Adzrago David, Williams Faustine
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
SSM Popul Health. 2023 Oct 4;24:101522. doi: 10.1016/j.ssmph.2023.101522. eCollection 2023 Dec.
Life satisfaction contributes to improved long and healthy lives, enhanced biological function, better mental health, and decreased mortality risks. Social needs (e.g., food security, employment, healthcare utilization) are important determinants of mental health and life satisfaction among immigrants. However, there is limited literature on how social needs influence mental health, which, in turn, affects life satisfaction among immigrants. We examined whether mental health influences the mechanisms of the relationship between social needs and life satisfaction among immigrants.
We used the 2021 cross-sectional National Health Interview Survey data on U.S. immigrants (n = 4320) aged ≥18 years. We conducted weighted mediation analyses with multiple linear regression. Life satisfaction (scores 0-10; ≥1 as higher life satisfaction) was the dependent variable; independent variables were food security, employment, and healthcare utilization; and the mediator, serious psychological distress (SPD: scores 0-24; ≥1 as higher SPD).
The total effect (not accounting for SPD) of food insecurity (vs. secure) on life satisfaction was negative (β = -0.61, p < 0.001); the direct effect (after accounting for SPD) was not statistically significant (β = -0.21, p = 0.153), while the indirect effect (food insecurity's effect explained by SPD) was negative (β = -0.40, p < 0.001). The total (β = 0.32, p < 0.001), direct (β = 0.24, p = 0.004), and indirect (β = 0.09, p = 0.006) effects of being employed (vs. unemployed) on life satisfaction were positive. The total (β = -0.12, p = 0.116) and direct (β = -0.03, p = 0.683) effects of healthcare utilization within the past year (vs. more than a year) on life satisfaction were not statistically significant, whereas the indirect effect was negative (β = -0.09, p < 0.001).
SPD mediates the effect of food security, healthcare utilization, and employment on life satisfaction, suggesting the need to improve social needs and mental health among immigrants.
生活满意度有助于延长健康寿命、增强生理功能、改善心理健康并降低死亡风险。社会需求（如食品安全、就业、医疗保健利用）是移民心理健康和生活满意度的重要决定因素。然而，关于社会需求如何影响心理健康进而影响移民生活满意度的文献有限。我们研究了心理健康是否会影响移民社会需求与生活满意度之间关系的机制。
我们使用了2021年美国≥18岁移民的横断面国民健康访谈调查数据（n = 4320）。我们采用多元线性回归进行加权中介分析。生活满意度（评分0 - 10；≥1表示更高的生活满意度）为因变量；自变量为食品安全、就业和医疗保健利用；中介变量为严重心理困扰（SPD：评分0 - 24；≥1表示更高的SPD）。
粮食不安全（与粮食安全相比）对生活满意度的总效应（不考虑SPD）为负（β = -0.61，p < 0.001）；直接效应（考虑SPD后）无统计学意义（β = -0.21，p = 0.153），而间接效应（由SPD解释的粮食不安全效应）为负（β = -0.40，p < 0.001）。就业（与失业相比）对生活满意度的总效应（β = 0.32，p < 0.001）、直接效应（β = 0.24，p = 0.004）和间接效应（β = 0.09，p = 0.006）均为正。过去一年（与一年以上相比）医疗保健利用对生活满意度的总效应（β = -0.12，p = 0.116）和直接效应（β = -0.03，p = 0.683）无统计学意义，而间接效应为负（β = -0.09，p < 0.001）。
SPD介导了食品安全、医疗保健利用和就业对生活满意度的影响，这表明有必要改善移民的社会需求和心理健康。
