Prevalence of depression among Asian-Americans

Validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a Moroccan sample with substance use disorder

BACKGROUND

Transcultural validation studies of depression scales are rare in Morocco. The Center for Epidemiologic Studies Depression Scale (CES-D) is commonly one of the most common and frequently used screening instruments for depressive symptoms, but the scale has not, up to date, been validated in dialect of Arabic in Moroccan contexts. Given the importance of assessing and preventing depressive symptoms in our Moroccan context, this study aims to validate the CES-D, translated, and adapted to the dialect of Arabic and Moroccan culture, in a sample with substance use disorder.

METHODS

The data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 140). Then, this structure was confirmed in the validation sample (N = 205) using confirmatory factor analysis (CFA).

RESULTS

Exploratory factor analysis extracted three factors different from the four factors in the original version. Confirmatory factor analysis confirmed the structure of three factors. The fit indices level showed acceptable to good performance of the measurement model. The instrument showed sufficient reliability and convergent validity, as demonstrated by acceptable values of composite reliability (CR = 0.89-0.93) and average variance extracted (AVE = 0.64-0.66), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio (HTMT) of correlations values was less than 0.85, indicating acceptable discriminant validity.

CONCLUSIONS

Overall reliability and both convergent and discriminant validity tests indicated that the Moroccan dialectal Arabic version of the CES-D had a good performance and may serve as a valid tool for measuring the severity of depression in people with substance use disorder.

Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework

OBJECTIVES

Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama.

DESIGN

Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23-75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression.

RESULTS

Perceived race discrimination was significantly associated with greater depressive symptoms (β = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (β = .247, SE = 1.118, p < .001), had lower level of health literacy (β = -.121, SE = .280, p < .05), and had higher social isolation scores (β = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms.

CONCLUSION

Rural-living KA immigrants' depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

Engaging an Asian Immigrant Older Adult in Depression Care: Collaborative Care, Patient-Provider Communication and Ethnic Identity

Minority older adults face multiple barriers when trying to access mental health services and often present with more severe symptoms of mental health conditions. We describe the multilevel factors that contributed to the engagement of an Asian immigrant older adult with depression. Systems-level innovations such as collaborative care in primary care can increase access to care for all, including minority older adults; however, one size fits all interventions may not meet the needs of communities of older adults with different life experiences, language needs, norms and values regarding help-seeking for mental health. Health outcomes remain unequal , suggesting the need to tailor interventions for minority older adults. For the patient, specific factors related to language and ethnic concordance between patient and healthcare provider, communication behaviors, ethnic identity, and social norms may be important to take into account. The recognition of the heterogeneity of patients and the limitations of cultural competence approaches defined as broad, general knowledge about ethnic cultures may be needed. A need to learn continuously from clinical experience and adopt a patient-oriented model of communication and decision-making may successfully engage Asian immigrant older adults in depression care services.

The Relationship Between Acculturative Stress and Postmigration Mental Health in Iraqi Refugee Women Resettled in San Diego, California

Due to the lack of research on the adverse impact of acculturative stress on the mental health, the current study examined the associations between acculturative stress and post-migration mental health outcomes among 219 Iraqi refugee women resettled in San Diego, California. Mental illness, trauma history, and acculturative stress were measured and descriptive statistical analyses, and multivariate logistic regression analyses were conducted to determine the association between acculturative stress, depression, and anxiety among the refugee women.About half of the participants were categorized as having anxiety (45.6%) and depression (55.3%). The multivariate regression analysis found that the odds of a mental health outcome of depression and anxiety in relation to acculturative stress, increases by a factor of 1.056 and 1.076 respectively, for every point increase on the acculturative stress scale.The study's findings reflect a linear association of acculturative stress with depression and anxiety among Iraqi refugee mothers resettled in San Diego. The mental well-being of refugees does not always improve nor does their trauma disappear by resettling in a new country. Policy makers should consider extending the evaluation, follow-up, and support of Iraqi refugee mental health long beyond the current 90 post arrival policy.

The Association Between Perceived Stress and Hypertension Among Asian Americans: Does Social Support and Social Network Make a Difference?

