Health New Media Res > Volume 6(2); 2022 > Article
King, Halversen, Pennington, and Morrow: Open communication in immigrant families: the role of social media mental health exposure

Abstract

Immigrant experiences in the U.S. can be particularly difficult, yet research indicates that family support and engagement on social networking sites with others who experience mental health issues can ameliorate their difficulties and improve psychological wellness. In order to determine what factors are related to immigrants’ mental health communication behaviors with family, we conducted a survey among U.S. immigrants (N = 331). Results indicated that social media mental health exposure (SMMHE) was positively related to open communication. Further, self-stigma mediates the relationship between SMMHE and open communication, providing evidence for the idea that the mere exposure effect can influence attitudes and behavior. As such, it is possible that exposure to mental health content on social media may positively influence offline communication behaviors.

Introduction

Immigrants to the United States (i.e., those who permanently relocate to the U.S.) may have experiences that can compromise their mental well-being, including discrimination, culture shock, financial and structural barriers, language difficulties, and homesickness (King & Callahan, 2020; Lassetter & Callister, 2009; Nadal et al., 2014; Negy et al., 2009; Sangalang et al., 2019; Szaflarski & Bauldry, 2019). Research indicates that acculturation, which is the process an individual undergoes when adjusting to a new culture (Berry, 2005), can play a role in both immigrants’ mental health and their help-seeking behaviors (Sánchez et al., 2014). Due to the difficulties they encounter in the host country, they may experience acculturative stress related to their communication struggles with English, safety concerns, employment opportunities, and lack of family support, among other issues (Lassetter & Callister, 2009; Negy et al., 2009). Those who are less acculturated may also be more at risk for a mental health disorder (Sánchez et al., 2014), but stigma may keep them from seeking help (Cheng et al., 2018; Sánchez et al., 2014) as they may fear that disclosing their mental health issues could lead to social rejection (Mascayano et al., 2016).
Family can play an integral role in this process, as strong family ties can mitigate acculturation stress (Ayón et al., 2010). Family support can provide positive psychological help for some immigrant groups (Joseph, 2011). Yet, sometimes discussing mental health with family may be difficult due to self-stigma, a lack of perceived support, and other barriers (Saechao et al., 2012; Wang et al., 2019). Further, there may be communication difficulties among immigrant generations that make dealing with mental health issues challenging (Meschke & Juang, 2014; Wang et al., 2019). Because the majority of research focuses on the barriers to communication about mental health among immigrant families, this study will do as suggested by Meschke and Juang (2014) and “identify why some immigrant and refugee families communicate well with one another despite potential barriers” (p. 115).
One potential source that may improve one’s ability to discuss mental health with family is social media—as peers, influencers, and other immigrants (Park et al., 2014) post mental health resources and provide personal experiences that help destigmatize mental health (Naslund et al., 2014; Naslund et al., 2016). The mere exposure effect may explain how repeated exposure to mental health messages on social media can positively influence attitudes about mental health such that it reduces stigma (Cheng et al., 2018; Zajonc, 1968). Because social media allow people to contemplate messages in a non-face-threatening space, interacting with content on social media may also be less intimidating than discussing mental health in person (Choudhury & De, 2014). Thus, this study will investigate the mental health communication behaviors of immigrants with family members using the framework of the mere exposure effect (Zajonc, 1968).

