J Immigrant Minority Health DOI 10.1007/s10903-014-0021-z
ORIGINAL PAPER
Friends, Depressive Symptoms, and Life Satisfaction Among Older Korean Americans Soonhee Roh • Yeon-Shim Lee • Kyoung Hag Lee Tazuko Shibusawa • Grace J. Yoo
•
Ó Springer Science+Business Media New York 2014
Abstract This study examined the interactive effects of social network support and depressive symptoms on life satisfaction among older Korean Americans (KAs). Using data from a sample of 200 elders in a large metropolitan area (Mage = 72.50, SD = 5.15), hierarchical regression analysis was used to examine the interaction between social network support and depressive symptoms on life satisfaction among older KAs. After controlling for demographic variables, both social network support and depressive symptoms were identified as predictors for life satisfaction. Interaction effects indicated strong associations between higher social network support specifically from friends and lower depressive symptoms with higher levels of life satisfaction. Findings highlight the important role that friends play in terms of social network support for the mental health of older KAs, and the need for geriatricpractitioners to monitor and assess the quality of social
S. Roh (&) Department of Social Work, University of South Dakota, 1400 West 22nd Street, Sioux Falls, SD 57105, USA e-mail: [email protected] Y.-S. Lee School of Social Work, San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132, USA K. H. Lee School of Social Work, Wichita State University, 1845 Fairmount Street, Wichita, KS 67260-0154, USA T. Shibusawa Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA G. J. Yoo Asian American Studies, San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132, USA
network support—including friendships—when working with older KAs. Keywords Depressive symptoms Social network support Life satisfaction Older Korean Americans
Introduction Life satisfaction is an important positive perception of psychological well-being that is seriously understudied among racial/ethnic minority elders [1–5]. It is often defined as the cognitive evaluation of one’s life as a whole [6], or more specifically, the fit between the desired goals in life and the actual outcome of one’s life [7], and can be an indicator of overall life quality [7, 8]. Compared to Whites, racial/ethnic minorities tend to report lower life satisfaction [9–11]. For example, Black elders reported slightly lower levels of life satisfaction than White elders (14.03 vs. 14.54) [10]. Among racial/ethnic minorities, older Korean Americans (KAs) stand out as having consistently lower levels of life satisfaction [1–4]. Studies with older community-dwelling KAs report lower mean scores on the Satisfaction with Life Scale (SWLS) [1, 2, 4] as compared to older Whites and African Americans (15.70 vs. 18.20 vs. 18.20) [1, 5, 12]. Stressful life events, depression, poor health, low socioeconomic standing, and low acculturation appear to have influence on life satisfaction among older KAs [1, 2, 29]. Depression is one of the most common psychological problems that adversely affect quality of life among older KAs [1, 13, 14]. Studies indicate that prevalence rates for probable depression are 20–53 % among older KAs [1–4, 13–20]. The rates are substantially higher than the 9–16 % found in community-dwelling Whites and African
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Americans [21, 22]. Furthermore, older KAs are less likely to seek mental health treatment [23] which might contribute to the persistency of depression in this population [24]. Although research indicates depressive symptoms as a predictor of life satisfaction in the general population [5, 25, 26], there is very limited research on racial/ethnic minority elders and potential buffering factors. To fill the gap, this study sought to examine ways to mitigate the negative effects of depressive symptoms on life satisfaction in older KAs. Specifically, we hypothesized that older KAs with high social network support through family and friends would be less susceptible to the deleterious effects of depressive symptoms on life satisfaction than older KAs with low social network support.
depressive symptoms on life satisfaction may vary across the levels and types of social network support. Family support has traditionally been studied among older KAs [33] but friendships may equally be an important source of support for older KAs. Research of older KAs indicates that support from friends is qualitatively different than support from family. Older KAs may rely on their family networks for linguistic and tangible support but prefer to maintain independent and depend on friends for advice and companionship [34]. The primary objective of this study is to explore the independent and interaction effects of social network support, including identifying differences between family and friend support, and depressive symptoms on life satisfaction among older KAs.
