Acculturation,perceived discrimination,and psychological distress: Experiences of South Asians in Hong Kong

Abstract

Although migration itself may not compromise the mental health of immigrants, the acculturative process can involve highly stressful factors that are specific to immigrant and minority status. Using structural equation modeling, this study examined the relations between acculturation orientations, perceived discrimination, acculturative stress, and psychological distress among 229 Pakistani and 218 Nepalese migrants living in Hong Kong. Although the initial hypothesized model was not confirmed, a modified model with good fit indices showed that acculturation orientation mediated the relationships of perceived discrimination and acculturative stress with psychological distress. Of all the factors in the model, acculturative stress had the strongest association with psychological distress.

Keywords

culture Hong Kong postmigration adjustment psychological distress South Asians

Introduction

In recent years, there has been a growing interest among researchers in the relationship between acculturative stress and the mental health of immigrants (e.g., Cassidy & O’Connor, 2004; Chou, 2009; Finch & Vega, 2003; Harker, 2001). Although migration itself may not necessarily compromise the mental health of immigrants, the acculturative process can involve highly stressful factors that are specific to their immigrant and minority status (Clark, Anderson, Clark, & Williams, 1999; Lay & Nguyen, 1998). Acculturation studies on migrants’ adaptation in Hong Kong have focused mainly on immigrant women and students from mainland China (e.g., R. Chan, 2001; Fung, 2005; Yi & Tsang, 2010). These studies have predominantly dealt with how acculturation strategies, host language proficiency, acculturative stress, and social support are related to adaptation outcomes (e.g., psychological and sociocultural adaptation). A few local studies on South Asians in Hong Kong have reported difficulties and barriers they encounter in various spheres of their daily lives, such as in employment (e.g., being paid less, having a heavier workload than their local counterparts in the same position), housing (e.g., being turned down by landlords), and education (Crabtree & Wong, 2012; Frost, 2004; Ku, 2006; Loper, 2001). However, what is lacking from the majority of previous studies is an investigation into the relationships between acculturation and psychological adaptation.

This study seeks to extend research on migrant health and well-being by examining the relationships between acculturation orientation, perceived discrimination, acculturative stress, and psychological distress in a sample of Nepalese and Pakistani migrants in Hong Kong. Specifically, it examines the effects of perceived discrimination, acculturative stress, and acculturation attitudes on psychological distress (in terms of symptoms of depression, anxiety, and stress).

According to the 2010 Census, there are about 16,518 Nepalese and 18,042 Pakistanis living in Hong Kong. The Pakistani community has a long history of migration to this territory, dating back to the early 20th century when the first “Indians” arrived as part of the overall British expansion into China and the Far East; at this time, most of the Indian subcontinent was under British colonial rule (Vaid, 1972). Many of the present-day Pakistanis in Hong Kong are descendants of the early 20th century migrants who migrated to Hong Kong to reunite with their families; others migrated more recently for economic reasons (Census and Statistics Department, 2007). The Nepalese migrants, on the other hand, arrived in the territory as “Gurkha” soldiers in the British army in 1948 (Far East Overseas Nepalese Association [FEONA], 2000). Many of them returned to their home country after the end of their contracts. However, uncertainties in the Right of Abode Policy (ROA) with the impending return of Hong Kong sovereignty to China in July 1997 led many Nepalese to migrate to Hong Kong in the early 1990s. Many others were attracted by the boom in jobs in the construction sector (e.g., the Hong Kong International Airport, the Tsing Ma Bridge). Because there are different contexts of migration for Pakistanis and Nepalese living in Hong Kong, it is plausible that these groups’ experiences of intercultural relations and acculturation are also different. Within the discourse of acculturation research in Hong Kong, both groups are understudied and underrepresented. Given the limited amount of information we have about the acculturation and health status of immigrants in Hong Kong, research aimed at understanding their acculturation experiences can help initiate and develop programs and services that will assist immigrants in adapting to the host society and alleviate the problems they encounter in economic, cultural, and social adjustment.

