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Japanese Americans' health concerns and depressive symptoms: implications for disaster counseling.

In 2010, Asians (alone, not in combination with other races) represented 4.8 percent of the U.S. population, a 43.3 percent increase from the 2000 Census data (U.S. Census Bureau [USCB], 2010a). Among them, Japanese Americans have rarely been selected as a single study target because, as of 2010, they represented only 5.6 percent of the country's Asian population and less than 1 percent (approximately 0.4 percent including combined races) of the entire U.S. population (USCB, 2010a).

Census 2010 also revealed that among the total Japanese population in the United States (1,304,286), 763,325 reported their ethnicity as Japanese alone without listing other ethnicities, and 540,961 listed at least one other ethnicity, of the same or a different race. These figures reflect a 41 percent interethnic representation rate, the highest among all Asian American groups (see Table 1). Even though Japan was ranked sixth as country of origin among the Asians residing in the United States, only 3.4 percent within the foreign-born Asian population (343,746) were of Japanese descent (USCB, 2010b). Over two-thirds of all Japanese Americans were born in the United States, the highest proportion among all Asian Americans. However, approximately half of all Japan-born immigrants in the United States are wives of American citizens (Toji, 2003), and many Japanese American families represent the third or higher generation in the United States (Machizawa & Lau, 2010). Thus, children of these families are less likely to identify themselves as Japanese than as American or Japanese American (Toji, 2003). These statistics demonstrate that members of this culturally diverse population have divergent and unique needs.

Many studies about Japanese Americans have focused on their long immigration history and cultural changes, but it is of equal importance to identify their needs and concerns, like those in the community-based study reported here. The literature review focuses on the mental health needs and depression prevalence of Japanese Americans in order to support our research study. As a result of scant research about Japanese Americans' depression, our review also extends to studies of Japanese nationals.

FACTORS CONTRIBUTING TO DEPRESSION

Professional Help and Informal Support

Japanese culture places strong emphases on family bonds, social harmony, emotional restraint, and avoidance of stigma or shame (haji), all of which may result in preferring alternative health care to treat psychological distress. For instance, Narikiyo and Kameoka (1992) reported that Japanese Americans rated informal support (family, friends, self-help or support groups) and the ability to "endure and adjust to [a] situation" (p. 365) as more helpful and beneficial in treating problems. Their findings revealed a greater tendency for Japanese Americans to resolve problems with informal support rather than with professional help because of shame and social stigma. Unexpectedly, the study also found that Japanese Americans and white Americans did not differ significantly in their perceptions of the helpfulness of psychotherapy and mental health professionals. The authors explained that those who sought professional help might have a higher level of acculturation, which could mediate the influence of stigma associated with professional help seeking.

Acculturation may also affect the adherence to traditional gender roles that can explain certain help-seeking behaviors. Yamawaki and Tschanz (2005) found that their subjects from Japan were more likely than their subjects from the United States to adhere to traditional gender role expectations. Japanese culture stresses a hierarchical family structure in which men are discouraged from seeking help, whereas women may disclose their problems to professionals to seek a harmonious life (Yamawaki, 2010). In Chan and Hayashi's (2010) study about traditional masculine identity and help-seeking behaviors in Japan, 265 Japanese male participants were skeptical about the effectiveness of professional help because of their inclination toward success and restrictive emotionality. Even when some of these men experienced depressive symptoms, their cultural alignment negatively impacted their willingness to seek professional help.

