Participants were 895 undergraduate students (61% … · Web viewContrary to our prediction, family income was not associated with depression, and this may be due to a limitation

Running head: RISK FACTORS FOR DEPRESSION 1

Depressed Mood, Body Dissatisfaction, and Exercise among Native Hawaiian, Japanese and

Filipino American College Students

Jeanne L. Edman

Cosumnes River College

Wesley C. Lynch

Montana State University

Alayne Yates

University of Hawaii

David J. Patron

University of California, Davis

Mara Aruguete

Lincoln University

Author Note

Jeanne L. Edman, Department of Social Sciences, Cosumnes River College; Wesley C. Lynch,

Department of Psychology, Montana State University; Alayne Yates, Department of Psychiatry,

University of Hawaii; David J. Patron, Center for Reducing Health Disparities, University of

California, Davis; Mara Aruguete, Department of Social and Behavioral Sciences, Lincoln

University.

Correspondence concerning this article should be addressed to Jeanne L. Edman,

Department of Social Sciences, Cosumnes River College, 8401 Center Parkway, Sacramento,

CA 95823, United States. Email: [email protected]

RISK FACTORS FOR DEPRESSION 2

Abstract

Background: Although ethnic minority groups are at greater risk for depression, findings among

Asian Pacific Island (API) groups are inconclusive. Aim: The present study examined the risk of

depression among three API groups residing in Hawaii and factors associated with depression.

Method: A total of 289 Filipino, Japanese and Native Hawaiian college students completed a

survey that examined symptoms of depression, exercise performance dissatisfaction, physical

exercise, body dissatisfaction, health status, and BMI. Results: Filipinos reported higher

depression scores than Japanese students and no gender differences in depression were found.

As predicted exercise performance dissatisfaction was positively associated with depression, and

physical exercise was negatively associated with depression. No relationship was observed

between depression and BMI which suggests that API groups residing in Hawaii may be more

tolerant of larger body types. Conclusion: The results support the need to further examine risk

of depression among API sub-groups and also the need to address negative exercise attitudes in

the use of exercise in depression treatment.

Keywords: negative exercise attitudes, Asian Americans, depressed mood, BMI, exercise


Depressed Mood, Body Dissatisfaction, and Exercise among Native Hawaiian, Japanese and

Filipino American College Students

The present study examined the risk of depression among Asian and Pacific Islanders

(API), one of the fastest growing ethnic minority groups in the U.S. (U.S. Census Bureau, 2010).

More specifically, we examined whether Filipino, Native Hawaiian and Japanese American

college students differed in risk of depression and what factors were associated with depression

among these groups. Understanding risk of depression among college students is important since

more than 50% report depressive symptoms (Fur, Westerfeld, McConnell, & Jenkins, 2001) and

depressed mood has a negative impact on academic success (Deroma, Leach, & Leverett, 2009).

Ethnicity, Gender and Depression among Asian-Pacific Islanders

Although ethnic minority status has been associated with increased risk of depression in

young adults (Rushton, Forcier, & Schectman, 2002), the impact of ethnic minority status on

mental health among APIs is inconclusive. Some studies suggest that API young adults are at

high risk for depression (Aczon-Armstrong, Inouye, & Reyes-Salvail, 2013; Costello, Swendsen,

Rose, & Dierker, 2008; Maier et al., 2009). For example, Native Hawaiians and Chinese

Americans reported higher levels of depressive symptoms than Caucasians (Chen, Haas,

Gillmore, & Kapak, 2011; Kanazawa, White, & Hampson, 2007). However, numerous studies

have suggested that APIs are at similar or lower risk of depression than other ethnic groups

(Herman et al., 2011; Lee, 2011; Ramisetty -Mikler, Geobert, Nishimura, & Caetano, 2006;

Rosenthal & Wilson, 2008; Takeuchi, Hong, Gile, & Alegria, 2007; Xie et al., 2010). Also,

ethnic differences in depression between API groups have been supported in several studies. For

example, Korean and Filipino Americans reported higher depression symptom levels than

Chinese and Japanese Americans (Kuo, 1984; Oh, Koeske, & Sales, 2002) and David (2008)


found Filipinos were at higher risk for depression than other groups. Native Hawaiians and other

Pacific Islanders may be at an especially high risk for depression (Yuen, Nahulu, Hishinuma, &

Miyamoto, 2000) since Pacific Islanders were three times more likely to develop depression than

other Asians (Aczon-Armstrong, Inouye, & Reyes-Salvail, 2013). These findings highlight the

importance of examining API sub-groups separately since they differ on a number of variables

such as income, educational level, and immigration status (Kalibatseva & Leong, 2011; Kuo,

1984; Oh et al., 2002).

Protective and Risk Factors of Depression

Participation in physical exercise has been found to be a protective factor for depression

for both genders (Balkin, Tietjen-Smith, Caldwell, & Shen, 2007; Leach, Christensen,

Mackinnon, Windsor, & Butterworth, 2008) and even low levels of exercise have been found to

have a protective effect (Teychenne, Ball, & Salmon, 2008). Good physical health is associated

with positive psychological adjustment since psychologically well-adjusted individuals reported

better physical health, including lower rates of diabetes and heart disease, than those with

depression (Karakus & Patton, 2011).

