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research-article2014

ISP0010.1177/0020764014522775International Journal of Social PsychiatryKim et al.

E CAMDEN SCHIZOPH

Article

The mental health of Korean transnational mothers: A scoping review

International Journal of Social Psychiatry 2014, Vol. 60(8) 783­–794 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764014522775 isp.sagepub.com

Jaemin Kim1, Branka Agic2,3 and Kwame McKenzie1,4

Abstract Background: A recent migration trend from Korea is transnational family arrangement where mothers migrate with children to English-speaking countries, while the fathers stay in the home country. Mothers in these families may experience more challenges than other family members because they have to adjust to a new country, new parenting role and family separation. But little is known about their mental health. Aims: This article scopes the evidences in the literature on impact of transnational family arrangement and migration on the mental health of Korean transnational mothers. Method: A comprehensive search was undertaken in 16 databases and 17 studies were identified. Results: The evidence on the mental health of Korean transnational mothers was analyzed into two themes: (1) challenges and life difficulties, (2) psychological and emotional states. In relation to the life difficulties such as role changes, adaptation in the host country and lack of social support, the mothers reported anxiety, depression, increased psychological distress and feeling of isolation. Positive perceptions such as sense of empowerment and increased selfconfidence were also reported. Conclusion: The evidence suggests that there may be a potential for vulnerability to mental health problems in Korean transnational mothers. More research is needed to assess their mental health and to identify the risk factors. Keywords Mental health, migration, Korean, mother, transnational family

Introduction Transnational family arrangement is a recent and growing migration trend where mothers migrate with children to English-speaking countries, while fathers stay in the home country to work and support their families financially. The transnational family arrangement significantly changes the roles and relationships within the family and affects family functioning. Mothers in these families may have challenging postmigration experience as they have to adjust not only to a new country but also to family separation and a new parenting role. Studies on other ethnic transnational families such as Chinese and Taiwanese families indicate that the mothers in these families are at increased risk for mental health problems (Aye & Guerin, 2001; Nora Chiang, 2008; Waters, 2002). While there are many similarities across East Asian transnational families, there are also some important differences in the premigration, migration and postmigration context surrounding Korean transnational families that may contribute to different mental health outcomes for this group. This study investigates the impact of migration and transnational family arrangement on the mental health and well-being of Korean transnational mothers. The purpose of this scoping

review is to (1) map the current state of evidence on the mental health impact of transnational family arrangement and migration on Korean transnational mothers, and (2) identify research gaps and needs for future research.

Background Transnational family arrangement is an increasing migration pattern observed since the 1990s in migrants from 1Social

Aetiology of Mental Illness training program, Centre for Addiction and Mental Health, Toronto, ON, Canada 2Health Equity, Centre for Addiction and Mental Health, Toronto, ON, Canada 3Collaborative Program in Addiction Studies, University of Toronto, Toronto, ON, Canada 4Department of Psychiatry, University of Toronto, Toronto, ON, Canada Corresponding author: Kwame McKenzie, Access & Transitions Program, Centre for Addiction and Mental Health, 455 Spadina Ave, Suite 300, Toronto, ON M5S2G8, Canada. Email: [email protected]

784 East Asian countries, such as Hong Kong, China, Taiwan and Korea to English-speaking countries such as Canada, the United States, Australia and New Zealand (Aye & Guerin, 2001; Nora Chiang, 2008; Waters, 2002). The primary purpose of migration is to increase children’s educational opportunities. The families have strong ties to both countries and there is a clear role division within the family. This type of family arrangement is distinct from other split-family arrangement in which, for instance, mothers migrate to earn money leaving their families in the home countries (Y. J. Jeong, You, & Kwon, 2013). In Korea, transnational families are often called kirogi (Korean word meaning a wild goose). Koreans consider wild geese as a symbol of the virtues that married couples must follow because wild geese pairs are known to be faithful to their partners and dedicated to caring for their children. The exact number of Korean transnational families is unknown, but the available data suggest that the number is significant. In 2008, the estimated number of fathers in transnational families in Korea was approximately 2,00,000 (E. G. Kim, 2008). In 2011, the total number of Korean students who had migrated abroad for primary and secondary education since 2001 was 1,86,807 (Korean Educational Development Institute (KEDI), 2011). In 2012, a survey reported that 59% of Korean parents believed that foreign education was necessary for their children’s success (KEDI, 2011). A variety of studies have explored the Korean transnational family phenomenon. They mainly examined the characteristics of these families and their motivations for migration (Y. J. Kang, 2009; K. Kim & Yoon, 2006). The narratives of fathers who remained in Korea gained more attention than those of mothers who migrated with their children, due to the prevalent perception in Korea that fathers are those who suffer the most in this family arrangement because they are left behind on their own (S. Kim, 2006; Y. J. Lee & Koo, 2006). Understanding the mental health of transnational mothers is important for developing appropriate social and service responses. It is also important because the mental health issues of mothers can influence the parenting styles and relationships with their children, and further impact the mental health of the children (Goodman & Ian, 1999). Studies of transnational mothers from China, Taiwan and Hong Kong reveal that mothers in these families are at increased risk for mental illness. Social isolation, role change and managing spousal relationships have been reported as the common stressors among Chinese and Taiwanese transnational mothers (Aye & Guerin, 2001; Waters, 2002). They reported experiencing chronic psychological strain because they have to carry out the responsibilities of single parenting and fulfill the dual role of father and mother (Aye & Guerin, 2001). Korean transnational mothers may experience similar stressors. However,