Japanese Americans have underutilized mental health services because of a denial of mental illness (Dennis, 2004; French, 2002). With help-seeking data, Narikiyo and Kameoka (1992) found that Japanese American undergraduate students (5.6 percent) were significantly less likely than their white American counterparts (25 percent) to receive mental health services when needed. The Japanese American students (13.2 percent) were also less likely than their white American counterparts (34 percent) to know whether family members or friends had used mental health services. In a community study in Hawaii, depressed Japanese Americans' mental health service utilization was lower than that of Native Hawaiians (Kanazawa, White, & Hampson, 2007). In terms of emotional regulation, Kanazawa et al. (2007) found that more Japanese Americans (n = 357) yielded low scores for positive affect than European Americans (n = 176) when riced with a problem. Ono et al. (2000) found that many people in Japan with somatic depressive symptoms choose to see physicians and disclose only physical symptoms. Similarly, another study showed that depressed patients in Japan presented more somatic complaints, such as abdominal distress, headaches, and neck pain, to their physicians than did American patients (Waza, Graham, Zyzanski, & Inoue, 1999). Aragona et al. (2005) identified these physical symptoms as having strong cultural significance for Japanese people with depression. All of these studies indicated that the help-seeking behaviors of Japanese Americans need further attention.

Depression Prevalence and Symptom Disclosure

In Japanese culture, depression is perceived as a consequence of interpersonal disturbances, and its treatment emphasizes the creation of positive aspects of life and the promotion of group harmony (Kanazawa et al., 2007). Individuals are expected to achieve mind-body connections to promote self, family, or group well-being (Young, 2003). Because mental illnesses are typically thought to represent shame and personal weaknesses, Japanese people in general are inclined to regard depression as a somatic problem with physical symptoms while simultaneously avoiding the label of a mental disorder (Young, 2003).

Despite knowledge regarding symptomology, there is a lack of published depression prevalence rates to inform mental health services for Japanese Americans. Because Japanese Americans represent only a small percentage in most Asian American studies, we found that the depression prevalence among Asian Americans (such as 19.6 percent in our recent study in Leung, Cheung, & Tsui, 2012) is often used to estimate the problems among the various Asian subgroups. Other research reports have addressed specific populations, such as the depression rates for older Japanese Americans, which range between three and 20 percent (Shibusawa & Mui, 2001; Yamamoto et al., 1985; Yeung et al., 2004), or use general data to compare Japanese Americans and white Americans in a specific city (Kuo, 1984). Specifically, a Honolulu study found that the depression prevalence rate among 3,139 Japanese American men age 71 to 93 years was 8.5 percent; the rate among those who adhered to the traditional Japanese culture was 28 percent lower than those assimilated to American culture (Harada et al., 2011). Tang (2007) states that the model minority image (that Asian people are high achievers) has masked Asians' ethnic diversity, and the inconsistent figures reported in the literature may have underestimated Japanese Americans' mental health needs.

Predictors of Depression among Japanese Americans

Cultural expectations and sociodemographic variables can serve as predictors of help-seeking preferences. In a longitudinal study of 9,201 adult respondents in Japan, health status was identified as a predictor of depression, with a 4.2 percent prevalence rate among those who expressed poor health versus 1.5 percent among all respondents (Tanaka, Sasazawa, Suzuki, Nakazawa, & Koyama, 2011). Although most of the cited depression studies focused on Japanese adolescents or college students, older adults, and women, Tanaka et al.'s (2011) study reported findings from the 40- to 69-year-old age group and identified a prevalence difference between genders: 5.3 percent among women and 4.6 percent among men.

Studies have found a number of other contributing factors to depression and other mental health disorders in the Japanese and Japanese American communities, including gender, language proficiency, acculturation, generational status, anxiety, domestic violence, interpersonal relationships, personality, support network, scarcity of resources, living arrangements, and life stressors (Gellis & Taguchi, 2004; Kamo & Zhou, 1994; Laser, Luster, & Oshio, 2007; Narikiyo & Kameoka, 1992; Padilla, Wagatsuma, & Lindholm, 1985; Takeuchi et al., 2007; Williams et al., 2002, 2005; Yoshihama, 2001). In a study of 97 Japanese American elderly age 65 years or older in community-based geriatric settings, findings revealed that health status, social support, negative life events, and family history of depression were associated with higher depression scores (Gellis & Taguchi, 2004). Another study that focused on Japanese youth age 18 to 22 years found five significant predictors of depression: a history of frequent physical illness, parental favoritism of a sibhng, maternal depression, being bullied, and the lack of an easy temperament (Laser et al., 2007). Narikiyo and Kameoka (1992) found that Japanese-American students were more likely than white American students to attribute mental illness to social causes such as "problems with other people," which is consistent with the Japanese value of preserving interpersonal harmony. In a confirmatory model integrating Japanese ethnicity, cultural identity, and depression, Williams et al. (2005) found that being Japanese American (versus part-Japanese American), female gender, and cultural events that required intensive time commitment were predictive of depression.

