Parent perceptions of mental illness in Chinese American youth

BACKGROUND

Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth.

METHODS

Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking.

RESULTS

While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences.

DISCUSSION

These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.

Accuracy and Bias in Perception of Distress Level and Distress Change Among Same-Sex College Student Roommate Dyads

University students often experience high levels of stress and, in some cases, the stress leads to tragic outcomes. An important question is whether roommates can perceive the level and change in distress in their peers. We examined self- and other-reports of 187 same-sex undergraduate dyads at two times in a spring semester. Using the truth and bias model, we found that roommates tended to underestimate their partner's distress at both time points, and that ratings were equally influenced by truth and self-focus bias forces. For change, however, there was no evidence of directional (average) bias, and perceived change was only significantly related to the truth force. There were no consistent moderation effects by closeness or gender. These findings are interpreted in the context of person perception theory and the practical need for early warning about extreme distress in college students.

Anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD): Cross-informant, sex, and subtype differences

OBJECTIVE

This study examined symptoms of anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD).

PARTICIPANTS

Data were collected between March 2011 and March 2016 from 150 college students with ADHD and 150 college students without ADHD.

METHOD

Participants with ADHD were compared to a sex- and ethnicity-matched control group. For the ADHD group, parent and self-report of anxiety and depression were also compared.

RESULTS

College students with ADHD self-reported significantly higher anxiety and depressive symptoms than did students without ADHD. Scores on parent-report measures of anxiety and depressive symptoms were significantly higher than scores on self-report measures. Significant sex differences were found for participants with ADHD, with females showing higher depressive and anxiety symptoms than males. Parent-reported anxiety symptoms were higher for those with inattentive type ADHD compared to combined type ADHD.

CONCLUSION

The current study highlights the importance of multi-informant assessment in ADHD evaluations for college-aged adults.

Social Anxiety and Mental Health Service Use Among Asian American High School Students

Asian American adults endorse more symptoms of social anxiety (SA) on self-report measures than European Americans, but demonstrate lower prevalence rates of SA disorder in epidemiological studies. These divergent results create ambiguity concerning the mental health needs of Asian Americans. The present study is the first to investigate this issue in adolescents through assessment of self-reported SA in Asian American high school students. Parent and self-ratings of impairment related to SA and self-reported mental health service use for SA were also measured. Asian American students endorsed a greater number of SA symptoms and scored in the clinical range more frequently than other ethnic groups. Also, Asian American and Latino students endorsed more school impairment related to SA than other ethnic groups. No differences in parent-reported impairment or service utilization were identified. Implications for future research and treatment for SA among Asian American adolescents are discussed.

Normative Data on the Beck Depression Inventory--Second Edition (BDI-II) in College Students

OBJECTIVE

This study was conducted to provide normative data on the Beck Depression Inventory--Second Edition (BDI-II) in college students.

METHOD

Data were obtained from 15,233 college students drawn from 17 universities in the United States, weighted to match the gender and race/ethnicity of enrollment in degree-granting institutions.

RESULTS

Descriptive statistics, point prevalence of individuals exceeding cutoff scores, and mean differences by gender and race/ethnicity were provided. Because the distribution of BDI-II scores was not normal, percentile ranks for raw scores were provided for the total sample and separately by gender and race/ethnicity for the total sample and by race/ethnicity for men and women. Normative data were used to calculate the Reliable Change Index on the BDI-II for college students.

CONCLUSION

Because the distribution of BDI-II scores demonstrated significant skewness and non-normal kurtosis, percentile ranks are important to consider in interpreting scores on the measure, in addition to descriptive statistics.