Acculturation, perceived discrimination, and psychological distress

The term “acculturation” refers to the process of change that occurs when different cultural groups come into continuous first-hand contact with subsequent changes in the original cultural patterns of either or both groups due to the mutual influence of intercultural contact (Redfield, Linton, & Herskovits, 1936). According to the bidimensional acculturation model proposed by Berry (1997), acculturating groups and individuals must deal with two basic issues during the process of acculturation: (a) the extent to which they wish to maintain their heritage culture and (b) the extent to which they wish to maintain contact and relations with members of the host culture. When these two issues are considered simultaneously, four strategies or modes are derived: integration (desire to maintain both heritage and host cultures), assimilation (favoring contact with host culture only), separation (preferring to maintain the heritage culture only), and marginalization (no desire to maintain the heritage culture or intercultural contact). Based on the bidimensional model, this study conceptualizes acculturation orientations as consisting of two dimensions: desire to maintain (or reject) one’s heritage culture and desire to adhere to the host culture. Since these acculturation dimensions have been shown to have different effects on psychological adaptation, depending on the acculturating groups (Ryder, Alden, & Paulhus, 2000), it is imperative to assess the independent contribution of each dimension on adaptation outcomes.

According to Berry’s (1997, 2006) acculturative framework, which incorporates Lazarus and Folkman’s (1984) stress and coping model, acculturation may be viewed as a series of life-changing events whereby the acculturating individuals may experience an array of adjustment issues arising from the cultural differences between their heritage culture and the host culture. These individuals might experience stress if they perceive the adjustment process to be taxing or exceeding of their resources, which in turn might endanger their well-being (Lazarus & Folkman, 1984). The emphasis is thus on psychological resources (e.g., adaptive coping strategies). Although it may be argued that any life-changing event, whether positive or negative, is intrinsically stressful, the stress and coping perspective places more emphasis on affective outcomes of acculturation such as life satisfaction, psychological well-being, and distress (Ward, 1996). Studies have shown that adapting to the cultural values and behaviors of the host culture may result in less stress (e.g., R. Chan, 2001; Fung, 2005). Fung’s (2005) study of female immigrants from mainland China found that, in Hong Kong’s assimilation-oriented society, participants adopting the host culture reported less stress. Thus, adopting the host culture appears to induce less psychological distress than other acculturation strategies. However, when there are obvious physical and cultural-behavioral differences between the host group and the acculturating group, full assimilation may not be possible. This is certainly the case for South Asians in Hong Kong, because their skin color (Mussap, 2009), dietary habits, and culture are distinguishable from those of the predominantly Chinese host society.

Generally, everyone encounters some degree of stress in their daily lives that may arise from various sources such as financial worries, time constraints, health concerns, and the future (Lay & Nguyen, 1998). In addition to these everyday worries, immigrants may also experience some degree of stress rooted in their acculturation experiences, which is referred to as “acculturative stress” (Abouguendia & Noels, 2001). Although stress may not in itself be an overly negative experience, when it is perceived as threatening, or when it exceeds one’s coping resources (Lazarus & Folkman, 1984), it may induce heightened depression and symptoms of psychological distress (Chou, 2009). In recent years, numerous researchers have investigated the relationships between acculturative stress and the health of immigrants (e.g., Cassidy & O’Connor, 2004; Chou, 2009; Harker, 2001), finding a negative relationship between acculturation-specific stress and psychological health and well-being (e.g., Lay & Nguyen, 1998; Safdar & Lay, 2003). Likewise, various studies have found that perceived discrimination was negatively associated with immigrants’ psychological adaptation (Finch, Kolody, & Vega, 2000; Jasinskaja-Lahti & Liebkind, 2001; Todorova, Falcon, Lincoln, & Price, 2010). However, these studies were cross-sectional and thus could not determine causality.

Several studies have found that perceived discrimination is significantly associated with forms of psychological distress, such as depression and anxiety (Araujo & Borrell, 2006; Gee, Spencer, Chen, Yip, & Takeuchi, 2007; Tummala-Narra, Alegria, & Chen, 2011). A review of studies on South Asians in Hong Kong found that ethnic discrimination is a major issue (e.g., Crabtree & Wong, 2012; Ku, 2006; Tang, Lam, Lam, & Ngai, 2006). Studies have also found that perceived discrimination is an important predictor for acculturation orientations: people who perceive higher discrimination prefer the heritage culture (Anand & Cochrane, 2005; Robinson, 2003).

