Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants

Trauma, Discrimination, and Psychological Distress Across Vietnamese Refugees and Immigrants: A Life Course Perspective

Vietnamese Americans are a heterogeneous group with varied migration histories. The life course perspective (LCP) suggests that different migration histories (immigrant vs. refugee) may affect their psychological health. Using Vietnamese refugee (n = 291) and immigrant (n = 211) subsamples from the National Latino and Asian American Study, selected LCP factors relevant to foreign-born Vietnamese were examined for their associations with psychological distress. Two separate regressions were conducted to examine differential factors across the subgroups. Results showed that sex, age at immigration, and pre- and post-migration traumas were significant factors for refugees. Among immigrants, only racial discrimination was significant factor. The results suggest that applying LCP among Vietnamese Americans helps to discern factors associated with their psychological distress outcomes depending on their initial immigration status. The results also indicate that healthcare professionals should consider the migration background of foreign-born Vietnamese in screening for potential psychological issues, particularly around their trauma history and discriminatory experiences.

Reliability and Validity of the Vietnamese Depression Interview (VDI)

Current instruments used to aid in the diagnosis of psychological disorders have limited effectiveness with clients from Asian backgrounds. The Vietnamese Depression Interview (VDI) is a diagnostic instrument created to assess the presence of current and lifetime history of major depressive disorder specifically among Vietnamese refugees and immigrants. The purpose of the present study is to provide a description of the VDI, while also noting it as a reliable and valid means by which to assess depression in Vietnamese individuals. Using the Longitudinal, Expert, and All Data (LEAD; Spitzer in Compr Psychiatry 24:399-411, 1983) standard and the VDI, experienced clinicians conducted the diagnosis process with 127 Vietnamese refugees and immigrants. Assessment of the reliability and validity of the VDI yielded good to excellent AUC and kappa values, indicating the reliability of the VDI and the agreement between the LEAD procedure and the VDI. These study results imply that the VDI performs successfully as a diagnostic instrument specifically created for Vietnamese refugees and immigrants in their native language. Current and future contributions of the VDI with Vietnamese individuals are discussed.

Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

The effect of acculturation and social support on change in mental health among young immigrants

The aim of the study was to examine the mediating and moderating roles of social support in the acculturation–mental health link, and to investigate how these processes combine with self-esteem to affect mental health change. Questionnaire data were collected twice from 137 immigrant students, first at the upstart in junior high school, and then again a year later (8th and 9th grade). Acculturation was described in positive terms as a developmental process towards gaining competence within more than one sociocultural setting. Perceived discrimination and ethnic identity crisis were included as risk factors in this process. A model of structural relations was tested, which after some modifications demonstrated a close fit to the data. The results supported our suggestions of two indirect paths of effects of acculturation on mental health change: one through culture domain-specific social support and another through self-esteem. Self-esteem was also identified as a mediator of identity crisis. Significant interaction effects between social support and culture competencies were demonstrated in addition to buffer effects of class and family support in relation to identity crisis and discrimination respectively. The study adds to our understanding of positive and negative developmental pathways in multicultural societies.

Problems of Research on Generations in Psychology

Modern psychology faces many tasks that require the study of social psychological characteristics of representatives of different generations. However, there still is no single, unified concept of generations in the psy¬chological science, which makes research into the subject even more difficult. Basing on a review of Russian and foreign works, the author describes the following three problems of research on generations in modern psychology: 1) The problem of defining the very concept of 'generation'; 2) The problem of defining quantitative and qualitative characteristics of 'generation'; 3) The problem of differentiating between generations. Creating a complex social psychological concept in which a generation would be considered a relatively independent social community of individuals united by common cultural-historical location and common experience may contribute to eliminating these problems. The author argues that generations functioning in society should be differentiated on the basis of the following criteria: historical era, age, family role and identification with one or another generation.

Effect of acculturation and health beliefs on utilization of health care services by elderly women who immigrated to the USA from the former Soviet Union

In this mixed methods study, researchers explored what conditions influence women's use of professional health care services, and how sociocultural environments and acculturation affect utilization of health care services. We recruited 15 women in the Ukraine, 15 women who immigrated from the former Soviet Union, and 10 female U.S. citizens. Data include open-ended interviews, a "general information" questionnaire, and the Language, Identity and Behavioral Acculturation scale. Acculturation levels and length of residency in the United States were not consistent predictors of health-seeking behaviors for immigrants. The stronger predictor of health beliefs and health related behaviors among all participants was their mothers' health beliefs and health related behaviors.