International Journal of Social Psychiatry 60(8) their risks and rates of mental health problems may differ due to different premigration, migration and postmigration contexts. For example, Korean transnational mothers appear to differ from other East Asian groups in terms of their intention of permanent residence in the host country. In transnational families from China, Taiwan and Hong Kong, mothers and children, or children only (so-called astronaut children), usually migrate first, and the remaining family members join them later in the host country (Aye & Guerin, 2001; Nora Chiang, 2008; Waters, 2002). The intention for permanent residence is evident in this type of migration, and family separation is considered as an involuntary and temporary option (Aye & Guerin, 2001). On the other hand, many Korean transnational mothers stay in the host country temporarily for the duration of their children’s education (Y. J. Jeong et al., 2013) with a temporary resident status which limits their access to social services and resources in the host country. The transnational mothers with permanent resident status in Canada, in many cases, keep their permanent residency plan open to change (S. Kim, 2007). This tendency may result in delay in their adaptation process and lack of coping resources for them. There may be some differences in cultural norms about the family structure and gender roles in Korea. For example, familism – the value system that centers on the demands of the family – has been used to explain the transnational family phenomenon (Ahn, 2009). Although the origin of familism can be found in Confucianism that is shared among East Asian countries, Korean familism is found to be unique in that it had been shaped as a strategy among Koreans to secure family prosperity (Ahn, 2009; E. Lee & Johnstone, 2013). Educational success has been considered as a gateway for upward social mobility, and Korean parents consider their children’s education as a family project and one of the most important parental duties (Y. J. Jeong et al., 2013). This can influence how Korean mothers perceive their maternal roles and cope with the family separation. Due to this uniqueness, it is important to investigate the experience and perceptions of transnational mothers within a Korean family context. This scoping review aims to identify the current knowledge on this topic and suggest directions for future research on this population.

Methods A scoping review (or scoping study) is a methodology designed to systematically and quickly summarize a range of evidence in order to map the breadth of literature in an area being researched (Arksey & O’Malley, 2005; Colquhoun, Levac, & O’Brien, 2010). We used a comprehensive information retrieval strategy to identify both quantitative and qualitative evidence on the transnational family arrangement among Korean migrants and its impact

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Kim et al. on mothers. In order to achieve a comprehensive review of the literature, we included unpublished PhD dissertations, gray literature and book chapters in search. The questions that guided the search process were (1) what is the current state of knowledge on Korean transnational mothers? (to identify the literature related to the topic), and (2) what is the evidence on the impact of the transnational family arrangement and migration on mental health of the mothers? (to map the literature according to mental health– related themes). In consultation with a senior librarian at the Centre for Addiction and Mental Health, 16 electronic databases (English and Korean) were identified to search. English databases included health-related ones such as MEDLINE, PsycINFO, CINAHL and PubMed. Social Work Abstracts, Educational Resources Information Center (ERIC), Sociological Abstracts and Humanities Abstracts were also searched in order to capture additional literature that addresses this topic in humanities or social science. We also included in search interdisciplinary databases such as Web of Knowledge, Scopus, Scirus and Google Scholar for a comprehensive search. For Korean literature, we searched KSCI (Korean Science Citation Index), RISS4U (a database from Korea Education and Research Information Service), KISS (a database from Korean Studies Information Service System) and DBpia. The electronic searches were conducted in March 2013. In scoping reviews, the study selection process is iterative and involves post hoc inclusion and exclusion criteria (Arksey & O’Malley, 2005; Armstrong, Hall, Doyle, & Waters, 2011; Colquhoun et al., 2010). The initial inclusion criteria for this review were (1) articles on Korean transnational mothers that were (2) written in English or Korean. Only a small number of literatures were captured by these criteria. Therefore, we used a more inclusive criterion, that is, any studies on Korean transnational families or transnational migration from Korea. We limited our search to literature released after 1994 because the transnational families started to appear in Korea after the government had announced the globalization (segyehwa) policy in 1994 (Cho, 2005). The revised inclusion criteria for search were (1) articles on the transnational family phenomenon from Korea, (2) articles written in English or Korean and (3) articles released after 1994. In cases of the published articles that are part of dissertations, we included dissertations only in order to avoid duplication of evidence. We mapped the keywords in three groups. We first performed searches using ‘OR’ in all keywords in each group. Then we combined groups one to three using ‘AND’ in the combination of the keywords. Since various terms such as kirogi, ‘goose’ or ‘wild-geese’ are used to describe Korean transnational families, we included these terms in the group three to capture a broad range of literature:

