Prevalence and Predictors of Depression in Korean American Elderly: Findings from the Memory and Aging Study of Koreans (MASK)

Abstract

Objectives To estimate the prevalence and identify the predictors of depression among community-dwelling Korean American elderly (KAE). Design A cross-sectional descriptive epidemiological survey using a two-step sampling strategy to obtain a representative community sample. Setting We recruited study participants at religious, service, and business establishments in the KA community (26 churches, 6 senior centers, 2 medical daycare centers, 1 supermarket). Participants Community-dwelling first-generation KAE (n=1,118; mean age ±SD; 70.5 ±7.0 years; female: 67.2%). Measurements Trained bilingual nurses and community health workers interviewed participants face-to-face for demographic information, chronic conditions, and depression using the Korean versions of the Patient Health Questionnaire (PHQ-9K). Results 30.3% of KAEs were classified as having either mild (PHQ-9K score = 5 to 9; n=218, 19.5%) or clinical depression (PHQ-9K score >=10; n = 120, 10.8%), respectively. One of seven KAE (n=164, 14.7%) endorsed thoughts of death or self-injury, but only 63 (5.7%) reported utilizing mental health services. We also identified several predictors of depression, including living arrangement (living alone vs. living with family/spouse); having chronic conditions such as diabetes, arthritis, digestive disorders, or chronic bronchitis; years of education; and cognitive impairment. Conclusions Our findings reveal a high prevalence of depression among KAE and a low level of mental health service utilization. Because there are urgent needs for culturally and contextually relevant interventions, we also discuss the feasibility of community-based interventions to reduce the burden of depression, which should be incorporated into a management system for multiple chronic conditions.

Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes

“…Then the differences between the two groups in mild (12.1%; z=4.59, 95% CI 0.062 to 0.180, p<0.001) and clinical (3.4%; z=1.55, 95% CI −0.013 to 0.081, p=0.121) depression can be attributed to personal, social, and environmental factors, some of which are modifiable. In fact, KAs' depression prevalence (measured by the PHQ-9) was higher than any other previous depression estimations among KAs including those in our own studies with KA elderly (≥60 years old, 30.3%)13 and South Korean elderly (27.8%)21 as well as in a comparative epidemiological study of Korean, Japanese, and Chinese American adults (33.3%, 15.7%, and 20.4%, respectively) 4. The high prevalence of depression among KAs with DM is alarming.…”

“…KAs, predominantly first-generation immigrants, suffer from a disproportionally high incidence of depression10 11 and DM,12 and they are socially isolated by linguistic and cultural barriers. A recent epidemiological study of elderly KAs (age ≥60) has reported a prevalence of depression of over 30% on the Patient Health Questionnaire (PHQ-9; mild depression score, 5–9; clinical depression, ≥10);13 DM was significantly correlated with depression. As depression affects individuals' abilities at DM self-management as well as clinical outcomes, future DM treatment and interventions will require a holistic approach, integrating strategies to improve mental and physiological health.…”

Community Health Workers Versus Nurses as Counselors or Case Managers in a Self-Help Diabetes Management Program

“…Only a few studies have reported employing community health workers for health coaches, counselors, or case managers, with varying degrees of fidelity. 9,11,21–24 …”

“…1,2 When it is combined with other theoretical frameworks that are designed to explain human behaviors, including the self-help model, 3 social learning theory, 4 and diffusion theory, 5,6 community-based participatory research has proved especially effective in the management and control of chronic conditions, including smoking cessation, 7 hypertension, 8 diabetes, 9,10 and depression. 11 …”

Health Disparities Research in Geriatric Mental Health: Commentary from the National Institute of Mental Health

“…What is clear from this article is that several approaches and strategies are needed to effectively recruit and retain a diverse sample of community-dwelling elders for participation in research studies. Jang et al 12 and Kim et al 13 describe interesting research that attempts to bridge gaps in both the understanding and the assessment of both clinical and cognitive domains among elder racial and ethnic minority populations. In addition to discussing the prevalence and perception of affective symptoms in these populations, both reports note high levels of problems and unmet service utilization in these groups due to both structural and individual differences in the perception of mental health distress and in willingness to seek treatment from traditional mental health sources.…”