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Correlates of DepressionAmong the Soviet Jewish Immigrant Elderly

Mikyong Kim-Goh

ABSTRACT. This exploratory study examined the prevalence rates ofdepressive symptoms among the elderly Soviet Jewish immigrants living

in Southern California. Structured interviews were conducted with a sam-ple of 50 self-identified Jewish elderly immigrants from the former SovietUnion, assessing their level of depression, health status, primary need ar-eas, and family support. According to the results, 72% of the respondentsreported mild to severe levels of depression. Age and satisfaction with thefamily assistance turned out to be significantly correlated with the level ofdepression among this group. Implications for human services practicewith vulnerable older immigrant populations are discussed. [Article copiesavailable for a fee from The Haworth Document Delivery Service: 1-800-

HAWORTH. E-mail address: Website: 2006 by The Haworth Press, Inc. All rights re-served.]

KEYWORDS. Soviet Jewish elderly immigrant, depression, Russian el-derly immigrants, older immigrants, immigrant mental health

Mikyong Kim-Goh, PhD, LCSW, is Chair and Associate Professor, Department of Hu-man Services (EC105), California State University, Fullerton, 800 North State College,Fullerton, CA 92834-6868 (E-mail: [email protected]). She holds a Doctorate andMasters degrees in Social Welfare from University of California at Berkeley.

The author wishes to thank Olga Royzman for her assistance with data collection.This research wassupportedby theUntenuredFaculty Development Grant from Cali-

fornia State University, Fullerton.

Journal of Human Behavior in the Social Environment, Vol. 13(2) 2006Available online at http://www.haworthpress.com/web/JHBSE 2006 by The Haworth Press, Inc. All rights reserved.

doi:10.1300/J137v13n02_03 35
http://www.haworthpress.com/http://www.haworthpress.com/web/JHBSEhttp://www.haworthpress.com/web/JHBSEhttp://www.haworthpress.com/

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INTRODUCTION

Since themid-1960s, nearly750,000 immigrants from theformer So-viet Union have settled in the United States (U.S. Department of Home-land Security, 2003). Among them, about half a million are believed tobe Jewish (Orleck, 1999). In response to the most favored nationtrade status granted by the U.S. government in 1974, the USSR agreedto relax her immigration policy, allowing Jewish people to emigrate,first only to Israel, and then by the late 1970s to the United States aswell. During the second half of the 1970s, more than 110,000 SovietJews emigrated to the United States (Orleck, 2001). With the Soviet in-vasionof Afghanistan in 1981,however, the number of Jewish refugees

entering the United States declined sharply until 1988 when the procla-mation of Perestroika by Gorbachevopened the doors for 20,000Sovietnationals to emigrate to the United States as refugees. Since then, thenumber of Soviet refugee admissions dramatically increased, peakingin 1994 with 63,420. In fact, between 1991 and 2000, as many as462,874 immigrants from the former Soviet Union entered the UnitedStates. Approximately 35% of them came from Ukraine, 23% fromRussia, 15% from Uzbekistan, and 8% from Belarus (U.S. Departmentof Homeland Security, 2003). The Greater New York City area has thelargest population of the Soviet Jewish in the United States, with morethan 300,000 migr, while approximately 100,000 settled in SouthernCalifornia, especially in the Los Angeles area near Plummer Park, theheart of this immigrant community (Orleck, 2001).

