Depression in Asian American Adolescents

DEFINITION:

--Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities.-- World Health Organization

Types of Depression (National Institute of Mental Health):

Major Depression: Combination of symptoms that interfere with the ability to work, eat, sleep, study, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymia: Long-term, chronic symptoms that do not disable, but keep one from functioning well, or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their llives.

Bipolar Disorder: Also called manic-depressive illness. Characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes mood switches are dramatic and rapid, but most often they are gradual.

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OVERVIEW:

Asian and Pacific Islander Americans (APIA) represent one of the fastest growing segments of the population, yet health status and outcomes among APIA and APIA communities have commanded limited attention and resources from health researchers. With the increasing population of APIA youth it is becoming increasingly important to monitor and assess their well-being and development, and the prevalence of depression is one indicator that may prove particularly valuable in doing so.

Though an increasing amount of attention has been given to mental health among APIA, most research to date has focused on adults and has been hindered by competing understandings and assessments of mental health status (Lin and Cheung, 1999). Research on youth has been limited by issues of sample size, and the aggregation of data for a very heterogeneous population of youth does not allow for the needed detailed exploration of the prevalence, predictors, and sequelae of depression within APIA subpopulations and across sociodemographic contexts. Accordingly, there is a paucity of quantitative and qualitative data and information, which points to an urgent need to upscale research efforts.

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IMPORTANCE:

Research/Data

Contrary to what is espoused by the notion of APIA as “model minorities”, a notion that is commonly extrapolated to cover health status, available data, though limited, suggest that depression is an important health issue among APIA youth.

According to nationally representative data from the Youth Risk Behavior Survey, in the previous year, 28% of Asian American high school students reported depressed feelings serious enough to disrupt their usual activities, 19% reported making a suicide plan, and 11% reported making at least one suicide attempt (Ozer and McDonald, 2006).
Research has consistently found that depression rates among APIA are comparable to those of whites, and that APIA underutilize mental health services (Gee, 2004).
A large multiracial study of high risk youth found that, when compared to all other racial groups, APIA had the lowest utilization rates for any mental health service and for outpatient services (Garland et al, 2005).
In a study of older adolescents (18-21), Asian Americans reported significantly higher levels of depression than Whites (Lorenzo et al, 2000).
In a study of Asian American and White college students, Asian American students reported higher levels of depression and social anxiety (Okazaki, 1997).
For depression, APIA have differing prevalence of diagnoses when compared to whites, with APIA boys less likely to be diagnosed than white boys, while APIA girls have higher rates than white girls (Abright, 2002).
Asian American adolescent girls have the highest rates of depressive symptoms of all racial and gender groups (Schoen et al, 1997).
Urban Chinese American middle school students who were exposed to and/or experienced violence reported more symptoms of depression and PTSD (Ozer and McDonald, 2006). It should be noted that 96% of Asian Americans live in metropolitan areas (U.S. Census 2000).
A study of Chinese American youth found that harsh parental disciplinary practices and mothers’ immigrant status were significantly associated with depressive symptoms (Kim and Ge, 2000). Furthermore, general issues of acculturation and intergenerational relations (Kwak, 2003) have been linked to negative health behaviors and psychological distress among Asian American youth (Aldwin and Greenberger, 1987; Nguyen et al, 1999; Wong, 2001; Farver et al, 2002; Gomez et al, 2004; Hahm et al, 2004; Willgerodt and Thompson, 2006; Ying and Han, 2007).
A Hawaii-based study found that part-Japanese American adolescents had higher scores for depressive symptoms than those who were only Japanese (Williams et al, 2005). It should be noted that 13.9% of Asian American and 54.4% of Native Hawaiian and Pacific Islanders reported being of two or more races on the 2000 U.S. Census (and APIA have the highest outmarriage rates), and that being multiracial is associated with higher levels of stress, depression, suicidal ideation, substance use, and bully victimization (Williams et al, 2005; Udry et al, 2003; Stein et al, 2007)

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RESOURCES:

Asian and Pacific Islander American Health Forum

National Asian American Pacific Islander Mental Health Association

The Office of Minority Health

The Centers for Disease Control and Prevention

The Office of Minority Health Multiracial Populations

National Asian Women's Health Organization

Asian American Health Initiative

Asian Nation

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REFERENCES:

Abright, AR (2002). Depression in Asian American children. West J Med, 2002; 176: 244-248.

