Between 68% and 90% of all unaccompanied immigrant youth apprehended at the United States (U.S.)-Mexico border between 2019 and 2023 made the migration journey from the Northern Triangle (NT; El Salvador, Guatemala, Honduras; USCBP, 2023). In 2023 alone, approximately 94,000 out of the 140,000 (68%) unaccompanied immigrant youth who made the migration journey to the U.S.-Mexico border hailed from the NT (USCBP, 2023). Even though the proportion of first-generation Latinx immigrant youth from the NT in the U.S. has been on the rise for decades, this population remains severely underrepresented in public health research and service, due to the structurally racist systems that have rendered certain immigrant populations invisible (Ataiants et al., 2018; Berger Cardoso et al., 2019; Linton et al., 2018). Immigrant youth from the NT face significant risk for experiencing trauma and stress across the phases of migration, which can harm their mental health (Ataiants et al., 2018; Berger Cardoso et al., 2019; Linton et al., 2018). Therefore, it is of grave urgency to focus public health research on the mental health of first-generation Latinx immigrant youth from the NT to identify and prevent the risk factors driving mental health inequity in this population.

Adolescent immigrant youth from the NT are in the “transition-to-adulthood” life course stage (Elder et al., 2003; Schulenberg et al., 2004), during which they are undergoing several external (e.g., changes in social roles and contexts) and internal (e.g., biological, physical, cognitive, emotional, and identity-related) developmental transitions that situate these youth at an important and precarious point in their developmental process, which can shape their health and mental health across the life course (Braveman, 2014). Specifically, first-generation Latinx immigrant youth from the NT face Intracategorical (McCall, 2005) Intersectionality (Bowleg, 2012; Collins, 2019) due to being situated at a socially neglected point of intersection (i.e., at the intersection of first-generation immigrant, Latinx, youth, and NT origin positionalities and identities), in which experiences can cross the boundaries of unitary minority (e.g., Latinx youth) or majority (e.g., white youth) identity groups. For instance, immigrant youth from the NT are undergoing unique developmental transitions due to being positioned at these intersections, such as migrating to and settling in the U.S., and developing their new identities as Latinx immigrants during a vulnerable developmental period. In addition to these unique developmental transitions, immigrant youth from the NT can face intersectional experiences of minoritized and compounded stress and trauma, which can impede their mental health.

Specifically, the Minority Stress Theory (Brooks, 1981; Meyer, 2003) posits that there are minority identity/status-related traumas that can have a substantial impact on the mental health of minoritized communities, such as immigrant youth from the NT. For instance, studies have documented the negative effects of forced immigration-related family separation on mental health among immigrant youth (Lovato et al., 2018; Roche et al., 2020; Salerno et al., 2024). Further, immigrant youth from the NT are also subject to more general forms of trauma during the life course (Brooks, 1981; Meyer, 2003), such as adverse childhood experiences (ACEs; e.g., violence, abuse, neglect, and household instability), which have been found to negatively impact mental health among Latinx immigrant youth (Grest et al., 2021; LaBrenz et al., 2020; Salerno et al., 2024). However, it is important to investigate how minority identity/status-related traumas, such as forced immigration-related family separation, can intersect with general childhood traumas, such as ACEs, and the nuanced and compounded effect that this could have on mental health among immigrant youth from the NT (i.e., intracategorical intersectionality-related vulnerability). Such investigation is gravely needed to inform public health policy and mental health services and prevention seeking to promote wellbeing among immigrant youth communities.

To address this gap, the current study seeks to understand whether experiencing forced immigration-related family separation moderates the association between ACEs and mental health (i.e., depression, anxiety, and PTSD symptoms) among immigrant youth from the NT. We hypothesize that experiencing forced immigration-related family separation will attenuate the detrimental effect of ACEs on all mental health outcomes. The rationale for our hypothesis is that forced immigration-related family separation alone will have a substantial association with mental health, such that the additional association of ACEs will be weakened due to the presence of a mental health saturation effect. Gained insight on the unique and compounded mental health impact of forced immigration-related family separation and ACEs can influence public mental health and policy, as well as mental health programming and practice seeking to address mental health and wellbeing among immigrant youth from the NT.