The Roles of Social Network Support Among Older Korean Americans
Methods Participants and Data Collection Procedures
The conceptual framework of this study was largely based on the stress process model [27] which proposed that disadvantaged social status and limited resources expose individuals to biological or psychological stressors [28]. At the same time, this framework proposes that social or personal resources (e.g., social network support) can moderate the effects of stressors on mental health outcomes (e.g., life satisfaction). Research on older KAs indicates that factors associated with status/environment strains, such as language barriers, acculturative stress, and financial hardships, are closely linked to an increased risk of depressive symptomology which may, in turn, lead to lower life satisfaction [1, 2, 29]. Social network support, such as assistance from family and friends, has been widely studied as a resource to prevent depression [1, 2, 4, 28]. In addition, research suggests that social network support is significantly associated with increased life satisfaction in the general population and older KAs [12, 28, 30]. Social network support is believed to be an important resource that protects older KAs from the potentially pathogenic influence of stressful events, such as depression [1]. It serves as an interpersonal environment for transmission of information, social influences, and networks [31]. Stronger and closer social ties provide social resources in times of need, reduce a sense of isolation, and increase physical/mental functioning among older KAs [32]. Although several studies [1, 4, 5, 28] have shown the independent contributions of depressive symptoms and social network support, they may have overlooked how these variables work together to influence assessments of life satisfaction among older KAs. For example, older KAs with depressive symptoms may have different levels and kinds of social network support and the impact of
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Upon receiving approval from the Institutional Review Board of New York University, a total of 212 KA older adults aged 65 and older were recruited through a purposive sampling method from January to May 2009, in partnership with two of the largest Korean senior centers in New York City. They were screened with the Short Portable Mental Status Questionnaire [35] to make sure that they had the cognitive ability to participate in the study. Of those, five refused to participate, and an additional seven were excluded because of their incomplete answers, leading to a final sample of 200 community-dwelling older KAs. Each participant had a face-to-face interview with a trained interviewer that lasted approximately 40 min. Participants were paid $10 for their participation. Measures Social Network Support The Korean version of Lubben Social Network ScaleRevised (K-LSNS-R) was used to assess social network support [36, 37]. The six-item scale probed for perceived social network support received by family. The Cronbach’s a was .79 in this study. Six items were selected to assess the level of perceived social network support from friends including neighbors across several areas, such as confiding relationships, trust, and the reciprocity of giving help. Internal consistency of friends was .78 in the current study. Each item measured the size and closeness of and the frequency of contact with one’s social network. Items were rated on a 6-point Likert scale, which ranged from 0 to 36 with higher values indicating greater perceived social networks. Each score of family and friends of K-LSNS-R
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was computed by summing equally weighted items for our analysis.
Table 1 Demographic characteristics of older KAs (in percent or mean, N = 200) Age
Depressive Symptoms
Ranged age from 65 to 89
Mean 72.50
Gender
The Korean version of 30-item Geriatric Depression Scale (GDS-K) was used to measure depression [38, 39]. The scale has been shown to be reliable and valid in assessing depressive symptoms of diverse older populations including Chinese elderly immigrants [40] and older Japanese Americans [41]. Using a yes/no format, respondents rated 30 items. The GDS-K scores ranged from 0 to 30, where a score ranging between 0–9, 10–19, and over 20 indicated normal, mildly depressed, and severely depressed. Internal consistency was .85 in the current study. Life Satisfaction The SWLS [6] was used to measure life satisfaction as the outcome variable. The five-item scale was originally developed by Diener et al. [6] to measure global life satisfaction as a cognitive-evaluative process. The Korean version of the SWLS by Kim and Kim [42] was used in this study. The Korean version utilizes a 5-point Likert scale since older Koreans are not comfortable with expressing their feelings in a 7-point Likert scale. Total scores were calculated for analysis, which ranged from 0 to 25 with higher scores indicating greater life satisfaction. Internal consistency was .88 with the current study. Data Analysis In addition to descriptive and correlational analyses, this study used a hierarchical regression analysis to examine the moderating roles of social network support from family and friends on the relationship between depressive symptoms and life satisfaction. Centered scores for depressive symptoms and social network support variables were used when computing the interactive variables to avoid multicollinearity problems [43]. There were no multicollinearity issues identified among independent variables since the tolerance scores for all independent variables were [.10 [44].
Results Sample Characteristics Table 1 summarizes the sample characteristics. The mean age was 72.5 years (SD = 5.10), with 69 % between the ages of 65 and 74. About 58 % of participants were male and 60 % married; about 83 % completed high school; and
Female
42.5
Male
57.5
Marital status Married
60.0
Widowed
22.5
Others (divorced, separated, etc.)