As a group, this new wave of Soviet Jewish population since 1988 isamong the most aged of all immigrant or refugee groups to settle in theUnited States. Nearly one in five Soviet Jews (17.5%) who entered theUnited States in 1993 were 65 and over, and the average age of the pop-ulation was 35.5 years. In contrast, the average age of immigrants to theUnited States was 29 (Gold, 1995). This phenomenon can be attributedto the Soviet migration policies that facilitated the emigration of multi-ple generations. In most of the former Eastern bloc countries, familiestended to consist of three generations living together in the same dwell-ing, which was the direct result of political and economic conditions(Althausen, 1993). When Soviet Jews applied for an exit visa, they hadto live on the margins of society before they were permitted to leave.For example, they were required to obtainpermission from their parentsand spouses, both current and former, if divorced. The potential migrwas also expected to be free of any debts, and was responsible for get-ting statements of non-indebtedness from all the local stores. When par-

36 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

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ents provided consent, they too were often viewed as traitors by thesociety and harassed as a result. This encouraged entire families of So-viet Jews to emigrate together (Drachman & Halberstadt, 1992). In theUnited States, the goal of most resettlement agencies has been to even-tually separate the generations into their own households. This has cre-ated difficulties in adjustment especially for elderly members oftenleading to an increase in depression and loneliness (Althausen, 1993;Gusovsky, 1995).

In a survey of 900 Soviet Jewish refugees in 14 cities in the UnitedStates, Simon andSimon(1985)found that themean levelsof educationfor males and females were 14 and 13 years, respectively, higher by oneyear than the average educational level of the U.S. population. Soviet

Jews arriving in this country were often perceivedas high-skilled work-ers who would easily adjust economically and who, in any case, wouldbe taken care of by a well-established American Jewish community.Thus, the study of Soviet Jewish refugees was not of interest to the gov-ernment bureaucracy as they were not viewed as a social problem,needing public attention and assistance. Due to the scanty informationon Soviet Jewish immigrants, therefore, a typical human service workerhas had little formal instruction on how to work sensitively and compe-tently with this specific group.

Soviet Jews have lived their entire lives under a Communist regime,and experienced long years of oppression, discrimination, and persecu-tion in their native country due to their Jewish heritage. Since the timeof the Czar, Jews were expelled from hundreds of villages, and severe

restrictions were placedon their trade in thecities. Jews suffered greatlyduring the brutal 30-year reign of Joseph Stalin, and they did not farewell under his successors. They had to face anti-Semitism at variouslevels, both personal and institutional, in the realms of higher educationand career advancement. In fact, many Soviet Jewish immigrants be-lieved that Russian anti-Semitism was more deeply rooted thanBolshevik ideology (Orleck, 1999). Over the years, Soviet Jews learnedto adapt to their intolerablesituations by skillfully manipulating thesys-tem. As a mode of survival, they developed culture of savvy charac-terized by adaptability and flexibility, exchanging favors at work, andfinding ways to get some privileges (Gold, 1995).

Although international migration and resettlement experiences havebeen associated with stress and conflicts among the newcomers in gen-eral, the elderly are especially vulnerable in the process. According toGozdziak (1989), problems of the recently immigrated elderly are moresevere than those faced by American-born elderly or long-time immi-

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grants. Indeedseveral studies of Soviet Jewish immigrants in theUnitedStates reported that the elderly among the immigrant cohort experi-enced a significant degreeof acculturative stress (Brodsky, 1988;Kohn,Flaherty, & Levav, 1989). Acculturative stress refers to a combinationof physical, mental, emotional, and spiritual tension, the source ofwhich is in the acculturation process. Common problems that elderlyimmigrants face include the loss of economic status, loss of familiarsupport systems, and the language barrier. It is typically more difficultfor elderly immigrants to master a foreign language and learn to navi-gate a new social system than it is for younger people.

Their financial and physical vulnerabilities create heightened anxi-eties, sometimes leading to confusion and a significant loss of self-es-

teem. For example, the Personal Responsibility and Work OpportunityReconciliation Act of 1996, better known as the Welfare Reform, gen-erated fear throughout many Soviet immigrant communities in theUnited States, for almost all of the elderly among Soviet Jewish immi-grants have been heavily dependent for their sustenance on the Supple-mental Security Income (SSI), Medicaid, food stamps, and federallysubsidized housing (Orleck, 2001). One major aspect of the legislationbarred legal immigrants from all means-tested and federally fundedpublic benefits for the first five years they were in the country. Legalimmigrants were barred from receiving SSI and food stamps as well asMedicaid coverage until they became United States citizens, a processwhich required 5 years of legal residency in this country. Among all theimmigrant groups, the Russians and the Koreans were found to be the

most in need of case management assistance as they remained ex-tremely vulnerable to the elimination of public assistance to legal immi-grants especially SSI (Cooper & Kleyman, 1997).

