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

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity

BACKGROUND AND OBJECTIVES

As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups.

RESEARCH DESIGN AND METHODS

Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations.

RESULTS

Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites.

DISCUSSION AND IMPLICATIONS

Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

Asian American mental health: Longitudinal trend and explanatory factors among young Filipino- and Korean Americans

OBJECTIVES

This study examined a longitudinal trend of mental health among young Asian Americans during the transition from adolescence to emerging adulthood and investigated explanatory factors of the trend.

METHOD

We longitudinally followed a cohort of Filipino American and Korean American youth and their families in Midwest since 2014 (N = 1,574 in Wave 1). This study used three waves of youth data (n = 781, M AGE  = 15 in W1).

RESULTS

Depressive symptoms and suicidal ideation significantly increased among the samples between 2014 and 2018, which also became more serious in severity. Intergenerational cultural conflict in the family and the experience of racial discrimination significantly contributed to the upsurge of mental health distress. Conversely, a strong peer relationship and ethnic identity were critical resources suppressing both depressive symptoms and suicidal ideation.

CONCLUSIONS

This study substantiated a troubling upward trend in mental health struggles among young Asian Americans and demonstrated a significant additive influence of culture and race/ethnicity on mental health beyond the normative influences of family process and peers. These key factors should be targeted in intervention to better serve Asian American young people who may mask their internal struggles.

Unmet Mental Health Need Among Chinese and Latino Primary Care Patients: Intersection of Ethnicity, Gender, and English Proficiency

BACKGROUND

Ethnic minorities who present with mental health symptoms in primary care are less likely to receive treatment than non-Hispanic whites; language barriers may magnify this disparity.

OBJECTIVE

We examined the contributions of ethnicity, gender, and English proficiency to unmet mental health need.

DESIGN

Cross-sectional study.

PARTICIPANTS

Chinese and Latino primary care patients with a preferred language of English, Cantonese, Mandarin, or Spanish.

MAIN MEASURES

Participants were interviewed within 1 week of a primary care visit and asked whether in the prior year they (1) needed help with emotional or mental health symptoms and (2) had seen a primary care physician or a mental health professional for these symptoms. Among those who reported "mental health need," we defined "unmet mental health need" as no reported use of services for these symptoms. Regression models explored independent and interaction effects among ethnicity, gender, and English proficiency, on the two outcomes.

KEY RESULTS

Among 1149 participants (62% women; 262 Chinese, with English proficiency [EP], 532 Chinese, with limited English proficiency [LEP], 172 Latino with EP; and 183 Latino with LEP), 33% reported mental health need. Among Chinese, but not Latino, participants, those with LEP were more likely than those with EP to report mental health need (AOR 2.55, 95% CI 1.73-3.76). Women were more likely to report mental health need than men (AOR 1.35, 1.03-1.79) regardless of ethnicity or English proficiency. Among participants reporting mental health need, 41% had unmet mental health need. Men with LEP, compared with those with EP, were more likely to have unmet mental health need regardless of ethnicity (AOR 2.53, 1.06-6.04).

CONCLUSIONS

We found high levels of mental health symptoms and unmet mental health need in both Chinese and Latino primary care patients. These results affirm the need to implement depression screening and targeted treatment interventions for patient subgroups at highest risk of untreated symptoms, such as men with LEP.

The prevalence of depression in patients living with implantable cardioverter defibrillator: a systematic review and meta-analysis

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD.

METHODS

In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator."

RESULTS

We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046).

CONCLUSION

Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

Health literacy, depression, and stress among Chinese immigrants in South Korea

OBJECTIVES

This study examined health literacy, depression, and stress in Chinese immigrants living in South Korea, and analyzed factors related to these outcomes.

DESIGN

This is a cross-sectional, descriptive study.

SAMPLE

Participants were 128 adult Chinese immigrants living in the Jung-gu District of Seoul, South Korea. The majority of the participants were women and in their 40s; had a high school diploma; and were employed and married. Most had lived in Korea for 5-10 years.

MEASUREMENTS

Outcome variables were health literacy, depression, and immigrant stress; independent variables were sociodemographic characteristics, language proficiency, health, and behavioral factors. Hierarchical multiple regression models based on the conceptual framework were tested.

