The Impact of Acculturation and Social Support on Mental Health among Korean-American Registered Nurses

Kumsook Seo; Miyoung Kim; Gunjeong Lee; Park Jinhwa; Jungmin Yoon

doi:10.7475/KJAN.2013.25.1.157

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Seo, Kim, Lee, Jinhwa, and Yoon: The Impact of Acculturation and Social Support on Mental Health among Korean-American Registered Nurses

Original Research

Korean J Adult Nurs 2013;25(2):157-169.

Published online: 18 April 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.1.157

The Impact of Acculturation and Social Support on Mental Health among Korean-American Registered Nurses

Kumsook Seo¹, Miyoung Kim^2,, Gunjeong Lee², Park Jinhwa¹, Jungmin Yoon¹

^¹Graduate School, Ewha Womans University, Seoul

^²Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seoul, Korea

Corresponding author: Kim, Miyoung Division of Nursing Science, College of Health Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-6694, Fax: +82-2-3277-2850, E-mail: mykim0808@ewha.ac.kr

Received 8 April 20139 April 2013 Accepted 22 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to examine the impact of acculturation and social support on the mental health among Korean-American registered nurses.

Methods

Data were collected with a convenience sample of 203 Korean-American registered nurses living in New York state and New Jersey state from 8th May to 25th August in 2012. The structured questionnaires measured the degree of acculturation, social support, and mental health. Data analysis was conducted using t-test, ANOVA, Pearson correlation efficient, and Stepwise multiple regression.

Results

Lower level of integration and higher level of marginalization were associated with the lower mental health. Social support was also positively related to mental health and had mediating effect on the relationship between acculturation and mental health. The five variables, including participants’ educational background, work shift, integration, marginalization, and social support were significant to predict the level of mental health among Korean-American registered nurses, accounting for 41% of the variability.

Conclusion

The results imply that higher level of social support and strong identity of both home and host culture will enable Korean-American registered nurses to maintain sound mental health.

Keywords: Acculturation, Mental health, Nurses, Korean Americans, Social support

REFERENCES

Abraido-Lanz A. F.., Chao M. T.., Florez K. R.2005. Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Social Science & Medicine. 61(6):1243–1255. http://dx.doi.org/10.1016/j.socscimed.2005.01.016.

Ahn J. H.2007. A path analysis of the relationship between migratory grief and depression among older Korean immigrants in the U.S. Mental Health & Social Work. 26:219–253.

Atri A.., Matorin A.., Ruiz P.2011. Integration of international medical graduates in U.S. psychiatry: The role of acculturation and social support. Academic Psychiatry. 35(1):21–26. http://dx.doi.org/10.1176/appi.ap.35.1.21.

Baron R. M.., Kenny D. A.1986. The moderator-medicator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 51(6):1173–1182.

Barry D. T.2001. Development of a new scale for measuring acculturation: The East Asian Acculturation Measure (EAAM). Journal of Immigrant Health. 3(4):193–197.

Berry J. W.1980. Acculturation as varieties of adaptation. Padilla A. M., editorAcculturation: Theory, models and some new findings. p. 9–25. Boulder, CO: Westview.

Berry J. W.2003. Conceptual approaches to acculturation. Chun K. M., Organista P. B., Martin G., editorsAcculturation: Advances in theory, measurement, and applied research. p. 17–38. Washington, DC: American Psychological Association.

Brunero S.., Smith J.., Bates E.2008. Expectations and experiences of recently recruited overseas-qualified nurses in Australia. Contemporary Nurse. 28(1-2):101–110. http://dx.doi.org/10.5172/conu.673.28.1-2.101.

Cemalcilar Z.., Falbo T.2008. A longitudinal study of the adaptation of international students in the United States. Journal of Cross-Cultural Psychology. 39(6):799–804. http://dx.doi.org/10.1177/0022022108323787.

Chae M. H.., Foley P. F.2010. Relationship of ethnic identity, acculturation, and psychological well-being among Chinese, Japanese, and Korean Americans. Journal of Counseling & Development. 88(4):466–476. http://dx.doi.org/10.1002/j.1556-6678.2010.tb00047.x.

Chiang V.., Crickmore B. L.2009. Improving English proficiency of post-graduate international nursing students seeking further qualifications and continuing education in foreign countries. Journal of Continuing Education in Nursing. 40(7):329–336. http://dx.doi.org/10.3928/00220124-20090623-03.

Deegan J.., Simkin K.2010. Expert to novice: Experiences of professional adaptation reported by non-English speaking nurses in Australia. Australian Journal of Advanced Nursing. 27(3):31–37.

