Prevalence and management of type 2 diabetes among Chinese Americans.

AIMS: This study examines: (a) the prevalence rate of type 2 diabetes mellitus (T2DM) in Chinese Americans (CAs); (b) the influence of acculturative status (i.e. generational status and linguistic fluency) on T2DM prevalence; (c) and differences in diabetes management between CAs and Non-Hispanic Whites (NHWs). METHODS: We used 2011-2018 data from the California Health Interview Survey (CHIS) to analyze the prevalence rate and management of diabetes among the CAs. Chi-squares, linear regressions, and logistic regressions were used to analyze the data. RESULTS: After controlling for demographic, socioeconomic, and health behaviors, there were no significant differences in the T2DM prevalence rate between CAs overall or of varying acculturative statuses compared with NHWs. However, there were differences in diabetes management, with first-generation CAs being less likely to exam glucose daily, have medical care plans developed by medical providers, or have confidence in controlling diabetes compared to NHWs. CAs with limited English proficiency (LEP) were less likely to perform self-monitoring of blood glucose or have confidence in managing their diabetes care compared to NHWs. Finally, non-first generation CAs were also more likely to take diabetes medication compared to NHWs. CONCLUSIONS: Although the prevalence rate of T2DM was found to be similar between CAs and NHWs, significant differences were found in diabetes care and management. Specifically, those who were less acculturated (e.g. first generation and those with LEP) were less likely to actively manage and have confidence in managing their T2DM. These results highlight the importance of targeting immigrants with LEP in prevention and intervention efforts.

Email me back: Examining provider biases through email return and responsiveness.

The majority of research on accessing and utilizing mental health services has focused on patient barriers to care. Few studies have explored possible provider biases that may impact client access at point of entry. Using the audit method, we conducted an email-based field experiment to investigate the responsiveness of psychotherapy providers to inquiries from simulated patients with different backgrounds (i.e., race, gender, diagnosis, and ability to pay). A total of 725 therapists (176 men, 549 women) practicing in Chicago, Illinois were identified from an online therapist directory and randomized to receive emails requesting therapy appointments. Overall, 21.7% of providers did not return prospective client email inquiries; 32.5% of providers were somewhat responsive in that they returned an email despite not being able to take on the client; and 45.7% were highly responsive in that they returned an email and offered an appointment or the opportunity to discuss the matter further. Male providers were less responsive to African American and Latinx simulated clients and most responsive to White clients, whereas female providers were more likely to respond similarly to all simulated clients. Moreover, regardless of the providers' gender, they were more responsive to simulated patients with depression than to simulated patients with schizophrenia or borderline personality disorder (BPD). Finally, providers were more responsive to those who could pay the full fee than to those who requested a sliding scale. Educating providers on these possible biases is important because it could help reduce biased behaviors and improve access to care for vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adolescents' Depressive Symptom Experience Mediates the Impact of Long-Term Exposure to Maternal Depression Symptoms on Adolescents' Body Mass Index.

BACKGROUND: Obesity is a cardiovascular disease risk factor and affects approximately 13.7 million U.S. children and adolescents between the ages 2 and 19 years old in 2015-2016. PURPOSE: To determine the relationship between children's average long-term exposure to maternal depressive symptoms age 1 month to Grade 6 and adolescents' body mass index (BMI) z-score at age 15 mediated by the adolescents' depressive symptom experience. METHODS: A total of 1,364 infants and their families from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were recruited. RESULTS: Mediation analyses revealed a significant relationship between children's average long-term exposure to maternal depressive symptoms from age 1 month to Grade 6 and adolescents' BMI z-score at age 15 (total effect = 0.015, p = .013, 95% confidence interval (CI): 0.0032, 0.027). The adolescents' experience of depressive symptoms significantly mediated this relationship (indirect effect = 0.0021, bias-corrected bootstrapped 95% CI: 0.0004, 0.0044), with this mediated relationship more pronounced in girls. CONCLUSIONS: Findings indicate the possible existence of a mediating role of adolescents' depressive symptoms experience in the pathway from average long-term exposure to maternal depressive symptoms during children's early life to adolescents' elevated BMI.

Daily living skills in school-age children with and without anxiety disorders.

