! 1Anxiety and Substance Abuse !!!!!!!!! !!!!!!The Co.docx

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Anxiety and Substance Abuse
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The Correlation Between Social Anxiety and Substance Use !
Loyola Marymount University !
Department of School Counseling !
EDSS 6390 !
Fall 2013 !
xxx-name-xxx !!!!!!!!!!!!!!!!!
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Abstract
The purpose of this research paper is to examine the
relationship between social anxiety
and substance use among adolescents and young adults. Erik
Erikson’s psychosocial theory will
be utilized as a central framework to in order to appropriately
understand the data presented in

the articles in accordance with life-span development. The
research question to be addressed is,
‘How is social anxiety associated with substance abuse?’
According to the results in past study 1,
girls are statistically more likely to abuse alcohol more than
boys as a coping strategy due to
their environmental circumstances. In past study 2, individuals
that score higher on the social
anxiety questionnaire, significantly are more likely to abuse
alcohol. Therefore, the implication
of this research paper is that educators develop specific
interventions that reduce social anxiety
based on the degree of anxiety for each individual.
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keywords:
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Introduction
Social acceptance is an essential factor in human development
that commonly assists in
psychological as well as emotional advancement. Adolescence
is one specific stage in which
peer acceptance is especially vital in order for positive
development to occur. Adolescents who
are not able to form significant peer relationships are more
likely to develop social anxiety,
shying away from others or altering habits and ideas to allow
for assimilation into a social group.
The purpose of this research paper is to examine the
relationship between social anxiety and
substance use among adolescents and young adults. If some
adolescents/young adults
experience high levels of social anxiety, are they more likely to
turn to drugs and alcohol than

peers who do not experience social anxiety.
In attempt to discover an answer to the hypothesis statement,
two peer reviewed articles
will be considered. The first examines smoking, drinking, and
illicit drug use in relation to
several different anxiety disorders including social anxiety
among adolescents, further analyzing
these findings in relation to gender (Wu, et al., 2010). The
second evaluates the impact of social
anxiety on control and experimental groups, the experimental
group being an alcohol
intervention program called BASICS (Terlecki, et al., 2011).
Each of these articles offers great
insight into the scope of the problem, building upon previous
studies that have proven that
elevated social anxiety has been consistently linked to greater
alcohol-related problems among
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citation? -1
Intro should include: Background of the problem from all

articles, past studies, overall purpose of your research.
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college students (e.g., Buckner et al., 2006; Gilles et al., 2006;
Lewis & O’Neill, 2000 as cited in
Terlecki, et al., 2011).
In order to appropriately understand the data presented in the
articles in accordance with
human development, Erik Erikson’s psychosocial theory will be
utilized as a central framework.
Being that there are eight stages in his theory, the primary stage
correlating with the research
question is the adolescent stage of identity versus role
confusion. The assumed age range for an
individual experiencing this conflict is eleven through eighteen.
The central objective for
succeeding in this stage is exploration, allowing adolescents to
decide who they are, what they
value, and how they fit into society. Role confusion can easily
lead to social anxiety, possibly
resulting in a harmful form of exploration such as substance
use.
Erikson’s Psychosocial Theory

Erik Erikson, a stage theorist who studied Sigmund Freud’s
principles, presented a
psychosocial theory involving eight stages of development.
Specific ages for the entering and
exiting of each stage were not provided, although ages can be
assumed, emphasizing Erikson’s
belief that each individual is unique and will encounter the
approaching stage when
developmentally ready (Newman & Newman, 2009). Each stage
concerns a conflict involving
biological, psychological, and societal development such as
trust versus mistrust or identity
versus role diffusion. While attempting to emotionally and
socially adjust to the new stage
approached, psychosocial crises are sparked by novel cultural
pressures and expectations
(Newman & Newman, 2009). Crises do “interfere with growth
and reduce one’s opportunities to
experience personal fulfillment”; however, an individual may be
able to advance to the next
stage without normally developing in the previous stage, later
reflecting on the difficulties of the
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citation from textbook?
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explain connections between the 3 domains
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prior stage (Newman & Newman, 2009, p. 216). This concept is
crucial because an individual
who struggles with forces such as mistrust, shame, and guilt, is
able to recollect experiences as a
child or adolescent that may have assisted in negative
developmental progressions.
Erikson’s Psychosocial Theory: Mechanism
One of Erickson’s primary principles or mechanisms of his
psychosocial theory is the
radius of significant relationships (Newman & Newman, 2009).
Through social relationships,

regardless of the developmental stage, cultural ideas and
expectations are enforced. In early
childhood, significant relationships generally only include
parents and siblings, whereas during
adolescence, teenagers begin expanding their social circles and
incorporating close friends as
meaningful persons in their lives. As stronger relationships
form with those other than
immediately family members, intimacy begins to develop and
the adolescent now views him/
herself as a member of a group of peers; “this network of
relationships determines the demands
that will be made on the person” (Newman & Newman, 2009, p.
220). Group affiliation
influences each person’s identity and the ways in which they
combat the psychosocial crises
encountered at each stage. For instance, if three of an
adolescent's closest friends begin
experimenting with alcohol use upon high school entrance, this
adolescent may also begin
experimentation due to fear of relationship loss during the
complicated stage of identity versus
role confusion. Social relationships are crucial to each stage of
development; however, peer

influence and acceptance is especially pivotal during adolescent
crises.
Defining Social Anxiety and Substance Use
Social anxiety, the independent variable, is characterized by
intense and/or persistent fear
or avoidance of social scrutiny (American Psychiatric
Association, 1994 as cited in Terlecki, et
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and Risk Factors
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al., 2011). To determine level of social anxiety among
participants, Terlecki, et al., (2011),
utilizes the Social Phobia Scale, assessing the adolescent’s fears
of social scrutiny when
completing daily activities such as eating and drinking. Heavy
alcohol consumption is
characterized by more than five drinks per sitting for men and
four for women (Terlecki, et al.,
2011). Wu, et al., (2010) furthers the definition of substance
use and considers cigarettes, heavy
drinking, and illicit drug use when defining the dependent
variable of substance use. Examples
of illicit drug use include marijuana, cocaine, and heroin. Wu,
et al., (2010) defines a frequent
smoker as an adolescent who has smoked at least one cigarette
every day for the past six months,
a frequent/heavy drinker has had at least one drink or becomes
drunk once per week, and an
illicit drug user has experimented with an illicit drug in the past
year. Social anxiety is
determined based on the information gained though the

Diagnostic Interview Schedule for
Children (DISC), meeting the DSM-III-R criteria, and
indicating diagnosis-specific impairment
(Wu, et al., 2010). Although the means of measuring social
anxiety differs between articles, the
definition of social anxiety remains consistent in both. Despite
the fact that Wu, et al. (2010)
utilizes a broader definition of substance use, any sense altering
substance is likely to be used in
greater quantity by those struggling with social anxiety
disorder; however, alcohol use may be
most common due to convenient access.
Past Study 1
The purpose of the study conducted by Wu et al. (2010) is to
determine the relationships
between specific anxiety disorders and substance use behaviors,
while incorporating gender
differences among adolescents in a community setting. Prior
studies have conducted research on
community dwelling adults, discovering that anxiety and
substance use disorders are positively
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clearly state the ‘risk factors’
Include section on Domains: 1. Define Domains from the
textbook. Then identify your variables (Social Anxiety (IV) and
Substance abuse (DV), and which 2 domains they fall under. -2
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related; however, few studies have been conducted on
adolescents within the community, and
even fewer demonstrated consistent results when comparing by
gender (Christie et al., 1988;
Brook et al., 2004 as cited in Wu et al., 2010). There was one
particular past study of
adolescents in the Great Smokey Mountains region examining
childhood anxiety disorders in
relation to alcohol. This study found that adolescents with
anxiety disorder were more likely to
abuse alcohol, while those with separation anxiety demonstrated
a decreased risk of alcohol use
(Kaplow et al., 2001 as cited in Wu et al., 2010). The Kaplow
study does present some valuable

information; however, gender differences were not examined
and only adolescents from one
small area participated, prevented the possibility of
generalizability. The Wu et al. (2010) study
is unique because it examines three different forms of substance
use, smoking, drinking, and
illicit drug use, in correlation with six different anxiety
disorders, although this research paper is
primarily concerned with social anxiety.
The independent variables are both gender and anxiety
disorders, while the dependent
variable is substance use, specifically smoking, drinking, and
illicit drug use. The participants
include 481 adolescents ages 9-17 from Connecticut, Georgia,
New York, and Puerto Rico. The
mean age is 15. 369 participants are girls, 49% white, 17%
African American, and 27%
Hispanic. 412 are boys, 49% white 17% African American, and
29.4% Hispanic. 4.4% of boys’
and 6% of girls’ parents have struggled with drug and alcohol
problems. Parental drug use may
not appear to be an essential fact; however, it has been proven
that there is a genetic link to

addiction, making this piece of information crucial. If a large
percentage of adolescents reported
having parents with substance abuse problems, the validity of
the population studied would
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decrease because these adolescents would be more inclined to
also struggle with substance
abuse, but this does not appear to be a concern in this study.
As explained briefly in the “defining social anxiety and
substance use” section of the
paper, the assessment to measure the variable of social anxiety
was gained through the
Diagnostic Interview Schedule for Children (DISC), which
consisted of three hour interviews
with one child and one parent or guardian in each household.
To further diagnose an individual
with anxiety, he/she would have to meet the DSM-III-R criteria,
and indicate diagnosis-specific
impairment. Substance abuse information gained through
interviews asks questions regarding