Prior research suggests that stress plays role in the etiology and progression of hypertension. To lend a more accurate depiction of the underlying mechanisms between stress and hypertension, this study aims to assess the associations between perceived stress and hypertension across varying levels of social support and social network among Asian Americans. We conducted a cross-sectional study using data on 530 Chinese, Korean and Vietnamese Americans recruited from a liver cancer prevention program in the Washington D.C.-Baltimore metropolitan area. Hypertension prevalence was 29.1%. Individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (odds ratio 1.61, 95% confidence interval 1.15, 2.46). There was no evidence that social support and social network acted as effect modifiers. Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. The relationship between perceived stress and hypertension was modified by gender and ethnicity whereby a significant positive association was only observed among male or Chinese participants. Our study highlights the importance of understanding the associations between stress, social support, and hypertension among Asian American subgroups. Findings from the study can be used to develop future stress management interventions, and incorporate culturally and linguistically appropriate strategies into community outreach and education to decrease hypertension risk within the Asian population.

The gender ideology of 'Wise Mother and Good Wife' and Korean immigrant women's adjustment in the United States

The notion of 'wise mother and good wife (WMGW)' (Hyonmo Yangcho) is the traditional idealized image of Korean womanhood as one who serves her country and others through her roles as a mother and wife. This ideology may continue to have some significance in the lives of many first-generation Korean immigrant women, but its potential role in the adjustment challenges these women may face while acculturating to the immigrant context in the United States has received little attention. In this paper, we briefly review the historical background of the WMGW ideology and discussed the significance of focusing research attention on the role of this notion in contemporary first-generation Korean immigrant women in the United States. We focus on the intersecting influences of gender, ethnicity, and immigrants' generation status, which may further marginalize some first-generation Korean immigrant mothers. We then outline possible unique challenges faced by some of these mothers due to the WMGW gender ideology, highlighting potential immigration-related difficulties including changes in their social support networks, parenting burden, mental health, and language issues. Finally, we provide suggestions for researchers and practitioners working with U.S. Korean immigrant women.

Health Literacy, Depression Literacy, and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.

Sex Differences, Duration of Stay in the United States, and Serious Psychological Distress: The Case of Middle Eastern Immigrants in the United States

Using data from the 2002-2012 National Health Interview Surveys, this study examines the association between duration of stay in the United States and serious psychological distress (SPD) among Middle Eastern (ME) immigrants and tests whether this association differs by sex. Results show that although ME immigrant women with longer duration are significantly more likely to report SPD than US-born white women, the SPD of ME immigrant men do not significantly differ from that of US-born white men. These findings emphasize the harmful influence of a longer duration of stay in the United States on the SPD of ME immigrant women.

Testing of the factor structure of the Center for Epidemiologic Studies Depression Scale 10 in a sample of Korean "geese" mothers

The author's purpose in this study was to establish the factor structure of the Korean version of the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10) by conducting confirmatory factor analysis based on preexisting models with a sample of Korean transnational mothers (referred to as "geese mothers"). Hundred and fifty-three Korean geese mothers in the USA and New Zealand completed the Korean version of the CES-D 10 questionnaire. The resulting data was subjected to confirmatory factor analysis, which tested three competing models. Our goodness-of-fit indices for the two-factor model indicated an acceptable fit with the current sample. Our results in the present study show that the CES-D 10 can be a useful tool for understanding the concept of depression in Korean geese mothers.

Acculturative Stress, Social Problem Solving, and Depressive Symptoms among Korean American Immigrants

The present study examined the relationship among acculturative stress, social problem solving, and depressive symptoms among 107 Korean American immigrants. Hierarchical regression analysis showed that acculturative stress significantly predicted depressive symptoms controlling for different domains of acculturation. With regard to the role of social problem solving, among the five dimensions of social problem solving (i.e., positive problem orientation, negative problem orientation, rational problem solving, impulsive/careless style, and avoidant style), negative problem orientation and impulsive/careless style significantly predicted depressive symptoms. Avoidant style significantly interacted with acculturative stress, indicating that avoidant style is associated with depressive symptoms when acculturative stress is high. The study underscores the impact of culture as well as severity of stress on the relationship among acculturative stress, coping, and depressive symptoms among Korean American immigrants.

Adaptation Stages and Mental Health of Korean Male Immigrants in the United States

This study examines the variation patterns of Korean male immigrants’ mental health in relation to their length of residence in the United States and identifies significant factors related to the variations. The main hypothesis suggests two critical stages in which Korean immigrants’ mental health would become highly vulnerable—the early exigency stage (1–2 years after immigration) and the later marginality stage (11–15 years after immigration). Hence, the hypothesis predicts a curvilinear (the inverted J-curve) relationship between length of residence and life satisfaction. This hypothesis is tested through an epidemiological survey of 334 Korean male immigrants (20 years and older) in the Chicago area. Results of data analyses generally confirm the hypothesis: 1) the immigrants’ mental health is most highly vulnerable at the early exigency stage, 2) the degree of their mental well-being generally increases with length of residence, 3) the rate of increase in mental well-being tends to stagnate after the resolution stage, confirming the inverted J-curve hypothesis and 4) job satisfaction is the most significant variable accounting for the mental health patterns of the Korean male immigrants. Theoretical and methodological implications of the findings are discussed in the conclusion.