The literature has yielded useful information about Japanese Americans' mental health needs and the correlates to depression. These correlates were grouped into demographic characteristics, mental health needs, and six other areas of needs (basic needs, community and social issues, family relationships, health concerns, hardships, and immigration issues). In this article, we report the findings of a community survey that focused on Japanese Americans' depressive symptoms as they relate to these needs and concerns.

METHOD

This study identifies predictors of depressive symptoms among Japanese Americans and explores their help-seeking preferences. A community survey was conducted in Houston, Texas, the fourth largest city in the United States. According to the U.S. Census, Japanese Americans composed 0.13 percent (2,519 in 2000 and 4,142 in 2008) of the Houston population (City-Data, 2010). Because sampling Japanese American respondents is difficult to achieve (Okazaki, 1997), we collected data from various cultural events in Houston and reached a convenience sample of 43 Japanese Americans in 2008, estimated to represent 1.04 percent of the Japanese population in Houston (City-Data, 2010). These survey participants self-identified as Japanese, were age 18 years or older, and resided in the greater Houston area.

Instruments and Data Collection

After obtaining approval from the institutional review board, the research team with four researchers and 10 trained volunteers attended 30 Asian community gatherings to invite voluntary participation. An anonymous survey entitled "Asian Survey" was designed to include 14 demographic items and 114 questions about needs and concerns. An informed consent letter, which explained the purpose of the study, voluntary participation, and anonymity, was attached to the survey. Prior testing provided good face and content validity in a study among six Asian Americans ethnic groups conducted by Leung and Cheung (2008). Participants were given small souvenirs as a token of appreciation upon completion of the survey.

Predictive variables were operationalized in concrete measures, asking respondents to answer on the basis of their individual or family needs, with a four-point response scale to indicate the level of concern (0 = none, 1 = a little, 2 = some, and 3 = serious). The six main needs variables were measured by the average four-point score from a number of needs or concerns listed below.

1. Basic needs: food, housing, clothing, adequate income, access to medical care

2. Community/social issues: crimes against people, crimes against property, unemployment, skills underutilized, transportation, adequate education/job training, daycare for children, 24-hour care for children, daycare for dependent adults, 24-hour care for adults, lack of recreational activities, poor performance in job/school, language barriers, financial assistance, discrimination, religious support, ethnic group support, lack of child mentoring programs, lack of Asian volunteers in the community

3. Family/relationship issues: conflict between family members such as problems with young children, problems with teenagers, problems with parents, problems with in-laws, problems with spouse or significant others, communication with family members, conflicting styles of parenting, children losing cultural roots, strict parents, financial management, child abuse, spousal abuse, elder abuse, isolation

4. Health issues: chronic pain or illness, disabling or terminal illness, alcohol/drug problems, pregnancy-related concerns, abortion, eating dimmers, sexual dysfunction, physical problems without medical cause, developmental disabilities

5. Hardship: rape, robbery, murder, loss/separation of family, dramatic loss of income, serious illness, refugee camps, war trauma

6. Immigration issues: uncertainty of sponsorship, uncertainty of employment, waiting for legal status, mode of transportation, political freedom, religious freedom, political asylum, family reunion, public financial assistance, acculturation, discrimination, adequate legal assistance

In addition to identifying these concerns, the Hopkins Symptoms Checklist (HSCL-25) was used to measure mental health issues as reflected by self-reported depression symptoms (Parloff, Kelman, & Frank, 1954). HSCL-25 consists of 25 questions (10 on anxiety and 15 on depression) with a 4-point response scale (1 = none and 4 = very often, with an average of 1.75 or higher being symptomatic). Reliability of this scale has been tested among Asian populations, with a coefficient alpha of .89 in the Anxiety subscale and .92 in the Depression subscale (Lhewa, Banu, Rosenfeld, & Keller, 2007).

