Ethnic differences in adolescents' mental distress, social stress, and resources.

Choi, Heeseung ; Meininger, Janet C. ; Roberts, Robert E. 等

INTRODUCTION

Studies, using the Diagnostic and Statistical Manual of Mental Disorders-IV ([DSM-IV] American Psychiatric Association [APA], 1994) criteria, estimated that about 15-28% of adolescents would experience depression at least once before reaching adulthood (Lewinsohn, Rohde, & Seeley, 1998; Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2000). Comorbidity and the recurrence rates of adolescent depression are comparable to, or even higher than, those for adults (Birmaher, Brent, & Benson, 1998; Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Lewinsohn et al., 1998; Son & Kirchner, 2000). Along with teenage pregnancy and substance abuse, depression is a significant predictor of school dropout (Rickert, Wiemann, & Berenson, 2000; Thornberry, Ireland, & Smith, 2001). Young adults who have experienced adolescent-onset depression have lower education and socioeconomic levels during adult life (Weissman et al., 1999).

Evaluating ethnic group differences in the prevalence of depression is difficult because of the sparsity of epidemiologic data that compare ethnic groups within the same study, using the same measures. According to one of only a few studies that has yielded data on prevalence of major depression in an ethically diverse sample of adolescents (N = 5,412), prevalence was lowest for Chinese Americans (2.9%) and highest for adolescents of Mexican origin (12.0%), followed by African Americans (AAs) (9.0%); European Americans (EAs) showed a midrange prevalence (6.3%) within the sample (Roberts, Roberts, & Chen, 1997). In contrast, other studies reported comparable or higher rates of depression among Asian American (Chinese or Korean) adolescents when compared with EAs (Choi, Stafford, Meininger, Roberts, & Smith, 2002; Stewart et al., 1999). In general, Hispanic Americans (HAs) consistently reported higher rates of depression than other ethnic groups across the different studies (Healthy People 2010, 2001).

Children and adolescents who are not yet cognitively mature may display irritability, negativity, sarcasm, criticism, and somatic symptoms, rather than sadness, when they are depressed (APA, 2000; Elliott & Smiga, 2003; Emslie, Mayes, Laptook, & Batt, 2003; Hauenstein, 2003). Headache, abdominal pain, muscular skeletal pain, weight loss, and decreased appetite are commonly exhibited somatic complaints among depressed adolescents (Rhee, 2003). Chen, Roberts, and Aday (1998) recommended that assessment instruments include items that measure somatic symptoms to increase their cultural sensitivity. In spite of consensus among researchers on the notable association between somatic symptoms and adolescents' mental distress, studies on ethnic differences in somatic symptoms are still limited (Rhee, 2003). Moreover, existing studies have focused on a few symptoms, not a wide spectrum of symptoms. Thus, this study measured a variety of somatic symptoms in addition to general depressive symptoms to more fully capture the signs and symptoms of depression in adolescents.

During the last decades, suicide rates have increased considerably among children younger than 15 years of age while death rates from other causes (e.g., influenza, cancer, and congenital anomalies) have decreased (Centers for Disease Control and Prevention, 1997). Ideas about harming self were more prevalent among younger than older adolescents (Puskar, Tusaie-Mumford, Sereika, & Lamb, 1999). More than 40% of depressed adolescents reported suicidal ideation (Lewinsohn et al., 1998).

Data on suicidal behaviors among minority ethnic groups are even more scant (Healthy People 2010, 2001). While some studies reported higher rates of suicidal behaviors among minority adolescents than EAs (Roberts & Chen, 1995; Vega, Git, Zimmerman, & Warheit, 1993), other studies have failed to demonstrate significant differences among ethnic groups (Grunbaum, Basen-Engquist, & Pandey, 1998; Warheit, Zimmerman, Khoury, Vega, & Gil, 1996). Because of the rarity of epidemiologic studies of mental distress with samples from diverse ethnic groups, however, findings from epidemiologic studies are often inconsistent, and knowledge about risks and resources related to minority ethnic status is limited.