17.5
Education Lower than high school diploma/GED High school diploma/GED
33.5 23.5
[High school diploma/GED
43.0
Living arrangement Living alone
24.0
Living with someone
76.0
Annual income \$10,000
55.5
$10,001–$20,000
30.0
More than $20,001
14.5
Religious affiliation No religion
11.0
Catholic
19.0
Protestant
61.5
Buddhist
8.0
Others
.5
Years in the US Ranged year from B1 to 45
Mean 21.86
85.5 % had an annual income of $20,000 or less. All participants were foreign born, with the length of time in the US ranging from 1 to 45 years (M = 21.86). About 89 % of participants reported that they were affiliated with a religion. Correlational Analysis Among Study Variables Table 2 presents the correlation coefficients to examine underlying associations among study variables. The mean scores of life satisfaction and depressive symptoms were 15.80 and 7.87, respectively. In terms of social network support from family, scores ranged from 0 to 36. A mean of 13.35 demonstrated somewhat low levels of social network support from family. Total scores possible ranged from 0 to 36. Scores of 0–13 illustrated low social network support, while 14–26 indicated moderate social network support, and 27 or above showed higher social network support. The mean scores of social network support from friends ranged
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J Immigrant Minority Health Table 2 Correlational analysis among study variables (N = 200) Life satisfaction
Depressive symptoms
Social network support of family
Social network support of friends
Life satisfaction Depressive symptoms
-.549***
Social network support of family
.283***
-.304***
Social network support of friends
.363***
-.277***
.606***
Range
Mean
SD
5–25
15.80
4.44
0–25
7.87
5.80
0–30
13.35
5.58
0–29
13.52
5.27
*** p B .001
Table 3 Coefficients of hierarchical regression for the moderating role of social network support on the relationship between depressive symptoms and life satisfaction (N = 200)
* p B .05; ** p B .01; *** p B .001 a
Unstandardized beta coefficients
b
Standard errors
Model
Model 1 Ba(SEb)
Model 2
Model 3
-.556(.051)***
-.493(.053)***
-.488(.056)***
Social network support of family
-.011(.065)
.003(.065)
Social network support of friends
.225(.070)**
Depressive symptoms
.213(.070)**
Depressive symptoms 9 Social network support of family
-.096(.011)
Depressive symptoms 9 Social network support of friends
.166(.012)*
F test
70.812***
28.396***
18.169***
R2
.309
.353
.371
2
.309
.044
.018
R change
from 0 to 29, with a mean of 13.52, indicating that respondents reported slightly low levels of social network support from friends. Life satisfaction was positively associated with social network support from family and friends, but negatively associated with depressive symptoms. Depressive symptoms were inversely associated with social network support from family and friends. Additionally, social network support from family was positively associated with social network support from friends. Interactive Role of Social Network Support of Family and Friends The hierarchical regression results in Table 3 show the moderating role of social network support from family and friends in the relationship between depressive symptoms and life satisfaction among older KAs. In Model 1, depressive symptoms explained 30.9 percent of the variance (R2) of life satisfaction. In Model 2, the entry of social network support from family and friends added 4.4 percent of the variance (R2) to the model. In Model 3, inclusion of the interaction variables increased the explanatory power of the model by 1.8 percent. Findings revealed that a high level of depressive symptoms was significantly related to decreased life
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Life satisfaction
satisfaction among older KAs (B = -.488, p B .001). Social network support from friends was significantly associated with the increased life satisfaction among older KAs (B = .213, p B .01). Also, social network support from friends significantly moderates the relationship between depressive symptoms and life satisfaction among older KAs (B = .166, p B .05) in Model 3. That is, social network support from friends may buffer the negative relationship between depressive symptoms and life satisfaction among older KAs. The regression lines for high and low social network support from friends are presented in Fig. 1. In plotting the graph, perceived social network support from friends was split into two groups according to the mean, with a score of 13.52. Values below the median score were categorized as having low social network support, and the remaining values were categorized as having high social network support. The figure shows that the line of low social network support from friends is lower than the line of high social network support from friends, thus pointing to a clear moderating or buffering effect of social network support from friends on depressive symptoms and life satisfaction. That is, high social network support from friends significantly decreased the relationship between depressive symptoms and life satisfaction more than low social network support from friends.