Furthermore, studies have found that acculturation orientations can partially buffer the negative effects of perceived discrimination on psychological well-being (e.g., Castro, 2003; Safdar, Calvez, & Lewis, 2012; Te Lindert, Korzilius, van de Vijver, Kroon, & Arends-Tóth, 2008). For instance, findings from a study of Iranian refugees in the Netherlands found that acculturation orientations (partially) mediated the negative relationship of perceived discrimination with psychological and sociocultural adaptation (Te Lindert et al., 2008). Castro’s (2003) study of Afro-Caribbean (ethnic minority groups) and White (majority group) adolescents in Costa Rican high schools found that perceived discrimination was positively associated with the adaptation outcome (self-esteem), and acculturation attitude towards heritage culture partially mediated this association. According to Branscombe and colleagues (Branscombe, Schmitt, & Harvey, 1999), perceived discrimination is more likely than acculturation attitudes to foster group identity and cohesion, which may act as a protective mechanism. Researchers have found that immigrants’ adherence to their heritage culture and experiences of discrimination reinforce each other. That is, immigrants who perceive discrimination group together, further exacerbating their distrust of host society members, who in turn regard them as troublemakers and unwilling to fit in (Birman, Trickett, & Vinokurov, 2002). Because past studies have reported that ethnic minorities in Hong Kong perceive discrimination and that perceived discrimination is predictive of depressive symptoms (e.g., Chou, 2012), in this study, we were also interested in examining the direct and indirect effects of perceived discrimination on psychological distress. In line with many previous studies, this paper treats perceived discrimination as an antecedent variable.

Several studies have found that gender influences the acculturation process, albeit with mixed results. Some studies have found that women may be more vulnerable to psychological distress than men (e.g., Aranda, Castaneda, Lee, & Sobel, 2001; Liebkind & Jasinskaja-Lahti, 2000; Yeh, 2003), while other studies found no significant gender difference (e.g., Chou, 2007; Furnham & Tresize, 1981). However, as most South Asian families espouse traditional gender roles (Crabtree, 2011; Crabtree, Hussain, & Spalek, 2008), it is important to note that some studies have reported that males tend to show a higher preference for the integration strategy (Farver, Bhadha, & Narang, 2002; Ghuman, 1997; Robinson, 2005) and are likely to adapt more quickly than women. Generally, it has been observed that most South Asian families traditionally emphasize different roles for men and women (e.g., Crabtree, 2011; Crabtree et al., 2008; Mahtani Stewart et al., 1999), entrusting child-rearing and transmission of cultural values to the mothers. Therefore, women may be more likely to identify with their heritage culture. Since this paper deals with Pakistani and Nepalese immigrants, we include gender as a major demographic variable.

Hypotheses

Based on previous studies, we proposed the following hypotheses:

H1. Females report higher psychological distress than males.

H2a. Heritage culture orientation is associated with higher psychological distress.

H2b. Host culture orientation is associated with lower psychological distress.

H3a. Perceived discrimination is associated with higher psychological distress.

H3b. Acculturation orientations mediate the association between perceived discrimination and psychological distress.

H4a. Acculturative stress is associated with higher psychological distress.

H4b. Acculturation orientations mediate the association between acculturative stress and psychological distress.

Methods

Procedures

After obtaining ethical approval from the University of Hong Kong, data were collected from July to December 2010 through various social service agencies, community organizations, and religious organizations using convenience and snowball sampling. Participants for this study were adults who self-identified as Pakistani and Nepalese and had resided in Hong Kong for more than a year at the time of the research. An information sheet and consent form explaining the research were included in the self-administered questionnaires. The final analysis included a total of 447 questionnaires.

Measures

A total of four scales were used, along with a demographic sheet that included age, gender, education, employment, income, and length of residence. All scales were translated into Urdu and Nepali based on the back-translation method (Brislin, 1970). First, two bilingual persons proficient in both the source and target languages translated the questionnaires into the target languages. The translated versions were then back-translated to English by two other professional bilingual translators. The first author and two other bilingual translators then compared the original and translated versions. The bilingual translators were university graduates with a high proficiency in both English and the target languages. After slight modifications were made to the wording of some of the items, the questionnaires were distributed to participants.

Acculturation orientation

Participants completed the 32-item Stephenson Multidimensional Acculturation Scale (SMAS; Stephenson, 2000). One of the main reasons for selecting the SMAS was that it is succinct and can be administered across diverse groups (Schwartz & Zamboanga, 2008). The SMAS is a general-purpose scale that consists of two subscales: Ethnic Society Immersion (ESI, 17 items) and Dominant Society Immersion (DSI, 15 items). Items in both subscales tapped respondents’ knowledge, attitudes, and behaviors towards language, social interactions, media, and food of the heritage culture (ESI) and the host culture (DSI). Sample items include, “I am familiar with the history of my native country” (ESI) and “I feel accepted by local Chinese people” (DSI). Items are scored on a four-point scale: 1 (false), 2 (partly false), 3 (partly true), and 4 (true). Higher scores indicate a higher orientation in each subscale. The reliability of the scale is α = .86 for the entire scale, .97 for the ESI, and .90 for DSI (Stephenson, 2000).

