Correlates of Depression

Among the Soviet Jewish Immigrant Elderly

Mikyong Kim-Goh
ABSTRACT. This exploratory study examined the prevalence rates of
depressive 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 Soviet
Union, assessing their level of depression, health status, primary need ar-
eas, and family support. According to the results, 72% of the respondents
reported mild to severe levels of depression. Age and satisfaction with the
family assistance turned out to be significantly correlated with the level of
depression among this group. Implications for human services practice
with vulnerable older immigrant populations are discussed. [Article copies
available for a fee from The Haworth Document Delivery Service: 1-800-
HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website:
<http://www.HaworthPress.com> 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: mkimgoh@fullerton.edu). She holds a Doctorate and
Masters 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 was supported by the Untenured Faculty Development Grant fromCali-
fornia State University, Fullerton.
Journal of Human Behavior in the Social Environment, Vol. 13(2) 2006
Available online at http://www.haworthpress.com/web/JHBSE
2006 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J137v13n02_03 35
INTRODUCTION
Since the mid-1960s, nearly 750,000 immigrants fromthe former 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 to
be Jewish (Orleck, 1999). In response to the most favored nation
trade status granted by the U.S. government in 1974, the USSR agreed
to relax her immigration policy, allowing Jewish people to emigrate,
first only to Israel, and then by the late 1970s to the United States as
well. During the second half of the 1970s, more than 110,000 Soviet
Jews emigrated to the United States (Orleck, 2001). With the Soviet in-
vasion of Afghanistan in 1981, however, the number of Jewish refugees
entering the United States declined sharply until 1988 when the procla-
mation of Perestroika by Gorbachev opened the doors for 20,000 Soviet
nationals to emigrate to the United States as refugees. Since then, the
number of Soviet refugee admissions dramatically increased, peaking
in 1994 with 63,420. In fact, between 1991 and 2000, as many as
462,874 immigrants from the former Soviet Union entered the United
States. Approximately 35% of them came from Ukraine, 23% from
Russia, 15% from Uzbekistan, and 8% from Belarus (U.S. Department
of Homeland Security, 2003). The Greater New York City area has the
largest population of the Soviet Jewish in the United States, with more
than 300,000 migr, while approximately 100,000 settled in Southern
California, especially in the Los Angeles area near Plummer Park, the
heart of this immigrant community (Orleck, 2001).
As a group, this new wave of Soviet Jewish population since 1988 is
among the most aged of all immigrant or refugee groups to settle in the
United States. Nearly one in five Soviet Jews (17.5%) who entered the
United 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 the
United States was 29 (Gold, 1995). This phenomenon can be attributed
to the Soviet migration policies that facilitated the emigration of multi-
ple generations. In most of the former Eastern bloc countries, families
tended 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 had
to live on the margins of society before they were permitted to leave.
For example, they were required to obtain permission fromtheir parents
and spouses, both current and former, if divorced. The potential migr
was also expected to be free of any debts, and was responsible for get-
ting statements of non-indebtedness fromall the local stores. When par-
36 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
ents provided consent, they too were often viewed as traitors by the
society and harassed as a result. This encouraged entire families of So-
viet Jews to emigrate together (Drachman & Halberstadt, 1992). In the
United 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 often
leading to an increase in depression and loneliness (Althausen, 1993;
Gusovsky, 1995).
In a survey of 900 Soviet Jewish refugees in 14 cities in the United
States, Simon and Simon (1985) found that the mean levels of education
for males and females were 14 and 13 years, respectively, higher by one
year than the average educational level of the U.S. population. Soviet
Jews arriving in this country were often perceived as high-skilled work-
ers who would easily adjust economically and who, in any case, would
be 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 information
on Soviet Jewish immigrants, therefore, a typical human service worker
has 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 time
of the Czar, Jews were expelled from hundreds of villages, and severe
restrictions were placed on their trade in the cities. Jews suffered greatly
during the brutal 30-year reign of Joseph Stalin, and they did not fare
well under his successors. They had to face anti-Semitism at various
levels, both personal and institutional, in the realms of higher education
and career advancement. In fact, many Soviet Jewish immigrants be-
lieved that Russian anti-Semitism was more deeply rooted than
Bolshevik ideology (Orleck, 1999). Over the years, Soviet Jews learned
to adapt to their intolerable situations by skillfully manipulating the sys-
tem. As a mode of survival, they developed culture of savvy charac-
terized by adaptability and flexibility, exchanging favors at work, and
finding ways to get some privileges (Gold, 1995).