There are several risk factors for depression. Although physical exercise is linked to

lower psychological distress, negative exercise attitudes were associated with greater

psychological distress (Boyd, Abraham, & Luscombe, 2007). For instance, exercise

performance dissatisfaction was positively associated with depression and disordered eating

among API adolescents and young adults (Aruguete, Yates, & Edman, 2007; Lynch, Eldridge,

Edman, & Yates, 2011). Obesity is also associated with increased risk of depression (Xie et al.,

2010). Pasco et al. (2013) found a positive association between Body Mass Index (BMI) and

depression, and higher rates of depression have been found among obese individuals (de Wit et


al., 2010). An association between being overweight and body dissatisfaction was found among

Asian females, which led to depression (Xie et al., 2010) and body dissatisfaction has been

linked to increased food consumption, BMI, obesity, and depression (Goldfield et al., 2010;

Sharma, Ikeda, & Fleming, 2013; Yates, Edman, & Aruguete, 2004). The high levels of body

dissatisfaction among overweight individuals may be due to obesity stigma since obese

individuals are often perceived as being lazy and blamed for their large body size (Martin, Rhea,

Greenleaf, Judd, & Chambliss, 2011; Puhl & Brownell, 2003). However, not all cultural groups

have negative attitudes toward large body types. For example, some Pacific Islander groups

traditionally value larger bodies and view a large body as healthy (Latner, Knight, & Illingworth,

2011; McCabe, Waqa, Dev, Cama, & Swinburn, 2013; Williams, Ricciardelli, McCabe, Waqa,

& Bavadra, 2006). A study in Hawaii indicated that females from all ethnic groups preferred

thin body types, but White females participated more in weight loss behaviors than Asians and

Pacific Islanders (Schembre, Nigg, & Albright, 2011), and no association between obesity and

depression was observed among individuals in Hawaii (Madan et al., 2012). Other studies

indicate API females also desire thinner bodies and are at similar risk as White students for

disordered eating (Brewis, McGarvey, Jones, & Swinburn, 1998; Edman & Yates, 2004;

Schembre, Nigg, & Albright, 2011). These studies indicate the need for further research of the

relationship between body dissatisfaction and depression among API women.

Other demographic variables are also linked to depression. For example, low levels of

education and family income were associated with depression among adult women (van der

Waerden, Hoefnagels, Hosman, & Jansen, 2014) and low socioeconomic status increased

depression risk (Lorant et al., 2003). Lastly, females are at higher risk of depression, and report

higher body dissatisfaction and lower exercise participation than males (Bayram & Bilget, 2008;


Dixon, Scheidegger, & McWhirter, 2009; Taliaferro, Rienzo, Pigg, Miller, & Dodd, 2008; Xie et

al., 2010).

As described above, research studies indicate that ethnic minority groups are at increased

risk of depression, but findings among API groups are inconclusive. Additionally, a number of

factors are linked with depression. However, more research is needed to further explore what

factors are associated with depression among API groups.

The present study examined the relationship between body dissatisfaction, exercise

performance dissatisfaction, BMI, health status, family income, and exercise among a group of

Japanese, Filipino and Native Hawaiian students attending college in Hawaii. Although these

groups are all within the Asian/Pacific Islander ethnic group, they differ on a number of social

and economic factors. Native Hawaiians and Filipinos are ranked among the lowest in both

education and income levels in the State of Hawaii, while Japanese reported the highest income

and education levels (U.S. Census Bureau, 2010). Filipinos are also at high risk for other social

problems including interpersonal violence (APIIDV, 2012) and reported higher levels of

psychological distress than other groups (Sorkin, Nguyen, Ngo-Metzger, 2011). Native

Hawaiians also have higher risk for obesity, cardiovascular disease, and diabetes than other

groups in Hawaii (Ka'opua, Braun, Browne, Mokuau, & Park, 2011; Latner et al., 2011; Madan

et al., 2012) and as described above, some research has indicated a high risk of depression

among Filipinos and Native Hawaiians (David, 2008; Kuo, 1984; Yuen, Nahulu, Hishinuma, &

Miyamoto, 2000). Based on the above past findings we predicted that:

1. Filipino and Native Hawaiians would be at higher risk for depression and report lower

family income than Japanese students. Native Hawaiian students would report lower

body dissatisfaction and higher BMI than other students.


2. Male students would report higher levels of physical exercise and lower levels of

depression and body dissatisfaction than female students.

3. Physical exercise, family income, and positive health status would be negatively

associated with depression.

4. Exercise performance dissatisfaction, body dissatisfaction, and BMI would be

positively associated with depression.

We will also examine whether there are ethnic group differences on exercise and exercise

performance dissatisfaction among Japanese, Filipino and Native Hawaiian college students.

Method

Participants

Participants included undergraduate students from six University of Hawai’i campuses

who identified themselves as either Native Hawaiian (N = 89), Filipino (N = 106) or Japanese (N

= 151) ethnicity. A total of 40% of the sample was male (mean age = 22.26, SD = 6.41) and

60% female (mean age = 22.73, SD = 6.15). Other API ethnic groups were excluded due to

insufficient sample size for appropriate statistical analyses.

