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. Author manuscript; available in PMC: 2025 Jun 1.
Published in final edited form as: Asian Am J Psychol. 2023 Aug 24;15(2):73–82. doi: 10.1037/aap0000328

Acculturation, Enculturation, Culture-Specific Emotional Distress, and Parenting Among Korean Immigrant Mothers

Han Na Lee 1, Eunju Yoon 1, Chelsea Yanuaria 1, Yoonsun Choi 2
PMCID: PMC11343448  NIHMSID: NIHMS1925239  PMID: 39184346

Abstract

This study examined how Korean immigrant mothers’ cultural orientations (i.e., acculturation and enculturation) were related to their mental health, specifically depression and the culturally specific syndrome of Hwa-byung (HB), and had direct and indirect relations to their parenting practices (i.e., authoritative, authoritarian, acceptance, rejection). In a sample of 412 Korean immigrant mothers (99.5% foreign-born; Mage = 45.31), a path analysis was conducted by using the maximum-likelihood and bootstrapping methods. Results revealed that mothers’ cultural orientations were indirectly related to parenting practices via depression and HB. Specifically, mothers’ acculturation and enculturation had positive indirect relationships to authoritative parenting and acceptance versus a negative relationship to rejection, via their links to depression. Mothers’ acculturation had a negative relationship to rejection via its link to HB, while enculturation was not related to HB. Additionally, cultural orientations were directly associated with parenting. Overall, the current findings highlighted that HB holds a unique role in parenting after controlling for the effects of depression, which suggests the importance of assessing culture specific syndrome, above and beyond depression, to have a better understanding of Korean immigrant mothers’ mental health and its relation to parenting. Implications for research and practice are discussed.

Keywords: Acculturation, Hwa-byung, Korean immigrants, parenting

Korean Americans are the fifth largest Asian group in the United States with numbers approximating 1.9 million (Budiman, 2022; H. Kim, 2005). The rapid growth of the Korean immigrant population in the United States warrants more culturally nuanced assessment and understanding of their mental health needs such as culture specific emotional distress termed Hwa-byung (HB). HB is a unique culture specific syndrome found in Korean culture, which is characterized by the somatization of unresolved anger resulting from repeated experiences of injustice (E. Kim et al., 2020; Min, 2009). While much of the research on immigrant families is focused on parent mental health (e.g., depression) and parenting practices (Benner & Kim, 2010; E. Kim, 2011), research on culture specific syndromes is scarce.

Parenting research has often solely relied on Western approaches (e.g., authoritative parenting) to understand parenting in Korean American families although Korean family culture is substantially different from mainstream family culture (Choi et al., 2013). For example, Korean culture has traditionally been influenced by Confucianism (Kuraaski et al., 2002), where family relationships are more vertical rather than horizontal based on gender and age. Close family ties and interdependency are highly valued in Korean society where family functions as a single tight unit. Therefore, doing research solely based on Western parenting practice likely fails to capture the uniqueness and complexities of Korean American family processes (Cheah et al., 2013; Choi et al., 2013). As previously indicated, parenting practices may be especially complex in immigrant families while both parents and children go through acculturation and enculturation in bicultural contexts. In brief, parents’ acculturation and enculturation experiences, as well as psychological distress related to this process, may affect their parenting practices.

As to the relations between parents’ mental health and parenting practices, depression has been found to be an influential factor (E. Kim, 2011). Research indicates that depressed parents are less nurturing and supportive of their children and are more hostile and coercive in their parenting (E. Kim, 2011). Such parenting practices are related to youth internalizing behaviors, depressive symptoms, and delinquent behaviors (Benner & Kim, 2010). In relation, a recent study reported high prevalence rates of depression (i.e., nearly 33%) among Korean Americans (H. Kim et al., 2015). The rates are higher compared to other groups of Eastern Asian Americans and rank twice as high compared to the general U.S. population (E. Kim, 2011; H. Kim et al., 2015). This high prevalence rate warrants research attention to Korean immigrants’ mental health, especially in relation to their parenting practices.

While the previous research elucidated the importance of parental depression in understanding parenting practices and youth outcomes (Benner & Kim, 2010), relatively little research has been done on how culturally specific emotional distress, such as HB, differs from depression and are uniquely related to parenting. Specifically, not much is known as to how Korean immigrant parents experience the culture specific syndrome of HB, in addition to depression, while undergoing acculturation and enculturation processes, and how such emotional distress is related to parenting. Therefore, this study aimed to explore how Korean immigrant mothers’ acculturation and enculturation had direct and indirect relations to parenting practices via the culturally specific syndrome of HB in addition to depression.