Perceived discrimination

Perceived discrimination was assessed with a four-item scale adapted from the Measure of Perceived Discrimination Scale (MPDS) developed by Phinney and colleagues (Phinney, Madden, & Santos, 1998). A sample item is “I often feel that other people treat me unfairly or negatively because of my ethnic background.” Items are scored from 1 (almost never) to 5 (very often). Higher scores indicate higher perceived discrimination. Previous research has reported a Cronbach’s alpha of .81 (Phinney et al., 1998).

Acculturative stress

Acculturative stress was assessed with the adapted 17-item Social Attitudinal Familial Environmental Stress Scale (SAFE; Mena, Padilla, & Maldonado, 1987). Items in this scale assess the stress of participants within their social, attitudinal, familial, and environmental contexts. A sample item is: “I have more barriers to overcome than most people.” Participants were asked to rate the extent to which each item applied to them from 1 (not stressful) to 5 (extremely stressful), with higher scores indicating higher acculturative stress. Mena and colleagues (1987) reported a Cronbach’s alpha of .89 for the entire scale.

Psychological distress

Psychological distress was assessed with the 21-item Depression Anxiety Stress Scale (DASS-21; Lovibond & Lovibond, 1995). The items in the DASS-21 are designed to assess negative emotional states that are indicative of depression, anxiety, and stress. In this study the DASS-21 was used to assess the dimensional nature of emotional distress and symptom-related experiences that are concerning to individuals but are not perceived as severe. This scale is not a diagnostic tool for mental disorders. A sample item is “I felt downhearted and blue.” Items are scored from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time), with higher scores indicating higher symptoms of psychological distress. The DASS-21 has been used in various studies of clinical and nonclinical populations, and the internal consistency and divergent/convergent validity were found to be similar across ethnic groups, in both clinical and nonclinical groups (e.g., Antony, Bieling, Cox, Enns, & Swinson, 1998; Henry & Crawford, 2005; Norton, 2007; Tonsing, Zimet, & Tse, 2012).

Hypothesized path model

In Figure 1, we outline a path model that summarizes the hypothesized relationships among the variables, which were assessed using structural equation modeling (SEM) in AMOS 5 (IBM SPSS). The use of SEM helps provide a clearer picture of the overall pattern among the variables in the model. Past studies have also examined the acculturation process using SEM (e.g., Kosic, 2004; Tartakovsky, 2012; Te Lindert Korzilius, van de Vijver, Kroon, & Arends-Tóth, 2008).

Figure 1.

Hypothesized model of the relationships between perceived discrimination, acculturative stress, acculturation orientations, and psychological distress.

Tests of normality of data

Prior to running the analyses, the data file was screened for accuracy, missing data, and distribution normality. Additionally, entries of 10% of the total participants were randomly selected and cross-checked with the original hard copy questionnaire. This revealed no errors or missing data. Tests of normality were performed to check for skewness and kurtosis of data distribution (see Table 1 below). As observed in Table 1, all of the values fell within the commonly acceptable range of ±1 for skewness, and ±3 for kurtosis (Tabachnick & Fidell, 2007). Furthermore, a visual observation of the histograms and normal Q-Q plots revealed that all the variables were within the acceptable criteria for normality.

Table 1.

Skewness and kurtosis.

	Pakistanis (N = 229)		Nepalese (N = 218)
	Skewness	Kurtosis	Skewness	Kurtosis
SMAS (heritage culture)	−.639	.679	−.826	.519
SMAS (host culture)	.197	−.409	.110	−.259
Perceived discrimination	.538	−.169	.154	−.236
Acculturative stress	.197	−.284	.102	−.020
DASS (psychological distress)	.778	.089	.793	.565

Note. SMAS = Stephenson Multidimensional Acculturation Scale; DASS = Depression Anxiety Stress Scale.

Results

Participants

In the Pakistani sample (N = 229; male = 103; female = 126), participants were relatively young (mean age = 30.60, SD = 8.45), and most were married (72%). About half (48%) were employed, with a monthly median income of HK $8,700 (US $1.00 equals approximately HK $7.78). In terms of education, 38.9% had attained a college education; 40.2% had a high school education; 18.3% had a primary education; 2.6% had no formal education. The average length of residence in Hong Kong was 13.2 years (SD = 8.71).