the number of times per week the adolescent had become
intoxicated or consumed 5 drinks (5 for
men and 4 for women) on one occasion, the regularity of
cigarette smoking, and the regularity of
non-medical illicit drug use.
The hypothesis presents the idea that if adolescent girls
demonstrate more anxiety
disorders, then they will show greater patterns of substance use.
In terms of the results, girls
show highly significant data at .001 for any anxiety disorder.
No significant associations were
found for boys between frequent/heavy drinking and anxiety
disorders when controlling for
demographic and familial factors. For girls, frequent or heavy
drinking was significantly
associated with any anxiety disorder. For boys, OCD was the
only anxiety disorder significantly
associated with drug use with a significance of .05. Boys with
social anxiety were significantly
more likely to be smokers, while girls with social anxiety
appeared to be less likely to smoke.
From these results, it is clear that the type of substances used
do vary based on gender; however,
girls appear more likely to turn to alcohol to cope with social

anxiety.
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Wu et al. (2010) poses a few possible explanations for the
significant data that resulted: it
may be that boys are more susceptible than girls to engaging in
tobacco use in response to the
self-presentation concerns, and high rates of habit-based,
repetitive, and ritualized behaviors that
typically accompany OCD may place girls who are afflicted
with OCD at greater risk of
converting casual substance use into habit-based substance
misuse (Wu et al., 2010). Although
OCD is not the disorder that was intended to be examined in
this research paper, it is very
possible that OCD is highly correlated to social anxiety.
Reliability statistics are not provided in
this article, however several correlations were proven highly
statistically significant. Overall, the

implications of the study involve the importance of recognizing
and treating childhood anxiety
disorders, especially among girls, in order to help them to avoid
developing secondary substance
use disorders.
Past Study 2
The purpose of the second study, conducted by Terlecki, et al.
(2011), is to evaluate the
impact of social anxiety on a college alcohol intervention
program, BASICS, which is the
experimental group, in comparison to a control group who did
not receive any treatment.
BASICS stands for The Brief Alcohol Screening and
Intervention for College Students. Students
were randomly assigned to either a control or experimental
group. The independent variable is
once again social anxiety and the dependent variable is
substance use, specifically alcohol use
reported when participating in BASICS training. Past studies
have discovered that social anxiety
disorder is related to alcohol dependence and abuse; however,
this particular study examines the
impact of a brief alcohol treatment using social norms feedback

among socially anxious heavy
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drinking students, which no existing study has conducted
(Kessler et al., 1997 as cited in Terlecki
et al., 2011).
Social anxiety is judged based on the Social Phobia Scale
(SPS) as well as the
Spielberger Trait Anxiety Inventory (STAI). SPS is highly
reliable at .93 and measures student’s
feelings of social scrutiny when completing routine activities
such as eating or drinking. STAI is
also reliable at .87, and demonstrates excellent convergent
validity. There are four measures
used to determine alcohol consumption: Alcohol Use Disorders
Identification Test (AUDIT), the
Daily Drinking Questionnaire, Quantity/Frequency/Peak Index,
and Rutgers Alcohol Problem
Index (RAPI). AUDIT is a ten item self-report measure ranging
from 0-40, 6 or higher

indicating higher risk drinking. This measure is reliable at .84.
The Daily Drinking
Questionnaire is another self-reported measure that utilizes the
Likert-scale to ask questions
regarding the influence of drinking on daily life, numbers
differing based on gender. Quantity/
Frequency/Peak Index is another self-report measure that asks
the number of drinks consumed
during one occasion in the past month, then provides several
options such as 0, 1-2, 3-4, 5-6, and
6 or more. Lastly, RAPI is a 23 item self-report measure of the
negative consequences of alcohol
consumption. The range for each question is 0-4 with a
maximum score of 92. Reliability for
this measure is .92.
Participants include 70 undergraduate college students ranging
from 18 to 24 years of age
who attend a large, public, southern university. 75% have been
diagnosed with social anxiety
disorder according to SPS. 26% demonstrate high social
anxiety and 44% low social anxiety. 38
individuals are placed in the experimental category and receive
BASICS training. BASICS

training asks participants to record their daily drinking habits,
later motivating the student to
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decrease use, therefore developing a discrepancy between use
patterns and feeling toward
alcohol consumption. The remaining 32 participants occupy the
control group, which does not
receive treatment. 85.7% are white, with a mean age of 20.5
years old. 68.6% are males, 64.3%
upper classmen, 74.3% live off campus, and 37.1% are members
of the Greek system.
The hypothesis presented argues that if students score on the
higher end of the social
anxiety scale, then BASICS treatment will be less effective in
reducing typical alcohol use.
According to the results, those with higher social anxiety,
report significantly (.007) heavier
typical drink habits during the post test than students with low

social anxiety when controlling
for baseline typical drinks, trait anxiety, and whether or not
they receive referral or volunteered
to enter the program. The BASICS group demonstrates
significant results at .04, showing lower
weekly alcohol consumption and alcohol-related problems
during the follow-up session than the
control group. Possible reasons for the results include the
authors belief that those with high
social anxiety may have responded to the intervention in a
socially favorably way to avoid
scrutiny for reporting numerous alcohol problems, regular heavy
alcohol use, or not changing
drinking behavior after receiving the intervention, as well as the
possibility that students who had
preexisting concerns about their drinking behavior could have
self-selected into the study
(Terlecki et al, 2011).
This study is particularly important because it notes not only
the high correlation between
social anxiety and substance use, but it provides information as
to the types of programs that may
be helpful when working with students of different anxiety
levels. Both social anxiety and

substance abuse are very commonly reported among college
students; therefore, it is important to
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know implications of practice, specifically the tactics and
programs that actually do work when
attempting to decrease the regularity of these disorders.
Comparison of Past Study 1 and Past Study 2
The Wu et al. (2010) and Terlecki et al. (2011) studies are
similar in that both articles
utilize the independent variable of social anxiety and the
dependent variable of substance use,
acknowledging the high correlations that previous studies have
proven. Each study presents an
additional variable to contribute to the uniqueness of their
research. Wu focuses on gender,
whereas Terlecki introduces a training and control group and
conducts an experiment. Wu also
did not include any information regarding reliability, causing

some skepticism when reviewing
the displayed results. The ages of participants also differed
slightly in each article. Wu
researches adolescents ages 9 through 17, while Terlecki
focuses on those 18-24 years of age.
Although 18-24 is not necessarily considered adolescence, it is
young adulthood, a time in which
much self discover occurs, especially when going away to
college. When taking both articles
into consideration, it becomes clear that earlier developmental
stages do influence future
development, and high social anxiety, especially in girls, puts
adolescents and young adults at
greater risk of substance abuse. Implications include the
importance of diagnosing and
appropriately treating anxiety disorders during childhood,
therefore, preventing comorbid
substance use disorders and failed treatment methods during
late adolescence and young
adulthood.
Conclusion
Although much research has been conducted in reference to
anxiety disorders and

substance use, the objective of this paper is to not only to
examine this relationship with the
overall purpose of the research paper, good
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assistance of two peer reviewed articles, but to consider the
stage of development that
participants are facing during adolescence and young adulthood
according to Erik Erikson’s
psychosocial theory. Despite the fact that every individual is
unique and enters developmental
stages when appropriate, adolescents who experience high
levels of social anxiety are at a greater
risk of substance abuse. This fact highlights the importance of
adequately diagnosing and
treating children who struggle with social anxiety before they
enter the stage of adolescence and
begin their period of exploration. The best method to prevent
substance dependence and
addiction is to address the underlying difficulty at hand before

allowing time for self-medication
or negative social interactions to occur.
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References !
American Psychiatric Association. (1994). Diagnostic and
statistical manual of mental disorders
(4th ed.). Washington, DC: Author. !
Breaux, J. J. (2009). James Marcia and the four identity
statuses theory. Helium, Inc.
Retrieved from http://www.helium.com/items/1560359-
marcias-four-identity-statuses. !
Brook, J. S., Cohen, P., & Brook, D. W. (1998). Longitudinal
study of co-occurring psychiatric
disorders and substance use. Journal of the American
Academy of Child and Adolescent
Psychiatry, 37(3), 322–330. !
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implication…citation needed from each article -1
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Buckner, J. D., Schmidt, N. B., & Eggleston, A. M. (2006).
Social anxiety and problematic
alcohol consumption: The mediating role of drinking

motives and situations. Behavior
Therapy, 37(4), 381–391. !
Christie, K. A., Burke, J. D., Regier, D. A., Rae, D. S., et al.
(1988). Epidemiologic evidence for
early onset of mental disorders and higher risk of drug abuse in
young adults. The
American Journal of Psychiatry, 145(8), 971–975. !
Gilles, D. M., Turk, C. L., & Fresco, D. M. (2006). Social
anxiety, alcohol expectancies, and
self-efficacy as predictors of heavy drinking in college
students. Addictive Behaviors,
31(3), 388–398. !
Kaplow, J. B., Curran, P. J., Angold, A., & Costello, E. (2001).
The prospective relation between
dimensions of anxiety and the initiation of adolescent alcohol
use. Journal of Clinical
Child Psychology, 30(3), 316–326. !
Kessler, R. C., Crum, R. M., Warner, L. A., Nelson, C. B.,
Schulenberg, J., & Anthony, J. C.
(1997). Lifetime co-occurrence of DSM-III-R alcohol
abuse and dependence with other
psychiatric disorders in the National Comorbidity
Survey. Archives of General
Psychiatry, 54(4), 313–321. !
Lewis, B. A., & O’Neill, H. K. (2000). Alcohol expectancies
and social deficits relating to
problem drinking among college students. Addictive
Behaviors, 25(2), 295–299.
Newman, B. M., Newman, P. R. (2009). Theories of Human
Development. NY: Psychology
Press. ISBN 0-8058-4702-2. Pages 212-238.
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Terlecki, Meredith, A., et al. (2011) The role of social anxiety
in a brief alcohol intervention for
heavy- drinking college students. Journal of Cognitive

