The influences of cultural values, ethnic identity, and language use on the mental health of Korean American college students

Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework

OBJECTIVES

Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama.

DESIGN

Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23-75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression.

RESULTS

Perceived race discrimination was significantly associated with greater depressive symptoms (β = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (β = .247, SE = 1.118, p < .001), had lower level of health literacy (β = -.121, SE = .280, p < .05), and had higher social isolation scores (β = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms.

CONCLUSION

Rural-living KA immigrants' depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

Exploring the relationship between mental health and dialect use among Chinese older adults: a moderated mediation estimation

Background

Mental health, conceptualized as psychological status that includes rational cognition, emotional stability, and interpersonal harmony, is highly relevant to the expected health and well-being of all humans. China is facing the dual risk of increased aging and mental health disorders in older adults, while the established studies have rarely focused on the influence of dialect on the mental health of Chinese older adults. The present study aims to capture the relationship between dialect and mental health in Chinese older adults.

Methods

We use cross-sectional data from the nationally representative China Family Panel Studies, which encompasses the dialect use, mental health, and other socioeconomic features of 4,420 respondents. We construct a moderated mediation model that uses dialects and mental health as the independent and dependent variables and income inequality and subjective well-being as the mediator and moderator to reveal the relationship between dialect and mental health in Chinese older adults.

Results

(1) Dialects are shown to have a negative influence on the mental health of older adults in the current study (coefficient = -0.354, 95% CI = [-0.608, -0.097]). (2) Income inequality positively mediates the correlation between dialects and mental health (coefficient = 0.019, 95% CI = [0.010, 0.045]). (3) Subjective well-being negatively moderates the potential mechanism between dialects and mental health (coefficient = -0.126, 95% CI = [-0.284, -0.010]).

Conclusion

The use of dialects is associated with worse mental health outcomes in Chinese older adults, while this negative influence is positively mediated by income inequality and negatively moderated by subjective well-being, simultaneously. This study contributes to the knowledge enrichment of government workers, older adults with mental disorders, medical staff, and other stakeholders.

Values of College Students Mandated to an Alcohol Intervention: A Qualitative Examination

Background: Personal values motivate action and have been shown to influence behavioral choices. Objectives: The purpose of this qualitative study was to identify which values are important to college student drinkers and what underlying principles and motivations support those values. A sample of 198 students who received a university mandate to complete an alcohol education intervention following a campus alcohol policy violation wrote essays regarding their values. These essays were categorized and thematically analyzed by the research team. Results: The majority of values fell under the category of Relationships, followed by Morality, Future Orientation, Wellness, and Benevolence. Conclusions: Most students placed a high value on their commitment to others, which may provide insight into effective and novel ways in which health messages could be communicated to college students. Additionally, findings show a relative lack of future-oriented values, particularly among the heavy-drinking students. Because future orientation is associated with engaging in less risky health behaviors, results suggest it may be beneficial to cultivate goal setting tasks early in college student education to enhance the efficacy of health promotion messages.

Discrimination as a Moderator of the Effects of Acculturation and Cultural Values on Mental Health Among Pregnant and Postpartum Latina Women

It is important to consider how identity, culture, and social adversity influence maternal mental health among Latina women both because this community faces unique cultural stressors and also because factors that undermine women's mental health during pregnancy and postpartum could have injurious consequences that cascade across generations. This study uses data from a questionnaire administered to Latina pregnant and postpartum women in Southern California, examining cultural orientation, discrimination, and mental health. Results demonstrate mental health benefits for both American and Latino cultural orientations, but the latter's benefit of lower anxiety was only apparent with high discrimination. American and Latino cultural values systems had opposite relationships with depression, with the latter protective and also positively associated with happiness. More traditional gender roles values were associated with greater perceived stress and lower happiness. Different aspects of familism had opposite effects as obligation was associated with less anxiety and referent (defining oneself communally with kin) with more. Results suggest that social adversity and cultural identity and values influence maternal psychology. This study makes a unique contribution by integrating anthropological and biopsychosocial methods and theories towards addressing an issue of public-health importance.

