Journal of Immigrant and Minority Health

, Volume 14, Issue 3, pp 361–370 | Cite as

Discrimination, Family Relationships, and Major Depression Among Asian Americans

  • David H. Chae
  • Sunmin Lee
  • Karen D. Lincoln
  • Emily S. Ihara
Original Paper


Depression represents a growing concern among Asian Americans. This study examined whether discrimination and family dynamics are associated with depression in this population. Weighted logistic regressions using nationally representative data on Asian American adults (N = 2095) were used to examine associations between discrimination, negative interactions with relatives, family support, and 12-month major depressive disorder (MDD). Discrimination (odds ratio [OR] = 2.13, 95% confidence interval [CI] = 1.67, 2.71) and negative interactions with relatives (OR = 1.28, 95% CI = 1.03, 1.58) were positively associated with MDD. Family support was associated with lower MDD (OR = 0.73, 95% CI = 0.59, 0.89), and buffered lower levels of discrimination. Results suggest that discrimination may have negative mental health implications, and also point to the importance of family relationships for depression among Asian Americans. Findings suggest that providers may consider stress experienced at multiple ecological levels to address Asian American mental health needs.


Asian Americans Major depressive disorder Discrimination Family relationships 



The National Latino and Asian American Study is funded by the National Institute of Mental Health (NIMH U01 MH62209 and U01 MH62207) with additional support from the Office of Behavioral and Social Science Research and the Substance Abuse and Mental Health Services Administration.


