Journal of Immigrant and Minority Health (2023) 25:1339–1353 https://doi.org/10.1007/s10903-023-01520-2 ORIGINAL PAPER Cross‑Cultural Validation of the Barcelona Immigration Stress Scale Francisco José Eiroa‑Orosa1 · Stella Evangelidou2 · Adil Qureshi3 · Francisco Collazos3 Accepted: 21 June 2023 / Published online: 17 July 2023 © The Author(s) 2023 Abstract The concept of acculturative stress has been the subject of debate, resulting in contradictory arguments regarding its meas- urement. Many of the existing acculturative stress instruments have been developed for use with specific migrant groups. The objective of the current study is to revisit the psychometric properties of the Barcelona Immigration Stress Scale, an instrument aimed at measuring stress levels associated with the migration trajectory in any migrant group. Using a sample of 915 migrants who consulted in primary care, we carried out principal component and confirmatory factor analyses as well as item response theory analyses applied both to the entire sample and to different migratory groups separately. The new reduced version of the scale has very good psychometric properties both in general and applied to the Latino migratory group, the largest in the area where the study was carried out. Results were acceptable among sub-Saharan, North African, and Asian groups but not among Eastern Europeans. These results are discussed through the specificities of each migratory group and the limitations of psychometrics to capture the complexity of immigration-related and acculturative stress. Keywords Acculturative stress · discrimination · homesickness · immigration stress · measurement · mental health · psychometrics · psychosocial Introduction repercussion on psychosocial stability. According to Bhu- gra [2] migrants often encounter cultural differences that Stress, Migration and Mental Health necessitate adaptation, identity restructuring, identification of losses, and preparation for potential stressors associated Stress refers to any event in which either the demands of with migration. If the crisis is not effectively resolved, this the environment or internal pressures, or both, exceed the process can lead to distress that may intensify and increase adaptive resources of the individual [1]. In recent decades, the likelihood of a person suffering from chronic stress. stress related to migration and intercultural contact has Consequently, Patino and Kirchner [3] suggest that the host gained significant research attention as a way to understand society must develop efficient tools to prevent mental health the connection between migration and mental health. Migra- problems linked to migration. tory processes have become an important topic in clinical research due to the potential stressors involved and their Immigration‑Related Acculturation and Acculturative Stress * Francisco José Eiroa‑Orosa fjeiroa@gmail.com; feiroa@ub.edu The classical definition of acculturation refers to the pro- 1 Section of Personality, Assessment and Psychological cess of cultural change that migrating individuals and groups Treatment, Department of Clinical Psychology experience when they come into contact with individuals and Psychobiology, Faculty of Psychology, Institute of Neurosciences, University of Barcelona, Passeig Vall from the receiving culture [4]. Based on the bidirectional d’Hebron, 171, 08035 Barcelona, Catalonia, Spain model of acculturation, this change describes acculturation 2 Barcelona Institute for Global Health (ISGlobal), Barcelona, in terms of two orientations: one’s relation to a home culture Catalonia, Spain (culture of origin) and one´s relation to a host culture (a new, 3 Department of Psychiatry, University Hospital Vall second culture) [5]. Schwartz and Unger [6] have exposed d’Hebron, CIBERSAM, Autonomous University the difficulties in the clear and precise conceptualizations of of Barcelona, Barcelona, Catalonia, Spain 13 Vol.:(0123456789) 1340 Journal of Immigrant and Minority Health (2023) 25:1339–1353 acculturation as well as in the definition, operationalization for instance the Hispanic Stress Inventory [25–27]; or the and measurement of the construct in host countries. Multidimensional Acculturative Stress Inventory [11] both The concept of acculturative stress has been debated and developed to assess acculturative stress among persons of criticized by both clinicians and researchers concluding to Latin-American origin living in the United States. contradictory arguments. Rudmin [7] has called for the dis- In contrast, the Demands of Immigration Scale [28] missal of the acculturative stress construct in psychological focuses on migration-related issues for migrants preced- research, arguing that it is illogical to create a stress-based ing from any cultural origin. The scale consists of 23 items construct based on a process that is not inherently stress- divided into 6 subscales: Loss, Novelty, Occupation, Lan- ful. This