In the Nepalese sample (N = 218; male = 106; female = 112), participants were also relatively young (mean age = 32.27, SD = 9.02), and most were married (71.6%). Of these respondents, 68.8% were actively employed, with a monthly median income of HK $9,500. In terms of education, 40.3% were college graduates; 52.8% had a high school education; and 6.9% had a primary education. The average length of time in Hong Kong was 10 years (SD = 6.85). Notably, the median income for the Nepalese was slightly higher than that of the Pakistanis, but lower than the median monthly income of HK $11,000 of the whole working population of Hong Kong (Census and Statistics Department, 2012).

Internal reliability of scales

All of the scales had adequate reliability in this sample. The coefficient alphas for the scales in this study were: DSI = .81 and ESI = .68 for Pakistanis (.76 for the entire scale) and DSI = .80 and ESI = .75 for Nepalese (.77 for the entire scale). Perceived discrimination had alphas of .86 and .81 for Pakistanis and Nepalese, respectively; the alpha values for the acculturative stress scale were .85 for Pakistanis and .81 for Nepalese, and for the DASS-21 were .94 and .92 for Pakistanis and Nepalese, respectively.

Descriptive statistics

Table 2 presents the means, standard deviations, and correlations among the variables of interest. There were moderate correlations between heritage culture orientation and perceived discrimination, acculturative stress, and psychological distress. These correlations were generally in the expected direction.

Table 2.

Correlations among the variables for Pakistanis (N = 229, below the diagonal) and Nepalese (N = 218, above the diagonal).

		M	SD	1	2	3	4	5	M	SD
1	Heritage culture orientation	3.39	.24	–	.11	−.06	−.01	−.24**	3.49	.22
2	Host culture orientation	2.09	.50	.03	–	−.28**	−.26**	−.20**	2.16	.43
3	Perceived discrimination	2.50	.92	−.15*	.03	–	.50**	.24**	2.40	.85
4	Acculturative stress	2.52	.69	−.17**	−.20**	.53**	–	.35**	2.67	.68
5	Psychological distress	11.74	7.92	−.16*	.05	.34**	.45**	–	10.40	7.15

***p < .05. p < .01.

With regard to psychological distress, assessed with the DASS scale (Lovibond & Lovibond, 1995), while the majority of participants were within the normal category (Table 3), a small number of participants scored within the moderate to higher categories. In these categories, participants’ scores were higher than 87% of those from the normative sample (Lovibond & Lovibond, 1995). It should be noted that these categorizations refer to the frequency of self-reported symptoms associated with depression, anxiety, and stress relative to the population and do not serve as a diagnostic of disorder.

Table 3.

Distribution of DASS scores into frequency of symptoms reported categories.

	Depression		Anxiety		Stress
	Pak	Nep	Pak	Nep	Pak	Nep
Normal	70.7	75.2	68.6	74.8	70.3	76.6
Mild	14.0	12.8	10.5	11.0	10.5	6.9
Moderate	10.5	7.8	11.8	10.6	13.1	13.3
Severe	3.5	3.7	8.3	2.8	5.7	2.8
Extremely severe	1.3	0.5	0.9	0.9	0.4	0.5
Moderate and above	15.3	12.0	21.0	14.3	19.2	16.6

Note. The scores were transformed to Z scores to facilitate comparison with the normative sample (Lovibond & Lovibond, 1996).

Gender differences

Independent-samples t tests were performed initially to test for gender differences on the scale scores (Table 4). Some of the variables showed significant gender differences. For Pakistani samples, females reported higher mean scores on heritage culture orientation, t(227) = 2.13, p < .05, whereas males reported higher mean scores on host culture orientation, t(227) = −2.55, p < .05, and acculturative stress, t(227) = −2.18, p < .05. A multivariate analysis of variance was conducted by entering these dependent variables, then gender as a fixed factor and the covariates. Controlling for host-language proficiency and length of residence, gender differences were no longer significant on heritage culture and host culture orientation. However, there were still significant gender differences in acculturative stress, even after controlling for these variables, F(1, 224) = 5.25, p < .05. Among the Nepalese, males reported significantly higher mean scores on heritage culture orientation, t(216) = −1.97, p < .05. However, after controlling for employment status (1 = employed, 0 = not employed), host-language proficiency, and length of residence, there were no significant gender differences. In addition, there were no significant gender differences in psychological distress for either group. Thus, the hypothesis that females would report higher psychological distress (H1) was not supported in either group.

