A longitudinal investigation of parenting, depression, and counseling use among Asian American adolescents

INTRODUCTION

Asian American adolescents are equally or more likely to experience depression but less likely to seek treatment for depression than adolescents from other racial and ethnic groups in the US. The current study examined the long-term effects of parental care, parental control, and parental closeness on depression and counseling use among Asian American adolescents.

METHODS

Using data from the National Longitudinal Study of Adolescent Health (Add Health), we conducted a cross-lagged path analysis with 270 Asian American adolescents (48.1% female; 51.9% male). The study used data from Waves I, II, and III (1994-2002) with participants' mean ages ranging from 14 to 23.

RESULTS

Findings indicated that the cross-sectional relationships between parenting characteristics and depression were stronger than the longitudinal relationships suggesting that parenting practices may be a stronger proximal, rather than distal, predictor of depression. Specifically, parental closeness was associated with less depression in early and mid-adolescence (age 12-18), but the relationship changed direction in young adulthood (age 18-26). Additionally, a significant interaction suggested that parental care was related to fewer depressive symptoms for those who reported high, compared to low, parental control in mid-adolescence (age 14-18). Furthermore, high parental care was associated with more counseling use at high levels of control. However, high parental care was associated with less counseling use at low levels of parental control in early adolescence.

CONCLUSION

These results highlight the importance of understanding parenting characteristics using longitudinal designs when examining the development of depression and help-seeking behaviors among Asian American adolescents.

Diabetes Distress and Associated Factors Among Chinese Americans with Type 2 Diabetes in New York City

Purpose

The purpose of this study is to describe diabetes distress and related factors among Chinese Americans with type 2 diabetes in New York City (NYC).

Methods

We conducted a secondary data analysis of the baseline data from three research studies conducted among community-dwelling Chinese American adults with type 2 diabetes. Diabetes Distress Scale (DDS) was used to measure sources of diabetes distress including emotional-, regimen-, interpersonal-, and physician-related distress. A score of 2 or greater indicates moderate diabetes distress or higher. Patient Health Questionnaire-2 (PHQ-2) was used to measure depressive symptoms. Participants' sociodemographic information was also collected. Descriptive statistics were used to describe diabetes distress, and logistic least absolute shrinkage and selection operator (LASSO) regression was used to examine factors associated with diabetes distress level.

Results

Data from 178 participants (mean age 63.55±13.56 years) were analyzed. Most participants were married (76.40%), had a high school degree or less (65.73%), had a household annual income < $25,000 (70.25%), and reported limited English proficiency (93.22%). About 25.84% reported moderate or higher overall distress. The most common sources of distress were emotional burden (29.78%), followed by regimen- (28.65%), interpersonal- (18.54%), and physician-related distress (14.04%). Participants who were younger, female, limited English proficient, and had elevated depressive symptoms were more likely to have higher diabetes distress.

Conclusion

Diabetes distress is prevalent among Chinese immigrants with type 2 diabetes, especially emotional- and regimen-related distress. Given the known link between diabetes distress and poor glycemic control, it is critical to screen for diabetes distress at primary care clinics and incorporate psychological counseling in diabetes care in this underserved population.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Social pathways to care: how community-based network ties shape the health care response of individuals with mental health problems

PURPOSE

Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks.

METHODS

The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks.

RESULTS

Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact.

CONCLUSIONS

Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.

Preferred and actual involvement of caregivers in oncologic treatment decision-making: A systematic review

INTRODUCTION

Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the importance of involving caregivers in the treatment decision-making process. We aimed to explore the preferred and actual involvement of caregivers in the decision-making process of patients with cancer and to see if there are age or cultural background related differences in caregiver involvement.

MATERIALS AND METHODS

A systematic review of Pubmed and Embase was performed on January 2, 2022. Studies containing numerical data regarding caregiver involvement were included, as were studies describing the agreement between patients and caregivers regarding treatment decisions. Studies assessing solely patients aged younger than 18 years old or terminally ill patients, and studies without extractable data were excluded. Risk of bias was assessed by two independent reviewers using an adapted version of the Newcastle-Ottawa scale. Results were analysed in two separate age groups, one <62 years and one ≥62 years.

RESULTS

Twenty-two studies with a total of 11,986 patients and 6,260 caregivers were included in this review. A median of 75% of patients preferred caregivers to be involved in decision-making and a median of 85% of caregivers preferred to be involved. With regards to age groups, the preferred involvement of caregivers was more frequent in the younger study populations. With regards to geographical differences, studies performed in Western countries showed a lower preference for caregiver's involvement compared to studies from Asian countries. A median of 72% of the patients reported the caregiver was actually involved in the treatment decision-making and a median of 78% of the caregivers reported they were actually involved. The most important role of caregivers was to listen and provide emotional support.

