Jamaican and Korean Women 1 Running Head

Jamaican and Korean Women

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Running Head: JAMAICAN AND KOREAN WOMEN Self-Report Ratings of Psychopathology in Jamaican and Korean Women Michael Canute Lambert 1, 2, 3 Ji Eun Lee 1 Maureen Samms-Vaughan2 Mikhail Lyubansky 2 George T. Rowan 3 Cheryl-Lynn Podolski 1 Tonnette Grandison 2 Andrew Holness 2 1

Department of Psychology, Michigan State University, 2 Department of Child Health, University

of the West Indies, 3 David Walker Research Institute, College of Human Medicine, Michigan State University. Corresponding author: Dr. Michael C. Lambert, Department of Psychology, Michigan State University, East Lansing MI 48824-1117. Telephone (517) 432-1625, Fax (517) 432-2476, E-mail: [email protected]. This manuscript emerged from a preliminary report presented at the 45th Commonwealth Caribbean Medical Research Council, Ocho Rios, Jamaica West Indies, April, 1998. The study was supported by a grant to the first author from the David Walker Research Institute, College of Human Medicine, Michigan State University which we gratefully acknowledge. We thank Hyunhee Chung and Hyunsun Park for help with translating and back translating the instrument. We are particularly indebted to Jungok Kim for her help with data collection and to Caleb Siefert, Faith Markle, Valerie Francois, David Rose, Heather Thomas, Jennifer Carwell, Taneka Jones, Chris Ketchman, Angela Shanley, Carolyn Spearman, Lisa White, and Lisa Price for their help with data reduction. Finally, we thank the participating agencies in Jamaica and Korea and the women from both nations who participated n the study.


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Abstract Women from nations with different customs may express varying levels of psychological distress and present problems in forms their societies foster. This study compared women from two nations, Korea, a country that supports women’s dependence, submissiveness, obedience, and inexpressiveness, and Jamaica, a nation where women are independent and expressive. The Brief Symptom Inventory (BSI), a multidimensional psychopathology measure, was used to survey 255 Korean and Jamaican women. The study tested whether Korean women reported higher overall problem scores and problems associated with anxiety and somatization. Using age as a covariate, nationality as an independent variable, and the nine BSI scale scores and the total problem score as dependent variables considered separately, ACNOVAs revealed significantly higher scores on five BSI scale scores for Korean than Jamaican women. Their significantly higher total problem score suggested that Korean women reported more overall psychological distress compared to Jamaican women. Large effects on the Somatization and Obsessive Compulsive scales suggest that Korean women are particularly vulnerable to developing somatic and anxiety-related problems.


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Self-Report Ratings of Psychopathology in Korean and Jamaican Women The population of Jamaican and Korean immigrants in industrialized nations like the United States has increased during the 20th century. For example, in major cities like New York, Jamaicans comprise one of the largest immigrant groups (Thomas, C., & Cindenthal, J., 1990) and Korean's comprise the fourth largest Asian group in the United States (US Census Bureau, 1996). The high representation of these immigrant populations within the United States and other nations makes understanding the cultural forces that influence their development of psychopathology and their resulting mental health needs extremely important (Lee, 1997). Understanding psychopathology in immigrant women and their descendants requires studies of their counterparts within their countries of origin. Establishing similarities and differences in psychological syndromes across different groups of women exposed to different societal customs and practices may inform researchers of the sociocultural factors that influence their psychopathology. This information can be equally important to interventionists and policy makers who design policy, programs, and interventions that address problems natives in their own countries experience and those that immigrants from the nations studied and their descendants present. Findings from these empirical efforts can therefore inform policy decisions regarding societal changes that can ameliorate psychological problems women across different nations present. More important, documenting problem similarities and differences across diverse groups of women who live in different cultural settings with different behavioral expectations can elucidate the impact of cultural forces that contribute to psychological problems these women develop. A sharp contrast in expectations regarding women's behavior exists between Jamaican versus Korean societies (Brown & Chevannes, 1998; Lee 1997). The two countries therefore provide a unique opportunity to study the impact of different customs on women's


