The Effects of Acculturation on Depression among Older Adult U.S. Immigrants
Introduction
With the advancement of medical technology, Americans are enjoying an extended life span. The growth of the older population has been significant over the past couple of years, which surprising. According to Cho (2019), while the population of the older population aged 65 years and above continues to grow in the U.S, it is expected in the next ten years, the country will mark a vital demographic turning point based on the current statistics. However, while the expanded life span is certainly a good thing, it has created its own set of challenges given that the older population remains highly vulnerable to chronic illness such as mental conditions where depression is the most common. Older people are more likely to suffer from depression because old age denies them the opportunity to participate in the day to day activities by taking away their independence due to morbidities. While it is only 20 percent of the older population in America that has been diagnosed with depression, most of them believe that depression is not a major health issue which indicates the level of denial. Also, depression is highly misdiagnosed due to the overlapping symptoms with other conditions and is the leading contributor to depression among older adults. Considering the vulnerable state of older adults, immigrants are more susceptible to depression as a result of the challenges associated with acculturation alongside other contributing factors like genetics, socio-economic status, gender, and family history. To treat depression successfully among older adults, cultural competence is an essential skill among social workers.
Thus the objective of this paper is to thoroughly examine the overall effects of acculturation on depression amongst older adult immigrants in the U.S. Thus, the research is an important part of social work since understanding the underlying cultural assimilation challenges can be vital in improving the quality of lives for all clients. The systemic review will be useful in gaining better-understanding acculturation factors that contribute to depression among older adults. Acculturation refers to the process of assimilating to the dominant culture which involves the change of behavior, values, attitudes as well as an identity which leads to the development of a new cultural belief. The acculturation process has widely been hypothesized across studies as stress and might adversely affect the mental health of individuals as it compels individuals to choose between two conflicting identities while trying to fit in a society that is aggressive to minorities. Acculturation has been established to intensify depression levels among older immigrants in the U.S. The report will begin by a review of existing literature to establish the overall implication of acculturation on depression among older U.S immigrants. This will be followed by a methodology section outlining the approaches to be used in data collection and analysis and a discussion of challenges and limitations associated with the current research.
Literature Review
Depression is one of the most common mental related illnesses that affect individuals of all ages. Cho (2019) posits that older adults are more susceptible to the condition as old age affects their ability to actively participate in the socio-economic setting as before. The loss of independence alongside social challenges contributes to the intensification of stress among older adults. Depression tends to negatively affect the way people feel, think, or behave in general. Older adults suffering from depression are from low socio-economic settings, and this implies that a significant number are from a minority group (Mao, Xu, Guo & Chi, 2018). The situation is because they lack the needed family and social support which further creates more challenges for them hindering their ability to navigate on a day to day basis. For this particular group access to basic needs and healthcare is limited or does not exist and this makes them more vulnerable.
According to Kim & Choi (2015), while most individuals immigrate to the U.S before the age of 65, the immigration process offers both challenges and opportunities. The challenges normally become more evident during old age as they have to contend with their cultural and social changes that are required to adapt to the new setting. It is apparent that while the American culture is more individualistic and modern most of the minority cultures hold rather conservative beliefs. There is a clear and visible mental health disparity among the majority and minority. While most studies have widely documented socio-economic factors and genetics as the leading contributor to the existing disparity, most have failed to acknowledge the effects of acculturation on the widening rate of depression among older adults’ immigrants in the U.S.
Acculturation and Mental Health among Older Adults
Based on Kim, Kim, Han & Chin (2015) acculturation refers to the process of adapting or changing one’s values, attitudes, beliefs, identity, and behaviors those result in experiencing a new culture. Assimilation comes as a necessary occurrence for immigrants based on the need to avoid the hostility that is associated with being from a minority group. Based on the stress process framework, immigrants are highly disadvantaged in society and they are more susceptible to social-related stress. Elderly immigrants are more likely to be classified under the low socio-economic setting, limited social and health services, and vulnerability to linguistic and social isolation (Cho, 2019). For this population their ability to interact with the wider population is limited and this further complicates their experiences subjecting them to more stressors. Acculturated immigrants are far off better both socially and economically when compared to those that are not fully acculturated. For most of the older immigrants, they have adapted less to the host culture which is dominant and this, therefore, implies that they have minimal resources for coping and are at higher risk or poorer changes. The situation is more noticeable for the older population since the opportunities associated with acculturation tend to change for every generation and duration of residence in the host nation.