Materials and Procedures

Participants signed a written consent form prior to data collection that was approved by

the Institutional Review Board of the University of Hawai’i. The survey packet consisted of

several sections including four previously validated screening instruments. A demographics

section asked students their gender, height, weight, and ethnicity. This paper will focus on a

subset of data that included the Center for Epidemiologic Depression Scales (CES-D), a measure

of exercise perfectionism, and several questions addressing levels of physical exercise. The

questionnaire was administered in a variety of social science, nursing, and philosophy classes.


Teachers were contacted in advance and agreed to make time available for students to complete

paper and pencil surveys either during or after classes on a voluntary basis.

Center for Epidemiologic Studies-Depression (CES-D; Radloff, 1977). The CES-D

was developed to measure depressive symptoms in the general population, and consists of 20

four point Likert type items. The CES-D has been found to have high internal consistency, test-

retest reliability and convergent and divergent validity (Morin et al., 2011; Opoliner, Blacker,

Fitzmaurice, & Becker, 2013; Van Dam & Earleywine, 2011) and been used among a variety of

age and ethnic groups including Asian and Pacific Islanders (Aruguete, Yates, Edman, &

Sanders, 2007; Boutin-Foster, 2008; Cheng & Chan, 2008; Kanazawa, White, & Hampson,

2007). There are four sub-scales including Depressed Affect (DA), Positive Affect (PA),

Somatic (SOM) and Interpersonal (IP). The total CES-D score can range from 0-60.

Cronbach’s alpha value for the CES-D for the present study was .89.

Self Loathing Sub-Scale (SLSS): Exercise Performance Dissatisfaction. Exercise

performance dissatisfaction, or exercise perfectionism, was assessed using the Self Loathing

Subscale (SLSS) of the Exercise Orientation Questionnaire (Yates, Edman, Crago, & Crowell,

2001). The SLSS includes the following four items: “I disliked my body before I began to

exercise,” “I am dissatisfied with my performance,” “I hate my body when it won’t do what I

want,” and “If I don’t reach my goals I feel like a failure.” All items were scored on 5-point

Likert scales ranging from 5 = strongly agree to 1 = strongly disagree. The SLSS total score was

computed by summing the four item scores. The SLSS correlates with measures of

perfectionism and has demonstrated high internal consistency, and convergent and concurrent

validity (Aruguete, Edman, & Yates, 2007; Yates, Andrus, & Draeger, 2007). It has been

successfully used as a measure for assessing the risk of disordered eating and exercise


perfectionism among a variety of ethnic and age groups (Aruguete, Yates & Edman, 2007;

Yates, Edman, & Crowell, 2003; Yates et al., 2007). Cronbach’s alpha for the present study

was .76.

Figure Rating Scale (FRS). The FRS, originally developed by Stunkard, Sorenson, and

Schulsinger (1983) is designed to assess body size or shape dissatisfaction. Participants are

instructed to choose one of nine gender-specific body shape figures that appears most similar to

his or her current body shape, and then to choose the figure that most closely matches his or her

preferred body shape. The absolute value of the discrepancy scores was computed to indicate the

level of body dissatisfaction (BD). Psychometric studies have shown this method of assessing

BD to have high test-retest and moderate construct validity when compared to other methods of

BD assessment among females, and is an appropriate measure of body size dimension of body

dissatisfaction among males (Thompson & Altabe, 1991; Williams, Gleaves, Cepeda-Benito,

Erath, & Cororve, 2001). Students were also asked to select the figure that represented the

healthiest male and female using the same nine figures of the FRS.

Exercise and Other Measures. Participants reported the number of weekly hours

exercised and rated exercise intensity (1 = mild to 3 = intense). They also rated their general

health on a Likert-type item (1 = not very healthy to 7 = very healthy) and reported their height

and weight. Body Mass Index (BMI) was computed by dividing the participants’ weight in

kilograms by height in meters squared (kg/m2). Participants also were asked their ethnicity, age,

gender and annual family income (1 = less than $10,000 to 4 = $100,000 or more).

Results

In order to examine whether there were gender or ethnic differences in depression, BMI,

body dissatisfaction, and exercise measures, a two (gender) X three (ethnicity) MANOVA was


conducted on the variables of depression, body dissatisfaction, exercise performance

dissatisfaction, BMI, health quality, family income and the two measures of exercise. The

analysis revealed a significant multivariate main effects for both gender, Wilks’ Lambda = .890,

F(8, 286) = 4.415; p < .0001; and ethnicity, Wilks’ Lambda = .808, F(16, 572) = 4.01, p < .0001,

and no significant interaction. Subsequent univariate analyses were conducted on the dependent

variables of depression, body dissatisfaction, health quality, family income, and exercise

measures. As shown in Table 1, gender differences were indicated on the following variables:

exercise hours, p < .0001; and exercise intensity, p < .0001, providing partial support for H1.