The Three Teachings of East Asia (TTEA) Inventory: Developing and Validating a Measure of the Interrelated Ideologies of Confucianism, Buddhism, and Taoism

Objectives: Buddhism, Taoism, and Confucianism have influenced societies and shaped cultures as they have spread across the span of history and ultimately across the world. However, to date, the interrelated nature of their impacts has yet to be examined largely due to the lack of a measure that comprehensively assesses their various tenets. Building on a conceptual integration of foundational texts on each ideology as well as on recent measure development work (much of which is unpublished), the current studies developed a comprehensive measure of these ideologies (the Three Teachings of East Asia Inventory; TTEA) and validated it across four languages.

Methods: A combined sample of 2,091 online respondents (Study 1: 322 Chinese respondents, Study 2: 400 Japanese respondents, Study 3: 362 Taiwanese respondents, Study 4: 688 White Americans and 319 Asian Americans) completed 25–35 min online survey in their preferred language: English, Traditional Mandarin, Simplified Mandarin, or Japanese.

Results: Exploratory Factor Analyses within a 122-item pool identified 18 stable dimensions across all samples. Measurement invariance analyses identified the final 61-items of the TTEA inventory (demonstrating reasonable invariance across all languages), confirming 18 individual tenet subscales that organize into four higher-order composites: Buddhism, Taoism, Restrictive Confucianism, and Empowering Confucianism. A shorter 36-item version of the TTEA inventory was also developed. The TTEA scales demonstrated (1) acceptable internal consistency, (2) discriminant validity, and (3) incremental predictive validity for current life satisfaction and vitality.

Conclusions: The TTEA inventory offers one of the first comprehensive, multilingual measures that will allow cross-cultural researchers to examine the influence of three related Eastern ideologies on societies across the world.

Mental Illness Public Stigma and Generational Differences Among Vietnamese Americans

Public stigma is one barrier to accessing behavioral health care among Vietnamese Americans. To explore and identify features of culture and acculturation that influence behavioral health-related stigma, six focus groups were conducted with Vietnamese American participants in three generational groups and eleven key informant interviews were conducted with Vietnamese community leaders, traditional healers, and behavioral health professionals. Data were analyzed using Link and Phelan's (Annu Rev Sociol 27(1):363-385, 2001) work on stigma as an organizing theoretical framework. Findings underline several key cultural and generational factors that intersect to affect perceptions, beliefs, and stigma about mental health treatment. In particular, participants in the youngest groups highlighted that while they recognized the value of mental health services, they felt culturally limited in their access. This appeared to be closely related to intergenerational communication about mental health. The findings suggest avenues for further research as well as interventions to increase mental health treatment access and adherence.

The role of ethnic identity in OC symptom dimensions among Asian Americans

Little is known about obsessive-compulsive (OC) symptoms in Asian Americans. Past research has shown elevations in certain symptom dimensions when compared with White Americans, but there have not been any studies on cultural mechanisms for these differences. In this study, we examined whether ethnic identity mediated differences in severity of various OC symptom dimensions between Asian and White Americans. A total of 453 participants (79 Asian American, 374 non-Hispanic White) completed measures of ethnic identity and OC symptoms. Separate boostrapped mediation analyses were conducted to determine the indirect (i.e., mediation) effect of ethnoracial group membership on different OC symptom dimensions, via ethnic identity. There was significant evidence of mediation across the majority of OC subscales examined. Asian Americans reported stronger ethnic identity than their White counterparts, which in turn predicted more severe contamination obsessions and washing compulsions, harm-related intrusions, checking, neutralizing, as well as symmetry/ordering symptoms. This study is the first to demonstrate an exacerbating function of ethnic identity for OC symptoms among Asian Americans, contrary to some previous evidence of its protective role for overall mental health among ethnoracial minorities. More research is needed to test and validate hypotheses about why ethnic identity mediated group differences in OC symptoms.