  1. 1.
    Sue S, Chu JY. The mental health of ethnic minority groups: challenges posed by the supplement to the Surgeon General’s Report on Mental Health. Cult Med Psychiatry. 2003;27:447–65.PubMedCrossRefGoogle Scholar
  2. 2.
    Kearney LK, Draper M, Baron A. Counseling utilization by ethnic minority college students. Cultur Divers Ethnic Minor Psychol. 2005;11:272–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Young CB, Fang DZ, Zisook S. Depression in Asian-American and Caucasian undergraduate students. J Affect Disord. 2010;125:379–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Duldulao AA, Takeuchi DT, Hong S. Correlates of suicidal behaviors among Asian Americans. Arch Suicide Res. 2009;13:277–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Takeuchi DT, Zane N, Hong S, Chae DH, Gong F, Gee GC, Walton E, Sue S, Alegría M. Immigration-related factors and mental disorders among Asian Americans. Am J Public Health. 2007;97:84–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Barreto RM, Segal SP. Use of mental health services by Asian Americans. Psychiatr Serv. 2005;56:746–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Spencer MS, Chen J, Gee GC, Fabian CG, Takeuchi DT. Discrimination and mental health-related service use in a national study of Asian Americans. Am J Public Health. 2010;100:2410–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Georg Hsu LK, Wan YM, Chang H, Summergrad P, Tsang BY, Chen H. Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry. 2009;71:210–8.Google Scholar
  9. 9.
    Noh S, Kaspar V, Wickrama KA. Overt and subtle racial discrimination and mental health: preliminary findings for Korean immigrants. Am J Public Health. 2007;97:1269–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Gee GC, Spencer M, Chen J, Yip T, Takeuchi DT. The association between self-reported racial discrimination and 12-month DSM-IV mental disorders among Asian Americans nationwide. Soc Sci Med. 2007;64:1984–96.PubMedCrossRefGoogle Scholar
  11. 11.
    Hwang WC, Goto S. The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultur Divers Ethnic Minor Psychol. 2008;14:326–35.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheng JK, Fancher TL, Ratanasen M, Conner KR, Duberstein PR, Sue S, Takeuchi D. Lifetime suicidal ideation and suicide attempts in Asian Americans. Asian Am J Psychol. 2010;1:18–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Juang LP, Alvarez AA. Discrimination and adjustment among Chinese American adolescents: family conflict and family cohesion as vulnerability and protective factors. Am J Public Health. 2010;100:2403–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Gee GC. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health. 2002;92:615–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Sue DW, Bucceri J, Lin AI, Nadal KL, Torino GC. Racial microaggressions and the Asian American experience. Cultur Divers Ethnic Minor Psychol. 2007;13:72–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Gee GC, Ro A, Shariff-Marco S, Chae D. Discrimination and health among Asian Americans: evidence, assessment, and direction for future research. Epidemiol Rev. 2009;31:130–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93:200–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003;93:215–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404–16.PubMedGoogle Scholar
  20. 20.
    Spencer MS, Chen J. Effect of discrimination on mental health service utilization among Chinese Americas. Am J Public Health. 2004;64:809–14.CrossRefGoogle Scholar
  21. 21.
    Huang B, Appel H, Ai AL. The effects of discrimination and acculturation to service seeking satisfaction for Latina and Asian American women: implications of mental health professions. Soc Work Public Health. 2011;26:46–59.PubMedCrossRefGoogle Scholar
  22. 22.
    Pettigrew TF. Social evaluation theory: convergences and applications. In: Levine D, editor. Nebraska symposium on motivation. Lincoln: University of Nebraska Press; 1967. p. 241–304.Google Scholar
  23. 23.
    Mead GH. Mind, self, and society. Chicago: University of Chicago Press; 1934.Google Scholar
  24. 24.
    Zhou M. Growing up American: the challenge confronting immigrant children and children of immigrants. Ann Rev Sociol. 1997;23:63–95.CrossRefGoogle Scholar
  25. 25.
    Oyserman D, Sakamoto I. Being Asian American: identity, cultural constructs, and stereotype perception. J App Behav Sci. 1997;33:435–53.CrossRefGoogle Scholar
  26. 26.
    Kwak K. Adolescents and their parents: a review of intergenerational family relations for immigrant and non-immigrant families. Hum Dev. 2003;46:115–36.CrossRefGoogle Scholar
  27. 27.
    Fuligni AJ, Tseng V, Lam M. Attitudes toward family obligations among American adolescents with Asian, Latin American, and European backgrounds. Child Dev. 1999;70:1030–44.CrossRefGoogle Scholar
  28. 28.
    Juang LP, Alvarez AA. Discrimination and adjustment among Chinese American adolescents: family conflict and cohesion as vulnerability and protective factors. Am J Public Health. 2010;100:2403–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Juan LP, Syed M, Takagi M. Intergenerational discrepancies of parental control among Chinese American families: links to family conflict and adolescent depressive symptoms. J Adolesc. 2007;30:965–75.CrossRefGoogle Scholar
  30. 30.
    Kuo BC, Chong V, Joseph J. Depression and its psychosocial correlates among older Asian immigrants in North America: a critical review of two decades’ research. J Aging Health. 2008;20:615–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Park IJ, Kim PY, Cheung RY, Kim M. The role of culture, family processes, and anger regulation in Korean American adolescents’ adjustment problems. Am J Orthopsychiatry. 2010;28:258–66.CrossRefGoogle Scholar
  32. 32.
    Hwang WC, Wood JJ. Acculturative family distancing: links with self-reported symptomatology among Asian Americans and Latinos. Child Psychiatry Hum Dev. 2009;40:123–38.PubMedCrossRefGoogle Scholar
  33. 33.
