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Open Access Publications from the University of California

Scholarly Works (26 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2012)

Unlabelled

Background

Despite the strong influence of culture on family involvement in disease management, few studies have examined how immigrant families care for persons with mental illness. The purpose of this study was to examine how immigrant families organize their world to care for a mentally ill person in the United States. The current analysis focused on how Confucian notions of filial piety and parental obligation shape caregiving in Korean immigrant families.

Methods

Participants in this interpretive phenomenological study were comprised of six Korean immigrant women caring for a family member with mental illness. Participants provided narratives that illustrate challenges and opportunities in caring for their mentally ill family member.

Results

Three family caregiving patterns were discerned. Insulating from the outside world describes a family's effort to accept a member's illness and to manage it within the family. Prioritizing education over well-being concerns parental commitment to the Confucian priority of educating one's children. Reciprocating the sacrifice describes how a family adapts and enacts filial piety.

Conclusion

The findings of this study warrant further study to examine the influence of Confucianism among Korean American families. The three patterns of caregiving are strongly aligned with Confucian notion of family and family engagement. These patterns may help health providers to anticipate the needs of and provide individualized, culturally appropriate mental health care for patients with mental illness and their families of Korean origin.
    Cover page: Filial piety and parental responsibility: an interpretive phenomenological study of family caregiving for a person with mental illness among Korean immigrants
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2021)
    The purpose of this paper is to provide a brief summary of mental health issues among Asian and Pacific Islander (API) communities in the U.S. APIs include individuals from Far East Asia (e.g., Korea, China), Central Asia (e.g., Afghanistan, Uzbekistan), South Asia (e.g., India, Pakistan), South East Asia (e.g., Thailand, Philippines), Western Asia (e.g., Iran, Saudi Arabia), and Pacific islands (e.g., Hawaii, Samoa, Mariana island, Fiji, Palau, French Polynesia, Marshall Islands, Micronesia, New Zealand, Tokelau islands, Niue, and Cook Islands). Collectively they speak more than one hundred languages and dialects. Such a diversity across the API community presents unique challenges and opportunities for research, education, and practice. The existing body of literature on mental health issues in API communities is marred by the lack of high-quality data and insufficient degrees of disaggregation. Such a knowledge gap hindered our ability to develop culturally and linguistically tailored interventions, and in turn, API communities have experienced mental health disparities and mental health services' disparities. To move the field forward, future research effort with APIs should focus on articulating variations across different API subgroups, identifying what explains such variations, and examining the implications of such variations to research, practice, education, and policy.
      Cover page: A Brief Review of Mental Health Issues among Asian and Pacific Islander Communities in the U.S.
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2017)
        Cover page: In Sickness and in Health: Spousal Caregivers and The Correlates of Caregiver Outcomes
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2012)
        Effective management of depression in the primary care setting requires a systematic, population-based approach, which entails systematic case finding and diagnosis, patient engagement and education, use of evidence-based treatments, including medications and/or psychotherapy, close follow-up to ensure patients are improving, and a commitment to adjust treatments or consult with mental health specialists until depression is significantly improved. Programs in which primary care providers and mental health specialists collaborate effectively using principles of measurement-based stepped care and treatment to target can substantially improve patients' health and functioning while reducing overall health care costs.
          Cover page: Strategies to Improve the Management of Depression in Primary Care
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2014)

          Background

          Although collaborative care programs are effective in improving late-life depression, only about half of treated patients achieve clinically meaningful improvement. Thus, we need to examine what characteristics may predict poor late-life depression course. Despite the robust evidence for the negative association between the quality of couple relationships and depression outcomes, few studies have examined these associations in the context of long-term late-life depression course.

          Aim

          The objective of this study is to examine the relations between the severity of couple conflict, receiving collaborative depression care program, and 24-months depression outcomes.

          Methods

          Study sample comprised 840 depressed older adults subsample from the improving mood, promoting access to collaborative treatment for late-life depression trial (IMPACT). Depression and couple conflict were assessed at baseline, 12-month, and 24-month follow-up. Descriptive statistics and multivariate regression analyses were performed to examine mean 24-month depression-free days (DFD) and the marginal effects of receiving IMAPCT program over usual care among participants with varying degrees of 24-month couple conflict.

          Results

          Compared with those who never endorsed frequent couple conflict over the three observation points, those who did twice had 63 fewer DFD (p = 0.01), and those who did three times experienced 148 fewer DFD (p < 0.001). Although the marginal effects of receiving IMPACT program over usual care was greater in overall sample, it was not statistically significant among those who endorsed frequent conflict at two or three times.

          Conclusion

          Frequent couple conflict is associated with worse long-term late-life depression outcomes among the patients in primary care clinics.
            Cover page: Hundred forty eight more days with depression: the association between marital conflict and depression‐free days
            • Thesis
            • Peer Reviewed
            UC San Francisco Electronic Theses and Dissertations (2007)

            The purposes of this hermeneutic phenomenological study were to 1) understand Asian American families' everyday caregiving practices for a person with mental illness and 2) understand how mental health care providers provide care for AA patients and families. AA was defined as immigrants from Korea, China, and Japan and their descendents.

