Immigration-Related Factors and Depression Help-Seeking Behaviors Among Older Chinese Americans.

OBJECTIVES: Asian Americans have the lowest mental health service utilization rate among all racial/ethnic groups. This study investigates how immigration-related factors shape the depression help-seeking behaviors of older Chinese Americans. METHODS: Data were collected from participants who reported experiencing any depressive symptoms in the Population-based Study of Chinese Elderly in Chicago (n = 907). Multinomial logistic regressions were conducted to examine the associations between immigration-related factors and help-seeking behaviors, including not seeking help (23.5%), seeking help from informal source(s) only (40%), seeking help from both informal and formal sources (28.7%), and seeking help from formal source(s) only (8.8%). RESULTS: Older Chinese Americans with lower levels of acculturation (OR = 0.88, 95% CI = 0.79-0.97) and those who lived in Chinatown (OR = 2.34, 95% CI = 1.21-4.52) were more likely to seek help from formal sources only (relative to not seeking any help). CONCLUSIONS: Older Chinese Americans with depressive symptoms predominately relied on informal sources of help, either solely or in combination with formal sources, to address their depressive symptoms. CLINICAL IMPLICATIONS: Leveraging informal support networks and ethnicity-specific resources represents a promising approach for this population.

Trust in physicians, health insurance, and health care utilization among Chinese older immigrants.

OBJECTIVE: Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status. DESIGN: The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), N = 3,157. The sample is representative of Chinese older immigrants (60+ years) in Chicago. Guided by Andersen's behavioral model, hierarchical regression analyses examined the role of TIP in physician visits, ER visits, and hospitalization among Chinese older immigrants. An interaction term was added to examine whether the aforementioned associations differed by insurance status. RESULTS: TIP was positively associated with the likelihood of physician visits (Odds Ratio [OR] = 1.07, p < 0.001) but not with ER (OR = 1.02, p = 0.054) or hospitalization (OR = 1.01, p = 0.13). The results of the moderation analyses further showed that TIP was more positively associated with ER visits (OR=0.94, p=0.006) and hospitalization (OR = 0.93, p = 0.004) among the uninsured population, compared to those insured. CONCLUSIONS: TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

Acculturation and depressive symptoms among older Chinese immigrants in the United States: the roles of positive and negative social interactions.

Objectives: Immigration is a stressful experience. Social interactions with family members and friends play an important role in the health and well-being of immigrant older adults. This study examined the association between different domains of acculturation and depressive symptoms among older Chinese immigrants in the United States and investigated the roles of positive and negative interactions with family and friends in such associations.Method: We used data from the Population Study of Chinese Elderly (PINE), a population-based survey of community-dwelling Chinese older adults in the Greater Chicago area (N = 3,158). Depressive symptoms were measured by the PHQ-9. Acculturation, positive and negative social interactions with partner/family/friends were all measured by standard scales. Binary logistic regression models were used to examine the relationship between acculturation and the probability of having depressive symptoms.Results: Results showed that only social acculturation was correlated with a higher likelihood of having depressive symptoms after controlling for relevant sociodemographic variables. Results also demonstrated that 'high positive & high negative', as well as 'high positive & low negative' social interactions had significant moderating effects on the association between media acculturation and depressive symptoms.Conclusion: The study findings suggest that although older Chinese immigrants in the United States with high levels of social acculturation are vulnerable to depressive symptoms, high positive social interactions with partner/family/friends buffer the relationship between media acculturation and depressive symptoms. Community services can help with social acculturation and more positive interactions from partner/family/friends to alleviate depressive symptoms among older Chinese immigrants.

Ethnic enclaves, social capital, and psychological well-being of immigrants: the case of Chinese older immigrants in Chicago.

Objectives: Using a large sample of Chinese older immigrants in Chicago, this study asked two questions: (1) Is living in Chinatown associated with better psychological well-being? (2) What is the role of social capital in such an association?Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,105). Depression and quality of life (QoL) were compared between those who lived in Chinatown and those who didn't. Negative binomial regressions (for depression) and logistic regressions (for QoL) were performed to examine the associations between Chinatown residence, social capital, and the two outcomes.Results: Net of social capital and the control variables, living in Chinatown was marginally associated with fewer depressive symptoms (ß= -.137, p = .057), but a significantly lower likelihood of reporting good QoL (OR = .797, CI: .661-.962). Although various forms of social capital were projective of positive psychological well-being, given the overall low social capital of the Chinatown residents, they heightened the mental health risks of this population.Conclusion: The neighborhood context may function to reproduce social disadvantage among aging immigrant populations. The findings point to the importance of intervention at the mezzo level to improve the psychological wellbeing of this population.