Acculturation, Enculturation and Depression

Researchers have conceptualized acculturation as the cultural socialization process into mainstream culture (Berry, 1994; Kim & Abreu, 2001) and enculturation as maintaining and/or socializing into one’s home culture (Herskovits, 1948; B. Kim, 2007). For Korean immigrant parents, acculturation refers to adapting to the mainstream U.S. culture, while enculturation is learning and maintaining Korean cultural norms and values. The process of acculturation, enculturation and its relationship to mental health has been widely studied (Yoon et al., 2013). Understanding this relationship is particularly important in parenting research given the previous findings of the negative impact of depression on parenting. For example, depression was related to parenting practices that are more hostile and coercive and less supportive and nurturing (E. Kim, 2011). Such parenting practices are, in turn, related to adolescents’ internalizing behaviors, depressive symptoms, and delinquent behaviors (Benner & Kim, 2010). Since Korean Americans tend to report higher levels of depressive symptoms than other East Asian groups or the general U.S. population (E. Kim, 2011), it is important to examine the factors associated with depression when studying Korean immigrant parenting.

Two meta-analytic studies on the relationships of acculturation, enculturation and mental health found significantly negative associations between acculturation and depression versus nonsignificant relationships between enculturation and depression, although there was some variability in these relationships by such moderators as ethnicity and generational status (Gupta et al., 2013; Yoon et al., 2013). There have been a multitude of studies on the relationships between acculturation, enculturation and mental health outcomes, especially depression. However, not much is known as to the relationships of acculturation and enculturation to the culturally specific syndrome of HB. HB taps into unique, culture specific emotional distress among Koreans that is not captured by depression (E. Kim et al., 2020). Thus, the current study aimed to further illuminate the relations of acculturation, enculturation and mental health by including the Korean culture specific syndrome of HB in addition to depression.

Culture specific Syndrome of Hwa-byung

The DSM-5 defines cultural syndromes as “clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts” (American Psychiatric Association, 2013, p. 758). HB was listed as culture specific syndrome in the DSM-IV (American Psychiatric Association, 1994), and was introduced as a “cultural concept of distress” in the DSM-5 (American Psychiatric Association, 2013, p. 834). Korean immigrants may experience Hwa-byung (HB; 화병, hwa-pyŏng), a cultural syndrome that literally means “anger disorder” or “fire disease,” characterized by unresolved resentment, suppressed anger, and chronic experiences of injustice and unfairness (American Psychiatric Association, 2000; Min, 2009). It is well understood as a common “folk illness” in Korean society (E. Kim et al., 2013, p. 497). Primary symptoms of HB are unique expressions of unresolved resentment which include somatic (e.g., chest tightness, indigestion, heat sensation), emotional (e.g., anger, resentment, regret), and behavioral/social symptoms (e.g., sighing, tearfulness, interpersonal relationship problems) (E. Kim et al., 2013; Min, 2009).

HB syndrome has been found in approximately 5% of the general Korean population and has been more prevalent among middle-aged or older women of lower socioeconomic status (Min et al., 1990, Y-J. Park et al., 2002). More recent report from the National Health Insurance Review Board in South Korea stated that over 200,000 individuals were diagnosed with HB between 2011 and 2013 (Health Insurance Review & Assessment Service, 2015). While these numbers of individuals diagnosed with HB have doubled from 10 years ago, it is likely that the rates of HB are vastly underreported. To understand the prevalence of HB among Korean women, researchers have focused on the oppressive female gender roles stemming from patriarchal familial, social structure, ideologies, and practices (E. Kim et al., 2013, J. Park & Han, 2018; Y-J. Park et al., 2002). In traditional Korean culture, women are given distinct and restricted roles as daughter, wife, mother, and daughter-in-law (Keum, 2003). Such societal norms and expectations have persisted in Korean society throughout history and resulted in gender-based inequality and oppression. Valuing harmonious familial and social relationships, individuals in a collectivistic society stifle their anger to maintain connections. The long-term accumulation of suppressed anger under oppression results in HB meaning “anger-fire” in Korean (Min, 2009).

Despite changes in the macro-cultural environments after immigration, studies suggest that HB still influences Korean immigrant women’s mental health and well-being (Min, 2009). Although HB is more prevalent among middle-aged or older women of lower socioeconomic status (Y-J. Park et al., 2002; E. Kim et al., 2020; Cheon & Cesario, 2022), it is unclear how the cultural significance of HB is manifested in realms other than gender relations. While acknowledging that HB’s cultural significance lies in the historical gender inequality of a patriarchal social structure, discrimination based on race, culture, and language may add new stress on Korean immigrant women. Thus, studying this cultural syndrome of HB in the context of immigration and acculturation would provide unique information about Korean mothers’ mental health and parenting. Given the prevalence of HB among Korean women compared to men, HB is especially important in understanding how Korean immigrant mothers’ mental health is related to parenting practices.

