Vietnamese Immigrant and Refugee Women's Mental Health: An Examination of Age of Arrival, Length of...

66 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • April 2010 • Vol. 38

articles

© 2010 American Counseling Association. All rights reserved.

Vietnamese Immigrant and Refugee Women’s Mental Health: An Examination of Age of Arrival, Length of Stay, Income, and

English Language ProficiencyChrisBrown,CodiL.Schale,andJohannaE.Nilsson

Vietnamese immigrant and refugee women (N = 83) were surveyed regarding their mental health, English language proficiency, age of arrival, length of stay, and income. English language proficiency and age of arrival correlated with reduced symptomatology. Moreover, English language proficiency was the sole predictor of somatic distress.

Se realizó una encuesta a un grupo de mujeres inmigrantes y refugiadas vietnamitas (N = 83) con respecto a su salud mental, nivel de inglés, edad de llegada, tiempo de estancia y nivel de ingresos. Su nivel de inglés y la edad de llegada mostraron correlación con una sintomatología reducida. Además, el nivel de conocimiento de inglés fue el único elemento capaz de predecir el malestar somático.

Refugeeindividualshavebeendefinedas“personswhoareunableorunwillingtoreturntotheircountryofnationalitybecauseofpersecu-tionorwell-foundedfearofpersecutiononaccountofrace,religion,

nationality,membershipinaparticularsocialgroup,orpoliticalopinion”(Vu,1990,p.234).TheUnitedStatesisknownforprovidingsafehaventothosefleeingoppressionanddauntingcircumstances.Refugeesconstitute10%ofannual immigration to theUnitedStatesandareadistinct componentoftheU.S.foreign-bornpopulation(Singer&Wilson,2007).ThenumberofVietnameseimmigrantsintheUnitedStatesquintupledfrom1980(231,120)to2006(1.1million),makingthemthefifthlargestimmigrantgroupintheUnitedStates(Terrazas,2008).ThenumberofSoutheastAsians immigratingtoEnglish-speakingcountriesisincreasing,leadingtogreaterinterestintheirmentalhealthandculturaladjustmentexperiences(Salant&Lauderdale,2003). ScholarshavestatedthatthefutureofAmericansocietyislargelycontingentontheadaptationofimmigrantfamilies(Pumariega,Rothe,&Pumariega,2005).Inreportingon the literature thathasexamined theassociationsamongmentalhealth,Englishlanguageproficiency,ageofarrival,andlengthofstayforimmigrantandrefugeesamples,wehavedrawnfromtheacculturation

Chris Brown, Codi L. Schale, and Johanna E. Nilsson, Division of Counseling and Educational Psychology, University of Missouri–Kansas City. Correspondence concerning this article should be addressed to Chris Brown, Division of Counseling and Educational Psychology, School of Education, University of Missouri–Kansas City, 5100 Rockhill Road, Room 215, Kansas City, MO 64110 (e-mail: [email protected]).

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • April 2010 • Vol. 38 67

literaturetodescribetheseassociations.GiventhatEnglishlanguageprofi-ciency,ageofarrival,andlengthofstayhaveallbeenimplicatedasindicatorsofacculturation(Kuo&Roysircar,2004;Sodowsky&Plake,1991),wehavechosentoconsidertheroleoftheselimited,butimportant,factorsinunder-standingthementalhealthofVietnameseimmigrantandrefugeewomen.