Univariate analyses on the dependent variables also indicated ethnic differences on depression, p

< .001; BMI, p < .01; and family income, p < .0001. Scheffe post hoc analyses indicated that

Japanese and Filipino reported lower BMI than Hawaiians, p < .05; Japanese reported higher

family income than Filipino and Native Hawaiians, p < .05; and Japanese indicated lower

depression than Filipinos, p < .05; supporting H2. In contrast to our prediction, there were no

gender or ethnic differences in body dissatisfaction and no gender differences in depression.

Pearson correlation analyses were conducted to determine whether depression was

negatively associated with physical exercise and physical health (H3), and positively associated

with BMI, body dissatisfaction, and exercise perfectionism (H4). As predicted, positive health

status, r(338) = -.355, p < .001; exercise intensity, r(338) = -.110, p < .05; and hours exercised,

r(330) = -.118, p < .05, were all negatively associated with depression. Exercise performance

dissatisfaction, r(339) = .537, p < .0001; and body dissatisfaction, r(342) = .246, p < .001, were

both associated with depression, but contrary to our prediction, no relationship was indicated

between depression and BMI (H4) or family income (H3).

Discussion


As predicted, Native Hawaiians had higher BMIs than other groups, but they did not

report higher depression scores. Only Filipinos indicated greater depression than Japanese which

failed to support previous research which suggested that Native Hawaiians were at a higher risk

for depression than other Asian groups (Aczon-Armstrong, Inouye, & Reyes-Salvail, 2013;

Yuen, Nahulu, Hishinuma, & Miyamoto, 2000). Although some studies have indicated that

Filipinos are at low risk for depression (Aruguete, Yates, Edman, & Sanders, 2007; Edman et al.,

1998), other studies have found that Filipinos are at higher risk for depression than other groups

(David, 2008; Kuo, 1984). As previously described, there are several possible explanations for

the high risk of depression among Filipinos including the high percentage of recent immigrants

which may result in acculturation stress and/or ethnic identity issues (Aruguete, Yates, Edman, &

Sanders, 2007; Hovey, 2000; Oh et al., 2002). Also, Filipinos in Hawaii have lower income

levels compared to Japanese and as describe above, low income is associated with increased risk

of depression (Lorant et al., 2003). More research should be conducted to further explore what

factors are associated with the higher risk of depression among Filipino college students, and

also explore the lower than expected risk among Native Hawaiians.

Contrary to our hypothesis, females were not at greater risk for depression than males.

Although most studies suggest that females are at higher risk, research in rural Hawaii, indicated

no gender differences in depression (Aruguete, Yates, Edman, & Sanders, 2007; Edman, Yates,

Aruguete, & Draeger, 2008). Further research that explores the impact of gender on risk of API

adolescents and young adults is needed. The data did support our predictions that females would

be more dissatisfied with their bodies and males would report higher levels of exercise.

As predicted, body dissatisfaction was positively associated with depression, but there

was no association between BMI and depression which supports previous research that indicates


a greater acceptance of larger bodies among some API groups (Latner et al., 2011; Wang, Abbot,

Goodbody, & Hui, 2001; Williams et al., 2006). For example, Native Hawaiians had higher

BMIs than other groups, but were not at greater risk for depression. Further studies are needed to

examine whether young adults in Hawaii have lower levels of obesity stigmatization than young

adults on the U.S. Mainland. Contrary to our prediction, family income was not associated with

depression, and this may be due to a limitation of our measure which included only 4 possible

income category responses. A future study should include a more precise measure of family

income as well as a measure of employment status which was found to be a better predictor of

depression than income (Zimmerman & Katon, 2005).

Although exercise and health were protective factors, the strong association between

exercise performance dissatisfaction and depression suggests that negative exercise perceptions

may be important factors to address when implementing exercise programs as part of treatment

of depression among API groups. It is possible that utilizing exercise programs in the treatment

of depression among individuals with high levels of exercise performance dissatisfaction could

result in excessive exercise which is associated with depression (Penas-Lledo, Vaz Leal, &

Waller, 2002).

The present study found ethnic differences among three API sub-groups which further

supports Kalibatseva and Leong’s (2011) suggestion that more studies are needed that examine

the heterogeneity of the API ethnic category. However, this study has several limitations.

Although the study compared three subgroups of APIs, several other API groups, such as

Chinese and Korean, were excluded due to their small sample size. Thus, further research is

needed to examine risk of depression among additional API groups. Also, we failed to include

measures of ethnic identity, acculturation and immigration status, which would be useful in


further explaining why Filipino college students are at high risk for depression. The sample

includes college students so the results may not generalize to those less educated. Also, socio-

environmental factors impact psychological distress among API groups (Kim, Kim & Nochajski,

2010), so these findings from Hawaii may not generalize to API groups residing in the

continental U.S.

Conclusion

The present findings indicated that risk of depression differs among API sub-groups with

Filipino students reporting higher depressive symptom levels than Japanese. Native Hawaiians

had higher BMIs than other groups, but were at no greater risk for depression. Males reported

higher exercise levels than females, but there were no gender differences in risk of depression.

Similar to other ethnic groups, depressive protective factors included participating in exercise

and good health, and risk factors included exercise performance dissatisfaction and body

dissatisfaction. There was no association between BMI and depression which may be due the

acceptance of large body types among residents of Pacific Islands.


