Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community
Abstract
:1. Introduction
2. Experimental Section
2.1. Methods
2.1.1. Participants
Characteristic | n (%) |
---|---|
Marital status | |
Single | 74 (21.1) |
Married | 256 (73.1) |
Widowed | 7 (2.0) |
Separated/divorced | 6 (1.7) |
Education | |
No high-school diploma | 18 (5.1) |
High-school diploma | 61 (17.4) |
Some college | 88 (25.1) |
≥Bachelor’s degree | 172 (49.1) |
Employment a | |
Employed | 198 (56.6) |
Unemployed | 150 (42.9) |
Birth place | |
U.S. | 46 (13.1) |
India | 293 (83.7) |
Other b | 9 (2.6) |
Living in a joint family c | |
Yes | 187 (53.4) |
No | 123 (35.1) |
M (SD) | |
Age | 41.85 (15.38) |
Years Married | 32.98 (25.20) |
Age Married | 24.04 (3.82) |
Years in U.S. | 18.62 (10.78) |
Assimilation | 0.72 (1.40) |
Separation | 2.77 (2.47) |
Integration | 4.32 (2.46) |
Marginalization | 0.14 (0.64) |
Attitudes towards women | 30.83 (6.98) |
Domestic violence myths | 3.53 (1.14) |
Positive religious coping | 5.36 (2.38) |
Negative religious coping | 8.43 (2.71) |
Overall religiosity | 1.67 (0.80) |
Satisfaction with life | 23.10 (8.87) |
Anxiety | 5.49 (5.27) |
Depression | 5.04 (5.32) |
2.1.2. Materials
2.2. Procedures
2.3. Measures
2.3.1. Satisfaction with Life Scale (SWLS)
2.3.2. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
2.3.3. Short Attitudes toward Women Scale (AWS)
2.3.4. Domestic Violence Myth Acceptance Scale (DVMAS)
2.3.5. Short Form of the Brief RCOPE
2.3.6. Patient Health Questionnaire 9 (PHQ-9)
2.3.7. General Anxiety Disorder-7 (GAD-7)
2.4. Analysis
3. Results
3.1. Preliminary Analysis
3.2. Bivariate Analysis
3.3. Multiple Regression
Characteristic | Women | Men | ||
---|---|---|---|---|
Punjabi (n = 52) | English (n = 165) | Punjabi (n = 30) | English (n = 103) | |
n (%) | n (%) | |||
Marital status | ||||
Single | 5 (9.6) | 22 (13.3) | 3 (10.0) | 44 (42.7) |
Married | 41 (78.8) | 133 (80.6) | 26 (86.7) | 56 (54.4) * |
Widowed | 3 (5.8) | 3 (1.8) | 1 (3.3) | 0 |
Separated/divorced | 0 | 4 (2.4) | 0 | 2 (1.9) |
Education | ||||
No high-school diploma | 5 (9.6) | 8 (4.8) | 2 (6.7) | 3 (2.9) |
High-school diploma | 15 (28.8) | 15 (9.1) | 13 (43.3) | 18 (17.5) |
Some college | 20 (38.5) | 32 (19.4) | 9 (30.0) | 27 (26.2) |
≥ Bachelor’s degree | 11 (21.2) | 104 (63.0) ** | 3 (10.0) | 54 (52.4) ** |
Employment a | ||||
Employed | 22 (42.3) | 88 (53.3) | 17 (56.7) | 32 (31.1) |
Unemployed | 29 (55.8) | 77 (46.7) | 12 (40) | 71 (86.9) |
Birth place | ||||
U.S. | 3 (5.8) | 18 (10.9) | 1 (3.3) | 24 (23.3) * |
India | 48 (92.3) | 140 (84.8) | 29 (96.7) | 76 (73.8) |
Other b | 0 | 6 (3.6) | 0 | 3 (2.9) |
Living in a joint family c | ||||
Yes | 41 (78.8) | 75 (45.5) *** | 26 (86.7) | 45 (43.7) *** |
No | 7 (13.5) | 70 (42.4) | 3 (10.0) | 43 (41.7) |
M (SD) | M (SD) | |||
Age | 45.67 (13.42) | 41.01 (12.82) * | 53.90 (16.22) | 37.78 (17.63) ** |
Years Married | 22.96 (13.09) | 19.11 (11.86) | 31.77 (16.33) | 20.22 (14.85) * |
Age Married | 23.29 (4.31) | 24.00 (17.39) | 24.81 (4.36) | 26.16 (5.32) |
Years in U.S. | 15.02 (10.47) | 19.61 (10.42) * | 14.72 (10.72) | 19.97 (11.02) * |
Assimilation | 0.38 (1.11) | 0.69 (1.27) | 0.24 (0.44) | 1.08 (1.78) ** |
Separation | 3.60 (2.42) | 2.56 (2.29) ** | 4.55 (2.94) | 2.19 (2.35) ** |
Integration | 3.48 (2.34) | 4.64 (2.34) ** | 2.76 (2.53) | 4.66 (2.44) ** |
Marginalization | 0.40 (1.11) | 0.09 (0.60) | 0.21 (0.56) | 0.08 (0.31) |
Attitudes towards women | 27.38 (5.70) | 32.19 (6.33) *** | 25.60 (3.37) | 31.67 (7.78) *** |
Domestic violence myths | 3.87 (0.90) | 3.34 (1.14) * | 4.28 (1.02) | 3.49 (1.19) * |
Positive religious coping | 6.19 (2.59) | 4.95 (2.19) ** | 4.70 (1.92) | 5.67 (2.49) |
Negative religious coping | 7.80 (2.56) | 8.45 (2.89) | 8.34 (2.71) | 8.70 (2.52) |
Overall religiosity | 2.06 (0.97) | 1.51 (.68) ** | 1.65 (0.94) | 1.69 (0.78) |
Satisfaction with life | 15.88 (8.83) | 26.23 (7.28) *** | 16.64 (8.78) | 23.92 (8.18) *** |
Anxiety | 7.19 (5.16) | 6.00 (5.32) | 4.36 (4.56) | 4.37 (5.19) |
Depression | 7.73 (6.19) | 4.89 (5.24) ** | 3.42 (3.96) | 4.39 (4.94) |
Characteristics Correlated with Depression | English n = 126 | Punjabi n = 45 |
---|---|---|
