Hyunwoo Yoon

Bridging the Gap between Common Mental Disorders and Service Use: The Role of Self-Rated Mental Health among African Americans

OBJECTIVE The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individuals subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use. DESIGN Cross-sectional analyses of the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005-2006. SETTING In-home personal interviews. PARTICIPANTS Self-identified African American/black participants aged 40 to 85 years (N = 460). MEASUREMENTS Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy). RESULTS Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor. CONCLUSIONS Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individuals self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.

Social Capital in Ethnic Communities and Mental Health: A Study of Older Korean Immigrants

This study examined how social capital in ethnic communities (e.g., social cohesion, community support, community participation, and negative interaction) influences depressive symptoms of older Korean immigrants. Using survey data from 209 participants in Central Texas (Mage = 69.6, SD = 7.50), hierarchical regression models of depressive symptoms were examined with the following sets of predictors: (1) demographics, (2) physical health, (3) sociocultural factors, and (4) ethnic community factors. After controlling for the multiple sets of individual-level variables previously known to be important predictors of mental health, ethnic community factors made a substantial contribution. Higher levels of depressive symptoms were observed among individuals who received lower levels of community support (β = −0.14, p < 0.05), had limited participation in ethnic community events and activities (β = −0.15, p < 0.05), and reported more frequent negative interactions with ethnic community members (β = 0.12, p < 0.05). Findings highlight the importance of social capital in ethnic communities and hold implications for improving older ethnic immigrants’ mental well-being.

Dental care utilization and unmet dental needs in older Korean Americans

Objective: The study explored predictors of dental care utilization and unmet dental needs in older Korean Americans, considering predisposing, enabling (dental insurance, acculturation, and family network), and need (self-rated oral health) variables. Method: Multivariate regression models were used to evaluate the data from 209 Korean Americans (aged ≥60) surveyed in Central Texas. Results: Participants with strong family networks and fair/poor self-ratings of oral health reported higher numbers of dental visits in the past year. The likelihood of having an unmet dental need increased when participants had less education, a shorter stay in the United States, no dental insurance coverage, lower levels of acculturation, more limited family networks, fair/poor self-ratings of oral health, and fewer numbers of dental visits. Discussion: Our findings underscore the vulnerability of individuals who are culturally and linguistically isolated and lack family resources, and they highlight the importance of incorporating social and cultural factors in intervention efforts.

Health Vulnerability of Immigrants with Limited English Proficiency: A Study of Older Korean Americans

To examine the extent to which limited English proficiency (LEP) poses a risk to physical and mental health, using older Korean Americans as a target population.

Computer Use and Computer Anxiety in Older Korean Americans

Responding to the limited literature on computer use in ethnic minority older populations, the present study examined predictors of computer use and computer anxiety in older Korean Americans. Separate regression models were estimated for computer use and computer anxiety with the common sets of predictors: (a) demographic variables (age, gender, marital status, and education), (b) physical health indicators (chronic conditions, functional disability, and self-rated health), and (c) sociocultural factors (acculturation and attitudes toward aging). Approximately 60% of the participants were computer-users, and they had significantly lower levels of computer anxiety than non-users. A higher likelihood of computer use and lower levels of computer anxiety were commonly observed among individuals with younger age, male gender, advanced education, more positive ratings of health, and higher levels of acculturation. In addition, positive attitudes toward aging were found to reduce computer anxiety. Findings provide implications for developing computer training and education programs for the target population.