References

Aczon-Armstrong, M., Inouye, J., & Reyes-Salvail, F. (2013). Depression and chronic illness:

Asian/Pacific Islander adults in Hawaii. Issues in Mental Health Nursing, 34, 169-179.

doi: 10.3109/01612840.2012.738356

Aruguete, M. S., Yates, A., & Edman, J. L. (2007). Further validation of the self-loathing

subscale as a screening tool for eating disorders. Eating Disorders, 15(1), 55-62. doi:

10.1080/10640260601044493

Aruguete, M.S., Yates, A., Edman, J.L., & Sanders, G, (2007). Eating and acculturation in a

Filipino American population on a small Hawaiian Island. North American Journal of

Psychology, 9, 347-358.

Asian Pacific Islander Institute of Domestic Violence (APIIDV). (2012, July). Domestic

Violence in Filipino communities. [Fact sheet]. Retrieved from

http://www.apiidv.org/files/DVFactSheet-Filpino-APIIDV-2012.pdf

Balkin, R. S, Tietjen-Smith, T., Caldwell, C., & Shen, Y. (2007). The unitization of exercise to

decrease depressive symptoms among young adult women. ADULTSPAN Journal, 6, 30-

35. doi: 10.1002/j.2161-0029.2007.tb00027.x

Bayram, N. & Bilget, N. (2008). The prevalence and socio-demographic correlations of

depression, anxiety and stress among a group of university students. Social Psychiatry

and Psychiatric Epidemiology, 43, 667-672. doi: 10.1007/s00127-008-0345-x

Boutin-Foster, C. (2008). An item-level analysis of the Center for Epidemiologic Studies

Depression Scale (CES-D) by race and ethnicity in patients with coronary artery disease.

International Journal of Geriatric Psychiatry, 23(10), 1034-1039. doi: 10.1002/gps.2029


Boyd, C., Abraham, S., & Luscombe, G. (2007). Exercise behaviours and feelings in eating

disorder and non-eating disorder groups. European Eating Disorders Review: Journal

of the Eating Disorders Association, 15(2), 112-118. doi: 10.1002/erv.769

Brewis, A. A., McGarvey, S. T., Jones, J., & Swinburn, B. A. (1998). Perceptions of body size in

Pacific Islanders. International Journal of Obesity and Related Metabolic Disorders:

Journal of the International Association for the Study of Obesity, 22(2), 185-189.

Chen, A. C., Haas, S., Gillmore, M. R. & Kopak, A. (2011). Trajectories of depressive

symptoms from adolescents to young adulthood: Chinese Americans versus non-Hispanic

whites. Research in Nursing Health, 34, 176-191. doi: 10.1002/nur.20429.

Cheng, S. T., & Chan, A. C. (2008). Detecting depression in Chinese adults with mild dementia:

findings with two versions of the Center for Epidemiologic Studies Depression Scale.

Psychiatry Research, 159(1-2), 44-49. doi: 10.1016/j.psychres.2007.06.023

Costello, D. M., Swendsen, J., Rose, J. S. & Dierker, L. C. (2008). Risk and protective factors

associated with trajectories of depressed mood from adolescence to early adulthood.

Journal of Consulting and Clinical Psychology, 76, 173-183. doi: 10.1037/0022-

006X.76.2.173.

David, E. J. (2008). A colonial mentality model of depression for Filipino Americans. Cultural

Diversity & Ethnic Minority Psychology, 14(2), 118-127. doi: 10.1037/1099-

9809.14.2.118

Deroma, V. M., Leach, J. B., & Leverett, J.P. (2009). The relationship between depression and

academic performance. College Student Journal, 43(2), 325-334.


de Wit, L. M., Fokkema, M., van Straten, A., Lamers, F., Cuijpers, P., & Penninx, B. W. (2010).

Depressive and anxiety disorders and the association with obesity, physical, and social

activities. Depression and Anxiety, 27(11), 1057-1065. doi: 10.1002/da.20738

Dixon, A. L., Scheidegger, C., & McWhirter, J. J. (2009). The adolescent mattering experience:

gender variations in perceived mattering, anxiety and depression. Journal of Counseling

and Development, 87, 302-310. doi: 10.1002/j.1556-6678.2009.tb00111.x

Edman, J. L., Andrade, N. N., Glipa, J., Foster, J., Danko, G. P., Yates, A., Johnson, R. C.,

McDermott, J. F., & Waldron, J. A. (1998). Depressive symptoms among Filipino ,

American adolescents. Cultural Diversity and Mental Health, 4, 45-54.

Edman, J. L., & Yates, A. (2004). Eating disorder symptoms among Pacific Island and

Caucasian women: The impact of self dissatisfaction and anger discomfort. Journal of

Mental Health, 13(2), 143-150. doi: 10.1080/0963823041000669273

Edman, J. L. Yates, A., Aruguete, M., & Draeger, J. (2008). Eating attitudes, self-dissatisfaction

and emotional distress among early adolescents in Hawai’i: A gender comparison.

Journal of Pacific Rim Psychology, 2, 53-59.

