Article Text

Protocol
COVID-19 pandemic and mental health among Hispanic/Latino/a immigrants in the USA: protocol for a scoping review
  1. Cameron K Ormiston1,
  2. Jolyna Chiangong1,
  3. Alicia Livinski2,
  4. Dera Tompkins2,
  5. Faustine Williams1
  1. 1National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland, USA
  2. 2National Institutes of Health Library, Bethesda, Maryland, USA
  1. Correspondence to Mr Cameron K Ormiston; ckormiston{at}gmail.com; Dr Faustine Williams; faustine.williams{at}nih.gov

Abstract

Introduction The COVID-19 pandemic has had drastic effects on worldwide mental health and laid bare health disparities and inequities among marginalised groups and racial/ethnic minoritised communities in the USA. This is especially the case among Hispanic/Latino/a immigrants who face numerous structural and socioeconomic barriers to well-being. The increased mental health burden on Hispanic/Latino/a immigrants may have far reaching effects if left unaddressed. Thus, by understanding further Hispanic/Latino/a immigrant mental health during the pandemic, communities and health providers may be able to better address this growing issue. This scoping review aims to assess and outline the current literature on the pandemic’s effects on Hispanic/Latino/a immigrant mental health in the USA, identify research gaps and areas of urgent concern, and inform future research and public health interventions and guidelines.

Methods and analysis A scoping review following the Joanna Briggs Institute methodology will be conducted. The PsycINFO, PubMed, Scopus and Web of Science: Core Collection databases and five grey literature sources will be searched for articles published in English from 1 January 2020 to 31 December 2022. Two independent reviewers will screen the search results at title and abstract and then full text using Covidence with conflicts resolved by a third reviewer. Data collection will also be performed in duplicate using Microsoft Excel with discrepancies resolved by a third reviewer and consensus discussion.

Ethics and dissemination Ethics approval is not required for this scoping review. Results will be published in a peer-reviewed journal as well as presented at local and national conferences and meetings relevant to our field. Furthermore, to make our findings accessible to non-scientific audiences, we will use various mediums, such as graphical abstracts, policy briefs and fact sheets to share the results in both English and Spanish on different platforms.

  • COVID-19
  • mental health
  • epidemiologic studies
  • health equity
  • public health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Strengths and limitations of this study

  • We use established and standardised scoping review methodology.

  • The planned review will investigate and identify the current knowledge on the mental health status of adult Hispanic/Latina/a immigrant in the USA during the pandemic and across intersectional identities, and we will also examine issues with access to mental health services.

  • We analyse mental health outcomes of Hispanic/Latina/a immigrants reported in the literature in the context of the current COVID-19 pandemic and preparation for future pandemics.

  • Literature regarding the effects of the COVID-19 pandemic on mental health is regularly published; it is therefore likely that relevant studies will be published after the search date of our review.

  • We exclude Spanish language literature in this review.

Introduction

Since the beginning of the COVID-19 pandemic, reports of psychological distress, anxiety, depression and other mental health issues have significantly increased.1–3 Among US adults, the prevalence of anxiety and depressive symptoms are three and four times, respectively, higher compared with pre-pandemic levels.4–6 These trends may be due to disease anxiety, COVID-19-related stressors (eg, lower socioeconomic status (SES), job loss) and isolating, although necessary, COVID-19 containment measures such as stay-at-home orders and social distancing.5–7 The pandemic has also widened mental health and social disparities, with individuals of lower SES, marginalised communities and racial/ethnic minoritised groups—especially non-Hispanic Black and Hispanic/Latino/a individuals—bearing a disproportionate burden of poorer COVID-19-related mental health outcomes.3 4

For the purposes of this scoping review, we define Hispanic/Latino/a immigrants as individuals born outside the USA who are of Cuban, Mexican, Puerto Rican, South American, Central American, and/or other Spanish or Spanish-speaking culture or origin, regardless of race, and/or those of Latin-American descent.8 9 Though we recognize the term Latinx is often used to be more gender inclusive, expansive and neutral, only 2%–4% of Hispanics/Latinos report using the term.10–12 As such, throughout this scoping review, we will use the terms Hispanic/Latino/a and Latinx interchangeably to refer all Spanish-speaking cultures or origins, regardless of race or gender.13

