Introduction

The COVID-19 pandemic has severely impacted Latinx mothers, and the social work profession must actively promote mothers’ human rights and self-determination during COVID recovery. For example, it is well documented that Latinx families have been disproportionately burdened by COVID-19 infection, hospitalization, and mortality (Centers for Disease Control & Prevention, 2021). This disparity is due to a confluence of social determinants of health encountered by Latinx communities, including language barriers, anti-immigrant sentiment, financial hardship, frontline employment, and an increased likelihood of living in a multi-family home (Hayes-Bautista et al., 2021). The pandemic has also had a disproportionate economic impact on Latinx individuals compared to non-Latinx whites (Saenz & Sparks, 2020); 29% of Latinx individuals have reported job losses and 33% drops in income (Vargas & Sanchez, 2020). In particular, Latinx mothers have taken on extra responsibilities during the pandemic, and many have left the job market (Almeida et al., 2020; Kantamneni, 2020).

Unsurprisingly, the mental health sequelae of the pandemic have also had a disproportionate impact on Latinx families, particularly mothers. In the months following the March 2020 shutdowns, estimates of depression and anxiety among Latinx adults were significantly greater than their non-Latinx white counterparts (Czeisler et al., 2020) and Latinx parents appear to be at even greater risk. Not only do Latinx parents report the highest numbers of COVID-19-related stressors (Brown et al., 2020), but in nationally representative survey data, Latinx ethnicity and living in a household with children were robustly associated with more likely symptoms of depression and anxiety (Fitzpatrick et al., 2020). Among Latinx mothers, making economic cutbacks (Hibel et al., 2021), food insecurity (Clawson et al., 2021), and reduced social support (Falicov et al., 2020) have been linked to higher rates of depression and anxiety during the pandemic. Furthermore, mothers have taken on more caretaking responsibilities in the transition to remote learning (Almeida et al., 2020) and many marginalized women have had to navigate role changes after disproportionate job losses (Kantamneni, 2020). Distress within families is transactional, and increases in maternal mental health problems in the context of the pandemic (Cameron et al., 2020) can influence child outcomes. A recent study finds that Latinx parents are more concerned about resource losses due to COVID-19 and rate their children as having worse psychosocial functioning than the parents of non-Latinx white youth (Clawson et al., 2021). Taken together, these data substantiate that the COVID-19 pandemic has resulted in a climate of psychological risk for Latinx mothers and their families.

Intersectionality theory (Crenshaw, 1991) provides a useful theoretical framework for understanding how new and existing health disparities can affect low-income, Latinx mothers. Intersectionality theory posits that as multiple identities intersect, they also bring in underlying systems of oppression and inequality that interact and can compound marginalization (Torres et al., 2018). For example, wage and educational gaps disadvantaged Latinx individuals before the pandemic (Semega et al., 2020), and this lower socioeconomic status profile was already associated with greater anxiety and depressive symptoms (Chen & Miller, 2013). Conceptual models of internalizing symptoms highlight additional risk factors relevant to the mental health of women with intersecting identities. For example, interpersonal violence exposure, discrimination, acculturative stress, and documentation status all contribute to elevated depression symptomology among Latinx mothers (Lara-Cinisomo et al., 2016). Thus, a myriad of sociocultural stressors affect maternal and family mental health, and are important to monitor in the context of changing sociopolitical climates that have worsened ethnic disparities in the USA and will have cascading effects on familial and child outcomes (Prime et al., 2020).

One particularly important factor to consider is immigration status. International human rights declarations assert that all persons have the right to food, clothing, housing, health, etc. regardless of their immigration status (Taran, 2001; United Nations, 1948), but US policies and practices continue to violate the human rights of immigrants. Before the pandemic, Latinx immigrants already faced barriers to accessing public social services in the USA. For example, undocumented individuals or those who had precarious immigration status may have been unaware of their eligibility for public benefits (Alvira-Hammond & Gennetian, 2015) or feared that utilizing benefits would result in immigration consequences due to policies like the “Public Charge” rule (Bernstein et al., 2020). The pandemic exacerbated these existing disparities, with US stimulus programs penalizing immigrant families (Cross & Gonzalez Benson, 2021). For example, safety net programs like the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act were not made available to undocumented immigrants and US citizens or legal immigrants who lived in mixed-status families. Since the onset of the pandemic, there has also been an increase in restrictive immigration policies, like higher rates of deportation and turning away asylum seekers (Cross & Gonzalez Benson, 2021; Garcini et al., 2020), which are extensions of decades-long patterns. Furthermore, undocumented Latinx immigrant women experience a unique social location due to discrimination based on gender, race/ethnicity, country of origin, and documentation status (Cleaveland & Waslin, 2021).

