Perceived Racial Discrimination, Depression, and Coping

Perceived Racial Discrimination, Depression, and Coping: A Study of Southeast Asian Refugees in Canada Author(s): Samuel Noh, Morton Beiser, Violet Kaspar, Feng Hou and Joanna Rummens Source: Journal of Health and Social Behavior, Vol. 40, No. 3 (Sep., 1999), pp. 193-207 Published by: American Sociological Association Stable URL: http://www.jstor.org/stable/2676348 Accessed: 21-11-2016 05:11 UTC

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This content downloaded from 130.63.180.147 on Mon, 21 Nov 2016 05:11:14 UTC All use subject to http://about.jstor.org/terms Perceived Racial Discrimination, Depression, and Coping: A Study of Southeast Asian Refugees in Canada*

SAMUEL NOH MORTON BEISER

University of Toronto and the Centre for Addiction and Mental Health-Clarke Division

VIOLET KASPAR

Centre for Addiction and Mental Health-Clarke Division

FENG HOU JOANNA RUMMENS

University of Toronto and the Centre for Addiction and Mental Health-Clarke Division

Journal of Health and Social Behavior 1999, Vol 40 (September): 193-207

Using data obtained from personal interviews with 647 Southeast Asian refugees in Canada, this study tests hypotheses regarding both the association between perceived racial discrimination and depression, and the roles of coping and ethnic identity in conditioning the nature of the discrimination-depression relation. Refugees who reported that they had experienced racial discrimination had higher depression levels than their counterparts who reported no such experiences. Responding to discrimination through confrontation was not significantly associated with depression. Study findings support the effectiveness offorbearance in diminishing the strength of the association between discrimination and depression. The moderating effect offorbearance was conditioned by the level of ethnic identity: The beneficial effect offorbearance was significantly greater among those holding stronger ethnic identification. Cultural and situational interpretations of the findings are presented.

*We gratefully acknowledge the contributions made That race or visible minority status is a prin- by anonymous reviewers and by the editor of this cipal determinant of access to social status and journal through their careful reviews and helpful resources, personal identity, and mortality and suggestions. We also wish to express our sincere morbidity in North America (Williams 1997) appreciation for the invaluable contribution of the Southeast Asian refugees who so generously par- is consistent with a sociological tradition that ticipated in this research, and without whose stresses the significance of social inequity as participation this study would not have been possi- the primary source of differential distributions ble. Mr. Daniel Roshi's contributions as the project of health and well-being (Aneshensel 1992; coordinator are also acknowledged. The study was Pearlin 1989). Although racism has been a supported by research grants from the National long-standing preoccupation in political, ethi- Health Research and Development Program, Health Canada to Dr. Beiser (6610-1249), Social Sciences cal, and social science discourse, health and Humanities Research Council of Canada to researchers have only recently begun to inves- Noh (410-96-1526), and Medical Research Council tigate its effects on individual well-being to Noh and Beiser (mal3752). All correspondence (Jackson, Brown, and Kirby 1998; Krieger regarding this article may be addressed to Dr. Beiser 1990; Salgado de Snyder 1987; Williams, or Dr. Noh, Culture, Community, and Health Lavizzo-Mourey, and Warren 1994). Yet most Studies, Centre for Addiction and Mental Health- Clarke Division, 250 College Street West, Toronto, studies do not illuminate how individual mem- ON, Canada. M5T 1R8; e-mail: nohs(cs.clarke- bers of racial groups respond to the experi- inst.on.ca. ences of discrimination, nor do they explain

