Acculturative family distancing (AFD) and depression in Chinese American families

Chronic pain among Asian American children and associations with racial and ethnic discrimination: a nationally representative study

Chronic pain affects up to 20% of children and adolescents and often persists into adulthood. Asian Americans, one of the fastest-growing U.S. minority groups for those under 18 years old, are underrepresented in chronic pain research despite facing racial and ethnic discrimination-a known risk factor for chronic pain. This study examines the prevalence of chronic pain in Asian American youth and its association with racial discrimination. Cross-sectional analysis of the 2016-2022 National Survey of Children's Health (NSCH) was conducted. Caregivers of children aged 3-17 reported if their child had been treated unfairly due to race/ethnicity. Chronic pain was defined as frequent or chronic physical pain over the past 12 months. Rates of chronic pain were compared across racial/ethnic groups, and analyses among Asian Americans (n=13,138) examined associations between discrimination and chronic pain, controlling for sociodemographics, health conditions, and adverse experiences. Asian Americans reported lower chronic pain rates (~2.8-4.9%) than other racial/ethnic groups (~5.1-11%, p<0.0001). Among Asian Americans, chronic pain prevalence was higher in those reporting discrimination (12.7% vs. 2.5%, p<0.0001). Risk factors included older age, female gender, low family income, non-U.S. birth, lower parental education, and adverse childhood experiences. In multivariate analyses, racial discrimination was significantly associated with increased chronic pain prevalence (adjusted prevalence ratio: 2.8, 95% CI: 1.5-5.3, p<0.0001). Asian Americans reported lower overall rates of chronic pain relative to other racial and ethnic groups within the United States. Exposure to racial and ethnic discrimination was associated with a significantly increased probability of reporting chronic pain among Asian Americans. PERSPECTIVES: This work addresses gaps in the literature related to the prevalence of pediatric chronic pain in a national sample of Asian American children. It also examines the unique contribution of race and ethnic discrimination to chronic pain among Asian American children.

The association between cultural and linguistic maintenance and mental health in migrant adolescents: A scoping review

BACKGROUND

Although previous reviews have examined the relationship between heritage cultural maintenance and mental health outcomes among migrants, none have focussed specifically on migrant adolescents (i.e. those aged 10-24 years).

AIMS

To examine (1) the focus, scope and nature of quantitative empirical research investigating heritage cultural maintenance - including linguistic maintenance - and mental health outcomes among migrant adolescents globally and (2) the association between cultural and linguistic maintenance and migrant adolescents' mental health outcomes.

METHOD

Following the Arksey and O'Malley methodological framework for scoping reviews, we searched 11 electronic health, medical, social science and language databases from database inception until the search date (6 June 2023), using English search terms. We extracted data from included empirical studies using a template with pre-defined data items, which we present in comprehensive overviews and narrative summaries.

RESULTS

Thirty-four studies met our inclusion criteria. We identified considerable heterogeneity between studies regarding their research foci, methodologies, terminologies, outcomes and findings regarding the association between cultural maintenance and mental health outcomes. We specifically identified mixed findings regarding the latter, which cannot be transferred or generalised.

CONCLUSIONS

The heterogenous nature of methodologies and outcome measures in the published literature, in addition to a scarcity of research from low- and middle-income countries, have hindered meaningful progress in this field. Efforts to address these issues, and to take adolescent context into consideration, will facilitate a more accurate understanding of how cultural maintenance relates to migrant adolescent mental health, and inform future interventions to improve mental health outcomes.

The darkness of reacculturation: examining factors influencing depression among Chinese international student returnees in the post-COVID-19 era

Introduction

In the aftermath of the COVID-19 pandemic, the reintegration of Chinese international student returnees intersects with China's critical effort to combat a significant brain drain of highly skilled talents, highlighting an unprecedented psychological battleground. This convergence underscores the urgent need for nuanced research to navigate the uncharted territory of their mental health.

Methods

Employing Bayesian analysis supported by Markov Chain Monte Carlo (MCMC) algorithms, this study examined depression prevalence and associated factors among 1,014 Chinese returnees. The sample comprised 44.87% male participants (455), 51.58% female participants (523), and 3.55% identifying as "Others" (36), with an age distribution of 61.74% aged 18-30 (626), 28.80% aged 31-40 (292), and 9.47% aged 41-50 (96). The mean age of participants was 29.6 years, ranging from 18 to 50 years. PHQ-9 diagnoses revealed alarming levels of depression, with 47.9% exhibiting a moderately severe degree of depressive disorder.

Results

Our findings highlight the intricate interplay between identity clusters- "homestayers" (those leaning towards a Chinese cultural identity), "navigators" (those with a bicultural identity), and "wayfarers" (those leaning towards a foreign cultural identity)-and the likelihood of depression. Specifically, homestayers showed a clear and strong negative association, navigators demonstrated a positive association, and wayfarers had a positive yet unclear correlation with depression levels. Furthermore, acculturation, age, and gender showed no significant effects, whereas education mildly mitigated depression.