Goldber D. P.1972. The detection of psychiatric illness by questionnaire: A technique for the identification and assessment of non-psychotic psychiatric illness. London: Oxford University Press.

Gonzalez H. M.., Haan M. N.., Hinton L.2001. Acculturation and the prevalence of depression in older Mexican Americans: Baseline results of the Sacramento area Latino study on aging. Journal of the American Geriatrics Society. 49(7):948–953. http://dx.doi.org/10.1046/j.1532-5415.2001.49186.x.

Health Resources and Services Administration. (HRSA. 2010. The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved February 15, 2012, from. http://bhpr.hrsa.gov/healthworkforce/rnsurvey2008.html.

Hong K.., Yoon S.., Kang C.2004. The study on Korean nurses' international employment and work performance. The Korean Nurse. 231:62–82.

Ivković M.2011. International nurse migrations-global trends. Journal of the Geographic Institute “Jovan Cvijić” SASA. 61(12):53–67. http://dx.doi.org/10.2298/IJGI1102053I.

Kang C. H.2012. Structured equation modeling on nursing competence of Korean registered nurses in the United States. Unpublished doctoral dissertation, Seoul National University, Seoul.

Kawachi I.., Berkman L. F.2001. Social ties and mental health. Journal of Urban Health. 78:458–467. http://dx.doi.org/10.1093/jurban/78.3.458.

Kim J. H.2000. Model construction of occupational stress in manufacturing workers. Unpublished doctoral dissertation, Seoul National University, Seoul.

Kingma M.2008. Nurses on the move: Diversity and the work environment. Contemporary Nurse. 28(1-2):198–206. http://dx.doi.org/10.5172/conu.673.28.1-2.198.

Knipscheer J. W.., Kleber R. J.2007. Acculturation and mental health among Ghanaians in the Netherlands. International Journal of Social Psychiatry. 53(4):369–383. http://dx.doi.org/10.1177/0020764007078344.

Learthart S.2000. Health effects of internal rotation of shifts. Nursing Standard. 14(47):34–36.

Lee E.., Son J. T.2010. Factors influencing intention of migration by hospital nurses in Korea. Journal of Korean Academy of Nursing Administration. 16(4):437–445.

Lee S.2006. Cultural hybrid in the process of globalization and migration: A comparative analysis of the cases of Korean migrant women in Germany and foreign migrant women in Korea. Zeitschrift der Koreanisch-Deutschen Gesellschaft fur Sozialwissenschaften. 16(2):191–228.

Nicholas B. L.., Davis C. R.., Richardson D. R.2010. An integrative review of global nursing workforce issues. Annual Review of Nursing Research. 28:113–132. http://dx.doi.org/10.1891/0739-6686.28.113.

Noh H. N.2007. A study on acculturative stress of the Chinese women who got married to Korean men and settled down in Korea-Focusing on the acculturation patterns and social support perceived by women-. Unpublished master's thesis, Ewha Womans University, Seoul.

Oh J. Y.2009. Korean mothers' passion to "go out to the U.S." as a registered nurse. Weekly Donga. 682:56–57.

Shin S. I.2001. The validity and reliability of the Korean Version of the General Health Questionnaire: KGHQ-20 & KGHQ-30. Korean Journal of Social Welfare. 46:210–230.

Statistics Calculators. 2013. Sobel test calculator for the significance of mediation. Retrieved April 20, 2013, from. http://danielsoper.com/statcalc3/calc.aspx?id=31.

Thompson S.., Hartel G.., Manderson L.., Woelz-Stirling N.., Kelaher M.2002. The mental health status of Filipinas in Queensland. Australian and New Zealand Journal of Psychiatry. 36:674–680. http://dx.doi.org/10.1046/j.1440-1614.2002.01070.x.

Yi M. S.1996. Overcoming language barrier by Korean nurses in U. S. hospital settings. Journal of Korean Academy of Nursing. 26(2):483–495.

Yi M. S.1998. A comparison of hospital nursing practice in Korea and the U.S. as experienced by Korean nurses. Journal of Korean Academy of Nursing. 28(1):60–69.

Yi M.., Jezewski M. A.2000. Korean nurses' adjustment to hospitals in the United States of America. Journal of Advanced Nursing. 32(3):721–729. http://dx.doi.org/10.1046/j.1365-2648.2000.01533.x.

Weinert C.1988. Measuring social support: Revision and further development of personal resource questionnaire. Waltz C. F., Strickland O. L., editorsMeasuring of nursing outcomes. p. 309–327. New York: Springer Publishing Company.