Literature Review

Immigrant Mental Health

As a result of these the complex adaptations immigrants undergo, they may struggle with mental health issues (Perreira et al., 2019; Sangalang et al., 2019; Sirin et al., 2019). Yet, the more time immigrants spend in the U.S., the more their acculturative stress lowers and their well-being improves, and they are more likely they are to seek out mental health treatment than their less acculturated counterparts (Park et al., 2014; Sánchez et al., 2014). Not all immigrants, however, will seek out help for the newfound stress they experience. Because mental health issues are stigmatizing for many immigrants, they may avoid seeking help from behavioral health specialists (Cheng et al., 2018; Fergie et al., 2016; King & Callahan, 2020; Naslund et al., 2016; Sánchez et al., 2014). In addition, that stigma may even keep them from telling family members, as they may fear that the disclosure would lead to social rejection (Mascayano et al., 2016). For that reason, it is possible that immigrants who do not have offline support may be more likely to become active prosumers (i.e., producers and consumers) of social media content in an attempt to receive support for their acculturative stress, as suggested by Fergie et al. (2016).
Because many studies have identified stressors related to immigration (Saechao et al., 2012), researchers have sought to determine which factors may protect against this stress. One main factor that has emerged is social or family support (Ayón et al., 2010; Perreira et al., 2019). While a number of studies indicate that family support may mitigate acculturative stress, communication about mental health among immigrant families has been understudied. Minority individuals in the U.S. may have a more stigmatized perception of mental health than is present in the dominant Western culture (King & Callahan, 2020; Mascayano et al., 2016), which suggests that more acculturated immigrants may have reduced mental health stigma. Therefore, it is possible that immigrants who have been living in the U.S. for a longer period of time (Berdahl & Stone, 2009; Miller et al., 2006) with lowered stigma may also be more likely to communicate about mental health with their parents. Thus, we hypothesize that
  • H1: Time in the U.S. will positively predict open communication about mental health among first- and second-generation immigrants and their parents.

Stigma and Generational Issues

Self-stigma occurs when individuals consider themselves socially unacceptable (Yee et al., 2020; Vogel et al., 2006), a self-perception that plays an important role in mental health help-seeking behavior (Cheng et al, 2018; Vogel et al., 2006). For instance, Cheng et al. (2018) found that as self-stigma increased, people were less likely to seek help for psychological health. Specifically, among Chinese Americans, Chinese immigrants, and Polynesian Americans, heightened self-stigma has also been associated with less help-seeking behavior (Yee et al., 2020) and less positive attitudes about seeking psychological help (Allen et al., 2016). Though research has focused on self-stigma and help-seeking, it typically examines help-seeking from professionals, rather than within families; our study will fill this gap. We hypothesize that
  • H2: Self-stigma will negatively predict open communication about mental health among first- and second-generation immigrants and their parents.

Aspects of immigrants’ home cultures may further increase self-stigma, which may result in less open communication between first- and second-generation immigrants and their parents. When children are raised in a culture different from the home culture of their parents, children in these families, often second-generation immigrants, typically acculturate faster than their first-generation parents, which results in a parent-child acculturation gap (Kwak, 2003; Liu, 2015). According to past research, this gap can undermine parent-child communication by creating incongruent values within families, causing breakdowns in family communication (Aumann & Tizmann, 2018). For example, Taoist, Confucianist, and Buddhist influences may perpetuate shame around expressing intense emotions or speaking publicly about mental illness; these feelings may be perceived as either an internal imbalance within the individual or a disruption of collective social harmony for the sake of one’s agenda (Yee et al., 2020). Such views around mental illness may make it more difficult for some immigrants to speak openly with their parents about psychological health. While it may seem that this research would suggest that first-generation immigrants would have a more difficult time speaking with parents about their mental health, the concept of acculturation gaps explains why it may be second-generation immigrants who have even more difficulty talking about mental health—despite their acculturation into Western individualism culture.
Acculturation gaps—meaning the difference between the acculturation level of a parent to a child—also appear to influence communication about mental health in immigrant families. Previous research has shown that immigrant families face a variety of barriers to family mental health communication including emotional discomfort; generational or cultural differences; lack of a parent-child bond; and differing traditions, values, and vocabulary (Meschke & Juang, 2014). While first-generation immigrants were born and raised—at least for a period of time—in the same country as their parents, second-generation immigrants were born and raised in different countries from their parents—likely contributing to a larger acculturation gap. According to Wang et al. (2019), migrant parents may struggle to connect with their more acculturated second-generation immigrant children or be less involved in their children’s lives due to other demands, which may cause parent-child mental health communication to suffer. Thus, we hypothesize that
  • H3: First-generation immigrants will have higher open communication about mental health with their parents than second-generation immigrants.

