How Often Do Asian Seek Mental Health Services? "Low Income"

• Journal List
• Due west J Med
• v.176(four); 2002 Sep
• PMC1071736

West J Med. 2002 Sep; 176(4): 227–231.

Cultural factors influencing the mental health of Asian Americans

Elizabeth J Kramer

¹Charles B Wang Community Health Centre 125 Walker St New York, NY 10013

Kenny Kwong

^twoCharles B Wang Community Health Center 125 Walker St New York, NY 10013

Evelyn Lee

³RAMS 3626 Balboa St San Francisco, CA 94121

Henry Chung

^fourPfizer, Inc 235 Due east 42nd St New York, NY 10017

Summary points

• Cultural factors, such equally linguistic communication, age, gender, and others, tin influencethe mental wellness of Asians, particularly immigrants

• Traditional (adhering to native values) Asians place great value on thefamily as a unit. Each individual has a clearly defined role and position inthe family hierarchy and is expected to function within that role, submittingto the larger needs of the family

• Social stigma, shame, and saving face often prevent Asians from seekingbehavioral health care

• Asian patients are likely to limited psychological distress as physicalcomplaints

Asian Americans are the fastest growing racial group in the United states.They are besides one of the most diverse, including at least 43 dissimilar ethnicgroups who speak more than 100 languages and dialects(box 1). The Asian Americanpopulation in the United states has grown from fewer than 1 one thousand thousand (0.5% ofthe total US population) in 1960 to 7.2 1000000 (two.nine%) in 1990, to 10,242,998(3.7%) in 2000. This number is expected to double past 2025. Approximately 7.2million (70.vii%) Asian Americans are foreign born, and Asian immigrants accountfor two.6% of the total USpopulation.³

Box 1

Distribution of the Asian American/Pacific Islander population bysubgroup reporting only one race in2000^*

According to the 2000 demography, the distribution of the Asian American andPacific Islander population in the U.s. is equally follows (Census Bureau2001a):

Chinese (25.4%) Filipino (19.3%) Asian Indian (17.6%) Vietnamese (xi.7%) Japanese (eight.three%) Korean (eight.3%) Other Asian (thirteen.4%) Pacific Islander (four.2%)

Primal CULTURAL FACTORS THAT INFLUENCE MENTAL HEALTH

Civilization influences the Asian health belief system and has an result on thediagnosis and treatment of mental disorders. Several key cultural factors thatare relevant to this process are described below. Notwithstanding, there is tremendouscultural variability among groups and heterogeneity within groups. Thesefactors will have differing furnishings, depending on the individual'south degree ofacculturation, socioeconomic status, and immigration status. Our accent hereis on new immigrants, who comprise one% of the USpopulation,ⁱ andthose who are more than traditionally oriented. We have called this focus becauseit is these patients who experience the greatest barriers to receiving mentalhealth intendance. Cardinal cultural factors are:

• Linguistic communication Cognition of English is one of the nigh important factorsinfluencing access to intendance. Asian languages and dialects usually are notwidely spoken outside the individual'southward indigenous grouping and, depending on degreeof acculturation, even inside information technology. Co-ordinate to the President's AdvisoryCommission on Asian Americans and Pacific Islanders, 42% of VietnameseAmerican, 41% of Korean American, and 40% of Chinese American households are"linguistically isolated." This designation means that no one inthe household age 14 years or older speaks English "verywell."^iv

• Level of acculturation Typically, it takes three generations forimmigrants to fully adopt the lifestyle of the dominant culture. This intervalis almost the amount of fourth dimension it takes to accept Western medical care morereadily than traditionalcare.⁵

• Age In general, the younger people are when they migrate, the morereadily they adapt to living in a state in the West.

• Gender Historically, men take acculturated more than rapidly than women.This standard may be changing, however, equally women enter the work strength.

• Occupational problems Especially among undocumented immigrants,professionals and highly skilled technicians oftentimes cannot admission pathways totheir previous careers because of linguistic communication or license verification issues.Some are forced to accept low level jobs equally is the case with white-collarworkers who become piece-appurtenances workers in garment factories and dishwashers orline cooks in restaurants where they earn minimum wage or less. Sometimes,women earn more than men, thereby disrupting family expectations andtraditionalvalues.^{half dozen}

• Family structure and intergenerational issues (see below).

