Immigrants showed fewer poor mental-health indicators in Spain’s 2023 survey

Foreign-born adults in Spain had lower rates of two poor mental-health indicators than native-born adults in a matched analysis of the 2023 Spanish Health Survey, despite the foreign-born population’s socioeconomic disadvantages. The study included 4,976 adults: 2,488 foreign-born and 2,488 native-born participants matched one to one by sex, age and region. Among men, 8.8% of foreign-born participants had low emotional well-being, compared with 13.0% of native-born men. Clinically relevant depressive symptoms were reported by 22.7% of foreign-born men and 28.9% of native-born men. Differences among women were smaller and less consistent: 32.4% of foreign-born women had clinically relevant depressive symptoms, compared with 36.5% of native-born women, while low emotional well-being did not differ significantly between the groups, at 15.8% and 18.4%, respectively.

The researchers conducted a secondary analysis of the nationwide, cross-sectional Spanish Health Survey, examining whether birthplace was associated with emotional well-being and depressive symptoms after accounting for sociodemographic, socioeconomic, social support, lifestyle and physical-health factors. Because the survey data were cross-sectional, the results describe associations at one point in time and do not establish changes over time or causal effects. The sex-stratified design was intended to capture differences that might be obscured when men and women are combined.

Emotional well-being was assessed with the World Health Organization-Five Well-Being Index, or WHO-5, with scores below 50 indicating low well-being. Depressive symptoms were assessed with the eight-item Patient Health Questionnaire-8, or PHQ-8, and a score of 10 or higher identified clinically relevant depressive symptoms. These two scales captured different aspects of mental health: the WHO-5 focused on emotional well-being, while the PHQ-8 measured depressive symptoms. The study therefore examined a positive dimension alongside a negative indicator rather than relying on one mental-health outcome alone.

To account for the matched design, the investigators used sex-stratified conditional logistic regression models. The models adjusted sequentially for sociodemographic, socioeconomic, social support, lifestyle and physical-health variables. In the fully adjusted analyses, native-born status remained associated with higher odds of low well-being and depressive symptoms among men. Native-born men had 2.23 times the odds of low emotional well-being relative to foreign-born men, with a 95% confidence interval of 1.19 to 4.14, and 1.68 times the odds of clinically relevant depressive symptoms, with a 95% confidence interval of 1.24 to 2.28.

Associations among women were also present after full adjustment, although their estimated magnitudes were smaller. Native-born status was associated with 1.51 times the odds of low well-being among women, with a 95% confidence interval of 1.08 to 2.12, and 1.45 times the odds of clinically relevant depressive symptoms, with a 95% confidence interval of 1.16 to 1.81. These model estimates support an association between birthplace and both mental-health outcomes after adjustment for the measured sociodemographic, economic, social, behavioural and physical-health factors.

The sex-stratified findings showed that birthplace-related differences were more pronounced among men. The prevalence of low emotional well-being differed by 4.2 percentage points between foreign-born and native-born men, compared with 2.6 points among women. The difference in clinically relevant depressive symptoms was 6.2 percentage points among men and 4.1 points among women. The men’s differences were statistically significant for both outcomes, with p = 0.002 for low well-being and p < 0.001 for depressive symptoms. Among women, the depressive-symptom difference was significant at p = 0.043, whereas the difference in low emotional well-being was not, with p = 0.078.

Several limits constrain what can be inferred from the analysis. The cross-sectional design cannot determine whether mental health changed after migration, whether birthplace caused the observed differences, or whether unmeasured experiences account for the associations. The PHQ-8 threshold identifies clinically relevant depressive symptoms and does not, by itself, establish a clinical diagnosis of depression. The WHO-5 index was used as a measure of emotional well-being, while the study’s conclusions about inequalities apply to the surveyed population and the outcomes included in the analysis. The matching procedure also made the groups comparable by sex, age and region, but the observational associations remain distinct from evidence of causation.

Overall, the study found that foreign-born status was associated with lower odds of low emotional well-being and clinically relevant depressive symptoms in both sexes, with the largest differences among men. The authors said the findings support assessing positive and negative dimensions of mental health together, while accounting for sex, when examining population health inequalities. The study was published in BMC Public Health as an open-access article and is described in the source as an early version subject to further editorial edits before replacement by the final Version of Record.

Subject of Research: Sex-stratified associations between birthplace, emotional well-being and depressive symptoms among adults in Spain

Article Title: Emotional well-being and depressive symptoms among immigrants and native-born adults in Spain: a matched analysis of the 2023 Spanish health survey

Article References: Fuentes-Arroyo, L., López-de-Andrés, A., Cuadrado-Corrales, N., Zamorano-León, J. J., Carabantes-Alarcón, D., Bodas-Pinedo, A., Redondo-González, E., Jiménez-García, R., & Mérida, D. M. (2026). Emotional well-being and depressive symptoms among immigrants and native-born adults in Spain: a matched analysis of the 2023 Spanish health survey. BMC Public Health. https://doi.org/10.1186/s12889-026-29654-6

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29654-6

Keywords: immigration, mental health, emotional well-being, depressive symptoms, Spain, health survey, sex differences, health inequalities, matched analysis, Emotional, well-being, depressive