Families in society-The journal of contemporary social services, Oct 1, 2003
THE ENORMOUS BURDEN involved in taking care of a family member suffering from a severe and persis... more THE ENORMOUS BURDEN involved in taking care of a family member suffering from a severe and persistent mental illness such as schizophrenia has been well docu
Adversities following disasters are associated with the delayed onset and persistence of post-tra... more Adversities following disasters are associated with the delayed onset and persistence of post-traumatic stress disorder (PTSD). In the wake of the World Trade Center attack, a sizeable group of Asian Americans being directly exposed to the disaster had endured job loss during the decade afterwards. Yet, no studies to date have examined the relationship between job loss and long-term PTSD in this group. This study examined the 10-11-year prevalence of probable PTSD (≥ PCL score of 44) among Asian (n=1,712) and Caucasian American (n=25,011) participants of the World Trade Center Health Registry who had completed three waves of survey studies (2003-04, 2006-08, 2011-12). Logistic regression was used to model the relationship between job loss since the disaster and probable PTSD for the two racial groups separately while controlling for sociodemographics, disaster exposure, post-disaster traumatic/stressful events exposure, lower respiratory symptoms, PTSD history since 911, and mental health service use. The long-term prevalence of probable PTSD was 15.1% for Asian Americans and 14.4% for Caucasian Americans, with no significant difference. For both groups, having job loss since 911 was a significant risk factor for probable PTSD (Asian Americans: AOR=1.80; 95% CI=1.19, 2.71; Caucasian Americans: AOR=1.73; 95% CI=1.56, 1.93). While job loss was an important risk factor, employment opportunities were more restricted for Asian Americans given the cultural and language limitations. Current findings highlight the importance of improving employment as part of post-disaster assistance.
Families in society-The journal of contemporary social services, Feb 1, 2001
Cultural beliefs of Chinese American families are discussed in relation to their caregiving exper... more Cultural beliefs of Chinese American families are discussed in relation to their caregiving experience of a mentally ill relative. Implications of such beliefs to mental health professionals are highlighted. Somatic factors and psychosocial stresses as causes of mental disorders are found compatible to the belief systems of these families. The stress-vulnerability dialysis is recommended as the explanatory model to be adopted by clinicians when they communicate the causes of mental illness to these families. In view of the pressure experienced by these families in the caregiving process and their relative social isolation as a result of their immigrant status, ways to harness the support from extended families and community resources are suggested. Also examined is a viable working alliance between these families and clinicians in terms of a therapeutic bond, consensual treatment goals, and relevant tasks. Finally, elements of a family intervention model compatible with cultural beliefs of these families are proposed.
This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predi... more This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2-3 years and 5-6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events. Although 16 years have lapsed since the terrorist attack at the World Trade Center (WTC) on September 11, 2001 (hereinafter referred to as 9/11), a substantial number of people who were directly exposed to the disaster are still suffering from physical as well as psychological problems (Jordan et al., 2015; Maslow et al., 2015). Posttraumatic stress disorder (PTSD) is one of the persisting mental health issues that continue to affect many survivors. A considerable number of Asians were exposed to the attack, as the WTC was less than 10 blocks away from Chinatown and many South Asians worked at the collapsed and nearby buildings (Asian American Federation of New York, 2003). While numerous studies have documented psychological distress associated with the attack among specific affected groups, such as rescue and recovery workers (Bowler et al., 2012; Cone et al., 2015), survivors of the collapsed buildings (DiGrande, Neria, Brackbill, Pulliam, & Galea, 2011), and Lower Manhattan residents (Welch et al., 2016), very few have focused on Asian Americans.
Recent epidemiologic studies have found that most patients with mental illness are seen exclusive... more Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Wayne J. Katon, M.D., will publish informative research articles that address primary care-psychiatric issues.
Journal of Comparative Family Studies, Dec 1, 2004
How the Socio-Cultural Context Shapes Women's Divorce Experience in Hong Kong. by Winnie W. ... more How the Socio-Cultural Context Shapes Women's Divorce Experience in Hong Kong. by Winnie W. Kung , Suet-Lin Hung , Cecilia LW Chan BACKGROUND AND FRAMEWORK The rising trend of divorce is a word-wide phenomenon. The impact of divorce can be fel.
