Depression, anxiety, and suicidal ideation among Chinese Americans: a study of immigration-related factors

Quality of Psychiatric Care for Immigrants and People With a Non-English Language Preference: A Systematic Scoping Review

OBJECTIVE

Immigrants and persons with a non-English language preference (NELP) face unique challenges in the mental health care system. This systematic scoping review aimed to evaluate the literature for disparities in psychiatric care delivery, beyond access and utilization barriers, experienced by these two populations.

METHODS

The authors queried four databases: PubMed, PsycInfo, Web of Science, and CINAHL. Studies published between August 1993 and August 2023 were selected if they had a population that included immigrants to English-language countries or patients with a NELP and a mental illness, had a relevant comparison group, and included outcome measures focused on quality of psychiatric care delivery. Studies focusing solely on care access or utilization, studies without original data, case reports, and commentaries were excluded.

RESULTS

The search identified 2,860 studies. Seventeen studies were included for full-text review (Cohen's κ=0.96). Large variability was found in the measures of quality used in the studies. Outcome variables were involuntary treatment rate, symptom management, unmet needs, medication use and monitoring, diagnosis, and psychiatric referral. Immigrants were more likely than nonimmigrants to receive involuntary treatments in all seven pertinent studies. An insufficient number of studies focused on other outcome measures, limiting analyses.

CONCLUSIONS

Many studies highlighted differences in care, especially with regard to involuntary hospitalization. Outcome measures varied and deviated from established quality metrics. Insufficient data were available to determine whether the identified differences in care represent a care delivery gap. Studies that use standardized measures would assist in evaluating the quality of care received by immigrants and patients with a NELP.

Meta-Analysis of Acculturation and Suicide-Related Outcomes: A Test of the Immigrant Paradox

OBJECTIVE

This meta-analysis aimed to systematically test the relation between acculturation and suicide-related outcomes among immigrants, with attention to key methodological (i.e., measure of suicide-related outcome, measure of acculturation) and demographic (i.e., race, gender, age, geographic region, publication year) moderators.

METHOD

We conducted a meta-analysis of 72 independent samples from 50 studies (38 peer-reviewed articles, 12 dissertations) representing more than 1.4 million immigrants. Participants' age ranged from 11.20 to 74.70 years (M = 29.96, SD = 15.07). Random effects models were used for both main and moderation analyses.

RESULTS

We found significant positive associations between acculturation and suicidal ideation, but not suicide attempts and deaths. We also found a significant and positive effect of acculturation on suicide-related outcomes when acculturation was measured by psychological scales, but not by generation status, length of residence in the host country, and proficiency in the host country's language. More acculturated Latinx immigrants were at higher risk for suicide-related outcomes, whereas a reverse pattern was found among Asian immigrants. Meta-regressions revealed that the moderating effects of participants' age and publication year were also significant.

CONCLUSION

Our results show partial support for the immigrant paradox but suggest that the relation between acculturation and suicide-related outcomes is complex and multifaceted. We discuss the implications of our findings and recommendations for research and prevention.

Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S

OBJECTIVE

Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults.

METHOD

Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors.

RESULTS

28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only.

CONCLUSIONS

There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depression and anxiety symptoms among Vietnamese migrants in Japan during the COVID-19 pandemic

This study aimed to examine the mental health status and related factors among Vietnamese migrants in Japan during the COVID-19 pandemic. We conducted an online cross-sectional survey between September 21 and October 21, 2021. Along with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scores, we collected data on demographics, changes in socioeconomic status due to the pandemic, language proficiency, social support, and health conditions. Multivariate logistic regression was performed to identify factors related to symptoms of depression and anxiety. Among 621 participants who completed the questionnaire, moderate-to-severe symptoms of depression (PHQ-9 score ≥ 10 points) and mild-to-severe symptoms of anxiety (GAD-7 score ≥ 5 points) were observed in 203 (32.7%) and 285 (45.9%) individuals, respectively. Factors related to depressive symptoms were age (95% confidence interval [CI]=0.89-0.99), pre-existing health conditions (95% [CI]=1.61-3.76), and a low subjective socioeconomic status (95% [CI]=1.64-3.71). Factors related to anxiety symptoms were being single (95% [CI]=1.01-2.93), having pre-existing health conditions (95% [CI]=1.63-3.88), subjective socioeconomic status (95% [CI]=1.87-3.97), and absence of a partner to discuss one's health with (95% [CI]=1.11-2.47). Vietnamese migrants in Japan experienced a decrease in income, worsening working conditions, and poor mental health status during the COVID-19 pandemic. Further investigations are necessary to find an effective way to increase their social support and mitigate socioeconomic adversities.

Towards Higher Psychometric Properties: Testing the Psychological Strain Scales with Larger Samples

This study aimed to further test the psychometric properties of the Psychological Strain Scales (PSS) with larger samples. A cluster sampling method was employed to recruit 13,250 college students from seven provinces in China. Descriptive statistics, item statistics, Cronbach's alpha, factor analysis, and correlation analysis were evaluated. Cronbach's alpha coefficient was 0.958 and Guttman's split-half coefficient was 0.866. All the item-total correlations were larger than 0.45 except one. Results from Exploratory Factor Analysis and Confirmatory Factor Analysis supported the four dimensions of psychological strains (value strain, aspiration strain, deprivation strain, and coping strain). The PSS was strongly correlated to the Depression, Anxiety, and Stress Scale (DASS-21), which was commonly used to measure risk for suicide and was predictive ofsuicidality as measured by the SBQ-R. The PSS was a self-report instrument with high reliability and validity which could be applied for extensive use in research to measure psychological strains.HighlightsThis is the first study testing the psychometric properties of the PSS in an unusually large sample.Confirmatory factor analysis was applied to provide empirical evidence to the four-factor structure of the PSS.Psychological strains were found to be significantly correlated with depression, anxiety, and stress symptoms and predictive of suicidality.

Religion, Strain and Suicidality among Chinese Young Adults

This study examined the mediating effects of psychological strain (Strain Theory) as a possible explanation for the relationship between religiosity and suicidality among Chinese young adults. A questionnaire was administered that included the Religious Orientation-Revised Scale (RO-RS), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Psychological Strains Scale (PSS). Using cluster sampling, we recruited 13,250 college students across seven provinces in China. Both univariate and multivariate analyses were used to identify the main determinants of suicidality. We further explored the mediation effect of psychological strains on the relationship between religion and suicidality. We found that non-believers obtained the lowest PSS. Believers of Islam and other religions obtained higher RO-RS scores compared to non-religious participants. Psychological strain imposed a complete effect between religiosity and suicidality. A positive relationship between religion and suicidality was present among the participants of the study. Individuals who are affiliated with a religion are considered as a marginalized population in China, which may lead to psychological strains, further increasing the risk of suicidality.

Caregiving and Care Receiving Experiences Among Older Chinese Immigrants and Their Home Health Aide

INTRODUCTION

There is limited information about how racial and cultural similarities or differences between patient and caregiver may affect quality care. The purpose of this study was to explore caregiving and receiving experiences among older Chinese immigrants and their home health aides by using in-depth interviews in culturally concordant dyads in a community setting.

METHODOLOGY

A purposive sample of 10 dyads of older Chinese immigrants and their home health aides were recruited using a snowball sampling method (N = 20). All interviews were audio recorded, transcribed, and coded for qualitative content analysis.

RESULTS

The majority of older adults were female (n = 8) and their average age was 76.8 years. The following themes emerged: companionship and rapport, reconciling the need for care services with the expectations of family, the value of matched gender, language, and ethnic foodculture, assisting with daily routines, and experiencing caregiving burden due to a dual role.

DISCUSSION

This study elucidated the dynamics between care recipients and their caregivers with shared cultural backgrounds.

Utilization of Mental Health Services Among Older Chinese Immigrants in New York City

Older immigrants are at risk of developing mental illness. This study aims to examine mental health service utilization among older Chinese immigrants, using a mixed-method design. Andersen's Behavioral Model of Health Services Use informed an examination of predictors of mental health services utilization, and semi-structured individual interviews were conducted to illuminate these findings. Participants who were younger, had less than a high school education, and had a higher level of depressive symptoms were more likely to use mental health services. Stressors of psychological distress included breakdown of support system, language barriers, and financial hardships. Factors influencing mental health services use included information from family/friends, referrals from primary care physicians, perceived needs for help, mental health stigma, and culturally competent mental health professionals. Understanding the factors associated with seeking mental health services for older Chinese immigrants could help health care providers to develop early screening programs and culturally sensitive interventions.