Given Hispanic/Latino/a immigrants are more likely to experience risk factors for mental health symptoms and be affected by COVID-19-related stressors,7 such as job and employment difficulties and poverty, the psychological impact of COVID-19 may be worse among this population. Indeed, over 60% of Hispanic/Latino adults in September 2020 reported having suicidal ideation, anxiety/depression, increased substance use, and/or COVID-19 related stressor-related or trauma-related disorder symptoms during the pandemic.14 Moreover, an observational study of Hispanic/Latino immigrant outpatients in New York City found 60% met criteria for serious mental illness.7 Hispanic/Latino immigrants are also more likely to work as frontline/essential workers, live in overcrowded households, and experience higher rates of food, job, and economic insecurity during the pandemic—all of which increase the risk of mental health symptoms.7 15–17 In addition, Hispanic/Latino adults have reported higher unmet needs for mental health services during the pandemic compared with other racial/ethnic groups and transitions to telehealth and service disruptions have been reported as significant barriers to care.18 19

Despite the need for synthesising what is currently known on the COVID-19 pandemic’s effects on the mental health of Hispanic/Latino/a immigrants in the USA, a scoping review of this burgeoning issue has yet to be done. We aim to identify the current scope of literature on Hispanic/Latino/a mental health (ie, depression, anxiety and psychological distress) and mental health service (ie, community mental health services, hospital inpatient and outpatient services, social work, emergency psychiatric services and counselling services) access during the COVID-19 pandemic in the USA. Our primary research question is: What is known about the mental health status (depression, anxiety, psychological distress) of the adult Hispanic/Latino/a community in the USA during the COVID-19 pandemic? Secondary research questions are: (1) specifically, what were the risks of developing mental health symptoms, issues with access to mental health service (ie, community mental health services, social work services, emergency psychiatric services and counselling services) and mental health outcomes reported in the literature for this population; and (2) in the USA, what is the mental health status of Hispanic/Latino/a immigrant adults across intersectional identities during the COVID-19 pandemic (eg, generational status, heritage group, sexual orientation and gender identity)?

Methods and analysis

Study design

We will follow the Joanna Briggs Institute’s methodology for conducting our scoping review20 and it will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.21 The protocol is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol extension.22

Eligibility criteria

Population

Hispanic/Latino/a immigrants living in the USA and Puerto Rico are the population of interest for this scoping review. We define immigrants as individuals who were not US citizens at birth. If it is unclear during the title/abstract screening stage if a study pertains to Hispanic/Latino/a immigrants but fulfils all other criteria, it will be included at title/abstract screening and confirmed at full text. For studies that include mixed population groups, they will be included at title/abstract screening and confirmed at full text if data is reported separately by racial/ethnic group. Similarly, regional and nationally representative studies of Hispanic/Latino/a immigrants will also be included. Studies that do not include Hispanic/Latino/a immigrants in their sample or that pertain to Hispanic/Latinos/as outside the USA will be excluded.

Outcomes

Mental health, particularly depression, anxiety and psychological distress, during the pandemic is the primary focus of this review. Classification and definition of mental health, depression, anxiety and psychological distress can be based on any standard diagnostic assessments or recognised instruments (eg, Kessler Psychological Distress Scale, Patient Health Questionnaire, Generalised Anxiety Disorder and the Hamilton Depression Rating Scale).23–27 Measures of mental health will include both symptoms and diagnosable disorders, as well as overall mental health, to be inclusive of the limited literature on Hispanic/Latino/a immigrant mental health during the pandemic. If mental health is not the primary focus or outcome of the study, the paper will be excluded.

Study designs

We will include all types of study designs such as observational, cross-sectional, interventional and longitudinal.

Article characteristics

Primary research, grey literature and all types of review articles published from 1 January 2020 to 31 December 2022, in English, will be included in this review. Studies that are not about the COVID-19 pandemic, not in English, or studies published before 1 January 2020, will not be included. If only the article title is available (ie, no abstract), the title must contain Hispanic/Latino/a and COVID-19 to be included at title/abstract screening.

