Resilience and depressive symptoms in mainland Chinese immigrants to Hong Kong

A Randomized Controlled Trial of Two Parent-Child Parallel Interventions to Enhance Positive Adaptation of Immigrant Families in Hong Kong: The Moderating Role of Depressive Symptoms

Parents and children who have recently immigrated from the Chinese mainland to Hong Kong face various challenges, including psychological and sociocultural adaptation difficulties. In collaboration with community partners, our research team has developed and implemented culturally sensitive and preventive parent-child parallel interventions to enhance positive adaptation among immigrant parents and children. Two interventions were conducted in this randomized controlled trial: an emotion regulation (ER) arm, which addressed psychological adaptation by reducing parent-child conflicts and improving emotions, and an information provision (IP) arm targeting sociocultural adaptation by increasing participants' knowledge about Hong Kong. The study randomly assigned 113 and 73 parent-child pairs (allocation ratio 3:2) into the ER and IP arms, respectively. Parents and children attended four two-hour weekly sessions of their assigned intervention and completed assessments before, immediately after, and one month following the intervention. The results showed that in the ER arm, parents showed improved positive affect, and children reported decreases in parent-child conflicts more than their counterparts in the IP arm. In the IP arm, parents and children increased their knowledge, and parents decreased sociocultural adaptation difficulties more than their counterparts in the ER arm. In addition, the moderation analyses showed that in both interventions, parents and children with elevated baseline depressive symptoms obtained greater benefits relative to their counterparts with fewer symptoms. Such marked improvements were seen among parents in negative affect and adaptation difficulties and among children in parent-child conflict, positive and negative affect in the ER arm. More improvements were noted among parents in negative affect and sociocultural adaptation difficulties and among children in negative affect in the IP arm. Future studies are suggested to develop and provide parent-child parallel interventions targeting both psychological and sociocultural adaptations to parents and children with heightened baseline depressive symptoms to facilitate their positive adaptation in Hong Kong.

A psychometric study of the revised Chinese version of the family resilience assessment scale among children disadvantaged due to family migration

OBJECTIVE

The family system is important for children's development. Previous research has demonstrated that some families are able to maintain good adaptability or resilience in the face of stressors. This study aimed to develop the revised Chinese version of the Family Resilience Assessment Scale and examine the psychometric properties of the scale among children disadvantaged in adversity due to family migration.

METHODS

A total of 1487 children (47.6 % girls) from disadvantaged families participated in this study, whom completed the revised Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Connor-Davidson Resilience Scale, and the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

(1) Good language equivalency was found (Intraclass Correlation Coefficient = 0.96); (2) Item analysis indicated that the critical ratio values of all 45 items were above 0.30 (p < 0.001), except for 7 items that were dropped from further analysis; (3) The exploratory factor analysis indicated that the best model was four-factor model; (4) The confirmatory factor analysis showed that the four-factor model had good model fit; (5) Family resilience was significantly correlated with personal resilience and depression; (6) The internal consistency reliability of the scale was 0.95.

CONCLUSIONS

This study confirmed that the revised Chinese version of the Family Resilience Assessment Scale was a reliable and valid instrument to assess family resilience of Chinese children who are disadvantaged.

Promotion of Resilience in Migrants: A Systematic Review of Study and Psychosocial Intervention

This systematic review aimed to contribute to a better and more focused understanding of the link between the concept of resilience and psychosocial interventions in the migrant population. The research questions concerned the type of population involved, definition of resilience, methodological choices and which intervention programmes were targeted at migrants. In the 90 articles included, an heterogeneity in defining resilience or not well specified definition resulted. Different migratory experiences were not adequately considered in the selection of participants. Few resilience interventions on migrants were resulted. A lack of procedure's descriptions that keep in account specific migrants' life-experiences and efficacy's measures were highlighted.