Although several studies have reported on impacts of the COVID-19 pandemic on Latinx families, data are overwhelmingly quantitative and lack focus on maternal well-being. There is a benefit to focusing on the experiences of Latinx mothers who are considered high risk due to a history of mental health concerns and ongoing challenges related to their immigration status in efforts to advocate for the human rights of this group. In particular, collecting narrative data is recommended for intersectional research (Abrams et al., 2020) because it can describe individuals’ nuanced social positions in terms of socioeconomic status, race/ethnicity, gender, and immigration/documentation status as they relate to well-being. Qualitative research is also ideal for this study to ensure that investigation is comprehensive and centers on individual’s voices. Furthermore, this study aligns with calls to go beyond identifying disparities, and instead to developing actionable recommendations for policymakers and practitioners (Lopez et al., 2012) to promote the human rights of vulnerable groups.

The purpose of the current study was to explore the COVID-19 pandemic’s impact on economic well-being, maternal mental health, and family functioning for Latinx mothers with a prior history of depression and to explore differences between documented mothers and those with precarious immigration status. This paper reports on the lived experiences of Latinx mothers and provides key recommendations to policymakers and community stakeholders. Research questions included the following: (1) What stressors are low-income, Latinx immigrant mothers with a history of depression experiencing in the context of the pandemic? (2) How have pandemic-related stressors affected maternal mental health, family functioning, and child well-being for this population? And (3) How do experiences differ among documented mothers and mothers with precarious immigration status?

Methods

Study Design

This study is grounded in the transformative paradigm, which uses inquiry to promote social justice and human rights (Mertens, 2007). The transformative paradigm advocates for the use of mixed methods in which the qualitative dimension gathers the perspectives of individuals and the quantitative dimension reports outcomes that have credibility with the larger research community (Mertens, 2007). In terms of epistemology, the transformative paradigm posits that researchers should be in close collaboration with participants in the study to ensure that they are gathering accurate knowledge and asserts that knowledge is located within a complex cultural context (Mertens, 2007). Mixed methods research is well-suited for both the transformative paradigm and intersectionality theory, and in this study, qualitative template analysis, case studies, and survey data were used to illuminate participants’ experiences and illustrate how systems of oppression interact to impact mothers.

Drawing participants from the "Healthy Moms, Healthy Kids" intervention study that provided a group maternal depression treatment to predominantly Latinx Head Start mothers in south Los Angeles (Mennen et al., 2021), this study utilized a convergent mixed method design to explore the impact of the COVID-19 pandemic on Latinx mothers with a history of depression, including mothers with precarious immigration status. In convergent mixed method designs, the researcher collects and analyzes both quantitative and qualitative data in parallel to obtain information that builds on the strengths of both types of data, providing a more comprehensive picture of the phenomenon being studied (Creswell & Plano Clark, 2018). There were multiple points of convergence in this study, including collecting quantitative and qualitative data on the same topics and then integrating findings from both sets of data in the analysis phase. Furthermore, data transformation procedures were used to convert qualitative data to quantitative data and then combine it with the quantitative dataset to further explore participants’ experiences by immigration status.

Participant Selection, Recruitment, and Data Collection

All participants lived in California’s Los Angeles and San Bernardino counties. Thirty mothers (88%) were located in Los Angeles County, and of those, 28 (93%) still lived in South Los Angeles, which has one of the highest rates of concentrated poverty in the county (Matsunaga & Flaming, 2008). This study was approved by the University of Southern California Institutional Review Board and informed consent was obtained from all participants. Data were collected remotely due to the pandemic between September and December of 2020. Mothers were recruited from both the intervention and control groups of the parent study (n = 119). All participants previously reported experiencing mild to moderate depressive symptoms when enrolling in the parent study. All formerly enrolled Latinx mothers were invited to participate, but many could not be reached because phone numbers were no longer in service. Two female, bilingual Latinx data collectors conducted semi-structured interviews with 34 mothers (26 in Spanish and 8 in English). Interviews typically lasted 45 min and were recorded and then professionally transcribed and translated. Transcripts translated into English were reviewed for accuracy by the data collector who conducted the interview, and changes were made when necessary to ensure that the participant’s meaning was captured correctly. Participants also completed questionnaires in either English or Spanish using REDCap electronic data capture tools (Harris et al., 2009) hosted at the Southern California Clinical and Translational Science Institute. Questionnaires typically took 20–30 min to complete and afterwards participants were provided with a list of community resources. Mothers received a $40 incentive for their participation.

Instrumentation

Qualitative Interview Guide

A semi-structured interview guide was developed to explore COVID-related stressors and impacts of the COVID-19 pandemic on Latinx mothers’ lives. The interview guide was pilot tested with families in Los Angeles and focused on aspects of mothers’ experiences including employment stressors, essential worker status, accessing basic necessities, pandemic-related stressors, discrimination, access to safety net programs, and the impact of the pandemic on maternal emotional well-being, family relationships, support from family and friends, and positive impacts of the pandemic.