While HB is a unique diagnosis, there has been controversy over whether HB should be aggregated into a subcategory under Major Depressive Disorder from a Western medical perspective due to their shared characteristics such as sadness, insomnia, and somatic symptoms (American Psychiatric Association, 2013). Even though HB consists of symptoms of depression along with somatic symptoms, there is often no link between HB and suicidality (E. Kim et al., 2013). Unlike depression, HB often suggests the will to live rather than inducing an impulse for suicide (E. Kim et al., 2013). Additionally, the major distinction between HB and depression is that HB is associated with a “building up of anger that generally develops over a long time” (E. Kim et al., 2013, p. 497; Min, 2009). This explains the prevalence of HB in middle or older ages.

To better understand the underlying emotions of HB, the Korean specific affective state of “Haan” (한) is critical. Hwang (1995) described “Haan” as a unique Korean affective state that cannot be translated into English or other languages:

a sense of unresolved resentment against injustice suffered, a sense of helplessness because of the overwhelming circumstances, a feeling of total abandonment, a feeling of acute pain of sorrow in one’s guts and bowels making the whole body writhe and wriggle, and an obstinate urge to take revenge and to right the wrong – all these to greater or lesser degree in combination.

(p. 32)

Haan is understood as a cluster of underlying emotions beneath HB that have accumulated over a long period of time without finding appropriate outlets (Min, 2009). Although Haan can be experienced individually, it can also be experienced as a collective affective state among Koreans resulting from Korea’s years of oppressive history to survive in the middle of superpower nations. In brief, Haan is a deep-seated, individual or collective affective base for the symptomology of HB. Haan is related to HB not only in relation to gender inequality but also in relation to other forms of oppressive experiences that affect immigrants (e.g., racism, linguistic discrimination, demoted social status, frustrated American dreams; Hwang, 1995; Min et al., 1997).

Differently from other mental health disorders (e.g., depression), Koreans appear to be more self-aware of experiencing HB and have less stigma attached to admitting to it, possibly due to the prevalence of this cultural syndrome among Koreans and their familiarity with it. As to the prevalence rates of HB among Korean immigrants, a community survey in Los Angeles showed that among 109 recent Korean immigrants, 12% suffered from HB (Lin et al., 1992), which is much higher than 4.1% in South Korea (Min, 2019). Given that HB taps into culture specific aspects of emotional distress among Korean immigrants that depression cannot, examining HB in addition to depression would add unique information to understanding Korean immigrant parenting.

Acculturation, Enculturation, Depression, Hwa-byung, and Parenting

Parenting has been established as a critical factor in children’s healthy psychological, social, emotional, and academic development (Kim & Rohner, 2002; E. Kim et al., 2006; E. Kim et al., 2007). The effects of parenting on child outcomes can be studied in typological or dimensional ways. The typological approach (Baumrind, 1971) typically classifies parenting styles to be authoritative or authoritarian (Baumrind, 1991; Kim & Rohner, 2002). Parents who engage in an authoritative style embody a warm, loving, supportive, and rational manner. They emphasize open communication and explain the reasons behind the rules (Kim & Rohner, 2002). Conversely, parents who engage in an authoritarian style attempt to manage, mold, and appraise the attitudes and behaviors of their children in accordance with a set of absolute rules, expecting strict obedience and respect. These parents are often forceful and tend to assert power arbitrarily with little explanation (Kim & Rohner, 2002).

Research suggests that an authoritative versus authoritarian parenting style yields better child outcomes, and this is particularly true in European American families (Kim & Rohner, 2002; E. Kim et al., 2006; Pinquart & Kauser, 2018). However, there are questions on whether an authoritative parenting style is necessarily associated with better outcomes in youth from other cultural backgrounds. Research suggests that Baumrind’s parenting styles may not adequately explain East Asian and East Asian American parenting as parental warmth and strictness may have different meanings and values to them (Chao, 1994; Choi et al., 2013). For example, based on Confucian family values, strictness may be equated with parental caring, concern, responsibleness, and involvement in East Asian families, while it is equated with hostility and rejection in Western families (Pinquart & Kauser, 2018). A study by Kim and Rohner (2002) found that the majority of parenting experiences perceived by 245 Korean American adolescents did not fit into Baumrind’s typologies, raising questions about its validity with this population.

Parental acceptance-rejection theory is another approach to understanding parenting from a dimensional perspective (Rohner, 1991). Parental acceptance-rejection theory places parenting practices on a continuum between acceptance and rejection based on the amount of warmth parents express to their children (E. Kim et al., 2006; E. Kim, 2011). Parental acceptance is displayed through warmth and affection. On the other hand, parental rejection is characterized as the withdrawal of affection and hostility and neglect in its place (E. Kim et al., 2006; E. Kim, 2011). In addition to acceptance and rejection, parental acceptance-rejection theory further understands parents’ behavioral control of their children on a continuum ranging from being permissive to being strict (E. Kim et al., 2006). Permissive parents exercise minimum control and provide no direction. Strict parents enforce many rules and limit their children’s autonomy (E.Kim et al., 2006; E. Kim, 2011). Korean American parents’ acceptance-rejection and control have been shown as important factors in their children’s mental health (E. Kim, 2011). Korean American adolescents’ evaluation of whether their parents were accepting and/or rejecting was found to considerably influence their psychological adjustment (E. Kim et al., 2006). Additionally, maternal acceptance-rejection has been found to influence children’s social competence (E. Kim et al., 2007). Taken together, parental acceptance and rejection might be useful variables for understanding Korean immigrant mothers’ parenting, which might compensate for the aforementioned limitations of authoritative versus authoritarian parenting styles in studying this population.

