Call for Action to Address MH Disparities Impacting Asian Americans and Pacific Islanders

Asian Americans and Pacific Islanders were among the hardest-hit groups by COVID-19, not only in terms of job loss due to customers shunning small businesses but also of racial discrimination. The Asian Pacific Policy and Planning Council has reported nearly 3,800 incidents of anti-Asian harassment (including verbal slurs, physical assault, being coughed at/spat upon, or vandalism) since March 2020. Twice as many Asian women have reported victimization than men, and 1 of 8 incidents has involved adults 60 years or older.

The most disturbing incident of them all occurred on March 16 with the mass shootings at three massage parlors in Atlanta resulting in the deaths of eight innocent lives, six of whom were women of Asian descent. This tragic event has sparked outcries from various Asian American and Pacific Islander communities, some of whom reflected on their own immigration history and others responded with fear and outrage about the violent crimes, which were primarily against working-class Asian women.

Research on the mental health of Asian Americans and Pacific Islanders during the pandemic has shown significant deterioration of their mental health. Exposure to ongoing media coverage of the pandemic, anti-Asian incidents, and the mass shooting may affect these individuals’ sense of security, safety, and stability and partially mediate negative outcomes.

Remembering the long history of prejudice against Asian Americans and Pacific Islanders is paramount to the importance of discussing the recent events magnifying racial tensions. From the 1850s, Chinese contract workers were thought to pose economic and moral threats to Americans, leading to the Chinese Exclusion Act in 1882 that restricted their immigration. The lesser-known Page Act of 1875 prohibited the entry of Chinese women who intended to immigrate for “lewd and immoral purposes.” These early examples of legal parameters perpetuated Asian stereotypes. Views of hypersexualized Asian American and Pacific Islander women have been culturally widespread since the 19th century as indicated by the trends of pornography, sex industry, and mail-order brides. Generational trauma since the early immigration history and the accumulation of discriminatory experiences have lasting negative psychological impact, including depression, anxiety, substance use, and suicidal ideation.

Psychiatrists and the broader scientific community have the shared responsibility of breaking the silence of mental health disparities. We are calling for action on three domains. First, we call for data-driven, standardized approaches for monitoring mental health disparities experienced by Asian Americans and Pacific Islanders. Studies have shown that this population, particularly those with mood disorders, underuse mental health services. However, the literature is lacking up-to-date, generalizable studies on the mental health needs and service use of Asian Americans and Pacific Islanders. With dwindling national support for rigorous longitudinal surveys, it is critical that various research sites use consistent measures for data comparison and harmonization efforts. It is also important to examine the intersectionality of race with gender, age, and immigration history.

Second, we call for developing and tailoring mental health interventions that incorporate lived experiences of Asian Americans and Pacific Islanders and address barriers to psychiatric care (for example, stigma, language, and financing). Culturally tailored community partnership is essential for generating creative solutions such as bringing mental health assessment and counseling to religious programs (for example, temples and churches) and workplaces (for example, groceries, nail salons, dry cleaners).

Third, we call for leveraging online resources used by Asian Americans and Pacific Islanders to promote mental health. Distribution of infographics and public health messaging through specific social media channels (for example, KakaoTalk, Line, WeChat, and Telegram) can serve as powerful tools to reduce the stigma of mental illness and encourage help seeking. Creative content in such media as movies, documentaries, and songs may be impactful in providing psychoeducation. Furthermore, expanding access to virtual care through services by Asian American and Pacific Islander psychiatrists and mental health professionals may reduce geographic and cultural barriers to initiating mental health care.

We invite you to stand together with Asian American and Pacific Islander communities in breaking the silence about mental health—in the efforts of monitoring mental health disparities, incorporating lived experiences into mental health interventions, and maximizing the use of online resources to promote mental health among Asian Americans and Pacific Islanders. ■

References

1. AP3CON. Stop AAPI hate reports: 2020-2021 national report. Accessed Mar 21, 2021.

2. Wu C, Qian Y, Wilkes R. Anti-Asian discrimination and the Asian-white mental health gap during COVID-19. Ethn Racial Stud. 2021;44(5):819-835.

3. Haft SL, Zhou Q. An outbreak of xenophobia: Perceived discrimination and anxiety in Chinese American college students before and during the COVID‐19 pandemic. Int J Psychol. 2021;E pub ahead of print.

4. Woan S. White sexual imperialism: A theory of Asian feminist jurisprudence. Washington and Lee Journal of Civil Rights and Social Justice. 2008;14:275-301.

5. Lee SY, Martins SS, Keyes KM, Lee HB. Mental health service use by persons of Asian ancestry with DSM-IV mental disorders in the United States. Psychiatr Serv. 2011;62(10):1180-1186.