Despite strong indications of high stress levels, studies have foundthat most immigrants tend to underutilize health and social services fora variety of reasons including lack of information and awareness ofavailable resources, barriers in accessing the services, and cultural tra-dition of relying on informal kinship network rather than formal ser-vices for problem solving (Damron-Rodriguez, Wallace, & Kington,1994; LeClere, Jensen, & Biddlecom, 1994). However, immigrantsfrom the former Soviet Union are unlike most other immigrant groupsin that they overuse health and social services (Aroian, Khatutsky,Tran, & Balsam, 2001; Wheat, Brownstein, & Kvitash, 1983). Gelfand(1986) found that many of the elderly Russian Jewish group showed astrong reliance on governmental assistance for financial needs, as op-posed to depending upon aid from their informal social networks. Cul-


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tural norms and beliefs such as expectations for medical cure andnumerous diagnostic tests, preference for lengthy hospitalizations, andusing medical services for social and psychological problems may havecontributed to the higher utilization of formal services by this group(Aroian, Khatutsky, Tran, & Balsam, 2001).

In helping families experiencing the acculturative stress, Litwin(1995) suggested network intervention designed to moderate the rela-tions within the family in such situations, and to diversify elderly immi-grants personal social networks by introducing them to culturallycompatible peer groups. Historically theactivereestablishingof a socialnetwork in the host society was thought to significantly decrease psy-chological distress and the detrimental effects of uprooting among

immigrants. In their study of some 300Asian Americans in Seattle, Kuoand Tsai (1986) identified several positive factors that mediate immi-grant social stress. Their results revealed that personality hardiness andthree social network variables (number of friends with whom one cantalk, network density, and size of the close circle of ties) were nega-tively correlated with the depression scale scores.

In an epidemiological study, Blazer et al. (1988) found depressivesymptoms among those over 65 living in the community to be as high as50 percent. The purpose of this study was to explore the prevalence rateof depression among the elderly Soviet Jewish immigrants in SouthernCalifornia and to delineate factors that correlate with depression. Morespecifically, this study examined the effects of age, gender, self-ratedhealth, and family support on the level of depression in this group. The

hypotheses were that given the long history of oppression and discrimi-nation prior to their immigration and acculturative stress inherent in theresettlement process in a new country, elderly Soviet Jewish immi-grants were likely to experience a higher level of depression than thegeneral elderly population, and that the elderly immigrants who wereyounger, who rated their health as good or excellent, and who were sat-isfied with family assistance were less likely to be depressed.

METHODS

Fifty Soviet Jewish immigrant elderly living in the greater Los An-geles area and Orange County were interviewed. Using a conveniencesampling, the subjects were recruited from three different senior hous-ing complexes in Orange County and from Plummer Park in West LosAngeles, a popular gatheringplace for theelderly Soviet Jewish migr.

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To maintain a consistent procedure, a bilingual, Russian-speaking inter-viewer administered a questionnaire through face-to-face interviews.All of thesubjects preferred the interviewconductedin Russian, andtheresponse rate was about 90 percent.

The questionnaire included measures such as the Geriatric Depres-sion Scale (GDS; Brink et al., 1982; Yesavage et al., 1983), health sta-tus, and family support. The GDS is a 30-item, self-report depressionscale in a simple yes-no format, designed for use with older adults. Itstotal scores ranging from 0 to 30, this scale is particularly useful be-cause it focuses on affective and behavioral symptoms rather than so-matic items which tend to inflate the depression scores in older adults.Its reliability and concurrent validity (test-retest reliability = .85; inter-

nal consistency = .94) have been demonstrated among the elderly livingin the community as well as those in the institutional settings (Norris,Gallagher, Wilson, & Winograd, 1987; Olin et al., 1992; Parmelee,Lawton, & Katz, 1989).