Discussion

Based on these findings, we suggest the implementation of better-tailored mental health support and policies to facilitate smoother reintegration.

A longitudinal test of acculturative family distancing theory explaining latino/a/x adolescents' adjustment

According to acculturative family distancing theory, adolescents' perceptions of cultural incongruencies with parents can diminish the quality of parent-adolescent relationships and, as a result, harm adolescent adjustment. Using four time points of data for a sample of 547 diverse Latino/a/x adolescents, this study examined how parent-adolescent relationship quality and acculturative family distancing were associated with changes in adolescent school performance and internalizing symptoms. At baseline, the school-based sample ranged from 11- to 14-years-old (M = 12.78) and included slightly more females (55%) than males (45%). Cross-lagged structural equation model results indicated that adolescent reports of greater acculturative family distancing were associated with adolescent perceived increases in parent-adolescent conflict and decreases in parental support. Conflict mediated associations between acculturative family distancing and decreased school performance. Associations between parent-child relationship qualities and Latino/a/x adolescent adjustment were bidirectional.

Review and Implications of Intergenerational Communication and Social Support in Chronic Disease Care and Participation in Health Research of Low-Income, Minority Older Adults in the United States

Background: Health disparities disproportionally affect Black and Hispanic older US adults. Health research is needed to understand and eliminate these disparities; however, older adults, and particularly Black and Hispanic/Latino older adults are underrepresented in health research. Adult children have influenced health behavior and health outcomes of their older parents in several demographics in the US. Analysis of these studies can lead to a model for the development of interventions aimed at improving health and healthcare participation of older Black and Hispanic US adults. Objectives: To review the role of intergenerational communication and social support in health behavior, health research, and health outcomes for older adults and to apply these findings toward a model for health interventions for Black and Hispanic US older adults. Methods: An analytical narrative review and application toward an intervention model. Results: Key topic areas were reviewed and analyzed by examining studies that applied forms of intergenerational communication and/or intergenerational social support with the goal of either improving health, disease management and/or participation in health research in populations world-wide. Next, a model for providing health interventions in older Black and Hispanic US adults was developed using strategies gleaned from the findings. Conclusion: A model for health intervention for Black and Hispanic/Latino US older adults was presented based on an analytical review and intergenerational communication and/or social support. Qualitative data are necessary to understand the enablers and barriers of intergenerational communication and social support to improve health outcomes in these populations.

Predictors of Latent Class Trajectories of Internalizing Symptoms in Latinx Adolescents

Guided by ecodevelopmental theories, the present study examined how both culture-specific and general risk and protective factors across contexts predicted trajectories of Latinx youth's internalizing symptoms during early and middle adolescence. Participants included 547 Latinx youth (M age = 12.80; 55% females) recruited in middle school and followed prospectively across four time points spanning two years. Youth reported on their internalizing symptoms at all four time points, and risk and protective factors were measured at Time 1 (T1). Latent class growth curve modeling was used to examine heterogenous trajectories of change in internalizing symptoms separately for females and males, and risk and protective factors were examined as predictors of class membership. Three classes based on symptom trajectories emerged for both females and males, with most adolescents falling into classes characterized by low symptoms that remained stable or decreased over time. Risk and protective factors were predictive of class membership in theoretically meaningful ways. Some predictors of internalizing symptom trajectories differed between females and males. Findings inform our understanding of factors that influence developmental trajectories in Latinx youth and can contribute to the refinement of prevention and intervention efforts to help ensure the well-being of this population.

Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review

Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community violence. Collectively, the majority of included studies suggest that depressive symptoms were more likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such findings offer a starting point to examine what factors should be necessarily included in related depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms.

Food insecurity among immigrants and refugees of diverse origins living in metropolitan Atlanta: the roles of acculturation and social connectedness

