Life Course Trauma and Chinese American Older Adults' Trust in Physicians

Background and Purpose: Cultural beliefs greatly influence the occurrence and perception of abuse and trauma among racial/ethnic minority populations.  Within the United States, the Chinese community is the largest and the fastest growing Asian American subgroup population. The population of U.S. Chinese adults aged 65 and above has increased by 55% in the past decade, far exceeding the population growth rate of 15% among U.S. older adults.  Despite a growing population, little is known about how traumatic events over the life course impact older Chinese Americans’ help-seeking behaviors. This study addresses the knowledge gap by applying Andersen’s behavioral model to an existing epidemiological study of Chinese American older adults in order to test the effects of traumatic events across the lifespan on trust in physicians.   

Methods: This study analyzed data from the Population Study of Chinese Elderly in Chicago (PINE), a population-based epidemiological study (N=3158).  Screening questions were used to identify the physical, verbal, and emotional dimensions of past child abuse and intimate partner violence (IPV). Elder mistreatment was measured using a 10-item self-reported instrument, derived from the Hwalek–Sengstok Elder Abuse Screening Test (H-S/EAST) and the Vulnerability to Abuse Screening Scale.  The dependent variable was measured using the Trust in Physician Scale. Model covariates were included based on the behavioral model.

Results: Elder mistreatment was endorsed by 15% of the sample, child abuse by 11%, and IPV by 6%.  The mean value of the Trust in Physician Scale was 42.0 (range 12-55, sd=6.4). Spearman correlation results showed significant, negative relationships among trust in physicians and child abuse (r=-.11, p<.001), IPV (r=-.09, p<.001), and elder mistreatment (r=-.14, p<.001).  Hierarchical OLS regression modeling showed the independent effects of child abuse (b=-1.04, p=.004), IPV (b=-1.35, p=.007), and elder mistreatment (b=-1.73, p<.0001) on trust in physicians. Among the behavioral model covariates, overall health status (b=.62, p=.01), satisfaction with insurance (b=2.63, p<.0001), speaking Chinese only (b=.79, p=.006) were each associated with increased trust in physicians.

Conclusions and Implications: The experience of child abuse, intimate partner violence, and elder mistreatment has deleterious effects on trust in physicians.  With implications for help-seeking behaviors that rely upon interpersonal trust, this study extends the effects of trauma across the life course. Implications for social work research and trauma-informed practice will be discussed.