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Asian-American Mental Health

Asian-American Mental Health. Jason Cheng APAMSA Mental Health Coordinator. 2000 Census. 11.9/281.4 million Asian (4.2%) 10.2 million only Asian (3.6%) 1.7 million Asian+other race(s) (0.6%) 43 ethnicities 100 languages Asian and Native American races separated.

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Asian-American Mental Health

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  1. Asian-AmericanMental Health Jason Cheng APAMSA Mental Health Coordinator

  2. 2000 Census • 11.9/281.4 million Asian (4.2%) • 10.2 million only Asian (3.6%) • 1.7 million Asian+other race(s) (0.6%) • 43 ethnicities • 100 languages • Asian and Native American races separated

  3. Surgeon General Says: • Mental health fundamental to health and productivity • Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2001.

  4. Minority Mental Health Disparities • Less access to services • Less likely to receive needed services • Decreased quality of care • Underrepresented in research

  5. Possible Reasons • Doctor-patient communication even more vital than in other specialties • Cost, fragmentation, low availability • Mistrust and fear of discrimination

  6. Asian AmericanAccess to Mental Health Care • Almost half experience language barriers • 21% lack insurance (vs. 16% all Americans) • AA/PI providers proportionally < ½ whites • Lower utilization regardless of gender, age, and location • only 17% who need help actually seek it

  7. Asian American Mental Health • Significant prevalence rates (CAPES study) • 6.9% major depression • 5.2% dysthmia • More psychiatric symptoms of depression • More somatic manifestations

  8. Special populations • AA/PI girls have higher incidence of depressive disorders than white girls • Among women over 65 yo, Asian Americans have highest risk of suicide • Refugees have a high incidence of PTSD Kim LS, Chun CA. Ethnic differences in psychiatric diagnoses among Asian American adolescents. J Nerv Ment Dis 1993;181:612-617 National Center for Health Statistics. Health, United States, 2006. Hyattsville, MD: US Public Health Service; 2006. Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2001.

  9. Why Asian-American women? • Women in general have higher incidence of mood and anxiety disorders • Traditional expectations differ from Western ideals of independence and achievement • Expectation to withdraw from conflicts

  10. Cultural Factors I • Stigma of Mental Illness • Familial shame • Lower chances of employment, marriage • Provider Stigma • Asians supposedly more mentally healthy • Providers less comfortable overcoming cultural barriers to talk about mental health Chung, H. The challenges of providing behavioral treatment to Asian Americans. WJM. 2002;176:222-223.

  11. Cultural Factors II • Diagnostic complexity • Non-classic somatic presentations • Language and culture • Self vs. society • Body vs. mind • Culture-bound syndromes such as neurasthenia

  12. Cultural Factors III • Expectations of patients • Doctor is authority, not partner • Family is involved in healthcare • Traditional treatments • Unknown effects • Potential drug-drug interactions

  13. Lower required psychotropic doses • Slower activity of P-450 isoenzymes • CYP2D6J mutation • Traditional neuroleptics • Tricyclic antidepressants • CYP2C19 mutation: diazepam • Increased responsiveness of lithium receptors Lin, KM and Cheung FK. Mental Health Issues for Asian Americans. Psychiatric Services. 1999;50:774-780.

  14. Research • Diversity makes research difficult • Few large studies available • Chinese American Psychiatric Epidemiological Study • National Latino & Asian American Study • Primary Care Research in Substance Abuse and Mental Health for the Elderly

  15. Specialized Program in NYC • Primary Care & Mental Health Bridge Program • Patients more likely to accept mental health care in primary care setting • Bilingual / bicultural staff with special training • Community education Seitz, PM. Building a bridge between two cultures of care. WJM. 2002;176:220-221.

  16. Results • Increased detection of disorders and utilization of resources • Decreased delay between onset of symptoms and seeking treatment • Federal “Models that Work” winner • Similar programs in Boston, NY, LA, SF, Portland, Seattle

  17. APAMSA Contacts • National Asian American Pacific Islander Mental Health Association • APA Committee of Asian American Psychiatrists • Yujuan Choy, M.D., Columbia • Relevant Research • Francis Lu, M.D., UCSF

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