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psychopathology in one nation versus the other. Korean society ascribes to Confucianism, a teaching that emphasizes internalization and inexpressiveness of emotions or emotional distress. Therefore, Koreans are expected to bear misfortunes and distress silently and patiently and the cultural mores forbid verbal expression of one's feelings and emotions (Kim, 1987). Besides Confucianism, the patriarchal nature of the Korean society emphasizes obedience and submissiveness in women. Thus, the society holds women in high esteem if they are obedient and submissive to their husbands and significant members of their husband's family (Hall, 1987). In contrast, to Korean women, Jamaican women live in a predominantly matrifocal society, and they comprise more than half of Jamaica's workforce (Dechesnay, 1986; Hamilton, 1984; Walls-Jones, 1992). Jamaican women's economic power and their developing yet strong women's movement has engendered and maintained gender equality in Jamaica. Therefore, Jamaican women are described as assertive and independent (Dechensay, 1986). Unlike their Korean counterparts, they seldom surrender their autonomy to their mates (Walls-Jones, 1992). Furthermore, Jamaican women readily express their feelings including their emotional distress. Although qualitative studies have examined Jamaican women’s expression of their emotions (e.g., Brown and Chevannes, 1998), no quantitative studies address this construct in Jamaican women. Moreover, our extensive literature search revealed no recent studies of psychopathology in Jamaicans or particularly on Jamaican women. While some research on emotional disorders in Koreans exists (e.g., Lin

et al., 1992) no research that compares Jamaica and

Korean women on psychopathology or other psychological constructs exists. Expression of emotions is positively associated with psychological health and negatively associated with psychopathology (Krystal, 1982). Therefore, the societal differences that condone and discourage emotional expression in Jamaican versus Korean women respectively may lead to differences in levels of distress and psychopathology across both groups of women. It is thus


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conceivable, that Korean women may experience and report higher levels of emotional distress and behavior disorders on measures of psychopathology than their Jamaican counterparts. Researchers (e.g., Lee 1977) have documented that because of admonitions against externalizing (e.g., via hostility) their problems, Koreans and Korean women in particular, manifest their psychological symptoms primarily via somatization and anxiety-related disorders, a process labeled Hwabyung (Lee, 1977; Prince, 1989). Therefore, while Korean women’s scores may be higher than Jamaican women on most syndromes, they may be considerably higher on measures of somatization and anxiety-related syndromes (e.g., obsessive compulsive) that are representative of Hwabyung. Conversely, one may speculate that since Korean women are discouraged from expressing their feelings, they may report significantly less symptomatic distress on measures of psychopathology than their Jamaican counterparts. The present study explored these questions by surveying Korean and Jamaican women in their respective countries. We therefore tested whether Korean women would report higher total problem scores or higher scores on certain problem dimensions (e.g., somatization) that are representative of Hwabyung than Jamaican women. Since the type of psychopathology either group presents may or may not be moderated by age, we tested for age main effects and for age X nationality interactions. Method Participants In Seoul, Korea, we recruited 99 women, ages 20 to 70 (Mean = 44.76, SD = 8.24) from six cultural centers that serve women (e.g., training, hobbies). We recruited 154 Jamaican women, ages 15 to 64 (Mean = 30.99, SD = 8.24) from large government agencies that serve women (e.g., training, employment) residing in Kingston, Jamaica’s largest city. Measures and Procedures In both countries, women completed the Brief Symptom Inventory (BSI: Derogatis, 1983),