HPV Vaccination and Korean American College Women: Cultural Factors, Knowledge, and Attitudes in Cervical Cancer Prevention

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection that leads to nearly all cervical cancers in the United States (U.S.), which could be prevented with the HPV vaccine. Korean American women experience a high burden of cervical cancer, but little is known about their awareness, knowledge, attitudes, sociocultural factors and social network/support related to intention to obtain the HPV vaccine. This study reports baseline characteristics of 104 Korean American college women aged 18-26 and who have not been previously vaccinated against HPV, as part of a pilot randomized controlled trial testing feasibility, acceptability, and preliminary effectiveness of an HPV storytelling intervention. Data were analyzed including descriptive statistics, bivariate analysis, and multivariate logistic regression. Multivariate logistic regression was performed to understand the relationship between independent predictors of intention to receive HPV vaccination. Overall, 34.6% of participants intended to obtain the vaccine. Positive predictors of intention to receive HPV vaccine were: years in the U.S., academic major, awareness of HPV and HPV vaccine, knowledge, and HPV recommendation by healthcare provider and parents. The multivariate logistic model showed that intention to receive the HPV vaccine was significantly associated with HPV vaccine recommendation by parents (OR 4.58, 95% CI 1.37-15.36) and knowledge (OR 1.11, 95% CI 1.11-1.22). These findings suggest a need for development of interventions that are not only culturally tailored but also acculturation-sensitive to promote HPV vaccination among Korean American college women. This may play a significant role in cervical cancer prevention among Korean American college women.

Depression and Pain in Asian and White Americans With Knee Osteoarthritis

Few studies have examined the underlying psychosocial mechanisms of pain in Asian Americans. Using the biopsychosocial model, we sought to determine whether variations in depression contribute to racial group differences in symptomatic knee osteoarthritis pain between Asian Americans and non-Hispanic white Americans. The sample consisted of 100 participants, including 50 Asian Americans (28 Korean Americans, 9 Chinese Americans, 7 Japanese Americans, 5 Filipino Americans, and 1 Indian American) and 50 age- and sex-matched non-Hispanic white Americans with symptomatic knee osteoarthritis pain. The Centers for Epidemiologic Studies Depression Scale was used to assess symptoms of depression, and the Western Ontario and McMaster Universities Osteoarthritis Index and the Graded Chronic Pain Scale were used to measure clinical pain. In addition, quantitative sensory testing was used to measure experimental sensitivity to heat- and mechanically-induced pain. The results indicated that higher levels of depression in Asian Americans may contribute to greater clinical pain and experimental pain sensitivity. These findings add to the growing literature regarding ethnic and racial differences in pain and its associated psychological conditions, and additional research is warranted to strengthen these findings.

PERSPECTIVE

This article shows the contribution of depression to clinical pain and experimental pain sensitivity in Asian Americans with knee osteoarthritis. Our results suggest that Asian Americans have higher levels of depressive symptoms and that depression plays a relevant role in greater clinical pain and experimental pain sensitivity in Asian Americans.

Mental health literacy as a mediator in use of mental health services among older korean adults

BACKGROUND

Existing literature suggests that mental health literacy is positively associated with mental health services utilization. Despite an aging population that faces significant mental health concerns in Korea, the role of mental health literacy on mental health services utilization is not known among older adults in Korea. This study aimed to (1) identify whether mental health literacy mediates the association between population characteristics and mental health services utilization and (2) identify an optimal path model for mental health services utilization among Korean older adults.

METHODS

Using a cross-sectional survey with a quota sampling strategy, we collected and analyzed responses from 596 community-dwelling individuals ages 65 years and older. We used structural equation modeling (SEM) to estimate the effect of mental health literacy as a mediator.

RESULTS

When controlling for other relevant covariates in the optimal path model, mental health literacy mediated the relationships between three socio-demographic factors (education, general literacy, and health status) and mental health services utilization. The model fit index shows that the SEM fits very well (CFI = 0.92, NFI = 0.90, RMSEA = 0.07).

CONCLUSIONS

Efforts to improve mental health literacy through community-based education programs may need to particularly target Korean older adults with the relevant socio-demographic characteristics to enhance their utilization of appropriate mental health services.

Counseling services for Asian, Latino/a, and White American students: Initial severity, session attendance, and outcome

OBJECTIVE

The current study examined racial/ethnic differences in initial severity, session attendance, and counseling outcomes in a large and diverse sample of Asian American, Latino/a, and White student clients who utilized university counseling services between 2008 and 2012.

METHOD

We used archival data of 5,472 clients (62% female; M age = 23.1, SD = 4.3) who self-identified their race/ethnicity as being Asian American (38.9%), Latino/a (14.9%), or White (46.2%). Treatment engagement was measured by the number of counseling sessions attended; initial severity and treatment outcome were measured using the Outcome Questionnaire-45.