Social Stress and Mental Distress

Various types of stress arising from convergence of life events and chronic life strains threaten one's mental health. Among various types of stress, in this study, three different types of social stress were defined and examined: general social stress, process-oriented stress, and discrimination (Chavez, Moran, Reid, & Lopez, 1997; Compas, Orosan, & Grant, 1993). General social stress refers to normative sources of stress that all adolescents may face as part of their developmental process (e.g., daily hassles, transition to new school) regardless of their ethnicity. Process-oriented stress is derived from adjusting (acculturating) to interactions with another culture. It is more discrete and pertinent to minority adolescents who are adapting to the dominant culture; discrimination originates in "being different" and is an ongoing chronic stress (Lee & Ramirez, 2000). Process-oriented stress and discrimination are considered sociocultural stresses (Chavez et al., 1997).

Given the different types and degrees of social stress to which adolescents are exposed, studying sociocultural stress is critical to understanding the anticipated disparity in the distribution of mental distress among ethnic groups (Caputo, 2003; Waslick, Kandel, & Kakouros, 2002). To study sociocultural stress, researchers constructed the concept of acculurative stress and examined the relations between acculurative stress and mental health. However, these studies have focused only on substance-abuse issues in HAs; little attention has been given to the study of the relations among acculurative stress, depression, and suicidal behaviors (Hovey & King, 1996). The few existing studies on depression and suicidal behaviors have provided only limited explanations of the complex nature because of restrictions in the size and ethnic diversity of their samples (Hovey & King, 1996; Kang, 1996). Because of the discussed limitations, it has been difficult to compare the extent of sociocultural stress and the relations between social stress and mental distress among various ethnic groups of adolescents.

Adolescents from each ethnic group are expected to experience different types and degrees of social stress, depending on their ethnicity. EAs are thought to be exposed to minimal amounts of sociocultural stress because they are the dominant group in most cases. AAs, HAs, and Asian Americans, on the other hand, will have greater chances of experiencing stress related to discrimination as a result of their minority status. Furthermore, HAs and Asian Americans who are acculturating may encounter process-oriented stress in addition to other sources of stress; thus, they may be at higher risk for mental distress (Chavez et al., 1997; Choi, 2001a,b).

Resources and Mental Distress

A perceived good relationship between parent and adolescent and family cohesion is negatively correlated with depressive symptoms (Gil-Rivas, Greenberger, Chen, & Montero y Lopez-Lena, 2003). However, traditional resources protecting against substance use, such as familism and value of family, were shown to be diminished in the families of U.S.-born HA adolescents; thus, these adolescents became vulnerable to substance use (Vega, Gil, & Wagner, 1998). Assessing dimensions of family relationships with regard to exposure to stress and level of mental distress is important.

The way one copes with stressful life events or experiences has a significant impact on mental health (Lamb, Puskar, Sereika, & Corcoran, 1998). Just as effective coping skills were negatively correlated with level of depression among adolescents, ineffective coping strategies were found to be positively correlated with depressive symptoms and various somatic complaints (Ruchkin, Eisemann, & Hagglof, 2000). Engaging in substance use is one example of ineffective coping strategies used by adolescents to deal with social stress (Vega et al., 1998).

Another important resource is self-esteem. Theoretically, self-esteem is established through combinations of an individual's perception of how others view him or her (reflected appraisals), appraisal of self on the basis of comparison with others (social comparison), and evaluation of self based on one's accomplishments (self-attribution) (Turner, Lloyd, & Roszell, 1999). Ethnic minority adolescents, who experience "being different" physically and culturally from other adolescents, may struggle with establishing positive self-esteem. Thus, ethnic minority adolescents are anticipated to have lower self-esteem than EAs. Self-esteem is important, particularly during adolescence, because peer relationships are highly valued and identity is formed during this period (Steinberg, 2004). Self-esteem has been correlated with stress and mental health (Wild, Flisher, & Lombard, 2004; Yarcheski & Mahon, 2000.

PURPOSES

Reviews of the literature revealed the gaps in current knowledge of the role of ethnicity in the distribution of adolescents' mental distress, social stress, and resources among diverse groups of adolescents. The present study was designed to examine differences among four ethnic groups of adolescents (AAs, EAs, HAs, and Asian Americans) on three indicators of mental distress (depression, somatic symptoms, and suicidal ideation), in social stress (general social stress, process-oriented stress, and sociocultural stress), and in resources (family relationships, coping, and self-esteem). The hypotheses of the present study are (1) compared to EAs, ethnic minority adolescents, particularly HAs and Asian Americans are expected to experience higher levels of social stress due to acculturation process as well as ethnic minority status; (2) adolescents from each ethnic group will have a different amount of resources depending on their ethnicity; (3) ethnic minority adolescents will be at higher risk for mental distress than EAs.