A culturally relevant conceptualization of depression: an empirical examination of the factorial structure of the Vietnamese Depression Scale

BACKGROUND

Despite the high risk of depression among Vietnamese refugees, there has been insufficient attention to the psychometric properties of the most utilized scale, the Vietnamese Depression Scale (VDS: Kinzie et al., 1982).

AIM

The primary aim of the study is to empirically derive the factorial structure of the VDS to support its use as a culturally responsive depression screening tool in community samples of Vietnamese adults.

METHOD

The factorial structure, reliability, and associations of the VDS factors with recognized socio-demographic correlates were examined using data collected from interviews with a non-probability community sample of 180 Vietnamese refugee adults in the Houston area.

RESULTS

The empirically derived factorial structure of the VDS approximated the theorized conceptualization of depression introduced by the scale's originators. Three factors (depressed affect, somatic symptoms, and cultural-specific symptoms) accounted for 65% of the variance. As hypothesized, the VDS factors correlated with age and acculturation variables.

CONCLUSION

Overall results suggest that the conceptualization of depression among this sample of Vietnamese refugees has both universal and culturally specific features. Implications for providing culturally responsive mental health services are offered.

Health status in immigrants and native early adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from "Health Behavior in School Aged Children", a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.

Relationships between culture and health status: a multi-site study of the older Chinese in Canada

This study examined the relationships between culture and the health status of older Chinese in Canada. Data were collected through face-to-face interviews with a cross-sectional, randomly selected sample of 2,272 older Chinese between 55 and 101 years of age in seven Canadian cities. Health status was assessed by the number of chronic illnesses, by limitations in ADL and IADL, and by information on the Medical Outcome Study Short Form SF-36. Although cultural variables explained only a small proportion of variance in health status, having a stronger level of identification with traditional Chinese health beliefs was significant in predicting physical health, number of illnesses, and limitations on IADL. Other cultural variables, including religion, country of origin, and length of residence in Canada, were also significant in predicting some health variables. Interventions to improve health should focus on strategies to enhance cultural compatibility between users and the health delivery system.

The impact of ethnicity and self-reported health on psychological well-being: a comparative study of Kurdish-born and Swedish-born people

Although immigrants generally have poorer health and higher psychological distress than the native population, information on Kurdish immigrants' psychological well-being is limited. The aims of the study were to examine the association between ethnicity and poor psychological well-being, and to assess the relationships between socio-demographic characteristics, self-reported health, somatic pain, gastrointestinal complaints and poor psychological well-being.

METHODS

Immigrants with self-reported Kurdish ethnicity (men, n=111; women, n=86) in Sweden from the national sample of immigrants aged 27-60 and 1407 Swedes (1996) were studied. Unconditional logistic regression was performed using the Stata Software program. In the logistic model adjusted for age, sex, employment and self-reported health, the odds ratio for Kurdish-born subjects for having poor psychological well-being is twice as high as for Swedish-born subjects. Subjects with poor self-reported health had more than a threefold higher odds ratio for having poor psychological well-being compared with those with good self-reported health. Furthermore, being female, having somatic pain and recurrent gastrointestinal complaints regardless of ethnicity increased the odds for having poor psychological well-being. Being Kurdish-born and/or reporting poor health in addition to age, female gender, somatic pain and recurrent gastrointestinal complaints is significantly and independently related to poor psychological well-being even when adjusted for all confounders.

The health of trafficked women: a survey of women entering posttrafficking services in Europe

Trained counselors interviewed 192 women who had been trafficked and sexually exploited about abuse and evaluated their physical and mental health status within 14 days of entry into posttrafficking services. Most reported physical or sexual violence while trafficked (95%), pre-trafficking abuse (59%), and multiple posttrafficking physical and psychological problems. Newly identified trafficked women require immediate attention to address posttrauma symptoms and adequate recovery time before making decisions about participating in prosecutorial or immigration proceedings or returning home.