argument opposes Bhugra’s [2] earlier statement guage, Discrimination, and Not at Home. It shows good psy- about the relationship between mental distress and migra- chometric properties and has been validated in a number of tion. There are also inconsistencies in defining the domains different languages, including Arabic [29] and Chinese [30], that acculturative stress may encompass, with little emphasis and has been used with other migrant groups such as Latinos on the contextual and multifaceted nature of acculturation in the United States [31]. processes [8]. While the Demands of Immigration Scale is a promising Some researchers tend to stay “true” to the accultura- assessment instrument, the Spanish and European immi- tive aspect of the construct; whereas others would appear gration context, coupled with research that emphasizes the to include stressors confronted by migrants and/or cultur- significance of various general psychosocial stressors, calls ally different people that are not directly related to intercul- for a more sensitive tool that can capture the heterogeneity tural contact, a requisite for “true” acculturative stress. The of the immigrant population in a specific local context. To inclusion of “discrimination” as a factor in the Acculturative that end, the Barcelona Immigration Stress Scale was devel- Stress in the International Students Scale [9] or the Barce- oped [10]. The instrument consisted of 42 items divided lona Immigration Stress Scale [10] exemplifies this issue. into 4 subscales: Rejection, Homesickness, Hopelessness However, the factor is explicitly rejected in the Multidimen- and Discrimination. sional Acculturative Stress Scale [11] precisely because, as Rodriguez and colleagues argue, it is not an inherent aspect Emic vs. Etic Approaches of acculturation. According to some proponents the effects of perceived As noted, many of the existing instruments associated with discrimination and low socioeconomic status (SES), which immigration stress have been developed for use with specific often co-occur with acculturation, have been confounded cultural groups. This clearly has the advantage of responding with and misattributed to acculturation processes [12, 13]. to the specific situation and characteristics of the different In addition, research shows that socioeconomic and other migrant groups, consistent with what has been called “cul- general psychosocial factors are central to explaining much tural psychology” perspective which is “emic” in its focus of the variance found in the mental health of migrants [14, on specific cultural groups [32]. This approach makes sense 15]. Thus, it appears that acculturative stress may be better in that it allows for the specificity of the construct to each predicted by these risk factors. group; however, this approach lacks the “cross-cultural psy- chology” or “etic” approach which allows for cross-cultural Measurement Issues and Tools comparisons and understanding [33]. The difficulty with on Immigration‑Related Stress cross-cultural comparisons, however, relies on the fact that cultural differences are such that certain constructs are To our understanding immigration-related stress is a broader derived from such different cultures that it would make no concept than acculturative stress. There are many stressors sense to treat them as belonging to the same entity. immigrants may face at host countries, other than the poten- The question of whether to adopt an emic or etic tial cultural changes at individual and community levels. approach to mental health is a complex issue in the meas- These stressors may include socioeconomic challenges, urement field. “Equivalence” [34] is the implicit notion work-related difficulties and harsh living conditions. The that exists in any intergroup study in which it is assumed main body of research on migration and stress focus on par- that variance in a given construct is a function of real vari- ticular culturally diverse migrant groups such as Mexican ance rather than group membership [35]. At the same time, migrant workers [13, 16], foreign students [17–20], elderly research increasingly indicates the centrality of culture Arabs [21], Latino adolescent drug users [22], Southeast in most everything human as exemplified by the cultural Asian refugees [23], and Indian migrants [24]. Indeed, the neurosciences [36]. The meaning of any given notion or bulk of studies focus on one target population, to the extent experience will have its particular cultural nuances, even that several instruments have been developed with one within a given culture. Moreover, research as such would particular population group in mind. Examples of this are be extraordinarily limited if it strictly follows an emic or 13 Journal of Immigrant and Minority Health (2023) 25:1339–1353 1341 relativist approach, in which any given construct can only Sample and Procedure be examined within a particular