Family life stress coping and mental health among vietnamese marriage migrant women in south korea a mixed methods study

Family Life Stress, Coping, and Mental Health among Vietnamese Marriage Migrant Women in South Korea: Nguyen Thi Phuong Thao* Abstract: Vietnamese marriage migrant women experience mul

Family Life Stress, Coping, and Mental Health among

Vietnamese Marriage Migrant Women in South Korea:

Nguyen Thi Phuong Thao*

Abstract: Vietnamese marriage migrant women experience multiple stressors associated with

married life in South Korea While there are a number of studies investigating acculturative stress, relatively little work has examined family life stress and its harmful effect on mental health among these marriage migrant women The purpose of this paper is to explore the impact of family life stress on depression and the mediating roles of some personal coping resources (self-esteem and specific coping behaviors) on this relationship among a sample of Vietnamese marriage migrant women living in South Korea The study utilizes a mixed methods design A quantitative survey is completed by 301 Vietnamese migrant wives with a mean age of 29 years (SD=5.49) Qualitative interviews are conducted with five Vietnamese migrant wives and analyzed using thematic analysis The findings indicate that family life stress is positively related to depression, both directly and indirectly through low self-esteem and greater use of avoidant coping The study provides several implications for social work research and practice

Keywords: Family life stress; coping; depression; Vietnamese marriage migrant women; South

Korea

Received: 1 st March 2016; Reviesed: 29 th March 2016; Accepted:10 th April 2016

1 Introduction

1During the last two decades, a number of

women from Asia have migrated to South Korea

through transnational marriage with Korean

men The phenomenon of marriage migration is

attributed to both domestic and global factors

(Chung et al 2013; Lee et al 2015)

Domestically, declining marriage and birth rates,

and a disproportionate sex ratio in rural areas

have made it hard for rural or low-income

1 This paper is a revised version of the author’s doctoral

dissertation from the Seoul National University (2016,

February)

*Institute of Social Welfare, Seoul National University,

South Korea email: thao_npo@naver.com

bachelors to find their wives (Chung et al 2013; Lee et al 2015) Globally, on the other hand, rapid growth of the Korean economy has served

as a pull factor attracting many young women from neighboring countries to South Korea (Lee

et al 2015) In particular, the number of marriage migrant women from Vietnam has grown each year and occupied the highest proportion of marriage migrant groups in this country, followed by Chinese and Korean-Chinese2 women (Statistics Korea 2015) According to the

2 Korean-Chinese (termed “Chosonjok”) refer to Koreans with citizenship of China, who are residing in China (doopedia.co.kr,

http://terms.naver.com/entry.nhn?docId=1176421&cid=409 42&categoryId=39994)

2015 Statistics, the number of unnaturalized

Vietnamese migrant wives has risen to nearly

40,000, which constitutes 30.4 percent of female

marriage migrants in South Korea Most of these

women have chosen transnational marriage as a

way to improve not only their lives but their

natal families’ lives as well (Hoang 2013)

Nevertheless, migration decision may put

foreign wives at risk for facing multiple stressors

and challenges related to cultural adaptation

(Castro et al 2010) or acculturation-which refers

to changes in attitudes, beliefs, and behaviors

that occur as an individual adjusts to a new

culture (Berry 1997) For instance, migrant

wives may experience such acculturative

stressors as language barriers, discrimination, or

pressures to assimilate (Williams et al 1991) In

the case of marriage migrant women,

particularly, they also have to face other potential

stressors associated with transnational marriage

such as family conflicts, child rearing as a

mother of a “multicultural child”, or financial

hardship (Jeong et al 2010; Lee et al 2015; Nam

2010; Park 2012) A great deal of evidence has

demonstrated that exposure to stress may lead to

mental health problems, particularly depression

(Noh et al 1996; Pearlin et al 1981; Williams et

al 1991) Empirically, Vietnamese wives have

reported higher levels of depressive symptoms

than other Asian women (Chae et al 2014; Choi

et al 2012) Thus, a growing body of research

recently has emerged to explore difficulties as

well as to identify risk and protective factors for

depression among Vietnamese marriage migrant

women (Byun 2012; Chae et al 2014; Choi et al

2012) However, previous studies have placed

primary emphasis on acculturative stress (Chae

et al 2014), not giving much attention to

family-related stress in marriage migrants The present

study, thus, has been conducted in an effort to fill this gap by exploring the impact of family life stress on depression among Vietnamese migrant wives