Zhou Y.., Windsor C.., Coyer F.., Theobald K.2010. Ambivalence and the experience of China-educated nurses working in Australia. Nursing Inquiry. 17(3):186–196. http://dx.doi.org/10.1111/j.1440-1800.2010.00492.x.

Figure 1.

The mediation effect on the relationship between acculturation and mental health.

Table 1.

The Characteristics of Participants and Differences of Accumulation, Social Support, and Mental Health according to Sample Characteries (N=203)

Characteristics	Categories	n (%) or M±SD	Assimilation			Separation			Integration			Margination			Social support			Mental health
Characteristics	Categories	n (%) or M±SD	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD t	t or F	p	M±SD	t or F	p
Age (year)	＜35	52 (25.6)	2.4±0.4	1.87	.136	2.9±0.4	0.26 .	.851	3.1±0.5	2.15	.096	2.1±0.5	0.94	.421	3.4±0.3	2.38	.071	2.0±0.3	0.38	.770
	35~44	59 (29.1)	2.3±0.5			3.0±0.5			3.1±0.6			2.3±0.5			3.3±0.4			2.1±0.3
	45~54	58 (28.6)	2.3±0.5			2.9±0.5			3.2±0.6			2.2±0.5			3.4±0.4			2.1±0.3
	≥55	34 (16.8)	2.5±0.5			3.0±0.4			3.4±0.6			2.2±0.5			3.5±0.4			2.1±0.3
		43.2±10.1
Gender	Male	4 (2.0)	2.3±0.5	-0.13	.897	3.0±0.5	0.16	.874	3.2±0.6	-0.78	.435	2.2±0.5	1.08	.280	3.4±0.4	0.37	.713	2.0±0.3	0.89	.373
Gender	Female	199 (98.0)	2.4±0.4			2.9±0.4			3.4±0.6			1.9±0.2			3.3±0.4			1.9±0.4
Marital status	Single^a	73 (36.0)	2.3±0.5	4.37	.014	3.0±0.4	0.20 .	.822	3.1±0.5	0.88	.417	2.3±0.5	2.02	.136	3.3±0.4	0.85	.430	2.1±0.3	1.03	.360
	Married^b	120 (59.1)	2.4±0.5			3.0±0.4			3.2±0.6			2.2±0.5			3.4±0.4			2.0±0.3
	Others^c	10 (4.9)	2.1±0.4			2.9±0.6			3.1±0.8			2.4±0.6			3.4±0.4			2.1±0.3
Religion	Protestant	120 (59.1)	2.3±0.5	0.42	.741	3.0±0.4	2.67 .	.049	3.1±0.6	1.05	.373	2.2±0.5	0.64	.589	3.4±0.4	1.68	.173	2.0±0.3	0.99	.400
	Catholic	41 (20.2)	2.4±0.5			2.9±0.5			3.3±0.5			2.3±0.6			3.4±0.4			2.0±0.3
	Buddhism	16 (7.9)	2.4±0.6			2.9±0.4			3.3±0.5			2.2±0.4			3.4±0.4			2.0±0.2
	None	26 (12.8)	2.4±0.4			2.8±0.4			3.1±0.6			2.3±0.5			3.2±0.4			2.1±0.4
Educational background	3-year college^a	97 (47.8)	2.4±0.5	0.33	.806	2.9±0.5	0.43 .	.735	3.2±0.6	1.99	.116	2.2±0.5	2.93	.035	3.4±0.4	0.87	.456	2.0±0.3	2.70	.047
	Bachelor degree^b	67 (33.0)	2.3±0.4			3.0±0.4			3.1±0.5			2.3±0.4		c＞d	3.3±0.4			2.1±0.3		b, c＞d
	≥Master degree^c	24 (11.8)	2.4±0.6			3.0±0.5			3.2±0.6			2.4±0.6			3.5±0.4			2.1±0.3
	NHSd	15 (7.4)	2.3±0.4			2.9±0.5			3.5±0.8			2.0±0.6			3.5±0.4			1.8±0.4
Nursing experience in Korea (year)	＜3^a	54 (26.6)	2.4±0.4	0.33	.800	2.9±0.4	0.83 .	.481	3.3±0.7	1.48	.220	2.1±0.5	4.20	.007	3.4±0.4	3.11	.028	2.0±0.3	1.31	.273
	3~＜6^b	57 (28.1)	2.4±0.5			3.0±0.4			3.2±0.5			2.2±0.5		d＞a	3.5±0.3			2.0±0.3
	6~＜9^c	45 (22.2)	2.3±0.5			3.0±0.5			3.1±0.5			2.3±0.5			3.3±0.4			2.1±0.3
	≥9^d	47 (23.2)	2.3±0.5			2.9±0.5			3.1±0.5			2.4±0.5			3.3±0.4			2.1±0.3
		6.0±5.1

NHS=nursing high school.

