DACA eligibility for mothers improves children’s mental health

Children with mothers eligible for the Deferred Action for Childhood Arrivals program suffer from lower rates of anxiety and adjustment disorders than those with mothers who lack DACA eligibility.

Stanford medical students show their support for the Deferred Action for Childhood Arrivals program during a Sept. 14 rally at the Li Ka Shing Center for Learning & Knowledge. A new Stanford study found that children of immigrant mothers eligible for the DACA program had fewer mental health issues than those whose mothers were ineligible.
Dale Lemmerick

Children of undocumented parents face high levels of anxiety, a natural result of living with the fear and uncertainty that a parent could be targeted for deportation, swept up by Immigration and Customs Enforcement, and sent back to his or her country of origin. Lack of documentation causes many such families to live in the shadows, attempting to stay off government radar while remaining in the United States.

A team of researchers led by the Stanford Immigration Policy Lab set out to examine if some measure of protection for undocumented mothers could result in less anxiety — and lessen the need for mental health treatment — for their children. Their study shows that U.S.-born children of mothers eligible for Deferred Action for Childhood Arrivals program suffer from lower rates of anxiety and adjustment disorders when compared with U.S.-born children of undocumented mothers ineligible for DACA.

The study was published Sept. 8 in Science. Lead authorship is shared by Jens Hainmueller, PhD, professor of political science at Stanford and co-director of the Stanford Immigration Policy Lab; Duncan Lawrence, PhD, executive director of the lab; and postdoctoral scholar Linna Marten, PhD. The senior author is David Laitin, PhD, professor of political science and co-director of the lab.

President Donald Trump recently announced plans to rescind DACA, a program enacted in 2012 that allows some people who entered the U.S. illegally as minors to receive renewable two-year periods of deferred action from deportation and eligibility for a work permit.

DACA has protected nearly 800,000 undocumented immigrants brought here as children. But the researchers hope policymakers will use a broader calculus in future decision-making and take into account the positive impacts DACA has on recipients’ families — and the negative impacts that could result from wholesale deportation.

Hainmueller said he and his colleagues were motivated by the lack of evidence that exists on the undocumented population in the United States. They chose to examine DACA, he said, because it’s the most significant immigration policy of the last two decades.

Fernando Mendoza

“There are a lot of beliefs about policies, but not a lot of evidence on how policies impact the undocumented and the communities in which they live,” Hainmueller said. Moreover, little has been written about how DACA protections impact a recipient’s family, with most research and policy focusing instead on the individual recipients, including studies that show DACA recipients have higher rates of employment and improved health outcomes.

“We decided to look at the intergenerational effects of DACA and whether there were spillovers on the protections of parents into the lives of their kids. That was the motivation — there had been no research on the intergenerational effects of DACA,” Hainmueller said.

Fernando Mendoza, MD, a professor of pediatrics at Stanford and co-author of the study, pointed to the loss of a parent — whether by death, divorce or deportation — as one of the greatest stresses of children.

“However, in the case of deportation, the level of stress is heightened by the uncertainty of the event. Think about a young child going to school one day and returning home and not finding their mother. Or having the father leave in the morning, and always thinking, ‘Will this be the last time I see him?’” Mendoza said. “This is the current status of 4 million children who have one undocumented parent. This is the stress and uncertainty that DACA was able to relieve.”

Digging into the data

The research team used claims data from Oregon’s Emergency Medicaid program, which is heavily used by undocumented immigrant mothers. The data on births spanned 2003-15; because the children were born in Oregon, and thus are U.S. citizens, those children became eligible for traditional Medicaid.

In all, they identified 5,563 mothers born between 1980 and 1982 who were covered by Emergency Medicaid and gave birth to 8,424 children during 2003-15. Then they tracked the children’s mental health outcomes using their Medicaid claims.

Jens Hainmueller

Researchers further narrowed in on adjustment and anxiety disorders, theorizing that children may be stressed by the uncertainty of their parents’ immigration status.

What they found is that mothers’ DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children and that parents’ unauthorized status is a significant barrier to normal child development and perpetuates health inequalities.

“We found that before DACA was implemented, the rates of mental health diagnosis were exactly the same; but in the post-DACA period, mothers started to benefit from protection and the rates of adjustment and anxiety disorders dropped by half,” Hainmueller said.

“When you consider the social determinants of mental health, there are a lot of things that are hard to change, but here we have an instance of a dramatic improvement in the mental health of those kids. You can, through a law, get a dramatic improvement in health. And unlike poverty, that’s something uniquely changeable,” he said.

But just as a law helped change mental health outcomes for kids in this study in a positive way, so too can an absence or reversal of the law change outcomes in a negative way.

“If it were to be reversed, those gains would quickly evaporate and maybe reverse and these parents would be back in the shadows,” Hainmueller said.

Next steps

The researchers are trying to obtain similar mental health data of children of DACA recipients in California and New York. Also, as a follow-up to the research based on data from Oregon, the team has an ongoing effort to interview families impacted by DACA. So far, they’ve completed 25 interviews.

“One of the things the study can’t do, with quantitative data, is determine what’s leading to the dramatic improvement we see,” Hainmueller said. “We don’t know if it’s job security, reduced stress because there’s less anxiety, but hopefully that will come out in more qualitative interviews.”

The study’s results imply that expanding deferred action to the millions of unauthorized immigrant parents who do not meet the current DACA eligibility criteria could further promote the health and well-being of this next generation of American citizens. And the study states it’s also reasonable to expect that permanent legal status or a pathway to citizenship would have an equal, if not greater, effect in improving children’s health.

Other Stanford co-authors of the study are postdoctoral scholar Lucila Figueroa, PhD; Michael Hotard, program manager of the Immigration Policy Lab; and Tomás Jiménez, PhD, associate professor of sociology.

Researchers from Uppsala University, Northwestern University and Oregon Health & Science University also contributed to the work.

The study was supported by the Russell Sage Foundation and the Ford Foundation.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

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