Health status was measured by self-report of the following condi-tions used in previous research with Chinese immigrant elderly group(Mui, 1996): high blood pressure, heart disease, stroke, diabetes, arthri-tis, osteoporosis, eye problems, stomachaches, fatigue, chest pain, un-usual cough, and frequent headaches. Subjects rated their perceivedhealth status on a four-point scale ranging from 1 = Poor to 4 =Excellent. Family support was measured by the following questions:size of family, type of help provided by family members, and satisfac-tion with the quality of family help. Answers to the last question ranged

on a four-point scale from 1 = Very dissatisfied to 4 = Very satisfied.Additional questions included their reasons for migration, primary con-cerns, and basic demographic information such as age, gender, income,education, religion, length of stay in the U.S., living arrangement, andEnglish-speaking abilities. The questionnaire was first translated intothe Russian language, and then back-translated into English to ensureaccuracy of the translation.

RESULTS

Demographic characteristics of the sample are presented in Table 1.The mean age of the subjects was 71.7 years (SD= 6.6 years), rangingfrom 65 to 93. Twenty-nine subjects (58%) were female. A majority ofthe subjects (76%; n = 38) were married. Over 95% of the respondentsreported annual income of $ 8,000 or below, and most of them (88%;


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n = 44) relied on government assistance for living. The sample repre-sented a highly educated group. Sixty-eight percent (n = 34) completedcollege education, and another 10% (n = 5) had at least some college ed-ucation. The mean length of stay in this country was 5 years (SD= 4.0years). Sixty percent of the sample (n = 30) were living with spouseonly, followed by living alone (12%) and with children (12%).

Most respondents (86%; n = 37) seemed satisfied with the help thatthey were receiving from their family members. The most commontypes of family assistance included emotional support (48%), help withactivities of daily living (36%), followed by transportation (32%). Noneof them reported receiving financial support from their children. Re-garding the health status, the sample represented a relatively frail group

of older adults. Only 14% of the respondents (n = 7) rated their health asgood, while 70% (n = 35) and 16% (n = 8) rated fair and poor, respec-tively. None of the respondents rated their health as excellent. Highblood pressure (64%; n = 32) and fatigue (56%; n = 28) were the pri-mary health problems mentioned by subjects. The most frequentlygiven responses to the reasons for their immigrationto theUnitedStateswere family reunion (40%; n = 20), anti-Semitism in the former Soviet

Mikyong Kim-Goh 41

TABLE 1. Demographic Characteristics of Soviet Jewish Sample (N = 50)

Characteristic N % Characteristic N %

GenderFemaleMale

Age (years)a

Under 7071-8081 and older

Marital StatusNever marriedMarriedDivorcedWidowed

EducationLess than high schoolHigh school graduateSome collegeCollege graduate

Annual Incomea

Less than $7,000

$7,001-8,000$8,001 or more

2921

25177

23828

385

34

9

312

58.042.0

51.034.714.3

4.076.04.0

16.0

6.016.010.068.0

21.4

73.84.8

Source of IncomeEmploymentGovernment AssistanceSocial SecurityOther

Years of U.S. Residencea

Less than 2 years2-3 years4-5 years6-7 years8 years or longer

Religiona

JudaismNone

Living ArrangementAloneWith spouse onlyWith childrenWith spouse and rela-

tivesOther

24422

9191065

831

63063

5

4.088.04.04.0

18.438.820.412.210.2

20.579.5

12.060.012.06.0

10.0

aIncludes missing data

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Union (26%; n = 13), and better opportunities for children (18%; n = 9)(Table 2). Subjects were most concerned about health problems (46%;n = 23), followed by U.S. citizenship exam (38%; n = 19), problem withEnglish language (28%; n = 14), and lack of transportation (26%; n =13) (Table 3).