Perceived Epidemic Risk and Depression Symptoms during the COVID-19 Pandemic: The Mediating Role of Security and the Moderation Role of Perceived Discrimination

The 2019 coronavirus disease pandemic has resulted in a significant increase in the incidence and prevalence of mental health problems such as anxiety and depression, posing a threat to peoples' lives and health safety all over the world. Research suggests some potential relationships among perceived risk, discrimination, security, and depression symptoms. However, little attention has been paid to the complex mechanisms of the associations between these variables. This study aimed to examine the mediating role of security and moderation role of perceived discrimination in the prediction of perceived epidemic risk on depression symptoms. Thus, we aimed to identify if perceived epidemic risk is a positive predictor of depression. A cross-sectional study was conducted through an anonymous online survey in China during the COVID-19 pandemic which measured perceived epidemic risk, discrimination, security, and depression symptoms. A total of 3443 valid questionnaires were obtained. The results indicated that depression symptoms were predicted by perceived epidemic risk through the mediating role of security, and this mediating role of security was moderated by perceived discrimination. Specifically, high levels of perceived discrimination may lead to a significant decrease in personal security, thus clustering depressive symptoms. These findings shed light on the influence of the perceived risk of the epidemic on depression symptoms in the context of the epidemic situation, which may help to develop targeted interventions.

Mental Health Among Chinese Immigrants in the United States During the COVID-19 Pandemic

INTRODUCTION

Chinese immigrants have faced tremendous health challenges during the coronavirus disease 2019 pandemic. The purpose of this study was to examine the prevalence of depression and anxiety and associated factors among Chinese immigrants in the United States.

METHODOLOGY

This is a cross-sectional study conducted online. Sociodemographic, immigration-related, and pandemic-related factors, racism, social support, depression, and anxiety were measured.

RESULTS

A total of 507 Chinese immigrants completed the survey, with 36% of participants having depression and 29% having anxiety. Younger age (p = .048), residing in the South (p = .017), being affected by the pandemic (p < .001), racism (p < .001), and lower levels of social support (p < .001) were associated with depression. Lower education levels (p = .017), unemployment (p = .036), being U.S.-born (China-born: p = .012; Other nativity: p = .034), being affected by the pandemic (p = .006), racism (p < .001), and lower levels of social support (p = .006) were associated with anxiety.

DISCUSSION

There is a pressing need for health care professionals and policymakers to develop effective strategies to decrease anti-Chinese racism and address Chinese immigrants' mental health needs during the pandemic and afterward.

Dyadic Effects of Fluid Mindset on Psychological Growth in Immigrant Mothers and Their Children: Indirect Effect of Resilience

Immigration research has recently investigated positive adaptation outcomes such as psychological growth. This study tested actor and partner effects between fluid mindset and psychological growth, mediated by resilience, in 200 migrant mother-child dyads from Mainland China to Hong Kong. Mothers' fluid mindset had significant actor and partner effects on their own and their children's psychological growth, whereas children's fluid mindset showed an actor effect. For mothers and children, fluid mindset had significant actor indirect effects on psychological growth via resilience. Mothers' fluid mindset had a significant partner indirect effect on children's psychological growth via children's resilience. The findings have implications for enhancing immigrants' psychological growth by strengthening fluid mindset and considering mothers and children as the intervention unit in resilience programs.

Childhood adversity and mental health among Chinese young adults: The protective role of resilience

AIM

The aims of this study were to examine the prevalence of adverse childhood experiences (ACEs) among health science students in China; associations between the number of ACE exposures and severity of depressive and anxiety symptoms; and the extent to which resilience moderates the effect of ACEs on mental health outcomes.

DESIGN

This descriptive, cross-sectional study was conducted May-August 2020.

METHODS

Five hundred and sixty-six health science students (18-38 years) from China completed online surveys measuring ACEs using the Simplified Chinese version of the ACE-International Questionnaire, depressive and anxiety symptoms and resilience. Descriptive statistical analysis, ANOVA with Tukey HSD post hoc tests and multiple regression analysis were performed using SPSS 27.

