Depression Trajectories in Relatively Recent Immigrants Karen J. Aroian and Anne E. Norris This longitudinal study of 253 ever-depressed former Soviet immigrants (1) examined the life circum- stances, demographic characteristics, and immigra- tion demands of individuals whose depression lifted, or who remained or became depressed over a 2-year period; and (2) investigated whether immigration de- mands, local relatives, age at immigration, gender, education, employment, and marital status differed among the three groups. Depression was determined based on depression scores at baseline and at 2-year follow-up. Forty-three percent of the sample re- mained depressed, 26% became depressed, and 30% had their depression lift over the course of 2 years. The three groups did not differ with regard to demo- graphic characteristics or loss of employment or a negative change in marital status over the 2-year study period. They did differ with respect to the pres- ence of local family and immigration demands ( P < .05). Those who remained depressed were less likely to have family in the area and had the highest immi- gration demand score at both time points. However, the effect for presence of local family was not signif- icant when immigration demands were included in the analysis ( P .32). Analysis of variance (ANOVA) for repeated measures revealed that the group whose depression lifted experienced the greatest change in immigration demand scores over the 2-year study period. Our findings argue that clinicians should not expect immigrants’ depression to always decrease over time and should assess depression by asking about immigration demands, even if depression was not present during an earlier clinical encounter. © 2003 Elsevier Inc. All rights reserved. D EPRESSION AMONG IMMIGRANTS from the former Soviet Union (FSU) is an impor- tant topic of inquiry. There are more than 1 million immigrants from the FSU throughout the world 1 and depression is common in this group. 2-7 In one study of relatively recent former Soviet immigrants (mean 3.73 years in Israel, SD 1.21), 55% of the sample was depressed. 8 In another study of more longstanding former Soviet immigrants (mean 3.80 years in the United States, SD 4.44), 36% of the sample was depressed. 9 Depres- sion significantly impairs immigrants’ ability to adapt to the new country and has serious emotional and economic consequences for immigrants and their families. 10,11 In an earlier report, we described findings from a longitudinal study of depression 2 years later in a sample of relatively recent, FSU immigrants. 12 Surprisingly, there was little improvement in de- pression for the sample over time. Thus, we de- cided to reanalyze the data to determine if we missed improved depression in some individuals by focusing on depression in the sample as a whole. Improvement in depression could have been present but obscured by the existence of sam- ple subgroups that each had different patterns of depression trajectories. Specific aims of the reanal- ysis were to: (1) describe the life circumstances, demographic characteristics, and immigration de- mands of individuals with different depression tra- jectories, and (2) investigate whether individuals with different depression trajectories also experi- ence different changes in the demands of immigra- tion over time. Identifying different depression tra- jectories and the characteristics associated with various depression trajectories is of clinical rele- vance because this information alerts clinicians to possible changes in emotional status and describes how these changes may be related to changing life circumstances and immigration demands in their immigrant patients. Findings about the course of immigrants’ depres- sion are mixed. A number of studies report higher rates of distress among recent rather than long- standing immigrants. 13-18 A number of other stud- ies report that years since arrival is unrelated to distress. 19-24 In two studies, number of years since arrival was unexpectedly associated with increased depression. 25,26 Nonetheless, there is a general expectation that immigrants’ emotional status will improve over time as they adapt to and overcome immigration demands like language, novelty, and finding suit- able work. When there is empirical evidence to the From the Wayne State University College of Nursing and Department of Anthropology, Detroit, MI; and the Boston Col- lege School of Nursing, Boston, MA. This work was conducted through Boston College and was funded by the National Institutes of Health R29 NR 02866. Address reprint requests to Karen Aroian, Ph.D., Wayne State University, Cohn Building, 5557 Cass Ave, Detroit, MI 48202. © 2003 Elsevier Inc. All rights reserved. 0010-440X/03/4405-0002$30.00/0 doi:10.1016/S0010-440X(03)00103-2 420 Comprehensive Psychiatry, Vol. 44, No. 5 (September/October), 2003: pp 420-427
