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Journal of GerontologicalSocial WorkPublication details including instructions forauthors and subscription informationhttpwwwtandfonlinecomloiwger20

Stress Coping and DepressionAmong Japanese AmericanEldersTazuko Shibusawa PhD a amp Ada C Mui PhD aa Columbia University School of Social Work USAPublished online 11 Oct 2008

To cite this article Tazuko Shibusawa PhD amp Ada C Mui PhD (2002) Stress Copingand Depression Among Japanese American Elders Journal of Gerontological SocialWork 361-2 63-81 DOI 101300J083v36n01_05

To link to this article httpdxdoiorg101300J083v36n01_05

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Stress Coping and DepressionAmong Japanese American Elders

Tazuko Shibusawa PhDAda C Mui PhD

SUMMARY This study examines the correlates of depressionamong Japanese American elders among 131 community-dwellingJapanese American elders aged 60 years or older Predictors of de-pression were examined from a stress and coping framework Depres-sion was measured using the Geriatric Depression Scale (GDS)Close to 20 of the respondents were mildly depressed Multiple re-gression analyses revealed that health fear of dependency on familynumber of close friends and availability of emotional support wereassociated with depression Previous studies indicate that traditionalJapanese values of interdependence facilitate dependency on familyamong Japanese American elders The findings of this study howeversuggest that the prospect of becoming dependent on family is a sourceof distress in this population Culturally appropriate ways for social

Tazuko Shibusawa and Ada C Mui are affiliated with Columbia University Schoolof Social Work

Address correspondence to Tazuko Shibusawa PhD MSW Assistant ProfessorColumbia University School of Social Work 622 West 113th Street New York NY10025-4600 (E-mail ts250columbiaedu)

This research was supported by the Center for the Study of Social Work Practice ajoint program of the Columbia University School of Social Work and the Jewish Boardof Family and Childrenrsquos Services

[Haworth co-indexing entry note] ldquoStress Coping and Depression Among Japanese American El-dersrdquo Shibusawa Tazuko and Ada C Mui Co-published simultaneously in Journal of Gerontological So-cial Work (The Haworth Social Work Practice Press an imprint of The Haworth Press Inc) Vol 36 No12 2001 pp 63-81 and Social Work Practice with the Asian American Elderly (ed Namkee G Choi) TheHaworth Social Work Practice Press an imprint of The Haworth Press Inc 2001 pp 63-81 Single or multi-ple copies of this article are available for a fee from The Haworth Document Delivery Service[1-800-HAWORTH 900 am - 500 pm (EST) E-mail address getinfohaworthpressinccom]

2001 by The Haworth Press Inc All rights reserved 63

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workers to address fear of dependency among Japanese American eldersare presented [Article copies available for a fee from The Haworth DocumentDelivery Service 1-800-HAWORTH E-mail address ltgetinfohaworthpressinccomgtWebsite lthttpwwwHaworthPresscomgt copy 2001 by The Haworth Press Inc All rights re-served]

KEYWORDS Japanese American dependency stress and coping de-pression social support

In recent years Asian American and Pacific Islander (API) eldershad the largest increase among all ethnic elderly populations in theUnited States The population of older APIs increased by 115 be-tween 1980 and 1990 Although data from the 2000 Census were notavailable at the time of this writing there is no reason to think that thistrend has not continued It is estimated that in the next 50 years thenumber of older APIs will increase by 1000 (US Bureau of the Cen-sus 1993 as cited by Tanjasiri et al 1997)

The older API population is diverse comprising of at least 60 differ-ent nationalities (Kagawa-Singer Hikoyeda amp Tanjasiri 1997) Theirimmigration history also varies The Pacific Islanders in Hawaii are na-tive to the United States while the Chinese and Japanese first immi-grated to the United States in the late 1800s However the SoutheastAsians such as the Vietnamese Cambodian Laotian and Hmong im-migrated during the 1970s and 1980s

Despite the increase in this population substantial knowledge gapsexist regarding their physical and mental health status This is in partbecause Asian Americans were not included as an ethnic category in thenational health statistics until 1979 and were not disaggregated bysubethnic groups until 1992 (Elo 1997) Furthermore methodologicaldifficulties in sampling due to small population size and misperceptionsregarding the existence of health and mental health problems have re-sulted in the lack of epidemiological studies

MENTAL HEALTH STATUS OF ASIAN AMERICAN ELDERS

Most studies examining the mental health status of Asian Americanelders have relied on relatively small nonrandom samples In recentyears however studies utilizing validated measurements have becomemore available Table 1 presents research using validated instrumentsamong community-dwelling Asian American elders Although not all

64 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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workers to address fear of dependency among Japanese American eldersare presented [Article copies available for a fee from The Haworth DocumentDelivery Service 1-800-HAWORTH E-mail address ltgetinfohaworthpressinccomgtWebsite lthttpwwwHaworthPresscomgt copy 2001 by The Haworth Press Inc All rights re-served]

KEYWORDS Japanese American dependency stress and coping de-pression social support

In recent years Asian American and Pacific Islander (API) eldershad the largest increase among all ethnic elderly populations in theUnited States The population of older APIs increased by 115 be-tween 1980 and 1990 Although data from the 2000 Census were notavailable at the time of this writing there is no reason to think that thistrend has not continued It is estimated that in the next 50 years thenumber of older APIs will increase by 1000 (US Bureau of the Cen-sus 1993 as cited by Tanjasiri et al 1997)

The older API population is diverse comprising of at least 60 differ-ent nationalities (Kagawa-Singer Hikoyeda amp Tanjasiri 1997) Theirimmigration history also varies The Pacific Islanders in Hawaii are na-tive to the United States while the Chinese and Japanese first immi-grated to the United States in the late 1800s However the SoutheastAsians such as the Vietnamese Cambodian Laotian and Hmong im-migrated during the 1970s and 1980s

Despite the increase in this population substantial knowledge gapsexist regarding their physical and mental health status This is in partbecause Asian Americans were not included as an ethnic category in thenational health statistics until 1979 and were not disaggregated bysubethnic groups until 1992 (Elo 1997) Furthermore methodologicaldifficulties in sampling due to small population size and misperceptionsregarding the existence of health and mental health problems have re-sulted in the lack of epidemiological studies

MENTAL HEALTH STATUS OF ASIAN AMERICAN ELDERS

Most studies examining the mental health status of Asian Americanelders have relied on relatively small nonrandom samples In recentyears however studies utilizing validated measurements have becomemore available Table 1 presents research using validated instrumentsamong community-dwelling Asian American elders Although not all

64 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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the instruments have been validated for use with Asian Americans thestudies represent an emerging field of empirically based researchamong this population For example Kuorsquos (1984) study using the Cen-ter of Epidemiological Studies of Depression Scale (CES-D) to exam-ine the mental health status of Asian American elders indicates higherrates of depression among Chinese Filipino Japanese and Korean el-ders than among white elders Gender differences were also found inwhich Chinese and Filipino women and Japanese and Korean men hadthe highest rates of depression In general poor health status lack of so-cial support and low acculturation have been reported as the main pre-dictors of depression among Asian American elders (Lam 1999 Lee etal 1996 Moon amp Pearl 1991) Mui (1996b) reported that poorself-rated health status living alone and dissatisfaction with familysupport were predictors of depression among Chinese elders in NewYork

Only two studies using validated measurements have been conductedto specifically examine mental health among Japanese American elders(Iwamasa 1998) Yamamoto et al (1985) identified 27 with symp-toms of dysthymia and 3 with symptoms of major depression in anonclinic sample of 78 respondents Iwamasa (1998) using the Geriat-ric Depression Scale (GDS) among 86 community-dwelling elders didnot find any respondents with depressive symptoms In the presentstudy a stress and coping framework (Lazarus amp Folkman 1984) isused to conceptualize and examine the relationship among stressescoping resources and depression in Japanese American elders

