Yeon-Shim Lee

Risk and protective factors for depressive symptoms among American Indian older adults: adverse childhood experiences and social support.

Objectives: Despite efforts to promote health equity, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression. Although adverse childhood experiences (ACE) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the midwest. Method: Data were collected using a self-administered survey completed by 233 AIs over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and the Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study. Results: Two dimensions of ACE (i.e., childhood neglect, household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors. Conclusion: ACE may play a significant role in depression among AI/AN across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.

Elder Mistreatment, Culture, and Help-Seeking: A Cross-Cultural Comparison of Older Chinese and Korean Immigrants

This study explored and compared the salient sociocultural characteristics that influenced elder mistreatment and help-seeking behaviors among older Chinese and Korean immigrants. Results from qualitative, in-depth focus groups with 30 participants revealed that elder mistreatment is a culturally laden construct, and core values of traditional culture and acculturation are significant contextual factors that profoundly affect the perceptions of elder abuse and receptivity of interventions. Older Korean participants, compared to their Chinese counterparts, demonstrated stronger influence of hierarchy and cultural beliefs in exclusive family ties and gender norms, and were less likely to disclose abuse. Implications for culturally based interventions are also discussed.

Typology of religiosity/spirituality in relation to perceived health, depression, and life satisfaction among older Korean immigrants.

Objectives: The objectives of this study were (1) to identify distinct subtypes of older Korean immigrants based on their levels of religiosity/spirituality (R/S) and (2) to determine if the identified subtypes differed by demographic characteristics, perceived health, depression, and life satisfaction.Method: Factor mixture models were evaluated with a nonprobability sample of older Korean immigrants (N = 200) residing in the New York City area in 2009 to classify typologies of R/S. Multiple regression was used to test the associations between the R/S subtypes and outcomes (perceived health, depression, and life satisfaction) while controlling for demographics.Results: Two substantively distinct latent profiles were identified: normally religious/spiritual (‘average R/S’) and minimally religious/spiritual (‘low R/S’). The average R/S subgroup (74.4%) showed higher means than those in the low R/S subgroup (25.6%) on all six R/S class indicators. Subtypes did not differ on age, education, income, marital status, living arrangements, or years in the USA. However, males were more likely than females to be ‘average R/S.’ The ‘average R/S’ subtype had significantly greater life satisfaction than their ‘low R/S’ counterpart. No differences between the two subtypes were found on perceived health or depression.Conclusion: Findings highlight the importance of the classifications of R/S for mental health outcomes, and they indicate that relationships among R/S, various demographic characteristics, and physical/mental health are complex. Future research should validate and refine this classification of R/S in order to help identify particular sources of health risks/behaviors, relevant treatments, and health-promoting interventions within homogenous subtypes of older Korean immigrants.

Elder Mistreatment among Chinese and Korean Immigrants: The Roles of Sociocultural Contexts on Perceptions and Help-Seeking Behaviors

The purpose of this study was to identify dimensions of elder mistreatment in Chinese and Korean immigrant communities and to increase sociocultural understanding of such mistreatment by elucidating the complexities of abuse embedded in unique social and cultural contexts. In-depth interviews were conducted with 20 local professionals working primarily in Asian elderly advocacy, and six focus group discussions were conducted involving 60 community members in the San Francisco Bay area. Five dimensions of elder mistreatment were identified: psychological abuse, neglect by a trusted person, financial exploitation, physical abuse, and sexual abuse. In general, fewer Korean community member participants reported having observed physical or financial abuse than Chinese groups, but they reported greater knowledge of situations involving psychological abuse, neglect by a trusted person, and sexual abuse. The contexts of cultural influences and immigration and acculturation were salient themes that shaped participants’ subjective perceptions and beliefs about elder abuse and hence help-seeking behaviors.

Predicting Help-Seeking Attitudes Toward Mental Health Services Among American Indian Older Adults Is Andersen’s Behavioral Model a Good Fit?