RESULTS

Asian American clients, particularly Chinese, Filipino/a, Korean, and Vietnamese Americans, had greater initial severity compared with White clients. Asian Indian, Korean, and Vietnamese American clients used significantly fewer sessions of counseling than White clients after controlling for initial severity. All racial/ethnic minority groups continued to have clinically significant distress in certain areas (e.g., social role functioning) at counseling termination.

CONCLUSIONS

These findings highlight the need to devote greater attention to the counseling experiences of racial/ethnic minority clients, especially certain Asian American groups. Further research directions are provided. (PsycINFO Database Record

Comparison of socio-demographic characteristics, substance, and depression among male heroin users attending therapeutic community and methadone maintenance treatment program in Nantou, Taiwan

Background

Little is known about differences between the characteristics and psychopathological symptoms of heroin users attending TC or MMT in Asia. This study aimed to compare characteristics and prevalence of depressive disorders among male heroin users in TC and MMT program in Nantou, Taiwan.

Methods

The study sample (n = 705) comprised male heroin users with heroin dependence recruited from the MMT program and TC program at a psychiatric center in Nantou, Taiwan between 2006 and 2014. Socio-demographic and heroin-related characteristics were obtained from self-report questionnaires. DSM-IV diagnoses of heroin dependence, major depressive disorder, and dysthymic disorder were evaluated by trained interviewers. T-test and chi-square test and multivariate logistic regression were performed to measure the differences on variables between samples of TC and MMT.

Results

Compared to MMT, TC participants had poorer family support, higher rate of unmarried, higher rate of unemployment, earlier onset of heroin use, longer length of heroin use, and lower daily dosage of heron. MMT heroin users had higher 1-month prevalence of major depressive disorder than TC participants. We found the distribution of current major depression disorder differed between heroin users choosing different treatment models even controlling for other demographic factors, substance related factors and psychosocial factors. The underlying explanations require further investigation.

Conclusions

This study found differences in the characteristics and prevalence of psychopathology. Further study to explore the effect of these differences on the outcome between MMT and TC is warranted.

How much orientation towards the host culture is healthy? Acculturation style as risk enhancement for depressive symptoms in immigrants

AIMS

As the specific acculturative tasks and challenges involved in the migration process can lead to an increased risk for depressive symptoms, the study was designed to gain further insight into the interrelation between acculturation styles and mental health.

METHODS

A total of n = 90 patients with different ethnic backgrounds from an outpatient consultation service for immigrants at the Hannover Medical School were investigated by the Hannover Migration and Mental Health Interview (HMMH), the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Frankfurt Acculturation Scale (FRAKK).

RESULTS

The majority of the subjects (84.4%) had a clinically significant depression. The extent of depressive symptoms was determined by the selected acculturation style (1) (F = 3.29, p = .025): Subjects with integration as acculturation style showed less depressive symptoms than subjects with assimilation as acculturation style. Furthermore, subjects with segregation as acculturation style also showed less depressive symptoms than subjects with assimilation.

CONCLUSION

The results suggest that even when undergoing extreme emotional distress, eventually leading to mental disorder, integration, as an acculturation style, seems to serve as a protective resource and possibly prevents further decline.

If times change, should we throw away the hearthstone? Exploring (Dis) continuities in autonomy and decision-making in the lives of Ghanaian women

This paper attempts to investigate continuities and discontinuities between traditional and modern representations of womanhood and female gender roles focusing primarily on family and work settings. Using approaches informed by Sociology, Cultural Psychology, and African Studies, the paper explores traditional views of womanhood encapsulated in (and also transmitted intergenerationally) through proverbs. This customary perspective is contrasted with the results of the Everyday Lives Survey from the Pathways of Women's Empowerment Ghana project. The survey investigated the nature of everyday life– education, work, decision making, access to institutions, and autonomy in relationships—in six hundred (600) adult women in both rural and urban communities in three regions of Ghana. We argue that although the times are changing, there have only been modest disruptions in the lives of Ghanaian women as far as issues of autonomy and decision-making in are concerned.