RESULTS

Respondent Characteristics

Among the 43 Japanese American participants, approximately 56 percent were female, and 61 percent were married. A typical respondent was approximately 38 years of age and lived in a three-member household in the United States for almost nine years (indicating non-U.S, born). Of the respondents, more than one-third (37 percent) were residing in a one-generation household, while approximately 18 percent reported living with one person under age 18, and 14 percent reported living with one person over the age of 60 in the same household. Approximately two-thirds (65 percent) obtained a bachelor's degree or higher, and more than half of the respondents (51 percent) had an annual household income of $50,000 or above. However, more than one-third (37.2 percent) reported that they were not employed (see Table 2).

Bivariate Analyses

Chi-square results showed that two dichotomy variables had statistically significant relationships with depressive symptoms: having anxiety symptoms [[chi square](1, N = 37) = 17.311, p < .001] and holding a master's degree [[chi square](1, N = 37) = 5.025, p = .025]. Independent-sample t tests evaluated whether Japanese Americans, with or without depressive symptoms, differed in association with the continuous-scaled variables in the survey. Only one variable was found to possess statistical significance: Japanese Americans experienced more health issues if they also had depressive symptoms compared with those who did not have depressive symptoms [t(34) = 2.499, p = .017, Cohen's d = 1.055].

Predicting Depressive Symptoms

As measured by HSCL-25, the prevalence of depression among the Japanese Americans in this study was 11.6 percent. Compared with the 4.1 percent prevalence found in Tanaka et al. (2011) study on Japanese Americans who had perceived poor health status, the rate found in this study is much higher. On the basis of the statistical criterion p < .05, all significant independent variables resulting from the aforementioned bivariate analyses and the interaction effects between the categorical variable "holding a master's degree" and a health concern variable were included in a logistic regression for predicting depressive symptoms.

Results from the logistic regression (n = 43) revealed that the overall model was significant in the relationship between participants' characteristics and the HSCL depressive symptoms [[chi square](5, N = 36) = 15.665, p < .01 with Negelkerke [R.sup.2] = .638]. Although individual variables in this model do not show statistical significance, the overall model shows statistical significance when having health issues, anxiety symptoms, and a master's degree are included to predict depressive symptoms. The combination of these factors with having health issues, such as having health issues with anxiety symptoms and having health issues and holding a master's degree, also seem to predict the presence of depressive symptoms (see Table 3).

Preference for Informal Care

The results did not show any significant relationships between help-seeking behaviors and depression, suggesting that Japanese Americans are disinclined to ask for help when experiencing depression. As a result, analysis of help-seeking behaviors was based on the total results from all respondents. Approximately one-fourth (23.3 percent) of the respondents did not indicate any service preference, whereas more than half (53.3 percent) indicated that they would prefer seeking advice from friends or family. Approximately 40 percent of the respondents preferred consulting physicians, and 23.3 percent assumed that the problem would take care of itself. Only 14 percent consulted mental health professionals, and a small portion turned to religious leaders (7 percent) and herbal doctors (4.7 percent) for assistance. Overall, Japanese Americans tended to seek advice from friends or relatives and were unlikely to seek professional consultation when facing family difficulties.

Further analyses were performed to examine the help-seeking patterns by demographic characteristics. The statistics indicate that female respondents are more likely than male respondents to seek help from religious leaders [[chi square](1, 4) = 4.00, p = .046]. Excluding gender, other demographic data did not show any significant differences in relation to help-seeking behaviors.

DISCUSSION

Research Implications

In this study, gender was not found to be predictive of depression, but it was significantly correlated to seeking religious leaders for support in this sample. The World Health Organization (2008a) reported that religious conviction may be a protective factor against suicide (see also, Vijayakumar, 2002). Krause, Ingersoli-Dayton, and Liang (1999) interviewed a national probability sample of 2,153 elderly men in Japan and found that greater involvement in religion was associated with providing help to others. In our study, female Japanese Americans were more likely than their male counterparts to approach religious leaders for help. Further studies may focus on how providing help for others through religious support can link to positive health and mental health outcomes.