193

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how those experiences are later manifested in preferred response to stress (e.g., Kuo 1995; physical and emotional casualties. Noh et al. 1998). In this regard, we may expect This study examines the experiences of a stronger stress-buffering effect of forbear- Southeast Asian refugees in Canada and con- ance among Asian respondents with stronger centrates on the relationship between per- ethnic identification, given that Asian cultural ceived racial discrimination and depression. norms and values dictate avoidance, self- We hypothesize that the association between regulation, and maintenance of interpersonal discrimination and depression is conditioned harmony rather than direct action (Aldwin by both the individual's coping response to dis- 1994; Tietjen 1989; Triandis 1994). crimination and by his or her ethnic identification. Direct, confrontational responses, such as protesting directly to an offender or reporting BACKGROUND to authorities, may mitigate the effect of perceived discrimination on psychological dis- Perceived Discrimination and Psychological tress because confrontation may alter the situ- Distress ation and reduce the sense of helplessness and victimization. However, confrontation might Jackson et al. (1998) define discrimination exacerbate the distress due to discrimination as "intentional acts that draw unfair or injuri- because direct responding can contribute to ous distinctions, that are based solely on ethnic instigation and escalation of conflict and hos- or racial basis and that have effects favorable tile interaction. Also, confrontation may not be to in-groups and negative to out-groups" (p. an option available to relatively powerless 110). Perceived racial discrimination may be groups such as visible minority immigrants. referred to as a minority group members' sub- Circumstances such as fear of losing a job, jective perception of unfair treatment of inadequate social support, and lack of institu- racial/ethnic groups or members of the groups, tional sanction for reporting racist incidents based on racial prejudice and ethnocentrism, militate against confrontational responses to which may be manifest at individual, cultural, discrimination. Forbearing responses such as or institutional levels (Jackson et al. 1998). passively accepting the experiences or not The unfair or injurious acts may be expressed reacting may be the most viable method of either in direct and blatant forms of behavior recourse for these minorities. Forbearance or in more subtle and elusive attitudes and may reduce the association between discrimi- behaviors. nation and depression because it might help to Studies of the psychological cost of being a avoid direct hostilities. However, it could con- target of discrimination tend to focus on per- tribute to further distress because the situation ceived discrimination. One reason is that, in is not altered and the sense of helplessness and most modern, Western societies where these victimization is amplified. Given the lack of studies are carried out, racial discrimination is evidence for either position, these remain subtle and elusive; it is, therefore, difficult to questions to be determined through empirical document except through the eyes of its vic- analysis. tims (Dovidio and Gaertner 1991, 1998; Another question that we address in this Gaertner and Dovidio 1986; Hamberger and paper is whether the association between dis- Hewstone 1997; Henry et al. 1995; Meertens crimination and depression depends on the and Pettigrew 1997). individual's level of ethnic identification. Qualitative studies of racial discrimination Strong ethnic identification may increase the (Essed 1991; Feagin 1991) and hate crime depression associated with racial discrimina- (Barnes and Ephross 1994) describe psycho- tion because of the perceived importance of logical consequences of social stigma and dis- the disparaged identity. In addition, ethnic crimination, citing frequently expressed feel- identity may alter the protective effects of con- ings of being worthless, helpless, powerless, frontation or forbearance. The idea that direct looked down upon, sad, and fearful. action is the best way to redress grievances is Community surveys have demonstrated an consistent with North American dominant cul- association between experiences with discrim- tural values, but studies of Asian-born resi- ination and psychological distress among both dents of both Canada and the United States Mexican immigrant women in Los Angeles find that forbearance, or passive coping, is the (Salgado de Snyder 1987) and Hispanic

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women in America (Amaro, Russo, and exerts only short-term influences on emotion- Johnson 1987). A study of Southeast Asian al distress, but the experience does not trans- refugees and Pacific Island (mostly Samoans) late into long-term effects on physical health. immigrants in New Zealand found that Asian For black Americans, however, racial and other refugees and Pacific Islanders, but not British forms of discrimination are more prevalent immigrants, experienced discrimination daily and more chronic, and their effects are more and that the experience of discrimination was likely to be cumulative. "the crucial post-migration factor associated Experimental studies also demonstrate a with high symptom levels (both anxiety and link between perceived discrimination and depression)" (Pernice and Brook 1996:516). psychological symptoms. Jewish students at There also appears to be evidence for a dose- the University of Toronto displayed signifi- response relationship between discrimination cantly higher levels of aggression, sadness, and psychological distress. In a study of black and egotism in a manipulated "discrimination" Americans, Sanders-Thompson (1996) report- condition than did Jewish students in the "no- ed that psychological distress symptoms (e.g., discrimination" condition (Dion and Earn troubling dreams, intrusive thoughts and 1975). A replication study with Chinese stu- images) were more pronounced when the dents at the same university produced identical nature of the racism experienced (within the findings (Pak, Dion, and Dion 1991; Dion, past 6 months) was moderate or severe than Dion, and Pak 1992). when it was mild. Thus, the weight of evidence supports the Based on a survey of over 5,000 adolescents hypothesis that perceived discrimination in Florida and California, Rumbaut (1994) constitutes a significant stressor which can reported a positive relationship between levels jeopardize the physical and mental health of of depressive symptoms and reports of dis- ethno-racial minority group members (Rabkin crimination experienced by immigrant youth. and Struening 1976; Moritsugu and Sue 1983; Williams and his colleagues (Jackson, Kessler and Neighbors 1986; Williams 1994). Williams, and Torres 1997; Williams, Yu, and The literature falls short, however, in explain- Jackson 1997a; Williams et al. 1997b) used ing the sources of individual variability in data from two U.S. national surveys (National response to this stressor. Study of black Americans, and Americans' In view of the stress-process paradigm, the Changing Lives) and a regional study (Detroit variability originates from both differential Area Study) to examine the impact of discrim- vulnerability to stressors (i.e., individual dif- ination on an array of health outcomes. They ferences in emotional reactions evoked by the found that a single-item self-report measure of social stressors) and the availability of coping racial or ethnic discrimination was powerful in resources, including personal coping ability, explaining the variance in health status of a social support, and mastery (Aneshensel 1992; sample of black Americans. Self-reported Avison and Gotlib 1994; Pearlin et al. 1981; experience of discrimination during the month Pearlin and Schooler 1978; Thoits 1995; prior to the survey was associated with Turner and Noh 1983; Turner and Lloyd 1998). increased levels of chronic health problems There would most likely be considerable vari- and physical disabilities, and with self- ability in psychological impacts of racial dis- reported physical symptoms, diagnosed crimination, but we are not aware of any depression, and compromised psychological empirical report examining the extent of the well-being (Jackson et al. 1997). variability, nor are we aware of any that exam- A U.S. study of other forms of discrimina- ine the factors that intensify or mitigate the tion, such as gender bias, demonstrated an impact of discrimination. association between experienced discrimination and both physical and mental health symptoms among African Americans. Coping with Discrimination However, among white Americans the association was limited to psychological symptoms Problem-focused coping, or confrontation, (Williams et al. 1997a). Taking the "weather- functions to minimize the harmful effects of a ing hypothesis" (Geronimus 1992) as a ftame perceived stressor through retrieval of person- of reference, Williams et al. (1997a) speculate al control over the stressful situation. Emotion- that, for white Americans, discrimination focused coping, or forbearance, is an attempt

