Perceptions of depression in korean american immigrants

Depression Literacy and Depressive Symptoms: The Mediating Role of Self-Rated Mental Health Among Korean Americans

OBJECTIVE

Depression literacy (DL) is increasingly recognized as an important predictor of mental health outcomes, but there remains a noticeable lack of scientific inquiry focusing on Korean Americans in this area. In addition, women are known to be more susceptible to depression, potentially affecting their DL and depressive symptoms differently than men. This study aimed to explore two primary objectives: (1) the potential role of self-rated mental health (SRMH) in mediating the association between DL and depressive symptoms in this population, and (2) whether gender differences exist in the presence and magnitudes of these mediation effects.

METHOD

Data were drawn from a survey with 693 Korean Americans aged 18 and older residing in New York and New Jersey. The PROCESS macro was used to test the mediation effect of self-rated mental health on the relationship between depression literacy and depressive symptoms in men and women.

RESULTS

Self-rated mental health was found to mediate the relation between depression literacy and depressive symptoms in women but not in men.

CONCLUSIONS

Providing evidence-informed, culturally tailored and gender specific depression literacy education and programs for the KA communities may be an important strategy to reduce depressive symptoms in this group.

Immigration Transition and Symptom Distress Changes by a Technology-Based Intervention: Asian American Breast Cancer Survivors

Technology-based programs using computers and mobile devices are known to be effective in providing information and support to marginalized populations including immigrants. Yet, little is still known on the factors that may influence the effectiveness of technology-based programs in improving symptom experience, including immigration transition, especially among Asian American breast cancer survivors. This study aimed to identify the characteristics related to immigration transition that significantly affected the symptom distress changes by a technology-based information and coaching/support program among Asian American breast cancer survivors. This secondary analysis was conducted with the data from 102 Asian American breast cancer survivors from a randomized clinical trial in progress. Multiple instruments were used: the questions on background characteristics and immigration transition and the Memorial Symptom Assessment Scale-Short Form. The data were analyzed using repeated-measurement analyses and decision tree analyses. The mean changes in the symptoms distress scores were as follows: -0.12 (SD, 0.47) in the Global Distress Index scores; -0.08 (SD, 0.43) in the physical symptom distress scores; and -0.15 (SD, 0.65) in the psychological symptom distress scores. The characteristics with the highest impact on the symptom distress score changes included the immigration age for Global Distress Index and physical symptom distress score and the level of acculturation for psychological symptom distress score.

Pharmacogenomic variabilities in geo-ancestral subpopulations and their clinical implications: Results of collaborations with Hmong in the United States

Underrepresentation of subpopulations within geo-ancestral groups engaged in research can exacerbate health disparities and impair progress toward personalized medicine. This is particularly important when implementing pharmacogenomics which uses genomic-based sources of variability to guide medication selection and dosing. This mini-review focuses on pharmacogenomic findings with Hmong in the United States and their potential clinical implications. By actively engaging Hmong community in pharmacogenomic-based research, several clinically relevant differences in allele frequencies were observed within key pharmacogenes such as CYP2C9 and CYP2C19 in Hmong compared to those in either East Asians or Europeans. Additionally, using state-of-the-art genome sequencing approaches, Hmong appear to possess novel genetic variants within CYP2D6, a critical pharmacogene affecting pharmacokinetics of a broad range of medications. The allele frequency differences and novel alleles in Hmong have translational impact and real-world clinical consequences. For example, Hmong patients exhibited a lower warfarin stable dose requirement compared to East Asian patients. This was predicted based on Hmong's unique genetic and non-genetic factors and confirmed using real-world data from clinical practice settings. By presenting evidence of the genetic uniqueness and its translational impact within subpopulations, such as the Hmong, we hope to inspire greater inclusion of other geo-ancestrally underrepresented subpopulations in pharmacogenomic-based research.

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.

Experiences of Sleep Problems Among Older Korean Immigrants

Despite poor sleep among older adults, little is known about the sleep habits of older immigrants living in the United States. The current pragmatic qualitative descriptive study explored sleep among older Korean immigrants, using a focus group with six participants and individual phone interviews with 22 Korean immigrants aged ≥60 years. Transcripts were coded to identify underlying themes. Several thematic categories were identified under six domains: daytime function, getting ready for bed, falling asleep, awakenings during sleep, going back to sleep, and seeking advice from peers. Unhealthy sleep behaviors were found during daytime and bedtime, particularly among those who were retired/unemployed or living alone. Seeking advice from peers was common but none of the advice helped participants sleep. Sleep education programs in Korean-speaking communities can be used to target those who are socially isolated and may benefit older Korean immigrants with sleep difficulties. [Research in Gerontological Nursing, xx(x), xx-xx.].