cultural context, rendering intercultural or comparative research impossible [37, 38]. Participants of this study were gathered from a large primary care study comparing mental health, substance use and som- atization among immigrants with their native counterparts The Barcelona Immigration Stress Scale (BISS) [42, 43]. A total of 20 primary care centers from the greater autonomous region of Catalonia, most of them located in The BISS was intended as a self-administered instrument the greater metropolitan area of Barcelona, participated in capable of agilely measuring stress levels related to the this study. migration process. It was designed to be suitable for use The sample used for the further psychometric validation in both epidemiological and clinical studies. The first psy- of the Barcelona Immigration Stress Scale (BISS) comprised chometric evaluation of the BISS was completed with a a total of 915 immigrants residing in the Barcelona province. small number of immigrants in the Barcelona region [10]. Among these, there were North Africans (14.3%), Eastern It is noteworthy that no Latin Americans were included Europeans (7.2%), Sub Saharans (12.8%), Latin Americans in this initial sample. Although the initial validation was (47.2%) and Asians (18.5%). The sampling strategy was carried out with the general “immigrant group” taken as based on the ethnic composition of foreign individuals uti- coherent, both conceptually and driven by research on lizing primary care services. Because of language familiar- similar datasets, we consider it important to acknowledge ity, there was a certain bias towards those participants who heterogeneity and as such not simply assume that different could respond to the questionnaires without comprehension migrant groups will perform in the same way. The cultural barriers. competence aspects of such instruments pertain to their The average age was 33.25 (± 8.9), with a range from 17 flexibility in screening across domains that are adjusted to 67 years. Regarding sex composition, 60.7% of the sample to the situational needs of migrants. Although nominally were women. The average time since migration to Spain was consistent with the proposed model, the original factor five years (± 4.2) with a range of 1 month to 30 years. 25% structure did not fit satisfactorily. In fact, the authors con- of the sample had completed higher education. In addition, cluded that the instrument was best suited for measuring a quarter of the sample was currently unemployed. Three a single construct. quarters of the sample reported a monthly income between The objective of this study is to reexamine the psycho- one and two times the Spanish National Minimum Wage. metric properties of the BISS with immigrants residing Relatedly, three quarters of the sample had a working permit in Catalonia, Spain. Specifically, the study will examine and 82% a residence permit. the internal validity of the instrument following both etic The study received ethical clearance from the University and emic approaches. Our aim is to effectively capture the Hospital Vall d’Hebron Institutional Review Board. All par- diverse experiences of acculturative stress by utilizing the ticipants gave informed consent, and the data collection was BISS as a culturally competent instrument. completed anonymously. Analysis Method Before analyzing the data, we carried an analysis of extreme Previous Scale Development cases by calculating the mean of all responses for each participant. As commented in the introduction, an initial set of 42 To decide upon its inclusion in principal component and items was developed and validated by Tomás-Sábado confirmatory factor analyses (PCAs and CFAs) we calcu- and colleagues [10] including subscales on Rejection, lated frequencies, skewness, kurtosis, and Item Response Homesickness, Hopelessness and Discrimination. This Theory (IRT) discrimination parameters for each item. preliminary version of the scale showed a strong one- Skewness measures the degree of asymmetry and Kurtosis dimensional structure with a very high reliability close to measures the degree of peakedness of a distribution. The one (α = 0.94). Regarding the anchor points, a four-point IRT discrimination parameter represents the degree to which Likert scale (totally agree, moderately agree, moderately the item discriminates between individuals who have high disagree, totally disagree) was chosen. This mode allows levels and those who have low levels of the trait being meas- to avoid middle response bias [39]. The scale has been ured. We considered adequate (symmetric, mesokurtic and used in several studies on acculturative stress [e.g. 40, 41]. discriminant) those items with skewness and kurtosis values 13 1342 Journal of Immigrant and Minority Health (2023) 25:1339–1353 between 1 and − 1 and IRT discrimination parameters above the items from the two factors that explained less variance 0.5. were combined