RESULTS

88.5% of participants reported at least one ACE; 42.6% reported four or more ACEs. Higher number of ACEs was associated with more symptoms of depression and anxiety. Four or more ACEs were associated with significantly worse mental health outcomes than those with no ACEs and those with one to three ACEs. Greater resilience significantly attenuated the effects of ACEs on mental health symptoms.

CONCLUSIONS

ACEs are highly prevalent among Chinese health science students but their impact on mental health can be buffered by higher levels of resilience.

IMPACT

Screening for ACEs and strength-based, trauma-informed interventions on fostering resilience is needed to promote mental health among Chinese young adults.

Culturally sensitive conceptualization of resilience: A multidimensional model of Chinese resilience

Cultural sensitivity is missing in the widely researched construct of resilience. The assumption that resilience takes the same form in all cultures fails to acknowledge that culture shapes the interpretation and instantiation of resilience. Examining how suffering and adversity are perceived and dealt with in Chinese contexts, can identify cultural concepts related to resilience. In this paper, we examine the ways in which Confucianism, Buddhism, and Taoism, the three main belief systems that have influenced Chinese people's perception of the nature of life, can serve as sources of strength to individuals facing adversity. We summarise three culturally inflected elements of dealing with adversities and compare them with existing, widely researched notions of resilience. Taking a socio-ecological perspective to explore resilience, this paper proposes a multidimensional model that can improve understanding of culturally embedded resilience.

Family Hardiness in Patients with Heart Failure: Exploring Protective Factors and Identifying the Mediator

Background

Struggling with heart failure (HF) may be a distressful experience for the entire family. As a key variable contributing to positive family functioning, family hardiness can protect against HF-related harm. Thus, recognizing factors associated with family hardiness could promote strategies that enable successful adaptation to HF. This study aimed to explore protective factors linked to family hardiness among HF patients.

Patients and Methods

A cross-sectional study was undertaken in 2020 among 167 HF patients in Nanjing, China. The study measures comprised a self-designed general information questionnaire, the Family Hardiness Index, the Mutuality Scale, the Positive and Negative Affect Scale, and the Simplified Coping Style Questionnaire. The data analysis was performed using IBM SPSS, version 25 and comprised Pearson’s correlation analysis, a multiple linear regression model, and an analysis of mediating effects.

Results

The average Family Hardiness Index score for the 167 HF patients was 57.95 ± 11.41. The multiple linear regression analysis revealed that mutuality, active coping style, and positive emotions of HF patients positively predicted family hardiness (β = 0.359, 0.308, and 0.215, respectively; all P ˂ 0.05). Mutuality between patients and family members had partial mediating effects between active coping style, positive emotions, and family hardiness.

Conclusion

Our results revealed that patients’ active coping styles, positive emotions, and mutuality were protective factors associated with family hardiness. In light of our findings, we suggest that active coping strategies, positive emotions, and, especially, closer relationships within families should be encouraged during the rehabilitation and follow-up care of HF patients.

Is This Stalking? Perceptions of Stalking Behavior Among Young Male and Female Adults in Hong Kong and Mainland China

Most studies of stalking are conducted with samples from individualist cultures. Little is known about the phenomenon within collectivist cultures. The present study is arguably the first stalking study conducted in Hong Kong. Specifically, this study investigates a large sample of Asian college students' (N = 2,496) perceptions of stalking behavior, potential reasons for stalking, and coping strategies that may be employed by stalking victims. Associations between these variables and gender and culture (Hong Kong vs. Mainland China) were also explored. Gender was more strongly associated with perceptions of stalking behavior than was culture. Gender was less strongly associated with perceptions concerning motivations for stalking and the effectiveness of coping strategies that may be employed by stalking victims than was culture. Effect sizes for all associations with culture were small, perhaps due to a high degree of similarity between the two cultures examined. The findings are generally supportive of similar results produced by previous work conducted within individualistic Western cultures, suggesting that stalking and the way that it is perceived may be universal in nature. This study concludes with the argument that legislation against stalking needs to be extended to non-Western countries, such as Hong Kong and Mainland China, as antistalking laws are relatively scarce outside Western industrialized countries.

