Depression among Korean American immigrants living in rural Alabama: use of social determinants of health framework.

OBJECTIVES: Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama.

DESIGN: Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23-75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression.

RESULTS: Perceived race discrimination was significantly associated with greater depressive symptoms ( β  = .180, SE  = .534, p  < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost ( β  = .247, SE  = 1.118, p  < .001), had lower level of health literacy ( β  = -.121, SE  = .280, p  < .05), and had higher social isolation scores ( β  = .157, SE  = .226, p  < .05) tended to have higher scores of depressive symptoms.

CONCLUSION: Rural-living KA immigrants' depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.