into a single factor. Therefore, we decided to Once we removed items that were considered asymmet- proceed with a three-factor solution (Table 2). The dimen- ric, leptokurtic, platykurtic, or non-discriminant, we calcu- sions of the model were named as follows: Discrimination lated Cronbach’s alpha for the remaining set of items, as well (variance explained 29.6%, items 4, 6, 10, 11, 12, 13, 14, as for each individual item if deleted. We then used PCA, 16, 18, 19, 20, 28, 35, 41), Psychosocial Stress (variance a data-driven technique, to identify underlying dimensions explained 7.3%, items 21, 22, 23, 24, 25, 26, 30, 32, 33) and within our set of observed variables (items). Through con- Homesickness (variance explained 5.4%, items 5, 8, 9, 27, secutive PCAs we aimed at reducing the number of items 34, 36, 38). and identifying stable and theoretically congruent structures We assessed the unidimensional and multidimensional that conform the underlying structure of the scale. CFA, on fit of the model through confirmatory factor analyses, using the other hand, was used as a model-driven technique to the second random half of the database. Table 3 shows uni- tests the underlying dimensions obtained through PCA. To dimensional and multidimensional fits for the initial 35-item prevent overfitting [44], a cross-validation was performed structure, the final 30-item structure, as well as unidimen- by randomly dividing the sample into two parts, with one sional fit parameters for each final subscale. Figure 1 shows undergoing PCA and the other undergoing PCA. Finally, the CFA path diagram of the final model. All models demon- Cronbach’s alpha was used to test the internal consistency strated an acceptable fit, and given the negligible differences, of all model steps and final subscales in the entire sample, the reduction from 35 to 30 items was deemed justifiable. as well as by ethnicity. All these analyses were performed first for the whole ethnically diverse sample, and, once a Calculations by Ethnic Group Differentiation coherent, well-fitted structure was identified, for each of the ethnic groups. The psych [45], lavaan [46], and ltm [47] Tables 2 and 3 offer factor loadings and fits of the previously packages for the R software were used to compute all the validated model by ethnic group. Although fits and internal statistical analyses. consistency were deemed satisfactory for all ethnic groups, the Latin American group demonstrated a better fit com- pared to the other groups. Conversely, the Eastern European Results group exhibited the worst fit parameters. Following an extreme cases analysis, we excluded 31 ques- tionnaires with extreme response patterns or incomplete data. As a result, the final database for analysis consisted of Discussion 884 participants. We have validated a shortened version of the Barcelona Calculations with No Ethnic Group Differentiation Immigration Stress Scale, consisting of 30 items, which exhibits improved psychometric properties. This new valida- Frequencies, skewness, kurtosis and IRT discrimina- tion has been developed both considering the overall group tion parameters for each item are displayed in Table 1. As of migrants and differentiating ethnic origins. The final discrimination was suitable for all items, items that had structure of the BISS demonstrated an adequate fit accord- skewness and kurtosis greater than 1 or less than − 1 were ing to IRT, PCA, and CFA parameters and good internal removed (7 items, see Table 1). We then calculated alpha consistency. The three subscales found (Discrimination, Psy- for the whole scale and alpha if item deleted for each item, chosocial Stress, and Homesickness) coincide approximately finding good values (α = 0.922 for the 35 items remaining, with the structure and variance explained by the subscales of all items above α = 0.919). the original validation (Rejection, Discrimination, Hopeless- Consecutive principal component analyses using Varimax ness, and Homesickness; [10]). According to our findings, rotations were carried with the 35 remaining items using the we consider that the further validation of the BISS has added first random half of the database. We fist used the eigenvalue value to the instrument in a way that best reflects the com- higher than one criterion and then forced the structure to 3 mon areas of distress experienced by migrants, who were and 4 factors. This procedure was repeated, excluding five attending primary health care centers in Catalonia, Spain. items with low (< 0.4) and/or distributed loadings. There- The sample for its further validation (n = 915) was larger fore, we identified a coherent 30-items three-factor structure. and more representative to the immigrant population in the There were small differences between three and four fac- region, than the one (n = 92) examined for its preliminary tor-solutions in terms of variance explained (46.6–42.3%). validation [10]. Moreover, the further validated version of Additionally, when we constrained to a four-factor solution, the scale emphasizes the need to assess migration stress 13 Journal of Immigrant and Minority Health (2023) 25:1339–1353 1343 Table 1  Descriptive, skewness, kurtosis and IRT parameters of the initial 42-item pool Item Title Frequencies (%) Skewness Kurtosis IRT discrim- Totally agree Mod- Mod- Totally disagree ination erately erately agree disagree **1 I do not feel good in this country. 