David A. Chiriboga

Acculturation and manifestation of depressive symptoms among Korean-American older adults

The present study examined the role of acculturation in manifestation of depressive symptoms among 230 Korean-American older adults (M age = 69.8, SD = 7.05) in Florida. Given the cultural emphasis on modesty and self-effacement in the traditional Korean society, we hypothesized that older Korean-Americans who were less acculturated to American culture, when compared to the more acculturated ones, would be more likely to inhibit positive affects in depressive symptom reports. Using two validated measures of depressive symptoms, the short forms of the Geriatric Depression Scale (GDS-SF) and the Center for Epidemiologic Studies-Depression Scale (CES-D), different response patterns for low and high acculturation groups were identified. First, there was low comparability in the factor structures for both the GDS-SF and the CES-D across low and high acculturation groups. A differential item function (DIF) analysis based on partial correlations indicated that older adults in the low acculturation group inhibited endorsing positive affect items; one item in the GDS-SF (#7 ‘feel happy’) and two items in the CES-D (# 5 ‘felt hopeful’ and # 8 ‘was happy’). The finding suggests the substantial cultural influences in expressing emotions, especially those related to positive affects. Implications are discussed from a cultural perspective.

Financial strain and health among elderly Mexican-origin individuals.

In this paper we examine the associations among perceived financial strain and various health measures--including self-rated health, self-reported functional capacity, performance-based mobility, and mortality--in a sample of older Mexican-origin individuals. We employ the Hispanic Established Population for Epidemiological Studies of the Elderly, an eight-year longitudinal survey of over 3,000 Mexican-origin individuals in five southwestern states who were initially interviewed in 1993 and 1994. Although financial strain is associated with actual income and poverty, it is also associated with cognitive capacity, depression, and self-esteem, and while it is strongly associated with subjective measures, it has a weaker association with more objective measures, such as performance-based mobility and mortality. Financial strain appears to be part of a package of cognitions and emotions indicative of low morale or demoralization that has adverse effects on subjective health.

Health, Healthcare Utilization, and Satisfaction with Service: Barriers and Facilitators for Older Korean Americans

The present study assessed predictive models of subjective perception of health, healthcare utilization (hospital visits), and satisfaction with healthcare service using a sample of 230 older Korean Americans. Predisposing characteristics (age, sex, and education), health needs (chronic conditions, functional disability, and number of sick days), and a variety of enabling factors (health insurance, English speaking ability, transportation, living arrangement, trust in Western medicine, and reported experience of disrespect in medical settings) were considered. After controlling for predisposing and need factors, health insurance coverage was found to be a significant enabling factor for hospital visits. Subjective perception of health was found to be significant not only for healthcare utilization, but also for satisfaction with service. A greater likelihood of satisfaction was also observed in individuals with health insurance, better English‐speaking ability, and greater trust in Western medical care. The reported experience of disrespect or discrimination in medical settings significantly reduced the odds of satisfaction with service.

Attitudes toward mental health services: Age-group differences in Korean American adults

The present study examined the attitudes toward mental health services held by younger (aged 20–45, n = 209) and older (aged 60 and older, n = 462) groups of Korean Americans. Following Andersens (1968; A behavioral model of families’ use of health service, Center for Health Administration Studies) behavioral health model, predisposing (age, gender, marital status and education), need (anxiety and depressive symptoms) and enabling (acculturation, health insurance coverage and personal experience and beliefs) variables were considered. In the mean-level assessment, younger and older adults were found to hold a similar level of positive attitudes toward mental health services. In the multivariate analysis, culture-influenced beliefs were shown to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was found to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Our findings show that older adults are not only more subject to cultural misconceptions and stigma related to mental disorders, but also their attitudes toward service use are negatively influenced by the cultural stigma. The findings provide important implications for interventions targeted to improve access to mental health care among minority populations. Based on the similarities and differences found between young and old, both general and age-specific strategies need to be developed in order to increase effectiveness of these programs.