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a 53-item self-administered measure. All items are rated on a five-point Likert scale ranging from 0-reflecting no distress to 4-indicating extreme distress. The BSI comprises nine dimensions labeled Somatization, Obsessive Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism, and total problem score. It is widely used in research and in clinical practice and its excellent psychometric properties are well documented (Derogatis, 1993). For example, it has excellent test-retest reliability (e.g., r = .90 for test-retest scores) and its internal consistency scores for its dimensions and total score range from .71 to .85. Jamaican women completed the BSI in its original form. However, we dropped three items from the Korean version because they were deemed offensive or culturally inappropriate for Korean women. Moreover, we changed the five-point scale to a four-point rating scale as the Korean translation for rating “3-quite a bit” and “4 -extremely” are virtually identical. We translated the BSI from English to Korean and back translated it from Korean to English twice to insure item equivalency in both languages. To make the Korean and Jamaican ratings equivalent, we dropped the items we omitted from the Korean BSI scale from all analyses. Moreover, by dividing each tem score by its potentially highest rating, (i.e., by four for Korea and five for Jamaica), we converted the scores on all items to decimals to insure equivalence in ratings across the five-point and four-point Jamaican and Korean respective items and their resulting scales. Our sample size for Korea and Jamaica did not allow the test of dimension equivalence via confirmatory factor analyses. However, we calculated internal consistency indices (coefficient alphas) for each dimension in each nation. For the Korean samples these indices were for the most similar to those of the original BSI as they ranged from .67 to .83. The lowest two indices emerged for .68 and .69 for Psychoticism and Interpersonal Sensitivity dimensions respectively. The


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indices for all other dimension were .70 and higher. For the Jamaican sample however, they ranged from .55 to .79 with the lowest two indices of .55 and .68 emerging for Psychoticism and Phobic Anxiety respectively and the indices for all other dimensions were .67 and higher. The coefficient alphas for total BSI scores for total scores in Korea and Jamaica were adequate as they were .96 and .94 respectively Results Using nationality (Jamaican versus Korean) and gender as independent variables, we performed 10 Analyses of Covariance (ANCOVAs) on each of the nine BSI dimensions and on total problem score as criterion variables considered separately. The mean ages of women in both nations are listed above. Since the mean age of the Korean sample seemed slightly older than the Jamaican sample we conducted a T test of the two means that accounted for unequal variances in the samples. The results revealed a significant difference between the two means T (1, 242) = 12.02, p < .0001. Thus, to concurrently partial out and tested for age effects, we entered age as a continuous variable (i.e., covariate) in the model. We applied the Bonferoni alpha correction criterion (Cliff, 1987) to reduce the chance of Type I error. Thus, only effects that had an alpha of level of < .005 were deemed significant. Also, we used Cohen’s (1988) criteria that consider ANCOVA effects sizes (ES) as small, medium, and large if they account for 1% to 5.9%, 5.9% to 13.8% and > 13.8% respectively. No interactions involving nationality and age emerged. Table 1 however, shows significant nationality effects emerged for six BSI dimensions, Somatization, Obsessive Compulsive, Depression, Anxiety, and Psychoticism and on the total BSI scores (Fs = 8.17 to 37.42, ps 10.60 ps < .005). For all age effects, younger women across both nations reported higher scores on each dimension than older women. Medium ESs emerged for Interpersonal Sensitivity and Hostility while the Depression ES was small. Discussion The findings clearly indicate that despite documented (Kim, 1987; Hall, 1987) cultural admonitions against expressing distress, Korean women reported higher levels of distress and psychopathology on most all BSI dimensions than Jamaican women endorsed. They further suggest that while Korean women may not verbally express their emotional problems, they readily admit to higher levels of distress when they were given an opportunity to do so via an anonymous questionnaire medium. Korean women also reported remarkably higher levels (i.e., medium to large ESs) than their Jamaican counterparts on problems that are associated with anxiety and somatic complaints than their Jamaican counterparts. These problems fit within the Hwabyung syndrome (i.e., Somatization, and Obsessive Compulsive symptoms) that Koreans and women in particular experience. This finding supports the notion that because of their societal proscriptions against most externalized (e.g., hostility) behavior, Korean women are especially likely to express their distress via somatization and other anxiety related syndromes. Jamaican women, however, exhibited far less specific (i.e., on BSI dimensions) and overall emotional distress and behavior disorders (i.e., total BSI scores) than their Korean counterparts. While we administered no measures of gender related oppression in either society, our findings suggest that Jamaica's focus on women's power may promote greater psychological health in Jamaican than in Korean women. The cross-national differences observed in the present study are intriguing, but most cross-cultural researchers (e.g., Draguns, 1982; Jahoda, 1997; & Triandis & Brislin, 1984) agree


