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contrary, a common post hoc explanation for unchanged or worsening depression is that depression
trajectories are group-specific and contingent upon
the nature of the groups stressors.19,25,26 For example, immigrants from countries that are war torn
or had repressive political regimes (e.g., Cambodia
or El Salvador) typically suffer extensive family
loss or personal violence like torture. These extreme premigration conditions are associated with
long-lasting emotional consequences that are initially masked by a brief period of post-traumatic
numbness or relief over surviving horrific
events.11,19,21,27 Group explanations, however, are
not always applicable. For example, most FSU
immigrants are refugees based on their ethnic minority status as Jews, Armenians, or Pentecostals.
These minority groups may have encountered discrimination in their daily life, such as decreased
access to career choices, or some pressure and
intimidation when trying to obtain exist visas to
immigrate to the United States. However, very few,
if any former Soviet immigrants suffered the horrific experiences that were common experiences in
groups with documented delayed or long-lasting
consequences.11,19,21,27 Yet, former Soviet immigrants appear to have sustained, unchanging depression.12
Individual differences in depression trajectories
within a single population of immigrants are seldom considered. Mixed findings regarding both the
course of depression in immigrants and its predictors could easily result when data are analyzed for
a sample as a whole and not according to individual differences in depression trajectories or demands of immigration.
We could locate only one study that looked for
patterns of increasing and decreasing emotional
distress in a single group of immigrants and for
factors, such as immigration demands, that might
be related to these patterns. Ritsner et al.28 found
different individual patterns of distress at 1-year
follow-up in a sample of relatively recent immigrants from the FSU. They assigned individuals to
one of three groups based on their pattern of distress: (1) stable low distress, (2) moderate or decreasing distress, and (3) high or increasing distress. The three groups differed in type and amount
of social support and number of immigration-related stressors. Lack of family support and ongoing
immigration-related stressors were associated with
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Sample
The data presented here are from 253 FSU immigrants to the
Boston area of the United States who were depressed at some
point during their early resettlement. These ever-depressed
participants were part of a larger longitudinal study of former
Soviet immigrants. In the larger study, 468 FSU immigrants
were interviewed twice, initially if they had been in the United
States 5 years or less, and again 2 years later. Participants were
considered ever-depressed if at least one of their Symptom
Checklist 90-R (SCL-90-R) depression scores (baseline, 2 years
later) met Derogatiss51 gender-specific criteria for caseness in a
community sample. Using these criteria, 253 (56.1%) of the
participants from the longitudinal study were categorized as
ever-depressed. Of these 253 ever-depressed participants, 109
participants were depressed at both time points or remained
depressed (RD); 77 participants were depressed at baseline
only, or, alternatively stated, their depression lifted (DL); and
77 participants were not depressed at baseline but became
depressed (BD) 2 years later.
As a group, ever-depressed participants were older at immigration (mean 49.76, SD 15.14) than the never-depressed
participants (mean 45.87, SD 17.55; t 2.539, df
425.73, P .01). Ever-depressed participants were also less
likely to be employed (36.8% v 53.8%, 2 13.38, df 1, P
.001). However, the two groups did not differ in terms of current
gender, marital status, ethnicity, education, years living in the
United States, or presence of relatives in Boston (P .08).
Also, like the never-depressed participants, the majority of the
ever-depressed participants were refugees (94.4%), had a minimum of a college degree (67.2%), and identified their ethnicity
as Jewish (79.1%). The second largest ethnic group was Armenian (11.5%), followed by Russian (6.3%). Their republics of
origin were as follows: 46.6% from Russia, 24.5% from the
Ukraine, 14.6% from Azerbaijan, and 14.3% from other republics. Almost all of the study participants were from urban
areas in these republics.
These demographic characteristics are similar to the local
Boston population of former Soviets52 and, to some extent, the
national US population of former Soviets.1,53 The educational
status of former Soviets who reside in Boston is, on average,
slightly higher than the educational status of former Soviet
immigrants who reside elsewhere in the United States.54 However, most FSU immigrants in the United States are from Russia
or the Ukraine and, as previously stated, have refugee status
based on ethnic minority status in the FSU. Soviet Jews are the
largest ethnic minority.1 Additional demographic characteristics
of the ever-depressed sample, including breakdown by depression trajectory group, are discussed later.
Participants were originally recruited through written advertisement in ethnic newspapers and verbal advertisement by a
data collection team of 12 people who were also FSU immigrants. The data collection team was representative of the local
former Soviet immigrant population so that their recruitment
efforts would not bias the sample toward particular demographic characteristics. Specifically, the data collectors were of
both genders, of various age groups, from representative repub-
lics of origin in the FSU, and had been in the United States for
varying lengths of time.
Change-of-address cards were mailed every 6 months after
the first data collection to maintain contact with the initial study
participants. Over the course of 2 years, 61.7% of the baseline
participants either were no longer eligible because of moving
out of the Boston area or moved without providing a forwarding
address. Of the remaining participants who were eligible and
could be located, only 9.5% declined to participate in the
second phase of data collection. More in-depth description of
the baseline-only sample is available elsewhere.12 Of note,
however, is that the longitudinal sample (i.e., the combined
ever- and never-depressed groups) did not differ significantly
from the baseline only sample in gender, education, marital
status, presence of relatives in Boston, or depression scores
(P .17).