Fur, R. S., Westerfeld, S. J., McConnell, N. G., & Jenkins, M. J. (2001). Suicide and depression

among college students: A decade later. Professional Psychology: Research and

Practice, 32, 97-100. doi: 10.1037//0735-7028.32.1.97

Goldfield, G. S., Moore, C., Henderson, K., Buchholz, A., Obeid, N., & Flament, M. F. (2010).

Body dissatisfaction, dietary restraint, depression, and weight status in adolescents. The

Journal of School Health, 80(4), 186-192. doi: 10.1111/j.1746-1561.2009.00485.x

Herman, S., Archambeau, O. G., Deliramich, A. N., Kim, B. S., Chiu, P. H., & Frueh, B. C.

(2011). Depressive symptoms and mental health treatment in an ethnoracially diverse


college student sample. Journal of American College Health, 59(8), 715-720. doi:

10.1080/07448481.2010.529625

Hovey, J.D. (2000). Acculturation stress, depression and suicidal ideation among Central

American immigrants. Suicide and Life-Threatening Behavior, 30, 125-139.

Ka'opua, L. S., Braun, K. L., Browne, C. V., Mokuau, N., & Park, C. B. (2011). Why Are Native

Hawaiians Underrepresented in Hawai'i's Older Adult Population? Exploring Social and

Behavioral Factors of Longevity. Journal of Aging Research, 2011, 701232. doi:

10.4061/2011/701232

Kalibatseva, Z., & Leong, F. T. (2011). Depression among Asian Americans: Review and

Recommendations. Depression Research & Treatment, 2011, 320902. doi:

10.1155/2011/320902

Kanazawa, A., White, P.M., & Hampson, S. E. (2007). Ethnic variation in depression symptoms

in a community sample in Hawaii. Cultural Diversity and Ethnic Minority Psychology,

13, 35-44. doi: 10.1037/1099-9809.13.1.35

Karakus, M. C., & Patton, L. C. (2011). Depression and onset of chronic illness in older adults:

a 12-year prospective study. Journal of Behavioral Health Services and Research, 38,

373-382. doi: 10.1007/s11414-011-9234-2.

Kim, W., Kim, I., & Nochajski, T.H. (2010). Risk and Protective factors of alcohol use disorders

among Filipino Americans: Location of residence matters, American Journal of Drug and

Alcohol Abuse, 36, 214-219. doi: 10.3109/00952990.2010.493593.

Kuo, W.H. (1984). Prevalence of depression among Asian-Americans. Journal of Nervous and

Mental Disease, 172, 449-457.


Latner, J. D., Knight, T., & Illingworth, K. (2011). Body image and self–esteem among Asian,

Pacific Islander, and White college students in Hawaii and Australia. Eating Disorders,

19, 355-368. doi: 10.1080/10640266.2011.584813

Leach, L. S., Christensen, H., Mackinnon, A. J., Windsor, T. D., & Butterworth, P. (2008).

Gender differences in depression and anxiety across the adult lifespan: the role of

psychosocial mediators. Social Psychiatry and Psychiatric Epidemiology, 43(12), 983-

998. doi: 10.1007/s00127-008-0388-z

Lee, S. (2011). Racial variations in major depressive disorder onset among immigrant

populations in the United States. Journal of Mental Health, 20, 260-269. doi:

10.31109/09638237.2011.562260.

Lynch, W.C., Eldridge, G., Edman, J.L., & Yates, A. (2011). Eating disorders risk among

White, Japanese, Chinese, Filipino, and Hawaiian students attending the University of

Hawaii. Hawaii Journal of Public Health, 3, 8-18.

Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003).

Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol, 157(2), 98-

112.

Madan, A., Archambeau, O. G., Milsom, V. A., Goldman, R. L., Borckardt, J. J., Grubaugh, A.

L., Tuerk, P., & Frueh, B.C. (2012). More Black than White: differences in predictors of

obesity among Native Hawaiian/Pacific Islanders and European Americans. Obesity, 20,

1325-1328. doi: 10.1038/oby.2012.15.

Maier, K. J., Goble, L. A., Neumann, S. A., Giggey, P. P., Surareq, E. C., Waldstein, S. R.

(2009). Dimensions across measures of dispositional hostility, expressive style and


depression show variation by race/ethnicity and gender in young adults. Journal of

Social and Clinical Psychology, 28, 1199-1225.

Martin, S. B., Rhea, D. J., Greenleaf, C. A., Judd, D. E., & Chambliss, H. O. (2011). Weight

control beliefs, body shape attitudes, and physical activity among adolescents. Journal of

School Health, 81(5), 244-250. doi: 10.1111/j.1746-1561.2011.00585.x

McCabe, M. P., Waqa, G., Dev, A., Cama, T., & Swinburn, B. A. (2013). The role of cultural

values and religion on views of body size and eating practices among adolescents from

Fiji, Tonga, and Australia. British Journal of Health Psychology, 18(2), 383-394.