DISCUSSION

Patients and caregivers both want caregivers to be involved in the treatment decision-making process and most caregivers are actually involved. An ongoing dialogue between clinicians, patients and caregivers about decision-making is important to meet the individual patient's and caregiver's needs when involved in the decision-making process. Important limitations were a lack of studies in older patients and significant differences in outcome measures among studies.

Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

BACKGROUND

Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system.

METHODS

Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model.

RESULTS

A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers' knowledge of PND, perceived need to seek help), interpersonal (new mothers' attitudes towards providers, family support), institutional (providers' perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma).

CONCLUSIONS

The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.

Association Between Social Support and Depression Help-Seeking Behaviors Among U.S. Chinese Older Adults

Objectives: Depression has become one major mental health concern among Asian older adults. Yet, less is known about the role of social support on depression help-seeking among this population. This study examined the association between positive (i.e., open up to, rely on) and negative (i.e., too many demands, criticism) social support and depression help-seeking among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Study sample consisted of 994 U.S. Chinese older adults with depressive symptoms. Results: Stepwise logistic regression results indicated that greater positive social support was associated with increased likelihood of both formal and informal help-seeking behaviors, whereas negative support was not a significant predictor. Discussion: Findings highlight the key role of positive social support in influencing U.S. Chinese older adults' depression help-seeking behaviors. Tailored strategies are recommended to better meet the mental health needs of this vulnerable population.

Churches as agents of community change: An introduction to the issue

Churches are enduring social institutions that play a critical role in the promotion of health and wellbeing. In this introduction, the function of churches as community change agents is highlighted. A brief history of the role of churches in shaping and transforming social systems is provided along with examples of recent church-based change efforts. Further, this issue presents six articles that explore church-based change efforts impacting relationship development, trauma response, wellbeing, pandemic response, and attitudes toward environmental justice. Each article identifies a specific social problem and examines how churches promote prevention and intervention efforts to address the problem. Overall, this issue suggests that churches continue to serve as a resource for community change and that helping professionals should seek to engage with churches when promoting health.

Effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the migrant older with children to Jinan, China

Due to the acceleration of China's urbanization, the number of migrant older with children (MOC) continued to increase. This study aimed to clarify the effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the MOC to Jinan, China. A cross-sectional study included 656 MOC (36.3% men and 63.7% women) using multi-stage cluster random sampling in Jinan, China. Childcare disagreement was evaluated by the differences between parents and grandparents on the diet, dressing, education, and childcare consumption. Social support was assessed using the social support rating scale (SSRS). Descriptive analysis, chi-squared test, and binary logistic regression were applied to analyze the association between childcare disagreement with children, social support, health status, and unmet healthcare-seeking behavior of the MOC. Approximately 41.3% of participants had unmet healthcare-seeking behavior. Logistic regression analysis showed that the MOC whose health status compared to last year get better were more likely to have unmet healthcare-seeking behavior, while who were women, had partial will of migration, hired a nanny, had smaller childcare disagreement with children on dressing, had smaller childcare disagreement with children on consumption, and had moderate social support, were less likely to experience unmet healthcare-seeking behavior. Recommendations were given to the government and family members to improve the health services-seeking behavior of the MOC.

Factors Associated with Mental Health Help-Seeking Among Asian Americans: a Systematic Review

OBJECTIVE

Asian Americans are underutilizing mental health services. The aim of the current systematic review was to identify protective and risk factors of mental health help-seeking patterns among the disaggregated Asian Americans and to classify types of help.

METHODS

A systematic literature review was conducted using the PRISMA guidelines. The Health Belief Model served as the theoretical framework for this review. Thirty-four articles were reviewed, and the studies investigated one of the following Asian ethnic subgroups: Chinese, Filipino, Asian Indian, Korean, or Vietnamese. Data were extracted based on the study characteristics, sample characteristics, and protective and risk factors to mental health help-seeking patterns.

RESULTS

Predisposing factors like female gender, higher levels of English proficiency, and history of mental illness increased the likelihood for help-seeking across several ethnic groups. Interestingly, cues to action and structural factors were under-examined. However, cues to action like having a positive social network did increase the likelihood of using formal support services among Chinese and Filipinx participants. Structural factors like lacking ethnic concordant providers and access to healthcare served as barriers for Korean and Vietnamese participants.

DISCUSSION

The findings showed a need for ethnic tailored approaches when supporting mental health help-seeking patterns. Asian ethnic group's immigration status, acculturation level, and psychological barriers to help-seeking should continue to be emphasized. Psychoeducational groups can be beneficial to expand the knowledge base surrounding mental illness and to link group members to culturally responsive resources.

