Childhood adversity

Traditional measures of childhood adversity have assessed the incidence of numerous psychologically distressing events, such as child maltreatment (e.g., physical, sexual or emotional abuse, or neglect) and household dysfunction (e.g., divorce, living with a substance using parent, or a household member going to prison). The landmark ACEs Study [11] and subsequent research on childhood adversity resulted in several key findings. First, childhood adversity was relatively common [11, 12]. Second, adversities often co-occurred and had a graded relationship to numerous health outcomes, such as depression [12]. This means that the effects of childhood adversity became incrementally worse with each additional exposure to an adverse event (i.e., dose-response) [11, 13]. Third, subgroups of individuals often experienced specific patterns of adversity; and these exposure patterns influenced their risk for mental health problems (e.g., dimensional and cluster-based approaches to adversity) [14–17]. For example, one study found that those who experienced child maltreatment were more likely to have mental health problems than those who experienced household dysfunction [18].

Several studies have used person-centered analysis (e.g., latent class analysis) to identify patterns of co-occurring ACEs that differ between subgroups. For example, Vaughn et al. [19] found that latent classes characterized by exposure to emotional and physical adversity (n = 1262), family violence (n = 358), and global adversity (n = 246) were significantly more likely to have mood, anxiety, and substance use problems than the low adversity class (n = 3,497). These studies provided evidence that lifetime adversities often cluster in distinct patterns and identifying these patterns may be useful for determining subgroups at risk for developing mental health problems.

Despite these advances in the field of childhood adversity, there are several limitations to this body of research. For one, prior literature has mainly focused on non-Latinx white samples [11, 12, 20]. For example, 80% of participants in the landmark ACEs study were non-Latinx white [11]. This is an important gap to address because Latinxs are at a heightened risk compared to their non-Latinx white counterparts for several ACEs, such as maltreatment [4]. Research by Llabre et al. [2] represented one of the few efforts to assess the prevalence of ACEs among U.S. Latinx adults. They found that approximately 75% of Latinxs born outside of the continental U.S. reported experiencing at least one childhood adversity, which can be detrimental to Latinxs’ short and long-term health [21–23]. Second, the original ACEs scale did not include several types of adversity relevant to Latinxs (or other ethnically/racially minoritized groups), such as discrimination. Third, few studies have assessed lifetime adversity occurring outside of childhood. This is a key limitation because many children continue experiencing adversity in other life stages [10, 24]. For example, Mersky et al. [10] found that the effects of childhood adversity on adult mental health were fully mediated by adverse adult experiences. In other words, they found that the direct effect of childhood adversity on adult mental health was no longer significant after accounting for adult adversity. Moreover, prior research with military populations has found higher prevalence of ACEs among veterans as compared to civilians [e.g., 15], highlighting the co-occurring nature of adversities across the lifetime. Although this is a nascent area of research, these studies suggest that when examining early risk factors for adult mental health, adult adversity should be assessed in addition to childhood adversity. This could be particularly important for Latinx populations, who often experience numerous stressors throughout their lifetimes (e.g., perceived discrimination, economic stress). Studying child adversity in isolation of adult adversity limits our ability to identify the collective influence of adversity across the lifespan.

Perceived discrimination

Another form of lifetime adversity Latinxs and other ethnically/racially minoritized individuals commonly experience is perceived discrimination. Perceived discrimination refers to unfair treatment based on one’s ethnic/racial background that is rooted in white supremacy and anti-black racism [25]. Latinxs can experience discrimination in a range of environments, such as at an interpersonal level (e.g., discriminatory comments) or a structural level (e.g., discriminatory policies). For the purposes of the present study, we focused on interpersonal discrimination that occurs over the course of one’s life, which we refer to as perceived discrimination. For Latinxs born outside (but living in) the continental U.S., perceived discrimination can be related to anti-immigrant and/or anti-black beliefs. In 2019, nearly 60% of U.S. Latinxs reported experiencing perceived discrimination at least “from time to time,” and even higher rates were reported for those with darker skin, highlighting the role of colorism and anti-blackness in these acts of discrimination [5]. Rates of perceived discrimination have increased in the last decade, in part, due to harsher immigration policies and increases in anti-immigrant sentiment in the U.S. [23, 26, 27]. For example, hate crimes have risen 80% in California since 2016 [28].