Quantitative Measures

Demographic Information

Mothers provided family information, employment status, housing status, and financial stressors. Undocumented status was not directly assessed to promote trust and minimize confidentiality concerns, but participants brought this up organically during interviews. Questions were translated into Spanish by the research team.

Access to Safety Net Programs

Mothers reported whether they had accessed a variety of safety net resources, including state unemployment insurance, federal stimulus checks, California disaster relief for undocumented immigrants, and the Angeleno Card program. The Angeleno Card provided financial assistance for households: (1) in the city of Los Angeles, (2) with total annual household incomes below the federal poverty level prior to COVID-19, and (3) that had fallen into economic hardship because at least one household member had lost a job or experienced a reduction in income of at least 50%. Families were eligible regardless of immigration status. Questions were translated into Spanish by the research team.

COVID-19 Stressors

Maternal report of the impact of the COVID-19 pandemic on the family was assessed using the 25-item exposure subscale of the COVID-19 Exposure and Family Impact Survey (CEFIS; Kazak et al., 2021). The Spanish version of the CEFIS developed by Kazak et al. (2021) was utilized for this study. One additional question was added to the CEFIS to assess whether the respondent identified as an essential worker during the pandemic.

Perceived Discrimination

Maternal self-report of perceived discrimination was assessed using the 10-item Everyday Discrimination Scale (EDS; Williams et al., 1997). The EDS demonstrates strong validity (Clark et al., 2004) and measurement equivalence across different ethnic and racial groups, including Latinx groups (Kim et al., 2014). The Spanish version of the EDS utilized in this study was developed and evaluated for accuracy by the University of Miami Center for HIV and Research in Mental Health. Statements were added to the EDS regarding experiences of discrimination by an employer, in accessing needed resources, or other forms of discrimination during the pandemic, which were translated into Spanish by the research team. The EDS demonstrated good internal consistency in this sample (α = 0.88).

Maternal Depressive Symptoms

Maternal self-report of depressive symptoms was assessed using the 20-item Center for Epidemiologic Studies Depression scale (CES-D; Radloff, 1977), a widely used self-report measure that shows strong reliability and validity, and has been used with diverse populations (Radloff, 1977). The Spanish version of the CES-D used in this study was psychometrically validated by Ruiz-Grosso et al. (2012). The CES-D demonstrated good internal consistency in this sample (α = 0.92), and mothers who scored above the clinical cut-off of ≥ 16 were considered to have probable depression.

Maternal Anxiety Symptoms

Maternal self-report of anxiety symptoms was assessed using the 7-item General Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006). The GAD-7 has shown strong criterion, construct, factorial, and procedural validity (Spitzer et al., 2006), and demonstrated good internal consistency in this sample (α = 0.92). The Spanish version of the GAD-7 utilized in this study was tested with US Hispanic and Latino populations and showed high validity (Mills et al., 2014). Mothers who scored above the clinical cut-off of ≥ 10 were considered to have a probable anxiety disorder.

Data Analysis

Qualitative Data Analysis

Interviews were analyzed using template analysis, which utilizes a coding template to develop hierarchies that show how themes relate to one another (King & Brooks, 2018). Template analysis was chosen because it is a rigorous, structured approach that provides a rich depth of description—focusing on developing four or more levels of hierarchical coding that capture nuance in participants’ experiences. The coding team was comprised of four members, including the PI (a White US-born PhD-level social work researcher who speaks Spanish), a master’s-level social worker born in Oaxaca, Mexico, who identifies as Latinx and is bilingual in Spanish, a Vietnam-born, master’s-level social worker who identifies as Asian American, and a White US-born PhD-level social work researcher. The second research team member conducted interviews with both English and Spanish-speaking mothers. All members engaged in regular discussions to ensure the study was guided by their collective cultural knowledge and expertise. Qualitative data analysis used Dedoose (Dedoose Version l8.3.43, Los Angeles, CA, USA, 2018). Analyses followed the steps outlined by King and Brooks (2018): (1) the PI became familiar with the  data and conducted preliminary coding, (2) the PI developed a draft coding template, (3) the coding team applied the draft template to 4 additional transcripts, and (4) the coding team finalized the template and each member of the coding team individually coded a portion of the remaining transcripts. As the team coded, they noted additional codes in a shared Google document, which the PI monitored. As the PI noticed similar new codes emerging, she clustered similar codes together or collapsed codes. The PI also identified integrative themes in the data, which are defined as themes that “permeate several thematic clusters” (King & Brooks, 2018, p. 11). Once coding was completed, the research team met to discuss findings and make final adjustments to the coding template. Steps were taken to ensure trustworthiness of the qualitative data analysis, including peer support/debriefing, utilizing multiple coders, and creating a clear audit trail. After coding was completed, the PI added descriptors indicating whether the participant was documented or had precarious immigration status based on the interview data and calculated code frequencies to examine differences between the two groups. In interviews, mothers were asked whether they were able to access governmental relief programs, and either shared that they were ineligible due to undocumented status or confirmed that they were documented and received federal support. When stratifying codes by descriptors, we normalized by total review count to account for unequal representation across groups. Finally, case studies (Sturman, 1997) were utilized to illustrate key themes. Case studies are utilized to explore a particular individual, group, or phenomenon in depth (Sturman, 1997), and in this study cases were defined as the individual mothers that were interviewed.