Little is known about the prevalence and correlates of food insecurity among immigrants and refugees. Acculturation and social connectedness may influence food insecurity (lack of access at all times to enough food for an active, healthy life) by affecting a person's ability to access and use governmental and charitable food assistance programs, as well as other community-based or informal food-related resources. We explored associations of acculturation and social connectedness with food insecurity among diverse immigrants and refugees living in metropolitan Atlanta, a major destination for these populations in recent years. From 2017 to 2018, we surveyed 162 adults attending health fairs or programs hosted by two community-based organizations serving immigrants and refugees. Food insecurity within the past year was assessed using the American Academy of Pediatrics' two-item questionnaire. Acculturation indicators included heritage culture and American acculturation scores (Vancouver Acculturation Index), English fluency, heritage language fluency, and percentage of lifetime in the USA. Social connectedness was operationalized using measures of religious attendance and social isolation. We conducted a multivariable logistic regression controlling for age, sex, education, household income, employment status, and household size. In the sample, 51.9% identified as Vietnamese, 16.0% Hispanic, 15.4% Burmese, 14.8% Bhutanese or Nepali, and 1.8% other. The average age was 39.10 (standard deviation [SD] =13.83), 34.0% were male, 73.8% had below a Bachelor's degree, and 49.7% were unemployed. Average scores for American acculturation (mean [M] = 3.26, SD = 1.05, range 1-5) were lower than heritage acculturation (M = 4.34, SD = 0.68, range 1-5). Additionally, 43.4% were fluent in English. Average percentage of life in the USA was 40.59% (SD = 33.48). Regarding social connectedness, 55.9% regularly attended religious services. Average social isolation scores were 3.93 (SD = 1.34, range 3-9). Overall, past-year food insecurity was reported by 17.3% (34.6% in Hispanics, 24.0% in Burmese, 13.1% in Vietnamese, and 8.3% in Bhutanese or Nepali). In adjusted models, food insecurity was associated with English fluency (adjusted odds ratio [aOR] = 0.36, p = .03) and social isolation (aOR = 2.29, p < .001) but not other measures of acculturation or religious attendance. Limited English proficiency may make it more difficult to navigate or use governmental and charitable food assistance programs. Social isolation may hinder individuals from obtaining information about food assistance programs, receiving aid for services navigation, and sharing or borrowing food from family, friends, and neighbors. Interventions should seek to improve access to English language and literacy services, enhance the linguistic and cultural competency of service providers, and build social connectedness among immigrants and refugees.

The Bayesian Multilevel Trifactor Item Response Theory Model

Advancements in item response theory (IRT) have led to models for dual dependence, which control for cluster and method effects during a psychometric analysis. Currently, however, this class of models does not include one that controls for when the method effects stem from two method sources in which one source functions differently across the aspects of another source (i.e., a nested method-source interaction). For this study, then, a Bayesian IRT model is proposed, one that accounts for such interaction among method sources while controlling for the clustering of individuals within the sample. The proposed model accomplishes these tasks by specifying a multilevel trifactor structure for the latent trait space. Details of simulations are also reported. These simulations demonstrate that this model can identify when item response data represent a multilevel trifactor structure, and it does so in data from samples as small as 250 cases nested within 50 clusters. Additionally, the simulations show that misleading estimates for the item discriminations could arise when the trifactor structure reflected in the data is not correctly accounted for. The utility of the model is also illustrated through the analysis of empirical data.

Longitudinal relations of cultural orientation and emotional expressivity in Chinese American immigrant parents: Sociocultural influences on emotional development in adulthood

Research in developmental psychology has traditionally focused on parents' roles as agents of emotion socialization in their children's socioemotional development. By contrast, little longitudinal research has examined sociocultural mechanisms shaping parents' own emotional development. Immigrant parents are an ideal population in which to examine these processes and advance conceptual models of culture and continuing emotional development in adulthood. Using developmental functionalism and bioecological models of development as theoretical frameworks, the present study examined how immigrant parents' and children's cultural orientations were prospectively related to parents' self-reported emotional expressivity in the family context. Chinese American immigrant parents (n = 210) with elementary-aged children were assessed at two time points approximately 2 years apart. Path analyses using longitudinal panel models indicated that immigrant parents' cultural orientation in various cultural domains (language, social relationships, media) prospectively predicted their emotional expressivity in the family context. Parents' emotional expressivity was also predicted by children's cultural orientation and by discrepancies between their own and their children's cultural orientations. Our results underscore pathways through which immigrants' interactions with the family and broader sociocultural context can contribute to continued emotional development in adulthood. We discuss implications of our findings for developmentally informed approaches to the study of culture and emotion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A general Bayesian multilevel multidimensional IRT model for locally dependent data

Many item response theory (IRT) models take a multidimensional perspective to deal with sources that induce local item dependence (LID), with these models often making an orthogonal assumption about the dimensional structure of the data. One reason for this assumption is because of the indeterminacy issue in estimating the correlations among the dimensions in structures often specified to deal with sources of LID (e.g., bifactor and two-tier structures), and the assumption usually goes untested. Unfortunately, the mere fact that assessing these correlations is a challenge for some estimation methods does not mean that data seen in practice support such orthogonal structure. In this paper, a Bayesian multilevel multidimensional IRT model for locally dependent data is presented. This model can test whether item response data violate the orthogonal assumption that many IRT models make about the dimensional structure of the data when addressing sources of LID, and this test is carried out at the dimensional level while accounting for sampling clusters. Simulations show that the model presented is effective at carrying out this task. The utility of the model is also illustrated on an empirical data set.

