Who Becomes Vulnerable to Depression?: Voices of Young Asian-Pacific Islander (API) Women

Background: Among US women between ages 15-24, Asian-Pacific Islanders (API) have the highest rate of suicide.  Nonetheless, little is known about the context and processes that underpin depression among API women. Thus, we compared 21 depressed API women with 18 non-depressed API women in a qualitative study.  Three family dynamic themes were found in both groups: (1) stress of being a child of immigrant parents, (2) value conflicts and negotiation within the family, and (3) emotional bonding and control.

Methods:  Our sample was drawn from participants in the Asian-American Women’s Sexual Health Initiative Project (AWSHIP) who were: ages 18-35; unmarried; Chinese, Vietnamese, Korean, or a mix thereof; and 1.5 or 2^nd generation immigrants.  Among those who participated in the AWSHIP survey (n = 718), 39 participants were randomly chosen and asked to participate in a semi-structured interview based on their level of acculturation, as well as history of traumatic life events including childhood sexual abuse, forced sex, suicide attempts, and hard drug use.  For this study, women were categorized as depressed if their CES-D score was 16 or higher. The interviews were transcribed verbatim and Atlas-Ti was used to analyze emergent coding themes. 

Findings:  Women in both groups have experienced various stresses related to parental immigration including micro-discrimination, financial hardship, and acculturation difficulties. However, the depressed group suffers from constant internal conflict and deeper levels of stress as they struggle to fit into mainstream American culture while striving to uphold the traditional Asian values of their family as the “ideal Asian woman.” Second, depressed women reported more frequent and severe conflicts with parents about their life choices including academic, career, financial, and dating.  Third, depressed women reported a pervasive lack of emotional bonding and poor communication with their parents, along with history of ongoing verbal and physical child abuse.

Conclusions:  Both non-depressed and depressed API children of immigrants do experience stress related to family immigration and value conflicts with their parents.  However, depressed women reported a greater extent of emotional disconnection and lack of positive bonding experiences with their parents and thus suffer more severely from a sense of disapproval and rejection. In addition to developing culturally-appropriate child abuse prevention programs, mental health awareness programs should be available for API families that emphasize the importance of cultivating mental wellbeing, negotiating values between parents and children, and developing coping skills to relieve stress related to immigration.