Physical Activity and Depressive Symptoms among Korean Americans in Los Angeles

Korean Americans are among the most rapidly growing U.S. population groups, yet relatively little is known about factors associated with their mental health. Depressive symptoms have been documented among Korean Americans, but targeting depression in this group may be challenging due to cultural norms that inhibit discussion of emotions and structural barriers to the receipt of health care. Physical activity (PA) has been negatively associated with depression in other groups and may be a promising means of addressing depressive symptoms among Korean Americans, yet the relationship between PA and depression has not yet been examined in this group. Moreover, few studies have investigated factors associated with PA among Korean Americans. Prevalence of tradition gender roles among Korean Americans suggest that gender may be important to consider in studies of PA and depression in this group. To address gaps in the extant literature, two studies are conducted to examine PA and depressive symptoms among Korean American women and men. The first study examines PA in detail and evaluates factors associated with obtaining minimally recommended levels of PA. The second study examines PA in relation to depressive symptoms, independently and in association with health insurance status and chronic disease diagnosis. Participants (N=260) were recruited at Los Angeles Korean churches. Data were collected on-site using interviewer administered Korean language questionnaires. PA was assessed using the International PA Questionnaire, Short Form (IPAQ-SF). Depressive symptoms were assessed using the Eight Item Patient Health Questionnaire (PHQ-8). Data are evaluated among the total sample and by gender. PA is described in terms of overall levels, intensity, common types of and barriers to activity, and guidelines knowledge. Logistic regression analyses are used to examine odds of meeting minimal PA guidelines in relation to guidelines knowledge, the most commonly reported barrier to PA (lack of time), social and environmental support for PA, presence of children in the home, weight status, and chronic disease diagnosis (hypertension, heart disease, or diabetes), controlling for demographic covariates. PA is evaluated in keeping with the 2007 ACSM/AHA PA guidelines, with secondary analyses to consider the 2008 PA Guideline for Americans. Overall levels of depressive symptoms are examined and ordinary least squares (OLS) regression is used to evaluate symptoms consistent with moderate or lesser levels of depression in relation to PA, chronic disease diagnosis, and health insurance status, controlling for demographic covariates. Seemingly unrelated regression analyses are conducted to examine relationships evaluated in OLS analyses of depressive symptoms while jointly estimating total PA as a function of factors examined in relation to meeting minimal PA guidelines. Rates of PA and depressive symptoms observed in the sample were higher than those reported for the U.S. population. Average levels of depressive symptoms were greater among women than men in the sample. Overall, PA levels did not vary by gender and PA was not independently associated with depressive symptoms among women or men. Among men, health status was a determinant of the association between: (a) PA and depression and (b) health insurance status and depression. Specifically, among men diagnosed with a chronic disease, depressive symptoms were lower among those who met, versus do not meet, minimal PA guidelines and higher among those without, versus with, health insurance coverage. Among women, lack of health insurance coverage was independently associated with higher levels of depressive symptoms whereas heath status was the factor most strongly associated with PA. Odds of obtaining minimally recommended levels of PA were greater among women with, versus without, chronic disease diagnoses. Guidelines knowledge and reporting time as a barrier were the factors most strongly associated with PA among men; odds of obtaining minimally recommended levels of PA were greater among men with, versus without, PA guidelines knowledge and lower among men who did, versus did not, report time as a PA barrier. Similarities were observed between Koreans and other Americans in terms of PA guidelines knowledge as well as common types of PA and barriers to PA. Failure to observe a relationship between PA and depression was surprising. Additional studies are needed to determine the reason for the findings, and to examine the relationship between PA and depressive symptoms among Korean Americans. Findings suggest that interventions may be needed to address depressive symptoms in this group and that gender differences may be important to consider in these efforts. Health status may be important to consider when targeting depression among Korean American men in particular. Insurance status may also be important to consider in such efforts; additional research is needed to examine the reasons underlying the relationship between insurance status and depression, especially among women. Despite higher levels of PA observed in the sample in comparison to U.S. population-level estimates, the finding that at least one-fourth of participants failed to obtain minimally recommended levels of PA indicates that efforts to increase PA levels among Korean Americans are needed. Findings suggest that chronic disease diagnosis may serve as a teachable moment for increasing PA in this group, particularly among women. Similarities observed between the sample and the larger population in terms of types of PA reported, barriers to activity, and knowledge of PA guidelines demonstrate a low need for tailoring of PA focused materials for Koreans. Findings expand the limited literatures related to PA and depressive symptoms among Korean Americans and point to numerous directions for future research