UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Patterns of social anxiety in Chinese and European Canadian students Hsu, Lorena 2004

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-ubc_2004-0495.pdf [ 4.02MB ]
Metadata
JSON: 831-1.0091608.json
JSON-LD: 831-1.0091608-ld.json
RDF/XML (Pretty): 831-1.0091608-rdf.xml
RDF/JSON: 831-1.0091608-rdf.json
Turtle: 831-1.0091608-turtle.txt
N-Triples: 831-1.0091608-rdf-ntriples.txt
Original Record: 831-1.0091608-source.json
Full Text
831-1.0091608-fulltext.txt
Citation
831-1.0091608.ris

Full Text

PATTERNS OF SOCIAL ANXIETY IN CHINESE AND EUROPEAN CANADIAN STUDENTS by LORENAHSU B.Sc, The University of Waterloo, 1995 M.Sc, The University of Toronto, 1999 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA October 2004 © Lorena Hsu, 2004 lUBCl THE U N I V E R S I T Y OF BRITISH C O L U M B I A F A C U L T Y OF G R A D U A T E S T U D I E S Library Authorization In presenting this thesis in partial fulf i l lment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely avai lable for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representat ives. It is understood that copying or publication of this thesis for f inancial gain shall not be al lowed without my written permission. Lor&na H$u os/io/boot Name of Author (please print) Date (dd/mm/yyyy) T i t le of Thesis: PaWorntf of tfaoidl Amir/ty in Chinee/ rind f.urapcjdn Odnadidn D e 9 r e e : MdS-for of !\rte Year: ftflflfr Department of ?SyMo\ Od\l T h p I Iniversitv nf Rritich f^nlnmhia L/ / The University of British Colu bia Vancouver, BC Canada grad.ubc.ca/forms/?formlD=THS page 1 of 1 last updated: 20-Jul-04 11 Abstract Although epidemiological data show that Asians are less often diagnosed with social phobia than are North Americans, North American studies show that Asians self-report higher levels of social anxiety than their European heritage counterparts. The present study examined this apparent discrepancy in an undergraduate sample of: a) students of Chinese heritage born in Hong Kong or Taiwan (N= 65), b) Canadian-born students of Chinese heritage (N= 51), and c) Canadian-born students of European heritage (N= 62). Participants completed a questionnaire battery as well as a face-to-face interview that assessed levels of social anxiety and impairment. Results showed that foreign-born Chinese participants reported significantly greater social anxiety and impairment than students of European heritage in both the questionnaire and interview format. The same general pattern was found among participants who had clinically severe levels of social anxiety. I l l TABLE OF CONTENTS Abstract ii Table of Contents iii List of Tables v List of Figures vi Acknowledgement vii Introduction 1 Ethnic Patterns of Social Anxiety 1 Ethnic Differences in Help-Seeking 5 Current Study 6 Method 7 Research Design 7 Participants 8 Descriptive Measures 9 Dependent Measures 10 Help-Seeking Measures 12 Procedure 13 Results - - 1 4 Preliminary Analyses. 14 Main Analyses 16 Clinical Fear Subgroup 20 Discussion.... 22 Footnotes 29 Bibliography 38 AppendixA Demographic Measure 43 Appendix B Vancouver Index of Acculturation 44 Appendix C Self-Construal Scale 45 Appendix D Social Interaction Anxiety Scale 47 Appendix E Social Phobia Scale 48 Appendix F Anxiety Disorders Interview Schedule for DSM-IV-R - Self-report Version 49 Appendix G Anxiety Disorders Interview Schedule for DSM-IV-R - Interview Version 51 Appendix H ADIS-IV-R Fear Criteria for Generalized Social Phobia 53 iv Table of Contents continued... Appendix I Social Behaviour Questionnaire 54 Appendix J Study Procedures. 59 Appendix K Consent Form 60 Appendix L Checklist of Interviewer Behaviours 62 Appendix M Guidelines for Observer Ratings of Interviewer Behaviours 63 V LIST OF TABLES Table 1. Demographic Measures by Ethnicity Group 30 Table 2. Means and Standard Deviations for Acculturation and Self-Construal Measures by Ethnicity Group and Reporting Method 31 Table 3. Intercorrelations between ADIS-IV-R and SIAS/SPS Measures 32 Table 4. Means and Standard Deviations for ADIS-IV-R Social Anxiety and Impairment Measures by Ethnicity Group and Reporting Method 33 Table 5. Intercorrelations between ADIS-IV-R Help-seeking Variables 34 Table 6. Means and Standard Deviations for Help-seeking Measures by Ethnicity Group and Reporting Method 35 Table 7. Proportions of Participants Meeting ADIS-IV-R Fear and Impairment Criteria 36 vi LIST OF FIGURES Figure 1. Help-seeking Levels by Social Anxiety Severity Levels based on the Social Behaviour Questionnaire 37 Acknowledgement I would like to thank my supervisor, Dr. Lynn Alden, for her guidance and advice throughout all stages of this project. I would also like to thank my committee members, Dr. Steve Heine and Dr. Del Paulhus for their helpful suggestions and comments with regard to cultural as well as methodological issues. I would also like to acknowledge the research assistants for their efforts and commitment to this project. Special thanks to my family and friends for their continuous support and counsel throughout this endeavour. 1 Patterns of Social Anxiety in Chinese and European Canadian Students Social anxiety is extremely pervasive, with a majority of people expressing some discomfort with at least one type of social situation (Stein, Walker, & Forde, 1994). For some individuals, however, this common experience crosses a threshold where the social anxiety becomes distressing or impairing, thereby warranting a diagnosis of social phobia. Social phobia is characterized by an excessive fear in response to, or in anticipation of, attention and scrutiny by others. It has an early onset and, without appropriate intervention, has a disproportionately higher risk for persistence compared to other anxiety disorders (Wittchen & Fehm, 2001). The curtailed social activities among individuals with social phobia often results in significant social and occupational impairment. Although over 30% of individuals with social phobia experience considerable impairment, only about 5% of individuals with social phobia seek help (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). For the present paper, the term 'social anxiety' corresponds to the entire spectrum of social discomfort, from shyness to social phobia, while 'social phobia' refers to social anxiety with distress or impairment. Ethnic Patterns of Social Anxiety One puzzling aspect of social anxiety is the apparent discrepancy in the literature with regard to its relative occurrence in Asian and Western populations. On the one hand, epidemiological studies suggest that social phobia is considerably less prevalent in Asians compared to Westerners. Studies conducted in Asian countries have reported lifetime prevalence rates of approximately 0.5% (Hwu, Yeh, & Chang, 1989; Lee et al., 1987), whereas studies done in North America and Europe have reported lifetime estimates in the range of 1% to 16% (Wittchen & Fehm, 2001). Although it might be reasoned that the lower prevalence estimates reported in Asian studies are related to their use of DSM-III criteria, which tends to produce lower rates of social phobia compared to later DSM versions (Lang & Stein, 2001), this is 2 countered by the fact that the Asian rates are still lower than rates from Western studies that also used DSM-III criteria (Somers, Goldner, Waraich, & Hsu, 2004). In contrast to the epidemiological data, self-report questionnaire data suggest the opposite pattern. Studies conducted in North America consistently demonstrate that Asian heritage samples score significantly higher on self-report measures of social anxiety compared to their European heritage counterparts (Okazaki, 1997, 2000; D. Sue, Ino, & Sue, 1983). As no study has explored the apparent discrepancy between epidemiological and self-report data, it is unclear whether it is due to true differences in ethnic patterns of social anxiety across North American and Asian countries, or whether it is a result of cultural and/or methodological variations. A comparison of epidemiological and questionnaire studies reveals a number of methodological differences. Epidemiological studies measure the number of people who meet formal diagnostic criteria for social phobia, a judgment that is based not only on severity of social anxiety, but also on the extent to which that anxiety causes impairment in life functioning. In addition, those studies diagnose social phobia through structured clinical interviews, whereas questionnaire studies are often conducted through surveys. Finally, epidemiological and questionnaire data have been collected on different populations. Epidemiological research involves samples drawn from the general population within a specified geographic location. In contrast, questionnaire studies are typically conducted within university settings and combine participants from a variety of Asian cultures and varying lengths of residence in North America. Each of these factors may affect data on occurrence and severity of social anxiety. One possible explanation for the discrepant patterns of social anxiety in Asian and Western populations is that Asians are less likely to meet the impairment criterion required for the diagnosis of social phobia. According to cognitive models, social phobia occurs when people negatively appraise the social anxiety symptoms they are experiencing as evidence of personal 3 inadequacy, defectiveness, or an emotional problem. Negative appraisals in turn exacerbate anxiety and lead to dysfunctional behaviours that cause life impairment (Clark, 2001; Rapee & Heimberg, 1997). In Western cultures, social anxiety is generally viewed as a negative characteristic, a tendency that suggests that social anxiety symptoms are likely to be negatively appraised (Leary & Kowalski, 1995; Purdon, Antony, Monteiro, & Swinson, 2001). Although the absence of social anxiety is seen as desirable and associated with better mental health in Western cultures, this ideal may be inconsistent with Asian cultural values. In contrast to Western cultures that foster individual uniqueness and autonomy, Asian cultures emphasize collectivistic values that encourage interdependent self-construal, in which relationships with other people are used to define the self (Markus & Kitayama, 1991). Thus, Asians may be socialized to be more acutely attuned to social cues and more sensitive to the opinions and negative evaluations of others (Okazaki, 1997), which are important cognitive components of social anxiety (Rapee & Heimberg, 1997). In fact, lower independent self-construal has been found to be significantly related to higher reports of social anxiety (Okazaki, 1997). If socialization fosters the experience of social anxiety, then Asians may appraise a certain level of anxiety in social situations as normal or expected, or even desirable (Okazaki, Liu, Longworth, & Minn, 2002), and consequently may not feel distressed or impaired by the anxiety until the condition is severe. Hence, Asians may be less likely to endorse the distress or impairment criteria required for the diagnosis of social phobia and would thus have a higher diagnostic threshold for social phobia compared to their Western counterparts. Another possible explanation for the discrepant patterns of social anxiety in Asian and Western populations may be that Asians are less likely than Westerners to report symptoms of social anxiety in face-to-face interview conditions (as done in epidemiological studies) compared to more anonymous reporting conditions. According to the self-presentation theory of social 4 anxiety, social anxiety results from people's concerns with the impressions others hold of them (Schlenker & Leary, 1982). Differences in self-presentation concerns among Asians and Westerners may arise from cultural values related to the stigma of mental illness, and/or emotional control and inhibition. The widely held collectivist principles in Asian cultures emphasize social and emotional closeness, and a shared sense of identity and responsibility. Thus, the burden of the stigma of mental illness not only falls on the afflicted individual but also on all family members (Chen, 1995). Although pervasive social stigma around mental illness exists in Western cultures, Asians are thought to experience a greater sense of stigmatization with such problems (Leong & Lau, 2001). The concern of bringing shame upon the family may cause Asians to be more reluctant to admit to mental health problems to strangers or to mental health professionals compared to those with a Western cultural background (Okazaki, 2000; Uba, 1994). Asian collectivistic values also place high importance on emotional restraint and self-control. Ethnic comparisons on self-report measures of emotional expression have shown that Asians in North America report lower levels of self-disclosure (Steel, 1991), lower levels of behavioural affective expression (Lai & Linden, 1993), and more attempts at hiding their feelings (Gross & John, 1998) compared to their European counterparts. Zhang, Snowden, & Sue (1998) found that Asian Americans were significantly less willing to disclose their mental health problems to professionals and even family and friends compared to White Americans. Based on the above evidence, one might expect that Asians would be less likely than Westerners to report symptoms of social anxiety. However, this would be inconsistent with the research showing that Asians report more social anxiety symptoms compared to Westerners on self-reports. To make sense of this discrepancy, since Asians show lower rates of social phobia compared to Westerners based on face-to-face interviews, it is possible that Asians may not as readily admit to social anxiety symptoms in an interview condition that threatens their public face versus a more anonymous self-report measure, compared to Westerners. Research on the interaction between ethnicity and assessment method has produced inconsistent findings. Okazaki (2000) found that Asian Americans and White Americans did not report differential levels of social anxiety symptoms in questionnaires compared to interviews. Instead, Asian Americans reported higher levels of social anxiety than White Americans in both assessment conditions, with foreign-born Asians reporting significantly more social anxiety than U.S.