Table 4.

Descriptive statistics by ethnicity and gender among Pakistani and Nepalese immigrants (N = 447)†.

	Pakistani (N = 229)		Nepalese (N = 218)
	Males (n = 103)	Females (n = 126)	Males (n = 106)	Females (n = 112)
Measures	M (SD)/M (SE)	M (SD)/M (SE)	M (SD)/M (SE)	M (SD)/M (SE)
SMAS heritage culture	3.35 (0.24) 3.35 (0.03)	3.42 (0.25) 3.43 (0.2)	3.52 (0.20) 3.52 (0.02)	3.46 (0.24) 3.47 (0.02)
SMAS host culture	2.19 (0.49) 2.04 (0.04)	2.02 (0.49) 2.14 (0.03)	2.20 (0.44) 2.19 (0.04)	2.12 (0.42) 2.14 (0.03)
Perceived discrimination	2.58 (0.86) 2.44 (0.10)	2.43 (0.97) 2.54 (0.09)	2.38 (0.91) 2.40 (0.08)	2.41 (0.80) 2.41 (0.08)
Acculturative stress	2.63 (0.67)* 2.66 (0.08)	2.43 (0.70) 2.41 (0.07)	2.68 (0.71) 2.70 (0.07)	2.66 (0.66) 2.64 (0.06)
DASS (psychological distress)	1.71 (1.10)* 1.69 (0.132)	1.64 (1.16) 1.67 (0.11)	1.46 (1.04) 1.47 (0.10)	1.50 (1.00) 1.50 (0.10)

Note. SMAS = Stephenson Multidimensional Acculturation Scale; DASS = Depression Anxiety Stress Scale.

*p < .05. †Controlling for employment status, host language proficiency, and length of residence in the host country.

Model estimation

Path model estimation for Pakistanis

To examine the relationships among the variables, a path model was analyzed using AMOS 5 (Arbuckle, 1999). An initial testing of the path model for Pakistanis (Figure 1) showed poor overall fit indices (χ²= 74.36; df = 2, p < .001; GFI = .90; AGFI = .25; NFI = .53; CFI = .52; RMSEA = .40). Researchers have suggested that good fit indices are values above .9 for GFI and AGFI; between .9 and .95 for NFI; .9 or higher for NFI (Iacobucci, 2010; Ingram, Cope, Harju, & Wuensch, 2000); and CFI “close to” .95 or lower (Hu & Bentler, 1999, p. 27). To improve the fit, modification indices were applied in a more exploratory way (for further discussion, see Kline, 2004; Vegener & Fabrigar, 2000). These modifications are best understood as fitting a structural model that has been tweaked post hoc based on the data. Also based on previous studies (e.g., Jasinskaja-Lahti, Liebkind, Horenczyk, & Schmitz, 2003; Liebkind, Jasinskaja-Lahti, & Solheim, 2004), a new path was added (i.e., the relationship between perceived discrimination and acculturative stress), such that people who perceive higher discrimination would also be expected to report higher acculturative stress. The modified model showed an overall good fit (χ²= 2.82; df = 2, p = .24; GFI = .99; AGFI = .96; NFI = .98; CFI = .99; RMSEA = .04). Standardized regression coefficients (β) are presented for the path relations (Figure 2).

Figure 2.

Path model with standardized regression coefficients (beta) for Pakistanis (N = 229), and Nepalese (N = 218; in parentheses).

The path analysis showed a significant negative relationship between perceived discrimination and heritage culture orientation (β = −.15, p < .05), and positive associations between perceived discrimination and host culture orientation (β = .19, p < .05). Host culture orientation showed a significant positive relationship with psychological distress (β = .13, p < .05); and the path between acculturative stress and psychological distress showed a significant positive association (β = −.30, p < .001), which was slightly moderated by host culture orientation (β = .13, p < .05). Overall, the factors in the model accounted for 23% of the variance in psychological distress. Thus, for Pakistanis, hypotheses H2b, H4a, and H4b were partly supported.

Path model estimation for Nepalese

The hypothesized path model (Figure 1) was repeated with the Nepalese group. Again, the overall hypothesized model showed poor fit for the Nepalese (χ²= 65.70; df = 2, p < .001; GFI = .90; AGFI = .28; NFI = .51; CFI = .48; RMSEA = .38). The modified model for the Pakistanis (Figure 2) was then tested amongst the Nepalese. This model showed good overall fit (χ²= 2.35; df = 2, p = .30; GFI = .99; AGFI = .96; NFI = .98; CFI = .99; RMSEA = .02). Standardized regression coefficients (β) are presented in the path relationships (Figure 2).