Our findings support that in crisis counseling, both risk and protective factors of depression should be assessed in relation to cultural variables and gender socialization. The vulnerability to stress and the adaptive capacity to build resilience are complex, thus both clinicians and researchers should focus on examining the effectiveness of culturally relevant approaches to prevent, assess, and treat depression. Although only a few factors were found to be significant in predicting depression, social workers may still use this information to plan prevention programs, similar to FRIENDS for Life (Rose, Millier, & Martinez, 2009). These programs may serve as a means to amplify clients' strengths, as many Japanese people are dealing with various stressors in different life stages, and as an educational opportunity to enhance a positive view of psychological well-being.

Another implication is that social work researchers must examine how study limitations such as a small convenience sample and reliance on volunteer participants may restrict generalizability. First, random selection of participants was not feasible because the participants were difficult to reach and surveys were filled out only by those who were willing to participate. Second, this community survey reached potential participants from various community events through voluntary participation, which might not represent all voices. Given that two-thirds of the entire Japanese American population was born in the United States, this sample over-represented non--U.S.-born immigrants (with an average of nine years of residence in the United States). Third, because U.S.-born Japanese Americans may not be likely to identify with their Japanese culture (because of the reasons described by Toji, 2003) and this study recruited subjects from Asian cultural events, it is likely that very few U.S.-born Japanese people attended these events or participated in this study. Thus, future studies may need to use other recruitment strategies to include more participants. In addition, it is important to collect additional qualitative data to further explore the cultural meaning of depression for this ethnic group.

Clinical Practice Implications

A main practical implication of this study relates to the help-seeking patterns of Japanese Americans. Most respondents tended to seek help from informal support networks (like friends and relatives) and physicians rather than mental health professionals. This finding is consistent with existing research on Japanese Americans (for example, Narikiyo & Kameoka, 1992), particularly regarding the cultural expectations of living up to the model minority image, family obligations, and the cultural values of this population (Lee et al., 2009). Low rates of use of mental health services do not always correlate with severity of mental health problems (Meadows, 1997), but rather are a function of cultural considerations such as avoiding disruption of family harmony. Therefore, we urge community educators to break down the barriers to treatment of mental health disorders and raise public awareness about depression. Mass media can play a role in promoting healthy well-being, positive mental health, and help-seeking behavior in society. With the federal government's increasing attention on the mental health needs of racial and ethnic minorities, more health-related interventions may be promoted, for example, via the National Minority Mental Health Awareness Month that began in July 2010.

This study also provides three clinical implications for improving social work practice. First, as supported by the literature (Jang, Shin, Cho, Kim, & Chiriboga, 2011; Mui & Kang, 2006), the logistic regression in this study indicated that those who had depressive symptoms may present their problem as a physical health issue. It is important to listen to their somatic complaints because the disclosure of physical symptoms can serve as a means for reporting psychological distress. Similar to the findings by Kung and Lu (2008), clients who somaticize depression are less reluctant to seek medical help for their psychological distress. When working with clients who face issues after a crisis or disaster, clinicians can help them think about counseling as a means to enhance personal functioning, promote interpersonal relationships, and maintain social harmony. Practitioners who pay attention to clients' complaints of having a high level of anxiety can help them develop a positive attitude toward seeking help. The health care focus will minimize the impact of social stigma caused by the perceived negativity toward mental health disorders.

A second implication is related to the stress resulting from high expectations, particularly related to educational achievement in the context of the model-minority stereotype. In our study, 65.1 percent of the respondents hold a bachelor's degree or higher, which is higher than Japanese Americans as a whole (41.9 percent indicated in the 2000 census; Li & Wang, 2008). Japanese Americans with a master's degree may have high expectations for self-achievement that can lead to stress and depression. This finding is similar to that from a study of 26 medical undergraduates in Japan that confirmed a significant impact of chronic academic stressors on a student's mental state (Kurokawa et al., 2011). Social work practitioners can also assess how family and cultural values reinforce high parental expectations of academic success for Japanese Americans in order to find ways of helping families design coping methods and make necessary changes.