Examining the Interdependence of Parent-adolescent Acculturation Gaps on Acculturation-based Conflict: Using the Actor-Partner Interdependence Model

While some studies have supported the conceptual models developed to explain how conflict may result from parent-adolescent acculturation gaps within immigrant families, others have produced contradictory findings. Therefore, the Actor-Partner Interdependence Model may be a step toward explaining the discrepancies in the field. It is a model for dyadic data analysis. It differs from prior approaches for assessing acculturation gaps because it considers the interdependence between two family members, suggesting that adolescents' perceived degree of conflict may be a response to their own acculturation (actor effect) and at the same time, to their parents' acculturation (partner effect), and vice versa. The purpose of this study is to assess parent-adolescent acculturation levels on perceived acculturation-based conflict using the Actor-Partner Interdependence Model within Chinese American families (n = 187 dyads). The mean age of the adolescents was 12.3 years old (SD = 0.95). Findings from the study demonstrate that adolescents perceived greater conflict the more they were acculturated but perceived less conflict the more their parents were acculturated. Parents perceived less conflict the higher their adolescents scored on both acculturation and cultural maintenance. However, parents perceived greater conflict the higher they maintained their own culture. Results suggest that the partner effects reveal information that may help clarify whether acculturation gaps are related to conflict within immigrant families.

Acculturative Family Distancing, Mother–Daughter Relationship, and Well-Being Among Asian Americans

This study examined how mother–daughter connectedness may moderate: (a) the effect of acculturative family distancing (AFD) on psychological well-being (PWB), (b) the effect of mother–daughter conflict on PWB, and (c) the mediation effect of AFD on PWB through mother–daughter conflict. Four hundred and ten Asian American students completed an online survey. Our first hypothesis was not supported; the relation between AFD and PWB was significantly negative for those with higher connectedness but not significant for those with lower connectedness. We found support for the second and third hypotheses, whereby the associations were significantly negative at very low levels of connectedness, significantly positive at very high levels of connectedness, and not statistically significant at low, moderate, or high levels of connectedness. Our findings highlight the protective nature of connectedness in the mother–daughter relationship, which challenges the notion that cultural differences within Asian American families are necessarily associated with negative outcomes.

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.

Prospective relations between parent-adolescent acculturation conflict and mental health symptoms among Vietnamese American adolescents

OBJECTIVES

Intergenerational acculturation conflict in immigrant families has been implicated as a risk factor for adolescent maladjustment. However, the directionality and specific family related mediators of this association have not been identified. The present study prospectively examined relations between adolescent reports of perceived acculturation conflict and internalizing and externalizing mental health symptoms. Perceived parent-adolescent relationship strain and perceived parental psychological control were examined as potential mediators.

METHOD

Survey measures were administered to 375 Vietnamese American adolescents (48.8% males; M = 15.55 years, SD = .59) at 3 time points over 6 months.

RESULTS

Using cross-lagged path analysis, perceived acculturation conflict predicted externalizing symptoms, whereas internalizing symptoms predicted perceived acculturation conflict. Perceived maternal psychological control mediated the association between perceived acculturation conflict and later externalizing symptoms, whereas maternal psychological control, parental unresponsiveness, and unmet parent expectations mediated the association between internalizing symptoms and later acculturation conflict.

CONCLUSION

Culturally competent enhancement of parental sensitivity and responsiveness might be targeted as a modifiable protective factor in family-based preventive interventions for at-risk immigrant families. (PsycINFO Database Record

Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data

Neurodevelopmental maturation takes place in a social environment in addition to a neurobiological one. Characterization of social environmental factors that influence this process is therefore an essential component in developing an accurate model of adolescent brain and neurocognitive development, as well as susceptibility to change with the use of marijuana and other drugs. The creation of the Culture and Environment (CE) measurement component of the ABCD protocol was guided by this understanding. Three areas were identified by the CE Work Group as central to this process: influences relating to CE Group membership, influences created by the proximal social environment, influences stemming from social interactions. Eleven measures assess these influences, and by time of publication, will have been administered to well over 7,000 9-10 year-old children and one of their parents. Our report presents baseline data on psychometric characteristics (mean, standard deviation, range, skewness, coefficient alpha) of all measures within the battery. Effectiveness of the battery in differentiating 9-10 year olds who were classified as at higher and lower risk for marijuana use in adolescence was also evaluated. Psychometric characteristics on all measures were good to excellent; higher vs. lower risk contrasts were significant in areas where risk differentiation would be anticipated.

Comparing Mental Health of US Children of Immigrants and Non-Immigrants in 4 Racial/Ethnic Groups

BACKGROUND

To compare the mental health status of children of immigrant (COI) and non-immigrant (NI) parents and to determine whether differences in mental health status between COI and NI vary across 4 racial/ethnic groups.

METHODS

We conducted universal mental health screening of 2374 sixth graders in an urban public school district. To screen, we administered well-validated adolescent depression and disruptive behavior problem questionnaires. We evaluated associations between child mental health, parent immigration status, and race/ethnicity using binomial regression.