-born Asians. However, the study had some limitations. First, students from a variety of Asian cultures were combined. Also, since the testing sessions for the questionnaire and interview were on average only 2 to 3 days apart, there is the possibility of carry-over effects. Furthermore, the self-report and interview were administered only by Caucasian interviewers. In contrast to the Okazaki study, Park, Upshaw, & Koh (1988) found that Korean immigrants reported higher emotional distress symptoms in self-report questionnaires compared to face-tO-face interviews, whereas American-born Japanese and White American participants did not differ with respect to symptom reports across assessment methods. Although this study did not examine social anxiety specifically, the findings suggest that ethnic differences in symptom reporting across methods may be affected by the degree to which an individual possesses Asian cultural values. More work is needed to resolve discrepancies in previous findings. Ethnic Differences in Help-seeking In addition to establishing the prevalence and severity of social anxiety, it is important to consider willingness to seek psychological treatment for social anxiety. It is well-documented that compared to other ethnic groups, Asians in North America tend to underutilize mainstream mental health services in proportion to their population size (Bui & Takeuchi, 1992; Fugita, 1990; Li & Browne, 2000). They also tend to delay or avoid seeking professional mental help 6 until their conditions are severe and all other resources have been exhausted (Li & Browne, 2000; K. M. Lin & Cheung, 1999). Although studies have examined Asian help-seeking attitudes and behaviours toward psychological distress in general (Abe-Kim, Takeuchi, & Hwang, 2002; Solberg, Ritsma, Davis, Tata, & Jolly, 1994), no studies have looked at help-seeking for social anxiety. Given the low rates of help-seeking for social phobia in Western populations (i.e. 5%) (Magee et al., 1996), it is likely that help-seeking for social phobia in Asians is extremely low. Understanding help-seeking attitudes among Asians and Westerners may provide further support for either the appraisal or self-presentation explanations of apparent differences in social anxiety. For example, in exploring reasons for not seeking help, Asians may be more reluctant to seek help either due to appraising their symptoms as less of a problem, or because they are less willing to report their symptoms to a mental health professional. Current Study The present study sought to better understand the discrepant patterns of social anxiety observed across epidemiological and self-report data in Asian and Western populations. A widely used clinical measure of social phobia was used to determine whether there are differences in levels of reported social anxiety and impairment, and/or differences across assessment methods among Chinese and European heritage individuals in a North American sample. The study focused on individuals of Chinese descent, since contrary to the wide assumption in the mental health literature that all Asian North Americans are similar, they actually represent quite a heterogeneous group, with over 20 subgroups each having their own unique cultural characteristics (Iwamasa, 1997). Within the group of Chinese participants, foreign-born Chinese (FBC) and Canadian-born Chinese (CBC) were also compared. Help-seeking attitudes among the three groups were also examined to further elucidate the patterns of social anxiety across Asian and Western populations. The following questions were examined: 7 1. Are there differences between Chinese and European heritage participants on: i) measures of social anxiety and impairment; and ii) measures of social anxiety and impairment across assessment methods? a) For those with high levels of social anxiety, are there differences between Chinese and European heritage participants on: i) measures of impairment; and ii) measures of impairment across assessment methods? 2. Are there differences between Chinese and European heritage participants on: i) levels of help-seeking; and ii) reasons for not seeking help? a) For those with high levels of social anxiety, are there differences between Chinese and European heritage participants on: i) levels of help-seeking; and ii) reasons for not seeking help? The effect of interviewer ethnicity on reported levels of social anxiety and impairment was also assessed, as this has not been examined in previous studies. Method Research Design This study employed a cross-sectional, between-within groups design to test the main hypotheses. The between-groups independent variable was ethnic group and the within-groups independent variable was assessment method (i.e. condition). The dependent variables were reported levels of social anxiety symptoms, impairment, and help-seeking. 8 Participants Participants were students in first and second year undergraduate psychology courses recruited through class announcements and advertisements posted on the main departmental bulletin board. They received extra course credit for completing the study. The research sample was composed of three groups: foreign-born Chinese participants (FBC), Canadian-born Chinese participants (CBC), and European Canadians (EC). For the FBC participants, only individuals born in Hong Kong and Taiwan were included in the study in order to keep this group as homogeneous as possible. The CBC group included those born in Canada as well as those born in the U.S. if they had lived in Canada for at least 10 years. For participants of European descent (EC), all those born in Canada were included, as well as those born in the U.S. or a Western European country who had lived in Canada for at least 10 years. Individuals bora in Eastern European countries were excluded. In order to maintain a relative distinction between the Chinese and EC groups, Chinese individuals of mixed racial background or who were adopted as infants into European Canadian families, were also excluded from the study. The final sample included 178 participants who took part in both components (i.e. questionnaire and interview) of the study: 65 FBC individuals (22 males and 43 females), 51 CBC individuals (17 males and 34 females), and 62 EC individuals (24 males and 38 females). Eight subjects (3 FBC, 3 CBC, and 2 EC participants) were not included in the study as they only took part in either the questionnaire or interview component. For the FBC group, 17 (26.2%) participants were born in Taiwan and 48 (73.8%) were born in Hong Kong. In the CBC group, 2 participants were born in the U.S. In the EC group, 3 participants were born in the U.K., while one was born in the U.S. The average age of all participants was 19.3 years (SD = 1.54), with a range of 17 to 25 years. Demographic information for participants is shown in Table 1. 9 Descriptive Measures Demographics. General demographic information such as age, gender, country of birth, and ethnic background was collected (see Appendix A). Vancouver Index of Acculturation (VIA; Ryder, Alden, & Paulhus, 2000). The VIA is a 20-item instrument designed to reflect the extent to which people have values and engage in behaviors that are characteristic of the culture in which they were born (i.e. their heritage culture) versus North American culture (see Appendix B). Items were generated in pairs with respect to content area, with one item referring to heritage culture (Heritage subscale) and the other item referring to North American culture (Mainstream subscale). Each item is rated on a 9-point scale, with higher subscale scores representing higher levels of identification with the corresponding culture. For the present study, Cronbach's alphas were .88 for the Heritage subscale and .87 for the Mainstream subscale. Ryder et al. (2000) reported Cronbach's alphas of .79 and .75 for the Heritage and Mainstream subscales, respectively. With respect to concurrent validity, significant associations were found between the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA) and the Heritage and Mainstream subscales (rs = -.30 and .54, respectively). The VIA was included as a check to ensure that groups differed on cultural values. Self-Construal Scale (SCS; Singelis, 1994). The SCS is a 24-item instrument that assesses levels of self-construal, based on the cultural model of Markus and Kitayama (Singelis, 1994). The scale consists of 12 items designed to measure the level of interdependent self-construal (reflective of collectivistic cultures), and 12 items to assess the level of independent self-construal (considered to reflect cultures that are individualistic) (see Appendix C). Cronbach alpha coefficients for the Independent and Interdependent subscales were reported to range between .69 and .74 (Singelis, 1994). In the present sample, Cronbach's alphas of .81 and !0 .74 were found for the Independent and Interdependent subscales, respectively. The SCS was included to ensure that the groups differed on levels of self-construal. Social Interaction Anxiety Scale and Social Phobia Scale (SIAS and SPS; Mattick & Clark, 1998). The SIAS and SPS are self-report measures of social anxiety. The SIAS was designed to assess anxiety concerning interpersonal interactions, while the SPS measures fear of scrutiny when performing a task or being observed by others (see Appendices D and E, respectively). Each scale consists of 20 items, rated on 0 to 4 Likert-type scales. Mattick & Clarke (1998) reported high levels of internal consistency for both the SIAS and SPS for various samples, with Cronbach's alphas ranging from 0.88 to 0.94. With respect to construct validity, the SIAS and SPS have been shown to have moderate to high intercorrelations with each other, as well as with other measures of social anxiety (Mattick & Clarke, 1998). The measures were used in this study to validate the self-report version of the ADIS-IV-R (see below). Dependent Measures Anxiety Disorder Interview Schedule for DSM-IV (ADIS-IV; Brown, DiNardo, & Barlow, 1994) - Social Phobia Section. The ADIS-IV is a semi-structured interview designed to establish reliable diagnosis of the anxiety disorders (Brown, Di Nardo, & Barlow, 1994). The social phobia section of the ADIS-IV includes dimensional ratings of fear and avoidance for 13 social situations, as well as ratings of interference and distress associated with having social anxiety symptoms. Excellent interrater reliability has been found for the diagnosis of DSM-IV social phobia (kappa=.77), as well as for dimensional ratings of social phobia symptoms, such as fear and avoidance (Pearson r=.86 for both) (Brown, Di Nardo, Lehman, & Campbell, 2001). Although the ADIS-IV is intended for use as a clinician-administered interview, it was translated into use for this study as a self-report measure of social anxiety and social phobia in order to have measures that were comparable to the interview version. All items between the 11 interview and self-report versions of the ADIS-IV-R are identical other than required changes in wording corresponding to the nature of the measure. The self-report and interview versions of the ADIS-IV-R are shown in Appendices F and G, respectively. Several revisions were