Validation of the Center for Epidemiological Studies Depression Scale among Korean Adolescents

OBJECTIVE

The Center for Epidemiological Studies Depression Scale (CES-D) is designed to measure the current level of depressive symptomatology in the general population. However, no review has examined whether the scale is reliable and valid among children and adolescents in Korea. The purpose of this study was to test whether the Korean form of the CES-D is valid in adolescents.

METHODS

Data were obtained from 1,884 adolescents attending grades 1-3 in Korean middle schools. Reliability was evaluated by internal consistency (Cronbach's alpha). Concurrent validity was evaluated by a correlation analysis between the CES-D and other scales. Construct validity was evaluated by exploratory factor and confirmatory factor analyses.

RESULTS

The internal consistency coefficient for the entire group was 0.88. The CES-D was positively correlated with scales that measure negative psychological constructs, such as the State Anxiety Inventory for Children, the Korean Social Anxiety Scale for Children and Adolescents, and the Reynold Suicidal Ideation Questionnaire, but it was negatively correlated with scales that measure positive psychological constructs, such as the Korean version of the Rosenberg Self-Esteem Scale and the Connor-Davidson Resilience Scale-2. The CES-D was examined by three-dimensional exploratory factor analysis, and the three-factor structure of the scale explained 53.165% of the total variance. The variance explained by factor I was 24.836%, that explained by factor II was 15.988%, and that explained by factor III was 12.341%. The construct validity of the CES-D was tested by confirmatory factor analysis, and we applied the entire group's data using a three-factor hierarchical model. The fit index showed a level similar to those of other countries' adolescent samples.

CONCLUSION

The CES-D has high internal consistency and addresses psychological constructs similar to those addressed by other scales. The CES-D showed a three-factor structure in an exploratory factor analysis. The present findings suggest that the CES-D is a useful and reliable tool for measuring depression in Korean adolescents.

Depression among older Japanese Americans: The impact of functional (ADL & IADL) and cognitive status

PURPOSE

The objective of this article is to investigate the relationship between activities of daily living, instrumental activities of daily living, cognitive impairment, and depression among Japanese American elders.

METHODS

A cross-sectional study of 207 older Japanese Americans (68 years and older) was conducted in Los Angeles, California and Honolulu, Hawaii. Independent variables included activities of daily living, instrumental activities of daily living, and cognitive functioning. Age, gender, marital status, and income were also identified. Depression was the dependent variable.

RESULTS

Descriptive analyses were done to show group differences in terms of gender, age and marital status. Gender (male) and marital status (married) were the determinants of lower rates of depression. Lower rates of IADL and cognitive functioning were significant determinants of higher rates of depression among older Japanese Americans.

CONCLUSIONS

This study provides empirical evidence that physical and cognitive functioning are directly associated with depression in older Japanese Americans. Social workers need to provide the services of ethnic-based via formal agencies in order to prevent depression of older Japanese Americans. Also, it is important to have sensitivity and competency to assess depressive symptoms and refer elders to an appropriate mental health agency.

The conceptualization of depression among Filipino seafarers

The Center for Epidemiological Studies – Depression (CES-D) scale is a well-validated and frequently used measure for assessing symptoms associated with depression. This scale was developed primarily on the basis of American populations, however, and previous research has suggested that the original factor structure may not be appropriate for all populations. One such population is the Filipino population. This study represents the first study we are aware of to examine the factor structure of the CES-D scale in a sample of Filipino seafarers. Seafaring is considered a high stress and high risk occupation. Based on data collected from 135 Filipino seafarers, we conducted factor analyses to identify the appropriate factor structure for the CES-D in this population. We found that a three-factor structure better described the responses of Filipinos in our sample than the standard four-factor structure. The Filipino factor structure appears to collapse depressive affect and somatic factors found in previous research, while including a specific factor of social-focused symptoms of depression. This structure maintains the positive affect factor found in previous work. Implications of this for clinical psychology assessment and practice in the Philippines are discussed.

Prevalence and Predictors of Depression and Anxiety among Korean Americans

Despite the significant growth of the Asian population in the United States, current knowledge on their mental health and service utilization behaviors is very limited. The study examined the prevalence and predictors of depression and anxiety among Korean Americans in the Washington, D.C. metropolitan area. A total of 602 Koreans completed a self-administered survey on physical and mental well-being, and the study found that 18.2% and 16.9% of the participants had severe symptoms of depression and anxiety, respectively. Acculturative stress and perceived social support were common predictors for depression and anxiety, and the effects of demographic factors were minimal.