RESULTS

The major factor influencing health literacy was perceived economic status (p = 0.021). The factors related to depression were life satisfaction in China (p = 0.032), life satisfaction in Korea (p = 0.040), and stress perception in everyday life (p = 0.001).

CONCLUSIONS

As the number of immigrants rises, there is increasing demand for public-health-center-based health promotion programs for immigrants. It is recommended that local public health practitioners, including public health nurses, closely analyze the characteristics of their community and immigrants, and develop and implement customized programs accordingly.

Racial/ethnic differences in experimental pain sensitivity and associated factors - Cardiovascular responsiveness and psychological status

This study evaluated the contributions of psychological status and cardiovascular responsiveness to racial/ethnic differences in experimental pain sensitivity. The baseline measures of 3,159 healthy individuals-non-Hispanic white (NHW): 1,637, African-American (AA): 1,012, Asian: 299, and Hispanic: 211-from the OPPERA prospective cohort study were used. Cardiovascular responsiveness measures and psychological status were included in structural equation modeling based mediation analyses. Pain catastrophizing was a significant mediator for the associations between race/ethnicity and heat pain tolerance, heat pain ratings, heat pain aftersensations, mechanical cutaneous pain ratings and aftersensations, and mechanical cutaneous pain temporal summation for both Asians and AAs compared to NHWs. HR/MAP index showed a significant inconsistent (mitigating) mediating effect on the association between race/ethnicity (AAs vs. NHWs) and heat pain tolerance. Similarly, coping inconsistently mediated the association between race/ethnicity and mechanical cutaneous pain temporal summation in both AAs and Asians, compared to NHWs. The factor encompassing depression, anxiety, and stress was a significant mediator for the associations between race/ethnicity (Asians vs. NHWs) and heat pain aftersensations. Thus, while pain catastrophizing mediated racial/ethnic differences in many of the QST measures, the psychological and cardiovascular mediators were distinctly restrictive, signifying multiple independent mechanisms in racial/ethnic differences in pain.

A systematic review of correlates of depression among older Chinese and Korean immigrants: what we know and do not know

OBJECTIVES

Guided by the stress and coping theory, this study provides a systematic review of existing research on acculutration, family support, and social support related correlates of depression among older Chinese and Korean immigrants in the United States.

METHOD

A comprehensive literature search was conducted in CINAHL Plus, Abstracts in Social Gerontology, AgeLine, Social Work Abstracts, PubMed, PsychINFO, and Social Science Citation Index databases to identify relevant articles that presented multivariate analysis results.

RESULTS

A total of 55 articles were identified, with the vast majority focusing on older Korean immigrants. The overall evidence showed that length of residence was largely unrelated to depression, and poor Enligsh proficiency also had a weak correlation with depression. However, a low level of acculturation measured by multidimensional scales was consistently associated with more depressive symptoms. Overall, living arrangements and the size and frequency of contact of both kin and non-kin networks were weak correlates of depression. In contrast, negative family and social interactions seem to be more consequential for depression in the two groups than positive relations and support.

CONCLUSION

The findings show that established acculturation instruments are useful tools to identify at-risk older Chinese and Korean immigrants. Future studies need to further examine which aspects of acculturation experience are more influential for immigrants' mental health. Although often conceptualized as important coping resources, family and social networks could present significant stressors for older immigrants. Future research and services could focus on these contexts to improve the mental health of these two rapidly increasing Asian populations.

The Relationship Between Intimate Partner Violence and Suicidal Ideation among Young Chinese, Korean, and Vietnamese American Women

High depression and suicide rates are critical problems that have a significant impact on the lives of young Asian American women. Intimate partner violence (IPV) has been identified as a predictor of suicidality in general female samples, but no research study has examined the relationship between IPV and suicidality in a sample of 1.5 and second-generation Chinese, Korean, and Vietnamese American women. We used data collected from 173 women (aged 18-35 years) who were screened for eligibility to participate in the development and efficacy study of Asian American Women's Action for Resilience and Empowerment (AWARE). We measured the prevalence of (a) IPV, (b) lifetime suicidal ideation/intent, and (c) childhood abuse and tested the association between IPV and lifetime suicidal ideation/intent among study participants who completed the clinical screening assessments. The results indicated that seven out of 10 women in our sample experienced lifetime suicidal ideation/intent, psychological aggression was the most commonly reported form of IPV during the last six months, followed by sexual coercion, and history of physical and/or sexual partner violence had the most robust association with lifetime suicidal ideation/intent after controlling for demographic factors and childhood abuse. Our study suggests that suicide prevention and intervention programs for young 1.5 and second-generation Asian American women should not only address experiences of childhood abuse, but also incorporate culturally adapted behavioral health approaches to identify and target physical and sexual partner violence. Furthermore, any such programs need to integrate a systemic approach in addressing IPV within the context of various marginalized experiences of Asian American women.