This content downloaded from 130.63.180.147 on Mon, 21 Nov 2016 05:11:14 UTC All use subject to http://about.jstor.org/terms 196 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR to regulate manifested emotional symptoms Previous studies suggest that many Asians (Billings and Moos 1981; Folkman and believe that "doing nothing" is the best way to Lazarus 1980). However, coping operates respond to discrimination, and they consider within a specific context (Eckenrode 1991; educational programs more effective than Folkman et al. 1991; Mattlin, Wethington, and social deterrence as a method of reducing Kessler 1990; Pearlin 1991; Wethington and racism (Buchignani 1982; Kuo 1995). A previ- Kessler 1991), and the behaviors and cognition ous report from the University of Toronto for each function vary according to situational Department of Psychiatry/Centre for context. Addiction and Mental Health Refugee The limited literature on coping with dis- Resettlement Project (RRP) revealed that a crimination suggests that confrontation is large proportion of Chinese, Laotian, and more adaptive than is forbearance. For exam- Vietnamese refugees who encountered racial ple, Krieger (1990) found that black American discrimination chose to regard it as a part of women who employed passive responses to life, or simply ignored or avoided it (Noh et al. racial discrimination had higher blood pres- 1998). A minority of the sample said they sure levels than those who coped through more protested verbally or reasoned with the offend- active, direct approaches, including talking to er, and only a very small proportion reported others about the situation or taking action to racially-based incidents to authorities. address the problem (as cited in Williams et al. In contrast to dominant North American val- 1994). ues which stress action over passivity, Asian Situations that are extremely difficult to culture dictates a preference for indirect change militate against the use of problem- problem-solving over self-assertion (Reynolds focused coping. Wethington and Kessler 1976, cited in Aldwin 1994). This is consistent (1991) have reported that, in chronically with the primacy of the collectivity over the threatening situations, passive coping may be individual, and with the over-riding impor- the only realistic option. Perceived powerless- tance most Asian cultures assign to the preser- ness affects the choice of coping responses. In vation of interpersonal relationships (Tietjen a comparison of responses to gender discrimi- 1989; Triandis 1994). Within this context for- nation, black women evidenced more recourse bearance may be more culturally congruent to passive coping than white women, leading than it is for other groups, and, therefore, a the researchers to suggest that the former were more effective coping strategy. Furthermore, if less likely than the latter to anticipate that they Hwang (1979) is correct in proffering that the could do anything to control the situation use of culturally discordant coping responses (Williams et al. 1994). With a present-day can accentuate stress and associated mental North American context characterized by health difficulties, active confrontation may color-based divisions of power and influence, actually be dysfunctional for Southeast Asians. highly selective immigration policies, and sub- This cultural congruence hypothesis also tle rather than overt discriminatory practices, suggests that the negative psychological visible minority immigrants have limited impact of perceived racial discrimination opportunity to react to racism through con- against one's own ethnic group may be greater frontation. Because of a fear of causing further among those holding a stronger ethnic identity trouble, the absence of institutional support for because, for these individuals, the disparaged direct complaints, a lack of social resources identity likely holds greater significance. In and skills for negotiation, and a skepticism addition, to the extent that either confrontation about the effectiveness of official procedures, or forbearance is sanctioned within the culture, and because their subtlety makes discriminato- the efficacy of coping responses will be high- ry acts difficult to document, visible minority lighted among those holding stronger ethnic group members are often reluctant to report identification. incidents to appropriate authorities or to engage in other direct forms of action against racial discrimination (Head 1975; Hofstede METHOD 1980; Kluegel and Smith 1986; Muszynski 1983; Kuo 1995). Sample Culture probably affects the choice of coping response and mediates its effectiveness. The data for this study were derived from