Predictors of depression in aging South Asian Canadians

This study examined the prevalence and factors of depression among aging South Asians in Canada. Telephone surveys were conducted with a random sample of aging South Asians aged 55 and above. Hierarchical regression analysis was used to determine the factors of depression, which was measured by an adapted 15-item Geriatric Depression Scale. Over one in five (21.4%) participants reported at least a mild level of depression. A stronger agreement with South Asian cultural values was significantly related to a higher probability of being depressed. Physical health variables were the most significant factors after controlling for socio-demographic and culture-related factors. The findings have demonstrated the linkages between the relationships among socio-cultural factors and depression in older South Asians. Mental health interventions should consider the cultural uniqueness of this target population and the service delivery system should ensure that services are known and accessible to the increasingly culturally diverse aging population.

Psychological distress in migrants in Australia over 50 years old: a longitudinal investigation

BACKGROUND

Although it is a well-known fact that migration is a risk factor contributing to psychopathology, little is known in migrants who migrated in their old age. The present study examined whether origin of countries and visa types predicted psychological distress over a period of 1 year and whether their association changed after factors in health, social roles, cohort effect and social support were adjusted.

METHODS

A nationwide representative sample of 431 migrants who aged 50 and above were interviewed in 2000-2001 and 359 of them were re-interviewed 1 year after the baseline assessment. 12-item General Health Questionnaire (GHQ-12) was used measure psychological distress and a series of questions regarding socio-demographic characteristics (age, gender, living alone), days in Australia, origin of countries, visa types, health, social role, cohort effect, and social support were also included.

RESULTS

GHQ-12 scores did deteriorate over a period of 1 year among older migrants to Australia. In multiple regression analyses, origin of countries and visa types were significant predictors of future GHQ-12 scores. Baseline GHQ-12 scores, age, gender, living alone, days in Australia, poor self-rated health, the presence of heart disease, diabetes, and asthma, being a student or economically inactive, widowhood or divorce, as well as education were also significant predictors of GHQ-12 scores at 1-year follow-up.

CONCLUSIONS

The status of refugees predicts future psychological distress in older migrants even when other known correlates of psychological distress are controlled.

Demography, immigration background, difficulties with living in Japan, and psychological distress among Japanese Brazilians in Japan

This study examined the relationship of demography, immigration background, and concerns and difficulties associated with living in Japan to nonpsychotic psychological disturbance (i.e., "caseness") measured by the GHQ-12. Data are from a sample of 265 Japanese Brazilians (JB) residing outside the Tokyo Metropolitan area. Employing multiple logistic regression analyses, it was found that JB who experienced lower economic conditions, lived alone, stayed relatively longer in Japan, migrated to Japan due to their dissatisfaction with the socio-economic conditions in Brazil, and who experienced severe family life concerns had a significantly higher ratio of "caseness," that is psychologically distressed. In contrast, JB over the age of 25 years, who acquired moderate Japanese language proficiency and decided to return to Brazil as soon as possible, were observed to have a significantly lower ratio of psychological distress. Socio-cultural and situational interpretations of the findings are presented.

Positive youth development linked with prevention in a Vietnamese American community: successes, challenges, and lessons learned

PURPOSE

To describe a positive youth development program that was successfully designed and implemented in partnership with a Vietnamese American community and to provide insight into the types of outcomes that can result from such programs in similar communities.

METHODS

In-depth interviews were conducted with Vietnamese community leaders (n = 8) and youth (n = 10) who were involved in a positive youth development program in Oklahoma City. Interviews were tape recorded, transcribed verbatim, and coded by two independent analysts. Data matrices were used to help identify major themes.

RESULTS

Participants felt they had strengthened numerous assets as a result of involvement in the youth development program, including communication with parents or another adult, leadership skills, constructive use of free time, and positive peer influences. Some of the participants also reported establishment of a relationship with a nonparent adult, inclusion of community service in their aspirations for the future, and avoidance of high-risk behaviors owing to their involvement in the program. Both adults and youth felt that the Vietnamese community had changed its perception of youth as a result of increased involvement of young people in community service and cultural activities.

CONCLUSION

Positive youth development is a promising prevention strategy that can be adapted to Vietnamese communities in the United States.

Impact of culture on depressive symptoms of elderly Chinese immigrants

OBJECTIVES

The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada.

METHOD

Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms.

RESULTS

Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive.

CONCLUSIONS

The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.

