Asian American Mental Health and Mental Health Stigma

The intention of this study is to track the progression of the mental illness stigma in the Asian American community over time. In addition, this study aims to identify the potential differences between levels of mental stigma between college students and individuals who are not attending college. This study will use a multi-step stratified sampling approach to gather subjects in California to obtain data for a comparative analysis to track levels of stigma over time.

A survey will also be distributed to identify subjects with mental illnesses; those that identify positive will be interviewed with open ended questions concerning mental health stigma and mental health services.

The two populations this study will be sampling from are Asian American college students and middle class to upper middle class Asian Americans not attending college. This project seeks to provide evidence that mental health services should be more understanding of Asian American culture in order to provide more effective treatments to lessen the disparities of utilization between this demographic group compared to their racial and ethnic counterparts.

Literature Review History

The late 20th century marks the beginnings of mental health integration into society. Policymakers helped configure former programs to help people with mental illnesses and were able to integrate mental illnesses into the medical and social service sectors. In congruence with these progressions, the rise of managed behavioral health care in the 1990s made “mental health services more accessible and reduced the intensity of service and cost” without reducing the quality. Although society has become more accepting of mental illness and accessibility has greatly increased, stigma still persists and often leads to underutilization of these services.

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Stigma

The RAND corporation conducted a qualitative study on psychologically distressed California adults found that there were significant differences among ethnic and racial groups concerning mental illness stigma and discrimination experiences. Asian Americans held more negative views about mental illness relative to the other groups. Compared to whites, they were significantly less likely to view those affected with mental illnesses as being able to contribute to society and were more likely to feel subordinate to those who have not had a mental illness. Evidence from similar studies have presented a pattern in which Asian Americans tend to hold more stigmatizing attitudes which may translate into higher levels of self stigma.

To further investigate difference in stigma among racial and ethnic groups, the RAND corporation conducted a study that used social distance as a measure of stigma (Collins 2014). Subjects were given various scenarios that varied in levels of social contact with individuals with various mental disorders and asked a series of three questions that aimed to identify the extent of their social contact. In congruence with the previous study, results showed that Asian Americans were the most hesitant and had the highest levels of concern when it came to social interaction with individuals with mental illnesses. Among college students, those that were more likely to openly talk about their feelings were more likely to use mental health services. Students who held more stigmatic views were also less likely to take advantage of these programs; nevertheless, racial and ethnic minority groups, which have higher levels of stigma, tend to use these services less than Whites.

Stigma on Mental Health Seeking Behavior

There is a plausible amount of evidence to infer that mental illness is highly stigmatized within the Asian American community, but not many studies provide evidence as to why this stigma persists despite the progressive integration and acceptance of mental illness in society as a whole. Chae, in a quantitative study on Asian Americans, found that negative familial interactions such as cultural expectations were positively correlated with levels of depression. (Chae 2012). Other potential sources of depression and stress were identified in a study conducted among focus groups on the Asian American youth (Lee 2009). A major source of stress stemmed from cultural values such as academic success and familial obligations. Participants felt that they had the obligation to take care of their parents by succeeding academically and obtaining high status jobs. Family dynamics also play a role in mental health seeking behavior.

Research concerning the mental health among the Asian American youth shed light on how stigma undermines mental health seeking behavior. Results from the study showed that the participants felt that it was taboo to openly discuss about their mental health. They felt that the Asian culture expects them to deal with their own mental health problems rather than seeking outside help. (Lee 2009) A longitudinal study focusing on the differences between racial and ethnic groups in counseling services found that Asian American students came into counseling with higher levels of psychological distress, used significantly less sessions than the other groups, and that their psychological issues were still significant by the end of counseling (Kim 2016). These reports provides evidence to support the idea that counseling services should be modified to provide culturally appropriate programs in order to deliver more effective treatments.

The literature shows that there are high levels of stigma concerning mental well being within the Asian American community. Family values and traditions may allow this stigma to persist through generations. Much of the youth within this demographic group reveal that they feel pressured and obligated to live up to high cultural standards. In addition, the literature provides evidence that mental health is not seen as important within the Asian American community. The taboo that comes with discussing mental health discourages positive mental health seeking behavior and may lead too even more severe mental health problems. There are disparities in mental service utilizations in both the college environment and Asian American community. This research strives to identify if being a college student has an additive effect on the mental health seeking behavior of Asian American adults.

Research Questions

This study is an attempt to answer the following research questions: Has the presence of the mental health stigma in the Asian American community been improving over time? Does this mental health stigma have more influence on college students or individuals not in college on their utilization of mental health services? What are some other factors that lead to the underutilization of mental health services within this demographic group?

The literature shows that there is a strong stigma within the Asian American community; nevertheless, I hypothesize that the stigma has not been significantly improving over time due to family dynamics and traditions that are allowing this stigma to persist. Academic success in addition to the taboo of emotional expression may result in an additive effect of mental health strains on college students leading them to contain their problems and underutilize mental health services. The main factors that may lead to underutilization may stem from public stigma, discrimination, and negative attitudes towards the effectiveness of these services.

Research Design

The two populations this study will be sampling from are all Asian American college students attending a four year university in California and all middle to upper middle class Asian American adults not attending college in California. Sampling from this distinct class serves as a form of class control since most students attending college are financially stable. A multistep stratified sampling approach will be used to recruit from both populations. All four year universities in California will be stratified into four geographically distinct groups: north, central-north, central-south, and south. One university will be randomly selected from each region. This approach allows for each region to be represented in the sample. One hundred participants will be recruited from each school. The registrar of each university will be contacted and instructed to advertise the study using money as an incentive to students that identify as Asian American.

The same approach will be used on large firms to recruit the non-college individuals. The Human Resources of these firms will be contacted and asked to advertise the study. They will be instructed to target individuals who have an annual household income of $40,425 and $120,672. This estimate is based off of a report done by the Pew Research Center done in 2014 that sets the bounds for the middle class in California. To answer the question concerning the mental health stigma over time, the population of college students will be used rather than adults in order to track the progression of the stigma through different generations. Data from this study will be compared to a study done in 2014 that measured stigma through social distance (Collins 2014). The data from this study will be restricted to only the data on Asian Americans.

This will be a comparison between data from Generation X and Generation Y. To answer the second question about the underutilization of mental health services, all subjects will be taking a survey containing questions from the Mental Health Survey screening test provided by Mental Health America to assess the state of their mental health. Mental health for this survey will be operationalized as either depression or anxiety. Those that receive a positive result for either depression or anxiety will be further interviewed with open ended questions about how the stigma affects their actions and attitudes. Questions will pertain to topics about willingness to use mental health services, attitudes on mental health, attitudes on the health stigma, and potential reasons for not wanting to use mental health services. The results obtained from both groups will be compared to answer the question of which group is more influenced by stigma.

Survey for Sample Of Asian American College Students

There will be three vignette types (schizophrenia, depression, or PTSD) and each will be randomly assigned to a subject. These vignette types will be taken from a general social survey done in 1996 and 2002. They will be asked several questions concerning their levels of social contact via a survey: whether they would be willing to be neighbors with, spend an evening with, or work closely with the individual previously described. There will be a total of four options: unwilling, probably unwilling, probably willing, and willing. The results from this data will be directly compared to a study done by the RAND Corporation. A chi-squared test can be applied to see how much the new set of data deviates from the old set.