made to the ADIS-IV for this study. In the original ADIS-IV, participants are asked for open-ended descriptions of impairment in a variety of domains (e.g., social, work) produced by fear and avoidance. The clinical interviewer then arrives at a global rating of impairment based on these open-ended responses. We felt that it might be problematic for people with limited clinical training to arrive at a general rating. Thus, in both the self-report and interview versions, participants were asked to rate the extent to which fear and avoidance interfered with the various life domains on 5-point Likert-type scales. In addition, the ADIS-IV contains items asking about panic attacks, which are used to distinguish social anxiety arising from panic disorder rather than social phobia per se. For the current study, the items assessing specific symptoms of panic attacks were replaced by two questions asking: a) if their fear of social situations was due to having a panic attack, and b) whether those attacks "came out of the blue". Participants scoring 4 or higher on both of these items were screened out as those whose social anxiety was secondary to panic attacks. A total of 4 participants endorsed both items1. For both the interview and self-report versions of the ADIS-IV-R, levels of social anxiety and impairment were assessed. Level of social anxiety was measured by summing the scores on ratings of a) fear and b) avoidance for various social situations to yield total scores for each. Level of impairment was represented by summing scores from the 5 items referring to interference in one's life. Participants with high levels of social anxiety were selected according to the ADIS-IV-R fear criterion for generalized social phobia (see Appendix Ff). Validation of the ADIS-IV-R as a self-report measure of social anxiety was carried out by correlating the scores from this measure with those of the SIAS and the SPS. 12 Help-seeking Measures Help-seeking was assessed with two measures developed for this study: a) Help-seeking questionnaire. Following the ADIS-IV-R items, participants were asked to rate whether they would seek help for the endorsed fears on a 5-point Likert-type scale. We also assessed reasons for not seeking help through items that asked about 'appraisal factors' (e.g., "Because it's not a serious enough problem to require help"), and 'self-presentation factors' (e.g., "It's embarrassing for others to know"). Thus, this measure yielded three scores: one for tendency to seek help, and two for reasons for not seeking help (Appendices F & G). b) Social Behaviour Questionnaire (SBQ). This measure was developed to assess help-seeking attitudes in response to various degrees of social anxiety (Appendix I). It consists of 9 vignettes, 3 each representing 3 different severity levels of anxiety experienced in various social situations. The participants are asked to imagine themselves in each situation and then to rate the extent to which they would seek help if they experienced the symptoms in question. Help-seeking attitudes were rated on a 1 to 5 Likert-type scale. In order to provide validation for the 3 different severity levels of social anxiety represented by the vignettes, a pilot study was conducted in which 17 graduate and senior undergraduate students rated 13 different vignettes in terms of severity of social anxiety. The vignettes were rated on a scale of 1 to 5, with 5 being the most severe experience of social anxiety. Of the raters, 10 were of Chinese descent and 7 of European descent. In general, vignettes that had ratings falling into one of three distinct levels of severity (i.e. greater than % standard deviation difference from vignette(s) in other levels) were retained as representing that particular severity level. Vignettes that did not fall into a distinct severity level or were considered similar in situation to another vignette were not included in the SBQ. 13 Procedure Participants were required to complete two parts of the study: a self-report questionnaire battery and a face-to-face interview. The two components were counterbalanced across participants to control for potential order effects. Participants were randomly assigned to the questionnaire first or interview first orders with the stipulation that the two orders were approximately equal in terms of ethnic group and proportion of males versus females. An outline of the study procedure is shown in Appendix J. Questionnaire First Order. Participants were provided with the questionnaire battery to complete on a take-home basis. Upon returning the questionnaire to the laboratory, participants' names and contact information were recorded, and an appointment for the interview component was scheduled for at least one week after the date of completion of the questionnaire (range: 1-5 weeks). The interview format was the same as that described below. Interview First Order. Participants were contacted by telephone to schedule an appointment to come into the laboratory for the interview. Interviewers first reviewed study procedures and obtained informed consent (Appendix K). They then administered the social phobia section of the ADIS-IV-R, followed by questions about help-seeking. At the end of the interview, participants were scheduled to either pick up or be mailed the questionnaire battery. The questionnaires were distributed at least one week after the interview (range: 1 to 8 weeks). As described for the questionnaire first condition, participants completed the questionnaire battery on a take-home basis and returned the battery to the laboratory. Personnel. Interviews were conducted by two male undergraduate research assistants, one of Chinese, and the other of European descent, who were trained to administer the interviews in a consistent and professional manner. Participants were randomly assigned to interviewers with the stipulation that each interviewer conducted approximately the same number of 14 interviews across the three ethnic groups and saw the same proportion of males vs. females. In addition to training, a proportion (17%) of the interviews was rated by two observers to ensure that the two interviewers delivered the interviews in a consistent fashion with each other and across participants. Raters completed two measures: a) a checklist of required interview behaviours (Appendix L) and b) ratings on 5 categories of interviewer behaviour (Appendix M). Results The data were examined for outliers, defined as values greater than 3 standard deviations above the mean. Three subjects (1 from the FBC group and 2 from the EC group) produced extreme scores on at least two of the dependent variables (i.e. fear, avoidance, impairment, or help-seeking). Therefore, they were removed from the dataset. Preliminary Analyses Descriptive Measures Demographics. As seen in Table 1, the male to female ratio was approximately 2:1 for each group, which reflects gender ratios seen in undergraduate psychology classes. Chi-square analysis for gender revealed no significant differences between the three groups, x2(2)=.46, p>. 1. An ANOVA showed that there were no significant differences in age between the three groups, F(2,175)=1.78,p>.l. Thus, the groups did not differ with respect to sex and age composition. With respect to number of years lived in Canada, FBC participants were significantly lower than both the CBC and EC groups, F(2,175),/?<.0001, which confirms the group assignment process. Acculturation and Self-Construal. Table 2 shows the means for measures of acculturation and self-construal. To examine the effects of ethnicity on acculturation, a one-way (group) ANOVA was carried out. The three groups were significantly different on the VIA 15 heritage subscale scores, F(2,175)=17.78),/><.0001, with FBC participants scoring significantly higher than both CBC and EC individuals. There were also significant differences on the VIA mainstream subscale scores for the three groups, F(2,175)=17.31,p<.0001, with FBC participants scoring significantly lower than both CBC and EC individuals. Thus, FBC participants were more likely to adhere to Chinese values and activities and less likely to endorse Canadian values and activities than the other two groups. A one-way (group) ANOVA on the SCS yielded nonsignificant results for the independent self-construal scale, F(2,175)= 1.17, p>. 1. However, there were significant differences on scores of interdependence, F(2,175)=17.21,/><.0001, with the FBC and CBC groups scoring significantly higher than the EC group. These results indicate that both Chinese groups were more likely to construe their sense of self in terms of interdependence with others. Interviewer Comparability In 100% of the interviews rated, raters agreed that the interviews were delivered as required. In addition, the raters were within one point of each other on the 5 rating scales of interviewer behavior. In light of the high level of agreement, the scores from the two raters were averaged for data analyses. A 3(group) x 2(interviewer) MANOVA on the behavioural ratings revealed no interaction effect between group and interviewer, F(10,40)=.69,/?>.5, which indicated that the interviewers did not differ in their behaviours between groups. To further check for possible interviewer effects on the dependent variables, a 3(group) x 2(interviewer) x 2(condition) between-within MANOVA was carried out on levels of fear, avoidance, interference, and help-seeking. There were no significant differences on any of the interaction effects, or based on whether participants were interviewed by the Chinese interviewer or the European interviewer, F(4,169)=.695,/?>.5. 16 Effects of interviewer ethnicity being similar to the participant's ethnicity were also analyzed using a 3 (group) x 2(interviewer ethnicity) x 2(condition) MANOVA. There were no significant differences on any of the interaction effects, or based on whether the interviewer's ethnicity was similar to or different from the participant's ethnicity, F{A,\69)=.11\,p>.5. Questionnaire Validation Self-report ADIS-IV-R. Intercorrelations between ADIS-IV-R self-report and interview measures, the SIAS, and the SPS are shown in Table 3. Correlations between the ADIS-IV-R self-report and interview measures of fear, avoidance, impairment, and help-seeking ranged from .62 to .77. Correlations between the ADIS-IV-R self-report measure and the SIAS were .77 and .70 for measures of fear and avoidance, respectively. This indicates good agreement between the ADIS-IV-R self-report and the SIAS on the measure of social anxiety. Correlations between the ADIS-IV-R self-report and the SPS were .65 and .56 for fear and avoidance, respectively, which also supports the validity of the self-report ADIS-IV-R. Order Effects To examine possible order effects, we divided participants into those who had received the interview first and those who received the questionnaire first. A 3 (group) x 2(condition) x 2(order) between-within MANOVA was conducted on dependent variables. Since the order in which the questionnaire and interview were given affected the results, order was included as a factor in the main analyses. Main Analyses Fear, Avoidance, and Impairment Table 4 presents the mean scores on measures of fear, avoidance, and impairment for the three groups in both the questionnaire and interview conditions. A 3(group) x 2(condition) x 2(order) between-within groups MANOVA conducted on these measures revealed a significant 17 main effect for group, F(6,340)=5.02,/?<.0001, and for the group by order interaction, F(6,340)=2.73,p<.05. There were no significant main effects for condition, F(3,173)=1.47, p>.l, or order, F(3,170)=1.31,p>.l. Similarly, no significant effects emerged for the interaction between group and condition, F(6,340)=1.41,p>.l, condition and order, F(3,170)=1.37,p>.l, or group by condition by order, F(6,340)=l .53, p>. 1. Univariate F-tests revealed significant between-group differences on all three variables: fear, F(2,172)=3.54,/K.05, avoidance, F(2,172)=9.40,/X.0001, and impairment, F(2,172)=7.03, /?=.001. Tukey HSD tests showed that FBC participants reported significantly higher fear (p<.05) than the EC group. The CBC group fell between and did not differ from the other two groups. Tukey HSD tests indicated that both the FBC and CBC groups reported significantly more avoidance (p<.0001 andp<.05, respectively) than the EC group. Finally, FBC participants reported significantly higher levels of impairment compared to both CBC and EC participants (p<.005 and p<.005, respectively), with the latter two groups not being significantly different from one another. With respect to the interaction between group and order, univariate F-tests revealed significant differences for avoidance, F(2,172)=4.54,/?