Although international migration and resettlement experiences have
been associated with stress and conflicts among the newcomers in gen-
eral, the elderly are especially vulnerable in the process. According to
Gozdziak (1989), problems of the recently immigrated elderly are more
severe than those faced by American-born elderly or long-time immi-
Mikyong Kim-Goh 37
grants. Indeed several studies of Soviet Jewish immigrants in the United
States reported that the elderly among the immigrant cohort experi-
enced a significant degree of acculturative stress (Brodsky, 1988; Kohn,
Flaherty, & Levav, 1989). Acculturative stress refers to a combination
of physical, mental, emotional, and spiritual tension, the source of
which is in the acculturation process. Common problems that elderly
immigrants face include the loss of economic status, loss of familiar
support systems, and the language barrier. It is typically more difficult
for 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 Opportunity
Reconciliation Act of 1996, better known as the Welfare Reform, gen-
erated fear throughout many Soviet immigrant communities in the
United 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 federally
subsidized housing (Orleck, 2001). One major aspect of the legislation
barred legal immigrants from all means-tested and federally funded
public benefits for the first five years they were in the country. Legal
immigrants were barred from receiving SSI and food stamps as well as
Medicaid coverage until they became United States citizens, a process
which required 5 years of legal residency in this country. Among all the
immigrant 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 found
that most immigrants tend to underutilize health and social services for
a variety of reasons including lack of information and awareness of
available 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, immigrants
from the former Soviet Union are unlike most other immigrant groups
in 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 a
strong reliance on governmental assistance for financial needs, as op-
posed to depending upon aid from their informal social networks. Cul-
38 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
tural norms and beliefs such as expectations for medical cure and
numerous diagnostic tests, preference for lengthy hospitalizations, and
using medical services for social and psychological problems may have
contributed 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 culturally
compatible peer groups. Historically the active reestablishing of a social
network 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 300 Asian Americans in Seattle, Kuo
and Tsai (1986) identified several positive factors that mediate immi-
grant social stress. Their results revealed that personality hardiness and
three social network variables (number of friends with whom one can
talk, 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 depressive
symptoms among those over 65 living in the community to be as high as
50 percent. The purpose of this study was to explore the prevalence rate
of depression among the elderly Soviet Jewish immigrants in Southern
California and to delineate factors that correlate with depression. More
specifically, this study examined the effects of age, gender, self-rated
health, 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 the
resettlement process in a new country, elderly Soviet Jewish immi-
grants were likely to experience a higher level of depression than the
general elderly population, and that the elderly immigrants who were
younger, 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 convenience
sampling, the subjects were recruited from three different senior hous-
ing complexes in Orange County and from Plummer Park in West Los
Angeles, a popular gathering place for the elderly Soviet Jewish migr.
Mikyong Kim-Goh 39
To maintain a consistent procedure, a bilingual, Russian-speaking inter-
viewer administered a questionnaire through face-to-face interviews.
All of the subjects preferred the interviewconducted in Russian, and the
response 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 depression
scale in a simple yes-no format, designed for use with older adults. Its
total 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 living
in 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 perceived
health 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, and
English-speaking abilities. The questionnaire was first translated into
the Russian language, and then back-translated into English to ensure
accuracy 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), ranging
from 65 to 93. Twenty-nine subjects (58%) were female. A majority of
the subjects (76%; n = 38) were married. Over 95% of the respondents
reported annual income of $ 8,000 or below, and most of them (88%;
40 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
n = 44) relied on government assistance for living. The sample repre-
sented a highly educated group. Sixty-eight percent (n = 34) completed
college 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 = 4.0
years). Sixty percent of the sample (n = 30) were living with spouse
only, followed by living alone (12%) and with children (12%).
Most respondents (86%; n = 37) seemed satisfied with the help that
they were receiving from their family members. The most common
types of family assistance included emotional support (48%), help with
activities of daily living (36%), followed by transportation (32%). None
of 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 as
good, while 70% (n = 35) and 16% (n = 8) rated fair and poor, respec-
tively. None of the respondents rated their health as excellent. High
blood pressure (64%; n = 32) and fatigue (56%; n = 28) were the pri-
mary health problems mentioned by subjects. The most frequently
given responses to the reasons for their immigration to the United States
were 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 %
Gender
Female
Male
Age (years)
a
Under 70
71-80
81 and older
Marital Status
Never married
Married
Divorced
Widowed
Education
Less than high school
High school graduate
Some college
College graduate
Annual Income
a
Less than $7,000
$7,001-8,000
$8,001 or more
29
21
25
17
7
2
38
2
8
3
8
5
34
9
31
2
58.0
42.0
51.0
34.7
14.3
4.0
76.0
4.0
16.0
6.0
16.0
10.0
68.0
21.4
73.8
4.8
Source of Income
Employment
Government Assistance
Social Security
Other
Years of U.S. Residence
a
Less than 2 years
2-3 years
4-5 years
6-7 years
8 years or longer
Religion
a
Judaism
None
Living Arrangement
Alone
With spouse only
With children
With spouse and rela-
tives
Other
2
44
2
2
9
19
10
6
5
8
31
6
30
6
3
5
4.0
88.0
4.0
4.0
18.4
38.8
20.4
12.2
10.2
20.5
79.5
12.0
60.0
12.0
6.0
10.0
a
Includes missing data
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), problemwith
English language (28%; n = 14), and lack of transportation (26%; n =
13) (Table 3).
