Stress, illness, and the social environment: depressive symptoms among first generation mandarin speaking Chinese in greater Los Angeles

Bi-dimensional acculturation and social support on perinatal depression in marriage-based immigrant women

BACKGROUND

Sociocultural factors play critical roles in the mental health of marriage-based immigrant women. However, the effect of bi-dimensional acculturation ("adaptation to host culture" and "maintenance of heritage culture") and social support on perinatal depression across time was unknown among them.

OBJECTIVE

To examine the effect of bi-dimensional acculturation and social support on perinatal depression among marriage-based immigrant women in Taiwan.

METHODS

This longitudinal study recruited 310 immigrant mothers to complete structured questionnaires during pregnancy and postpartum periods. Depression was assessed using the Edinburgh Postnatal Depression Scale. Bi-dimensional acculturation was measured using the Bi-dimensional Acculturation Scale for Marriage-Based Immigrant Women. Social support was measured by a three-subscale instrument, namely emotional, instrumental, and informational support.

RESULTS

Depression scores increased from pregnancy to three months postpartum, and decreased from six to twelve months postpartum. The generalized estimating equation results showed that lower adaptation to host culture, emotional support, and informational support were associated with higher maternal depression scores over time. Maintaining heritage culture has both positive (from pregnancy to three months postpartum) and negative associations (from six to twelve months postpartum) with maternal depression, further, increased emotional support enhanced the protective effect of adaptation to host culture, but decreased the positive effect of maintenance of heritage culture on depression.

CONCLUSION

Strategies should be developed to assist perinatal immigrant women to adapt to the host culture, maintain their heritage culture, and resolve potential cultural conflicts to decrease their depression. Respect for immigrant mothers' heritage cultures should be accompanied by increased emotional support.

Assessing the validity, reliability and efficacy of the Cross-Cultural Stress Scale (CCSS) for psychosomatic studies

OBJECTIVE

The impact of stressful life events (SLEs) on health has been empirically studied with significant correlations documented. We developed a comprehensive stress rating toolkit, the Cross-Cultural Stress Scale (CCSS) from a triangulated qualitative research study. This article describes our pilot test of the scale to explore demographic-specific patterns of SLE scores and evaluate the scale's aptitude in assessing the stress-health correlation.

METHODS

The face and content-validated CCSS was shared via a web-based survey to diverse individuals grouped by: (a) gender, (b) age, (c) race and ethnicity, (d) native, foreign-born or first-generation, (e) educational attainment, and (f) income. Participants from the Amazon crowdsourcing marketplace MTurk (N = 216) first indicated perceived stress intensities assuming experiences of all the SLEs in the CCSS. They then selected SLEs they had personally experienced in the last 12 months (N = 176). Multivariable analyses were conducted on perceived intensities. Correlations of experienced SLEs with self-reported health based on the Centers for Disease Control and Prevention (CDC) Health Related Quality of Life (HRQOL) indicators measured by the Behavioral Risk Factors Surveillance System (BRFSS) were analyzed.

RESULTS

We validated the CCSS and obtained a high internal reliability (Cronbach's alpha >0.9). We found significant differences in stress rating by and within demographics. We also correlated stress to perceived health using the HRQOL and presence of a chronic disease ascertaining the stress-health hypothesis.

LIMITATION

Sampling limitations observed include data drawn from a convenience sample.

CONCLUSION

Despite sampling limitations, our research highlights demographic-specific stressors and offers an updated methodology in the stress-health correlation.

A comparative study of domestic decision-making power and social support as predictors of postpartum depressive and physical symptoms between immigrant and native-born women

Background

Women’s participation in decision-making in the household is an indicator of women’s empowerment. Few studies have compared domestic decision-making power and its effect on postpartum health between immigrant and native-born women. This study aimed to examine the effect of domestic decision-making power and social support during pregnancy on predicting postpartum depressive and physical symptoms among immigrant and native-born mothers in Taiwan.

Methods and findings

This prospective study recruited 177 marriage-based immigrant mothers and 230 native-born women who were at least twelve weeks pregnant from hospitals, clinics and health centers. Data were collected in the 2nd or 3rd trimester of pregnancy and at 3 months postpartum from March 2013 to March 2015. Postpartum depression and the severity of postpartum physical symptoms were measured using the Edinburgh Postnatal Depression Scale, and a 17-item, 4-point Likert scale, respectively. Linear regression was used to examine the relationship between “domestic decision-making power and social support during pregnancy” and “depressive and physical symptoms at 3 months postpartum.” Women who had lower domestic decision-making power and social support during pregnancy had higher postpartum depressive and physical symptoms. Those women with full-time employment and insufficient family income had higher postpartum depressive symptoms. Though immigrant women scored lower in domestic decision-making power and social support than native-born women, they had lower mean scores in postpartum depressive and physical symptoms. After accounting for the abovementioned factors, immigrant women remained at lower risk for postpartum depressive and physical symptoms than native-born women. There was significant interaction between domestic decision-making power and immigrant status, suggesting that the association between domestic decision-making and postpartum depressive and physical symptoms was smaller for immigrants than for native women.

