DEPRESSION PREVALENCE, SYMPTOM PATTERN, AND MENTAL HEALTH SERVICE USE AMONG CHINESE AMERICANS: A QUANTITATIVE ANALYSIS OF ETHNOCULTURAL DISPARITIES

Abstract

My dissertation examines the depression prevalence, symptom patterns and dimension, and mental health service use among Chinese Americans. The purpose of this research is to, 1) provide epidemiological data on the prevalence of depression among Chinese Americans, 2) examine sociocultural impacts on the prevalence and specific symptoms patterns of depression, and 3) generate implications for more culturally-sensitive approaches in psychiatric diagnosis and treatment. I use secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES). The CPES consists of three nationally representative surveys conducted between 2001 and 2003. Each of three substantive chapters attempts to a set of issues, and together they contribute to the literature on generational differences in mental health status and help-seeking behaviors among Chinese Americans. The first substantive chapter examines depression prevalence and correlates among different generations of Chinese Americans, using non-Hispanic whites as a comparison group, using weighted multinomial logistic regression. Results of the study indicate that Chinese Americans in general have a lower risk of depression than do non-Hispanic whites. Moreover, the prevalence and correlates of depression do not show a linear trend of difference from first to second to third-or-higher generation Chinese Americans, and then to non-Hispanic whites; rather, the risk of depression and its associated with social relational factors present distinct patterns for first and second generation Chinese Americans, compared to third-or-higher generation Chinese Americans and non-Hispanic whites. Specifically, friend network and extended family network play different roles in their influence on depression risk for different generations of Chinese Americans. In the Chapter Four, I conduct exploratory factor analysis to examine two subgroups of Chinese Americans, the foreign-born and the US-born, and compare them to the non-Hispanic whites. I also conduct weighted binary logistic regression to examine the patterns of depressive symptoms for Chinese Americans (separate by nativity status) and compare the two groups to non-Hispanic whites. I also examine how demographic characteristics and social factors are related to different dimensions of depressive symptoms for each group. I also find very similar factors structures of DSM-IV depressive symptoms among foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. For all three groups, suicidal ideation or attempt is a construct that is distinct from the rest of the symptoms items. The three groups have different social correlates, yet there are only minor differences in the social correlates for each one of the four depression dimensions within each group. Chronic physical condition is the most consistently significant predictor, for the negative affect, somatic symptoms, and cognitive symptoms among the two Chinese groups, and for all four dimensions of depression among non-Hispanic whites. Finally, in Chapter Five, I find significant heterogeneity of exclusive complementary and alternative medicine (CAM) use by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first generation Chinese immigrants lag behind second, third-or-higher generation Chinese Americans, and non-Hispanic whites in the likelihood of using exclusive CAM services, as well as any services in general. In addition, this chapter finds that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both, among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans.