DIVERSITY IN ADULT CHILD CAREGIVERS: EXPLORING THE ASSOCIATIONS BETWEEN IMMIGRANT STATUS, SEX, RACE/ETHNICITY, HEALTHCARE USE, AND DEPRESSIVE SYMPTOMS

Abstract

The United States is undergoing a significant demographic transformation characterized by increasing racial and ethnic diversity, including a growing multiracial population. Immigration plays a pivotal role in driving this trend, contributing to a surge in the immigrant population. The aging population is also rising, with immigrants comprising a growing proportion of older adults. However, despite their substantial presence, immigrants, particularly those serving as caregivers for older parents, may encounter various obstacles, such as language barriers, limited employment opportunities, acculturation stress, and discrimination. These challenges can exacerbate disparities in healthcare access and use, impacting the well-being of immigrant adult child caregivers and their care recipients. Nevertheless, research on immigrant caregivers remains limited due to data deficiencies and conceptual gaps. To address this gap, this dissertation adopts a "three-paper" structure to examine the relationship between population characteristics—particularly sex and race/ethnicity—healthcare use, and depressive symptoms among adult child caregivers by immigrant status. The first paper (Chapter 2) aimed to explore the basic characteristics and depressive symptoms among caregivers based on immigrant status, highlighting data gaps and describing their characteristics. The second paper (Chapter 3) investigated whether immigrant status moderates the relationship between population characteristics and healthcare utilization. Finally, the third paper (Chapter 4) examined potential differences in the direct and indirect associations among population characteristics, healthcare service use, and depressive symptoms based on immigrant status. I conducted analyses on a sample of 1,587 community-dwelling adult child caregivers using secondary data from Wave 2016 and 2018 of the Health and Retirement Study. I employed a range of statistical analyses including the Chi-square test, t-test, multiple linear regression modeling, and structural equation modeling to fulfill research aims. Key findings unveiled significant demographic variances among caregivers, encompassing racial/ethnicity, employment status, marital status, and insurance coverage. While non-immigrant caregivers tended to be older, more educated, and possess higher incomes, no significant difference in depressive symptoms was observed between them and immigrant caregivers (Chapter 2). Immigrant status exerted an influence on healthcare use, with differences noted based on sex, race/ethnicity, and healthcare usage frequency. Female caregivers exhibited more frequent doctor visits, alongside non-African American/Black, non-Hispanic caregivers, signaling racial/ethnic differences (Chapter 3). The intricate relationship between demographic attributes and depressive symptoms, mediated by healthcare use, implied the heavier caregiving burdens experienced by female caregivers, potentially contributing to heightened depressive symptoms. Direct effects revealed that being female, being non-Black/African caregivers of non-Hispanic origin, and being non-Hispanic were associated with more frequent doctor visits. Indirect effects reveal that doctor visits mediate the relationship between population characteristics and depressive symptoms, particularly among female, non-Hispanic Black/African, and Hispanic caregivers. While no mediating role was found for immigrant status, it was linked to fewer doctor visits, emphasizing the need for further research to develop tailored interventions for diverse caregiver populations (Chapter 4). These findings emphasize the imperative of addressing intersectional relationships to mitigate differences in healthcare use among adult child caregivers for older adults, necessitating targeted interventions and policies informed by these insights to enhance health outcomes among varied caregiver populations. Future studies should explore the underlying mechanisms and design effective interventions specifically tailored to address the unique needs of caregivers from diverse backgrounds.