The Present Study

To our knowledge, no study has examined the relationships of Korean immigrant mothers’ cultural orientations and parenting by using both depressive symptoms and culture specific emotional distress of HB as mediators. Thus, the purpose of this study was to examine how mothers’ acculturation (e.g., cultural socialization to mainstream culture) and enculturation (e.g., retention of or cultural socialization to one’s ethnic culture) were distinctly related to depression and HB and had direct and indirect relations to parenting practices (i.e., authoritative, authoritarian, acceptance, and rejection). To summarize the conceptual model, (see Figure 1), we hypothesized that higher levels of acculturation would be associated with lower levels of depression and HB. Given the mixed results from the prior research on the relation of enculturation and psychological distress (Yoon et al., 2013), we left the link from enculturation to depression to be exploratory although enculturation might be positively related to the cultural syndrome of HB. We hypothesized that lower levels of depression and HB would, in turn, be related to more authoritative and accepting parenting practices (vs. less authoritarian and rejecting parenting practices). We particularly attended to if HB was uniquely related to parenting practices after controlling for the effects of depression.

Figure 1.

Figure 1

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Conceptual Model

Method

This study is a part of the Midwest Longitudinal Study of Asian American Families (MLSAAF) project, a large and ongoing longitudinal research focused on Filipino and Korean immigrant families (Choi, 2021). The MLSAAF data have been utilized to examine parent-child relationships in Filipino and Korean immigrant families since 2014 (Choi et al., 2017). Previous publications from this data have used the variables of cultural orientations and some parenting practice variables (e.g., authoritarian and authoritative styles; Choi et al., 2013), but have not examined their associations in relation to mothers’ mental health variables including depression and culture-specific syndromes (e.g., HB) or the other parenting variables of acceptance and rejection. Differently from the previous use of this data, the current study examines how mothers’ cultural orientations are related to their mental health (e.g., depression and HB) as opposed to children’s mental health. This study specifically explores the relationship between the culture-specific syndrome of HB among first-generation Korean immigrant mothers and their parenting practices, which was not examined in the previous studies utilizing this data set.

Participants and Procedure

The present study focused on Korean American families only. Participants were recruited from public and private schools, phonebooks, ethnic churches/temples, ethnic community organizations, and ethnic grocery stores. Questionnaires were available in both English and Korean, were distributed to eligible participants in paper-pencil and web-survey form, and were collected in person, by mail, or via web. There were no mean differences in the main variables by language used or method of data collection. The English version of questionnaires was translated utilizing a committee translation process which involves multiple translators working first independently and then with a committee to reconcile discrepancies in translation and reach a final consensus (Epstein et al., 2015). The study procedure was approved by the IRB of the researcher who did data collection. The current study used the Wave 1 data collected in 2014–2015 from Korean immigrant mothers (N = 412, Mage = 45.31, SD = 3.76). They lived in the United States for an average of 16.15 years (SD = 8.69) at the time of data collection. Almost all mothers were first-generation immigrants (99.5%). The majority of them were married (92.03%) and were either U.S. citizens or permanent residents (84.1%). See Table 1 for detailed demographic information.

Table 1.

Demographic Characteristics

Variables Frequency (%)
Relationship to Child
 Biological Mother 394 (95.6%)
 Adoptive Mother 2 (0.5%)
 Step-Mother 2 (0.5%)
 Legal guardian 1 (0.2%)
 Other 13 (3.2%)
Nativity status
 Foreign-born 410 (99.5%)
 U.S.-born 2 (0.5%)
Status in US
 U.S. citizen 199 (48.3%)
 Permanent resident 140 (34%)
 Temporary visa 59 (14.3%)
 Other 5 (1.2%)
 Missing 9 (2.2%)
Income
 Less than $25,000 34 (8.4%)
 $25,000 – $49,999 108 (26.2%)
 $50,000 – $74,999 97 (23.5%)
 $75,000 v $99,999 61 (14.8%)
 $1000,000 – $149,999 63 (15.3%)
 $150,000 or more 27 (6.6%)
 Missing 22 (5.3%)
M (SD)
Age 45.31 (3.76)
Years of residence in the U.S. 16.15 (8.69)
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Note. N = 412.