RESULTS

Among Asian American/Pacific Islanders and Latinos, COI had significantly higher depression and disruptive behavior scores compared to NI. For Blacks/African Americans, children of NI parents had significantly higher disruptive behavior scores compared to COI. For European Americans, scores of COI and NI did not differ and were relatively low.

CONCLUSION

Our study suggests that how the emotional health of COI is faring relative to children of NI depends on the child's race/ethnicity.

Acculturation Gap Distress among Latino Youth: Prospective Links to Family Processes and Youth Depressive Symptoms, Alcohol Use, and Academic Performance

Latino youth have higher rates of educational and mental health difficulties compared to peers from other racial/ethnic groups. To understand the factors related to such maladjustment, a mediational model linking youth report of parent-youth acculturation gaps to prospective changes (from spring to fall semester) in youth report of academic performance, depressive symptoms and alcohol use via youth report of parent-youth conflict and family cohesion, was studied in a sample of 248 U.S.-and foreign-born Latino youth (Mage = 15.21 years; 50% female; 67% U.S.-born). Parent-youth acculturation gaps were associated with changes in youth academic performance across two semesters via their negative impact on family functioning. For U.S.-born youth, parent-youth acculturation gaps were also linked to changes in alcohol use via parent-adolescent conflict. Results provide some support for the acculturative gap hypotheses while unique findings across nativity groups suggest that such individual-level characteristics may serve as important sources of variation for Latino youth.

An Integrated Conceptual Framework for the Development of Asian American Children and Youth

The diversity of circumstances and developmental outcomes among Asian American children and youth poses a challenge for scholars interested in Asian American child development. This article addresses the challenge by offering an integrated conceptual framework based on three broad questions: (a) What are theory-predicated specifications of contexts that are pertinent for the development of Asian American children? (b) What are the domains of development and socialization that are particularly relevant? (c) How can culture as meaning-making processes be integrated in conceptualizations of development? The heuristic value of the conceptual model is illustrated by research on Asian American children and youth that examines the interconnected nature of specific features of context, pertinent aspects of development, and interpretive processes.

Effects of maternal traumatic distress on family functioning and child mental health: An examination of Southeast Asian refugee families in the U.S

BACKGROUND

The psychological effects of trauma are well-documented among refugee adults and children alone, yet less research has attended to the intergenerational transmission of trauma within refugee families. Additionally, there is considerable diversity between refugee populations as well as within-group variation in the experiences and effects of refugee trauma.

OBJECTIVE

The current study examines the longitudinal effects of maternal traumatic distress on family functioning and child mental health outcomes among Southeast Asian refugee women and their adolescent children. Given the potential for variation in these effects, we also explore group differences in these relationships by ethnicity and child nativity.

METHODS

Longitudinal data were collected from a random sample of 327 Southeast Asian refugee mothers and their children in the United States. We employed structural equation modeling to examine associations between latent variables representing maternal traumatic distress, family functioning, and child mental health outcomes (i.e., depressive symptoms, antisocial and delinquent behavior, and school problems). We then tested for group differences in these associations by ethnicity (Cambodian and Vietnamese subgroups) and child nativity (U.S.-born and foreign-born children).

RESULTS

We found maternal traumatic distress was indirectly linked to child mental health outcomes, and that child nativity was associated with these paths while ethnicity was not. For foreign-born children, maternal traumatic distress was associated with diminished family functioning a year later, which was associated with increased school problems at the two-year mark. Maternal traumatic distress was indirectly associated with depressive symptoms and antisocial and delinquent behavior, respectively, after accounting for family functioning. For all children, weaker family functioning was significantly associated with poorer mental health.

CONCLUSIONS

Findings suggest that refugee parents' trauma can adversely affect family relationships and the mental health of children. Interventions that address parental trauma and support intergenerational relationships may enhance mental health within refugee communities for future generations.

Family Efficacy within Ethnically Diverse Families: A Qualitative Study

Family efficacy, which refers to a family's belief in its ability to produce a desired outcome, has been shown to protect adolescents from risky health behaviors. Few studies have examined family efficacy within diverse populations, however, and understanding of how efficacy is framed and formed within the context of cultural and familial values is limited. This descriptive qualitative study examined sources of family efficacy within ethnically and socioeconomically diverse families, evaluating how such families develop and exercise family efficacy with the intent to protect adolescents from risky health behaviors (i.e., marijuana and alcohol use and early sexual activity). We collected qualitative data via two semi-structured interviews, 4-6 months apart, with 31 adolescents (ages 12-14) and their parent/s, for total of 148 one-on-one interviews. Thematic analysis identified three distinct domains of family efficacy: relational, pragmatic, and value-laden. Prior experiences and cultural background influenced the domain/s utilized by families. Significantly, families that consistently tapped into all three domains were able to effectively manage personal and family difficulties; these families also had family strategies in place to prevent adolescents from risky behaviors. Health professionals could utilize this concept of multidimensional family efficacy to promote health within culturally diverse families.

