Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Anxiety Symptoms, Depressive Symptoms, and Traditional Chinese Medicine Use in U.S. Chinese Older Adults


This study examined the association between anxiety symptoms, depressive symptoms, and Traditional Chinese Medicine (TCM) use among U.S. Chinese older adults. Data was obtained from the Population Study of Chinese Elderly in Chicago (N = 3157; mean age = 72.8). Anxiety symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS‐A). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). TCM modalities included herbal products, acupuncture, massage therapy, Taichi, and other types of TCM. Although not significant, there was a trend indicating that higher levels of anxiety symptoms showed a higher rate of acupuncture use and massage therapy. Older Chinese Americans with depressive symptoms were more likely to use acupuncture and massage therapy; and they were less likely to use other TCM. Future research is needed to identify reasons for TCM use; and how these factors mediate or moderate the relationship between psychiatric symptoms and TCM use.

This is a preview of subscription content, log in to check access.


  1. 1.

    Dong XQ, Chen R, Li C, Simon MA. Understanding depressive symptoms among community-dwelling Chinese older adults in the Greater Chicago area. J Aging Health. 2014;26(7):1155–71.

  2. 2.

    Dong XQ, Chen R, Simon MA. Anxiety among community-dwelling U.S. Chinese older adults. J Gerontol Ser A. 2014;69(Suppl 2):S61–7.

  3. 3.

    Xu Y, Okuda M, Hser Y-I, et al. Twelve-month prevalence of psychiatric disorders and treatment-seeking among Asian Americans/Pacific Islanders in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions. J Psychiatr Res. 2011;45(7):910–8.

  4. 4.

    United States Census Bureau. American community survey. 2014; http://www.census.gov/programs-surveys/acs/.

  5. 5.

    Hong S, Walton E, Tamaki E, Sabin JA. Lifetime prevalence of mental disorders among Asian Americans: nativity, gender, and sociodemographic correlates. Asian Am J Psychol. 2014;5(4):353–63.

  6. 6.

    Pearlin LI. The sociological study of stress. J Health Soc Behav. 1989;1989:241–56.

  7. 7.

    Substance Abuse and Mental Health Services Administration. Racial/ethnic differences in mental health service use among adults. Rockville, M.D.: Substance Abuse and Mental Health Services Administration; 2015.

  8. 8.

    Dong X, Bergren SM, Chang ES. Levels of acculturation of Chinese older adults in the Greater Chicago area—the population study of chinese elderly in Chicago. J Am Geriatr Soc. 2015;63(9):1931–7.

  9. 9.

    Seo JY, Bae SH, Dickerson SS. Korean immigrant women’s health care utilization in the United States: a systematic review of literature. Asia Pac J Public Health. 2016;28(2):107–33.

  10. 10.

    Yang LH, Corsini-Munt S, Link BG, Phelan JC. Beliefs in traditional Chinese medicine efficacy among Chinese Americans: implications for mental health service utilization. J Nerv Ment Dis. 2009;197(3):207–10.

  11. 11.

    National Center for Complementary and Integrative Health (NCCIH). Traditional Chinese Medicine: In depth. 2018; https://nccih.nih.gov/health/whatiscam/chinesemed.htm.

  12. 12.

    Arcury TA, Suerken CK, Grzywacz JG, Bell RA, Lang W, Quandt SA. Complementary and alternative medicine use among older adults: ethnic variation. Ethn Dis. 2006;16(3):723–31.

  13. 13.

    Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280(18):1569–75.

  14. 14.

    Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry. 2001;158(2):289–94.

  15. 15.

    Dong XQ, Bergren SM, Chang ES. Traditional Chinese medicine use and health in community-dwelling Chinese-American older adults in Chicago. J Am Geriatr Soc. 2015;63(12):2588–95.

  16. 16.

    Lam TP. Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese. J Epidemiol Community Health. 2001;55(10):762–5.

  17. 17.

    Dong XQ, Jiang J. Association between cancer and utilization of traditional Chinese medicine in U.S. Chinese women: findings from the PINE study. Gerontol Geriatr Med. 2018;4:2333721418778199.

  18. 18.

