Advertisement

Journal of Immigrant and Minority Health

, Volume 17, Issue 6, pp 1643–1653 | Cite as

The Relationships Between Functional Limitation, Depression, Suicidal Ideation, and Coping in Older Korean Immigrants

  • Joonhee AhnEmail author
  • Bum Jung Kim
Original Paper

Abstract

Older adults with functional limitations may be at higher risk for depression and suicidal ideation compared to their counterparts without such limits. This study examined the structural relationships between functional limitation, depression, suicidal ideation, and coping strategies in older Korean immigrants. Using data from 220 community dwelling Korean immigrants (age ≧ 65) in Los Angeles County, path analysis was conducted to test the study hypotheses. The resulting model accounted for 56 % of the variance in suicidal ideation, with functional limitation making significant contribution to suicidal ideation. Meanwhile, depression, which had the strongest direct effects on suicidal ideation, also played a significant role in mediating between functional limitation and suicidal ideation. Furthermore, adaptive coping was significantly associated with both functional limitation and suicidal ideation. Findings provide implications for implementing suicide-prevention programs for older Korean immigrants, especially those living with functional disability.

Keywords

Suicidal ideation Functional limitation Depression Coping Older Korean immigrants 

Notes

Acknowledgments

The paper was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF- 2012S1A2A1A01031727, PI: Joonhee Ahn). The authors would like to thank Jeane W. Anastas, PhD, professor at the New York University, Silver School of Social Work, for her advisement on the draft manuscript.