This content downloaded from 130.63.180.147 on Mon, 21 Nov 2016 05:11:14 UTC All use subject to http://about.jstor.org/terms PERCEIVED RACIAL DISCRIMINATION, DEPRESSION, AND COPING 197 the third wave survey of the Refugee outs" were not different from "stayers." Resettlement Project (RRP), a decade-long Depression at the second wave was signifi- study of the psychological, economic, and cantly (p < .03) lower for attriters than for social adaptation of Southeast Asian refugees those retained for follow-up, although the in Canada. The RRP began in 1981 with a one- effect size was small (standardized effect of in-three probability sample of 1,348 adult 0.12). Perceived racial discrimination at the refugees (18 years and over) who resettled in third wave was not related to level of depres- Vancouver, British Columbia, between 1979 sion assessed at either baseline or at the 1983 and 1981. Details of the multi-wave sampling re-interview. Higher rates of attrition among procedure have been reported elsewhere the less depressed could potentially result in an (Beiser and Fleming 1986). Trained bilingual increased estimate of the crude rate of per- interviewers, most of them refugees them- ceived discrimination. However, it is difficult selves, conducted the structured interviews, to determine the extent to which the sample which were prepared in Cantonese, attrition would bias the associations among Vietnamese, and Laotian versions using stan- perceived racial discrimination, depression, dard back-translation procedures (Brislin coping, and ethnic identity. 1970) on an interview schedule. The comple- Of the 647 refugee adults who participated tion rate was 97 percent. Two years later, 86.7 in the third wave, 10-year follow-up survey, percent of the original sample participated in 281 (43.4%) were Chinese. The remaining 366 the second wave follow-up survey. (56.6%) were Vietnamese and Laotian. Men A second follow-up interview conducted 10 were slightly over-represented (57.3%). At the years later (between 1991 and 1993) contained time of the 1991 follow-up, the RRP respon- a series of questions about personal experi- dents ranged in age from 26 to 88 years. The ences with racial discrimination. Sixty-two mean age of the sample was 41 years, and and one half percent of the 1,348 participants fewer than 20 percent were 50 years of age or in the baseline survey were located for the ten older. In 1991, 80 percent of the sample were year follow-up. Thirty-seven and one half per- currently married. The refugees' level of for- cent were not located: 15.8 percent had moved mal education was significantly lower than out of British Columbia without leaving a for- that of the general population of Canada. warding address, and 21.7 percent were other- Fewer than 30 percent of the refugees had wise lost to follow-up. Of the 842 who were completed 12 or more years of formal school- located, 155 did not answer or were "out of ing. Only 8.5 percent had received formal edu- town" most of the time on business; 21 were cation after arriving in Canada. However, a either deceased or too ill to participate in the large proportion of the sample (71.4%) had interview. Interviews were completed with a been employed for 100 percent of the time dur- total of 666 respondents, but 19 cases were ing the five years prior to the survey, and an dropped because they could not be aligned additional 20 percent had worked for some with absolute certainty with their respective portion of that time. baseline or first follow-up interviews. The remaining sample was made up of 647 cases. The overall retention (62.5%) and response Measuring Perceived Discrimination and (76.8% of the 842) rates are reasonably high Coping considering the 10 year follow-up period and the degree of mobility among the sample sub- Discrimination. The interview's section on jects. The results compare very favorably to discrimination was introduced by a screening the success rates reported in other longitudinal question: "Some people have experienced dis- studies of Southeast Asian refugees (Burwell, crimination (e.g., being looked down upon, Hill, and Van Wicklin 1986; Lewis, Fraser, and insults about one s race, being passed over for Pecora 1988). a promotion) because they belong to a partic- Comparisons between the dropout and ular racial group rather than because of their retained samples suggested that the largest lack of English or other skills. In Canada, threat to validity was that single refugees were have you been discriminated against because more likely to attrite than the ever-married. On of your race? ""I More than one quarter of the a number of other characteristics, including respondents (n = 168, 26.0%) answered the gender, age, and employment status, "drop- question in the affirmative. The interviewers

This content downloaded from 130.63.180.147 on Mon, 21 Nov 2016 05:11:14 UTC All use subject to http://about.jstor.org/terms 198 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR then asked all respondents who had answered Health Organization for studies in a number of in the affirmative about their coping responses developing countries (Harding et al. 1980); to discrimination. This measurement encom- selected portions of the Diagnostic and passed personal experiences covering the Statistical Manual of Mental Disorders-ILL entire duration of residence in Canada. derived Diagnostic Interview Schedule Detailed findings pertaining to the nature of (Robins, HeIzer, Croughan, and Ratcliff reported discrimination have been reported 1981); and the Affect Balance Scale (Bradburn elsewhere (Noh et al. 1998). 1969). "Emic" items were derived from the Coping responses. Following the questions Vietnamese Depression Scale developed by about the experience of discrimination, Kinzie et al. (1982) for their research of Asian respondents were asked: "Overall how did you refugees in Oregon, as well as through inter- mainly react to these unpleasant experi- views with expert informants, including per- ences? " Interviewers read a total of seven pos- sonnel of the health authority assigned to help sible reactions, to each of which respondents the refugees when they arrived in Vancouver, a answered "yes" or "no." A principal compo- Vietnamese linguistic anthropologist skilled in nent analysis of the responses identified two survey research, and other Southeast Asian coping modes, one describing behavioral and community members. cognitive responses reflective of forbearance Using a trichotomous forced-choice format and the other representing a confrontational "often" (coded 3), "sometimes" (coded 2), or response style. The forbearance mode is simi- "never" (coded 1), respondents were asked to lar to what the coping literature has described report their experiences with each of the as passive or emotion-focused coping, and the depression symptoms during the few weeks confrontational response refers to what others prior to interview. The depression scale con- have called active or problem-focused coping. sists of 17 items, each introduced by a stem The forbearance items asked respondents if question, "Have you been feeling": unhappy; they "took it as a fact of life," "did not react," sad; inner turmoil; discouraged; nervous, and "(did not) return in kind." These were the tense, or worried; low and hopeless; bored; a refugees' most prevalent responses to their worthless person; lonely, even when you are experiences with racism, claimed by 77.9 per- with other people; remorseful; upset because cent, 60.6 percent and 6.5 percent, respective- someone criticized you; restless; like you've ly. The confrontation coping dimension includ- lost interest and pleasure; that you have trouble ed four items: "made verbal protests," "rea- making up your mind; worry about what peo- soned with offenders," "discussed with other ple say about you; that you have trouble con- people," and "reported to authorities." centrating; and that your thoughts are mixed Respondents said "yes" to these items 58.9 up. For the current study, the mean item-total percent, 37.5 percent, 31.5 percent, and 14.3 correlation for the depression scale was 0.41, percent, respectively. The internal consistency and the standardized alpha reliability coeffi- of scales based on the identified factors (stan- cient was 0.92. Items are summed to provide dardized alpha coefficients) were 0.50 forfor- an over-all depression score. Scores in the cur- bearance and 0.65 for confrontation. rent study ranged from a low of 17 to a high of 48, with a mean of 20.75 (standard deviation of 5.02). Measuring Depression and Ethnic Identity Ethnic identity. The variable ethnic identity' was measured by a scale consisting of respons- Depression. Previous publications have es to nine questions tapping self-appraised eth- described the development-and the very nic salience (e.g., "my ethnicity is of [minor to good psychometric properties of-the depres- central] importance for my life;" "I make deci- sion scale (Beiser 1988; Beiser and Fleming sions on the basis of ethnic background;" and 1986; Beiser, Johnson, and Turner 1993). The "without my ethnic background, the rest of my scale contains "etic" items derived from mea- life would not have much meaning to it"), atti- sures which have been widely used with a vari- tude toward intermarriage (e.g., "people ety of populations. Sources for scale items should marry someone from their own ethnic include the Senegal Health Scales (Beiser et al. background;" and "I would like to see my chil- 1976); the Self-Report Questionnaire (SRQ), a dren marry Caucasian Canadians"), language 24-item schedule developed by the World retention (e.g., "how important do you feel it is

