Blog post - Minority Mental Health: An Example of the Effect of Stigma in the Asian American Community

by Swathi Krishna M.D.

This past July, we celebrated Minority Mental Health Awareness month and, as a minority mental health provider, I had a few reflections on the current state of minority mental health in our community.  Also as a South Indian Woman, a First Generation American, and a Psychiatry Fellow, I feel like I may have a unique perspective on the shift of Minority Mental Health over the past few decades. 

When I was a child growing up in my local Indian community, mental health was not discussed.  In fact mental health issues were actively avoided and concealed within the community.  The stigma toward mental illness and treatments was so profound that now, looking back, I can see that people who were actively suffering either denied symptoms, hid away from the community, or got treatment in secret.  This further perpetuated the stigma. How can you promote awareness of a community issue when none of its members will acknowledge its existence or speak about it openly? 

There was even conjecture in the past amongst mental health professionals and members of the Asian American community that psychiatric illness was less prevalent in Asian Americans because they were the least likely ethnic group to utilize mental health services (1).  This theory was previously referred to as the “model minority” theory.  It was thought that close community bonds, familial attachments and individual mental resilience were protective and caused a lower level of psychiatric symptoms in the Asian American community.  However, this theory has since been proven to be untrue. 

In fact, Asian American adolescents and young adults endorse depression and anxiety symptoms at an equal or higher rate than their Caucasian counterparts.  By not seeking treatment, they may actually perpetuate more dangerous consequences in their population’s mental health. 

It has been shown in a previous survey of college students that Asian American college students report more suicidal thoughts and have more suicide attempts than Caucasian college students (2).  Another study has estimated that 28% of Asian American high school students had depression serious enough to impair functioning, 19% had a suicide plan, and 11% had a suicide attempt.  (3)

These statistics make one wonder what factors specific to the Asian American culture factor into psychiatric symptoms.  When identifying sources of stress, anxiety and depression, Asian American adolescents and young adults reported parental pressure to succeed, difficulty balancing two different cultures (American culture and Asian culture), difficulty communicating with parents, family obligations based on strong family values, and discrimination or isolation due to cultural or racial background. (4)  And, this study was conducted almost a decade ago.  If one would look at the current racial, cultural and divided state of our nation, one could argue that these factors are probably far worse now than then.   

This emphasizes the importance in identifying factors that may contribute to cultural stigma and low mental health utilization in all vulnerable minority groups, not just Asian Americans, so that mental health providers may be able to recognize unreported mental illness in minority community populations that they may work with on a daily basis. 

Personally, I am passionate about working within the South Asian community specifically to help educate the community about mental health awareness. I have seen a more open attitude towards mental illness over recent years, but it is a slow journey for the community as a whole. This serves as a reminder that many minority groups can hold deep held cultural stigmas towards mental illness, and it is our job as culturally sensitive providers to keep these attitudes in mind so that vulnerable individuals do not fall thought the cracks and miss the opportunity for beneficial treatment. 

  • Dr. Krishna is currently a Child and Adolescent Psychiatry Fellow and Chief Resident at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. She is also a former APA/SAMHSA Minority Fellow and has served on the APA Council for Children, Adolescents and their Families.

 

References:

1.     Lee, Su Y., Martins Silvia S., Keyes, Katherine M., and Hochang B. Lee. Mental Health Service Use by Persons of Asian Ancestry With DSM-IV Mental Disorders in the United States.  Psychiatric Serv. 2011 October; 62(10): 1180-1186.

2.     Kisch, Jeremy, Leino, Victor, and Morton Silverman.  Aspects of suicidal behavior, depression and treatment in college students: Results from the spring 2000 National College Health Assessment Survey.  Suicide and Life-Threatening Behavior, 35, 3-13.

3.     Jacob, Jeena, Gray, Barbara, & Johnson, Ann.  The Asian American Family and Mental Health: Implications for Child Health Professionals.  Journal of Pediatric Health Care.  2013. 27(3):180-188.

4.     Lee, Sunmin, Juon, Hee-Soon, Martinez, Genevieve, Hse, Chiehwen E., Robinson, E. Stephanie, Bawa, Julie and Grace X. Ma.  Model Minority at Risk: Expressed Needs of Mental Health by Asian American Young Adults. J Community Health. 2009 April; 34(2): 144-152.

New Pediatric Integrated Care Resource with Multiple GCCAP Member Contributors

Pediatric Mental Health for Primary Care Provider’s - A Clinician’s Guide

Georgia Council for Child and Adolescent Psychiatry members were instrumental in the creation of the ground-breaking new text Pediatric Mental Health for Primary Care Provider’s: A Clinician’s Guide, published by Springer, one of the world’s leading medical publishers. Congratulations to Co-Editor Sarah Y. Vinson, MD and chapter authors Hasani Baharanyi, MD, Nicole Cotton, MD, Kevin Simon, MD, Peter Ash, MD, Steve Jaffe, MD and Michael Ellis, MD.

Praise for the text:

“ More than ever before, pediatricians are being called upon to address a myriad of mental health disorders in children and adolescents. Dr. Sarah Vinson has given pediatricians much needed insight and guidance into this field for which most are ill-equipped to handle through her exemplary book, Pediatric Mental Health for Primary Care Providers. Dr. Vinson is an extraordinary psychiatrist who through her lectures, workshops, and consultations have increased the knowledge and skills of primary care physicians throughout the country on the assessment and treatment of mental health disorders in the pediatric population.”

  • Veda Johnson, M.D., FAAPM Marcus Professor in General Academics and Pediatrics, and Director of PARTNERS for Equity in Child and Adolescent Health (PARTNERS) for the Department of Pediatrics at Emory University

Dr. Vinson is a visionary leader who is deeply connected with the issues that plague underserved children and families. Her new book Pediatric Mental Health for Primary Care Providers fills a critical gap in knowledge and skills around addressing the shortage of pediatric behavioral health providers. This is a valuable resource for pediatricians, nurse practitioners, and other primary care providers who serve pediatric patients.  

  • Glenda Wrenn, MD, FAPA, Director of the Kennedy Center for Mental Health Policy and Research, Satcher Health Leadership Institute, Morehouse School of Medicine


GCCAP Board Member, Dr. Michael Ellis as Author - "Caring for Autism: Practical Advice from a Parent and Physician"

Michael A. Ellis, DO 

  • Dr. Ellis is the current Secretary/Treasurer of the GCCAP board and has published a book through Oxford University Press: "Caring for Autism: Practical Advice from a Parent and Physician"
    • Written from the unique perspective of a psychiatrist who specializes in Autism Spectrum Disorder (ASD) and father of a child with ASD
    • Discusses the effect of ASD on the whole family, not just the patient involved, and the grieving process that comes with it; and
    • Covers diagnosis, medications, treatments, lifestyle, the educational system and legal issues surrounding ASD, including guardianship
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