My dissertation examines the depression prevalence, symptom patterns and dimension, and mental health service use among Chinese Americans. The purpose of this research is to, 1) provide epidemiological data on the prevalence of depression among Chinese Americans, 2) examine sociocultural impacts on the prevalence and specific symptoms patterns of depression, and 3) generate implications for more culturally-sensitive approaches in psychiatric diagnosis and treatment. I use secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES). The CPES consists of three nationally representative surveys conducted between 2001 and 2003. Each of three substantive chapters attempts to a set of issues, and together they contribute to the literature on generational differences in mental health status and help-seeking behaviors among Chinese Americans. The first substantive chapter examines depression prevalence and correlates among different generations of Chinese Americans, using non-Hispanic whites as a comparison group, using weighted multinomial logistic regression. Results of the study indicate that Chinese Americans in general have a lower risk of depression than do non-Hispanic whites. Moreover, the prevalence and correlates of depression do not show a linear trend of difference from first to second to third-or-higher generation Chinese Americans, and then to non-Hispanic whites; rather, the risk of depression and its associated with social relational factors present distinct patterns for first and second generation Chinese Americans, compared to third-or-higher generation Chinese Americans and non-Hispanic whites. Specifically, friend network and extended family network play different roles in their influence on depression risk for different generations of Chinese Americans. In the Chapter Four, I conduct exploratory factor analysis to examine two subgroups of Chinese Americans, the foreign-born and the US-born, and compare them to the non-Hispanic whites. I also conduct weighted binary logistic regression to examine the patterns of depressive symptoms for Chinese Americans (separate by nativity status) and compare the two groups to non-Hispanic whites. I also examine how demographic characteristics and social factors are related to different dimensions of depressive symptoms for each group. I also find very similar factors structures of DSM-IV depressive symptoms among foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. For all three groups, suicidal ideation or attempt is a construct that is distinct from the rest of the symptoms items. The three groups have different social correlates, yet there are only minor differences in the social correlates for each one of the four depression dimensions within each group. Chronic physical condition is the most consistently significant predictor, for the negative affect, somatic symptoms, and cognitive symptoms among the two Chinese groups, and for all four dimensions of depression among non-Hispanic whites. Finally, in Chapter Five, I find significant heterogeneity of exclusive complementary and alternative medicine (CAM) use by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first generation Chinese immigrants lag behind second, third-or-higher generation Chinese Americans, and non-Hispanic whites in the likelihood of using exclusive CAM services, as well as any services in general. In addition, this chapter finds that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both, among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. / Sociology

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.

Objective: To examine health services use on the basis of alcohol consumption. Material and Methods: A cross-sectional study was carried out on patients visiting the Primary Health Care (PHC) settings in Catalonia during 2011 and 2012; these patients had a history of alcohol consumption. Information about outpatient visits in the PHC setting, hospitalizations, specialists’ visits and emergency room visits for the year 2013 was obtained from 2 databases (the Information System for the Development of Research in PHC and the Catalan Health Surveillance System). Risky drinkers were defined as those who consumed more than 280 g per week for men or more than 170 g per week for women, or any amount of alcohol while being involved in a high risk work activity, or taking medication that significantly interferes with alcohol or when being pregnant. Binge drinkers (>60 g in men or >50 g in women in a short amount of time more than once a month) were also considered risky drinkers. Results: A total of 606,948 patients reported consuming alcohol (of which 10.5% were risky drinkers). Risky drinkers were more likely to be admitted to hospitals or emergency departments (range of ORs 1.08–1.18) compared to light drinkers. Male risky drinkers used fewer PHC services than male light drinkers (OR 0.89, 95% CI 0.87–0.92). In general, risky alcohol users used services more and had longer hospital stays. When stratifying by socioeconomic level of the residential area, we found that risky drinking failed significance, while current or past cigarette smoking was associated with higher healthcare use. Conclusions: Risky drinkers use more expensive services, such as hospitals and emergency rooms, but not PHC services, which may suggest that prevention strategies and alcohol interventions should also be implemented in those settings.