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Detection of major depressive disorder in Chinese Americans in primary care


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Objective: To assess the prevalence of major depressive disorder in Chinese Americans in the greater Boston area. Patients and Methods: Chinese American participants were recruited through 10 primary care clinics in greater Boston. Depression was determined by assessment on 2 screening instruments, the Mental Health Index-5 and Primary Care Screener for Affective Disorders for the first-stage survey and by Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition for the second-stage interview. Results: The prevalence of major depressive disorder among Chinese Americans attending primary care clinics (one-year prevalence of about 10%) appeared similar to the prevalence reported in other ethnic groups. The brief survey (Mental Health Index-5) performed as well as the lengthier one (Primary Care Screener for Affective Disorders). Few Chinese Americans with identified major depressive disorder had received antidepressant treatment from their primary care physician. Conclusion: Cultural beliefs about mental health appeared as barriers to both detection and treatment in this study.
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Detection of Depression in Chinese Americans
Hong Kong J Psychiatry 2005, Vol 15, No.3
Hong Kong J Psychiatry 2005;15:71-76 Original Article
© 2005 Hong Kong College of Psychiatrists
Detection of Major Depressive Disorder in
Chinese Americans in Primary Care
GLK Hsu, YM Wan, D Adler, W Rand, E Choi, BYP Tsang
Objective: To assess the prevalence of major depressive disorder in Chinese Americans in the
greater Boston area.
Patients and Methods: Chinese American participants were recruited through 10 primary care
clinics in greater Boston. Depression was determined by assessment on 2 screening instruments,
the Mental Health Index-5 and Primary Care Screener for Affective Disorders for the first-stage
survey and by Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental
Disorders, 4th edition for the second-stage interview.
Results: The prevalence of major depressive disorder among Chinese Americans attending
primary care clinics (one-year prevalence of about 10%) appeared similar to the prevalence
reported in other ethnic groups. The brief survey (Mental Health Index-5) performed as well as
the lengthier one (Primary Care Screener for Affective Disorders). Few Chinese Americans with
identified major depressive disorder had received antidepressant treatment from their primary
care physician.
Conclusion: Cultural beliefs about mental health appeared as barriers to both detection and
treatment in this study.
Key words: Chinese Americans, Major depressive disorder, Prevalence, Primary health care, Questionnaires
First presented at the 2001 American Psychiatric Association Annual
Meeting, New Orleans, USA.
Dr George LK Hsu, MD, FRCPsych, Tufts-New England Medical
Center, Boston, Massachusetts, USA.
Dr Yu Mui Wan, EdD, Boston University Center for Psychiatric
Rehabilitation, Boston, Massachusetts, USA.
Dr David Adler, MD, Tufts-New England Medical Center, Boston,
Massachusetts, USA.
Dr William Rand, PhD, Tufts-New England Medical Center, Boston,
Massachusetts, USA.
Dr Elaine Choi, MD, Tufts-New England Medical Center, Boston,
Massachusetts, USA.
Dr Bill YP Tsang, EdD, Research Associate, Hong Kong Chinese
University Department of Social Work, Hong Kong, China.
Address for correspondence: Dr George LK Hsu, Professor of Psychiatry,
Tufts-New England Medical Center, Tufts University School of Medicine,
Tufts-NEMC, 750 Washington Street, Box, #1007, Boston, MA 02111, USA.
Tel: 617 636 7584; Fax: 617 636 4852;
Submitted: 11 April 2005; Accepted: 29 December 2005
Depression is a common disorder in the USA. Between 5%
to 12% of men and 10% to 25% of women have an episode
of major depressive disorder (MDD) during their lifetime.1
Depression is also a serious illness, leading to functional
impairment, poor quality of life, loss of economic produc-
tivity, greater health care utilisation, and an increased risk
for suicide and increased mortality.2-9 It has been estimated
that MDD is associated with 20,000 suicides and $44
billion in health care costs in the USA annually.10,11 However,
little is known about the prevalence of MDD among Asian
Americans in the USA, despite the fact that they constitute
one of the fastest growing sectors of the population over the
last 30 years.12
It is widely acknowledged that Asian Americans shun
mental health services,13 as most ethnic minorities do.14
There is evidence to indicate that Asian Americans under-
utilise outpatient,15 inpatient16 and emergency17 psychiatric
services. Reasons for this may be complex but the stigma
of mental illness is thought to be a major factor.18-21 It is
possible that the use of alternative methods of treatment
(such as acupuncture) along with barriers to care (such as
language and cost issues) may also have reduced the use of
mainstream psychiatric services by Asian Americans.