Quantitative and Qualitative Evaluations of the Enhanced Logo-autobiography Program for Korean-American Women

This study extends Bernstein et al.'s (2016) investigation of the effects of the Enhanced Logo-autobiography Program on Korean-American women's depressive symptoms, coping strategies, purpose in life, and posttraumatic growth by analyzing quantitative and qualitative data. This study's participants significantly improved on quantitative measures of depression, coping strategies, purpose in life, and post-traumatic growth at eight weeks post-intervention and follow-up. The qualitative content analysis revealed 17 themes with five essential themes. The program's activity to promote purpose in life through posttraumatic growth facilitated participants' recovery from traumatic experiences. Standardized guidelines are needed to conduct this program in Korean community centers.

Targeting Body Compassion in the Treatment of Body Dissatisfaction: A Case Study

Mindfulness and acceptance-based cognitive-behavioral therapies (MAB CBTs) are increasingly used in the treatment of body image disturbances. This case report describes an adjunct treatment component targeting body compassion in the course of an MAB CBT for an individual with body dissatisfaction. Body compassion is a new body-focused mindfulness and acceptance-based (MAB) construct that specifically describes the facets of the relationship individuals have with their bodies. The course of treatment included the originally planned MAB CBT protocol plus the additive component for five weekly 50-min individual sessions. During these sessions, body compassion was the primary treatment target. This phase of treatment utilized cognitive defusion, mindfulness, and self-compassion exercises. Over the course of this phase of treatment, the patient’s body compassion and body image flexibility significantly improved. The patient’s presenting symptoms also abated. Improvements were maintained at 1-, 3-, and 18-month follow-up time points. This case study illustrates several clinical strategies and provides initial support for body compassion as a viable treatment target for individuals struggling with body dissatisfaction.

How do people of South Asian origin understand and experience depression? A protocol for a systematic review of qualitative literature

INTRODUCTION

Individuals from Black and Asian Minority Ethnic (BAME) groups are less likely to receive a diagnosis and to engage with treatment for depression. This review aims to draw on international literature to summarise what is known about how people specifically of South Asian origin, migrants and non-migrants, understand and experience depressive symptoms. The resulting evidence base will further inform practices aimed at encouraging help-seeking behaviour and treatment uptake.

METHODS AND ANALYSIS

A systematic review and thematic synthesis of qualitative literature conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Using predefined inclusion and exclusion criteria, electronic searches will be conducted across 16 databases. Study quality will be assessed using the Critical Appraisal Skills Programme (CASP). Data will be extracted independently by 2 reviewers.

ETHICS AND DISSEMINATION

Ethical approval is not required. A comprehensive evidence base of how people from South Asian backgrounds conceptualise and experience depression will better inform the design and delivery of mental health initiatives and advance directions for future research. Findings will be published in a peer-reviewed journal, and disseminated through existing networks for professionals, researchers, patients and the public.

TRIAL REGISTRATION NUMBER

CRD42015026120.

A Cross-Cultural Study of Self-Report Depressive Symptoms among College Students

A study of self-report depressive symptoms as measured by the Zung Self-Rating Depression Scale (SDS) was conducted in three Asian countries-Korea, the Philippines, and Taiwan - and in the United States. Mean scores for the 966 college students varied significantly across countries, with Korean students reporting high levels of depressive symptoms. Further, there are marked differences between countries in symptomatic manifestations, even after controlling for between-country differences in response set and overall level of symptoms. Future research addressed to cross-cultural differences in level and manifestations of depression should incorporate (a) research designs that control for identifiable measurement artifacts and (b) triangulation of measurement strategies.

Asian American and White American Differences on Affective Distress Symptoms

This study examined whether Asian Americans and White Americans would show differential patterns of reporting their levels of depressive and social anxiety symptoms depending on the method of reporting. Standard self-report measures of depressive, social anxiety, and somatic symptomatology as well as measures of cultural self- construal and social desirability were administered twice to Asian American and White American participants. The results showed that there were no interaction effects between ethnicity and reporting method in any of the self-report measures, both ethnic groups reported lower levels of depressive symptoms in interview condition than in written condition, and Asian Americans reported higher levels of social anxiety than White Americans on both interview and written conditions. The findings suggest that although the method of reporting does not differentially affect Asian Americans, there are persistent ethnic differences between Asian Americans and White Americans in the types and levels of distress they report.