OBJECTIVE: Anxiety may interfere with school-age children's independent behaviour and hence, their daily living skills (DLS). Nonetheless, this has not been tested in previous studies of children with clinical anxiety. METHOD: This study compared two groups of age-, gender-, and ethnicity-matched children with and without anxiety disorders (N = 60), testing the association of anxiety disorders with a lack of independence in DLS. RESULTS: Anxiety disorders are significantly associated with less mastery of DLS. Age moderated this effect for children with anxiety disorders; older children were more negatively impacted by anxiety disorders than younger children. CONCLUSIONS: Anxiety disorders may negatively impact children's independence in DLS. As children transition from mid- to late childhood - a period normally marked by increasing independence - this effect may grow in magnitude.

Demystifying and addressing internalized racism and oppression among Asian Americans.

Asian Americans (AAs) are a diverse group who come from many different cultures, backgrounds, immigration histories, geographic regions, and experiences. Unfortunately, AAs are commonly stereotyped as a model minority, used as an intermediary minority, and consequently have been marginalized and left out of dialogues of racism and discrimination. Internalized racism (IR), defined as the internalization of bias and oppression toward one's group, is an especially insidious form of divisive racism that remains largely misunderstood and unaddressed in AAs. In addition to devaluing oneself, IR creates division in communities and reinforces systems of oppression. This paper reviews the extant literature on IR among AAs and discusses the importance of addressing this deleterious issue and its consequences on individual, family, and community mental health. Moreover, I discuss and elucidate how stereotypes about AAs (e.g., model minority, perpetual foreigner, gendered stereotypes, and conceptions of beauty) directly promote and reinforce different types of internalized oppression (e.g., intraracial hierarchies, intraethnic othering, gendered emasculation, and hypersexualization, colorism and Western standards of beauty). Clinical and community recommendations are provided through a multilevel preventive intervention framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reducing mental health disparities by increasing the personal relevance of interventions.

One of the most persistent health disparities is the underutilization of mental health services by people of color. Neither evidence-based treatments (universal focus) nor culturally adapted treatments (group focus) have reduced these disparities. We propose the personal relevance of psychotherapy (PROP) model, which integrates universal, group, and individual dimensions to determine the personal relevance of interventions. A cultural example of personal relevance among people of East Asian ancestry involves "face" (i.e., one's prestige and position in society), which may moderate treatment outcomes. Pragmatic intervention approaches focused on helping individuals cope with specific external problems, compared to managing a "personal" disease, can effectively "restore" face. Thus, social problem-solving interventions may be more personally relevant to many people of East Asian ancestry than are approaches that are internally focused. In addition, we posit that social neuroscience can offer unique opportunities above and beyond self-report measures when assessing the impact of PROP and the personal relevance of interventions for diverse populations. Our preliminary evidence upon testing this hypothesis indicated that among Asian Americans, exposure to problem-solving therapy content elicited significantly greater neural activity in brain areas associated with personal relevance compared to exposure to cognitive-behavioral therapy content. Identifying personally relevant interventions has the potential to reduce mental health disparities by increasing engagement with mental health services for diverse groups. The increased client engagement produced by personally relevant interventions also has the potential to make mental health services more effective for diverse groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Acculturative family distancing: links with self-reported symptomatology among Asian Americans and Latinos.

OBJECTIVE: Our knowledge of how acculturative processes affect families remains quite limited. This article tests whether acculturative family distancing (AFD), a more proximal and problem-oriented measure of the acculturation gap, influences the mental health status of Asian American and Latino college students. AFD occurs along two dimensions: communication difficulties and cultural value incongruence. METHODS: Data were collected from 186 Asian American (n=107) and Latino (n=79) undergraduates, who provided self-reports on psychological problems, depressive symptoms, and family conflict. A new self-report measure of AFD evidencing good psychometric properties was used to test hypothesized relations among these variables in structural equation models (SEM). RESULTS: For both Asian American and Latinos, results indicated that higher levels of AFD were associated with higher psychological distress and greater risk for clinical depression, and that family conflict mediated this relation. CONCLUSION: AFD processes were associated with the mental health of students and the functioning of their families. These findings highlight potential foci to address in prevention and intervention programs, such as improving communication and teaching families how to negotiate cultural value differences.

Cultural influences on help-seeking attitudes in Asian American students.