Page 1. Chinese Americans' Help Seeking for Emotional Distress Winnie W. Kung University of ... more Page 1. Chinese Americans' Help Seeking for Emotional Distress Winnie W. Kung University of Southern California This study examines help-seeking behaviors for emotional distress among 1,747 Chinese Americans. Seventy ...
Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this repor... more Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this report examined perceived barriers to mental health treatment. Two factors emerged, namely practical barriers, which included cost of treatment, time, knowledge of access, and language, and cultural barriers consisting of credibility of treatment, recognition of need, and fear of loss of face. Average ratings of all practical barrier items were higher than cultural barrier items, demonstrating the importance of pragmatic considerations for this population. In a novel attempt, this study examined the empirical link between these perceived barriers and actual mental health service use. The practical barrier factor showed significance in predicting service use for both the whole sample and a subsample of individuals with at least one lifetime mental disorder.
Journal of Ethnic & Cultural Diversity in Social Work, 2004
ABSTRACT Causal attributions of schizophrenia by 30 Chinese American caregivers in the Los Angele... more ABSTRACT Causal attributions of schizophrenia by 30 Chinese American caregivers in the Los Angeles area are investigated. Stress-related and biological explanations are most highly endorsed. Interpersonal and familial stress attributions reflect the sociocentric culture and centrality of family. A better match in causal attributions is key to improving interactions between mental health service providers and Chinese American patients and their caregivers. To this end, a stress-vulnerability model is suggested. Higher acculturation is also found to be positively associated with biological attributions of the illness, and supernatural attributions significantly relate to caregivers' objective and total burden. Implications of the findings are discussed.
From a stress and coping perspective, this qualitative study examined the impact of Hong Kong&... more From a stress and coping perspective, this qualitative study examined the impact of Hong Kong's sociocultural context on divorce experience of 35 women. Under the bind of traditional Chinese values and Western ideals, divorce was experienced as a threat to normal life and an oppression leading to economic hardship and a loss of self-identity. However, these women were hardy and
Within the framework of the interpersonal view of depression, this article examines the linkage b... more Within the framework of the interpersonal view of depression, this article examines the linkage between depression and four aspects of marital relationship: stress, support, role expectations, and interactional dynamics. Acknowledging the intertwined relationship between depression and marital adjustment, existing models of marital therapy for married depressed patients are examined for the extent to which they address these four aspects. The empirical evidence for the eficacy of these models is also reviewed, suggesting elements of marital therapy that are conducive to effective treatment outcome. In the past three decades, mental health theorists, clinicians, and researchers have increasingly recognized the important linkage between depression and the marital relationship. This association has been validated through numerous empirical studies. Various models of marital therapy as an approach to treatment with married depressed patients have also been developed and empirically tested in the past two decades. Some reviews have examined the evidence for the efficacy of various marital therapy models (Beach, Whisman, & O'Leary, 1994; Prince & Jacobson, 1995). However, to date, no attempt has been made to systematically examine the relationship between depression and marital adjustment under a comprehensive framework or to review the marital therapy models using the same lens. This article examines such linkage under the broad framework of the interpersonal view of depression and considers four dimensions within the marital context: stress, support, role expectations, and interactional cycle. Subsequently, various marital therapy models are reviewed under the same framework. Empirical evidence for the efficacy of these models is then discussed, suggesting elements of marital therapy that are conducive to effective treatment outcome and conclusions that could be drawn from these studies. DEPRESSION IN THE INTERPERSONAL, CONTEXT: THEORETICAL AND EMPIRICAL, BASES Depression does not occur in a vacuum. It occurs in an interpersonal context. Paykel and Cooper (1992), in their review of studies done in the past 20 years on depression and the social or interpersonal environment, conclude that changes in the social environment and the level of social support have been demonstrated to have clear association with depression. In the study of depression, some researchers emphasize the social roots of the disorder and thus the need to attend to interpersonal aspects (Becker, 1974;
International Journal of Environmental Research and Public Health, Apr 11, 2019
This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associ... more This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.
