Depression among Asian Americans: Review and Recommendations

Patterns of Alcohol, Cannabis, and E-Cigarette Use/Co-Use and Mental Health Among U.S. College Students

Substance use and mental health are highly correlated, though few studies assess the risk for depression and anxiety associated with dual and polysubstance use among college students. The purpose of this study was to characterize the relationship between alcohol, cannabis, and e-cigarette exclusive, dual, and polysubstance use and depression and anxiety among U.S. college students by racial and ethnic subgroup and stratified by sex.

Data from 83,467 undergraduate students participating in the 2020-2021 Health Minds Survey, a multi-campus, web-based survey, were used. Sex-stratified logistic regression models examined the effects of exclusive (past 30-day cannabis use, past 30-day e-cigarette use, past 2-week heavy alcohol use), dual (two among cannabis, e-cigarette, or alcohol use), and polysubstance (all three substances) use on anxiety (≥10 GAD-7 score) and depression (≥15 PHQ-9 score).

The study included 60,746 females and 22,721 males. Among females, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (adjusted odds ratio (aOR) = 1.92) and anxiety (aOR = 1.69) followed by polysubstance users (aORs = 1.85 and 1.53, respectively). Among males, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (aOR = 2.72) and anxiety (aOR = 2.23) followed by polysubstance users (aOR = 1.71 and 1.85, respectively). African American female and male students had lower odds of anxiety and depression compared to White students.

The results suggest that single, dual, and polysubstance use are associated with anxiety and depression among U.S. college students, though not necessarily in additive ways.

Association of social isolation and depressive symptoms with workplace productivity loss in a multi-ethnic Asian study

The association of health-related productivity loss (HRPL) with social isolation and depressive symptoms is not well studied. We aimed to examine the association of social isolation and depressive symptoms with productivity loss. Data on employed adults aged 21 years and above were derived from the Population Health Index (PHI) study conducted by the National Healthcare Group (NHG) on community-dwelling adults, residing in the Central and Northern residential areas of Singapore. The severity of depressive symptoms and social isolation were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and Lubben Social Network Scale-6 (LSNS-6) respectively. Productivity loss was assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). We used Generalised Linear Models, with family gamma, log link for the analysis. Models were adjusted for socio-demographic variables (including age, gender, ethnicity, employment status, housing type) and self-reported chronic conditions (including the presence of diabetes, hypertension, and dyslipidemia). There were 2,605 working (2,143 full-time) adults in this study. The median reported percentage of unadjusted productivity loss was 0.0%, 10.0% and 20.0% for participants with social isolation, depressive symptoms, and both, respectively. In the regression analysis, mean productivity loss scores were 2.81 times (95% Confidence Interval: 2.12, 3.72) higher in participants with depressive symptoms than those without. On the other hand, social isolation was not found to be associated with productivity loss scores (1.17, 95% Confidence Interval: 0.96, 1.42). The interaction term of depressive symptoms with social isolation was statistically significant, with an effect size of 1.89 (95% Confidence Interval: 1.04, 3.44). It appeared that productivity loss was amplified when social isolation and depressive symptoms were concomitant. Our results suggested significant associations of social isolation and depressive symptoms with productivity loss. These findings highlighted the potential impact of social isolation and depressive symptoms on work performance and drew attention to the importance of having a holistic work support system that promotes social connectedness, mental wellbeing and work productivity.

Differences in Depressive Symptom Profile by Age Group in Koreans With Major Depressive Disorder: Results From Nationwide General Population Surveys

OBJECTIVE

This study investigated to what extent a range of depressive symptoms was differentially present depending on age group in Korean population.

METHODS

Data was pooled from five nationally representative surveys in which 29,418 respondents aged at least 18 years were interviewed face-to-face using the Korean version of the Composite International Diagnostic Interview. A total of 691 (2.1%) respondents were found to have had at least 1 episode of major depressive disorder (MDD) within the last 12 months. Logistic regression analysis was conducted to identify the association between age groups (18-39 years, 40-59 years, and 60 years or older) and 26 depressive symptoms among the respondents with MDD.

RESULTS

Associations were observed between somatic symptoms-including insomnia, awakening 2 h earlier-and cognitive symptoms such as feelings of guilt, thoughts of death, and suicidal ideation with the older age group. Whereas, atypical depressive symptoms such as increased appetite, weight gain, and hypersomnia were associated with the younger age group. When adjusted for sociodemographic factors, symptoms such as depressed mood, awakening 2 h earlier, and feeling guilty in the older age group, and hypersomnia, psychomotor retardation, and worse in the morning in the younger age group still remained statistically significant. Furthermore, fatigue and decreased libido were newly associated with the younger age group.

CONCLUSION

The findings of this study revealed distinct patterns of symptomatology in MDD based on age groups. These differences should be considered owing to their potential relevance to treatment response and prognosis in the clinical setting.

Psychosocial health of migrant careworkers from Southeast Asian countries in Israel: A mixed methods study

Background

In 2018, 66,859 migrant careworkers were in Israel, most of whom originated from Southeast Asian countries and 81 % of whom are women. Stringent regulations combined with social invisibility creates vulnerabilities that may contribute to emotional distress. This study aimed to assess psychosocial status and determine mechanisms of emotional distress and resilience in this population.

Methods

Mixed methods were used in this cross-section study. An online survey measured demographic variables, psychosocial wellbeing using the HSCL-25 questionnaire, general health, perceived social support, cultural identity, and perceived othering. Based on the survey's results, interviews were conducted with a subpopulation of respondents (n = 15) to further understand the mechanisms of emotional distress and resilience, and were analyzed using a postcolonial feminist framework and grounded theory. Data collection took place during 2018-2019.