Given the antipathy that Asian Americans appear to hold
for mental health services, it seemed reasonable to specu-
late that Asians who are depressed may be more likely to
seek treatment from primary care physicians (PCPs) than
from psychiatrists. This may be particularly the case for in-
dividuals who experience and present with somatoform
symptoms of MDD.22-24 Research in this area is lacking,
however. Despite the recent increase in research on MDD
in primary care,25-28 only one published study29 was identi-
fied that focused specifically on the issue of MDD among
Chinese Americans in primary care. A further study by Yeung
and colleagues noted that consulting a PCP for symptoms
GLK Hsu, YM Wan, D Adler, et al
Hong Kong J Psychiatry 2005, Vol 15, No.3
related to MDD was considered more acceptable to Chinese
Americans than consulting a psychiatrist.30
In a 14-nation survey conducted by the World Health
Organization, rates of depression reported were the lowest
in two Asian countries, China and Japan.31 This finding is
difficult to explain since China and Japan have suicide rates
that are among the highest in the world.32 It is possible that
there is under-reporting of depression in such surveys
because of the stigma attached.
This paper reports a two-stage survey to determine the
prevalence of MDD in Chinese Americans in primary care
conducted in metropolitan Boston. Chinese Americans were
the focus of the survey because they constitute the largest
group among Asians in Massachusetts.12 The study was ap-
proved by the Human Institutional Review Committee of
Tufts-New England Medical Center, and was designed to
answer the following questions:
1. Is a simple screening instrument, the Mental Health
Index-5 (MHI-5),33 better or worse at detecting depres-
sion in primary care in Chinese Americans than the
Primary Care Screener for Affective Disorders (PC-
SAD),34 a detailed screening instrument?
2. What is the estimated prevalence of depression in this
3. Do Chinese Americans diagnosed with MDD under-
utilise mental health services? If so which of the 3
factors that Rogler and colleagues14 identified as rea-
sons for mental health service underutilisation (cultural
beliefs that impede use of services, use of alternative
pathways of care, and actual barriers to care) are
responsible for underutilisation in Chinese Americans?
4. What is the influence of the level of acculturation on the
performance of the screening instruments, the prevalence
of depression, and the pattern of service utilisation?
Patients and Methods
Participants and Procedure
The study was conducted at ten PCP offices in the metro-
politan Boston area. Five of the PCPs belonged to the Gen-
eral Medical Associates of Tufts-New England Medical
Center. The other 5 were private practitioners, 3 with of-
fices in the Chinatown area, and 2 with offices in nearby
towns (Quincy and Malden) with large Chinese immigrant
populations. The questionnaire phase of the study was con-
ducted between November 1999 and March 2000 and the
interview phase from February 2000 to July 2000.
Chinese patients attending one of the 10 above-mentioned
PCP clinics were approached for recruitment to the study.
During the first 4 weeks of the recruitment phase, a study
packet containing a one-page flyer describing the study, a
copy of the consent form, the MHI-5 and PC-SAD were
placed at the receptionist’s counter at each clinic. All Chi-
nese patients who came to register at the receptionist’s
counter were given the study packet by the receptionist.
Those who expressed an interest in participating in the study
were encouraged to call the research assistant (RA) at
Dr Hsu’s office regarding study participation. The initial
response was very poor and after 4 weeks, RAs trained
by one of the authors on how to approach a patient for
a research study, were stationed at each PCP clinic for 4
to 12 hours each week. The RA would approach each
Chinese patient at the clinic and describe the study.