•• Group 1: Korea* •• Group 2: mother*, woman, women, famil*, immigra*, migration* •• Group 3: transnational*, goose, geese, kirogi We used these keywords to scan the full texts of documents for a match rather than the titles and abstracts only. We consulted the librarian to ensure that all key terms were included.

Results We initially obtained 373 studies. Of these studies collected, we selected abstracts that were relevant to our research objectives, guided by the criterion whether they are the studies on Korean transnational mothers or families, or transnational migration from Korea. Among the 94 abstracts identified as meeting this criterion, 45 articles were excluded for duplication. We assessed the abstracts based on the criterion whether the articles included any evidences on Korean transnational mothers in relation to transnational migration or a split-family situation. This process selected 22 articles for the full-text review. We complemented the search by conducting footnote chasing and reference checking in the selected articles, and Google search. Two articles were added in this step. After thorough assessment of the full texts, seven articles were excluded because (1) they did not include any data describing the mothers’ perceptions or experiences of transnational migration or split-family situation, or (2) the data did not reflect any themes related to their well-being and mental health. This review includes 17 studies. As scoping reviews do not intend to assess the quality of the literature scoped (Arksey & O’Malley, 2005; Armstrong et al., 2011; Colquhoun et al., 2010), this review does not assess the quality of the studies collected (Figure 1).

Methodology, study location and purpose of the studies This study includes 13 journal articles, two book chapters and two dissertations (Tables 1 and 2). There are eight studies in English, and nine in Korean. In terms of methodology, there are 13 qualitative studies, two quantitative studies and two mixed method studies. We only included qualitative evidence from the mixed-methods studies for analysis because the quantitative data were not relevant to the mental health of the population. All the articles were published between 2005 and 2013. Thirteen studies were released or published in the past 4 years, which indicates recent attention to the transnational family phenomenon from Korea (Figure 2). The study locations range from across the United States, Canada, New Zealand and Singapore. The focus

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Studies identified initially through database searches (n = 373) Studies excluded based on title scan for relevance (n = 279) Criterion: studies on Korean transnational mothers or families, or a transnational migration from Korea

Studies excluded for duplication (n = 45)

Studies excluded based on abstract scan for relevance (n = 27) Studies included after title and abstract scan for relevance (n = 22)

Criterion: studies include any evidences on Korean transnational mothers in relation to transnational migration or a split family situation

Studies included by food note chasing, reference checking, and Google search (n = 2) Full text articles retrieved for a thorough review (n = 24) Studies excluded based on full review for relevance (n = 7) Studies included in scoping review (n = 17)

Figure 1.  Study selection process.

of the studies varied. Five studies had their main focus on investigating the experiences of families or couples, rather than focusing specifically on transnational mothers. Among 12 studies with main focus on transnational mothers, three were health related. Cha (2010a) examined perception of health and health promotion behaviors of Korean transnational mothers. Two studies addressed the mental health of Korean transnational mothers: J. H. Kim and Chung (2006) applied the art therapy to explore the transnational family experiences of the mothers and addressed their mental health. Yoon and Shin (2010) examined depression rates and self-esteem of the mothers. This was the only study that assessed the rate of mental illness among Korean transnational mothers using standardized tools.

Mental health–related evidence In scoping reviews, thematic content analysis is the most appropriate method to analyze the results (Arksey & O’Malley, 2005; Colquhoun et al., 2010). This section summarizes all the evidence in the literature that describes mental health–related issues affecting Korean transnational mothers. Based on thorough review of the selected articles, we identified two themes: (1) challenges and life difficulties reported, and (2) psychological and emotional states reported by the mothers.

