摘要：Objectives. We examined migration to the United States as a risk factor for suicidal behavior among people of Mexican origin. Methods. We pooled data from 2 nationally representative surveys in the United States (2001–2003; n = 1284) and Mexico (2001–2002; n = 5782). We used discrete time survival models to account for time-varying and time-invariant characteristics, including psychiatric disorders. Results. Risk for suicidal ideation was higher among Mexicans with a family member in the United States (odds ratio [OR] = 1.50; 95% confidence interval [CI] = 1.06, 2.11), Mexican-born immigrants who arrived in the United States at 12 years or younger (OR = 1.84; 95% CI = 1.09, 3.09), and US-born Mexican Americans (OR = 1.56; 95% CI = 1.03, 2.38) than among Mexicans with neither a history of migration to the United States nor a family member currently living there. Risk for suicide attempts was also higher among Mexicans with a family member in the United States (OR = 1.68; 95% CI = 1.13, 2.52) and US-born Mexican Americans (OR = 1.97; 95% CI = 1.06, 3.65). Selection bias caused by differential migration or differential return migration of persons at higher risk of suicidal ideation or attempt did not account for these findings. Conclusions. Public health efforts should focus on the impact of Mexico–US migration on family members of migrants and on US-born Mexican Americans. Transnational migration shapes the lives of people of Mexican origin on both sides of the Mexico–US border. The 11 million Mexican-born individuals in the United States comprise approximately 10% of the total Mexican population and approximately one third of the total foreign-born population in the United States. 1 The economic and social influence of this migrant population is multiplied through the impacts that their absence, 2 return migration, 3 and remittances 4 , 5 have on communities in Mexico and through their participation in American society and the growth of the US-born Mexican American population. 6 To study the mental health consequences of migration in this population, data from both sides of the border are needed but have rarely been available. Suicide-related outcomes, which include suicidal ideation, having a specific plan to commit suicide, and making a suicide attempt, are particular concerns for the immigrant population for several reasons. First, evidence from studies conducted in the United States suggests that US-born Mexican Americans have a much higher risk for psychiatric disorders than do Mexican-born immigrants. 7 , 8 Because psychiatric disorders are risk factors for suicidality, 9 we expect a similar increase in suicidality to be associated with US birth among Mexican Americans in the United States. Second, there is evidence that return migrants and family members of migrants are more likely than are others in the Mexican population to use alcohol and illicit drugs and to have a substance abuse or dependence disorder. 10 Because substance use and substance use disorders are risk factors for suicidality, 11 migration may be associated with higher risk for suicidality in the general Mexican population. Third, social stressors related to migration, both for migrants themselves and for the families they leave behind, may also increase the risk for suicidality. Migrants in the United States experience a range of stressors associated with acculturation, including social isolation and discrimination. 12 – 14 In 1 study of women in Mexico whose husbands were working in the United States, the women reported significant stressors associated with the loss of support, with adjustment to new obligations, and with the potential for family disintegration. 15 A study in Albania found that the absence of a family member through labor migration was associated with higher rates of acute coronary syndrome. 16 Despite the economic benefits of migration, these associated social stressors may lead to increased risk for suicidality among migrants and their families. Research from the United States suggests that among Mexican Americans, those born in the United States are at higher risk for suicide-related outcomes and completed suicide than are those born in Mexico. 17 – 21 In addition, the younger the age at immigration—which is an indicator of socialization in the United States—the higher the risk of mental disorders 22 and of suicide-related outcomes. 18 To date, however, no study has been able to simultaneously address the broader pattern of the association between migration and suicidality among family members who remain in Mexico, migrants who return to Mexico, migrants who remain in the United States, and US-born Mexican Americans. In addition, studies that focus exclusively on the United States have not been able to assess the contribution of selective migration and return migration on risk of suicide. This is a significant gap in the literature because the effect of migration on suicidality cannot be examined without data from both the sending and receiving country. In our study, we combine data from 2 national surveys, 1 from Mexico and 1 from the United States, that used the same fully structured interview. Retrospective reports by respondents in these surveys allowed us to identify the timing of immigration to the United States, psychiatric disorders, and suicidality across the entire Mexican-origin population in both countries and to address 2 possible sources of bias that may have affected prior estimates of the relationship between immigration and suicide-related outcomes.