STRESS AND COPINGAMONG OLDER ASIAN PACIFIC ISLANDERS

According to the stress and coping framework stress is conceptual-ized as events and conditions that are perceived by the individual as apotentially difficult situation (Lazarus amp Folkman 1984) Stressorshave been linked with negative mental health outcomes such as depres-sion and anxiety (Lazarus amp Folkman 1984) Sources of stress includemajor life events enduring problems and daily hassles (Pearlin ampSchooler 1978) Responses to stress are associated with an individualrsquosability to cope and the resources that enable him or her to do so includ-ing physical psychological spiritual and social skills as well as socialsupport which are seen as mitigating stress (Pearlin amp Schooler 1978)Sources of stress among older adults often include multiple losses such

Tazuko Shibusawa and Ada C Mui 65

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as the death of family and close friends and the decline of physical so-cial and financial status

Older APIs experience fear of racial discrimination and lack of cul-turally appropriate services in addition to the stressors just mentioned(Damon-Rodriguez Wallace amp Kington 1994) Furthermore recentlyarrived older API immigrants experience loss of familiar environmentsupport systems identity and status as well as language barriers al-tered social resources changes in family relationships and feelings ofhelplessness (Cheung 1989 Kao amp Lam 1997 Le 1997 Tsai ampLopez 1997) Wong and Ujimoto (1998) point to the ldquothe dual chal-

66 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 1 Depression Studies Among Community-Dwelling Asian AmericanElders Using Measurements

Authors Ethnicitysettingsample size

Measurement Major findings

Iwamasa et al(1998)

Japanese AmericanLos Angeles (n = 86)

GDS a Respondents were not depressedMean score males 444 females 436

Kuo (1984) Chinese FilipinosJapanese KoreansSeattle

CES-D b All four groups had higher CES-D scoresthan did Caucasians

Lam et al(1997)

Chinese (n = 45) GDS a 30 were mildly to severely depresseddepression was associated with life satis-faction satisfaction health years in theUnited States acculturation and lan-guage skills

Lee et al(1996)

Elderly Koreanimmigrants (n = 200)

CES-Db Depression was associated with havingless friends and less social contacts

Mui (1996) Elderly Chinese (n = 50)New York

GDS a Mean 72 with 18 mildly to severelydepressed depression was associatedwith poor self-rated health living aloneand dissatisfaction with family help

Pang (1995) Elderly Koreanimmigrants (n = 69)

DIS-IIIc Lifetime prevalence rate for the Koreanimmigrants 71

Wong et al(1999)

Asian elders (n = 77)Caucasians (n = 128)

BDI d Self-reinforcement predicted depressionfor both groups while perceived controlpredicted only depression for the Cauca-sian group

Yamamotoet al (1985)

Japanese Americanelders (n = 78)Los Angeles

DIS-IIIc 27 dysthymia 3 major depression

Yamamotoet al (1994)

Elderly Koreanimmigrants (n = 100)Los Angeles

DIS-IIIc Prevalence of generalized anxiety disor-der affective disorder and phobia amongfemales and alcohol abuse and depend-ence among men

aGDS Geriatric Depression ScalebCES-D Center for Epidemiological Studies of Depression ScalecDIS-III Diagnostic Interview ScheduledBDI Beck Depression InventoryD

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lenge of aging and acculturationrdquo in which immigrant elders have tocontend with their aging process and acculturation at the same time

A major stressor among elders is the need to seek and depend on familymembers for care Close to 40 of community-dwelling older adults in theUnited States are dependent on others for basic health and social support(Brody 1985) Yet studies indicate negative associations between depend-ency and psychological well-being In fact the most important variable inlow self-esteem among older adults is not the care they receive from theirfamilies but the lack of physical financial and emotional independence(Clark 1972 Stoller 1985) In a society that values independence andself-reliance elders who are unable to cope on their own suffer from em-barrassment shame and a sense of failure (Johnson 1990)

A number of studies examine dependency and psychologicalwell-being among community-dwelling elders from the perspective ofreciprocity Elders are defined as being dependent if they receive morecare or support than they give The studies are based on the premise thatelders have better psychological well-being if there is reciprocity At-tempts to link reciprocity and psychological well-being however shownondefinitive results Some studies indicate positive associations be-tween reciprocity and well-being (Antonucci amp Akiyama 1987) whileothers show negative (Lee amp Ellithorpe 1982) or inconclusive (LeeNetzer amp Coward 1995) associations

Older immigrants tend to be more dependent on their families becausethey lack language skills and access to resources (Lubben amp Becerra1983) This dependency however can threaten intergenerational solidarityand negatively impact older immigrants if families are not able or willingto provide assistance Adult offspring may not be able to assist their par-ents because of their own struggles in adjusting to a new country (Yu ampWu 1985) Other offspring may prefer to live in nonethnic neighbor-hoods and chose not live with their parents (Ishii-Kuntz 1997) Isolationand lack of respect and caring from adult offspring have been identifiedas sources of stress among older Chinese immigrants (Cheung 1989)

A study of Hispanic elders using data from the 1988 National Surveyof Hispanic Elderly People found fear of overdependence on familiesto be a strong predictor of psychological distress among Cuban Ameri-can and Puerto Rican elders (Mui 1996c) As in Asian cultures familybonding and reciprocity between generations is expected in Hispaniccultures (Mui 1996c) The findings suggest that dependence on familycan be a source of psychological distress especially among elders infamily-centered cultures

Tazuko Shibusawa and Ada C Mui 67

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The present study examines stress and coping factors associated withdepressive symptoms among older Japanese Americans Among API el-ders Japanese Americans have the largest proportion of elders 60 and over84 of Chinese and 92 of Korean elders are foreign born compared withonly 324 of Japanese elders (US Bureau of the Census 1993) This isbecause the major wave of immigration from Japan took place between thelate 1800s and early 1900s Elders constitute 12 of the Japanese Ameri-can population an age structure similar to that of the white population(Lee 1998) Currently the largest elderly grouping in the Japanese Ameri-can community comprises the second-generation men and women knownas Nisei who were born to first-generation immigrants known as IsseiThere are two groups of Nisei those who grew up in the US and thoseknown as Kibei Nisei who were born in the United States and then sent toJapan during their childhood to be educated in their parentsrsquo homelandThe latter are less acculturated than the former preferring to speak Japa-nese and sharing similarities with later-arriving immigrants from Japanknown as Shin Issei the ldquonew first generationrdquo

Research indicates that the first-generation Japanese American el-ders (Issei) adapted well to old age and expressed less conflict over be-coming dependent on their families than did their white counterparts(Kendis 1989 Kiefer 1974 Osako 1979) Keifer (1974) attributes thisto traditional Japanese culture which views dependency as a normalpart of the aging process Elders in traditional Japanese society are ex-pected to become dependent on their adult children when they becomefrail This expectation is reinforced by Confucian norms of filial obliga-tion (Keifer 1974) Research among the second-generation Nisei whoembrace the Western values of independence and autonomy on theother hand indicate reluctance to become dependent on their children(Tomita 1998) The norm of filial piety is declining among later-gener-ation Japanese Americans and thus the Nisei may not expect their chil-dren to care for them in old age (Ishii-Kuntz 1997)

METHOD

Sample and Data Collection

The sample consists of 131 elderly Japanese Americans (53 male 78female) living in a major US metropolitan area who volunteered toparticipate in the study Respondents were recruited through senior citi-zen centers and community service centers in the Japanese American

