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Depression Among Chinese Americans [Autosaved]


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Depression Among Chinese Americans [Autosaved]

  1. 1. DEPRESSION AMONG CHINESE AMERICANS Yan Li University of San Francisco
  2. 2. Introduction Chinese Americans are the largest ethnic group among the Asian American populations in the United States, with a population of 4.3 million (U.S. Census Bureau, 2015). Depression-related symptoms is reported in approximately 10% of Asian Americans. 15.9% of young Asian American women report suicidal thoughts (Kalibatseva & Leong, 2011). The purpose of this systemic review is to find the depression risk factors and the effectiveness of culturally relevant interventions for reducing depression among Chinese Americans.
  3. 3. Introduction The Asian American Journal of Psychology The Journal is dedicated to research, practice, advocacy, education, and policy within Asian American psychology (APA, 2015). Published: quarterly, beginning in March
  4. 4. Introduction Database: CINAHL and PUBMED Search Year and Language: 2010 – 2015, English Keywords: Chinese Americans, Asian Americans, depression, behavioral health, mental health, cultural barrier, immigration Inclusion criteria: peer reviewed articles, primary quantitative and qualitative research, health outcomes of interest, publication language.  522 search articles yielded and 6 articles were selected for the review.
  5. 5. Methods Yeung et al. (2010) Included: a sufficient sample size and randomized controlled trials (RCT). Excluded: participants with a high risk of suicide, substance use disorder, bipolar disorder and unstable medical conditions. Hwang et al. (2015) Included: a small sample size and a RCT. Excluded: reliable data and sufficient sample size Kwong, Chung, Cheal, Chou and Chen (2011) Included: a RCT and a small sample size Excluded: adequate and reliable samples due to high refusal rate. Chao et al. (2014) Included: both participants and matching group in the UCSF. Excluded: diverse sample size. Zhang, Fang, Wu and Wieczorek (2013) Included: date from the National Latino and Asian Study (NLAAS) Excluded: the RCTs and controlled groups Hsieh and Bean (2014) Included: interpreting findings that understating cultural factors in Chinese American families. Excluded: a summary statistic
  6. 6. Author: Yeung et al. (2010) Study Design • Sample size: 4,228 Chinese American patients • Participants: participants were randomized into culturally sensitive collaborative treatment (CSCT) and compared group (Yeung et al., 2010). Study Results • Results clearly showed that CSCT model achieved a nearly 7-fold increase in treatment than the control care group (Yeung et al., 2010). Study Conclusion • CSCT is an effective model in improving the treatment among depressed Chinese Americans, given patients the knowledge and treatment based on culturally-based interventions (Yeung et al., 2010). Evidence Rating • This article was rated as a level 1 good quality study due to sufficient sample size, randomized control group and reasonable consistent results. However, there were some limitations, which included low response rate and limited generalizability to other setting (John Hopkins Hospital, 2012).
  7. 7. Author: Hwang et al. (2015) Study Design • Sample size: 50 Chinese Americans met criteria ( 145 Pre-Screening at intake) • Participants: 27 participants were randomized into culturally adapted CBT (CA-CBT) and 23 participants were computer randomized into cognitive behavioral health (CBT) (Hwang et al., 2015). Study Results • Results clearly presented that participants in both CBT and CA-CBT significantly decreased in depressive symptoms (Hwang et al., 2015). Study Conclusion • Author suggested that more intensive and longer treatments may be needed for severe depression and also cultural adaptations may increase additional treatment benefits. • It is unclear how the results might have been different if the sample size was larger (Hwang et al., 2015). Evidence Rating • This article is a level 1 low quality study because of insufficient sample (John Hopkins Hospital, 2012).
  8. 8. Author: Kwong et al. (2011) Study Design • Sample size: 6,065 Chinese Americans were screened for depression, 57 participated. • Participants: participants were randomly assigned to receive either enhanced physician care with care management or enhanced physician care only (Kwong et al., 2011). Study Results • Result clearly states that both groups resulted in significant reduction of depressive symptoms, so there was no difference between the two groups (Kwong et al., 2011). Study Conclusion • Both physician care model and physician care with care management models are not based on cultural interventions. • The findings of the study may be related to high refusal rates and small sample size (Kwong et al., 2011). Evidence Rating • This article is a level 1 low quality study due to some control - RCT but insufficient sample size (John Hopkins Hospital, 2012).
  9. 9. Author: Chao et al. (2014) Study Design • The sample included 137 elderly, cognitively impaired and cognitively normal Chinese Americans and 140 Caucasians with and without cognitive impairment. • Demographic variables and clinical variables were compared across both groups (Chao et al., 2014). Study Results • The results clearly showed depression was more common in cognitively impaired Chinese Americans (35%) versus cognitively impaired Caucasians (15%); Chinese Americans were less likely to be treated for depression (12%) than Caucasians (37%) (Chao et al., 2014). Study Conclusion • Increased depression among cognitively impaired Chinese Americans, but they are less likely to be treated (Chao et al., 2014). Evidence Rating • This article is a level 2 good quality study due to sufficient sample, some control and reasonably consistent results, The limitation of the article is a lack of randomized controlled group (John Hopkins Hospital, 2012).