Qualitative evidence Challenges and life difficulties reported. ‘Increased responsibilities and role change’ were the difficulties most commonly reported by Korean transnational mothers. Studies indicate that the transnational mothers experience increased role expectations as a household caretaker and a decision maker for their children (Ahn, 2009; Y. J. Jeong et al., 2013; S. Kim, 2007, 2009; K. H. Kim, 2010). This challenge includes ‘parenting difficulties’, ‘absence of father figure in parenting’ and ‘being a lone decision maker,’ as reported by the mothers in some studies (J. Jeong & Belanger, 2012; Y. J. Jeong et al., 2013; J. H. Kim & Chung, 2006; Y. H. Kim & Kim, 2009). Another challenge widely reported among Korean transnational mothers was adaptation to the host country. ‘Language and cultural barriers’ and ‘unfamiliarity or lack of knowledge of the host society’ were also reported (Cha, 2010a; Y. J. Jeong et al., 2013; Y. Kang, 2012; K. H. Kim, 2010; Y. H. Kim, Choi, & Lee, 2005; J. H. Kim & Chung, 2006; Yeom, 2008; Yoon & Shin, 2010). Social support–related difficulties were also frequently reported. ‘Social isolation’ or ‘lack of social support’ was reported in eight studies (Cha, 2010a; S. Kim, 2007, 2009; K. H. Kim, 2010; Y. H. Kim et al., 2005; J. H. Kim & Chung, 2006; Yeom, 2008; Yoon & Shin, 2010). ‘Cultural criticism’ and ‘social stigma’ toward transnational mothers were reported in three

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Kim et al. Table 1.  Studies included in the scoping review (language, study location and methodology). Author

Title

Resource type

Year

Language

Study location

Methodology

Y. H. Kim and Kim

A study of the families in long-term separation: marital relationship of ‘Wild Geese Families’ A qualitative study on the life experience and identity maintenance of the full-time housewives of the Korean Wild Geese Family in U.S.A. A qualitative study on the Wild Goose Mother’s everyday life, family relationship and social networking Separation experiences of Wild Geese Families from a social exchange perspective Actual state of Korean ‘Geese Mothers’ in New Zealand Adaptation process of the Korean ‘Geese Mothers’ in U.S.A. : A grounded theory approach The actor effect and the partner effect of self-esteem and mother– adolescent communication on depression in mothers and adolescents in Kirogi families according to adolescent’s development stage Composing life as a Korean Goose Mother: A narrative inquiry into Sue’s experience ‘I am a kirogi mother’ : Education exodus and life transformation among Korean transnational women Kirogi families in the US: transnational migration and education Transnational life of Korean ‘Wild Geese Family’: Coping strategies and family paths across time A study on experience of art therapy with the ‘Geese-Mother’ Health and health promotion among Korean Goose Mothers Kirogi families as virtual families: Perspectives and experiences of Kirogi mothers Transnational motherhood in the making of global kids: South Korean educational migrants in Singapore South Korean transnational mothers: familism, cultural criticism and education project One family in two countries: mothers in Korean transnational families

Journal article

2009

Korean

The United States

Qualitative

Journal article

2007

Korean

The United States

Qualitative

Journal article

2009

Korean

The United States

Qualitative

Journal article

2012

Korean

The United States

Qualitative

Journal article

2005

Korean

New Zealand

Quantitative

Journal article

2010

Korean

The United States

Qualitative

Journal article

2010

Korean

The United States

Quantitative

Journal article

2008

English

Canada

Qualitative

Journal article

2010

English

The United States

Qualitative

Journal article

2012

English

The United States

Mixed method

Journal article

2009

Korean

The United States

Qualitative

Journal article

2006

Korean

Canada

Qualitative

PhD dissertation

2010(a)

English

Book chapter

2012

English

The United States /Canada Canada

Mixed method Qualitative

Book chapter

2012

English

Singapore

Qualitative

PhD dissertation

2009

English

The United States

Qualitative

Journal article

2013

English

The United States

Qualitative

S. Kim

S. Kim

K. Kim and Yang Y. H. Kim, Choi, and Lee K. H. Kim Yoon and Shin

Yeom H. Lee

Finch and Kim Kang J. H. Kim and Chung Cha J. Jeong and Belanger Kang

Ahn Y. J. Jeong, You, and Kwon

A qualitative study on the wild goose mother’s everyday life, family relationship and social networking Separation experiences of wild geese families from a social exchange perspective

S. Kim

Actual state of Korean ‘Geese Mothers’ in New Zealand

Adaptation process of the Korean ‘Geese Mothers’ in U.S.A. : A grounded theory approach

Y. H. Kim, Choi, and Lee

K. H. Kim

K. Kim and Yang

A qualitative study on the life experience and identity maintenance of the full-time housewives of the Korean wild geese family in U.S.A.