Dual Ethnicity and Depressive Symptoms: Implications of Being Black and Latino in the United States

This study investigated the expression of depressive symptoms in adolescents who are of Afro-Latino descent. Levels of expression of depressive symptoms were compared for four groups of adolescents in Grades 7 through 12 residing in the United States: European Americans, African Americans, Latinos, and Afro-Latinos. One hypothesis is that Afro-Latinos should exhibit higher levels of depressive symptoms than either African Americans or Latinos by virtue of being double minorities. An alternative hypothesis is that Afro-Latino youth will show lower levels of depressive symptomology because of their access to a broader repertoire of cultural resources when faced with stress and depression-inducing events. Results indicated that Afro-Latino females tended to exhibit higher levels of depressive symptoms than those of the other ethnic groups. Across all ethnic groups, adolescent females tended to show higher levels of depressive symptoms than adolescent males and older adolescents tended to show higher levels of depression than younger adolescents.

The Ethnic Identity, Other-Group Attitudes, and Psychosocial Functioning of Asian American Emerging Adults From Two Contexts

Drawing from two samples of Asian American emerging adults, one in an ethnicallyconcentrated context ( n = 108) and the other in an ethnically-dispersed, mainly White context ( n = 153), we examined (a) how ethnic identity and other-group attitudes were related to psychosocial functioning (i.e., depression, self-esteem, and connectedness to parents) and (b) how these relations were moderated by context. Results (direct effects) indicated that ethnic identity predicted more positive functioning in terms of self-esteem and connectedness to parents, whereas other-group attitudes predicted more positive functioning in terms of self-esteem and depression. Furthermore, moderated effects indicated that the links with other-group attitudes did not vary with context but that the links with ethnic identity did. Ethnic identity was linked to more positive functioning in terms of depression and connectedness to parents only for those in the ethnically-concentrated context. These findings demonstrate how different types of functioning are differentially influenced by ethnic identity and other-group attitudes and by the contexts in which these identities and attitudes are embedded.

The Revised Ces-D Scale for Caregivers of the Elderly in India

The purpose of this article is to empirically determine the factor structure of the original Radloff's (1977) Center for Epidemiological Studies-Depression Scale (CES-D), on Indian caregivers of the elderly population. The CES-D was administered to 255 caregivers via face to face interviews. The confirmatory factor analysis results did not support the original four-factor theoretical structure, but did suggest a three-factor model. In addition the three-factor version showed high internal consistency among the sub scales. The results of the present study indicate that the revised CES-D scale reflects the difference in the manifestation of depression in caregivers of the elderly in the Indian community in Allahabad, India. This scale should be validated further by replication. Implications for future research are presented.

Mental Health Issues Among Urban Korean American Immigrants

Korean immigrants' perception and understanding of mental health and illness were surveyed during four monthly mental health seminars in New York City. In all, 86 Korean immigrants attended the seminars and 34 completed the survey. The seminar participants were primarily financially stable Korean women who were married, educated, and had lived in America more than 10 years. All seminar leaders were Korean immigrants who were working in the mental health field and/or educational setting. Most of the participants acknowledged the need for mental health services but did not seek professional help and coped with the stressors of immigrant life by endurance, patience, and religion. Feedback from seminar leaders noted the following: (a) greater seminar attendance than anticipated, (b) participants' openness to their mental illness issues, (c) need for tailored mental health program for Koreans. Findings support an understanding of the Korean immigrants' mental health issues as complex, chronic, and serious.

Teaching Gender Issues in Asian American Psychology

This article presents a set of pedagogical approaches and suggested topics and materials for teaching gender issues in Asian American psychology. The experiences of contemporary Asian American women and men must be understood with an appreciation for the larger social, political, and historical contexts in which they live. Thus, several topics designed to “set the stage” for exploration of gender issues are presented. Central issues in teaching gender-related topics within Asian American psychology are discussed under the categories of gender roles, gender stereotypes, and gender differences. Instructors are encouraged to use multimedia resources and interdisciplinary approaches to promote critical thinking about the complex interactions of ethnicity, gender, and the larger sociocultural forces that shape Asian American women and men's psychological experiences.

