Asian Americans' lay beliefs about depression and professional help seeking

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

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

Cultural differences in appraisals of control and posttraumatic stress disorder symptoms

Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms.Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms.Method: European Australian (n = 140, Mage = 35.80, SD = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian (n = 129, Mage = 30.16, SD = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms.Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people's ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms.Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

Social Engagement and Mental Health Symptoms Across Asian American Ethnic Groups During the COVID-19 Pandemic

Background

To examine social engagement and mental health symptoms during the COVID-19 pandemic across Asian American (AA) ethnic groups.

Methods

Data from three waves of the nationally representative COVID-19 Household Impact Survey (4/20/2020-6/8/2020) were used to describe social engagement and mental health symptoms during the pandemic. Associations between mental health and social engagement were assessed via multinomial logistic regression.

Results

In this sample of 312 AAs (36.9% Chinese American, 30.9% South Asian American, 20.1% Filipino/Vietnamese American, and 12.0% Japanese/Korean American), daily communication with neighbors declined for Chinese, South Asian and Filipino/Vietnamese Americans but increased for Japanese/Korean Americans (P=.012) whereas communication with friends/family increased only for Filipino/Vietnamese, Japanese/Korean and South Asian Americans (P<0.001). Differences in self-reported symptoms of anxiety, depression, loneliness, and hopelessness were observed across AA ethnic groups. In adjusted models, lower social engagement was associated with frequent (3-4 days/week) depressive symptoms during the preceding week (cOR:3.26, 95%CI:1.01-10.5). This association was heightened for Asian men (cOR:14.22, 95%CI:3.62-55.8).

Conclusions

Heterogeneity of social engagement and mental health symptoms across AA ethnicities was observed. Understanding associations between social engagement and mental health within different communities is necessary to provide culturally and linguistically appropriate mental health treatment and care.

Hierarchical Cluster Analysis of Human Value Priorities and Associations with Subjective Well-Being, Subjective General Health, Social Life, and Depression across Europe

Human values are a central component in understanding individuals’ choices. Using the Schwartz’s Values instrument, this study aimed to identify patterns of human value priorities of 35,936 participants across 20 European countries and analyse their relations with subjective well-being (SWB), subjective general health (SGH), social life, and depression indices in Europe. A hierarchical cluster analysis of data from the seventh European Social Survey (ESS) round 7, based on the higher order dimensions of the Schwartz values model, allowed identifying four European groups with distinct indicators. Indices of SWB, SGH, social life, and depression showed statistically significant differences among the four different sociodemographic groups. The graphical representation of the monotonic correlations of each of these indices with the value priorities attributed to the ten basic human values was ordered according to the Schwartz circumplex model, yielding quasi-sinusoidal patterns. The differences among the four groups can be explained by their distinct sociodemographic characteristics: social focus, growth focus, strong social focus, and weak growth focus. The results of this study suggest a rehabilitation of the notion of hedonism, raising the distinction between higher and lower pleasures, with the former contributing more to well-being than the latter.

Stigmatizing Beliefs About Depression in Diverse Ethnic Groups of Asian Americans

Focusing on diverse ethnic groups of Asian Americans, the present study examined the prevalence, ethnic variations, and predictors of stigmatizing beliefs about depression (beliefs that associate depression with a sign of weakness, shame to the whole family, and family disappointment, and beliefs that antidepressant medicines are addictive). Data were drawn from 2609 participants (age range 18-98) in the 2015 Asian American Quality of Life survey that includes Chinese, Asian Indian, Korean, Vietnamese, Filipinos, and other Asians. Results of a series of logistic models indicated that age, gender, ethnicity, length of stay in the U.S., English proficiency, and acculturation were significantly associated with stigmatizing beliefs about depression. Ethnic variations in beliefs were also observed. Implications for research and practice are discussed.