Studies have shown that experiencing perceived discrimination activates the body’s stress response [29, 30] and contributes to negative mental health outcomes [31]. For example, Flores et al. [32] found that Mexican-origin adults’ reports of perceived discrimination predicted depressive symptoms and poor general health, above and beyond the effects of general life stressors. Similarly, a study with Puerto Rican adults found that higher perceived discrimination was associated with higher depressive symptoms and perceived stress [6]. Although several recent studies have examined perceived discrimination among Latinx adults, prior studies assessing the effects of perceived discrimination on Latinxs have typically focused on youth [e.g., 33, 34] and have not considered co-occurring experiences of other forms of childhood adversity. Additional research is needed to advance the understanding of the effects of perceived discrimination across adulthood and in combination with other types of adversity.

Latinx subgroup differences

Prior theory and research suggest that exposure and response to adversity can vary depending on context and culture [6, 35]. Latinxs are a heterogeneous group, made up of individuals with ethnic backgrounds from over 20 different countries. Therefore, it is reasonable to assume that the experiences of adversity may differ between Latinx subgroups. A study using the same dataset as in the current study, found differences in exposure to risk factors as well as differences in participants’ responses to the risk factors between four Latinx ethnic groups born outside the continental U.S. (i.e., Mexicans, Puerto Ricans, Cubans, and Dominicans) [36]. Cooper et al. [36] reported significant differences in marital status, household income level, language preference, age, gender, and years lived in the continental U.S. They also found that certain risk factors were associated with mental health for some Latinx ethnic groups, but not for others. Specifically, discrimination was associated with mental health for Mexican immigrants, but not for Cuban, Puerto Rican, or Dominican immigrants. The present study aimed to build on Cooper et al.’s [36] study using a person-centered approach to determine whether unique combinations of lifetime adversity were associated with distinct mental health outcomes for Latinxs born outside the continental U.S. Specifically, our goal was to conduct a detailed comparison of two Latinx groups to assess whether differences in exposure patterns to lifetime adversity influenced individuals’ responses to adversities within these two groups.

Therefore, we selected Puerto Ricans and Mexicans born outside the continental U.S. because they represented some of variability that exists between U.S. Latinx groups (e.g., immigrant status, skin color, acculturation levels) and are the two largest Latinx ethnic groups living in the U.S. Although these groups share a common language, there are many within-group differences that may influence their perception and experience of adversity [37]. Few studies have conducted direct comparisons between Puerto Ricans and Mexicans born outside the continental U.S., nonetheless, past research comparing Latinx groups more broadly suggests that differences may exist. For example, several studies have suggested that Puerto Ricans have the highest rates of unemployment and one of the highest rates of divorce as compared to other Latinx groups [36, 38]. Puerto Ricans may also report one of the highest levels of discrimination [36, 39]. On the other hand, Mexican immigrants report higher rates of acculturation stress compared to other Latinx subgroups [40]. This could be attributed to having one of the lowest proportions of naturalized citizens, being more often targeted by immigration officials, and being least prepared to migrate to the U.S. as compared to other Latinx groups [38, 40].

In addition to Latinx ethnic group differences (i.e., between Latinx ethnic groups), there may be individual differences (i.e., within-group differences) that affect Latinxs’ experience of adversity. Prior research suggests that experiences of discrimination may differ based on numerous individual factors which can vary between and within groups, such as immigration status [41], acculturation levels [41], ethnic identity [29, 42], and age [39]. Finch et al. [41], for instance, found that highly acculturated Mexican-origin adults reported higher levels of discrimination as compared to their less acculturated counterparts. Perez et al. [39] found that 25% of foreign-born Latinxs reported experiencing discrimination compared to 50% of U.S.-born Latinxs. Moreover, several studies have found that those with higher levels of ethnic identity reported experiencing less discrimination [39, 42]. In addition to isolating the effects of individual characteristics alone, it is important to understand the overlapping influences of these types of characteristics on health outcomes. One useful approach to identifying the ways in which different characteristics interact to influence response to risk is by using latent profile analysis. However, few studies have assessed subgroup differences based on Latinxs exposure to various patterns of risk. This information could be used to help determine subgroups at highest and lowest risk for mental health problems and inform preventive interventions tailored to the individuals’ pattern of risk exposure.