Age | −0.139 | −0.144 |
Employed | −0.123 | −0.010 |
≥Bachelor’s degree | −0.150 | 0.294 |
U.S. Born | 0.031 | 0.062 |
Years in the U.S. | −0.100 | −0.177 |
Ever or currently married | 0.129 | −0.269 |
Age married | 0.106 | 0.417 ** |
Years married | 0.122 | 0.243 |
Living in joint family | 0.023 | −0.237 |
Ideal family size | 0.200 * | 0.001 |
Ideal number of boys | 0.146 | −0.047 |
Ideal number of girls | −0.075 | 0.139 |
Age at first pregnancy | −0.166 | −0.324 * |
Assimilation | 0.017 | −0.058 |
Separation | 0.018 | −0.039 |
Integration | −0.023 | 0.129 |
Marginalization | 0.010 | −0.164 |
Positive religious coping | −0.163 | 0.286 |
Negative religious coping | −0.298 ** | −0.174 |
Overall religiosity | −0.058 | 0.126 |
Attitudes towards women | −0.039 | −0.075 |
Domestic violence myths | −0.060 | −0.333 * |
Satisfaction with life | −0.143 | 0.031 |
Anxiety | 0.770 *** | 0.763 ** |
Women Who Did the English Survey | Depression | |||
Model 1 (r2 = 0.127) | B | SE B | β | 95% CI |
Ideal family size | 2.04 | 0.75 | 0.258 ** | 0.55–3.52 |
Negative religious coping | −0.52 | 0.18 | −0.280 ** | −0.86–−0.17 |
Model 2 (r2 = 0.647) | B | SE B | β | 95% CI |
Ideal family size | 0.49 | 0.51 | 0.061 | −0.52–1.49 |
Negative religious coping | −0.28 | 0.12 | −0.149 * | −0.51–−0.04 |
Anxiety | 0.79 | 0.07 | 0.753 *** | 0.65–0.92 |
Women Who Did the Punjabi Survey | Depression | |||
Model 1 (r2 = 0.519) | B | SE B | β | 95% CI |
Age married | 0.41 | 0.30 | 0.317 | −0.20–1.02 |
Age at first pregnancy | −0.84 | 0.38 | −0.505 * | −1.62–−0.06 |
Domestic violence myth acceptance | −0.86 | 1.33 | −0.116 | −3.57–1.86 |
Model 2 (r2 = 0.568) | B | SE B | β | 95% CI |
Age married | 0.05 | 0.24 | 0.041 | −0.44–0.55 |
Age at first pregnancy | −0.43 | 0.31 | −0.259 | −1.06–0.20 |
Domestic violence myth acceptance | 0.15 | 1.04 | 0.020 | −1.98–2.28 |
Anxiety | 0.82 | 0.18 | 0.664 *** | 0.45–1.19 |
3.4. Qualitative Results
3.4.1. Acculturative Difference by Language
3.4.2. Marriage and Family Conflict
3.4.3. Domestic Abuse Issues
Qualitative Theme | Quantitative | |
---|---|---|
Theme 1: Acculturative Differences by Language | Correlates of Themes | |
“...because we were raised in India, our society was different. Our in-laws and our parents—we came with those kinds of values. Our kids are raised differently. Their bringing up and our bringing up was different. For them, it will be a burden if I don’t change.” (Punjabi language preference female focus group participant) |
| |
“...but my husband was also taking the responsibility back home (India) for whole family…I was raised here (U.S.), even nobody told me, but I knew that’s what’s going to be expected from me…I kept quiet even if I didn’t like it.” (English language preference female focus group participant) | ||
“In India, I was going to college and I was doing my masters and I was doing research to write a book and I wanted to be a teacher, and I got married and I had to leave my studies. So I wanted more of a career…but then I came here (U.S.) so everything got changed. Since then, I have been in my family, I had my kids, taking care of them and my mother-in-law, she’s a 24-h bed patient and I am taking care of her.” (Punjabi language preference female key informant) | ||
“So for me there was this fear to even talk to men. I think our own sexuality was affected-like in terms of how do you perceive yourself you know? I’m a woman, and is it OK to even talk to a guy? And be yourself and just feel like a woman? I struggle with that to this day. There is that fear. To me it was fear that was embedded in my conscious.” (English language preference female focus group participant) | ||
“Yeah definitely as an adolescent it’s depressing, like you know because again you don’t know, you’re growing up in this first generation culture where it’s like your parents don’t understand where you’re coming from. You wanna be more liberal you know, you can’t voice your concerns, you can’t do none of that stuff so it, there will, there can be times that it can be, you know, really depressing and if you don’t have again, somebody to talk to, luckily I had friends and stuff that were going through the same stuff, but as far as family goes, nobody.” (English language preference female key informant) | ||