Mental Health Media Exposure

Content shared on social media can provide heightened access to more positive mental health information, especially for those with stigmatized ideas about mental health (Fergie et al., 2016). When individuals hold a stigma about mental health and fear reaching out to those around them (including family), they may go online to seek information or support, which in turn lowers their stigma toward mental health (Naslund et al., 2016). King and Callahan (2020) found that Brazilian immigrants dealing with acculturative stress and mental health struggles sought out information online about mental health and thereafter experienced lowered stigma toward mental illness. Further, social media has been a valuable source of anti-stigma campaigns that have sought to replace negative stereotypes with accurate information about mental health (Livingston et al., 2014; Sampogna et al., 2017). Thus, social media has the potential to reeducate individuals about mental illness and lower stigma.
Social media allow users to connect with others from similar backgrounds, share their illness experiences, and seek advice from those with similar health concerns. Through support groups on Facebook, comment sections on mental illness YouTube videos, and interactive Reddit forums dedicated to mental health, individuals with mental illness can interact online and experience greater levels of social connectedness (Naslund et al., 2014; Naslund et al., 2016). These platforms allow individuals with mental health struggles to give and receive peer support (Naslund et al., 2016). Research has found that people with illnesses that are commonly stigmatized are more likely to use the Internet to access health information, interact with other users with similar experiences, and communicate online with clinicians about their condition (Choi et al., 2012; Fergie et al., 2016). Possibly due to the stigmatizing nature of mental illness, social media has also been shown to be an effective tool for helping immigrants discuss and find support for mental illness (Merisalo & Jauhiainen, 2020). Thus, social media serves as a valuable resource for immigrants to learn about stigmatized topics such as mental health and may in turn destigmatize mental health and help them more openly discuss it with others, as has been found in qualitative research (King & Callahan, 2020). Accordingly, we hypothesize that
  • H4: Social media mental health exposure will positively predict open communication about mental health among first- and second-generation immigrants and their parents.

The Mere Exposure Effect

The mere exposure effect (Zajonc, 1968) explains the idea that simply being exposed to a stimulus can create liking or a positive attitude toward a person or thing, and repeated exposure begets more liking. There are various explanations as to how this effect occurs; some state that no cognitive appraisal is necessary to induce liking (Zajonc, 2001), while others argue the phenomenon occurs through the cognitive processing of information from the stimulus, which then enacts an emotional reaction (Bornstein, 1989). We take the latter approach in this study. A number of studies have investigated the mere exposure effect in social media. Kim (2021), for instance, found that mere exposure to political candidates’ tweets was positively related to participants’ voting behavior and their perceived likability of the candidates. Thus, mere exposure is not only responsible for the liking of something but can also influence behavior. In the current study, we will investigate how people’s exposure to mental health messages influences their behaviors regarding mental health communication with parents. We contend that in order to share messages about mental health, one must first be exposed to them; for that reason, we examine all mental health-related social media behavior as exposure to such content. Because exposure to mental health content may make the content more positively perceived—and likely reduce any self-stigma—immigrants may be more likely to increase their open communication behaviors about mental health. Thus, we hypothesize the following:
  • H5: Self-stigma will mediate the relationship between SMMHE and open communication with parents.

The Current Study

The current study examines the mere exposure effect in a novel context. We find that mere exposure to mental health content on social media has the potential to improve family communication about mental health. Further, while earlier work has found that lowered self-stigma can improve the chances of professional help-seeking (Cheng et al. 2018), our results indicate it may also relate to more open mental health communication within family relationships. We further corroborate the mere exposure effect such that our results find that mere exposure can occur through cognitive processing of the information in the stimulus, which enacts an attitudinal reaction (i.e., indirect effect). As such, we argue that mere exposure to social media mental health content may positively influence offline communication behaviors.

