Giyeon Kim

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.

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.

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.

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.

Depressive Symptoms in Four Racial and Ethnic Groups The Survey of Older Floridians (SOF)

Responding to the need for research on the mental health of minority elders, the present study explored determinants of depressive symptoms using a statewide sample of African Americans, Cubans, non-Cuban Hispanics, and Whites from the Survey of Older Floridians. The investigators focused on direct and interactive effects of demographic variables and stressful life conditions (chronic health conditions, functional disability, and negative life events) on depressive symptoms. A hierarchical regression model showed that lower income, more chronic health conditions, greater disability, and more life events were common risk factors for depressive symptoms across all groups. The impacts of age and education were found to be group specific. Significant interactions were also obtained among predictor variables in each group, identifying risk-reducing and risk-enhancing factors within each group. The findings on race-specific risk factors and within-group variability should be taken into consideration when developing and implementing services for diverse older populations.

Knowledge of Alzheimer’s Disease, Feelings of Shame, and Awareness of Services Among Korean American Elders

Objective: To explore predictors of knowledge of Alzheimer’s disease (AD), feelings of shame if a family member were to have AD, and awareness of AD-related services among Korean American elders. Method: Using data from 675 Korean American elders (mean age = 70.2, SD = 6.87), the study estimates hierarchical linear or logistic regression models. Results: Greater knowledge of AD is predicted by higher levels of education and acculturation. Feelings of shame associated with family members having AD are more likely to be reported by individuals with lower levels of education, acculturation, and knowledge of AD. Those who are married have greater levels of education and acculturation, and those who have a family member with AD are more aware of AD-related services. Discussion: The study findings underscore the pivotal role of education and acculturation in predicting knowledge of AD, feelings of shame, and awareness of AD-related services.

Racial and ethnic disparities in healthcare use, delayed care, and management of diabetes mellitus in older adults in California.

This study examined racial and ethnic differences in healthcare use, delayed care, and management of care of older adults with a self‐reported diagnosis of diabetes mellitus. Drawing on the 2009 California Health Interview Survey (CHIS), the sample included 3,003 adults (representative of N = 998,795) aged 60 and older from five racial and ethnic groups: non‐Hispanic white (n = 2,153), African American (n = 213), Hispanic (n = 336), Asian (n = 306), and American Indian and Alaska Native (AI/AN) (n = 59). All self‐reported a diagnosis of diabetes mellitus. Descriptive statistics and logistic regression analyses were conducted using weighted data. Results from adjusted logistic regressions indicated significant racial and ethnic differences between non‐Hispanic white elderly and the other groups examined. Specifically, African Americans were significantly less likely than whites to see a doctor and to have a usual source of care, and were more likely to visit the emergency department (ED) for diabetes mellitus and to have their feet examined by a provider. Hispanics were significantly less likely to take medicine to lower cholesterol but were more likely to test their blood glucose regularly (following ADA guidelines). Asians were significantly less likely than whites to test their blood glucose regularly or have a foot examination. AI/ANs were significantly less likely than whites to see a doctor, visit an ED, and take medication to reduce heart attack risk but were more likely to use insulin, oral diabetic medication, or both. The findings suggest the need for racial‐ and ethnic‐specific interventions for managing diabetes mellitus to help reduce existing racial and ethnic disparities among elderly adults.