8.3 11.5 8.9 71.3 − 1.468 0.667 2.719 *2 Since I moved here, my life has gotten worse. 5.6 7.3 11.1 76.0 − 1.954 2.638 2.665 *3 I often feel that I am treated like a delinquent. 3.6 5.0 4.7 86.7 − 2.834 6.964 2.592 4 People here think that immigrants do not have 28 18 12.7 41.2 − 0.193 − 1.641 2.640 the same social rights. 5 I regret having left my country. 12,4 10,3 11,4 65,8 − 1.227 − 0.065 3.558 6 People here would never accept an immigrant in 10,2 11,2 16,1 62,5 − 1.217 0.073 3.095 their family. **7 I cannot handle the pace of life in this country. 10,0 9,4 10,9 69,6 − 1.442 0.581 3.323 8 I am not sure if I want to stay here. 30,0 11,1 10,0 48,9 − 0.363 − 1.657 1.436 9 I feel guilty for having left my family. 17,4 9,9 6,7 65,9 − 1.041 − 0.662 3.328 10 Society constantly reminds you that you are an 32,8 12,2 9,8 45,1 − 0.218 − 1.74 2.983 immigrant. 11 In this country, immigrants do not have the 26,5 12,3 11,6 49,5 − 0.453 − 1.537 2.595 opportunity to obtain higher− ranking jobs. 12 To succeed here one has to renounce one’s 15,1 6,6 7,8 70,6 − 1.335 0.066 3.663 culture. 13 I feel that people often do not include me in 14,5 7,1 8,6 69,8 − 1.325 0.069 5.047 their activities because I belong to a different culture. 14 It bothers me that people here do not understand 16,4 8,5 10,2 64,8 − 1.107 − 0.459 4.376 my cultural values. *15 I do not feel accepted here. 8,1 9,1 11,3 71,6 − 1.594 1.142 4.035 16 People do not trust me because I am an immi- 17,6 10,5 12,3 59,6 − 0.922 − 0.811 4.907 grant. *17 I am treated worse because of my appearance. 8,8 6,5 8,8 75,9 − 1.807 1.79 4.672 18 I feel discriminated against when it comes to 18,7 7,4 8,4 65,4 − 1.055 − 0.643 3.842 finding housing. 19 I feel pressured by the people of this country to 11,6 8,0 9,7 70,7 − 1.453 0.535 3.980 adopt their lifestyle. 20 I feel observed when I enter a store because 20,3 9,1 7,3 63,3 − 0.914 − 0.942 3.303 they suspect that I will steal something. 21 I feel alone. 25,9 11,1 7,0 55,9 − 0.571 − 1.48 3.368 22 I cannot put up with the situation, which I am in 11,7 9,2 8,6 70,6 − 1.397 0.349 4.651 for much longer. 23 I am worried that I cannot support my family. 35,8 11,0 6,3 46,9 − 0.169 − 1.815 2.504 24 I frequently feel tense. 24,2 14,7 10,6 50,4 − 0.475 − 1.495 3.629 25 I have financial problems. 29,2 17,4 14,4 39,0 − 0.153 − 1.642 2.210 26 I am very worried about my health. 42,7 12,9 9,5 34,8 0.193 − 1.747 1.460 27 I feel very bad when I think about everything I 32,5 13,8 10,8 42,9 − 0.170 − 1.731 3.974 left behind in my country. 28 I feel that people observe me when I am out in 14,7 10,4 6,7 68,1 − 1.170 − 0.337 4.063 public. *29 I feel that I have failed. 9,1 5,0 7,6 78,3 − 1.943 2.254 4.351 30 It is very difficult for me to solve my problems. 18,8 11,3 10,7 59,3 − 0.851 − 0.973 4.316 *31 It worries me that I have involved other people 12,1 7,5 4,1 76,2 − 1.571 0.75 4.546 in my decision to immigrate. 32 I have too many responsibilities. 42,3 12,5 9,3 35,9 0.161 − 1.767 2.247 33 I do not have adequate housing. 22,0 7,5 8,8 61,7 − 0.869 − 1.032 1.900 34 I feel like I have abandoned my family. 20,3 8,3 6,6 64,9 − 0.961 − 0.872 4.183 13 1344 Journal of Immigrant and Minority Health (2023) 25:1339–1353 Table 1  (continued) Item Title Frequencies (%) Skewness Kurtosis IRT discrim- Totally agree Mod- Mod- Totally disagree ination erately erately agree disagree 35 I do not trust the people of this country. 11,3 8,4 9,9 70,5 − 1.446 0.527 3.469 36 I miss my family. 66,9 12,9 5,4 14,8 1.321 0.126 1.628 **37 It worries me that I cannot educate my children 21,9 9,1 6,2 62,9 − 0.849 − 1.087 1.926 according to my culture. 38 I miss the ambience of my hometown. 55,4 15,7 7,1 21,9 0.805 − 1.047 1.499 * 39 It is difficult for me to practice my religion. 9,9 4,2 3,3 82,6 − 2.070 2.582 3.825 **40 I feel that I will fail in this country. 16,7 7,3 6,4 69,6 − 1.215 − 0.286 4.153 41 I have felt that my culture is undervalued. 11,7 8,1 8,6 71,6 − 1.461 0.53 4.235 **42 I feel that I do not belong to this society. 