Results

In total, 263 careworkers completed the survey and 15 careworkers were interviewed. The overall prevalence of emotional distress according to the HSCL-25 was 36.8 %, 22.6 % on the anxiety subscale, and 41.8 % on the depression subscale. Emotional distress was associated with female sex, not being parents, poorer general health, high perceived othering, and low perceived social support. Interviews revealed that Israeli policy, and relationships with family in their country of origin and with Israeli employers and their families can either contribute to or mitigate emotional stressors.

Conclusions

Symptoms of emotional distress among Southeast Asian migrant careworkers in Israel are frequently reported, and may indicate rates of anxiety and depression higher than in careworkers' countries of origin and host country. Increased monitoring to protect careworkers' rights and including mental health services as part of their health insurance plan are warranted.

Emotion expressivity, suicidal ideation, and explanatory factors: Differences by Asian American subgroups compared with White emerging adults

OBJECTIVE

The relationship between emotion expressivity and psychological symptoms varies by race/ethnicity, and reduced expression of emotions has been implicated in risk for suicidal ideation. The present study examined differences in the relation between emotion expressivity and suicidal ideation through well-documented correlates of suicide risk (i.e., hopelessness, depressive symptoms) among Asian American subgroups compared with White emerging adults.

METHOD

A sample of 829 emerging adults, Ages 18 to 28 years, identifying as Asian American (27% East Asian, 18% South Asian, 11% Southeast Asian) or White (44%) completed measures of emotion expressivity, hopelessness, depressive symptoms, and suicidal ideation.

RESULTS

Lower emotion expressivity was statistically associated with higher levels of suicidal ideation, via hopelessness and depressive symptoms, among White, East Asian, and South Asian American emerging adults, but not among Southeast Asian Americans, though this difference in mediation was not statistically significant.

CONCLUSION

A focus on Asian Americans as a homogenous group occludes important ethnic differences in the relation between emotion expressivity and vulnerability to suicidal ideation. Ethnic differences in the function of emotion expressivity should be considered in suicide prevention and interventions among Asian American emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cultural immersion, acculturation strategies, and depressive symptoms among first-generation Vietnamese migrants in Germany

BACKGROUND

Worldwide migration represents a major challenge of the 21st century. Despite the strong association between acculturation and mental health, research findings on underlining mechanisms remain inconsistent. Prior research urges to investigate sample characteristics in a more structured manner.

AIMS

The purpose of this study was to systematically investigate factors impacting acculturation and depressive symptoms in a large, not exclusively clinical, sample of Vietnamese migrants in Germany.

METHOD

This study investigated, with multiple regressions, factors (age at arrival, gender, education, religiousness, language skills, residence status, economic status, occupational status, migration motivation, duration of stay, and depressive symptoms) impacting the two dimensions of acculturation, dominant society immersion (DSI) and ethnic society immersion (ESI), in a not exclusively clinical sample (n = 582) of first-generation Vietnamese migrants in Germany. Further, this study examined the relationship between depressive symptoms, DSI and ESI with correlations and acculturation strategies with an ANOVA.

RESULTS

Integration (72.5%) was the most common acculturation strategy, followed by separation (26.8%). In contrast, assimilation (0.5%) and marginalization (0.2%) were very rare acculturation strategies. As predictive factors for DSI lower depressive symptoms scores, male gender, higher education, and better German language skills were found significant. For ESI, less German language skills and older age at arrival were found to be significant. Higher ESI and DSI were correlated to lower depressive symptom scores. Compared to the three other acculturation strategies, integration was linked to the lowest depressive symptoms scores.

CONCLUSIONS

The current study identified crucial factors in the acculturation process, such as depressive symptoms, language skills, education, gender, and age at arrival. Our findings emphasize that immersion into both the dominant and the ethnic culture plays an essential supportive role in the mental health of migrants.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Associations of Discrimination, Low Social Support, and Limited English Proficiency with Depression in South Asian Immigrants

South Asians face stressors as a growing immigrant group in America. Work is needed to understand how these stressors impact mental health to identify those at risk of depression and design interventions. This study examined associations of three stressors (discrimination, low social support, limited English proficiency) with depressive symptoms in South Asians. Using cross-sectional data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 887), we fit logistic regression models to evaluate independent/joint effects of three stressors on depression. Overall prevalence of depression was 14.8%; 69.2% of those with all three stressors had depression. The combined effect of high discrimination/low social support was significantly greater than the sum of the individual factors. Experiences of discrimination, low social support, or limited English proficiency, as well as a combination of these factors, should be considered when diagnosing/treating South Asian immigrants in a culturally appropriate manner.

Exploring Levels and Correlates of Depression Literacy Among Older Korean Immigrants

OBJECTIVES

Despite the high prevalence of depression among older Korean Americans (KAs), there has been very little research on depression literacy among older KAs. This study identified specific areas of improvement in depression literacy to address mental health promotion among KAs. Twenty-two items on the depression literacy scale were grouped under five key themes: incidence and prognosis, differential symptoms, symptom recognition, non-pharmacological effectiveness, and pharmacological knowledge. This study aimed to assess the level of understanding depression literacy based on five domains and identify factors associated with depression literacy and its domains among older KAs.

METHODS

A cross-sectional study with 178 KAs aged 60 years and older was conducted in the Washington DC Metro area. Interviewer and self-administered questionnaires were used to collect data. Multiple linear regression analyses were conducted to identify factors associated with depression literacy and its domains. Statistical significance was set at p < .05 for analyses.

RESULTS

Knowledge pertaining to all 5 depression literacy domains was low, particularly on pharmacological treatment and differential symptoms were noticeably low. The majority of participants had misconceptions about antidepressants. 86% believed that antidepressants can have a rapid effect on symptoms, 82.6% believed people with depression should stop taking antidepressants as soon as they feel better, and 66.3% believed antidepressants were addictive.

CONCLUSION

Misperception about depression and antidepressants may be associated with poor mental health outcomes among older KAs. Culturally-tailored education for older KAs with limited English proficiency could be beneficial in promoting depression literacy and reducing stigma or misconceptions regarding depression and treatments.

Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop

Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

Prevalence of Depression Symptoms Before and During the COVID-19 Pandemic Among Two Asian American Ethnic Groups

Asian Americans have experienced compounding stressors during the pandemic as a result of racial discrimination. We aim of to investigate the prevalence of depression symptoms among Asian Americans before and during the COVID-19 pandemic and examine differences based on socio-demographic factors. Data are from a cross-sectional study (N = 636) among Chinese and South Asian adults in Chicago collected between February and May 2020. One cohort of participants were surveyed from each ethnic group before the pandemic and a second cohort of participants were surveyed during the pandemic. Depression symptoms increased more than two-fold, from 9% pre-pandemic to 21% during the COVID-19 pandemic. We found an increase in depression symptoms during the pandemic for South Asians, men and adults older than 30 years. These findings call for public health education that effectively addresses anti-Asian harassment and violence and ensure that culturally competent mental health services are provided to Asian Americans from diverse ethnic backgrounds.

Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly

Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer's disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.

Mental Health Screening Needs and Preference in Treatment Types and Providers in African American and Asian American Older Adults

Older African Americans and Asian Americans in the U.S. underuse mental health services, despite their vulnerability to diverse mental health problems. This study examined their perspectives on the importance of various mental health problems, mental health treatment, and provider type preference. A total of 243 participants residing in Philadelphia were recruited through community-based organizations. Chi-square, ANOVA, and logistic regression were conducted to examine ethnic differences in demographic characteristics, mental health screening needs, and treatment preferences. African Americans were more likely to endorse the screening needs for depression (AOR: 3.77; 95% CI: 1.19-11.93, p < 0.05) and less likely to endorse the screening needs for suicide (AOR: 0.24; 95% CI: 0.08-0.76, p < 0.05) compared to Asian Americans. For treatment preferences, African Americans were more likely to seek help from primary care physicians (AOR: 8.26; 95% CI: 1.71-32.86, p < 0.01) and less likely to prefer medication as a treatment option (AOR: 0.36; 95% CI: 0.09-0.79, p < 0.05) than Asian Americans. African Americans and Asian Americans prioritized mental health screening needs differently and had different treatment preferences, indicating that matching community needs and preferences regarding mental health services is critical to improve mental service utilization rates in the targeted populations.

Racial disparities in supportive medication use among older patients with brain metastases: a population-based analysis

BACKGROUND

Brain metastases (BM) cause symptoms that supportive medications can alleviate. We assessed whether racial disparities exist in supportive medication utilization after BM diagnosis.

METHODS

Medicare-enrolled patients linked with the Surveillance, Epidemiology, and End Results program (SEER) who had diagnoses of BM between 2007 and 2016 were identified. Fourteen supportive medication classes were studied: non-opioid analgesics, opioids, anti-emetics, anti-epileptics, headache-targeting medications, steroids, cognitive aids, antidepressants, anxiolytics, antidelirium/antipsychotic agents, muscle relaxants, psychostimulants, sleep aids, and appetite stimulants. Drug administration ≤30 days following BM diagnosis was compared by race using multivariable logistic regression.

RESULTS

Among 17,957 patients, headache aids, antidepressants, and anxiolytics were prescribed less frequently to African Americans (odds ratio [95% CI] = 0.81 [0.73-0.90], P < 0.001; OR = 0.68 [0.57-0.80], P < 0.001; and OR = 0.68 [0.56-0.82], P < 0.001, respectively), Hispanics (OR = 0.83 [0.73-0.94], P = 0.004 OR = 0.78 [0.64-0.97], P = 0.02; and OR = 0.63 [0.49-0.81], P < 0.001, respectively), and Asians (OR = 0.81 [0.72-0.92], P = 0.001, OR = 0.67 [0.53-0.85], P = 0.001, and OR = 0.62 [0.48-0.80], P < 0.001, respectively) compared with non-Hispanic Whites. African Americans also received fewer anti-emetics (OR = 0.75 [0.68-0.83], P < 0.001), steroids (OR = 0.84 [0.76-0.93], P < 0.001), psychostimulants (OR = 0.14 [0.03-0.59], P = 0.007), sleep aids (OR = 0.71 [0.61-0.83], P < 0.001), and appetite stimulants (OR = 0.85 [0.77-0.94], P = 0.002) than Whites. Hispanic patients less frequently received antidelirium/antipsychotic drugs (OR = 0.57 [0.38-0.86], P = 0.008), sleep aids (OR = 0.78 [0.64-0.94, P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.04). Asian patients received fewer opioids (OR = 0.86 [0.75-0.99], P = 0.04), anti-emetics (OR = 0.83 [0.73-0.94], P = 0.004), anti-epileptics (OR = 0.83 [0.71-0.97], P = 0.02), steroids (OR = 0.81 [0.72-0.92], P = 0.001), muscle relaxants (OR = 0.60 [0.41-0.89], P = 0.01), and appetite stimulants (OR = 0.87 [0.76-0.99], P = 0.03). No medication class was prescribed significantly less frequently to Whites.

CONCLUSIONS

Disparities in supportive medication prescription for non-White/Hispanic groups with BM exist; improved provider communication and engagement with at-risk patients is needed.

KEY POINTS

1. Patients with BM commonly experience neurologic symptoms.2. Supportive medications improve quality of life among patients with BM.3. Non-White patients with BM receive fewer supportive medications than White patients.

A systematic review of the latent structure of the Center for Epidemiologic Studies Depression Scale (CES-D) amongst adolescents

BACKGROUND

The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents.

METHODS

We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data.

RESULTS

Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia.

LIMITATIONS

Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure.

CONCLUSIONS

A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.

A rapid assessment of migrant careworkers' psychosocial status during Israel's COVID-19 lockdown

BACKGROUND

Israel hosts nearly 70,000 migrant careworkers. Migrant careworkers work and live with populations extremely vulnerable to the novel Coronavirus, including the elderly and people with pre-existing physical conditions. This rapid assessment aimed to explore psychosocial status and mental wellbeing of migrant careworkers in Israel during the ongoing Covid-19 pandemic and determine risk and protective factors associated with mental distress, anxiety, and depression.