S. Kim

2010

2005

2012

2009

2007

A study of the families in 2009 long-term separation: Marital relationship of ‘Wild Geese Families’

Y. H. Kim and Kim

Year

Title

Author

16 mothers

66 mothers

16 mothers

16 mothers

13 mothers

11 mothers, 1 father

Sample

In-depth interview/ grounded theory

Survey/descriptive statistics

Participatory observation, indepth interview/ thematic content analysis In-depth interview/thematic content analysis

In-depth interview/thematic content analysis

In-depth interview/thematic content analysis

Data collection/ analysis

To understand how Korean transnational mothers adapt themselves in life changes and the challenges in their adaptation process

To understand separation experiences of transnational families from a perspective of the social exchange theory To understand the daily life patterns of Korean transnational mothers

To understand the transnational mothers’ lives in the host country and how they build and manage social networks

To explore the experiences of transnational mothers and identify difficulties with living as a transnational mother

To explore how the married couples perceive their marital relationships during the transnational family arrangement

Purpose of the study

Table 2.  Studies included in the scoping review (samples, data collection and analysis methods, study purposes and results).

The participants maintain their marriage by sharing a common priority of supporting their children, yet the marital relationships may be damaged Individual differences in motivation and planning of migration result in different life experiences of transnational mothers (i.e. radical role change and increased responsibilities resulted in anxiety and depression for some participants, whereas others enjoyed positive psychological outcomes; the cultural backgrounds and the family context affect their experiences Transnational mothers experience increased responsibilities in the family but their resources are limited to manage the responsibilities Transnational family members consider increased psychological pressure and financial burdens as investments rather than costs Korean transnational mothers reported isolated life styles and limited social networks, but were fairly satisfied with their lives in New Zealand Premigration context (i.e. preparation, migration decision process), personal characteristics (i.e. self-esteem, being independent) and length of stay in the host country affect the psychological impact of the adaptation process on Korean transnational mothers

Results

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Composing life as a Korean goose mother: a narrative inquiry into Sue’s experience

‘I am a kirogi mother’ : 2010 Education exodus and life transformation among Korean transnational women

Kirogi families in the US: transnational migration and education

Transnational life of Korean ‘Wild Geese Family’ Coping strategies and family paths across time

Yeom

H. Lee

Finch and Kim

Kang 2009

2012

2008

2010

The actor effect and the partner effect of self-esteem and mother–adolescent communication on depression in mothers and adolescents in Kirogi families according to adolescent’ development stage

Yoon and Shin

Year

Title

Author

Table 2. (Continued)

11 mothers

49 transnational family members/ 15 mothers and their children

2 mothers

1 mother

107 mothers and their children

Sample Survey questionnaire (CES-D, SelfEsteem Scale, Parent–Adolescent Communication Inventory)/Chisquare, t-test, MANCOVA, Pearson’s correlation coefficients In-depth interview (multiple interviews during 8-month period)/ narrative inquiry In-depth interview (multiple interviews during 12 months period)/a narrative inquiry Survey (49 transnational family members), in-depth interviews (15 mothers)/thematic content analysis In-depth interview/thematic content analysis

Data collection/ analysis

To explore how Korean transnational families manage and adapt to transnational family arrangement

To understand the cultural logic and motivations behind Korean transnational families’ choice of maintaining a split household

To explore how the experiences of Korean transnational mothers influence their identity transformation

To explore the experiences of a Korean transnational mother and the meanings of the experiences

To examine the actor effect and the partner effect of selfesteem and mother–children communication on their depression

Purpose of the study

(Continued)

The mothers manage spatial distance from husbands by frequent communications, and by reidentifying the role expectations in the family. They consider the challenges of transnational family arrangement as a long-term investment for their children’s future.

Social mobility and the striving for cosmopolitan experience draw Korean families to pursue the transnational family project, and the ideology of familism is at the core of it

The participants constantly evaluate and develop new understanding of their identities, and see themselves as empowered

The mother’s story revealed that her life as a transnational mother was closely interconnected to her son’s story

Mothers’ self-esteem and communication with children have an association with depression rates of themselves and their children

Results

Kim et al. 789

Kirogi families as virtual families: Perspectives and experiences of Kirogi mothers

Transnational motherhood in the making of global kids: South Korean educational migrants in Singapore

South Korean transnational mothers: familism, cultural criticism and education project

One family in two countries: mothers in Korean transnational families

J. Jeong and Belanger

Kang

Ahn

Y. J. Jeong, You, and Kwon

MANCOVA: multivariate analysis of covariance.