Quantitative Data Analysis

To supplement the core qualitative findings, descriptive statistical analyses of demographic and survey data were conducted in SPSS Version 27.

Integration

The “point of interface” in which the qualitative and quantitative results were combined occurred in a results narrative, as recommended by Morse and Maddox (2014).

Results from the demographic surveys, COVID stressors measures (CEFIS), perceived discrimination scale, and maternal mental health measures were used to provide complementary or divergent evidence of COVID-related stressors and impacts featured in the qualitative results. In addition, total scores on the CES-D, GAD7, and Everyday Discrimination Scale were compared across immigration status after this emerged as a salient theme.

Results

The majority (76.5%) of mothers in the sample were born outside of the USA, in Mexico (38.2%), El Salvador (26.5%), Guatemala (8.8%), or Ecuador (2.9%). Overall, 18 mothers were documented, and 16 mothers reported precarious immigration status (15 were undocumented and one was on a work visa). 23.5% of mothers were born in the USA. Mothers were 38 years of age on average and reported having 1 to 6 children, with children’s ages ranging from 8 months to 26 years old. In terms of partner status, 58.5% of mothers were married or living with a romantic partner, 17.6% were divorced or separated, and 20.6% were single or never married. This sample was of very low socioeconomic status, with 71% of mothers reporting monthly income from earnings of less than $1499 (equivalent to less than $18,000 per year).

Results Narrative

Qualitative analysis revealed several themes, including pandemic-related stressors; experiences of interpersonal and structural discrimination; negative impacts of the pandemic on mothers, families, and children; supports and buffering factors during the pandemic; and resilience through the pandemic. Integrative themes were also identified, including immigration status, exacerbation of existing disparities, and cascading effects of stressors.

Pandemic-Related Stressors

Stay-at-Home-Orders and Distance Learning

Overall, mothers described the disruptive effect of the implementation of county-wide stay-at-home orders, including the sudden shift to distance learning. In the quantitative data, all participants reported that their children’s school or daycare closed. Most mothers reported that the role of teacher fell on them at this time, and that they often had to monitor the progress of multiple children throughout the school day. Monolingual Spanish-speaking mothers reported that they faced considerable language and technological barriers, even after attempting to utilize resources given to them by the school. For example, some mothers reported being unable to communicate with school staff or effectively teach their children because they did not speak English:

At school, at least he has his instructors to help him. But I don’t speak English and so although he may want my help so that I can explain things to him, but I’m unable to help him and so it makes me sad.

Others shared technological barriers that raise concerns about educational inequality. For example, some mothers reported that the internet hotspots provided by the schools did not function adequately.

Economic Stressors

Mothers shared fears about whether they would be able to survive the pandemic, since they had exhausted any small savings they may have had and most families’ incomes had decreased. Results from the survey substantiated this point—most mothers (28/34) reported that their family income had decreased since the pandemic began.

Employment-Related Concerns

Most mothers also shared that their families had experienced job loss or had work hours reduced. One mother stated:

In my mind I was under the impression that it would be temporary, only 40 days and everything would return to normal…Instead I was out of work for 7 months.

Findings from the survey converged with the qualitative data: most mothers (27/34) reported that a family member had to cut back hours at work, many (22/34) reported that a family member was required to stop working temporarily, and just below half (16/34) reported that a family member had lost their job permanently. In the qualitative data, mothers also shared their struggles with unreliable work schedules and the challenges of juggling work and childcare.

Accessing Basic Necessities

Mothers faced difficulties affording and accessing basic necessities, including problems paying rent, losing phone and internet service, experiencing food insecurity, and accruing debt as they were given extensions on rent and other expenses that eventually needed to be paid back. One mother explained:

We’ve had financial limitations. If I used to eat five eggs, now I may have to eat two or three…We have to eat less, so the food lasts more.