A correlation matrix of key study variables can be found in Table 2. Bivariate associations with mental health are reported in-text below, and multivariable associations with mental health are reported in Table 3 and in-text below. Fig. 1 provides a visual of the moderation effect of forced immigration-related family separation on the association between ACEs and mental health outcomes.

In bivariate analysis, forced immigration-related family separation was significantly and positively associated with depression (F = 7.18, p = .008), anxiety (F = 5.55, p = .020), and PTSD (F = 8.77, p = .004) symptoms. ACEs were significantly and positively associated with depression (B = 1.41, CI = [0.94, 1.88], p < .001), anxiety (B = 1.10, CI = [0.69, 1.52], p < .001), and PTSD (B = 2.32, CI = [1.51, 3.12], p < .001) symptoms. Sex assigned at birth was significantly associated with anxiety symptoms (girls suffered more; F = 6.95, p = .009), and time living in the U.S. was significantly associated with anxiety (F = 8.37, p = .004) and depression (F = 4.65, p = .033) symptoms, with those who lived in the U.S. for longer having suffered more.

In multivariable main effects analysis, forced immigration-related family separation was significantly and positively associated with depression (B = 2.11, CI = [0.11, 4.11], p = .039) and PTSD (B = 4.01, CI = [0.63, 7.40], p = .021) symptoms, but not anxiety (B = 1.62, CI = [−0.16, 3.40], p = .074) symptoms. Adverse childhood experiences were significantly and positively associated with depression (B = 1.34, CI = [0.86, 1.81], p < .001), anxiety (B = 1.05, CI = [0.63, 1.47], p < .001), and PTSD (B = 2.17, CI = [1.37, 2.97], p < .001) symptoms.

In multivariable interaction effects analysis, forced immigration-related family separation moderated the association between 1) ACEs and depression (B = −1.21, CI = [−2.18, −0.25], p = .014), 2) ACEs and anxiety (B = −1.00, CI = [−1.86, −0.13], p = .024), and 3) ACEs and PTSD (B = −2.23, CI = [−3.84, −0.62], p = .007) symptoms, such that experiencing forced immigration-related family separation attenuated the harmful effect of ACEs on all mental health outcomes. See Fig. 1 for a visual representation.

Study findings are consistent with existing research, which has documented the detrimental associations of both ACEs (Grest et al., 2021; LaBrenz et al., 2020) and forced immigration-related family separation (Lovato et al., 2018; Roche et al., 2020) on the mental health of Latinx immigrant youth communities. Additionally, our findings add existing knowledge by demonstrating that the harmful mental health associations of ACEs may be attenuated when youth have experienced forced immigration-related family separation. This may suggest a saturation effect, in which NT immigrant youth who have experienced only forced immigration-related family separation (i.e., no ACEs) may already bear such a substantial mental health burden that the additional association of ACEs is diminished, weakening the otherwise expected magnitude of their harmful association. These findings underscore the salient role of forced immigration-related family separation in shaping mental health outcomes, such that its impact when coupled with up to three ACEs—surpasses that of comparable ACE exposure in the absence of forced immigration-related family separation.

If replicated, findings could suggest for a review of inclusivity among ACE measures, particularly around immigration-related trauma. The original ACE study was conducted with a majority white, middle class, and highly educated sample, which impeded the identification of minority-relevant ACEs and development of effective ACE prevention programs for minority groups (Zhen-Duan et al., 2023). In the current study, findings suggest that forced immigration-related family separation may represent such a severe form of adversity that it dominates mental health burden, thereby diminishing the observable additive effects of ACEs—consistent with a possible saturation effect. Experts have suggested that compared to general trauma (i.e., ACEs), immigration-related trauma, such as forced family separation, may function as a form of toxic stress that increases vulnerability to mental health burden (Galvan et al., 2024), which may help to explain this study finding. These findings support the need for expanded and culturally relevant ACE assessment tools, which are able to capture the otherwise missed experiences of immigration-related traumas that can substantially harm mental health, specifically among Latinx immigrant youth communities. Indeed, experts have previously identified that immigration-specific trauma is missed by existing trauma assessments (e.g., ACE tools), and has a substantial bearing on mental health among Latinx immigrant youth (de Arellano et al., 2018). Further, experts have found that Latinx immigrant youth are more likely to report immigration-related ACEs compared to traditional ACEs (Conway & Lewin, 2022), and have called for revision of traditional ACE assessments to be inclusive of immigration-related trauma (Barajas-Gonzalez et al., 2021; Conway & Lewin, 2022). Study findings provide a foundation for further research seeking to examine immigration-related ACEs and their impacts on mental health among immigrant youth communities.