This study aims to examine how help-seeking behaviors of Chinese Americans are associated with th... more This study aims to examine how help-seeking behaviors of Chinese Americans are associated with the types of mental disorder, the tendency to somatize symptoms, social disruptiveness of symptoms, and comorbidity. Based on data from the Chinese American Psychiatric Epidemiological Study, we examined 246 Chinese Americans with a diagnosable major depressive disorder, anxiety disorder, or somatoform disorder, using hierarchical logistic regression analyses. Compared with respondents with somatoform disorder, those with anxiety or depressive disorder were 94% and 87% less likely to seek professional help. The tendency to somatize distress is positively related to soliciting help, especially medical help. Social disruptiveness had a very potent positive association with help seeking whereas comorbidity is nonsignificant when the symptom severity is controlled. The overall picture indicates that somatic expression of distress is a major impetus to help seeking, which happens to concur with the cultural conceptualization and subjective embodied experience of mental disorders among Chinese.
This study uses World Trade Center Health Registry data, based on Andersen’s health-care model, t... more This study uses World Trade Center Health Registry data, based on Andersen’s health-care model, to investigate 2,557 Asians’ mental health service use and associated factors 5–6 years after the World Trade Center attack, compared against 32,111 non-Hispanic white participants. We find that Asians had a lower proportion of service use (15.76 vs. 26.60 percent) than white people. A previous mental health diagnosis and perceived and evaluated mental health needs strongly predicted Asians’ mental health service use, as did having routine medical checkups, being female, and being married or cohabiting. These factors, in addition to other socioeconomic predictors that were nonsignificant among Asians, were significant among white people, as well. Our findings suggest that service providers need to provide clear diagnoses to service users, explore mental health needs during medical checkups, and provide postdisaster mental health education and free treatment.
Families in society-The journal of contemporary social services, Oct 1, 2003
THE ENORMOUS BURDEN involved in taking care of a family member suffering from a severe and persis... more THE ENORMOUS BURDEN involved in taking care of a family member suffering from a severe and persistent mental illness such as schizophrenia has been well docu
Adversities following disasters are associated with the delayed onset and persistence of post-tra... more Adversities following disasters are associated with the delayed onset and persistence of post-traumatic stress disorder (PTSD). In the wake of the World Trade Center attack, a sizeable group of Asian Americans being directly exposed to the disaster had endured job loss during the decade afterwards. Yet, no studies to date have examined the relationship between job loss and long-term PTSD in this group. This study examined the 10-11-year prevalence of probable PTSD (≥ PCL score of 44) among Asian (n=1,712) and Caucasian American (n=25,011) participants of the World Trade Center Health Registry who had completed three waves of survey studies (2003-04, 2006-08, 2011-12). Logistic regression was used to model the relationship between job loss since the disaster and probable PTSD for the two racial groups separately while controlling for sociodemographics, disaster exposure, post-disaster traumatic/stressful events exposure, lower respiratory symptoms, PTSD history since 911, and mental health service use. The long-term prevalence of probable PTSD was 15.1% for Asian Americans and 14.4% for Caucasian Americans, with no significant difference. For both groups, having job loss since 911 was a significant risk factor for probable PTSD (Asian Americans: AOR=1.80; 95% CI=1.19, 2.71; Caucasian Americans: AOR=1.73; 95% CI=1.56, 1.93). While job loss was an important risk factor, employment opportunities were more restricted for Asian Americans given the cultural and language limitations. Current findings highlight the importance of improving employment as part of post-disaster assistance.