Method

A total of 450 participants were recruited through Amazon Mechanical Turk. In order to participate in this study, participants were required to be at least 18 years old and identify as a first- or second-generation immigrant. We checked the data for speeders (i.e., those who completed the survey in less than 50 seconds; N = 62), bots (i.e., open-ended questions that were copy-pasted from the internet; N = 50), and straightlining (N = 7), which were eliminated from the analysis. The final number of participants included for analysis was 331 (Mage = 31.27, SDage = 9.18). The sample was 54.7% male and 43.1% female, and 2.2% preferred not to answer. Individuals of all races were present in the sample, including 6.0% American Indian or Alaska Native, 34.7% Asian, 6.9% Black or African American, 9.1% Hispanic/Latinx, 3.3% Multiracial, 0.6% Native Hawaiian or Other Pacific Islander, and 35% White (and 4.4% that preferred not to answer). Years spent in the U.S. for all participants ranged from 0 (i.e., less than 1 year) to 68 (M = 20, SD = 14.13). There were 192 first-generation immigrants (Mage = 31.71, SDage = 9.12; Myears in U.S. = 17.13, SDyears in U.S. = 13.35), 119 second-generation immigrants (Mage = 30.36, SDage = 9.36; Myears in U.S. = 24.87, SDyears in U.S. = 14.03), and 20 who declined to answer. All participants self-identified as immigrants. The following explanation was provided to participants to distinguish between first- and second-generation immigrants: “You are a first-generation immigrant if both your parents were born outside the U.S., and you were not born in the U.S., but you moved to the U.S. (at any age). You are a second-generation immigrant if neither of your parents were born in the U.S., but they moved to the U.S. where you were born” (United States Census Bureau, 2019). This study was approved by the IRB, and participants provided consent for their participation.

Measures

For this study, we administered a survey of self-report measures.

Demographics

Demographic data included age, gender, race, and years in the U.S. We also asked participants if they were first- or second-generation immigrants and if they have had a conversation about mental health with a parent.

Self-Stigma

We used the 10-item Self-Stigma of Seeking Help (SSOSH) scale (Vogel et al., 2006), which measures internalized stigma of seeking professional help; it was modified to reflect discussing mental health with parents rather than therapists. Participants were asked to respond to each item on a 7-point Likert scale from strongly disagree (1) to strongly agree (7). Scales were averaged. Example questions included, “I would feel inadequate if I went to my parent(s)/guardian(s) for psychological help” and “It would make me feel inferior to ask my parent(s)/guardian(s) for psychological help.” Items 2, 4, 5, 7, and 9 are reverse coded. The scale was reliable (α=0.76).

Open Communication

Utilizing the nine-item subscale for open communication of the Parent-Adolescent Communication Scale (Barnes & Olson, 1982), participants reported on their open communication about mental health with their parents. The questions were prefaced by, “When I discuss mental health with my parent(s)/guardian(s) . . .” Example items include, “My parent(s)/guardian(s) are good listeners” and “I can discuss my beliefs with my parent(s)/guardian(s) without feeling restrained or embarrassed.” Participants responded on a 7-point Likert scale from strongly disagree (1) to strongly agree (7). Scales were averaged. The scale was reliable (α=0.93). There were two versions of the questions; one set in the past tense for those who have had a conversation about mental health with their parents and one set in the hypothetical for those who have not yet had a conversation about mental health with their parents. The latter reported on their perception of how they would feel if they were to discuss mental health with their parents.

