Depression Disparities in Older Korean and Chinese Immigrants in the United States

TL;DR

Older Korean immigrants in the U.S. report higher depression symptoms than Chinese immigrants, but differences depend on the assessment tool used.

Contribution

This study is the first meta-analysis comparing depression levels in older Chinese and Korean immigrants using multiple assessment tools.

Findings

Korean immigrants showed higher depressive symptoms than Chinese immigrants using the PHQ, but not the GDS.

Both immigrant groups had higher depression scores with the GDS compared to the PHQ, suggesting PHQ may underestimate depression.

CES-D scores for Korean immigrants were lower than GDS scores, indicating measurement variability across tools.

Abstract

This meta-analysis compares depression levels among Chinese and Korean immigrants aged 60 and older in the United States. Studies published between 2010 and 2024 were synthesized using standardized mean differences (SMDs) from a random-effects model. Korean immigrants reported higher depressive symptoms than Chinese immigrants when assessed with the Patient Health Questionnaire (PHQ) (SMD = 0.0778, SE = 0.0193, p < .0001, 95% CI [0.0409, 0.1147]), but no significant difference emerged with the Geriatric Depression Scale (GDS) (SMD = -0.0060, SE = 0.0625, p = 0.9233, 95% CI [-0.1284, 0.1164]). Within-group analyses indicated that GDS produced higher depression scores than PHQ for both groups. Among Chinese immigrants, PHQ scores were significantly lower than GDS scores (SMD = -0.2430, SE = 0.0411, p < .0001, 95% CI [-0.3235, -0.1625]), suggesting PHQ may underestimate depression. Likewise, Korean immigrants recorded lower PHQ scores than GDS scores (SMD = -0.1601, SE = 0.0569, p = 0.0049, 95% CI [-0.2715, -0.0486]). Korean immigrants’ CES-D scores were also lower than GDS scores (SMD = -0.0998, SE = 0.0417, p = 0.0167, 95% CI [-0.1816, -0.0181]). Potential contributors included acculturation, social support, socioeconomic status, language barriers, healthcare availability, and intergenerational dynamics. These findings underscore the importance of culturally tailored screening and interventions. Research should address measurement disparities, investigate longitudinal patterns, and develop targeted strategies to reduce depression among older Asian immigrants. This could inform policies and optimize mental health outcomes for this vulnerable population. Clinicians and policymakers should prioritize culturally responsive mental health screening, interventions, and policy reforms.