METHODS

The target population for this cross-sectional study was AA, EA, HA, and Asian American adolescents attending middle schools in a metropolitan area in southeast Texas. A nonprobability sampling strategy was used to identify prospective participants from designated middle schools for this study. The sample for the study consisted of voluntary participants who self-identified as AA, EA, HA, or Asian American.

Sampling and Data Collection Process

After the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects (CPHS) and Houston Independent School District (HISD) Research Committee approved the proposal, this study was conducted in three middle schools (grades 6-8) with ethnically diverse student bodies (HISD, 2001-2002). All middle school students who returned a signed parental consent form were invited to participate in the study. An endorsement letter and parental consent form were sent to the parental address on file at school. All parental consent forms were written in both English and Spanish. To increase the response rate, a stamped return envelope and an endorsement letter from the principals of participating schools were included. A total of 30 gift certificates ($10 each) were given away by raffle for students who returned the parental consent form. Students who had returned the forms were assembled in the cafeteria during the extracurricular period and requested to read and sign the assent forms before completing the questionnaire as a group. Participants anonymously completed the questionnaire in 20-30 minutes without apparent difficulties.

Measurement of Variables

Depression and suicidal ideation were assessed by using the DSM Scale for Depression (DSD). In contrast to other scales, the DSD is designed to elicit DSM criteria precisely. The DSD is composed of items rephrased from the stem questions on affective disorders of the Diagnostic Interview Schedule for Children: Child Informant Interview about Self(DISC-C), a psychometrically sound instrument for measuring child and adolescent depression (National Institute of Mental Health [NIMH], 1992). The DSD uses the past 2 weeks as its time frame. The DSD has shown excellent internal consistency reliability [alpha] = .91-.93) and good construct validity correlating negatively with self-esteem, social support, active coping, happiness, and optimism and positively with loneliness, life stress, and somatic symptoms among more than 10 different ethnic groups of middle school students (Chen et al., 1998; Choi et al., 2002; Roberts et al., 1997). Suicidal ideation was assessed with three items of the DSD. These items queried whether adolescents had thoughts about death; wished they were dead; or considered suicide more than usual.

The recently developed Somatic Symptom Scale is based on a Chinese translation of the General Health Questionnaire (Cheng & Williams, 1986). The 11 items correspond to the most frequent signs and symptoms manifested by depressed adolescents, such as headache, chest pain, stomach pain, or dizziness. Although the Somatic Symptom Scale is not yet in common use among young adolescents, the scale has shown excellent internal consistent reliability ([alpha] = .78-.93) and a high correlation with depression in diverse samples of Korean and Chinese American adolescents (Pearson's r = 0.61-0.62) (Choi et al., 2002).

Different types of social stress were measured using the Social, Attitudinal, Familial, and Environmental Scale for Children (SAFE-C) (Chavez et al., 1997). This scale is a modification of the 24-item SAFE Stress Scale, which was constructed to assess the multidimensional aspects of stress (Padilla, Wagatsuma, & Lindhorm, 1985). Both the original SAFE Stress Scale and the 36-item SAFE-C have been used in ethnically diverse adolescent samples (e.g., EAs, HAs, Japanese Americans, Korean Americans) and have demonstrated satisfactory internal consistency reliability (SAFE-C: [alpha] = .79-.84) (Chavez et al., 1997; Choi, 2001a; Hovey & King, 1996; Padilla et al., 1985). Construct and convergent validities of the SAFE Stress Scale have also been established (Fuertes & Westbrook, 1996; Padilla, Alvarez, & Lindhorm, 1986). The SAFE-C consists of items measuring sociocultural stress and items appraising general social stress related to relationships with teachers, peers, and families; academic performance; finances; and health. Sociocultural stress items are divided into two components: process-oriented stress (e.g., "People think I am shy, when I really just have trouble speaking English"), and discrimination (e.g., "I feel bad when others make jokes about people who are in the same group as me"). The six-point-Likert scale in the SAFE-C includes 0 (doesn't apply), which allows respondents to indicate that the source of stress does not apply to them. Thus, the scale can be applied to any adolescent, regardless of ethnicity or immigrant status.