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for children to maintain their mother For respondents who did not perceive discrim- tongue?"), and ethnic identification (e.g., "all ination, depression scores equal bo. For those people who come to this country should forget who perceived discrimination, depression their cultural background as soon as possible;" scores vary with forbearance (F): "ethnic organizations are important in rein- forcing ethnic identity;" and "how would you Dep = (bo + b, - b2F) + b2E (2) define your ethnicity-Canadian, Ethnic (Chinese, Laotian, Vietnamese), or Hyphena- This approach assumes that those who had not ted?"). Responses to these items were coded perceived discrimination never had to cope on diverse scales. For example, responses to with discrimination. In the same way, con- the item "All people who come to this country frontational coping was computed as a condi- should forget their cultural background as tionally relevant variable. The procedure was soon as possible" were coded on a seven-point extended to three-way interaction terms to esti- Likert scale ranging from 1 (strongly agree) to mate interaction effects of ethnic identity by 7 (strongly disagree), but responses to the each type of coping. question "Without my ethnic background, the rest of my life would not have much meaning to it" were scored on a five-point scale ranging RESULTS from 1 (strongly disagree) to 5 (strongly agree). All items were scored so that higher Perceived Racial Discrimination and scores would indicate stronger ethnic identity. Depression For example, ethnic identification was coded as 1 for Canadian, 2 for hyphenated identity The relationship between perceived discrim- (e.g., Chinese-Canadian), and 3 for ethnic ination and depressive symptoms was positive identity (e.g., Chinese). and statistically significant (Table 1, model 1). To compute scale scores, individual scores The mean depression score for the group that for each item were standardized into z-scores, had experienced discrimination was 1.58 high- with a mean of 0 and a standard deviation of 1. er than the mean for the sample who had not Internal consistency of the nine-item scale, as had these experiences. This is equivalent to a assessed by Cronbach's alpha, was 0.72. The standardized effect size of 0.315, or 31.5 per- sample distribution of the scale had a mean of cent of the standard deviation of the depres- 0 and a standard deviation of 0.59, with scores sion variable. The direct effect of perceived ranging from -1.55 to 1.1 1. discrimination could, therefore, be considered relatively moderate. The effect of discrimination was not affected by the inclusion of Statistical Analysis sociodemographic factors in the model. Among the demographic correlates appearing The dependent variable for the study, in Table 1, model 1, age, education, and cur- depression (Dep), is a continuous variable, rent employment status were inversely related while the primary independent variable is to levels of depression (p < .05). There was no dichotomous (Dis = 1 if perceived discrimina- association between gender and depression. tion, Dis = 0 if no perceived discrimination). The central moderating factors, forbearance and confrontation, were applicable only to Effects of Coping those cases who had perceived discrimination. These conditionally relevant variables (Cohen Based on the hypothesis that cultural con- 1968; Ross and Mirowsky 1992) were com- gruence conditions the effectiveness of cop- puted as conditional deviation scores. For ing, we predicted that forbearance would example, forbearance (F) was computed as an attenuate the relationship between discrimina- interaction between discrimination (binary) tion and depression, and that confrontation and the deviation scores for F. In its simplest might have a potentially deleterious impact. As form, this conditionally relevant variable shown in Table 1 (model 2), confrontation cop- appears in a regression model as follows: ing had no effect on the relationship between discrimination and depression. Forbearance, Dep = bo + b1Dis + b /F - F)Dis. (1) however, displayed a substantial and statisti-