<.05, and impairment, F(2,172)=5.85, p<.005. Simple main effect analyses showed that CBC participants in the interview first group reported lower levels of avoidance, F(l,172)=4.22,/K.05, and impairment, F(l,172)=6.9,/?<.01, compared to those in the questionnaire first group. No order effects were found for the FBC or EC groups on either avoidance, Fs(l,172) = 0.37 and .17, both ps>.25, for the FBC and EC groups, respectively, or impairment, Fs(l,172) = 0.02 and .38, bothps >.25, for the FBC and EC groups, respectively. Supplemental Analysis. In light of the significant interaction between group and order, a supplementary analysis was conducted to remove the order effect. The sample was subdivided 18 into questionnaire first and interview first subgroups within each ethnic group. A 3 (group) x 2(condition) between-groups MANOVA was then conducted on fear, avoidance, and impairment. As before, a significant multivariate effect emerged for group, F(6,340)=3.01, p<.0l. Follow-up univariate tests showed significant between-group differences on all three variables: fear, F(2,172)=3.17,p<.05, avoidance, F(2,172)=6.60,/?<.005, and impairment, F(2,172)=3.73,/><.05. Post hoc Tukey analyses revealed that, as before, FBC participants were significantly higher than EC participants on levels of fear (p<.05) and impairment (p=.01), with CBC participants falling in between. Both FBC and CBC participants, were significantly higher than the EC group on avoidance (p=.001 andp<.05 for FBC and CBC, respectively). The condition effect was not significant, F(3,170)=.465,/?>.5; however, similar to the first analysis, the group by condition interaction was significant, F(6,340)=2.19,/?<.05. Simple main effects analyses revealed that CBC participants reported higher levels of fear, F(l,172)=4.773jp<.05, avoidance, F(l,172)=6.54,/X.025, and impairment, F(l,172)=10.64, p<.0l, in the questionnaire versus interview conditions, while the FBC and EC participants reported similar levels of the dependent variables in both conditions. Help-Seeking Intercorrelations and mean scores for measures of help-seeking are shown in Tables 5 and 6, respectively. A 3 (group) x 2(condition) x 2(order) between-within groups ANOVA was conducted on each of the help-seeking measures. For level of help-seeking, analyses revealed significant differences for the condition by order interaction, F(l,172)=6.05,/?<.05. Simple main effects analysis revealed that on the questionnaire, participants in the questionnaire first group reported higher levels of help-seeking compared to those in the interview first group, while on the interview, there were no differences in reported levels of help-seeking across orders. No significant main effects emerged for group, F(2,172)=2.80,p>.05, or condition, F(l,172)=1.05, 19 p>.\. There were also no significant interaction effects for group by condition, F(2,172)=1.04, p>.l, group by order, F(2,172)=.026,/?>.5, of group by condition by order, F(2,172)=.262,/?>.5. With respect to not seeking help due to appraisal factors, there was a significant main effect for condition, F(l,138)=5.81,/K.05, with participants reporting higher levels of not seeking help due to appraisal factors in the interview vs. questionnaire condition. No significant main effects emerged for group, F(2,138)=1.56,/?>.1, or order, F(l,138)=.003,/?>.5. There were also no significant interaction effects for group by condition, F(2,138)=3.02,;?>.05, group by order, F(2,138)=.35,/?>.5, condition by order, F(l,138)=1.39,p>.l, or group by condition by order, F(2,138)=.847,/».l . For not seeking help due to self-presentation factors, a significant main effect emerged for group, F(2,138)=4.24,/K.05, with post hoc Tukey tests showing that FBC participants were significantly higher than EC participants (p<.05), and that CBC participants were not different from the FBC (p>.l) or EC (p>.5) groups. There were no significant main effects for condition, F(l,138)=.249, p>.5, or order, F(l,138)=.144,/>>.5. Similarly, no significant interaction effects emerged for group by condition, F(2,138)=.597,/?>.5, group by order, F(2,138)=.235,/>>.5, condition by order, F(l,138)=2.72,/?>.1, or group by condition by order, F(2,138)=.233,/?>.5. In order to control for various levels of fear or impairment on willingness to seek help, analyses for help-seeking variables were repeated with the addition of fear and impairment as covariates. A 3 (group) x 2(order) between-between ANOVA revealed no significant differences on levels of help-seeking on either of the questionnaire or interview for group, F(2,170)=.164, p>.5 andF(2,178)=1.17,/».l, order, F(1,178)=1.43,^ >.1 andF(l,178)=.261,/».5, or the group by order interaction, F(2,178)=1.74,p>.\ and F(2,178)=.480,/».5, respectively. SBQ Help-seeking. Analyses were carried out to test the validity of the severity levels of social anxiety on the SBQ. A 3(group) x 3(severity level) repeated measures ANOVA revealed 20 that there were significant differences in levels of help-seeking across the low, medium, and high severity levels of social anxiety represented in the vignettes, F(2,174)=145.39,/K.0001, with Tukey's test showing that significantly higher levels of help-seeking were reported for the high severity vignettes compared to the medium and low severity vignettes, and for the medium vs. low severity vignettes. These results indicate good construct validity for the severity levels of social anxiety in the SBQ. To examine differences between the three groups on help-seeking, three one-way (group) ANOVAs were conducted on levels of help-seeking at each severity level on the SBQ. Table 6 shows the mean scores for help-seeking at the three severity levels. The ANOVAs revealed no significant differences in the likelihood of seeking help between the three groups for the low, F(2,175)=.462, medium, F(2,175)=2.79, or high, F(2,175)=.927, severity level groupings for social anxiety. However, for the medium level of severity, there was a trend observed with the means in the direction of the hypothesis. To explore this trend, the above analysis was repeated combining the two Chinese groups. When comparing all Chinese participants to the EC group, Chinese participants were less likely to seek help for social anxiety at the medium level of severity items compared to the EC group, F(l,176)=5.61,/?<.05, but were not significantly different with respect to the low and high severity items (see Figurel). Clinical Fear Subgroup Proportions of Fear and Impairment Table 7 shows the proportions of participants in each group meeting the fear criteria for generalized social phobia based on the ADIS-IV-R. Chi-square analysis revealed that there were no differences between groups on the questionnaire, x2(2)=T .42,/?>. 1. However, on the interview, significant differences were found among groups, x2(2)=10.4,/?=-005, with the FBC 21 group having the highest proportion of participants reporting clinical levels of fear, and the EC group having the lowest proportion of participants with high levels of fear. Among the clinical fear subgroup based on the interview data, the proportions of participants in each ethnicity group meeting ADIS-IV-R impairment criteria (i.e. rating of at least 5 on any of the interference items) are shown in Table 7. There were no significant differences across groups in the proportion of participants meeting impairment criteria, X (2)=.649,/?>.5. This may have been due to the low numbers in each group meeting criteria. Impairment To examine whether there were differences in overall severity of impairment among the clinical fear subgroup, a 3(group) x 2(condition) x 2(order) between-within ANOVA was conducted on levels of impairment. A significant interaction effect was found for group by order, F(2,86)=4.04,/K.05. Thus, to control for order effects, the sample was subdivided into questionnaire first and interview first subgroups within each ethnic group. A 3(group) x 2 (condition) between-groups ANOVA revealed no significant main effects for group, F(2,86)=.729,/?>.1, or condition, F(l,86)=.196,/?>.5. However, similar to the complete sample, a significant interaction effect emerged for group by condition, F(2,86)=5.14, /?<.0T. Simple main effects analyses revealed that CBC participants reported higher levels of impairment, F(l,86)=12.01,/K.001, in the questionnaire versus interview condition, while the FBC and EC participants reported similar levels of impairment in both conditions. Help-seeking A 3 (group) x 2(condition) x 2(order) between-within ANOVA was conducted on level of help-seeking for the clinical fear subgroup. No significant main effects emerged for group, F(2,86)=.541,/?>.5, condition, F(l,86)=2.315jp>.l, or order, F(l,86)=3.77,/».05. Similarly, there were no significant interaction effects for group by condition, F(2,86)=l.54,/>>.!, group by 22 order, F(2,86)=.278,/>>.5, condition by order, F(l,86)=1.46,/?>.1, or group by condition by order, F(2,86)=.203, p>.5. With respect to appraisal factors for not seeking help, a 3(group) x 2(condition) between-within ANOVA revealed no significant effects for group, F(2,68)=2.08,p>.l, condition, F(l,68)=.001,_p>.5, or group by condition, F(2,68)=1.86,/?>.1. Similarly, a 3(group) x 2(condition) between-within ANOVA on self-presentation factors for not seeking help showed no significant effects for group, F(2,68)=2.32,j?>.l, condition, F(l,68)=2.72,/?>.1, or group by condition, F(2,68)=.509,/?>.5. Discussion The present study is the first to examine both social anxiety and impairment across different reporting conditions within the same sample. Our findings showed that foreign-born Chinese students experience higher levels of social anxiety and impairment, and that they are more likely to implicate self-presentational concerns for not seeking help. The results also suggest that Chinese students have a higher threshold of seeking help for social anxiety symptoms compared to their European counterparts. The first question we examined was whether there were differences between Chinese and European heritage participants on levels of social anxiety and impairment. FBC participants reported higher levels of social anxiety (measured by levels of fear and avoidance) compared to EC participants, and the CBC group was higher in avoidance compared to the EC group. The higher levels of social anxiety reported by FBC participants in this study is consistent with previous findings of higher social anxiety in Asian vs. European heritage groups (Okazaki, 2002; D. Sue et al., 1983), as well as higher social anxiety reported in foreign-born Asians (Okazaki, 2000). A new finding from this study was that FBC participants also reported higher levels of 23 impairment compared to both the CBC and EC groups. Taken together, these findings do not support the explanation that Chinese individuals tend to report higher levels of social anxiety but lower levels of impairment compared to their European counterparts, due to appraising their social anxiety as being less of a problem. The second issue addressed was whether the three groups differed on social anxiety and impairment in the two assessment conditions. We found that FBC participants reported higher levels of social anxiety and impairment compared to EC participants in both the questionnaire and interview conditions. In general, these findings do not support the contention that Chinese participants are less likely to admit to symptoms of social anxiety in a face-to-face interview compared to a self-report questionnaire due to self-presentational concerns, compared to EC participants. While these results are consistent with the findings from the Okazaki (2000) study, they differ from those of Park et al. (1988), who found differences in the reporting of emotional distress symptoms across a self-report questionnaire and face-to-face interview. Given that the Park et al. study examined a Korean population, and did not look at social anxiety per se, it is difficult to make direct comparisons with the present study. Interestingly, when we controlled for order, we found that CBC participants reported lower levels of social anxiety and impairment in the interview compared to the questionnaire condition. Thus, CBC individuals may be less willing to admit to their symptoms when their public face is threatened, thus supporting the self-presentation explanation for this particular group. Indeed, our findings showed that similar to the FBC group, CBC participants had a higher sense of interdependent self-construal compared to the EC group. The lack of this finding in the FBC group may be due to their high levels of social anxiety which compels them to report their symptoms regardless of assessment method. While these findings require replication, they support our contention that FBC and CBC groups be examined separately. 