Morin, A. J., Moullec, G., Maiano, C., Layet, L., Just, J. L., & Ninot, G. (2011). Psychometric

properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French

clinical and nonclinical adults. Revue d'Epidemiologie et de Sante Publique, 59(5), 327-

340. doi: 10.1016/j.respe.2011.03.061

Oh, Y., Koeske, G. F., & Sales, E. (2002). Acculturation, stress, and depressive symptoms

among Korean immigrants in the United States. The Journal of Social Psychology,

142(4), 511-526. doi: 10.1080/00224540209603915

Opoliner, A., Blacker, D., Fitzmaurice, G., & Becker, A. (2013). Challenges in assessing

depressive symptoms in Fiji: A psychometric evaluation of the CES-D. International

Journal of Social Psychiatry. doi: 10.1177/0020764013490871

Pasco, J. A., Williams, L. J., Jacka, F. N., Brennan, S. L. & Berk, M. (2013). Obesity and the

relationship with positive and negative affect. Australian and New Zealand Journal of

Psychiatry, 47, 477-482. doi: 10.1177/0004867413483371. Epub 2013 Mar 22.


Penas-Lledo, E., Vaz Leal, F. J., & Waller, G. (2002). Excessive exercise in anorexia nervosa

and bulimia: relation to eating characteristics and general psychopathology. International

Journal of Eating Disorders, 31, 370-375.

Puhl, R. M., & Brownell, K. D. (2003). Psychosocial origins of obesity stigma: toward changing

a powerful and pervasive bias. Obesity Review, 4(4), 213-227.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general

population. Applied Psychological Measures, 1, 385-401.

Ramisetty-Mikler, Goebert, D., Nishimura, S. & Caetano, R. (2006). Dating violence

victimization: Associated drinking and sexual risk behaviors of Asian, Native Hawaiian,

and Caucasian high school students in Hawaii. Journal of School Health, 76, 423-429.

doi: 10.1111/j.1746-1561.2006.00136.x

Rosenthal, B. S. & Wilson, W. C. (2008). Mental health services: use and disparity among

diverse college students. Journal of American College Health, 57, 61-68. doi:

10.3200/JACH.57.1.61-68.

Rushton, J. L., Forcier, M., & Schectman, R. M. (2002). Epidemiology of depressive symptoms

in the National Longitudinal Study of adolescent health. Journal of the American

Academy of Child and Adolescent Psychiatry, 41, 199-206. DOI: 10.1097/00004583-

200202000-00014

Schembre, S. M., Nigg, C. R., Albright, C. L. (2011). Race/ethnic differences in desired body

mass index and dieting practices among young women attending college. Hawaii

Medical Journal, 70, 32-36.


Sharma, S., Ikeda, J., & Fleming, S. E. (2013). Influence of body dissatisfaction on 1-year

change in nutrient intake of overweight and obese inner-city African American children.

Body Image, 10(1), 121-126. doi: 10.1016/j.bodyim.2012.07.008

Sorkin, D. H., Nguyen, H., & Ngo-Metzger, Q. (2011). Assessing the mental health needs and

barriers to care among a diverse sample of Asian American older adults. Journal of

General Internal Medicine, 26(6), 595-602. doi: 10.1007/s11606-010-1612-6

Stunkard, A. J., Sorensen, T., & Schulsinger, F. (1983). Use of the Danish Adoption Register for

the study of obesity and thinness. Research publications - Association for Research in

Nervous and Mental Disease, 60, 115-120.

Takeuchi, D. T., Hong, S., Gile, K., & Alegria, M. (2007). Developmental Contexts and Mental

Disorders Among Asian Americans. Research in Human Development, 4(1 &AMP), 49.

doi: 10.1080/15427600701480998

Taliaferro, L. A., Rienzo, B. A., Pigg, R. M., Miller, D., & Dodd, V. J. (2008). Associations

between physical activity and reduced rates of hopelessness, depression, and suicidal

behavior among college students. Journal of American College Health, 57, 427-435. doi:

10.3200/JACH.57.4.427-436

Teychenne, M., Ball, K., & Salmon, J. (2008). Physical activity and likelihood of depression in

adults: a review. Preventive Medicine, 46(5), 397-411. doi: 10.1016/j.ypmed.2008.01.009

Thompson, J. K., & Altabe, M. N. (1991). Psychometric qualities of the figure rating scale.

International Journal of Eating Disorders, 10(5), 615-619. doi: 10.1002/1098-

108x(199109)10:5<615::aid-eat2260100514>3.0.co;2-k

U.S. Census Bureau. (2010). The 2006-2010 ACS 5-Year Selected Population Tables. Retrieved

August 26, 2014, from


http://www2.census.gov/acs2010_SPT_AIAN/SelectedPopulationTables/ACS_SPT_SF_

Tech_Doc.pdf

Van Dam, N. T., & Earleywine, M. (2011). Validation of the Center for Epidemiologic Studies

Depression Scale--Revised (CESD-R): pragmatic depression assessment in the general

population. Psychiatry Research, 186(1), 128-132. doi: 10.1016/j.psychres.2010.08.018

van der Waerden, J. E., Hoefnagels, C., Hosman, C. M., & Jansen, M. W. (2014). Defining

subgroups of low socioeconomic status women at risk for depressive symptoms: The

importance of perceived stress and cumulative risks. International Journal of Social

Psychiatry, 0020764014522751.