68 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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community They were included in the study when a social workerjudged them to be mentally competent to participate The response ratewas 97 Social workers and trained graduate students conductedface-to-face structured interviews at the senior centers or in the respon-dentsrsquo homes Respondents were given the option of being interviewedin English or in Japanese Each interview lasted between an hour and anhour and a half Data were collected on sociodemographic characteris-tics monthly income social support health and mental health statuslife stressors help-seeking attitudes and knowledge and utilization offormal services

Measurement

Dependent Variable

The GDS was used to measure depression (Brink et al 1982) It is a30-item inventory with scores ranging from 0 to 30 representing the to-tal number of depressive symptoms Used widely in measuring depres-sion among older adults the GDS has excellent reliability and validity(test-retest reliability = 85 internal consistency = 94) The GDS corre-lates highly with other depression measures and the authors reported analpha reliability coefficient of 94 and a split-half reliability of 94(Yesavage et al 1983) A Japanese version of the GDS which has beenused widely in Japan (Matsubayashi et al 1994) was used with the Jap-anese-speaking respondents

Independent Variables

Stress factors included the total number of stressful life events fearof dependency and self-rated health Stressful life events were mea-sured by asking respondents if they had experienced the following 11events in the preceding three years (1) children moving out (2) seriousillness or injury (3) being robbed or burglarized (4) addition of newfamily members (5) death of spouse (6) death of other family memberor good friend (7) divorce or separation (8) illness or injury of a familymember (9) change in residence (10) family discord and (11) changein financial status These stressful life events were selected becausethey were used in previous research with Chinese elders (Chi amp Boey1993) and found to have significant impact on depressive symptomsFear of dependency was measured by asking if the respondents worriedabout becoming too dependent on their family members (1 = yes 0 =

Tazuko Shibusawa and Ada C Mui 69

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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as the death of family and close friends and the decline of physical so-cial and financial status

Older APIs experience fear of racial discrimination and lack of cul-turally appropriate services in addition to the stressors just mentioned(Damon-Rodriguez Wallace amp Kington 1994) Furthermore recentlyarrived older API immigrants experience loss of familiar environmentsupport systems identity and status as well as language barriers al-tered social resources changes in family relationships and feelings ofhelplessness (Cheung 1989 Kao amp Lam 1997 Le 1997 Tsai ampLopez 1997) Wong and Ujimoto (1998) point to the ldquothe dual chal-

66 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 1 Depression Studies Among Community-Dwelling Asian AmericanElders Using Measurements

Authors Ethnicitysettingsample size

Measurement Major findings

Iwamasa et al(1998)

Japanese AmericanLos Angeles (n = 86)

GDS a Respondents were not depressedMean score males 444 females 436

Kuo (1984) Chinese FilipinosJapanese KoreansSeattle

CES-D b All four groups had higher CES-D scoresthan did Caucasians

Lam et al(1997)

Chinese (n = 45) GDS a 30 were mildly to severely depresseddepression was associated with life satis-faction satisfaction health years in theUnited States acculturation and lan-guage skills

Lee et al(1996)

Elderly Koreanimmigrants (n = 200)

CES-Db Depression was associated with havingless friends and less social contacts

Mui (1996) Elderly Chinese (n = 50)New York

GDS a Mean 72 with 18 mildly to severelydepressed depression was associatedwith poor self-rated health living aloneand dissatisfaction with family help

Pang (1995) Elderly Koreanimmigrants (n = 69)

DIS-IIIc Lifetime prevalence rate for the Koreanimmigrants 71

Wong et al(1999)

Asian elders (n = 77)Caucasians (n = 128)

BDI d Self-reinforcement predicted depressionfor both groups while perceived controlpredicted only depression for the Cauca-sian group

Yamamotoet al (1985)

Japanese Americanelders (n = 78)Los Angeles

DIS-IIIc 27 dysthymia 3 major depression

Yamamotoet al (1994)

Elderly Koreanimmigrants (n = 100)Los Angeles

DIS-IIIc Prevalence of generalized anxiety disor-der affective disorder and phobia amongfemales and alcohol abuse and depend-ence among men

aGDS Geriatric Depression ScalebCES-D Center for Epidemiological Studies of Depression ScalecDIS-III Diagnostic Interview ScheduledBDI Beck Depression InventoryD

ownl

oade

d by

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ase

Wes

tern

Res

erve

Uni

vers

ity]

at 1

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22

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embe

r 20

14

lenge of aging and acculturationrdquo in which immigrant elders have tocontend with their aging process and acculturation at the same time

A major stressor among elders is the need to seek and depend on familymembers for care Close to 40 of community-dwelling older adults in theUnited States are dependent on others for basic health and social support(Brody 1985) Yet studies indicate negative associations between depend-ency and psychological well-being In fact the most important variable inlow self-esteem among older adults is not the care they receive from theirfamilies but the lack of physical financial and emotional independence(Clark 1972 Stoller 1985) In a society that values independence andself-reliance elders who are unable to cope on their own suffer from em-barrassment shame and a sense of failure (Johnson 1990)

A number of studies examine dependency and psychologicalwell-being among community-dwelling elders from the perspective ofreciprocity Elders are defined as being dependent if they receive morecare or support than they give The studies are based on the premise thatelders have better psychological well-being if there is reciprocity At-tempts to link reciprocity and psychological well-being however shownondefinitive results Some studies indicate positive associations be-tween reciprocity and well-being (Antonucci amp Akiyama 1987) whileothers show negative (Lee amp Ellithorpe 1982) or inconclusive (LeeNetzer amp Coward 1995) associations

Older immigrants tend to be more dependent on their families becausethey lack language skills and access to resources (Lubben amp Becerra1983) This dependency however can threaten intergenerational solidarityand negatively impact older immigrants if families are not able or willingto provide assistance Adult offspring may not be able to assist their par-ents because of their own struggles in adjusting to a new country (Yu ampWu 1985) Other offspring may prefer to live in nonethnic neighbor-hoods and chose not live with their parents (Ishii-Kuntz 1997) Isolationand lack of respect and caring from adult offspring have been identifiedas sources of stress among older Chinese immigrants (Cheung 1989)

A study of Hispanic elders using data from the 1988 National Surveyof Hispanic Elderly People found fear of overdependence on familiesto be a strong predictor of psychological distress among Cuban Ameri-can and Puerto Rican elders (Mui 1996c) As in Asian cultures familybonding and reciprocity between generations is expected in Hispaniccultures (Mui 1996c) The findings suggest that dependence on familycan be a source of psychological distress especially among elders infamily-centered cultures

Tazuko Shibusawa and Ada C Mui 67

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The present study examines stress and coping factors associated withdepressive symptoms among older Japanese Americans Among API el-ders Japanese Americans have the largest proportion of elders 60 and over84 of Chinese and 92 of Korean elders are foreign born compared withonly 324 of Japanese elders (US Bureau of the Census 1993) This isbecause the major wave of immigration from Japan took place between thelate 1800s and early 1900s Elders constitute 12 of the Japanese Ameri-can population an age structure similar to that of the white population(Lee 1998) Currently the largest elderly grouping in the Japanese Ameri-can community comprises the second-generation men and women knownas Nisei who were born to first-generation immigrants known as IsseiThere are two groups of Nisei those who grew up in the US and thoseknown as Kibei Nisei who were born in the United States and then sent toJapan during their childhood to be educated in their parentsrsquo homelandThe latter are less acculturated than the former preferring to speak Japa-nese and sharing similarities with later-arriving immigrants from Japanknown as Shin Issei the ldquonew first generationrdquo