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that there is equal value in similarities across different cultures. The age effects reported here may represent important similarities. Higher levels of specific syndromes like depression and hostility that younger Korean and Jamaican women reported may suggest that regardless of customs and practices across two very different societies, younger women seem more susceptible to specific types of psychological syndromes than older women. The presence of these disorders in younger women from very different corners of the globe suggests underlying biological or developmental processes. These findings may also reflect an interaction between biological and developmental forces and similar environmental factors across both nations. Despite the reasons, policy makers and program planners should consider addressing the treatment needs younger women across both nations manifest. Although the present study has revealed some intriguing findings, it possesses some limitations that should be considered when one interprets the results. First, we noted earlier that we have no direct measures of gender oppression that women in both nations may experience, or how this phenomenon impacts on their types and severity levels of psychopathology. Second, since both samples were drawn from Kingston and Seoul, we cannot claim that the findings represent those one might obtain from studies that sample women across both nations. Third we tried to recruit women from randomly selected centers that serve women across both nations, but we cannot profess that these samples represent all women in the regions sampled. Fourth, we know that SES is often associated with psychopathology (Dohrenwend, et al., 1992) but we had no appropriate measures of SES that were equivalent or could be adjusted to meet equivalency across both nations. Due to its high correlation with SES in prior studies we attempted to use years of education as a measure of SES (see Lambert, 1992 for discussion). While educational level revealed no significant effects, the vast differences in educational systems across both nations made reliable and trustworthy results difficult.


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To tackle these limitations, further studies are needed to address gender oppression magnitudes in general population samples of Jamaican and Korean women and how this construct impacts on their mental health. Studies that randomly survey women across different regions in the two nations are needed to determine whether the findings presented here are replicated in broader population samples across the two nations. Longitudinal studies that follow women at various points in their lives are also needed to unravel the causes of specific problems and problem bluffers in younger versus older women across the two nations. Finally, research that develop and test equivalent measures of SES across the two nations are needed to validly assess the impact of SES on the present findings. Despite its limitations, the present study is the first effort we know of that addresses psychopathology in women from Korea and Jamaica. It suggests that by virtue of their societal mores, women may develop and express varying types and severity levels of psychopathology. More specifically, women's psychological disorders and the form they take may reflect the customs that are present in their respective societies. The study also suggests that researchers and clinicians who study, assess, and treat women in both nations, women who migrate from these countries to other nations, and women who are descendants of immigrants from either country should evaluate their risks for development of the syndromes the present study identified. These professionals should pay special attention of the high risks for specific psychological disorders in Korean women and in younger women from both Jamaica and Korea. Educators who train professionals with the goal of understanding and reducing psychopathology in these groups of women should sensitize their trainees to the cultural factors that may influence or buffer the development of psychopathology in these women. Policy makers in both countries and especially those in Korea should also consider the toll societal customs and environments take on women in both societies. With the help of program planners, they may


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consider developing programs that address psychopathology that women from both nations report. By focusing on changing the societal customs that promote emotional distress and behavior disorders women present, this broad community-based intervention may alleviate and prevent further distress women from both nations experience.


