Anti-Asian rhetoric and incidents have increased in recent years, spurred by the COVID-19 pandemic.
These types of events reinforce trauma and fear within the Asian American and Pacific Islander (AAPI) community and have profound effects on mental and physical health, says Gilbert Gee, Ph.D., professor in the Department. of Community Health Sciences at the UCLA Fielding School of Public Health.
“People’s reported cases of discrimination and unfair treatment have been associated with major depressive disorders, clinical anxiety disorders, and mood disorders,” says Dr. Gee. “This has very serious consequences on people’s mental health.”
And physically, he says, “even these mundane daily experiences of microaggressions can contribute to stress and allosteric load – wear and tear on the body.”
In some cases, Dr. Gee says, the racism and discrimination faced by older Chinese Americans has been shown to increase the risk of suicidal ideation.
Different ethnicities, different needs
The AAPI community is made up of more than 22.6 million individuals from more than 40 distinct ethnicities, as well as distinct differences in language, religion, education, socioeconomic status, and role models immigration.
There is variability in mental health conditions and needs within the AAPI community, studies show:
- 78% of Filipino American women rate their mental health as “excellent or very good,” compared to 45% of Chinese American women and 50% of Vietnamese women.
Rates of various mental health diagnoses also differ across generations, regardless of ethnicity. For example, second-generation Asian Americans have higher rates of psychopathology (symptoms that may indicate mental disorders) than Asian Americans who immigrated to the United States, according to a 2014 study in the Asian-American Journal of Psychology.
Combining AAPI data into one group can be misleading, suggests one 2015 review from the Department of Pacific Island Veterans Affairs and Connecticut Health Care Systems on the impact of cultural norms, sociohistorical factors, racism, and bias on trauma, PTSD, and seeking mental health care.
Among Vietnam veterans, Japanese Americans had lower rates of combat PTSD than Native Hawaiians. New research suggests that other differences may persist among AAPI veterans who served in the conflicts in Iraq and Afghanistan.
Although more research On the use of mental health services among these groups, disaggregating data can provide a more complete picture of the disparities that remain.
“Aggregation is a big problem because Asian Americans represent many diverse groups,” says Dr. Gee. “There are people from Pakistan who are supposed to be equivalent to people from Korea or Thailand or the Philippines, and all of these subgroups are very different.”
Yet AAPIs as a group face several systemic challenges in the United States that can impact accessibility to mental health services, such as harmful stereotypes and biases, language barriers, and lack of insurance .
The best known stereotype is that of the model minority, born in 1966 from a history in The New York Times and has been perpetuated by Western society to this day. The stereotype presents Asian Americans as the quiet success story of all other racial minority groups; However, research shows that the model minority myth can lead to resentment from non-AAPI peers. This leads to isolation and harassment of AAPI individuals, who then suffer from depression and anxiety. The myth is cited as one of the biggest sources of stress for Asian American youth.
Even when seeking care, AAPI individuals have historically faced insurance issues, particularly among immigrant communities.
According to Mental Health America, a community program, approximately 7% of Asian Americans and 9% of Pacific Islanders are uninsured. Under the Affordable Care Act between 2013 and 2016, the uninsured rate among non-elderly Asian Americans, this proportion fell from 15% to 8%.
A national investigation from the Centers for Disease Control and Prevention (CDC) found that one in three Asian Americans diagnosed with depression were unable to see a doctor due to cost.
The survey’s recommendations suggest that expanded coverage and free access to mental health and substance use disorder services would benefit and reduce health care disparities for the AAPI community.
Additionally, hiring more Asian American and Pacific Islander psychologists could reduce barriers to stigma and help overcome some of the cultural barriers to mental health care that can arise in hospitals and clinics, says Brandon Ito, MDchild and adolescent psychiatrist and assistant clinical professor of psychiatry and biobehavioral sciences at UCLA.
“In many Asian cultures, there is less of a divide between the individual and the family,” he says. “When we do medical training, the emphasis is on the patient’s privacy, autonomy and seeing them without family members.”
This adds complexity to interventions, Dr. Ito says, because “there are so many challenges in terms of how we, as a Westernized country, conceptualize mental health.”
Even the typical care practices of American medicine can be a challenge, he says.
“For some families, it seems inappropriate for family members to share information that is confidential or has not been discussed within the family. »
But for other families, he says, having children and caregivers present during difficult conversations could make a difference.
Culture and mental health
Overall, Asian Americans are 50% less likely than other racial groups to use mental health services, Dr. Ito says. In some Asian cultures, mental health issues are seen as an individual problem or weakness, and talking openly about sadness, disappointment, or depression is rarely encouraged.
“We know that within Asian American populations, the stigma around mental health is very significant. Asian Americans are more likely to be afraid of a diagnosis or accessing mental health,” says Dr. Ito. “They fear it will affect their job or their ability to keep their job, as well as their peers’ perception of it. »
He says that often when doctors consider family history for medical causes such as cardiovascular disease or diabetes, they are aware of previous family problems. However, when it comes to mental health issues, diagnoses, and treatments, AAPI patients provide vague answers or do not know family history.
A common response he gets is that mental health is not addressed in their family culture. Even within his own family, he has seen how mental health stigma is a barrier to care.
“I see now that there are examples of mental illness or behavioral health issues within the family, but I don’t know anything about what’s happening to them,” he says.
Dr. Ito believes privacy and shame could be factors in why family members have not sought his expertise.
“In other fields of medicine, my friends frequently receive phone calls from family members asking about health problems and recommendations, saying, ‘I have this problem’ or ‘I’m having pain in my neck. chest “. Whereas it’s much, much less common in terms of mental health,” he says.
Dr. Gee agrees.
“There’s even some denial that their problems exist and it’s like if only you can be a stronger person everything will be fine. We know that’s really not the case and that it’s important to get help,” he says.
Dr. Jeffrey Hsucardiologist at UCLA and co-author with Dr. Gee of an article describing the plight of the AAPI community during the COVID-19 pandemic, says that culturally competent care, or equipping providers with education and training to understand a person’s values, experiences and experiences. personal beliefs, is essential to improving health outcomes.
“I think it’s important to make sure that (AAPI) patients are heard and that they feel comfortable coming back and seeking care knowing that they will be adequately heard,” says -he.
According to the National Alliance on Mental Illness, the integration of Ayurveda (traditional Indian medicine), Japanese herbal medicines, acupuncture, Chinese medicine, energy health exercises, spiritual healing and Guided meditation can help some people.
This may work for some, Dr. Ito says, but if clinics are not built in Asian communities and run with cultural competency, access will remain a challenge.
“Many (UCLA) Extension clinics are not located within Asian communities, making mental health access and treatment poor across the board,” he says.
Dr. Gee says it’s important for mental health providers to recognize the health effects of racism, harassment and discrimination.
“We also need to think about the core ideas we put in our textbooks, how we think about race and racial groups in general in the United States,” he says. “We really need to think about these broader systemic issues, alongside smaller types of interpersonal discrimination, in order to make a difference. »