The patient would complete the MHI-5 and PC-SAD after
they had signed the consent form. The RA was present to
answer any questions that the patient had regarding the
questionnaires, but the questionnaires were not administered
orally by the RA. Subjects were reimbursed $5 for comple-
tion of the questionnaires.
The two questionnaires were: (1) MHI-5,33 a subscale of
the SF-36,35 a 5-item general mental health screening
instrument for psychiatric symptoms that have occurred in
the past 4 weeks. The MHI-5 took 2 to 3 minutes to complete;
and (2) PC-SAD, a 37-item self-administered questionnaire
consisting of a 3-item pre-screener, a 26-item MDD section,
and an 8-item dysthymia section. The pre-screener, designed
to reduce respondent burden by terminating the question-
naire when all responses to the 3 items are negative, con-
sists of 2 depression questions closely related to the World
Health Organization depression screening tool36 and one
dysthymia question. The PC-SAD provides a breakdown of
each of the Diagnostic and Statistical Manual of Mental
Disorders, 4th edition (DSM-IV) MDD/dysthymia symp-
toms for the diagnosis of current MDD (sensitivity 87.2%,
specificity 95%) and dysthymia according to DSM-IV
criteria.34 It takes 1 to 2 minutes to complete the PC-SAD pre-
screener, but about 30 minutes for the full questionnaire if the
individual answers “yes” to any of the pre-screening questions.
To obtain a valid Chinese version of both questionnaires,
the authors followed the guidelines for the cross-cultural
adaptation of health measures.37 The 2 questionnaires were
translated into Chinese and then translated back into English.
Equivalence in conceptual content for the Chinese and
English versions of the two questionnaires was achieved after
several revisions by discussion among the authors.
Second-stage Interview
All subjects who had a positive score on the MHI-5 or PC-
SAD were approached by telephone for an interview, as was
a randomly chosen group (20%) of subjects with a negative
score on both questionnaires. Every effort was made to con-
duct the interview as soon as possible after the questionnaire
screening. Subjects were reimbursed $50 for the interview.
A trained and experienced assessor administered the Struc-
tured Clinical Interview for the DSM-III-R (SCID),38 which
had been translated into Chinese, and an Acculturation
All subjects who were diagnosed as having MDD on
interview were approached by telephone at 6 months for
a telephone interview by one of the authors. Questions
Detection of Depression in Chinese Americans
Hong Kong J Psychiatry 2005, Vol 15, No.3
on current mental status and service utilisation were admin-
istered over the telephone to those who consented to the
telephone interview.
Number of Subjects
It was estimated that about 1000 patients were approached
for the Phase I Study. An exact count was not possible be-
cause it was unclear how many patients received the study
packet during the initial 4 weeks of the study. The number
of subjects who participated at each stage of the study is
summarized in Figures 1 and 2.
First Phase: Screening
A total of 560 questionnaires were returned. Among the
returned questionnaires, 500 MHI-5 (293 female, mean age
[± SD] 44.8 ± 10.4 years; 207 male, mean age 45.9 ± 10.7
years) and 476 PC-SAD (282 female, mean age 44.9 ± 10.5
years; 194 male, mean age 46.0 ± 10.8 years) were usable.
For the MHI-5, when a cut-off score of 52 was used (ie, a
score of less than 52 was considered “depressed”, a score of
52 or above was considered not depressed), 50 out of 500 sub-
jects (10%) had a positive score. For the PC-SAD, 45 of the
476 (9.5%) had a positive score. Therefore, both question-
naires identified about 10% of subjects as being depressed.
Second Phase: Interview
Interviews with the SCID were conducted in person by one
of the authors. Due to the one- to five-month gap between
the questionnaire survey and the interview, subjects were
asked specifically for: (1) the presence of depression
around the time of the questionnaire survey, defined for
the purpose of this study as current depression (CMDD)
and specifically about why they had visited their PCP at the
time; (2) presence of depression within the past 12 months
(one-year depression, OMDD); and (3) lifetime depression
Thirty nine of the 50 MHI positive cases and 38 of the
45 PC-SAD positive cases were interviewed. Among the
MHI-5 and PC-SAD negative cases, 85 of 110 approached
were interviewed. The findings are summarised in Figures
1 and 2.
