At the Mass General Research Institute, our community of 9,500+ investigators work diligently to publish peer-reviewed work and scientific findings to better understand disease and develop solutions to medicine’s most pressing challenges.

Footnotes in Science is a space where investigators bring you the behind-the-scenes details of their recently published work.

In this Q&A we pick the brain of Margarita Alegría, PhD, first author of a recent study published in American Psychologist, Addressing health inequities for children in immigrant families: Psychologists as leaders and links across systems.

Dr. Alegría is chief of the Disparities Research Unit in the Mongan Institute at Massachusetts General Hospital, the Harry G. Lehnert, Jr. and Lucille F. Cyr Lehnert Endowed MGH Research Institute Chair and a professor of Medicine and Psychiatry at Harvard Medical School.

What motivated you and your team to publish this review?

Children in immigrant families (CIF), defined as those who are either foreign-born or have at least one parent who is foreign-born, are a high-priority group for receiving mental health support. They have often fled violence in their home countries and experienced additional traumas during their journey to the United States.

However, the field of psychology must continue to increasingly prioritize health equity. All aspects of the psychology field, from training to practice to research, should ensure to attend to and address the mental health issues impacting CIF.

We sought to identify an opportunity for psychologists to engage in multidisciplinary work, collaborate across sectors, and work in multi-level dimensions to improve mental health outcomes for children in immigrant families.

Psychologists are well-positioned to work with policymakers and people leading social structures and systems (such as schools) and communities to address the structural inequities in immigrant families. 

Limited research has explored this expanded role of psychologists, so we sought to fill this gap in the literature, particularly addressing social determinants and policy gaps.

Can you explain the social determinants of health and their influence on health inequities?

Social determinants of health are non-medical and non-biological factors that impact health outcomes.

Social determinants of health include, for example, socioeconomic status, neighborhood and community environment, housing, transportation, working conditions and access to health care.

They also include larger upstream systems that confer downstream community-level and individual-level impacts, including structural racism, residential segregation and immigration policy.

The inequities caused by social determinants of health and adverse conditions for minoritized populations confer worse health outcomes and lead to health disparities.

For example, housing instability, job insecurity, poor housing conditions, food insecurity, and poverty have been linked to worse mental health outcomes.

Staying in clinics and receiving medical care is insufficient to address these health disparities. Attention must be paid to the social determinants.

What are the remaining gaps in current research? 

Much more work is required to improve the mental health of children in immigrant families and leverage psychologists in these efforts. One remaining gap is best practices for collaborations between psychology researchers, practitioners, and policymakers.

Quality and sustainable relationships between researchers and policymakers are needed to ensure that research gets implemented into policy and practice. Still, there has been an inadequate focus on fostering and supporting these collaborations.

More research and efforts are needed in implementation and building potential for psychology research to be used in policymaking to improve the health outcomes of marginalized populations.

How can healthcare systems and external institutions help promote health equity among children in immigrant families (CIF)?

Healthcare systems should ensure cultural competency and culturally and linguistically tailored care to improve the healthcare provided to children in immigrant families.

Additionally, hiring practices in healthcare systems need to be changed to enhance racial and cultural concordance between provider and patient. There is evidence that concordance improves retention in care and patient-provider relationships.

Healthcare systems should also consider employing non-clinical workers, including community health workers, case managers, and social workers, as they have shown a better understanding and response to the needs of marginalized populations.

Healthcare systems should also work with external institutions, such as trusted community centers, to bring care out of the clinics and into communities.

Psychologists can help to facilitate these connections as previous research shows their success in creating programs with schools and community organizations that improve mental health.

What is the anticipated impact of psychologists’ role in achieving systemic change? 

Psychologists have great potential to help achieve systemic change. They are well-positioned to work across sectors and collaborate to ensure different systems work together in achieving systemic change.

For example, psychologists have previously led multidisciplinary teams to implement screening and case management systems for marginalized populations.

Additionally, collaborations between psychologists and those working in economics and social policy fields can help achieve systemic and long-lasting change.

Psychologists are exceptionally well-positioned to tackle the systemic inequities negatively impacting the health of marginalized populations due to their understanding of the mental health and psychological impacts of marginalization.

What are the biggest takeaways from your study?

Our study’s most significant takeaways are that there are many opportunities for psychologists and other mental health professionals to advance health equity for children in immigrant families by leveraging multi-sector and interdisciplinary teams. This leverage allows us to address upstream systemic inequities that confer adverse health outcomes.

Psychologists can bridge healthcare, communities, schools, and policymakers and facilitate efforts to improve community health and address multi-level factors negatively impacting mental health.

Collaboration between mental health professionals and policymakers is an area of great potential, but more research and efforts are needed to strengthen these collaborations and make them a win-win for both.