  10. 10. Author: Zhang et al. (2013) Study Design • Sample size: 600 participants • The study analyzed the immigration related depression among Chinese Americans and used Stata Software 10.0 to analyze data for controlling age, education level or marital status, and other related factors (Zhang et al., 2013). Study Results • The depression rates were 23.20% (vs. 8.25% for China born), compared with those who immigrated to the United States at different ages (<18 vs. Q18 years), the lifetime prevalence rates of depressive disorder (17.95% vs. 7.14%) (Zhang et al., 2013). Study Conclusion • The conclusion stated the study found United States–born immigrants at young age (<18 years old) had higher depression rates than Chinese-born immigrates (Zhang et al., 2013). Evidence Rating • This article is a level 3 good quality study based on some control and reasonably consistent results (John Hopkins Hospital, 2012).
  11. 11. Author: Hsieh and Bean (2014) Study Design • The article by Hsieh and Bean (2014) discussed a culturally- competent treatment for working with Chinese American Families. • This is a qualitative study Study Results • The article explained and analyzed the effect of cultural factors, collectivism, gender factors, family hierarchy, acculturation and sexual development on Chinese adolescent depression (Hsieh & Bean, 2014). Study Conclusion • The conclusion clearly states that be aware of these factors benefits doctors and clinicians to treat this problem in a systemic perspective (Hsieh & Bean, 2014). Evidence Rating • This article is a level 3 good quality study that identifies key concepts and fairly definitive conclusions, the limitation of article is lacking of data and compared group (John Hopkins Hospital, 2012).
  12. 12. Conclusion  Depression among Chinese Americans continues to be a constant issue. The findings of this literature review support prior findings indicating high rates of depression among Chinese Americans.  All selected articles found that the cultural barrier and culture-related factors may cause under- recognition and under-utilization of the mental health services.  The research findings support that the effectiveness of utilizing culturally collaborative treatment and overcoming the language and cultural barrier for depression among Chinese Americans.
  13. 13. Discussion  Cross-cultural barriers are often blocked the road to the treatment of mental health illness.  A culturally-based care model plays an important role in screening, treatment and intervention of depression among Chinese population.  Also high refusal rate leaded to a smaller sample size which increased the difficulty for this issue related research.  Future research is needed to focus on how to utilize the cultural-based model to make depression screening, interventions and treatment more accessible for Chinese Americans.
  14. 14. Nursing Implications • Utilize culturally collaborative model for depression screening and intervention • Overcome the language and cultural barrier • Improve the patient-provider relationship • Use risk factors to implement treatment • Discuss concerns with patients • Education
  15. 15. References Chao, S. Z., Matthews, B. R., Yokoyama, J. S., Lai, N. B., Ong, H., Tse, M., & ... Rosen, H. J. (2014). Depressive symptoms in Chinese-American subjects with cognitive impairment. American Journal of Geriatric Psychiatry, 22(7), 642-652. doi:10.1016/j.jagp.2012.10.029 Hsieh, A. L., & Bean, R. A. (2014). Understanding familial/cultural factors in adolescent depression: A culturally-competent treatment for working with Chinese American families. American Journal of Family Therapy, 42(5), 398-412. doi:10.1080/01926187.2014.884414 Hwang, W., & Fujimoto, K. (2015). Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: A randomized controlled trial. Psychiatric Services, 66(10), 1035-1042. doi:10.1176/ Johns Hopkins Hospital/The Johns Hopkins University (2012). Research evidence appraisal tool. Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed., pp. 237-240). Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing. Kwong, K., Chung, H., Cheal, K., Chou, J., & Chen, T. (2013). Depression care management for Chinese Americans in primary care: A feasibility pilot study. Community Mental Health Journal, 49(2), 157-165. doi:10.1007/s10597-011-9459-9
  16. 16. References United States Census Bureau. (2015). Chinese American population. Retrieved from features/2015/cb15-ff07.html Yeung, A., Shyu, I., Fisher, L., Wu, S., Yang, H., & Fava, M. (2010). Culturally sensitive collaborative treatment for depressed Chinese Americans in primary care. American Journal of Public Health, 100(12), 2397–2402. Zhang, J., Fang, L., Wu, Y.-W. B., & Wieczorek, W. F. (2013). Depression, anxiety, and suicidal ideation among Chinese Americans: A study of immigration-related factors. The Journal of Nervous and Mental Disease, 201(1), 17–22. Zornitsa Kalibatseva and Frederick T. L. Leong, “Depression among Asian Americans: Review and Recommendations,” Depression Research and Treatment, vol. 2011, Article ID 320902, 9 pages, 2011. doi:10.1155/2011/320902
  17. 17. QUESTIONS?
  18. 18. THANK YOU!