Another intriguing and concerning finding was that the main and interaction associations of forced immigration-related family separation and ACEs similarly influenced all three mental health outcomes (i.e., depression, anxiety, and PTSD symptoms). This finding emphasizes the broad mental health influence of forced immigration-related family separation and ACEs, and gives rise to a potential co-occurrence or sequelae of mental health conditions as a function of forced immigration-related family separation and ACEs. Findings call for future research to investigate the temporality of general and immigration-related traumas and mental health conditions through longitudinal studies, and points to the potential need for tailored trauma and mental health interventions seeking to address multiple mental health outcomes among immigrant youth communities.

This study used a cross-sectional study design and non-probability sampling strategy, which prevented our ability to establish temporality and causality, and generalize findings to broader populations of NT immigrant youth. Additionally, sample size limitations may have affected statistical power and our ability to detect a significant main effect of forced immigration-related family separation on anxiety symptoms. Larger probability samples and longitudinal studies are needed to address these limitations and replicate study findings. As in most psychosocial survey research, retrospective self-report data collection increased risk for recall and social desirability biases. Further, youth were recruited from a mental health program; although associations may have been dampened due to partial receipt of this program, statistically significant associations were still detected. Lastly, future research is needed to 1) assess the influence of psychosocial protective and resilience factors on the association between immigration-related/traditional ACEs and mental health, 2) investigate the relationship between immigration-related/traditional ACEs and co-occurring vs. sequential mental health conditions, 3) examine immigration-related ACEs as a form of toxic stress (Galvan et al., 2024), whereby immigration-related adversity occurring during sensitive developmental periods may dysregulate physiological stress-response systems and heighten vulnerability to mental health burden, and 4) identify the most salient immigration-related ACEs for Latinx immigrant youth communities to inform mental health prevention research, programming, practice, and policy.

First, it is imperative for public and mental health services researchers and practitioners to integrate Life Course, Intersectionality, and Minority Stress framing into their investigation and care of immigrant youth communities. For example, mental health services practitioners and researchers should ensure to screen for youths’ multiple marginalized social identities and positionalities (i.e., intersectionality) in addition to more general sociodemographic characteristics (Huang et al., 2020), 2) probe on potential culturally relevant social-developmental transitions (i.e., life course perspective and intersectionality) in addition to considering more general developmental transitions (Augustyn & Jackson, 2017; Braveman, 2014; Schulenberg et al., 2004), and 3) consider potential minority identity/status-related trauma experiences (i.e., minority stress theory) in addition to more general forms of stress and trauma (Brooks, 1981; Meyer, 2003). Utilizing such an approach would allow for a more comprehensive assessment of the experiences of marginalized immigrant youth, which could facilitate a more effective culturally tailored treatment process. Similarly, researchers can utilize this integrated framework in their mental health services and prevention investigations with immigrant youth to increase explanatory power that promotes mental health equity.

Lastly, the majority of unaccompanied immigrant youth, all of whom have experienced immigration-related family separation, do not receive post-release mental health services and follow-up (Berger Cardoso et al., 2019) and do not qualify for federal/state coverage of health and mental health care services (Linton et al., 2018). Thus, based on the current study and previous research documenting severe mental health detriments associated with immigration-related family separation (Lovato et al., 2018; Roche et al., 2020), there is an urgent need for public mental health, immigration, and child welfare policy reform to prevent immigration-related family separation at all costs, and to expand access to federal/state health insurance coverage and post-release mental health services and follow-up for all unaccompanied immigrant youth released from U.S. governmental custody.