Source of perceived social support and cognitive change: an 8-year prospective cohort study.

OBJECTIVES: This study explored the longitudinal association between overall and individual sources of social support and global cognitive function in older adults.Methods:Data were drawn from three waves (2006, 2010 and 2014) of the Health and Retirement Study (HRS). The analytic sample included participants aged 65 and above who were married and had at least one child (N = 1319). Global cognitive function was measured through a 35-point Telephone Interview Cognitive Screen (TICS). Perceived social support was measured via questions across four sources of support (spouse, child, other family members, and friends). Analyses were conducted using Hierarchical Linear Modeling (HLM) with the addition of a cross-lagged panel model (CLPM). RESULTS: There was no significant association between perceived overall social support and global cognitive function over time (ß=-0.02, p=0.19). However, changes in perceived support from children were positively associated with changes in global cognition (ß=0.05,p<0.01). In contrast, changes in perceived support from other family members were negatively associated with changes in cognitive function (ß=-0.07,p<0.01). CONCLUSIONS: Our findings highlight the importance of examining perceived social support from specific elements of one's social networks, rather than in an aggregated variable. Although the positive effect of perceived support from children may be small to moderate, the findings could provide a target for interventions to protect the cognitive function of older adults.

A Social-Ecological Approach to Understanding Activity Engagement Patterns Among Older Chinese Immigrants.

Few studies have focused on activity engagement among older immigrants. We aim to map the patterns of activity engagement and examine the associations with social-ecological factors in a sample of older Chinese immigrants. Participants were from the Population Study of Chinese Elderly in Chicago (PINE). Four patterns of activity engagement were identified through latent class analysis: restricted, diverse, informal social, and community-based social. Intrapersonal, interpersonal, cultural, and environmental factors distinguished latent classes of activity engagement. In particular, acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment such as social network size, positive social support, and neighborhood cohesion were associated with the likelihood of categorization in the diverse, informal social, and community-based social groups relative to the restricted group. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants.

Social Support and Unmet Needs for Personal Assistance Among Community-Dwelling U.S. Chinese Older Adults: Does the Source of Support Matter?

This study examines the relationship between social support sources and unmet needs among U.S. Chinese older adults. Data were from the Population Study of Chinese Elderly in Chicago. Unmet needs were assessed by indexes of activities of daily living (ADL) and instrumental activities of daily living (IADL). Three specific sources of social support (spouse, family members, and friends) were included. Multivariable logistic regression models were conducted. Approximately 17% of the 3,157 respondents reported having unmet ADL/IADL needs. U.S. Chinese older adults with less overall social support were more likely to have unmet ADL needs (odds ratio [OR]=0.91, 95% CI=0.83-0.99) and IADL needs (OR=0.84, 95% CI=0.81-0.88). Family and friend support were associated with a lower likelihood of having unmet ADL needs. Support from spouse, family, and friends was associated with a lower likelihood of having unmet IADL needs. The findings highlight the importance of informal social support in addressing unmet needs .

Advancing clinical genomics and precision medicine with GVViZ: FAIR bioinformatics platform for variable gene-disease annotation, visualization, and expression analysis.

BACKGROUND: Genetic disposition is considered critical for identifying subjects at high risk for disease development. Investigating disease-causing and high and low expressed genes can support finding the root causes of uncertainties in patient care. However, independent and timely high-throughput next-generation sequencing data analysis is still a challenge for non-computational biologists and geneticists. RESULTS: In this manuscript, we present a findable, accessible, interactive, and reusable (FAIR) bioinformatics platform, i.e., GVViZ (visualizing genes with disease-causing variants). GVViZ is a user-friendly, cross-platform, and database application for RNA-seq-driven variable and complex gene-disease data annotation and expression analysis with a dynamic heat map visualization. GVViZ has the potential to find patterns across millions of features and extract actionable information, which can support the early detection of complex disorders and the development of new therapies for personalized patient care. The execution of GVViZ is based on a set of simple instructions that users without a computational background can follow to design and perform customized data analysis. It can assimilate patients' transcriptomics data with the public, proprietary, and our in-house developed gene-disease databases to query, easily explore, and access information on gene annotation and classified disease phenotypes with greater visibility and customization. To test its performance and understand the clinical and scientific impact of GVViZ, we present GVViZ analysis for different chronic diseases and conditions, including Alzheimer's disease, arthritis, asthma, diabetes mellitus, heart failure, hypertension, obesity, osteoporosis, and multiple cancer disorders. The results are visualized using GVViZ and can be exported as image (PNF/TIFF) and text (CSV) files that include gene names, Ensembl (ENSG) IDs, quantified abundances, expressed transcript lengths, and annotated oncology and non-oncology diseases. CONCLUSIONS: We emphasize that automated and interactive visualization should be an indispensable component of modern RNA-seq analysis, which is currently not the case. However, experts in clinics and researchers in life sciences can use GVViZ to visualize and interpret the transcriptomics data, making it a powerful tool to study the dynamics of gene expression and regulation. Furthermore, with successful deployment in clinical settings, GVViZ has the potential to enable high-throughput correlations between patient diagnoses based on clinical and transcriptomics data.