The path analysis showed a significant negative relationship between perceived discrimination and host culture orientation (β = −.20, p < .01). There was a significant negative relationship between heritage culture orientation and psychological distress (β = −.23, p < .001). Acculturative stress was associated negatively with host culture orientation (β = −.16, p < .05) and positively with psychological distress (β = .30, p < .001). Contrary to the hypothesis, there was no significant relationship between perceived discrimination and psychological distress. However, there was a positive association between perceived discrimination and acculturative stress, which in turn was positively associated with psychological distress. For acculturation orientation, we did not find the expected relationships between host culture orientation and psychological distress. Overall, the factors in the model accounted for 19% of the variance in psychological distress. Thus, hypotheses H2a and H4a were partly supported in the Nepalese group.

Discussion

This study used SEM to test an integrated model of the relationships between acculturation orientation, perceived discrimination, acculturative stress, and psychological distress. Although the hypothesized model (Figure 1) was not confirmed, the modified model (Figure 2) indicated that acculturative stress and acculturation orientations were significantly related to psychological distress. The modified model was successfully replicated in the second group (Nepalese). Based on past studies that found that perceived discrimination is a major acculturative stressor, a new path from perceived discrimination to acculturative stress was included in the modified model, which improved overall fit to the model (e.g., Jasinskaja-Lahti et al., 2003; Liebkind et al., 2004).

Results showed that acculturation orientation was related to psychological distress differently for Pakistanis and Nepalese. For the Nepalese, heritage culture orientation was associated with lower psychological distress, indicating that a positive attitude towards their heritage culture was linked to lower psychological distress. For the Pakistanis, although the path model did not indicate significant relationships between heritage culture orientation and psychological distress, the observed relationship followed the expected direction (Figure 2). The path model for the Pakistani sample showed a significant positive association between host culture orientation and psychological distress.

Regarding the variations in acculturation attitudes of the two groups, the positive association between host culture orientation and psychological distress for Pakistanis may be explained by the fact that adhering to the host culture may have led to some conflict with their own heritage culture, which in turn could lead to some degree of psychological distress. Although this should be interpreted with caution because this study could not determine causality, it has been observed that cultural distance or similarities also play a role in whether immigrants are accepted (or not) by host members (Kosic, 2002). Brilliant (2000) and Ku (2006) have noted that when there are distinguishable cultural differences between the acculturating group and the host culture, adjusting to the host culture is likely to be more stressful. For instance, compared to the Nepalese, the Pakistanis are easily distinguishable by their traditional dress, the hijab worn by females (head scarf) and the kurta pyjama worn by males (a knee-length shirt and a loose trouser), which differ markedly from the “westernized social uniforms of fashion conscious Hong Kong Chinese residents” (Ku, 2006, p. 296). Findings from past studies assessing Hong Kong Chinese people’s attitude towards non-Chinese groups have found that acceptance of South Asians was the lowest when compared to the level of acceptance of Caucasians or other Asian groups (e.g., Japanese, Koreans; e.g., A. Chan & Wong, 2005; Equal Opportunities Commission, 2009).

Contrary to the hypotheses, there were no significant gender differences in psychological distress (Table 2). With regard to acculturation orientation, the results showed that Pakistani males were more favorable towards the host culture, which is consistent with previous studies (e.g., Farver et al., 2002; Liebkind, 1996; Robinson, 2005). Some studies have reported that individuals may indicate a preference for host culture orientation when in the public domain (e.g., work, education, host language), but a preference for the heritage culture in the private domain (e.g., Arends-Tóth & van de Vijver, 2006). Similar to the findings in the Pakistani sample, there were no gender differences when controlling for covariates in the Nepalese sample.

In this study, perceived discrimination did not show a direct effect on psychological distress. However, we found that perceived discrimination was positively related to acculturative stress, which in turn was associated with significant psychological distress. From the model tested in this study, it can be observed that acculturative stress was positively associated with psychological distress. Past studies have shown that perceived discrimination is a major acculturative stressor that may increase psychological distress among immigrants (e.g., Araujo & Borrell, 2006; Finch & Vega, 2003; Hwang & Ting, 2008; Tummala-Narra, Alegria, & Chen, 2011). Recent studies of students from mainland China in Hong Kong discovered that continued exposure to acculturative stress (e.g., difficulties finding paid employment and settling into a new school) were linked to higher psychological maladjustment (e.g., Chou, 2009; Wu & Mak, 2012).