The Family Environment Scale (FES) has been tested and widely used to assess family functioning and the social-environmental characteristics of families from diverse ethnic backgrounds (Moos & Moos, 1994). Among the diverse domains of the FES, only cohesion and conflicts were measured in this study to assess the level of family support, family cohesion, and perceived anger, aggression, and conflicts in the four groups of adolescents. Internal consistent reliabilities for these scales ranged from a = .75-.86 (Moos & Moos, 1994). The two subscales, Cohesion and Conflict, consist of nine items each. A score is obtained for each subscale by summing the scores for items on the subscale. Generally, higher scores on the Cohesion subscale show a positive family environment, and higher scores on the Conflict subscale indicate a family with a high level of conflict.

The six-item Coping Scale was derived from the Coping Scales of Rosenbaum (Rosenbaum, 1980) and from Folkman and Lazarus (Folkman & Lazarus, 1980). This scale has shown good reliability for young adolescents [alpha] = .73-.88) (Choi et al., 2002; Roberts, Roberts, & Chen, 2000). The Self-Esteem Scale is an eight-item version of Rosenberg's scale (Rosenberg, 1965). The eight-item scale includes "take a positive attitude toward myself," "satisfied with myself," "useless at times," and "a failure," and has satisfactory reliability [alpha] = .82) for adolescents (Roberts et al., 2000).

Socioeconomic status (SES) was measured by asking participants about perceived SES. This self-report measure of SES has been used and validated in previous studies of ethnic group differences in mental distress among adolescents (Roberts et al., 1997). Besides SES, students were asked to rate their school grades and report their birthplace.

Statistical Analysis

Data were analyzed by using SPSS 11.5. To address the specific aims, descriptive statistics, analysis of variance (ANOVA), analysis of covariance (ANCOVA), and logistic regression analysis were used. For logistic regression, summated depression scores were dichotomized into depressed and nondepressed by using the upper quartile score as a cutoff point. The same rule was applied for all other scales. Logistic regression analyses, used to estimate the magnitude of risks for experiencing social stress, resources, and mental distress, were performed by using EA as a referent group. To determine whether the ethnic differences in study variables were the result of differences in socio-demographic factors, ANCOVA and logistic regression analysis were performed after controlling for potential confounding factors: age, gender, and SES (Kleinbaum, Kupper, Muller, & Nizam, 1998). The strength of associations was estimated by the odds ratio with a p-value.

RESULTS

Sociodemographic Characteristics of the Sample

A total of 316 students from three middle schools (grades 6-8) completed the self-administered questionnaires: 66 AAs, 144 EAs, 77 HAs, 20 Asian Americans, and 9 others. Since the actual numbers of letters that were delivered to a parent who could consent for the student were not known, return rate could not be calculated precisely. Subtracting the number of letters returned to schools from the number sent indicates that the response rates might have been as low as 27% among EAs and 10% among ethnic minorities. Low return rates among ethnic minorities have been reported in previous studies (Esbensen, Miller, Taylor, He, & Freng, 1999; Thompson, 1984). In spite of low response rates, the overall findings of the present study were consistent with those of previous studies. Sociodemographic characteristics of the respondents are presented in Table 1.

The differences in sociodemographic characteristics across ethnic groups were assessed for three ethnic groups only (AAs, EAs, and HAs) by using the chi-square test. These three groups were significantly different in school grades, SES, and birthplace (p [less than or equal to] .004).

Psychometric Properties of the Measures

Overall, in the study sample, internal consistency statistics for all measures were satisfactory ([alpha] = .76-.94), especially for the DSD ([alpha] = .94), indicating that these are reliable measures for young adolescents. All types of mental distress were positively correlated with risk factors (social stress and family conflicts) and negatively correlated with resources (family cohesion, self-esteem, and coping). All correlations were statistically significant at the .001 level. Substantial correlations were observed between depression and process-oriented stress (r = 0.56), self-esteem (r = -0.61), cohesion (r = -0.57), and conflicts (r = 0.54). Depression also was highly correlated with somatic symptoms (r = 0.67) and suicidal ideation (r = 0.74). The pattern of correlations provides evidence of construct validity of the measures used in this study.

