Jang Yuri, Chiriboga David A, Okazaki Sumie
Department of Aging and Mental Health, University of South Florida, Tampa, FL, USA.
Aging Ment Health. 2009 Jan;13(1):127-34. doi: 10.1080/13607860802591070.
The present study examined the attitudes toward mental health services held by younger (aged 20-45, n = 209) and older (aged 60 and older, n = 462) groups of Korean Americans. Following Andersen's (1968; A behavioral model of families' use of health service, Center for Health Administration Studies) behavioral health model, predisposing (age, gender, marital status and education), need (anxiety and depressive symptoms) and enabling (acculturation, health insurance coverage and personal experience and beliefs) variables were considered. In the mean-level assessment, younger and older adults were found to hold a similar level of positive attitudes toward mental health services. In the multivariate analysis, culture-influenced beliefs were shown to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was found to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Our findings show that older adults are not only more subject to cultural misconceptions and stigma related to mental disorders, but also their attitudes toward service use are negatively influenced by the cultural stigma. The findings provide important implications for interventions targeted to improve access to mental health care among minority populations. Based on the similarities and differences found between young and old, both general and age-specific strategies need to be developed in order to increase effectiveness of these programs.
本研究调查了韩裔美国人中较年轻群体（20 - 45岁，n = 209）和较年长群体（60岁及以上，n = 462）对心理健康服务的态度。遵循安德森（1968年；《家庭使用健康服务的行为模型》，卫生管理研究中心）的行为健康模型，考虑了易感性（年龄、性别、婚姻状况和教育程度）、需求（焦虑和抑郁症状）和促成因素（文化适应、医疗保险覆盖范围以及个人经历和信念）等变量。在平均水平评估中，发现年轻和年长成年人对心理健康服务持相似程度的积极态度。在多变量分析中，文化影响的信念在两个年龄组对心理健康服务态度模型中都有重大贡献。发现认为抑郁症是一种疾病的信念是各群体积极态度的常见预测因素。在年长成年人样本中，那些认为抑郁症是个人软弱的表现以及有精神疾病家庭成员会给整个家庭带来耻辱的人表现出更消极的态度。我们的研究结果表明，年长成年人不仅更容易受到与精神障碍相关的文化误解和污名的影响，而且他们对服务使用的态度也受到文化污名的负面影响。这些发现为旨在改善少数族裔人群获得心理健康护理机会的干预措施提供了重要启示。基于年轻和年长群体之间发现的异同，需要制定通用和针对特定年龄的策略，以提高这些项目的有效性。