Measures

We used a part of the MLSAAF dataset that were already collected prior to this study. The MLSAAF survey included a combination of a series of newly developed and pretested measures and several existing measures. The survey included up to 70 scales; thus, reduced as opposed to full scales were often used. For example, when the psychometrically well-validated measures such as the Language, Identity and Behavioral Acculturation Scale (Birman & Trickett, 2001) or the Parenting Authority Questionnaires (Buri, 1991) were too long to include in their entirety, the lengths of the scales were reduced. In consultation with original scale developers, scales reduction was done in consideration of clarity on translated items, reviews by both community and academic experts, and most importantly, psychometric properties in previous studies when available (e.g., Choi et al., 2013). While maintaining the conceptual dimensions (e.g., factor structure) of the original scales, the correlation between each item and total score as well as Cronbach’s alpha with or without each item was examined.

The preliminary questionnaires were pretested in 2013 with a sample of 188 Korean parent-youth dyads and 150 Filipino parent-youth dyads prior to the start of the MLSAAF project. Those with sound psychometric properties were included in the final MLSAAF survey. The reduced scales were used in previous studies among Korean American parents and their adolescent children (e.g., Choi et al., 2014; Choi et al., 2016; Choi et al., 2018), and further details on how new measures were developed and tested are found in other literature (Choi et al., 2017; Choi et al., 2018; Choi et al., 2021). In this study, Cronbach’s alphas were calculated using the combined English and Korean versions of the survey. If not indicated otherwise, responses to measures were on a 5-point Likert scale, ranging from 1 (not at all, never, or strongly disagree) to 5 (very much, very well, always, or strongly agree), with higher scores indicating higher levels of the variable assessed. All variables were computed to calculate their item-level mean scores.

Mother Reported Acculturation and Enculturation

The Language, Identity, and Behavioral Acculturation Scale (LIB; Birman & Tricket, 2001) assesses acculturation and enculturation across the dimension of language, identity, and behavior. The original scale was condensed from 54 items to 24 items in consultation with the scale developer. The measure included items such as “How well do you understand English?” and “I think of myself as being Korean.” Previously reported Cronbach’s alphas for this shortened measure ranged from .85 to .91 for acculturation and .82 to .88 for enculturation (Choi et al., 2018). The Cronbach’s alphas in the present sample were .87 for acculturation and .74 for enculturation.

Depressive Symptoms

The Center for Epidemiological Studies-Depression (CES-D; Radloff, 1977) measures the occurrence of depressive symptoms including restless sleep, poor appetite, and feelings of loneliness over the past week. The scale includes 20 items such as “My sleep was restless,” “People were unfriendly to me,” and “I felt that people disliked me.” Responses are recorded on a 4-point Likert scale ranging from 0 (= rarely or none of the time, less than 1 day) to 3 (= most or all of the time, 5–7 days). Previously reported Cronbach’s alphas ranged from .86 to .88 (Yasui et al., 2018). The current Cronbach’s alpha was .74.

Culturally Specific Syndrome (Hwa-byung)

Hwa-byung was assessed utilizing four items derived from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). This measure assessed the physiological symptoms of HB, participants’ self-diagnosis of HB, and its underlying affective state of Haan. The HB measure was then refined based on focus group interviews, literature review, and input by both community and academic experts. More details of how they were developed are described elsewhere (Choi & Kim, 2010; Choi et al., 2013). The scale was tested using a community sample of Korean American men (N = 164) and women (N = 272) and a paper that examined its validity along with its associations with multidimensions of depression is currently under review (author citation). Sample items included “When I am upset, I had oppressive and heavy feelings in my chest,” and “I feel like I have hwa-byung.” The Cronbach’s alpha value for the HB measure was .82 for Korean American women and .91 for Korean American men (author citation). The current Cronbach’s alpha value was .87.

Authoritative and Authoritarian Parenting Styles

Authoritative parenting, measuring a parenting style of high responsiveness and high demands, utilized five out of the 10 items from the Parenting Authority Questionnaire (Buri, 1991). Items included, “I direct the activities and decisions of my child through reasoning and discipline,” and “I always encourage verbal give-and-take whenever my child feels that family rules and restrictions are unreasonable.” Previously reported Cronbach’s alphas for this shortened measure ranged from .66 to .75 (Choi et al., 2013). The current Cronbach’s alpha was 0.66.

Authoritarian Parenting, measuring a stern and strict parenting style, utilized seven of the 10 items from the Parenting Authority Questionnaire (Buri, 1991). Items included “It is for my child’s good to be forced to conform to what I thought was right, even if my child doesn’t agree with me,” and “I would get very upset if my child tries to disagree with me.” Previously reported Cronbach’s alphas for this shortened measure ranged from .64 to .73 (Choi et al., 2013). The current Cronbach’s alpha value was 0.76.