Is Mental Illness like Any Other Medical Illness? Causal Attributions, Supportive Communication and the Social Withdrawal Inclination of People with Chronic Mental Illnesses in China

The saying "mental illness is like any other illness" has increasingly become pervasive in promoting mental health literacy among the public in China. This discourse is based on the fact that mental illness is attributed to primarily biogenetic causes. This study comprises an investigation of the impact of causal attributions of mental illness on the social withdrawal inclination of people with chronic mental illnesses (PCMIs) in China. Drawing on attribution theory and a sample of PCMIs, the current authors further question the effectiveness of biogenetic discourse to combat social stigma and to integrate PCMIs into society. In addition, in response to the proliferation of discussion on the digital inclusion of those with mental disabilities, this study constructs a structural model in which the varied effects of supportive communication are used as bridging factors, including face-to-face, telephonic and social media communication. The results indicate a stronger social withdrawal inclination when the PCMIs attributed their illnesses to biogenetic causes. In addition, biogenetic attribution was also found to potentially hinder the PCMIs from using the telephone and social media to seek supportive communication, while psychosocial attribution was found to have potential to combat PCMIs' social withdrawal inclination. In this vein, this study calls for further investigation on the conditional factors upon which digital inclusion might work for PCMIs in China.

Mapping the steps to reach psychiatric care in Singapore: An examination of services utilized and reasons for seeking help

OBJECTIVE

The aim of this study is to shed light on the types of services utilized and map the steps taken by patients in their pathways to receiving psychiatric care in Singapore.

METHODS

Participants were outpatients who were recruited from a psychiatric tertiary hospital (n = 323). Pathways to psychiatric care form was administered to collect information on sources of care utilized, reasons for seeking help and the time point of each contact made. Pathways taken by patients to reach psychiatric care were mapped, and reasons for seeking help were reviewed and analyzed. Quantile regression was conducted to explore association between sociodemographic and clinical factors with duration between onset of problem and receiving psychiatric care.

RESULTS

The need to manage symptoms was most commonly endorsed by participants as the reason that first prompted them to seek help. Prior to receiving psychiatric care, participants on average obtained services from 1.2 other care providers and the main pathway to psychiatric services was via primary care and community services (37.2%). The median duration between onset of problem and receiving psychiatric care was 6 months, and age was found to be significantly associated with shorter median duration (β = -0.172, p = 0.009).

CONCLUSIONS

Patients often consult different care providers prior to obtaining psychiatric services and contact was made more frequently via primary care and community care providers. Findings from this study reiterate the need for engaging community partners to render timely and relevant support for individuals with mental health issues.

Experiences and perceptions of perinatal depression among new immigrant Chinese parents: a qualitative study

BACKGROUND

Immigrant status, acculturation level, race and ethnicity have been found to contribute to the utilization of mental health services in the perinatal period. This study explored perinatal experiences and perceptions among Chinese immigrant mothers and their spouses, as well as the possible barriers and facilitators that affect their health care utilization.

METHODS

We recruited 13 women ages 18-35 years born in mainland China, living in Rochester, New York, and residing less than 5 years in the United States. Participants primary language was Mandarin Chinese and all had given birth to at least one live infant within the past 7 years. Participants' age was at least 18 years old at the time of delivery. Five spouses also participated. We divided women in two focus groups and held one focus group for men, with data collection including demographic questionnaires and semi-structured focus group questions conducted in December 2014. Data were analyzed following thematic analysis.

RESULTS

Four themes emerged: experiences of perinatal depression; perceptions of perinatal depression; general preventive and coping strategies; and attitudes toward the supportive use social media applications (apps) and text messaging during the perinatal period. Participants had limited knowledge of perinatal depression and had difficulty distinguishing between normal perinatal mood fluctuations and more severe symptoms of depression. They discussed immigrant-related stress, conflicts with parents/in-laws while "doing the month", the perceived gap between the ideal of "perfect moms" and reality, and challenges with parenting as the causes of perinatal depression. Women approved of screening for the condition but were conservative about follow-up interventions. As for the management of perinatal depression, participants preferred to deal with the problem within the family before seeking external help, due to potential stigma as well as Chinese traditional culture. They were receptive to obtaining pertinent health information from anonymous social media apps, preferring these to personal text messages.

CONCLUSION

The recent immigrant Chinese parents to the United States in the study had limited knowledge of perinatal depression and did not make full use of mental health services for support due to language and cultural barriers. Screening for perinatal depression is only the first step. Future research should explore what interventions may serve as an acceptable approach to overcoming these gaps.

