AsianAmerican Mental Health

1
Asian-AmericanMental Health

• Jason Cheng
• APAMSA
• Mental Health Coordinator

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2000 Census

• 11.9/281.4 million Asian (4.2)
• 10.2 million only Asian (3.6)
• 1.7 million Asianother race(s) (0.6)
• 43 ethnicities
• 100 languages
• Asian and Native American races separated

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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

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Possible Reasons

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

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Asian AmericanAccess to Mental Health Care

• Almost half experience language barriers
• 21 lack insurance (vs. 16 all Americans)
• AA/PI providers proportionally
• Lower utilization regardless of gender, age, and
  location
  
• only 17 who need help actually seek it

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Asian American Mental Health

• Significant prevalence rates (CAPES study)
• 6.9 major depression
• 5.2 dysthmia
• More psychiatric symptoms of depression
• More somatic manifestations

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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 1993181612-617
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.
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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

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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.
2002176222-223.

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Cultural Factors II

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

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Cultural Factors III

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

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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.
199950774-780.

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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

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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. 2002176220-221.

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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

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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