Health and health promotion 2010(a) among Korean goose mothers

Cha

2013

2009

2012

2012

2006

A study on experience of art therapy with the ‘GeeseMother’

J. H. Kim and Chung

Year

Title

Author

Table 2. (Continued)

13 mothers

30 mothers

18 mothers, and 2 grandmothers, and 20 children

30 mothers

140 mothers (112 in the United States, 28 in Canada)

2 mothers

Sample

In-depth interview/ symbolic interactionism, phenomenology

In-depth interview, participatory observation/ thematic content analysis

In-depth interview, focus groups/ thematic content analysis

In-depth interview/thematic content analysis

In-depth interview/thematic content analysis

In-depth interview, art therapy activities/ phenomenology

Data collection/ analysis

To explore the intersection among transnational migration, education and notions of mothering by examining South Korean educational migration to Singapore To examine re(de)construction of Korean familism in lieu of transnational educational migration, and how the mothers negotiate and navigate their everyday struggles despite the cultural criticism To explore how Korean transnational mothers perceive the transnational family situation and how their perception influence their maternal roles

To explore the meaning of health to Korean transnational mothers and describe their perceived health, healthpromoting behaviors and their attitudes toward acculturation, social support and perceived family strength in relation to their health and healthpromoting behaviors To understand the perspectives and experiences of Korean transnational mothers

To explore the experiences of Korean transnational mothers and the meaning of the art therapy to them

Purpose of the study

The transnational mothers reshaped their maternal self and re-negotiated gendered roles in response to their residence in the host country and physical separation from their husbands

The type of family relationships (the level of dependence on their husbands and power relations between the couples) affects experiences of transnational mothers after migration The notions of motherhood among Korean transnational mothers in Singapore were constantly negotiated and redefined based on their aspirations for their children’s future success Cultural criticism in family-centered and marital relation–based ethnic church cultures, and legal status of the mothers affect children’s educational setting, strategies and changes of the mothers

The art therapy helped the participants express their psychological burdens and inner conflict, and had positive psychological effect on them Korean transnational mothers perceived the meaning of health in relation to a mothering role, and this perception shapes their health behaviors to provide better support for their children

Results

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Kim et al. studies in association with ‘social isolation’ (Ahn, 2009; Cha, 2010a; K. Kim & Yang, 2012). In addition, difficulties in managing spousal relationships were described in two studies (S. Kim, 2007; Y. H. Kim & Kim, 2009). ‘Financial burdens’ and ‘visa status’ were also reported in a few studies (Cha, 2010a; Finch & Kim, 2012; Y. J. Jeong et al., 2013). Psychological and emotional states reported. Korean transnational mothers described several common psychological and emotional issues in relation to the challenges and life difficulties that they reported. ‘Increased psychological burden’, ‘psychological distress’ or ‘psychological strain’ was the most commonly reported issue. ‘Depression’ or ‘feeling depressed’ was reported in three studies (Y. J. Jeong et al., 2013; K. H. Kim, 2010; J. H. Kim & Chung, 2006), but these studies did not measure or assess the condition. Cha (2010a) indicated ‘decline in the perceived mental health’ among the mothers. ‘Feeling of isolation and loneliness’ was also a common issue (J. Jeong & Belanger, 2012; S. Kim, 2009; K. H. Kim, 2010; J. H. Kim & Chung, 2006). In addition, ‘feeling helpless’ (Y. J. Jeong et al., 2013; K. H. Kim, 2010; J. H. Kim & Chung, 2006; H. Lee, 2010), and ‘lowered self-esteem or self-confidence’ were also reported (S. Kim, 2009; K. H. Kim, 2010; J. H. Kim & Chung, 2006). ‘Being anxious’, ‘anxiety’, ‘fear’ or ‘worry’ appeared in three studies (Cha, 2010a; Finch & Kim, 2012; S. Kim, 2007) and ‘tiredness’ or ‘exhaustion’ was reported in two studies (S. Kim, 2009; Y. H. Kim & Kim, 2009). Positive emotional and psychological impact of the transnational family arrangement was also reported. ‘Sense of empowerment’, ‘freedom’, or ‘feeling independent’ was reported in seven studies (Ahn, 2009; J. Jeong & Belanger, 2012; Y. J. Jeong et al., 2013; Y. J. Kang, 2009; S. Kim, 2007, 2009; H. Lee, 2010), and ‘increased selfconfidence’ or ‘feeling strong inner-self’ was reported in two studies (Y. J. Kang, 2009; K. H. Kim, 2010). Some transnational mothers expressed positive feelings when they described spousal relationships, such as ‘increased appreciation and trust toward husband’ (Ahn, 2009; J. Jeong & Belanger, 2012; Y. J. Jeong et al., 2013). Quantitative evidence Psychological and emotional states reported.  In the quantitative studies, both negative and positive psychological states were reported. Depression was reported in the study of Yoon and Shin (2010). They used Center for Epidemiologic Studies–Depression (CES-D) scale to assess depression level among the sample. The results showed that 38.3% of the sample experienced clinical depression. The study on Korean transnational mothers in New Zealand reported higher life satisfaction rate among the mothers than the dissatisfaction rate. While 48% of the sample reported being ‘satisfied’ or ‘very satisfied’, only

9% reported being ‘dissatisfied’ and 42% showed neutral response (Y. H. Kim et al., 2005).

