Diversity in Adult Child Caregivers: Exploring the Associations Between Immigrant Status, Sex, Race/Ethnicity, Healthcare Use, and Depressive Symptoms

Title of Dissertation: Diversity in Adult Child Caregivers: Exploring the Associationsbetween Immigrant Status, Sex, Race/Ethnicity, Healthcare Use, and DepressiveSymptomsMin Kyoung Park, Doctor of Philosophy, 2024Dissertation Directed by: Christine A. Mair, Ph.D., Director for Center for Health,Equity, & Aging and Associate Professor, Department of Sociology, Anthropology, &Public Health (SAPH), University of Maryland Baltimore County (UMBC)The United States is undergoing significant demographic transformation with increasingracial and ethnic diversity, driven largely by immigration, leading to a surge in theimmigrant population. The aging population is also rising, with immigrants comprising agrowing proportion of older adults. Immigrants, especially those serving as caregivers forolder parents, face various challenges that exacerbate healthcare disparities, impactingtheir well-being and that of their care recipients. Despite their importance, research onimmigrant caregivers is limited due to data deficiencies and conceptual gaps. To addressthis gap, this dissertation adopts a "three-paper" structure to examine the relationshipbetween population characteristics—particularly sex and race/ethnicity—healthcare use,and depressive symptoms among adult child caregivers by immigrant status.▪ The first paper (Chapter 2) explored caregiver characteristics and depressivesymptoms based on immigrant status, identifying data gaps.▪ The second paper (Chapter 3) examined how immigrant status moderates therelationship between population characteristics and healthcare utilization.▪ The third paper (Chapter 4) investigated differences in the associations amongpopulation characteristics, healthcare use, and depressive symptoms based onimmigrant status.Analyses were conducted on a sample of 1,587 community-dwelling adult childcaregivers using secondary data from the 2016 and 2018 Health and Retirement Study,employing statistical methods such as Chi-square tests, t-tests, multiple linear regression,and structural equation modeling. Key findings revealed significant demographicdifferences among caregivers, including race/ethnicity, employment status, marital status,and insurance coverage. Non-immigrant caregivers were generally older, more educated,and had higher incomes, but no significant difference in depressive symptoms comparedto immigrant caregivers (Chapter 2). Immigrant status influenced healthcare use, withvariations based on sex, race/ethnicity, and healthcare frequency. Female and nonAfrican American/Black, non-Hispanic caregivers had more frequent doctor visits,indicating racial/ethnic differences (Chapter 3). The relationship between demographicsand depressive symptoms, mediated by healthcare use, suggested heavier burdens onfemale caregivers, contributing to increased depressive symptoms. Doctor visits mediatedthe relationship between demographics and depressive symptoms, especially for female,non-Hispanic Black/African, and Hispanic caregivers. While immigrant status did notmediate this relationship, it was linked to fewer doctor visits, highlighting the need fortailored interventions for diverse caregivers (Chapter 4). These findings underscore theneed for targeted policies to address healthcare disparities among adult child caregivers