Findings from the survey reiterated these concerns, with just under half of mothers (15/34) reporting that they had difficulty getting food, even though many mothers reported in the qualitative data that they were using several types of food supports. In addition, about a quarter of mothers (9/34) reported difficulty accessing healthcare or medicine, just under half (16/34) were without telephone/cell service because of financial reasons, and half of mothers (17/34) reported being unable to pay the full amount of their rent or mortgage. Although there were strict eviction moratoriums in place at the time of this study, several mothers reported that their landlords were harassing them and threatening to kick them out if they did not pay the rent that was owed. Survey findings also revealed concerns about housing instability, with just over half (18/34) of participants reporting worry about having to move in the near future.

Accessing Safety Net Programs

When trying to access safety net programs, some mothers reported that they did not qualify for any benefits due to immigration status. One mother shared:

[The pandemic] has taken away jobs from so many employees and those that have [unemployment] insurance have benefited from receiving government assistance. But some of us unfortunately cannot get any other help except from churches, which only provide assistance with food.

Findings from the survey supported this, with about a third of respondents (11/34) reporting that the family was in need but received no governmental assistance at all. Other mothers shared that they lost benefits for themselves or their children or experienced difficulties verifying their eligibility for benefits, explaining that they never heard back from agency workers or were unable to schedule in-person visits to sort the problem out. Others had difficulties navigating through misinformation to figure out what benefits were available and how to apply, particularly because information was not available in Spanish. Many mothers had difficulty distinguishing between safety net programs like the federal CARES Act, local rent/mortgage relief, and Angeleno Card and there was confusion about eligibility, with one mother reporting that she was informed she would need to pay back the CARES Act stimulus payment.

Additional Financial Stressors

Additional challenges for immigrant mothers included the pressure to financially support family members in their home country. Many mothers shared the emotional impact of this additional stressor:

I feel anxious because I’m able to eat because of the food stamps I receive, but when I eat, I think of them not being able to eat, because they don’t have support for food like food stamps in their country.

Health-Related Stressors

Mothers reported being exposed to COVID-19, or having family members who tested positive, were hospitalized, or died from the disease. The impact of on the family appeared particularly difficult for mothers whose families still lived in their country of origin. Survey data revealed that over a quarter of mothers (10/34) had at least one family member exposed to someone with COVID-19, while 5 mothers had family members with symptoms or who were diagnosed with COVID-19, 2 had family members who had been hospitalized with COVID-19, and 3 had family members who had died from COVID-19. Qualitative findings revealed additional COVID-related illnesses and deaths in the broader extended family. Mothers also shared that some family members did not seek out testing, raising the possibility that the rate of COVID infection could be even higher for families in this sample.

Mothers reported considerable health concerns because of having family members who were essential workers (i.e., employed in factories, restaurants, security services, and childcare settings). Survey data supported this finding, with half of mothers (17/34) reporting that they worked outside the home as an essential worker at some point during the pandemic, and just over a quarter (9/34) reporting that another family member was employed as an essential worker. For some mothers, fears of work exposure to COVID led them to live separately from their partners or children due to this concern. Overall, over a third of mothers (13/34) reported that their family lived separately for health, safety, or job demands during the pandemic. Mothers voiced that they struggled to access coronavirus testing and medical treatment if it was needed. One mother shared:

When my husband had his coronavirus test...he doesn’t have the best medical insurance and so he had a portion of it to pay...and that’s going to collection because he doesn’t have good insurance at work.

Experiences of Discrimination

In qualitative interviews, some mothers voiced instances of discrimination they experienced as immigrants in the USA, particularly for undocumented mothers or members of mixed status families. However, only a few mothers endorsed experiences of interpersonal discrimination in individual interviews. One mother explained:

I’ve been to places where information is provided in English and you ask them to provide [it] in Spanish, and they look at you and talk to you in a very different and rude manner, and you’re advised that this is a country where English is spoken.

However, the survey data provided a contrasting view of mothers’ experiences of perceived discrimination, with a third or more of mothers reporting that they experienced each of the 9 forms of discrimination “almost every day.” The most highly endorsed items were “people act as if they think you are dishonest,” “you are called names and insulted,” and “you are threatened or harassed,” with almost two-thirds reporting that these events occurred almost every day. Most mothers attributed their discriminatory experiences to language (e.g., speaking Spanish), followed by national origin and weight. When discussing structural discrimination, the biggest challenge reported by undocumented immigrant mothers was being ineligible for the CARES Act stimulus payment, even if their partner or children were documented:

First of all, as an undocumented, we didn’t qualify for resources, although some of my family members are legal residents and two of them citizens. Because of me, they couldn’t benefit from the small amount of money we would have received.

Mothers reported that this experience made them feel invisible and excluded by society. Mothers also shared that the anti-immigrant political climate amplified their stress and contributed to fears of discrimination when leaving the home to look for resources.