Discussion This article mapped a scope of existing evidence on the mental health of Korean transnational mothers. To our knowledge, this is the first systematic scoping review of the literature related to Korean transnational mothers. In terms of the study location, 11 studies were conducted in the United States. This concurs the fact that the United States is the most preferred destination country among Koreans who migrate for educational purposes (KEDI, 2011). However, the number of Korean students has been increasing rapidly in Southeast Asian countries such as the Philippines and Singapore (KEDI, 2011). Further research is needed to investigate transnational family arrangement and mental health issues of transnational mothers residing in these countries. This scoping review reveals that Korean transnational mothers experience various challenges and life difficulties as a result of migration and a split-family arrangement. Table 3 presents the summary of these challenges described in the literature. In association with these challenges and life difficulties, Korean transnational mothers reported various mental health–related issues and negative psychological and emotional states. The narratives of Korean transnational mothers described ‘increased responsibilities’ in connection with other life difficulties. For example, ‘increased responsibilities’ were described in relation to ‘lack of social support’ (Y. J. Kang, 2009) and ‘adaptation difficulties’ (Ahn, 2009). In a similar way, ‘language and cultural barriers’ were often reported in relation to a challenge in providing adequate support to children (Cha, 2010a; Y. J. Jeong et al., 2013; Y. Kang, 2012; K. H. Kim, 2010; Yeom, 2008). Several narratives indicate that these mothers perceive their limited language skills and lack of knowledge about the host society as equal to lack of parenting ability. They described the adaptation difficulties in a context of being unable to fulfill their maternal roles in a satisfactory manner (Cha, 2010a; Y. J. Jeong et al., 2013; Y. Kang, 2012; K. H. Kim, 2010; Yeom, 2008). This indicates the complexity of the mental health risk factors for Korean transnational mothers. They may be interconnected and reinforce each other. In-depth examination of these factors is necessary to further understand the mental health of Korean transnational mothers. Social support–related difficulties were also noticeable in the literature. ‘Social stigma’ and ‘cultural criticisms’ were reported in relation to isolation and lack of social support. Studies revealed that these mothers had experienced prejudice and rejection from the local Korean community (Ahn, 2009; S. Kim, 2009), and some mothers had intentionally avoided interaction with other

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Table 3.  Mental health–related evidences. Life difficulties and challenges Role change and increased responsibilities

12 studies

Language/cultural barriers

8 studies

Unfamiliarity, lack of knowledge about the host society Social support related

2 studies 8 studies

Stigma, criticism 3 studies Spousal relationship 2 studies Psychological and emotional states, and mental health issues Psychological burden, distress, or strain 8 studies Feeling isolated, loneliness

4 studies

Emotional distance from spouses

3 studies

Anxiety; feeling anxious, fear, worry Lowered self-esteem or self-confidence, feeling helpless Feeling tired or exhausted

3 studies 5 studies 4 studies

Psychological and emotional states – positive themes Sense of empowerment or freedom, feeling 7 studies independent Increased self-confidence, strong inner-self Life satisfaction

2 studies 1 study

6 5 4 3 2 1 0

2005

2006

2007

2008

2009

2010

2012

2013

Figure 2.  Number of studies by year.

Korean transnational mothers because of further stigmatization (S. Kim, 2009). However, we did not find any studies that examined barriers in seeking social support among these women and its possible association with their mental health. Given that social support is a key protective factor for mental health and well-being (Simich, 2004), further investigation on this topic will be

S. Kim (2007), S. Kim (2009), K. Kim and Yang (2012), K. H. Kim (2010), Yoon and Shin (2010), H. Lee (2010), Cha (2010a), Finch and Kim (2012), Y. J. Kang (2009), J. H. Kim and Chung (2006), Ahn (2009), Y. J. Jeong, You, and Kwon (2013) Y. H. Kim, Choi, and Lee (2005), K. H. Kim (2010), Yoon and Shin (2010), Yeom (2008), J. H. Kim and Chung (2006), Cha (2010a), Y. Kang (2012), Y. J. Jeong et al. (2013) Y. J. Jeong et al. (2013), K. H. Kim (2010) S. Kim (2007), S. Kim (2009), Y. H. Kim et al. (2005), K. H. Kim (2010), Yoon and Shin (2010), Yeom (2008), Cha (2010a), J. H. Kim and Chung (2006) Ahn (2009),Cha (2010a), K. Kim and Yang (2010) Y. H. Kim and Kim (2009), S. Kim (2007) S. Kim (2009) K. Kim and Yang (2012), K. H. Kim (2010), Y. J. Kang (2009), J. H. Kim and Chung (2006), Cha (2010a), Ahn (2009), Y. J. Jeong et al. (2013) S. Kim (2009), K. H. Kim (2010), J. H. Kim and Chung (2006), J. Jeong and Belanger (2012) Y. J. Jeong et al. (2013), J. Jeong and Belanger (2012), Y. H. Kim and Kim (2009) S. Kim (2007), Finch and Kim (2012), Cha (2010a) J. H. Kim and Chung (2006), K. H. Kim (2010), S. Kim (2009), H. Lee (2010), Y. J. Jeong et al. (2013) Y. H. Kim and Kim (2009), S. Kim (2009), J. H. Kim and Chung (2006), Y. J. Jeong et al. (2013) S. Kim (2007), S. Kim (2009), H. Lee (2010), Y. J. Kang (2009), J. Jeong and Belanger (2012), Ahn (2009), Y. J. Jeong et al. (2013) K. H. Kim (2010), Y. J. Kang (2009) Y. H. Kim et al. (2005)