The Enculturation Experience of Three Chinese American Adolescents

The authors designed a qualitative, multiple case study that employed the photovoice method to explore how enculturation is experienced by three Chinese adolescents living with their families in a nonethnically dense cultural community. A total of 18 one-on-one interviews were conducted with three youth and their parents. Photos were also used as elicitation tools to understand the meaning of enculturation for each individual. Case descriptions of each adolescent are presented, followed by five cross-case themes: (a) Self-Identifying as Chinese, (b) Parental Strictness, (c) Multiple Groups of Comparison, (d) (Not) Having a Chinese Community, and (e) Messages to Excel. The findings provide a descriptive understanding of how adolescent enculturation is shaped by the family, community, and their intersections. Implications for research and practice, such as the continued need to understand enculturation as a dynamic phenomenon and process, are presented.

Culturally Adapted Cognitive-Behavioral Therapy for Chinese Americans With Depression: A Randomized Controlled Trial

OBJECTIVE

No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults.

METHODS

This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12.

RESULTS

Participants in CA-CBT demonstrated a greater overall decrease in depressive symptoms compared with participants in CBT, but the groups had similarly high depression rates at week 12. Differences in dropout rates for the two groups approached, but did not meet, statistical significance (7%, CA-CBT; 26%, CBT).

CONCLUSIONS

Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT demonstrated significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.

Adolescents in conflict: Intercultural contact attitudes of immigrant mothers and adolescents as predictors of family conflicts

Recent research demonstrates that intergenerational differences in immigrant families' adaptation can be detrimental for family functioning. However, most of the findings originate from immigrant groups in North America who face different situations compared with European Diaspora returnees. This comparative study investigated whether ethnic German Diaspora immigrant adolescents' and mothers' disagreement about the desirability of adolescents' intercultural contact with native peers relates to more conflict in the family domain. In addition, we accounted for general developmental factors predicting family conflict by considering adolescents' background in terms of prosocial behaviour and hyperactivity. Participants comprised 185 Diaspora immigrant mother-adolescent dyads from the former Soviet Union living in Germany (adolescents: mean age 15.7 years, 60% female) and 197 native German mother-adolescent dyads (adolescents: mean age 14.7 years, 53% female). Results indicated a similar level of family conflict in immigrant and native families. However, conflict was elevated in those immigrant families disagreeing on intercultural contact attitudes, independent of the significant effects of adolescents' background of prosocial behaviour or hyperactivity. Our study highlights potential side effects in the family domain, if immigrant adolescents and parents disagree in their attitude regarding adaptation to the host culture's life domains, such as contact with native peers.

Exploratory examination of the relationship between acculturation and personal growth among Korean immigrants

Korean immigrants are motivated to accept new cultural perspectives and/or transform their own cultural values into those of their new country. During this acculturation process, they encounter cultural differences, make adaptations, and thus may experience positive changes in social relationships, coping resources, personal strength, and cultural knowledge. The purpose of this study was to investigate the relationship between the dimensions of acculturation and personal growth. The results indicated that two dimensions of acculturation (e.g., self-control and collectivism), age, and length of stay were predictors of personal growth that involves social relationships, personal resources, life philosophy, and coping skills. This study suggests that high scores on two acculturation dimensions indicated lower acculturation, which predicts personal growth.

Exploring Culturally Based Intrafamilial Stressors Among Latino Adolescents

Despite the profound impact that intrafamilial stressors, including parent - adolescent acculturation discrepancies, may have on Latino adolescent behavioral and mental health, this line of research remains underdeveloped. The purpose of this study is to obtain rich descriptions from Latino adolescents of the most salient intrafamilial stressors. The authors employ focus group methodology with a grounded theory approach. A total of 25 focus groups were conducted with 170 Latino adolescents in the Northeast and Southwest United States. Findings indicate that Latino adolescents experience significant stressors related to parent - adolescent acculturation discrepancies. From this qualitative study the authors derive a series of testable hypotheses aimed at fully understanding the role of parent - adolescent acculturation discrepancies on Latino adolescent behavioral and mental health and informing the development of culturally responsive preventive interventions for this population.

The Exploration of Acculturation and Health Among Immigrants From Non-Eastern Cultures

Literature on acculturation has been mainly focused on how acculturation influences the perception of health and well-being among immigrants from non-Western cultures. Conversely, we sought to explore immigration experiences associated with health and well-being among immigrants from non-Eastern cultures during their acculturation process. With a sample of 9 participants, we identified two major themes as outcomes of acculturation: psychological well-being and social benefits. We found that during acculturation, Western immigrants improved their sense of happiness, experienced reduced stress, and discovered meaning through activities, and that overall, acculturation facilitated personal growth. In addition, they developed a sense of cross-group friendships with Korean people and facilitated group cohesion within their own ethnic group. Further implications and future research avenues are discussed.