A third implication is related to the lack of service utilization as a result of the stigma of mental illnesses. It is important to reframe help seeking as a means of finding support to release tension. The findings here suggested that anxiety can predict depression, which has been well documented (Leung et al., 2012; Brawman-Mintzer et al., 1993; Hilliard & Iwamasa, 2001; Iwamasa, Hilliard, & Osato, 1998; Williams et al., 2002, 2005). The correlation between anxiety and depression supports the use of a depression instrument to simultaneously assess depression and anxiety (Ledley et al., 2007). To help families in treatment planning, social workers can use the assessed result as a means to reframe anxiety and depression as health issues to analyze how these issues connect to the client's life stressors.

Unlike studies of other ethnic groups such as Chinese and Asian Indians (Leung & Cheung, 2008; Leung et al., 2012) and studies of Asian older adults (e. g., Harada et al., 2011), this study did not identify employment status and other socio-cultural correlates (such as family relationship, domestic violence, and acculturation concerns) as predictors of depression for Japanese Americans. This is perhaps due to the underreporting of depression symptoms, which is not uncommon among this ethnic group (World Health Organization, 2008b). The finding of informal care preference in this study implies that, as a result of the shame and stigma associated with depression, Japanese Americans might have a tendency to keep problems to themselves rather than opening up to mental health professionals or others. It is important to provide educational information about depression and reframe the negative concept of seeking mental help as addressing a health care need.

In addition, it is important to note that the devastating earthquakes and tsunami have caused chronic pain and illness among the survivors in Japan and their overseas relatives (Psychology Advice, 2011). Even though our data were collected before the March 11, 2011, Japan earthquake, this report aims to instill hope for Japanese Americans to deal with life stress and build resilience so that they can use their strengths (such as academic success and cultural knowledge) to share their experience, which is framed as helping others. Clinicians may design assessments that focus on health care needs and also address Japanese Americans' post-traumatic reactions. They can also highlight individual and family strengths while clients are analyzing their reactive depression to crises and stressors. It is essential to treat depression using information from the clients about their perceptions of observable symptoms.

Conclusion

Understanding the concept of depression as it relates to the psychological impact of life stressors is instrumental to the study of Japanese Americans' help-seeking behaviors. In this study, the 11.6 percent prevalence finding confirmed that Japanese Americans, who are often held to model minority standards, are not shielded from having depression. As implied in one of its findings connecting depression to health care, primary health care professionals may serve as an important entry point for treatment of Japanese help seekers, particularly for those clients who have waited until a crisis affected their physical and psychological well-being. One treatment approach is to promote an exchange dialogue with the clients to learn about Japanese cultural practices and health care concepts. Service providers should pay attention to the interview setting, service arrangement, and confidentiality of treatment, as well as analyze clients' expressions of distress. Knowing that a caring professional is listening to their physical complaints, clients may become more willing to talk about how the illness may have been caused by stressful matters that affected their individual and family functioning. Programs that address health care concerns may use a combined staff-development effort to train both medical and mental health professionals so that their shared practice wisdom can be incorporated in treatment planning.

doi: 10.1093/sw/swt016

Original manuscript received November 8, 2011

Final revision received March 12, 2012

Accepted May 30, 2012

Advance Access Publication June 20, 2013

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Monit Cheung, PhD, is professor, and Patrick Leung, PhD, is professor, Graduate College of Social Work, University of Houston. Venus Tsui, PhD, is assistant professor, Social Work at the Worden School of Social Service, Our Lady of the Lake University, San Antonio, TX. Address correspondence to Monit Cheung, Graduate College of Social Work, 110HA Social Work Building, University of Houston, Houston, TX 77204; e-mail: mcheung@uh.edu.
Table 1: Interethnic Representation Rates 2010 U.S. Census Data