Acculturationinvolvesthe“processofadoptingtheculturaltraitsorsocialpat-ternsofanothergroup”(Stein,1975,p.10).Ageisacontributortoacculturationspeedandresponsiveness,andthosewhomovetotheUnitedStatesatyoungeragesadoptAmericanvaluesandbehaviorsmoreeasilythanthosemovingatlaterlifestages(Matsuoka,1990).YoungerrefugeesalsohaveanadvantageovertheiroldercounterpartsinthattheymorereadilylearntowriteandspeakEnglish.ThosearrivingintheUnitedStatesatanearlydevelopmentalstage(i.e.,whenlanguageandcultureareataformativeperiod)mayexperiencepsychosocialadjustmentthatissmootherthanthatexperiencedbythosearrivingduringalaterdevelopmentalperiodwhomayfeelthepressureofrapidadaptationandlanguageacquisition(Chung,Bemak,&Wong,2000).Researchershave supported theuseofEnglish languageproficiencyandlengthofstaytoassesslevelsofacculturation(Sodowsky,Lai,&Plake,1991).PhanandSilove(1997)reportedthatEnglishlanguageproficiencyandlengthof stay influencedpsychologicaldistress inVietnameseAmerican families.Researchers have found similar results in samples of Asian internationalstudents(Poyrazli,Kavanaugh,Baker,&Al-Timimi,2004)andAsianIndianimmigrants(Mehta,1998).Scholarshavealsoconsideredtheimportanceofincomewhenattemptingtounderstandthementalhealthandculturaladjustmentofimmigrantandrefugeefamilies.Incomeisawidelyaccepteddeterminantofmentalhealth,andtheassociationbetweenlowincomeandpoorhealthiswelldocumented(Marmot&Wilkinson,2006).Beiser,Johnson,andTurner(1993)investigatedSoutheastAsianrefugeesandfoundthatthemostsalientfactoraccountingforthelinkbetweenunemploymentanddepressionwaslossofincomeandnotthesubsequentlossofopportunitiestosocializewithothersorlossofstatusfromone’s job.Similarly,Angel,Buckley,andFinch(2001) found incometobeassociatedwithpositivehealthoutcomesinimmigrantandnative-bornHispanics,aswellasnon-HispanicWhites.ResearchershavenotspecificallyconsideredtheassociationsamongEng-lish languageproficiency, age of arrival, length of stay, and incomewhenattempting to understand the mental health of Vietnamese immigrant and refugeewomen.Hence,thepurposeofthepresentstudywastoexploretherelations among selecteddemographic variables and threedimensions ofmentalhealth(generaldistress,somaticdistress,andperformancedistress).Specifically, we consideredwhether English language proficiency, age ofarrival, lengthofstay,andincomewouldmakesignificantcontributionstoVietnamesewomen’smentalhealth.


methodPARTICIPANTS

Participantsinthestudywere83Vietnamesewomen,whoseageofimmigra-tionrangedfrom5to69years(M=35.23,SD=14.3)andwhoselengthofresidenceintheUnitedStatesrangedfrom2to30years(M=11.62,SD = 7.3). Yearly family incomebefore taxes ranged from$0 to $100,000 (M = 21,344.94,SD=19,848).Regardingrelationshipstatus,67.5%weremarried(n=56),15.7%weresingleandnevermarried(n=13),8.4%werewidowed(n=7),4.8%weredivorced(n=4),and1.2%werepartnered(n=1);2.4%ofparticipantsdidnotdisclosetheirrelationshipstatus(n=2).Regardingparenthood,75.9%hadchildren(n=63),withthemajorityofwomenhav-ingeithertwo(25.3%, n=21)orfourchildren(16.9%,n=14).Participants’educationlevelsrangedfromnoschoolingtoGrade16orgraduatedegree(M=9.10,SD=4.3).Oftheparticipants,1.2%didnotcompleteanygradelevel(n=1),32.5%completedGrades1through6(n=27),15.7%completedGrades7through9(n=13),24.1%completedGrades10through12(n=20),6.0%completedsomecollegeorvocationaltraining(n=5),7.2%graduatedfroma2-yearcollege(n=6),8.4%graduatedfroma4-yearcollege(n=7),and1.2%receivedagraduatedegree(n=1);3.6%ofparticipantsdidnotdisclosetheireducationlevels(n=3).Regardingreligiousaffiliation,79.5%wereBuddhist(n=66),14.5%wereChristian(n=12),and6.0%werefromotherreligions(n=5).Participants’agesrangedfrom19to74years(M = 45.96,SD=14.7).