Theme 2: Marriage & Family Conflicts | Correlates of Themes | |
“…I think a lot of women are expected to be submissive once they get married, because again their parents don’t want that shame.” (English language preference female key informant) |
| |
“You have to adjust your lifestyle to that of the family you’re marrying into. You have the responsibility of the children, husband. Major change happens.” (Punjabi language preference female key informant) | ||
“Everything was in the hands of my husband and my mother-in-law, all the decisions, everything, it was between the mother and son…daughter in laws are always the outsiders, okay.” (Punjabi language preference female focus group participant) | ||
“I came here (U.S.) when I got married and joined my husband’s business….now I have 2 kids so I’m a housewife and a working person, who’s not given any credit because the pay check doesn’t come home.” (Punjabi language preference female focus group participant) | ||
“…they (in-laws) expect that the daughter-in-law come in and do everything…but it doesn’t work like that, it’s like if there’s more people and just the daughter-in-law is doing the work-that’s a lotttt to do-no one wants to do that.” (Punjabi language preference female key informant) | ||
Theme 3: Domestic Abuse Issues | Correlates of Themes | |
“Abuse, um—I’ve been it, but they don’t say anything. So, if they’re not saying I guess it is OK.” (English language preference female key informant) |
| |
“Before you couldn’t (go outside the family for help), no one wanted that their own family matters and situations be revealed outside. But if there’s a lot of abuse going on, only a brave girl will go out and talk to someone about it. In my cause, I would resolve it at home as much as I can…mostly I would keep it in my own family to resolve. The outside world doesn’t help as much as you think- they tend to just listen and enjoy the entertainment you’re feeding them.” (Punjabi language preference female key informant) | ||
“That is really messed up, lots of health problems arise when knowing there’s no decent help I can receive. Girls will start to worry knowing that they have wedded into this family, and no one else will be able to take care of us. Even if they hit me or whatever, there’s no one else that can be trusted. If there can be any lady that sees this it could be helpful, but if you come across another man things can get worse…emotionally its very tough.” (Punjabi language preference female key informant) | ||
“…If there’s a person that they (women in need of help) could talk to and feel safe at the same time doing it, with complete confidentiality and someone who will listen to them- would be something good. That will lessen anxiety, (be) cause lots of problems arise with anxiety…but sadly there is no one like that..“ (Punjabi language preference female key informant) |
“Lots (of women face this problem). Indian women that are already facing lots of problems that do discuss with someone and even they might keep it inside them because they don’t want to create more problems usually end up not saying anything.” (Primarily Punjabi speaking female KI).
4. Discussion
“...It takes a long time for a Punjabi woman to see a psychiatrist, to get help. As I said it’s a taboo…” (KI-Punjabi health care provider).
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Roberts, L.R.; Mann, S.K.; Montgomery, S.B. Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community. Int. J. Environ. Res. Public Health 2016, 13, 27. https://doi.org/10.3390/ijerph13010027
Roberts LR, Mann SK, Montgomery SB. Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community. International Journal of Environmental Research and Public Health. 2016; 13(1):27. https://doi.org/10.3390/ijerph13010027
Chicago/Turabian StyleRoberts, Lisa R., Semran K. Mann, and Susanne B. Montgomery. 2016. "Depression, a Hidden Mental Health Disparity in an Asian Indian Immigrant Community" International Journal of Environmental Research and Public Health 13, no. 1: 27. https://doi.org/10.3390/ijerph13010027