Psychotherapy: An International
Quarterly. Doi: 10.1891/0889-8391.25.1.7.
Wu, P., Goodwin, R., et al. (2010) The relationship between
anxiety disorders and substance use
among adolescents in the community: Specificity and
gender differences. Journal of
Youth and Adolescence. Doi: 10.1007/s10964-008-
9385-5.
Chinese American adolescents: perceived
parenting styles and adolescents’
psychosocial health
W. Yuwen1 RN, BSN & A. C. C. Chen2 RN, PhD, PMHNP-BC
1 Doctoral Student, School of Nursing, University of
Washington, Seattle, WA, 2 Associate Professor, College of
Nursing &
Health Innovation, Arizona State University, Phoenix, AZ, USA
YUWEN W. & CHEN A. C. C. (2013) Chinese American
adolescents: perceived parenting styles and
adolescents’ psychosocial health. International Nursing Review
60, 236–243
Background: Asian Americans are one of the fastest-growing
minority groups in the USA, and Chinese
constitute the largest group. Evidence suggests that Asian
American adolescents experience higher levels of
depressive symptoms than their same-gender white counterparts.
Quantitative findings suggest associations

between parenting factors and Chinese American adolescents’
mental health. A qualitative understanding
regarding Chinese American adolescents’ perceived parenting
styles and its relationship with adolescents’
psychosocial health is warranted.
Aim: To gain an in-depth understanding of Chinese American
adolescents’ perceived parenting styles and how
parenting styles might influence adolescents’ psychosocial
health.
Methods: In this qualitative study, we recruited 15 Chinese
American adolescents aged 12–17 years in a
southwest metropolitan area. We conducted two focus group
interviews. Participants also filled out a brief
questionnaire that included their socio-demographic
information, immigration history and level of
acculturation.
Results: Participants reported perceiving that parents had high
expectations about academic performance
and moral values. They also perceived stricter family rules
regarding choices of friends compared with their
non-Asian peers. Parents tended to be more protective of girls
than of boys. Both Chinese American boys and
girls reported poor or ineffective communication with their

parents, which contributed to increased conflict
between parents and adolescents and emotional distress of the
adolescents.
Conclusions: The findings provide evidence for nurses to
develop linguistically and culturally tailored
resources (e.g. parent support groups, programs aimed to
improving parent–child communication) or connect
these families with existing resources to enhance parenting
skills and consequently reduce emotional distress of
their adolescent children.
Keywords: Culture Education, Focus Groups, Health
Disparities, Parenting, Psychology
Introduction
Asian Americans are one of the fastest-growing minorities in
the USA, and Chinese constitute the largest group (US Census
Bureau 2011). While the perception persists that Asian Ameri-
cans are the model minority, evidence suggests that Asian
Correspondence address: Weichao Yuwen, University of
Washington School of
Nursing, Box 357260, Seattle, WA 98195 USA; Tel: 480-600-
3347;
Fax: 206-543-3624; E-mail: [email protected]
bs_bs_banner
Clinical
© 2012 The Authors. International Nursing Review © 2012
International Council of Nurses 236

American adolescents experience higher levels of depressive
symptoms than their same-gender white counterparts (Brown
et al. 2007; Chen et al. 2011; Costello et al. 2008; Greenberger
et al. 2000). A recent report from a National Alliance on Mental
Health listening session suggested that Asian American girls
aged from 15 to 24 have the highest depressive symptoms and
suicide mortality rates across all racial/ethnic groups (Africa &
Carrasco 2011). Furthermore, Asian American youth are less
likely to receive services for emotional problems compared with
other racial/ethnic groups (Africa & Carrasco 2011; Chang &
Sue 2003).
Researchers have examined various factors that may explain
the high level of depressive symptoms among Chinese adoles-
cents, with one line of research studying the influence of family
and parenting. Family and parenting factors were found to be
associated with Chinese American adolescents’ depressive
symptoms, including family functioning (Crane et al. 2005),
family conflict (Juang et al. 2007; Lim et al. 2009), supportive
parenting (Kim & Ge 2000), parental control (Juang et al. 2007;
Lim et al. 2009), and parental monitoring (Kim et al. 2009; Kim
& Ge 2000).
Family functioning, a multidimensional aspect of family and
parenting factors, includes family structure, family communica-
tion, adaptability, cohesion, and problem solving (Crane et al.
2005). Crane et al. (2005) found that Chinese American adoles-
cents from families with higher functioning were found to have
fewer mental health issues and behavioural problems. One
aspect of family functioning, family communication, refers to a
set of norms regulating the exchange of information among its
members. The way of communication between parents and
their children can influence their interactions and affect adoles-

cent’s psychosocial health (Crane et al. 2005).
Family conflict, which refers to adverse and angry interac-
tions between parents and their children, may put the Chinese
American adolescents at risk for higher levels of depressive
symptoms (Juang et al. 2007; Lim et al. 2009). Immigrants often
experienced considerable stress in the new host country during
the acculturation process, and immigrant children usually
assimilate faster than their parents (Crane et al. 2005). The dif-
ferential rates of acculturation among family members may
increase parent–child conflicts due to a lack of shared under-
standing that could lead to or increase depressive symptoms in
the adolescents (Crane et al. 2005; Organista et al. 2002).
Supportive parenting, characterized by high levels of warmth,
democratic discipline and involvement/supervision, has been
reported to be associated with lower levels of depressive symp-
toms and adjustment problems in Chinese American youth
(Kim & Ge 2000). Parental control, an important dimension of
parenting, may hold very different meanings in different cul-
tures. In Western culture, parental control often implies parents’
desire to dominate their children’s lives (Huang 2007) and is
seen as a negative aspect of parenting for mainstream European
Americans (Rohner & Pettengill 1985). In Chinese American
families, parental control is often interpreted as a sign of paren-
tal caring and involvement and therefore considered positive for
children’s development (Huang 2007). Parental control’s influ-
ence on Chinese American adolescents’ depressive symptoms
was inconsistent in the literature. For instance, Lim et al.
(2009)
tested Chinese American adolescents’ perceived parental psy-
chological control using the Parental Bonding Instrument, and
they did not find significant relationships between
psychological
control and adolescents’ distress. Juang et al. (2007) measured

Chinese American parents’ attitudes and values concerning
appropriate levels of control with their children and the adoles-
cent’s endorsement of parental control behaviours. They found
that greater parent–adolescent discrepancies in perceptions of
parental control were related to higher depressive symptoms in
Chinese American adolescents. Parental monitoring, also
known as behavioural parenting, is another critical dimension
of parenting. Empirical evidence has consistently suggested a
negative relationship between parental monitoring and Chinese
American adolescents’ depressive symptoms (Kim et al. 2009;
Kim & Ge 2000; Weaver & Kim 2008).
The majority of empirical studies on family and parental
influences on Chinese American adolescents’ mental health
have been conducted via quantitative surveys. A qualitative
understanding regarding the adolescents’ perceived parenting
styles and their relationships with the adolescents’ psychosocial
health can enhance our understanding of the parents’ and ado-
lescents’ struggles and needs and contribute to the design of lin-
guistically and culturally tailored programs in promoting
Chinese American adolescents’ psychosocial health.
Method
Sample and sampling
Purposive sampling, one of the most commonly used sampling
strategies in qualitative research, recruits samples based on pre-
selected sample criteria related to particular research questions
(Mack et al. 2005). Because the study aimed to understand and
obtain information from a target population and sample repre-
sentativeness was not the primary concern, we used the purpo-
sive sampling strategy to recruit Chinese American adolescents
from a Chinese school and a church.
The inclusion criteria included: (1) self-identified as Chinese,

Taiwanese, Chinese American or Taiwanese American, (2) aged
12–19 years old, and (3) has at least one parent who was born in
China or Taiwan. Individuals were excluded from the study if
Chinese American adolescents 237
International Council of Nurses
they did not meet the inclusion criteria, refused to participate or
did not return parental consent and adolescent assent forms.
Sample size
It is typical to include four to 12 participants in a focus group
(e.g. Bouma 1996). Researchers have suggested an average of
6–7 participants for each focus group to allow diversity in per-
spectives while making participants feel comfortable to share
their thoughts and experiences (e.g. Holloway 1997). We had
included seven and eight participants in the two focus groups,
respectively.
Procedure
Learning from our previous experiences working with Chinese
American communities, we identified two key members in the
Chinese American communities to assist with sample recruit-
ment. We gave the parental consent and adolescent assent forms
to Chinese American adolescents who were eligible and inter-
ested in participating. After we received parental consents and
adolescent assents, we identified time and locations convenient
to adolescents to conduct focus groups. Institutional Broad
Review approval for human subjects protection was received
before we approached the target sample.