The present study

The aims of our study were to (a) identify latent profiles of Puerto Rican and Mexican individuals exposed to unique combinations of lifetime adversity (i.e., childhood adversity and perceived discrimination) and (b) compare the prevalence and level of adult mental health problems (i.e., trait anxiety, depressive symptoms, and trait anger) based on latent profile membership. We tested three main hypotheses. First, prior person-centered research on childhood adversity identified between 3–7 latent classes (or profiles) as being the best fit to the data [e.g., 14, 17, 19]. Therefore, we hypothesized that there would be at least three profiles of lifetime adversity. Second, based on our review of past literature and theory, we expected to find differences in the class structure and prevalence between Mexicans and Puerto Ricans. For example, we expected to find a lower prevalence of household dysfunction (e.g., divorce, neglect) for Mexicans [38]. Third, we hypothesized that we would find differences in the ways in which certain risk profiles would be linked with mental health problems. For example, we expected that latent subgroups that experienced numerous ACEs in addition to discrimination would be at a higher risk for mental health problems than profiles with low adversity. Moreover, latent subgroups that experienced more harmful ACEs (e.g., abuse and neglect) [18] or more violent discrimination (e.g., threats) may be particularly vulnerable to mental health concerns.

Sample

To address the aims of this study, we used the Hispanic Community Health Survey/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS) dataset [43]. This ancillary study was conducted using a subset of participants recruited from the original HCHS/SOL parent study. The HCHS/SOL parent study randomly sampled households, using stratified probability sampling, in four U.S. cities with large Hispanic/Latinx populations, the Bronx, Miami, San Diego, and Chicago. Participants were eligible if they (a) self-identified as having Hispanic/Latinx background and (b) were between the ages of 18–74. The household level response rate was 33.5%. Of those who met the inclusion criteria, 41.7% consented to be in the study (N = 16,415). The HCHS/SOL study was focused on risk and protective factors for health conditions and disease states (e.g., cardiovascular disease, diabetes) and the baseline assessments were conducted between 2008–2011.

In 2009, the SCAS was launched to assess psychosocial factors related to health conditions among U.S. Latinxs [43] using a representative sub-sample of the HCHS/SOL parent study (N = 5313). The present study only included individuals who consented to sharing their data to investigators not associated with HCHS/SOL and associated laboratories (N = 4645). We constrained our analytic sample to individuals born in the following two areas outside the continental U.S.: Puerto Rico (n = 402) and Mexico (n = 1351). These were two of the largest Latinx subgroups in the sample and represent the two largest Latinx subgroups living in the U.S. We obtained approval to conduct this secondary data analysis from the Institutional Review Board (STUDY00013534) at the Pennsylvania State University.

Measures

Lifetime adversity indicators.

Childhood adversity was assessed using the ACEs scale, a measure developed in a large-scale study by the Center for Disease Control and Prevention [11]. The ACEs scale examines exposure to various potentially stressful life events during the first 18 years of life. Participants reported whether they experienced the following 10 ACEs: physical abuse and neglect, emotional abuse and neglect, sexual abuse, witnessing abuse of caregiver, living with a substance user, living with a mentally ill person, parental divorce, and having a household member go to prison. Due to high collinearity, we combined the physical abuse and the emotional abuse items into one indicator so that 0 represented no physical/emotional abuse and 1 indicated that respondents answered “yes” to at least one of the two items. All other items were dichotomous with a score of one indicating that a participant reported experiencing a given adverse childhood experience. All items were included as binary indicators of childhood adversity in latent profile analysis (see Table 1).

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Table 1. Descriptive statistics of study variables for Mexicans and Puerto Ricans.

https://doi.org/10.1371/journal.pone.0258324.t001

We assessed perceived discrimination using the 17-item Brief Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ) [44]. The PEDQ assesses lifetime experiences of self-reported discrimination based on race or ethnicity. It includes various aspects of discrimination, including five stigmatization/evaluation items (e.g., “police officers have been unfair to you”), four threat/aggression items (e.g., “others threatened to hurt you”), four work/school items (e.g., “treated unfairly by coworkers or classmates”), and four exclusion/rejection items (e.g., “others made you feel like an outsider”). Respondents rated all items on a scale from 1 (never) to 5 (very often). To create scores for stigma/evaluation, exclusion/rejection, threat/aggression, and school/work discrimination, we calculated the mean item responses within each of the four dimensions of perceived discrimination so that higher scores reflected more discrimination. Mean scores were calculated for participants with complete data (i.e., responded to all 17 items). The PEDQ has been commonly used with Latinx populations [44, 45] and demonstrated acceptable internal consistency in this study (see Table 1). Each of the four sum scores were included as continuous indicators of discrimination in the latent profile analysis.