Chinese Women's Acceptance and Uptake of Referral after Screening for Perinatal Depression

China recently issued a national plan on perinatal depression (PND) screening. Previous studies elsewhere suggested that uptake of referral after screening for PND is suboptimal, but little is known in China. In this cohort study including 1126 women in Hunan, we identified women at a high risk of PND using the Edinburgh Postpartum Depression Scale (EPDS) over multiple time points. We texted them and offered free consultations with a psychiatrist/psychologist. Among 248 screen-positive women, only three expressed interest and one attended the appointment. We surveyed the women about their reasons for declining referrals and preferred means of care. Of the 161 respondents, 128 (79.5%) indicated that they could cope with the condition without professional assistance and 142 (88.2%) chose their families as the preferred source of help. Only 15 (9.3%) chose professionals as their first option. Implementing a referral policy for screen-positive women would mean approximately one-third of women who gave birth in China would be eligible. Our result argues against referring all screen-positive women for professional services at this time. Interventions should instead build upon the tradition of family support in a more engaged response. These considerations are relevant for the implementation of national screening for PND in China.

Are Filial Piety and Ethnic Community Engagement Associated With Psychological Wellbeing Among Older Chinese American Immigrants? A Cultural Resource Perspective

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population.

Help-seeking preferences among Chinese college students exposed to a natural disaster: a person-centered approach

BACKGROUND

Direct exposure to natural disasters is associated with increased mental disorders. Help-seeking behaviour among Chinese adults is low and the barriers and facilitators of help-seeking among Chinese adults exposed to natural disasters is understudied.

OBJECTIVE

Using a person-centred approach, this study describes help-seeking preferences and their correlates in a sample of Chinese college students after experiencing Typhoon Hato, the strongest storm to affect Macao, China in the past 50 years.

METHOD

The baseline sample was collected one month following exposure to the Typhoon (September 2017). Six months following the baseline study (April, 2018), a total of 815 students (females = 71.5%) completed follow-up and were included in the data analysis. Latent Class Analysis (LCA) and Multinomial Logistic Regression were used to analyse the data via Mplus 7.4 and Stata 15.0.

RESULTS

Three latent classes of help-seeking preferences were identified in this study, including: 'mental health professionals and close people' (MHPCP, 52%), non-seekers (31%), and 'multiple sources' (17%). The results of multinomial logistic regression showed that region of origin (mainland versus Macao, China), self-stigma, perceived helpfulness of professional mental health help, previous professional help-seeking behaviour, and perceived social support, were significantly associated with MHPCP help-seeking preferences.

CONCLUSION

A large proportion of students preferred to seek support from loved ones and professionals. However, over 30% of the sample preferred not seeking help for mental health concerns. Further research is needed to enhance mental health treatment seeking preferences among Chinese college students.

Seeking Help for Mental Health Problems in Hong Kong: The Role of Family

Family members, rather than mental health professionals, are often the first responders for emotional or mental problems, particularly in Chinese societies where family is regarded as the primary care unit. Using data from the third wave of a representative sample of Chinese adults in the Hong Kong Panel Study of Social Dynamics, we investigate how family, and particularly family functioning, is associated with individual mental health help seeking and perceived barriers to professional service use, and how the associations vary across different generations of immigrants and between individuals with high versus low psychological distress. Our results demonstrate that family is still the primary source of help sought for mental health problems. Stronger family functioning is particularly significant for second-generation immigrants when they consider seeking help from immediate family members. Seeking professional help is uncommon, and stronger family functioning is associated with a lower probability of seeking help from general health professionals and alternative services. A well-functioning family is related to certain structural and cultural barriers to seeking professional help, yet trust in professional mental health services does not diminish along with stronger family functioning, even among the high psychological distress subgroup. The findings indicate that family can facilitate mental illness prevention and service integration. It is recommended that appropriate family support and services be incorporated into mental health treatment according to clients' differential family circumstances.

Psychosis risk stigma and help-seeking: Attitudes of Chinese and Taiwanese residing in the United States

AIM

Intervention during the clinical high-risk phase for psychosis (CHR) can reduce duration of untreated psychosis and associated negative outcomes. Early treatment access and sustained engagement are important to understand for effective intervention. Understanding stigma and help-seeking processes is particularly important for groups that experience mental healthcare disparities such as those of Chinese heritage living in the United States.

METHODS

Chinese and Taiwanese participants (N = 215) residing in the United States were randomly assigned to one of three CHR vignette conditions based on the "what matters most" stigma framework for Chinese groups, which identifies capacities that define "personhood" and thereby shapes stigma for members of a particular cultural group. Participants completed measures of help-seeking attitudes, family stigma and individual stigma.

RESULTS

More stigma towards the CHR vignette character's family was associated with positive CHR help-seeking attitudes. Participants who read the vignette describing CHR affecting family obligations, "what matters most" and participants who read the vignette describing CHR symptomology only had more positive CHR help-seeking attitudes compared to participants who read the vignette describing CHR affecting individual aspirations.

CONCLUSIONS

Chinese and Taiwanese residing in the United States may perceive professional mental healthcare to be especially relevant for persons with CHR when symptoms are particularly stigmatizing for the person's family and when symptoms threaten the person's ability to fulfil family obligations (ie, "what matters most"). Clinical implications of findings include the importance of emphasizing positive treatment outcomes that increase an individual's ability to engage in valued life domains.