Research indicates that the first-generation Japanese American el-ders (Issei) adapted well to old age and expressed less conflict over be-coming dependent on their families than did their white counterparts(Kendis 1989 Kiefer 1974 Osako 1979) Keifer (1974) attributes thisto traditional Japanese culture which views dependency as a normalpart of the aging process Elders in traditional Japanese society are ex-pected to become dependent on their adult children when they becomefrail This expectation is reinforced by Confucian norms of filial obliga-tion (Keifer 1974) Research among the second-generation Nisei whoembrace the Western values of independence and autonomy on theother hand indicate reluctance to become dependent on their children(Tomita 1998) The norm of filial piety is declining among later-gener-ation Japanese Americans and thus the Nisei may not expect their chil-dren to care for them in old age (Ishii-Kuntz 1997)

METHOD

Sample and Data Collection

The sample consists of 131 elderly Japanese Americans (53 male 78female) living in a major US metropolitan area who volunteered toparticipate in the study Respondents were recruited through senior citi-zen centers and community service centers in the Japanese American

68 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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community They were included in the study when a social workerjudged them to be mentally competent to participate The response ratewas 97 Social workers and trained graduate students conductedface-to-face structured interviews at the senior centers or in the respon-dentsrsquo homes Respondents were given the option of being interviewedin English or in Japanese Each interview lasted between an hour and anhour and a half Data were collected on sociodemographic characteris-tics monthly income social support health and mental health statuslife stressors help-seeking attitudes and knowledge and utilization offormal services

Measurement

Dependent Variable

The GDS was used to measure depression (Brink et al 1982) It is a30-item inventory with scores ranging from 0 to 30 representing the to-tal number of depressive symptoms Used widely in measuring depres-sion among older adults the GDS has excellent reliability and validity(test-retest reliability = 85 internal consistency = 94) The GDS corre-lates highly with other depression measures and the authors reported analpha reliability coefficient of 94 and a split-half reliability of 94(Yesavage et al 1983) A Japanese version of the GDS which has beenused widely in Japan (Matsubayashi et al 1994) was used with the Jap-anese-speaking respondents

Independent Variables

Stress factors included the total number of stressful life events fearof dependency and self-rated health Stressful life events were mea-sured by asking respondents if they had experienced the following 11events in the preceding three years (1) children moving out (2) seriousillness or injury (3) being robbed or burglarized (4) addition of newfamily members (5) death of spouse (6) death of other family memberor good friend (7) divorce or separation (8) illness or injury of a familymember (9) change in residence (10) family discord and (11) changein financial status These stressful life events were selected becausethey were used in previous research with Chinese elders (Chi amp Boey1993) and found to have significant impact on depressive symptomsFear of dependency was measured by asking if the respondents worriedabout becoming too dependent on their family members (1 = yes 0 =

Tazuko Shibusawa and Ada C Mui 69

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

p lt 05 p lt 01 p lt 0001

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

p lt 05 p lt 01 p lt 0001

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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lenge of aging and acculturationrdquo in which immigrant elders have tocontend with their aging process and acculturation at the same time

A major stressor among elders is the need to seek and depend on familymembers for care Close to 40 of community-dwelling older adults in theUnited States are dependent on others for basic health and social support(Brody 1985) Yet studies indicate negative associations between depend-ency and psychological well-being In fact the most important variable inlow self-esteem among older adults is not the care they receive from theirfamilies but the lack of physical financial and emotional independence(Clark 1972 Stoller 1985) In a society that values independence andself-reliance elders who are unable to cope on their own suffer from em-barrassment shame and a sense of failure (Johnson 1990)

A number of studies examine dependency and psychologicalwell-being among community-dwelling elders from the perspective ofreciprocity Elders are defined as being dependent if they receive morecare or support than they give The studies are based on the premise thatelders have better psychological well-being if there is reciprocity At-tempts to link reciprocity and psychological well-being however shownondefinitive results Some studies indicate positive associations be-tween reciprocity and well-being (Antonucci amp Akiyama 1987) whileothers show negative (Lee amp Ellithorpe 1982) or inconclusive (LeeNetzer amp Coward 1995) associations

Older immigrants tend to be more dependent on their families becausethey lack language skills and access to resources (Lubben amp Becerra1983) This dependency however can threaten intergenerational solidarityand negatively impact older immigrants if families are not able or willingto provide assistance Adult offspring may not be able to assist their par-ents because of their own struggles in adjusting to a new country (Yu ampWu 1985) Other offspring may prefer to live in nonethnic neighbor-hoods and chose not live with their parents (Ishii-Kuntz 1997) Isolationand lack of respect and caring from adult offspring have been identifiedas sources of stress among older Chinese immigrants (Cheung 1989)

A study of Hispanic elders using data from the 1988 National Surveyof Hispanic Elderly People found fear of overdependence on familiesto be a strong predictor of psychological distress among Cuban Ameri-can and Puerto Rican elders (Mui 1996c) As in Asian cultures familybonding and reciprocity between generations is expected in Hispaniccultures (Mui 1996c) The findings suggest that dependence on familycan be a source of psychological distress especially among elders infamily-centered cultures

Tazuko Shibusawa and Ada C Mui 67

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The present study examines stress and coping factors associated withdepressive symptoms among older Japanese Americans Among API el-ders Japanese Americans have the largest proportion of elders 60 and over84 of Chinese and 92 of Korean elders are foreign born compared withonly 324 of Japanese elders (US Bureau of the Census 1993) This isbecause the major wave of immigration from Japan took place between thelate 1800s and early 1900s Elders constitute 12 of the Japanese Ameri-can population an age structure similar to that of the white population(Lee 1998) Currently the largest elderly grouping in the Japanese Ameri-can community comprises the second-generation men and women knownas Nisei who were born to first-generation immigrants known as IsseiThere are two groups of Nisei those who grew up in the US and thoseknown as Kibei Nisei who were born in the United States and then sent toJapan during their childhood to be educated in their parentsrsquo homelandThe latter are less acculturated than the former preferring to speak Japa-nese and sharing similarities with later-arriving immigrants from Japanknown as Shin Issei the ldquonew first generationrdquo

Research indicates that the first-generation Japanese American el-ders (Issei) adapted well to old age and expressed less conflict over be-coming dependent on their families than did their white counterparts(Kendis 1989 Kiefer 1974 Osako 1979) Keifer (1974) attributes thisto traditional Japanese culture which views dependency as a normalpart of the aging process Elders in traditional Japanese society are ex-pected to become dependent on their adult children when they becomefrail This expectation is reinforced by Confucian norms of filial obliga-tion (Keifer 1974) Research among the second-generation Nisei whoembrace the Western values of independence and autonomy on theother hand indicate reluctance to become dependent on their children(Tomita 1998) The norm of filial piety is declining among later-gener-ation Japanese Americans and thus the Nisei may not expect their chil-dren to care for them in old age (Ishii-Kuntz 1997)

METHOD

Sample and Data Collection

The sample consists of 131 elderly Japanese Americans (53 male 78female) living in a major US metropolitan area who volunteered toparticipate in the study Respondents were recruited through senior citi-zen centers and community service centers in the Japanese American

68 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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community They were included in the study when a social workerjudged them to be mentally competent to participate The response ratewas 97 Social workers and trained graduate students conductedface-to-face structured interviews at the senior centers or in the respon-dentsrsquo homes Respondents were given the option of being interviewedin English or in Japanese Each interview lasted between an hour and anhour and a half Data were collected on sociodemographic characteris-tics monthly income social support health and mental health statuslife stressors help-seeking attitudes and knowledge and utilization offormal services