Fox, Entringer, Buss, DeHaene & Wadhwa (2015) established that there is a positive link between the challenges of adjustment in the process of acculturation and high-stress levels among older immigrants. Low acculturation due to linguistic challenges, illiteracy, and lack of social support contributes to a high depression rate (Cho, 2019). The stress that is acquired from cultural incongruence has adverse effects on older immigrants as it affects their psychological adaptation, coping ability, and access to essential services. Even though the level of acculturation is determined by the time spent in the host country, several factors such as education level and language barrier tend to hinder a significant number of older immigrants from successfully assimilating into the host country (Tran, Jorm, Johnson, Bambrick & Lujic, 2015). Most elder people despite spending a significant part of their life in the U.S retain their attachment to their conventional cultural values and also maintain close relationships with other individuals from their respective cultural backgrounds irrespective of their residence time.
Sun, Gao, Gao, Li & Hodge (2018) found that language plays a critical role throughout the acculturative change process. It is believed that close to 30 percent of older immigrants have challenges in speaking English which is the dominant language in the U.S. in this case, language barriers are likely to hinder individuals social and economic opportunities as well as access to social and health services and the lack of exposure to the basic institution for the elderly immigrants' communities (Cho, 2019). The partial English proficiency can serve as a significant life stressor contributing to limited functionality for the group. Hence, increased English proficiency is associated with better mental health outcomes among older immigrants.
Individual Culture versus the Individualistic Culture
According to Sun, FGao, Gao, Li & Hodge (2018), culture is a vibrant system comprising of rules and beliefs that are established a group of individuals to promote their survival by adhering to a set of norms, values, beliefs, and behaviors that are unique to the specific group. The individualistic culture generally upholds uniqueness and independent values while the collectivist culture normally tries to promote individual fitting in a community. Collectivism is about group process where individuals work together without promoting independence as the individualistic culture (Kim & Choi, 2015). Most of the minority ethnic groups are collective meaning that they are focused on creating a community-based harmony.
The U.S similar to other Western countries occupies an individualistic culture compared to Eastern and Asian countries which are individualistic (Kim & Choi, 2015). Therefore, immigrants from the collectivist cultures might face intense challenges trying to attain independence where community harmony is not encouraged which creates inner conflicts. For these individuals, they only become comfortable after examining the social-cultural suitability of a given role. Attention seeking and being competitive among these individuals is not something that they appreciate in general (Cho, 2019). In such cases, the difference between the two cultures is likely to create a major challenge to the overall adaptation process as they are surrounded by people who are focused on their independence and personal achievements to gain attention from others.
Acculturation and Social Support
As noted by Mao, W Xu, Guo & Chi (2018) social support serves as an essential factor that can be vital in mitigating stress that is normally acquired from the acculturative process. For immigrants, their social and familial networks are normally important in the acquisition of resources, information as well as emotional support. Social networks are considered as instrumental and emotional assistance that people gain from their interpersonal relationships. Social support is hypothesized as an aid that helps in diminishing the overall implications of stress on individuals’ mental health. In light of recent research, social support is perceived as an effective channel for coping with stress among older adults (Sun, FGao, Gao, Li & Hodge, 2018). The evidence of the research aligns with the notion that the components of social networks have a positive influence on the welfare of older adults’ immigrants especially those from collectivist culture. Having a wide or an intimate social network with family and friends is associated with low-stress levels hence eliminating the potential of depression. Older adults with great social support tend to experience an improved quality of life compared to the ones that lack the connection and this is consistent with their traditional norms which normally promotes interdependence.