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Fig. 1 Moderating role of social network support of friends on the relationship of depressive symptoms and life satisfaction. To understand the direction of the interactions, the high social support of friend group and low social support of friend group were divided according to the mean scores of the social support of friends. In each group, simple bivariate regressions were conducted to understand the direction between depressive symptoms and life satisfaction. The figure shows the line of high social support of friends (R2 = .249, B = -.412, p B .001) steeper than the line of low social support of friends (R2 = .342, B = -.419, p B .001), thus pointing to a clear buffering role of social support of friends on depressive symptoms– life satisfaction relation. Since the social support of family was not a significant moderating factor on depressivesymptoms–life satisfaction relation, the figure of the regression plot graph was removed
Discussion This study examined the independent and interaction effects of depressive symptoms and social network support on life satisfaction among older KAs, in order to understand the associations among these variables more precisely and to provide guidance for prevention and intervention. The strength of this study is its analytic approach that takes into account the joint effects of two predictive factors. Convergent with prior literature [45], depressive symptoms appear to be a risk factor for low life satisfaction among older KAs. Friend network support showed a significant and strong independent relationship with depression and its interaction showed a buffering effect on the severity of depressive symptoms on life satisfaction among older KAs. Despite a general notion on the importance of family network to older KAs, support from family network fails to exert a similar effect. The current study’s most striking finding is the contrastbetween family and friend network support. Specifically, our hypothesis that depressive symptoms in combination with friend network support influence life satisfaction was supported. Consistent with the stress process model, we found that the negative association between depressive symptoms and life satisfaction was offset for older KAs who had greater friend network support. In fact,
among elderly KAs with an equivalent degree of depressive symptoms, those high in friend network support indicated higher life satisfaction than those low in friend network support. This suggests that depressive symptoms may have more harmful effects for older KAs low in friend network support than for older KAs high in friend network support. Moreover, even though the interaction effect was significant, the difference in life satisfaction between high and low social support of friends was \2-points. Further study is needed to understand variation in levels of friend support among older KAs. Surprisingly, on the contrary to our prediction, we did not find evidence supporting the moderating effect of family network support on the relationship between depressive symptoms and life satisfaction. These findings seem to contradict others showing centrality of family network support, particularly adult children among elderly KAs [18, 46], but they somehow corroborate studies reporting changes in the meaning of family support [47, 48] and the effects of close friendship on lowering depressive symptoms [34, 49, 56]. Elderly KA have adopted US norms of living independently from their adult children and relying on support from sources outside the family, such asfriends and community resources [34]. Research also indicates that elderly KAs may prefer independence from adult children because soliciting support from adult children creates disruptions and tension with their adult children’s spouse and the care of their young children [48, 50]. The exact mechanisms through which friend network has a beneficial effect on life satisfaction have still yet to be investigated. One possibility is that instead of turning to adult children for assistance, elderly KAs may rely on friends for emotional support which, then in turn, can become a very important psychosocial coping resource and can have a large effect on alleviating stress. Elderly KAs with higher friend support are also likely to have stronger ties to community-based services through their relationships with friends, and hence have greater access to emotional support and instrumental resources to cope with negative life events [28]. It is also possible that engaging in relaxing and pleasant activities with friends, such as socializing, may diminish stress by fulfilling a need for belongingness, facilitate self-esteem and positive affective moods, and promote the global emotional well-being of older adults [51–53]. Our results suggest that friends as a source of support may be an effective form of coping for elderly KAs who face with depressive symptoms. Future intervention efforts to enhance psychological well-being among older KAs should be directed toward promoting supportive relationships between friends. Mental health professionals working with elderly KAs should pay closer attention to strengthening friendships to prevent social isolation. Particular
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attention to the ways in which a friend network is implicated in health promoting behaviors and practices could help with designing effective health interventions and illness management for older KAs. Although this study found that friend network support seemed to be more efficacious than family network support, future research is needed to investigate why this is the case. This finding was certainly intriguing given the importance of family as a core social value as well as a vital coping strategy that has traditionally been used for older KAs [3, 34, 54, 55]. After many years in the US, older KAs have acculturated and live independently from their family [56]. Moreover, the availability of ethnic community organizations and churches may help expand support networks beyond those of family/ kin. Subsequent research among older KAs on the changing nature and meaning of family support to mental health outcomes is needed. Finally, other unmeasured culturally specific coping resources may also attenuate the impact of depressive symptoms on life satisfaction. For example, the importance of religious support to better mental health and psychological well-being of older KAs is highlighted in several studies [4]. The Korean ethnic church provides a powerful support system to many older KAs including health/mental health education [47, 57]. In our sample, nearly 90 % of participants are affiliated with a religious organization. More research needs to be done on the role of Korean ethnic churches in the lives of older KAs especially in understanding friendships and spiritual and emotional support from clergy and congregational members. Some limitations to the current study should be noted. First, this sample relies on a convenience sample. The use of probability sampling can be a challenge in studies involving minority elderly KAs because of the limited pool of the population. Since participants were recruited from New York City senior centers, our findings may not be generalizable to older KAs from other regions of the US Moreover, the sampling strategy through senior centers disallows us to reach elderly KAs who were more isolated or institutionalized. Second, this study is based on crosssectional data and it is not possible to claim a causal relationship between life satisfaction and depressive symptoms. Further examination with longitudinal designs would help to determine the relationships of aforementioned variables. Despite these limitations, the current findings may contribute to the scarce literature investigating social network support associated with mental health and psychological well-being among immigrant elders. To our knowledge, this is the first study to explore friend support and depressive symptoms on life satisfaction among older KAs. Our data highlight the need for public health education and communication that underscore the importance
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of friendships and social support among the aged. With the growth of diverse aging communities in the US, creating culturally and linguistically appropriate interventions that can facilitate psychosocial coping resources and sustainable health behaviors will be an important step toward decreasing mental health disparities and enhancing the quality of life for racial/ethnic minority elders.