Further, the current study also identifies some coping resources, including self-esteem and specific coping behaviors (problem solving, support seeking, and avoidance) in the relationship between family life stress and depression to provide a broader understanding of the stress process among Vietnamese wives Indeed, research has emphasized the role of coping in the migration process as migrants have

to cope with the challenges and stressors for adaptation to the new culture (Berry 1997, 2006) Very few studies to date have examined coping behaviors in marriage migrant women in South Korea Therefore, the main objectives of this mixed-methods study are (1) to understand the effect of family life stress on mental health; and (2) to explore the mediating roles of coping resources (self-esteem, coping behaviors) in this relationship, utilizing the stress process model (Pearlin et al 1981) as a theoretical framework Significant findings from this study are expected

to enhance people’s understanding of stress and coping in Vietnamese marriage migrant women and provide useful information for social workers when working with Vietnamese wives Specifically, the current study addresses the following research questions:

- What is the relationship between family life stress and depression among Vietnamese marriage migrant women in South Korea?

- Do self-esteem and coping behaviors mediate the relationship between family life stress and depression among Vietnamese marriage migrant women in South Korea?

2 Literature review

2.1 The stress process model

The stress process paradigm (Pearlin et al.,

1981) is one of the most widely held

perspectives in the sociology of mental health

(Noh et al 1996) The basic conceptual

framework of the stress process model focuses

on the interrelationships among three major

components: the sources of stress (i.e life events,

chronic stress), the mediators of stress (i.e social

resources, psychological resources, specific

coping responses), and mental health outcomes

(e.g depression, anxiety) (Pearlin et al 1981) In

this model, it is assumed that a change in one of

these factors can lead to changes in the others,

thus comprising chains of effect (Pearlin 1999)

Several assumptions have been proposed

regarding the roles of coping and psychosocial

resources in the stress process First, it begins

with the assumption that unchecked external

stressors will disrupt one’s psychological

equilibrium and induce psychological outcomes

in the form of distress or depression (Pearlin et al

1981) Second, it is further hypothesized that

certain psychosocial resources and coping may

intervene in this process so as to (1) eliminate or

change conditions leading to the problems, (2)

alter the meaning of the situation in a manner

that reduces its threat, or (3) keep the symptoms

of stress within manageable bounds (Pearlin et al

1978) Consequently, the stress process

framework undergirds the core components of

the present study concerning the relationship

between family life stress and depression, as well

as the potential mediating effects of some

psychological and coping resources among

Vietnamese marriage migrant women in South

Korea

2.2 Depression among marriage migrant women in South Korea

Depression is common in many societies and has been defined in recent years as a major global public health problem (Karasz 2005) In South Korea, depression is also arising as a major mental health problem among marriage migrant women (Kim et al 2010) The high prevalence of depression in migrant wives has been shown in earlier research Roh and Kim (2012), for example, have studied mental health among over 200 marriage migrant women in rural areas and reported 52.9% of the participants being at risk for clinical depression and approximately 23.4% having depression In Kim and colleagues’ (2015) recent study on female marriage migrants living in urban and rural areas, 39.9% of the participants have been found

to be at risk for clinical depression Common problems such as acculturative stress, marital stress, economic and language difficulties, or lack of social support may predispose female marriage immigrants to a high risk of increasing mental health problems (Roh et al 2012; Shu et

al 2011) Particularly, Vietnamese marriage migrant women have been found to have higher levels of depressive symptoms than other Asian wives such as Japanese or Chinese (Cha et al 2008; Lim et al 2010) Choi and colleagues (2012) have examined the prevalence of postpartum depression in immigrant Vietnamese mothers in Korea and found that 34.3% of the participants represented serious depression Most

of the Vietnamese marriage immigrant women

in Chae and associates' (2014) study also have been reported to be at risk for an impairment in mental health functioning Several factors for such high levels of depression among Vietnamese wives are suggested as marital discord, inadequate social support, poor Korean language ability, and strong ties to the original culture (Cha et al 2008; Choi et al 2012)