Parental attitude toward children's mental disorders and its relationship with help seeking behaviors

Background The purpose of the study was to assess parent's attitudes toward mental illness in children and its relationship with help seeking behaviors. Method This cross-sectional study was conducted in a pediatric psychiatric clinic of under affiliation of Tehran University of Medical Sciences in 2016-2017. All children's parents or guardians who referred for the first time to the clinics were the study population. Convenient sampling was applied and 400 subjects were included by survey method. The data collection tool for this study included a form for demographic data, a questionnaire for assessing parents' attitude toward the causes, behavioral demonstrations and treatment of mental disorders in children, and finally a checklist to determine help seeking behaviors. Descriptive and inferential statistics was applied with SPSS software version 16 for data analysis. Results Of the parents, 93.7% had a good attitude toward mental illness in the three studied realms. Of the parents, 56.25% referred to official sources of help. The results of this research showed that there was a significant difference between the mean scores of parents' attitude (sum of the three areas) in terms of child's gender, parents' marital status, father's job, father's education, and mother's education and there was a significant relationship between help seeking behavior of parents just with fathers' education level (p<0.05). Conclusions The results showed that parents had a good attitude toward their children's mental disorders. However, it should not be overlooked that nearly half of the parents were still referring to unofficial sources of assistance.

Depressive Symptoms Among Older Chinese Americans: Examining the Role of Acculturation and Family Dynamics

Objectives

This study identified the prevalence of depression and tested the influence of acculturation and family dynamics on depressive symptoms, among a community sample of older Chinese Americans.

Method

Data came from a survey of 385 Chinese Americans aged 55 and older (Mage = 72.4 years, SD = 8.7) living in a large metropolitan area in the American Southwest. The survey was administered in 2013 through face-to-face interviews. Depressive symptoms were assessed with the 12-item Center for Epidemiological Studies Depression scale.

Results

Approximately 19.5% of the sample reported mild depressive symptoms and an additional 8.5% reported moderate depressive symptoms. Three-step hierarchical regression analyses indicated that smaller family support network size and more family conflict were risk factors for depressive symptoms. The effect of acculturation was not significantly associated with depressive symptoms after controlling for family dynamics.

Discussion

Family support and conflict play a prominent role in explaining depressive symptoms among Chinese American older adults. The effect of acculturation is minimal when older adults have supportive families and good health. Interventions or services aimed at promoting family harmony for members of this population should be considered.

Research-grade data in the real world: challenges and opportunities in data quality from a pragmatic trial in community-based practices

Randomized controlled trials face cost, logistic, and generalizability limitations, including difficulty engaging racial/ethnic minorities. Real-world data (RWD) from pragmatic trials, including electronic health record (EHR) data, may produce intervention evaluation findings generalizable to diverse populations. This case study of Project IMPACT describes unique barriers and facilitators of optimizing RWD to improve health outcomes and advance health equity in small immigrant-serving community-based practices. Project IMPACT tested the effect of an EHR-based health information technology intervention on hypertension control among small urban practices serving South Asian patients. Challenges in acquiring accurate RWD included EHR field availability and registry capabilities, cross-sector communication, and financial, personnel, and space resources. Although using RWD from community-based practices can inform health equity initiatives, it requires multidisciplinary collaborations, clinic support, procedures for data input (including social determinants), and standardized field logic/rules across EHR platforms.

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants' health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health-related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88-1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46-0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants' health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.

Predicting help-seeking behavior: The impact of knowing someone close who has sought help

OBJECTIVES

This study sought to replicate and extend research on social facilitators of college student's help seeking for psychological problems.

PARTICIPANTS

We collected data on 420 ethnically diverse college students at a large public university (September 2008-May 2010).

METHODS

Students completed a cross-sectional online survey.

RESULTS

We found that students who were aware of close others' (eg, family, friends) help seeking were two times more likely to have sought formal (eg, psychologist) and informal (eg, clergy) help themselves. Tests of moderation revealed the incremental effect (ie, controlling for help-seeking attitudes, internalizing symptoms, cultural demographics) of close others' formal help seeking was strong and significant for men (R² = 0.112), while it was negligible and nonsignificant for women (R² = .002).

CONCLUSIONS

We discuss the importance for students-particularly men-to learn about close others' help seeking for facilitating their own help seeking during times of distress.

Strategies for Working with Asian Americans in Mental Health: Community Members' Policy Perspectives and Recommendations

This qualitative study used snowball sampling of individuals known to provide informal assistance to Asian American community members with their mental health problems in a locality in the South where there has been an exponential increase of the Asian American population. The major themes found include: (1) the existence of cultural, language, knowledge, and transportation barriers and the importance of policy in addressing them; (2) the impact of the model minority myth and the need for inclusive policymaking; and (3) the unique service and policy needs of immigrants. Findings demonstrate the importance and value of including diverse Asian American individuals in mental health policymaking efforts.