A Moderated Mediation Analysis on the Association Between Perceived Discrimination and Physical Symptoms Among Immigrant Women from Mainland China into Hong Kong: Evidence from the FAMILY Cohort

With a research focus on the possible impact of perceived discrimination on physical symptoms, this study examined a moderated mediation model that depressive symptoms would mediate the association between perceived discrimination and physical symptoms, and family satisfaction would show moderating effects on both depressive and physical symptoms among immigrants. Immigrant women from Mainland China into Hong Kong (N = 966) completed a cross-sectional survey. Depressive symptoms mediated the association between perceived discrimination and physical symptoms. Family satisfaction moderated the association between perceived discrimination and depressive symptoms that participants with lower family satisfaction showed a stronger association. However, family satisfaction did not moderate with perceived discrimination or depressive symptoms to predict physical symptoms. Our findings demonstrated the health consequences of perceived discrimination. Development of resilience programs, particularly with a focus of strengthening family resources, may in tandem help immigrants manage their experiences with discrimination.

A peer support and peer mentoring approach to enhancing resilience and empowerment among refugees settled in southern Spain

This study aims to analyze the processes of resilience and empowerment experienced by refugees in southern Spain during their participation in a community-based intervention. Intervention design covered two phases over 15 weeks: (a) accompanying a group of 10 settled refugees to become mentors, making use of a peer-support-group format; and (b) holding four cultural peer-support groups made up of newly arrived refugees led by the previously trained settled refugees, following a peer-mentoring format. We analyzed the mentors' narratives and written evaluations produced over the course of the intervention program. Mentor resilience increased during the first program phase and remained high and stable during the second phase. Mentor empowerment steadily increased throughout the duration of the program, and was fueled when participants became mentors to newly arrived refugees during the second phase. This study highlights how a peer-support and peer-mentoring approach is useful for enhancing the resilience and empowerment of refugees in receiving societies.

Variations in Dyadic Adjustment Among Heterosexual HIV-Discordant Couples in Rural China: A Latent Profile Analysis

The systemic framework of resilience and dyadic perspective of couple coping suggests that HIV-discordant couples may show heterogeneous profiles of dyadic adjustment, shaped by contextual risks and resources. This study aimed to identify heterogeneous profiles of dyadic adjustment and thus investigate the expression of resilience among 159 heterosexual HIV-discordant couples in rural China. We hypothesized that the couples could be grouped into distinct profiles: both members showing poor well-being, both members showing good well-being, and discrepant well-being across the two members. A latent profile analysis classified the couples into three subgroups based on well-being, which was measured using the World Health Organization Well-Being Index. As expected, one subgroup, labeled Maladapted Couples (n = 58, 36.5%), reported poor well-being in both people living with HIV/AIDS (PLWHA) and the seronegative spouse. The second subgroup, labeled Resilient Couples (n = 50, 31.4%), was characterized by relatively good well-being in both partners. In the third subgroup, labeled Maladapted PLWHA and Resilient Spouses (n = 51, 32.1%), the PLWHA showed poor well-being, while the seronegative spouses demonstrated good well-being. The identified subgroups were validated against external well-being measures, including depression and self-rated health measures. Exploratory analyses identified distinct patterns of contextual risks (including HIV stigma and financial difficulties) and resource factors (including individual resources and relational resources) across the subgroups. These findings underscore the heterogeneity of adjustment among heterosexual HIV-discordant couples in rural China and suggest the potential usefulness of services tailored to specific subgroups.

Effects of Neighborhood Discrimination Towards Mainland Immigrants on Mental Health in Hong Kong

Using data from a representative sample of Chinese adults who were surveyed in the Hong Kong Panel Study of Social Dynamics (HKPSSD), we estimate the effects of neighborhood discrimination towards immigrants from Mainland China on the mental health of Chinese residents in Hong Kong. Contrary to our expectations, discrimination towards immigrants from Mainland China measured at the neighborhood level is not associated with the poor mental health of post-1997 immigrants; instead, a higher level of immigrant discrimination is associated with a lower level of psychological distress for both post-1997 Mainland immigrants and other Chinese residents in Hong Kong. A functional family also appears to be a consistent predictor of better mental health for both groups. Our findings, therefore, suggest that immigrant discrimination can signify a prejudice that leads to social distance or avoidance and that the post-1997 Mainland immigrants do not have extensive contact with other local residents in Hong Kong. Although local residents’ discriminatory attitudes may not result in aggressive behaviors that have a negative impact on newcomers’ mental health, the social distance between the immigrants and the local residents is still an issue that requires further research and practical attention.

