Authors: AJ Chowdhury, Max Wei, Alex Belzer
AJ Chowdhury is a Bangladeshi-American medical student at Iowa. Max Wei is a Chinese-American medical student at Iowa. Alex Belzer is a medical student at Iowa.
This post is one of a series of mental health pieces from the AMSA WSL Committee.
Mental health is a public health concern for Asian Americans and Pacific Islanders (AAPI), and each group faces unique challenges regarding mental health. The following is a full summary of the mental health of Asian Americans and Pacific Islanders as well as the changes we propose to support mental wellness within the AAPI population.
Mental Health and Asian Americans
The rate of mental health issues for Asian Americans is lower than non-Hispanic whites. However, Asian Americans are less likely to use the mental health system, regardless of geographic location, age, gender, education, or Asian subgroup. Even when controlling for the prevalence of disorders, Asian Americans were less likely to use mental health services. Compared to non-Hispanic whites, Asian Americans were also 3 times less likely to seek healthcare for mental illnesses. Additionally, only 3.6% of Asian Americans received prescription medications for mental illnesses versus 15.4% of non-Hispanic whites. The lack of utlization of mental health care partially explains why suicide is the leading cause of death for Asian Americans 15-24 in 2017.
Issues Affecting Asian Americans Regarding Mental Health
This discrepancy in mental health system utilization can be attributed to the unique issues that affect Asian Americans. These issues include the stigma of mental health, cultural expectations, discrimination and difficulty of cultural assimilation in Asian American communities. From a study conducted by the University of Maryland School of Public Health as well as a study by Spencer and colleagues, mental health is considered taboo in many Asian cultures, causing Asian Americans to dismiss, deny, or neglect their symptoms. Many do not seek help because of the shame that results in public knowledge of their familial difficulties. Furthermore, many Asian American parents do not believe in mental illness and tell their children to “get over it.” This stigma is compounded with the cultural expectations found in Asian American communities. The model minority stereotype puts pressure not to acknowledge mental health issues. Individuals are told that they must be successful and not show any signs of weakness. This creates the expectation that Asian American individuals must be highly successful and pursue a highly skilled profession. This in itself can add additional stress and lead to the development of mental illnesses. Another unique cultural value of Asian Americans is interdependence, relying on the family and community, rather than seeking the help of a professional. The discrimination that Asian Americans face and the difficulty of cultural assimilation can further create mental health issues in Asian Americans. There is often a difficulty finding a self-identity and balancing two different cultures, with the pressure to conform to Western ideals of individualism, which conflicts with traditional Asian family expectations.
Mental Health of Pacific Islanders
Despite there being 1.4 million Pacific Islanders living in the U.S. and their population having grown by over 40% between 2000 and 2010, not much is known about their mental health due to the disproportionate underuse of mental health care services. According to a 2019 study of 223 Pacific Islanders, the prevalence of major depression, generalized anxiety disorder, and alcohol use disorder was 21%, 12%, and 22%, respectively, compared to a 12 month prevalence of 6.8%, 2.7%, and 3.1%, respectively, for the general US population. However, over a quarter of the participants reported avoiding or delaying seeking mental health care in the past year. As a result of low levels of mental healthcare usage among Pacific Islanders, significant knowledge gaps exist in the specific health profile of the demographic.
These gaps must be closed. There undoubtedly exist specific and unique issues that affect the access to, availability of, and drive to utilize mental healthcare in Pacific Islander populations, which can and should be identified and better understood through research initiatives. Until such research is done, mental illnesses that affect Pacific Islanders will be chronically underdiagnosed and undertreated. It would be yet another disservice to a historically colonized and exploited population to not make this investment in their health. Efforts could act in conjunction with or be incorporated into programs such as the Pacific Island Health Care Project, a massive humanitarian telemedicine initiative that specifically provides care to Pacific Islanders but notably does not include significant mental health directives.
Issues Affecting Pacific Islanders Regarding Mental Health
Pacific Islanders are one of the fastest growing groups in the U.S., yet little is known about mental health in Pacific Islander communities due to many barriers in their healthcare delivery and cultural stigma. In a 2019 study done Subica et al., it was found that over a third Pacific Islanders reported needing mental health services but only 26% of them delayed seeking help. Pacific Islanders face many of the same barriers to seeking mental health services as Asian Americans.
Pacific Islander communities tend to have limited discussions around mental health due to the stigma of mental illness within the family, stemming from cultural and spiritual values. Another significant barrier is the lack of education in these communities, with high school graduation rates around 74% for the Marshallese. This is exacerbated by the language barrier between Pacific Islanders and healthcare services There are many ethnic groups with different languages that fall into this population, and yet a lack of mental health services that can accommodate language needs with interpreters.
Financial barriers also stand in the way of many Pacific Islanders, with many suffering from significantly higher rates of poverty, unemployment, and lack of insurance compared to non-Hispanic white Americans. The median household income in 2017 for Pacific Islanders was $60,734 compared to the non-Hispanic white household income of $65,845. Pacific Islanders also report higher rates of poverty compared to non-Hispanic whites, with 15.4% of Pacific Islanders living at poverty levels compared to 9.6% of non-Hispanic whites. Difficulties with seeking mental healthcare is also exacerbated by decreased insurance coverage, with Pacific Islanders having a slightly higher rate of being uninsured compared to non-Hispanic white Americans and nearly 10% lower rates of private insurance coverage.
Pacific Islanders have many obstacles to navigate when seeking mental healthcare, including but not limited to: personal and cultural stigma, lower rates of attainment of secondary and higher education, language barriers, and difficulties with healthcare access due to poverty and lack of insurance. As Pacific Islanders are a rapidly growing population, their healthcare needs will continue to increase in the future. It is of utmost important to work with Pacific Islander communities in efforts to destigmatize mental health while improving access to mental health services.
Improving Access for Asian Americans and Pacific Islanders
There are several necessary steps to take requiring community engagement and education efforts to improve mental healthcare access and utilization for the AAPI population. To begin this process, we need to destigmatize the use of mental health services in order to dispel myths about mental illnesses and promote better well being of AAPIs. Educating the AAPI population on mental health will require developing culturally sensitive programming which will address issues specific to AAPI populations and will also serve to destigmatize mental illness. Programs like the Healthy Minds Initiative have been working to reach out to AAPI communities to raise mental health awareness and destigmatize mental illnesses with fundraising and finding common purposes between partner agencies and community organizations. Finally, improving mental health service access for AAPIs with culturally competent mental healthcare providers and increased interpreter availability in AAPI communities will allow the ever-growing AAPI population to seek mental health services more easily.