    Simon MA, Chang ES, Rajan KB, Welch MJ, Dong X. Demographic characteristics of US Chinese older adults in the Greater Chicago area: assessing the representativeness of the PINE study. J Aging Health. 2014;26(7):1100–15.

  19. 19.

    Dong XQ, Wong E, Simon MA. Study design and implementation of the PINE study. J Aging Health. 2014;26(7):1085–99.

  20. 20.

    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

  21. 21.

    Chang ES, Beck T, Simon MA, Dong X. A psychometric assessment of the psychological and social well-being indicators in the PINE study. J Aging Health. 2014;26(7):1116–36.

  22. 22.

    Chen R, Simon MA, Chang ES, Zhen Y, Dong X. The perception of social support among U.S. Chinese older adults: findings from the PINE Study. J Aging Health. 2014;26(7):1137–54.

  23. 23.

    Smith CA, Hay PPJ, MacPherson H. Acupuncture for depression. Cochrane Database Syst Rev. 2010;20:19. https://doi.org/10.1002/14651858.CD004046.pub4.

  24. 24.

    Field T. Massage therapy research review. Complement Ther Clin Pract. 2016;24:19–31.

  25. 25.

    Özen EM, Serhadlı SNA, Türkcan AS, Ülker GE. Somatization in depression and anxiety disorders. J Psychiatry Neurol Sci. 2010;23(1):60–5.

  26. 26.

    Liu L, Liu C, Wang Y, Wang P, Li Y, Li B. Herbal medicine for anxiety, depression, and Insomnia. Curr Neuropharmacol. 2015;13(4):481–93.

  27. 27.

    Simon MA, Li Y, Dong X. Levels of health literacy in a community-dwelling population of Chinese older adults. J Gerontol Ser A. 2014;69(Suppl 2):S54–60.

  28. 28.

    Yang LH, Phelan JC, Link BG. Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese-Americans. Cult Divers Ethn Minor Psychol. 2008;14(1):10–8.

  29. 29.

    Wu B, Chi I, Plassman BL, Guo M. Depressive symptoms and health problems among Chinese immigrant elders in the U.S. and Chinese elders in China. Aging Mental Health. 2010;14(6):695–704.

  30. 30.

    Dong XQ, Li K. The association between musculoskeletal symptoms and traditional Chinese medicine use among Chinese older adults in the greater Chicago area. Gerontol Geriatr Med. 2018;4:2333721418778179.

  31. 31.

    Hsiao AF, Wong MD, Goldstein MS, Becerra LS, Cheng EM, Wenger NS. Complementary and alternative medicine use among Asian-American subgroups: prevalence, predictors, and lack of relationship to acculturation and access to conventional health care. J Altern Complement Med (New York, NY). 2006;12(10):1003–10.

  32. 32.

    Arcury TA, Bell RA, Altizer KP, Grzywacz JG, Sandberg JC, Quandt SA. Attitudes of older adults regarding disclosure of complementary therapy use to physicians. J Appl Gerontol. 2013;32(5):627–45.

  33. 33.

    Bahall M, Legall G. Knowledge, attitudes, and practices among health care providers regarding complementary and alternative medicine in Trinidad and Tobago. BMC Complement Altern Med. 2017;17(1):144.

Download references


We thank the study participants and staff of the Chinese Health, Aging, and Policy Program (CHAPP), Rush Institute for Healthy Aging. Dr. XinQi Dong was supported by National Institute on Aging Grants (Grant Nos. R01 AG042318, R01 MD006173, R01 AG11101, and RC4 AG039085), Paul B. Beeson Award in Aging (Grant No. K23 AG030944), the Starr Foundation, American Federation for Aging Research, John A. Hartford Foundation, and the Atlantic Philanthropies.

Author information

Correspondence to Ying-Yu Chao.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chao, Y., You, E., Chang, Y. et al. Anxiety Symptoms, Depressive Symptoms, and Traditional Chinese Medicine Use in U.S. Chinese Older Adults. J Immigrant Minority Health (2019). https://doi.org/10.1007/s10903-019-00935-0

Download citation


  • Traditional Chinese medicine
  • Anxiety
  • Depression
  • Chinese older adults