Predictors of immigrant children's mental health in Canada: selection, settlement contingencies, culture, or all of the above?

BACKGROUND AND STUDY AIMS

A previous publication from the New Canadian Children and Youth Study, a national study of immigrant children and youth in Canada, showed a gradient of levels of emotional distress with children from Hong Kong (HK) at the most severe end, Filipino children at the least severe, and children from the People's Republic of China (PRC) in between. Based on the premise that country of origin can be regarded as an index for differing immigration trajectories, the current study examines the extent to which arrival characteristics, resettlement contingencies and cultural factors account for country of origin variations in immigrant children's mental health. Arrival characteristics included child's age at arrival, parental education, parental fluency in English or French, and assistance from family at arrival. Resettlement contingencies included parental mental health, intra-familial conflict, settlement stress, separations from parents and child's age when mother started working outside the home. Cultural factors included one-child family composition and parenting styles.

METHODS

A national survey of 2,031 families with at least one child between the ages of 4 and 6 or 11 and 13 from HK, the PRC and the Philippines was conducted with the Person Most Knowledgeable (PMK) in snowball-generated samples in 6 different cities across Canada. Predictors of the dependent variable, emotional problems (EP), were examined in a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; arrival characteristics were added in model 2; resettlement contingencies in model 3 and cultural factors in model 4.

RESULTS

The final set of predictor variables accounted for 19.3 % of the variance in EP scores among the younger cohort and 23.2 % in the older. Parental human and social capital variables accounted for only a small amount of the overall variance in EP, but there were statistically significant inverse relationships between EP and PMK fluency in English or French. Settlement contingencies accounted for a significant increase in the explanatory power of the regression equation, net of the effects of country of origin and selection characteristics. This block of variables also accounted for the Filipino mental health advantage. Levels of parent's depression and somatization, harsh parenting, intrafamilial conflict, and resettlement stress each varied directly with levels of children's EP. Cultural variables made a significant contribution to explaining the variance in EP scores. Harsh parenting was significantly associated with increased levels of EP in both age groups, and supportive parenting was a mental health protective factor for younger children.

CONCLUSIONS

Immigrant family human and social capital, according to which immigrants are selected for admission to Canada, play a relatively small role in determining children's mental health. These effects are overshadowed by resettlement contingencies and cultural influences. Concentrating on trying to find a formula to select the "right" immigrants while neglecting settlement and culture is likely to pay limited dividends for ensuring the mental health of children.

Acculturation and its implications on parenting for Chinese immigrants: a systematic review

PURPOSE

To systematically review and synthesize existing findings on acculturation and its implications on parenting for Chinese immigrants.

METHOD

Three electronic databases were searched for original research articles that examined acculturation and its influence on parenting in Chinese immigrants.

RESULTS

Twenty-two studies were included. Findings suggest that acculturation influences parenting beliefs, attitudes, and practices, as well as parent-child relationships among Chinese immigrants. Acculturation discrepancies between parents and children are associated with negative child outcomes.

DISCUSSION AND CONCLUSIONS

Further research is needed to better understand the relationships among acculturation and parenting perceptions, parent-child relationships, and parent-child acculturation discrepancies and associated child outcomes. In particular, longitudinal studies with larger samples and multiple methods are needed to suggest causal inferences and validate these relationships.

IMPLICATIONS FOR PRACTICE

Nurses are at the unique junction to identify these problems through interacting with individuals and families at the clinical and mental/community health levels.

The immigrant paradox among Asian American women: are disparities in the burden of depression and anxiety paradoxical or explicable?

OBJECTIVE

We evaluated potential explanations for advantaged mental health status among immigrant Asian American women compared to U.S.-born Asian American women.

METHOD

In a nationally representative sample of 1,030 women (185 U.S.-born, 368 early-life immigrants [arrived before 25 years of age], 477 late-life immigrants), we examined the hypothesis that increased exposure to social risk factors mediate nativity-based differences in lifetime prevalence of depression and anxiety disorders. Indicators of social class were also examined as protective factors enjoyed by U.S.-born women that may suppress observed nativity-based disparities. We also examined whether there were group differences in reactivity to stress in predicting disorder.

RESULTS

U.S.-born women were twice as likely as late-life immigrants to report lifetime history of depression (odds ratio [OR] = 2.03, 95% CI [1.35, 4.54]) and anxiety (OR = 2.12, 95% CI [1.34, 5.19]). Nativity differences in perceived discrimination, family conflict, and cultural conflict explained disparities in rates of disorder. There was no support for the contention that immigrant women were more psychologically hardy or resilient to social stress.