Cultural attributes of suicidal ideation among older immigrants: a qualitative study.

BACKGROUND: Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants. METHODS: A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month. RESULTS: In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness. CONCLUSIONS: Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.

Coping repertoires and psychological well-being of Chinese older immigrants in the United States.

OBJECTIVES: This study examines (1) the overall structures of multifaceted coping resources, that is, coping repertoires, among Chinese older immigrants in the United States, (2) the optimal coping repertoire that is associated with best psychological outcomes of these older immigrants, and (3) the most effective coping repertoire in different adversities. METHOD: Using data from 2,923 Chinese older immigrants in Chicago, Latent Class Analysis (LCA) was performed to identify the overall coping repertoires of U.S. Chinese older adults. Negative binomial and logistic regressions were used to examine associations between coping repertoires and depression and Quality of Life (QoL), respectively. We further tested whether coping repertories moderate the relationships between adversities in health, economic, and social domains, and the two psychological outcomes. RESULTS: LCA revealed four types of coping repertories: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping (10%). Overall, Chinese older immigrants who had the multi-source coping repertoire reported the best psychological outcomes. The community-oriented and multi-source coping repertories had significantly stronger buffering effects on psychological well-being among individuals with IADL difficulties or low acculturation. However, spouse-oriented coping intensified the association between ADL difficulties and depression, and community-oriented coping intensified the association between poorer subjective health and lower quality of life. CONCLUSION: This study revealed overall low coping repertories of Chinese older immigrants, suggesting the most optimal coping repertories should consist of both intrinsic and extrinsic coping sources. The findings further show that relying on limited sources might be harmful to older immigrants' mental health.

The influence of perceived discrimination in healthcare settings on psychological distress among a diverse sample of older Asian Americans.

OBJECTIVES: The purpose of this study was to determine the relationship between discrimination in healthcare settings and psychological distress. METHOD: This study utilized a retrospective cross-sectional study design. The dataset was obtained from 2015-2017 California Health Interview Survey (CHIS). Healthcare discrimination experience (yes, no) was measured using the following question "Over your entire lifetime, how often have you been treated unfairly when getting medical care (never, rarely, sometimes, often)?". Psychological distress was the study outcome and was measured using the Kessler Psychological Distress Scale. A composite score (0-24) was created for psychological distress for the prior 30 days and for the worse most in the past 12 months. A hierarchical multivariate linear regression was conducted to examine the influence of healthcare discrimination experience on psychological distress after adjusting for other covariates. RESULTS: Study participants (weighted N = 1,360,487) had a mean age of 64.35 years (SD = 0.61), were primarily female (54.93%), heterosexual (96.61%), and married or living with a partner (73.37%). About 10.00% of older Asian Americans ever perceived healthcare discrimination over their entire lifetime. Perceived discrimination was associated with higher levels of psychological distress for the past 30 days (beta= 2.107, SE = 0.662, p < 0.05) and for the worst month in the past year (beta= 2.099, SE = 0.697, p < 0.05) after controlling for covariates. CONCLUSION: Self-reported discrimination was relatively low in this sample of older Asian American adults. However, consistent with prior research, perceived discrimination in the healthcare setting was associated with increased psychological distress. The findings have implications for improving the quality of health care services received.

Family type and cognitive function in older Chinese Americans: acculturation as a moderator.