2.3 Family life stress and depression among

marriage migrant women

Previous research has reported numerous

pressures that marriage migrant women may

face in their daily lives in South Korea,

particularly financial hardship and family

conflicts (Kim et al 2011; Lee 2013) While the

family plays an extremely important role in life

for Vietnamese people (Nguyen 2003), family

conflict has a profound negative impact on their

mental health status (Kim 2011) The main cause

of conflicts between migrant wives and Korean

family members is considered the lack of mutual

understanding of cultural differences in family

values (Kim et al 2007; Won et al 2014) Indeed,

adapting to the Korean patriarchal culture is

considered a big challenge for Vietnamese

marriage migrant women as Vietnam is a

well-known Asian country that has relative gender

equality (Knodel et al 2004) Hence, they may

find it hard to understand such Korean traditional

customs or beliefs as paternalistic authority,

daughters-in-law’s role overload, or

mothers-in-law’s interference (Jeong et al 2010; Park 2012)

In addition, lack of respect towards the foreign

wives among Korean husbands and in-laws has

also contributed to increasing family conflicts as

well as daily life stress in Vietnamese marriage

migrant women (Jeong et al 2010) Also, the

presence of children can increase stress levels

and mental health problems among migrant

wives (Shu et al 2011) According to Shu and

colleagues (2011), migrant mothers suffer from

more pressures than local mothers because they

have to both adjust to an alien culture and serve

as a mother in the Korean family (Shu et al

2011) Moreover, children’s Korean language

ability and school bullying are also everyday

concerns among migrant mothers in South Korea

(Park 2012) The weight of evidence has

demonstrated that exposure to such life stressors

can potentially increase depressive symptoms

(Hammen 2005; Noh et al 1996; Paykel 2003; Pearlin et al 1981)

2.4 Stress, self-esteem, and depression

Self-esteem is a primary personal resource in the stress process model (Noh et al 1996) Self-esteem “involves the judgments one makes about one’s own self-worth” (Pearlin et al., 1981, p.340) and is regarded a protective psychological resource that help people adapt to stressful situations (Greenberg et al 1992) This type of resources has been shown to be negatively associated with psychological distress among persons experiencing life stress (Pearlin et al 1981; Noh et al 1996) In the stress process, self-esteem is considered a mediator which is hypothesized to be diminished by uncontrollable external stressors, then resulting in psychological distress or a loss of well-being (Pearlin et al 1981) Many empirical studies have demonstrated the mediating role of self-esteem

in the relationship of stress to depression (Jesse

et al 2014; Lee et al 2013) Specifically, exposure of stress is often linked to decreasing levels of self-esteem, which in turn increase depressive symptoms (Jesse et al 2014; Lee et al 2013)

2.5 Stress, coping behaviors, and depression

Coping responses or strategies are defined as

“cognitive and behavioral efforts to master, reduce, or tolerate the internal and/or external demands that are created by the stressful transaction” (Folkman 1984: 843) As responses

to stress are various; many researchers have categorized these coping behaviors In 1980, Folkman and Lazarus proposed two major types

of coping: problem-focused coping, which aims

at taking actions to deal directly with the

problems, and emotion-focused coping, which

involves efforts to reduce emotional distress,

such as avoiding, blaming, minimizing, wishful

thinking, ventilation, or seeking social support

In 1990, Amirkhan classified coping behaviors

into three categories, including problem-solving,

social support-seeking, and avoidant behaviors

The Amirkhan’s (1990) classification of three

types of coping behaviors has been widely used

in many studies for its generalizability across

populations (Ager et al 1998; as cited in

Desmond, Shevlin, and MacLachlan 2006)

