Exploring the Immigrant Paradox: Nativity, Ethnicity, and Postpartum Mental Health Among Latinas in Central Texas

Background: Mental health conditions are a leading cause of maternal mortality. Within Latina ethnicity, being foreign-born has been associated with better health outcomes than being US born, but the relevance of this immigrant paradox to perinatal mental health remains underexplored. This study investigates whether ethnicity (Latina/non-Latina) and nativity (foreign vs. US born) are associated with differences in postpartum depression and anxiety within a sample of women in Central Texas. Methods: We conducted a secondary analysis of a prospective observational cohort (n = 76). Participants completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7) between 6 and 12 weeks postpartum. We performed stepwise forward linear regression models with log-transformed depression and anxiety scores. Results: The mean GAD-7 score amongst all participants was 4.07 (SD = 4.72), and the mean EPDS score was 4.68 (SD = 5.21). Approximately 21% of participants met the clinical threshold for anxiety, and 10.8% met the clinical threshold for depression. Hispanic/Latina participants had 56% lower GAD-7 scores compared to non-Latina participants (95% CI: 0.29-0.67), and foreign-born participants had 39% lower GAD-7 scores compared to U.S. born participants (95% CI: 0.39-0.95). Nativity was not significantly associated with EPDS scores and was not retained in the final depression model. Hispanic/Latina participants had 43.1% lower EPDS scores than non-Latinas (95% CI: 0.38-0.86). All results are based on adjusted, log-transformed linear models. Conclusions: We found that Hispanic/Latina ethnicity was associated with lower postpartum anxiety and depression scores. Additionally, being foreign born was associated with lower postpartum anxiety scores. These findings suggest the immigrant paradox may apply to perinatal mental health outcomes among Latinas. Future research should explore within-group differences among Latinas and consider variables such as acculturation, immigration status, income, and country of origin.