CONCLUSION

Findings suggest that the gap in mental health status between U.S.- and foreign-born Asian American women would indeed be magnified if differences in social status were accounted for, but also that ready explanations for the so-called immigrant paradox are found in differential levels of reported stress exposure.

The experience of acculturative stress-related growth from immigrants' perspectives

Previous literature has mainly focused on the positive effects of stress associated with disability and illness, called stress-related growth. Little research has explored positive changes as a result of acculturative stress among a group of immigrants. In particular, older Asian immigrants may experience a high level of stress related to acculturation because they may face more challenges to adapt to and navigate a new culture. This study was designed to capture the characteristics of stress-related growth associated with acculturative stress. Using in-depth interviews among 13 older Korean immigrants, three main themes associated with the stress-coping strategies were identified: (a) the development of mental toughness, (b) engagement in meaningful activities, and (c) promotion of cultural understanding. These themes indicate that by following the stressful acculturation process, participants developed a better understanding of the new culture, engaged in various leisure activities, and enhanced mental strength. This finding provides information on how immigrants deal with acculturative stress and have positive psychological changes, which results in a sense of happiness and psychological well-being.

Language spoken at home and parental birthplace moderate the association of race/ethnicity and distorted weight perception

Distorted weight perception (DWP), specifically overestimating weight status, is common in adolescents and may lead to eating disorders. The authors examined the role of acculturation proxies as effect modifiers of the relationship between race/ethnicity and DWP in a diverse adolescent population. Analysis of the 2005 California Health Interview Survey showed that of 2955 adolescents with underweight or healthy weight status, 10.6% reported DWP. Latino adolescents had increased odds of DWP compared with white adolescents (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [CI] = 2.00, 4.57). Latinos who spoke English and other language(s) at home (aOR = 3.38; 95% CI = 2.11, 5.41) and Latino (aOR = 5.00; 95% CI = 2.34, 10.72) and Asian (aOR = 3.10, 95% CI = 1.15, 8.35) adolescents who spoke no English at home had increased odds of DWP compared with white, English-only speakers. Latino adolescents had increased odds (aOR = 3.98, 95% CI = 2.45, 6.47) of DWP if neither parent was US born. Assessing acculturation proxies may help identify adolescents at risk of DWP.

Family conflict among Chinese- and Mexican-origin adolescents and their parents in the U.S.: an introduction

This volume explores how cultural and family contexts inform parent-adolescent conflict and adjustment among Chinese- and Mexican-origin families in the United States. Collectively, the chapters examine outcomes associated with family conflict and provide an in-depth analysis of how and for whom conflict is related to adjustment. Findings, for example, illustrate how cultural factors (e.g., acculturation) modify the links between conflict and adjustment. Furthermore, the collection allows for a simultaneous examination of normative, everyday parent-adolescent conflict and conflict that is specific to the process of cultural adaptation, and furthers our understanding of how both developmental and cultural sources of conflict are linked to adjustment.

Conflicts and communication between high-achieving Chinese American adolescents and their parents

Drawing on in-depth interview data collected on 18 high-achieving Chinese American students, the authors examine domains of acculturation-based conflicts, parent and child internal conflicts, and conflict resolution in their families. Their analyses show that well-established negative communication patterns in educational expectations, divergent attitudes toward other races and country of origin, and cultural and language barriers contributed to parent-child conflicts. Their findings also illustrate important internal conflicts both adolescents and parents had along the cultural tightrope of autonomy and relatedness. Finally, the vertical in-group conflict resolution style that was evidenced in youths' accounts raises questions about cultural differences in constructive versus destructive conflict resolution styles.

Testing the moderating effect of parent-adolescent communication on the acculturation gap-distress relation in Korean American families

Although the acculturation gap generally has been associated with poor mental health outcomes among Asian American children, some studies have failed to find a significant relationship between the gap and distress. Using two different methods of operationalizing the gap between mothers and their children, the current study addressed this tension in the literature by testing the following hypotheses in a sample of Korean American families. It was hypothesized that mother-adolescent discrepancies in acculturation and enculturation levels would be associated with youth internalizing and externalizing symptoms and that parent-adolescent communication would moderate the gap-distress relationship. Multi-informant questionnaires were administered to 77 Korean American mother-adolescent dyads from the Midwest. Surprisingly, results indicated that consonance in low levels of mother-adolescent enculturation was associated with the highest levels of externalizing symptoms (interaction term method). Adolescents' perception of communication with their fathers significantly moderated the relationship between the enculturation gap and internalizing symptoms, such that in dyads with a greater enculturation gap, less perceived open communication with fathers was associated with more internalizing symptoms (difference score method). Clinically, the findings indicate a potential target (i.e., parent-adolescent communication) for treatment programs that aim to improve family relations and youth adjustment in immigrant families.