Measurement

Dependent Variable

The GDS was used to measure depression (Brink et al 1982) It is a30-item inventory with scores ranging from 0 to 30 representing the to-tal number of depressive symptoms Used widely in measuring depres-sion among older adults the GDS has excellent reliability and validity(test-retest reliability = 85 internal consistency = 94) The GDS corre-lates highly with other depression measures and the authors reported analpha reliability coefficient of 94 and a split-half reliability of 94(Yesavage et al 1983) A Japanese version of the GDS which has beenused widely in Japan (Matsubayashi et al 1994) was used with the Jap-anese-speaking respondents

Independent Variables

Stress factors included the total number of stressful life events fearof dependency and self-rated health Stressful life events were mea-sured by asking respondents if they had experienced the following 11events in the preceding three years (1) children moving out (2) seriousillness or injury (3) being robbed or burglarized (4) addition of newfamily members (5) death of spouse (6) death of other family memberor good friend (7) divorce or separation (8) illness or injury of a familymember (9) change in residence (10) family discord and (11) changein financial status These stressful life events were selected becausethey were used in previous research with Chinese elders (Chi amp Boey1993) and found to have significant impact on depressive symptomsFear of dependency was measured by asking if the respondents worriedabout becoming too dependent on their family members (1 = yes 0 =

Tazuko Shibusawa and Ada C Mui 69

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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The present study examines stress and coping factors associated withdepressive symptoms among older Japanese Americans Among API el-ders Japanese Americans have the largest proportion of elders 60 and over84 of Chinese and 92 of Korean elders are foreign born compared withonly 324 of Japanese elders (US Bureau of the Census 1993) This isbecause the major wave of immigration from Japan took place between thelate 1800s and early 1900s Elders constitute 12 of the Japanese Ameri-can population an age structure similar to that of the white population(Lee 1998) Currently the largest elderly grouping in the Japanese Ameri-can community comprises the second-generation men and women knownas Nisei who were born to first-generation immigrants known as IsseiThere are two groups of Nisei those who grew up in the US and thoseknown as Kibei Nisei who were born in the United States and then sent toJapan during their childhood to be educated in their parentsrsquo homelandThe latter are less acculturated than the former preferring to speak Japa-nese and sharing similarities with later-arriving immigrants from Japanknown as Shin Issei the ldquonew first generationrdquo

Research indicates that the first-generation Japanese American el-ders (Issei) adapted well to old age and expressed less conflict over be-coming dependent on their families than did their white counterparts(Kendis 1989 Kiefer 1974 Osako 1979) Keifer (1974) attributes thisto traditional Japanese culture which views dependency as a normalpart of the aging process Elders in traditional Japanese society are ex-pected to become dependent on their adult children when they becomefrail This expectation is reinforced by Confucian norms of filial obliga-tion (Keifer 1974) Research among the second-generation Nisei whoembrace the Western values of independence and autonomy on theother hand indicate reluctance to become dependent on their children(Tomita 1998) The norm of filial piety is declining among later-gener-ation Japanese Americans and thus the Nisei may not expect their chil-dren to care for them in old age (Ishii-Kuntz 1997)

METHOD

Sample and Data Collection

The sample consists of 131 elderly Japanese Americans (53 male 78female) living in a major US metropolitan area who volunteered toparticipate in the study Respondents were recruited through senior citi-zen centers and community service centers in the Japanese American

68 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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community They were included in the study when a social workerjudged them to be mentally competent to participate The response ratewas 97 Social workers and trained graduate students conductedface-to-face structured interviews at the senior centers or in the respon-dentsrsquo homes Respondents were given the option of being interviewedin English or in Japanese Each interview lasted between an hour and anhour and a half Data were collected on sociodemographic characteris-tics monthly income social support health and mental health statuslife stressors help-seeking attitudes and knowledge and utilization offormal services

Measurement

Dependent Variable

The GDS was used to measure depression (Brink et al 1982) It is a30-item inventory with scores ranging from 0 to 30 representing the to-tal number of depressive symptoms Used widely in measuring depres-sion among older adults the GDS has excellent reliability and validity(test-retest reliability = 85 internal consistency = 94) The GDS corre-lates highly with other depression measures and the authors reported analpha reliability coefficient of 94 and a split-half reliability of 94(Yesavage et al 1983) A Japanese version of the GDS which has beenused widely in Japan (Matsubayashi et al 1994) was used with the Jap-anese-speaking respondents

Independent Variables

Stress factors included the total number of stressful life events fearof dependency and self-rated health Stressful life events were mea-sured by asking respondents if they had experienced the following 11events in the preceding three years (1) children moving out (2) seriousillness or injury (3) being robbed or burglarized (4) addition of newfamily members (5) death of spouse (6) death of other family memberor good friend (7) divorce or separation (8) illness or injury of a familymember (9) change in residence (10) family discord and (11) changein financial status These stressful life events were selected becausethey were used in previous research with Chinese elders (Chi amp Boey1993) and found to have significant impact on depressive symptomsFear of dependency was measured by asking if the respondents worriedabout becoming too dependent on their family members (1 = yes 0 =

Tazuko Shibusawa and Ada C Mui 69

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

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community They were included in the study when a social workerjudged them to be mentally competent to participate The response ratewas 97 Social workers and trained graduate students conductedface-to-face structured interviews at the senior centers or in the respon-dentsrsquo homes Respondents were given the option of being interviewedin English or in Japanese Each interview lasted between an hour and anhour and a half Data were collected on sociodemographic characteris-tics monthly income social support health and mental health statuslife stressors help-seeking attitudes and knowledge and utilization offormal services

Measurement

Dependent Variable

The GDS was used to measure depression (Brink et al 1982) It is a30-item inventory with scores ranging from 0 to 30 representing the to-tal number of depressive symptoms Used widely in measuring depres-sion among older adults the GDS has excellent reliability and validity(test-retest reliability = 85 internal consistency = 94) The GDS corre-lates highly with other depression measures and the authors reported analpha reliability coefficient of 94 and a split-half reliability of 94(Yesavage et al 1983) A Japanese version of the GDS which has beenused widely in Japan (Matsubayashi et al 1994) was used with the Jap-anese-speaking respondents

Independent Variables

Stress factors included the total number of stressful life events fearof dependency and self-rated health Stressful life events were mea-sured by asking respondents if they had experienced the following 11events in the preceding three years (1) children moving out (2) seriousillness or injury (3) being robbed or burglarized (4) addition of newfamily members (5) death of spouse (6) death of other family memberor good friend (7) divorce or separation (8) illness or injury of a familymember (9) change in residence (10) family discord and (11) changein financial status These stressful life events were selected becausethey were used in previous research with Chinese elders (Chi amp Boey1993) and found to have significant impact on depressive symptomsFear of dependency was measured by asking if the respondents worriedabout becoming too dependent on their family members (1 = yes 0 =

Tazuko Shibusawa and Ada C Mui 69

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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no) Self-rated health was measured using a five-point scale with fivebeing the highest Acculturation emotional support from family andfriends and number of close friends were conceptualized as coping re-sources Acculturation was measured by language preference (Japaneseor English) which is a commonly used method to assess acculturationamong Asian elders (Burr amp Mutcher 1993) Social support was mea-sured by the number of close family and friends frequency of contactwith other people and the amount of emotional support from family orfriends A four-point Likert-like scale was used with higher scores in-dicating more support (0-3)