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.

Current Smoking Behavior Among Medical Students in Mainland China: A Systematic Review and Meta-Analysis

This study aimed to estimate the prevalence of current smoking among medical students in mainland China through a systematic search across 6 electronic databases for English or Chinese studies published before May 25, 2018. A total of 79 studies were included; 26 had a high risk of bias. The overall pooled prevalence of current smoking was 10.93% (7460/68 253; 95% confidence interval = 0.09%, 13.08%, I² = 98.6%). This study found a decreasing prevalence of current smoking over the period studied (survey year range of 1988-2014). More specifically, the current smoking prevalence in males decreased progressively across time, while the prevalence in females remained relatively constant. The overall prevalence in the west was higher than in the middle or east of mainland China ( P = .0061). The overall prevalence of current smoking increased with year in school ( P = .0028). The present study provides a comprehensive synthesis of current smoking prevalence among medical students in mainland China. Although there have been some improvements in the status of tobacco use among medical students, given the leading role of physicians in tobacco control, sustained efforts are needed to curb the tobacco epidemic among medical students.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans

OBJECTIVES

Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans.

METHODS

This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists.

RESULTS

A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences.

CONCLUSIONS

Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

Voices of the Filipino Community Describing the Importance of Family in Understanding Adolescent Behavioral Health Needs

Filipinos are a large, yet invisible, minority at high risk for adolescent behavioral health problems. Limited research describes the family as offering a source of positive support for some Filipino youths and yet for some it is also a source of stress and isolation, leading to struggles with adolescent depression and suicidal behavior. This article describes a qualitative study that investigates the role of family when understanding behavioral health needs among Filipino adolescents. Findings highlight the importance of addressing family cohesion when designing interventions aimed at improving the well-being of Filipino youth.

Major depression disorder trajectories and HIV disease progression: results from a 6-year outpatient clinic cohort

Contradictory evidence exists on the role of Major depression disorder (MDD) as a predictor of human immunodeficiency virus (HIV) disease progression, particularly regarding the effect of MDD presence versus pattern of illness. The objective of this study was to examine whether MDD status and pattern of illness differentially predict HIV disease progression. Retrospective cohort data from a six-year follow-up of HIV patients at an outpatient clinic were analyzed. MDD trajectories were identified by latent class growth analysis and generalized linear mixed models were used to examine their relation to low CD4+ T-lymphocyte counts (<200 cells/μL) during follow-up. Among 1,494 HIV patients, four MDD trajectory groups were identified: Low-Chronic, Moderate-Ascending, High-Episodic, and High-Chronic. Trajectory group membership was predicted by male sex (P = .04), minority race (P < .01), older age (P < .01) and low baseline CD4 count (P = .04). The High-Chronic group had lower odds of having a low CD4 count than the Low-Chronic group (adjusted Odds Ratio [aOR]: 0.63; 95%CI: 0.49-0.81) while the Moderate-Ascending group had higher odds (aOR: 1.53; 95%CI: 1.08-2.19). The odds of having a low CD4 count were higher among male (aOR: 1.25; 95%CI: 1.03-1.52), minority races (American Indian [aOR: 1.85; 95%CI: 1.38-2.49] and African Americans [aOR: 1.58; 95%CI: 1.33-1.87]), Hispanic (aOR: 1.52; 95%CI: 1.06-2.18), and divorced/separated patients (aOR: 1.62; 95%CI: 1.16-2.28) but decreased over time (P < .01) across trajectory groups. In this study, because MDD trajectories and CD4 counts were determined based on secondary data abstracted from electronic medical records, the results should be interpreted cautiously due to the potential for selection and misclassification bias. Overall, study findings suggest the pattern of MDD illness among HIV patients can be classified into clinically meaningful trajectory groups that appear to be programmed by known risk factors, and are useful for predicting HIV disease progression. Targeted interventions among at-risk patients may be critical to altering MDD illness patterns and curtailing HIV disease progression.