            The specific aims were to 1) examine patterns of family caregiving practices for mentally ill family members among AA families as observed by mental health care providers 2) provide a systematic articulation of Confucianism as manifested in the AA family caregiving practices and describe how Confucianism is modified as families acculturate to the United States, 3) identify the particular difficulties perceived by mental health care providers and some strategies they use to cope with these difficulties, and 4) examine patterns of practice among mental health professional providing care for AA patients and families.

            Participants were comprised of twenty providers who have treated mentally ill AA patients and families in the past 5 years in the San Francisco Bay Area. Data were collected through fact-to-face, in-depth interviews. In addition, field notes and memos were also included in the analysis.

            Study findings are consistent with the current knowledge of strong family supports in the AA population. However, the study findings emphasize that AA family caregiving practices should be understood in a much more complex manner. The study findings also highlight that a strong Confucian emphases on the family is still present among AA families, particularly in issues around caregiving and communication among family members.

            Narratives from practitioners illustrate the clinical reality of cultural competency and describe providers' practices when caring for mentally ill AA patients and their families. Such detailed illustrations provide insight for novice practitioners or those who have limited opportunity to work with this population. The findings of this study support some current guidelines while challenging others. For example, the emphasis on short-term result oriented solutions was problematized because it ignored the chronic nature of mental illness. This study found that providers had to cover broader and more complicated material in psychoeducation for AAs than current literature recommended.

              Cover page: Working with Culture: Psychiatric and Mental Health Care Providers' Perspectives on Practice with Asian American Families
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2012)
              Depression is a common, disabling, and costly condition encountered in older patients. Effective strategies for detection and treatment of late-life depression are summarized based on a case of a 69-year-old woman who struggled with prolonged depression. Clinicians should screen older patients for depression using a standard rating scale, initiate treatment such as antidepressant medications or evidence-based psychotherapy, and monitor depression symptoms. Patients who are not improving should be considered for psychiatric consultation and treatment changes including electroconvulsive therapy. Several changes in treatment approaches are usually needed before patients achieve complete remission. Maintenance treatment and relapse-prevention planning (summarization of early warning signs for depression, maintenance treatments such as medications, and other strategies to reduce the risk of relapse [eg, regular physical activity or pleasant activities]) can reduce the risk of relapse. Collaborative programs, in which primary care clinicians work closely with mental health specialists following a measurement-based treatment-to-target approach, are significantly more effective than typical primary care treatment.
                Cover page: Older Adults With Severe, Treatment-Resistant Depression
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2015)
                Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.
                  Cover page: Depression Among Older Adults with Diabetes Mellitus
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2017)
                  Siblings of individuals diagnosed with schizophrenia are an important source of family caregiving. Unfortunately, limited information is available about sibling caregivers because existing studies have focused on other family relationships such as parents, spouses, and children. To fill the knowledge gap, the purpose of this study is to describe Korean sibling caregivers' experience with individuals diagnosed with schizophrenia. Guided by Colaizzi's descriptive phenomenological methodology, we conducted in-depth, semi-structured, face-to-face interviews with eight individuals who have a sibling (1) diagnosed with schizophrenia and (2) hospitalized in an inpatient psychiatric unit. We discerned six key themes: sorrow, burnout, shame, different perspectives in life, acceptance, and responsibility. We categorized these themes into three groups: suffering, hope, and responsibility and obligation. Sibling caregivers of individuals with schizophrenia experience a mixture of several emotions. Participants loved their brother or sister with schizophrenia, but at the same time they felt shame and fear. While they were burdened by the responsibilities of caregiving, they remained loyal to their sibling with schizophrenia, continuing to help their siblings reach their full potential. Although participants were confused about the symptoms of schizophrenia, they were committed to learning more about the illness. Because we conducted the current study in Korea, the findings of this study may be unique to Korea culture. Further studies are needed to compare and contrast nuanced differences in sibling caregivers' experience among different cultural groups.
                    Cover page: Korean Sibling Caregivers of Individuals Diagnosed with Schizophrenia
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2015)

                    Objective

                    This study aims to examine if older adults living in poverty and from minority racial/ethnic groups experienced disproportionately high rates of poor oral health outcomes measured by oral health quality of life (OHQOL) and number of permanent teeth.

                    Methods

                    Cross-sectional analysis of 2,745 community-dwelling adults aged ≥65 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Oral health outcomes were assessed by questionnaire using the NHANES-Oral Health Impact Profile for OHQOL and standardized examination for dentition. Logistic and linear regression analyses were used to determine the association between oral health outcomes and predictors of interest. All analyses were weighted to account for complex survey sampling methods.

                    Results

                    Both poverty and minority race/ethnicity were significantly associated with poor oral health outcomes in OHQOL and number of permanent teeth. Distribution of scores for each OHQOL domain varied by minority racial/ethnic group.

                    Conclusions

                    Oral health disparities persist in older adults living in poverty and among those from minority racial/ethnic groups. The racial/ethnic variation in OHQOL domains should be further examined to develop interventions to improve the oral health of these groups.
                      Cover page: Socioeconomic and racial/ethnic oral health disparities among US older adults: oral health quality of life and dentition
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