RESULTS

Sample Characteristics

The sociodemographic characteristics of the respondents are pre-sented by grouping them according to whether or not they fear depend-ency (Table 2) The respondents ranged from 63 to 97 years of age witha mean age of 77 years 60 were female while 40 were male 35were married 45 widowed and 19 divorced separated or nevermarried Close to 60 lived alone The majority were either secondgeneration born and raised in the United States (Nisei 336) secondgeneration born in the United States and raised in Japan (Kibei Nisei298) or new immigrants who had immigrated after the 1965 revisionof the Immigration Act (Shin Issei 328) Of the respondents 37preferred to speak English while 63 preferred to speak JapaneseClose to one third of the respondents (31) feared becoming dependenton their family while two thirds (66) did not fear dependency Sev-eral significant differences were found between the two groups Thosewho were female less educated unemployed with lower levels of in-come and andor who were less acculturated tended to fear depend-ency

Stresses Coping Resources and Depression

As seen in Table 3 close to 30 of the respondents had experiencedthe death of a family member or friend and had also experienced illnessor injury in the preceding three years Those who had suffered injury orillness were less likely to fear dependency on family Over 16 had en-countered illness or injury among family member(s) Most of the re-

70 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

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Tazuko Shibusawa and Ada C Mui 71

TABLE 2 Demographic Characteristics of Sample by Attitudes Toward Dependency

Total No fear Fear

Characteristic (n = 128) (n = 41) (n = 87)

Age

60-69 122 98 138

70-79 550 512 563

80-89 298 341 276

90+ 31 49 23

Mean age (SD) 771 (650) 785 (660) 763 (648)

Sex (female) 595 390 678

Marital statusMarried 345 341 356

Widowed 458 439 471

Separateddivorced 115 146 92

Never married 84 73 80

Living arrangementAlone 580 610 552

With spouse only 290 244 323

With spousechildgrandchild 53 73 46

With childgrandchild 46 73 34

With other relatives 08 00 11

Other 23 00 34

EducationLess than high school 130 146 115

Some high school 115 49 149

High school graduate 489 390 540

Some technical training 122 244 80

Other 08 24 00

Place of birthUnited States 649 756 598

Japan 328 220 379

Other 02 24 23

Language preferenceEnglish 374 610 264

Japanese 626 390 736

GenerationIssei 31 49 23

Shin Issei 328 195 391

Nisei 336 488 253

Kibei Nisei 298 268 322

Sansei 08 00 11

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

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spondents considered themselves to be in good health and thus healthwas not a stress factor in this population In terms of coping resourcesthe two groups did not differ significantly in the number of close familyand friends the frequency of contact with other people and the amountof emotional support from family or friends

Responses to the GDS items and the mean scores are presented in Ta-ble 4 Respondents who expressed fear of dependency were more likelyto feel helpless (item 10) worry about the future (item 13) and worryabout the past (item 18) than those who did not The overall mean forthis group was 73 (SD = 57) which is significantly higher that thegroup that did not express fear of dependency (mean = 46 SD = 38)The alpha coefficient of GDS in this sample was 87 which indicatesgood reliability Brink and colleagues (1982) consider a score of 10 onthe GDS as the cutoff point for depression Those who score between 11to 20 are considered to be mildly depressed and those who score 21 orabove are considered to be moderately to severely depressed Accord-ing to the original cutoff points 224 the respondents who expressedfear of dependency were mildly depressed compared to 103 of thosewho did not Although the results of this study are not intended for pop-ulation estimates the rate of mild depression in this community samplewas 18 which is slightly higher than that of an elderly Chinese Amer-

72 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 2 (continued)

CharacteristicTotal

(n = 128)No fear(n = 41)

Fear(n = 87)

EmploymentNot employed 878 774 949

Employed 122 226 51

Monthly incomeLess than $500 46 49 46

$501-$1000 496 341 575

$1001-$1500 198 220 195

$1501-$2000 107 171 69

$2001-$2500 69 122 46

$2501 or more 84 98 69

Self-rated healthExcellent 69 73 69

Very good 145 73 184

Good 374 439 345

Fair 244 268 218

Poor 168 146 184

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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ded

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ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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ican community sample as well as other community samples of elderlypersons (Mui 1996b Rankin Galbraith amp Johnson 1993)

Correlates of Depression

Depression was regressed with sociodemographic variables fear ofdependency stress and coping resource variables Sociodemographicvariables included age gender living arrangement and income Livingarrangement was recoded into whether or not the respondents livedalone Stress included self-rated health and a sum of stressful eventsthat the respondents had encountered during the preceding three yearsCoping resources included the amount of emotional support receivedfrom others and the number of close friends

Tazuko Shibusawa and Ada C Mui 73

TABLE 3 Stressful Life Events and Social Support by Attitudes Toward De-pendency

Total No fear Fear(n =128) (n = 41) (n = 87)

Stressful life eventsChildren move out 31 49 23Robbedburglarized 92 122 80New family member 92 98 92Death of spouse 23 49 11Death of familyfriend 282 293 264Illnessinjury (self) 290 415 230Illnessinjury (family) 168 171 161Change in residence 69 122 46Family discord 15 00 23Change in financial status 38 73 23

Mean 110 (112) 139 (138) 95 (99)Family satisfaction

Very satisfied 764 825 729Somewhat satisfied 165 100 200Somewhat dissatisfied 47 50 47Very dissatisfied 24 25 24

Social support mean (0-3)Comfort 168 (131) 168 (137) 170 (128)Financial 19 (62) 09 (43) 24 (70)Advice 139 (127) 124 (122) 147 (128)ADL 27 (82) 31 (84) 26 (81)When ill 159 (135) 156 (138) 162 (134)Escort 29 (77) 31 (75) 28 (79)

Has close friends () 809 878 770No of close family 281 (235) 312 (241) 253 (216)No of close friends 257 (290) 271 (234) 265 (297)

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

p lt 05 p lt 01 p lt 0001

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

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Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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74 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

TABLE 4 Percentage of Respondents Agreeing with Geriatric DepressionScale (GDS) Items

Total No fear Fear

Scale Item (n = 128) (n = 41) (n = 87)

1 Satisfied with life 931 927 931

2 Dropped activities and interest 145 122 161

3 Life is empty 250 231 256

4 Often got bored 191 195 184

5 Hopeful about future 527 744 437

6 Obsessive thoughts 138 100 149

7 In good spirits 946 976 930

8 Fear bad things 130 146 126

9 Happy most of the time 883 927 859

10 Often feel helpless 177 73 221

11 Often get restless 153 122 161

12 Prefer to stay home 445 333 500

13 Worry about the future 162 73 198

14 Problem with memory 344 244 402

15 Wonderful to be alive 855 951 824

16 Feel downhearted and blue 166 122 172

17 Feel worthless 183 122 207

18 Worry about the past 92 24 115

19 Life is exciting 723 805 690

20 Hard to start new projects 385 400 379

21 Full of energy 756 780 736

22 Situation hopeless 200 146 209

23 Others are better off 277 244 302

24 Upset over little things 275 195 310

25 Feel like crying 130 98 149

26 Trouble concentrating 192 98 244

27 Enjoy getting up in the morning 808 925 747

28 Avoid social gatherings 328 244 368

29 Easy to make decisions 746 825 701

30 Mind as clear as used to be 685 780 628

MeanDiagnosis

644 (529) 463 (384) 730 (570)

Normal (1-10) 802 897 753

Mildly depressed (11-20) 183 103 224

Moderately to

severely depressed (21-30) 15 0 24p lt 05 p lt 001 p lt 0001

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

p lt 05 p lt 01 p lt 0001

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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2014

It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

Dow

nloa

ded

by [

Cas

e W

este

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] at

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ovem

ber

2014

Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

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ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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] at