Parental Acceptance and Rejection

Parental Acceptance and Rejection used nine items to measure an accepting parenting style and 15 items to measure a rejecting parenting style from the original 60 items of the Parental Acceptance-Rejection Questionnaire (PARQ; Rohner, 2004). Items included “I say nice things about my child,” and “I make it easy for my child to tell me things that are important to him/her.” for acceptance, and “I see my child as a big nuisance,” and “I resent my child” for rejection. Previously reported Cronbach’s alphas for the shortened measures ranged from .87 to .89 (Choi et al., 2013). The current Cronbach’s alphas were .85 for acceptance and .82 for rejection.

Results

Preliminary Analyses

The percentages of missing cases per item ranged from 0% to 2.7%, and the overall rate of missing cases was .79%. Item-level missing values were treated by using multiple imputation via expectation-maximum likelihood algorithm in the PRELIS of the LISEREL program (version8.80; Jöreskog & Sörbom, 2006). Descriptive statistics and correlations of the study variables are presented in Table 2. The values of skewness and kurtosis were acceptable based on the criteria of < 2 and < 7 respectively (West et al., 1995). Based on the zero-order correlations, acculturation was weakly to moderately related to all study variables, whereas enculturation was weakly related to only two parenting practices (i.e., Authoritarian parenting and Rejection). Depression was weakly to strongly related to all four parenting practices, whereas Hwa-byung (HB) was weakly to moderately related to Authoritarian parenting, Acceptance, and Rejection.

Table 2.

Correlations and Descriptive Statistics of Variables

1 2 3 4 5 6 7 8
1. Acculturation —
2. Enculturation −.32*** —
3. Depression − 20*** −.05 —
4. Hwa-byung −.19*** .04 .69*** —
5. Authoritative .16*** .06 −.16** −.05 —
6. Authoritarian −.10* .17*** .14** .17*** .14** —
7. Acceptance .17*** 0.03 −.20*** −.17*** .46*** −.10* —
8. Rejection −.13** .14** .31*** .35*** −.17*** .37*** −.40*** —
M 2.66 4.03 1.56 1.76 3.54 2.76 4.06 1.71
SD .67 .45 .41 .75 .54 .58 .61 .42
Kurtosis .55 −.59 1.27 1.34 −.03 .10 −.41 .78
Skewness .51 .52 2.75 2.07 .13 .13 .78 .49
Cronbach’s Alpha .87 .74 .90 .87 .66 .76 .85 .82
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Note. N = 412.

*

p < .05,

**

p <.01.

***

p < .001

Main Analyses

As shown in Figure 2, a path analysis was conducted to test the proposed conceptual model using Mplus version 8.5 (Muthén & Muthén, 2017). A partial mediation model was examined to test both direct and indirect paths where depression and HB mediated the relations of cultural orientations (i.e., acculturation, enculturation) and parenting practices (i.e., authoritarian, authoritative, acceptance, rejection). The predictors (acculturation and enculturation), mediators (depression and HB), and outcomes (authoritarian, authoritative, acceptance, and rejection) were respectively allowed to covary with each other given their conceptual and empirical overlaps. The path model was just identified (i.e., saturated), and, thus, had perfect fit indices (e.g., χ2 =0). The purpose of this study was to examine significance and magnitudes of relationships as opposed to model selection, so the subsequent report focused on the former.

Figure 2.

Figure 2

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The Path Model

Note. All path coefficients are standardized values.

*p<.05; **p<.01; ***p<.001

Indirect Effects through Depression and HB

The model accounted for 6% of the variance in authoritative parenting, 6% in authoritarian parenting, 7% in acceptance, and 15% in rejection. As hypothesized, acculturation was negatively associated with depression (b = −.14, SE = .03, β = −.23, p< .001) and HB (b = −.22, SE = .06, β = −.20, p < .001). Enculturation indicated a negative association with depression (b = −.11, SE = .05, β = −.12, p = .016) versus a nonsignificant relationship to HB (β = −.03, p = .62). As hypothesized, depression was negatively associated with authoritative parenting styles (b = −.26, SE = .09, β = −.20, p = .003) and acceptance (b = −.20, SE = .10, β = −.14, p = .038), while being positively associated with rejection (b = .15, SE = .06, β = .15, p = .02). Conversely, HB was positively associated with rejection (b = .13, SE = .04, β = .24, p < .001). By using 5,000 bootstrap samples, we examined the seven indirect effects with a bias-corrected 95% confidence interval of the standardized indirect effects. As shown in Table 3, all seven indirect effects were significant.

Table 3.

Bootstrap Tests of Standardized Indirect Effects

Indirect path Indirect effect size Bias-corrected 95% CIa
Acculturation → Depression → Authoritative (−.23) × (−.20) = .046 .015, .080
Acculturation → Depression → Acceptance (−.23) × (−.14) = .032 .003, .061
Acculturation → Depression → Rejection (−.23) × (.15) = −.034 −.062, −.010
Acculturation → Hwa-byung → Rejection (−.20) × (.24) = −.047 −.077, −.021
Enculturation → Depression → Authoritative (−.12) × (−.20) = .024 .005, .049
Enculturation → Depression → Acceptance (−.12) × (−.14) = .017 .001, .038
Enculturation → Depression → Rejection (−.12) × (.15) = −.018 −.037, −.003
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Note. N = 412. All values are standardized. CI = Confidence interval.

a

Exclusion of zero indicates a significant indirect effect at p < .05.