Families in society-The journal of contemporary social services, Feb 1, 2001
Cultural beliefs of Chinese American families are discussed in relation to their caregiving exper... more Cultural beliefs of Chinese American families are discussed in relation to their caregiving experience of a mentally ill relative. Implications of such beliefs to mental health professionals are highlighted. Somatic factors and psychosocial stresses as causes of mental disorders are found compatible to the belief systems of these families. The stress-vulnerability dialysis is recommended as the explanatory model to be adopted by clinicians when they communicate the causes of mental illness to these families. In view of the pressure experienced by these families in the caregiving process and their relative social isolation as a result of their immigrant status, ways to harness the support from extended families and community resources are suggested. Also examined is a viable working alliance between these families and clinicians in terms of a therapeutic bond, consensual treatment goals, and relevant tasks. Finally, elements of a family intervention model compatible with cultural beliefs of these families are proposed.
This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predi... more This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2-3 years and 5-6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events. Although 16 years have lapsed since the terrorist attack at the World Trade Center (WTC) on September 11, 2001 (hereinafter referred to as 9/11), a substantial number of people who were directly exposed to the disaster are still suffering from physical as well as psychological problems (Jordan et al., 2015; Maslow et al., 2015). Posttraumatic stress disorder (PTSD) is one of the persisting mental health issues that continue to affect many survivors. A considerable number of Asians were exposed to the attack, as the WTC was less than 10 blocks away from Chinatown and many South Asians worked at the collapsed and nearby buildings (Asian American Federation of New York, 2003). While numerous studies have documented psychological distress associated with the attack among specific affected groups, such as rescue and recovery workers (Bowler et al., 2012; Cone et al., 2015), survivors of the collapsed buildings (DiGrande, Neria, Brackbill, Pulliam, & Galea, 2011), and Lower Manhattan residents (Welch et al., 2016), very few have focused on Asian Americans.
Recent epidemiologic studies have found that most patients with mental illness are seen exclusive... more Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Wayne J. Katon, M.D., will publish informative research articles that address primary care-psychiatric issues.
Journal of Comparative Family Studies, Dec 1, 2004
How the Socio-Cultural Context Shapes Women's Divorce Experience in Hong Kong. by Winnie W. ... more How the Socio-Cultural Context Shapes Women's Divorce Experience in Hong Kong. by Winnie W. Kung , Suet-Lin Hung , Cecilia LW Chan BACKGROUND AND FRAMEWORK The rising trend of divorce is a word-wide phenomenon. The impact of divorce can be fel.
Page 1. Chinese Americans' Help Seeking for Emotional Distress Winnie W. Kung University of ... more Page 1. Chinese Americans' Help Seeking for Emotional Distress Winnie W. Kung University of Southern California This study examines help-seeking behaviors for emotional distress among 1,747 Chinese Americans. Seventy ...
Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this repor... more Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this report examined perceived barriers to mental health treatment. Two factors emerged, namely practical barriers, which included cost of treatment, time, knowledge of access, and language, and cultural barriers consisting of credibility of treatment, recognition of need, and fear of loss of face. Average ratings of all practical barrier items were higher than cultural barrier items, demonstrating the importance of pragmatic considerations for this population. In a novel attempt, this study examined the empirical link between these perceived barriers and actual mental health service use. The practical barrier factor showed significance in predicting service use for both the whole sample and a subsample of individuals with at least one lifetime mental disorder.
Journal of Ethnic & Cultural Diversity in Social Work, 2004
ABSTRACT Causal attributions of schizophrenia by 30 Chinese American caregivers in the Los Angele... more ABSTRACT Causal attributions of schizophrenia by 30 Chinese American caregivers in the Los Angeles area are investigated. Stress-related and biological explanations are most highly endorsed. Interpersonal and familial stress attributions reflect the sociocentric culture and centrality of family. A better match in causal attributions is key to improving interactions between mental health service providers and Chinese American patients and their caregivers. To this end, a stress-vulnerability model is suggested. Higher acculturation is also found to be positively associated with biological attributions of the illness, and supernatural attributions significantly relate to caregivers' objective and total burden. Implications of the findings are discussed.