In both groups of our study, acculturative stress had a direct effect on psychological distress (Figure 2). In this study, acculturative stress and not perceived discrimination showed strong associations with the outcome variable. This in turn was partially mediated by host culture orientation. The strong effect of acculturative stress on psychological distress for both groups indicates that irrespective of their acculturation orientations, acculturative stress was associated with psychological distress. Previous studies have found that many South Asians in Hong Kong encounter numerous challenges in their daily lives, especially in terms of housing, education, and employment. It is apparent that these difficulties, often inherent to the immigration experience, are a major source of stress and psychological distress. In terms of psychological distress, although the majority of participants scored within the normal category (Table 3), some participants scored within the moderate to higher categories higher than those from the normative sample (Lovibond & Lovibond, 1995). These results suggest the importance of considering stressors associated with immigrants’ acculturation process, which have the potential to affect acculturation outcomes (Vang Geel & Vedder, 2010).

This study found that perceived discrimination was related to psychological distress and acculturative stress. Although earlier studies have noted that South Asians may be reluctant to disclose information that deals with stressful situations or psychological distress (Tummala-Narra et al., 2011), experiences of ethnic discrimination still prevail in Hong Kong (Crabtree & Wong, 2012). This study provides evidence that perceived discrimination is indirectly related to psychological distress. In light of the findings of this study, it is hoped that future studies will examine what kind of mechanisms of social support and family interactions help South Asians cope with discrimination and related stress. For example, future studies can explore the role of peer support in buffering the effects of discrimination. Such knowledge would help service providers and helping professionals working with South Asians. Additionally, such work may be used to review the policies and practices of relevant agencies to ensure that they align with the needs of ethnic minorities, while also challenging the more macroscale systemic and legislative issues that have reinforced discrimination and prejudice.

This study found that acculturative stress was most strongly associated with psychological distress. Based on the stress and coping model, when adequate support and resources are not available or access to resources is hindered (e.g., lack of information support for ethnic minority groups in local neighborhoods), it may lead to heightened degrees of psychological distress, which in turn may lead to various psychological problems if left unattended. Steps should be taken to help ameliorate various acculturative stressors and to promote the health and well-being of immigrants as they go through the acculturation process.

Limitations and conclusion

This study is one of the first to examine the relationships of perceived discrimination, acculturative stress, and acculturation orientations with psychological distress among Pakistanis and Nepalese in Hong Kong. The findings of this study shed light on the importance of examining the factors that contribute to changes in the psychological health and well-being of immigrants. This study found that acculturative stress had the strongest association with psychological distress. It is therefore imperative to implement programs and support services that help ameliorate various acculturative stressors related to economic, cultural, and social adjustment, and to take steps to promote the health and well-being of immigrants as they go through the acculturation process. The findings of this study also highlight the need to develop a workable mental health model for practice and teaching that focuses on the impact of cultural adjustment and the various stressors that have the potential to affect immigrant groups’ psychological health and well-being.

The modified path model we identified is only one way to explain the relationships between acculturation and distress. Because acculturation is a complex process, using multivariate process models is very helpful in increasing our understanding of the various aspects involved in acculturation. Future studies can focus on testing longitudinal models that can better explain the multiple interacting factors that contribute to the acculturation process of immigrants over time. Despite methodological limitations, the relatively large sample of Pakistani and Nepalese immigrants in the present study provides a useful picture of the acculturation experiences and settlement outcomes of South Asian immigrants in Hong Kong.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Kareen N. Tonsing, PhD, is an Assistant Professor of Social Work at Oakland University. Kareen's research interests are in the area of immigration related factors including acculturation, psychological adaptation and well-being, and social support.

Samson Tse, PhD, is the Director of the Masters of Social Sciences in Counselling, and a Professor of Mental Health in the Department of Social Work and Social Administration at the University of Hong Kong. Professor Tse has researched mental health services for over 20 years in other ethnic populations. His published works focus on mental health services research, severe mental illness with minority populations, and application of recovery-orientated interventions.

Jenny Tonsing, PhD, is a Lecturer of Social Work at the University of South Pacific, Fiji, School of Social Science. Her area of research interests includes migration, domestic violence impact on mental health, cultural competency, and South Asian diaspora.

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