19,6 11,7 9,4 59,4 − 0.814 − 1.06 4.664 *Removed for being asymmetric and or lepto/platykurtic. **Removed within factorial calculations across multiple domains that are tailored to the specific situ- the loss experience and changes to their circumstances, ational needs of the migrant. homesick individuals must cope with the loss (even if Results show three final dimensions/subscales, namely: temporary) of their family and friends, as well as their Discrimination, Psychosocial Stress and Homesickness. changed circumstances. The Discrimination subscale addresses the perceived dis- As commented above, the psychometric properties of crimination on migrants’ acculturation [52, 53]. Perceived the scale, regardless of origin, were very good, both in discrimination can be conceived as a belief that one has relation to the discriminative power of the items, internal been treated unfairly because of one’s origin. It may result consistency, and fit. Upon conducting analyses by ethnic from a sense of being differentially treated in public places group, we found that the Latin American sample, which was or of being barred access to sources of information, social the largest, exhibited the most favorable reliability and fit networks, and peer groups. In a sense, perceived discrim- parameters. Conversely, the other ethnic groups displayed ination indicates the nature of the interaction between poorer reliability and fit parameters, with particularly migrants and the receiving society. It shows the incon- lower fit observed among individuals from Eastern Europe. gruence between the orientation and expectations that Although the discriminatory power of specific items was migrants and the receiving society have of each other [54]. generally adequate for all ethnic groups, some illustrative It constitutes a negative life experience and a potential examples within Eastern European participants can be seen. source of chronic stress and, thus, can explain deficiencies For instance 12 “To succeed here one has to renounce one’s in migrants’ well-being and health, resulting in a disrup- culture” (0.597), 18 “I feel discriminated against when it tive effect on the social adjustment in the host society [55]. comes to finding housing” (0.897), 26 “I am very worried Psychosocial Stress within our instrument refers to any about my health” (0.689), 32 “I have too many responsibili- everyday life stressors that may condition the wellbeing of ties” (0.796), 33 “I do not have adequate housing” (0.781), the migrant, such as issues related to housing, family, work 36 “I miss my family” (0.748) and 38 “I miss the ambience and other responsibilities [56, 57]. Such stressors are not of my hometown” (0.764). Some of these items had also low unique to the post-migration phase since native popula- discriminant power in the case of North Africans (32, 33) tions may also face similar life challenges in everyday life and Sub-Saharans and Asians (26, 32, 33, 36 and 38) and in the same social contexts where migrants are studied. additionally, 8 “I am not sure if I want to stay here” (0.830 Homesickness refers to the distress caused by actual for North Africans and 0.427 for Asians). or anticipated separation from familiar or loved people or Eastern European immigrants in Barcelona hold indeed places. According to Thurber [58], it is mostly accompa- some particularities in relation to the rest of the non-EU nied by cognitive components such as acute longing and immigrants in the city. Social relations between Eastern intrusive thoughts about home and attachment objects. Europeans and the native population are often described Stroebe and colleagues [59] have proposed that home- in terms of cultural proximity (e.g., religion) and high lev- sickness results from the combined effects of loss (loss- els of integration in the Spanish society. However, interac- orientation) and adjustment to the new situation (restora- tion between Eastern European migrants and other migrant tion-orientation). Just as grieving people must cope with groups are described in terms of distance and prejudiced 13 Table 2  Principal component analysis of the selected 30 items with the ethnically diverse sample and stratified by ethnicity ItemsN Ethnically diverse* North Africans Eastern Europeans Sub-Saharans Latin Americans Asians D S H IRT** D S H IRT* D S H IRT* D S H IRT* D S H IRT* D S H IRT* 4 People 0.597 2.268 0.579 1.519 0.760 2.250 0.683 1.612 0.611 1.711 0.602 1.614 here think that immi- grants do not have the same social rights. 5 I regret 0.571 2.688 0.441 0.585 1.646 0.588 0.235 1.148 0.676 0.125 0.698 0.321 0.575 1.902 0.519 0.244 1.361 having left my country. 6 People 0.521 2.708 0.564 0.266 1.747 0.598 1.267 0.574 0.264 1.791 0.450 1.178 0.566 1.515 here would never Journal of Immigrant and Minority Health (2023) 25:1339–1353 accept an immi- grant in their family. 8 I am not 0.524 1.383 0.434 0.830 0.366 1.166 0.398 0.196 0.163 0.855 0.286 0.531 0.931 0.401 0.427 sure if I want to stay here. 9 I feel 0.613 2.507 0.693 1.369 0.587 1.636 0.262 0.499 0.268 3.162 0.210 0.330 0.523 1.920 0.644 1.432 guilty for having left my family. 10 Society 0.629 2.730 0.553 0.234 0.217 2.537 0.649 1.623 0.626 0.190 1.764 0.663 1.807 0.601 1.047 con- stantly reminds you that you are an immi- grant. 