Preliminary analysis

We conducted preliminary analyses to assess variable distributions and examine bivariate correlations (see Table 1). For Mexicans, the average number of ACEs was 2.20. The most common ACEs for Mexicans were physical and emotional abuse (43%), caregiver substance use (33%), and parental divorce (30%). The highest scores for discrimination among Mexicans were on the exclusion/rejection (M = 8.73) and stigmatization/evaluation (M = 6.66) aspects. For Puerto Ricans, the average number of ACEs was 2.52. The most common ACEs were parental divorce (49%), caregiver substance use (38%) and physical and emotional abuse (37%). The highest discrimination scores were exclusion/rejection (M = 9.22) and stigmatization/evaluation (M = 7.05). Mexicans and Puerto Ricans had significantly different mean scores on most of the ACEs and perceived discrimination items. Correlations between the adversity items (ACEs and discrimination) ranged from .06 - .70 and most were statistically significant (see Tables 2 and 3).

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Table 2. Bivariate correlations of ACEs and perceived discrimination indicators for Puerto Ricans.

https://doi.org/10.1371/journal.pone.0258324.t002

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Table 3. Bivariate correlations of ACEs and perceived discrimination indicators for Mexicans.

https://doi.org/10.1371/journal.pone.0258324.t003

Latent profiles of lifetime adversity

We determined that a four-profile solution was the best fit to the data for Mexicans and a three-profile solution was the best fit for Puerto Ricans (see Table 4). Overall, the AIC, BIC, and a-BIC values improved as the number of profiles increased and the BLRT values were significant for all profile solutions for both ethnic groups. For Mexicans, the three-, four- and five- profile solutions had comparable fit indices. We favored the four-profile solution over the three-profile solution because of the emergence of a distinct, conceptually meaningful fourth profile (i.e., ACEs Only) and over the five-profile solution because the fifth profile was small (less than 5% of the sample), which can lead to less reliable parameter estimates and limits the relevance of this subgroup [67, 68]. Moreover, the fifth profile was not conceptually distinct from the Dual Exposure profile. The six- and seven-profile models had profiles that were even less prevalent than the five-profile model and significant LMRT statistics, indicating worse fit. Therefore, for Mexicans, we selected the four-profile solution as the best fit to the data.

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Table 4. Model fit statistics & selection criteria for Mexicans and Puerto Ricans.

https://doi.org/10.1371/journal.pone.0258324.t004

For Puerto Ricans, we selected the three-profile solution as the best fit to the data. Although the AIC, BIC, and a-BIC values improved as the number of profiles increased, the size of the profiles were very small (less than or equal to 5%) and the improvement started to plateau after three profiles. Additionally, the four-profile solution did not have any conceptually distinct profiles as compared to the three-profile solution. Our decision was also based on significant LMRT statistics for the four-, five-, six- and seven-profile solutions, indicating that these solutions were a worse fit than the three-profile solution.

Three profiles were similar between Mexicans and Puerto Ricans (see Table 5). For Mexicans and Puerto Ricans, we labeled the profile that had lower than average scores on all the items, Low Exposure. We named the profile that had higher than average scores on the ACEs items, but average or lower than average on the discrimination items, ACEs Only. It is important to note that among Puerto Ricans, two aspects of discrimination (i.e., work/school and exclusion/rejection) were higher than average for the ACEs Only profile. However, we determined that the strength of the effect of one of these aspects of discrimination (work/school discrimination) was small 95% CI [-.19, -.02]. For this reason, we maintained that ACEs Only was an appropriate name for this profile. We named the profile that had higher than average scores on all childhood adversity and discrimination items, Dual Exposure. One profile was unique to Mexicans. We named this profile—which had higher than average scores on the abuse and neglect items, having a family member go to prison, and higher than average scores on three out of the four aspects of discrimination—Maltreatment and Discrimination. Our decisions regarding profile names were based on evaluating the indicator means and probabilities shown in Table 5.