Data Analysis
A series of analyses were used to investigate differences in
demographic characteristics, life circumstances, and demands
of immigration for three depression trajectory groups (BD, RD,
and DL). First, chi-square analyses and analysis of variance
(ANOVA) were used to determine if these three groups differed
on any demographic variables. Next ANOVA for repeated measures was used to study changes in the demands of immigration
experienced by these three groups over time. Scores on the DI
at baseline and 2 years later served as the dependent variable.
Independent variables included: time (baseline, two years later)
and depression group (BD, RD, DI). Finally, the ANOVA was
repeated with any demographic variables that the three groups
differed on significantly treated as additional independent variables in the analysis.
RESULTS
Demographic Characteristics
With the exception of having a relative in Boston, the three depression trajectory groups did not
differ in their demographic characteristics. A
greater proportion of those whose depression lifted
(87%) had at least one relative in Boston as compared to those who became depressed (82%) or
remained depressed (73%; 2 3.96, df 1, P
.05). However, the three groups did not differ in
their age at immigration (P .59) and there was
no association with age group, gender, education,
or employment (P .34). In addition, neither
becoming unemployed, nor divorced, separated, or
widowed was associated with becoming depressed,
remaining depressed, or having ones depression
lift (P .40). The proportion of those who had
become unemployed (3% to 5%) or experienced a
negative change in their marital status (2% to 4%)
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Remained Depressed
(n 109)
Depression Lifted
(n 77)
Total
(N 253)
11.9%
44.8%
43.3%
49.20
(SD 16.49)
3.59
(SD .28)
7.3%
48.3%
44.0%
50.86
(SD 12.97)
3.47
(SD .06)
14.3%
41.6%
44.2%
48.68
(SD 16.80)
3.80
(SD 1.11)
10.7%
45.5%
43.9%
49.76
(SD 15.15)
3.60
(SD 1.14)
56.7%
43.3%
53.2%
46.8%
58.4%
41.6%
55.7%
44.3%
82.1%
0.0%
14.9%
0.0%
3.0%
76.1%
6.4%
1.9%
3.7%
1.8%
80.5%
11.7%
7.8%
0.0%
0.0%
79.1%
6.3%
11.5%
1.6%
1.6%
4.5%
23.9%
7.5%
61.2%
3.0%
34.3%
65.7%
81.8%
1.8%
15.6%
8.3%
66.1%
8.3%
33.3%
71.6%
72.5%
1.3%
6.5%
11.7%
74.0%
6.5%
42.9%
74.0%
87.0%
2.4%
15.0%
9.1%
67.2%
6.3%
36.5%
70.8%
79.4%
Table 2. Depression Group Means on Demands of Immigration Scale at Times One and Two
Demands of Immigration
Depression Group
Time 1
Time 2
3.47 (.98)
4.05 (.92)
3.70 (.87)
3.42 (1.09)
3.85 (1.01)
2.67 (1.09)
P .05
P .05
P .001
NOTE. Standard deviations are reported in parentheses. Significant between-group comparisons at time one were: BD v RD; RD
v BD, DL (P .05). Significant between-group comparisons at time two were: BD v RD, DL; RD v BD, DL (P .05).
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The lack of significance of demographic variables in this study was somewhat anticipated. Even
though the literature suggests that demographic
variables make some contribution, we expected
immigration demands to provide more information. Gender, on the other hand, may be insignificant because we used gender-specific norms for
interpreting depression scores. An unexpected
finding was that the three depression groups did
not differ with regard to the availability of local
family. This finding is contradictory to findings
from studies that document the importance of family for buffering or preventing immigrants depression.18,19,50 On the other hand, family presence
may not have been a good indicator of family
support. In one study of former Soviet immigrants,
families were only supportive if family members
were not preoccupied or overwhelmed with their
own immigration difficulties.10
This study contributed to understanding the
range of individual differences in depression trajectories in relatively recent FSU immigrants.
More importantly, it identified the life circumstances associated with clinically relevant distinctions, specifically improved, worsening, or unchanging depression. Study findings suggest that
clinicians should not expect immigrants depression to always decrease over time. Individual assessments should include directly inquiring about
the signs and symptoms of depression, even if
depression was not present during an earlier clinical encounter. Key questions about the presence
and magnitude of immigration demands over time
should also be included. Interventions should be
geared toward alleviating immigration demands.
Specifically, clinicians should intervene by addressing practical issues, such as learning English
and obtaining meaningful employment, as well as
REFERENCES
1. Basok T, Brym RJ. Introduction. In: Basok T, Brym RJ.
Soviet-Jewish Emigration and Resettlement in the 1990s: An
Overview. Toronto, Canada, York Lanes Press, 1991:11-22.
2. Barankin T, Konstantareas MM, Bosset F. Adaptation of
recent Soviet Jewish immigrants and their children to Toronto,
Canada. Can J Psychol 1998;34:512-518.
3. Factourovich A, Ritsner M, Maoz B, Levin K, Mirsky J,
Ginath G, et al. Psychological adjustment among Soviet immigrant
physicians: distress and self-assessments of its sources. Isr J Psychiatry
Relat Sci 1996;33:32-39.
4. Flaherty JA, Kohn R, Levav I. Demoralization in SovietJewish immigrants to the United States and Israel. Compr
Psychiatry 1998;29:588-597.
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