Aldwin, C and Greenberger, E (1987). Cultural Differences in the Predictors of Depression. American Journal of Community Psychology. 1987; 15:6, 789-813.

Farver, JAM et al (2002). Acculturation and Psychological Functioning in Asian Indian Adolescents. Social Development, 11, 1, 2002.

Garland, AF et al (2005). Racial and Ethnic Differences in Utilization of Mental Health Services Among High-Risk Youths. Am J Psychiatry, 2005; 162:1336–1343.

Gee, CB (2004). Assessment of Anxiety and Depression in Asian American Youth. Journal of Clinical Child and Adolescent Psychology, 2004, Vol. 33, No. 2, 269–271.

Gomez, SL et al (2004). Immigration and Acculturation in Relation to Health and Health-Related Risk Factors Among Specific Asian Subgroups in a Health Maintenance Organization. American Journal of Public Health , November 2004, Vol 94, No. 11.

Hahm, HC et al (2004). Asian American Adolescents, Acculturation, Binge Drinking, and Alcohol- and Tobacco-using Peers. Journal of Community Psychology, Vol. 32, No. 3, 295–308.

Kim, SY and Ge, X (2000). Parenting Practices and Adolescent Depressive Symptoms in Chinese American Families. Journal of Family Psychology, 2000. Vol. 14. No. 3. 120-135.

Kwak, K (2003). Adolescents and Their Parents: A Review of Intergenerational Family Relations for Immigrant and Non-Immigrant Families. Human Development, 46; 115-136.

Lin, KM and Cheung, F (1999). Mental Health Issues for Asian Americans. Psychiatric Services, June 1999, Vol. 50, No. 6.

Lorenzo, MK et al (2000). Social and Emotional Functioning of Older Asian American Adolescents. Child and Adolescent Social Work Journal, Volume 17, Number 4.

Nguyen, HH et al (1999). Toward a more Complex Understanding of Acculturation and Adjustment: Cultural Involvements and Psychosocial Functioning in Vietnamese Youth. Journal of Cross-Cultural Psychology, Vol. 30, No. 1, 5-31.

Okazaki, S (1997). Sources of Ethnic Differences Between Asian American and White American College Students on Measures of Depression and Social Anxiety. Journal of Abnormal Psychology, 1997, Vol. 106, No. I. 52-60.

Ozer, EJ and McDonald, KL (2006). Exposure to Violence and Mental Health Among Chinese American Urban Adolescents. Journal of Adolescent Health 39 (2006) 73–79.

Schoen C, et al (1997). The Commonwealth Fund Survey of the Health of Adolescent Girls. Louis Harris and Associates, Inc. New York, NY, 1997.

Stein, JA et al (2007). Adolescent Male Bullies, Victims, and Bully-Victims: A Comparison
of Psychosocial and Behavioral Characteristics. Journal of Pediatric Psychology, 32(3) pp. 273–282.

Udry, JR et al (2003). Health and Behavior Risks of Adolescents with Mixed-Race Identity. American Journal of Public Health, November 2003, Vol. 93, No. 11.

Willgerodt, MA and Thompson, EA (2006). Ethnic and Generational Influences on Emotional
Distress and Risk Behaviors Among Chinese and Filipino American Adolescents. Research in Nursing & Health, 2006, 29, 311–324.

Williams, JKY et al (2005). A Confirmatory Model for Depression Among Japanese American and Part-Japanese American Adolescents. Cultural Diversity and Ethnic Minority Psychology, Vol. 11, No. 1, 41–56.

Wong, SL (2001). Depression Level in Inner-City Asian American Adolescents: The Contributions of Cultural Orientation and Interpersonal Relationships. Journal of Human Behavior in the Social Environment, Vol. 3, No. 3/4, 49-64.

Ying, Y and Han, M (2007). The Longitudinal Effect of Intergenerational Gap in Acculturation on Conflict and Mental Health in Southeast Asian American Adolescents. American Journal of Orthopsychiatry, 2007, Vol. 77, No. 1, 61–66.

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DEPRESSION IN APIA ADOLESCENTS

DEFINITION:

OVERVIEW:

IMPORTANCE:

RESOURCES:

REFERENCES: