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Influencing Factors of Depression Among Adolescent Asians

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Influencing Factors of Depression Among Adolescent Asians healthcare Review Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review Ping Zou 1,* , Annisa Siu 2, Xiyi Wang 3, Jing Shao 4, Sunny G. Hallowell 5, Lihua Lydia Yang 6 and Hui Zhang 7 1 School of Nursing, Nipissing University, Toronto, ON M5T 1V4, Canada 2 Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; [email protected] 3 School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; [email protected] 4 Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou 310058, China; [email protected] 5 College of Nursing, Villanova University, Villanova, PA 19085, USA; [email protected] 6 Wellness Counselling Centre for Youth Canada, Markham, ON L3R 6G2, Canada; [email protected] 7 Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang 550002, China; [email protected] * Correspondence: [email protected] Abstract: Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and Citation: Zou, P.; Siu, A.; Wang, X.; influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, Shao, J.; Hallowell, S.G.; Yang, L.L.; (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic Zhang, H. Influencing Factors of discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community Depression among Adolescent Asians violence. Collectively, the majority of included studies suggest that depressive symptoms were more in North America: A Systematic likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant Review. Healthcare 2021, 9, 537. status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic https://doi.org/10.3390/ situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive healthcare9050537 negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This Academic Editor: Pedram Sendi systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such Received: 20 March 2021 findings offer a starting point to examine what factors should be necessarily included in related Accepted: 26 April 2021 depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened Published: 4 May 2021 family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in Keywords: influencing factors; depression; adolescent; Asians; North America; systematic review published maps and institutional affil- iations. 1. Introduction Depression is defined as a mood disorder that causes persistent feelings of sadness Copyright: © 2021 by the authors. and loss of interest [1]. Symptoms include persistent feelings of hopelessness, sadness, Licensee MDPI, Basel, Switzerland. worthlessness, guilt, irritability, lethargy, or “emptiness” and may manifest as physical This article is an open access article aches, pains, headaches, cramps, or irregular eating/sleeping habits. Adolescents may distributed under the terms and further experience an inability to focus and follow through with tasks, likely resulting conditions of the Creative Commons in lower academic performance or disinterest in usual activities. More severe symptoms Attribution (CC BY) license (https:// include substance abuse, strong feelings of guilt, and panic attacks, with the most serious creativecommons.org/licenses/by/ one being recurrent thoughts of death or suicide [2]. Lifelong consequences can include 4.0/). Healthcare 2021, 9, 537. https://doi.org/10.3390/healthcare9050537 https://www.mdpi.com/journal/healthcare Healthcare 2021, 9, 537 2 of 19 impaired educational or vocational achievement, impaired relationships, and severe loss of self-esteem [1]. In the United States, undiagnosed depression has resulted in a surge in gun violence and shootings in schools and communities [3]. Within the last decade (specifically, 2011–2016), the prevalence of depression in American adolescents has increased from 8.3% to 12.9%. Rates of depression are even greater among females and older adolescents aged 14 to 19 [4,5]. Existing literature recognizes this upward trend and urges the need for improved screening and access to treatment for adolescents [4,6,7]. Asian Americans represent one of the fastest growing ethnic groups in North America, making up 6.5% of the U.S. population and 17.7% of the Canadian population [8,9]. Asians between the age of 5 to 17 are projected to increase from 5.58% to 8.09% of the resident population in the U.S. by 2060 [10]. In 2016, 27% of Canadian youth aged 15 to 30 belonged to a visible minority group, who are non-Caucasian in race or non-White in colour other than aboriginal peoples, and this number is only projected to increase [11,12]. Thus, it is important to identify influencing factors that are linked to Asian American communities. The perception that Asian Americans disproportionately achieve higher economic and educational success has perpetuated the myth of Asian Americans as the “model minor- ity” and resulted in inadequate assessment and treatment of physical and mental health problems in Asian communities [13]. Furthermore, as of 2003, research found that 47% of Asian American adolescents experience depression compared to 30% of their European American counterparts [14]. This finding is especially concerning when considering the evidence that cultural barriers and biases have masked the true rates of depression among Asian American adolescents [1,15,16]. There is a need for more accurate identification of Asian American adolescents at risk for depression and increased accessibility to mental health services [16,17]. A summary of psychosocial factors may offer insight into the protective factors, screening interventions, and culturally sensitive treatments that should be further investigated. A key gap in this emergent field is the lack of specificity when addressing Asian American adolescent populations in terms of ethnicity and age. The most comprehensive systematic review of factors in this field included studies published between 2000 and 2015, included Native Hawaiian and Pacific Islander youth, and had a broad age range of 18 or younger [1]. Other reviews encompassed diverse minority groups, including African American and Latino groups, or addressed general outcomes such as well-being [18–20]. Since then, research has advanced, and new studies regarding Asian American adolescent depressive symptoms have been published. In response, this present review seeks to synthesize the essential results of studies identifying upstream risk and protective factors focused on depressive symptoms, rather than suicidality or general well-being, in Asian Americans specifically. This review further distinguishes adolescents as youth aged 10 to 19 rather than 18 years old and younger as done before [1]. This is an important consideration since youths aged younger than 10 are in a unique developmental period and may interact differently at individual, familial, and societal levels. Furthermore, the onset of COVID-19 has elevated the risk of violence and racial discrimination against Asian Americans [21,22]. A recent study found that increased perceived racism due to the pandemic is associated with poorer mental health in youth aged 10 to 18 years old [22]. Such findings bring to light many racially and ethnically associated burdens that may have lacked serious investigation previously [21]. Overall, the longstanding issue of disentangling factors influencing the depressive symptoms of Asian Americans aged 10 to 19 has yet to be clearly addressed. The ecosocial theory is used to guide data collection, data analysis, and presentation of findings in this review. The ecosocial framework construes human development as a process arising from complex interactions between a person and their environment on intrapersonal, interpersonal, and broader societal levels [23,24]. This theory has been used in studies examining factors influencing healthy eating in aged Chinese Canadians, the impact of the financial recession on student mental health, and how discrimination manifests as health inequities [24–26]. A recent study addressing various risk factors for depression in U.S. children used a modified ecosocial framework to account for dynamic Healthcare 2021, 9, 537 3 of 19 inferences in a hierarchical structure [27]. The present review applies this theoretical framework to conceptualize the relationship between illness, distribution of depressive symptoms, and the resources
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