Estimated Prevalence of Depression
The prevalence of current depression, as indicated by
interview, was estimated as 6.5% of the 500 who provided
usable MHI-5 and 7.8% of 476 usable PC-SAD results
(Table 1). Since not all subjects were interviewed, these es-
timates are based on projecting the depression percentages
of those interviewed to the full sample. The estimated one-
year rate was 10.2% according to the MHI-5, and 10.7%
according to the PC-SAD. The estimated lifetime rate was
about 41% for both questionnaires.
Figure 1. Screening for depression with the Mental Health
Index-5 (MHI-5).
Abbreviations: SCID = Structured Clinical Interview for the
Diagnostic and Statistical Manual of Mental Disorders-IV;
LMDD = patients with lifetime major depression; OMDD =
one-year major depression; CMDD = current major depression;
DYS = dsythymia; OTH = other diagnosis; NOD = no diagnosis.
Figure 2. Screening for depression with the Primary Care
Screener for Affective Disorders (PC-SAD).
Abbreviations: LMDD = patients with lifetime major depression;
OMDD = one-year major depression; CMDD = current major
depression; DYS = dsythymia; OTH = other diagnosis;
NOD = no diagnosis.
Patient approached
PC-SAD completed
n=3 OTH
n=5 NOD
n=4 LMDD
n=2 OTH
n=13 NOD
SCID interview
n=35(78%) SCID interview
PD-SAD positive
n=45(9.5%*476) PD-SAD negative
n=431 (90.5%)
Patient approached
MHI-5 completed
n=1 LMDD
n=3 OTH
n=12 NOD
SCID interview
n=39(78%*50) SCID interview
MHI-5 positive
(< 52)
MHI-5 negative
n=450 (90%)
GLK Hsu, YM Wan, D Adler, et al
Hong Kong J Psychiatry 2005, Vol 15, No.3
Performance of Each Questionnaire for Detecting
Current Depression
The sensitivity, specificity, positive predictive value (PPV),
and negative predictive value (NPV) of the MHI-5 and PC-
SAD are presented in Table 1, as determined by the “gold
standard” of interview with the SCID.
Level of Acculturation
Of 126 subjects interviewed, 20 were at Level 1 (Very
Chinese), 100 at Level 2 (Mostly Chinese), and only 4 at
Level 3 (Bicultural). A further 2 subjects did not complete
the acculturation scale.
Subsequent Treatment
Eleven of the 16 CMDD patients identified by MHI-5 and
SCID were interviewed by telephone at 6 months. Two pa-
tients returned to consult their PCP for their MDD, with
neither receiving antidepressant medication. Two were
treated at a mental health clinic with antidepressant medi-
cation. Two sought alternative treatment (Qigong, traditional
Chinese medicine). All still had some residual symptoms
at follow-up. The 5 patients who declined follow-up had
received no treatment from their PCP. Therefore, most pa-
tients received no antidepressant treatment for their MDD.
Reasons for Mediocre Performance of Screening
The authors were interested in identifying why both ques-
tionnaires had a relatively high false-negative rate and, par-
ticularly for the PC-SAD, a relatively higher false-positive
The high false-negative rate was related to 2 issues. Many
subjects reported a reluctance to endorse the presence of
depressive symptoms on a self-report questionnaire. They
expressed a fear that if they did they might be perceived to
be abnormal or mentally ill. A second reason was a different
conceptualisation of depression. Many would not accept that
they were “depressed” (ie, that they had a depressive or
mental disorder) as they believed their symptoms were
explained by their personal circumstances. Therefore,
depressive symptoms occurring in the context of a stressful
or traumatic life event such as immigration, the cultural
revolution, or unemployment, they argued, were “natural”
and not abnormal (“everyone gets depressed at such times”).
The high false-positive rate occurred primarily because
our subjects failed to distinguish between current and past
depression (ie, presence of lifetime depression but not within
the past 4 weeks) on both screening questionnaires, and for
the PC-SAD, to distinguish between current major depres-
sion and dysthymia. It appeared that subjects either did not
understand the questions that specified a time-frame (eg,
“In the past 4 weeks…”), or else did not consider the finer
distinctions of symptoms occurring in different contexts to
be important.