Resilience, Acculturative Stress, and Family Norms Against Disclosure of Mental Health Problems Among Foreign-Born Filipino American Women

The present study explores the relationships between resilience, acculturative stress, and family norms against disclosure of mental health problems among foreign-born Filipino American women. The sample consisted of 159 foreign-born Filipino American women aged 18 years and above and residing in Las Vegas, Nevada, United States. Participants completed paper-and-pencil questionnaires. Results indicated high levels of resilience and moderate levels of acculturative stress. Findings also showed a significant negative correlation between resilience and acculturative stress, and a significant predictive effect of resilience on acculturative stress. We also found a significant negative relationship between resilience and family norms against disclosure of mental health problems but no significant mediating effect of resilience on the relationship between acculturative stress and family norms. This lack of significant findings related to the mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental illness may be due to the absence of theoretical models and research regarding the role of resilience in the context of acculturation among Filipino American women. Our findings imply the need to further explore underlying mechanisms that explain the relationships between resilience, acculturative stress, and family norms. The findings of the study also confirm the need to develop interventions and resources that ameliorate acculturative stress and promote an increase of the disclosure and reporting of mental health problems among Filipino American women.

Resilience mediated the association between acculturation and psychological growth in college students from Hong Kong to Guangzhou, China

BACKGROUND

The number of Hong Kong citizens living in mainland China is increasing. The process of acculturation may create opportunities for psychological growth.

AIMS

This study aimed at examining whether resilience mediated the effects of acculturation on psychological growth in college students from Hong Kong to Guangzhou.

METHOD

In this cross-sectional survey, 164 college students in Guangzhou who were Hong Kong permanent residents (female: 46%, age: 21.09 ± 1.50) joined the study.

RESULTS

The integration group reported more psychological growth than the assimilation, separation, and marginalization groups. Resilience partially mediated the effect of integration on psychological growth and fully mediated the effect of marginalization on psychological growth.

CONCLUSIONS

Resilience represents one of the mechanisms to explain beneficial effects of integration on psychological growth in college students from Hong Kong to Guangzhou. Theoretical considerations to rethink the acculturation model, implications for developing intervention programs, and recommendations for future research are discussed.

Dyadic Effects of Stigma and Discrimination on Distress in Chinese HIV Discordant Couples

The present study investigated the dyadic effects of stigma and discrimination on distress in Chinese couples affected by HIV. Chinese people living with HIV (PLHIV) and their seronegative spouses (N = 119 couples) participated in this study. The PLHIV completed measures on stigma beliefs about being better off dead and dignity-related distress. The spouses completed measures on perceived discrimination and exclusion and caregiver distress. The results showed that there was no significant correlation between the PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion. The couples showed significant associations in their dignity-related distress and caregiver distress. Analyses using the actor-partner interdependence model showed that PLHIV's stigma beliefs and the spouses' perceived discrimination and exclusion both had significant actor and partner effects on distress within the dyad. Psychosocial interventions aiming for distress reduction in the context of HIV should tackle stigma and discrimination and target the couples rather than solely the patient or spouse.

Factors associated with psychological distress or common mental disorders in migrant populations across the world

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants' residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies.