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Table 5. Item response probabilities for Mexicans and Puerto Ricans.

https://doi.org/10.1371/journal.pone.0258324.t005

We examined the characteristics of the risk profiles by testing covariates as predictors of profile membership using the R3STEP approach with the Low Exposure profiles set as the reference group (see Table 6). For Mexicans, we found that age, gender, reason for migration, household income, language preference, social support, and ethnic identity were significant predictors of profile membership relative to the Low Exposure profile. For example, as age increased, there were lower odds of belonging to the ACEs Only, Maltreatment and Discrimination, or Dual Exposure profile compared to the Low Exposure profile. As compared to women, men had greater odds of belonging to the Dual Exposure profile and lower odds of belonging to the ACEs Only profile compared to the Low Exposure profile. Mexicans who migrated with their parents as a child had lower odds of belonging to the ACEs Only or Dual Exposure profiles as compared to the Low Exposure profile. As household income level increased, the odds were lower for belonging to the Dual Exposure profile compared to the Low Exposure profile. As compared to those who preferred speaking Spanish, those who preferred speaking English had greater odds of belonging to the Dual Exposure and Maltreatment and Discrimination profiles as compared to the Low Exposure profile. As social support increased, the odds were lower for belonging to the Maltreatment and Discrimination and the Dual Exposure profile as compared to the Low Exposure profile. As ethnic identity increased, there were higher odds of belonging to the Maltreatment and Discrimination profile as compared to the Low Exposure profile.

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Table 6. Results from LPA with covariates analysis for Mexicans and Puerto Ricans: Odd ratios.

https://doi.org/10.1371/journal.pone.0258324.t006

For Puerto Ricans, gender and social support were significantly associated with risk profiles. Compared to women, men had greater odds of belonging to the Dual Exposure profile compared to the Low Exposure profile. As social support increased, the odds were lower for belonging to the ACEs Only and Dual Exposure profiles compared to the Low Exposure profile.

Latent risk profiles and mental health

Using the BCH approach with regression, we found that mean levels of mental health problems (i.e., trait anxiety, depressive symptoms, trait anger) differed significantly across risk profiles. For Mexicans, the Dual Exposure and the Maltreatment and Discrimination profiles had significantly higher levels of all mental health problems than the ACEs Only and Low Exposure profiles. The Dual Exposure profile and the Maltreatment and Discrimination profile did not differ in their levels of mental health problems. For Puerto Ricans, the ACEs Only profile had significantly higher levels of all mental health problems as compared to the Low Exposure profile. The Dual Exposure profile had significantly higher levels of trait anger (but not trait anxiety or depressive symptoms) as compared to the Low Exposure profile. There was not a significant difference between the Dual Exposure and ACEs Only profiles in any of the mental health problems. See Table 7 and Table 8 for a full description of the differences in mental health outcomes between profiles.

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Table 7. Associations between latent profile membership and depressive symptoms, trait anxiety, and trait anger among Mexicans.

https://doi.org/10.1371/journal.pone.0258324.t007

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Table 8. Associations between latent profile membership and depressive symptoms, trait anxiety, and trait anger among Puerto Ricans.

https://doi.org/10.1371/journal.pone.0258324.t008

Comparing risk profiles for Puerto Ricans and Mexicans

As expected, our best-fitting LPA solutions had at least three profiles. For Mexicans, we identified Low Exposure (52), ACEs Only (24%), Maltreatment and Discrimination (15%), and Dual Exposure profiles (9%). For Puerto Ricans, we identified Low Exposure (58%), ACEs Only (32%), and Dual Exposure profiles (10%). These results suggest that certain patterns of lifetime adversities tend to cluster together for Puerto Ricans and Mexican immigrants. Other studies using person-centered analysis to identify subgroups of individuals experiencing different combinations of adversity identified at least three profiles/classes [e.g., 14, 17, 19]. For example, one study with Latinx immigrants selected a four-class model for childhood adversity that included limited adverse experience (65%), emotional and physical abuse (24%), family violence (7%), and global adversity (5%) [19]. However, our study was the first to include perceived discrimination and ACEs items in the assessment of lifetime adversity.