Both bilingual investigators conducted two focus groups
(n = 8 and n = 7, respectively) in a safe and quiet room in a
local
Chinese school and a church. Specific guidelines were used to
ensure confidentiality of the data, such as securing data in
password-protected computers and a locked cabinet to which
only investigators had access. Each participant was assigned a
numeric code so that no identifying information would be
revealed. Adolescents were given contact information if they
had questions regarding this study. We also provided a list of
local mental health providers in the event that any emotional
issues occurred because of their participation. Each focus group
lasted 60–90 min and was audiotaped or videotaped with per-
mission. Focus group questions were asked in either English or
Chinese, according to the participants’ preference. Each adoles-
cent also filled out a brief socio-demographic questionnaire. We
sent a $15 gift card to each participant to compensate his/her
time and effort; the amount and format of compensation are
well accepted in the USA for participating in focus groups.
Measures
The focus groups questions and socio-demographic question-
naire were prepared in English and two written Chinese ver-
sions (traditional and simplified) through rigorous translation
and back-translation procedures.
Focus group questions
Fifteen questions were asked to explore the adolescents’ percep-
tion of their father’s and mother’s parenting styles and how the
parenting styles might influence adolescent psychosocial health.
Socio-demographic questionnaire

The socio-demographic questionnaire assessed the adolescent’s
ethnicity, age, sex, grade, whether or not he or she received
reduced-priced or free lunch at school, family structure, immi-
gration history, birthplace, highest level of education and occu-
pation of parents. Two scales measuring adolescents’ level of
acculturation, Vancouver Index of Acculturation (VIA; Ryder
et al. 2000) and language proficiency, were also included in the
socio-demographic questionnaire to understand the target
sample better.
The 20-item VIA includes two subscales: 10 items regarding a
Chinese orientation (e.g. I often follow Chinese culture tradi-
tions) and 10 items asking corresponding questions regarding
an American orientation (e.g. I often follow mainstream Ameri-
can culture traditions). Adolescents rated the items on a scale
from 0 (strongly disagree) to 4 (strongly agree). Psychometric
properties of VIA were tested and demonstrated satisfied valid-
ity and reliability (Weaver & Kim 2008).
We used four items to assess adolescents’ speaking, under-
standing, reading and writing skills in Chinese and English (e.g.
how well do you speak and understand Chinese). The scale
ranged from 0 (not well at all) to 4 (extremely well).
Analysis
Focus group data
With all participant identifiers (i.e. names if mentioned in the
discussion) removed, one investigator listened to the audiotapes
or watched the videotapes recorded from the focus groups and
transcribed them. The other investigator read and validated the
transcriptions done by the first investigator. The two investiga-
tors then independently conducted a qualitative analysis of the
transcripts and summarized the findings, recommended by
researchers (e.g. Kurasaki 2000) to increase reliability and

valid-
ity of the findings. There were a few minor discrepancies in cat-
egorizing data into themes when the two investigators reviewed
the initial analysis results. The two investigators continued to
discuss and finalize the findings until a 100% agreement was
reached.
The 8-step content analysis method (Downe-Wamboldt
1992) that guided our qualitative data analysis were: (1) select-
ing the unit of analysis (in this case, responses to questions
posed and topics that come up spontaneously), (2) creating and
defining the categories (a classification schema; includes
238 W. Yuwen & A. C. C. Chen
definitions of categories), (3) pre-testing the category defini-
tions and rules (examining utility of the schema, inter-rater
agreement), (4) assessing reliability and validity (the
exhaustive-
ness and exclusivity of schema), (5) revising the coding rules if
necessary (tightening or redefining schema rules), (6) pre-
testing the revised category scheme (as in 3), (7) coding all the
data (applying schema to classify data, count occurrences, and
determine salience of emerging claims about the data), and (8)
reassessing the reliability and validity (reliability = consistency
in coding decisions; validity = congruence between claims
about
the data and reality as recalled by the group moderators).
Data from the socio-demographic questionnaire

Frequency distributions and descriptive statistics (mean,
median, standard deviation, %) were calculated in SPSS
18.0 (IBM 2009) for variables in the socio-demographic
questionnaire.
Results
Sample socio-demographic characteristics
A total of 15 adolescents aged 12–17 years old participated
(M = 15.1; SD = 1.5); 67% were girls. All participants
identified
themselves as Chinese American or Taiwanese American. About
67% of the adolescents (n = 10) were born in the USA, and four
of the five foreign-born adolescents came to the USA at or
under age 5. The majority (87%) lived with their birth parents.
Only one adolescent (7%) received free lunch from the school.
About 93% adolescents reported that they could speak and
understand Chinese moderately or very well; all adolescents
reported that they spoke English extremely well. Their parents
usually spoke to them in Chinese, and they answered in English.
The adolescents reported slightly higher Chinese orientation
scores (M = 29.5; SD = 5.4) than US orientation scores
(M = 28.3; SD = 4.5). All of the adolescents’ parents were
foreign born, except one father who was born in the USA.
About half of the adolescents’ fathers and mothers finished
graduate or professional degrees. Most parents (90%) were
employed in professional occupations such as engineering,
accounting and teaching.
Findings from the focus groups
Five themes were generated from the focus groups data. The
main categories were: strict family rules, parental expectations,
parenting styles for boys and girls, parenting styles between
mothers and fathers and the role of parenting in the adoles-

cents’ psychosocial health.
Strict family rules
The adolescents were asked whether their parents knew where
they were, with whom they were hanging out and whether or
not they followed the family rules. Almost all adolescents felt
that their parents were very strict about their choices of friends
and the social activities they could participate in. One adoles-
cent, for example, said the following:
I have certain friends that my mom knows and she allows me
to go out with them . . . My parents have rules like I can’t get
into a car with another student who’s driving, it has to be a
parent who’s driving (16-year-old girl from the Chinese
school group).
Another 16-year-old girl from the Chinese school group
commented,
My mom would let me hang out with guys that she knows
and she talked to, like people from orchestra. But like other
people in general, [they don’t allow].
Sometimes, the adolescents were not given a reason for their
activity restriction:
. . . Sometimes they are like, you can’t go, but they don’t really
have a reason to hold that (16-year-old girl from the Chinese
school group).
Parental expectations
The adolescents in this study consistently perceived that their
parents had high expectations for academic performance. One
participant felt it was positive rather than negative:

My parents, they think education is very important. But since
they raise me in that way, now I think it’s important (12-year-
old girl from the Chinese school group).
In addition, adolescents from the church group expressed their
own and their parents’ high expectations on moral values. One
16-year-old girl said:
Her [mother] biggest dream for me is to respect myself and
respect other people. Her importance [emphasis] is not really
on school, but is about how you present about yourself and
how you make yourself in life.
Another 16-year-old girl from the church group also said:
He [father] puts big importance on moral integrity and
families.
The girls also perceived that the parents, especially the mothers,
had higher expectations for them than they had for the boys.
For instance, a 15-year-old girl from church group said:
My mom can’t really do anything other than working in the
Chinese restaurant. She would want me to do better, have a
good education and get a good job.
Another girl interpreted this expectation based on cultural
differences:

I guess in America, you have the opportunity to like, instead
of being a housewife, you can be a businesswoman, be a
doctor, [and] you don’t have to be there for your husband
(16-year-old girl from the church group).
Parenting styles for boys and girls
In discussing the perceived gender difference in parenting
styles,
the girls consistently perceived higher standards and more
restrictions from parents, compared with the boys:
I feel like guys have more freedom to do stuff. Like my
brother, when he was in high school, he got to play video
games and stuff. If I try to do something, my mom will be
like, what are you doing, go studying (16-year-old girl from
the Chinese school group).
Another 16-year-old girl from the church group related similar
experiences:
My parents are super harsh on me and my sister because
there’s something with girls that you need to be more inde-
pendent, be on your own. While my brother is so sweet, they
are like, oh get a good job, get a girl, do your thing. But with
us, study hard, we have to be the best, we have to do every-
thing pretty much.
The adolescents thought that the different parenting styles for
boys and girls might be due to parents being more protective of
girls ‘because they think something bad’ will happen to girls.
Parenting styles between mothers and fathers
The adolescents have commented on the different parenting

styles of their mothers and fathers. In general, mothers were
perceived to be stricter than fathers, whereas fathers were per-
ceived to be more relaxed and supportive.
Adolescents from both groups were more likely to communi-
cate with fathers rather than with mothers, because ‘she
[mother] doesn’t communicate very well (14-year-old girl from
the church group).’ A 16-year-old girl from the church group
said, ‘he [father] is always there for me . . . When I’m crying or
I
have problem with my relationships, I go to my dad because he
is a great listener.’ Another 16-year-old girl from the church
group shared, ‘My dad is like the complete opposite than my
mom. He is very supportive.’ Similar to girls, a boy from the
Chinese school group said, ‘I feel like my dad pays more atten-
tion [to me] than my mom [does].’
The role of parenting in the adolescents’ psychosocial health
Adolescents were asked how parenting might influence the
adolescents’ psychosocial health. Poor or ineffective parent–
child communication and lack of support were identified
as negative influences on their psychosocial health. Some
adolescents said that their parents ‘did not communicate
as much overall’. Others said, ‘There’s really nothing to
talk about.’ Adolescents would like their parents to be more
open and be more direct about their expectations. For
example:
I wish they were more open. If they want me to do some-
thing, they should tell me straightforward. Like, tell me what
you want me to do, so I know what you expect me to do (16-
year-old girl from the church group).
One 16-year-old girl from the Chinese school group thought