Are Immigrants Healthier? The Case of Depression among Filipino Americans

Immigration has fundamentally changed American society by increasing racial and ethnic diversity. Yet, our knowledge of the relationship between immigrant status and mental health remains limited. This study provides evidence that Filipino American immigrants have significantly lower levels of depressive symptoms than Filipinos born in the United States, net of gender, age, marital status, socioeconomic status, and place of residence. I also examine the mediating effects of individualism, collectivism, ethnic identification, and perceived racial/ethnic discrimination to understand why immigrants are healthier. Furthermore, my results suggest that age at immigration warrants more attention. Immigrating during childhood predicts significantly higher levels of depressive symptoms in adulthood than immigrating after childhood, independent of the duration of residence in the United States. Although this study is specific to Filipino Americans, it has implications for theories about selective migration and the social psychological ramifications of adapting to American culture as a racial/ethnic minority.

Intent to Seek Counseling Among Filipinos

Cramer’s model of help-seeking behavior posited that self-concealment, social support, attitudes toward counseling, and problem severity are essential in understanding individuals’ intent to seek counseling. Path analysis results from 359 Filipino university students indicated that the original Cramer’s model did not achieve the requisites of good model fit and that social support was not associated with problem severity. After adding loss of face to Cramer’s model, we found positive associations with self-concealment and intent to seek counseling and a negative association with attitudes toward counseling. Multiple group analysis of the expanded Cramer’s model indicated that, apart from social support and problem severity intercept differences, path coefficients, intercepts, and residual variances were invariant across gender. The previously nonsignificant social support to problem severity path is now significant. The addition of loss of face and accounting for gender differences in social support and problem severity improved the model fit of Cramer’s model.

Correlates and Predictors of Psychological Distress Among Older Asian Immigrants in California

Psychological distress occurs frequently in older minority immigrants because many have limited social resources and undergo a difficult process related to immigration and acculturation. Despite a rapid increase in the number of Asian immigrants, relatively little research has focused on subgroup mental health comparisons. This study examines the prevalence of psychological distress, and relationship with socio-demographic factors, and health care utilization among older Asian immigrants. Weighted data from Asian immigrants 65 and older from 5 countries (n = 1,028) who participated in the California Health Interview Survey (CHIS) were analyzed descriptively and in multiple linear regressions. The prevalence of psychological distress varied significantly across the 5 ethnic groups, from Filipinos (4.83%) to Chinese (1.64%). General health status, cognitive and physical impairment, and health care utilization are all associated (p < .05) with psychological distress in multiple linear regressions. These findings are similar to those from previous studies. The findings reinforce the need to develop more culturally effective mental health services and outreach programs.

John Henryism Active Coping, Acculturation, and Psychological Health in Korean Immigrants

This study aimed to explore the levels of John Henryism (JH) active coping and its association with acculturation status and psychological health (specifically perceived stress, acculturative stress, anxiety, and depression) in Korean immigrants to the United States. In 102 Korean immigrants, JH active coping was measured by the JH Scale; acculturation by the Bidimensional Acculturation Scale; perceived stress by the Perceived Stress Scale; acculturative stress by the Social, Attitudinal, Familial, and Environmental Scale; anxiety by the State Anxiety Subscale of the Spielberger State-Trait Anxiety Inventory; and depression by the Center for Epidemiological Studies Depression Scale. The levels of JH active coping in this sample of Korean immigrants appear to be lower than the levels reported in other racial groups. Independent of demographic factors, JH active coping was a significant predictor of higher acculturation status and better psychological health as indicated by lower levels of perceived stress, acculturative stress, anxiety, and depressive symptoms.

Immigration transition and depressive symptoms: four major ethnic groups of midlife women in the United States

The purpose of this study was to explore the relationships between immigration transition and depressive symptoms among 1,054 midlife women in the United States. This was a secondary analysis of the data from two national Internet survey studies. Questions on background characteristics and immigration transition and the Depression Index for Midlife Women were used to collect the data. The data were analyzed using inferential statistics including multiple regressions. Immigrants reported lower numbers of symptoms and less severe symptoms than nonimmigrants (p <.01). When controlling for background characteristics, self-reported racial/ethnic identity and immigration status were significant predictors of depressive symptoms (R(2) =.01, p <.05).

The factor structure of the CES-D in a sample of Rwandan genocide survivors

BACKGROUND

Past research suggests that culture shapes the way psychopathology is experienced and expressed. Standard psychiatric assessment instruments may therefore not capture the same underlying constructs in different contexts. The present study investigated the factor structure of a standard depression scale in a sample of Rwandan genocide survivors.

METHODS

One hundred ninety six Rwandan adults provided socio-demographic information and completed the Center for Epidemiological Studies-Depression scale (CES-D), one of the most widely used self-report instruments assessing depressive symptoms, as part of a larger study on well-being and mental health in Rwanda.