Social Media Mental Health Exposure

In order to assess an individual’s exposure to mental health social media content, we constructed a Social Media Mental Health Exposure (SMMHE) scale (see Table 1) based on existing literature about how people use social media to discuss mental health (Choudhury & De, 2014; Fergie et al., 2016; Naslund et al., 2014; Naslund et al., 2016). The items are prefaced with “How often do you . . .” followed by seven items. Participants were asked to report the frequency of exposure to each type of social media mental health content. Participants responded to each item on a 7-point Likert scale from Never (1) to Always (7), and items were averaged. Using Mplus, an exploratory factor analysis confirmed one factor (χ2 = .04, p = 1.00; RMSEA = .001; CFI = 1.00; TLI = 1.00; SRMR = .002). Confirmatory factor analysis indicated a satisfactory fit (χ2 = 93.17, p = .001; RMSEA = .125; CFI = .96; TLI = .94; SRMR = .03). The following cut-off criteria were used for EFA and CFA: RMSEA < .06 (Hu & Bentler, 1999), CFI > .90 (Fan et al., 1999), TLI > .90 (Byrne, 1994), and SRMR < .08 (Hu & Bentler, 1999). Cronbach’s alpha for SMMHE was .93.

Results

We utilized SPSS for all quantitative analyses. See Table 2 for preliminary correlations and descriptive statistics.
To test generational differences, we performed independent t-tests between first- and second-generation immigrants to compare means of their age and the number of years they had been in the U.S. There was no significant difference between first- (M = 31.71, SD = 9.12) and second-generation (M = 30.36, SD = 9.36) immigrants’ age, t(305) = 1.25, p = .21. There was, however, a significant difference in time spent in the U.S. such that second-generation immigrants (M = 24.87, SD = 14.03) had spent more time in the U.S. than first-generation immigrants (M = 17.13, SD = 13.34), t(296) = -4.80, p < .001. In addition, we found no significant difference in self-esteem between first- and second-generation immigrants, t(286) = -.06, p = .48. We did, however, find that first-generation (M = 4.27, SD = 1.49) immigrants reported higher SMMHE than second-generation immigrants (M = 3.61, SD = 1.54), t(292) = 3.68, p <.001. For this reason, we conducted two mediation analyses (i.e., one for first-generation immigrants and the second for second-generation immigrants) to address H1, H2, H4, and H5.
Using the SPSS PROCESS macro (Hayes, 2017), we ran a mediation analysis using model 4 and 5000 bootstrapped samples for first-generation immigrants. In the model, SMMHE predicted open communication as mediated through self-stigma with whether or not the participant had already had a conversation about mental health with parents (had conversation = 1, had not had a conversation = 0), years in the U.S, age, and gender (female = 1, male = 0) as controls. Self-stigma, SMMHE, age, and years in the U.S. were mean centered. The model met all assumptions of linearity, independence, normality, equality of variance, and multicollinearity. SMMHE significantly predicted self-stigma (β = .17, SE = .05, t(150) = 3.32, p = .001), and open communication (β = .32, SE = .05, t(150) = 6.87, p < .001). Thus, there was a significant direct relationship between SMMHE and open communication. There was also a significant indirect relationship (β = -.12, SE = .05, CI [-.22, -.03]; see Figure 1. In addition, self-stigma (β = -.70, SE = .07, t(150) = -9.61, p < .001), having had a conversation about mental health (β = .33, SE = .14, t(140) = 2.37, p = .02), and gender (β = .28, SE = .12, t(150) = 2.26, p = .03) significantly predicted open communication; however, age (β = .01, SE = .01, t(150) = 1.89, p = .06) and years in the U.S. (β = .01, SE = .01, t(150) = 1.41, p = .16) did not.
Using the SPSS PROCESS macro (Hayes, 2017), we ran a mediation analysis using model 4 and 5000 bootstrapped samples for second-generation immigrants. In the model, SMMHE predicted open communication as mediated through self-stigma with whether or not the participant had already had a conversation about mental health with parents (had conversation = 1, had not had a conversation = 0), years in the U.S, age, and gender (female = 1, male = 0) as controls. Self-stigma, SMMHE, age, and years in the U.S. were mean centered. The model met all assumptions of linearity, independence, normality, equality of variance, and multicollinearity. SMMHE significantly predicted self-stigma (B =.16, SE = .07, t(95) = 2.25, p = .03), and open communication (β = .26, SE = .07, t(94) = 3.83, p < .001). Thus, there was a significant direct relationship between SMMHE and open communication; thus, H4 was supported (i.e., SMMHE positively predicts open communication). There was also a significant indirect relationship (β = -.13, SE = .06, CI [-.21, -.01]; see Figure 2, indicating H5 was supported (i.e., self-stigma mediates SMMHE and open communication). In addition, self-stigma (β = -.85, SE = .10, t(94) = -8.67, p < .001) significantly predicted open communication; thus, H2 was supported (i.e., self-stigma would negatively predict open communication). However, having had a conversation about mental health (β = -.13, SE = .21, t(94) = -.60, p =.55), age (β =.03, SE = .02, t(94) = 1.78, p = .08), gender (β = -.34, SE = .19, t(94) = -1.74, p = .09) and years in the U.S. (β = -.01, SE = .01, t(94) = -1.05, p = .30) did not. As such, H1 (i.e., time in the U.S. would positively predict open communication) was not supported.
In order to test H3, we analyzed the data of only those who have already had conversations with their parents in order to test actual (i.e., rather than hypothetical) open communication differences between generations. Analyses indicate a significant difference such that first-generation immigrants report greater open communication with parents (M = 5.39, SD = .96) than second-generation immigrants (M = 4.80, SD = 1.24), t(102.60) = 3.35, p < .001. Thus, H3 was supported.

