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Working with Asian American Patients

Prepared by Geetha Jayaram, M.D.

The Asian American Population

The Asian American population in the US is comprised of people having origins in East Asia, Southeast Asia, or the Indian subcontinent. According to the 2015 Census Bureau population estimate, there are 17.3 million Asian Americans living in the United States. They account for 5.4 percent of the nation's population and have mainly a bicoastal distribution. It is one of the fastest growing minority groups.

Significant History – Events which influenced the community and contextualize assessment and treatment

As immigrants, Asian Americans as any other group, experience emotional and behavioral problems. They tend to underuse services unless they are culturally and linguistically compatible1.

Be aware that this group encompasses a tremendous heterogeneity in language, culture, religious traditions, dietary practices and immigration history1.

Asians differ from their Western counterparts in their view of "self", the mind body- interface, and their approach to mental health care, and in their response to psychotropic medications1.

The pressure to excel academically places Asian- American teens under great stress and may put them at risk of suicide1.

Language fluency varies among Asian- American groups; so does educational attainment. Taiwanese had the highest percentage of bachelor's degree attainment at 77 percent. In regards to employment, about 52.1 percent of Asian Americans work in management and white collar professions. Among Asians, women live an average of 85 years4.

Economic status varies widely among Asian populations in the US. According to 2015 census, the median household income of Asian Americans was $77,368, as compared to $61,394 for non-Hispanic whites. Yet more Asians than Caucasians may live at a poverty level. Insurance coverage varies.

A Few Best Practices for Working with Asian Patients

There are many cultural factors that can impact the access and effectiveness of mental health services provided to Asian Americans. These factors—which psychiatrists should be aware of—may include:

  • Language barriers.
  • Stigma or discrimination against mental illness or people with mental illness.
  • Cultural reliance on traditional Eastern-based practices to treat mental illness such as herbal medicine and spiritual healing.
  • Cultural practices of involved decision-making by family and community regarding health care decisions.
  • Lack of accessibility to mental health care facilities that are affirming to Asian American populations.
  • Fear of being deported due to an illegal immigration status.
  • Provider’s misunderstanding of culturally sanctioned expressions of distress among Asian American patients.
  • Provider’s knowledge of appropriately prescribing psychopharmacotherapies to Asian American patients. For example, slower metabolism of drugs by some Asian Americans indicates need for lower doses.

Best practices to consider:

  • Assessment of language barriers. Ascertain whether the patient speaks English or not, their native dialect, and the degree of acculturation.
  • Allowing sufficient time for interviews. Be patient. Translation often extra time. It may also take time for some Asian American patients to feel comfortable in sharing very intimate, personal information with outsiders.
  • Promotion of educational resources about mental health. Increase the patient's and/or community's awareness of mental health and, more specifically, Asian American mental health via promotion of available resources—in English and Asian languages—on such topic. One of the best methods to reducing stigma is through informing.
  • Inquiries about traditional beliefs. Ask about traditional beliefs to gather any information on how these beliefs can influence an individual's expression of mental distress and their preferred methods of treating mental health disorders. For example, some non-English speaking or unacculturated Asian Americans hold traditional values and concept of health and disease (e.g., Yin/Yang) that may influence them to express mental distress through somatic symptoms. Some may also seek traditional healers such as acupuncturists and herbalists to treat health and mental health disorders.
  • Incorporation of traditional interventions. When appropriate—culturally and individually—consider traditional practices, as a supplemental treatment. This includes, if indicated, diets, exercises, and other traditional methods used to reduce stress and increase relaxation, such as Yoga, Tai-Chi, breathing exercises, etc.
  • Utilization of Cognitive Behavioral Therapy (CBT). Consider prescribing cognitive behavioral therapy, where appropriate. Research suggest that CBT, compared with other traditional western psychotherapies, is an effective psychological treatment for Asian American patients. This is based on the compatibility of CBT with certain Asian cultural values (e.g., emphasis on education and self-improvement, etc)2.
  • Becoming familiar with ethnopsychopharmacological research. Research shows that there are differences in which racial/ethnic groups respond to psychiatric medication3. According to research, for some Asian Americans subpopulation—for example—it is suggested to prescribe at lower dosages of psychotropics because of slower metabolism of these medicines, compared with white populations3.

References

  1. American Psychiatric Association. 2019. "Treating Asian Americans." Stress & Trauma Toolkit for Treating Historically Marginalized Populations in a Changing Political and Social Environment.
  2. Tang J, Li C, Rogers R et al. "Effectiveness of Cognitive Behavioral Therapy with Asian American Patients in an Acute Psychiatric Partial Hospital Program." 2015. North American Journal of Medicine & Science
  3. Silva, H. "Ethnopsychopharmacology and pharmacogenomics." 2013. Adv. Psychosom. Med. 33: 88–96.
  4. U.S. Office of Minority Health. (2019, August 22). Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=63

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