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References Brown, J. & Chevannes, B. (1998). “Why man stay so:” Tie the heifer, loose the bull: An examination of gender socialization in the Caribbean. Mona, Jamaica: University of the West Indies. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159. Dechesnay, M. (1986). Jamaican family structure: The paradox of normalcy. Family Process. 25, 293-300. Derogatis, L.R. (1993). Brief Symptom Inventory. Minnesota: National Computer Systems, Inc. Draguns, J.G. (1973). Comparison of psychopathology across cultures: Issues, findings, directions. Journal of Cross-Cultural Psychology, 4, 9-47. Glass, G.V., McGaw, B., & Smith, M.L. (1981). Meta-analysis in social science research. Beverly Hills, CA: Sage. Hall, R. S. (1987). The life of Rev. William James Hall, M.D. medical missionary to the slums of New York, pioneer missionary to Pyong Yang, Korea. New York: Press of Eaton and Mains. Hamilton, M.A. (1984). Evidence of sex typed behaviors in professional Jamaican men and women. Sex Roles. 11. 1009-10019. Jahoda, G. (19977). In pursuit of the emic-etic distinction: Can we ever capture it? In Y.H. Poortinga (Ed.), Basic Problems in cross-cultural psychology (pp. 55-63). Amsterdam: Swets & Zatlinger. Kim, I. H. (1987). Korean families and family therapeutic paradigm for Korean urban middle-class families. New York:Verlag Perter Lang. Korean Crime and Justice Department (1997). Crimes in Korea from 1995 to 1996. Seoul,


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Korea. Jamaica Statistical Department Crime Office (1997). Major crimes in Jamaica during 1996 and 1997. Available HTP: www.infochan.com jcf.fatal.htm. Krystal, H. (1992). Alexithymia and the effectiveness of psychoanalytic treatment. International Journal of Psychoanalytic Psychotherapy. 9, 353-378. Lambert, M.C., Weisz, J.R., & Knight, F. (1989). Over- and undercontrolled problems in Jamaican and American children and adolescents: The culture general and culture specific. Journal of Consulting and Clinical Psychology. 57, 465-472. Lee, J. (1997). Somatization among Korean Women. Unpublished manuscript. Lin, M.K. (1983). Hwa-Byung: A Korean Cultural-Bound Syndrome? American Journal of Psychiatry, 140, 105-107. Lin, M.K. (1990). Hwa-Byung: The Construction of a Korean Popular Illness Among Korean Elderly Immigrant Women in The United States. Cultural Medicine and Psychiatry, 14, 495-512. Lin, M.K., Lau, J.K.C., Yamamoto, J., Zheng, Y.P., Kim, H.S., & Nakasaki, G. (1992). Hwa-Byung: A Community Study of Korean Americans. The Journal of Nervous and Disease, 180(6). 386-391. Prince, R. (1989). Somatic complaint syndromes and depression: The problem of cultural effects on symptomatology. Mental Health Research, 8, 104-117. Thomas, C., & Cindenthal, J. (1990). Migration and Mental Health among the People of the Caribbean, 1948-1980. International Review of Mental Health. 18(4). 92-102. Triandis H.C. & Brislin, R.W. (1984). Cross-cultural psychology. American Psychologist, 39, 1006-1016. United States Department of State (1997a) Korea-Consular Information Sheet. Available htp: travel.state.gov.skorea.html.


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United States Department of State (1997b) Jamaica-Consular Information Sheet. Available htp: travel.state.gov jamaica.html. Walls-Jones, D. (1992). Cultural and integrative therapy issues in the treatment of a Jamaican woman with panic disorder. Family Process, 31. 105-113.

Jamaican and Korean Women Table 1 Descriptive Statistics (means and standard deviations) of the Brief Symptom Inventory in Jamaican and Korean samples _______________________________________________________________________ Jamaica Sub-scale variable

Mean

Korea SD

Mean

SD

_______________________________________________________________________

*Somatization

3.88

3.87

7.31

5.29

*Obsessive-Compulsive

4.90

4.47

8.52

4.28

Interpersonal Sensitivity

2.38

2.59

3.15

2.30

*Depression

4.12

4.51

5.88

4.49

*Anxiety

3.75

3.88

5.33

4.12

Hostility

2.71

3.10

3.57

2.61

Phobic Anxiety

2.72

3.41

3.93

3.47

Paranoid Ideation

5.06

4.51

3.90

3.05

*Psychoticism

2.01

2.56

3.00

2.70

*Total BSI 33.99 26.34 48.19 28.4 ______________________________________________________________ * p < .005

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