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.

Differential Patterns of Healthcare Service Use Among Chinese and Korean Immigrant Elders

Previous studies of healthcare service use among Asian immigrant elders have been conducted in major metropolitan areas with established ethnic enclaves. The factors that affect levels of utilization by Asian immigrant elders who live in places where systematic support from an ethnic community is not readily available are unknown. This study employed the Andersen-Newman healthcare service utilization model to examine unique correlates of healthcare service use among Chinese and Korean immigrant elders. Between 2005 and 2007, we used a snowball sampling method to collect data from Chinese (n = 116) and Korean (n = 101) immigrant elders living in Arizona. We then performed two negative binomial regressions based on ethnic background to identify factors associated with the number of annual physician visits. The results indicated that the number of medical conditions they experienced was positively associated with an increased likelihood of healthcare service utilization for both subgroups. However, the results indicated that each ethnic group had distinctive predisposing (sex and length of US stay for Chinese; marital status for Korean), enabling (English proficiency and cultural gap; insurance status), and need factors (depressive symptoms; self-reported health status) for predicting healthcare service utilization. Asian immigrant elders in this study experienced unique barriers and facilitators based on their ethnic backgrounds. Communicating with these two different groups in their native languages and better understanding their cultural backgrounds are imperative to understanding the factors related to their healthcare service utilization. Thus, rather than viewing Asians as a homogeneous population, the differences found in heterogeneous ethnic groups, such as language and cultural variations, should be taken into account when planning and implementing approaches to intervention.

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients

BACKGROUND

The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge.

METHODS

Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled.

DISCUSSION

Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices.

TRIAL REGISTRATION

This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.

Offline Social Relationships and Online Cancer Communication: Effects of Social and Family Support on Online Social Network Building

This study investigates how social support and family relationship perceptions influence breast cancer patients' online communication networks in a computer-mediated social support (CMSS) group. To examine social interactions in the CMSS group, we identified two types of online social networks: open and targeted communication networks. The open communication network reflects group communication behaviors (i.e., one-to-many or "broadcast" communication) in which the intended audience is not specified; in contrast, the targeted communication network reflects interpersonal discourses (i.e., one-to-one or directed communication) in which the audience for the message is specified. The communication networks were constructed by tracking CMSS group usage data of 237 breast cancer patients who participated in one of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of a diagnosis of primary breast cancer or recurrence at the time of recruitment. Findings reveal that breast cancer patients who perceived less availability of offline social support had a larger social network size in the open communication network. In contrast, those who perceived less family cohesion had a larger targeted communication network in the CMSS group, meaning they were inclined to use the CMSS group for developing interpersonal relationships.

Social support and networks: cardiovascular responses following recall on immigration stress among Chinese Americans

Social support has been shown to act as a buffer for cardiovascular responses to stress. However, little is known about how social support and networks are related to cardiovascular responses to immigration stress recall. The current study evaluated the impact of structural and functional support on cardiovascular reaction following immigrant stress recall provocation as well as the moderation effect of interdependent self-construal among first-generation Chinese immigrants. One hundred fifty Chinese immigrants were recruited in the New York Chinatown area. Participants completed questionnaires assessing their levels of social support and networks, and interdependent self-construal. Following adaptation, participants recalled a recent post-immigration stress-provoking situation. Cardiovascular measures were taken during adaptation, stressor task, and recovery period. Hierarchical multiple regression analysis was performed. Social network size and type, as well as perceived emotional support were positively predictive of systolic blood pressure (SBP) reactivity changes. Instrumental support seeking was a positive predictor of SBP and diastolic blood pressure (DBP) reactivity. The moderation effect between instrumental support seeking and interdependent self-construal were significantly predictive of DBP reactivity and recovery, suggesting that perceptions about themselves in relation to others is a crucial factor for determining whether support seeking is beneficial or not. Social support was not a direct buffer on cardiovascular responses to stress among Chinese immigrants. Chinese values of interdependence and collectivism may partly explain the disconfirming results. Still, when interdependent self-construal was taken into account, Chinese immigrants who had less interdependent self-construal, but solicited more instrumental support, had faster adaptation to stress over the long term.

Disabled Children in Special Education Programs in Taiwan: Use of Mental Health Services and Unmet Needs

Despite national health insurance coverage in Taiwan, many health care needs remain unmet. In the current study, the behavior and emotional problems of 1,042 disabled children in special education programs were evaluated using the Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF). Using the 60th percentile on the two tests as a cutoff representing a clinical indication, students who reached this cutoff point but did not receive mental health services in the past six months were considered to have “unmet mental health needs.” Of the special education students in the study 73.9% reached clinical indications, but did not receive mental health care.

