Major Depression in Chinese Americans: The Role of Informal Supportive Network

Purpose. Depression is a worldwide public health problem and is projected to be the leading cause of disability in the U.S.  Due to the strong stigma associated with mental illness such as depression, Chinese American families tend to restrict the disclosure of mental health issues to family members or closed ones. Given the important role of informal supportive network in the Chinese culture, this study aims to provide empirical evidence regarding the relations between the perceived informal supportive network and the likelihood of major depression occurrence among Chinese Americans.

Methods.  This study used a national representative sample of Chinese Americans (N=600) that was derived from the National Latino and Asian American Study (NLAAS).  The NLAAS research team has ensured that the instruments used with Latino and Asian Americans have evidenced validity and reliability (Alegria et al., 2004). Participants in the sample aged from 18 to 99, with 53.7% female and 81.9% born outside the U.S.  Major depression was determined by the DSM-IV criteria of the lifetime major depression.  We conceptualized informal supportive network to encompass support from family, relatives and friends.  We included family cohesion and family conflict to capture the diversity of family process. Thus, informal supportive network was measured by four scales: the Family Cohesion Scale, the Family Conflict Scale, and two separate scales measuring perceived support from friends and relatives. Hierarchical logistic regression analyses were used to identify the contribution of informal supportive network in predicting the likelihood of major depression occurrence beyond control variables (i.e., demographics, health status, and nativity and English proficiency as proxies of acculturation). All estimates and analyses were weighted to adjust for non-response and the complex survey design.

Results.  Among the 600 participants, 11.3% had a lifetime major depressive disorder. Results from the hierarchical logic regressions suggest that family conflict was associated with a greater likelihood of major depression; and so were more perceived support from friends and relatives. Family cohesion was related to lower likelihood of major depression but such a relationship was not significant. Being female and being unmarried were associated with a greater likelihood of major depression. In terms of the influence of acculturation, being born in the U.S. was associated with a greater likelihood of major depression, while English proficiency was related to a lower likelihood of major depression.

Conclusions and Implications. Acknowledging the cross-sectional nature of this study, we suspect that depressed Chinese Americans tended to seek and receive more support from relative and friends rather than more informal support caused more depression.  Family conflict is a risk factor for depressive feelings among Chinese Americans. Findings of this study highlight the important role of informal support network in influencing mental health status of Chinese Americans. The findings are helpful for professionals including social work practitioners to construct more culturally appropriate assessments of informal supportive network, thereby identifying those who are at high risk of depression.