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TABLE 1. Regression of Depression on Perceived forbearance response increased to 2, and the Discrimination, Forbearance, and trend was reversed at the highest point of the Confrontation forbearance response. According to the R2 reported in Table 1, the Model 1 Model 2 coping variables explained an additional 5 per- Age -.046* -.038 (.021) (.021) cent of the variance in symptoms over and Female -.500 .501 above that accounted for by discrimination and (.416) (.407) demographic variables. These results suggest Married -.912 -.752 that perceived racial discrimination affected (.495) (.484) the mental health of refugees, but responding Employed -2.052* -1.499* (.629) (.618) through culturally congruent coping, forbear- Years of education -.129** -.159* ance, was an effective buffer against psycho- (.067) (.066) logical consequences of discrimination. Discrimination 1.579*** 1.566*** (.441) (.429) Forbearance -2.494*** (.457) Effects of Ethnic Identity Confrontation .414 (.304) Table 2 explores the effects of ethnic affili- Constant 25.558*** 24.894*** (1.461) (1.428) ation on the relationship between discrimination and depression, as well as the interaction Adjusted R2 .052 .100 between ethnic identity and coping styles. *p < .05; ** p < .01; * p < .001 (two-tailed tests) Note: numbers in parentheses According are to model standard 3 in Table 2, errors.strength of N = 643. ethnic identity had no direct relationship with level of depression. To examine the moderat- cally significant negative coefficient. This ing effects of ethnic identity, the effects of moderating effect of forbearance is illustrated three interaction terms were tested following graphically in Figure 1. Clearly, the increase in the entry of the discrimination variable and the depressive symptoms in the "discriminated" two coping measures. A two-way interaction group was substantial at the lowest end of for- term between ethnic identity and discrimina- bearance. The group difference in depression tion was entered into the regression equation, was moderated considerably as the level of the followed by three-way interaction terms between ethnic identity and each of the coping variables (note that the coping strategies as FIGURE 1. Conditional Effects of Perceived conditionally relevant variables are in fact two- Discrimination and Forebearance way interaction terms). Coping on Depression As reported in Table 2 (model 4), the positive coefficient for the interaction of ethnic identity by discrimination (b = 1.95, p < .05) suggests that ethnic identity intensified the link between discrimination and depression. However, ethnic identity also enhanced the moderating effect of the forbearance response.

0 For a less technical illustration, we refer to Figure 2. The stress-moderating effect of for- o bearance was highlighted among refugees holding stronger attachments to traditional ethnic values and group identification. Thus, when Asian refugees held a strong ethnic identity, they were most vulnerable to the psychological consequences of perceived racial discrimination if they failed to use forbearance

Has Not Experienced Discrimination coping. While the stress-moderating effect of forbearance coping was observed even among

0 1 2 3 the Asian refugees who did not identify strong- Forbearance Coping Response ly with ethnic values and traditions, the mag-

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TABLE 2. Regression of Depression on Per- terized as passive acceptance and avoidance- ceived Discrimination, Coping, and diminished the strength of the link between Ethnic Identity discrimination and depression. This pattern of results contradicts the assertion that problem- Model 3 Model 4 focused coping is more adaptive than passive Age -.042 -.042* acceptance (e.g., Krieger 1990; Williams et al. (.022) (.021) Female .355 .432 1994). (.428) (.422) One explanation for the stress-buffering Married -.638 -.722 effect of forbearance may be that most expres- (.512) (.504) sions of discrimination are subtle and difficult Employed -1.539* -1.271 * to ascertain objectively and publicly. A major- (.640) (.637) Years of education -.176* -.152* ity of the refugees included in this study who (.068) (.068) experienced discrimination reported that it Discrimination 1.671*** 1.812*** occurred in elusive or subtle forms, such as (.447) (.448) Forbearance -2.582*** -2.692*** being looked down upon and receiving unfair (.472) (.478) treatment. Reports of blatant or explicit dis- Confrontation .349 .192 crimination were rare (Noh et al. 1998). A con- (.312) (.319) frontational response to subtle discrimination Ethnic Identity .276 -.149 may be difficult to justify, and may even be (.376) (.420) Ethnic Identity x counter-productive. Discrimination 1.949* Maintenance of cultural values and norms (.897) provides a conceptual bridge helpful in under- Ethnic Identity x standing the link between adaptive coping Forbearance - 3.427*** responses and mental health (Aldwin 1994). (.828) Ethnic Identity x Problem-focused coping strategies, considered Confrontation -.820 adaptive in pragmatic, task-oriented Western (.613) societies, may not constitute the prototype of Constant 25.188*** 24.806*** "successful coping" in cultural groups holding (1.478) (1.457) person-oriented values and norms. For exam- Adjusted R2 .102 .132 ple, Hwang (1979) described coping strategies * p < .05; ** p < .01; * p < .001 (two-tailed tests) adopted by unemployed Taiwanese males. Note: numbers in parentheses are standard errors. N = 643. Although their fatalism could, according to

FIGURE 2. Moderating Effect of Ethnic nitude of the effect was significantly dimin- Identity for the Effect of Forebear- ished in this low ethnic identity group. ance Coping on Depression