References

  1. 1.
    Pearson JL, Conwell Y. Suicide in late life: challenges and opportunities for research. Int Psychogeriatr. 1995;7(2):131–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Alexopoulos GS, Bruce ML, Hull J, Sirey J, Kakuma T. Clinical determinants of suicidal ideation and behavior in geriatric depression. Arch Gen Psychiatry. 1999;56:1048–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Hintikka J, Koivumaa-Honkanen H, Lehto S. Are factors associated with suicidal ideation true risk factors? A 3-year prospective follow-up study in a general population. Soc Psychiatry Psychiatr Epidemiol. 2009;44(1):29–33. doi: 10.1007/s00127-008-0401-6.CrossRefPubMedGoogle Scholar
  4. 4.
    Cattell H. Suicide in the elderly. Adv Psychiatr Treat. 2000;6:102–8.CrossRefGoogle Scholar
  5. 5.
    Yip PSF, Chi I, Chiu H, Kwan CW, Conwell Y, Caine ED. A prevalence study of suicide ideation among older adults in Hong Kong SAR. Int J Geriatr Psychiatry. 2003;18(11):1056–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Beckett LA, Dwight BB, Lemke JH, Mendes de Leon CF, Guralnick JM, Fillenbaum GG, Branch LG, Wetle TT, Evans DA. Analysis of change in self-reported physical function among older persons in four population studies. Am J Epidemiol. 1996;143:766–78.CrossRefPubMedGoogle Scholar
  7. 7.
    Mendes de Leon CF, Glass TA, Beckett LA, Seeman TE, Evans DA, Berkman LF. Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. J Gerontol B Psychol Sci Soc Sci. 1999;54B:162–72.CrossRefGoogle Scholar
  8. 8.
    Yang Y. How does functional disability affect depressives symptoms in late life? The role of perceived social support and psychological resources. J Health Soc Behav. 2006;47:355–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002;52:193–204.CrossRefPubMedGoogle Scholar
  10. 10.
    Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: a population-based study. Am J Orthopsychiatry. 2007;77(1):56–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Conwell Y, Duberstein PR, Hirsch JK, Conner KR, Eberly S, Caine ED. Health status and suicide in the second half of life. Int J Geriatr Psychiatry. 2010;25(4):371–9.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Park SM, Cho SI, Moon SS. Factors associated with suicidal ideation: role of emotional and instrumental support. J Psychosom Res. 2010;69(4):389–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Steffens DC, Hays JC, Krishnan KRR. Disability in geriatric depression. Am J Geriatr Psychiatry. 1999;7:34–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Kiosses DN, Alexopoulos GS. IADL functions, cognitive deficits, and severity of depression: a preliminary study. Am J Geriatr Psychiatry. 2005;13(3):244–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2–3):97–116.CrossRefGoogle Scholar
  16. 16.
    Celso BG, Ebener DJ, Burkhead EJ. Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities. Aging Ment Health. 2003;7(6):438–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Hsu HC, Tung HJ. Coping strategies and adaptation for the disabled elderly in Taiwan. Geriatr Gerontol Int. 2011;11(4):488–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Endler N, Corace K, Summerfeldt L, Johnson J, Rothbart P. Coping with chronic pain. Personal Individ Differ. 2003;34:323–46.CrossRefGoogle Scholar
  19. 19.
    Mikulinecer M, Florian V. Coping and adaptation to trauma and loss. In: Zeidner M, Endler NS, editors. Handbook of coping: theory, research and applications. New York: Wiley; 1996. p. 554–72.Google Scholar
  20. 20.
    Park JI, Han M, Kim MS, Yoon MS, Ko SH, Cho HC, Chung YC. Predictors of suicidal ideation in older individuals receiving home-care services. Int J Geriat Psychiatry. 2014;29:367–76. doi: 10.1002/gps.4012.CrossRefGoogle Scholar
  21. 21.
    Fiksenbaum E, Greenglass L, Eaton J. The relationship between coping, social support, functional disability and depression in the elderly. Anxiety Stress Coping. 2006;19(1):15–31.CrossRefGoogle Scholar
  22. 22.
    US Census Bureau. 2010 Census American fact finder. 2011. http://factfinder.census.gov.
  23. 23.
    Jang Y, Chriboga DA. Living in a different world: acculturative stress among Korean American elders. J Gerontol B Psychol Sci Soc Sci. 2010;65B:14–21. doi: 10.1093/geronb/gbp019.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Min JW, Moon A, Lubben JE. Determinants of psychological distress over time among older Korean immigrants and Non-Hispanic White elders: evidence from a two-wave panel study. Aging Ment Health. 2005;9(3):210–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Mui AC, Kang SY. Acculturation stress and depression among Asian immigrant elders. Soc Work. 2006;51(3):243–55.CrossRefPubMedGoogle Scholar
  26. 26.
    Kim O. Predictors of loneliness in elderly Korean immigrant women living in the United States of America. J Adv Nurs. 1999;29:1082–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Kim BJ, Sangalang CC, Kihl T. Effects of acculturation and social network support on depression among elderly Korean immigrants. Aging Ment Health. 2003;16(6):787–94.CrossRefGoogle Scholar