Impacts on Maternal, Family, and Child Well-Being

Mothers discussed a range of negative impacts on their own functioning, as well as family and child well-being. Regarding their own mental and physical health, mothers discussed the impacts of depression, anxiety, sleeping problems, overeating, and gaining weight, and lack of access mental health services during the pandemic. One mother shared:

There was a point where I would think to myself “Wow, what am I going to do?” I felt sad, like I couldn’t breathe. I felt negativity all around, but I would try to stop myself because here I was going backwards instead of moving forward.

Survey results supported participants’ narrative reports, with over half of mothers (19/34) scoring above the clinical cut-off for probable depression on the CES-D, and just over a quarter (9/34) scoring above 10 on the GAD-7, indicating rates of anxiety that could affect functioning.

Mothers discussed the ways that COVID-related stressors like financial hardship led to isolation and stress. Often mothers reported that they were unable to take their kids to do activities or had to cut back on phone/internet service, all of which led to fewer opportunities to connect with other people. Mothers also shared how financial stress affected their mood:

On a personal level it has been frustrating because you don’t know what to give in to, things can amplify quickly such as your rent, car payment, your bills, food...This all can be emotional and depressing because it stresses you out and makes you irritable of having this constant pressure of what are you going to do.

Mothers shared feelings of loss as they experienced shifts in identity as family roles changed. Mothers also shared experiences of loneliness and diminished social support. In terms of the family, mothers shared stories of heightened stress and conflict among family members, often due to financial stress, parenting differences, and managing the fear of infection with the virus. Mothers also shared that the stressors of the pandemic have affected their parenting, with several mothers reporting feeling less patient and more irritable:

In some ways I feel frustrated, angry and there’s been a bit of friction towards my children, and I feel I may have raised my voice at them at times for things when it wasn’t necessary.

For their children, many mothers reported concerns about the loss of peer socialization and delays in academic and developmental progress. Mothers also voiced increasing concerns about their children’s physical and mental health.

Supports and Buffering Factors

Mothers demonstrated creativity in accessing and utilizing supports, from formal government programs to church and other community resources. Mothers obtained information through word of mouth and trusted institutions like schools and early education programs. Mothers also received social support from family members, partners, neighbors, and friends. However, several families reported that they did not receive any financial support. Mothers reported attempting to piece together financial support from several sources, including through their children’s schools, as well as utilizing food stamps and food pantries. Survey findings revealed that over half of mothers (20/34) reported receiving food stamps during the pandemic. One mother explained the impact of food support:

The food program has benefited us greatly because it’s been able to provide us with meals. I don’t believe that we would have been able to go on with the children without this program. The pandemic may not have killed us, but starvation would have.

However, there were stark differences between families who were able to access social safety net programs (CARES Act stimulus payment, unemployment insurance, Angeleno Card, local rental assistance program, etc.), and those who were not. In particular, the Angeleno card proved to be a key support for undocumented families:

[The Angeleno Card] was a great help because it helped me practically for a month’s rent, which was a little more than that. For me, it was a great help...otherwise I’d be behind about 4 months.

Survey data showed that just over a quarter of mothers (10/34) received the Angeleno Card, and half of mothers (17/34) received the CARES stimulus payment. Only 2 mothers received governmental rental or mortgage assistance. Interestingly, only one mother in the sample reported receiving a $500 payment as part of the California Disaster Relief for Immigrants program, which was directed specifically for undocumented immigrants.

Mothers’ Resilience Through the Pandemic

Although families faced overwhelming obstacles as a result of the pandemic, mothers actively coped with these challenges. Many mothers demonstrated resilience, including reporting that they experienced a greater sense of family unity, better communication between family members, and insight into what they truly value in life. One mother stated:

We know now—which is something we didn’t know before—that our health is the most valuable thing and that if there is health, we can make plans, we can all be together and that material things don’t matter.

Integrative Themes and Case Examples

Template analysis also identified several integrative themes related to mothers’ experiences, including exacerbating vulnerabilities for specific groups and the cascading effects of stressors, particularly for those with precarious immigration status. For example, the theme of exacerbating vulnerabilities for specific groups revealed that mothers within this larger sample experienced additional layers of disadvantage based on aspects of their identity, including undocumented mothers, single mothers, and mothers with disabilities. The theme of the cascading effects of stressors identified the ways in which disadvantage accumulated to put mothers and families at even greater risk of negative outcomes. Case examples were then chosen to illustrate how stressors accumulated and differentially affected members of specific marginalized groups, particularly undocumented mothers:

Rosa

Rosa and her family struggle to make ends meet after her husband was laid off. She has three children and says they have had to sell items or borrow money to cover their rent. She worries about her son, who is an essential worker, and shared that four of her close family members have tested positive for COVID-19. More than anything, Rosa is sad that her family did not qualify for unemployment or the stimulus package, even though she and her husband pay taxes. She and her husband are undocumented, but she wishes her children, who are citizens, could have qualified for the stimulus benefit. “It makes me sad to not receive that assistance. To not be seen as a human being. Especially in times when we should all be equal. But that’s not the way it is.” Rosa is also frustrated by managing remote learning for her son who has autism, spending 6 h a day supporting him in school and then with his additional therapy sessions.