that depression could result from the culture instead of the
parenting style:
They [Chinese] are more introverted, so they have more time
to think deeper, which ends up depressing them.
Discussion
This qualitative study aimed to obtain an in-depth understand-
ing of Chinese American adolescents’ perception of parenting
styles and how parenting styles might influence their psychoso-
cial health. Many of the study findings are consistent with prior
research. For instance, our study findings suggest that Chinese
American adolescents perceived that their parents had high
expectation for academic performance and moral values. The
high parental expectations about academic performance among
Chinese American families are well documented (e.g. Chen &
Lan 1998; Goyette & Xie 1999). Compared with non-Chinese
students, Chinese students were more likely to fulfil their
parents’ expectations on academic performance (Chen & Lan
1998). This might be explained by the cultural and historical
backgrounds of Chinese, which have been influenced by the
Confucian philosophy for over 2000 years. The Confucian phi-
losophy highly values human malleability, self-improvement
and filial piety (Chen & Lan 1998; Leung et al. 1998). Thus,
Chinese children are more obedient to their parents. They are
more concerned about and live up to or even exceed their
parents’ expectations (Chen & Lan 1998). Lee et al. (2009) con-
ducted focus groups among 17 Asian American young adults
(18–30 years old) and found that they perceived a greater pres-

sure to meet their parental expectations about high academic
achievement and carried the ‘model minority’ stereotype. In this
study, the Chinese American adolescents also perceived high
parental expectations about academic performance, but they
accepted the expectation as part of the family norms and did
not necessarily consider it to be negative. The different findings
reported in this study and Lee’s might be due to the sample
difference (younger vs. older; Chinese Americans vs. Asian
Americans).
High parental expectations about moral values were men-
tioned by participants in the church group but not in the
Chinese school group. For example, a 16-year-old girl from the
church group said: ‘He [father] puts big importance on moral
integrity and family’. This difference likely results from their
religious beliefs (Chinese school group vs. Chinese church
group). Appropriate parental monitoring has been found to be
protective of Chinese American youth’s mental health (Kim
et al. 2009; Kim & Ge 2000; Weaver & Kim 2008). The
relation-
ship between parental monitoring and control and youth’s
mental health may depend on how the youth perceive it. For
instance, Kim & Ge (2000) found that adolescent perceptions of
a high level of parental monitoring were positively related to
adolescents’ mental health. We found that Chinese American
girls perceived a higher level of parental monitoring and control
than boys did with parents tending to be more protective of
girls than boys, similar to Shek’s (2006) findings from a
Chinese
adolescent sample in Hong Kong. In the current study, parental
monitoring behaviour is presented by limiting the adolescent
children’s choices of friends, time they need to be back home
and recreational activities they can participate in. Although
girls
tended to perceive higher levels of parental monitoring and

control than boys did, both girls and boys had reported
increased parent–child conflicts due to disagreement about the
parental monitoring and controlling behaviour.
Interestingly, parents (especially mothers) expected their
daughters to be independent psychologically and financially so
that they would not rely on men in the future. This expectation
is different from the gender roles in traditional Chinese culture,
in which females are expected to stay home to take care of the
entire family and rely on men for mental and financial support.
Parents’ expectations for Chinese American girls may be related
to mothers’ education and career as the majority (n = 12) of the
mothers held professional jobs. Furthermore, good education
helps new immigrants survive and establish social status.
Several adolescents recalled their mothers using themselves as
examples of good education bringing high social status and psy-
chological and financial independence, while a lower education
level led to blue-collar work and low socio-economic status.
Thus, it is not surprising that blue-collar mothers in this study
also expected their daughters to be independent psychologically
and financially.
Adolescents in the current study mentioned different parent-
ing styles between their mothers and fathers. Unlike the
common authoritarian figure of traditional Chinese fathers
(Shek 2006), Chinese American adolescents perceived their
fathers to be more supportive, less strict than mothers and
easier to communicate with. This finding may result from
higher stress that immigrant mothers perceive or experience
(Buki et al. 2003). Chinese mothers usually are the primary car-
egivers and experience conflicting child-rearing practices or
philosophies in a different cultural context. The stress
associated
with child-rearing that immigrant mothers perceive and the
limited family resources that they have in a different culture

may lead them to be more controlling when disciplining their
children (Ji 2007). In the current study, poor and ineffective
parent–child communication was identified by the adolescents
as the main reason contributing to poor emotional well-being.
Research findings revealed that inductive reasoning that empha-
sizes providing rationales to children for parents’ decisions and
rules and engages children in the decision-making process was
positively related to adolescents’ mental health (Kim et al.
2009;
Kim & Ge 2000; Weaver & Kim 2008). Thus, promoting effec-
tive parent–child communication by engaging children in the
process of decision making and providing rationales to children
should enhance Chinese American adolescents’ psychosocial
health.
Limitation
Because most of the sample came from upper-middle and
middle-class families, the study findings may not be generalized
to other Chinese American youth with different socio-
demographic characteristics. With this limitation in mind, rig-
orous study procedures were used to enhance the validity of the
findings.
Implications for practice
Acculturation, identified as acquiring traits from the new
culture, represents an important first step towards the new host
country for immigrant families (Kim et al. 2009). Although
immigrant parents and their children often experience the force
of assimilation, children are more likely to assimilate faster
than
their parents (Crane et al. 2005; Organista et al. 2002; Zheng &
Berry 1991). First-generation Chinese American parents may
find it challenging to discipline their adolescent children within
a different culture context. The poor and ineffective communi-
cation between parents and adolescents may put Chinese
American adolescents at greater risk for psychosocial impair-

ment. The study findings point to the importance for nurses to
understand the possible intergenerational acculturation gaps
and conflicts between Chinese American parents and their ado-
lescent children. In clinical practice, implementing family-
focused nursing that incorporates supportive conversations
about effective communication will minimize misunderstand-
ing and resolve unnecessary conflicts between parents and their
adolescent children. In nursing education, it is important for
students to understand factors associated with parent–child
communication in immigrant families and how these may have
an impact on children’s psychosocial health.
Our findings about factors associated with Chinese immi-
grant youth’s psychological health are similar to research con-
ducted among the same population in other countries (e.g.
Crane et al. 2005; Spectrum Migrant Resource Centre 2008;
Tardif & Geva 2006). Nurses in the USA and globally can
promote Chinese immigrant youth’s psychological health by
developing and connecting the families with linguistically and
culturally tailored resources that focus on improving parent–
child communication and enhancing parenting skills.
Acknowledgements
We gratefully acknowledge Arizona State University Barrett
Honors College that supported this project financially. We
thank Nancy Moore from Arizona State University for her con-
structive comments on the paper. Most importantly, we would
like to thank all the participants, their parents, the workers and

volunteers at the Chinese school and the Chinese church who
made this study possible.
Author contributions
Study conception/design, WY, AC; data collection/analysis,
WY,
AC; drafting of manuscript, WY, AC; critical revisions for
important intellectual content, WY, AC; administrative/
technical/ material support, WY, AC.
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and Adolescent Psychiatric Nursing1073-60771744-
6171XXXOriginal Articles
Korean American Adolescent Depression and Parenting
AUTHORS RUNNING HEAD:
Korean American Adolescent Depression and
Parenting
Eunjung Kim, PhD, ANRP, and Kevin C. Cain, PhD

PROBLEM:
Korean American adolescents tend to
experience more mental health problems than
adolescents in other ethnic groups.
METHODS:
The goal of this study was to examine
the association between Korean American parent–
adolescent relationships and adolescents’
depressive symptoms in 56 families.
FINDINGS:
Thirty-nine percent of adolescents
reported elevated depressive symptoms.
Adolescents’ perceived low maternal warmth and
higher intergenerational acculturation conflicts
with fathers were significant predictors for
adolescent depressive symptoms.

CONCLUSIONS:
The findings can be used to
develop a family intervention program, the aim of
which would be to decrease adolescent depressive
symptoms by promoting parental warmth and
decreasing parent–adolescent acculturation
conflicts.
Search terms
:
Depression, Korean American,
parent–adolescent conflict, parental control,
parental warmth
Eunjung Kim, PhD, ANRP, is Assistant Professor,
Department of Family and Child Nursing, University of
Washington, Seattle, WA; and Kevin C. Cain, PhD, is
Biostatistician, Office of Nursing Research, University of
Washington, Seattle, WA.

E
levated depressive symptoms are one of the most
prevalent mental health problems among adolescents;
they are increasing, recurring, and associated with
poor school performance, delinquency, running away,
substance abuse, and suicide (Hale, Van Der Valk, Engels,
& Meeus, 2005; Saluja et al., 2004). Increasing evidence
shows that adolescent depressive symptoms are related
to the quality of relationships between adolescents and
their parents. Adolescents tend to experience elevated
levels of depressive symptoms when they perceive
their parents to be low in warmth but high in control
(Hale et al.; Rapee, 1997), and when they experience
more frequent conflicts with their parents (Sheeber,
Hops, Alpert, Davis, & Andrews, 1997). These findings
are true for both European American and Asian American
adolescents (Greenberger & Chen, 1996).
Although Greenberger and Chen’s (1996) sample
included both Chinese and Korean American adoles-
cents, data from the two ethnic groups were combined
for analysis. Therefore, this association is not known
specifically for Korean American adolescents, who tend
to experience more mental health problems than Euro-
pean American adolescents (Choi, Stafford, Meininger,
Roberts, & Smith, 2002) or Chinese and Japanese American
adolescents (Yeh, 2003). The goal of this study was to
examine the associations between perceived parent–
adolescent relationships and depressive symptoms in
Korean American adolescents. The research questions
were: (a) How are parent–adolescent relationships (i.e.,
parental warmth, parental control, and intergenerational

acculturation conflicts) associated with adolescents’
depressive symptoms? (b) Of the three factors (i.e.,
parental warmth, parental control, and intergenerational
acculturation conflict), which one is the most significant
106 JCAPN Volume 21, Number 2, May, 2008
contributing factor to adolescent depressive symptoms?
and (c) How does the frequency of common parent–
adolescent conflict situations contribute to adolescents’
depressive symptoms?
Theoretical Framework
Parental warmth and control are considered to be
important dimensions of parenting (Maccoby &
Martin, 1983). According to the parental acceptance–
rejection theory (Rohner, 2007; Rohner, Khaleque, &
Cournoyer, 2007), parents can be placed on a contin-
uum between acceptance and rejection based on how
warm they are toward their adolescents. Warm parents
are accepting and affectionate. When parents are low
in warmth, they tend to be cold, hostile, indifferent,
undifferentiating, and rejecting. Parental control
ranges from permissiveness to strictness. Permissive
parents exercise minimum control over their children
and allow adolescents to do things their own way.