Depressive Symptom Severity and Immigration-Related Characteristics in Asian American Immigrants

The study examined immigration factors associated with depressive symptom severity among Asian American immigrants. Participants were 458 Chinese, Korean and Vietnamese adults. Depressive symptom severity was measured by PHQ-9. Overall, the likelihood of being moderately to severely depressed was significantly increased among immigrants living in the US for < 10 years and Korean Americans compared to Chinese Americans. However, mild level of depressive symptoms was not associated with any immigration-related factors. The positive impact of shorter duration of living in the US and a younger age at immigration (≤ 17) on depressive symptoms was evident among women but not among men. For men, marital status and education level were significant predictors of being moderately to severely depressed. Differentiating immigrant factors and identifying depressive symptom severity can help drive community and clinical interventions to detect and treat depression early among Asian American immigrants.

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.

Relationships between addictive Facebook use, depressiveness, insomnia, and positive mental health in an inpatient sample: A German longitudinal study

BACKGROUND AND AIMS

Individuals with high level of negative mental health often tend to use the social platform Facebook to escape from daily stress. They are at risk to develop an emotional bond to Facebook linked to a need to stay permanently online. The current work investigated addictive use of Facebook and its conceptual framework in clinical context.

METHODS

In a longitudinal study design, duration of daily use of Facebook, addictive Facebook use, depressiveness, insomnia, and positive mental health (PMH) were assessed in a sample of 349 inpatients [M_age (SD_age) = 50.13 (9.41)] of a psychosomatic rehabilitation clinic in Germany over a period of on average 6 weeks.

RESULTS

Regression analyses revealed that duration of daily Facebook use at the first measurement time point (T1) served as significant positive predictor of addictive Facebook use at the second measurement time point (T2). Addictive Facebook use (T1) significantly positively predicted depressiveness and insomnia (T2). Its prediction of PMH (T2) was significantly negative. Mediation analyses showed that PMH (T1) partially mediated the association between addictive Facebook use (T1) and depressiveness (T2), and fully mediated the relationship between addictive Facebook use (T1) and insomnia (T2).

DISCUSSION AND CONCLUSIONS

Current longitudinal results indicate that addictive Facebook use might negatively impact the recovery process of inpatients. Thus, it might be relevant to assess and consider addictive Facebook use in the clinical context. Therapeutic interventions are suggested to focus on the enhancement of inpatients' PMH level, which may buffer the negative effect of problematic Facebook use.

Refining Psychological, Substance Use, and Sociodemographic Predictors of Suicide Ideation and Attempts in a National Multiethnic Sample of Adults, 2008-2013

The purpose of this study was to examine psychological, substance use, and sociodemographic predictors of 12-month suicide ideation and attempts across six US racial/ethnic groups-white, Latino/a, Black, Asian or Pacific Islander (A/PI), American Indian or Alaska Native (AI/AN), and multiracial adults. Multiple logistic regression analyses were conducted for 218,765 adults who participated in the 2008-2013 National Survey on Drug Use and Health. Overall, commonly cited factors were associated with increased risk for suicide ideation and attempt for some racial/ethnic groups, but not for others. As one example, 12-month depression was associated with 12-month suicide attempt for A/PI, AI/AN, Latino/a, and white, but not for Black or multiracial adults. Alcohol abuse and dependence were also associated with suicide attempt for AI/AN, Black, and white respondents but not for other racial/ethnic groups. Risk factors for suicide ideation and attempt may not increase risk universally. More theoretically supported research is needed.

Symptoms and Experience of Depression Among Chinese Communities in the West: A Scoping Review

Despite the increasing presence of Chinese communities in the West, their experiences of depression and the variations in symptoms or presentation are not well understood. Using Arksey and O'Malley's methodical framework, we conducted a scoping review of the published literature, using electronic databases MEDLINE and PsycINFO, and searched for articles published since 1999. Out of 1177 articles identified, 21 met the inclusion criteria. Thematic synthesis revealed valuable scholarly work on (1) depression rates, migration, and contextual determinants, (2) causation beliefs and help seeking, (3) acculturation and symptoms, (4) presenting symptoms and somatization, and (5) culturally sensitive assessment and care. Overall, this review has identified the importance of contextual determinants in the development of depression, low rates of seeking of professional help, subtle variations in somatization, and knowledge gaps in culturally sensitive care. The findings suggest that, rather than treating migration as a cause of mental distress, the accompanying conditions and events need to be further examined and addressed as potential risk or protective factors. Subtle variations in somatization are also evident, and future scholarly work should examine the notion of cultural scripts-namely, that people attend and react to particular experiences in culturally based ways. For this reason (among others), practice models need to develop strategies for culturally sensitive care, such as co-construction of illness narratives and finding common ground. Given the stigma of mental illness and the low level of seeking professional help, the role of primary care should be expanded. Further studies investigating mental health issues beyond depression are also warranted in the studied community.

