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Objectives. We examined potential pathways by which time in the United States may relate to differences in the predicted probability of past-year psychiatric disorder among Latino immigrants as compared with US-born Latinos. Methods. We estimated predicted probabilities of psychiatric disorder for US-born and immigrant groups with varying time in the United States, adjusting for different combinations of covariates. We examined 6 pathways by which time in the United States could be associated with psychiatric disorders. Results. Increased time in the United States is associated with higher risk of psychiatric disorders among Latino immigrants. After adjustment for covariates, differences in psychiatric disorder rates between US-born and immigrant Latinos disappear. Discrimination and family cultural conflict appear to play a significant role in the association between time in the United States and the likelihood of developing psychiatric disorders. Conclusions. Increased perceived discrimination and family cultural conflict are pathways by which acculturation might relate to deterioration of mental health for immigrants. Future studies assessing how these implicit pathways evolve as contact with US culture increases may help to identify strategies for ensuring maintenance of mental health for Latino immigrants. (Am J Public Health. 2009;99:2247-2254. doi: 10.2105/AJPH.2008.137091)

This article presents analyses of a representative sample of U.S. Latinos (N = 2,540) to investigate whether family cohesion moderates the effects of cultural conflict on psychological distress. The results for the aggregated Latino group suggest a significant association between family cohesion and lower psychological distress, and the combination of strong family cohesion with presence of family cultural conflict is associated with higher psychological distress. However, this association differs by Latino groups. In this study, no association for Puerto Ricans is seen; Cuban results are similar to the aggregate group, family cultural conflict in Mexicans is associated with higher psychological distress whereas family cohesion in other Latinos is associated with higher psychological distress. Implications of these findings are discussed to unravel the differences in family dynamics across Latino subethnic groups. Keywords: family cohesion; family conflict; psychological distress; Latino ethnic groups

This article discusses a nested latent class model for analyzing longitudinal randomized trials when subjects do not always adhere to the treatment to which they are randomized. In the Prevention of Suicide in Primary Care Elderly: Collaborative Trial, subjects were randomized to either the control treatment, where they received standard care, or to the intervention, where they received standard care in addition to meeting with depression health specialists. The health specialists educate patients, their famillies, and physicians about depression and monitor their treatment. Those randomized to the control treatment have no access to the health specialists; however, those randomized to the intervention could choose not to meet with the health specialists, hence receiving only the standard care. Subjects participated in the study for two years where depression severity and adherence to meeting with health specialists were measured at each follow-up. The outcome of interest is the effect of meeting with the health specialists on depression severity. Traditional intention-to-treat and as-treated analyses may produce biased causal effect estimates in the presence of subject noncompliance. Utilizing a nested latent class model that uses subject-specific and time-invariant 'superclasses' allows us to summarize longitudinal trends of compliance patterns and to estimate the effect of the intervention using intention-to-treat contrasts within principal strata that correspond to longitudinal compliance behavior patterns. Analyses show that subjects with more severe depression are more likely to adhere to treatment randomization, and those that are compliant and meet with health specialists benefit from the meetings and show improvement in depression. Simulation results show that our estimation procedure produces reasonable parameter estimates under correct model assumptions. KEY WORDS: Geriatric depression: Latent class model; Longitudinal compliance class model; Potential outcomes; Principal stratification; Randomized trial.