Moderately controlling parents set a few clear limits
and then allow adolescents to regulate their own
activities within these constraints. Firm parents guide
the adolescents’ behavior by a firm schedule and
parental intervention. Restrictive parents enforce many
rules on their adolescents’ behaviors, and by doing so,
limit the adolescent’s autonomy (Rohner).
Review of Literature
Depressive Symptoms in Adolescents
Overall, one in six adolescents living in the United
States reports depressive symptoms (Saluja et al., 2004).
Depressive symptoms were most prevalent among
American Indian adolescents (29%), followed by Euro-
pean American (22%), Mexican American (18%), Asian
American (17%), and African American (15%) adole-
scents (Saluja et al.). Symptoms often include depressed
mood (e.g., feelings of sadness, loneliness, and crying);
unhappiness (e.g., not enjoying life, feeling unhopeful);
somatic complains (e.g., being bothered, restless sleep,
change in appetite); and interpersonal difficulty (e.g.,
feeling that people dislike them) (Bonnie, 2006; Radloff,
1991). This study defines elevated depressive symptoms
as being present when adolescents score higher than
16 on the Center for Epidemiologic Studies Depression
Scale (CES-D) (Radloff, 1977, 1991).
Factors related to depressive symptoms included
gender and functional impairment, parental rejection,
primary caretaker’s psychopathology, negative disci-
pline, parental discord, poor parent–child attachment,
poor parent–child involvement, and exposure to violence,

neglect, physical abuse, sexual abuse, and assault
(Gonzales-Tajera et al., 2005). Among all these factors,
the importance of the quality of parent–adolescent
relationships has been increasingly emphasized.
Specifically, low parental warmth or care, high parental
rejection, high parental control, overprotection, parental
harshness, inconsistent discipline, hostility, and high
family conflict are related to depressive symptoms in
adolescents (Heaven, Newbury, & Mak, 2004; Zuniga
de Nuncio, Nader, Sawyer, & Guire, 2003).
Cultural Contexts and Adolescent Depressive
Symptoms
Adolescent depressive symptoms need to be under-
stood within cultural contexts because factors related
to these symptoms differ slightly between European
American and Asian/Asian American adolescents (Choi,
2002). For example, the quality of family relationships
(i.e., parental warmth and conflicts with parents) and
their grades in school were significantly linked with
depressive symptoms among Chinese adolescents
living in China than among American adolescents (53%
European, 16% Latino, 12% Asian, 11% African, and
other) living in the United States (Greenberger, Chen,
Tally, & Dong, 2000). Within the United States, the ethnic
differences found in connection with depressive symp-
toms were not evident between European and Asian
(Chinese and Korean) American young adolescents
(Greenberger & Chen, 1996). But in late adolescence,
Asian American adolescents exhibited elevated depres-
sive symptoms, perceived lower parental warmth, and
experienced higher frequency of parent–adolescent
conflicts than their European American counterparts

(Greenberger & Chen, 1996). Other factors related to
the depressive symptoms of predominantly Chinese
American adolescents included harsh parental disci-
pline, a lack of supervision, and low inductive reason-
ing (Kim & Ge, 2000), as well as more negative peer
relationships, a rejection of American culture, and
immigration to the United States after age 12 (Wong,
2001). This relationship is not known for Korean
American adolescents.
Korean American Parenting
Korean Americans compose one of the largest Asian
American populations in the United States (Kim, Do, &
Park, 2005). However, relatively little is known about
this population. In general, Korean Americans are
voluntary migrants who came to the United States
seeking more political and social security, as well as
better educational opportunities for their children (Shin
& Shin, 1999). Researchers have found that Korean
American parents are warm and sensitive (Kim, 2005b;
Kim & Hong, 2007). Korean mothers especially have
been shown to interact sensitively with their children
by reading and responding to their children’s subtle
cues (Kim & Hong). Despite their warmth, however,
Korean American parents are not accustomed to
expressing this warmth to their children through hugs,
kisses, praise, and saying, “I love you,” which are the
common parenting practices in the United States (Kim

& Hong). Under Confucianism, parents are trained to
suppress rather than to express their emotions, and,
therefore, such expression is difficult for them. Korean
American parents also ask their adolescents to obey
them without talking back or questioning their author-
ity because that was how they were raised as children.
Therefore, these parents tend to be described as
authoritarian, characterized by a lack of affection, a
lack of communication, and by their stress on absolute
obedience (Kim, 2005a). However, it is not known how
Korean American parenting (i.e., warmth and control)
is linked to adolescents’ depressive symptoms.
Under Confucianism, parents are trained to
suppress rather than to express their emotions,
and, therefore, such expression is difficult for
them.
Intergenerational Acculturation Conflicts and
Depressive Symptoms
The generation gap or intergenerational conflict has
often been examined to understand the nature of parent
–adolescent conflict within Western culture (Lee,
Choe, Kim, & Ngo, 2000). Higher conflicts with their
parents tend to be related to elevated depressive
symptoms in adolescents (Greenberger, Chen, Tally, &
Dong, 2000). In Korean American families, parent–

adolescent conflicts are more complicated than a
European American intergenerational gap or conflicts.
Korean American families are influenced by two
cultural values (i.e., Korean culture and American
culture), and adolescents generally acculturate to the
majority culture at a faster rate than their parents (Lee
et al.). This situation creates acculturation conflicts in
families and threatens the traditional hierarchical
relationships between parents and adolescents (Choi,
2002). For example, Korean American adolescents often
hear their parents saying, “You are too Americanized
and don’t act like a proper Korean teen,” while adoles-
cents think, “My parents are being too traditional.”
This kind of conflict needs to be understood within the
framework of intergenerational acculturation conflicts.
Intergenerational acculturation conflict in Korean
American families may be more critical in father–
adolescent relationships than mother–adolescent rela-
tionships. Kim (2005b) found that Korean American
adolescents and mothers were in agreement in
perceiving higher control as lower maternal warmth.
Korean American fathers, however, perceived higher
control as a manifestation of high warmth, whereas
adolescents perceived it as a sign of lower warmth.
Korean American adolescents experienced higher
intergenerational conflicts than Chinese and Japanese
American adolescents (Yeh & Inose, 2002). In Chinese
American families, the perceived acculturation dis-
parity was related to father–child conflicts, but not to
mother–child conflicts (Fu, 2002). Due to the similari-
ties between Chinese and Korean culture, the conflicts
coming from the differences in acculturation may have
more impact in father–adolescent relationships than
mother–adolescent relationships in Korean American
families as well. However, it is not known how

intergenerational acculturation conflicts are related to
depressive symptoms in Korean American adolescents.
Method
Participants
The convenience sample consisted of 56 Korean
American adolescents (25 girls and 31 boys) recruited
from Korean American churches and language schools
in the Pacific Northwest. Inclusion criteria were: (a) the
adolescent was between the ages of 11 and 17; (b) both
parents were Korean Americans; and (c) the family
lived in the United States at the time of the study.
Table 1 summarizes demographic characteristics of
adolescents and their mothers and fathers. Overall,
adolescents’ mean age was 13 and they had lived in the
United States for approximately 10 years. Their mothers’
average age was 43 and they had lived in the United
States for 11 years, whereas fathers’ mean age was 47
and they had lived in the United States for 18 years.
Instrumentation

Adolescents filled out four self-report instruments
as described in below.
Depressive Symptoms
The CES-D (Radloff, 1977), developed for the general
community population, was used to assess Korean
American adolescent depressive symptoms. The CES-
D consists of 20 items that include negative affect (i.e.,
blues, depressed, lonely, cry, sad); positive affect
(i.e., good, hopeful, happy, enjoy); somatic complaints
(i.e., appetite, sleep); and interpersonal difficulty (i.e.,
unfriendly, dislike). It utilizes a 4-point Likert-type scale
from “rarely, less than 1 day/week” to “almost or all
of the time, 5–7 days/week.” Scores range from 0 to 60
with a higher score indicating elevated depressive
symptoms. A score over 16 is considered being “posi-
tive” for depressive symptoms. Cronbach’s alpha for
the current study sample was .89.
Parental Warmth
The Parental Acceptance–Rejection portion of the
Parental Acceptance–Rejection/Control Questionnaire
(PARQ/Control, Rohner, 1991) was used to assess
adolescents’ views of maternal and paternal warmth.
It is a 60-item, 4-point Likert-type scale instrument (1 =
almost always true to 4 = almost never true). Four
subscales include parental warmth/affection, hostility/
aggression, indifference/neglect, and undifferentiated

rejection. Total PARQ scores range from 60 – 240;
higher scores indicate lower parental warmth. Sample
questions include: “My mother/father says nice things
about me (warmth)”; “My mother/father is irritable
with me (hostility)”; “My mother/father forgets
events that I think she/he should remember (indiffer-
ence)”; and “I wonder if my mother/father really loves
me (undifferentiated rejection)” (Rohner, 1991). Rohner
has reported evidence for convergent, discriminant, and
construct validity for the PARQ. Cronbach’s alpha for
the current study sample was .74 for paternal warmth
and .63 for maternal warmth.
Parental Control
The Control portion of the PARQ/Control (Rohner,
1991) was used to measure adolescents’ perceptions of
parental control. It is a 13-item, 4-point Likert-type
scale instrument (1 = almost always true to 4 = almost
never true). Scores on the Control Questionnaire range
from 13 to 52, with higher scores indicating higher
control. Sample question item includes “My mother/
father tells me exactly what time to be home when I go
out.” Cronbach’s alpha for the current study sample was
.71 for paternal control and .67 for maternal control.
Table 1. Demographic Characteristics of Adolescents and Their
Mothers and Fathers (N = 56)
Demographic characteristics
Adolescents
M (SD)/n (%)
Fathers