Finally, many complained predominantly of somatoform
symptoms such as dizziness, palpitations, tinnitus, anorexia,
insomnia and lack of strength. They believed that subjec-
tive dysphoria was a natural reaction to the somatoform
symptoms (“Wouldn’t you be depressed if you had these
symptoms?”). This interpretation precluded them from en-
dorsing the presence of depression on the questionnaire.
This study found that the prevalence of 7% for current MDD
among Chinese Americans in primary care was similar to
that of other ethnic groups in a similar setting,40,41 although
lower than the 14.6% reported by Yeung et al.30 About 10%
of subjects had had an episode of MDD in the last 12 months,
a rate that was comparable to that found in the National
Comorbidity Survey,42 but about 3 times higher than the 12-
month rate of the respondents in the Chinese American Psy-
chiatric Epidemiology Study conducted in Los Angeles.43
Differences between samples and study methodology could
have accounted for the disparate results across studies, but
it seems unlikely that the prevalence of MDD among Chi-
nese Americans is very different from that in the other eth-
nic groups. It may also be possible that Chinese Americans
are more likely to experience depression in terms of somatic
or somatoform symptoms.23,44,45
There were 3 methodological limitations with this
study. The first was the fact that the questionnaire survey
and the SCID interview were not conducted at the same
time. The SCID interview, conducted on average 3 months
after the screening questionnaire survey, could have yielded
biased data because of problems of recall. The second
problem was the non-random selection of subjects. Many
factors might have determined who in the end chose to
complete and return the questionnaire, or to participate
in the interview. The third problem was that our subjects
were Cantonese or Mandarin speaking. Chinese subjects
that did not speak either of these languages were excluded.
These findings therefore may not be applicable to the
overall population of Chinese Americans attending primary
Taking into account these limitations, the study high-
lighted the difficulties encountered in the detection of depres-
sion in Chinese Americans in primary care. A review by
Table 1. Performance of the Mental Health Index-5 (MHI-5)
and Primary Care Screener for Affective Disorders (PC-SAD).
Sensitivity 51.20 31.80
Specificity 92.90 92.40
Positive predictive value 33.30 26.30
Negative predictive value 96.50 94.10
Estimated prevalence of 6.51% 7.81%
current depression
Estimated prevalence of 10.20% 10.69%
one-year depression
Estimated prevalence of 41.57% 42.69%
lifetime depression
Detection of Depression in Chinese Americans
Hong Kong J Psychiatry 2005, Vol 15, No.3
Mulrow and colleagues found that nine widely used depres-
sion screening instruments had an average sensitivity of 84%
(range, 67% to 99%) and an average specificity of 72%
(range, 40% to 95%).46 The sensitivity data for the 2 screen-
ing questionnaires in this study were at the lower end of this
range, although in terms of specificity they performed well.
The mediocre performance of the questionnaires in this study
seemed to be related to cultural factors: a fear of disclosure,
a different conceptualisation of depression, unfamiliarity
with screening instruments, and a somatoform symptom
profile. Our findings therefore were in accord with those of
Yeung and colleagues.30 They reported that a brief face-to-
face screening conducted by an experienced researcher was
likely to be more effective than a paper-and-pencil screen-
ing procedure for the detection of MDD in Chinese Ameri-
cans in primary care. It would be important to study the
effectiveness of a two-question face-to-face case-finding
interview in this population.47
That Chinese Americans would conceptualise major
depression differently than current psychiatric thinking was
not surprising,45 and raised ontological issues regarding the
nature of MDD which are beyond the scope of this study.
From a pragmatic standpoint, the conceptualisation of de-
pression resulted in a passive acceptance of the symptoms
that remained largely untreated during the subsequent
6 months. Untreated depression has been identified as a
major burden to the individual and to society,48 leading to
impaired physical, mental and social well-being, decreased
productivity, and increased mortality.2-4,9,10 Our findings
highlight the need for vigorous detection and treatment of
MDD in Chinese Americans.