METHODS

This quantitative study was conducted via an online survey. The online survey collected social and demographic data, including country of origin, residence, age, sex, and time in Israel. In addition, questions were asked about knowledge of COVID-19 guidelines, access to supplies, and COVID-related racism. Respondents also completed a psychosocial screening tools, the Hopkins Symptom Checklist-10 (HSCL-10), which was used to screen for depression and anxiety.

RESULTS

As of May 3rd, 2020, 307 careworkers responded to the online survey, of whom 120 (39.1%) were found symptomatic using the HSCL-10. Separating the HSCL-10 into subscales, 28.0% were symptomatically anxious, and 38.1% were symptomatic for depression. In multivariate regression, emotional distress was associated with household food insecurity (OR: 5.85; p < 0.001), lack of confidence to care for oneself and employer during the pandemic (OR: 3.85; p < 0.001), poorer general health (OR: 2.98; p < 0.003), non-Philippine country of origin (OR: 2.83; p < 0.01), female sex (OR: 2.34; p < 0.04),, and inversely associated with age (p < 0.03). While 87.6% of careworkers reported having access to hand sanitization materials regularly, only 58.0% had regular access to a medical grade mask, and 21.5% reported household food insecurity. Moreover, 40.0% of careworkers claimed to lack confidence to care for themselves and their employer during the COVID-19 pandemic.

CONCLUSIONS

Migrant careworkers exhibited high levels of mental distress during the COVID-19 lockdown, associated with lack of confidence or resources to properly care for themselves and their employer. Guidelines and support programs specific to the carework sector, that respect their rights and guard their health, must be developed as part of a coordinated COVID-19 response.

Stress and depression in the context of migration among Haitians in the United States

Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration-related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross-sectional pilot study used purposive sampling methods to recruit 76 first-generation Haitian immigrants living in South and West Florida from February 2018-May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration-related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration-related stress and depression (CESD (β =.606, 95% CI [.296, .556]) and ZLDSI (β = .624, 95% CI [.242, .440]). Relative to the standardized coefficient, migration-related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration-related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre-migration factors and the degree of migration-related stress encountered while adapting to life post-migration is critical because they play a significant role in shaping immigrants' depression realities. Community-based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration-related stressors and facilitate mental health promotion and prevention.

Mental Health of Asian American Older Adults: Contemporary Issues and Future Directions

Given the increased attention to older Asian Americans due to their increasing numbers in the United States, this article aims to provide a collective appraisal of older Asian American mental health issues by reviewing trends in older Asian American mental health research over the past 2 decades. This review article provides an overview of the current state of mental health and care research on older Asian Americans and vital factors associated with older Asian American mental health and care. We also identify gaps in current research on Asian American mental health issues and propose 5 potential areas for future research into which gerontologists need to put more effort during the next decade. Ways to reduce disparities in mental health and improve the quality of mental health of older Asian Americans are also discussed.

Are Filial Piety and Ethnic Community Engagement Associated With Psychological Wellbeing Among Older Chinese American Immigrants? A Cultural Resource Perspective

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population.

The Association of Race/Ethnicity, Dietary Intake, and Physical Activity with Depression

OBJECTIVE

This study investigated the association of race/ethnicity, dietary intake, and physical activity with depression and potential other barriers associated with the use of mental health services among depressed people.

METHODS

We used the nationally representative data, 2011-2016 National Health and Nutrition Examination Survey. Depression status was defined using a Patient Health Questionnaire. Multivariable logistic regressions were conducted on depression status and the use of mental health specialists among depressed adults, accounting for the complex sampling design.

RESULTS

The prevalence of depression was 8.3% with substantial racial/ethnic differences (8.0% for white, 3.1% for Asian, 9.2% for black, 7.6% for Mexican Hispanics, 13.0% for other Hispanics). Good/acceptable diet and a high level of physical activity were negatively associated with depression. Among depressed people, no significant racial/ethnic differences were observed in using mental health specialists.

CONCLUSION

Prevalence for depression was lower among people who have good or acceptable diet and moderate physical activity. These modifiable factors as well as race/ethnicity should be incorporated into psychotherapeutic interventions to improve depression.

Measurement equivalence of the Kessler 6 Psychological Distress Scale for Chinese and Korean immigrants: Comparison between younger and older adults

OBJECTIVES

The Kessler 6 (K6) Psychological Distress Scale is a well-known instrument to screen for psychological distress of general populations. It is critical to perform the equivalence test of the K6 for Asian immigrant subgroups.

METHODS

The 2012 California Health Interview Survey data were used (N = 1,210; Chinese = 640, Koreans = 570). Among 1,210, 734 were younger (18-64 years) and 476 were older (65+) adults. It was examined whether parameters in the measurement model is equivalent across the two groups, using multiple-group analysis. The equivalence tests for Chinese and Koreans were separately performed based on different age groups (younger [18-64] vs. older [65+]).

RESULTS

The younger group had good model fit (X² = 41.27 [df = 16, p = .001], X² /df = 2.58, Comparative Fit Index [CFI] = 0.99, Goodness of Fit Index [GFI] = 0.98, root mean square error or approximation [RMSEA] = 0.05, standardized root mean residual [SRMR] = 0.03), and the older group also showed good model fit (X² = 41.70 [df = 16, p < .001], X² /df = 2.61, CFI = 0.98, GFI = 0.97, RMSEA = 0.06, SRMR = 0.04). The model for older group indicated measurement noninvariance between Chinese and Korean immigrants (ΔX² = 17.86, Δdf = 5, p = .003, CFI = 0.972, ΔCFI = 0.009). The items "hopeless," "restless," and "depress," were significantly nonequivalent between the two groups.