RESULTS

A two-factor solution provided the best fit for these CES-D data. The first factor corresponded to general depressive symptoms (including depressed affect, somatic symptoms, and interpersonal concerns) and explained 37.20% of the variance. The second factor included items assessing positive affect and explained 8.68% of the variance.

CONCLUSIONS

The two-factor solution found in the present study deviates from the commonly reported four-factor structure, but is consistent with studies showing that depressed affect and somatic symptoms may not be experienced as distinct in certain non-Western and minority cultural groups.

Private religious practice, spiritual coping, social support, and health status among older Korean adult immigrants

This study explored the role of spiritual factors and social support on the health status of 246 older Korean adult immigrants age 65 years or older. Ordinary least squares regression results revealed that private religious practice, spiritual coping, and social support were significantly associated with improved health status. However, stressors such as the lack of English proficiency and transportation, longer residency in the United States, and financial problems were significantly associated with lower health status. Social workers need to consider providing appropriate spiritual interventions and social support programs for older Korean adult immigrants so that they may better handle their stressors and health problems.

Factors associated with mental health service utilization among Korean American immigrants

This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services.

Stressors, social support, religious practice, and general well-being among Korean adult immigrants

Through this cross-sectional study the authors explore how stressors, social support, and religious practice are associated with the general well-being of 147 Korean adult immigrants through interviews. Hierarchical regression analysis reveals that low English proficiency and financial hardship are significantly related to low general well-being. However, high social support and religious practice are significantly associated with high general well-being. Social service and health care providers need to carefully assess stressors, social support systems, and spiritual issues for providing appropriate services/programs for English, culture, or social activities as well as spiritual intervention to maximize the strengths of Korean immigrants coping with health issues.

Negative emotions and risk for type 2 diabetes among Korean immigrants

PURPOSE

The purpose of this study is to examine the relationship between negative emotions and bio-behavioral risk factors among Korean immigrants at risk for type 2 diabetes (T2DM).

METHODS

Data were collected from 148 Korean immigrant adults who are "at risk" for T2DM as defined by having family history of T2DM in first-degree relatives, body mass index greater than 23, or history of gestational diabetes in women. Participants completed questionnaires and underwent biological measures. Negative emotions included feeling nervous, hopeless, restless, anxious, and stressed as well as depressive symptoms.

RESULTS

High percentages of participants had T2DM risk factors including overweight, greater than normal waist to hip ratio, and blood glucose readings that are indicative of T2DM. Feeling stressed was the most commonly reported negative emotion (66%), followed by feeling anxious (51%), restless (38%), nervous (30%), and hopeless (13%). Experience of negative emotions was significantly related to behavioral risk factors; higher levels of experiencing negative emotions were related to increased soda intake and a decreased likelihood of doing at least 10 minutes of moderate exercise. Stress and anxiety were each negatively related to moderate exercise, and depressive symptoms were negatively related to both moderate and vigorous exercise. No significant relationship was found between negative emotions and biological risk factors.

CONCLUSIONS

Findings suggest that negative emotions, individually and taken together, may be related to T2DM risk behaviors in high-risk Korean immigrants. Behavioral interventions to prevent T2DM in this population should consider assessing and addressing negative emotions.

Japanese Americans' health concerns and depressive symptoms: implications for disaster counseling

This study examined factors contributing to depressive symptoms among Japanese Americans. Data were collected in Houston, Texas, in 2008, before the March 2011 Japan earthquake, through a community survey including demographic and mental health questions and the Hopkins Symptoms Checklist. Among 43 Japanese American respondents in this convenience sample, the depression prevalence was 11.6 percent. Chi-square results found that having anxiety symptoms and holding a master's degree had statistically significant relationships with depressive symptoms. An independent sample t test found that those having depressive symptoms experienced significantly more health issues than those without depressive symptoms. When these statistically significant variables were entered into a logistic regression model, the overall effect of having health issues, anxiety symptoms, and a master's degree collectively predicted depressive symptoms. It was also found that Japanese Americans rarely consult mental health professionals; in particular, female Japanese American respondents tend to seek help from religious leaders. As implied by these findings, the reluctance of Japanese Americans to seek formal help can be explained by social stigma, a health-oriented approach to treatment, and other cultural considerations. Practice implications focus on disaster counseling with a connection between mental health needs and health care support.

Contributors to depressive symptoms among Korean immigrants with type 2 diabetes

BACKGROUND

Patients with diabetes have a higher prevalence of depression than the general population. Korean immigrants with type 2 diabetes are understudied.

OBJECTIVES

The aim of this study was to identify the prevalence and correlates of depressive symptoms in Korean immigrants.