Table 1.

The Characteristics of Participants and Differences of Accumulation, Social Support, and Mental Health according to Sample Characteries (Continued) (N=203)

Characteristics	Categories	n (%) or M±SD	Assimilation			Separation			Integration			Margination			Social support			Mental health
Characteristics	Categories	n (%) or M±SD	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p	M±SD	t or F	p
Nursing experience in the U.S (year)	＜1^a	14 (6.9)	2.4±0.3	7.01	＜.001	2.8±0.5	1.89	.132	2.9±0.5	8.52	＜.001	2.1±0.5	1.48	.221	3.4±0.4	0.54	.654	1.9±0.3	0.66	.576
	1~＜5^b	73 (36.0)	2.3±0.5		d＞c	2.9±0.4			3.1±0.5		d＞a, b, c	2.3±0.5			3.4±0.4			2.1±0.3
	5~＜10^c	64 (31.5)	2.2±0.5			3.0±0.5			3.1±0.5			2.2±0.5			3.3±0.4			2.0±0.3
	≥10^d	52 (25.6)	2.5±0.4			3.0±0.4			3.5±0.5			2.1±0.4			3.4±0.4			2.0±0.3
		8.3±8.5
Current position	GRS^a	183 (90.2)	2.3±0.5	0.50	.606	3.0±0.4	0.61 .	.545	3.1±0.6	8.64	＜.001	2.3±0.5	6.00	.003	3.4±0.4	3.77	.025	2.1±0.3	2.86	.060
	Nurse manager^b	14 (6.9)	2.4±0.4			2.8±0.5			3.7±0.4		b＞a	1.8±0.4			3.6±0.4			1.9±0.4
	Nurse practitioner^c	6 (3.0)	2.5±0.3			3.0±0.4			3.6±0.5		b＞a	1.9±0.4			3.6±0.3			1.8±0.2
Work shift	Per day^a	137 (67.5)	2.4±0.5	1.39	.247	3.0±0.5	1.66 .	.176	3.2±0.5	3.98	＜.001	2.2±0.5	2.37	.072	3.4±0.4	1.41	.240	2.0±0.3	2.97	.033
	Per evening^b	12 (5.9)	2.6±0.5			2.7±0.4			3.4±0.5			2.3±0.6			3.4±0.5			2.1±0.4		d＞a, b, c
	Per night^c	40 (19.7)	2.3±0.4			3.0±0.5			3.0±0.6			2.3±0.6			3.3±0.4			2.1±0.4
	Rotating/Per diem^d	14 (6.9)	2.4±0.6			3.1±0.3			2.9±0.7			2.4±0.5			3.2±0.4			2.3±0.2
Working hours (per week)	＜30	34 (16.8)	2.3±0.5	0.90	.410	2.9±0.4	0.23	.791	3.1±0.5	1.34	.264	2.3±0.5	1.97	.142	3.3±0.4	0.32	.730	2.1±0.3	0.61	.543
	30~40	101 (49.8)	2.3±0.5			3.0±0.5			3.2±0.6			2.1±0.5			3.4±0.4			2.0±0.3
	＞40	68 (33.5)	2.4±0.4			3.0±0.4			3.2±0.5			2.3±0.5			3.4±0.4			2.1±0.3
Annual income (US dollar)	＜50,000^a	46 (22.7)	12.4±0.4	0.88	.455	3.0±0.4	0.36	.780	3.0±0.5	6.10	＜.001	2.2±0.5	2.49	.061	3.4±0.4	2.07	.105	2.0±0.4	0.61	.610
	50,000~＜75,000^b	50 (24.6)	2.3±0.5			2.9±0.5			3.0±0.5		d＞a, b	2.3±0.5			3.4±0.4			2.1±0.3
	75,000~＜90,000^c	51 (25.1)	2.3±0.5			3.0±0.5			3.2±0.6			2.3±0.5			3.3±0.4			2.1±0.3
	≥90,0000^d	56 (27.6)	2.4±0.5			3.0±0.5			3.4±0.6			2.1±0.5			3.5±0.4			2.0±0.3
Current visa	Citizen^a	69 (34.0)	2.4±0.5	3.44	.018	3.0±0.5	1.44 .	.231	3.4±0.5	5.75	＜.001	2.1±0.5	5.43	.001	3.5±0.4	4.73	.003	2.0±0.3	0.64	.589
	Permanent resident^b	69 (34.0)	2.3±0.5		a＞d	3.0±0.4			3.1±0.6		a＞d	2.3±0.5		d＞c, a	3.3±0.4		a＞d	2.1±0.3
	Student/CPT^c	55 (27.1)	2.4±0.3			2.9±0.4			3.1±0.4			2.2±0.5			3.4±0.4			2.0±0.3
	OPT^d	10 (4.9)	2.0±0.4			3.0±0.6			2.9±0.6			2.6±0.6			3.1±0.4			2.1±0.3

