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Abstract
Objective. Many Haitian migrants live and work as undocumented laborers in the Dominican Republic. This study examines the legacy of anti-Haitian discrimination in the Dominican Republic and association of discrimination with mental health among Haitian migrants.
Design. This study used mixed methods to generate hypotheses for associations between discrimination and mental health of Haitian migrants in the Dominican Republic. In-depth interviews were conducted with 21 Haitian and 18 Dominican community members and clinicians. One hundred and twenty-seven Haitian migrants participated in a pilot cross-sectional community survey. Instruments included culturally adapted Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) and a locally developed function impairment scale.
Results. Haitian migrants described humiliation (imilyasyon) as a reason for mental distress and barrier to health care. Dominicans reported that discrimination (discriminación) was not a current social problem and attributed negative social interactions to sociocultural, behavioral, and biological differences between Dominicans and Haitians. These qualitative findings were supported in the quantitative analyses. Perceived discrimination was significantly associated with depression severity and functional impairment. Perceived mistreatment by Dominicans was associated with a 6.6-point increase in BDI score (90% confidence interval [CI]: 3.29, 9.9). Knowing someone who was interrogated or deported was associated with a 3.4-point increase in BAI score (90% CI: 0.22, 6.64).
Conclusion. Both qualitative and quantitative methods suggest that perceived discrimination and the experience of humiliation contribute to Haitian migrant mental ill-health and limit access to health care. Future research should evaluate these associations and identify intervention pathways for both improved treatment access and reduction of discrimination-related health risk factors.
Objetivo: Muchos inmigrantes haitianos viven y trabajan sin documentos en la República Dominicana. Este estudio examina la discriminación haitiana en la República Dominicana, y su asociación con la salud mental de los migrantes haitianos.
Diseño: Se realizaron métodos mixtos para generar hipótesis sobre las asociaciones entre la discriminación y la salud mental de migrantes haitianos en la República Dominicana. Entrevistas de profundidad fueron conducidas con 21 haitianos y 18 dominicanos en la comunidad y en varias clínicas. Una muestra probabilística de 127 haitianos participaron en una encuesta de corte transversal, que incluyó un Inventario de Depresión de Beck (BDI) y un Inventario de Ansiedad de Beck (BAI) adaptados a la cultura haitiana y una escala de evaluación de función.
Resultados: Los haitianos describieron la humillación (imilyasyon) como una razón de la angustia mental y una barrera a la búsqueda de atención médica. Los dominicanos contestaron que la discriminación no era un problema corriente social, citando diferencias socioculturales, tanto como diferencias en comportamiento, y en lo biológico entre dominicanos y haitianos como obstáculos a la interacción positiva social. El análisis cuantitativo apoyó estos resultados cualitativos. La discriminación percibida fue asociada con la severidad de depresión y la dificultad funcional. La percepción de maltrato percibido de haitianos por dominicanos fue asociado con un aumento de 6.6 puntos en el promedio del BDI (IC 95%: 3.29, 9.9). Conocer a alguien interrogado o deportado fue asociado con un aumento de 3.4 puntos en el promedio del BAI (90% IC: 0.22, 6.64).
Conclusión: Ambos métodos cualitativos y cuantitativos sugieren que la discriminación percibida y la experiencia de humillación contribuyen significativamente a la angustia mental de los migrantes haitianos y son barreras al acceso a la asistencia médica. En el futuro, las investigaciones deberían evaluar estas asociaciones e identificar modos de intervención para mejorar el acceso a la asistencia médica y reducir el efecto de discriminación.
Acknowledgments
The authors wish to express their sincere gratitude to the research assistants who collected data for this study, namely Mere Dieuliphene, Willy Altindor, Jean Peter Osirias, and Jhefri Augustin Reyes Reinoso. We thank Dhaysi Batista Berroa, Rossemary Ausuncion Hierro Burgos, and Ivette Esperanza Hierro Burgos for their time in transcribing Spanish audio files. Bethany Battig, Jean Verneus, and Brian Gross translated Spanish and Kreyòl documents into English. We thank Brianna Sky Keefe-Oates and Dhaysi Batista Berroa for assistance in translating the abstract to Spanish. Without the support of Sr. Rafael Alvarez Castillo, Dr Ambrosio Rosario, and Dr Luis Adolfo Dominguez Garcia, this study would not have been possible. We thank the two anonymous reviewers who provided helpful feedback on earlier versions of this manuscript.
Key messages
Many Haitian migrants live in the Dominican Republic. This study suggests perceived discrimination is common in self-reported experiences of Haitian migrants. Haitians describe experiencing imilyasyon (humiliation) resulting from interactions with Dominicans.
Dominican informants deny discrimination against Haitians and attribute negative social interactions to sociocultural, behavioral, or biological differences.
Exploratory quantitative analyses suggest perceived mistreatment by Dominicans associates with increased depression, anxiety, and functional impairment among migrants. Migrating alone, being single, and experiencing interrogation or deportation also associate with depression. Knowing someone who was interrogated or deported associates with higher levels of anxiety.
Notes
1. Pseudonym.