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Does Cultural Assimilation Influence Prevalence and Presentation of Depressive Symptoms in Older Japanese American Men? The Honolulu-Asia Aging Study

https://doi.org/10.1097/JGP.0b013e3182107e3bGet rights and content

Objective

Sociocultural factors have been implicated in affecting prevalence, incidence, and diagnosis of depression but previous studies have included heterogeneous ethnic populations. We studied the influence of cultural assimilation on the prevalence and presentation of depressive symptoms in elderly Japanese American men.

Method

This analysis was based on 3,139 Japanese American men aged 71–93 years who were participants in the Honolulu-Asia Aging Study between 1991 and 1993. We created a Cultural Assimilation Scale (CAS) using 8 questions assessing the degree of Japanese identity and lifestyle compared to a Western one. Subjects were divided into tertiles of CAS score for analysis. Prevalence of depressive symptoms was measured using an 11-question version of the Centers for Epidemiologic Studies Depression Scale questionnaire, and presence of depressive symptoms was defined as score 9 or more.

Results

Prevalent depressive symptoms did not reach a statistically significant association with CAS tertiles (Western, 10.8%; Mixed, 9.6%; and Japanese, 8.5%). However after adjusting for demographic, functional, and disease factors, the most culturally Japanese group had significantly lower odds for prevalent depressive symptoms, compared to the most Western group. Among the subset of subjects with a high-Centers for Epidemiologic Studies Depression Scale-11 score, there were no significant differences in both mean psychological scores and mean somatic scores between the three CAS groups.

Conclusions

Prevalent depressive symptoms were significantly lower among elderly Japanese American men who were most culturally Japanese, compared to more westernized men. Improving knowledge and understanding about the pathogenesis of depression will have important public health implications.

Section snippets

Study Sample

The Honolulu Heart Program began as a prospective study of cardiovascular diseases in 8,006 men of Japanese ancestry living on the island of Oahu, Hawaii in 1965, born between 1900 and 1919. All men of Japanese ancestry identified by using World War II selective service registration cards were invited to participate.10 Since 1965, the full cohort has been examined nine more times and an eleventh examination cycle is in progress. The Honolulu-Asia Aging Study began with the fourth examination

RESULTS

The prevalence of depressive symptoms showed a dose response relationship among the CAS tertiles (Table 3). Comparing baseline characteristics between tertiles of the CAS, those who were most culturally Japanese were significantly older, less educated, and had lower incomes. They had significantly lower body mass index, lower cognitive test scores and lower rates of prevalent diabetes. Comparing baseline characteristics between those with and without prevalent depressive symptoms, subjects with

DISCUSSION

We found significant associations between cultural assimilation and prevalent depressive symptoms, with lower prevalent depressive symptoms among those most culturally Japanese. The most culturally Japanese men had a 28% decrease in odds of depressive symptoms that is clinically meaningful. We did not find any association between cultural assimilation, and both prevalent psychological and somatic complaints. Older Japanese American men who were more culturally Japanese had fewer depressive

CONCLUSIONS

We found significant associations between cultural assimilation and prevalent depressive symptoms, with lower prevalent depressive symptoms among those who were most culturally Japanese when compared to those who are most westernized. Our study confirmed the hypothesis that depressive symptoms were significantly associated with sociocultural factors in a relatively homogenous population of Japanese American elderly men in Hawaii, a group not previously studied. We feel that the difference in

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    The authors thank Robert Ewart, M.D., for providing valuable comments about the manuscript.

    This study was supported by contract N01-HC-05102 from the National Heart, Lung, and Blood Institute, contract N01-AG-4-2149 and grant 5 U01 AG019349-05 from the National Institute on Aging. The authors received support from the Office of Research and Development, Medical Research Service, Department of Veterans Affairs. The information contained in this article does not necessarily reflect the position or the policy of the government, and no official endorsement should be inferred.

    This study was accepted for poster presentation at the Hawaii Chapter American College of Physicians meeting in January 2010.

    Disclosure of Interests: The authors on this article do not have any conflict of interest to report that is related to this publication.

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