Investigating Emotion in Malay, Australian and Iranian Individuals with and without Depression

This study investigated the influence of culture and depression on (1) emotion priming reactions, (2) the recall of subjective experience of emotion, and (3) emotion meaning. Members of individualistic culture (Australia, n = 42) and collectivistic culture (Iran, n = 32, Malaysia, n = 74) with and without depression completed a biological motion task, subjective experience questionnaire and emotion meaning questionnaire. Those with depression, regardless of cultural group, provided significantly fewer correct responses on the biological motion task than the control group. Second, the collectivistic control groups reported greater social engaging emotion than the Australian control group. However, the three depressed groups did not differ culturally. The Australian depressed group reported significantly greater interpersonally engaging emotion than the Australian control group. Third, the collectivistic groups reported significantly greater social worth, belief changes and sharing of emotion than the individualistic group. Depression did not influence these cultural effects. Instead we found that those with depression, when compared to controls, considered emotions as subjective phenomena, that were qualifying for relationships with others, and associated with greater agency appraisals. The applicability of the biocultural framework of emotion in depression was considered.

The impact of depression and culture on responses to intrusive autobiographical memories: Cognitive appraisals, cognitive avoidance, and brooding rumination

OBJECTIVES

Those with depression ascribe more negative appraisals to intrusive autobiographical memories and use maladaptive strategies to regulate intrusive memory distress. However, it is unknown whether these patterns extend to East Asian samples. This study investigated the influence of culture and depression on intrusive remembering.

DESIGN

The study used a 2 (group: European Australian, East Asian) × 2 (depression: depressed, control) cross-sectional design, with an online intrusive memory diary.

METHODS

European Australian (n = 46) and East Asian (n = 45) participants living in Australia, with and without depression, reported two intrusive memories in real-time and completed self-report measures indexing their appraisals of the memories, and their use of cognitive avoidance and brooding rumination in response to the memories.

RESULTS

East Asian participants reported significantly greater negative, control, and responsibility appraisals than European Australian participants. Regardless of cultural group, depressed participants endorsed greater maladaptive memory appraisals and brooding compared to controls. Additionally, among East Asian participants, those with depression cognitively avoided memories significantly more than controls. When comparing the two depressed groups, East Asians reported significantly greater brooding and avoidance in response to intrusive memories than Australians.

CONCLUSIONS

The findings suggest that depression may be associated with some similar maladaptive responses to intrusive autobiographical memories across cultural groups. Clinical interventions targeting unhelpful responses may, therefore, be beneficial for those with depression, regardless of cultural background.

PRACTITIONER POINTS

Across both European Australian and East Asian cultures, depressed participants endorsed higher maladaptive intrusive memory appraisals and brooded more in response to memories. Clinical interventions targeting appraisals and emotion regulation in response to intrusive memories may be beneficial for those with depression across both cultural groups. Language and acculturation may have impacted findings, as measures were administered in English and in Australia. Replication using a cross-country design and larger sample would be beneficial to confirm findings.

Integrated decision-making model for community-based rehabilitation service utilisation among persons with severe mental illness in China: protocol for a cross-sectional, mixed-methods study

INTRODUCTION

A common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem, the factors and pathways followed influencing one's decision on service utilisation in China have not been fully comprehended. This study aims to develop a theory-based model that systematically describes the integrated decision-making process of mental health CBR utilisation among persons with SMI in China.

METHODS/DESIGN

This cross-sectional, mixed-methods study involves three main stages and is expected to last 3 years, from January 2018 to December 2020. In stage 1, the Social Exchange Theory is deployed as an analytical framework to comprehensively capture factors associated with tendency to use CBR services in China using semistructured interview methodology involving patients with SMI, their primary caregivers and CBR service providers. In stage 2, interpretive structural modelling will be applied to analyse the relationships between factors in different dimensions, at different levels and with different levels of impact. Stage 3 involves a multiregion survey among at least 300 family decision-makers (either the patient or their caregivers) in six communities in three cities to statistically validate the initial model derived in stage 2 using a further structural equation modelling.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No 2017S319). All interviewees will be provided with written information about the study, and a signed consent will be retrieved prior to the interview. Rules on confidentiality and anonymity of data will be strictly followed. The findings of this study will be disseminated via international and domestic peer-reviewed journals, reports, conference presentations and symposium discussions. Reports will be submitted to the National Natural Science Foundation of China.