DISCUSSION

Consistent with reports by others (Amaro O \ . et al. 1987; Barnes and Ephross 1994; Essed 1991; Feagin 1991; Jackson et al. 1997; 0 Krieger 1990; Pernice and Brook 1996; Rumbaut 1994; Salgado de Snyder 1987; o Sanders-Thompson 1996; Williams et al. 1997a, 1997b), the findings in this paper provide empirical evidence for a link between perceived discrimination and depressive symptoms. The current study also adds to the literature by providing information about the moderating effects of coping and ethnic iden- Has Not Experienced Discrimination tity. In this sample of Southeast Asian refugees, forbearance-consisting of cognitive 0 1 2 3 and behavioral responses that may be charac- Forbearance Coping Response

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Western standards, be characterized as passive not passive resignation. It is simply tactical. and unlikely to be adaptive, they did in fact Certain sorts of problems are held to be prove more effective than active and self- best handled by indirection and internal change" (Pp. 1 10-1 1). serving coping strategies. As among the This position emphasizes the difference Southeast Asians taking part in the current between locus of control (one's belief about study, the passive coping adopted by the whether it is possible to effect a change on the Taiwanese may have been effective because it was consistent with cultural values which external environment) and locus of preferred assign primacy to the promotion of interper- activity (the domain in which one chooses to sonal cooperation and the avoidance of con- exert control), a distinction implying that indirect action is not synonymous with passivity. flict. Studying Hispanic women dealing with This interpretation supports theoretical specu- family conflicts, Garrison (1977) advanced a lations regarding a tendency among members similar argument regarding culturally mandat- of Asian culture to exercise self-regulation ed coping strategies. The emotionally charged rather than affect a change on the environment. Furthermore, it is reminiscent of an effective coping strategies adopted by these women were not characterized as problem-focused, yet coping strategy, perception-focused coping, were effective in reducing conflict. that entails cognitive recasting of a stressful This explanation-that preferred style of event (Pearlin and Schooler 1978). For exam- coping reflects cultural norms and values-is ple, faced with a negative event, one may cope consistent with the literature on differences in by adopting the belief that, for example, approaches to conflict resolution employed by "adversity makes one a better person." Even in members of collectivistic and individualistic some inventories designed to assess coping in societies. Recent study findings suggest that, Asian samples, researchers, in an attempt to compared to members of individualistic cul- construct items that are reflective of Asian tures such as United States majority culture, beliefs and proverbs, have included items such members of collectivistic cultures such as as "it is best to do nothing" and "to lose is to Latin Americans are more likely to resolve win" (Furukawa et al. 1993). interpersonal conflicts in ways that reflect con- Interestingly, while the current findings sup- cern over the consequences for others port the view that emotion-focused coping, or (Gabrielidis et al. 1997). Gabrielidis et al. forbearance, is effective in reducing the (1997) also reported that collectivists' avoidant adverse impact of perceived discrimination, coping patterns were part of a method that the stress-buffering effect of forbearance was evaded conflict in order to preserve the inter- augmented among those refugees with the personal relationships integral to the mainte- strongest attachments to traditional ethnic val- nance of collectivistic culture (Tietjen 1989; ues and ethnic communities. For those who did Triandis 1994). not identify with traditional ethnic values and These interpretations are consistent with the practices, neither forbearance nor confronta- view that Western dichotomies, such as active tion was an effective coping strategy for pro- versus passive or internal versus external, tecting mental health. probably fail to capture complexities in cultur- Alternatively, the benefits of forbearance ally patterned responses. As Reynolds (1976, for dealing with perceived discrimination may as cited in Aldwin 1994) explains this notion: be explained through reference to reports that "Instead of an active-struggling versus a the adaptiveness of active and passive coping passive-acceptance dichotomy, I would is situationally determined (Folkman 1984; suggest that a more useful contrast between Forsythe and Compas 1987; Mattlin et al. Oriental and Western approaches to prob- 1990; Vitaliano et al. 1990). Within this litera- lem solving lies in the locus of preferred ture passive coping is considered adaptive, as activity. One's phenomenological reality is indexed by lower levels of negative psycholog- a product of one's inner state and objective ical symptoms, in the face of uncontrollable reality. By manipulating either factor it is stressors, and active coping is adaptive when possible to change phenomenological reali- the stressor is controllable. Moreover, there is ty. It seems that, in very general terms, the West is more accepting of activity directed research to support the view that avoidant cop- toward changing objective reality.... But I ing strategies are more adaptive in dealing must reemphasize that the Japanese value is with stressors that are associated with unfavor-