Korean Immigrants' Perception of Mental Well-Being and Help-Seeking Behaviors

This article describes a study that investigated Korean immigrants' perception of mental well-being and help-seeking behaviors with particular focus on those with mental illness. Participants with probable diagnoses of anxiety or depression were more likely to recognize their mental health problems and their impact than those without such diagnoses. However, many of them did not acknowledge experiencing mental health problems and did not show high likelihood of seeking professional mental health services. The cultural beliefs and the lack of culturally competent mental health services appeared to contribute to the low levels of recognition of mental health problems and also the low rates of mental health service utilization. The participants listed mental health professionals' ability to communicate in the language of their preference, confidentiality, and affordability as significant factors in their decision to seek professional help. The study findings emphasize the great need of mental health educational programs within the Korean immigrant community. The findings also suggest that resources and infrastructures be secured for the provision of culturally competent mental health services for this population.

The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences

OBJECTIVES

Despite an increasing number of studies reporting significant associations of depression to sleep problems in general, few studies have been conducted on racial/ethnic variations in the associations among midlife women in their menopausal transition. The purpose of this study was to determine the associations between depressive symptoms and sleep-related symptoms in a multiethnic group of midlife women while considering the women's race/ethnicity and menopausal status.

METHODS

This was a secondary analysis of the data from 1,054 midlife women in two larger studies. The depression index for midlife women and the sleep index for midlife women were used to measure sleep-related symptoms and depressive symptoms. Descriptive and inferential statistics including hierarchical multiple regression analyses were used for data analyses.

RESULTS

In the regression models by race/ethnicity, the total numbers (0.294 in non-Hispanic [NH] African Americans ≤ β ≤ 0.410 in NH Asians), and total severity scores (0.141 in Hispanic ≤ β ≤ 0.365 in NH Whites) of depressive symptoms were positively associated with the total severity of sleep-related symptoms (all P < 0.01). In the regression models by menopausal status, the total numbers (β = 0.106 in premenopausal and 0.443 in postmenopausal) and total severity scores (0.272 ≤ β ≤ 0.561) of depressive symptoms were positively associated with the total severity scores of sleep-related symptoms (all P < 0.05).

CONCLUSIONS

Further studies with diverse groups of midlife women using objective measurements and biomarkers are warranted to confirm the findings.

Health Literacy, Depression Literacy, and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.

The Role of Economic Stress and Coping Resources in Predicting Hwabyung Symptoms

This article reports the findings from a study that examined the role of economic stress and coping resources in predicting hwabyung symptoms among Koreans in the United States. The literal meaning of hwabyung is "fire illness" or "anger illness." Koreans believe that chronic stress can cause the onset of hwabyung, manifested mainly through somatic symptoms. Data collected from an anonymous survey of 242 voluntary participants were analyzed using hierarchical multiple regression (R²). The findings demonstrated the important role that social support and sense of self-esteem play in explaining hwabyung symptoms. Also, the graduate education attained in the United States appears to play positive role in reducing the hwabyung symptoms, while being a woman can increase their vulnerability to this indigenous psychiatric illness to Korean people. Based on the findings, the implications for practice and suggestions for future study are discussed.

Stigma and Attitude Toward Service Use Among Korean American Parents of Adolescent Children: Does Depression Literacy Act as a Mediator and/or Moderator?

The current study used secondary data analysis to examine mediating and moderating effects of depression literacy on the relationship between depression stigma and attitude toward use of mental health care services in Korean American parents. Of 141 survey respondents, 36 (25.2%) were fathers and 105 (74.8%) were mothers. In mediation analysis, the indirect effects of personal stigma (B = -0.14, p < 0.05) and total stigma (B = -0.09, p < 0.05) were statistically significant. The moderating eff ect of depression literacy on the relationship between personal stigma and attitudes was also significant (B = -0.06, p < 0.05). The current study found that only the relationship between personal stigma and attitude toward mental health care service use was mediated by depression literacy. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 46-55.].