CONCLUSIONS

Clinicians/researchers should be aware of the potential risk for misclassification when they screen psychological distress of Chinese or Korean older immigrants. Professionals should pay attention to cross-cultural comparability when interpreting results from the K6.

Depression symptoms and recurrent aphthous stomatitis-Evidence from a population-based study in Indonesia

OBJECTIVES

This study aims to report the prevalence and distribution of recurrent aphthous stomatitis (RAS) among Indonesian adults and to test the relationship between symptom of depression and RAS.

METHODS

Data from the 2007 Indonesia Family Life Survey (IFLS 2007) were analysed to assess the association between symptom of depression and RAS. The prevalence of RAS in the previous month was self-reported. Symptom of depression was measured using the 10-item Center for Epidemiologic Studies Depression (CES-D) scale. The distribution of RAS according to age, sex and level of stress was also presented in the bivariate analysis. Multivariable logistic regression models were fitted to test associations between symptom of depression and RAS, controlling for age, sex and the stress level.

RESULTS

The previous month prevalence of RAS in Indonesian population was 12%. The adjusted odds ratios (ORs) from the logistic regression models indicate that, for each unit increase in the CES-D depression score (range: 0-30), there was a 9% increase in the odds of having RAS (OR: 1.09, 95%CI: 1.08-1.10). Being older and being male was related with lower prevalence of RAS.

CONCLUSIONS

A higher score of depression was related to a higher prevalence of RAS. This association was persistent even after controlling for age, sex and the level of stress.

Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant

BACKGROUND

Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity.

METHODS

One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy.

RESULTS

Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy.

CONCLUSIONS

Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.

Depressive Symptoms Among Older Chinese Americans: Examining the Role of Acculturation and Family Dynamics

Objectives

This study identified the prevalence of depression and tested the influence of acculturation and family dynamics on depressive symptoms, among a community sample of older Chinese Americans.

Method

Data came from a survey of 385 Chinese Americans aged 55 and older (Mage = 72.4 years, SD = 8.7) living in a large metropolitan area in the American Southwest. The survey was administered in 2013 through face-to-face interviews. Depressive symptoms were assessed with the 12-item Center for Epidemiological Studies Depression scale.

Results

Approximately 19.5% of the sample reported mild depressive symptoms and an additional 8.5% reported moderate depressive symptoms. Three-step hierarchical regression analyses indicated that smaller family support network size and more family conflict were risk factors for depressive symptoms. The effect of acculturation was not significantly associated with depressive symptoms after controlling for family dynamics.

Discussion

Family support and conflict play a prominent role in explaining depressive symptoms among Chinese American older adults. The effect of acculturation is minimal when older adults have supportive families and good health. Interventions or services aimed at promoting family harmony for members of this population should be considered.

Using Korean Dramas as a Precision Mental Health Education Tool for Asian Americans: A Pilot Study

Precision mental health (MH) holds great potential for revolutionizing MH care and reducing the burden of mental illness. Efforts to engage Asian Americans in precision MH research is necessary to help reduce MH disparities. Korean drama ("K-drama") television shows may be an effective educational tool to increase precision MH knowledge, attitudes, and behaviors (KAB) among Asian Americans. This study determined whether KAB improved after participating in a K-drama precision MH workshop, and examined the participants' perspectives about K-dramas' utility as an educational tool. A K-drama precision MH workshop in English/Vietnamese/Korean was conducted with a convenience sample (n = 122). Pre-/post-tests on precision MH KAB (genetics and genetic testing, and MH and help-seeking) and a survey on K-dramas' utility as an educational tool were administered. Findings revealed a significant difference in the pre- and post-test KAB scores overall, by genetics and genetic testing, and by MH and help-seeking. There were also significant increases in the overall post-test KAB scores by workshop (language) participation. Overall, participants responded positively on the utility of K-dramas as a precision MH educational tool. This study demonstrates the feasibility of K-drama as an innovative and widely available health education tool to educate communities about precision MH.

Depression in primary care: part 1-screening and diagnosis

Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. In this first of two reviews, we outline an approach to screening and diagnosing depression in primary care that evaluates current evidence based guidelines and applies the recommendations to clinical practice. The second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.

Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995-2008

Depression in adolescents and young adults remains a pressing public health concern and there is increasing interest in evaluating population-level inequalities in depression intersectionally. A recent advancement in quantitative methods-multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)-has many practical and theoretical advantages over conventional models of intercategorical intersectionality, including the ability to more easily evaluate numerous points of intersection between axes of marginalization. This study is the first to apply the MAIHDA approach to investigate mental health outcomes intersectionally in any population. We examine intersectionality and depression among adolescents and young adults in the U.S. along dimensions of gender, race/ethnicity, immigration status, and family income using a large, nationally representative sample-the National Longitudinal Study of Adolescent to Adult Health. We find evidence of considerable inequalities between social strata, with women, racial/ethnic minorities, immigrants, and low income strata experiencing elevated depression scores. Importantly, the majority of between-strata variation is explained by additive main effects, with no strata experiencing statistically significant residual "interaction" effects. We compare these findings to previous intersectional research on depression and discuss possible sources of differences between MAIHDA and conventional intersectional models.

Factor structure of the Geriatric Depression Scale and measurement invariance across gender among Chinese elders

BACKGROUND

The Geriatric Depression Scale (GDS) is commonly used in research and clinical settings for screening of depression. The current study aimed to examine the best-fit factor structure model of the GDS among Chinese elders and to evaluate the measurement invariance of the GDS across genders.

METHODS

Participants included 1,553 elderly residents from the Hunan, Shandong, and Beijing provinces. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted in tandem to determine the structure of the GDS on a large scale. Multigroup CFA (N = 1553, 45.24% male, mean = 71.33 ± 8.06) was utilized to test the measurement invariance of the depressive symptom structure, which was generated by EFA and confirmed by CFA across gender.