Discussion

This study examines first- and second-generation immigrants’ mental health communication with their parents. Understanding these relationships is important, as family support can help some immigrants experiencing acculturative stress (Joseph, 2011; Pollock et al., 2012). Using quantitative methods, we found that a) social media mental health exposure is positively related to open communication about mental health among immigrant parents and children; b) self-stigma is negatively related to open communication with parents about mental health; c) self-stigma mediates the relationship between social media mental health exposure and open communication about mental health with parents; d) first-generation immigrants reported higher communication about mental health with parents than did second-generation immigrants; e) previous experience with having conversations about mental health with parents and being female are positively associated with open communication about mental health with parents, but only for first-generation immigrants; and e) mere exposure to social media mental health content may positively influence offline communication behaviors.

Mere Exposure Effect of Social Media Mental Health Content

There are two competing viewpoints about the mere exposure effect: 1) there is no cognitive appraisal necessary for attitude change (Zajonc, 2001) and 2) cognitive processing of information in the stimulus incites an emotional reaction and thus attitude change (Bornstein, 1989). In the case of the current study, we assumed the framework of the latter, in that exposure to social media mental health content influences attitudes of self-stigma, which then influences behavior about open communication. Our findings indicate that this cognitive processing may in fact occur such that increased self-stigma hinders open communication. It is not surprising that lowered self-stigma predicted higher open communication, as previous research has shown that self-stigma has a significant negative association with mental health help-seeking behaviors (Cheng et al. 2018). Thus, it appears that those with higher self-stigma may be reticent to communicate about mental health not only in a clinical setting (Pollock et al., 2012), but also in a familial interpersonal setting.
However, we also found that mere exposure also directly influences open communication willingness and behavior. These findings indicate that immigrants’ mere exposure to mental health content on social media has the potential to improve their familial open communication about mental health. It further indicates that immigrants who may be hesitant to speak with family members about mental health (Mascayano et al., 2016) may change their attitudes with more exposure to mental health messages on social media (Naslund et al., 2014; Naslund et al., 2016). It is important to note, however, that these findings are correlational, meaning directionality should be tested in future experiments. As this data is correlational, it is also possible that those who openly communicate about mental health with family are those who are more willing to also discuss mental health openly online. Despite the correlational nature of this study, it does help confirm previous qualitative interview research, which indicated that learning about mental health online helped Brazilian immigrants reduce stigma and increase knowledge of mental health, which played a part in their discussing of mental health with their families (King & Callahan, 2020).
While we supported our hypothesis that an increase in self-stigma would be related to a lowering of open communication, a finding that was not hypothesized—but was nonetheless unexpected—was that SMMHE was positively associated with self-stigma, meaning that an increase in SMMHE was associated with an increase in self-stigma. This may be the result of a cognitive processing of information about the stigma associated with mental health, which is often highlighted in communications about mental health literacy campaigns online. As people see or interact with information about mental health online, they may become more aware of the stigma associated with mental health, which they may then internalize. Existing research indicates that people seek out SMMHE when they experience self-stigma (Naslund et al., 2016). Because this relationship is correlational, however, it is possible too that those who have higher self-stigma are those who are seeking out or targeted by campaigns online related to mental health (i.e., based on their search history). Future research should examine the directional relationship between SMMHE and self-stigma and measure the content of mental health messages.