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ORIGINAL PAPER
Friends, Depressive Symptoms, and Life Satisfaction Among Older Korean Americans Soonhee Roh • Yeon-Shim Lee • Kyoung Hag Lee Tazuko Shibusawa • Grace J. Yoo
•
Ó Springer Science+Business Media New York 2014
Abstract This study examined the interactive effects of social network support and depressive symptoms on life satisfaction among older Korean Americans (KAs). Using data from a sample of 200 elders in a large metropolitan area (Mage = 72.50, SD = 5.15), hierarchical regression analysis was used to examine the interaction between social network support and depressive symptoms on life satisfaction among older KAs. After controlling for demographic variables, both social network support and depressive symptoms were identified as predictors for life satisfaction. Interaction effects indicated strong associations between higher social network support specifically from friends and lower depressive symptoms with higher levels of life satisfaction. Findings highlight the important role that friends play in terms of social network support for the mental health of older KAs, and the need for geriatricpractitioners to monitor and assess the quality of social
S. Roh (&) Department of Social Work, University of South Dakota, 1400 West 22nd Street, Sioux Falls, SD 57105, USA e-mail: [email protected] Y.-S. Lee School of Social Work, San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132, USA K. H. Lee School of Social Work, Wichita State University, 1845 Fairmount Street, Wichita, KS 67260-0154, USA T. Shibusawa Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003, USA G. J. Yoo Asian American Studies, San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132, USA
network support—including friendships—when working with older KAs. Keywords Depressive symptoms Social network support Life satisfaction Older Korean Americans
Introduction Life satisfaction is an important positive perception of psychological well-being that is seriously understudied among racial/ethnic minority elders [1–5]. It is often defined as the cognitive evaluation of one’s life as a whole [6], or more specifically, the fit between the desired goals in life and the actual outcome of one’s life [7], and can be an indicator of overall life quality [7, 8]. Compared to Whites, racial/ethnic minorities tend to report lower life satisfaction [9–11]. For example, Black elders reported slightly lower levels of life satisfaction than White elders (14.03 vs. 14.54) [10]. Among racial/ethnic minorities, older Korean Americans (KAs) stand out as having consistently lower levels of life satisfaction [1–4]. Studies with older community-dwelling KAs report lower mean scores on the Satisfaction with Life Scale (SWLS) [1, 2, 4] as compared to older Whites and African Americans (15.70 vs. 18.20 vs. 18.20) [1, 5, 12]. Stressful life events, depression, poor health, low socioeconomic standing, and low acculturation appear to have influence on life satisfaction among older KAs [1, 2, 29]. Depression is one of the most common psychological problems that adversely affect quality of life among older KAs [1, 13, 14]. Studies indicate that prevalence rates for probable depression are 20–53 % among older KAs [1–4, 13–20]. The rates are substantially higher than the 9–16 % found in community-dwelling Whites and African
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Americans [21, 22]. Furthermore, older KAs are less likely to seek mental health treatment [23] which might contribute to the persistency of depression in this population [24]. Although research indicates depressive symptoms as a predictor of life satisfaction in the general population [5, 25, 26], there is very limited research on racial/ethnic minority elders and potential buffering factors. To fill the gap, this study sought to examine ways to mitigate the negative effects of depressive symptoms on life satisfaction in older KAs. Specifically, we hypothesized that older KAs with high social network support through family and friends would be less susceptible to the deleterious effects of depressive symptoms on life satisfaction than older KAs with low social network support.
depressive symptoms on life satisfaction may vary across the levels and types of social network support. Family support has traditionally been studied among older KAs [33] but friendships may equally be an important source of support for older KAs. Research of older KAs indicates that support from friends is qualitatively different than support from family. Older KAs may rely on their family networks for linguistic and tangible support but prefer to maintain independent and depend on friends for advice and companionship [34]. The primary objective of this study is to explore the independent and interaction effects of social network support, including identifying differences between family and friend support, and depressive symptoms on life satisfaction among older KAs.
