Past and Present Situations of Korean Americans
From 1903 to 1905, 7,000 Koreans were moved to Hawaii to work as plantation laborers due to the labor demand on Hawaiian plantations after the Chinese labor immigration act (9). Since the 1960s, the Korean American population has dramatically increased as a result of political, economic, and military relations between South Korea and the U.S. In 2017, about one million Korean immigrants resided in the United States (10).
As of 2010, the racial population percentage of the U.S. is 64.7% White, non-Hispanic, 16% Hispanic or Latino, 13.6% Black, 5.3% Asian, and 1.8% Multiracial groups. This percentage is predicted to change to 46.3%, 30.2%, 15.0%, 9.2%, and 3.9% respectively by 2050 (7). Out of the Asian population, and the Korean group is ranked as the fifth-largest after India, China, the Philippines, and Vietnam (8). According to the change of the percentage, it is noticeable that racial/ethnic groups other than White, non-Hispanic will continue to grow, and they will take up more than 50% of the U.S. population.
Notably, Korean Americans are likely to have higher incomes and educational achievement and less likely to experience poverty or lack health insurance. In 2017, the median income of Korean Americans’ households was $65,000 compared to $57,000 for all immigrant households and $61,000 for U.S.-born families; around 34% of Korean Americans had a bachelor’s degree, compared to 18% of the foreign-born and 20% of the U.S.-born populations; and 20% of Korean Americans had graduate or professional degrees compared to other immigrants (13%) and native-born Americans (12%). However, Korean Americans have lower workforce participation rates and lower English proficiency than other racial/ethnic immigrant populations (10).
Korean Americans’ Experiences of Mental Health
The U.S. government has made an effort to reduce racial discrimination and promote economic and social justice in various sectors, such as profit- or non-profit, the government, and the educational sector. However, in spite of their efforts, fully exerting racial equality is difficult to do in reality. Even though the U.S. is considered a “majority-minority” nation, non-White racial/ethnic groups are disproportionally represented among those living in poverty and child welfare services and experience racial disparities in employment, health care access, and schools; furthermore, communities are visibly segregated (7).
Racial discrimination affects mental and physical health among minority populations (11) (12) (13). However, so far, the study of understanding racial discrimination among racial/ethnic groups has heavily focused on Black communities, and it is urgent to extend the scope of this subject to other minority groups, including Asians (14, 15).
A study by Noh et al. (2007) (16), one of few studies that examined the impact of racial discrimination on the mental health of Korean Americans, discovered that experiencing subtle bias or unfair treatment (e.g., perceived discrimination) caused Korean Americans to produce distress symptoms because of their unstable or ambiguous social identity.
Mental Health and Accessibility to Health Care Services
When individuals suffer from mental health problems, it is crucial to access mental health care services on a regular basis. In particular, low-income individuals are likely to lack knowledge of the specific illness and less likely to seek health care services. Therefore, it is imperative for health-related professionals to acknowledge the situation of low-income households and understand their barriers. In addition, in low-income communities, increasing availability and accessibility to health care services and improving the quality of health care utilities is crucial for residents to heal their mental problems (17).
The combination of primary care and mental health care service integration (Primary Care-Mental Health Integration) by providing easy access to mental health service within primary community care appeared useful for individuals with mental illness. This collaborative approach is composed of nurse care managers, mental health specialists, psychologists, social workers, and licensed mental health counselors and was created with the aim of saving time and providing evidence-based treatment directly in primary care. When examining the effectiveness of this system, Leung et al. (2017) (18) discovered that it was effective for individuals with depression, anxiety, and alcohol misuse.
Many immigrants experience more mental health problems than native-born individuals. However, unfortunately, they are less likely to use health care services for mental illness and experience barriers—in particular, language difficulties and lack of knowledge about the available resources—when trying to access care for mental health problems.19 Such physical hardships could exacerbate immigrants’ mental health problems. On the other hand, the longer the migrants (called health immigrants) are in the U.S., the more likely they are to access health care services (19). Their study implies that language barriers and lack of information about their communities could be significant factors that hamper immigrants’ access to health care services in communities.
It has been previously noted that English fluency affects immigrants’ utilization of health care services. Non-U.S.-born immigrants are prone to underuse health care services, heavily rely on ‘ad hoc interpreters’ (family members, friends, relatives) when seeing health professionals, have less understanding of the care they receive, have delayed diagnoses, be less satisfied with the care they receive, and be less likely to follow recommendations for treatment (20) (21) (22). A recent study by Durbin et al. (2017) (23) also confirmed that U.S. immigrants expressed difficulties accessing community health care services due to lower English proficiency. This report was more evident among older immigrants. To meet the needs of those immigrants, communities that have high immigrant populations are recommended to employ translators or interpreters whose assistance these immigrant patients can easily ask for whenever they visit community health clinics or services. In addition, training staff to work with non-English speaking immigrants and preparing enough resources written in different languages are essential to take care of these immigrants more effectively (23).
Mental Health, Family and Social Support
According to Seeman (2016), mental health is demonstrated by the protective effects of social integration healing the negative results of being isolation (24). In other words, social support can buffer or mediate the detrimental impacts of psychological stress (24).