Generational Differences

First- and second-generation immigrants showed a number of differences in their open communication. For instance, first-generation immigrants reported more open communication with parents than second-generation immigrants. This may be due to the fact that first-generation immigrants share the same homeland and birthplace with their parents, whereas second-generation immigrants are those born in the U.S. to non-U.S. born parents. Existing literature explains that second-generation immigrants typically acculturate faster than their first-generation counterparts, which can create an acculturation gap between them and their parents (Kwak, 2003; Liu, 2015)—meaning that they diverge more quickly in culture norms, culture, and behaviors. As such, first-generation immigrants may be closer in values than their parents. It is possible that the cultural differences between first- and second-generation immigrants may make open communication about mental health more difficult for second-generation immigrants. Thus, our study found support for possible breakdowns in family communication due to differences in generation (Aumann & Tizmann, 2018); further research should investigate which other factors, such as value differences, may account for lower open communication for second-generation immigrants.
In addition, for first-generation immigrants, having previously had a conversation about mental health and being female were more likely to predict open communication; however, those relationships were not true for second-generation immigrants. These differences may also be explained by acculturation gaps in that first-generation immigrants who may be less acculturated may hold to more conservative, traditional gender stereotypes that allow women to be more open in their communication about emotions (McKenzie et al., 2018). Thus, differences in home culture and cultural gender roles of immigrants may explain our results (Fischer & Manstead, 2000). For second-generation immigrants, whether or not they have had a conversation with their parents about mental health was not associated with their willingness or previous open communication behavior; this difference may be explained by the fact that the U.S. culture is considered to encourage more direct and open communication compared to that of some other cultures—including Asian culture, which constitutes the majority of this sample after Whites (Park & Kim, 2008).
Surprisingly, however, neither age nor time in the U.S. predicted open communication about mental health with parents. Though past research has shown that age is associated with mental health help-seeking for younger adults (Mackenzie et al., 2006), age may not make much of a difference in relation to a topic such as mental health, which is stigmatized regardless of age. Additionally, time in the U.S. has also previously been found to predict less acculturative stress over time (Park et al., 2014), yet it did not predict more willingness to discuss mental health. Although time in the U.S.—a measure of acculturation (Berdahl & Stone, 2009; Miller et al., 2006)—has been associated with an increased willingness to access mental healthcare services, rates can vary among different immigrant groups, which may explain the nonsignificant findings in our model. Further, time in the U.S. is conflated with the fact that though some immigrants may experience more acculturative stress over time (Berdahl & Stone, 2009), more time in the U.S. may provide them more time to build a social support system (Miller et al., 2006). Future studies should investigate multiple measures of acculturation in relation to mental health discussion willingness and behavior.

Practical Implications

Due to the stigmatizing nature of mental health issues, research should identify ways in which immigrants might lower their stigma toward mental health while allowing them to save face to some extent; this may be possible through mere exposure to mental health content on social media. Clinicians and educators should encourage immigrants and children of immigrants struggling with mental health to repeatedly seek out social media-based information on mental health and interact with the content—even if casually by following certain mental health-related hashtags or accounts (i.e., mere exposure). However, in addition to mere exposure, they may also encourage participants to interact with the content by participating in online discussions and asking questions, which has been found by other research to be effective in positively influencing well-being (Naslund et al., 2014; Naslund et al., 2016). For those who are worried about stigma and their profile being associated with their online interactions, clinicians should suggest the use of Reddit, which allows for anonymous posting (Choudhury & De, 2014). By participating in these forms of social media, immigrants may become more aware of their self-stigma, which may have positive influences on the openness of communication they have with their parents about mental health.