GRS=general registered nurse; CPT=curricular practical training; OPT=optional practical training.

Table 2.

Levels of Acculturation, Social Support, and Menta Health (N=203

Variables	n (%) or M±SD	Items
Acculturation
Assimilation	2.3±0.5	8
Separation	3.0±0.5	7
Integration	3.2±0.6	5
Marginalization	2.2±0.6	9
Social support	3.4±0.4	21
Mental health	2.0±0.3	20
≥13	4 (2.0)
＜13	199 (98.0)

Table 3.

Correlations among Acculturation, Social Support, Mental Health (N=203)

Variables	Categories	Mental health	Assimilation	Separation	Integration	Marginalization
Variables	Categories	r (p)	r (p)	r (p)	r (p)	r (p)
Acculturation	Assimilation	-.10 (.160)	1
	Separation	.10 (.136)	-.30 (＜.001)	1
	Integration	-.30 (＜.001)	.51 (＜.001)	-.24 (.001)	1
	Marginalization	.56 (＜.001)	-.10 (.153)	.21 (.003)	-0.36 (＜.001)	1
Social support		-.52 (＜.001)	.22 (.001)	-.12 (.078)	0.26 (＜.001)	-0.43 (＜.001)

Table 4.

Levels of Health Perception and Related Variables (N=203)

Model	Categories	B	SE	_β	t	p	Collinearity statistics
Model	Categories	B	SE	_β	t	p	Tolerance	VIF	Adj. R²	F (p)
Model 1	(Constant)	40.21	0.68	.05	59.15	＜.001			.06	3.04 (.007)
	Bachelor degree	0.61	1.00	.04	0.61	.543	.85	1.18
	Master degree	0.69	1.41	-.19	0.49	.624	.91	1.10
	Nursing high school	-4.58	1.74	.08	-2.63	.009	.90	1.11
	Evening shift	2.25	1.91	.05	1.18	.241	.92	1.09
	Night shift	0.82	1.11	.21	0.74	.463	.95	1.05
	Rotating/per diem	5.18	1.73		3.00	.003	.97	1.03
Model 2	(Constant)	30.36	3.37	.00	9.00	＜.001			.32	16.65 (＜.001)
	Bachelor degree	0.11	0.85	.01	0.14	.892	.84	1.18
	Master degree	-0.86	1.21	-.04	-0.71	.476	.88	1.14
	Nursing high school	-2.51	1.49	-.10	-1.68	.095	.88	1.14
	Evening shift	1.38	1.63	.05	0.85	.399	.91	1.10
	Night shift	-0.55	0.96	-.03	-0.57	.567	.91	1.09
	Rotating/per diem	3.06	1.49	.12	2.05	.041	.94	1.06
	Integration	-0.21	0.14	-.10	-1.49	.138	.82	1.22
	Marginalization	0.70	0.09	.50	7.78	＜.001	.81	1.23
Model 3	(Constant)	51.26	4.96	.00	10.33	＜.001			.41	16.65 (＜.001)
	Bachelor degree	0.16	0.79	.01	0.20	.843	.84	1.18
	Master degree	0.10	1.14	.01	0.09	.929	.86	1.17
	Nursing high school	-2.65	1.39	-.11	-1.90	.059	.88	1.14
	Evening shift	1.49	1.52	.06	0.98	.328	.91	1.10
	Night shift	-0.67	0.90	-.04	-0.75	.457	.91	1.09
	Rotating/Per diem	2.72	1.39	.11	1.96	.052	.94	1.07
	Integration	-0.14	0.13	-.06	-1.06	.290	.81	1.23
	Marginalization	0.51	0.09	.36	5.57	＜.001	.69	1.45
	Social support	-0.26	0.05	-.33	-5.45	＜.001	.78	1.28

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