Quantitative and Qualitative Evaluations of the Enhanced Logo-autobiography Program for Korean-American Women

This study extends Bernstein et al.'s (2016) investigation of the effects of the Enhanced Logo-autobiography Program on Korean-American women's depressive symptoms, coping strategies, purpose in life, and posttraumatic growth by analyzing quantitative and qualitative data. This study's participants significantly improved on quantitative measures of depression, coping strategies, purpose in life, and post-traumatic growth at eight weeks post-intervention and follow-up. The qualitative content analysis revealed 17 themes with five essential themes. The program's activity to promote purpose in life through posttraumatic growth facilitated participants' recovery from traumatic experiences. Standardized guidelines are needed to conduct this program in Korean community centers.

Qualitative Study of Depression Literacy Among Korean American Parents of Adolescents

Lack of depression literacy is associated with low help-seeking behaviors for mental health care in adolescents. As parents generally determine adolescents' health care, ensuring parents can recognize depressive symptoms is crucial. The current study explored depression literacy among Korean American parents of adolescents ages 12 to 19 using a qualitative descriptive design. Semantic content analysis was performed using data from three focus group interviews conducted in 2015 with Korean American parents (10 mothers, four fathers) of adolescents. Participants lacked knowledge about the biological causes and medicinal treatment of depression. Most believed that depression cannot be fully treated, relapses occur easily, and medication is taken indefinitely. Gender influenced perceptions of symptoms. Parents often overlooked children's depressive symptoms until schools alerted them. Nursing interventions should educate parents about the biological causes of depression, strategies for addressing adolescents' symptoms, community-based professional resources, and success stories about depression treatment. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 48-56.].

Toward a Culturally Responsive Model of Mental Health Literacy: Facilitating Help-Seeking Among East Asian Immigrants to North America

Studies have consistently found that East Asian immigrants in North America are less likely to use mental health services even when they experience levels of distress comparable to Euro-Americans. Although cultural factors that may prevent East Asian immigrants from seeking mental health care have been identified, few studies have explored ways to foster appropriate help-seeking and use of mental health services. Recent work on mental health literacy provides a potential framework for strategies to increase appropriate help-seeking and use of services. This paper reviews the literature on help-seeking for mental health problems among East Asian immigrants living in Western countries to critically assess the relevance of the mental health literacy approach as a framework for interventions to improve appropriate use of services. Modifications needed to develop a culturally responsive framework for mental health literacy are identified.

Testing a Theoretical Model of Immigration Transition and Physical Activity

The purposes of the study were to develop a theoretical model to explain the relationships between immigration transition and midlife women's physical activity and test the relationships among the major variables of the model. A theoretical model, which was developed based on transitions theory and the midlife women's attitudes toward physical activity theory, consists of 4 major variables, including length of stay in the United States, country of birth, level of acculturation, and midlife women's physical activity. To test the theoretical model, a secondary analysis with data from 127 Hispanic women and 123 non-Hispanic (NH) Asian women in a national Internet study was used. Among the major variables of the model, length of stay in the United States was negatively associated with physical activity in Hispanic women. Level of acculturation in NH Asian women was positively correlated with women's physical activity. Country of birth and level of acculturation were significant factors that influenced physical activity in both Hispanic and NH Asian women. The findings support the theoretical model that was developed to examine relationships between immigration transition and physical activity; it shows that immigration transition can play an essential role in influencing health behaviors of immigrant populations in the United States. The NH theoretical model can be widely used in nursing practice and research that focus on immigrant women and their health behaviors. Health care providers need to consider the influences of immigration transition to promote immigrant women's physical activity.

The relationships between psychological symptoms and cardiovascular symptoms experienced during the menopausal transition: racial/ethnic differences

OBJECTIVE

The purpose of the study was to examine the relationships between psychological and cardiovascular symptoms in a multiethnic group of midlife women while controlling for other influencing factors, and to determine the association of race/ethnicity to the relationships between psychological and cardiovascular symptoms.

METHODS

This was a secondary analysis of the data among 1,054 midlife women from two Internet surveys. The instruments included the questions on background characteristics, health, and menopause status and the Midlife Women's Symptom Index. The data were analyzed using correlation analyses, chi-squared tests, analysis of variance, and multivariate linear and logistic regression analyses.

RESULTS

The total numbers and total severity scores of psychological symptoms were significantly related to those of cardiovascular symptoms as a whole and in each racial/ethnic group (P < 0.01). In total participants, both the total numbers and total severity scores of psychological symptoms were significantly associated with increased risk for cardiovascular symptoms after adjusting for race/ethnicity (P < 0.01), and there were no interactions between race/ethnicity and psychological symptoms. The existence of diagnosed cardiovascular diseases was significantly associated with the total numbers of and total severity scores of psychological symptoms only in Asian women.