OBJECTIVES: Acculturation to the mainstream culture and the settlement contexts could shape cognitive function of older immigrants. Guided by ecological theory, this study examines the interaction effect between individual acculturation and ecology of family on cognitive function among older Chinese Americans. METHODS: Data were derived from the Population Study of Chinese Elderly in Chicago (n = 3,019). Family types included tight-knit (high solidarity and low conflicts), unobligated-ambivalent (high solidarity and conflicts), commanding-conflicted (low solidarity and high conflicts), and detached (low solidarity and low conflicts). Acculturation was measured via language ability, media use, and ethnic social relations. Cognitive function was evaluated by global cognition, episodic memory, working memory, processing speed, and mini-mental state examination. Multiple regression analyses and interaction terms were used. RESULTS: Older adults in the commanding-conflicted type had the lowest cognitive function. After controlling confounding variables, higher levels of acculturation (b = 0.009, SE = 0.003, p < .01) were associated with higher levels of global cognition. Acculturation buffered the negative impact of having a commanding-conflicted relationship with children on global cognition (b = 0.070, SE = 0.016, p < .001). Language ability, media use, and ethnic social relations played a unique role in the relationships between family types and cognitive domains. CONCLUSION: Acculturation to the dominant culture is identified as a cultural asset for cognitive function in older Chinese Americans. Social services could protect cognitive function of older immigrants in the commanding-conflicted type through enhancing cultural participation. Future research could test how affective and cognitive aspects of acculturation affect health.

Acculturation Mitigates the Negative Impact of Perceived Stress on Depressive Symptoms Among U.S. Chinese Older Adults.

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants' acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.

Sources of Intergenerational Conflict in Chinese Immigrant Families in the United States.

Studies of family relations have not kept pace with the acceleration of international migration. To address this gap, this study relied on a survey of 545 Chinese immigrants in Chicago who reported information of 869 older parents to examine the sources of intergenerational conflict in five domains: norms/values, relationship itself, money, health, and parenting. The results of logistic regression showed that maintaining one's traditional culture, in the form of endorsing a sense of filial obligation, was a significant protective factor against all types of conflict. Immigrants with a higher level of acculturation were more likely to report conflict regarding norms/values and relationship itself, but not more so regarding practical issues such as health, money, and parenting. Helping parents with ADLs, not IADLs, was associated with more conflict regarding monetary and health issues. Immigrants' greater sense of mastery was associated with a lower chance of reporting norm/value-related intergenerational conflict.

Kinship bereavement and psychological well-being of U.S. Chinese older women and men.

This study examined the relationship of kinship bereavement with the psychological well-being of Chinese American older women and men. Data from the Population Study of ChINese Elderly were used. Respondents were asked if their spouse, children/grandchildren, siblings, close relatives, and friends had died. Widowhood was associated with more loneliness for both genders. For women, close relative/friend loss was associated with more stress, and children/grandchildren loss was linked to stronger anxiety. Only coefficients for close relative in the stress model were significantly different between genders. The variation in patterns of kinship bereavement may be attributed to Chinese cultural attitudes toward death.

Perceived social support and help-seeking among U.S. Chinese older adults who reported elder mistreatment.

This study aimed to examine the associations between perceived social support and help-seeking among U.S. Chinese older adults who reported elder mistreatment (EM). Data were from the Population Study of Chinese Elderly in Chicago. Perceived social support and informal/formal help-seeking intentions and behaviors were measured. Descriptive statistics, multiple linear regressions, and multinomial logistic regression analyses were performed. A total of 450 participants reported EM. Mean age of the sample was 72.73 ± 8.03 years old. Perceived social support was associated with an increase in intentions of seeking help from informal sources. Compared with not seeking help, older Chinese-American adults with any EM who perceived social support were more likely to seek help from informal and formal sources. The potential role of social support in increasing help-seeking was highlighted. Culturally tailored interventions that provide social support might promote help-seeking among U.S. Chinese elder immigrants who experienced EM.

Lower urinary tract symptoms in older Chinese American women: prevalence and risk factors.

INTRODUCTION AND HYPOTHESIS: The aim was to examine the prevalence of and risk factors for lower urinary tract symptoms (LUTS) in a community-dwelling cohort of older Chinese American women. METHODS: We performed a secondary analysis of a prospective cross-sectional population-based survey of community-dwelling Chinese Americans aged 60 and older in English, Mandarin, Cantonese, Taishanese, or Teochew between 2011 and 2013. A clinical Review of Systems (ROS) was used to assess LUTS, which included urinary frequency, urgency, burning or pain, blood in urine, and urinary incontinence. RESULTS: Of the 1,829 women queried, 28.6% reported LUTS. The cohort of women who reported LUTS had a mean ± SD age of 74.7 ± 8.7 years, with a BMI of 23.4 ± 3.7 kg/m2 and had lived in the USA for 21.5 ± 13.1 years. Nearly 90% earned less than $10,000 a year, 50% were married, and 50% used traditional Chinese medicine (TCM) once monthly or more. In comparison with women without LUTS, women with LUTS had significantly higher rates of medical comorbidities and a poorer perception of their general health and quality of life. In multivariate regression analysis, any LUTS were significantly associated with older age (aOR 1.03, 95% CI 1.01-1.04), TCM use (aOR 1.67, 95% CI 1.34-2.07), anxiety (aOR 1.45, 95% CI 1.02-2.06), depression (aOR 2.00, 95% CI 1.53-2.61), and a history of stroke (aOR 1.90, 95% CI 1.19-3.02). CONCLUSIONS: Lower urinary tract symptoms are common among older Chinese American women, particularly in those who are older, use TCM regularly, or report a history of anxiety, depression, or stroke.