Problem solving refers to instrumental and

problem-focused approaches to management of

stress; seeking support involves a process of

turning to others for seeking comfort, help, and

advice; and avoidance relates to escape

responses regarding physical and/or

psychological withdrawal (Desmond et al 2006)

Particularly, the classification of these three

categories of coping may reflect Asians’ culture

regarding the use of seeking support and

avoidance coping (Wong et al 2010) For

instance, researchers noted that Asians’ coping

behaviors are shaped by Asian cultural values

and worldviews indicating that individuals

should adjust their feelings or behaviors to fit

their environment so as to preserve social

harmony, which emphasize the importance of

accepting rather than confronting the problems,

and the need for saving their face by not

disclosing the problems to others (Inman et al

2007) Likewise, other studies have found

greater reluctance to seek social support among

many Asian Americans than European

Americans and stated that this trend is linked to

Asian Americans’ concerns that social support

would result in a disruption of group harmony or

loss of face (Kim et al 2006; Wong et al 2010)

Hence, the present study used the Amirkhan’s

(1990) classification to explore coping behaviors

utilized by Vietnamese marriage migrant women

in dealing with family life stress they experience

in South Korea

In the stress process, coping behaviors are regarded as an important resource “that people can tap to mediate the stressful impact of life problems” (Pearlin et al 1981:341) The critical role of coping in immigrants’ adaptation to the new environment is also well recognized (Berry 1997; Yakhnich et al 2008) That is, coping successfully with stress helps migrants adaptive

to the new society, while unsuccessful coping may lead to maladaptive outcomes including specific behaviors and thought or negative emotional patterns such as depression (Berry 1997) Regarding the roles of specific coping behaviors, previous studies have shown that support seeking and problem solving are often associated with lower levels of depressive symptoms, while using avoidance can lead to high depressive symptoms (Crockett et al 2007; Martin et al 2013; Roohafza et al 2014)

On the basis of the findings from existing research, in the current study it is hypothesized that 1) family life stress will be positively associated with depression among Vietnamese marriage migrant women; 2) self-esteem and coping behaviors will mediate the effects of family life stress on depression Specifically, it is further hypothesized that 2-1) low self-esteem will augment the effects of family life stress on depression; 2-2) problem-solving behaviors will reduce the effects of family life stress on depression; 2-3) support-seeking behaviors will reduce the effects of family life stress on depression; 2-4) avoidant behaviors will augment the effects of family life stress on depression The conceptual research model for this study is shown in Figure 1

Figure 1: Research model (Adapted from Wolf, Stidham, and Ross 2015)

3 Methods

3.1 Study design

This study used a quantitative-qualitative

explanatory sequential design in which the

qualitative data were used to illuminate the

quantitative results (Creswell 2006) The

purpose of this design was to gain more detailed

information about family life stress and specific

coping behaviors among Vietnamese marriage

migrant women The study was approved by

Seoul National University’s Institutional Review

Board (approval number 1503/001-003)

3.2 Quantitative phase

The quantitative data were obtained via a

cross-sectional survey, using a structured questionnaire

Criteria for selecting the participants for the

quantitative phase included (1) Vietnamese

women; (2) being married with Korean men; (3)

currently residing in South Korea; (4) having basic

reading ability in the Vietnamese language; and (5)

being willing to participate the survey Two

sampling techniques were used in this phase: (1)

convenience sampling, drawn from multicultural family support centers; and (2) snowball sampling, with participants referred to the researcher by other participants of the study Data collection was performed both directly by the researcher and indirectly by some representative participants Totally, 420 questionnaires were distributed to Vietnamese marriage migrant women residing in Seoul city, Incheon city, and Gyeonggi, Gyeongsang, Chungcheong and Jeolla provinces over two months of June and July, 2015; of these,