Direct Effects

Both predictors showed several significant direct effects on the outcomes. Acculturation was positively associated with authoritative parenting (b = .13, SE = .06, β = .18, p < .001) and acceptance (b = .15, SE = .05, β = .16, p < .001). Enculturation was positively associated with authoritative parenting (b = .21, SE = .09, β = .11, p = .04), authoritarian parenting (b = .22, SE = .08, β = .17, p = .003), and rejection (b = .13, SE = .05, β = .13, p = .01).

Discussion

The current study examined the relationship between Korean immigrant mothers’ cultural orientations, emotional distress (i.e., general depression and culture specific distress), and parenting practices. As hypothesized, acculturation was negatively associated with both depression and HB. This finding aligns with the previous meta-analysis findings that acculturation was especially beneficial to Asian Americans in reducing their negative mental health outcomes and enhancing their positive mental health outcomes (Yoon et al., 2013). For example, language skills are closely related to immigrants’ survival and success in mainstream society, which can conditionally ameliorate psychological distress (Yoon et al., 2013).

Enculturation was also negatively associated with depression, but it had no significant association with HB. According to previous meta-analytic findings, enculturation was often related to positive mental health outcomes but had nonsignificant associations with adverse mental health outcomes (Gupta et al., 2013; Yoon et al., 2013). In the current sample of Korean immigrant mothers, a bivariate correlation of enculturation and depression was nonsignificant, being consistent with the meta-analytic findings. However, after controlling for the effects of acculturation in the path model, enculturation was negatively related to depression. Teasing out its covariance with acculturation appears to have uncovered the beneficial effect of enculturation on depression.

The nonsignificant path from enculturation to HB is also noteworthy. One developing hypothesis of an underlying mechanism could be that enculturation is likely to be positively related to HB given the cultural origins of HB. Conversely, enculturation may have a beneficial effect of reducing HB, similar to its effect on depression. As HB is a traditionally held cultural syndrome of experiencing injustice and suppressed anger, previously identified risk factors were related to Korean patriarchal social context such as in-law conflict or gender discrimination (E. Kim, 2013). As Korean immigrants stay in the US longer and more acculturated to the Western values (i.e., ideas of gender equality), those traditionally endorsed values may produce tension across the subsystems of self, family, ethnic community, and the large society. Additionally, social issues other than gender inequality may contribute to the cultural make up of HB (Min, 2019). Thus, it is important to note different social structure (i.e., Western culture) which promote gender equality but add different layers of risk factors such as racial discrimination or identity confusion. As immigrants from a racially homogeneous society, Korean immigrants may experience racial, cultural, and linguistic discrimination along with the abrupt changes in their social identities from being a member of majority to a minority. Thus, these contradictions from different social structures may add complexity to the relation of enculturation and HW and partially explain their nonsignificant relationship.

Researchers have stated that HB is distinguishable from depressive symptoms and taps into unique aspects of emotional distress among Koreans that depression does not (Min, 2009). The significant mediation effect of HB on rejection after controlling for the effects of depression suggests that depression does not fully explain Korean immigrant mothers’ emotional distress in relation to parenting. Future research needs to elucidate shared versus distinct characteristics of depression and HB and their links to other outcomes of interest. Overall, the significant mediating effects of depression and HB on parenting (i.e., lowered authoritative parenting and acceptance vs. heightened rejection) highlight the importance of attending to immigrant mothers’ mental health in their acculturative context to optimize their parenting effectiveness.

As to the findings of direct effects, it is noteworthy that enculturation is positively associated with both authoritative and authoritarian parenting, while acculturation is positively related only to authoritative parenting. These findings suggest the importance of taking cultural backgrounds into account in parenting research. Current parenting literature and theories are predominantly based on European American family experiences and usually take a categorical approach to parenting styles (e.g., authoritative vs. authoritarian; Baumrind, 1991; Choi et al., 2013; Kim & Rohner, 2002). However, the findings of this study revealed that highly enculturated Korean immigrant mothers simultaneously embraced both parenting styles. East Asian culture has been influenced by Taoism which values maintaining the middle way by integrating two seemingly contradictory forces and positions (Kurasaki et al., 2002). As shown in their positive relationship in this study, authoritative (firm and warm) and authoritarian (strict and cold) parenting styles are not necessarily contradictory and can coexist in Korean immigrant families since strict and harsh parenting styles are often understood as pushing their children to become better people (Choi et al., 2013).