  28. 28.
    Mui A, Lee ES. Correlates of depression among Chinese and Korean immigrant elders in the United States. Ageing International. 2013. Published on-line. doi: 10.1007/s12126-013-9183-6.
  29. 29.
    Pang KYC. Symptoms of depression in elderly Korean immigrants: narration and the healing process. Cult Med Psychiatry. 1998;22(1):93–122.CrossRefPubMedGoogle Scholar
  30. 30.
    Sung H. Development and test of a model that explains depression among Korean older immigrants in the United States. 1998; Doctoral Dissertation in Indiana University.Google Scholar
  31. 31.
    Bjorck JP, Cuthbertson W, Thurman JW, Lee YS. Ethnicity, coping, and distress among Korean Americans, Filipino Americans, and Caucasian Americans. J Soc Psychol. 2001;141(4):421–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim BJ, Ahn J. Factors that influence suicidal ideation among elderly Korean immigrants: focus on diatheses and stressors. Aging Ment Health. 2014;18(5):619–27.CrossRefPubMedGoogle Scholar
  33. 33.
    Joiner T. Why people die by suicide. Cambridge: Harvard University Press; 2005.Google Scholar
  34. 34.
    Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite S, Selby EA, Thomas E, Joiner TE. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Van Orden KA, Cukrowicz KC, Witte TK, Joiner TE. Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychol Assess. 2012;24(1):197–215.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Thompson MG, Heller K. Facets of support related to well-being: quantitative social isolation and perceived family support in a sample of elderly women. Psychol Aging. 1990;5:535–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Williamson GM, Schulz R. Pain, activity restriction, and symptoms of depression among community residing elderly adults. J Gerontol B Psychol Sci Soc Sci. 1992;47:367–72.Google Scholar
  38. 38.
    Awata S, Seki T, Koizumi Y, Sato S, Hozawa A, Omori K, Kuriyama S, Arai H, Nagatomi R, Matsuoka H, Tsuji I. Factors associated with suicidal ideation in an elderly urban Japanese population: a community-based, cross-sectional study. Psychiatry Clin Neurosci. 2005;59(3):327–36.CrossRefPubMedGoogle Scholar
  39. 39.
    Lee D, Ko T, Han S. Effects of Community-Dwelling Older Adults’ Demographics and Social, Mental, and Physical Functions on Depressive Disorder. J Phys Ther Sci. 2013;25:463–6.CrossRefGoogle Scholar
  40. 40.
    Ahn J. An analysis on the explanatory model for suicidal ideation among older Korean immigrants in the US: mediating effects of depression and moderating effects of age. Korean J Fam Soc Work. 2012;38:257–90.Google Scholar
  41. 41.
    Choi SJ. Changing attitudes to filial piety in Asian countries. Paper presented at 17th World Congress of International Association of Gerontology, Vancouver, Canada. 2001.Google Scholar
  42. 42.
    Chow N. Filial piety in Asian Chinese communities. Paper presented at Symposium on Filial Piety, 5th Asia/Oceania Regional Congress of Gerontology, Hong Kong. 1995.Google Scholar
  43. 43.
    Jang SN, Kawachi I, Chang J, Boo K, Shin HG, Lee H, Cho SI. Marital status, gender, and depression: analysis of the baseline survey of the Korean Longitudinal Study of Ageing (KLoSA). Soc Sci Med. 2009;69:1608–15.CrossRefPubMedGoogle Scholar
  44. 44.
    Kiosses DN, Klimstra S, Murphy C, Alexopoulos GS. Executive dysfunction and disability in elderly patients with major depression. Am J Geriatr Psychiatry. 2001;9:269–74.CrossRefPubMedGoogle Scholar
  45. 45.
    Forsell Y, Jorm AF, Winblad B. Suicidal thoughts and associated factors in an elderly population. Acta Psychiatr Scand. 1997;95:108–11.CrossRefPubMedGoogle Scholar
  46. 46.
    Goldney RD, Wilson D, Dal-Grande E. Suicidal ideation in a random community sample: attributable risk due to depression and psychological and traumatic events. Aust N Z J Psychiatry. 2000;34:98–106.CrossRefPubMedGoogle Scholar
  47. 47.
    Wasserman D. Stress-vulnerability model and development of the suicidal process from suicidal ideation to suicide. In: Wasserman D, editor. Suicide: unnecessary death. London: Martin Dunitz; 2001.CrossRefGoogle Scholar
  48. 48.
    Yang SM, Rim CS. Relative effects of depression on suicide ideation of the rural elderly. J Welf Aged. 2006;32:377–96.Google Scholar
  49. 49.
    Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267–83.CrossRefPubMedGoogle Scholar
  50. 50.
    Folkman S. Personal control and stress and coping processes: a theoretical analysis. J Pers Soc Psychol. 1984;46:839–52.CrossRefPubMedGoogle Scholar
  51. 51.
    Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21:219–39.CrossRefPubMedGoogle Scholar
  52. 52.
    Folkman S, Lazarus RS. If it changes it must be a process: study of emotion and coping during three stages of a college examination. J Pers Soc Psychol. 1985;48:150–70.CrossRefPubMedGoogle Scholar
  53. 53.
    Carels RA. The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Qual Life Res. 2004;13(1):63–72.CrossRefPubMedGoogle Scholar
  54. 54.