Self-rated mental health in socio-structural contexts: an examination with Korean American older adults

Objectives: Following the socio-structural framework of health, the study examined the role of social/interpersonal and environmental/neighborhood factors in predicting self-rated mental health (SRMH) in Korean American older adults. Method: Using the survey data from 420 older Korean Americans (mean age = 71.6, SD = 7.59), multivariate models of SRMH was estimated with sets of predictors: (1) background information (demographic characteristics and chronic conditions), (2) mental health symptom measures (depressive symptoms and anxiety), (3) social/interpersonal factors (social network and filial satisfaction), and (4) environmental/neighborhood factors (neighborhood safety and residential satisfaction). Results: Social/interpersonal and environmental/neighborhood factors were found to make a significant contribution to the predictive model even after controlling for background information and mental health symptom measures. Those with higher levels of filial satisfaction and more favorable perceptions of neighborhood safety were likely to have positive ratings of SRMH. Conclusion: Findings supported the importance of considering socio-structural contexts in the assessment of SRMH and provided implications for mental health services for the target population.

Oral Health and Dental Care in Older Asian Americans in Central Texas

To examine factors associated with dental health insurance, self‐rated oral health, and use of preventive dental care services in older Asian Americans.

Mental health literacy in religious leaders: a qualitative study of Korean American Clergy

Although religious leaders in ethnic minority communities are often the first point of contact for mental health needs, little is known about their mental health literacy. The aim of the current study was to explore the knowledge and beliefs about depression held by Korean American clergy, using a qualitative approach. The Gateway Provider Model (GPM) and Jorms conceptualisation of mental health literacy served as a framework for the enquiry. Seventeen clergy members serving in Korean communities in two U.S. metropolitan cities participated in an individual in-depth interview during the spring of 2013. Using the constant comparison method, the research team coded the data independently, compared and modified codes, and derived major categories and themes in consensus approach. Eight themes emerged from the interviews, and they were grouped into five categories: (i) the ability to identify the problem; (ii) knowledge about causes and risk factors; (iii) knowledge and beliefs about treatment; (iv) knowledge about resources and services; and (v) contextual factors. Despite some variations, a majority of the participants acknowledged that depression is an important issue in the Korean American community and felt a sense of responsibility for the well-being of their community members. The findings highlight the need for mental health education and training for religious leaders in ethnic minority communities to help them properly respond to community mental health needs.

Older Adults’ Internet Use for Health Information: Digital Divide by Race/Ethnicity and Socioeconomic Status:

Building upon literature suggesting low Internet use among racial/ethnic minorities and socioeconomically disadvantaged groups, this study examined how race/ethnicity and socioeconomic status (SES) influence the Internet use for health information, addressing both independent and interactive effects. Using data from 17,704 older adults in the California Health Interview Survey, logistic regression models were estimated with race/ethnicity (Whites, African Americans, Latinos, and Asians), SES index, and the interaction between race/ethnicity and SES index. Overall, approximately 40% of participants were Internet-users for health information. Direct effects of race/ethnicity and SES—and their interactions—were all found to be significant. Minority status combined with the lowest levels of SES substantially reduced the odds of using Internet for health information. Findings suggest the combination of racial/ethnic minority status and low SES as a source of digital divide, and provide implications for Internet technology training for the target population.

Measurement equivalence of English versus native language versions of the Kessler 6 (K6) Scale: An examination in three Asian American groups.

The use of languages other than English in population-based surveys is necessitated by the linguistic diversities in the United States. However, inclusion of multiple languages in survey data collection raises concerns about whether an instrument administered in different languages functions equivalently across groups. Using the Kessler Psychological Distress Scale 6 (K6), the present study examined differential item functioning (DIF) between surveys conducted either in English or the native language of the groups of Chinese Americans (n = 622), Korean Americans (n = 471), and Vietnamese Americans (n = 513). DIF analyses using a series of multiple-indicator multiple-cause models showed that there were substantial differences between English and non-English versions in the endorsement of the K6 items, with patterns that differed by ethnicity. The K4 (depressed) showed DIF in all three groups: Non-English survey users consistently showed a higher degree of endorsement compared with their English survey user counterparts. It is speculated that its translated expression in Asian languages may carry few associations with illness/disorder than the English word, thereby making it easy to endorse among Asian language survey users. Findings suggest a lack of measurement equivalence between the K6 administered in English and Asian languages and call for caution in cross-linguistic contexts.