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2 N

ovem

ber

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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Table 5 shows the results of the hierarchical regression models De-pression was first regressed with sociodemographic variables and fearof dependency (Model 1) While none of the sociodemographic vari-ables predicted depressive symptoms fear of dependency (beta = 26)was a significant predictor of GDS scores This model accounted for 7of the variance Stress and coping resource variables were then added tothis model (Model 2) The most important predictive stressor wasself-rated health (beta = 45) The coping resource factors whichwere significant in predicting depressive symptoms were the numberof close friends (beta = 18) and the amount of emotional support(beta = 16) This model explains 35 of the variance in GDS scoresThe results suggest that respondents with poorer self-rated health fearof dependency on family fewer close friends and lack of emotional sup-port reported more depressive symptoms

Tazuko Shibusawa and Ada C Mui 75

TABLE 5 Predictors of Depressive Symptoms Among Japanese American El-ders

Model 1 Model 2

Predictors

Betas Betas

Age 066 053

Gender 123 020

Income 155 076

Living alone 148 025

Fear of dependency 256 236

Stressful events 051

Self-rated health 447

Acculturation 036

Emotional support 161

Number of close friends 177

F 3187 7789

R2 116 398

Adjusted R2 079 347

∆R2 116 283

p lt 05 p lt 01 p lt 0001

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DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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ded

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] at

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ber

2014

Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

DISCUSSION

This study examined depression among a community sample of Jap-anese American elders The findings suggest that depression in thispopulation is associated with poor health fear of dependency and lackof social support Japanese American elders like other elderly groupsare vulnerable to psychological distress in the form of depressive symp-toms (Mui 1996a 1996c 1998 Mui amp Burnette 1996) The predictivepower of poor perceived health is consistent with the findings of earlierstudies using white and other ethnic elderly populations (Berkman etal 1986 Blazer Burchett Service amp George 1991 Mui 1996a)

An important finding in this study is the association between fear ofdependence and depression In the bivariate analysis Japanese elderswho were less acculturated (ie Japanese-speaking) were more likely toexpress fear of dependence Previous studies on Japanese American el-ders conclude that traditional Japanese culture facilitates dependenceamong elders because of its emphasis on interdependence (Keifer 1974)It would seem therefore that elders who are less acculturated and preferto speak Japanese would feel more comfortable with dependence thanwould their more acculturated counterparts The findings of this studyhowever suggest the contrary The prospect of having to depend on familyis more stressful for less acculturated Japanese American elders This maybe influenced by two factors First Japanese-speaking elders in this sampletended to be female with lower income and less education These eldersmay feel that they lack the resources to reciprocate for the care that theyreceive from their children Although caring for elderly parents is upheldas an important value among present-day Japanese Americans(Shibusawa Lubben amp Kitano in press) filial obligation is no longer re-inforced by traditional social norms Thus Japanese American elderscannot automatically expect to be cared for by their adult offspring In ad-dition elders who are more acculturated may feel closer to their childrenbecause they have fewer cultural differences in the family Second inJapanese culture people who are not able to reciprocate in a helping rela-tionship become indebted and obligated to the care provider (Johnson1993) Those who are indebted are not supposed to assert their needs lestthey offend the care provider and they are expected to passively receiveassistance even though the help may not be the kind of assistance they de-sire Dependency therefore may be more stressful among elders who donot have the resources to reciprocate for the assistance since indebtednesscan undermine the need for autonomy and self-control

76 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

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nive

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] at

17

09 2

2 N

ovem

ber

2014

It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

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It is important to note that respondents who did not fear dependencywere more likely to have been ill or injured in the preceding three yearsThis may suggest that fear of dependency is based on anticipation ofhaving to become dependent rather than actually having to be depend-ent Elders who experienced injury or illness may have discovered oneof two things that they were not as dependent as they had anticipatedor that intergenerational relationships had not become strained becauseof their change in physical status

Elderly Japanese respondents in this study admitted to depressive symp-toms at a rate higher than that found in a study among Chinese Americanelders (Mui 1996b) Furthermore research in the Los Angeles area foundthat elderly Chinese immigrants showed greater moderation and reportedfewer physical and mental health problems than the white American el-derly (Raskin Chien amp Lin 1992) Therefore it is possible that there aredifferences between Japanese and Chinese American elders

Close to 20 of the respondents scored as being mildly depressedindicating that depression in Japanese American elders is potentially aserious problem as seen in the high suicide rate Japanese American el-ders have the third-highest suicide rate (189 per 100000) followingChinese American (259 per 100000) and white (191 per 100000) el-derly (Baker 1994) The rates of completed suicide among JapaneseAmerican elders over 75 years of age are 25 times higher than the ratesof their white cohorts The suicide rate among Japanese American menage 85 and over is almost three times higher than the rates of their whitecohorts (Baker 1994)

As this study was limited by a small sample size and the voluntarynature of subject participation its findings must therefore be inter-preted with caution Although age was not associated with depression inthe present cross-sectional sample results might have been differenthad a longitudinal design been used In addition environmental factorssuch as racial discrimination and safety were not addressed in thisstudy Future studies on ethnic elders must concern themselves with thesocial context in which these elders live The findings of the presentstudy are most appropriately generalizable to mentally capable commu-nity-dwelling Japanese American elders

IMPLICATIONS FOR SOCIAL WORK PRACTICE

The findings of this study provide new directions for culturally ap-propriate social work interventions with Japanese American elders

Tazuko Shibusawa and Ada C Mui 77

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Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

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rsity

] at

17

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2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

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ded

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e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Fear of dependency among this population suggests that social workersmust conduct a careful assessment of the Japanese American eldersrsquo at-titudes toward seeking help The social worker must be aware of thepsychological distress that elders may experience in having to seek as-sistance from their families Social workers must explore their elderlyclientsrsquo fears of dependency and work with them in appraising the ex-tent to which these fears are based in reality Intergenerational relation-ships must also be assessed to determine the context of these fears If thefears are anticipatory social workers need to help the elder and familydiscuss concerns about the helping relationship If the family is not ableto provide care social workers need to minimize the eldersrsquo depend-ency on adult offspring by seeking outside resources for assistance

Finally the large proportion of Japanese American elders who weremildly depressed points to the need for active depression preventionprograms Social workers need to find ways to increase and activate so-cial support networks so that elders can develop meaningful social rela-tionships and overcome social isolation In addition communityeducation is needed to enable elders their families and social organiza-tions such as churches and Buddhist temples along with primary healthcare providers to detect depressive symptoms Bilingual depressionprevention groups for seniors also need to be implemented in the Japa-nese American community

REFERENCES

Antonucci T Akiyama H amp Lansford JE (1998) Negative effects of close socialrelations Family Relations 47(4) 379-384

Baker FM (1994) Suicide among ethnic minority elderly A statistical andpsychosocial perspective Journal of Geriatric Psychiatry 27(2) 241-264

Berkman LF Berkman CS Kasl S Freeman DH Leo L Ostfeld AMCoroni-Huntley J amp Brody J (1986) Depressive symptoms in relation to physi-cal health and functioning in the elderly American Journal of Epidemiology 124372-388

Blazer D Burchett B Service C amp George L K (1991) The association of ageand depression among the elderly An epidemiologic exploration Journal of Ger-ontology 46 210-215

Brody E (1985) Parent care as a normative family stress Gerontologist 25 19-29Brink TL Yesavage JA Lum B Heersma P Adey M amp RoseTA (1982)

Screening tests for geriatric depression Clinical Gerontologist 1 37-44Burr JA amp Mutcher JE (1993) Nativity acculturation and economic status Expla-

nations of Asian American living arrangements in later life Journal of Gerontol-ogy 48(2) 55-63

78 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Cheung M (1989) Elderly Chinese living in the United States Social Work 34457-461

Chi I amp Boey KW (1993) A mental health and social support study of the old-old inHong Kong (Resource Paper Series No 22) Hong Kong University of HongKong Department of Social Work and Social Administration