Conclusion and Limitations

In addition to the strengths of this study, the results should also be examined in light of its limitations. First, we did not control for direct or indirect experience with mental health problems, which could influence social media mental health exposure and open communication—especially because the mere exposure literature has found that stimuli perceived without awareness may produce larger exposure effects than those that are consciously perceived (Bornstein, 1989). Also of note is that this sample was drawn from Amazon Mechanical Turk users, all of whom could read English and are required by Amazon Mechanical Turk to have a social security number in order to create an account, which limits this sample to only immigrants who are English-speaking U.S. citizens, DACA recipients with a social security number, and non-citizens with authorized to work in the U.S. with a social security number. Thus, these individuals also have a higher digital literacy as well; future research should investigate the experiences of non-English speaking immigrants’ and undocumented immigrants’ use of social media in the context of mental health communication. Future research should investigate any racial differences in parent-child open communication. Future studies might also examine the specific types of content (i.e., memes, personal stories, professional tips) that participants interact with.
In conclusion, these results indicate that social media exposure can positively influence a person’s in-person mental health-related communication behaviors with family, and lowered self-stigma not only contributes to professional help-seeking but is also positively related to communication about stigmatized topics among families. Mere exposure to mental health content on social media has the potential to improve family communication and thereby help immigrants navigate their acculturative stress.

Notes

Disclosure statement

The authors have no conflicts of interest.

Biographical statement

Jesse King is a doctoral student at UC Santa Barbara studying communication.

Audrey Halverson, MA, is a doctoral student at the University of Michigan.

Anessa Pennington is an undergrad student studying communications at Brigham Young University.

Olivia Morrow, BA, is a master’s student studying mass communications at Brigham Young University.

Figure 1.
Mediation model for first-generation immigrants
Note: *p < .05, **p < .01, ***p < .001
hnmr-6-2-162f1.jpg
Figure 2.
Mediation model for second-generation immigrants
Note: *p < .05, **p < .01, ***p < .001
hnmr-6-2-162f2.jpg
Table 1.
Items for the Social Media Mental Health Exposure (SMMHE) scale
Items Estimate S.E. Two-tailed Est./S.E.
Post about your own experience with mental health on social media (without sharing an article or video)? 0.83 0.02 44.34
Share others’ posts about mental health on social media? 0.88 0.02 59.08
Share articles or videos about mental health on social media (without mentioning your personal experience)? 0.88 0.02 59.51
Comment on or like someone else’s post on mental health? 0.73 0.03 27.56
Visit an online support group that focuses on a mental health issue? 0.85 0.02 51.29
Watch YouTube videos about mental health? 0.79 0.02 35.64
Follow people on social media who regularly talk about mental health? 0.85 0.02 50.35

Note: All items were significant at the p < .001 level.

Table 2.
Descriptive and bivariate correlations
1 2 3 4 5 M(SD)
1 .19 -.63*** -.22* -.12 3.69(.98)
2 .27*** .20* -.09 -.11 3.61(1.54)
3 -.49*** .36*** .22* .05 4.60(1.27)
4 -.28*** -.25*** .18* .75*** 30.36(9.36)
5 .004 .09 .20*** .40*** 24.87(14.03)
M(SD) 3.69(.88) 4.27(1.49) 5.16(1.11) 31.71(9.12) 17.13(13.34)

Note: 1. Self-stigma, 2. SMMHE, 3. Open communication, 4. Age, 5. Years in the U.S. Correlations for first-generation immigrants are on the bottom-left side of the table; descriptives are in the bottom row. Correlations for second-generation immigrants are on the top-right side of the table; descriptives are in the far-right column.

*p < .05,

**p < .01,

***p < .001.

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