RESULTS

A three-factor model with 15 depression, 9 apathy and 4 vigor items presented the best fit indices. Measurement invariance of the new proposed model across gender was supported fully assuming different degrees of invariance.

LIMITATIONS

Our sample was entirely Chinese, and thus may not be representative of populations outside of China. Our results are based on a cross-sectional study, which did not take into consideration changes that may occur over time within individuals.

CONCLUSIONS

A three-factor model best fits the depressive symptom structure of the GDS among elderly Chinese, with measurement invariance across genders.

Cultural Factors, Depressive and Somatic Symptoms Among Chinese American and European American College Students

This study seeks to fill a gap in the existing empirical literature about the relationship between somatic and depressive symptoms and their associations with cultural factors among Chinese American and European American college students. In particular, the study examined how three culturally relevant psychological constructs, self-construal, loss of face, and emotion regulation, associate with depressive and somatic symptoms among Chinese American and European American college students and if they can explain possible group differences in depressive symptoms. The sample consisted of 204 Chinese American and 315 European American college students who completed an online survey. Based on multiple regression analyses, European American students reported higher levels of somatic symptoms on the Patient Health Questionnaire–15 (PHQ-15) than Chinese Americans. There was no initial group difference in depressive symptoms based on Center for Epidemiologic Studies–Depression Scale (CES-D) scores. Correlations between depressive and somatic symptoms, independent and interdependent self-construal, and cognitive reappraisal and independent self-construal were stronger for European Americans than Chinese Americans. Somatic symptoms, loss of face, and expressive suppression were positively associated with depressive symptoms, whereas independent self-construal and cognitive reappraisal were negatively associated with depressive symptoms for both groups. When controlling for gender and somatic symptoms, being Chinese American and male was significantly and positively associated with depressive symptoms measured with the CES-D. These ethnic and gender differences in depressive symptoms were explained by independent self-construal, loss of face, cognitive reappraisal, and expressive suppression. Clinical implications include the incorporation of specific culturally relevant constructs and avoidance of race-, ethnicity-, and gender-based stereotypes to reduce health disparities in depression treatment.

The Psychometric Validation of the EPDS-K Among Korean Women: Does It Only Measure Depressive Symptoms?

PURPOSE

The purpose of this study was to test the validity of the Edinburgh Postnatal Depression Scale-Korean (EPDS-K) and compare the specified models (one-, two-, three-factor model, and a model in the current study) in pregnant, first-trimester Korean women.

DESIGN AND METHODS

The study consisted of two groups of 100 first-trimester Korean women recruited from maternity clinics in Korea.

FINDINGS

The results show that the EPDS-K has depression, anxiety, and anhedonia factors, and that the validity of the EPDS-K with Korean women is questionable.

PRACTICE IMPLICATIONS

Healthcare providers should test the psychometric properties of tools for screening accuracy, clinical decision-making, and understanding of a phenomenon within different cultural settings.

The effectiveness of solution-focused brief therapy for psychological distress among Chinese parents of children with a cancer diagnosis: a pilot randomized controlled trial

PURPOSE

Given the critical role of parental care for pediatric cancer patients, this pilot study evaluated the feasibility and effectiveness of a hospital-based solution-focused brief therapy (SFBT) intervention for reducing psychological distress among parents of pediatric cancer patients in China. Differences between treatment and active control (AC) groups were assessed on dimensions of psychological distress. Parents' level of hope was also assessed.

METHODS

Participants (N = 44) were randomly assigned to SFBT or AC. Parents received four sessions of SFBT twice a week delivered by graduate-level hospital social workers. Pre- and post-intervention assessments measured change in distress (depression, anxiety, and somatization symptoms) of parents as well as their level of hope.

RESULTS

Analysis of covariance (ANCOVA) indicated the SFBT group had better outcomes than the AC group on overall distress of somatic, anxiety, depression symptoms and level of hope. Within- and between-group treatment effects reported significantly greater effect of the SFBT group than of the AC group.

CONCLUSIONS

Considering the inherent limits of a pilot feasibility study, results suggest that SFBT is a feasible, culturally compatible, and promising intervention for alleviating distress among Chinese parents of children with cancer. Additional comprehensive trials are needed to draw more definitive conclusions.

RELEVANCE

SFBT may be beneficial for improving the critical support systems of parents of pediatric cancer patients. Thus, SFBT may have the potential to enhance children's well-being during cancer treatment and recovery.

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.

Depression Symptom Patterns and Social Correlates among Chinese Americans

The aim of this study is to examine and compare the depression symptoms pattern and social correlates in three groups: foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. This study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES). The study sample consists of 599 Chinese Americans (468 for the foreign-born and 121 for the US-born) and 4032 non-Hispanic whites. Factor analysis was used to examine the depression symptom patterns by each subgroup. Four depression symptoms dimensions were examined: negative affect, somatic symptoms, cognitive symptoms, and suicidality. Logistic regression was used to investigate the effects of sociodemographic (age, gender, marital status, and education), physical health condition, and social relational factors (supports from and conflict with family and friends) on specific types of depression symptoms separately for the three subgroups. The findings showed little differences in depression symptom patterns but clear variation in the social correlates to the four depression dimensions across the three ethnocultural groups, foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. Clinicians should take into account the sociocultural factors of patients when making diagnosis and suggesting treatments. In addition, psychiatrists, psychologists, or other mental health service providers should offer treatment and coping suggestions based on the specific symptom dimensions of patients, and patients’ ethnocultural backgrounds.

Comparing five depression measures in depressed Chinese patients using item response theory: an examination of item properties, measurement precision and score comparability

Background

Item response theory (IRT) has been increasingly applied to patient-reported outcome (PRO) measures. The purpose of this study is to apply IRT to examine item properties (discrimination and severity of depressive symptoms), measurement precision and score comparability across five depression measures, which is the first study of its kind in the Chinese context.

