How stress, discrimination, acculturation and the gut microbiome affect depression, anxiety and sleep among Chinese and Korean immigrants in the USA: a cross-sectional pilot study protocol

Abstract

IntroductionAlthough a considerable proportion of Asians in the USA experience depression, anxiety and poor sleep, these health issues have been underestimated due to the model minority myth about Asians, the stigma associated with mental illness, lower rates of treatment seeking and a shortage of culturally tailored mental health services. Indeed, despite emerging evidence of links between psychosocial risk factors, the gut microbiome and depression, anxiety and sleep quality, very few studies have examined how these factors are related in Chinese and Korean immigrants in the USA. The purpose of this pilot study was to address this issue by (a) testing the usability and feasibility of the study’s multilingual survey measures and biospecimen collection procedure among Chinese and Korean immigrants in the USA and (b) examining how stress, discrimination, acculturation and the gut microbiome are associated with depression, anxiety and sleep quality in this population.Method and analysisThis is a cross-sectional pilot study among first and second generations of adult Chinese and Korean immigrants in the greater Atlanta area (Georgia, USA). We collected (a) gut microbiome samples and (b) data on psychosocial risk factors, depression, anxiety and sleep disturbance using validated, online surveys in English, Chinese and Korean. We aim to recruit 60 participants (30 Chinese, 30 Korean). We will profile participants’ gut microbiome using 16S rRNA V3-V4 sequencing data, which will be analysed by QIIME 2. Associations of the gut microbiome and psychosocial factors with depression, anxiety and sleep disturbance will be analysed using descriptive and inferential statistics, including linear regression.Ethics and disseminationThis study has been approved by the Institutional Review Board at Emory University (IRB ID: STUDY00000935). Results will be made available to Chinese and Korean community members, the funder and other researchers and the broader scientific community.

Twenty Important Research Questions in Microbial Exposure and Social Equity

“…The risk of chronic inflammatory and stress-related psychiatric conditions is increased in members of urban communities, immigrants, and in particular, those moving from a low- to a high-income country during infancy ( 6 , 7 ). In addition, the prevalence of chronic inflammatory disorders increases further in second generation immigrants, suggesting that critical exposures modulating disease risk occur during pregnancy and infancy ( 6 ). Although the mechanisms underlying the increased risk of chronic inflammatory conditions in immigrants are not clearly understood, the microbiota potentially plays an important role.…”

“…Vangay et al ( 8 ) investigated the microbiomes of immigrants and refugees migrating from Thailand to Minnesota in the United States. The researchers observed that participants had reduced gut microbiome diversity and reduced plant-degrading glycoside hydrolase enzymes, proportional to the time spent in the United States ( 6 ). For example, refugees from the Karen community (Indigenous to the Thailand-Burma border area and impacted by conflict with Burmese military attacks) were included and had decreased Prevotella and increased Bacteroidetes after just 6 to 9 months following arrival.…”

“…In communities that experience deprivation, an individual’s metagenome will most certainly be affected. It is in these communities that greater numbers of microbiome-influenced diseases are reported ( 6 , 128 , 142 – 144 ). Vulnerable populations and the trajectory of immune responses as a result of social inequities need to be examined more closely.…”

Methodology Considerations in Studying Mental Health, Sleep Quality, and Biopsychosocial Determinants Among Chinese and Korean Americans During the COVID-19 Pandemic

“…Thus, studying the changes in the gut microbiome during and after migration could provide a unique opportunity to ascertain how external stimuli (eg, immigration status and lifetime stressors), psychological factors, and biological factors contribute to mental health disorders and poor sleep quality among Asian Americans during the immigration process ( Figure 1 ). We conducted a parent study [ 20 ] to examine the relationships of psychosocial factors and the gut microbiome with anxiety, depression, and sleep disturbance among Asian Americans during the COVID-19 pandemic.…”

“…Therefore, the purpose of this study was to suggest methodological considerations in recruiting Asian Americans in the community during the COVID-19 pandemic and to collect more reliable data on their mental health and sleep quality, as well as their biopsychosocial risk and protective factors. These suggestions were formulated based on our experience in carrying out a parent study [ 20 ] to examine the associations of psychosocial determinants and the gut microbiome with mental health and sleep quality among Chinese and Korean immigrants. Here, a summary of our parent study is presented.…”