 (A) (B) Interethnic
 One Ethnicity Alone or in Any Representation
Asian American Alone Combination (a) Rate (b)
Ethnic Group n n %

Asian Indian 2,843,391 3,183,063 11
Bangladeshi 128,792 147,300 13
Bhutanese 15,290 19,439 21
Burmese 91,085 100,200 9
Cambodian 231,616 276,667 16
Chinese (except 3,137,061 3,794,673 17
 Taiwanese)
Filipino 2,555,923 3,416,840 25
Hmong 247,595 260,073 5
Indonesian 63,383 95,270 33
Japanese 763,325 1,304,286 41
Korean 1,423,784 1,706,822 17
Laotian 191,200 232,130 18
Malaysian 16,138 26,179 38
Nepalese 51,907 59,490 13
Pakistani 363,699 409,163 11
Sri Lankan 38,596 45,381 15
Taiwanese 196,691 230,382 15
Thai 166,620 237,583 30
Vietnamese 1,548,449 1,737,433 11

Source: U. S. Census Bureau. (2010a). 2010 Census data. Retrieved
from http://www.census.gov/2010census/data/

(a) Combination within the same ethnicity or in any other race group.

(b) The interethnic representation rate is calculated by
[(B)-(A)]/(B)x100%.

Table 2: Demographic Characteristics of Respondents (N=43)

Variable n % M (SD)

Age 34 79.1 38.3 (12.2)
 Missing 9 20.9
Number of years in United States 42 97.7 9.3 (8.4)
 Missing 1 2.3
Gender
 Male 17 39.5
 Female 24 55.8
 Missing 2 4.7
Marital status
 Single 15 34.9
 Married 26 60.5
 Divorced/separated 1 2.3
 Living with significant other(s) 1 2.3
Currently employed
 Yes 26 60.5
 No 16 37.2
 Missing 1 2.3
Education
 High school 3 7.0
 Some college 10 23.3
 Bachelor's degree 17 39.5
 Master's degree 8 18.6
 Other 4 9.3
 Missing 1 2.3
Household income
 Less than $19,999 3 7.0
 $20,000 to $39,999 10 23.3
 $40,000 to $59,999 14 32.6
 $60,000 to $79,999 8 18.6
 $80,000 and over 6 14.0
 Missing 2 4.7
Number of people living in the 2.7(1.5)
household, including the respondent
 1-2 21 48.8
 3-4 13 30.3
 5 and over 5 11.6
 Missing 4 9.3
Number of generations 1.5 (0.7)
 1 16 37.2
 2 14 32.6
 3 3 7.0
 Missing 10 23.3
Number of household members 0.5 (0.8)
under age 18 years
 0 20 46.5
 1 8 18.6
 2-3 4 9.3
 Missing 11 25.6
Number of household members 0.5 (0.7)
age 60 years and over
 0 20 46.5
 1 6 14.0
 2 4 9.3
 Missing i3 30.2

Table 3: Logistic Regression Model for Depressive Symptoms (n = 36)

Variable B SE OR

Constant -3.695 1.504 0.025
Anxiety symptoms 1.802 2.242 6.061
Master's degree holder 1.622 2.056 5.061
Health issues -0.396 2.431 0.673
Health issues x anxiety symptoms 2.445 2.768 11.533
Health issues x master's 0.019 2.639 1.020
 degree holder

 95% CI for OR

Variable p Lower Lower

Constant 0.014
Anxiety symptoms 0.422 0.075 491.340
Master's degree holder 0.430 0.090 284.546
Health issues 0.871 0.006 78.972
Health issues x anxiety symptoms 0.377 0.051 2,618.303
Health issues x master's 0.994 0.006 179.620
 degree holder

Note: Negelkerke [R.sup.2] = .638; model [chi square](5, N = 36) =
15.665, p<.01. OR = odds ratio. CI = confidence interval.
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Author:Cheung, Monit; Leung, Patrick; Tsui, Venus
Publication:Social Work
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Date:Jul 1, 2013
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