The association between dietary intake of folate and physical activity with psychological dimensions of depressive symptoms among students from Iran

Depression in students is a major public health problem. Although several risk factors associated with depression have been identified, the cause of depression is still not clear. Several studies have demonstrated that physical activity and nutrient intake, such as increased levels of B vitamins in serum, decrease symptoms of depression. The aim of this study was to investigate the association between physical activity and dietary intake of vitamins B₆, B₉, and B₁₂ and symptoms of depression among postgraduate students. The results of this study suggest that intake of vitamin B9 may modulate the total score of Center for Epidemiological Studies Depression Scale (CES-D) and two subscales of the CES-D including depressive affect and interpersonal difficulties. This study also showed that moderate/high levels of physical activity were inversely and significantly associated with symptoms of depression (total scores) and three subscales of the CES-D including depressive affect, positive affect, and somatic complaints.

Correlates of sexual, ethnic, and dual identity: a study of young Asian and Pacific Islander men who have sex with men

Having a positive attitude toward one's own sexual and ethnic identity can improve psychological well-being and self-efficacy and may reduce vulnerability to HIV infection. We sought to understand factors associated with having greater self-worth about being Asian and Pacific Islander (API), being gay/bisexual, and being both gay/bisexual and API (dual identity). We conducted serial, cross-sectional surveys of 763 API men who have sex with men (MSM) annually from 1999 to 2002 in San Diego, California and Seattle, Washington. We found (a) sexual and ethnic identity were intertwined and mutually influential; (b) a positive attitude toward sexual identity was associated with higher socioeconomic status, greater social support, and self-identified homosexual orientation (as opposed to "straight/undecided"); (c) a positive dual identity was associated with higher socioeconomic status, greater social support, and levels of acculturation (being United States born and speaking English and another language equally); and (d) a positive sexual identity and dual identity were associated with HIV testing. The findings suggest that targeted programs should address cultural issues at the intersection of sexual and ethnic identity, promote social support and self-acceptance around homosexual identity, and help MSM build a positive sense of self to foster their self-esteem and HIV prevention self-efficacy.

The relationship between acculturation factors and symptoms of depression: a cross-sectional study with immigrants living in Athens

The process of acculturation observed in immigrants is part of an adjustment to the values and norms of a new society, and possibly the loss of norms of the society of origin. Acculturation has been linked to stress-related psychological disorders such as depression. The present study investigates the relationship between three acculturation domains (everyday life behaviors, wishful orientation/nostos, and ethnic identity) and symptoms of depression in a sample of foreign immigrants living in Athens, Greece. The sample consisted of 317 immigrants who visited two non-governmental organization polyclinics. All participants were interviewed using the Immigrant Acculturation Scale (IAS) and the Center for Epidemiological Studies Depression Scale (CES-D). The results showed that 133 (42%) out of the 317 interviewees were in a depressive state (CES-D > 15). The main finding was that high CES-D scores were related to low scores in the IAS Everyday Life and Wishful Orientation factors, while no relationship was found between depressive symptomatology and the IAS Identity factor. Short duration of stay in Greece, lack of steady job, and lack of residence permit were also related to high CES-D scores. In conclusion, adaptation to mainstream culture daily behaviors as well as the wish to integrate with individuals from the mainstream culture and settle permanently in the new country could be seen as part of an adaptive mechanism that protects the individual from experiencing depressive symptomatology.

Acclimating international graduate students to professional engineering ethics

This article describes the education portion of an ongoing grant-sponsored education and research project designed to help graduate students in all engineering disciplines learn about the basic ethical principles, rules, and obligations associated with engineering practice in the United States. While the curriculum developed for this project is used for both domestic and international students, the educational materials were designed to be sensitive to the specific needs of international graduate students. In recent years, engineering programs in the United States have sought to develop a larger role for professional ethics education in the curriculum. Accreditation requirements, as well as pressures from the private sector, have helped facilitate this shift in focus. Almost half of all engineering graduate students in the U.S. are international students. Further, research indicates that the majority of these students will remain in the U.S. to work post-graduation. It is therefore in the interest of the profession that these students, coming from diverse backgrounds, receive some formal exposure to the professional and ethical expectations and norms of the engineering profession in the United States to help ensure that they have the knowledge and skills--non-technical as well as technical--required in today's engineering profession. In becoming acculturated to professional norms in a host country, international students face challenges that domestic students do not encounter; such as cultural competency, language proficiency, and acculturation stress. Mitigating these challenges must be a consideration in the development of any effective education materials. The present article discusses the project rationale and describes the development of on-line instructional materials aimed at helping international engineering graduate students acclimate to professional engineering ethics standards in the United States. Finally, a brief data summary of students' perceptions of the usefulness of the content and instructional interface is provided to demonstrate the initial effectiveness of the materials and to present a case for project sustainability.