• Religious beliefs and spirituality The predominant religions ofAsians who do not practice some form of Christianity or Muslim religion are:Buddhism, which promotes spiritual agreement of disease causation;Confucianism, an ethical belief organisation that stresses respect for authority,filial piety, justice, benevolence, fidelity, scholarship, andself-development; Taoism, which is the basis for yin andyang theory; and animism, which is the conventionalities that human beings,animals, and inanimate objects possess souls andspirits.​

  Table 2

  Traditional beliefs and behaviors relating to mental wellness

  Culture	Beliefs	Coping behaviors and treatments
  Chinese	Mental disease acquired past lack of harmony of emotions or by evil spirits	Ofttimes endeavor traditional herbs and acupuncture kickoff; healers may be usedconcurrently to get rid of evil spirits
  Japanese	Mental affliction caused by evil spirits; often thought non to be real illness	Delay or avoid seeking professional assistance; many volition use traditional sources ofcare
  Korean	Mental disease caused by disruption of harmony within individual or byancestral spirit coming back to haunt patient because of by bad beliefs;result of bad luck or misfortune; payback for something done wrong in thepast; is considered shameful	May deny issues, resulting in helplessness and depression; not likely toreveal the problem unless asked; may show signs through nonverbalcommunication and posture; may utilise shamanism
  Vietnamese	Depression is sadness	Not readily acknowledged because of stigma; usually effort home remedies,spiritual consultations, or Chinese herbs before seeking Western medical intendance;some apply of exorcists; seek assistance just when problems become astute or obvious;family members try to cheer up or distract the patient

• Traditional beliefs about mental health In the traditional beliefsystem, mental illnesses are acquired by a lack of harmony of emotions or,sometimes, by evil spirits. Mental wellness occurs when psychological andphysiologic functions are integrated. Some elderly Asian Americans share theBuddhist belief that issues in this life are well-nigh probable related totransgressions committed in a past life. In add-on, our previous life andour future life are as much a role of the life cycle every bit our present life.

Health beliefs and behaviors of Chinese, Japanese, Korean, and Vietnamesecultures are briefly summarized in the Table.

Civilisation shapes the expression and recognition of psychiatric issues. Theinfluence of the teachings and philosophies of a Confucian, collectivisttradition discourages open up displays of emotions in order to maintain socialand familial harmony or to avoid exposure of personal weakness. Savingface—the ability to preserve the public appearance of the patient andfamily for the sake of customs propriety—is extremely important tomost Asian groups. Patients may not be willing to talk over their moods orpsychological states because of fears of social stigma and shame. In manyAsian cultures, mental illness is stigmatizing; information technology reflects poorly on familylineage and can influence others' beliefs near the suitability of anindividual for spousal relationship. It is more acceptable for psychological distress tobe expressed through the body than through themind.^{i , 7 , 8 , 9 , 10 , 11}

The Asian American family

Traditional (adhering to native values) Asians identify great value on thefamily every bit a unit of measurement. Each individual has a clearly defined part and position inthe family hierarchy, which is adamant by historic period, gender, and social form.Each person is expected to part within that role, submitting to the largerneeds of the family unit. Rituals and customs such as antecedent worship, familycelebrations, funeral rites, and the maintenance of genealogy recordsreinforce this concept. To accomplish peaceful coexistence with the family unit andothers, harmonious interpersonal relationships and interdependence areemphasized. Mutual obligations and shame are the mechanisms that assistance toreinforce societal expectations and proper behavior.

Extended families are common among Asian Americans, and two or threegenerations oft live in the same household. In traditional Asian Americanfamilies, major decision-making is the purview of the male parent, followed by theoldest son who receives preferential treatment on the assumption that he willaccept greater responsibility in the care of the family. The mother's task isto nurture and intendance for her hubby and children. Female person children accept a lowerstatus than male children within the family. In some cultures, such as theChinese, the wife is expected to go part of her husband'due south family.