Maria

Maria describes the stress of being undocumented and a single mother. First, she lost her job at a factory, then found work at a lower wage, but then had to start paying for childcare. After realizing how little money she had left over, she decided to quit to take care of her children and look for a better paying job. “I worry about paying rent and how to survive with 2 children…This pandemic has caused hardships I never imagined I’d live through in my lifetime.” Maria has not received the stimulus check or the Angeleno Card and has been waiting for 5 months to hear back about her CalWORKs application. She is not able to reach anyone by phone and cannot visit the office in person. She is also struggling with a harassing landlord and pain from a medical problem she cannot afford to address. She says: “I get depressed and have the feeling of not wanting to do anything. It’s really horrible because you wonder, why continue?”.

Differences by Immigration Status

Based on the emergence of immigration status as a key integrative theme, qualitative themes and subthemes were then analyzed to determine whether there were differences between documented mothers and those with precarious immigration status. Results showed that most pandemic stressors were more highly endorsed among the undocumented/precarious immigration group, whereas impacts for mothers, children, and the family were differentially endorsed by the two groups (see Figs. 1 and 2).

Fig. 1
figure 1

Pandemic stressors by immigration status. This figure indicates the percentage of respondents who discussed COVID-19-related stressors in qualitative interviews by respondents’ immigration status

Full size image
Fig. 2
figure 2

Impacts on the family by immigration status. This figure indicates the percentage of respondents who discussed COVID-19-related impacts in qualitative interviews by respondents’ immigration status

Full size image

Additionally, when examining responses on the CES-D, GAD7, and Everyday Discrimination Scale (EDS), documented mothers had average scores of 18.2 (SD = 11.5), 7.0 (SD = 5.0), and 40.6 (SD = 17.6), respectively, while undocumented mothers or those with precarious immigration status had average scores of 20.0 (SD = 12.1), 6.5 (SD = 4.7), and 48.6 (SD = 8.5) respectively.

Discussion

In this study, we explored mothers’ lived experiences to understand how pandemic-related stressors affected maternal, family, and child well-being for Latinx mothers with a prior history of depression, particularly for those with precarious immigration status. Many of the stressors Latinx mothers reported in this sample echo findings from prior literature, including high exposure to the COVID-19 virus and resulting negative health impacts (Centers for Disease Control & Prevention, 2021), job losses and decreases in income (Vargas & Sanchez, 2020), and increased caretaking duties (Almeida et al., 2020).

However, findings provide new evidence regarding the particularly important role of immigration status, which was identified as an important cross-cutting theme throughout the interviews. Mothers with undocumented or precarious immigration status endorsed a greater range of pandemic-related stressors than their documented counterparts, a finding that has not yet been reported in the literature. Additionally, although few mothers shared specific stories of interpersonal discrimination in interviews, most mothers endorsed daily experiences of discrimination based on language and national origin on standardized questionnaires. Mothers also shared the impact of being excluded from receiving initial stimulus payments through the CARES Act, which jeopardized each family’s ability to survive. The Migration Policy Institute estimates that 14.4 million individuals who were otherwise eligible based on income were excluded from the CARES Act due to immigration status, which represents 12% of the population in California (Gelatt et al., 2021), where the study was conducted. Although the American Rescue Plan passed in early 2021 provided stimulus checks to couples who jointly filed taxes and had at least one valid social security number, this did not help all undocumented families (Gelatt et al., 2021).

Findings highlight how federal COVID-19 policy violates individuals’ human rights by systematically penalizing undocumented individuals and members of mixed status families (Cross & Gonzalez Benson, 2021). In this way, COVID pandemic policy seems to be drawing new lines in the sand in terms of distinguishing between “deserving” and “undeserving” immigrants, setting a very concerning precedent. Many mothers expressed their feelings about being overlooked in national policy and reported feeling like they were being treated inhumanely. Mothers also articulated the ways that public school systems and social service agencies engaged in discriminatory practices based on language. Mothers’ stories show how this population experiences “social exclusion,” referring to the ways in which individuals and communities are systematically blocked from accessing resources and asserting rights enjoyed by members of mainstream society (Stewart et al., 2005, 2006).