The Roles of Social Network Support Among Older Korean Americans
Methods Participants and Data Collection Procedures
The conceptual framework of this study was largely based on the stress process model [27] which proposed that disadvantaged social status and limited resources expose individuals to biological or psychological stressors [28]. At the same time, this framework proposes that social or personal resources (e.g., social network support) can moderate the effects of stressors on mental health outcomes (e.g., life satisfaction). Research on older KAs indicates that factors associated with status/environment strains, such as language barriers, acculturative stress, and financial hardships, are closely linked to an increased risk of depressive symptomology which may, in turn, lead to lower life satisfaction [1, 2, 29]. Social network support, such as assistance from family and friends, has been widely studied as a resource to prevent depression [1, 2, 4, 28]. In addition, research suggests that social network support is significantly associated with increased life satisfaction in the general population and older KAs [12, 28, 30]. Social network support is believed to be an important resource that protects older KAs from the potentially pathogenic influence of stressful events, such as depression [1]. It serves as an interpersonal environment for transmission of information, social influences, and networks [31]. Stronger and closer social ties provide social resources in times of need, reduce a sense of isolation, and increase physical/mental functioning among older KAs [32]. Although several studies [1, 4, 5, 28] have shown the independent contributions of depressive symptoms and social network support, they may have overlooked how these variables work together to influence assessments of life satisfaction among older KAs. For example, older KAs with depressive symptoms may have different levels and kinds of social network support and the impact of
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Upon receiving approval from the Institutional Review Board of New York University, a total of 212 KA older adults aged 65 and older were recruited through a purposive sampling method from January to May 2009, in partnership with two of the largest Korean senior centers in New York City. They were screened with the Short Portable Mental Status Questionnaire [35] to make sure that they had the cognitive ability to participate in the study. Of those, five refused to participate, and an additional seven were excluded because of their incomplete answers, leading to a final sample of 200 community-dwelling older KAs. Each participant had a face-to-face interview with a trained interviewer that lasted approximately 40 min. Participants were paid $10 for their participation. Measures Social Network Support The Korean version of Lubben Social Network ScaleRevised (K-LSNS-R) was used to assess social network support [36, 37]. The six-item scale probed for perceived social network support received by family. The Cronbach’s a was .79 in this study. Six items were selected to assess the level of perceived social network support from friends including neighbors across several areas, such as confiding relationships, trust, and the reciprocity of giving help. Internal consistency of friends was .78 in the current study. Each item measured the size and closeness of and the frequency of contact with one’s social network. Items were rated on a 6-point Likert scale, which ranged from 0 to 36 with higher values indicating greater perceived social networks. Each score of family and friends of K-LSNS-R
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was computed by summing equally weighted items for our analysis.
Table 1 Demographic characteristics of older KAs (in percent or mean, N = 200) Age
Depressive Symptoms
Ranged age from 65 to 89
Mean 72.50
Gender
The Korean version of 30-item Geriatric Depression Scale (GDS-K) was used to measure depression [38, 39]. The scale has been shown to be reliable and valid in assessing depressive symptoms of diverse older populations including Chinese elderly immigrants [40] and older Japanese Americans [41]. Using a yes/no format, respondents rated 30 items. The GDS-K scores ranged from 0 to 30, where a score ranging between 0–9, 10–19, and over 20 indicated normal, mildly depressed, and severely depressed. Internal consistency was .85 in the current study. Life Satisfaction The SWLS [6] was used to measure life satisfaction as the outcome variable. The five-item scale was originally developed by Diener et al. [6] to measure global life satisfaction as a cognitive-evaluative process. The Korean version of the SWLS by Kim and Kim [42] was used in this study. The Korean version utilizes a 5-point Likert scale since older Koreans are not comfortable with expressing their feelings in a 7-point Likert scale. Total scores were calculated for analysis, which ranged from 0 to 25 with higher scores indicating greater life satisfaction. Internal consistency was .88 with the current study. Data Analysis In addition to descriptive and correlational analyses, this study used a hierarchical regression analysis to examine the moderating roles of social network support from family and friends on the relationship between depressive symptoms and life satisfaction. Centered scores for depressive symptoms and social network support variables were used when computing the interactive variables to avoid multicollinearity problems [43]. There were no multicollinearity issues identified among independent variables since the tolerance scores for all independent variables were [.10 [44].
Results Sample Characteristics Table 1 summarizes the sample characteristics. The mean age was 72.5 years (SD = 5.10), with 69 % between the ages of 65 and 74. About 58 % of participants were male and 60 % married; about 83 % completed high school; and
Female
42.5
Male
57.5
Marital status Married
60.0
Widowed
22.5
Others (divorced, separated, etc.)