Conclusions

Domestic decision-making power and social support during pregnancy are protective predictors of postpartum depressive and physical symptoms. However, the effect of domestic decision-making power appeared to be less salient for immigrants, probably due to the “healthy immigrant effect” and/or lower expectations toward domestic decision-making power among immigrants. The finding that immigrant women demonstrated a lower level of domestic decision-making power suggests that empowerment issues need to be addressed among immigrants.

The moderating role of social support for marital adjustment, depression, anxiety, and stress: Evidence from Pakistani working and nonworking women

BACKGROUND

This study examined how social support moderates the prolongation of mental distress related to depression, anxiety, stress, and marital adjustment in working and nonworking women. The study aimed to reveal the relationship between social support and mental health issues associated with depression, anxiety, stress, and marital adjustment among females.

METHODS

This research study is among the few studies performed in a Pakistani context and was conducted in 2017 to measure affective disorders among nonworking and working married females. Questionnaires were distributed among 500 targeted women, and valid responses were received from married working women in hospitals, banks, and multinational companies, and married nonworking women from residential areas of Islamabad and Rawalpindi, Pakistan. A cross-sectional design with purposive sampling was adapted for this research, and three scales were used to measure stress, anxiety, depression, social support, and marital adjustment and its social and cultural implications among the sampled population.

RESULTS

Social support was positively and significantly associated with marital adjustment, although it showed a negative association with anxiety, depression, and stress in working and nonworking women; this finding reflects the better mental health of the study population. The findings proved that marital adjustment has a negative relation with depression and anxiety in married working and nonworking females. Social support acts as a moderator for marital cohesion, affection, stress, and depression, and the results reflected that nonworking women with higher marital cohesion and affection showed less stress and depression because of social support.

LIMITATIONS

The findings of this sample cannot be generalized to the whole population as they are specific to the targeted respondents only.

CONCLUSION

The study revealed that women's mental health is affected by psychological distress caused by depression, anxiety, stress, social and cultural norms, and their implications. Lower stress and depression lead to better mental health as ostensive social support may help to explain the relationship between depression, anxiety, and stress.

Ethnic Drinking Culture, Acculturation, and Enculturation in Relation to Alcohol Drinking Behavior Among Marriage-Based Male Immigrants in Taiwan

Drinking behavior among immigrants could be influenced by drinking-related cultural norms in their country of origin and host country. This study examined the association of ethnic drinking culture, acculturation, and enculturation with alcohol drinking among male immigrants in Taiwan. This cross-sectional survey recruited 188 male immigrants. Ethnic drinking culture was divided into dry and wet according to per capita alcohol consumption and abstinent rate in the countries of origin in reference to that in Taiwan. A scale, Bidimensional Acculturation Scale for Marriage-Based Immigrants, was developed to measure acculturation (adaptation to the host culture) and enculturation (maintenance of the original culture). Drinking patterns (abstinent, low-risk drinking, and hazardous drinking) were determined by scores on the Alcohol Use Disorder Identification Test. There was a significant interaction between ethnic drinking culture and enculturation/acculturation on drinking patterns. Multinomial logistic regression models identified that for those from dry ethnic drinking cultures, a high level of acculturation was associated with increased low-risk drinking, while a high level of enculturation was associated with decreased low-risk drinking. For those from wet ethnic drinking cultures, a low level of acculturation and high level of enculturation were associated with increased hazardous drinking. High family socioeconomic status was associated with increased drinking, while perceived insufficient family income was positively associated with hazardous use. To prevent hazardous use of alcohol, health education should be targeted at immigrant men who drink, especially among those who have economic problems, are from wet ethnic drinking cultures, and demonstrate low adaptation to the host culture.

Recruiting migrants for health research through social network sites: an online survey among chinese migrants in australia

BACKGROUND

Traditionally, postal surveys or face to face interviews are the main approaches for health researchers to obtain essential research data. However, with the prevalence of information technology and Internet, Web-based surveys are gaining popularity in health research.

OBJECTIVE

This study aims to report the process and outcomes of recruiting Chinese migrants through social network sites in Australia and to examine the sample characteristics of online recruitment by comparing the sample which was recruited by an online survey to a sample of Australian Chinese migrants collected by a postal survey.

METHODS

Descriptive analyses were performed to describe and compare the process and outcomes of online recruitment with postal survey questionnaires. Chi square tests and t tests were performed to assess the differences between the two samples for categorical and continuous variables respectively.

RESULTS

In total, 473 Chinese migrants completed the online health survey from July to October 2013. Out of 426 participants recruited through the three Chinese social network sites in Australia, over 86.6% (369/426) were recruited within six weeks. Participants of the Web-based survey were younger, with a higher education level or had resided in Australia for less time compared to those recruited via a postal survey. However, there was no significant difference in gender, marital status, and professional occupation.

CONCLUSIONS

The recruitment of Chinese migrants through social network sites in our online survey was feasible. Compared to a postal survey of Chinese migrants, the online survey attracted different group of Chinese migrants who may have diverse health needs and concerns. Our findings provided insightful information for researchers who are considering employing a Web-based approach to recruit migrants and ethnic minority participants.