From a stress and coping perspective, this qualitative study examined the impact of Hong Kong&... more From a stress and coping perspective, this qualitative study examined the impact of Hong Kong's sociocultural context on divorce experience of 35 women. Under the bind of traditional Chinese values and Western ideals, divorce was experienced as a threat to normal life and an oppression leading to economic hardship and a loss of self-identity. However, these women were hardy and
Within the framework of the interpersonal view of depression, this article examines the linkage b... more Within the framework of the interpersonal view of depression, this article examines the linkage between depression and four aspects of marital relationship: stress, support, role expectations, and interactional dynamics. Acknowledging the intertwined relationship between depression and marital adjustment, existing models of marital therapy for married depressed patients are examined for the extent to which they address these four aspects. The empirical evidence for the eficacy of these models is also reviewed, suggesting elements of marital therapy that are conducive to effective treatment outcome. In the past three decades, mental health theorists, clinicians, and researchers have increasingly recognized the important linkage between depression and the marital relationship. This association has been validated through numerous empirical studies. Various models of marital therapy as an approach to treatment with married depressed patients have also been developed and empirically tested in the past two decades. Some reviews have examined the evidence for the efficacy of various marital therapy models (Beach, Whisman, & O'Leary, 1994; Prince & Jacobson, 1995). However, to date, no attempt has been made to systematically examine the relationship between depression and marital adjustment under a comprehensive framework or to review the marital therapy models using the same lens. This article examines such linkage under the broad framework of the interpersonal view of depression and considers four dimensions within the marital context: stress, support, role expectations, and interactional cycle. Subsequently, various marital therapy models are reviewed under the same framework. Empirical evidence for the efficacy of these models is then discussed, suggesting elements of marital therapy that are conducive to effective treatment outcome and conclusions that could be drawn from these studies. DEPRESSION IN THE INTERPERSONAL, CONTEXT: THEORETICAL AND EMPIRICAL, BASES Depression does not occur in a vacuum. It occurs in an interpersonal context. Paykel and Cooper (1992), in their review of studies done in the past 20 years on depression and the social or interpersonal environment, conclude that changes in the social environment and the level of social support have been demonstrated to have clear association with depression. In the study of depression, some researchers emphasize the social roots of the disorder and thus the need to attend to interpersonal aspects (Becker, 1974;
International Journal of Environmental Research and Public Health, Apr 11, 2019
This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associ... more This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.
This study aims to examine how help-seeking behaviors of Chinese Americans are associated with th... more This study aims to examine how help-seeking behaviors of Chinese Americans are associated with the types of mental disorder, the tendency to somatize symptoms, social disruptiveness of symptoms, and comorbidity. Based on data from the Chinese American Psychiatric Epidemiological Study, we examined 246 Chinese Americans with a diagnosable major depressive disorder, anxiety disorder, or somatoform disorder, using hierarchical logistic regression analyses. Compared with respondents with somatoform disorder, those with anxiety or depressive disorder were 94% and 87% less likely to seek professional help. The tendency to somatize distress is positively related to soliciting help, especially medical help. Social disruptiveness had a very potent positive association with help seeking whereas comorbidity is nonsignificant when the symptom severity is controlled. The overall picture indicates that somatic expression of distress is a major impetus to help seeking, which happens to concur with the cultural conceptualization and subjective embodied experience of mental disorders among Chinese.
This study uses World Trade Center Health Registry data, based on Andersen’s health-care model, t... more This study uses World Trade Center Health Registry data, based on Andersen’s health-care model, to investigate 2,557 Asians’ mental health service use and associated factors 5–6 years after the World Trade Center attack, compared against 32,111 non-Hispanic white participants. We find that Asians had a lower proportion of service use (15.76 vs. 26.60 percent) than white people. A previous mental health diagnosis and perceived and evaluated mental health needs strongly predicted Asians’ mental health service use, as did having routine medical checkups, being female, and being married or cohabiting. These factors, in addition to other socioeconomic predictors that were nonsignificant among Asians, were significant among white people, as well. Our findings suggest that service providers need to provide clear diagnoses to service users, explore mental health needs during medical checkups, and provide postdisaster mental health education and free treatment.
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Papers by Winnie Kung