According to Brink and his colleagues (1982), those who reported 10or fewer symptoms out of the 30 GDS scale items were considered nor-mal, those who reported 11 to 20 symptoms were considered mildly de-pressed, and those who reported 21 or more symptoms were consideredmoderately to severely depressed. The overall mean for this samplewas13.9 (SD= 6.2), scores ranging from 3 to 30 (Table 4). Applying theBrink et al. cutoff points, 54% (n = 27) of the sample were mildly de-


TABLE 2. Reasons forSoviet Jewish Elderly Immigration to theUnitedStates

Reasons for Immigration N

Family Reunion in the United States 20

Anti-Semitism in the Soviet Union 13

Better Opportunities for Children 9

Increased Nationalism in Republics 8

For Medical Treatment 3

Other 2

TABLE 3. Major Concerns of Soviet Jewish Elderly Sample

Type of Concern N

Health Problems 23

Citizenship Exam 19

Problem with English Language 14

Lack of Transportation 13

Well-being of Family 12

Financial Instability 8

Being Separated from Family 6

Dissatisfaction with Healthcare 6

Affordable Housing 6

Familys Health 5

Poor Memory 2

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pressed and 18% (n = 9) were moderately to severely depressed, while28% (n = 14) fell within the normal range. Among the GDS items, re-spondents were most worried about the future, found it hard to start newprojects, and felt others were better off than they were. In order to delin-

eate factors that correlate with depression among these elderly immi-grants, a multiple regression analysis was conducted using the followingindependent variables; age, gender, self-rated health, and satisfaction

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TABLE 4. Percentage of the Sample Agreeing with Geriatric Depression Scale

(GDS) Items

Scale Item Percentage Scale Item Percentage

1. Satisfied with life 82.0 22. Situation hopeless 22.0

2. Dropped activitiesand interests

64.0 23. Others are better off than you* 66.7

3. Life is empty 30.0 24. Upset over little things 54.0

4. Often get bored 26.0 25. Feel like crying 30.0

5. Hopeful about the future 74.0 26. Trouble concentrating 60.0

6. Obsessive thoughts 36.0 27. Enjoy getting up in themorning

48.0

7. In good spirits* 59.1 28. Avoid social gatherings 40.08. Fear bad things will

happen62.0 29. Easy to make decisions 34.0

9. Happy most of the time* 71.4 30. Mind as clear as it used to be 28.0

10. Often feel helpless 38.0

11. Often get restless 64.0

12. Prefer to stay home 40.0

13. Worry about the future 80.0 Diagnosis (Brink et al. , 1982)

14. Problem with memory 66.0 Normal (0-10) 28.0

15. Feel wonderful to bealive

84.0 Mildly depressed (11-20) 54.0

16. Feel downhearted andblue

40.0 Moderately to severelydepressed (21-30)

18.0

17. Feel worthless 38.0

18. Worry about the past 66.0

19. Feel life is exciting 64.0

20. Hard to start newprojects*

67.4

21. Full of energy 48.0

*Includes missing data

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with the family assistance. The model explained 29% of the variance(Table 5). Age (Beta= .38;p= .01) and satisfaction with the family as-sistance (Beta= .333;p= .032) turned out to be significant correlatesof depressive symptoms in our sample, and self-rated health (Beta=.26;p= .07) approached significance. An alpha level of .05 was usedfor all statistical tests.