400 questionnaires were returned in which 30 obtained by convenience sampling and 370 obtained by snowball sampling Then, 60 cases were excluded due to missing and 301 cases having children were used in the final analysis as the aim of the study is to investigate the impact of stress including child-related stressors on mental health among Vietnamese women

3.3 Questionnaire

A comprehensive questionnaire was created including four widely used standardized

questionnaires: the Center for Epidemiologic

Studies Depression Scale (CES-D), the Family

Inventory of Life Events and Change (FILE), the

Rosenberg Self-Esteem Scale (RSES), and the

Coping Strategy Indicator (CSI)

Specifically, the Vietnamese version of the

CES-D (Radloff 1977) was used to explore

depressive symptoms among Vietnamese wives in

South Korea This is a 20-item self-reported scale

that assesses the severity of depressive symptoms

during the past week on a 4-point Likert scale

(ranging from 0 = “less than one day” to 3 = “five to

seven days”) Items were scored either 0-3 or 3-0

with positive items (items 4, 8, 12, and 16) being

scored reversely Possible range of scores is zero to

60, with the higher scores indicating the presence of

more symptomatology This scale has been

validated in Vietnamese language (Nguyen et al

2007) High internal consistency has been reported

with Cronbach’s alpha coefficients ranging from 87

to 92 among Vietnamese population samples

(Doan 2011; Nguyen et al 2007) The scale also

showed very good internal consistency (α = 89) in

this study

Family life stress was measured through a

28-item scale which was adopted and standardized by

Choi (1990) from the 71-item FILE (McCubbin et

al 1981) This scale addresses five aspects of life

which can cause stress, including difficult

relationships to the husband, children,

parents-in-law, and economic and health problems For each of

items, respondents reported the degree to which

they perceived the problems using a 5-point Likert

scale ranging from “strongly disagree (0)” to

“strongly agree (4)” Factor scores were calculated

as the mean of each participant’s responses to all

items in the scale Higher scores indicate higher

levels of stress The internal consistency (.95) of the

scale has been established with 289 Vietnamese,

Filipino, Chinese, Mongolian, Thailand, and

Japanese wives living in Seoul city and Gyeonggi

province, South Korea (Park 2012) The scale also

had good internal consistency (α = 92) in this study Additionally, the internal consistency of each of the five subscales was moderate with 80 for Marital Stress (6 items), 73 for Parenting Stress (5 items), .87 for In-law Stress (6 items), 65 for Financial Problems (6 items), and 64 for Health Problems (5 items)

The Vietnamese version of the RSES (Rosenberg 1965) was adopted to measure feelings

of self-worth and self-acceptance among the participants All items were answered using a 5-point Likert scale format ranging from strongly disagree (0) to strongly agree (4) Negatively-phrased items were reverse scored Factor scores were calculated as the mean of each participant’s responses to all items, with higher scores indicating higher self-esteem The internal consistency (.86) and the test-retest reliability (.80) of this scale were established with Vietnamese-born students in America (Dinh et al 1994) In this study, the internal consistency of the RSES was 72

The CSI (Amirkhan 1990) was used to identify specific coping behaviors the participants used to cope with life stress Respondents were asked to identify a stressful event occurring within the last six months and to consider the manner in which they had coped with it For each of items, respondents reported the degree to which they used the strategy by using a 3-point Likert scale: not at all (0), a little (1), or a lot (2) Each of the three subscales (Seeking Social Support, Problem Solving, and Avoidance) contained 11 items, and subscale scores were calculated as the mean of each participant’s responses to appropriate items Higher scores reflect greater use of a specific coping strategy Li (2014) affirmed the CSI scale’s validity and reliability on Asian samples In this study, Cronbach’s alpha coefficients also indicated adequate internal consistency for the scale (.89), and for each of the subscales with 83 for Seeking Social Support, 87 for Problem Solving, and 75 for Avoidance