Search strategy

The following databases will be searched by a biomedical librarian (AL, DT): PsycINFO (American Psychological Association), PubMed (US National Library of Medicine), Scopus (Elsevier) and Web of Science: Core Collection (Clarivate Analytics). A combination of keywords and controlled vocabulary terms (eg, MeSH and Thesaurus of Psychological Index Terms) for each concept of interest (ie, population of interest, specific mental health conditions, COVID-19) will be used to search. The search strategies will be peer-reviewed by the second librarian and other team members for feedback prior to running the final searches. The search strategies are included in online supplemental file 1. The searches will be limited studies in English published 1 January 2020 to 31 December 2022, as the COVID-19 pandemic was declared in March 2020.

The results of the literature searches will be exported to EndNote 20 (Clarivate Analytics) and duplicates identified and removed by the librarians. The unique records will be exported into Covidence (Veritas Health Innovation) for screening.

The reference lists of articles included after full text screening and relevant reviews will be reviewed by two reviewers to identify other potentially relevant articles. Any articles identified through this process will proceed through the screening process.

The websites of the following organisations will be searched by two reviewers to identify relevant grey literature (ie, reports, white papers) for this scoping review: US Centers for Disease Control and Prevention (https://www.cdc.gov), US National Institutes of Health (https://www.nih.gov), Commonwealth Fund (https://www.commonwealthfund.org), Kaiser Family Foundation (https://www.kff.org), Brookings Institution (https://www.brookings.edu), Academy Health (https://www.academyhealth.org) and Robert Wood Johnson Foundation (https://www.rwjf.org). These sources were selected based on discussions with experts in the public health, health disparities and immigrant health research fields. If the organisational websites have a research or publications section, those pages will be browsed for any items on COVID-19, mental health, and Hispanic/Latino/a/x or minority or immigrant populations in the USA. We will also employ a simpler set of search terms to search each of the websites. The search strategies used will include: COVID-19 pandemic Hispanic (or) Latino mental health; COVID-19 pandemic Hispanic (or) Latino/a/x immigrant depression, COVID-19 pandemic Hispanic (or) Latino/a/x immigrant depression, COVID-19 pandemic Hispanic (or) Latino/a/x immigrant mental health and COVID-19 pandemic immigrant mental health. Searches will be performed using the search function on each website and results will be manually browsed. Each reviewer will use Microsoft Excel to record the grey literature source searched, date of search, search terms used, number of records selected and the URL of each selected record.

Additionally, two preprint servers, bioRxiv and medRxiv, will be searched by the biomedical librarians using the same search strategies used for searching the organisational websites listed earlier. All results from the preprint searches will be exported to EndNote, duplicates removed and unique records uploaded to Covidence for screening.

Any items identified from the grey literature sources will proceed through the full text screening process using the same eligibility criteria.

Selection of sources of evidence

Covidence will be used for the pilot and study selection (ie, screening) process. A two-level screening process will be conducted for the scoping review. First, the titles and abstracts will be screened, and second the full text of those records included after the title and abstract screening. Two reviewers will independently screen each record in duplicate using the established eligibility criteria at both levels. At both levels, disagreements between reviewers will be resolved by a third reviewer. Before beginning screening, a pilot of the screening process will be conducted on a random sample of 20 records at title/abstract level and 10 records at full text level with all reviewers, and the eligibility criteria adjusted, if necessary.

Data charting process and data items

A data collection form using Microsoft Excel will be developed and pilot tested among two reviewers using at least two articles prior to starting this step, and any revisions to the protocol, data charting process and data items will be made. Two reviewers will independently collect data in duplicate from the included records. The collected data will be reviewed, and any discrepancies will be reconciled by the third reviewer. Any further conflicts around the collected data will also be discussed as a team with the intention of reaching a consensus.