The associations between social support and negative social interaction with suicidal ideation in US Chinese older adults.

To examine associations between social support and negative social interaction with past suicidal ideation (SI) at multiple time intervals. The study used cross-sectional data collected from 3157 US Chinese older adults in Chicago to assess past 2-week, 1-month, 1-year, and lifetime SI. Self-perceived social support and negative social interaction were measured. Multiple logistic regression analyses were used to examine the associations. People perceived more social support and less negative social interaction were 17-19% less likely to have SI. People perceived more social support were 14-20% less likely to have SI. Meanwhile, people perceived more negative social interaction were 28-37% more likely to have SI. The independent associations between different social interaction and SI are significant regardless of the time intervals. Research should pay attention not only to bolstering perceptions of social support, but also to strategies that help individuals cope with the influence of negative social interactions.

Development and validation of a predictive index of elder self-neglect risk among a Chinese population.

OBJECTIVE: To develop a predictive index that estimates the individual risk of incident self-neglect onset among the US Chinese older adults. METHODS: The study used two waves of longitudinal data from 2713 participants of the Population Study of Chinese Elderly (PINE). Data were collected during 2011-2015 in Chicago, Illinois, with approximately 2-year follow-up intervals. The main outcomes are incident self-neglect cases. Variables in 14 potential predictive domains were considered, which are (1) sociodemographic/socioeconomic, (2) neighborhood/community, (3) immigration and acculturation, (4) adverse events, (5) culture, (6) general wellbeing, (7) health behavior, (8) medical health, (9) health care, (10) physical function, (11) cognitive function, (12) social wellbeing, (13) violence, and (14) psychological wellbeing. Stepwise selection in multivariable logistical regression models and bootstrapping were used to develop and validate the predictive index. RESULTS: The 2-year self-neglect incidence rate was 237 (8.7%). A 19-item predictive model (with a c-statistic of 0.74) was developed. After correcting for overfitting by validating in 100 bootstrapping samples, the model demonstrated moderate predictive accuracy by a c-statistic of 0.68. A point-based risk index was developed and has an area under the receiver operating characteristic curve of 0.73. DISCUSSION: The study developed an efficient index with a moderate-to-good predictive ability of self-neglect. With further external validation, modification, and impact studies, the index could be a culturally relevant tool for practitioners to quantify the risk of self-neglect among the US Chinese older population.

Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life.

OBJECTIVES: To examine the added effect of having both cognitive deficit and physical frailty, compared to having either one only, on hospitalization and emergency department (ED) visits. METHODS: Data from a population-based study of 3,157 community-dwelling older (≥60 years) Chinese adults in the U.S. were used. Cognitive deficit was measured by the Mini-Mental State Examination (i.e. education-adjusted score: 16 [illiterate], 19 [primary school], and 23 [≥middle school]). Physical frailty was identified using the Short Performance Physical Battery (0-6 out of 15). The numbers of hospitalizations and ED visits in the previous two years were self-reported. RESULTS: In this sample, 12.63% had cognitive deficit alone, 5.95% had physical frailty alone, and 4.26% had both. Compared with participants having neither cognitive deficit nor physical frailty, those having physical frailty alone were 1.5 times as likely to have hospitalizations (Rate Ratio [RR] = 1.52 [1.07, 2.16], p = 0.02) and ED visits (RR = 1.52 [1.07, 2.15], p = 0.02). Having cognitive deficit alone was not significantly related to either outcome. However, having cognitive deficit with existing physical frailty increased the likelihood of both hospitalization (RR = 2.00 [1.36, 2.96], p < 0.001) and ED visits (RR = 2.04 [1.37, 3.03], p < 0.001) to a greater extent than having physical frailty alone. CONCLUSION: Having cognitive deficit alone was not significantly related to the likelihood of hospitalizations or ED visits, however having cognitive deficit with existing physical frailty increased the likelihood of both outcomes to a greater degree than having physical frailty alone. This suggests cognitive deficit and physical frailty have synergistic effects on hospitalizations and ED visits.