Finally, cultural beliefs about mental illness appear to
be the main impediment to mental health service utilisation
among the Chinese Americans in this study. There was little
evidence that alternative treatments or actual barriers to care
prohibit the use of mainstream mental heath services. As
the majority of study subjects were traditionally Chinese in
their cultural orientation, it could not be determined whether
acculturation to Western beliefs about mental illness would
improve the detection and treatment of MDD. This is an
issue that future studies must explore. Unfortunately, many
Chinese immigrants to the USA may still find the diagnosis
of depression “morally unacceptable and experientially
This research was supported by a grant from the New
England Medical Center Research Foundation and the
General Clinical Research Center at Tufts-New England
Medical Center under NIH grant M01 RR00054.
The authors would like to thank the following primary
care physicians for their collaboration in the study and the
support and assistance of their office staff: Dr Wing Ar Moy,
Dr Stephen Louie, Dr Matthew Siu, Dr Lei Wang, Dr Yun
Lam, Dr Robert Wu, Dr Barbara Edwards, Dr Joseph Lau,
and Dr Eileen Hession.
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... In contrast, other research indicated that depression is significantly higher in European Americans than in African Americans and Mexican Americans (Riolo, Nguyen, Greden, & King, 2005). On two studies of depression among Chinese Americans, Hsu et al. (2005) found Chinese American attending primary care clinics had a major depressive disorder rate of 7% and Yeung et al. (2004) found the prevalence of depression was 19.6%. However, the literature provides very little information about the rates of maternal depression in Asian American mothers. ...
... Current findings revealed a low incidence of depressive symptomology among study mothers, with only 7% of mothers considered at risk for clinical depression. This percentage is below the average 10% of mothers who are reported to suffer depression annually (NIMH, 2005), but similar to the 7% rate found among Chinese American men and women in a previous study of primary care patients (Hsu et al., 2005). The rate of depressive symptoms for mothers of Asian heritage in this study is also far below that found in some studies of mothers from other racial/ethnic groups in the U.S. In two previous community studies, 41% to 47% of African American low income mothers of preschools were considered at high risk for clinical depression (McGroder, 2000;Tyler, 2004). ...
... Depression is a serious mental health problem among the rapidly growing Chinese older adults and is associated with significant and negative consequences such as higher functional disability (Chi et al. 2005), chronic physical conditions (Chi et al., 2005;Wu et al., 2010), increased suicide rates (Hsu et al., 2005), and lower quality of life . ...
Objective: To determine the efficacy of mind-body interventions in depressive symptoms treatment among older Chinese adults (>60 years of age). Methods: We searched MEDLINE, PsycINFO (Ovid), Embase (Ovid), CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Literature Database, and Chongqing VIP for eligible studies until September 2016. We reviewed randomized controlled trials investigating the efficacy of mind-body interventions for depressive symptoms among Chinese older adults. Two authors independently conducted screening, and risk of bias assessment. Data were extracted by one author and crosschecked by the research team. Cohen's d standardized mean differences were calculated to represent intervention effects. Results: A comprehensive search yielded 926 records; 14 articles met inclusion criteria. Relative to the control groups, mind-body interventions had large short-term effects in reducing depressive symptoms in older Chinese adults (standardized mean differences = -1.41; 95% CI [-1.82, -0.99]). Most studies did not report the long-term effects of mind-body interventions. Subgroup analyses by type of mind-body interventions, participants' age group, and control condition yielded different effect sizes; however, these differences did not all reach a statistically significant level. The interpretation of the subgroup analysis should be considered with caution given its observational nature and a small number of included studies. Conclusions: This systematic review suggests that mind-body interventions had short-term effects in alleviating depressive symptoms among older Chinese adults. Further research (randomized controlled trials with active controls and follow-up tests) are needed to assess the effects of mind-body interventions on depressive symptoms among this population. Copyright © 2017 John Wiley & Sons, Ltd.