INSTRUMENTS

InstrumentswereavailableineitherEnglishorVietnamese.TranslationfromEnglishtoVietnamesewasconductedbyaprofessionallanguageservice.Spe-cifically,ateamofthreelinguists(translator,editor,andproofreader)fluentinbothlanguagesandculturestranslated,edited,andproofedtheinstruments.Following teamconsensusof the translatedversions, the instrumentswerereviewedandpilotedbyanotherpersonfluentinbothlanguages.Allbut8participantschosetocompletetheinstrumentsinVietnamese.

Mental health.TheHopkinsSymptomChecklist–21(HSCL-21;Green,Walkey,McCormick,&Taylor,1988) isa21-itemmeasurewiththreesubscales(7itemseach)thathasbeenwidelyusedtomeasurementalhealthsymptoms.TheGeneralFeelingsofDistress(GFD)subscalemeasuresfeelingsofloneli-ness,hurt,andinferiority(e.g.,“Feelingothersdonotunderstandyouorareunsympathetic”).TheSomaticDistress(SD)subscaleassessesbodilyandphysicalconcernsandpains(e.g.,“Heavyfeelingsinyourarmsorlegs”).ThePerformanceDifficulty(PD)subscalemeasuresmemory,concentration,andspeechdifficulties(e.g.,“Havingtocheckanddouble-checkwhatyou


do”).Participantsrateitemsusinga4-pointLikert-typescalerangingfrom1=not at allto4=extremely,withhigherscoresindicatinggreatersymptomdistress.ContentvalidityhasbeenestablishedthroughcorrelationsbetweentheHSCL-21andtheState-TraitAnxietyInventoryandbetweentheHSCL-21andtheBriefHopkinsPsychiatricRatingScale(Deane,Leathem,&Spicer,1992).Chungetal.(2000)usedtheHSCL-21andreplicatedtheoriginalHSCL-21factorstructureintheirsampleoffirst-andsecond-waveVietnam-eseimmigrants.Greenetal.(1988)reportedinternalconsistenciesof.90forthetotalscoreand.86,.75,and.85fortheGFD,SD,andPDsubscales,respectively. Cronbach’s alpha in the current study was .92 for the totalscoreand.90,.82,and.76fortheGFD,SD,andPDsubscales,respectively. Hereinafter,scoresontheGFD,SD,andPDsubscalesrepresentthementalhealthvariablesnamedgeneraldistress,somaticdistress,andperformancedistress,respectively.

Demographics.We included questions regarding English language profi-ciency,ageofarrival,lengthofstay,income,relationshipstatus,parenthood,education level, religious affiliation, andage in thedemographic survey.Participants indicated theirEnglish languageproficiencyusing a 5-pointLikert-typescalerangingfrom1=very poorto5=excellent(M=2.94,SD = .97).Participantsreportedtheireducations levelsby indicatingthehigh-estgradelevelcompleted(0ornoschoolingtoGrade16;Grades13,14,15,and16representedsomecollegeorvocationaltraining,2-yearcollegedegree,4-yearcollegedegree,andgraduatedegree,respectively).Althoughweused thesedemographic variables todescribe the sample,wedidnotuseallthevariablesasstatisticalpredictorsofmentalhealth.Hereinafter,responsestothedemographicsurveyrepresentthevariablesnamedEnglishlanguage proficiency, age of arrival, length of stay, income, relationshipstatus,parenthood,andeducationlevel.