Ethnic Differences in Social Stress, Resources, and Mental Distress

Compared to EAs, ethnic minority adolescents, particularly Asian Americans, reported higher scores on negative scales (social stress, family conflicts, mental distress), and lower scores on positive scales (coping, self-esteem, and family cohesion) than EAs (see Table 2). Among four ethnic groups, Asian Americans reported the highest scores in process-oriented stress, discrimination, family conflicts, and somatic symptoms and reported the lowest scores in coping, self-esteem, family cohesion, and suicidal ideation. Ethnic differences in social stress, self-esteem, and family conflicts were statistically significant.

In the Tukey Honestly Significant Difference (HSD) test, Asian Americans reported significantly higher scores in family conflicts than EAs (p = .007) and a higher level of process-oriented stress and lower level of self-esteem than EAs and AAs (.001 [less than or equal to] p [less than or equal to].003). Asian Americans also reported significantly higher levels of discrimination than did all other ethnic groups (.001 [less than or equal to]p [less than or equal to].014). HAs reported significantly higher levels of process-oriented stress and discrimination and a lower level of self-esteem than did EAs (.045 [less than or equal to] p [less than or equal to].001). HAs also had a significantly higher level of general social stress than did EAs and AAs (.018 [less than or equal to] p [less than or equal to] 1).

When the ethnic group differences were examined after adjusting for the effects of age, gender, and SES, the Asian American group was excluded because of the small sample size. Three ethnic groups of adolescents were significantly different in social stress, coping, self-esteem, family cohesion, somatic symptoms, and depression (see Table 3). Overall, compared to EAs, ethnic minority adolescents reported higher scores on scales measuring risk factors and mental distress and lower scores on scales assessing resources except for coping and self-esteem scales. AA adolescents reported the highest scores on self-esteem but had the lowest scores on coping skills.

To compare the magnitude of risks for experiencing social stress, resources, and mental distress among three ethnic groups, logistic regression analyses were performed. As predicted, HA adolescents were more likely to experience general stress (OR = 4.1, 95% CI -1.96-8.62), process-oriented stress (OR = 4.3, 95% CI = 2.03-8.98), and discrimination (OR = 2.2, 95% CI = 1.08-4.55) than EAs. AAs had about 2.4 times greater odds of experiencing process-oriented stress than EAs (95% CI = 1.06-5.32). Regarding mental distress, HAs had a significantly elevated risk for suicidal ideation (OR = 2.04; 95% CI = 1.04-3.98) (see Table 4). The difference disappeared, however, after controlling for risk factors and resources. Three ethnic groups of adolescents were not significantly different in other variables.

DISCUSSION

Using age-appropriate and reliable measures, this school-based study examined ethnic group differences in social stress, resources, and mental distress among AA, EA, HA, and Asian American adolescents. The main findings of the study are (1) among four ethnic groups of adolescents, ethnic minority adolescents, particularly Asian Americans, had significantly higher levels of social stress and family conflicts and lower levels of self-esteem than did EAs; (2) when AAs, EAs, and HAs were compared after adjusting for the effects of age, gender, and SES, AAs and HAs reported significantly higher scores on scales measuring social stress and mental distress and lower scores on scales assessing resources than did EAs; (3) compared to EA adolescents, AA and HA adolescents were more likely to experience social stress and HAs were more likely to have suicidal ideation.

Overall, AA, HA, and Asian American adolescents consistently showed higher levels of social stress than did EAs even if ethnic group differences in mental distress were not prominent. The response patterns indicate that ethnic group differences in social stress begin as early as young adolescence even if differences in mental distress are not yet noteworthy. Ethnic minority adolescents may be exposed to a considerable amount of social stress and not present noticeable symptoms of mental distress at a given point in time. In previous studies, ethnic minority adolescents frequently reported high levels of social stress, particularly stress related to acculturation and discrimination. Social stress is found to be closely related to mental distress (Romero & Roberts, 2003; Szalacha et al., 2003; Yeh, 2003). Longitudinal studies are needed that explore ethnic group differences in the developmental trajectory of mental distress with an emphasis on the immediate and long-term consequences of social stress.

