FIG1 Although Asian Americans
have some of the highest suicide rates in the United States, many are
reluctant to access mental health services due to stigma and shame. Those who
do seek treatment must often wait for months before sitting down with a
psychiatrist or mental health practitioner.
Henry Chung, M.D.: Despite high rates of mental health problems among
Asian Americans, mental health services are underutilized among this
Henry Chung, M.D., illuminated the problems facing Asian Americans with
mental illness at a meeting whose theme was "Overcoming Stigma in Asian
American Mental Health" in New York City in October. The meeting was
sponsored by the New York Coalition for Asian American Mental Health, an
organization established in 1988 to improve the quality of mental health care
services available to Asian Americans in the New York City area.
"Are we not restigmatizing Asian-American patients again by telling
them, `I know you need help, but you must wait three to six months before you
can get care?'" asked Chung, who is a clinical associate professor of
psychiatry at New York University School of Medicine and senior director of
research and strategic management at the Charles B. Wang Community Health
Center in New York.
One mental health problem that must be dealt with immediately is suicide,
and Asian-American women commit suicide at higher rates than women from other
ethnic groups in the United States, Chung said.
In data compiled from 1990 to 2001 by the National Center for Health
Statistics of the Centers for Disease Control and Prevention, the suicide
rates among older Asian or Pacific Islander (API) women consistently topped
those for elderly women from other ethnic groups.
For example, in 1995, there were 8.6 suicides per 100,000 people among API
women over age 65, compared with 5.8 suicides for age-matched white women and
2.1 suicides for age-matched African-American women. (Suicide rates for Latino
women over age 65 were listed as unreliable due to the low frequency with
which such events were reported.)
Elderly Asian patients also had the highest rates of death
ideation—passive death wishes—and suicidal ideation in one primary
care study, according to Chung.
In the Primary Care Research in Substance Abuse and Mental Health for the
Elderly study published in 2002, psychiatrist Stephen Bartels, M.D., examined
more than 2,000 primary care patients aged 65 and older with depression,
anxiety, and risky alcohol use. He found that Asians had the highest rate of
death ideation (37.8 percent) when compared with Latinos (34.8 percent),
whites (27.2 percent), and blacks (21.76 percent), and the highest rate of
suicidal ideation (18.9 percent) when compared with whites (13.5 percent),
blacks (5.3 percent), and Latinos (5 percent).
"These are our elderly folks walking around in the community,"
Chung said. "These are your parents and my parents."
Depression, in particular, often goes unnoticed in the primary care
setting, he noted.
Chung conducted a study of 252 Asian and Latino patients entering a public
ambulatory medical clinic over a six-month period and found that 41.6 percent
of the Asian patients had symptoms of depression, yet only 23.6 percent of
them were identified as such by primary care physicians working in the
"The problem was not that we had bad doctors," Chung remarked,"
but that these patients did not come in complaining of psychological
problems—they didn't say they were worried or sad."
Asian patients with depression instead tend to complain of backaches,
headaches, or other somatic complaints, he said, "and if they don't
volunteer information about their depression, it can be difficult to recognize
Chung also emphasized the impact of stigma on Asian Americans with mental
illness. Many are hesitant to acknowledge symptoms of mental illness because
such admissions may damage the reputation of the person's family in their
As a result, utilization rates of mental health services are low among
For instance, Chung cited data from a study conducted by Sheying Chen,
Ph.D., showing that although Asian Americans comprised 9.1 percent of the San
Diego County population, they only represented 3.6 percent of those receiving
mental health services in the county.
Removing cultural and language barriers that keep many Asian Americans away
from the mental health system may improve utilization of mental health
services in this population, Chung said. "An ethnic match between
clinicians and patients can increase treatment utilization and
Individually, clinicians can more successfully engage Asian-American
patients by helping them to achieve goals valued in Asian culture.
"Asian patients value employment, a concrete means of demonstrating
their value to society and to their families," Chung said. "One
way to engage Asian patients is to ask, `What if I were to tell you that by
getting treatment, I could help you to be more satisfied with your job and
Chung recalled antidepressant advertisements in which consumers wore wide
smiles after receiving treatment. "That does not work for this
community," he said. "`Don't worry about the smile—I want a
job, a future for myself, and a future for my family. Do that for me, and
maybe I'll listen to you.'"
Chung encouraged clinicians to "organize ways of engaging patients
and improving coordination of care," for Asian patients, which includes
streamlining treatment plans that are unnecessarily complex.
He also advised them to adopt evidence-based treatments. "We need to
take what works, adapt it to our practices, and then put it to work in our
communities," he said.
More information about the New York Coalition for Asian American
Mental Health is posted online at<www.asianmentalhealth.org/>.▪