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able outcome expectancies (Abella and Heslin ences of discrimination and to blame them for 1989). Perceived discrimination is a stressor their current unhappiness. Similarly, strong that is both elusive, in that it is often subtle and ethnic identification may increase the likeli- difficult to detect, and is perceived as uncon- hood of recalling or perceiving discrimination. trollable by most refugees. Moreover, any Future research on the topic of discrimina- reaction to it is highly likely to be associated tion and mental health should employ mea- with negative outcomes. When encountering sures of discrimination that capture subtle discrimination, minority group members usu- interactions. Williams et al. (1997a) suggest ally face a no-win situation. If they react in a that poor conceptualization and operational- direct, problem-oriented manner, such as fil- ization of discrimination are major obstacles ing a formal complaint with the Canadian to developing a knowledge base regarding the Human Rights Commission, for example, they association between discrimination and health. may be regarded as uncivilized and militant if In most research to date, including the present they win, or as morally and physically weak if study, a single-item measure of discrimination they lose: "In opting to cope 'safely' by avoid- is used, a strategy that may underestimate the ance, they can at least preserve themselves and true rate of racial discrimination (Sigelman salvage a minimal degree of self-esteem and and Welch 1991). Scales of discrimination, self-worth" (Chan and Lam 1986). such as those used in the Detroit Area Study, In exploring the relation between ethnic probably constitute a significant methodologi- identity and depression we found no signifi- cal advance. cant effect. Sanders-Thompson's (1996) U.S. study findings also suggest that racial identification is not associated with psychological dis- NOTE tress among black Americans. In regard to the mediating effect of ethnic identity on the rela- 1. The translation of such keywords as "race" tion between discrimination and depression, and "ethnicity" often poses difficulty in our findings also were consistent with those cross-cultural research. In our estimation, observed in Sanders-Thompson's study, and the term race was translated into the three they suggest that ethnic identity did not medi- languages for this study with little difficul- ate the link between discrimination and ty in conveying the meaning of the term. depression. However, our analyses provided The terms "ethnicity" and "ethnic identity" evidence to support a moderating effect of eth- might represent less clearly defined con- nic identity: The effect of passive coping, or cepts than race for the study respondents, forbearance, was dramatically highlighted and as such may pose a greater challenge when adopted by refugees holding strong for translation. In essence, the conception attachments to traditional ethnic values and of the term "ethnicity" for respondents of ethnic community. In our view, this finding the present study referred to "the people" of points to the salience of a cultural interpretation of the distress-reducing effect of emotion- China, Vietnam, or Laos for the respective focused coping. communities. For most Asians, the term Finally, alternative explanations for the ethnicity is not familiar prior to their migra- findings cannot be ruled out. While the find- tion to North America. They are more ings of the current study are consistent with familiar with terms such as nationality or the hypothesis that exposure to discrimination national identity. Within the North is associated with elevated levels of depressive American context ethnicity, for refugees, symptoms, and that forbearance, particularly may refer to cultural or national minorities when adopted by individuals with strong who share historical, cultural, and linguistic ethnic identity, reduces the emotional impact backgrounds. While we can never be of the exposure for this sample of Southeast assured that the meaning and nuance of Asian refugees in Canada, the issue of causal "ethnic" has been consistently maintained order remains an important consideration. in all translated terms, conceptions of eth- Given that these data are cross-sectional and nicity in terms of minority status shared by retrospective, the possibility remains that the three subgroupings of respondents in depressed individuals are more likely than the this study may transcend linguistic repre- psychologically comfortable to recall experi- sentations of the concept.

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Dr. Samuel Nob, a sociologist and epidemiologist, is Associate Professor in the Department of Psychiatry at the University of Toronto, and Senior Research Scientist at the Clarke Division of the Centre for Addiction and Mental Health. He also serves the national Metropolis Project through the Joint Centre of Excellence for Research on Immigration and Settlement (CERIS) in Toronto as Leader of the Health Domain Research section. His current research projects include a longitudinal study of pre- and post- migration determinants of health among immigrants and their children, including the impact of racism and discrimination, as well as a cross-cultural comparison study of the stress process among youth in Canada, China, Japan, and Korea.

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Dr. Morton Beiser, a psychiatrist, is David Crombie Professor of Cultural Pluralism and Health in the Department of Psychiatry, University of Toronto, and Program Head of Culture, Community, and Health Studies at the Clarke Division of the Centre for Addiction and Mental Health. He also serves as director of the Joint Centre of Excellence for Research on Immigration and Settlement (CERIS) in Toronto. He is the principal investigator of the Refugee Resettlement Project, a decade-long investigation of resettlement and mental health among Southeast Asian refugees in Canada. His current research includes studies of the impact of settlement stress on TB among immigrants, immigrant conceptions of mental illness, ethnic identification and mental health among children in immigrant families, and longitudinal investigations of academic and social adaptation of native children in the United States and Canada.

Dr. Violet Kaspar, a developmental psychologist, is a Research Scientist with the Clarke Division of the Centre for Addiction and Mental Health. Her research examines the mental health status of immigrant youth previously exposed to war, and cultural variations in the influences of stress and coping on child development and adaptation. She recently received a grant to examine the effects of war-related traumatic stress on the psycho-social adaptation of children and adolescents.

Dr. Feng Hou, a demographer, is an Assistant Professor with the Department of Psychiatry at the University of Toronto, and a Research Scientist with the Culture, Community, and Health Studies Program at the Clarke Division of the Centre for Addiction and Mental Health. His research interests include socioeconomic and psychological adjustment of immigrants, as well as statistical methods in social and bio- medical studies. His current research examines the effects of poverty, unemployment, underemployment, and family process on the mental health of visible minorities and immigrant families.

Dr. Joanna Rummens, an anthropologist and sociologist, is an Assistant Professor with the Department of Psychiatry at the University of Toronto, a Research Scientist at the Clarke Division of the Centre for Addiction and Mental Health, and the Academic Coordinator of the Joint Centre of Excellence for Research on Immigration and Settlement (CERIS) in Toronto. A specialist in Latin American and Caribbean studies, she is the former Deputy and Acting Director of the Centre for Research on Latin America and the Caribbean (CERLAC) at York University. Her current research focuses on identity formation and negotiation among newcomer immigrant and refugee youth.

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