Factors that Put Asian Americans at Risk for Mental Health Problems
Racism, racial bias, and discrimination: Racism, racial bias, and discrimination contribute to Asian Americans’ experience of marginalization and alienation. Although many Asian Americans have achieved professional success, they may still encounter barriers preventing them from reaching leadership positions in their respective professions.
Racial stereotypes and profiling: Asian Americans are frequently stereotyped as being smart, hard-working, successful, and eager to enter and blend into American society. However, while many Asian Americans excel educationally and financially, others may struggle. The ‘model minority’ stereotype only exacerbates Asian Americans’ tendencies to not seek help, even in the face of mental illness.
Language barriers: English is not the primary language for some Asian American immigrants. For these, language barriers may pose challenges to acculturation and assimilation into American life. A common example of this occurs when an Asian American is ridiculed, misunderstood, or even bullied as a result of their accent.
Immigration status: The estimated 1.5 million undocumented Asian Americans (represent 14% of all undocumented immigrants in the U.S. They remain in perpetual fear of arrest, deportation, and separation from their families as well as the loss of businesses they have worked hard to build over the years.
Trauma: Immigration leaves people susceptible to trauma in various stages of the migration process. For example, older immigrants may have experienced trauma associated with historical events in their countries of origin such as China’s Cultural Revolution or the Vietnam War.
Low levels of mental health literacy: Some Asian Americans are unfamiliar with Western medical models of mental illness and the availability of effective treatment for several common psychiatric conditions. This knowledge gap leads to under-recognition and delayed treatment of their mental illness.
Stigma towards mental illnesses: Stigma surrounding mental illness may prevent some Asian Americans from admitting to symptoms of mental illness. They are also known to have the lowest rates of mental health service utilization among any racial or ethnic group. Medical literature shows that education about mental health reduces mental health stigma in Asian Americans. Mental illness can be stigmatized by some Asian cultures as a weakness in an individual and/or a collective failing or weakness of the individual’s entire social group.
Varying presentation of symptoms in different groups: Asian Americans may present in primary care settings with somatic complaints for underlying psychiatric conditions. For example, research has shown that a significant number of Asian Americans--including those of Chinese and Indian descent--with depression may present with insomnia and gastrointestinal issues. Insomnia itself may be an early sign of a psychiatric illness, such as post-traumatic stress disorder (PTSD), in Asian Americans who experienced political strife in their countries of origin such as Vietnam and Cambodia.
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Suggested Assessment and Treatment Recommendations
- Please see Suggested Assessment and Treatment Recommendations for Marginalized Populations
- Work towards integrated care models: Collaboration with primary care providers is recommended for two major reasons: (1) Asian American patients often express emotional distress through somatic symptoms and (2) Stigmatization of mental illness in Asian American communities makes it unlikely that patients will seek mental health services. Integrated Care Treatment can include routine screening for stress, anxiety, depression, and trauma in primary care settings to help identify patients, connect them to resources promptly, and reduce healthcare disparities.
- Provide relevant resources in English and Asian languages: Information or links to online resources about mental illness in both English and Asian languages can be helpful. It is advised not to use family members as translators. If possible, provide information regarding community-based mental health services, health insurance, and immigration policies.
- Acknowledge the role of spirituality/religion: When appropriate, address the spiritual dimension of mental health and treatment for Asian Americans. Collaborate with spiritual care professionals in identifying and managing mental health issues.
- Pay attention to protective factors: A strong ethnic identity can help protect against mental illness. Encouraging these cultural identities may help build resilience in patients.
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American Psychiatric Association. Mental Health: A Guide for Faith Leaders. 2015. /psychiatrists/cultural-competency/faith-community-partnership
Best Practice Highlights for Treating Diverse Patient Populations: Working with Asian Patients /psychiatrists/cultural-competency/treating-diverse-patient-populations/working-with-asian-american-patients/working-with-asian-american-patients
Building Community Raising API Voices for Health Equity (BRAVE) Study website. http://www.thebravestudy.org/
Gaw A. Working with Asian American Patients. American Psychiatric Association website on Cultural Competency. /psychiatrists/cultural-competency/treating-diverse-patient-populations/working-with-asian-american-patients
Integrated Care: Learn About the Collaborative Care Model. American Psychiatric Association website. /psychiatrists/practice/professional-interests/integrated-care/learn
Mental Health and Faith Community Partnership. American Psychiatric Association website on Cultural Competency. /psychiatrists/cultural-competency/faith-community-partnership