M (SD)
Mothers
M (SD)
Age in years 13.36 (1.81) 46.98 (3.65) 43.21 (2.67)
U.S. residency in years 10.26 (4.39) 18.36 (8.18) 11.35 (9.06)
Education in years 15.96 (2.40) 14.91 (2.35)
Working hours per week 52.23 (16.54) 27.18 (16.63)
Ethnic identity of adolescents Korean American 39 (70%)
Korean 13 (23%)
American 0 (0%)
Missing 4 (7%)
Family income > $60,000 43 (76%)
Intergenerational Acculturation Conflicts
Adolescents’ perceptions of intergenerational
acculturation conflicts were measured with the Asian
American Family Conflict Scale (Lee et al., 2000). It is
a 10-item scale that measures the frequency of Asian
American parent–adolescent intergenerational and
acculturation conflicts in 10 typical disagreements
over values and practices. Sample items include, “I
have done well in school, but my parents’ academic
expectations always exceed my performance.”
Respondents answer on a 5-point Likert-type scale (1 =

almost never to 5 = almost always). Scores range from
10 to 50; higher scores indicate a higher frequency of
parent–adolescent conflict. Cronbach’s alpha for the
current study sample was .82 for father–adolescent
conflict and .85 for mother–adolescent conflict.
Data Analysis
Descriptive statistics including means, standard
deviations, ranges, and distributions were calculated
using SPSS (Norusis, 2006). Differences between mother–
adolescent relationships and father–adolescent relation-
ships were examined using paired
t
-tests. Then, research
questions were analyzed using Pearson correlations,
regression, analysis of variance (ANOVA), and chi-square
test as outlined in Table 2. To analyze the third question,
the adolescents were divided into two groups: low
(i.e., those who had a frequency of “almost never” or
“once in a while”) and high (i.e., those who had
frequency of conflict by answering “sometimes,” “often,”
and “almost always”) conflict groups. The CES-D score
was calculated for low and high group adolescents
for each intergenerational acculturation conflict item.
ANOVA was used to examine mean differences between
low and high conflict groups. Then, to check for prevalent
differences, adolescents in the low conflict group were
divided into those who had CES-D scores lower than

16 and those who had scores of 16 and over. The same
division was done for the high conflict adolescent group,
yielding 4 groups: low conflict and low CES-D, low
conflict and high CES-D, high conflict and low CES-D,
and high conflict and high CES-D. The distribution
of adolescents for each group was calculated and the
distribution differences were tested using chi-square.
Results
Table 3 shows means and standard deviations for
each study variable. The paired sample
t
-test indicated
that Korean American adolescents did not perceive a
difference between maternal and paternal warmth.
Adolescents perceived mothers as significantly more
controlling than fathers. Means for intergenerational
acculturation conflicts showed a trend of adolescents’
perceiving higher conflicts with mothers than fathers.
The mean CES-D score showed 39.3% (
N
= 22) of
adolescents scored higher than 16, the indication
of being “positive” for depressive symptoms. None of
the demographic variables were related to depressive

symptoms.
The first research question was “how are parent–
adolescent relationships (i.e., parental warmth, parental
control, and intergenerational acculturation conflicts)
Table 2. Data Analysis Plan
Research question Data analysis plan
1. Association between parent–adolescent relationships and
adolescents’ depressive symptoms Pearson correlations
2. The most important parent–adolescent relationship factor in
contributing to adolescent
depressive symptoms
Regression analysis
3. Association between the frequency of parent–adolescent
conflicts and adolescents’ depressive
symptoms
ANOVA, chi-square test
4 groups CES-D
Low High
Conflicts Low Low conflict
Low CES-D
Low conflict
High CES-D
High High conflict
Low CES-D

High conflict
High CES-D
associated with adolescents’ depressive symptoms?”
As shown in Table 3, lower maternal warmth, higher
maternal control, and higher intergenerational conflicts
were positively correlated with adolescents’ elevated
depressive symptoms for mother–adolescent relation-
ships. For father–adolescent relationships, lower paternal
warmth, and higher intergenerational conflict also
were associated with adolescents’ elevated depressive
symptoms. However, paternal control was not correlated
with adolescents’ elevated depressive symptoms.
The second research question was “of the three
factors (i.e., parental warmth, parental control, and
intergenerational acculturation conflict), which one is
the most significant contributing factor to adolescent
depressive symptoms?” As shown in Table 4, both
the father–adolescent relationship model and mother–
adolescent relationship model were significant. The
father model explained 25% of the variance in adoles-
cent depressive symptoms, and the mother model
explained 32% of the variance. However, a comparison
of unstandardized beta weights suggests that the
magnitude of association between parent–adolescent

relationships and adolescent depressive symptoms was
subsequently different between the fathers’ and mothers’
models. For the fathers’ model, intergenerational conflict
was the significant factor. For the mothers’ model,
maternal warmth was the significant factor.
The third research question was “how does the fre-
quency of common parent–adolescent conflict situations
contribute to adolescents’ depressive symptoms?” It
was tested with two subgroups of adolescents using
each of the 10 items on the Asian American Family
Conflict Scale (Lee et al., 2000). The low conflict group
included adolescents who answered “almost never” to
“once in a while.” The high conflict group included
adolescents who answered from “sometimes” to
“almost always.” As shown in Table 5, adolescents in
the high conflict group had CES-D scores over 16,
compared to the low conflict group adolescents who
scored below 16. Principally, the differences between
the high and low conflict group adolescents were
significant in 6 out of 10 items: academic expectation,
sacrificing one’s interests, ways of expressing love,
saving face, expressing opinions, and showing respect
Table 3. Means, Standard Deviations, and Intercorrelations
Among Study Variables (N = 56)
Warmth Control Conflict Depressive symptoms Father–
Adolescent
Warmth — .33* .56*** .34** 110.51 (25.25)
Control .30* — .38** .20 34.56 (5.31)
Conflicts .63*** .51*** — .49*** 22.65 (9.01)
Depressive symptoms .53*** .28* .48*** — 15.17 (10.77)
Mother–adolescent 107.06 (24.36) 35.85 (5.13) 23.59 (9.02)
15.17 (10.77) —

Note. The upper right side indicates father–adolescent
relationships, and the lower left side indicates mother–
adolescent relationships.
*p < .05, **p < .01, ***p < .001 (two-tailed).
Table 4. Unstandardized Coefficients for Regression of
Depressive Symptoms on Measures of
Father–Adolescent and Mother–Adolescent Relationships (N =
56)
Variable
Father–adolescent relationships Mother–adolescent
relationships
B (SE) B (SE)
Warmth 0.04 (0.06) 0.17 (0.07)*
Control 0.01 (0.27) 0.13 (0.28)
Conflict 0.52 (0.18)** 0.26 (0.20)
ΔR2 0.25 0.32
ΔF 5.72** 8.13***
Note. *p < .05, **p < .01, ***p < .001 (two-tailed).
to the elderly. These 6 items were the same for father–
adolescent conflict and mother–adolescent conflict. Next,
the distribution of adolescents was examined among
the four possible groups using a CES-D score of 16 as

a cut-off point. Table 5 shows the same 6 items had
significantly different distributions using chi-square.
Discussion
This study examined the association between per-
ceived parent–adolescent relationships and depressive
symptoms among Korean American adolescents.
Overall, Korean American adolescents reported their
Table 5. Center for Epidemiologic Studies Depression Scale
(CES-D) Mean Score and Distribution Differences
According to High and Low Intergenerational Acculturation
Conflict in 10 Typical Disagreements
Over Values and Practices (N = 56)
Intergenerational
acculturation conflict
Conflict
level
Father–adolescent conflict Mother–adolescent conflict
ANOVA
M (SD)
Chi-square
ANOVA
M (SD)
Chi-square

n CES-
D < 16
n CES-
D ≥≥≥≥ 16
n CES-
D < 16
n CES-
D ≥≥≥≥ 16
1. My parent tells me what to do
with my life, but I want to make
my own decisions.
Low 12.96 (10.43) 19 8 13.41 (10.80) 19 8
High 17.81 (11.28) 13 13 16.81 (10.66) 15 14
2. My parent tells me that a
social life is not important at my
age, but I think that it is.
Low 14.11 (10.46) 25 12 13.43 (9.13) 24 12
High 17.53 (12.24) 7 8 18.30 (12.88) 10 10
3. I have done well in school, but
my parent’s academic expectations
always exceed my performance.
Low 10.48 (9.05) 18 5 10.16 (8.74) 20 5
High 19.07 (11.08)** 14 16* 19.21 (10.66)*** 14 17**
4. My parent wants me to
sacrifice personal interests for
the sake of family, but I feel this

is unfair.
Low 11.23 (8.51) 30 9 11.53 (8.50) 29 10
High 26.46 (9.39)*** 2 11*** 23.06 (11.16)*** 5 11**
5. My parent always compares
me with others, but I want them
to accept me for being myself.
Low 13.47 (10.30) 20 10 13.06 (9.61) 18 8
High 17.78 (11.68) 12 11 17.00 (11.52) 16 14
6. My parents argue that they show
me love by housing, feeding, and
educating me, but I wish they
would show more physical and
verbal signs of affection.
Low 12.74 (9.93) 29 10 12.83 (9.96) 28 10
High 22.57 (11.02)** 3 11*** 20.11 (11.00)* 6 12**
7. My parent doesn’t want me to
bring shame upon the family,
but I feel that my parent is too
concerned with saving face.
Low 12.89 (9.30) 26 11 12.49 (9.13) 27 10
High 21.00 (12.84)* 6 10* 20.40 (12.00)** 7 12**
8. My parent expects me to
behave like a proper Korean boy
or girl, but I feel my parent is
being too traditional.
Low 13.48 (11.34) 21 10 14.00 (11.10) 21 11
High 17.95 (10.25) 11 11 16.73 (10.32) 13 11