Methods

A clinical sample of 207 Hong Kong Chinese outpatients was recruited. Data analyses were performed including classical item analysis, IRT concurrent calibration and IRT true score equating. The IRT assumptions of unidimensionality and local independence were tested respectively using confirmatory factor analysis and chi-square statistics. The IRT linking assumptions of construct similarity, equity and subgroup invariance were also tested. The graded response model was applied to concurrently calibrate all five depression measures in a single IRT run, resulting in the item parameter estimates of these measures being placed onto a single common metric. IRT true score equating was implemented to perform the outcome score linking and construct score concordances so as to link scores from one measure to corresponding scores on another measure for direct comparability.

Results

Findings suggested that (a) symptoms on depressed mood, suicidality and feeling of worthlessness served as the strongest discriminating indicators, and symptoms concerning suicidality, changes in appetite, depressed mood, feeling of worthlessness and psychomotor agitation or retardation reflected high levels of severity in the clinical sample. (b) The five depression measures contributed to various degrees of measurement precision at varied levels of depression. (c) After outcome score linking was performed across the five measures, the cut-off scores led to either consistent or discrepant diagnoses for depression.

Conclusions

The study provides additional evidence regarding the psychometric properties and clinical utility of the five depression measures, offers methodological contributions to the appropriate use of IRT in PRO measures, and helps elucidate cultural variation in depressive symptomatology. The approach of concurrently calibrating and linking multiple PRO measures can be applied to the assessment of PROs other than the depression context.

Configural and scalar invariance of the center for epidemiologic studies depression scale in Egypt and Canada: Differential symptom emphasis across cultures and genders

BACKGROUND

Depression is a significant contributor of global disease burden. Previous studies have revealed cross-cultural and gender differences in the presentation of depressive symptoms. Using the Center for Epidemiologic Studies-Depression Scale (CES-D), the present study examined differences in self-reported somatic, negative affective, and anhedonia symptoms of depression among Egyptian and Canadian university students.

METHODS

A total of 338 university students completed study questionnaires from two major universities in Egypt (n=152) and Canada (n=186). Symptom domains were calculated based on the 14-item model of the CES-D.

RESULTS

We found significant culture by gender interactions of total CES-D scores, wherein Egyptian females reported higher scores compared to their Canadian and Egyptian male counterparts.

LIMITATIONS

Limitations include using analogue student samples and using only one self-report measure to examine different depressive symptom domains.

CONCLUSIONS

Findings of this study provided support that males and females may differentially report depressive symptoms across cultures. Implications of these results are further discussed.

The effects of the gender-culture interaction on self-reports of depressive symptoms: cross-cultural study among Egyptians and Canadians

PURPOSE

Research in depression has revealed differences in the way depressed individuals across cultures report their symptoms. This literature also points to possible differences in symptom reporting patterns between men and women. Using data from a larger dataset (Beshai et al. 2016), the current study examined whether non-depressed and depressed Egyptian and Canadian men and women differed in their self-report of the various domains of the Beck Depression Inventory -II (BDI-II).

METHOD

We recruited a total of 131 depressed and non-depressed participants from both Egypt (n = 29 depressed; n = 29 non-depressed) and Canada (n = 35 depressed; n = 38 non-depressed). Depression status was ascertained using a structured interview. All participants were asked to complete the BDI-II along with other self-report measures of depression. BDI-II items were divided into two subscales in accordance with Dozois, Dobson & Ahnberg (1998) factor analysis: cognitive-affective and somatic-vegetative subscales.

RESULTS

We found a significant three-way interaction effect on the cognitive-affective (F(1,121) = 9.51, p = .003) and main effect of depression status on somatic-vegetative subscales (F(1,121) = 42.80, p < .001). Post hoc analyses revealed that depressed Egyptian men reported lower scores on the cognitive-affective subscale of the BDI-II compared to their depressed Canadian male counterparts.

CONCLUSIONS

These results suggest that males across cultures may differentially report cognitive symptoms of depression. These results also suggest that clinicians and clinical scientists need to further examine the interaction effect of culture and gender when investigating self-reported symptoms of depression.

Reducing the Stigma of Depression Among Asian Students

In North America, Asians reliably report higher levels of stigma toward people with depression than do Europeans. Possible methods of reducing this discrepancy have rarely been explored. Asian undergraduate students ( n = 132) were presented with one of four antistigma videos with two actresses: one portraying a student with depression and the other a professor. The videos used the concept of social proof, presenting either positive or negative descriptive norms, to effect change in stigma, measured by social distance. It was hypothesized that the positive descriptive norms intervention would show significantly greater positive change in social distance compared with the negative descriptive norms intervention. All videos were effective in reducing preferred social distance toward people with depression relative to the control condition. The effectiveness of the positive descriptive norm video was mediated through descriptive norms and self-efficacy. The effectiveness of the negative descriptive norm video was mediated through injunctive norms and perceived value of support. The findings can help guide interventions that aim to encourage social engagement with people with depression among Asian student populations. Manipulating social norms and increasing self-efficacy may be especially effective.

Comparison of the Prevalence and Predictors of Depression in Taiwanese and American Older Patients With Arthritis

PURPOSE

To compare the prevalence and predictors of depression in Taiwanese and American older patients with arthritis.

DESIGN AND METHODS

A secondary analysis was conducted to assess 151 Taiwanese and 70 American arthritic patients in Taipei, Taiwan and Chicago, USA.

FINDINGS

The prevalence of depression of Taiwanese and American older arthritic patients was 34% and 40%, respectively. Depression was explained by life satisfaction and functional ability in Taiwanese patients, and by life satisfaction and level of pain in American patients.

PRACTICE IMPLICATIONS

Nurses should assess patients' level of pain and functional ability, as well as their life satisfaction and depression.