Is There a Healthy Immigrant Effect Among Women Through Transnational Marriage? Results from Immigrant Women from Southeast Asian Countries in Taiwan

In this study we examine whether there is healthy immigrant effect among women immigrated to Taiwan through transnational marriage. A sample of immigrant women (N = 246) with original nativity of Southeast Asian countries and Taiwanese-born women sample (N = 201) was recruited from December 2008 to December 2009. Their depressive symptoms, acculturative stresses and family functioning were assessed by a series of questionnaires. Immigrant women had lower depressive scores than their native-born counterparts when other potential confounders were controlled for in the multiple regression model. Our findings suggest that the healthy immigrant effect exists among immigrant women in Taiwan. Although such effect may due to immigrant women is a highly selective population with hardy mental characteristics, it is crucial to improve immigrant women's mental health by helping them to enhance the ability of expressing emotions between family members as well as by mitigating socioeconomic inequality of cross-cultural immigrant families.

The strain theory of suicide

Suicide is a global public health problem, but very few theories have been developed for its etiology and effective prevention. Presented in this article is a comprehensive and parsimonious theory explaining the socio-psychological mechanism prior to suicidal behavior. Strain, resulting from conflicting and competing pressures in an individual’s life, is hypothesized to precede suicide. The strain theory of suicide (STS) proposes four sources of strain leading to suicide: (1) value strain from differential values; (2) aspiration strain from the discrepancy between aspiration and reality; (3) deprivation strain from the relative deprivation, including poverty; and (4) coping strain from deficient coping skills in the face of a crisis. This new model is built on previous notions of anomie (Durkheim, 1897/1951 ), strain theories of deviance (Merton, 1957 ) and crime (Agnew, 1992 ), although suicide is not a major target for explanation in those theories. Future research with rigorous quantitative data needs to be conducted to further test STS on a more comprehensive level.

Combined effects of depression and anxiety on suicide: A case-control psychological autopsy study in rural China

Most of the previous researches indicated depression and anxiety were potential risk factors for suicide, and they were also highly correlated. However, few studies have explored their combined effects on suicide and the dimensions which really work. A total of 392 suicide cases aged 15-34 years and 416 community controls of the same age range were investigated. The results showed that after controlling confounding factors, people with low depression and high anxiety, with high depression and low anxiety, with high depression and high anxiety were at 2.46, 26.32, 54.77 times more risk for suicide (all P < 0.05), compared with subjects with low depression and low anxiety. Only two of seven dimensions of depression (including cognitive disturbance, helplessness, excluding anxiety dimension) and one of two dimensions of STAI anxiety (anxiety dimension, not depression dimension) were risk factors for suicide (all OR > 1). Our main findings was that combined effects of depression and anxiety on suicide were complicated, and the effects of anxiety dimension of depression and depression dimension of anxiety must be cautiously evaluated, avoiding overlapping inclusion.

Maternal Encouragement of Modest Behavior, Temperamental Shyness, and Anxious Withdrawal Linkages to Chinese American Children's Social Adjustment: A Moderated Mediation Analysis

Past studies have revealed potential differences in the functional meaning and social evaluation of children's temperamental shyness between Chinese interdependence-oriented and North American independence-oriented cultural contexts. However, very little is known about shy Chinese American children's adjustment in Western school contexts and potential pathways underlying their adjustment. To address this gap in the literature, we examined the associations between Chinese American children's temperamental shyness and their social adjustment outcomes, including peer exclusion, prosocial behavior, and assertiveness/leadership skills. In addition, the mediating role of children's display of anxious-withdrawn behavior and the moderating role of first-generation Chinese immigrant mothers' encouragement of modesty in their parenting practices as applied to associations between temperamental shyness and social adjustment outcomes were explored. Path analyses indicated that the impact of Chinese American children's temperamental shyness on their socio-emotional adjustment was mediated by their display of anxious-withdrawn behavior in school. However, when Chinese immigrant mothers encouraged their children to be more modest, children's temperamental shyness was less strongly related to negative social adjustment outcomes through diminished anxious-withdrawn behavior. These results highlighted the importance of culturally-emphasized parenting practices in fostering Chinese American children's adjustment in the U.S.