In this study, compared to EAs, AAs, HAs, and Asian American adolescents demonstrated lack of resources protecting them from mental distress. Meta-analyses of ethnic differences in self-esteem revealed that Asian American adolescents have constantly reported lower self-esteem scores than EAs, AAs, HAs, and American Indians (Twenge & Crocker, 2002). Without the influence of age, gender, and SES, HAs had the lowest level of self-esteem among three ethnic groups and AAs showed lack of coping skills. Ethnic minority adolescents also reported difficulties in family relationships. In previous studies, Asian American and HA adolescents, particularly recent immigrants, have reported communication problems with parents and lack of parental support (Blake, Ledsky, Goodenow, & O'Connell, 2001; Rhee, Chang, & Rhee, 2003). Changes in family dynamics and structure during the immigration process may threaten the parent-child relationships and cause erosion of the traditional family system (Choi, 2002; Escobar, Nervi, & Gara, 2000; Gil, Wagner, & Vega, 2000). The scarcity of these resources along with exposure to a high level of social stress may make ethnic minority adolescents vulnerable to mental distress.

Findings of the present study in ethnic differences in mental distress are generally consistent with those of previous studies. In this study, Asian Americans reported the highest somatic symptom scores, followed by AAs, HAs, and EAs. This finding is consistent with that of a previous study in which Asian American adolescents reported the highest somatic symptom scores (Rhee, 2001). Adolescents who experience high level of somatic symptoms also tend to have a high level of depression (Rhee, 2003; Saluja et al., 2004).

Consistent with previous studies (Olvera, 2001; Roberts et al., 1997; Siegel, Aneshensel, Taub, Cantwell, & Driscoll, 2001; Tortolero & Roberts, 2001), the present study has identified HAs as a high-risk group for depression and suicidal ideation. Researchers have attempted to relate this increased risk to a number of factors, including acculurative stress, fatalism, and deprived SES (Hovey & King, 1997; Roberts, 2000). In this study, the increased risk for suicidal ideation no longer existed after controlling for risk factors or resources (stress, family characteristics, self-esteem, or coping). The findings of the present study provide preliminary evidence for designing suicide intervention programs to modify the risk factors and resources for HAs.

Certain limitations in the present study deserve mention. First, causal relations among the study variables could not be addressed owing to the cross-sectional nature of the data. Second, the generalizability of the findings is limited by the relatively small sample size and possible selection bias attributable to the active parental consent process (Tigges, 2003). The relatively low return rate was discouraging but not surprising. Similarly, low return rates have been reported in previous school-based studies requiring active parental consent (Tigges, 2003). Adolescents who are under sociodemographic or psychosocial distress could be excluded because of the active parental consent process, and nonresponse rates were different across the ethnic groups. In addition, the sample was composed largely of EAs and females. More rigorous and culturally sensitive recruitment procedures targeting ethnic minority adolescents are required in future studies.

In spite of these limitations, it is evident that the results of the present study are, overall, similar to those of previous studies. Ethnic minority adolescents were found to be at increased risk for experiencing social stress and mental distress; in particular, HAs were identified as a high-risk group for depression and suicidal ideation. Also, Asian Americans exhibited elevated risk for mental distress even if they were excluded from the main analysis because of the small subsample size. Further studies focusing on Asian American adolescents are needed.

CONCLUSION

The present study makes several contributions to our understanding of ethnic differences in mental distress and related psychosocial factors. In particular, this study identified significant differences in social stress among ethnic groups and highlighted the importance of understanding the role of social stress in development and reporting of adolescents' mental distress. Observed ethnic differences in social stress provide preliminary evidence for incorporating social stress as a critical component not only in research but also in culturally sensitive prevention programs. This study is one of very few that have examined ethnic differences in social stress among young adolescents.

The current study also identified ethnic minority adolescents as vulnerable for mental distress. Ethnic minority adolescents have already shown evidence of increased risk for somatic symptoms, depression, and suicidal ideation and require additional research and attention from health care providers. The present study not only strongly reflects national efforts to overcome ethnic disparities in health within this decade, but also could eventually contribute an empirical basis for developing culturally competent prevention programs for vulnerable youth.