According to Brink and his colleagues (1982), those who reported 10
or 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 considered
moderately to severely depressed. The overall mean for this sample was
13.9 (SD = 6.2), scores ranging from 3 to 30 (Table 4). Applying the
Brink et al. cutoff points, 54% (n = 27) of the sample were mildly de-
42 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
TABLE2. Reasons for Soviet Jewish Elderly Immigration to the United States
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
pressed and 18% (n = 9) were moderately to severely depressed, while
28% (n = 14) fell within the normal range. Among the GDS items, re-
spondents were most worried about the future, found it hard to start new
projects, 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 following
independent variables; age, gender, self-rated health, and satisfaction
Mikyong Kim-Goh 43
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 activities
and 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 the
morning
48.0
7. In good spirits* 59.1 28. Avoid social gatherings 40.0
8. Fear bad things will
happen
62.0 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 be
alive
84.0 Mildly depressed (11-20) 54.0
16. Feel downhearted and
blue
40.0 Moderately to severely
depressed (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 new
projects*
67.4
21. Full of energy 48.0
*Includes missing data
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 correlates
of depressive symptoms in our sample, and self-rated health (Beta =
.26; p = .07) approached significance. An alpha level of .05 was used
for all statistical tests.
DISCUSSION
The elderly Soviet immigrants in our study reported a significantly
higher 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 younger
than the Chinese sample, this finding is even more significant. Age and
perceived family assistance turned out to be significant correlates of
depression 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 experiencing
depression. The results of the study, however, must be addressed in the
light of the methodological limitations of the study: the small size of the
44 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
TABLE 5. Regression Model: Correlates of Depressive Symptoms Among
Elderly Soviet Jewish Immigrants
Dependent Measures
Correlates Unstandardized
Coefficient
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 with
the family assistance
2.017 .903 .333 .032
R
2
.29
Adjusted R
2
.22
F 3.92
df 4, 38
P .009
sample, the possible effects of underlying physical disorder, and the ab-
sence of controlled variables in the analysis. The sampling procedure, a
convenience sampling, may also have resulted in selection bias.
Despite the limitations of the study, the following implications for
human services practice can be drawn. First, given the low ratings on
health status in this sample, the worker needs to pay close attention to
any unmet medical needs among this elderly group. Conceivably poor
physical health contributes to depression and a sense of helplessness.
Although frequent somatization and obsession with physical health
among this group have been observed by some researchers (Kohn,
Flanerty, & Levav, 1989), ruling out any medical conditions that may
be 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 psychopharmacological
referral and treatment. The basic principles of clinical practice should
be observed, such as establishing a warm and trusting relationship, ac-
ceptance and validation of the clients feelings, and understanding of
the clients frame of reference. The worker should allow the expression
of feelings of grief and loss while being familiar with the role of cultural
values and norms including the dynamics of the process of resettlement
and acculturation, and provide ego-supportive treatment by reinforc-
ing the elderly immigrants past strengths and coping mechanisms
rather than challenging and weakening the clients ego defenses
(Gusovsky, 1995).
Third, the participants primary concerns indicated a need for basic
concrete services such as transportation, assistance with the citizenship
exam, trained interpreters, and information and referral services staffed
by bilingual/bicultural workers. Fourth, workers need be sensitive to the
impacts of significant social policies such as the Welfare Reform or
anti-immigration bills on the immigrant population in general, and on
the older immigrants in particular, and advocate for the clients when-
ever necessary. Considering 78% (n = 38) of the respondents in this
study 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 for
living, their concerns about financial vulnerability and uncertainty
about their future are understandable. In fact, many of the participants
were studying the English language and civic lessons in order to prepare
for the citizenship test, and 19 subjects specifically identified the re-
quired citizenship examination as their primary concern. Therefore, one
needs to separate clinically significant depression from realistic worry
Mikyong Kim-Goh 45
about survival such as economic issues that are normal and appropriate
especially 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. Although
multigenerational households were common in the former Soviet Un-
ion, a majority (60%; n = 30) of the study sample were living with
spouses 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 structure
and intergenerational relationships should be an integral part of the
workers function. One of the goals of a human service worker while
working 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 with
existing neighborhood networks that can provide needed information
and practical assistance, and by connecting clients with appropriate
community resources. Helping the Soviet elderly immigrants expand
their social networks beyond their spouses and children to the broader
communities may help reduce the level of depression and enhance their
quality of living.
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