Gender

Traditional roles for men and women prevail among the Vietnamese. Womenusually maintain that their husbands accept a legitimate correct to brand finaldecisions, and they normally will withdraw from spousal conflict to maintainharmony within the family unit.

Women are at especially high risk for the evolution of psychiatricdisorders during their lifetimes. Almost major mood and anxiety disorders, withthe exception of obsessive compulsive disorder, occur more often in womenthan in men.¹²Various biologic, social, and cultural hypotheses have been advanced toexplain this miracle.

Unfortunately, the value placed on males manifests in sex-specificinfanticide and a disproportionate number of females in orphanages andavailable for adoption in China.

In the United States, traditional Asian expectations of women can severelyconflict with ideals that emphasize independent thinking, accomplishment, andself-sufficiency, even at the expense of others' feelings and needs. Theseconflicting values can play out in several ways:

• Stress and conflict in teenagers pb to isolation and withdrawal or actingout behaviors that in turn can atomic number 82 to low

• Spousal disharmonize tin can occur as women work in and interact with a civilization inwhich their condition is compared to that of their husband

• Resistance to or refusal of psychiatric treatment resulting from chroniclow self-esteem can lead to a sense of fatalism

Amongst persons aged 15 to 24 and older than 65, Asian females are at thegreatest run a risk of suicide compared with women of all other racialgroups.^thirteen

Health practitioners must be sensitive and attuned to these bug and so theycan enhance the therapeutic alliance and do not miss opportunities fordiagnosis and treatment.

The life bicycle

Asian society has specific expectations of each historic period group that differgreatly from those in American gild. Because of this difference, all agegroups are exposed to conflicts or clashes that may increase the risk fordevelopment of mental illness.

Children and adolescents

Children are highly valued in Asian American families. They are taught tobe polite, quiet, shy, humble, and deferential. Conformity to expectations isemphasized, and emotional outbursts are discouraged. Failure to meet thefamily's expectations brings shame and loss of face to both the children andtheir parents. Parents are seldom forthcoming with affection and praisebecause of fear that such demonstrations will encourage laziness. Education isimportant and children who do non do well in school bring shame to theirfamilies. Positive reinforcement and discussion of personal achievements areuncommon.

Adolescence has limited meaning in most Asian cultures becauseindividuation carries little value and seeking a definition of self outsidethe family is not encouraged.

Children unremarkably acculturate more than readily than their parents and otherelders. Members of older generations benefit from this rapid acculturation bythe children serving as interpreters and negotiators for them in the newculture. Although parents expect their children to acquire the language andskills that will enable them to be successful in their new country, they oftenare reluctant to have them fully embrace most aspects of American culture forfear that they will abandon their native civilisation. For example, parents mayencourage their children to learn English in order to succeed in Americansociety but may refuse to allow them to speak English at home. Such confusingmessages to the child lead to transgenerational conflict.

Young adults

For many Asians, young adulthood means achieving for the family. Withal,with increased exposure to or immersion in Western cultures and values, andconflict between peer force per unit area and family expectations, many immature AsianAmerican adults brainstorm to question their family values. Interpersonalrelationships go more of a challenge. Interracial relationships may causeserious conflicts considering of parental fears that biracial children willdiffuse the family lineage and civilization. Asian men may feel pressured to dateonly women from their specific ethnic group.

Many Asian adults may misunderstand the meaning of the often brief andtransient personal relationships that are common in urban settings in theWest. Young adults also face such dilemmas as deciding the group with whichthey want to be identified and having i identity at home and another whenout in public, a phenomenon known as dual identity.

Often the obligation to parents takes precedence over the private'schoice of career. Choice of a career that is unlike from that chosen by hisor her parents can result in loss of emotional and financial support.

Other stresses facing Asian young adults are shown inbox 2.