An Examination of the Measurement Equivalence of the Brief Fear of Negative Evaluation Scale Across Individuals Who Identify With an Asian Ethnicity and Individuals Who Identify With a European Ethnicity

A body of research has demonstrated that individuals with Asian ethnicity endorse higher levels of fear of negative evaluation compared with individuals with European ethnicity. To date, no study has examined whether this Asian-European difference may be confounded by the differential interpretation of the measures of fear of negative evaluation by the two groups. The current study thus aimed to examine the measurement equivalence of the 12-item Brief Fear of Negative Evaluation (BFNE) scale and its 8-item variant composed of straightforwardly worded items (BFNE-S) in a sample of individuals who identified with a Chinese ethnicity ( n = 204) and a sample of individuals who identified with an Anglo ethnicity ( n = 528). Measurement equivalence across the samples was obtained for a two-factor BFNE model and a one-factor BFNE-S model. However, the BFNE-S model demonstrated superior fit to the data. Using the BFNE-S, we found that the Chinese ethnicity sample scored significantly higher on the latent dimension of fear of negative evaluation compared with the Anglo ethnicity sample ( d = 0.24). These findings disambiguate previous research on Asian-European differences in fear of negative evaluation and highlight the need for the continued examination of the validity of measures across different ethnicities and cultures.

Do Higher Self-Reports of Social Anxiety Translate to Greater Occurrence of Social Anxiety Disorder in Asian Americans Compared to Caucasian Americans?

This study was designed to clarify the discrepancy between data showing higher self-reported levels of social anxiety in Asian Americans (Horng, 2004; Okazaki, 1997, 2000, 2002) but lower lifetime prevalence rates of social anxiety disorder (SAD) in Asian Americans compared to Caucasian Americans (Hwu, Yeh, & Chang, 1989; Lee et al., 1990b; Takeuchi et al., 1998). Results revealed that based on responses on the self-report Social Phobia Inventory (SPIN), Asian Americans endorsed higher levels of social anxiety symptoms and were more likely to meet a threshold for "high social anxiety," using the diagnostic cutoff score of 19 or higher on the SPIN. However, when clinician-formulated diagnoses were assigned, there was no evidence for significant differences in the prevalence of SAD in Asian Americans versus Caucasian Americans. Explanation of the results, their implications, limitations, and future directions are discussed.

CONVERGENCE OF DEPRESSION AND ANXIETY SYMPTOMS IN FRIENDSHIP DYADS

Despite psychometric rationale to include multiple informants, psychological assessment typically involves data collected from the patient (target) only, particularly with regard to depressive and anxious symptomatology. This study addressed this gap in the literature by assessing convergence between targets and their close friends (informants) in an ethnically diverse sample of young adults. One hundred and thirty-nine friendship dyads completed a packet of questionnaires including different versions administered to the targets and informants, with targets completing the standard questionnaire battery focused on their own symptoms and informants completing questionnaires on their view of the target participants' symptoms, rather than their own characteristics. Measures were included to assess a wide range of symptomatology, including behavioral, cognitive, and physiological symptoms of anxiety and depression. The target-informant correlations were largely significant and of small-to-medium magnitude. In addition, target-informant agreement was higher in more visible symptoms (e.g., behavioral) than in less visible symptoms (e.g., physiological) of anxiety and depression. Interestingly, level of closeness in the relationship did not influence the magnitude of correlations. Implications for future research and integration into clinical assessment practices are discussed.

Measurement Invariance of the Beck Depression Inventory–Second Edition (BDI-II) Across Gender, Race, and Ethnicity in College Students

Measurement invariance of the Beck Depression Inventory–Second Edition (BDI-II) across gender, race, and ethnic groups was evaluated in a large sample of college students, using pooled data from 11 universities from diverse geographical regions in the United States ( N = 7,369). Confirmatory factor analysis was used to test the fit of several possible factor structures, and the results from these analyses indicated that the BDI-II was most adequately represented by a hierarchical four-factor structure, composed of three first-order factors and one second-order factor. Results based on analyses of covariance structures indicated there was factorial invariance for this hierarchical four-factor structure across groups, suggesting that the BDI-II provides an assessment of severity of depressive symptoms that is equivalent across gender, race, and ethnicity in college students.

Korean Anxiety Sensitivity Index-3: its factor structure, reliability, and validity in non-clinical samples

OBJECTIVE

The aim here is to examine the factorial structure, internal consistency, and concurrent validity of the Korean version of the Anxiety Sensitivity Index-3 (K-ASI-3) in student samples in Korea. Also, we investigated the cross-cultural differences in the Social Concerns factor.

