By Nida Anjum, MD
Child and Adolescent Psychiatry Fellow
VCU Health System
Over the last few years, we are seeing a notable rise in anxiety, depression and trauma-related symptoms among immigrant children and adolescents. According to the National Survey of Children’s Health (2023), more than 5.3 million adolescents ages 12-17 years are currently diagnosed with mental or behavioral health conditions, with anxiety (16.1%) being the most prevalent condition followed by depression (8.4%). For immigrant youth, their presentations are rarely circumscribed to individual psychopathology alone. Rather, they reflect the cumulative burden of immigration-based sociopolitical stressors, intergenerational fear, parental separation, and the ongoing demands of cultural assimilation. During a critical period of identity formation, there is an added challenge negotiating parallel identities. Additionally, they must also maintain cultural and familial expectations, while adapting to the norms of school, managing peer dynamics, language barriers, and academic strain. Cultural competence serves as a critical lens through which these intersecting influences can be more accurately understood and addressed.
Recently, I cared for an immigrant teenage girl on an inpatient unit whose grief was compounded by unimaginable trauma following the death of her father in an act of a religiously targeted violence. Her clinical needs extended beyond stabilization of symptoms. Therapeutic engagement required not only individual rapport building but intentional creation of a milieu that supported safe participation and reengagement into normative developmental experiences. Family engagement presented additional challenges, influenced by cultural and religious hesitancy, as well as family’s first exposure to the mental health system. Additionally, language discordance complicated care as interpreter services did not adequately match mother’s dialect. While this posed initial inconveniences and some delays in establishing therapeutic alliance, these challenges underscore a critical truth: these details matter deeply.
Experiences such as these illuminate the importance of cultural competence. Cultural competence is a patient centered clinical stance that is attuned to diverse sociocultural needs that shape patient clinical encounters and interventions. The American Academy of child and Adolescents Psychiatry (AACAP) practice parameters for cultural competence are part of an ongoing commitment to recognizing with acculturative variables. Symptom expression, patterns of engagement, idioms, and assessment tools do not seamlessly translate across cultures and languages. Clinical pictures are often marred with guardedness and mistrust resulting in limited engagement, which may be misinterpreted as psychiatric symptoms.
Using cultural competencies, clinicians can move beyond standardized approaches to better understand and effectively advocate for patients and their mental health care. These competencies help build practices where protective factors – cultural pride, strong family relationships, and community–based support – are recognized and integrated into patient care. In doing so, we offer the message: patients matter, patients belong, and healing is possible.