Box 2

Stresses facing Asian young adults

• Peer pressure to fume, drinkable, and have sexual activity

• Pressure level to conform to societal norms of individuation, which oftenconflict with traditional family expectations

• Mutual traditional Asian modes of communication (eg, being indirect,avoiding direct disharmonize, respect for authorization through verbal and nonverbalbehavior, and deference toward authority figures) often are non understoodwithin the majority culture

• New immigrants confront severe and sudden challenges to cope with the cultureand demands of a new country

• Anti-Asian sentiment

The elderly

Whereas elderly Americans emphasize independence as a means to maintaintheir self-esteem and to avoid becoming burdens to their children, elderlyAsians look forward to having their grown children intendance for them. TraditionalAsian elders tend to take full control over family and fiscal decisionswhether or not they live with their children. Virtually elderly Chinese immigrantsprefer to accept their children move in with them rather than moving in withtheir children. They are not inclined to value independence and, when theylive separately, it is to avoid disharmonize over family unit roles.

Elders are highly respected and honored past all Asian cultures. In extendedChinese families, grandparents ofttimes are responsible for the care ofgrandchildren. Families are expected to care for their children and elders.Japanese Americans ofttimes maintain separate households from their childrenand grandchildren. Korean and Vietnamese elders are welcomed to live withtheir children for the balance of their lives. Those who reside with children andgrandchildren are viewed as having been rewarded for everything they haveprovided to younger generations.

ELICITING PATIENTS' VIEWS ABOUT THEIR ILLNESS

Culturally competent assessment and treatment of mental health problems inAsian Americans requires that health professionals ask patients and theirfamily members to share their cultural views on the crusade of the problem, pastcoping patterns, health care-seeking behaviors, and treatmentexpectations.¹⁴ Inthe context of health care, the medico-patient relationship is not seen asa partnership; rather, the dr. is considered the authority. Asianpatients volition answer questions merely are not likely to raise problems, and theywill tell the dr. what they remember he or she wants to hear. The healthcare provider must reassure patients that they may talk almost their problemsand no judgments about them or their family will exist made.

Kleinman's seminal work in the development of a health explanatory beliefmodel has led to a series of questions that can exist used to arm-twist informationfrom patients and their families (box3).¹⁵Specifically, these questions draw out patients' understanding of the causesof disease. The explanatory model is critical to successful patient engagementbecause it provides a context for diagnosis and treatment negotiation.

Box 3

Questions from the Patient's Cultural Health BeliefsQuestionnaire

1. What brought yous to the doctor today?

2. What do you think acquired your problem?

3. Why exercise you lot think information technology started when it did?

4. What do y'all think your sickness does to your body?

   1. How does information technology work?

5. How bad is your sickness?

   1. Has this difficulty interfered with your normal daily routines?

   2. If yeah, how?

6. How long do you recall information technology will final?

7. Do you know others who take had this problem?

   1. What did they do to care for it?

8. Did y'all discuss the trouble with any of your relatives or friends?

   1. What did they say?

9. What kinds of medicines, home remedies, or other treatments accept you triedfor this sickness? (Include quantity, dosage, frequency, how treatmentsprepared)

   1. Did they help?

   2. Are you lot nevertheless using them?

10. What type of treatment do you lot think you demand from the doctor today?

    1. What practise yous hope the treatment will practice for y'all?

11. Do y'all call up there is whatsoever way to preclude this problem in the futurity?

Another important step for the practitioner is to identify sources ofsupport and strength to the individual, family unit, and community network in pastadaptation, coping, and problemsolving.^sixteen In Asianculture, strength lies in the Confucian teaching of the "middleway," the Buddhist teaching of compassion, the strong focus on theimportance of family harmony and interpersonal relationships, and the highvalue of teaching and difficult piece of work. Asian cultures emphasize family, friends,and ethnic community. During a crisis, Asian families can usually count onsupport from extended family members, friends/villagers, and customs networkand organizations. We discover it helpful to explore, recognize, and make use ofthese back up systems in the handling process.

Successful assessment of mental health issues in the Asian Americanpatient is based on:

• Practitioner awareness of private patient demography

• The patient's beliefs about health and mental health

• Eliciting an explanatory model from the patient

• Negotiation around acceptable diagnosis and treatment

• Use of the family support system to increment adherence to treatmentregimens and to reduce barriers

​

UNICEF

Many Chinese girls who are abandoned by their parents grow up inorphanages

UNICEF

Elders are honored and respected and often play a key role in raising theirgrandchildren

Notes

Competing interests: None declared

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How Often Do Asian Seek Mental Health Services? "Low Income",

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071736/

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