24 The same general pattern of results held when we selected a subgroup of participants who met the ADIS-IV-R fear criteria for generalized social phobia. The FBC group had the highest proportion of individuals with clinical levels of fear, while the EC subgroup had the lowest proportion. Although these results were not significant in the questionnaire condition, they were significant in the interview, which tends to be the standard clinical diagnostic procedure. Among the clinical fear subgroup, there were no differences among ethnicity groups in the proportions meeting the criteria for impairment, or in overall severity of impairment, which, again, does not provide support for the appraisal explanation of social anxiety. We also found that reported levels of impairment were consistent across both the questionnaire and interview, which does not support the self-presentation explanation. When we controlled for order, our findings were similar to those of the complete sample in that CBC participants reported lower levels of impairment in the interview compared to the questionnaire condition. Again, this supports the notion of differences among Chinese groups and the need to examine them separately. Another question we examined was whether there were differences between Chinese and European heritage participants on levels of help-seeking. Our findings showed that there were no differences among the three groups in willingness to seek help. This appears to be inconsistent with previously suggested findings that Asians seek help for emotional distress at lower rates than other ethnic groups relative to their population size (Cheung & Snowden, 1990; S. Sue, Fujino, Hu, Takeuchi, & Zane, 1991). However, given that the FBC group reported higher levels of fear and/or avoidance, and impairment compared to the other two groups, their level of help-seeking is disproportionate to the social anxiety and impairment they experience. Thus, this suggests some reticence toward seeking help for FBC participants. One possible explanation for not seeking help may be suggested by measures that assess reasons for not seeking help. FBC participants were more likely than the EC group to implicate self-25 presentation concerns, such as feeling embarrassed, as their reasons for not seeking help. Stigma and distrust regarding the use of mental health care have been shown to be barriers to help-seeking for Asians (Boey, 1997; K. Lin, Inui, Kleinman, & Womack, 1982; Takeuchi, Leaf, & Kuo, 1988; See, however, Abe-Kim et al., 2002, for an exception). With respect to the clinical fear subgroup, there were also no differences among groups in willingness to seek help. In contrast to the entire sample, the FBC clinical fear subgroup was no more likely than the EC subgroup to implicate self-presentation concerns as reasons for not seeking help. Thus, it may be that for those with severe social anxiety, attitudes toward help-seeking are similar, regardless of whether they are of Chinese or European heritage. We also addressed help-seeking using vignettes describing various levels of social anxiety. We found that at low and high levels of severity of social anxiety, there were no differences between the three groups in terms of willingness to seek help. However, at the medium level of severity, the results showed a trend for differences in help-seeking among the groups. When we explored this trend, differences were found in level of help-seeking among Chinese and EC participants. These results suggest that there may be differences in the threshold for seeking help among Chinese and EC individuals. Thus, when social anxiety symptoms are mild, both groups may feel that seeking help is not necessary. However, when social anxiety becomes more severe, European Canadians are more likely to believe that seeking help is necessary compared to Chinese individuals. It is not until the social anxiety is severe that Chinese individuals are willing to seek help at the same level as their European counterparts. These results are consistent with the above help-seeking findings that there are no differences in help-seeking between Chinese and EC participants who have high social anxiety. Although the delay in help-seeking in Asians has been consistently found for mental health conditions in 26 general (Li & Browne, 2000; K. M. Lin & Cheung, 1999), this is the first study to examine help-seeking specifically for social anxiety. There are some limitations to this study that should be addressed. First, since this study was conducted with a sample of university students, the results cannot be generalized to Chinese and European heritage individuals in the community. There were also limitations with respect to the interviewers used in the study. Given that they were trained research assistants, with limited clinical experience, this may have affected the interview data collected. Also, given that the interviewers were senior undergraduate students, participants may have felt comfortable enough to disclose personal information. It is encouraging, however, that there were no differences found in the behaviours of the interviewers across the three groups. Finally, female interviewers were not used in the study, so it is unclear whether they may have produced different demand characteristics compared to male interviewers. With respect to instruments employed, we did not use the complete ADIS-IV due to simplifying it and removing the need for clinical judgment for use by non-clinician interviewers. Thus, we did not include a global rating of impairment to assess for a diagnosis of DSM-IV social phobia. Also, the questionnaires were not completely anonymous for participants in the interview first group, which may have affected their willingness to disclose information. Consistent with this, our analysis of order effects revealed that CBC participants in the interview first group reported lower levels of avoidance and impairment compared to those in the questionnaire first group, although no order effects were found for the FBC and EC groups. An important strength of this study is that we controlled for interviewer ethnicity. Our findings showed that interviewer ethnicity did not affect reporting of social anxiety and impairment among the three groups. Even for the FBC group, who may be less accustomed to disclosing personal information to individuals of European background, level of reporting did 27 not differ for both the Chinese and European heritage interviewers. Perhaps the fact that the Chinese interviewer appeared acculturated to Canada (e.g., spoke fluent English) made the participants feel that the interviewers were similar. Previous findings have similarly shown that ethnicity of female experimenters did not affect behavioural displays of assertiveness in Chinese and Caucasian American women (D. Sue, Sue, & Ino, 2001). Another strength of this study is that we examined homogeneous groups of both foreign-bom and Canadian-born Chinese. Furthermore, we attempted to control for practice effects by separating the two study B components by at least one week. To address the broader question of the observed discrepancy in the patterns of social anxiety among Asian and Western populations, our findings are consistent with studies that find higher levels of social anxiety in Chinese compared to European heritage students in North America, but did not provide additional support for the lower rates of social phobia found in Asian vs. Western populations. A number of factors could account for the lack of support for lower rates of social phobia in Asians. First, it is possible that the discrepancy between the epidemiological and self-report data represents true variation in the patterns of social anxiety among Asians living in Asia compared to North America. Another factor may involve variations in the conditions under which interviews are conducted in the Asian epidemiological studies. Since the instruments employed in the Asian studies were administered in native languages, this may have affected individuals' reporting of symptoms. It has been shown that language activates associated cultural knowledge and beliefs, and leads individuals to adopt self-views consistent with these knowledge structures. Studies have found that bicultural Chinese individuals exhibit more characteristically Western self-perceptions or values when they respond to self-report questionnaires in English rather than in Chinese and vice versa (Ross, Xun, & Wilson, 2002). Furthermore, the trained lay interviewers used in the epidemiological studies 28 may have produced different demand characteristics from the undergraduate interviewers used in our study. Another reason may be that individuals in North America and Asia are comparing themselves to different sets of social norms when reporting symptoms of social anxiety. For example, Asians may feel relatively less socially anxious in Asia where cultural norms emphasize emotional restraint and inhibition in social situations, compared to North America where assertiveness and the absence of social anxiety are seen as desirable. Finally, acculturation stress may play a role in increased levels of social anxiety for foreign-born Asians. Future studies should address the study questions in a more representative community sample, using interviewers with clinical experience. Studies should also address the effects of authority status on symptom reports. The effect of language priming on the endorsement of social anxiety symptoms also warrants further research. To summarize, the present findings replicate previous findings that Chinese students, particularly those who are foreign-born, experience more social anxiety compared to their European counterparts. Furthermore, foreign-born Chinese students also experience higher levels of impairment. The findings also suggest that the Chinese are more likely to delay seeking help for social anxiety symptoms. While foreign-bom Chinese appear to be more reticent in seeking help due to self-presentational concerns, it seems that once they have access to mental health services, they would have no problem admitting to symptoms. Given their higher levels of social anxiety and impairment, it seems important that efforts be directed at improving recognition of social anxiety in Chinese individuals before it becomes severe, especially given the importance of early intervention for this disabling disorder. 29 Footnotes 'Since there were no differences in the results of the main analyses with the exclusion of these 4 participants, we decided to employ the entire sample for all analyses. 30 Table 1 Demographic Measures by Ethnicity Group Variable Ethnicity Group Canadian-born Foreign-born Chinese Chinese European Canadian Gender(%) Male 33.85 33.33 38.71 Female 66.15 66.67 61.29 Age 19.29 19.00 19.55 (1.52) (1.48) (1.60) Years Lived in Canada 9.75 18.51 18.85 (3.74) (2.44) (3.21) Note. Standard deviations in parentheses. 31 Table 2 Means and Standard Deviations for Acculturation and Self-Construal Measures by Ethnicity Group and Reporting Method Variable Foreign-born Chinese Ethnicity Group Canadian-born Chinese European Canadian VIA Heritage subscale Mainstream subscale SCS Independence Interdependence 7.30 (1.13) 6.27 (1.32) 4.59 (0.59) 4.83 (0.51) 6.46 (1.25) 7.25 (0.85) 4.77 (0.70) 4.58 (0.68) 5.98 (1.40) 7.33 (1.10) 4.60 (0.81) 4.24 (0.53) Note. VIA = Vancouver Index of Acculturation; SCS = Self-Construal Scale. fN CO 00 CD 0 x c < c o t3 2 00 to co CN m CD CO oo * * * * * * * * o CN CO CD CO CD IO ro o o CO II CO < CO T3 CU 03 > CD or co ro H a? CO CO .CD CO CL 55 CO CO •o c CO or i CO Q c o S CO c .o •2 c CO CN CD CO CN CD CN * CD in * * * * * * CO T — CD CO « CD • * * 00 * o CN CN LO r*-CD * o CD r--00 CN CD * LO * CO LO o I ists CD CO cc I CO Q ro 0 0 o c ro •g 'o 3 T - CN C OJ E ' r o CL E co c 0 0 co Q. 0 I .0 cc I CO Q ro 0 LO 0 o c ro TJ "o CD C 0 E "ro CL E co CO CD * co co CN * CO CO * * o r-* LO CN co o * CD CO CO CO LO * * CD LO * LO CD 0) c 0 0 w i Q. 0 X CO CO < CO CO CL CO CO O _0 D TO 0 sz o CO 0 0 0 "E o co b 0 x a) < s M W co Q-Q ro <e 00 w h~ II •*~ CO II Q_ __ C CO o Q> ®" V 5 o Q. ^ CO * 33 Table 4 Means and Standard Deviations for ADIS-IV-R Social Anxiety and Impairment Measures by Ethnicity Group and Reporting Method Variable Foreign-born Chinese Ethnicity Group Canadian-born Chinese European Canadian Fear rating Self-report 27.25 (12.43) 25.22 (11.68) 22.57 (13.04) Interview Avoidance rating 29.86 (12.69) 25.25 (11.93) 22.95 (10.95) Self-report 32.78 (13.30) 28.22 (14.03) 23.23 (12.21) Interview 32.32 (10.93). 