"We Went Out to Explore, But Gained Nothing But Illness": Immigration Expectations, Reality, Risk and Resilience in Chinese-Canadian Women with a History of Suicide-Related Behaviour

Suicide is a complex and tragic outcome driven by biological, psychological, social and cultural factors. Women of Chinese descent and women who have immigrated to other countries have higher rates of suicidal ideation and behaviour, and immigration-related stress may contribute. To understand the experiences of immigration and their relationship with distress and suicide-related behaviour in Chinese women who have immigrated to Canada. 10 semi-structured qualitative interviews with Chinese women who have immigrated to Toronto, Canada and have a history of suicide-related behaviour were completed and analyzed using a constructivist grounded theory methodology. Immigration-related and acculturation stress stemmed from unmet expectations and harsh realities. These repeated experiences resulted in hopelessness, helplessness, and alienation, which are risk factors for suicide and suicide-related behaviour. However, immigration-related support can also increase hope, self-efficacy and connectedness to foster recovery and resilience. This is the first qualitative study focusing on immigration experiences and its relationship to suicide-related behaviour in Chinese immigrant women. Knowledge of immigration and acculturation stressors can a) help identify and support women at risk for suicide and b) form a target for social intervention for all immigrant women, regardless of suicide risk.

Association Between Perceived Social Support and Depressive Symptoms Among Community-Dwelling Older Chinese Americans

Purpose: This study examined the association between social support and depressive symptoms among U.S. Chinese older adults. Methods: Data were from the Population Study of Chinese Elderly in Chicago (PINE) study. Independent variables were positive and negative perceived social support (PSS). Dependent variable was depressive symptoms. Multinomial logistic regression analyses were performed. Results: A total of participants were 3,157 Chinese older adults with the mean age of 72.8 years (range 60-105 years). After controlling for confounding factors, Chinese older adults with higher positive PSS were 12% (odds ratio [OR] = 0.88, 95% confidence interval [CI] = [0.85, 0.92]) and 18% (OR = 0.82, 95% CI = [0.79, 0.86]) less likely to report mild and moderate-severe depressive symptoms, respectively, compared to reporting minimal depressive symptoms; On the contrary, Chinese older adults with higher negative PSS were 34% (OR = 1.34, 95% CI = [1.24, 1.46]) and 38% (OR = 1.38, 95% CI = [1.26, 1.52]) more likely to report mild and moderate-severe depressive symptoms, respectively. Discussion: The study findings corroborate previous research that social support is significantly associated with depressive symptoms. Our findings reinforce the importance of developing strategies to utilize positive social support and limit negative support in practice for the depressed older adults. Further studies should be conducted to better understand the associations between different dimensions of social support and depression among U.S. Chinese older adults.

Psychological strain and suicidal ideation: A comparison between Chinese and US college students

OBJECTIVE

This study was to explore the relation between psychological strains and suicidal ideation among Chinese and American college students. Another secondary purpose of the study was to examine the reliability of the psychological strains scales (PPS: Ref) one more time in China and the United States in college populations.

METHOD

Samples of college students were randomly recruited from China and United States. All of 529 college students (aged 17-27, 68.9% female) completed self-report assessments of psychological strains (Psychological Strain Scale), suicidal ideation (Beck Scale for Suicide Ideation), and indicators of psychological well-being (e.g., depression, anxiety, and stress).

RESULTS

Empirical results show that Psychological Strain Scales (PSS) has a good reliability. Chinese college students reported higher suicide ideation scores than American students whereas there was no statistical difference in psychological strains. Psychological strains and, depression, anxiety, and stress, were positively related to suicidal ideation in both countries. Stepwise multiple regression analysis indicated that psychological strain can significantly predict suicidal ideation.

CONCLUSIONS

These findings provide support for the Strain Theory of Suicide for both Chinese and American college students and some measures can be taken to reduce psychological strains in students. However, future work could extend these findings by utilizing a longitudinal design to determine whether psychological strains are in fact antecedents, and not simply correlates, of suicide ideation.