Bullying and discrimination experiences among Korean-American adolescents

The bullying experiences of Korean-American adolescents (N = 295) were explored in relation to discrimination and mental health outcomes. Bullying experiences were assessed by the Bully Survey (Swearer, 2005), discrimination by the Perceived Ethnic and Racial Discrimination Scale (Way, 1997) and depression by the Center for Epidemiological Studies - Depression Scale (CES-D). Those who reported being bullied (31.5%) as well as those who reported both being bullied and bullying others (15.9%) experienced a higher level of depression, which was elevated beyond the clinically significant level of CES-D. The results of a LISREL model suggest that the experiences of bullying among Korean/Asian-American adolescents and their related mental health issues need to be addressed in a comprehensive context of their discrimination experiences, acculturation, family and school environments.

Depression in Asian-American and Caucasian undergraduate students

BACKGROUND

Depression is a serious and often under-diagnosed and undertreated mental health problem in college students which may have fatal consequences. Little is known about ethnic differences in prevalence of depression in US college campuses. This study compares depression severity in Asian-American and Caucasian undergraduate students at the University of California San Diego (UCSD).

METHODS

Participants completed the nine item Patient Health Questionnaire and key demographic information via an anonymous online questionnaire.

RESULTS

Compared to Caucasians, Asian-Americans exhibited significantly elevated levels of depression. Furthermore, Korean-American students were significantly more depressed than Chinese-American, other minority Asian-American, and Caucasian students. In general, females were significantly more depressed than males. Results were upheld when level of acculturation was considered.

LIMITATIONS

The demographic breakdown of the student population at UCSD is not representative to that of the nation.

CONCLUSIONS

These findings suggest that outreach to female and Asian-American undergraduate students is important and attention to Korean-American undergraduates may be especially worthwhile.

Model minority at risk: expressed needs of mental health by Asian American young adults

The objective of this study is to obtain and discuss in-depth information on mental health problems, including the status, barriers, and potential solutions in 1.5 and 2nd generation Asian American young adults. As a part of the Health Needs Assessment project, the researchers conducted two focus groups with 17 young adults (mainly 1.5 or 2nd generation) from eight Asian American communities (Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese) in Montgomery County, Maryland. We developed a moderator's guide with open-ended questions and used it to collect qualitative data. Using a software, we organized and identified emergent themes by major categories. Participants reported a several common sources of stress that affect the mental health of Asian American young adults including: pressure to meet parental expectations of high academic achievement and live up to the "model minority" stereotype; difficulty of balancing two different cultures and communicating with parents; family obligations based on the strong family values; and discrimination or isolation due to racial or cultural background. Young Asian Americans tend not to seek professional help for their mental health problems; instead they use personal support networks-close friends, significant others, and religious community. Participants suggested that Asian cultural norms that do not consider mental problems important, and associated stigma of seeking professional care might undermine their mental health help seeking behavior. Our findings support a need for delivering culturally appropriate programs to raise awareness of mental health and cultural training for health providers to deliver culturally appropriate care.

Identity gaps and level of depression among Korean immigrants

Identity gaps are a new theoretical construct that provide a framework for integrating communication into the study of identity and understanding the relationship between identity and health outcomes, such as depression. Derived from the communication theory of identity, identity gaps emerge when elements of identity are inconsistent with each other. This article focuses on 2 types of identity gaps, personal-enacted and personal-relational, examining their relationships with situational variables and depression. A questionnaire was administered to a community sample of 377 Korean immigrants to test a hypothesized path model predicting that 3 situational variables (intercultural communication competence, middleperson status, and perception of racial hierarchy) would influence the identity gaps that, in turn, influence Korean immigrants' levels of depression. Results showed that all 3 situational variables predicted Korean immigrants' personal-relational identity gaps, whereas only intercultural communication competence predicted their personal-enacted identity gaps. Both types of identity gaps predicted the level of depression. The personal-relational identity gap significantly mediated the effects of all 3 situational variables on levels of depression. However, the personal-enacted identity gap mediated only the effects of intercultural communication competence on the levels of depression.