29.06 (12.59) 23.71 (10.94) Interference rating Self-report 14.48 (4.96) 12.22 (4.98) 11.94 (4.58) Interview 15.09 (4.45) 12.37 (4.47) 12.63 (4.24) Note. Standard deviations in parentheses. Table 5 Intercorrelations Among ADIS-IV-R Help-seeking Variables Measure 1 2 3 ADIS-IV-R Self-report 1. Help-seeking 2. Not seeking help due to appraisal factors 3. Not seeking help due to self-presentation factors ADIS-IV-R Interview 4. Help-seeking 5. Not seeking help due to appraisal factors 6. Not seeking help due to self-presentation factors -.26** .22** .03 .63** -.16 .20* - .31* * .25** -.24** .08 -.12 .53** Note. n= 178. ADIS-IV-R = Anxiety Disorders Interview Schedule for DSM-IV Revised. *p<.05. **p < .01 35 Table 6 Means and Standard Deviations for Help-seeking Measures by Ethnicity Group and Reporting Method Factor Foreign-born Chinese Ethnicity Group Canadian-born Chinese European Canadian ADIS-IV-R Self-report Help-seeking Appraisal factors Self-presentation factors Interview Help-seeking Appraisal factors Self-presentation factors SBQ Help-seeking 2.22 (1.05) 7.95 a (1.50) 4 .82 a (1.85) 2.34 (1.11) 7.92 d (1.65) 4 .57 d (1.98) 1.92 (1.00) 7 .82 b (2.07) 4 .07 b (1.92) 2.10 (1.01) 8.78 e (1.20) 3.80 6 (1.78) 1.97 (1.07) 8.24 c (2.01) 3.60 c (2.06) 1.84 (1.06) 8.68 f (1.20) 3.74 f (1.52) Low severity Medium severity High severity 7.62 (1.99) 8.43 (2.35) 10.52 (2.36) 7.24 (2.01) 8.45 (2.42) 10.1 (2.67) 7.44 (2.32) 9.34 (2.49) 10.69 (2.07) Note. S t a n d a r d dev ia t ions in pa ren theses . A D I S - I V - R = A n x i e t y D isorders In terv iew S c h e d u l e for D S M - I V R e v i s e d ; S B Q = Soc ia l Behav iou r Q u e s t i o n n a i r e . an = 57 .  bn = 4 5 . °n = 5 5 . d n = 54 .  en = 4 5 . fr? = 57 . 36 Table 7 Proportions of Participants Meeting ADIS-IV-R Fear and Impairment Criteria Foreign-born Chinese Ethnicity Group Canadian-born Chinese European Canadian p -value 3 Self-report (%) Meets fear criteria Interview (%) Meets fear criteria Meets impairment criteria13 50.8 63.1 14.6 47.1 56.9 10.3 40.3 35.5 18.2 >.1 0.005 >.5 Based on chi-square analysis. Proportions are calculated for subsample meeting fear criteria. ' 15 Low Medium High Severity Levels of Social Anxiety Figure 1. Help-seeking Levels by Social Anxiety Seventy Levels based on the Social Behaviour Questionnaire Bibliography Abe-Kim, J., Takeuchi, D., & Hwang, W.-C. (2002). Predictors of help seeking for emotional distress among Chinese Americans: Family matters. Journal of Consulting & Clinical Psychology, 70(5), 1186-1190. Boey, K. W. (1997). Paths to psychiatric care: A study of the elderly in urban China. Clinical Gerontologist, 18, 65-80. Brown, T. A., Di Nardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). Albany, New York: Graywind Publications Incorporated. Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110(1), 49-58. Bui, K. V., & Takeuchi, D. T. (1992). Ethnic minority adolescents and the use of community mental health care services. American Journal of Community Psychology, 20, 403-417. Chen, D. (1995). Cultural and psychological influences on mental health issues for Chinese Americans. In L. L. Adler & B. R. Mukherji (Eds.), Spirit versus scalpel. Westport, Connecticut: Bergin & Garvey. Cheung, F. K., & Snowden, L. R. (1990). Community mental health and ethnic minority populations. Community Mental Health Journal, 26, 277-291. Clark, D. M. (2001). A cognitive perspective on social phobia. In W. R. Crozier & L. E. Alden (Eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness (pp. 405-429). Chichester: John Wiley & Sons Ltd. Fugita, S. S. (1990). Asian/Pacific-American mental health: Some needed research in epidemiology and service utilization. In F. C. Serafica, A. I. Schwebel, R. K. Russell, P. 39 D. Isaac & L. B. Myers (Eds.), Mental health of ethnic minorities (pp. 66-83). New York: Praeger Publishers. Gross, J. J., & John, O. P. (1998). Mapping the domain of expressivity: Multimethod evidence for a hierarchical model. Journal of Personality and Social Psychology, 74,170-191. Hwu, H.-G., Yeh, E.-K., & Chang, L.-Y. (1989). Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatrica Scandinavica, 79, 136-147. Iwamasa, G. Y. (1997). Asian Americans. In S. Friedman (Ed.), Cultural issues in the treatment of anxiety (pp. 99-129). New York: The Guildford Press. Lai, J., & Linden, W. (1993). The smile of Asia: Acculturation effects on symptom reporting. Canadian Journal of Behavioural Science, 25, 303-313. Lang, A. J., & Stein, M. B. (2001). Social phobia: Prevalence and diagnostic threshold. Journal of Clinical Psychiatry, 62(suppl 1), 5-10. Leary, M. R., & Kowalski, R. M. (1995). Social anxiety. New York: Guilford Press. Lee, C. K., Kwak, Y. S., Rhee, H., Kim, Y. S., Han, J. H., Choi, J. O., et al. (1987). The nationwide epidemiological study of mental disorders in Korea. Journal of Korean Medical Science, 2, 19-34. Leong, F. T. L., & Lau, A. S. L. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research, 3, 201-214. Li, H. Z., & Browne, A. J. (2000). Defining mental illness and accessing mental health services: Perspectives of Asian Canadians. Canadian Journal of Community Mental Health, 19, 143-159. Lin, K., Inui, T. S., Kleinman, A. M., & Womack, W. M. (1982). Sociocultural determinants of the help-seeking of patients with mental illness. Journal of Nervous & Mental Disease, 170(2), 78-85. Lin, K. M., & Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services, 50, 774-780. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224-253. Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470. Okazaki, S. (1997). Sources of ethnic differences between Asian American and White American college students on measures of depression and social anxiety. Journal of Abnormal Psychology, 106(1), 52-60. Okazaki, S. (2000). Asian American and White American differences on affective distress symptoms. Do symptom reports differ across reporting methods? Journal of Cross-Cultural Psychology, 31(5), 603-625. Okazaki, S. (2002). Self-other agreement on affective distress scales in Asian Americans and White Americans. Journal of Counseling Psychology, 49(4), 428-437. Okazaki, S., Liu, J. F., Longworth, S. L., & Minn, J. Y. (2002). Asian American-White American differences in expressions of social anxiety: A replication and extension. Cultural Diversity and Ethnic Minority Psychology, 8(3), 234-247. 41 Park, K. B., Upshaw, H. S., & Koh, S. D. (1988). East Asians' responses to Western health items. Journal of Cross-Cultural Psychology, 19, 51-64. Purdon, C , Antony, M., Monteiro, S., & Swinson, R. P. (2001). Social anxiety in college students. Anxiety Disorders, 15, 203-215. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social i phobia. Behaviour Research and Therapy, 35, 741-756. Ross, M., Xun, W. Q. E., & Wilson, A. E. (2002). Language and the bicultural self. Personality and Social Psychology Bulletin, 28,1040-1050. Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79, 49-65. Schlenker, B. R., & Leary, M. R. (1982). Social anxiety and self-presentation: A conceptualization and model. Psychological Bulletin, 92(3), 641-669. Singelis, T. M. (1994). The measurement of independent and interdependent self-construal. Personality and Social Psychology Bulletin, 20, 580-591. Solberg, V. S., Ritsma, S., Davis, B. J., Tata, S. P., & Jolly, A. (1994). Asian-American students' severity of problems and willingness to seek help from university counseling centers: Role of previous counseling experience, gender, and ethnicity. Journal of Counseling Psychology, 41(3), 275-279. Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2004). Prevalence and incidence studies of anxiety disorders: A systematic review of the literature. Manuscript submitted for publication. Steel, J. L. (1991). Interpersonal correlates of trust and self-disclosure. Psychological Reports, 68, 1319-1320. Stein, M. B., Walker, J. R., & Forde, D. R. (1994). Setting diagnostic thresholds for social phobia: Considerations from a community survey of social anxiety. American Journal of Psychiatry, 151, 408-412. Sue, D., Ino, S., & Sue, D. M. (1983). Nonassertiveness of Asian Americans: An inaccurate assumption? Journal of Counseling Psychology, 30(4), 581-588. Sue, D., Sue, D. M., & Ino, S. (2001). Assertiveness and social anxiety in Chinese-American women. The Journal of Psychology, 124(2), 155-163. Sue, S., Fujino, D. C , Hu, L., Takeuchi, D. T., & Zane, N. W. S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting & Clinical Psychology, 59, 533-540. Takeuchi, D. T., Leaf, P. J., & Kuo, H. S. (1988). Ethnic differences in the perception of barriers to help-seeking. Social Psychiatry and Psychiatric Epidemiology, 23, 273-280. Uba, L. (1994). Asian Americans: Personality patterns, identity, and mental health. New York: Guilford. Wittchen, H.-U., & Fehm, L. (2001). Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatric Clinics of North America, 24(4). Zhang, A. Y., Snowden, L. R., & Sue, S. (1998). Differences between Asian and White Americans' help seeking and utilization patterns in the Los Angeles area. Journal of Community Psychology, 26, 317-326. Appendix A 43 Demographic Measure Thank you for participating in our research project. We would like to ask you to complete the following battery of questionnaires. Please read the instructions carefully for each questionnaire and answer the questions accordingly. Prior to asking about some specific areas, such as your thoughts about social behaviours, we would kindly request that you complete the following questions on your personal background. Your answers will be kept completely confidential. B a c k g r o u n d Please mark the appropriate answer or complete in the space provided: Your gender: Male Female Your age: years Your own country of bi r th: Your mother 's country of bir th: Your father 's country o f b i r th: How many years have you lived in Canada? years Have you ever l ived in another country (other than Canada)? Yes No If YES, in which country and for how long? Country: Time spent abroad: Your ethnic background (e.g. Chinese, German, etc.): Date this quest ionnaire battery f i l led out: 44 Appendix B Vancouver Index of Acculturation The questions below ask about your friendships, values, and activities. Many of these questions will refer to your heritage culture, meaning the culture which you feel has influenced you most, other than North American culture. It may be the culture of your birth, the culture in which you have been raised, or another culture which forms part of your background. If there are several such cultures, please indicate the culture which has influenced you most (e.g. Irish, Chinese, German). It may be the case that you have not been influenced by any culture other than North American culture. Nevertheless, please try to identify a culture that may have had an impact on previous generations of your family. Please write your heritage culture in the space provided: Strongly Disagree J — 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 Strongly Agree 1. I often participate in heritage cultural traditions. 1 „ . 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 2. I often participate in North American cultural traditions. 1 — 2 — 3 — 4 — 5 6 — 7 — 8 — 9 3. I would be willing to marry a person from my heritage culture. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 4. I would be willing to marry a North American person. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 5. I enjoy social activities with people from the same heritage culture as myself. 1 — 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 6. I enjoy social activities with North American people. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 7. I am comfortable working with typical people from my heritage culture. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 8. L am comfortable working with typical North American people. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 9. I enjoy entertainment (e.g., movies, music) from my heritage culture. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 10. I enjoy.North American entertainment. 1... 2 — 3. — 4 — 5 — 6 — 7 — 8 — 9 11. I often behave in ways that are typical of my heritage culture. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 12. I often behave in ways that are 'typically North American.' - ; ; .] . . . 2 — 3 -~ 4 — 5 — 6 —.7 — 8 — 9 13. It is important for me to maintain or develop cultural practices from my heritage culture. 1... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 14. It is important for me to maintain or.develop North American cultural practices. ... 2 — 3 — 4 — 5 — 6 7 — 8 — 9 15. I believe in the values of my heritage culture. 1 ... 2. — 3 — 4 — 5 — 6 — 7 — 8 — 9 16. I believe in mainstream North Americanvvalues. 1 ... 2 — 3 — 4 5 — 6 — 7 — 8 — 9 17. I enjoy jokes and humor from my heritage culture. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 18. I enjoy North American jokes and humour. : 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 19. I am interested in having friends from my heritage culture. 1 — 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9 20.: I am interested in having North American friends. 1 ... 2 — 3 — 4 — 5 — 6 — 7 — 8 — 9. 45 Appendix C Self-Construal Scale Listed below are a number of statements. Read each one as if it referred to you. Beside each statement circle the number that best matches your agreement or disagreement. Please respond to every statement. Strongly Don't Somewhat Agree or Agree 1. I enjoy being unique and different from others in many r e s p e c t s . 2~i can talk openly with a person for the first time," even when this person is much older than I am. 3. E v e n when I strongly disagree with group members, I avoid an argument. 4. I have respect for the authority figures with whom I interact. 5. I do my own thing, regardless of what otheis 6. If my brother or sister fails, I feel responsible. 7. I feel it is important for me to act as an independent person. sHTwill sacrifice my self-interest foTThe benefiTof -the group I am in 9. I'd rather say "No" directly, than risk being misunderstood. 10. H a v i n g a lively imagination is important to me. 11.1 shjmld;ta^^ advice.wh'en making education/career plans. 12. I feel my fate is intertwined with The fate of those around me. 13. I prefer to be direct and forthright when dealing with people I've just met. 14. | feel good when I cooperate with others. 15. I am comfortable with being singled out for praise or rewards. 16. If my brother or sister fails, I feel responsible. 17. | often have the feeling that my relationships with others are more important than my own accomplishments 18. S p e a k i n g up during a class (or a meeting) is not a problem for me. 19. I would offer my seat in a bus to my professor (or my boss). Disagree Disagree Disagree Disagree Somewhat Agree 2 3 4 5 6 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 Strongly Agree 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 46 Appendix C cont'd. Strongly Don't Somewhat Agree or Agree Strongly Disagree Disagree Disagree Disagree Somewhat Agree Agree 20.1 act the same way no matter who I am with. 21. My happiness depends on the happiness of those around me. 22.1 value being in good health above everything. 23.1 will stay in a group if they need me, even when I am not happy with the group 24.1 try to do what is best for me, regardless of how that might affect others. 25. Being able to take care of myself is a primary concern for me. 26 It is important for me to respect decisions made by the group 27. My personal identity, independent of others, is very important to me. 28. It is important for me to maintain harmony within my group. 29 | act the same way at home that I do at school l l l l l l w ^ 30.1 usually go along with what others want to do, even when I would rather do something different. 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 G 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 47 Appendix D Social Interaction Anxiety Scale Please indicate the degree to which you feel the statement is characteristic or true of you. Not at all Slightly Moderately Very 1. I get nervous if I have to speak with someone in 0 authority (teacher/boss, etc.). 2. I have difficuityjpaking eye contact with others. 3. I become tense if I have to talk about myself or my feelings. 4 I have difficulty mixing comfortably with the people I work with. 5. I find it easy to make friends my own age. 6 I tense up if I meet an acquaintance in the street 7. When mixing socially I am uncomfortable. 8 I feel tense if I am alone with just one person. 9. I am at ease meeting people at parties. 10. I have difficulty talking with other people. 11.1 find it easy to think of things to talk about. 12. Tworry about expressing myself in case I appear awkward. 13. I find it difficult to disagree with another's point of view. 14. I have difficulty talking to an attractive person of the opposite sex. 15. I find myself worrying that I won't know what to say in social situations. 16. I am nervous mixing with people^ don't know well. 17. I feel I'll say something embarrassing when talking. 18. When mixing in a group, I find myself worrying I will be ignored. 19. I am tense mixing in a group. 20 I am unsure whether to greet someone I know only slightly. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Extremely 4 HHflHI 4 4 4 4 4 4 4 4 4 4 4 4 4 4 48 Appendix E Social Phobia Scale Please indicate the degree to which you feel the statement is characteristic or true of you. Not at all Slightly Moderately Very Extremely 1. I become anxious if I have to write in front of other 0 people. 2 I become self-conscious when using public toilets. 0 3. I can suddenly become aware of my own voice and 0 of others listening to me. 4. I get nervous that people are staring at me as I walk 0 down the street 5. I fear I may blush when I am with others. 0 6. I feel self-conscious if I have to enter a room where 0 others are already seated. 7. I worry about shaking or trembling when I'm watched 0 by other people. : 8. I would get tense if I had to sit facing other people 0 ' on a bus or a train. 9. I get panicky that others might see me faint, or be 0 sick or ill. 10. I would find it difficult to drink something if in a group 0 of people. 11. I am worried people will think my behaviour odd. 0 12. It would make me feel self-conscious to eat in front 0 of a stranger at a restaurant. 13. I would get tense if I had to carry a tray across a 0 crowded cafeteria. 14. I worry I'll lost control of myself in front of other 0 people. 15. I worry I might do something to attract the attention 0 of other people. 16. When in an elevator, I am tense if people look at 0 17. I can feel conspicuous standing in a line. 0 18. I get tense when I speak in front of other people. 0< 19. I worry my head will shake or nod in front of others. 0 20. I feel awkward and tense if I know people are 0 watchinqlme. * 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 49 Appendix F Anxiety Disorders Interview Schedule for DSM-IV-R Self-report Version Please mark the appropriate responses to the following questions: 1 a. Do you find it easy to meet people on campus? YES NO_ b. Do you feel that the campus offers appropriate types of social YES NO_ activities to meet people? c. In general, do you take part in social functions on campus? YES NO_ d. In social situations where you might be observed or evaluated by YES NO_ others or when you are meeting new people, do you feel fearful, anxious, or nervous? e. Are you overly concerned that you may do and/or say something YES NO_ that might embarrass or humiliate yourself in front of others, or that others may think badly of you? 2. Using the scale below, please separately rate: 1) how fearful you would feel in each of the following situations and 2) how much you avoid these situations: 0 1 2 3 4 5 6 7 8 No fear/ Mild fear/ Moderate fear/ Severe fear/ Very severe fear/ Never avoids Rarely avoids Sometimes avoids Often avoids Always avoids Fear Rating Avoidance Rating Comments Parties Participating at meetings/classes Talking in front of a group/formal speaking Speaking with unfamiliar people Eating in public Using public restrooms Writing in public (signing checks, filling out forms) Dating situations Talking to persons in authority Being assertive, e.g.: a. Refusing unreasonable requests b. Asking others to change their behaviour Initiating a conversation Maintaining a conversation Other situations (specify) 50 Appendix F cont'd. 3a. From the above social situations, which might be the most problematic for you? b. The following questions refer to the situation(s) listed in 3a. Please circle the appropriate number to the right of the question: What are you concerned will happen in the above situations? I'll do something foolish I'll have a panic attack People will judge me People will see how nervous I am Other (Specify): Probably Neutral/ Probably Definitely Not at all not Depends yes yes 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 Do you ever have panic attacks that come out of the blue, outside of social situations? In what ways have these fears interfered with the following aspects of your life? Daily routine Job Education Making friends Dating Social activities Other (Specify): 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 5 5 5 5 5 5 5 Would you seek help for these fears? 1 If not, why not? Because it's not a serious enough problem to require help 1 I should be able to deal with it on my own 1 It's embarrassing for others to know 1 I don't think others would understand 1 I wouldn't know where to go for help 1 Other (Specify): 1 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 5 5 5 5 5 5 51 Appendix G Anxiety Disorders Interview Schedule for DSM-IV-R Interview-Administered Version I. INITIAL INQUIRY Now I'm going to ask you more questions about some specific kinds of problems that may or may not apply to you. 1a. Currently, in social situations where you might be observed or evaluated by others or when you are meeting new people, do you feel fearful, anxious, or nervous? YES NO b. Currently, are you overly concerned that you may do and/or say something that might embarrass or humiliate yourself in front of others, or that others may think badly of you? YES NO 2. I am going to describe some situations of this type and ask how you would feel in each situation and to what extent you avoid these situations. 0 1 2— 3- 4 5 6 7 8 No fear/ Mild fear/ Moderate fear/ Severe fear/ Very severe fear/ Never avoids Rarely avoids Sometimes avoids Often avoids Always avoids Fear Rating Avoidance Rating Comments Parties Participating at meetings/classes Talking in front of a group/formal speaking Speaking with unfamiliar people Eating in public Using public restrooms Writing in public (signing checks, filling out forms) Dating situations Talking to persons in authority Being assertive, e.g.: a. Refusing unreasonable requests b. Asking others to change their behaviour Initiating a conversation Maintaining a conversation Other situations (specify) 52 Appendix G cont'd... II. CURRENT EPISODE Now I want to ask you a series of questions about current anxiety in social situations. If ratings of 1 or greater: From the situations we just discussed, which would you say is the most problematic for you? If all ratings of 0: From the situations we just discussed, which might be the most problematic for you? List most problematic situations: What are you concerned will happen in the above situations? You'll do something foolish You'll have a panic attack People will judge you People will see how nervous you are Other (Specify): Not at all Probably Neutral/ Probably Definitely not Depends yes 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 yes 5 5 5 5 5 Do you ever have panic attacks that come out of the blue, outside of social situations? In what ways have these fears interfered with the following aspects of your life? Daily routine Job Education Making friends Dating Social activities Other (Specify): 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 5 5 5 5 5 5 5 Would you seek help for these fears? 1 If Neutral/Depends or No, then ask: If not, why not? Because it's not a serious enough problem to require help 1 You should be able to deal with it on your own 1 It's embarrassing for others to know 1 You don't think others would understand 1 You wouldn't know where to go for help 1 Other (Specify): 1 2 2 2 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 5 5 5 5 5 5 53 Appendix H ADIS-IV-R Fear Criteria for Generalized Social Phobia To meet the fear criteria for generalized social phobia, the following must be met: • 3 or more social situations with a rating of 4 or higher on fear (i.e. can make diagnosis on fear ratings alone since many individuals will not avoid social situations, but will endure them with great discomfort); • Rating of less than 4 for two items concerning panic attacks. 54 Appendix I Social Behaviour Questionnaire Imagine yourself in the following situations. Try to really put yourself in these situations. Then answer the questions that follow by circling the appropriate number to the right of each question. 