Prevalence of Depression in the Community from 30 Countries between 1994 and 2014

The prevalence of depression may be affected by changes in psychiatric practices and the availability of online mental health information in the past two decades. This study aimed to evaluate the aggregate prevalence of depression in communities from different countries between 1994 and 2014 and to explore the variations in prevalence stratified by geographical, methodological and socio-economic factors. A total of 90 studies were identified and met the inclusion criteria (n = 1,112,573 adults) with 68 studies on single point prevalence, 9 studies on one-year prevalence, and 13 studies on lifetime prevalence of depression. A random-effects model meta-analysis that was performed to calculate the aggregate point, one-year and lifetime prevalence of depression calculated prevalences of 12.9%, 7.2% and 10.8% respectively. Point prevalence of depression was significantly higher in women (14.4%), countries with a medium human development index (HDI) (29.2%), studies published from 2004 to 2014 (15.4%) and when using self-reporting instruments (17.3%) to assess depression. Heterogeneity was identified by meta-regression and subgroup analysis, and response rate, percentage of women and year of publication, respectively, were determined contribute to depression prevalence. This meta-analysis allows benchmarking of the prevalence of depression during the era when online health information emerged, facilitating future comparisons.

Cross-national comparisons of increasing suicidal mortality rates for Koreans in the Republic of Korea and Korean Americans in the USA, 2003-2012

AIMS

Korea has the highest suicide rate of developed countries, two times higher than the USA. Suicide trends among Koreans Americans living in the USA during the same period have not yet been described. We report suicide mortality rates and trends for four groups: (1) Korean Americans, (2) non-Hispanic White (NHW) Americans, (3) selected Asian American subgroups and (4) Koreans living in the Republic of Korea.

METHODS

We used US national (n = 18 113 585) and World Health Organization (WHO) (n = 232 919 253) mortality records for Korea from 2003 to 2012 to calculate suicide rates, all expressed per 100 000 persons. We assessed temporal trends and differences in age, gender and race/ethnicity using binomial regression.

RESULTS

Suicide rates are highest in Koreans living in the Republic of Korea (32.4 for men and 14.8 for women). Suicide rates in Korean Americans (13.9 for men and 6.5 for women) have nearly doubled from 2003 to 2012 and exceed rates for all other Asian American subgroups (5.4-10.7 for men and 1.6-4.2 for women). Suicide rates among NHWs (21.0 for men and 5.6 for women) remain high. Among elders, suicide in Korean Americans (32.9 for men and 15.4 for women) is the highest of all examined racial/ethnic groups in the USA.

CONCLUSIONS

Suicide in Korean Americans is higher than for other Asian Americans and follows temporal patterns more similar to Korea than the USA. Interventions to prevent suicide in Korean American populations, particularly among the elderly, are needed.

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.

Effects of mind-body interventions on depressive symptoms among older Chinese adults: a systematic review and meta-analysis

OBJECTIVE

To determine the efficacy of mind-body interventions in depressive symptoms treatment among older Chinese adults (>60 years of age).

METHODS

We searched MEDLINE, PsycINFO (Ovid), Embase (Ovid), CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Literature Database, and Chongqing VIP for eligible studies until September 2016. We reviewed randomized controlled trials investigating the efficacy of mind-body interventions for depressive symptoms among Chinese older adults. Two authors independently conducted screening, and risk of bias assessment. Data were extracted by one author and crosschecked by the research team. Cohen's d standardized mean differences were calculated to represent intervention effects.

RESULTS

A comprehensive search yielded 926 records; 14 articles met inclusion criteria. Relative to the control groups, mind-body interventions had large short-term effects in reducing depressive symptoms in older Chinese adults (standardized mean differences = -1.41; 95% CI [-1.82, -0.99]). Most studies did not report the long-term effects of mind-body interventions. Subgroup analyses by type of mind-body interventions, participants' age group, and control condition yielded different effect sizes; however, these differences did not all reach a statistically significant level. The interpretation of the subgroup analysis should be considered with caution given its observational nature and a small number of included studies.