We found three similarities in risk profiles between Mexicans and Puerto Ricans. First, both groups had ACEs Only profiles. This finding aligns with prior literature suggesting that ACEs are prevalent across U.S. Latinx populations [e.g., 2]. For example, Loria and Caughy [69] assessed the prevalence of ACEs in a national U.S. sample and found that 65% of Latinx immigrants reported at least one ACE and over 23% reported two or more ACEs. Second, both Latinx ethnic groups had a Low Exposure profile, in which individuals experienced lower than average levels of all lifetime adversity items. This aligns with past literature that has found low risk profiles when using person-centered analysis to examine patterns of adversity [e.g., 19]. Third, Puerto Ricans and Mexicans in our study each had a subgroup of individuals experiencing Dual Exposure (i.e., high levels of childhood adversity and high levels of perceived discrimination). Participants in our study may have experienced these adversities at different developmental periods (i.e., ACEs in childhood and perceived discrimination in adulthood) because most participants arrived in the U.S. after the age of 18. This means participants in our sample likely did not experience discrimination, at least not to the same extent, until arriving in the continental U.S. as adults. Several studies have found that childhood adversity is associated with experiencing adversity in adulthood [10, 70]. Our finding that subgroups of Puerto Ricans and Mexicans experienced dual exposure to ACEs and discrimination provides evidence for the importance of assessing cumulative adversity across different life stages and is consistent with life course theory’s emphasis on the developmental timing and historical context in assessing the impact of life events [35]. Future measures would benefit from adopting a lifespan approach to measuring adversity in order to better understand the experiences of U.S. Latinxs.

On the other hand, we found two main differences in profile structure and prevalence between Mexicans and Puerto Ricans. First, Mexicans had an additional profile (i.e., Maltreatment and Discrimination) that was unique to the Mexican sample. Puerto Ricans did not have a subgroup who were experiencing this combination of adversities. Second, we found that Puerto Ricans had higher mean discrimination scores in the Low Exposure, ACEs Only and Dual Exposure profiles as compared to Mexicans. This finding supported our hypothesis that there would be differences in the class structure and prevalence between Mexicans and Puerto Ricans. It also aligns with past literature that has found that Puerto Ricans may experience among the highest levels of discrimination as compared to other Latinx subgroups [39, 71].

Risk profiles and mental health problems

As expected, results from BCH analyses indicated that risk profiles were significantly associated with Mexicans’ and Puerto Ricans’ mental health problems (i.e., depressive symptoms, trait anxiety, and trait anger), even after controlling for the effects of age, gender, years lived in the continental U.S., reason for migration, language preference, education level, household income, possession of health insurance, social support, and ethnic identity. Our findings correspond with past studies that found a link between lifetime adversities and mental health symptoms among Latinxs [21–23].

Additionally, results from BCH analyses indicated that many risk profiles varied in their levels of mental health problems (i.e., depressive symptoms, trait anxiety, and trait anger), after adjusting for control variables. For Puerto Ricans, individuals in the ACEs Only and Dual Exposure profiles had higher levels of mental health problems as compared to the Low Exposure profile. However, it was surprising that, for Puerto Ricans, the ACEs Only profile had similar levels of mental health problems as the Dual Exposure profile. This suggests that, for Puerto Ricans, experiencing discrimination in addition to childhood adversity is not more damaging than experiencing childhood adversity alone. This is contrary to the life course theory, which assumes that an accumulation of adversity across life stages is particularly damaging to health and well-being [32]. One potential explanation for this finding is that Puerto Ricans may be more resilient than Mexican immigrants to the effects of discrimination based on their citizenship status. In fact, Latino critical scholars have argued that individuals’ experiences of the world are shaped by various intersecting aspects of their identity, such as language and citizenship status [8]. Studies have shown that anti-immigrant policy may drive discriminatory behaviors and attitudes towards Latinx immigrants [72]. However, Puerto Ricans may be more protected from these discriminatory processes than other Latinx groups because they are U.S. citizens by birth. Additionally, Puerto Ricans in our study had higher levels of health insurance coverage. Therefore, despite experiencing relatively high levels of discrimination, the impact on their mental health might be minimized given that being a U.S. citizen protects them from the fear of being deported or not hired due to their documentation status and allows for access to health insurance. These findings underscore the importance of adopting a critical, intersectional approach to understanding within- and between-group differences among Latinxs.