Impact of culture on autobiographical life structure in depression

OBJECTIVES

Distortions in autobiographical memory have been implicated in major depressive disorder (MDD). Those with MDD demonstrate a 'depressogenic' autobiographical life structure. Research has not examined how culture influences this process. We investigated whether Malay individuals (members of an interdependent culture) with MDD demonstrated a 'depressogenic' autobiographical life structure similar to that of British individuals (members of an independent culture) with MDD.

DESIGN

A 2 (Culture; Malay, British) × 2 (Mood; depressed, control) cross-sectional design using a card sort task and self-report measures was used.

METHODS

Malay individuals with MDD or no history of MDD completed the life-structure card-sorting task, which provided a novel method for investigating organizational structure of the life narrative. These data were compared to previously collected data in which British individuals with MDD or without MDD had completed the same task within the same experimental protocol.

RESULTS

Pan-culturally those with MDD had greater negativity (i.e., used more negative attributes), negative redundancy (i.e., used the same negative attributes repeatedly across life chapters) and negative emodiversity (i.e., had greater variety and relative abundance of negative attributes), and reduced positive redundancy (i.e., used the same positive attributes repeatedly across chapters) in their structuring relative to controls. While the British MDD group had greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters) than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls.

CONCLUSIONS

The findings suggest culture may shape aspects of the autobiographical life structure in MDD.

PRACTITIONER POINTS

The majority of the literature investigating depression pertains to individuals from European Western cultures, despite recognition that depression ranks as one of the most debilitating diseases worldwide. This raises questions as to whether current depression models and interventions can be applied universally or whether they are limited to European Western groups. The current study found that pan-culturally those with MDD had similar structuring of their life story relative to controls. However, there were some cultural differences that need to be considered (e.g., Malay individuals provided less detailed, less elaborate and less emotionally diverse life stories and while the British MDD group had greater compartmentalization than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls). Limitations of the study included group differences in gender and mood at the time of testing. Cultural differences in the number of attributes used may have influenced findings. Only the Malay group completed the individualism-collectivism measure.

Racial/ethnic differences in perception of need for mental health treatment in a US national sample

PURPOSE

To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample.

METHODS

Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment.

RESULTS

Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, -5.8% (95% CI -6.5, -5.2%), and largest among Hispanics interviewed in Spanish, -11.2% (95% CI -12.4, -10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, -23.3% (95% CI -34.9, -11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI -48.0, -17.2%).

CONCLUSIONS

This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities.

Public stigma of mental illness in the United States: a systematic literature review

Public stigma is a pervasive barrier that prevents many individuals in the U.S. from engaging in mental health care. This systematic literature review aims to: (1) evaluate methods used to study the public's stigma toward mental disorders, (2) summarize stigma findings focused on the public's stigmatizing beliefs and actions and attitudes toward mental health treatment for children and adults with mental illness, and (3) draw recommendations for reducing stigma towards individuals with mental disorders and advance research in this area. Public stigma of mental illness in the U.S. was widespread. Findings can inform interventions to reduce the public's stigma of mental illness.

Asian International Students’ Mental Health-Related Outcomes

Guided by a Person × Context cultural framework, this is the first known study to examine the relationship between cultural values and mental health-related outcomes (depressive symptoms and professional psychological help seeking) across diverse interpersonal contexts. Using a quasi-experimental research design, 465 Asian international college students were randomly assigned to report their adherence to the Asian cultural values of emotional self-control and humility during interactions with (a) their families of origin, (b) peers from their country of origin, or (c) American peers. Humility was positively associated with depressive symptoms only during interactions with nonfamily members, and not with family members. Emotional self-control was negatively associated with attitudes toward seeking psychological help only during participants’ interactions with members of their country of origin. Humility was negatively related to psychological help seeking only during participants’ interactions with nonfamily members.