Additionally, the questionnaire comprised

socio-demographic characteristics, including age,

education, monthly income, length of stay, use of

broker agency, and Korean language, which were

used as control variables in this study as these

variables have been found to influence depressive

symptoms among marriage migrant women (Ha et

al 2013; Kang et al 2010; Youn et al 2010; Won et

al 2014) Age was measured by asking respondents

to indicate their exact age Education was measured

by asking respondents to indicate the highest

education they received, ranging from zero (no

education at all), one (elementary school), to five

(university or more) Income was measured by

asking respondents to indicate the average monthly

salary they earned from work, ranging from zero

(no income), one (less than 500,000 won), to five

(more than 3,000,000 won) Length of stay was

measured by asking respondents how long they had

been living in Korea in year- and month-unit Use

of broker agency was measured by asking

respondents whether they married the current

spouse through a marriage broker The last control

variable was Korean language proficiency which

was measured by asking respondents’ perception of

how fluent they were in Korean speaking, listening,

reading, and writing on a 5-point Likert scale,

ranging from one (very poor) to five (very good) In

the regression model, factor scores were calculated

as the mean of participant’s responses to all items of

four skills, with higher scores indicating higher

levels of language ability

In the current study, quantitative data were

coded and entered into the Statistical Package for

Social Science (SPSS) program (version 21) for

statistical analysis The method of regression

analysis was utilized to test the research questions

and hypotheses The process of analysis included

the initial and main analysis phases The initial

analysis phase was descriptive statistics of all

variables to provide information on general

characteristics of the participants, and the main

analysis included three regression models to identify the relationships among the variables In particular, I used bootstrap method through the PROCESS macro for SPSS developed by Hayes (2013) to test

a multiple mediator model with four mediators: self-esteem, problem solving, support seeking, and avoidance Bootstrapping is a nonparametric approach involving the process of repeatedly sampling from the data set and estimating the indirect effect in each resampled data set based on confidence intervals (Hayes 2008) There is significant mediation at the 05 level if the bias-corrected 95% confidence interval excludes zero (Hayes 2013) The mediating effects of four mediators were assessed based on Baron and Kenny’s (1986) four steps in establishing mediation

3.4 Qualitative phase

In the qualitative phase, I used a multiple case study approach (Yin 2002) to provide the rich and detailed descriptions of the participants’ experiences (Monette et al 2005) of stress and coping through in-depth semistructured telephone interviews in Vietnamese with five participants who completed the survey Each of the interviews took approximately 1-1.5 hour(s) The interview questions included: (1) How do you feel about your family life in South Korea? (2) What makes you stressed in your family life in South Korea? (3) How does that stressor affect your mental health? (4) How do you cope with your family life stress? Five telephone interviews were recorded and transcribed verbatim Data were analyzed using Rubin and Rubin’s (1995) formal systems for the analysis of qualitative data (coding, categorizing, linking different themes to one another) (O’Connor and Gibson 2003)

4 Quantitative results

4.1 Descriptive statistics

Descriptive statistics for the variables are shown in Table 1

Table 1: Descriptive statistics (n = 301)

Education

None

Elementary school

Middle school

High school

Vocational school

University or more

2 (0.7)

23 (7.6)

85 (28.2)

119 (39.5)

41 (13.6)

31 (10.3) Monthly income

None

Below KRW 500,000

KRW 500,000–999,000

KRW 1,000,000–1,999,000

KRW 2,000,000–2,999,000

More than KRW 3,000,000

170 (56.5)

9 (3.0)

34 (11.3)

70 (23.3)

14 (4.7)

4 (1.3)

Use of broker agency

No

Yes

143 (47.5)

158 (52.5) Korean language proficiency

Listening

Speaking

Reading

Writing

301 (100)

3.31 (.88) 3.19 (.87) 3.36 (.86) 3.12 (.88)

Family life stress

Marital stress

Parenting stress

In-law stress

Financial problems

Health problems

1.66 (.77) 1.69 (.71) 1.61 (.86) 1.77 (.60) 1.55 (.70)

