Depression and Anxiety among Asian Americans: The Effects of Social Support and Strain

Conventional wisdom indicates that receipt of social support is universally beneficial. Social support from network ties is believed to be a fundamental aspect of psychological well-being and the therapeutic process (Kawachi & Berkman, 2001); however, social strain rooted in the same support networks may contribute to poorer mental health outcomes (Kook, 1992). Furthermore, research suggests support and strain may differentially affect men and women (Umberson, Chen, House, Hopkins, & Slaten, 1996). Recent research suggests that social networks and the ways individuals use these networks may also vary by culture, yet studies on minority communities, such as Asian Americans, are limited (H. S. Kim, Sherman, Ko, & Taylor, 2006). Asian Americans are one of the fastest-growing minority groups in the United States (U.S. Census Bureau, 2011). Although prior research suggests that Asian Americans have lower rates of psychological disorder and use of mental health services than other racial and ethnic groups (Matsuoka, Breaux, & Kyujin, 1997), recent studies indicate a substantial need for mental health care among Asian Americans (Marshall, Schell, Elliott, Berthold, & Chun, 2005; Mui & Kang, 2006; Takeuchi et al., 2007). Shame and stigma associated with mental illness may discourage people from using formal mental health services. This may be particularly true among Asian Americans, who often rely on family and members of their informal networks for support of their mental health problems (Leong & Lau, 2001; Spencer & Chen, 2004). The purpose of this study is to investigate the effect of social support and strain on mental health among Asian Americans. This study has several unique features. First, in contrast to prior studies that only focus on either support or strain, we examine both factors simultaneously while distinguishing between support and strain from friends and from family. Second, we investigate major depressive disorder (MDD) and generalized anxiety disorder (GAD) because these are clinical outcomes that contribute to considerable disability (World Health Organization, 2001). Third, we explore possible gender differences in these relations. Finally, we examine these issues among an understudied population and use a nationally representative sample. BACKGROUND Social Support, Social Strain, and Well-Being A large body of literature has described the salubrious effects of social support (Berkman & Glass, 2000; House, Landis, & Umberson, 1988). Berkman and Glass described social support as emotional, instrumental, tangible, and informational resources that individuals obtain from their network ties. These resources are known to promote mental health by enhancing self-esteem, strengthening effective coping, and mitigating distress. In studies on Asian Americans, social support has been negatively associated with acculturative stress and depression (Mui, 2001; Yeh & Inose, 2003). Social support also buffered the effect of stressors on mental and physical health among diverse Asian American groups (Choi, 1997; Gee et al., 2006). Other research suggests that Asian cultural values related to collectivism can limit the healthful benefits of social support. In contrast to Western individualism, a collectivist orientation may hinder disclosure of personal problems for fear of burdening others, disrupting group harmony, or losing face (B.S.K. Kim, Atkinson, & Umemoto, 2001; H. S. Kim et al., 2006). Indeed, some studies have found that compared with white Americans, Asian Americans appear less likely to seek social support in response to stress (Taylor et al,, 2004) or after breast-cancer treatment (Wellisch et al., 1999). H. S. Kim et al. (2006) found that Asian American students sought less support from family and friends and, further, perceived support to be less helpful in dealing with stress than white students. Taken together, the conflicting findings regarding social support's effectiveness for Asian Americans demonstrate a need for further investigation. …