PROCEDURE

WerecruitedparticipantsfromaVietnamesecommunitycenter,aVietnameseBuddhisttemple,andaninternationalwomen’sinstitutelocatedintheMid-west.Weadministeredthemeasures(bothEnglishandVietnameseversions)usingagroupformat.Consultants,whowerecommunityexpertsfamiliarwithVietnamesecultureandfluentinbothlanguages,assistedwiththeadminis-trationandexplaineditemstoparticipantswhohadquestions.Womenwerecompensated$15fortheirparticipation.

resultsWe conducted Pearson product–moment correlations among the studyvariablesandfoundseveralsignificantrelationships(seeTable1).Womenwho reported poorer English language proficiency also reported greater


general distress and somatic distress and lower income, andwomenwitholderageofarrivalreportedgreatersomaticdistress.FurtherexaminationofthecorrelationalfindingsrevealedastronginverserelationshipforEnglishlanguageproficiencyandageofarrival:WomenwhowereolderatthetimetheymigratedtotheUnitedStatesreportedpoorerEnglishspeakingability.Weinspectedthefrequenciesforparticipantself-reportedEnglishlanguageproficiencyandfoundthat10.8%ratedtheirEnglishasvery poor(n=9)and2.4%ratedtheirEnglishasexcellent(n=2).We found that higher incomewas significantly related to betterEnglishlanguageproficiency,olderageofarrival,andlongerlengthofstay;however,wefoundnosignificantrelationshipsbetweenincomeandthementalhealthvariables.Theonlydemographicvariablesassociatedwithperformancedis-tress were parenthood and education level: Women with more children and less education reported greater forgetfulness and worries regarding accurate andthoroughtaskcompletion.

Note. HSCL-Gen = general distress measured by the Hopkins Symptom Checklist–21 (HSCL-21) General Feelings of Distress subscale; HSCL-Som = somatic distress measured by the HSCL-21 Somatic Distress subscale; HSCL-Perf = performance distress measured by the HSCL-21 Performance Difficulty subscale; English = self-rated English language proficiency; Moving age = age of arrival in United States; Time in U.S. = length of stay in United States; Income = yearly family income before taxes; Relationship status = married, single and never married, widowed, divorced, or partnered; Parenthood = number of children, if any; Education level = highest grade level completed, if any; 100K = 100,000.*p < .05. **p < .01.

TABLE 1

Intercorrelations, Means, Standard Deviations, Ranges, and Medians of Scores Among the Mental Health, Acculturation,

and Demographic Variables

Variable 1. HSCL-Gen 2. HSCL-Som 3. HSCL-Perf 4. English 5. Moving age 6. Time in U.S. 7. Income 8. Relationship status 9. Parenthood 10. Education level

MSDRangeMedian

1 2 3 4 5—

13.7 4.4 7–26 14.0

.63**—

13.0 4.2 7–26 13.0

.63** .55**

—

15.0 3.6 8–28 15.0

–.25* –.44** –.21

—

2.94 0.97 1–5 3.0

.20 .41** .20 –.71**

—

35.2 14.3 5–69 34.3

6 7 8 9 10 –.21 –.16 –.09 .34** –.23*

—

11.6 7.3 2–30 10.0

.01 –.05 –.03 .34** –.33** .55**

—

21,344 19,848 0–100K 16,000

–.01 .09 .09 –.30** .24* .00 –.07

—

.19 .20 .30** –.34** .36** .07 –.02

.42**—

3.62 2.46 0–10 3.0

–.19 –.26* –.27* .55** –.42** .41** .42**

–.15 –.35

—

9.04 4.3 0–16 9.0


Becausesomaticdistresswascorrelatedwithmoredemographicvariablesthanweretheothertwomentalhealthvariables,wechosetoexaminetheserelationshipswithsomaticdistressmoreclosely.WeconductedasimultaneousmultipleregressionanalysiswithsomaticdistressasthedependentvariableandEnglishlanguageproficiencyandageofarrivalasthepredictorvariables(wedroppedlengthofstayandincomefromtheanalysesbecauseoftheirinsignificantcorrelationswithsomaticdistress).TheregressionmodelwassignificantF(2,72)=10.42,p<.001,andaccountedfor22%ofthevariancein somaticdistress.English languageproficiency(p= .03)emergedas theonlysignificantpredictorofsomaticdistress.