Social support and acculturation are interlinked as they influence the quality of life experienced by older adults (Kim & Choi, 2015). Although increased acculturation among older immigrants leads to better mental health outcomes, certain cultural factors like familial, friends, and co-ethnic networks have been found to lead to lower stress levels and improved well-being. While most of the older adults tend to immigrate to the U.S in the hope of maintaining their family ties, their expectations are in most cases disrupted by the existing cultural differences which emerge as a result of their family members assimilating.
Depression among Older Adult Population
Arguably, immigration is one of the most stressful expresses for individuals seeking to assimilate into society. Changes about the social conditions and norms are challenging for older immigrants as they lack vital information that is required to fit in a society that is individualistic and less supportive of interdependence. Older people above 55 tend to experience migratory grief based on the inner conflict between their ancestral culture and norms within the host culture (Sun, FGao, Gao, Li & Hodge, 2018). For most of them, they hold the beliefs of their traditional culture very close and this normally affects their overall proficiency score in English compared to the younger population which increases their vulnerability rate. The language barrier is a factor that affects the ability of the individuals to gain great social networks leading to isolation and depression as the outcome.
Older adults particularly immigrants experience social adversities and migration-related stressors and this has negative effects on their behaviors and health outcomes. They are predisposed to depression and other chronic illnesses due to their socio-economic challenges, cultural barriers, and old-age vulnerabilities to morbidities (Cho, 2019). Low socioeconomic status remains to be a major health risk amongst older adults for depression. Most immigrants are believed to be living in a low socio-economic setting because of their limited educational achievement, lack of employment, and cultural challenges. Immigrants normally fight with feelings of psychosocial adversity and cultural challenges that affect their mental health in general (Kim & Choi, 2015). The lack of financial security also leads to stress as they are unable to afford basic services such as healthcare which they desperately require leading to depression. The feelings of hopelessness trigger deep emotions of being overwhelmed, which are associated with sadness and depression among older adults (Kim, BLinton, Cho & Ha, 2016).
Based on the above analysis of existing literature about the effect of acculturation on depression among older adults, a significant gap exists on approaches to address acculturation challenges. The issue of depression among older adults is believed to affect less than 20 percent of the population but is more dominant among immigrants. The factors that promote acculturation stressors in older adults need to be examined and suitable solutions to achieve cultural competence among social workers proposed to promote better mental outcomes among older immigrants.
Methodology
The Systematic Review
A systematic approach was utilized to review existing literature of qualitative and quantitative studies on the effects of acculturation on depression among older immigrants. A systematic approach involves reviewing past literature and the method is designed to investigate, assess, synthesize, and evaluate existing evidence with regard to a specific subject. Different peer-reviewed articles were selected for use for this study following the identified themes relating to the factors that make the acculturation of older immigrants in the U.S challenging. The articles reviewed are those that: examined the risk factors of depression among older immigrants, explored the factors that lead to improved mental health outcomes as a resulted of better acculturation and examined potential solutions for minimizing depression rates among older immigrants from the social work worldview.
The Literature Search
Articles reviewed were sourced from several healthcare databases including PubMed, Cochrane Library, Up ToDate, and EbscoHost. Peer-reviewed sources were preferred for this research based on their ability to provide reliable, accurate, and credible data. Sources published in the last five years were included in the study while those older than five years were eliminated based on their inability to offer relevant and timely data. The articles were generated by including one or more search terms and phrases such as depression, acculturation, and older immigrants. For the initial search, 800 articles were retrieved but most of them were eliminated particularly those that are not free to access. A large number of articles created a limitation since large exclusion criteria had to be applied to eliminate a significant number of sources. Articles published in the last 10 years were more compared to the ones published within the last five years.
Data Analysis
In analyzing data collected in the systematic review, thematic analysis was selected as the appropriate approach. The objective of the study was to establish the overall effects of acculturation on depression among older immigrants. The study hypothesized that acculturation challenges contribute to higher depression levels among older immigrants. Thus, the data were summarized and classified three themes including acculturation level, social support and acculturation, and social support and acculturation.