Prevalence of major depressive disorder and socio-demographic correlates: Results of a representative household epidemiological survey in Beijing, China

BACKGROUND

Major depressive disorder (MDD) is the most prevalent mental disorder in the general population and has been associated with socioeconomic factors. Beijing has undergone significant socioeconomic changes in last decade, however no large-scale community epidemiological surveys of MDD have been conducted in Beijing since 2003.

AIMS

To determine the prevalence of MDD and its socio-demographic correlates in a representative household sample of the general population in Beijing, China.

METHOD

Data were collected from the 2010 representative household epidemiological survey of mental disorders in Beijing. The multistage cluster random sampling method was used to select qualified subjects in 18 districts and counties, and then face-to-face interviews were administered using the Chinese version of Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) during November 1, 2010 to December 31, 2010.

RESULTS

19,874 registered permanent residents were randomly identified and 16,032 (response rate=80.7%) completed face-to-face interviews. The time-point and life-time prevalence rates of MDD were estimated to be 1.10% (95% CI: 0.94-1.26%) and 3.56% (95% CI: 3.27-3.85%) respectively. Significant differences were found in sex, age, location of residence, marital status, education, employment status, personal/family monthly income, perception of family environment and relationship with others, when comparing residents with MDD to those without MDD. Those who were female, aged 45 or above, reported low family income, or reported an "average" or "poor" family environment were associated with a higher risk of MDD.

CONCLUSIONS

The prevalence of MDD reported in this survey is relatively lower than that in other western countries. Female sex, age older than 45, low family income, and poor family environment appear to be independent risk factors for MDD.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Self-harm amongst people of Chinese origin versus White people living in England: a cohort study

BACKGROUND

There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities.

METHODS

We conducted a prospective cohort study using self-harm presentation data (1997-2011) collected from three hospitals in the City of Manchester, which has the largest Chinese population across all UK Local Authorities. Rate ratios between the Chinese and White groups were calculated using Poisson regression models. Chi-square tests (or Fisher's exact tests), logistic regression, and log-binomial regression were used to examine differences in characteristics and clinical management between groups.

RESULTS

Ethnicity was known in the study cohort for 23,297 (87%) amongst 26,894 individuals aged 15 years and above. A total number of 97/23,297 (0.4%) people of Chinese ethnic origin presented with self-harm over the study period and 20,419 (88%) were White people. Incidence of self-harm in the Chinese group (aged 16-64 years) was less than one fifth of that found in White people (0.6 versus 3.2 per 1000 person-years; rate ratio 0.18, 95% confidence interval 0.13-0.24), and was particularly low amongst men of Chinese origin. Individuals of Chinese origin who presented with self-harm were younger, more likely to be female and students, and more likely to self-injure and describe relationship problems as a precipitant than White people. They were less likely to have clinical risk factors such as drug/alcohol misuse and receiving psychiatric treatment, and were rated to have lower risk of self-harm repetition by treating clinicians.

CONCLUSION

Future research needs to investigate whether the low incidence of self-harm presenting to hospitals amongst people of Chinese origin truly reflects a lower frequency of self-harm, or alternatively is due to markedly different post-episode help-seeking behaviours or student overrepresentation in this ethnic group. Relevant healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.

Risk and Protective Factors for Three Major Mental Health Problems Among Latino American Men Nationwide

The present study investigated psychosocial predictors for major depressive disorder (MDD), general anxiety disorder (GAD), and suicidal ideation (SI) of Latino American men identified in the first national mental health epidemiological survey of Latinos. Three separate sets of logistic regression analyses were performed for 1,127 Latinos, following preplanned two steps (Model 1—Known Demographic and Acculturation Predictors as controls, Model 2—Psychosocial Risk and Protective Factors). Results show that Negative Interactions with family members significantly predicted the likelihood of both MDD and SI, while SI was also associated with Discrimination. Acculturation Stress was associated with that of GAD (alongside more Income, Education of 12 years, and Years in the United States for less than 11 years). Other potential protective factors (social support, racial/ethnic identity, religious involvement) were not influential. The differential predictors for mental health issues among Latino men imply that assessment and intervention for them may need certain gender-specific foci in order to improve mental health disparities in this population.