discussionWe found thatEnglish languageproficiency and age of arrival correlatedwithmental health.Womenwho reportedpoorerEnglish languageprofi-ciency also reported greater general distress and somatic distress; womenwitholder ageof arrival reportedgreater somaticdistress.Aplausible ex-planation for the greater mental distress found among women with poorer Englishspeakingability isthataninabilitytocommunicateeffectivelymayberelatedtoalackofconnectednessorisolationfromthehostculture.Forexample,Oppedal,Røysamb,andSam(2004)recognizedthathostculturecompetenceisanimportantandnecessarysteptowardgainingacceptanceandbeing acknowledgedaspart ofmainstream society.We speculate thatlimitedEnglishlanguageproficiency,whichmaybeassociatedwithalackofconnectednesstomainstreamsociety,couldplacewomenatriskforgreatergeneralandsomaticdistress.Ourfindingthatsomaticdistresscorrelatedwitholderageofarrivaliscon-sistentwithpreviousresearch.Researchershavenotedthatyoungerrefugeesand immigrants adoptAmerican values and customs and adjust to a newculturemoreeasilythandothosewhomovelaterinlife(Matsuoka,1990),which facilitates aneasierbicultural identity adaptation.Weacknowledge,however,thatourstudydidnotassesstheextenttowhichAmericanvaluesandcustomswereadoptedbyourparticipants.Researchershavealsofoundthat younger immigrants (e.g., adolescents) evidence greater adjustmentdifficulties(Sodowsky&Lai,1997).Perhapstheseinconsistentfindingscanbeexplainedbyrecentresearchinwhichimmigrantsofmiddle-classstatusandwithhigher educationbackgroundswere found to bemore adaptive(Roysircar,Carey,&Koroma,inpress).Furthermore,wefoundthatageofarrivalwasrelatedtosomaticdistressandthatEnglishlanguageproficiencywas related toboth somaticdistressandgeneraldistress;however,neitherofthesevariableswasrelatedtoperformancedistress.Thislackofrelation-shipmaybebecauseofthetypesofitemsmeasuredbythePDsubscale(e.g.,troublerememberingthings).


Performancedistresswasassociatedwithparenthood:Womenwhohadmorechildrenindicatedgreaterdifficultyrememberingthings,worryingaboutbe-ingcareless,andhavingtocheckanddouble-checkthingstheyhaddone.Weconsideredtheliteratureonroleoverloadforanexplanationofthisfinding.AccordingtoKater(1985),roleoverloadisassociatedwiththemultitudeofresponsibilities thatwomenencounterandareknownto stemfromhomecaretasks.Inshort,it“isthesenseoftoomuchtodoandnotenoughtimetodoit”(Kater,1985,p.75).Perhapstherelationshipbetweenpsychologicaldistressandparentingdemandsamongourparticipantsispartiallyexplainedbythisroleoverloadphenomenon.Performancedistresswasalsoassociatedwith education level: Women who were less educated also reported greater performancedifficulties.Maybe lesseducatedwomenexperiencedgreaterperformancedifficultiesbecausetheirlimitededucationdidnotaffordthemaccesstoavailableresourcesorofferthemconfidenceintheirabilitiestoac-curatelyandsuccessfullymultitask.Researchershavefoundolderageofarrivaltobeapredictorofaccultura-tivestress(e.g.,Kuo&Roysircar,2004;Sodowsky&Lai,1997).Therefore,wefinditdifficulttoexplaintheinsignificantrelationshipfoundinourstudybetweenageof arrival andgeneraldistress.Wemight expectwomenwhomigratedatanolderagetobelesswillingtoreportsuchconcernsbecausestatementsregardingfeelinglonelyorbluemaybeatoddswithtraditionalcollectivistic norms and gender expectations. In certain cultures, peoplemaymorereadilyexpresstheirdistresssomaticallythantheywouldthroughwords such as blue or lonely,andcertainemotionalexpressions,suchasfeel-ing blue,maybeculturallyrelevantonlyintheUnitedStates.Moreover,theolderwomenareatthetimeofentryintotheUnitedStates,themorelikelythattheymaybeinfluencedbytheirnativecultures;incontrast,womenwhoimmigrateatayoungeragemightbemorewillingtoendorsesuchfeelings.Thelackofasignificantrelationshipbetweenageofarrivalandgeneraldis-tressremainspuzzlingandisyetanotherindicatorofthecomplexityofthelinksbetweenrelevantdemographicfactorsandmentalhealth,particularlyamongVietnamesewomen.AgeofarrivalwasassociatedwithEnglishlanguageproficiency:WomenwhowereolderatthetimeofarrivalreportedpoorerEnglishproficiency.ThisfindingseemsconsistentwiththeaforementionedresearchinwhichwomenwhomovedwhentheywereyoungerembraceAmericancustomsmoreeasilythandothosewhohavemovedlaterinlife.WesupposethatEnglishlanguageproficiencycouldberegardedasoneofthosecustoms.Furthermore,wereal-izethatwomenwhocometotheUnitedStatesatayoungeragearelikelytoparticipateintheAmericaneducationsystemandhavegreaterexposuretotheEnglishlanguage.We also found thatwomenwithhigher family income reported greaterEnglishspeakingability,hadmigratedatanolderage,andhadresidedin