Vulnerability of Older Latino and Asian Immigrants with Limited English Proficiency

OBJECTIVES: To explore the implications of limited English proficiency (LEP) for disparities in health status and healthcare service use of older Latino and Asian immigrants.

Race/Ethnicity and the Factor Structure of the Center for Epidemiologic Studies Depression Scale: A Meta-Analysis

The purpose of this meta-analysis was to examine racial/ethnic differences in the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D). The total number of participants (N) in the assessed studies (k) varied according to whether the original study had used either Exploratory Factor Analysis (EFA; N = 19,206, k = 13) or Confirmatory Factor Analysis (CFA; N = 65,554, k = 16). The factor structures of the CES-D were compared across five racial/ethnic groups: African Americans, American Indians, Asians, Whites, and Hispanics. Meta-analysis results suggest that the structure of the CES-D observed in EFAs varied substantially between racial/ethnic groups, whereas the CFA-assessed structure of the CES-D was mostly consistent between racial/ethnic groups. The meta-analysis of EFA studies did not consistently replicate the original four-factor structure reported by Radloff (1977), but the meta-analysis of CFA studies replicated the original four-factor structure in four of the five racial/ethnic groups. Overall, the present meta-analysis found strong evidence that the original four-factor structure may not be the best fit for all racial/ethnic groups. Thus, in clinical settings where the CES-D is used as a tool to screen for depression, clinicians and researchers should recognize the risk that symptoms of depression may be presented differently by members of different racial/ethnic groups.

Health Status of Older Asian Americans in California

Given the paucity of research on differences between older adults representing the many Asian‐American subcategories, the present study explored physical and mental health status in five subcategories of Asian Americans aged 60 and older: Chinese, Japanese, Korean, Vietnamese, and Filipino. Data were drawn from the 2007 California Health Interview Survey (CHIS). Background characteristics and physical and mental health conditions were compared, with results showing differences cross the five subcategories of older Asian Americans. Specific patterns were identified in chronic diseases, disease comorbidity, and disability rates. Vietnamese and Filipinos tended to have poorer physical health than Chinese, Japanese, and Koreans. The poorest self‐rated health and the highest disability rate were found in the older Vietnamese. Filipinos also exhibited the greatest number of chronic diseases, including the highest rates of asthma, high blood pressure, and heart disease. Although Koreans had the fewest self‐reported chronic diseases and the least evidence of disease comorbidity, they also had the highest psychological distress. The lowest psychological distress was found in older Japanese. Findings suggest that generalizing findings from one particular Asian category or from an aggregate Asian category may be problematic and may not reflect an accurate picture of the burden of health in specific Asian categories. Being aware of these differences in background and health characteristics may help providers to better serve older Asian clients.

A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans.

Previous research has shown that interpersonal conflict and depression are cross-sectionally associated with hostility. Our objective was to determine whether hostility is longitudinally predictive of interpersonal distress and depression and to replicate previous research that suggests that hostility is a risk factor for other health behaviors (e.g., smoking and excessive alcohol use) and psychosocial health problems. We use data from the youngest generation of a three-generation, 11-year follow-up study of Mexican Americans, that represent 251 Mexican Americans between the ages of 18 and 42 years. Our indicator of hostility was the irritability subscale from the Buss-Durkee Hostility Inventory. After statistically controlling for marital status, language acculturation, education, age, and sex, irritability was found to predict subsequent heavy drinking, somatic symptoms associated with depression, psychosomatic symptoms, infectious disease, divorce, marital separation, ending a serious nonmarital relationship, not being married at the follow-up, and more negative feelings associated with divorce, marital separation, and ending a serious relationship. Our research supports theory and research suggesting that hostility is predictive of physical symptoms, poor health habits, and interpersonal conflict.

Cultural equivalence in depressive symptoms in older white, black, and Mexican-American adults.

OBJECTIVES: To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups.

Factors associated with mental health service use in Latino and Asian immigrant elders.

Objectives: The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersens behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services. Method: Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders. Results: For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders. Conclusion: Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.