13 1345 Table 2  (continued) 1346 ItemsN Ethnically diverse* North Africans Eastern Europeans Sub-Saharans Latin Americans Asians D S H IRT** D S H IRT* D S H IRT* D S H IRT* D S H IRT* D S H IRT* 13 11 In this 0.503 2.264 0.609 2.253 0.393 0.575 0.262 2.011 0.580 0.245 1.517 0.476 0.245 1.181 0.655 1.461 country, immi- grants do not have the oppor- tunity to obtain higher- ranking jobs. 12 To 0.606 3.631 0.608 0.219 2.159 − 0.314 0.499 0.597 0.455 0.184 1.303 0.592 1.611 0.663 1.666 succeed here one has to renounce one’s culture. 13 I feel 0.642 5.845 0.709 0.318 4.709 0.706 3.584 0.633 0.211 2.080 0.619 0.248 2.085 0.584 1.486 that peo- ple often do not include me in their activities because I belong to a different culture. 14 It 0.677 4.283 0.613 0.329 3.000 0.667 1.693 0.688 2.171 0.651 0.232 2.090 0.580 0.342 1.587 bothers me that people here do not under- stand my cultural values. 16 People 0.663 4.151 0.574 0.361 2.837 0.716 0.300 4.349 0.647 0.194 1.448 0.641 0.235 2.354 0.440 0.308 1.235 do not trust me because I am an immi- grant. Journal of Immigrant and Minority Health (2023) 25:1339–1353 Table 2  (continued) ItemsN Ethnically diverse* North Africans Eastern Europeans Sub-Saharans Latin Americans Asians D S H IRT** D S H IRT* D S H IRT* D S H IRT* D S H IRT* D S H IRT* 18 I feel 0.533 2.817 0.624 1.906 0.250 0.897 0.483 0.286 1.275 0.569 0.217 1.598 0.288 0.208 0.310 1.104 discrimi- nated against when it comes to finding housing. 19 I feel 0.567 3.019 0.572 0.279 2.487 0.333 1.066 0.484 0.257 1.521 0.547 0.273 1.655 0.290 0.489 0.999 pressured by the people of this country to adopt their lifestyle. Journal of Immigrant and Minority Health (2023) 25:1339–1353 20 I feel 0.565 2.669 0.527 0.424 1.860 0.497 0.307 0.327 1.946 0.519 0.298 1.193 0.535 0.201 1.554 0.403 0.376 1.158 observed when I enter a store because they suspect that I will steal some- thing. 21 I feel 0.462 2.523 0.256 0.472 1.344 0.690 1.192 0.230 0.248 0.629 1.783 0.228 0.475 0.378 1.611 0.236 0.542 1.222 alone. 22 I cannot 0.413 3.001 0.525 0.352 1.292 0.787 1.855 0.140 0.116 0.494 1.035 0.341 0.534 0.223 2.014 0.422 0.331 0.340 1.904 put up with the situation, which I am in for much longer. 23 I am 0.730 3.459 0.612 1.357 0.234 0.496 0.318 1.888 0.585 0.224 1.264 0.680 1.680 0.517 0.238 1.104 worried that I cannot support my fam- ily. 13 1347 Table 2  (continued) 1348 ItemsN Ethnically diverse* North Africans Eastern Europeans Sub-Saharans Latin Americans Asians D S H IRT** D S H IRT* D S H IRT* D S H IRT* D S H IRT* D S H IRT* 13 24 I fre- 0.573 4.518 0.225 0.697 1.921 0.301 0.280 0.628 2.530 0.263 0.233 0.609 1.916 0.324 0.611 1.965 0.285 0.595 1.649 quently feel tense. 25 I have 0.747 3.589 0.310 0.605 1.621 0.444 0.319 1.274 0.116 0.532 0.403 1.896 0.710 1.780 0.748 1.117 financial prob- lems. 26 I am 0.500 2.008 0.252 0.590 1.003 0.534 0.689 − 0.122 0.393 0.211 0.760 0.502 1.114 0.606 0.275 1.061 very worried about my health. 27 I feel 0.646 4.717 0.734 0.242 2.897 0.539 0.220 2.923 0.433 0.402 0.320 2.280 0.431 0.650 2.861 0.318 0.442 0.350 1.757 very bad when I think about every- thing I left behind in my country. 28 I feel 0.569 3.036 0.601 1.767 0.411 0.507 0.251 1.902 0.616 1.438 0.531 0.287 1.809 0.407 0.328 0.254 1.125 that people observe me when I am out in public. 30 It is 0.641 5.581 0.715 1.544 0.499 0.541 2.434 0.198 0.368 0.500 1.820 0.294 0.685 3.157 0.316 0.460 0.323 1.779 very difficult for me to solve my prob- lems. 32 I have 0.560 2.304 0.251 0.406 0.868 0.255 0.289 0.796 0.581 0.688 0.232 0.580 1.330 0.625 1.166 too many responsi- bilities. 33 I do 0.451 2.230 0.331 0.685 0.514 0.781 0.679 0.852 0.234 0.505 1.358 0.306 0.291 0.769 not have adequate housing. Journal of Immigrant and Minority Health (2023) 25:1339–1353 Table 2  (continued) ItemsN Ethnically diverse* North Africans Eastern Europeans Sub-Saharans Latin Americans Asians D S H IRT** D S H IRT* D S H IRT* D S H IRT* D S H IRT* D S H IRT* 34 I feel 0.623 3.394 0.644 1.687 0.495 1.184 0.224 0.548 0.211 2.207 0.414 0.587 2.744 0.380 0.471 1.649 like I have aban- doned my family. 35 I do not 0.528 3.052 0.398 0.463 1.889 0.566 1.456 0.511 0.279 − 0.327 0.945 0.534 0.254 1.845 0.411 0.337 1.082 trust the people of this country. 36 I miss 0.599 1.727 0.527 0.355 1.867 0.676 0.748 0.619 0.709 0.658 1.513 0.585 1.074 my fam- ily. 38 I miss 0.606 1.785 0.535 0.264 1.393 0.251 0.501 − 0.214 0.764 0.187 0.498 0.683 0.678 1.466 0.618 0.909 the Journal of Immigrant and Minority Health (2023) 25:1339–1353 ambience of my home- town. 41 I have 0.620 2.867 0.511 0.343 1.751 0.645 1.930 0.557 0.106 1.203 0.590 1.638 0.264 0.357 1.018 felt that my culture is underval- ued. *Performed using the first random half of the database, **Calculated within each subscale using the complete database D Discrimination, S Psychosocial stress, H Homesickness 13 1349 1350 Journal of Immigrant and Minority Health (2023) 25:1339–1353 Table 3  Reliability and MTBM CFI TLI RMSEA SRMR Alpha confirmatory factor analysis fit parameters Ethnically diverse migrant sample