    Lee S, Juon H-S, Martinez G, Hsu CE, Robinson S, Bawa J, Ma GX. Model minority at risk: expressed needs of mental health by Asian American young adults. J Community Health. 2009;34:144–52.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim J, Choi NG. Twelve-month prevalence of DSM-IV mental disorders among older Asian Americans: comparison with younger groups. Aging Ment Health. 2010;14:90–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Yoon J, Lau AS. Maladaptive perfectionism and depressive symptoms among Asian American college students: contributions of interdependence and parental relations. Cultur Divers Ethnic Minor Psychol. 2008;14:92–101.PubMedCrossRefGoogle Scholar
  36. 36.
    Noh S, Kaspar V. Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health. 2003;93:232–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Yip T, Gee GC, Takuechi DT. Racial discrimination and psychological distress: the impact of ethnic identity and age among immigrant and United States-born Asian adults. Dev Psychol. 2008;44:787–800.PubMedCrossRefGoogle Scholar
  38. 38.
    Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The stress process. J Health Soc Behav. 1981;22:337–56.PubMedCrossRefGoogle Scholar
  39. 39.
    Pearlin LI, Mullan JT, Semple SL, Skaff MM. Caregiving and the stress process: an overview of concepts and measures. Gerontologist. 1990;30:583–94.PubMedCrossRefGoogle Scholar
  40. 40.
    Pennell BE, Bowers A, Carr D, Chardoul S, Cheung GQ, Dinkelmann K, Gebler N, Hansen SE, Pennell S, Torres M. The development and implementation of the National Comorbidity Survey Replication, the National Survey of American Life, and the National Latino and Asian American Survey. Int J Methods Psychiatr Res. 2004;13:241–69.PubMedCrossRefGoogle Scholar
  41. 41.
    Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P. Sample designs and sampling methods for the collaborative psychiatric epidemiology studies (CPES). Int J Methods Psychiatr Res. 2004;13:221–40.PubMedCrossRefGoogle Scholar
  42. 42.
    Alegria M, Takeuchi D, Canino G, Duan N, Shrout P, Meng XL, Vega W, Zane N, Vila D, Woo M, Vera M, Guarnaccia P, Aguilar-Gaxiola S, Sue S, Escobar J, Lin KM, Gong F. Considering context, place and culture: the National Latino and Asian American Study. Int J Methods Psychiatr Res. 2004;13:208–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13:93–121.PubMedCrossRefGoogle Scholar
  44. 44.
    Jordanova WC, Gerada C, Prince M. Validation of two survey diagnostic interview among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories. Psychol Med. 2004;34:1013–24.PubMedCrossRefGoogle Scholar
  45. 45.
    Kessler RC, Wittchen H-U, Abelson JM, Mcgonagle K, Schwarz N, Kendler KS, Knäuper B, Zhao S. Methodological studies of the composite international diagnostic interview (CIDI) in the US National Comorbidity Survey (NCS). Int J Methods Psychiatric Res. 1998;7:33–55.CrossRefGoogle Scholar
  46. 46.
    Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socioeconomic status, stress, and discrimination. J Health Psychol. 1997;2:331–5.CrossRefGoogle Scholar
  47. 47.
    US Census Bureau. Poverty in the United States: 2000. Washington, DC: US Government Printing Office; 2001.Google Scholar
  48. 48.
    National Center for Health Statistics. Health, United States, 1998 with Socioeconomic and Health Chartbook. Hyattsville, MD: US Government Printing Office; 1998.Google Scholar
  49. 49.
    Marlowe D, Crowne DP. Social desirability and response to perceived situational demands. J Consult Psychol. 1961;25:109–15.PubMedCrossRefGoogle Scholar
  50. 50.
    Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.CrossRefGoogle Scholar
  51. 51.
    Schafer JL, Graham JW. Missing data: our view of the state of the art. Psychol Meth. 2002;7:147–77.CrossRefGoogle Scholar
  52. 52.
    Allison PD. Multiple imputation for missing data—a cautionary tale. Sociol Meth Res. 2000;28:301–9.CrossRefGoogle Scholar
  53. 53.
    Horton NJ, Lipsitz SF, Parzen M. A potential for bias when rounding in multiple imputation. Am Stat. 2003;57:229–32.CrossRefGoogle Scholar
  54. 54.
    Schafer JL. Analysis of incomplete multivariate data. New York: Chapman and Hall; 1997.CrossRefGoogle Scholar
  55. 55.
    RTI International. SUDAAN: version 9.0.0. Research Triangle Park, NC: RTI; 2004.Google Scholar
  56. 56.
    Jaccard J. Interaction effects in logistic regression. Thousand Oaks: Sage; 2001.Google Scholar
  57. 57.
    Yeh KH, Bedford O. A test of the dual filial piety model. Asian J Soc Psychol. 2003;6:215–28.CrossRefGoogle Scholar
  58. 58.
    Youn G, Knight BG, Jeong H-S, Benton D. Differences in familism, values, and caregiving outcomes among Korean, Korean American, and White American dementia caregivers. Psychol Aging. 1999;14:355–64.PubMedCrossRefGoogle Scholar
  59. 59.
    Han H-R, Kim M, Lee H, Pistulk G, Kim KB. Correlates of depression in the Korean American elderly: focusing on personal resources of social support. J Cross Cult Gerontol. 2007;22:115–27.PubMedCrossRefGoogle Scholar
  60. 60.
    Adlwin C, Greenberger E. Cultural differences in predictors of depression. Am J Commun Psychol. 1987;15:789–813.CrossRefGoogle Scholar
  61. 61.
    Gee GC, Chen J, Spencer MS, See S, Kuester OA, Tran D, Takeuchi D. Social support as a buffer for perceived unfair treatment among Filipino Americans: differences between San Francisco and Honolulu. Am J Public Health. 2006;96:677–84.PubMedCrossRefGoogle Scholar
  62. 62.
    Yoshikawa H, Wilson PA, Chae DH, Cheng JF. Do family and friendship networks protect against the influence of discrimination on mental health and HIV risk among Asian and Pacific Islander gay men? AIDS Educ Prev. 2004;16:84–100.PubMedCrossRefGoogle Scholar
  63. 63.
    Chae DH, Gavin AR, Takeuchi DT. Smoking prevalence among Asian Americans: findings from the National Latino and Asian American Study (NLAAS). Public Health Rep. 2006;121:755–63.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • David H. Chae
    • 1
  • Sunmin Lee
    • 2
  • Karen D. Lincoln
    • 3
  • Emily S. Ihara
    • 4
  1. 1.Department of Behavioral Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthUniversity of MarylandCollege ParkUSA
  3. 3.School of Social WorkUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of Social Work, College of Health and Human ServicesGeorge Mason UniversityFairfaxUSA

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