Mental health, life stress and social support among young Norwegian adolescents with immigrant and host national background

The first aim of the study was to investigate differences in level of mental health, life stress and social support among adolescents with immigrant and domestic background. A second aim was to identify culture group and gender specific sources of risk and protective factors and their relation to mental health. Questionnaire data were collected from 633 students, aged 13, in Oslo, Norway. Immigrant adolescents reported higher level of psychological distress and lower social support than host students. Of the four gender-culture groups, immigrant boys reported the highest level of problems, with a 28% prevalence of anxiety/depression. There were no significant differences in prevalence among the girls. Specific patterns of relationships between life stress, support, and mental health were found across gender and culture. The results were discussed within a framework of culture differences in values and gender role expectancies, underscoring the importance of studying each gender/culture group separately.

Age differences in stress process of recent immigrants

In the present study we sought to examine whether age affects the relationship between stress/social support and psychological distress in community residents in Israel who recently emigrated from the former Soviet Union (FSU). A cross-sectional and partly longitudinal design was used to compare emotional distress, stressor, and social support measures in three age groups (18 to 29, 30 to 59, and 60 to 86 years) of adult immigrants (N = 563). Age-related differences in the parameters of interest and their changes over time were examined with analysis of variance (ANOVA), t tests, and multiple regression analyses. We found that older immigrants reported higher levels of health-related stressors, but did not differ on total social support from younger immigrants. Specific predictors of elevated distress differed by age. For the youngest cohort, these included climate changes and anxiety for the future. For the middle-aged immigrants, these included female gender, lower education, unemployment, and longer time in Israel. For the oldest immigrants, predictors of distress included being divorced, separated, or widowed, and perceiving long-time residents of Israel as hostile. Only the middle-aged cohort showed a significant decline in levels of perceived stressors and distress during a 1-year follow-up. Thus, age differences in the stress process of recent immigrants are associated with age-specific perceived adjustment difficulties and demographic characteristics.

Metric Equivalence Assessment in Cross-Cultural Research: Using an Example of the Center for Epidemiological Studies–Depression Scale

Metric equivalence is a quantitative way to assess cross-cultural equivalences of translated instruments by examining the patterns of psychometric properties based on cross-cultural data derived from both versions of the instrument. Metric equivalence checks at item and instrument levels can be used as a valuable tool to refine cross-cultural instruments. Korean and English versions of the Center for Epidemiological Studies–Depression Scale (CES–D) were administered to 154 Korean Americans and 151 Anglo Americans to illustrate approaches to assessing their metric equivalence. Inter-item and item-total correlations, Cronbach’s alpha coefficients, and factor analysis were used for metric equivalence checks. The alpha coefficient for the Korean-American sample was 0.85 and 0.92 for the Anglo American sample. Although all items of the CES–D surpassed the desirable minimum of 0.30 in the Anglo American sample, four items did not meet the standard in the Korean American sample. Differences in average inter-item correlations were also noted between the two groups (0.25 for Korean Americans and 0.37 for Anglo Americans). Factor analysis identified two factors for both groups, and factor loadings showed similar patterns and congruence coefficients. Results of the item analysis procedures suggest the possibility of bias in certain items that may influence the sensitivity of the Korean version of the CES–D. These item biases also provide a possible explanation for the alpha differences. Although factor loadings showed similar patterns for the Korean and English versions of the CES–D, factorial similarity alone is not sufficient for testing the universality of the structure underlying an instrument.

Cross-cultural comparisons of health status in Canada using the Health Utilities Index

OBJECTIVE

The purpose of this study was to examine the differences in health status, as measured by the Health Utilities Index (HUI), among seven cultural groups in Canada defined by place of birth and language.

DESIGN

The study analysed cross-sectional data from the National Population Health Survey conducted by Statistics Canada in 1994-95.

RESULTS

Age-standardized prevalence of dysfunction, defined as HUI < 0.83, varied from 12.7% in English-speaking immigrants to 17.8% in French-speaking Canadians. Considerable differences between the groups were found in the reporting of pain, emotional function, and cognitive function. The variation in HUI scores across the cultural groups could not be explained by differences in socioeconomic status and self-reported chronic conditions.

CONCLUSIONS

Although the healthy immigrant effect is probably responsible for some of the variation in health status among cultural groups in Canada, considerable differences exist within the immigrant and Canadian-born populations. Cultural factors may have a substantial effect on the reporting of pain and mental health problems. Further studies are needed to determine the cross-cultural validity of the HUI.