Unidimensional fit after excluding asym- 4262.33 0.798 0.786 0.059 0.059 0.922 metric and or lepto/platicurtic items (35 items) Multidimensional fit (35 items) 4262.33 0.870 0.861 0.047 0.052 Unidimensional fit (final 30 items) 3657.79 0.788 0.772 0.065 0.062 0.911 Multidimensional fit (30 items) 3657.79 0.882 0.872 0.049 0.051 Final subscales’ unidimensional fit Discrimination (14 items) 1545.33 0.911 0.894 0.064 0.049 0.872 Psychosocial stress (9 items) 795.18 0.948 0.930 0.059 0.042 0.801 Homesickness (7 items) 549.20 0.923 0.884 0.083 0.051 0.754 Multidimensional analyses by ethnicity North Africans 1412.94 0.764 0.745 0.073 0.088 0.897 Eastern Europeans 1066.77 0.503 0.462 0.116 0.124 0.862 Sub-Saharans 1198.25 0.753 0.732 0.071 0.085 0.887 Latin Americans 4507.38 0.886 0.877 0.053 0.050 0.921 Asians 1422.61 0.751 0.730 0.067 0.076 0.892 MTBM Model Test Baseline Model, CFI Comparative Fix Index, TLI Tucker Lewis Index, RMSEA Root Mean Square Error of Approximation, SRMR Standardized Root Mean Square Residual Fig. 1  Path diagram summarizing the multidimensional fit of the between factors. These parameters indicate the strength and direc- final confirmatory factor analysis (30 items). *The values displayed tion of the relationship between each latent construct and its observed on the arrows represent standardized factor loadings and collinearity indicators or between them views influenced by negative rhetoric about non-white and health symptoms, such as stress [51]. Our findings may non-European migrants in Spain [48]. Ramírez Goicoe- imply that perceived discrimination may not be necessar- chea [49] highlights the “invisibility” of Eastern European ily related to attitudes by the host community but by other migrants in Spain because of their physical similarity of migrant ethnic groups too, as this may apply to the Eastern them to Catalans and Spaniards. As a result, Eastern Euro- European migrant community. peans in Spain may experience lower levels of acculturation The clinical implications of the study include a culture- stress, possibly due to encountering less discrimination and sensitive approach in screening for migration-related stress prejudice. Future community-based studies are needed to in primary health care. Migration stress may compromise confirm this statement. the physical and mental health of individuals if not identified Discrimination appears to be a universal explanatory fac- and addressed [2]. Early screening and detection of stressors tor of migration stress for all immigrants, regardless of their and risk factors related to acculturation stress can contribute ethnic origin, as it showed a very good fit in all groups. to the prevention of mental health problems in migrant popu- Immigrants may be more vulnerable to certain types of dis- lations [3]. Prolonged exposure to these stressors can have a crimination than the native born [50] and the very percep- destabilizing effect on mental health, and early detection is tion of discrimination is related to the perception of specific crucial to prevent further distress. 13 Journal of Immigrant and Minority Health (2023) 25:1339–1353 1351 Among the limitations of the study, it is important to note Declarations that the sample we used may not be fully representative of migrants in Catalonia or in general. Our sample consisted of Competing Interests The authors report no conflicts of interest. individuals who have access to primary care, which could have implications for the composition of the sample in terms Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- of ethnicity, gender, socioeconomic status, and legal status. tion, distribution and reproduction in any medium or format, as long Regarding the latter, in the case of Spain, access to primary as you give appropriate credit to the original author(s) and the source, healthcare does not necessarily require legal residency, but provide a link to the Creative Commons licence, and indicate if changes there may be an overrepresentation of individuals with work were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated and residence permits. Consequently, the method of sam- otherwise in a credit line to the material. If material is not included in ple selection employed in this study may have resulted in the article's Creative Commons licence and your intended use is not a scale with a different dimensional structure compared to permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a what would have been obtained in a different context. copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The present validation of the BISS adopts an etic approach while acknowledging that migration stress is a multi-dimensional construct, and its effective measurement in primary health care depends on the flexibility in under- References standing the situational needs of every individual across the 1. Lazarus RS, Folkman S. 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