METHODS

K-ASI-3 was administered to non clinical samples in Korea. Internal consistency, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-ASI-3.

RESULTS

Results from CFA comparing our data to factor solutions commonly reported as representative of European-American samples indicated an adequate fit. The K-ASI-3 showed good performance on the indices of internal consistency and concurrent validity. In addition, using regression analyses, we found the Social Concerns factor is most strongly related to life satisfaction and worry. However, we found no evidence that Korean college students express more Social Concerns than their European Caucasian counterparts.

CONCLUSION

The authors demonstrate that the K-ASI-3 has highly internally consistent and psychometrically sound items, and that it reliably measures three lower-order domains assessing Physical, Social, and Cognitive Concerns.

Social Anxiety and Holistic Cognition

Previous cultural psychological studies suggest that East Asians tend to think more holistically than Westerners and that these cultural differences in cognition are accounted for, in part, by psychological processes associated with a predominant social orientation of the self as independent in the West and as interdependent in the East. In addition to examining these self-construal variables as predictors of holistic cognition, the current study also examined the role that a self-focused manifestation of social anxiety ( social phobia tendencies) common in the United States and the role that an other-focused manifestation of social anxiety ( taijin kyofusho, or TKS tendencies) common in Japan play in holistic cognition. Samples of 142 Japanese and 125 Americans completed an instrument that measures degree of skill in holistic cognition and then completed measures of self-construal, social phobia, and TKS. The current study found that, in unpackaging cultural differences in holistic cognition, social phobia tendencies, given their self-focused nature, were associated with decreased levels of holistic cognition while TKS tendencies, given their other-focused nature, were associated with increased levels of holistic cognition. Thus, holistic cognition served as an important basic cognitive feature which distinguishes between the two culturally divergent versions of social anxiety. Furthermore, independent self-construal was found to be more strongly associated with the self-focused component of social anxiety while interdependent self-construal was only associated with the other-focused component of social anxiety.

Substance use among Asian-American adolescents: perceptions of use and preferences for prevention programming

Rarely has substance use prevention programming targeted Asian-American adolescents. Using a focus group methodology, we explored perceptions of substance use and preferences for prevention programming among 31 Asian-American adolescents in New York City. Participants considered substance use common in the community. Factors contributing to substance use among Asian-American adolescents (e.g., peer pressure, pressure to achieve, family factors, and community influence) were identified, and the need for prevention programs tailored for the Asian-American community was highlighted. Participants discussed preferred program content, delivery settings, and recruitment and retention strategies. Despite the favorable attitude for family-based prevention programming, participants raised potential issues concerning the feasibility of such a program. Study findings facilitate understanding of Asian-American adolescents' substance use behavior and shed light on prevention program development for this underserved population.

Psychometric properties of the state-trait inventory for cognitive and somatic anxiety (STICSA) in friendship dyads

Recently, Gros, Antony, Simms, and McCabe (2007) demonstrated support for the psychometric properties of a new measure of state and trait anxiety, the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA). In the present study, we further investigated the STICSA-Trait Version in 127 friendship dyads with a self-report from one participant (target) and an other-report of the target from a friend (informant). Consistent with previous research, confirmatory factor analyses supported the 2-factor structure of the STICSA-Trait in the target and informant reports. Moreover, the STICSA-Trait Cognitive and Somatic Anxiety subscales showed acceptable convergent and discriminant validity with related measures of anxiety. In addition, the STICSA-Trait subscales demonstrated adequate internal consistency and self-other agreement across the target and informant reports. Together, these findings provide additional support for the STICSA-Trait subscales as reliable and valid measures of cognitive and somatic anxiety.