17.5
Education Lower than high school diploma/GED High school diploma/GED
33.5 23.5
[High school diploma/GED
43.0
Living arrangement Living alone
24.0
Living with someone
76.0
Annual income \$10,000
55.5
$10,001–$20,000
30.0
More than $20,001
14.5
Religious affiliation No religion
11.0
Catholic
19.0
Protestant
61.5
Buddhist
8.0
Others
.5
Years in the US Ranged year from B1 to 45
Mean 21.86
85.5 % had an annual income of $20,000 or less. All participants were foreign born, with the length of time in the US ranging from 1 to 45 years (M = 21.86). About 89 % of participants reported that they were affiliated with a religion. Correlational Analysis Among Study Variables Table 2 presents the correlation coefficients to examine underlying associations among study variables. The mean scores of life satisfaction and depressive symptoms were 15.80 and 7.87, respectively. In terms of social network support from family, scores ranged from 0 to 36. A mean of 13.35 demonstrated somewhat low levels of social network support from family. Total scores possible ranged from 0 to 36. Scores of 0–13 illustrated low social network support, while 14–26 indicated moderate social network support, and 27 or above showed higher social network support. The mean scores of social network support from friends ranged
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J Immigrant Minority Health Table 2 Correlational analysis among study variables (N = 200) Life satisfaction
Depressive symptoms
Social network support of family
Social network support of friends
Life satisfaction Depressive symptoms
-.549***
Social network support of family
.283***
-.304***
Social network support of friends
.363***
-.277***
.606***
Range
Mean
SD
5–25
15.80
4.44
0–25
7.87
5.80
0–30
13.35
5.58
0–29
13.52
5.27
*** p B .001
Table 3 Coefficients of hierarchical regression for the moderating role of social network support on the relationship between depressive symptoms and life satisfaction (N = 200)
* p B .05; ** p B .01; *** p B .001 a
Unstandardized beta coefficients
b
Standard errors
Model
Model 1 Ba(SEb)
Model 2
Model 3
-.556(.051)***
-.493(.053)***
-.488(.056)***
Social network support of family
-.011(.065)
.003(.065)
Social network support of friends
.225(.070)**
Depressive symptoms
.213(.070)**
Depressive symptoms 9 Social network support of family
-.096(.011)
Depressive symptoms 9 Social network support of friends
.166(.012)*
F test
70.812***
28.396***
18.169***
R2
.309
.353
.371
2
.309
.044
.018
R change
from 0 to 29, with a mean of 13.52, indicating that respondents reported slightly low levels of social network support from friends. Life satisfaction was positively associated with social network support from family and friends, but negatively associated with depressive symptoms. Depressive symptoms were inversely associated with social network support from family and friends. Additionally, social network support from family was positively associated with social network support from friends. Interactive Role of Social Network Support of Family and Friends The hierarchical regression results in Table 3 show the moderating role of social network support from family and friends in the relationship between depressive symptoms and life satisfaction among older KAs. In Model 1, depressive symptoms explained 30.9 percent of the variance (R2) of life satisfaction. In Model 2, the entry of social network support from family and friends added 4.4 percent of the variance (R2) to the model. In Model 3, inclusion of the interaction variables increased the explanatory power of the model by 1.8 percent. Findings revealed that a high level of depressive symptoms was significantly related to decreased life
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Life satisfaction
satisfaction among older KAs (B = -.488, p B .001). Social network support from friends was significantly associated with the increased life satisfaction among older KAs (B = .213, p B .01). Also, social network support from friends significantly moderates the relationship between depressive symptoms and life satisfaction among older KAs (B = .166, p B .05) in Model 3. That is, social network support from friends may buffer the negative relationship between depressive symptoms and life satisfaction among older KAs. The regression lines for high and low social network support from friends are presented in Fig. 1. In plotting the graph, perceived social network support from friends was split into two groups according to the mean, with a score of 13.52. Values below the median score were categorized as having low social network support, and the remaining values were categorized as having high social network support. The figure shows that the line of low social network support from friends is lower than the line of high social network support from friends, thus pointing to a clear moderating or buffering effect of social network support from friends on depressive symptoms and life satisfaction. That is, high social network support from friends significantly decreased the relationship between depressive symptoms and life satisfaction more than low social network support from friends.