METHODS

In this cross-sectional descriptive study, a community sample of 164 Korean immigrant adults with type 2 diabetes were assessed for depressive symptoms using the Center for Epidemiological Studies Depression scale. Predictors of depression were grouped into three categories: demographic (age, gender, education, English proficiency), clinical (duration of diabetes, comorbidities, insulin use), and psychosocial (general health, diabetes-related quality of life [QOL], family support).

RESULTS

Approximately 56% of participants had Center for Epidemiological Studies Depression Scale scores of ≥16. Higher levels of depression were associated with greater impact of diabetes on QOL (b = 5.68, p = .001), worse overall health (b = -0.09, p = .012), and less family support (b = -4.02, p = .042). The relationship between depression and diabetes impact on QOL was stronger for men than women (b = 6.67, p = .020).

DISCUSSION

Depressive symptoms are common among Korean immigrants with type 2 diabetes. Assessing diabetes-related QOL, general health, and family support may be of value in better understanding depressive symptoms among this population. Among Korean immigrant men with type 2 diabetes, specific attention should be paid to diabetes-related QOL.

Do Korean Immigrant Adolescents Experience Stress-Related Growth During Stressful Intergroup Contact and Acculturation?

Asian immigrant adolescents have a difficult time adapting to unfamiliar customs and cultural values as well as interacting with other ethnic groups. During intergroup contacts and acculturation, Asian immigrant adolescents have negative experiences such as discrimination experiences, intergroup anxiety, interracial tension, and limited social support. In spite of such stressful and negative life experiences, some research has shown that individuals may develop the ability to thrive or grow from stressful life events. Using grounded theory, we explored the characteristics of positive psychological changes that occurred as the result of stressful intergroup contacts and acculturation from the perspective of Korean immigrant adolescents. We captured three main themes related to stress-related growth: (a) psychological thriving, (b) cultural and ethnic understandings, and (c) culturally attuned relationships. This finding implies that stressful intergroup contacts and acculturation provide an opportunity in which Korean immigrant adolescents develop coping abilities and enhance a sense of personal growth.

Reliability and validity of the Center for Epidemiological Studies Depression Scale in 2 special adult samples from rural China

Few studies on the validation of the Center for Epidemiological Studies Depression Scale (CES-D) in Chinese have been conducted in the samples from rural area, whereas the mental health problems among rural Chinese deserve more attention. For instance, the suicide rate in rural China is about 3 times that of the urban rate. This study aimed at assessing reliability and validity of the CES-D in 2 special adult samples in rural China, with data obtained by face-to-face interviews. One sample consisted of the proxy informants for subjects who committed suicide, and the other was of the proxy informants for living controls. For each person who committed suicide and each control, a family member and close friend served as informants. This study focused on informants themselves (not the persons who committed suicide or the living control himself/herself). Suicide informants (n = 781) who had experienced the suicide of a relative or close friend in the past 6 months were compared with the control informants (n = 832) who had no such experience. Internal reliability was satisfactory (Cronbach coefficients were .949 for suicide informants and .880 for control informants). Good concurrent validity and criterion validity were found by analyzing the relations to negative life events and the Scale for Suicide Ideation. Confirmatory factor analyses indicated that 3-factor structure (positive affect, interpersonal problems, depressive mood and somatic symptoms combined) had good fit in rural Chinese. These findings suggested that the CES-D had good reliability and validity when applied in these 2 adult samples in rural China. Factor structure analyses of the CES-D indicated that "somatization" process of expressing depressive symptoms still existed among rural Chinese.

Problems with the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly: an examination of the factor structure

PURPOSE

The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.

METHODS

The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.

RESULTS

From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.

CONCLUSION

An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

Logo-autobiography and its effectiveness on depressed Korean immigrant women

This study aimed to explore the effectiveness of logo-autobiography (LA) as a therapeutic modality for Korean immigrant women suffering from depression and perceiving their lives as meaningless. A nonrandomized quasi-experimental study was conducted with pretest, posttest, and a 4-week follow-up test. Forty subjects--20 with antidepressants and 20 without--were divided quarterly and assigned to the experimental group and the control group. The experimental group reported a significant lower score on depressive symptoms (F = 6.832, p = .013; F = 19.800, p ≤ .001) and a higher score on meaning of life (F = 12.294, p = .001; F = 12.232, p = .001) than did the control group immediately after completing the LA and a 4-week follow-up. The LA was more effective for the subjects in the nonmedication group than in the medication group. In conclusion, LA is effective in reducing depressive symptoms and increasing a sense of meaning in life among Korean immigrant women suffering from depression.