theUnitedStates fora longer time.Thecorrelationbetween incomeandEnglish languageproficiency seems consistentwith previous research, inwhichrefugeesandimmigrantswhoarefluentinEnglishwerefoundtohavegreater employment options (Beiser&Hou, 2001),which could translateintogreaterincome-earningpotential.Forexample,BeiserandHou(2001)foundthatEnglishlanguageproficiencysignificantlypredictedemploymentintheirsampleofSoutheastAsianrefugees,andrefugeewomeninparticular.Anotherplausibleexplanationisthatimmigrantsandrefugeesmayhavehadmiddle-classstatusintheirhomecountries,highprofessionaleducation(e.g.,medical, engineering, computer science), and familiaritywith theEnglishlanguagepriortotheirimmigrationorrefugeeentrytotheUnitedStates.WefoundthroughregressionanalysisthatEnglishlanguageproficiencyispredictiveofsomaticdistressandassumesagreaterroleincontributingtoVietnamesewomen’smentalhealththandoesageofarrival.Women’sabilitytospeakEnglishisimportanttotheirmentalhealthregardlessoftheageatwhichtheymigrated.ThisfindingparallelsthoseofotherstudiesinwhichEnglishspeakingabilitypositivelycorrelatedwithmentalhealthinasampleofVietnameserefugees(e.g.,Starr&Roberts,1982).ResearchershavesuggestedthatimprovedEnglishproficiencymaycontributetofewercommunicationdifficultiesandenhancedinterpersonalinteractions(Kuo&Roysircar,2004;SalgadodeSnyder,1987).

IMPLICATIONS FOR COUNSELING

TheexperiencesofVietnameseimmigrantandrefugeewomenarecom-plexandposeuniquechallengesasthesewomenseektofindcomfortwithnewcustoms,waysofliving,andanewlanguage.Itisnosurprisethattheculturalnuancesofbeinginaforeigncountryinvolvecountlessstressorsthatlikelypressontheadaptationprocessandsubsequentmentalhealthof Vietnamese immigrant and refugeewomen.We offer several recom-mendations for counseling professionals attempting to assist Vietnamese immigrant and refugee women in their transition process. Counselingsupport and interventions that target English language proficiency areencouraged.Wespecificallyrecommendthatcounselorscontactresettle-mentagenciestogatherinformationaboutclassesonEnglishasasecondlanguage.Womenmayalreadyknowabout theseclasses,but issuesmayexistthatpreventthemfromattending.Wespeculatethatpotentialbar-rierstoattendingclassesmightbeinconvenientclasstimeofferings,lackofchildcare,limitedornotransportation,anddisapprovalfromspouseorfamilytotaketheclass.