There is considerable evidence indicating that Asian American college students have less favorable attitudes toward and are less likely to use mental health services than other ethnic groups in the United States. Because a person's attitudes are often strongly associated with their voluntary behaviors, understanding what influences help-seeking attitudes may help shed light on why Asian American college students refrain from seeking mental health treatment. Andersen's Sociobehavioral Model is commonly used as a guide to understand help-seeking in the mainstream population. A modified version of this model that includes culture-related variables (i.e., level of acculturation and stigma tolerance) was used to guide this study. Results indicated that stigma tolerance predicted help-seeking attitudes above and beyond traditional variables associated with help-seeking. These findings suggest that reducing societal stigma and increasing individual tolerance to stigma should be a focus for prevention and intervention programs on college campuses.

The Formative Method for Adapting Psychotherapy (FMAP): A community-based developmental approach to culturally adapting therapy.

How do we culturally adapt psychotherapy for ethnic minorities? Although there has been growing interest in doing so, few therapy adaptation frameworks have been developed. The majority of these frameworks take a top-down theoretical approach to adapting psychotherapy. The purpose of this paper is to introduce a community-based developmental approach to modifying psychotherapy for ethnic minorities. The Formative Method for Adapting Psychotherapy (FMAP) is a bottom-up approach that involves collaborating with consumers to generate and support ideas for therapy adaptation. It involves 5-phases that target developing, testing, and reformulating therapy modifications. These phases include: (a) generating knowledge and collaborating with stakeholders (b) integrating generated information with theory and empirical and clinical knowledge, (c) reviewing the initial culturally adapted clinical intervention with stakeholders and revising the culturally adapted intervention, (d) testing the culturally adapted intervention, and (e) finalizing the culturally adapted intervention. Application of the FMAP is illustrated using examples from a study adapting psychotherapy for Chinese Americans, but can also be readily applied to modify therapy for other ethnic groups.

Compassionate meditation to heal from race-related stress: A pilot study with Asian Americans.

Racism and race-related stress can negatively impact the mental health status of ethnic minorities. In recent years, college campuses have held demonstrations to promote awareness regarding racism and to call for resources to help improve campus climate and to address the needs of students of color. This study answers this call by developing and evaluating the benefits of a peer-led compassionate meditation program to help students of color heal from race-related stress. To date, no studies have examined whether compassionate meditation (a specific type of meditation) can be used as a therapeutic tool to address racial stress. This article discusses the formative process for developing and pilot-testing the effects of this culturally responsive 8-session compassionate meditation program with Asian American college students. Despite a small sample size, results were promising. and participants evidenced decreases in general distress, as well as depression, anxiety, and PTSD symptoms. Moreover, by the end of the program, fewer students were clinically depressed. The results of this study provide some initial evidence that brief, culturally responsive compassionate meditation interventions may be a promising and cost-effective method for addressing the impact of racism and race-related stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A conceptual paradigm for understanding culture's impact on mental health: the cultural influences on mental health (CIMH) model.

Understanding culture's impact on mental health and its treatment is extremely important, especially in light of recent reports highlighting the realities of health disparities and unequal treatment. This article provides a conceptual paradigm for understanding how culture influences six mental health domains, including (a) the prevalence of mental illness, (b) etiology of disease, (c) phenomenology of distress, (d) diagnostic and assessment issues, (e) coping styles and help-seeking pathways, and (f) treatment and intervention issues. Systematic interrelationships between each of these domains are highlighted and relevant literature is reviewed. Although no one model can adequately capture the complex facets of culture's influence on mental health, the Cultural Influences on Mental Health (CIMH) model serves as an important framework for understanding the complexities of these interrelationships. Implications for clinical research and practice are discussed.

Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans.

This study examines the impact of level of acculturation and acculturative stress on the mental health of Asian American college students. Hierarchical regression analyses were used to clarify the relation between level of acculturation, acculturative stress, and mental health outcomes (psychological distress and clinical depression). Being less identified with mainstream United States culture was associated with higher psychological distress and clinical depression, but lost significance when acculturative stress was introduced into the model. Retention or relinquishing of identification with one's heritage culture was not associated with mental health outcomes. Although understanding level of acculturation can help us identify those at risk, findings suggest that acculturative stress is a more proximal risk factor and increases risk for mental health problems independently of global perceptions of stress.

The impact of perceived racial discrimination on the mental health of Asian American and Latino college students.

The authors examined the impact of perceived racial discrimination on various mental health outcomes for Asian American and Latino college students within an emic and etic framework. Results indicate that Asian American and Latino college students experienced similar exposure and reactions to various kinds of discrimination. However, Latino students were more likely than Asian American students to have been accused of doing something wrong, such as cheating and breaking the law, and more likely to appraise these experiences as stressful. Asian Americans evidenced higher risk for trait anxiety. Regardless of ethnicity, perceived racial discrimination was associated with several negative mental health outcomes, including higher psychological distress, suicidal ideation, state anxiety, trait anxiety, and depression. Findings highlight the need to address discrimination across multiple social and professional settings and to understand the broad array of mental health outcomes.