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Fig. 1 Moderating role of social network support of friends on the relationship of depressive symptoms and life satisfaction. To understand the direction of the interactions, the high social support of friend group and low social support of friend group were divided according to the mean scores of the social support of friends. In each group, simple bivariate regressions were conducted to understand the direction between depressive symptoms and life satisfaction. The figure shows the line of high social support of friends (R2 = .249, B = -.412, p B .001) steeper than the line of low social support of friends (R2 = .342, B = -.419, p B .001), thus pointing to a clear buffering role of social support of friends on depressive symptoms– life satisfaction relation. Since the social support of family was not a significant moderating factor on depressivesymptoms–life satisfaction relation, the figure of the regression plot graph was removed
Discussion This study examined the independent and interaction effects of depressive symptoms and social network support on life satisfaction among older KAs, in order to understand the associations among these variables more precisely and to provide guidance for prevention and intervention. The strength of this study is its analytic approach that takes into account the joint effects of two predictive factors. Convergent with prior literature [45], depressive symptoms appear to be a risk factor for low life satisfaction among older KAs. Friend network support showed a significant and strong independent relationship with depression and its interaction showed a buffering effect on the severity of depressive symptoms on life satisfaction among older KAs. Despite a general notion on the importance of family network to older KAs, support from family network fails to exert a similar effect. The current study’s most striking finding is the contrastbetween family and friend network support. Specifically, our hypothesis that depressive symptoms in combination with friend network support influence life satisfaction was supported. Consistent with the stress process model, we found that the negative association between depressive symptoms and life satisfaction was offset for older KAs who had greater friend network support. In fact,
among elderly KAs with an equivalent degree of depressive symptoms, those high in friend network support indicated higher life satisfaction than those low in friend network support. This suggests that depressive symptoms may have more harmful effects for older KAs low in friend network support than for older KAs high in friend network support. Moreover, even though the interaction effect was significant, the difference in life satisfaction between high and low social support of friends was \2-points. Further study is needed to understand variation in levels of friend support among older KAs. Surprisingly, on the contrary to our prediction, we did not find evidence supporting the moderating effect of family network support on the relationship between depressive symptoms and life satisfaction. These findings seem to contradict others showing centrality of family network support, particularly adult children among elderly KAs [18, 46], but they somehow corroborate studies reporting changes in the meaning of family support [47, 48] and the effects of close friendship on lowering depressive symptoms [34, 49, 56]. Elderly KA have adopted US norms of living independently from their adult children and relying on support from sources outside the family, such asfriends and community resources [34]. Research also indicates that elderly KAs may prefer independence from adult children because soliciting support from adult children creates disruptions and tension with their adult children’s spouse and the care of their young children [48, 50]. The exact mechanisms through which friend network has a beneficial effect on life satisfaction have still yet to be investigated. One possibility is that instead of turning to adult children for assistance, elderly KAs may rely on friends for emotional support which, then in turn, can become a very important psychosocial coping resource and can have a large effect on alleviating stress. Elderly KAs with higher friend support are also likely to have stronger ties to community-based services through their relationships with friends, and hence have greater access to emotional support and instrumental resources to cope with negative life events [28]. It is also possible that engaging in relaxing and pleasant activities with friends, such as socializing, may diminish stress by fulfilling a need for belongingness, facilitate self-esteem and positive affective moods, and promote the global emotional well-being of older adults [51–53]. Our results suggest that friends as a source of support may be an effective form of coping for elderly KAs who face with depressive symptoms. Future intervention efforts to enhance psychological well-being among older KAs should be directed toward promoting supportive relationships between friends. Mental health professionals working with elderly KAs should pay closer attention to strengthening friendships to prevent social isolation. Particular
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attention to the ways in which a friend network is implicated in health promoting behaviors and practices could help with designing effective health interventions and illness management for older KAs. Although this study found that friend network support seemed to be more efficacious than family network support, future research is needed to investigate why this is the case. This finding was certainly intriguing given the importance of family as a core social value as well as a vital coping strategy that has traditionally been used for older KAs [3, 34, 54, 55]. After many years in the US, older KAs have acculturated and live independently from their family [56]. Moreover, the availability of ethnic community organizations and churches may help expand support networks beyond those of family/ kin. Subsequent research among older KAs on the changing nature and meaning of family support to mental health outcomes is needed. Finally, other unmeasured culturally specific coping resources may also attenuate the impact of depressive symptoms on life satisfaction. For example, the importance of religious support to better mental health and psychological well-being of older KAs is highlighted in several studies [4]. The Korean ethnic church provides a powerful support system to many older KAs including health/mental health education [47, 57]. In our sample, nearly 90 % of participants are affiliated with a religious organization. More research needs to be done on the role of Korean ethnic churches in the lives of older KAs especially in understanding friendships and spiritual and emotional support from clergy and congregational members. Some limitations to the current study should be noted. First, this sample relies on a convenience sample. The use of probability sampling can be a challenge in studies involving minority elderly KAs because of the limited pool of the population. Since participants were recruited from New York City senior centers, our findings may not be generalizable to older KAs from other regions of the US Moreover, the sampling strategy through senior centers disallows us to reach elderly KAs who were more isolated or institutionalized. Second, this study is based on crosssectional data and it is not possible to claim a causal relationship between life satisfaction and depressive symptoms. Further examination with longitudinal designs would help to determine the relationships of aforementioned variables. Despite these limitations, the current findings may contribute to the scarce literature investigating social network support associated with mental health and psychological well-being among immigrant elders. To our knowledge, this is the first study to explore friend support and depressive symptoms on life satisfaction among older KAs. Our data highlight the need for public health education and communication that underscore the importance
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of friendships and social support among the aged. With the growth of diverse aging communities in the US, creating culturally and linguistically appropriate interventions that can facilitate psychosocial coping resources and sustainable health behaviors will be an important step toward decreasing mental health disparities and enhancing the quality of life for racial/ethnic minority elders.
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