Challenges and Limitations
Similar to any other study, this systematic review study was subject to several challenges and limitations. The main limitation faced by the study is a large data source. The search resulted in a significant number of articles which made it rather challenging to summarize and simplify the data. Narrowing the scope of research was challenging based on the availability of an extensive range of information. However, by focusing on the studies conducted in the U.S this was vital in guarding the reliability and credibility of the study.
Appendices
Search Strategy
A systematic approach was utilized to review existing literature of qualitative and quantitative studies on the effects of acculturation on depression among older immigrants. A systematic approach involves reviewing past literature and the method is designed to investigate, assess, synthesize, and evaluate existing evidence with regard to a specific subject. Different peer-reviewed articles were selected for use for this study following the identified themes relating to the factors that make the acculturation of older immigrants in the U.S challenging. The articles reviewed are those that: examined the risk factors of depression among older immigrants, explored the factors that lead to improved mental health outcomes as a resulted of better acculturation and examined potential solutions for minimizing depression rates among older immigrants from the social work worldview.
|
Screening |
Eligibility |
Included |
Exclusion |
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Ø Sources retrieved from database searching (n = 800 |
Ø Abstracts evaluated for eligibility based on title and publication date(n = 450) |
Ø Studies included in systematic review (n = 8) |
Ø Full-text articles excluded: Ø Focused on the population other than older adults Ø Not empirical and quantitative study-Published prior to 2015 or Not written in English (n=640) |
|
|
Ø Full-text articles evaluated for eligibility based on content (n=14) |
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References
Cho, S. (2019). Acculturation and Depression among Older U.S. Immigrants: A Systematic Review. Retrieved from: https://sophia.stkate.edu/msw_papers/866
Fox, M., Entringer, S., Buss, C., DeHaene, J., & Wadhwa, P. D. (2015). Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective. American journal of public health, 105(S3), S409-S423. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455494/
Kim, B. J., & Choi, Y. (2015). The relationship between activities of daily living (ADL), chronic diseases, and depression among older Korean immigrants. Educational gerontology, 41(6), 417-427. https://www.tandfonline.com/doi/abs/10.1080/03601277.2014.982006
Kim, B. J., Linton, K., Cho, S., & Ha, J. H. (2016). The relationship between neuroticism, hopelessness, and depression in older Korean immigrants. PloS one, 11(1), e0145520. https://www.researchgate.net/publication/289355475_The_Relationship_between_Neuroticism_Hopelessness_and_Depression_in_Older_Korean_Immigrants
Kim, J., Kim, M., Han, A., & Chin, S. (2015). The importance of culturally meaningful activity for health benefits among older Korean immigrant living in the United States. International Journal of Qualitative studies on Health and Well-being, 10(1), 27501.
Mao, W., Xu, L., Guo, M., & Chi, I. (2018). Intergenerational support and functional limitations among older Chinese immigrants: Does acculturation moderate their relationship?. Journal of Ethnic & Cultural Diversity in Social Work, 27(4), 294-309. https://www.researchgate.net/publication/327756577_Intergenerational_support_and_functional_limitations_among_older_Chinese_immigrants_Does_acculturation_moderate_their_relationship
Sun, F., Gao, X., Gao, S., Li, Q., & Hodge, D. R. (2018). Depressive symptoms among older Chinese Americans: Examining the role of acculturation and family dynamics. The Journals of Gerontology: Series B, 73(5), 870-879. https://pubmed.ncbi.nlm.nih.gov/27048568/
Tran, D. T., Jorm, L., Johnson, M., Bambrick, H., & Lujic, S. (2015). Effects of acculturation on lifestyle and health status among older Vietnam-born Australians. Asia pacific Journal of public Health, 27(2), NP2259-NP2274. https://www.researchgate.net/publication/249649046_Effects_of_Acculturation_on_Lifestyle_and_Health_Status_Among_Older_Vietnam-Born_Australians