Race and beliefs about mental health treatment among anxious primary care patients

Large racial disparities in the use of mental health care persist. Differences in treatment preferences could partially explain the differences in care between minority and nonminority populations. We compared beliefs about mental illness and treatment preferences between adult African-Americans, Hispanics, Asian Americans, Native Americans, and White Americans with diagnosed anxiety disorders. Measures of beliefs about mental illness and treatment were drawn from the National Comorbidity Survey Replication and from our previous work. There were no significant differences in beliefs between the African-Americans and the White Americans. The beliefs of the Hispanics and the Native Americans were most distinctive, but the differences were small in magnitude. Across race/ethnicity, the associations between beliefs and service use were generally weak and statistically insignificant. The differences in illness beliefs and treatment preferences do not fully explain the large, persistent racial disparities in mental health care. Other crucial barriers to quality care exist in our health care system and our society as a whole.

Attitudes toward hepatitis B virus among Vietnamese, Chinese and Korean Americans in the Houston area, Texas

We explored attitudes about prevention, screening and treatment of hepatitis B virus (HBV) infection in Chinese, Korean and Vietnamese communities. We use qualitative methods in 12 focus groups (n = 113) of adults who self-reported their ethnicity to be Chinese, Korean, or Vietnamese. We use grounded theory (i.e., consensus-building between co-coders about recurring, emerging themes) for analysis. Diet, nutrition, fatigue and stress were misidentified as HBV causes. Improving hygiene, diet, exercise, and holistic methods were misidentified as viable HBV prevention methods. Common screening problems included not affording test and not understanding test results. Participants shared reasons for using complementary and alternative medicine--when Western medicine fails or becomes unaffordable. Participants sought information from medical providers and fellow community members, but also from the internet. Many of the attitudes and opinions that emerged may deter participation in HBV screening, prevention and treatment, insofar as community members may factor them into healthcare decision-making, choose alternative but ineffective methods of prevention and treatment, and undervalue the benefits of screening. More patient education in both traditional and new media is necessary for clarifying transmission, screening and treatment misunderstandings.

Acculturative stress, work-related psychosocial factors and depression in Korean-Chinese migrant workers in Korea

OBJECTIVES

The purposes of this study were to identify the relationships among acculturative stress, work-related psychosocial factors and depression in Korean-Chinese migrant workers living in Korea and to determine whether work-related psychosocial factors mediate the relationship between acculturative stress and depression.

METHODS

A descriptive correlational cross-sectional design was used. A convenience sample of 200 Korean-Chinese full-time migrant workers was recruited, and 170 completed questionnaires were included in the analysis. Acculturative stress was assessed by Sandh and Asrabadi's Acculturative Stress Scale. Work-related psychosocial factors were assessed by job demand, insufficient job control and interpersonal conflict measures from the Korean Occupational Stress Scale. Depression was assessed by the Center for Epidemiologic Studies Depression Scale. Self-administered or face-to-face surveys were conducted by trained data collectors. Multiple regression and path analysis were used.

RESULTS

Roughly 30% of the sample met the criteria for depression. Female workers had significantly higher depression scores than male workers. Acculturative stress and work-related psychosocial factors significantly predicted 26.3% of the variance in depression. A path model revealed the mediating effect of job demand on the relationship between acculturative stress and depression.

CONCLUSIONS

Our results indicate that work-related psychosocial factors are salient factors that lead to depression among Korean-Chinese migrant workers living in Korea. The results suggest that occupational health-care professionals should promote the prevention and management of depression in this population and highlight the importance of acculturation context in the development of interventions designed to reduce work-related stress.

Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity

OBJECTIVE

This study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.

METHOD

We first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.

RESULTS

Rates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.

CONCLUSIONS

Our findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.