In terms of the impacts on maternal mental health, over half of mothers scored above the clinical cut-off for depression, and more than a quarter for anxiety. Mothers in this study may have been vulnerable to the mental health impacts of the pandemic due to the accumulating impacts of disadvantage, including their gender, low socioeconomic status, marginalized race/ethnic identity, and a prior history of depression. Although studies on the “immigrant health paradox” have shown the resilience of Latinx immigrants, especially Mexican American immigrants, to the effects of stress on mental health, recent studies critique this body of work for taking a unidimensional view of immigrants and not considering the effects of increased immigration enforcement and racialization of legal status in today’s society, which impacts both documented and undocumented US Latinos (Bacong & Menjívar, 2021). Results from the qualitative data showed that maternal mental health concerns were more salient among mothers with precarious immigration status, and in this sample depressive symptoms appeared elevated in the precarious immigration group compared to the documented group. Findings show that those with precarious status who previously experienced depressive symptoms may be particularly at-risk for re-experiencing depression in the context of the pandemic.

Lastly, this study demonstrated that economic pressure, social standing, and discrimination appear to be related to both maternal psychological well-being and family functioning, as mothers perceived that their stress spilled over into their relationships with their partners and children. This cascading effect of pandemic stressors fits with the family stress model (Masarik & Conger, 2017), and highlights the need for intervention along a continuum, from addressing financial well-being and maternal mental health to intervening in the couple relationship, parent–child relationship, and addressing concerns about children’s health and development. The social work profession is uniquely poised to support this range of needs and advocate for a holistic response to the COVID-19 pandemic that will promote the human rights of all Latinx mothers and their families. The positive impact of the Angeleno Card program demonstrates the importance of addressing the root causes of poverty and inequality that can lead to disruptions in child and family functioning for marginalized Latinx families, particularly those who are undocumented. However, it is important to note that the Angeleno Card and Disaster Relief Program were limited to Los Angeles and California, respectively, examples of only a few programs in the USA that offered financial support to undocumented individuals during the pandemic (Disney et al., 2022). Comprehensive policy change is needed to ensure that the human rights of all undocumented immigrants in the USA are protected. Interestingly, qualitative results showed that overall, negative impacts on children were more highly endorsed by the undocumented/precarious group, whereas some impacts on mothers and the family were more highly endorsed by documented mothers. Results point to the need for further research to explore how to best support both groups.

Overall, mothers’ stories highlight how the confluence of marginalized identities, including being an ethnic minority woman, a mother, low-income, monolingual Spanish-speaking, having a history of mental health difficulties, and endorsing precarious immigration status contributed to experiencing unique pandemic-related sequalae. Consistent with intersectionality theory, we found that mothers experienced compounded COVID-19 vulnerabilities driven by social inequality, discrimination, and marginalization (Crenshaw, 1991). For example, for mothers like Rosa and Maria, the grave economic impacts of the pandemic combined with prior economic difficulties were exacerbated by a complete lack of access to benefits due to their undocumented status, ultimately impacting their individual and family functioning. Their stories also demonstrate an awareness of these social and structural determinants, which led to a sense of hopelessness and being forgotten by society.

Strengths and Limitations

The merging of qualitative and quantitative data is a major strength of this study. Qualitative data provided insight into how contextual stressors and maternal social location influence maternal and family functioning. Quantitative data provided context for how specific stressors affected the overall sample and provided both complementary and divergent evidence. This study also benefited from having a diverse team involved in data collection and analysis. However, this study is limited to the geographic area of Southern California and may not be generalizable to other areas. Participants also had a prior history of depression, and mental health concerns may be more likely to re-emerge for this group during a crisis like the pandemic.

Implications

This study raises several important areas for future inquiry. Quantitative studies should examine associations between documentation status and maternal mental health, family functioning, and child well-being for Latinx families, and assess whether safety net programs are buffering against the negative impacts of the pandemic for this population. Studies are also needed that explore the experiences of undocumented immigrants in other parts of the country, particularly in places with fewer pandemic-related programs for undocumented individuals. It will be important to explore how families navigate confusion about public programs and identify strategies that can improve access for families. Lastly, the unique effects of the pandemic for Latinx immigrant mothers, particularly in terms of domestic violence (Cleaveland & Waslin, 2021) (not assessed in this study), deserve urgent attention.

This study also provides important implications for the social work profession. Social workers are uniquely equipped to tackle social problems from several angles, including intervening at both the micro and macro levels, and can play a key role in advocating for the human rights of marginalized groups. Social work advocates should help mobilize communities to push for important policy changes, including making food assistance through public schools permanent, providing financial relief all undocumented families, expanding physical and mental health services for families regardless of immigrant status or ability to pay, and providing targeted public outreach to provide de-stigmatizing information about mental health and ways to access support. Social workers should also develop close relationships with medical-legal partnership programs that embed attorneys in the healthcare system to treat social and legal problems that impact physical health, as these programs can be particularly helpful for promoting immigrant rights (League et al., 2021). Social workers should also facilitate partnerships with other institutions (e.g., schools, churches, and early education settings) to help facilitate the dissemination of information, particularly since undocumented families may distrust formal government agencies.

Endnotes

1All names and some identifying details have been changed to protect confidentiality.