Family involvement for breast cancer decision making among Chinese-American women

BACKGROUND

To describe family involvement in decision making for primary treatment in Chinese-American women with early-stage breast cancer.

METHODS

Qualitative data were collected in 2003 from semi-structured questions in interviews with a sample of Chinese-American (ChA) women with breast cancer, who were recruited from the metropolitan New York area. Responses to the questions were written in Chinese immediately during the interview and read back to the subject for accuracy and validation. Content analysis was used to inductively code and analyze the data to generate themes.

RESULTS

The participants consisted of 123 ChA women with early stage breast cancer with a mean age of 48.7 years (±9.3) and who had lived in the United States a median of 13.6 years. Support and Caring was the major theme that described family involvement in the breast cancer decision-making process. Gathering Information, Being There, Navigating the Health Care System, Maintaining Family Life and Making the Decision described the aspects of family support in the process. The majority of women described the treatment decision making as a collaborative supportive process with the family, but limited English fluency, strong opinions, lack of a shared perspective, distant living proximity and competing work responsibilities of family members were stressful for the women and perceived as non-supportive.

CONCLUSIONS

Family involvement in health care decision making is culturally embedded in Asian populations. Culturally sensitive patient and family consultation strategies are needed to assist informed treatment decision making in Chinese-American women diagnosed with breast cancer. Copyright © 2015 John Wiley & Sons, Ltd.

Current state and recent developments of child psychiatry in China

China has a population of 1.3 billion, of which 238 million are children under age 15. The rapid economic development and social reforms that have taken place in recent years all had a great influence on child and adolescent mental health. Though a nationwide prevalence study for child and adolescent mental disorders in China is lacking, several regional studies have shown the prevalence of mental disorders in children to be close to the worldwide prevalence of 20%. This article reviews the current status of Chinese child psychiatry, the prevalence of specific disorders in China and the influence of culture on the diagnosis and treatment of child and adolescent mental disorders. Several important social issues are also explored in detail, including the one child policy and left-behind children of migrating workers. Changes in family structures along with the growing competitions in life have weakened the traditional social support system. As a result childhood behavioral problems, mood disorders in young college students, substance abuse and youth suicide are all increasing in China. Many who suffer from mental disorders are not adequately cared for because the scarcity of qualified service providers and pathways to care. This article also lists some challenges and possible solutions, including the multidisciplinary and culture sensitive service model for child mental health. Relevant laws, policies and regulations are also introduced.

Family Influences on the Use of Mental Health Services among African Americans

We examine how families influence mental health service (MHS) utilization among African Americans by drawing on the concept of family ambivalence, which encompasses both family support and stress, and by placing utilization within the context of family histories of psychiatric disorder and treatment. Data are from the 2001-2003 National Survey of American Life, a nationally representative sample of African American adults (n = 3,149), including a clinical need subsample (n = 605) of respondents with a disorder. Negative family interactions have indirect positive effects on use of any MHS through need for care, whereas family social support lacks any effect. Although poor self-rated mental health (SRMH) is associated with greater utilization of any and specialty MHS given family histories of no disorder or treated disorder, utilization is low given a family history of untreated disorder, irrespective of SRMH. Screening for family histories of psychiatric disorder in primary care is recommended.

The impact of acculturation and acculturative stress on alcohol use across Asian immigrant subgroups

Acculturation and acculturative stress are examined as predictors of alcohol use among Asian immigrants, using the 2004 National Latino and Asian Americans Survey (NLAAS). Separate regression analyses were conducted for Chinese (n = 600), Filipino (n = 508), and Vietnamese (n = 520) immigrants. Alcohol use varied for the three groups. English proficiency was associated with drinking for all groups. Family conflict was associated with drinking for Chinese immigrants. General acculturative stress and discrimination were associated with drinking for Vietnamese immigrants. Results underscore acculturation and acculturative stress as being contributors to alcohol consumption, and the importance of considering the heterogeneity of Asian immigrants in research on their alcohol use. The study's limitations are noted.

A brief anti-stigma intervention for Chinese immigrant caregivers of individuals with psychosis: adaptation and initial findings

Mental illness stigma has adverse effects on both the caregivers' psychological well-being and the effectiveness of care that consumers receive. While anti-stigma interventions for family caregivers from Western settings have recently shown efficacy, these interventions may not be equally applicable across culturally diverse groups. Specifically, Chinese immigrant caregivers experience heightened internalized stigma, which predisposes the adoption of harmful coping strategies and reduced quality of social networks. We present an anti-stigma intervention based on a peer-family group format, co-led by a clinician and a trained family caregiver, to counter stigma among Chinese immigrants. Data are presented from a brief intervention administered to a pilot sample of 11 Chinese immigrant caregivers that provides: psychoeducation, strategies to counter experienced discrimination, and techniques to resist internalized stigma. Case vignettes illustrate implementation of this intervention, and how the peer-family format via interactive contact counteracts internalized stereotypes, encourages adaptive coping strategies, and reinvigorates social networks. Quantitative results further suggest preliminary efficacy in reducing internalized stigma for caregivers who evidenced at least some prior internalized stigma. This study constitutes an initial but important step towards reducing mental illness stigma among Asian Americans, for whom stigma has played a powerful role in the delay and underuse of treatment.

