Hispanic Immigrants and Suicide: Overcoming Data Challenges in an Anti-immigrant Climate

Background Patients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). We performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. Methods Databases (MEDLINE, EMBASE, PROSPERO, Cochrane library and MedRxiv) were searched up to 31st August 2020, for studies reporting COVID-19 data disaggregated by ethnicity. Outcomes were: risk of infection; intensive therapy unit (ITU) admission and death. PROSPERO ID: 180654. Findings 18,728,893 patients from 50 studies were included; 26 were peer-reviewed; 42 were from the United States of America and 8 from the United Kingdom. Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection compared to White individuals. This was consistent in both the main analysis (pooled adjusted RR for Black: 2.02, 95% CI 1.67–2.44; pooled adjusted RR for Asian: 1.50, 95% CI 1.24–1.83) and sensitivity analyses examining peer-reviewed studies only (pooled adjusted RR for Black: 1.85, 95%CI: 1.46–2.35; pooled adjusted RR for Asian: 1.51, 95% CI 1.22–1.88). Individuals of Asian ethnicity may also be at higher risk of ITU admission (pooled adjusted RR 1.97 95% CI 1.34–2.89) (but no studies had yet been peer-reviewed) and death (pooled adjusted RR/HR 1.22 [0.99–1.50]). Interpretation Individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.

Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.

Rationale Despite abundant state-level policy activity in the U.S. related to immigration, no research has examined the mental health impact of the overall policy climate for Latinos, taking into account both inclusionary and exclusionary legislation. Objective To examine associations between the state-level policy climate related to immigration and mental health outcomes among Latinos. Methods We created a multi-sectoral policy climate index that included 14 policies in four domains (immigration, race/ethnicity, language, and agricultural worker protections). We then examined the relation of this policy climate index to two mental health outcomes (days of poor mental health and psychological distress) among Latinos from 31 states in the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey of non-institutionalized individuals aged 18 years or older. Results Individuals in states with more exclusionary immigration policies had higher rates of poor mental health days than participants in states with less exclusionary policies ( RR : 1.05, 95% CI : 1.00, 1.10). The association between state policies and the rate of poor mental health days was significantly higher among Latinos versus non-Latinos ( RR for interaction term: 1.03, 95% CI : 1.01, 1.06). Furthermore, Latinos in states with more exclusionary policies had 1.14 (95% CI : 1.04, 1.25) times the rate of poor mental health days than Latinos in states with less exclusionary policies. Results were robust to individual- and state-level confounders. Sensitivity analyses indicated that results were specific to immigration policies, and not indicators of state political climate or of residential segregation. No relationship was observed between the immigration policy index and psychological distress. Conclusion These results suggest that restrictive immigration policies may be detrimental to the mental health of Latinos in the United States.