The relation between risk profiles and mental health problems was distinct for Mexicans. The Maltreatment and Discrimination and the Dual Exposure profiles had higher levels of mental health problems as compared to the ACEs Only and Low Exposure profiles. Said differently, for Mexicans, the two risk profiles experiencing higher than average discrimination had higher levels of mental health problems as compared to the profile that experienced high levels of ACEs only. This suggests that Mexicans may be more vulnerable to the effects of discrimination as compared to ACEs. Accordingly, several scholars have argued that the literature examining the effects of childhood adversity on adult mental health often overlooks the mediational stressors that may occur along the way [10, 24]. For example, Roos et al. [24] found that adversity experienced in childhood is predictive of life adversity (i.e., homelessness) later in life. Moreover, Mersky et al. [10] found evidence that adult adversity was more predictive of adult mental health (i.e., anxiety, depression, and PTSD) than childhood adversity. These studies are consistent with life course theory which indicated that proximal risk factors may be more harmful than distal risk factors [32]. Similarly, our findings suggest that lifetime discrimination (likely experienced in adulthood) may be more harmful to Mexicans than childhood adversity alone.

Implications

Our findings have implications for advancing the assessment of lifetime adversity and improving personalized prevention research aimed at tailoring mental health interventions to meet the specific needs of diverse populations. Individuals interested in assessing Latinx risk factors may benefit by including measures of perceived discrimination as well as childhood adversity, because certain subgroups may have been exposed to both types of adversity and could be at a heightened risk for negative outcomes. Understanding the effects of discrimination is particularly important in light of past research documenting the racialization of Latinx immigrants, a process that often associates Latinx immigrants with criminality [73]. Results from our study also suggest that different patterns of adversity exposure are linked to different levels of mental health outcomes, and therefore, may require different intervention dosage. For example, Mexicans experiencing abuse, neglect and discrimination or high ACEs and high discrimination may need a distinct and more intensive intervention than Mexicans exposed to high ACEs alone. Using a universal approach to prevention, in which everyone gets the same intervention, may be less effective in such cases where the needs of individuals may vary. Understanding which individuals are at the highest and lowest risk for mental health problems is critical for developing tailored programs to intervene across these risk levels. Consistent with Latino critical perspectives [8], our findings suggest that Latinx groups that experience the same pattern of risk factors may not have the same likelihood for developing mental health problems. This has important implications for intervention developers and policymakers focused on implementing prevention programs to promote resilience to adversity. We need to know which subgroups are at greatest risk for negative outcomes in order to effectively deliver interventions. Further studies are needed to substantiate our finding that experiencing unique patterns of lifetime adversity is associated with distinct mental health outcomes.

Limitations

Our study was not without limitations. First, there were numerous demographic constraints to the study. For example, the sample we used from the HCHS/SOL SCAS data was comprised of Puerto Ricans and Mexicans born outside the continental U.S. living in well-established urban immigrant destinations (i.e., Chicago, Miami, San Diego, the Bronx), primarily middle-aged adults that have lived in the continental U.S. for an average of over 20 years. Therefore, our findings may not generalize to other Latinx populations outside of our sample (e.g., younger adults, recent migrants, individuals living in other areas of the U.S., continental U.S.-born individuals, Latinxs born in other parts of Latin America). Second, our measure of perceived discrimination did not specify the timing of the event. Therefore, we could not distinguish those who experienced the event recently from those who experienced the event in the distant past. However, participants in our study indicated the frequency of the event, and it is likely that if they reported an event occurred “very often,” than it was probably an ongoing experience. Third, our study assessed childhood adversity that occurred outside of the continental U.S., therefore, results are not generalizable to childhood adversity experienced in the U.S. Fourth, this was cross-sectional data, so we cannot infer temporality or causation. Fifth, we were unable to assess the effects of skin color variation or racial identity on the relation between discrimination and mental health outcomes, which past literature indicates to be an important factor to consider [8]. Sixth, although our measures had been validated with Latinx populations, few had been validated with our exact sample (i.e., Puerto Ricans and Mexicans born outside, but living in, the continental U.S.). However, this is a limitation to the broader field of mental health research, as more studies are needed to determine the validity of mental health measures across various Latinx populations. Finally, studies suggest that U.S. Latinx populations have experienced an increase in political stress due to the rise of anti-immigrant sentiment and policies [74]. Hence, experiences of discrimination may be different than they were at the time the data were collected.