Wang, C. Y., Abbot, L., Goodbody, A. K., & Hui, W. (2001). Ideal body image and health status

in low-income Pacific Islanders. Journal of Cultural Diversity, 9(1), 12-22.

Williams, T. L., Gleaves, D. H., Cepeda-Benito, A., Erath, S. A., & Cororve, M. B. (2001). The

reliability and validity of a group-administered version of the body image assessment.

Assessment, 8(1), 37-46. doi: 10.1177/107319110100800104

Williams, L. K., Ricciardelli, L. A., McCabe, M. P., Waqa, G. G., & Bavadra, K. (2006). Body

image attitudes and concerns among indigenous Fijian and European Australian

adolescent girls. Body Image, 3(3), 275-287.

Yates, A., Edman, J., Crago, M., & Crowell, D. (2001). Using an exercise based instrument to

detect signs of an eating disorder. Psychiatric Research, 105, 231-241. doi

10.1016/S0165-1781(01)00341-9

Yates, A., Andrus, J., & Draeger, J. (2007). Self-loathing and perfectionism: Linking eating

disorders and compulsive exercise. Paper presented at the annual meeting of the

American Psychiatric Association, San Diego, CA.


Yates, A., Edman, J. L., & Crowell, D. (2003). Eating disorder symptoms in runners, cyclists,

and paddlers. Addictive Behaviors, 28, 1473-1480.

Yates, A., Edman, J. & Aruguete, M. (2004). Ethnic differences in BMI and body/self

dissatisfaction among Whites, Asian sub-groups, Pacific Islanders, and African

Americans. Journal of Adolescent Health, 34, 300-307. doi:

10.1016/j.jadohealth.2003.07.014

Yuen, N. C., Nahulu, L. B., Hishinuma, E. S. & Miyamoto, R. H. (2000). Cultural identification

and attempted suicide in Native Hawaiian adolescents. Journal of the Academy of Child

and Adolescent Psychiatry, 39, 361-372. . doi: 10.1097/00004583-200003000-00019

Xie, B., Unger, J. B., Gallaher, P., Johnson, C. A., Wu, Q., & Chou, C. P. (2010). Overweight,

body image and depression in Asian and Hispanic adolescents. American Journal of

Health Behavior, 34, 476-488.

Zimmerman, F. J., & Katon, W. (2005). Socioeconomic status, depression disparities, and

financial strain: what lies behind the income‐depression relationship? Health Economics,

14(12), 1197-1215.

Table 1

Mean Scores Among Study Variables by Gender and Ethnicity

Gender Ethnicity CES-D SLSS BMI Exercise Hours

Exercise Intensity

FRS

M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)

Females Japanese 12.93 (9.04)

11.30 (3.37)

22.29 (5.00)

3.66 (3.27) 1.62 (0.61) 1.15 (0.90)


Filipino 16.98 (10.53)

11.38 (3.48)

24.10 (5.04)

3.79 (6.32) 1.52 (0.60) 1.31 (0.96)

Hawaiian 14.79 (9.38)

11.74 (4.21)

27.28 (7.07)

4.21 (2.86) 1.67 (0.55) 1.27 (1.16)

Total 14.92 (9.84)

11.42 (3.57)

23.94 (5.70)

3.82 (4.66) 1.60 (0.59) 1.24 (0.99)

Males Japanese 12.80 (8.47)

10.97 (2.94)

25.36 (5.41)

4.94 (4.80) 1.91 (0.68) 1.20 (0.89)

Filipino 15.96 (11.14)

12.25 (3.42)

25.06 (3.90)

5.50 (4.88) 1.94 (0.72) 1.28 (1.17)

Hawaiian 11.32 (8.53)

10.45 (3.79)

27.22 (8.92)

7.13 (5.91) 2.11 (0.68) 1.21 (1.00)

Total 13.27 (9.24)

11.19 (3.26)

25.65 (6.00)

5.48 (5.06) 1.96 (0.68) 1.22 (0.98)

Note: CES-D = Center for Epidemiological Studies – Depression Scale. SLSS = Self Loathing Sub-Scale: Exercise Performance Dissatisfaction. BMI = body mass index. FRS = Figure Rating Scale: Body Dissatisfaction.

Table 2

Correlations Among Study Variables for Asian/Pacific Islander Students

1 2 3 4 5 6 7

1. CES-D ——

2. SLSS .519* ——

3. Health Quality -.370* .193* ——

4. BMI -.022 .003 -.203* ——

5. Exercise Hours -.158* .037 .256* .059 ——

6. Exercise Intensity -.167* -.167* .288* .084 .444* ——

7. FRS .246* .398* -.366* .517* -.111 -.111* ——


*

8. Family Income -.093 .029 .047 -.149* .112* .165* -.041

Note: CES-D = Center for Epidemiological Studies – Depression Scale. SLSS = Self Loathing Sub-Scale: Exercise Performance Dissatisfaction. BMI = body mass index. FRS = Figure Rating Scale: Body Dissatisfaction.*p < 0.01

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Participants were 895 undergraduate students (61% … · Web viewContrary to our prediction, family income was not associated with depression, and this may be due to a limitation