Counselors can also consider free online resources that can assist clients inbolsteringtheirEnglishproficiency.CounselorswhofrequentlyworkwithVietnamesewomencanconsiderbuyinganinteractivelanguageprogramthatclientscanuse(e.g.,RosettaStone,availableathttp://www.rosettastone.com/


personal/languages/english-american).Vietnamese–Englishdictionariesarealsogoodonlinesources.Empoweringwomentoidentifytheirownresourcesfor learningEnglish isalso important.For instance, ifaclient isreligious,sheshouldbeempoweredtofindanEnglishversionofherreligioustextandseekassistancewithpracticingcross-referencingreligiouswritings.Becauselanguagebarriersmayresultinwomenremainingclosetotheircommunities,counselorsmaywanttocarefullydiscusswomen’sreadinesstoreachoutsidetheircommunitiesasawaytopracticetheirEnglish.WeacknowledgethatEnglishbarriersandculturalbeliefsaboutpreservingfamilyintegritymightprecludesomewomenfromseekingcounselingordisclosingpertinentfam-ily dynamics.As such,we suggest outreachprograms that donot requireself-disclosure and thatmaybeperceived asnonthreatening.Examples ofhelpful programs areworkshops that offer resources for learningEnglishandfreecareerbuildersessionsthatteachwomenhowtopreparerésumésorconductjobsearches.

LIMITATIONS AND FUTURE RESEARCH

Ourfindingsmustbeexaminedinlightofmethodologicallimitations.Giventhatthemeaneducationlevelwasninthgrade,somewomenmayhavehaddifficultyincomprehendingtranslateditemsthatrenderedunconventionalgrammarorcontent,whichmighthaveledtotheirguessingonitemresponses.Furthermore,theconstructsunderinvestigationcontainculturalvaluesthatmayhavebeenfalselyoperationalizedforVietnamesewomen(i.e.,mentalhealthsymptomsmaymanifestdifferently inAsiancultures).Althoughwetookprecautions to ensure that the translated instrumentswere accurateandreflectedconceptuallyrelevantconstructs,otherdevelopedscalesnowexistthatmightbemorevalidindicatorsofsymptomatology.Notwithstand-ing the aforementioned cultural limitations, the internal consistencies fortheHSCL-21were adequate tohigh andourmethods of translationwithmultiplereviewers shouldhaveactedasa safeguardfor thevalidityofourinstruments.Theinterpretabilityofourfindingsislimitedbecauseoftheuseofcorrelationalstatistics.Finally,wereceivedfeedbackfromafewparticipantsthatthestudy’smeth-odofsurveywassomewhatconfusing inthat theywerenotaccustomedtorankingpersonalinformationonanumberedscale.ThismethodofsurveyisbasedonWesternpractice,andSoutheastAsiansmayhavefounditchal-lengingtoquantifytheirpersonalexperiences.Supportingthisnotion,Phanand Silove (1997) discussed the difficulty with translating symptoms anddisordersfromEnglishtoVietnamesebecauseofsemantic,conceptual,andcontextual problems.They specifically noted thepotential for inaccuracyinratingtheseverityofsymptomswithscaleanchorssuchasquite a bit and extremelybecauseverylittledistinctionexistsbetweenthesetwoexpressionsinVietnameseculture.


conclusionOurfindingsdirectattentiontotheimportantroleofEnglishproficiencyinglobalmentalhealthandtheneedtoincludeameasureofsomaticdistresswhenassessingVietnamesewomen’smentalhealth.Englishlanguageprofi-ciencywasanindependentlysignificantfactor inthementalhealthofourVietnamesesample,andisthereforeworthyofconsiderationwhenattemptingtounderstandVietnamesewomen’smentalhealth.

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