title: Associations of multicultural status with depressive mood and suicidality among Korean adolescents: the roles of parental country of birth and socioeconomic position.
abstract: The mental health of the offspring of immigrants is a major public health concern. In this study, we examined associations of multicultural status and parental country of birth with adolescent mental health in South Korea, and assessed the effect of socioeconomic position (SEP) on these associations.
  
  
  
  We used four waves of the Korea Youth Risk Behavior Web-based Survey (KYRBS) between 2011 and 2014, including 294,324 participants (149,219 boys and 145,105 girls aged 13-18 years) as study subjects. KYRBS is a cross-sectional survey conducted annually by the Korea Centers for Disease Control and Prevention. The participants in the KYRBS were drawn as stratified multistage clustered samples from Korean middle schools and high schools. We calculated the age-adjusted 12-month prevalence of depressive mood and suicidal behaviors by parental country of birth, and estimated the effects of SEP indicators on the relationship.
  
  
  
  The age-standardized prevalence of suicidality (suicide ideation, plans, and attempts) was significantly different between multicultural and non-multicultural boys. The impact of multicultural status on mental health varied with parental foreign-born status and maternal country of birth. Compared with non-multicultural counterparts, boys with Japan-born mothers showed lower prevalence ratios (PRs) of suicidal plans (PR = 0.34, 95% CI 0.16-0.70). Girls with Japan-born mothers also showed lower PRs of depressive mood (PR = 0.77, 95% CI 0.63-0.95) and suicidal ideation (PR = 0.59, 95% CI 0.41-0.83), while adolescents with Korean-Chinese mothers showed similar PRs. Boys with foreign-born fathers as well as boys with two foreign-born parents were at a greater risk of suicidality than non-multicultural boys. The magnitude of the relationship between multicultural status and mental health outcomes was generally attenuated after adjusting for SEP indicators.
  
  
  
  In general, adolescents with Japan-born mothers showed lower PRs of depressive mood and suicidality than non-multicultural adolescents, while those with Korean-Chinese mothers showed similar PRs. Boys who had foreign-born fathers generally showed greater PRs of depressive mood and suicidality than non-multicultural boys. To ensure the effective implementation of policies to reduce mental health problems among multicultural adolescents in South Korea, detailed information should be considered regarding the cultural and socioeconomic backgrounds of families, such as parental country of birth and SEP.
authors.affiliation: Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
authors.forename: Jinwook
authors.initials: J
authors.lastname: Bahk
authors.affiliation: Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
authors.forename: Agnus M
authors.initials: AM
authors.lastname: Kim
authors.affiliation: Institute of Health Policy and Management, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. yhkhang@snu.ac.kr.|Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. yhkhang@snu.ac.kr.
authors.forename: Young-Ho
authors.identifier: 0000-0002-9585-8266
authors.initials: YH
authors.lastname: Khang
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology* / Q000523:psychology; D000339:Affect; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D003863:Depression / Q000208:ethnology* / Q000523:psychology; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D009035:Mothers / Q000523:psychology; D010290:Parents / Q000523:psychology; D015995:Prevalence; D056910:Republic of Korea; D012574:Schools; D012959:Socioeconomic Factors; D013405:Suicide / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Adolescent; Depressive mood; Immigrant; Mental health; Socioeconomic position; South Korea; Suicidality