9. I want to state my opinion, but
my parent considers it to be
disrespectful to talk back.
Low 11.03 (11.03) 24 6 10.17 (8.55) 24 5
High 20.96 (11.01)*** 8 15*** 20.54 (10.42)*** 10 17***
10. My parent demands that
I always show respect for elders,
but I believe in showing respect
only if they deserve it.
Low 10.82 (7.67) 25 8 10.69 (7.79) 25 7
High 22.80 (11.82)*** 7 13** 21.15 (11.40)*** 9 15**
Total conflict score Low 11.33 (8.88) 21 6 10.04 (7.81) 19 4
High 18.74 (11.27)** 13 16* 18.74 (11.19)** 15 18**
Note. 10 items from the Asian American Family Conflict Scale
(Lee et al., 2000).
Conflict level: Low conflict (“almost never” to “once in a
while”), high conflict (“sometimes” to “almost always”).
*p < .05, **p < .01, ***p < .001 (two-tailed).
mothers and fathers as warm and moderately control-
ling. In addition, adolescents perceived mothers as

more controlling than fathers. This finding is consist-
ent with previous findings among Korean American
adolescents in the Midwest (Kim, 2005b). The mean
score of adolescents’ perceived intergenerational
acculturation conflicts was 23.50 (
SD
= 9.02). This
score is lower than what Lee et al. (2000) found among
Asian American (i.e., Chinese, Vietnamese, Filipino,
Korean, Japanese, etc.) college students (age 16 – 52),
which ranged from 27.39 (
SD
= 9.44) to 31.72 (SD
= 7.66). The differences may be related to characteris-
tics of the different samples used in these two studies;
participants of the present study were much younger
and they were all Korean Americans. In Greenberger
and Chen’s (1996) study, Asian American college
students reported higher scores on conflict with both
mothers and fathers than junior high students did.
It is problematic that approximately 40% of Korean
American adolescents experienced depressive symp-
toms. This is particularly of concern since previous
studies showed that Korean American adolescents had
the poorest mental health among all Asian American
adolescents. Using Symptom Checklist 90–Revised,
Korean American adolescents (55.69 ± 31.40) scored

significantly higher than Chinese (32.76 ± 19.70) or
Japanese (46.70 ± 27.74) American adolescents (Yeh,
2003). Furthermore, Korean American adolescents were
least likely to seek social support (Yeh & Inose, 2002).
A recent study found that only 23% of adolescents
who met
DSM–IV
criteria for depressive disorder used
mental health services (Essau, 2005). African American
and Asian American adolescents were especially
likely not to ask for mental health services (Sen, 2004).
Furthermore, Korean Americans provide traditional
Asian self-care practices and prolonged care within
their families that leads to a delay in seeking profes-
sional mental health services (Shin, 2002). These find-
ings suggest the necessity of educating the Korean
American population of parents and adolescents about
depressive symptoms and the importance of getting
appropriate treatment.
Results indicate that the factors related to depressive
symptoms are similar across father–adolescent and
mother–adolescent relationships. This is consistent with
past findings that low parental warmth is an important
factor related to adolescent depression (Greenberger &
Chen, 1996; Rapee, 1997; Rohner & Britner, 2000). In
addition, as stated in Rapee’s review, parental warmth
was a more important factor than parental control.
Among three different aspects of the parent–adolescent
relationship, low maternal warmth and higher inter-

generational acculturation conflict with fathers were
the critical factors for predicting adolescents’ depressive
symptoms. This finding fits the traditional description
of Korean paternal and maternal roles expressed in a
popular Korean phrase, “om bu ja mo,” or “strict father,
benevolent mother” (Rohner & Pettengill, 1985). When
mothers, whose role is prescribed as benevolent, don’t
provide warm caring to their offspring, adolescents tend
to have elevated depressive symptoms. According to
psychodynamic perspectives, when parents fail to meet
the child’s psychological needs to feel accepted, it gives
rise to adolescent depressive symptoms (Zahn-Waxler,
Duggal, & Gruber, 2002).
For the father–adolescent relationship, however, the
significant factor was intergenerational acculturation
conflict. This result is specifically related to the fact
that Korean American fathers hold more traditional
views of parent–adolescent relationships than mothers
and adolescents. Korean American fathers tend to hold
the traditional belief that there should be a distance
between adults and offspring in order to maintain the
offspring’s respect for their parents (Oak & Martin,
2000). These fathers are not willing to listen to their
offspring’s expressions of worry and anxiety (Shrake,
1996). Korean American fathers tend to resist letting
go of their authority (Kim, 2005b), which possibly creates
a greater acculturation gap between fathers and ado-
lescents. Korean American fathers’ attitudes toward
their adolescents may cause conflicts with adolescents,
and increase adolescents’ depressive symptoms.
Findings indicated that overall, the high conflict group
adolescents scored 16 or higher on the CES-D, indicating
that they were experiencing elevated depressive symp-
toms. In particular, the high conflict adolescent group

had significantly elevated depressive symptoms as
compared to the low conflict group adolescents. The
situations include conflicts in academic expectation,
sacrificing one’s interests, ways of expressing love, saving
face, expressing opinions, and showing respect to the
elderly. All of these conflicts are related to traditional
Korean Confucian culture and authoritarian parenting
style. Coming from Confucian culture, which stresses
the importance of education (Lee, 2004), 80% of Korean
American mothers perceive a “B” as “not a good
grade” (Shrake, 1996). When adolescents know the
American school’s definition of B is “above average,”
their parents’ perception can create conflict between
them. Still, adolescents who fail to satisfy their parents
with good grades in school feel shamed and depressed
(Choi, 2002) and may have suicidal ideation (Jones &
Kaderlan-Halsey, 2003).
Korean American parents tend not to express their
affection, try to save face, ask their children to obey,
and respect parents and elders unconditionally (Kim
& Hong, 2007; Shrake, 1996). Coming from collectivistic
Confucian culture, where fulfilling obligations is
important (Kim & Choi, 1994), parents believe that
providing clothes, housing, food, and education is the
best means of expressing love for their adolescents
(Oak & Martin, 2000). However, adolescents who are
growing up in the expressive, individualistic American
society want to have parents who show more physical

and verbal signs of affection (Hong, 2003).
Hierarchical Confucian culture emphasizes unidi-
rectional communication (i.e., from parent to child rather
than child to parent). Korean American parents tend
to consider assertive and verbally expressive adolescents
as problematic and rebellious (Choi, 2002). Stating
one’s opinion, which is viewed highly in American
schools, is often viewed as talking back and considered
disrespectful in the Korean home culture. They get
upset when adolescents talk back and tell them not to
argue with their parents (Shrake, 1996). They try to
impose parental values on adolescents, insist on their
adolescents’ obedience, and feel hurt when adolescents
don’t follow their parents’ advice (Shrake). Since nor-
mally accepted behaviors and norms in the American
school setting are not favorable or acceptable at home,
this would cause conflict, which is linked to elevated
depressive symptoms in Korean American adolescents.
These findings expand existing literature by adding
valuable information that these specific conflict situa-
tions are related to adolescents’ elevated depressive
symptoms.
Limitations
One of the major limitations of this study was the
fact that the adolescents’ self-report questionnaires,
which were used to measure all study variables and
depressive symptoms, can influence various aspects of
information processing (Rapee, 1997). Adolescents
without depressive symptoms may tend to give posi-
tive answers to measures, while adolescents with

depressive symptoms may tend to give negative
answers to measures, which can induce a false correla-
tion between any two self-reported measures (Duggal,
Carlson, Sroufe, & Egeland, 2001). In addition, the
adolescents may have elevated depressive symptoms
due to reasons other than parent–child interactions.
Because the data are not longitudinal, we cannot show
that parent–adolescent relationship variables actually lead
to differences in adolescents’ depressive symptoms,
nor can we rule out the possibility that adolescents
who are depressed may simply view the relationships
with their parents as more negative than they really
are. Other limitations include a small sample size and
further division of sample into four groups, wider age
range of sample (i.e., 11 to 17 years), and low alpha
reliability for maternal warmth (.63) and for maternal
control (.67).
Implications for Nursing Practice and Research
The study findings offer nurses several opportuni-
ties for reducing Korean American adolescent depres-
sive symptoms. First, it would be important to offer
parenting education on how to increase maternal and
paternal warmth. Education may include how to
express affection to their adolescents. Many Korean
American parents are trained not to express their
emotions and feelings; therefore, showing behavioral
and verbal affection toward adolescents is not easy
or natural for them (Kim & Hong, 2007). However,
parents need to understand the importance of kisses,
hugs, praise, and compliments. Parental warmth
needs to be demonstrated to make a positive influence
on children (Gordon, 2000). Second, it would be neces-

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