Clark MS (1984) A distinction between two types of relationships and its implica-tions for development In JC Masters amp K Yarkin-Levin (Eds) Boundary areasin social and developmental psychology (pp 241-270) New York AcademicPress

Damon-Rodriguez J Wallace S amp Kington R (1994) Service utilization and mi-nority elderly Appropriateness accessibility and accessibility Gerontology amp Ge-riatrics Education 15 45-63

Elo IT (1996) Adult mortality among Asian Americans and Pacific Islanders A re-view of the evidence In KS Markeides amp M Miranda (Eds) Minorities agingand health (pp 41-78) Thousand Oaks CA Sage Publications

Ishii-Kuntz M (1997) Intergenerational relationships among Chinese Japanese andKorean Americans Family Relations 46 23-32

Iwamasa GY Hilliard KM amp Kost CR (1998) Geriatric Depression Scale andJapanese American older adults Clinical Gerontologist 19(3) 13-24

Johnson F (1993) Dependency and interdependency In J Bond amp P Coleman(Eds) Aging in society An introduction to social gerontology (pp 209-228) Lon-don Sage

Kagawa-Singer M Hikoyeda N amp Tanjasiri SP (1996) Aging chronic condi-tions and physical disabilities in Asian and Pacific Islander Americans In KSMarkeides amp M Miranda (Eds) Minorities aging and health (pp 149-180) Thou-sand Oaks CA Sage Publications

Kao S-K R amp Lam ML (1997) Asian American elderly In E Lee (Ed) Workingwith Asian Americans A guide for clinicians (pp 122-139) New York GuilfordPress

Kendis RJ (1989) Attitude of gratitude The adaptation to aging of the elderly Japa-nese in America New York AMS Press

Kiefer C (1974) Lessons from the Issei In J Gubrium (Ed) Late life communitiesand environmental policy (pp167-197) Springfield IL Charles C Thomas

Kuo WH (1984) Prevalence of depression among Asian Americans Journal of Ner-vous and Mental Disease 172 (8) 449-457

Lam RE Pascala JT amp Smith SL (1997) Factors related to depressive symptomsin an elderly Chinese American sample Clinical Gerontologist 17(4) 57-70

Lazarus RS amp Folkman S (1984) Stress appraisal and coping New YorkSpringer

Le QK (1997) Mistreatment of Vietnamese elderly by their families in the UnitedStates Journal of Elder Abuse amp Neglect 9 51-62

Lee GR amp Ellithorpe E (1982) Intergenerational exchange and subjective well-be-ing among the elderly Journal of Marriage and the Family 44 217-224

Lee GR Netzer JK amp Coward RT (1995) Depression among older parents Therole of intergenerational exchange Journal of Marriage and the Family 57823-833

Tazuko Shibusawa and Ada C Mui 79

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

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e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Lee MS Crittenden KS amp Yu E (1996) Social support and depression among el-derly Korean immigrants in the United States International Journal of Aging andDevelopment 42(4) 313-327

Lee SM (1998) Asian Americans Diverse and growing Population Bulletin 532-40

Lubben JE amp Becerra RM (1983) Social support among Black Mexican and Chi-nese elderly In DE Gelfand amp CM Barresi (Eds) Ethnic dimensions of aging(pp 130-144) New York Springer

Matsubayashi K Wada T Okumiya K Fujisawa M Taoka H Kimura S amp DoiY (1994) Comparative study of quality of life in the elderly between in Kahokuand in Yaku Nippon Ronen Igakkai Zasshi (Japanese Journal of Geriatrics) 31(10) 790-799

Moon J amp Pearl JH (1991) Alienation of elderly Korean American immigrants asrelated to place of residence gender age years of education time in the US livingwith or without children and with and without a spouse International Journal ofAging and Development 32(2) 115-124

Mui AC (1996a) Geriatric Depression Scale as a community screening instrumentfor elderly Chinese immigrants International Psychogeriatric 8(3) 445-458

Mui AC (1996b) Depression among elderly Chinese immigrants An exploratorystudy Social Work 41 633-645

Mui AC (1996c) Correlates of psychological distress among Mexican AmericanCuban American and Puerto Rican elders in the USA Journal of Cross-CulturalGerontology 11 131-147

Mui AC (1998) Living alone and depression among older Chinese immigrantsJournal of Gerontological Social Work 30(34) 147-166

Osako M (1979) Aging and family among Japanese Americans The role of ethnictradition in the adjustment to old age Gerontologist 19 (5) 448-455

Pang KY (1995) A cross-cultural understanding of depression among Korean immi-grants Prevalence symptoms and diagnosis Clinical Gerontologist 15(4) 3-20

Pearlin LI amp Schooler C (1978) The structure of coping Journal of Health and So-cial Behavior 19 2-21

Rankin SH Galbraith ME amp Johnson S (1993) Reliability and validity data for aChinese translation of the Center for Epidemiological Studies-Depression Psycho-logical Reports 73 1291-1298

Raskin A Chien CP amp Lin KM (1992) Elderly Chinese and Caucasian Ameri-cans compared on measures of psychic distress somatic complaints and social com-petence International Journal of Geriatric Psychiatry 7 191-198

Shibusawa T Lubben J amp Kitano H (in press) Japanese American Caregiving InLK Olson (Ed) Through Ethnic Lenses Caring for the Elderly in a Multi-Cul-tural Society Boulder CO Rowan amp Littlefield Publishers

Stoller EP (1985) Exchange patterns in the informal networks of the elderly The im-pact of reciprocity on morale Journal of Marriage and the Family 47 335-342

Tanjasiri SP Wallace SP amp Shibata K (1995) Picture imperfect Hidden prob-lems among Asian Pacific Islander elder Gerontologist 35 753-760

Tomita SK (1998) The consequences of belonging Conflict management tech-niques among Japanese Americans Journal of Elder Abuse amp Neglect 9(3) 41-68

80 SOCIAL WORK PRACTICE WITH THE ASIAN AMERICAN ELDERLY

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014

Tsai DT amp Lopez RA (1997) The use of social supports by elderly Chinese immi-grants Journal of Gerontological Social Work 29 77-94

US Bureau of the Census (1993) 1990 Census of population Asian and Pacific Is-landers in the United States (1990 CP-3-5) Washington DC US GovernmentPrinting Office

Wong PTP amp Ujimoto KV (1998) The elderly Their stress coping and mentalhealth In LC Lee amp NWS Zane (Eds) Handbook of Asian American psychol-ogy (pp 165-209) Thousand Oaks CA Sage Publications

Wong SS Heiby EM Kameoka VA amp Dubanoski JP (1999) Perceived con-trol self-reinforcement and depression among Asian American and CaucasianAmerican elders Journal of Applied Gerontology 18(1) 46-62

Yamamoto J Machizawa S Araki F Reece S Steinberg A Leung J amp CarterR (1985) Mental health of elderly Asian Americans in Los Angeles AmericanJournal of Social Psychiatry 5 37-46

Yamamoto J Rhee S amp Chang D (1994) Psychiatric disorders among elderly Ko-reans in the United States Community Mental Health Journal 30(1) 17-26

Yesavage JA Brink TL Rose TL Lum O amp Huang V (1983) Developmentand validation of a screening scale A preliminary report Journal of Psychiatric Re-search 17 37-49

Yu LC amp Wu SC (1985) Unemployment and family dynamics in meeting theneeds of Chinese elderly in the United States Gerontologist 25 472-476

Tazuko Shibusawa and Ada C Mui 81

Dow

nloa

ded

by [

Cas

e W

este

rn R

eser

ve U

nive

rsity

] at

17

09 2

2 N

ovem

ber

2014