Health Care Neglect, Perceived Discrimination, and Dignity-Related Distress Among Chinese Patients With HIV

Dignity-related distress is overlooked in patients with HIV (PHIV). The dignity model, which elucidates the key features of dignity-related distress, has not been applied to the context of stigmatized diseases. By targeting the stigmatized disease of HIV among a Chinese sample, the present study examined the roles of health care neglect and perceived discrimination in dignity-related distress. In this cross-sectional study, 119 Chinese PHIV completed measures of dignity-related distress, psychological symptoms, physical symptoms, health care neglect, and perceived discrimination. The results showed that psychological symptoms, physical symptoms, and health care neglect not only independently predicted dignity-related distress, but also moderated with each other to show a three-way interaction. Perceived discrimination also explained the variance in dignity-related distress. Our findings contribute to the dignity model by providing evidence for factors associated with dignity-related distress, with focus on HIV. Suggestions to advocate for fair treatment for PHIV and reduce HIV-related discrimination are given.

Mediation of Short and Longer Term Effects of an Intervention Program to Enhance Resilience in Immigrants from Mainland China to Hong Kong

Few clinical trials report on the active intervention components that result in outcome changes, although this is relevant to further improving efficacy and adapting effective programs to other populations. This paper presents follow-up analyses of a randomized controlled trial to enhance adaptation by increasing knowledge and personal resilience in two separate brief interventions with immigrants from Mainland China to Hong Kong (Yu et al., 2014b). The present paper extends our previous one by reporting on the longer term effect of the interventions on personal resilience, and examining whether the Resilience intervention worked as designed to enhance personal resilience. The four-session intervention targeted at self-efficacy, positive thinking, altruism, and goal setting. In this randomized controlled trial, 220 immigrants were randomly allocated to three arms: Resilience, Information (an active control arm), and Control arms. Participants completed measures of the four active components (self-efficacy, positive thinking, altruism, and goal setting) at baseline and immediately after the intervention. Personal resilience was assessed at baseline, post-intervention, and 3- and 6-month follow-ups. The results showed that the Resilience arm had greater increases in the four active components post-intervention. Changes in each of the four active components at the post-intervention assessment mediated enhanced personal resilience at the 3-month follow-up in the Resilience arm. Changes in self-efficacy and goal setting showed the largest effect size, and altruism showed the smallest. The arm effects of the Resilience intervention on enhanced personal resilience at the 6-month follow-up were mediated by increases of personal resilience post-intervention (Resilience vs. Control) and at the 3-month follow-up (Resilience vs. Information). These findings showed that these four active components were all mediators in this Resilience intervention. Our results of the effects of short term increases in personal resilience on longer term increase in personal resilience in some models suggest how changes in intervention outcomes might persist over time.

Discrimination and Ethnic Identity as Predictors of Substance Use and Delinquency Among Immigrant Adolescents From the FSU and Ethiopia in Israel

The current study explores perceived discrimination and ethnic identity as predictors of delinquency and substance use among adolescent immigrants in Israel. Theoretically, the study draws from strain theory, immigration-related theories of ethnic identity formation in adolescence, bi-dimensional theories of acculturation, and the rejection-identification model. The study involved 250 adolescents, 140 from the Former Soviet Union (FSU) and 110 from Ethiopia, aged 15 to 18 years ( M = 16.7 years). Adolescents were assessed on substance use (cigarettes, marijuana, binge drinking, drunkenness), delinquent behavior, parental relationships (support, limit setting), perceived discrimination, host identity (Jewish Israeli), and ethnic identity (Russian/Ethiopian). Results from structural equation modeling showed that delinquency was predicted directly by greater discrimination, a weaker ethnic (Russian/Ethiopian) identity, and greater substance (alcohol and cigarette) use. Higher levels of parental limit setting and lower levels of parental support predicted higher levels of substance use, but only predicted delinquency indirectly through their impact on substance use. Findings support the hypotheses that perceived discrimination and a weaker ethnic identity predict involvement in delinquency and partially support a hypothesis that higher levels of a positive host identity are related to lower levels of substance use and delinquency among immigrant adolescents. A perceived lack of equal opportunities may lead to stress, anger, and frustration toward society leading to delinquent behavior, whereas difficulties in consolidating a positive cultural identity may lead the young adolescent to fill a void through substance use.