Factors Contributing to Hwabyung and Depressive Symptoms of Korean Immigrants in the United States

Purpose: The strikingly high prevalence of hwabyung among Korean immigrants in the United States is unprecedented. Hwabyung is a culture-bound syndrome fairly common among Koreans. A prolonged suppression of stress can cause the onset of this indigenous illness. Almost 12% of Korean immigrants suffer from hwabyung in contrast to a 4.2% reported prevalence rate among the general population in Korea (Lin, et al, 1992; Min, Namkoong, Lee, 1990). Despite its pervasiveness, little is known about hwabyung in the United States. This study examines the factors contributing to hwabyung and depressive symptoms among Korean immigrants. The following questions guided this study: (1) What are the relative importance of social support, self-esteem, and differences in individual characteristics on hwabyung and depressive symptoms? (2) What is the correlation between hwabyung and depressive symptoms?

Method: This cross-sectional study employed a non-probability sample of 242 adult Koreans who immigrated to the United States at the age of 18 and older. In addition to individual characteristics relevant to demographic makeup, socioeconomic conditions, and acculturation, a self-administered anonymous survey consisted of four standardized Korean language instruments including the Hwabyung Scale, the CES-D Scale, the Social Support Scale, and the Rosenberg Self-Esteem Scale. A series of hierarchical multiple regression (R2) analyses were performed utilizing three blocks: Sense of self-esteem in the first block; social support in the second block. In the third block, individual characteristics were entered. Pearson's correlation coefficient (r) was performed to determine the statistically significant link between the hwabyung and depressive symptoms.

Results: The hierarchical multiple regression (R2) analyses demonstrated that a sense of self-esteem, social support, and individual characteristics explained 38% of the variance in hwabyung symptoms (F14, 208 = 223; p < .001) and 25% of the variance in depressive symptoms (F14, 207 = 4.90; p < .001). Five independent variables including social support (18.5%), sense of self-esteem (5.8%), having a graduate school education in the United Sates (4.0%), receiving money from Korea (3.6%), and being a woman (2.5%) were found to be significantly related to hwabyung symptoms. Although social support (7.84%) and sense of self-esteem (6.25%) were significantly linked to depressive symptoms, no factors related to individual characteristics appeared to have a significant impact on depressive symptoms. Also, a positive, moderate correlation (r = .56; P < .001) between hwabyung and depressive symptoms was found.

Implications: The findings of the study underscore the importance of culturally appropriate practice. Korean immigrants tend to underutilize metal health services because the conventional diagnostic criteria do not capture their expression of psychiatric symptoms. By being familiar with hwabyung symptoms, social workers can provide mental health services that take into account Korean culture that shapes Korean immigrants expression of psychiatric symptoms. Along with discussing the culturally specific illness and coping behaviors of Korean immigrants, policy and research implications are presented.