Is Social Support Associated with Depression Help-Seeking Behaviors Among U.S. Chinese Older Adults?

Background and Purpose: Depression has become one major mental health concern among U.S. Chinese older adults, the largest ethnic subgroup of older Asian Americans. This population is found to be vulnerable to depression which may result from a host of risk factors, such as chronic illness, traumatic experience, and acculturative stress. Despite their vulnerability, this population tend to underutilize help-seeking behaviors as a mechanism to cope with depression. Knowledge about factors associated with the use of formal (e.g., mental health related services) and informal (e.g., family, friend, or partner) depression help-seeking behaviors warrants further investigation. Amongst, social support plays a key role in affecting one’s awareness and acknowledgement of mental health needs and decision on whether to seek help and from which source, which is particularly salient given the collectivist Chinese culture. Yet, less is known about the role of social support on help-seeking for depression among this population. To address the knowledge gap, guided by Andersen’s Behavioral Model, this study investigates the extent to which social support is associated with U.S. Chinese older adults’ use of formal and informal help-seeking behaviors for elder depression.

Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE), a community-engaged, population-based epidemiological study. Depression help-seeking behavior was assessed by asking respondents whether they had gone for advice or help for elder depression during the past 2 years from a list of formal service providers such as mental health professionals, Western primary care physicians, and religious workers (use of formal help-seeking behavior, coded as yes/no), or from family, friend, or partner (use of informal help-seeking behavior, coded as yes/no). Social support was assessed using a 12-item measurement adopted from the Health and Retirement Study to evaluate participants’ perceived positive support and negative support from partner, family members, and friends. Stepwise logistic regression models were conducted to examine whether seeking help from formal and informal sources was related to positive and negative social support, respectively, controlling for covariates.

Results: The study sample consisted of 994 Chinese older adults with depressive symptoms (mean age of 74.81 ± 8.31 years old, 66.30% female). Of these participants who had depressive symptoms, approximately 40% and 88% reported the use of formal and informal help-seeking behaviors, respectively, during the past 2 years for advice or help for depression. Findings from logistic regressions indicated that U.S. Chinese older adults with higher level of positive social support were more likely to use both formal and informal help-seeking behaviors for depression. Whereas negative social support did not emerge as a significant predictor to depression help-seeking.

Conclusions and Implications: The study findings underscore the critical role of positive social support in influencing U.S. Chinese older adults’ depression help-seeking behaviors. Tailored strategies that promote positive support between older Chinese Americans and their social network members, and culturally appropriate interventions that facilitate depression help-seeking behaviors, are suggested to better address the mental health needs of this vulnerable population.