Steptoe et al. (2008) (25), found that having greater social connectedness, emotional and practical support, social support, optimism, and adaptive coping responses from family members assists in lowering an individual’s mental health problems, including chronic stress and depression and optimizes psychological well-being. For instance, regardless of socioeconomic status (SES) and educational attainment, individuals increased psychological well-being when they possessed many health-protective psychosocial resources, such as emotional, practical, and social support. On the other hand, negative social support, such as lack of protective resources, was related to individuals’ stress exposure, poorer mental health, pessimism, and avoidant coping (25). Having many psychological problems, in turn, leads to coronary heart disease and other physical health problems (26).
Social support—social resources that individuals perceive as available, either instrumental/tangible in a physical way or emotional—functions to serve a variety of needs. On the other hand, social networks—or social relationships—vary in source and frequency and embrace the structure of social ties (27). A study by Chou et al. (2011) (28) also verified that social isolation, such as the absence of frequent contact with close friends, family members, and religious groups, was associated with mental health issues such as depression and multiple moods anxiety, and substance use disorders. More specifically, infrequent religious contact was significantly related to substance use disorders; infrequent meetings with close friends and family members were significantly associated with major depressive disorder (28). Additionally, Smyth et al. (2014) (27) pointed out that having a high level of emotional support was associated with decreased common mental disorder, and having weekly family and friend contact and a high level of emotional support was associated with a decrease of depressive episodes. Overall, emotional support, social support, and contact with family and friends were more crucial protective factors for a range of mental health outcomes (27).
Mental Health, Family and Social Support within Racial/Ethnic Minority Populations
Social support and social networks were demonstrated to be effective in particular for the mental health of ethnic minority groups who value family, kin, and culture highly (27). For instance, Mexican Americans live in closer proximity to extended kin networks, which leads to a healthy exchange of social support (29). Latinos who have a family-oriented mindset can establish social support and health (30). In particular, the frequent connection between Mexican family members is higher in non-U.S.-born households than subsequent U.S.-born families (30). This result validated that foreign-born Mexicans have stronger familiar social support than U.S.-born Mexican generations, which reported lower perceived familial, social support. In other words, familism is a crucial resource for non-U.S.-born immigrants to maintain healthy lifestyles while living in a foreign country (30).
Disadvantaged minority groups try to build social networks secure within their co-ethnic groups and extended families as a coping mechanism when dealing with poverty or discrimination. This situation is more evident in households whose primary language is different from English. Almedia et al. (2009)(30) observed that the Mexican participants whose mother tongue is not English and are not U.S.-born had more frequent family connections and support than U.S.-born generations whose primary language is English. The reason why foreign-born Mexicans had close contact with family members and received family support was that they had strong traditional cultural values and acculturation, and such support could be a healthy advantage while they could not rely on non-kin social ties due to migration (30).
As several studies mentioned earlier, there were numerous findings of the importance of family support and proximity to family members and relatives in racial/ethnic minority populations, particularly for Mexican communities. However, even though numerous studies noticed the variation of social support across population subgroups (30) (31), few studies have aimed to explore the association between social and family support and Asian communities, including Korean families (30).
The most recent studies by Liu et al. (2020) (6), Li et al. (2020) (5) and Choi et al. (2020) (32)—all of which investigated East Asians’ mental health, social support, mental health amid COVID-19—discovered that, even though all participants in the studies reported high levels of psychological distress, Li et al. (2020) (5) did not find a significant association between perceived support and a decrease of mental health problems, while Choi et al. (2020) (32) unearthed that Koreans’ psychosocial distress due to racial discrimination during the COVID-19 pandemic was likely to be reduced because of overall social support (using “social interaction” scale).
Mental Health, Health Care Services, and COVID-19
The breakout of COVID-19 has caused individuals not only to experience physical threats but also to increase psychological and mental problems (33) (34). According to a recent survey in the U.S. Health Affairs, the elderly reported that stress from COVID-19 had been a challenge while a third of Americans reported mental health problems (34). Rapid contagious disease resulted in lockdowns in many households and communities, which in turn led them to experience drastic social distancing, self-quarantine, another disease, isolation, xenophobia, and mental health illness, such as depression and stress (33). Most notably, quarantine and self-isolation prevalently cause individuals to have a serious mental illness. The separation from loved ones, loss of freedom, boredom, and uncertainty most likely affect individuals by worsening their mental status. Older individuals and individuals with disabilities that put them at risk are more likely to be negatively affected by COVID-19 due to being both clinically and socially distanced from their families, friends, and healthcare services (33) (34) (35).
Another source of this anxiety was that elders generally used their smartphones to keep themselves during the pandemic, causing them to be more susceptible to the spread of fake news. In addition, many Asian Americans (Chinese, Koreans) appeal that they also have high levels of psychosocial distress due to perceived racial discrimination amid the COVID-19 pandemic (6) (32).
However, a senior mental health counselor was able to demonstrate that access to mental health resources alleviated the mental stress that elders faced. In her practice, virtual communication and supportive therapy were very effective for these patients. The counselor utilized video consultations, the assigning of daily chores schedules, cognitive behavior therapy, and the establishment of phone contact with the elders and their family relatives. For many of her patients, these types of resources have led to reports of less compulsive behavior, instillation of hope, and reduction of apprehension. This more non-traditional form of healthcare access has decreased mental health struggles that elders faced during the midst of the pandemic (34).
Another form of healthcare access that has shown significant improvements in the mental health of individuals is practicing yoga in India—a therapeutic intervention that includes non-rigorous exercise, medication, and breath control techniques (35). Along with its physical benefits, yoga has been shown to lighten an individual’s mood and decrease anxiety and depression among the elderly. With more accessibility to a health service, including a yoga intervention, elders’ mental health has improved drastically (35).