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Sizhe Liu and Wei Zhang

related factors are associated with severe mental health problems among Asian-
American immigrants who constitute approximately 28% of the immigrant population
in the U.S., and how individual religious involvement moderates the associations.
Compared to other racial/ethnic groups, the Asian-American population contains a
substantially larger proportion (more than 70%) of the foreign-born (Pew Research
Center, 2010). For foreign-born immigrants, adapting to new cultural settings is often
associated with strain and stress that may result in adverse mental health consequences.
Largely due to their close relationships with socioeconomic status, immigration-related
factors are found to be associated with depressive disorder and suicidal behaviors
among Asian-American immigrants (Alegria, Takeuchi, Canino et al., 2004; Breslau
and Chang, 2006; Kposowa, McElvain, and Breault, 2008; Mossakowski, 2007; Zhang,
Fang, Wu et al., 2013). However, empirical findings show inconsistent evidence.
While some studies found earlier age at immigration increases the risk of developing
mental health problems (Mossakowski, 2007; Zhang, Fang, Wu et al., 2013), others
found the opposite (Takeuchi, Chuang, Lin et al., 1998). Among foreign-born Asian
Americans, approximately 48% of them reported limited English proficiency (Pew
Research Center, 2010). When limited English proficiency is examined as a stressor,
some studies found that it is associated with psychological distress among Asian-
American immigrants (Kim, Worley, Allen et al., 2011; Zhang, Hong, Takeuchi et al.,
2012). Another study (Takeuchi, Zane, Hong et al., 2007) revealed that its association
with mental disorder only exists among Asian-American males.
This work aims to continue efforts along this line by examining how immigration-
related factors such as age at immigration and English proficiency are related to
depressive disorder and suicidal ideation among Asian-American immigrants.
Major depressive disorder is one of the most common mental illnesses in the United
States and it is associated with comorbidity, substantial impairment, poor health,
and mortality (Hasin, Goodwin, and Stinson, 2005). Suicide is one of the leading
causes of death worldwide; suicidal ideation (serious thought about suicide-related
behaviors) is a symptom that is strongly associated with mental disorders (World
Health Organization, 2017). The presence of major depressive disorder is among the
strongest risk factors that may induce suicidal ideation among Asian Americans (Cheng,
Fancher, Ratanasen et al., 2010). Although some studies focusing on mental health
issues among Asian Americans have employed depressive disorder as the outcome
variable (Breslau and Chang, 2006; Takeuchi, Zane, Hong et al., 2007; Zhang, Fang,
Wu et al., 2013), limited efforts have been made to understand suicidal ideation/
behaviors. In this regard, it is worthwhile to examine whether immigration-related
factors show similar effects on depressive disorder as on suicidal ideation, a more
severe episode of mental health problem.
Besides examining the main effects of immigration-related factors, this study also
focuses on the stress-buffering role of individual religious involvement. Empirical
evidence shows that religious involvement has positive effects on mental health
(Hackney and Sanders, 2003; Moreire-Almeida, Neto, and Koenig, 2006), because
aspects of religion tend to encourage social support, promote healthy behaviors,
enhance self-esteem and sense of personal control, and provide coping resources
(Ellison and Levin, 1998; George, Ellison, and Larson, 2002; Nooney and Woodrum,
2002). Meanwhile, the stress-buffering role of religion on mental health is also
documented in literature (Bierman, 2006; Bjorck and Thurman, 2007; Bradshaw
and Ellison, 2010; Ellison, Boardman, Williams et al., 2001; Ellison, Musick, and
Henderson, 2008; Lee, 2007; Kim and Seidlitz, 2002; Krause, 2006; Schnittker,
2001), but few studies have focused on Asian-American immigrants. Being a racial/
ethnic minority and an immigrant increases the risk of exposure to the stress of social
stigma, prejudice, and discrimination that may generate mental health problems when
coping resources are limited (Pearlin, Menaghan, Lieberman et al., 1981; Pearlin,
1989). So if we consider some immigration-related factors as stressors, will religious
involvement provide stress-buffering effects that may alleviate their detrimental mental
health impact? Recent psycho-social approaches emphasize the ability of religion in

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