DISCUSSION

The elderly Soviet immigrants in our study reported a significantlyhigher level of depression and health problems than the general popula-

tion and other immigrant elderly groups such as the Chinese (Mui,1996). Given the mean age of the current sample being 5 years youngerthan the Chinese sample, this finding is even more significant. Age andperceived family assistance turned out to be significant correlates ofdepression among this group and self-rated health approached near sig-nificance. The older the subject and the less satisfied with family assis-tance, the more likelihood that the subject would be experiencingdepression. The results of the study, however, must be addressed in thelight of the methodological limitations of the study: the small size of the


TABLE 5. Regression Model: Correlates of Depressive Symptoms Among

Elderly Soviet Jewish Immigrants

Dependent Measures

Correlates UnstandardizedCoefficient

SE Beta P

Age .34 .12 .38 .010

Gender 1.35 1.65 .11 .419

Self-rated health 2.62 1.42 .26 .073

Satisfaction withthe family assistance

2.017 .903 .333 .032

R2 .29

AdjustedR2

.22

F 3.92

df 4, 38

P .009

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sample, the possible effects of underlying physical disorder, and the ab-sence of controlled variables in the analysis. The sampling procedure, aconvenience sampling, may also have resulted in selection bias.

Despite the limitations of the study, the following implications forhuman services practice can be drawn. First, given the low ratings onhealth status in this sample, the worker needs to pay close attention toany unmet medical needs among this elderly group. Conceivably poorphysical health contributes to depression and a sense of helplessness.Although frequent somatization and obsession with physical healthamong this group have been observed by some researchers (Kohn,Flanerty, & Levav, 1989), ruling out any medical conditions that maybe affecting their mental status is important. Second, the high level of

depression reported by the sample demands careful attention to the psy-chiatric vulnerability among this group, and requires an appropriate ac-tion by the human services worker such as psychopharmacologicalreferral and treatment. The basic principles of clinical practice shouldbe observed, such as establishing a warm and trusting relationship, ac-ceptance and validation of the clients feelings, and understanding ofthe clients frame of reference. The worker should allow the expressionof feelings of grief and loss while being familiar with the role of culturalvalues and norms including the dynamics of the process of resettlementand acculturation, and provide ego-supportive treatment by reinforc-ing the elderly immigrants past strengths and coping mechanismsrather than challenging and weakening the clients ego defenses(Gusovsky, 1995).

Third, the participants primary concerns indicated a need for basicconcrete services such as transportation, assistance with the citizenshipexam, trained interpreters, and information and referral services staffedby bilingual/biculturalworkers. Fourth, workers need be sensitiveto theimpacts of significant social policies such as the Welfare Reform oranti-immigration bills on the immigrant population in general, and onthe older immigrants in particular, and advocate for the clients when-ever necessary. Considering 78% (n = 38) of the respondents in thisstudy have lived in the United States for 5 years or less, and that 92%(n = 46) of them relied at least partially on government assistance forliving, their concerns about financial vulnerability and uncertaintyabout their future are understandable. In fact, many of the participantswere studying theEnglish languageandcivic lessons in order to preparefor the citizenship test, and 19 subjects specifically identified the re-quired citizenship examination as their primary concern. Therefore, oneneeds to separate clinically significant depression from realistic worry

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about survival such as economic issues that are normal and appropriateespecially with this group in a given sociopolitical context.

Finally human service workers must be sensitive to potential inter-generational issues and conflicts in the Soviet Jewish group. Althoughmultigenerational households were common in the former Soviet Un-ion, a majority (60%; n = 30) of the study sample were living withspouses only or living alone (12%; n = 6), while only 8 subjects (16%)were living with their children. Exploring the loss of parental status, es-pecially among the highly educated and those who left prestigious po-sitions in their native countries, and its impact on the family structureand intergenerational relationships should be an integral part of theworkers function. One of the goals of a human service worker whileworking with this specific group is to reinforce a new sense of inde-pendence and reciprocity between the generations by considering cli-ents history and culture, understanding clients relationships withexisting neighborhood networks that can provide needed informationand practical assistance, and by connecting clients with appropriatecommunity resources. Helping the Soviet elderly immigrants expandtheir social networks beyond their spouses and children to the broadercommunities may help reduce the level of depression and enhance theirquality of living.

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