The data items we will collect from each included article are the following: publication type (journal article or grey literature); first author last name; title of article or report; date of publication; location of the study/study setting/geographic scope (ie, city and/or state the study was conducted); study aims; study participant characteristics and descriptive statistics (eg, age, gender identity, sexual orientation, sex, occupation, income, education, country immigrated from/heritage group, immigrant generational status (number of participants for each category will also be recorded)); documented and/or undocumented immigrants; intervention used if applicable; study type (ie, primary research, review); study design (eg, interventional, cross-sectional, longitudinal) and methods (eg, interviews, surveys); key concepts; survey/questionnaire information (number of questions, whether survey was verbal or written, how survey was administered and information was collected) study results and conclusions; information on depression, anxiety, psychological distress, mental health (self-reported and diagnosed, psychological assessments used will also be recorded).

For any missing or unclear data in the article, two reviewers will contact the corresponding author. If missing or unclear data is not reconciled or if no response is received within 30 days of contacting the corresponding author, the data will be marked as missing.

Synthesis of results

The results of the review will be presented as both a flowchart of the study selection process and a narrative synthesis and mapping of results. A table of eligible studies and the data collected on each will be created. The table will list the study type, study population, aims, outcome measures, study outcomes. However, it should be noted that the exact reporting format will be determined after the data charting process and discussion among the study team. Additionally, if applicable, we will use a thematic analysis to identify and highlight patterns and common themes across the studies. Study quality assessment and meta-analysis of quantitative results will not be performed as they are outside the scope and objectives of the study. All eligible studies will be synthesised.

Patient and public involvement

None.

Ethics and dissemination

The study will not involve patients or research subjects, thus institutional review board or ethics approval is not required. The results of the scoping review will be disseminated through a peer-reviewed publication and presentation at local and national conferences/meetings. Additionally, we intend to make our findings accessible to non-scientific audiences through various mediums, such as a graphical abstract, policy brief, and fact sheet which will be shared across multiple platforms in English and Spanish.28 29

Discussion

We present a protocol for a scoping review of peer-reviewed and grey literature on the COVID-19 pandemic’s effects on the mental health of Hispanic/Latino/a immigrants in the USA. To the best of our knowledge, this scoping review will be the first of its kind and will thus advance the knowledge on how Hispanic/Latino/a immigrants are uniquely impacted by the pandemic’s effects on mental health and mental health service access. There is limited research on the impact of COVID-19 on the mental health of Hispanic/Latino/a immigrants in the USA. As a result, this scoping review aims to contribute valuable evidence on this topic while identifying existing research gaps. Additionally, it seeks to enhance our understanding of unmet mental health needs withing this population during the pandemic. Importantly, this review will address the growing mental health crisis by providing a foundation for interventions and assisting in the development of guidelines and more tailored recommendations to meet the mental healthcare needs of Hispanic/Latino/a immigrants in the US.

There are some limitations of our study that should be considered. First, we will include only English language published articles because our study focuses on research conducted in the USA with Hispanic/Latino/a immigrants and the majority of research published in or about the USA is in English. Second, it is important to note that literature regarding COVID-19’s effects on mental health is regularly published, and also the field’s understanding is continually evolving, and it is highly likely that relevant studies will be published after conclusion of our review. Finally, it is essential to acknowledge that many other factors may influence the mental health of Hispanic/Latino/a immigrants during the pandemic. Notwithstanding these limitations, previous authors have emphasised the importance of understanding and addressing the mental health of Hispanic/Latino immigrant during the pandemic.13 The main strengths of this review will be identifying the current knowledge on the mental health status of the adult Hispanic/Latina/a immigrant community in the USA during the pandemic, examining differences by intersectional identities, assessing the risks associated with developing mental health symptoms, examining issues with access to mental health service and analysing mental health outcomes reported in the literature for this population in the context of the current pandemic and preparation for future public health crises. Similarly, synthesising what is presently known and identifying the gaps in the literature are essential and vital first steps in understanding and addressing potential care needs within this population.

Ethics statements

Patient consent for publication

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Contributors CO and FW conceived the study. CO, JC, AL, DT and FW contributed to the protocol and plan. AL and DT developed and performed the literature search. All authors contributed to the drafting and revision of the manuscript, in addition to protocol development.

  • Funding CO, JC and FW are supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities (ZIA MD000015). AL and DT are supported by the NIH Library within the Office of Research Services at the NIH.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.