Integrated mental health services in China: challenges and planning for the future.

Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

The psychotherapy adaptation and modification framework: application to Asian Americans.

Although effective treatments for many mental disorders have been developed, little research has been conducted to determine whether these interventions are effective in treating those from diverse backgrounds. Recent reports have suggested that ethnic minorities are less likely to receive quality health services and that they evidence worse treatment outcomes when compared with other groups. To improve care for those from diverse backgrounds, Western-developed psychotherapies may need to be culturally modified or adapted to become more effective in treating ethnic minorities. This article addresses the need for adapting psychotherapy and provides a conceptual framework for making such modifications. The psychotherapy adaptation and modification framework model is applied to recent Asian American immigrants as an illustrative example. However, it may also serve as a point of departure to adapt therapies for other ethnocultural groups.

Acculturative family distancing: Theory, research, and clinical practice.

Despite the rapidly growing immigrant population settling in the United States, our knowledge of acculturative processes and their impact on immigrant families remains quite limited. This article describes a theoretical construct called Acculturative Family Distancing (AFD), the distancing that occurs between immigrant parents and children that is a result of immigration, cultural differences, and differing rates of acculturation. AFD occurs along two dimensions: communication and cultural values. Breakdowns in communication and incongruent cultural values between immigrant parents and children are hypothesized to increase over time and place families at risk for mental illness and family dysfunction. Clinical illustrations of AFD's impact on immigrant Asian families are provided and recommendations for dealing with AFD are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Age of first onset major depression in Chinese Americans.

Using data from the Chinese American Epidemiological Study, risk for experiencing an initial episode of major depression across the life course was examined. Data were collected on 1,747 U.S.-born and foreign-born Chinese Americans (ages 18-65 years). Results suggest that Chinese American women did not evidence higher risk than Chinese American men for experiencing a 1st major depressive episode. Risk for experiencing a 1st depressive episode decreased as length of residence in the United States increased. Although those who immigrated at younger ages evidenced greater overall risk, those who came at later ages were more likely to become depressed at or soon after arrival. Competing theories of acculturation-related risk are discussed and directions for future research are proposed.

Culturally Adapted Cognitive-Behavioral Therapy for Chinese Americans With Depression: A Randomized Controlled Trial.

OBJECTIVE: No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults. METHODS: This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12. RESULTS: Participants in CA-CBT demonstrated a greater overall decrease in depressive symptoms compared with participants in CBT, but the groups had similarly high depression rates at week 12. Differences in dropout rates for the two groups approached, but did not meet, statistical significance (7%, CA-CBT; 26%, CBT). CONCLUSIONS: Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT demonstrated significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.

Predictors of help seeking for emotional distress among Chinese Americans: family matters.

Using data from the Chinese American Psychiatric Epidemiological Study, the authors examined longitudinal predictors of help seeking for emotional distress in a community sample of 1,503 Chinese Americans. Specifically, they assessed the relative contribution of family relational variables (e.g., levels of family support and family conflict) in predicting help seeking for medical, mental health, and informal services. After traditional need, predisposing, and enabling factors were controlled for in hierarchical logistic regression analyses, family conflict predicted both mental health and medical service use, whereas family support was not predictive of help seeking. In addition to family conflict, mental health service use was predicted by negative life events, emotional distress, and insurance coverage. Implications of the findings for assessing and treating Asian American clients are explored.

Ethnic differences in clinical presentation of depression in adult women.

This study examined ethnic differences in self-report and interviewer-rated depressive symptoms and estimated the contributions of sociodemographic and psychosocial factors in predicting severity of depression. One hundred twenty-five clinically depressed African American (n = 46), Caucasian (n = 36), and Latina (n = 43) women were recruited. After controlling for differences in socioeconomic status, African American women reported more symptoms of distress and Latinas were rated as significantly more depressed than the other groups. However, these ethnic differences were not moderated by either education or employment. Finally, hierarchical regression analysis indicated that severity of depression was predicted by low education, being single, being Latina, high perceived stress, and feelings of hopelessness. Additional research is needed to validate these results and to investigate their clinical significance.