Exploring the Validity of the College Student Reasons for Living Inventory among Asian American College Students

We examined the cultural validity of the College Student Reasons for Living Inventory (CSRLI) with Asian American College Students (N = 314). Although results did not completely replicate the six factor structure of the CSRLI as identified in Westefeld, Cardin, and Deaton (1992), partial support was found. The content of the five factors that emerged corresponded to five of the original scales. Our factor solution accounted for 50.25% of common variance and demonstrated moderate to high coefficient alphas. Validity of the CSRLI subscales was supported through significant negative relations with measures of depression and hopelessness. Furthermore, the CSRLI subscales accounted for 8% of the variance in suicidal behavior above and beyond that accounted for by the risk factors of depression and hopelessness alone.

Culture and social support: neural bases and biological impact

Social support is an effective means by which people cope with stressful events, and consequently, it beneficially affects health and well-being. Yet there are profound cultural differences in the effectiveness of different types of support and how people use their support networks. In this paper, we examine research on the impact of culture on social support, the neural underpinnings of social support, and how cultural differences in social support seeking are manifested biologically. We focus on cultural factors that may affect individuals' decisions to seek or not to seek social support and how culture moderates the impact of support seeking on biological and psychological health outcomes. We also examine recent research on the interaction between genes and culture in social support use. Discussion centers on the importance of developing an overarching framework of social support that integrates health psychology, cultural psychology, social neuroscience, and genetics.

Status-based rejection sensitivity among asian americans: implications for psychological distress

We examined whether anxious expectations of discrimination among Asian Americans can help explain this group's elevated levels of internalizing symptomatology, such as lower self-esteem (Twenge & Crocker, 2002) and higher depressive symptoms (Okazaki, 1997, 2002) relative to European Americans. Study 1 reports on the development and validation of a scale measuring status-based rejection sensitivity among Asian Americans (RS-A). In Study 2, scores on the RS-A were related to spontaneous discrimination attributions specifically in situations where discrimination is both applicable and possible for Asian Americans. Study 3 revealed that shame mediated the relationship between RS-A and internalizing symptomatology. Implications for well-being and intergroup interactions are discussed.

Cultural mediators of self-reported social anxiety

East Asians generally endorse higher social anxiety than do Westerners. Widely used measures of social anxiety, however, may not account for different social values across cultures. Drawing from Korean (n=251) and Euro-Canadian (n=250) community samples, this study used a cross-sectional design to examine the relationship between ratings of social anxiety and beliefs and self-views typically found in East Asian cultures. Results indicated that independent self-construal and identity consistency, views of the self that are typically associated with Western cultures, fully mediate the ethnic difference on self-reported social anxiety. Moreover, two indicators of East Asian views of the self in social contexts (interdependent self-construal and self-criticism) were partial mediators. Overall, the data suggest conceptualizations of pathological social anxiety may need to be revised to be useful for studying individuals in East Asian cultures.

Frequency and intensity of social anxiety in Asian Americans and European Americans

Asian American students have typically reported greater levels of social anxiety than European American students on self-report measures (e.g., Okazaki, 1997; Norasakkunkit & Kalick, 2002). This study employed an event-contingent experience sampling methodology to examine whether Asian American university students experienced social anxiety more often and more intensely than European Americans in their daily lives. Forty-five Asian American and 38 European American students participated in a two-week diary study. The results showed that on average, Asian Americans and European Americans reported a similar number of events that evoked anxiety in social situations, but Asian Americans reported more negative emotions on average in social situations than did European Americans.

Assessment of Adult Psychopathology: Meta-Analyses and Implications of Cross-Informant Correlations

Assessment of adult psychopathology relies heavily on self-reports. To determine how well self-reports agree with reports by "informants" who know the person being assessed, the authors examined 51,000 articles published over 10 years in 52 peer-reviewed journals for correlations between self-reports and "informants" reports. Qualifying correlations were found in 108 (0.2%) of the articles. When self-reports and informant reports were obtained with parallel instruments, mean cross-informant correlations were .681 for substance use, .428 for internalizing, and .438 for externalizing problems. When based on different instruments, the mean cross-informant correlation was .304. The moderate sizes of the correlations argue for systematically obtaining multi-informant data. National survey findings were used to illustrate practical ways to obtain and use such data.