... Individuals encounter two major subjects within the two-dimensional acculturation process. The first subject is sustaining the origin culture by the individual, and the second is coming into contact with the new culture by the individual and keeping up this culture after adopting it (Hsu et al. 2005). When these two subjects are taken into account, four adaptation strategies have been developed in classification of the acculturation levels of the individuals encountering two cultures. ...
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Consumer acculturation studies have been very popular in the last four decades. Different cultures are meeting more frequently with regard to both person and products, in our multi-cultural world where the flow of people, money, information and technologies and even media images and ideologies takes place in global sense. Whether it is desired or not, the borders are being crossed by migrants and the global flow of people is happening in an intense and increasing rate. The present article reviews consumer acculturation of immigrants and tourists. The following is a comprehensive review broadly examining consumer acculturation of migrant group and tourist, more specially, acculturation concept and models.
... Depression is a significant mental health problem in the rapidly growing aging population worldwide. It is associated with substantial disability (Mathers et al., 2008), chronic physical condition (Wu et al., 2010), increased suicide rates (Hsu et al., 2005), incident dementia (Steffens et al., 2006), lower quality of life (Mohd et al., 2005), and higher health care costs (Simon et al., 2000). Depressive disorders are defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (American Psychiatric Association, 2013), or the International Classification of Diseases (ICD)-10 (World Health Organization, 1992). ...
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Objectives: To determine the efficacy of music therapy in the management of depression in the elderly. Method: We conducted a systematic review and meta-analysis of randomized controlled trials. Change in depressive symptoms was measured with various scales. Standardized mean differences were calculated for each therapy-control contrast. Results: A comprehensive search yielded 2,692 citations; 19 articles met inclusion criteria. Meta-analysis suggests that music therapy plus standard treatment has statistical significance in reducing depressive symptoms among older adults (standardized mean differences = 1.02; 95% CI = 0.87, 1.17). Conclusions: This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required.
... (Ho and Mak, 2009;Yu and Lee, 2012). Previous studies have indicated its good predictive validity, with an optimal cut-off score of 52 or greater to indicate the presence of severe depressive symptoms in Chinese Americans and Asian population (Hsu et al., 2005;Yamazaki et al., 2005). ...
... Diagnostic screenings were conducted by using a modified version of the Structured Clinical Interview for DSM-IV (SCID) (37). A Chinese version of the SCID has demonstrated good psychometric properties and evidences good validity when used with Chinese individuals and Chinese Americans (38)(39)(40). The 17-item Hamilton Depression Rating Scale (HDRS) was used to diagnose depression (scores $14) and assess depression symptoms (41,42). ...
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. 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. 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). 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.
... Therefore, impairments that each chronic condition has on health at population level, as well as the individual level, should be considered. Mental disease is often difficult to detect and diagnose due to the delicacy of the issue in Chinese culture [36,37]. For this reason, the prevalence and the level of impairment brought on by mental disease may have been underestimated in this study. ...
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The aim of this study was to examine health-related quality of life (HRQoL) as measured by EQ-5D and to investigate the influence of chronic conditions and other risk factors on HRQoL based on a distributed sample located in Shaanxi Province, China. A multi-stage stratified cluster sampling method was performed to select subjects. EQ-5D was employed to measure the HRQoL. The likelihood that individuals with selected chronic diseases would report any problem in the EQ-5D dimensions was calculated and tested relative to that of each of the two reference groups. Multivariable linear regression models were used to investigate factors associated with EQ VAS. The most frequently reported problems involved pain/discomfort (8.8%) and anxiety/depression (7.6%). Nearly half of the respondents who reported problems in any of the five dimensions were chronic patients. Higher EQ VAS scores were associated with the male gender, higher level of education, employment, younger age, an urban area of residence, access to free medical service and higher levels of physical activity. Except for anemia, all the selected chronic diseases were indicative of a negative EQ VAS score. The three leading risk factors were cerebrovascular disease, cancer and mental disease. Increases in age, number of chronic conditions and frequency of physical activity were found to have a gradient effect. The results of the present work add to the volume of knowledge regarding population health status in this area, apart from the known health status using mortality and morbidity data. Medical, policy, social and individual attention should be given to the management of chronic diseases and improvement of HRQoL. Longitudinal studies must be performed to monitor changes in HRQoL and to permit evaluation of the outcomes of chronic disease intervention programs.
