL1TR001449.

 

FURTHER READING

E Mendez Huerta, L Munguia, R Ramirez Molina, et al., Our Voices, Our Lives: Unforeseen Stories After the Violence, and Opening the Door to Becoming Whole Again, Women’s Health, 19. DOI: https://doi.org/10.1177/17455057231197159

J Page-Reeves, C Murray-Krezan, L Regino, et al., A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants, BMC Public Health, 2021, 21, 119. DOI: https://doi.org/10.1186/s12889-020-09867-z

J Page-Reeves, S Shrum, F Rohan-Minjares, et al., Addressing Syndemic Health Disparities Among Latin Immigrants Using Peer Support, Journal of Racial and Ethnic Health Disparities, 2019, 6, 380–392. DOI: https://doi.org/10.1007/s40615-018-00535-y

 

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