Efficacy of a Culturally Tailored Therapeutic Intervention Program for Community Dwelling Depressed Korean American Women: A Non-Randomized Quasi-Experimental Design Study

BACKGROUND

Asian American women are more prone to suffer from depression compared to their non-Asian American counterparts and have lower rates of seeking mental healthcare services due to lack of available culturally appropriate therapies. Two prior studies of a culturally tailored therapeutic intervention called LogoAutobiography were helpful in treating depressed Korean American women. The LogoAutobiography program was revised to enhance its efficacy not only for depressive symptoms and purpose in life but also to increase coping strategies.

OBJECTIVES

To test the efficacy of the Enhanced LogoAutobiography program on depressive symptoms, purpose in life, and coping strategies of depressed community-dwelling Korean American women.

DESIGN

Two-group, non-randomized quasi-experimental design.

SETTINGS

Local Korean community areas located in New York City and eastern New Jersey of the United States.

PARTICIPANTS

A total of 54 depressed women with Korean heritage completed either experimental group (n1=25) or control group (n2=29). Sample inclusion criteria were adult women with Korean heritage, depressive symptoms as measured by a CES-D score 16 or higher, fluent Korean language, and able to participate independently. Sample exclusion criteria were those who presented active suicidal ideation and history of episodes of mania or psychosis screened by the psychosocial survey questionnaire.

METHODS

The experimental group received Enhanced Logo-Autobiography program which was guided by a facilitator who used a manualized intervention for 90minute sessions over 8weeks; the control group attended routine weekly community activities. Data were collected during the first session (pretest), the end of 8weeks (posttest), and the 3months follow-up session. Time and group changes in depressive symptoms, purpose in life, and coping strategies were computed using Repeated Measures General Linear Model (RMGLM).

RESULTS

Findings suggested that the experimental group showed greater improvement in depressive symptoms (F=6.94 (2, 88), p<0.01), active cognitive coping (F=5.07 (2, 86), p<0.01), and avoidance coping strategies (F=3.48 (2, 86), p<0.05) compared to the control group during the three time intervals. Purpose in life showed statistically significant Time and Group effects (F=5.18 (2, 88), p<0.01; F=9.44 (2, 88), p<0.01, respectively), but no significant interaction effect of Time and Group was detected.

CONCLUSION

These findings suggest that enhanced LogoAutobiography is effective for depressive symptoms and coping strategies and somewhat effective for improving purpose in life for depressed Korean American women.

Psychometric Properties of the Persian Version of the Short Beck Depression Inventory with Iranian Psychiatric Outpatients

The short form of the Beck Depression Inventory (BDI-13) is useful for the screening and assessment of depression in clinical and research settings. The aim of the present study was to investigate the psychometric properties of the Persian (Farsi) version of BDI-13 in an Iranian clinical sample. The sample consisted of 52 Iranian psychiatric outpatients who received services at psychiatric and psychological clinics at the School of Behavioral Sciences & Mental Health-Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS) in Tehran, Iran. The study examined the reliability, construct validity, and factor structure of the instrument. The instrument indicated good reliability with Cronbach's alpha of .85 and strong construct validity based on moderate to strong positive correlations with other measures of mental health issues. Using a Principal Component Analysis and Varimax Rotation with Kaiser Normalization, three factors were identified and labeled Affective (F1), Somatic/Vegetative (F2), and Cognitive/Loss of Functioning (F3). The current factor structure suggests that depression is a multidimensional construct in an Iranian clinical sample. This study provides further evidence that the Persian version of the BDI-13 is a psychometrically sound instrument that can be used for clinical and research purposes in Iran.

An Exploration of Parenting Stress in Immigrant and Taiwanese Mothers

To assess parenting stress and major difficulties experienced in early motherhood among immigrant and Taiwanese women in Pingtung, southern Taiwan. A comparative, descriptive, cohort study of parenting stress and maternal psychological health, using the Child Care Stress Checklist and Edinburgh Postpartum Depression Scale. A purposive sample of 26 foreign-born Vietnamese and 162 Taiwanese mothers were surveyed at 6 weeks' postpartum. Both groups of mothers experienced similar parenting difficulties including the establishment of a regular sleeping schedule for the infant, consoling a crying infant, awareness of infant's needs, conflict with family members, and difficulties managing household chores. Curtailment of social activities was reported more often by Taiwanese mothers, whereas inaccessibility to other experienced mothers and poor maternal-infant bonding were experienced more by immigrant mothers. There were significant differences between groups, with high levels of child care stress and postpartum depression symptoms reported more often by immigrant mothers. Nurses-midwives and community child health nurses need to be sensitive to the particular difficulties and stresses of parenting in mothers from different backgrounds and provide effective interventions and support activities.

Acculturative heterogeneity among Asian/Pacific Islanders in the United States: Associations with DSM mental and substance use disorders

Extant studies on the links between acculturation and mental and substance use disorders among Asian/Pacific Islanders have been based on the assumption that acculturation is a homogeneous construct. However, emerging evidence suggests that the various components of acculturation do not manifest independently, but rather cluster in ways that reflect distinct profiles. We employ data on Asian/Pacific Islanders from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 968). Latent profile analysis is used to identify acculturation subgroups on the basis of indicator variables related to cultural identification, language ability and preference, and social engagement. Subsequently, the distribution of outcome variables in the domains of DSM disorders (lifetime history of clinical, personality, and substance use disorders) is examined across latent subgroups. We identified a 5-class solution: Class 1: Separated (12.91%), Class 2: Partial Bilingual/Bicultural (30.06%), Class 3: English Dominant/Asian Oriented (12.29%), Class 4: Full Bilingual/Bicultural (19.42%) and Class 5: Assimilated (25.31%). The highest rates of clinical disorders were observed among members of the 2 classes characterized by a strong preference for the use of the English language (Classes 3 and 5). The highest prevalence of nicotine (12%) and illicit drug use (15%) disorders was observed among members of the Assimilated class. Consistent with prior research, findings suggest that risk of morbidity is greater among more acculturated individuals; however, findings also suggest that an important level of nuance can be observed with respect to acculturative subtypes identified on the basis of cultural identification, language ability and preference, and social engagement.

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.