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This study was made possible by Grant Number 1 F31 NR07933-01 from the National Institute of Nursing Research, National Institute of Health and by Grant Number T32 NR07964 from the National Institute of Nursing Research, National Institute of Health.

Janet C. Meininger, School of Nursing, University of Texas Health Science Center, Houston.

Robert E. Roberts, School of Public Health, University of Texas Health Science Center, Houston.

Requests for reprints should be sent to Heeseung Choi, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave., Chicago, Illinois 60612. E-mail: hchoi20@uic.edu Table 1. Sociodemographic Characteristics of the Four Groups European African American American (n = 144; (n = 66; 46.9%) 21.5%) Characteristic n (%) n (%) Age 11 or younger 17 (11.8) 9 (13.6) 12 56 (38.9) 22 (33.3) 13 45 (31.2) 20 (30.3) 14 or older 26 (18.1) 15 (22.7) Gender Male 66 (45.8) 24 (36.4) Female 78 (54.2) 42 (63.6) School Grades Much below average 1 (0.7) 0 (0.0) Below average 7 (4.9) 1 (1.5) Average 46 (32.4) 38 (57.6) Above average 68 (47.9) 25 (37.9) Much above average 20 (14.1) 2 (3.0) Socioeconomic Status (compared with other families) Much worse off 6 (4.3) 2 (3.1) Somewhat worse off About the same 68 (48.2) 42 (64.6) Better off 51 (36.2) 17 (26.1) Much better off 16 (11.3) 4 (6.2) Birthplace U.S. born 135 (93.8) 58 (87.9) Foreign born 8 (5.6) 8 (12.1) Do not know 1 (0.7) 0 (0.0) Hispanic Asian American American (n = 77; (n = 20; 25.1%) 6.5%) Characteristic n (%) n (%) Age 11 or younger 8 (10.4) 6 (31.6) 12 30 (39.0) 7 (36.8) 13 27 (35.1) 3 (15.8) 14 or older 12 (15.6) 3 (15.8) Gender Male 23 (29.9) 10 (50.0) Female 54 (70.1) 10 (50.0) School Grades Much below average 2 (2.6) 0 (0.0) Below average 4 (5.3) 1 (5.0) Average 39 (51.3) 5 (25.0) Above average 21 (27.6) 9 (45.0) Much above average 10 (13.2) 5 (25.0) Socioeconomic Status (compared with other families) Much worse off 11 (14.5) 5 (26.3) Somewhat worse off About the same 48 (63.2) 8 (42.1) Better off 11 (14.5) 5 (26.3) Much better off 6 (7.9) 1 (5.3) Birthplace U.S. born 53 (70.7) 8 (40.0) Foreign born 22 (29.3) 12 (60.0) Do not know 0 (0.0) 0 (0.0) Note. Percentages were calculated for valid cases only. Table 2. Differences in Social Stress, Resources, and Mental Distress in Four Ethnic Groups European American African American (n = 144) (n = 66) Measure M (SD) M (SD) Social Stress General social 24.93 (12.75) 28.15 (12.83) stress Process-oriented 10.54 (9.74) 14.03 (11.12) stress Discrimination 5.16 (4.98) 6.83 (5.63) Resources Coping 19.84 (6.02) 19.63 (6.54) Self-esteem 32.29 (6.97) 32.59 (5.80) Family cohesion 6.75 (2.29) 6.65 (2.19) Family conflicts 2.60 (2.28) 3.20 (2.49) Mental Distress Somatic symptoms 15.08 (4.48) 16.06 (4.56) Depression 40.52 (13.56) 42.91 (11.47) Suicidal ideation 4.07 (2.09) 4.25 (2.04) Hispanic American Asian American (n = 77) (n = 20) Measure M (SD) M (SD) Social Stress General social 34.84 (14.38) 32.26 (17.80) stress Process-oriented 18.03 (10.41) 24.53 (17.24) stress Discrimination 8.42 (5.57) 12.79 (9.80) Resources Coping 20.19 (6.82) 19.22 (6.32) Self-esteem 29.78 (7.26) 26.28 (7.05) Family cohesion 6.44 (2.50) 