American Indian (AI) older adults are vulnerable to mental health disparities, yet very little is known about the factors associated with help-seeking for mental health services among them. The purpose of this study was to investigate the utility of Andersen’s Behavioral Model in explaining AI older adults’ help-seeking attitudes toward professional mental health services. Hierarchical regression analysis was used to examine predisposing, enabling, and need variables as predictors of help-seeking attitudes toward mental health services in a sample of 233 AI older adults from the Midwest. The model was found to have limited utility in the context of older AI help-seeking attitudes, as the proportion of explained variance was low. Gender, perceived stigma, social support, and physical health were significant predictors, whereas age, perceived mental health, and health insurance were not.

A comparison of risk and protective factors related to depressive symptoms among American Indian and caucasian older adults

Despite efforts to reduce health disparities, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression and associated suicide. Although adverse childhood experiences (ACEs) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the Midwest. Data were collected using a self-administered survey completed by 479 AI and Caucasian respondents over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study. Results indicate that two dimensions of ACEs (childhood neglect and household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors of depressive symptoms. ACEs may play a significant role in depression among AI/AN populations across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.

Religion, Social Support, and Life Satisfaction Among American Indian Older Adults

This study examined the associations among religion, social support, and life satisfaction with 233 older American Indians in the Northern Plains region. Hierarchical regression indicated that those with higher religiousness and greater social support were found to have greater life satisfaction. Findings suggest that religion and social support provide promising pathways to build upon existing strengths to ameliorate mental health disparities. Health professionals must be sensitive to the complexities of religion and social support, and consider ways to incorporate cultural practices into health education and interventions to promote the quality of life for older American Indians.

Intimate Partner Abuse and Women's Employment: A Study on Afro-Trinidadian Women

This study examines the impact of intimate partner abuse on womens employment in Trinidad and Tobago. Using a qualitative method and data from in-depth interviews with 17 Afro-Trinidadian women, the study found that 12 women were able to seek and maintain employment without interference from their abusers. Data analyses suggest that abusers monitored the womens work schedules and manipulated them into using their earnings for household expenses. While five women were unemployed, only two were prevented from working despite severe economic need. The findings also show that three women were harassed or stalked at their workplaces. Three women who told their employers or co-workers about the abuse received mixed responses. Fourteen women hid their abuse from co-workers because of shame or fear of stigmatization. The findings further highlight the need for workplace interventions for dealing with partner abuse. Implications for research, practice and policy are also discussed.

Caring from Afar: Asian H1B Migrant Workers and Aging Parents

With the growth in engineering/technology industries, the United States has seen an increase in the arrival of highly skilled temporary migrant workers on H1B visas from various Asian countries. Limited research exists on how these groups maintain family ties from afar including caring for aging parents. This study explores the experiences and challenges that Asian H1B workers face when providing care from a distance. A total of 21 Chinese/Taiwanese, Korean, and Indian H1B workers participated in in-depth qualitative interviews. Key findings indicate that despite distance, caring relationships still continue through regular communications, financial remittances, and return visits, at the same time creating emotional, psychological, and financial challenges for the workers. Findings highlight the need for further research in understanding how the decline of aging parent’s health impacts the migrants’ adjustment and health in the United States.

A History of Childhood Maltreatment and Intimate Partner Violence Victimization Among Native American Adults

This study examined the association between childhood maltreatment and intimate partner violence (IPV) victimization among Native American adults. Based on Riggs’s theoretical model of the long-term effects of childhood abuse, we also examined the mediating roles of insecure attachment patterns and depressive symptoms. The current study was a secondary data analysis using the 2013 General Well-Being Among Native Americans dataset (N = 479). Structural equation modeling was used to examine the hypothesized relationships among key constructs. Consistent with existing literature of revictimization, our findings showed that the experience of childhood maltreatment was positively associated with IPV victimization. Mediation analyses indicated that depression was a significant mediator in the association between childhood maltreatment and IPV victimization. In addition, all the paths linking childhood maltreatment, fearful attachment, depressive symptoms, and IPV victimization were statistically significant, although the overall mediation effect was not significant. The results of this study suggest that Riggs’s model can serve as a useful theoretical framework for understanding the long-term effects of childhood maltreatment among Native American adults. Practitioners in the area of IPV should include maltreatment history and current attachment patterns in client assessments, which could help address conflict and violence within intimate relationships.