CONCLUSIONS

This systematic review suggests that mind-body interventions had short-term effects in alleviating depressive symptoms among older Chinese adults. Further research (randomized controlled trials with active controls and follow-up tests) are needed to assess the effects of mind-body interventions on depressive symptoms among this population. Copyright © 2017 John Wiley & Sons, Ltd.

Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes

BACKGROUND

Comorbid depression and diabetes mellitus (DM) compound challenges to disease management such as low health literacy, insufficient access to care, and social or linguistic isolation. Korean Americans (KAs), predominantly first-generation immigrants, suffer from a high prevalence of type 2 DM and depression. Limited research on KAs has prevented the development of effective interventions.

OBJECTIVES

To compare the prevalence of depression in KAs with DM and all Americans with/without DM, and to explore correlates of comorbid DM and depression and strategies to address KAs' DM and depression.

METHODS

KAs' data were from a clinical trial of a community-based self-help intervention to improve KAs' DM and mental health outcomes. National Health and Nutrition Examination Survey data sets enabled comparison. Clinical indicators included hemoglobin A1C, lipid panel, and body mass index. Psychobehavioral indicators included self-efficacy for DM management, quality of life, and depression (Patient Health Questionnaire-9 (PHQ-9)).

RESULTS

More KAs with DM had depression (44.2%) than did all Americans with DM (28.7%) or without DM (20.1%). Significantly more KAs with DM had mild (29.3%) or clinical (14.9%) depression than did Americans with DM (mild, 17.2%; clinical, 11.5%) or without (mild, 13.8%; clinical, 6.3%). One of six KAs with DM (16.9%) thought of suicide or self-harm (Americans with/without =5.0%, 2.8%). The self-help intervention reduced the mean PHQ-9 from 5.4 at baseline to 4.1 at 12 months.

LIMITATIONS

External validity might be limited; KAs' data were from one study site.

CONCLUSIONS

The prevalence of depression and DM among KAs warrants the development of efficacious interventions.

TRIAL REGISTRATION NUMBER

NCT01264796.

Depression in the Family of Patients With Dementia in Korea

INTRODUCTION

Dementia is the leading cause of disability worldwide in the elderly individuals. Although prior studies have examined psychiatric symptoms in dementia caregivers, few studies have examined physician-diagnosed depression in the family caregiver of a patient with dementia.

METHODS

We used data from 457 864 respondents from the Korea Community Health Survey. We used logistic regression to examine the relationship between physician-diagnosed depression and cohabitation with a patient with dementia.

RESULTS

Cohabitation with a patient with dementia (1.2% of the Korean population) was significantly associated with physician-diagnosed depression. The significance remained in females when the data were stratified by sex. A significant association also occurred among males with low family income.

CONCLUSION

To reduce the burden of dementia, we need a management policy that includes the caregiver as well as the patient with dementia. In particular, political management for the vulnerable population, male caregiver in low-income family and female caregiver in high-income family, should be prepared.

The Mental Health of People Living with HIV in China, 1998-2014: A Systematic Review

BACKGROUND

Understanding the mental health burdens faced by people living with HIV in China is instrumental in the development of successful targeted programs for psychological support and care.

METHODS

Using multiple Chinese and English literature databases, we conducted a systematic review of observational research (cross-sectional, case-control, or cohort) published between 1998 and 2014 on the mental health of people living with HIV in China.

RESULTS

We identified a total of 94 eligible articles. A broad range of instruments were used across studies. Depression was the most widely studied problem; the majority of studies reported prevalence greater than 60% across research settings, with indications of a higher prevalence among women than men. Rates of anxiety tended to be greater than 40%. Findings regarding the rates of suicidality, HIV-related neurocognitive disorders, and substance use were less and varied. Only one study investigated posttraumatic stress disorder and reported a prevalence of 46.2%. Conflicting results about health and treatment related factors of mental health were found across studies.

CONCLUSIONS

Despite limitations, this review confirmed that people living with HIV are vulnerable to mental health problems, and there is substantial need for mental health services among this population.