5.72 (2.42) Family conflicts 3.36 (2.30) 4.50 (2.50) Mental Distress Somatic symptoms 15.58 (3.58) 17.30 (6.78) Depression 45.26 (14.67) 43.25 (10.58) Suicidal ideation 4.47 (2.28) 3.80 (1.67) Measure F p Social Stress General social 9.42 .000 stress Process-oriented 14.45 .000 stress Discrimination 13.10 .000 Resources Coping .16 .923 Self-esteem 6.30 .000 Family cohesion 1.17 .321 Family conflicts 4.57 .004 Mental Distress Somatic symptoms 1.82 .143 Depression 2.21 .087 Suicidal ideation .85 .470 Table 3. Differences in Social Stress, Resources, and Mental Distress in Three Ethnic Groups, Adjusted for Age, Gender, and Socioeconomic Status European American (n = 144) Measure M (SD) Median Social Stress General social 24.79 (12.73) 23 stress Process-oriented 10.44 (9.75) 8 stress Discrimination 5.10 (4.97) 4 Resources Coping 19.84 (6.06) 20 Self-esteem 32.21 (7.00) 34 Family cohesion 6.72 (2.30) 7 Family conflicts 2.62 (2.28) 2 Mental Distress Somatic symptoms 15.13 (4.51) 14 Depression 40.66 (13.62) 36 Suicidal ideation 4.09 (2.09) 3 African American (n = 66) Measure M (SD) Median Social Stress General social 27.84 (12.68) 27 stress Process-oriented 14.03 (11.20) 11 stress Discrimination 6.81 (5.67) 5 Resources Coping 19.70 (6.56) 20 Self-esteem 32.57 (5.80) 34 Family cohesion 6.72 (2.13) 7 Family conflicts 3.22 (2.50) 3 Mental Distress Somatic symptoms 15.89 (4.39) 15 Depression 42.76 (11.50) 40 Suicidal ideation 4.22 (2.04) 3 Hispanic American (n = 77) Measure M (SD) Median Social Stress General social 34.68 (14.40) 36 stress Process-oriented 18.11 (10.46) 17 stress Discrimination 8.43 (5.60) 8 Resources Coping 20.16 (6.86) 22 Self-esteem 29.83 (7.29) 29 Family cohesion 6.41 (2.50) 7 Family conflicts 3.39 (2.30) 3 Mental Distress Somatic symptoms 15.60 (3.60) 15 Depression 45.32 (14.76) 44 Suicidal ideation 4.53 (2.24) 3 Measure F p Social Stress General social 9.06 .000 stress Process-oriented 6.74 .000 stress Discrimination 5.15 .002 Resources Coping 4.80 .003 Self-esteem 16.12 .000 Family cohesion 11.11 .000 Family conflicts 1.31 .273 Mental Distress Somatic symptoms 3.61 .014 Depression 4.66 .003 Suicidal ideation 1.90 .130 Table 4. Logistic Regression of Suicidal Ideation on Ethnicity, Age, Gender, and Socioeconomic Status Regression Wald Variable Coefficient SE Statistic Ethnic Group European American (R) African American .35 .37 .90 Hispanic American .71 .34 4.33 Age 11 or younger .46 .46 1.00 12 (R) 13 .42 .34 1.52 14 or older -.19 .44 .19 Gender Male (R) Female .16 .30 .28 Socioeconomic Status (compared with other families) Much worse off 1.01 .52 3.81 Somewhat worse off About the same (R) Better off .04 .35 .01 Much better off .89 .46 3.75 Odds Variable p Ratio 95% CI Ethnic Group European American (R) African American .34 1.42 .69-2.93 Hispanic American .04 2.04 * 1.04-3.98 Age 11 or younger .32 1.58 .64-3.87 12 (R) 13 .22 1.52 .78-2.96 14 or older .67 .83 .35-1.95 Gender Male (R) Female .59 1.18 .65-2.13 Socioeconomic Status (compared with other families) Much worse off .05 2.76 * .99-7.63 Somewhat worse off About the same (R) Better off .91 1.04 .53-2.06 Much better off .05 2.45 * .99-6.05 Note. R = referent group. * p [less than or equal to] .05.