    Strug DL, Mason SE, Auerbach C. How older Hispanic immigrants in New York city cope with current traumatic stressors: practice implication. J Gerontol Soc Work. 2009;52(5):503–16.CrossRefPubMedGoogle Scholar
  55. 55.
    Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med. 1993;55:234–47.CrossRefPubMedGoogle Scholar
  56. 56.
    Livneh H, Antonak RF, Gerhardt J. Multidimensional investigation of the structure of coping among people with amputations. Psychosomatics. 2000;41(3):235–44.CrossRefPubMedGoogle Scholar
  57. 57.
    Carver CS, Pozo C, Harris SD, Noriega V, Scheier MF, Robinson DS, Ketcham AS, Moffat FL Jr, Clark KC. How coping mediates the effects of optimism on distress: a study of women with early stage breast cancer. J Pers Soc Psychol. 1993;65:375–90.CrossRefPubMedGoogle Scholar
  58. 58.
    Kraaij V, Pruymboom E, Garnefski N. Cognitive coping and depressive symptoms in the elderly: a longitudinal study. Aging Ment Health. 2002;6(3):275–81.CrossRefPubMedGoogle Scholar
  59. 59.
    Bosworth HB, Park KS, McQuoid DR, Hays JC, Steffens DC. The impact of religious practice and religious coping on geriatric depression. Int J Geriatr Psychiatry. 2003;18:905–14.CrossRefPubMedGoogle Scholar
  60. 60.
    Koenig HG, Hays JC, George LK, Blazer DG, Larson DB, Landerman LR. Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms. Am J Geriatr Psychiatry. 1997;5(2):131–44.CrossRefPubMedGoogle Scholar
  61. 61.
    Chun M, Knight BG, Youn G. Differences in stress coping models of emotional distress among Korean and Korean-American and White-American caregivers. Aging Ment Health. 2007;11(1):20–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Kim MT, Han HR, Shin HS, Kim KB, Lee HB. Factors associated with depression experience of immigrant populations: a study of Korean immigrants. Arch Psychiatr Nurs. 2005;19(5):217–25.CrossRefPubMedGoogle Scholar
  63. 63.
    Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol. 1979;47(2):343–52.CrossRefPubMedGoogle Scholar
  64. 64.
    Park GB, Shin MS. College goal and suicidal ideation among high school students. Korean J Clin Psychol. 1990;9(1):20–32.Google Scholar
  65. 65.
    Carver CS. You want to measure coping but your protocol’s too long: consider the brief cope. Int J Behav Med. 1997;4(1):92–100.CrossRefPubMedGoogle Scholar
  66. 66.
    Benson PR. Coping, distress, and well-being in mothers of children with autism. Res Autism Spectr Disord. 2009;4(2):217–28.CrossRefGoogle Scholar
  67. 67.
    Won CW, Rho YG, Kim SY, Cho BR, Lee YS. The validity and reliability of Korean Activities of Daily Living (K-ADL) scale. J Korean Geriatr Soc. 2002;6:98–106.Google Scholar
  68. 68.
    Radloff LS, Locke BZ. The community mental health assessment survey and the CES-D Scale. In: Weissman MM, Myers JK, Ross CE, editors. Community Surveys of Psychiatric Disorders. New Burnswick: Rutgers University Press; 1986. p. 177–89.Google Scholar
  69. 69.
    Arbuckle JL. Amos for windows: analysis of moment structures (Version 3.6). Chicago: Small Waters Corp/SPSS; 1995.Google Scholar
  70. 70.
    Loehlin JC. Latent variable models: an introduction to factor, path, and structural analysis. 2nd ed. Hillsdale: Eribaum; 1992.Google Scholar
  71. 71.
    Fitchett G, Benjamins MR, Skarupski KA, Mendes de Leon CF. Worship attendance and the disability process in community-dwelling older adults. J Gerontol Soc Sci. 2013;68(2):235–45.CrossRefGoogle Scholar
  72. 72.
    Hertzog C, Van Alstine J, Usala PD, Hultsch DF, Dixon R. Measurement properties of the Center for Epidemiological Studies Depression Scale (CES-D) in older populations. Psychol Assess J Consult Clin Psychol. 1990;2(1):64–72. doi: 10.1037/1040-3590.2.1.64.Google Scholar
  73. 73.
    Arbuckle J, Wothke W. Amos users guide (Version 4.0). Chicago: Small waters Corp/SPSS; 1999.Google Scholar
  74. 74.
    Klem L. Path analysis. In: Grimm LG, Yarnold PR, editors. Reading and understanding multivariate statistics. Washington, DC: American Psychological Association; 1995.Google Scholar
  75. 75.
    Choi YH, Kim SH. Suicidal ideation and related factors according to depression in older adults. J Korean Gerontol Soc. 2008;28(2):345–55.Google Scholar
  76. 76.
    Jang Y, Kim G, Han L, Chiriboga DA. Attitudes of older Korean Americans toward mental health services. J Am Geriatr Soc. 2007;55(4):616–20. doi: 10.1111/j.1532-5415.2007.01125.x.PubMedCentralCrossRefPubMedGoogle Scholar
  77. 77.
    Marusic A, Goodwin RD. Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping. Suicide Life Threat Behav. 2006;36(3):323–8.CrossRefPubMedGoogle Scholar
  78. 78.
    Kim HS, Yeom HA, Seo YS, Kim NC, Yoo YS. Stresss and coping strategies of patients with cancer. Cancer Nurs. 2002;25:425–31.CrossRefPubMedGoogle Scholar
  79. 79.
    Mendes de Leon CF, Seeman TE, Baker D, Richardson ED, Tinetti ME. Self-efficacy, physical decline, and change in functioning in community-living elders: a prospective study. J Gerontol Soc Sci. 1996;51B:S183–90.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Welfare for the ElderlyHoseo UniversityChungchungnam-doSouth Korea
  2. 2.School of Social WorkUniversity of Hawaii at ManoaHonoluluUSA

Personalised recommendations