1. You feel uncomfortable meeting new people, but you are able to do it if you try. a) In your opinion, should you seek help for this? Probably Neutral/ Probably Definitely Not at all not Depends yes yes 1 b) If you were going to seek help, who would you seek help from? Mental health professional Professor/Teacher Family doctor Friends/Family Other (Specify): 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 c) What factors would prevent you from seeking help? Because it's not a serious enough problem to require help I should be able to deal with it on my own It's embarrassing for others to know I don't think others would understand I wouldn't know where to go for help Other (Specify): 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 55 Appendix I cont'd... 2. You feel anxious talking with people in authority, such as your professor, and you avoid doing so, even if you need help in the course. In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? N o t a t a l l P r o b a b l y n o t N e u t r a l / D e p e n d s P r o b a b l y y e s D e f i n i t e l y y e s b) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : 2 2 2 2 2 4 4 4 4 4 c) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it o n m y o w n It 's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o f o r h e l p O t h e r ( S p e c i f y ) : 4 4 4 4 4 5 5 5 5 5 3. You feel panicky whenever you have to talk with people you don't know. You avoid situations where you have to talk with strangers. N o t a t a l l In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? P r o b a b l y n o t N e u t r a l / D e p e n d s P r o b a b l y y e s D e f i n i t e l y y e s b) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 c) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e he lp I s h o u l d b e ab le to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o fo r he lp O t h e r ( S p e c i f y ) : 56 Appendix I cont'd... 4. You feel somewhat anxious maintaining a conversation with another person. You often avoid situations in which you have to talk to people for longer lengths of time. a ) I n y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? b) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : N o t a t a l l 1 P r o b a b l y N e u t r a l / P r o b a b l y D e f i n i t e l y y e s n o t 2 2 2 2 2 2 D e p e n d s 3 3 3 3 3 3 y e s 4 4 4 4 4 4 c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d be a b l e to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e t o g o f o r h e l p O t h e r ( S p e c i f y ) : . . 4 4 4 4 5 5 5 5 5 5. You feel uncomfortable going to parties, and you often have to make yourself do it. a ) In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? N o t a t a l l P r o b a b l y n o t N e u t r a l / D e p e n d s P r o b a b l y y e s D e f i n i t e l y y e s b) If y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l 1 P r o f e s s o r / T e a c h e r 1 F a m i l y d o c t o r 1 F r i e n d s / F a m i l y 1 O t h e r ( S p e c i f y ) : 1 c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o fo r he lp O t h e r ( S p e c i f y ) : 5 5 5 5 5 57 Appendix I cont'd. 6. You feel very anxious speaking up in class. You avoid taking classes that involve participation even if they are required for your degree, therefore requiring you to change majors. a) In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? b ) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : N o t a t a l l 1 P r o b a b l y N e u t r a l / n o t D e p e n d s P r o b a b l y D e f i n i t e l y y e s y e s 4 5 4 4 4 4 4 c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o fo r he lp O t h e r ( S p e c i f y ) : 7. You feel very anxious interacting with people at large social functions, and you usually can't do it. N o t a t a l l a) In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? P r o b a b l y N e u t r a l / P r o b a b l y D e f i n i t e l y n o t D e p e n d s y e s y e s b) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : . c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it on m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o fo r he lp O t h e r ( S p e c i f y ) : 58 Appendix I cont'd... 8. You feel anxious on dates so you don't date very much. a ) In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? P r o b a b l y N e u t r a l / P r o b a b l y D e f i n i t e l y N o t a t a l l n o t D e p e n d s y e s y e s b) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it 's n o t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g fo r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o f o r he lp O t h e r ( S p e c i f y ) : 2 2 2 2 2 4 4 4 4 4 5 5 5 5 5 You feel somewhat anxious giving your opinions to others. You try to avoid doing so unless you absolutely have to. a ) In y o u r o p i n i o n , s h o u l d y o u s e e k h e l p f o r t h i s ? N o t a t a l l P r o b a b l y n o t N e u t r a l / D e p e n d s P r o b a b l y y e s D e f i n i t e l y y e s b ) I f y o u w e r e g o i n g t o s e e k h e l p , w h o w o u l d y o u s e e k h e l p f r o m ? M e n t a l h e a l t h p r o f e s s i o n a l P r o f e s s o r / T e a c h e r F a m i l y d o c t o r F r i e n d s / F a m i l y O t h e r ( S p e c i f y ) : 4. 4 4 4 4 5 5 5 5 5 c ) W h a t f a c t o r s w o u l d p r e v e n t y o u f r o m s e e k i n g h e l p ? B e c a u s e it's no t a s e r i o u s e n o u g h p r o b l e m to r e q u i r e h e l p I s h o u l d b e a b l e to d e a l w i t h it o n m y o w n It's e m b a r r a s s i n g f o r o t h e r s to k n o w I d o n ' t t h i n k o t h e r s w o u l d u n d e r s t a n d I w o u l d n ' t k n o w w h e r e to g o f o r he lp O t h e r ( S p e c i f y ) : 2 2 2 2 2 4 4 4 4 4 Appendix J Study Procedures Class announcement Poster advertisement Hand out quest ionnaires Pass a round s ign-up sheet Contact s tudents by phone or e-mail Ask t h e m to pick up quest ionnaire f rom lab Schedu le t ime for an interview Questionnaire First Group W h e n return comple ted quest ionnai re in person, schedule interview ~2 w e e k s after quest ionnai re fi l led out Admin is ter interview Admin is ter interview Mail out quest ionnai re so they receive ~2 w e e k s after interview Give credit sl ip W h e n return comple ted quest ionnai re in person, g ive credit sl ip 60 Appendix K Consent Form Patterns of Social Behaviour in Chinese and European Canadian Students Pr inc ipa l Inves t iga to r : Dr. Lynn E. Alden Department of Psychology, University of British Columbia 604-822-2198 Co- Inves t iga to r : Lorena Hsu, M A . Candidate Department of Psychology, University of British Columbia 604-822-5047 This research study is part of the thesis requirement for a graduate degree. The information f rom the completed study will therefore be made available as a public document. P u r p o s e : The purpose of the study is to examine the similarities and differences in patterns of social behaviour among Chinese and North American cultures. You have been invited to participate in the study so you can help us better understand the role of culture in social experience and behaviour. S t u d y P r o c e d u r e s : Participation in this study will require that you fill out and return a questionnaire, which will take approximately 75 minutes. Also, y o u r participation in this study will involve taking part in an interview at the laboratory, which will take about 45 minutes. The questionnaire a n d interv iew componen ts o f t h e s tudy w i l l t a k e p l a c e approx imate ly 3 weeks apart. Potential risks of the study may involve psychological discomfort if you happen to be sensitive to topics raised in the study. If you do express psychological distress during the study, we will refer you to counseling to help manage your distress. Con f iden t ia l i t y : Your identity will be kept strictly confidential and you will not be identified by name in any reports of the completed study. All documents will be identif ied only by code number and kept in a locked filing cabinet. Data records kept on a computer hard disk will be password protected to maintain the security of computer records. The principal investigator, co-investigator, and research assistants of the study will have access to the data. 61 R e n u m e r a t i o n / C o m p e n s a t i o n : You will be offered 2 credits for your participation in both the questionnaire and interview components of the study. If you complete only one component of the study (i.e. either the questionnaire or interview), you will be given 1 credit for your participation. If you decide to withdraw before full complet ion of the interview, and have not yet filled out a questionnaire, you will receive 1 credit for your participation. Con tac t f o r i n f o r m a t i o n a b o u t the s t u d y : If you have any quest ions or desire further information with respect to this study, you may contact Dr. Lynn Alden or one of her associates at 604-822-5047. Con tac t f o r c o n c e r n s a b o u t the r i gh ts o f research s u b j e c t s : If you have any concerns about your treatment or rights as a research subject, you may contact the Research Subject Information Line in the UBC Office of Research Services at 604-822-8598. C o n s e n t : Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any t ime without jeopardy to your class standing. Your signature below indicates that you have received a copy of this consent form for your own records. Your signature indicates that you consent to participate in this study. Subject Signature Date Printed Name of the Subject Appendix L C h e c k l i s t o f In te rv iewer B e h a v i o u r s 1 Follows script (i.e. confidentiality) 2 Gives subject consent form to read and sign 3 Gives subject copy of consent form 4 Asks items of interview in correct order 5 Shows fear, avoidance, and help-seeking rating scales appropriately 6 Clarifies response if subject not giving clear.rating 7 Does not influence responses (e.g. nods, encouragement, etc.) 8 Gives general response if subject asks specifically about questions 9 For subjects in interview-first condi t ion, explains need to do questionnaire component and takes down address or date for questionnaire pick-up at conclusion of interview 10 For subjects in questionnaire-f irst condi t ion, gives credit slip and debriefing form at conclusion of interview 63 Appendix M Guidelines for Observer Ratings of Interviewer Behaviour Friendly: 1 = the interviewer did not appear friendly at all. He rarely displayed any signs of warmtlVfriendliness (e.g. smiling, nodding). He seemed standoffish and appeared as though he obviously did not want to be talking to the subject. 4 = the interviewer acted in a reserved, but not unfriendly manner. He displayed some signs of warmth/friendliness (e.g. smiling, nodding), but in a relatively reserved manner. He was polite, but seemed somewhat indifferent about whether he was talking to the subject or not. 7 = the interviewer appeared very friendly. He frequently displayed signs of warmth/friendliness (e.g. smiling, nodding) that appeared natural and obvious. He seemed as though he really enjoyed talking to the subject. Confident: 1 = the interviewer did not appear confident at all. He appeared unsure of what he was saying and his abilities to conduct the interview. He rarely displayed any signs of confidence (e.g. appropriate eye contact, speaking with steady tone). 4 = the interviewer appeared hesitant in what he was saying at times, but seemed as though he was fairly certain of his abilities to carry out the interview. 7 = the interviewer appeared very confident. He seemed to be sure of what he was saying and appeared certain of his abilities to conduct the interview. He frequently displayed signs of confidence (e.g. appropriate eye contact, speaking with steady tone). Assertive: 1 = the interviewer did not appear assertive at all. He appeared to allow the subject to dominate and take charge of the interview. 4 = the interviewer appeared to direct the interview somewhat, but did not seem very dominant or forceful. 7 = the interviewer appeared very assertive. He exhibited a dominant and forceful manner, without being hurtful toward the subject. He seemed to take charge of the interview. Professional: 1 = the interviewer did not appear professional at all. He rarely displayed any courtesy toward the subject, and seemed like he did not care about conducting the interview properly. 4 = the interviewer appeared somewhat professional in his behaviour. He exhibited some degree of courtesy toward the subject, and seemed to place some effort in carrying out the interview properly. 7 = the interviewer appeared very professional. He exhibited a courteous, conscientious, and generally businesslike manner with the subject. 64 Formal: 1 = the interviewer did not appear to be serious at all. He seemed very relaxed and casual, and frequently displayed signs of informality (e.g. making jokes, laughing). 4 = the interviewer displayed some signs of informality (e.g. making jokes, laughing), but appeared to be serious at times. 7 = the interviewer appeared to be very serious. He rarely displayed any signs of informality (e.g. making jokes, laughing). 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0091608/manifest

Comment

Related Items