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

Despite the rapid growth of the foreign-born population in Spain, mental health evidence remains inconsistent and focused on psychopathology rather than positive dimensions. This study compared emotional well-being and depressive symptoms between foreign-born and native-born adults, examining the association between birthplace and these outcomes after adjusting for socioeconomic, lifestyle, and physical health factors from a gender perspective. We conducted a secondary analysis of the nationwide cross-sectional 2023 Spanish Health Survey. A 1:1 individual matched design by sex, age, and region yielded a sample of 4,976 adults (2,488 foreign-born and 2,488 native-born). Emotional well-being was assessed using the World Health Organization-Five Well-Being Index (WHO-5 < 50 indicating low well-being), and clinically relevant depressive symptoms using the Patient Health Questionnaire-8 (PHQ-8 ≥ 10). Sex-stratified conditional logistic regression models were sequentially adjusted for sociodemographic, socioeconomic, social support, lifestyle, and physical health covariates. Despite socioeconomic disadvantages, foreign-born participants exhibited lower prevalences of poor mental health indicators. Foreign-born men reported lower prevalences of low emotional well-being (8.8% vs. 13.0% in natives; p = 0.002) and depressive symptoms (22.7% vs. 28.9% in natives; p < 0.001). Among women, foreign-born individuals reported fewer depressive symptoms (32.4% vs. 36.5% in natives; p = 0.043), though perceived emotional well-being did not differ significantly between groups (15.8% vs. 18.4%; p = 0.078). In the fully adjusted models, native-born status was associated with higher odds of low well-being (OR 2.23; 95% CI 1.19–4.14) and depressive symptoms (OR 1.68; 95% CI 1.24–2.28) among men. Similar associations were observed among women for low well-being (OR 1.51; 95% CI 1.08–2.12) and depressive symptoms (OR 1.45; 95% CI 1.16–1.81). Birthplace-related differences in these outcomes were more pronounced among men. Birthplace remains associated with emotional well-being and depressive symptoms after adjusting for sociodemographic, socioeconomic, lifestyle, and physical health determinants, with patterns differing by sex. Simultaneously assessing positive and negative dimensions of mental health through sex-stratified analyses is essential to capture population health inequalities and guide targeted public health interventions.