CONCLUSIONS

Further studies on the mechanisms through which psychological symptoms are related to cardiovascular symptoms are needed while controlling for race/ethnicity.

Physical activity and depressive symptoms in four ethnic groups of midlife women

The purpose of this study was to determine the associations between physical activity and depression and the multiple contextual factors influencing these associations in four major ethnic groups of midlife women in the United States. This was a secondary analysis of the data from 542 midlife women. The instruments included questions on background characteristics and health and menopausal status; the Depression Index for Midlife Women (DIMW); and the Kaiser Physical Activity Survey (KPAS). The data were analyzed using chi-square tests, the ANOVA, two-way ANOVA, correlation analyses, and hierarchical multiple regression analyses. The women's depressive symptoms were negatively correlated with active living and sports/exercise physical activities whereas they were positively correlated with occupational physical activities (p < .01). Family income was the strongest predictor of their depressive symptoms. Increasing physical activity may improve midlife women's depressive symptoms, but the types of physical activity and multiple contextual factors need to be considered in intervention development.

A qualitative analysis of stress and coping in Korean immigrant women in middle-age and older-adulthood

This qualitative grounded theory study explored stress-coping mechanisms in 14 Korean immigrant women (age ≥40) in the USA, by analyzing existing focus group data about relevant concepts that had been collected in a parent study. Using content analysis, stressors related primarily to socioenvironmental changes following immigration: language barriers, lack of trusting human relationships, and role changes were identified. Both healthy (activities, church, staying busy) and unhealthy (being alone and keeping negative feelings inside) coping strategies were reported by participants. The findings reveal unique aspects of stress-coping among Korean women who had immigrated after being culturally engrained with Confucian influences.

Immigration transition and depressive symptoms: four major ethnic groups of midlife women in the United States

The purpose of this study was to explore the relationships between immigration transition and depressive symptoms among 1,054 midlife women in the United States. This was a secondary analysis of the data from two national Internet survey studies. Questions on background characteristics and immigration transition and the Depression Index for Midlife Women were used to collect the data. The data were analyzed using inferential statistics including multiple regressions. Immigrants reported lower numbers of symptoms and less severe symptoms than nonimmigrants (p <.01). When controlling for background characteristics, self-reported racial/ethnic identity and immigration status were significant predictors of depressive symptoms (R(2) =.01, p <.05).

Somatic symptoms and depressive symptoms among older adult Korean immigrants

Given the lack of understanding of how Korean immigrants express depressive symptoms, the purpose of this descriptive correlational study was to describe somatic symptoms and depressive symptoms and examine the relationship between them, as reported by older adult Korean immigrants. Purposive sampling was used in this study of 160 older adult (ages 65 to 91) Korean immigrants. Most of these participants immigrated to the United States at an older age. They reported a high level of depressive symptoms, and these symptoms were closely associated with somatic symptoms, a finding that coincides with previous studies differentiating Korean individuals from individuals of other cultures. The findings from this study highlight the need for health care providers to be aware of and recognize cultural differences in how patients express depressive symptoms somatically when assessing and treating depression within the older adult Korean immigrant population.

Effects of the body mass index on menopausal symptoms among Asian American midlife women using two different classification systems

OBJECTIVE

To explore the effects of the body mass index (BMI) on menopausal symptoms among Asian American midlife women using two different classification systems: the international classification and the BMI classification for public health action among Asian populations.

DESIGN

Secondary analysis using data from two large Internet survey studies.

SETTING

Communities and groups of midlife women on the Internet.

PARTICIPANTS

A total of 223 Asian American midlife women who were recruited over the Internet.

METHODS

The Midlife Women's Symptom Index and self-reports of height and weight were used to collect data. The data were analyzed using multiple analyses of covariance.

RESULTS

No significant differences in the prevalence and severity scores among three subscales and total menopausal symptoms according to the international classification were found. When the BMI classification for public health action among Asian populations was used as an independent variable, significant differences were found in the severity scores of three subscales and total menopausal symptoms. Results of the post-hoc analyses showed that Asian American midlife women who were in the BMI classification for high risk had significantly more severe menopausal symptoms than those who were in the BMI classification for increased risk.

CONCLUSION

For Asian American women, BMI categorized using the BMI classification for Asian populations is more closely related to the severity of menopausal symptoms than BMI categorized using the international classification. Nurses need to consider the BMI classification for Asian populations when they develop interventions to prevent and alleviate menopausal symptoms among Asian American midlife women.