Coping behaviors

Problem solving

Support seeking

Avoidance

301 (100)

1.24 (.44) 1.02 (.40) 0.81 (.35)

Note: SD = standard deviation

With respect to socio-demographic

characteristics, the mean age of the participants

at the time of the survey was 29.49 years (SD =

5.49) The majority (76.1%) of the participants

had high school education or less, while 13.6%

completed vocational school and 10.3% were

university graduates or more Regarding

monthly income, 56.5% of the participants

reported to have no income or to be unemployed

Of the employed, 37.6% reported their monthly income of less than two million won, while only 6.0% reported higher income levels The average length of stay in Korea of the participants was

5.25 years (SD = 3.45) More than a half of the

participants (52.5%) used a marriage broker for the current transnational marriage In terms of

Korean language ability, the mean score for

reading skills was the highest (M = 3.36, SD =

0.86), while the mean score for writing was the

lowest (M = 3.12, SD = 0.88)

As for depression, the mean score for this

factor was 22.31 (SD = 11.35), higher than the

cut-off score over 21 for having depressive

symptoms (Cho & Kim, 1998).The mean score

for family life stress was 1.66 (SD = 0.59)

Specifically, financial hardship appeared to be

the biggest life stressor (M = 1.77, SD = 0.60),

while health problems were the smallest stressor

(M = 1.55, SD = 0.70) among the participants

The mean score for self-esteem was 2.34 (SD =

0.47) Regarding coping behaviors, the

participants tended to use problem-solving

behaviors (M = 1.24, SD = 0.44) more than

support-seeking (M = 1.02, SD = 0.40) or

avoidance behaviors (M = 0.81, SD = 0.35)

4.2 Mediation analysis

The results for the mediation analysis are

shown in Table 2 In the first step (Model 1),

family life stress was included in the model to

examine its total effects on depression while

controlling for socio-demographic variables

This model accounted for 27.7% of the

explained variance in depression (R 2 = 277, F(7,

293) = 16.071, P< 001) The findings show that

a high level of family life stress predicted higher

levels of depressive symptoms (b = 8.133, P<

.001) Of the socio-demographic variables, only

Korean language showed a significant effect on

depression with low language proficiency

associated with high levels of depressive

symptoms (b = -2.883, P< 001)

In the second step (Model 2), the

relationships between family life stress and

mediators were explored, controlling for

socio-demographic variables As can be seen in the

table, family life stress showed its significant effects on self-esteem and avoidance coping, but not problem-solving or support-seeking behaviors Specifically, a high level of family life stress predicted lower levels of self-esteem

(b = -0.299, P< 001) and greater use of avoidance behaviors (b = 0.223, P< 001)

In the final model (Model 3), the relationships between mediators and depression were examined while controlling for family life stress In this model, the predictors accounted for 41.2% of the explained variance in depression

(R 2 = 412, F (11, 289) = 18.381, P< 001)

Self-esteem negatively predicted depression, indicating that low self-esteem was linked to a

high level of depressive symptoms (b = -7.040,

P< 001) Of the three types of coping behaviors,

only avoidance was significantly associated with depression with greater use of avoidance related

to higher levels of depressive symptoms (b = 8.641, P< 001) Based on these findings, the

mediating roles of self-esteem and avoidance coping were assessed in the following step The results obtained in Model 3 showed that family life stress was still a significant predictor for depression when mediators were controlled

(b = 4.153, P< 001) Also, there was a decrease

in its effect on depression when mediators were

included (b 1 = 8.133, P< 001; b 2 = = 4.153, P< 001; where b 1 is the total effect of family life

stress on depression in Model 1, and b 2 is the direct effect of family life stress on depression while controlling for mediators in Model 3) Such findings supported the partial mediation

of self-esteem and avoidance (Baron et al 1986) Thus, a bootstrap analysis was performed to test the statistical significance of the indirect effects

of self-esteem and avoidance on the relationship between family life stress and depression The bootstrapping estimates are shown in Table 3