necessary to better understand the mental health of this population. Positive perceptions are another area that requires further research. ‘Sense of freedom’ and ‘feeling independent’ were recurrent themes in the literature. In relation to ‘increased responsibilities and role change’, some mothers expressed positive feelings as they had felt more selfconfident and empowered, and independent from their husbands (Ahn, 2009; J. Jeong & Belanger, 2012; Y. J. Jeong et al., 2013; Y. J. Kang, 2009; S. Kim, 2007, 2009; H. Lee, 2010). ‘Increased appreciation and trust toward a spouse’ (Ahn, 2009; J. Jeong & Belanger, 2012; Y. J. Jeong et al., 2013) and high life satisfaction rate among the mothers in New Zealand (Y. H. Kim et al., 2005) add to the evidence on the positive perception of Korean transnational mothers. However, no studies have attempted to examine what causes this gap in their perceptions. Why Korean transnational mothers interpret a similar challenging situation differently, and how this

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Kim et al. difference in their perception affects their mental health? Or it may be possible that the mothers perceive their own situations as empowering yet challenging at the same time, and their mental well-being is influenced by their perceptions. Future research on this gap will help to further develop our understanding of this population.

Future research on Korean transnational mothers: Diversification of methods and necessity for mental health research Two studies addressed mental health–related themes (J. H. Kim & Chung, 2006; Yoon & Shin, 2010). However, it is important to note that these studies do not have their main focus on investigating the mental health of the population. J. H. Kim and Chung (2006) explored the transnational family experiences of the mothers and the meaning of the art therapy experience to them. Although Yoon and Shin (2006) measured depression rates of the mothers, the purpose of the study was to examine the effect of self-esteem and mother–child communication on depression in mothers and children, respectively. Most studies focused on exploring the transnational family experiences of mothers and their adaptation process to new life situations. Qualitative research methods have been widely used to study this population. In this scoping review, we found only two quantitative studies. The transnational family arrangement for children’s education purpose is a unique phenomenon that is mostly shared among the limited number of Koreans with high income and education level. Thus, Korean transnational mothers are a relatively narrow population. The lack of quantitative research may be due to this uniqueness of the population. However, considering that Korean transnational families have gained researchers’ attention since the early 2000s, it is surprising that similar qualitative methods have been repeatedly used and only a few quantitative approaches have been attempted. The lack of quantitative research on this population is an important gap to fill in future research. Investigating the mental health of transnational mothers in association with their children’s mental health is another area for future research. The Korean cultural context that places high priority on educational achievement has a significant influence on transnational families. Aspirations for children’s educational attainment can impact the mental health of mothers, further affecting their children’s mental health. A recent study reported that high parental locus of control and low perceived academic achievement were associated with the high likelihood of depression among children in Korea (Park, Heo, Subramanian, Kawachi, & Oh, 2012). Children in transnational families may experience higher pressure for academic performance and higher parental control, because their mothers accompany them for their educational success. In addition, these children may experience stress from family separation.

Thus, it will be meaningful to investigate transnational families (a mother and children together) as a unit of analysis in the future studies.

Conclusion We presented current state of knowledge on Korean transnational mothers and summarized the evidences focusing on the impact of the transnational family arrangement and migration on the mental health of mothers. Due to a lack of literature on mental health of Korean transnational mothers, we scoped the evidences from studies exploring a broad range of topic areas, many of which did not focus on mental health or mental health–related topics. The evidences on the split-family and migration-related experiences of Korean transnational mothers suggest potential mental health vulnerability of this population. However, no studies have systematically examined mental health of Korean transnational mothers. More research is needed to assess their mental health and to identify the risk factors. Funding This research was supported by the Social Aetiology of Mental Illness training program (SAMI). SAMI is a Strategic Training Initiative in Health Research funded by the Canadian Institutes of Health Research at the Centre for Addiction and Mental Health and the University of Toronto.

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