Furthermore, in the Korean culture, strict parenting is not necessarily perceived as negative, as “strictness” can indicate parents’ responsibleness in raising good children. Asian culture usually holds high standards for children’s behaviors and promotes such values as humility and interdependence (Kuraaski et al., 2002). For example, it is common that Asian parents withhold direct compliments to their children lest they become arrogant. Even when others compliment their children, parents often reject or deny the compliments, even if they may agree internally, as showing a humble attitude is a cultural virtue. In a similar way, first-generation Korean immigrant mothers may be harsh on themselves and be self-critical in evaluating their parenting practices. Such response style needs to be considered interpreting the current findings.

Limitations

The findings of this study should be understood in the context of its limitations. First, the measure for HB was based on four items. Even though these items were refined based on focus group discussion, literature review, and reviews by community and academic experts in Korean culture (Choi et al., 2013, Choi et al., 2014, Choi et al., 2016, Choi et al., 2018), the current measure focused on physiological manifestation and self-diagnosis. Development of a more comprehensive measure of HB that includes specific affects related to HB (e.g., “ukwool,” “boon”) is recommended (see Min et al., 2009). Second, although the current study utilized the data that was a part of a large-scale longitudinal study (MLSAAF), our path model was based on the cross-sectional data from Wave 1. The Wave 2 data did not include the outcome measures we needed (e.g., authoritarian and authoritative parenting), so the current study could not use a longitudinal design to examine causal relationships among the study variables. Future research may consider how the long-term process of acculturation and enculturation is related to the development or amelioration of HB and has an impact on parenting. Third, this study relied on the parenting measures developed in the mainstream cultural context. Given the different nuances of parental warmth and strictness between Asian and European American families (Chao, 1994; Choi et al., 2013), the current variables may be limited in uncovering the full picture of Korean immigrant parenting. Finally, this study did not include any contextual variables. It is important to consider the ecological context of parenting as the social environment in which a family is embedded in (i.e., nested within an ethnic enclave with shared cultural values versus within a community with dissonant values) is likely to affect both parenting practices and children’s receptivity.

Implications for Practice and Research

The present study has important implications for practice and research. First, clinicians need to understand that cultural awareness and humility are paramount in providing the best possible care for immigrant families including Korean immigrants. It is important to consider the cultural context of a family in assessment and treatment. Next, clinicians need to be aware of the impacts of parental depression on parenting as well as culture specific manifestations of emotional distress. HB is common and familiar cultural specific manifestation of distress, which aligns with traditional Korean cultural values of preserving harmony with others and dissuading outward expression of anger (Min, 2009). When working with Korean immigrant families, clinicians need to be aware of how suppressed distress and anger may be manifested as HB, especially among middle-aged and older Korean women, and its impact on parenting. They need to develop diagnostic skills to differentiate HB from depression. Given the particular importance of sociocultural injustice and mistreatment (e.g., gender-based oppression in patriarchal culture, racial injustice after immigration) in the development of HB, clinicians may use this systemic understanding in treatment decisions.

For future research, developing a more comprehensive measure for HB would be critical given that HB explained Korean immigrant women’s emotional distress and parenting, above and beyond depression. Considering the reciprocal relationship between research and measures, developing a comprehensive and psychometrically solid measure for HB would catalyze research on this culturally specific syndrome. It will also help further clarify the distinction between HB and other DSM diagnoses and the unique associations of HB with other outcome variables of interest. Additionally, Asian immigrant parenting literature has often been painted as paradoxical by employing Western theories and conceptualization of parenting. Conceptualizing and evaluating Asian parenting practices drawing on Western theories may limit our understanding of Asian parenting and family dynamics. It is important to incorporate culturally nuanced variables and measures when studying Asian immigrant parenting.

Furthermore, adding more complexity to Asian immigrant parenting, children who are more acculturated to U.S. mainstream culture may compare their experiences as children with those of their White peers (Choi et al., 2008). Differences between parents and children as to cultural norms, reference groups (e.g., Korean immigrant parents vs. White peers’ parents), and parenting expectations may have important implications for parent-child relationship and family dynamics. Therefore, future research and practice with Asian immigrant families need to attend to such complexities. In conclusion, this study explored the interrelations among Korean immigrant mothers’ cultural orientations, depression, culture specific emotional distress, and their parenting. The unique explanation of parenting practices by HB above and beyond depression as well as the co-existence of authoritative and authoritarian styles among highly enculturated Korean immigrant mothers highlighted the importance of culturally informed parenting research and practice.

Public significance statements:

This study suggests the importance of understanding the culture specific emotional distress of Hwa-byung in relation to first-generation Korean immigrant mothers’ parenting practices.

Acknowledgments

This study was supported by a grant from Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; R01 HD073200, PI: Yoonsun Choi).

Footnotes

This study was presented at the 129th Annual Convention of the American Psychological Association, Chicago, IL, August, 2021.

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