Background Mounting evidence indicates that early recognition and treatment of behavioral health disorders can prevent complications, improve quality of life, and help reduce health care costs. The aim of this systematic literature review was to identify and evaluate publicly available, psychometrically tested tools that primary care physicians (PCPs) can use to screen adult patients for common mental and substance use disorders such as depression, anxiety, and alcohol use disorders. Methods We followed the Institute of Medicine (IOM) systematic review guidelines and searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify literature addressing tools for screening of behavioral health conditions. We gathered information on each tool’s psychometrics, applicability in primary care, and characteristics such as number of items and mode of administration. We included tools focused on adults and the most common behavioral health conditions; we excluded tools designed for children, youth, or older adults; holistic health scales; and tools screening for serious but less frequently encountered disorders, such as bipolar disorder. Results We identified 24 screening tools that met the inclusion criteria. Fifteen tools were subscales stemming from multiple-disorder assessments or tools that assessed more than one mental disorder or more than one substance use disorder in a single instrument. Nine were ultra-short, single-disorder tools. The tools varied in psychometrics and the extent to which they had been administered and studied in primary care settings. Discussion Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.
In this study the authors assessed the effects of disability beliefs, conceptualization and labeling of emotional disabilities, and perceived barriers on help-seeking behaviors among depressed Chinese Americans in a primary care setting. Forty-two Chinese Americans participated in semistructured interviews using established psychological measures and open-ended questions adapted from the Explanatory Model Interview Catalogue. The authors found that care utilization appears to be complicated by somatization of emotional problems, variations in causal attribution to depression, barriers to receiving mental health care, and the burden of comorbid physical conditions. Their findings highlight the importance of addressing these issues and educating patients about body-mind dialectic common to depression.
Major depressive disorder is a serious and disabling illness in the world and is common chronic and recurrent disorder. It is the fourth most important cause of worldwide loss in disability. This was prospective and open-label study, study conducted in JPMC. Karachi, to evaluate the efficacy and adverse effects in major depressive disorder individuals. A total of 40 patients irrespective of the gender, aged 18 years up to 65 years were enrolled from OPD of Psychiatry Department. Follow-up visits were carried out fortnightly after making evaluation of symptoms at baseline visit (day 0), follow-up continued till 90 days when the results were compiled. Statistically significant (p < 0.05) results were observed in all the parameters at the end of study, i.e., day 90. Among all the symptoms of major depressive disorder, trazodone proved to be more effective in controlling insomnia.
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Over the past 30 years the World Health Organization (WHO) has produced a number of assessment instruments intended for national and cross-cultural psychiatric research. WHO instruments have been tested and used in many collaborative studies involving more than 100 centres in different parts of the world. This article reviews the main WHO instruments for the assessment of (a) psychopathology, (b) disability, quality of life and satisfaction, (c) services, and (d) environment, and risks to mental health. The principles used in the development of WHO instruments, their translation and their use across cultures and settings are discussed.
Objective: To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. Design: The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. Setting: Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. Participants: Five hundred thirty-six consecutive adult patients without mania or schizophrenia. Measurements and main results: Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. Conclusions: The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.
A telephone survey was conducted on a representative sample of 1273 Chinese in Hong Kong to examine public attitudes to the mentally ill and mental health rehabilitation facilities. Attitudes were compared with a study using the same measures carried out two years previously. Results indicated that public concern about their mental health and their attitudes to mental patients was decreased and became more negative slightly, respectively. On the other hand, their knowledge of mental illness and attitudes to community care of mental patients were improved slightly. Their views on the mentally ill were found to be associated with their contacts with mental patients and their socioeconomic variables including age and education, but not sex.
Level of acculturation has been recognized as important in clinical work with ethnic minorities. However, scales are lacking for assessment of this variable for Asians. The SL-ASIA, Suinn-Lew Asian Self-Identity Acculturation Scale, was modeled after a successful scale for Hispanics. Initial reliability and validity data are reported for two samples of Asian subjects, from two states.