A mediation model of professional psychological help seeking for suicide ideation among Asian American and white American college students

This study examined professional psychological help seeking among 1,045 white American and Asian American students from 70 U.S. colleges and universities who had seriously considered attempting suicide. The authors found that Asian American college students had lower rates of professional psychological help seeking for their suicide ideation than White American college students. Guided by social network perspectives on professional psychological help seeking, the authors also tested mediators of this racial disparity. Relative to white Americans, Asian Americans were advised by fewer people (especially fewer family members) to seek professional help, which was, in turn, associated with lower rates of professional psychological help seeking for suicide ideation. These findings underscore the importance of gatekeeping as a suicide prevention strategy for Asian American college students.

Practice parameter for cultural competence in child and adolescent psychiatric practice

The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families.

Chinese older adults' resilience to the loneliness of living alone: a qualitative study

OBJECTIVE

The purpose of this study was to investigate resilience factors that help Chinese older adults living alone cope with senses of loneliness.

METHOD

Qualitative in-depth interviews were conducted on 13 older adults living alone in the community who did not show severe loneliness. Trained research assistants conducted interviews guided by semi-structured interview guidelines. The analysis followed a five-step interpretive approach.

RESULTS

The primary theme of resilience was found in cognitive competence, self and personality, and social relations. The secondary theme of resilience showed a family-oriented, relationship-focused resilience coping, which is in line with Chinese culture.

CONCLUSION

This study demonstrated that family-oriented and relationship-focused resilience at the cognitive, self and personality, and social relations levels played significant roles in helping the Chinese older adults overcome their high risk of loneliness. Developing and maintaining dynamic daily rhythms that can integrate family-oriented and relationship-focused coping strategies at the cognitive and social levels are recommended.

Perceived social support, coping styles, and Chinese immigrants' cardiovascular responses to stress

BACKGROUND

Social support and coping strategies are important determinants of health, especially for those in the immigrant community adjusting to a new environment.

PURPOSE

This study assessed the buffering effects of perceived social support and different coping styles on cardiovascular reactivity to stress among Chinese immigrants in the New York City Chinatown area.

METHOD

Participants (N = 50, 76% women, and 22-84 years old) completed questionnaires assessing their perceived social support and coping strategy preferences. They were then asked to recall a stress-provoking event related to their immigration experience in a semi-structured interview format.

RESULTS

Hierarchical multiple regression analyses confirmed the interaction effect between perceived social support and problem-focused, emotion-focused, or reappraisal coping on heart rate reactivity. Additionally, Chinese immigrants who upheld more Chinese values were highly correlated with stronger perceived availability of social support and were more likely to incorporate the use of problem-focused and reappraisal coping styles.

CONCLUSION

Findings suggest that high level of social support and the use of reappraisal coping strategies were associated with attenuated cardiovascular responses to stress.

Acculturation and perceived mental health need among older Asian immigrants

The demographic landscape of the United States is changing as the general population ages and the size of racial/ethnic minority groups grows. Most prior studies on mental health service use among Asians in America have overlooked older adults. A deeper understanding of the way acculturation factors impact help-seeking behaviors among older Asian Americans will inform behavioral health practice and program planners as they address the disparities affecting a diverse racial group. The California Health Interview Survey was used to examine the correlates of perceived mental health need among 980 older Asian immigrants. The study found that English proficiency and other covariates affected how Asian Americans perceived mental health need. Implications for understanding the help-seeking behaviors of older Asian immigrants are discussed.

Help-seeking behaviors among Chinese Americans with depressive symptoms

An exploratory survey indicated that the depression prevalence among Chinese Americans is 17.4 percent. Of 516 respondents, 34.9 percent preferred seeking advice from friends or relatives, followed by 30.2 percent not showing any preference when facing a mental health problem. Logistic regression results pointed to three contributing factors: anxiety problems, acculturation concerns, and domestic violence. Learning from these factors, the authors conducted additional analyses to connect depressive symptoms with demographics to explain the underutilization of mental health services. Significant results showed that male Chinese Americans were more likely than female Chinese Americans to seek help from physicians but less likely to seek help from friends. Those who were not employed were more likely than those who were employed to think that a family problem would take care of itself or to seek help from herbalists, from physicians, or from friends. Implications for social work practice are discussed and address risk factors and multicultural considerations.