Mental illness and principal physical diagnoses among Asian American and Pacific Islander users of emergency services

Understanding ADHD in AAPI College Students: Prevalence, Comorbidities, Impairments, and Treatment Utilization

OBJECTIVE

Asian American and Pacific Islander (AAPI) students with ADHD may face increased risk for college maladjustment due to cultural factors and a tendency to delay treatment. This is the first study to examine ADHD prevalence, ADHD-related impairments and comorbidities, and ADHD treatment utilization in AAPI college students.

METHOD

AAPI, White, Hispanic, and Black undergraduates (n = 258,005) from the American College Health Association-National College Health Assessment II survey were included in the study.

RESULTS

AAPI students had lower ADHD prevalence rates than White and Black students, and similar prevalence to Hispanic students. AAPI students with ADHD had significantly higher risk for comorbidities and social and academic impairments, compared to White students with ADHD. Approximately half of AAPI students with ADHD did not utilize treatment despite experiencing psychiatric comorbidities and functional impairments.

CONCLUSION

AAPI college students with ADHD are underutilizing treatment despite elevated psychiatric comorbidities and functional impairment.

Mental health service use types among Asian Americans with a psychiatric disorder: considerations of culture and need

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n = 230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.

More alike than different: health needs, services utilization, and outcomes of Asian American and Pacific Islander (AAPI) populations treated for substance use disorders

Asian Americans and Pacific Islanders (AAPIs) are often portrayed as a healthy group with minor substance use problems. Using data from two studies of patients treated in 44 community-based substance use treatment sites located in three states, 298 AAPIs and a matched comparison group of 298 non-AAPI patients were compared on demographic characteristics, treatment experiences, and 1-year outcomes. At treatment entry, more AAPIs reported recent drug use and fewer injected drugs, AAPIs had less severe medical and alcohol problems, and AAPIs reported worse general health but less desire for medical and alcohol services. After controlling for baseline problem severity, there were no differences in treatment retention, completion, or outcomes. Contrary to the model minority stereotype, AAPIs have mostly similar treatment needs, experiences, and outcomes as other racial/ethnic groups in drug treatment.

Twelve-month prevalence of psychiatric disorders and treatment-seeking among Asian Americans/Pacific Islanders in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions

To compare the 12-month prevalence of psychiatric disorders in Asian Americans/Pacific Islanders in contrast to non-Hispanic whites; and further compare persistence and treatment-seeking rates for psychiatric disorders among Asian American/Pacific Islanders and non-Hispanic whites, analyses from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1 (n=43,093) were conducted for the subsample of 1332 Asian Americans/Pacific Islanders (596 men and 736 women) and 24,507 non-Hispanic whites (10,845 men and 13,662 women). The past 12-month prevalence for any psychiatric disorder was significantly lower in Asian American/Pacific Islander males and females than non-Hispanic white males and females. Asian American/Pacific Islander males were less likely than non-Hispanic white males to have any mood, anxiety, substance use, and personality disorders, whereas the prevalence of mood disorders among Asian American/Pacific Islander females did not differ from those of non-Hispanic white females. In some cases, such as drug use disorders, both male and female Asian Americans/Pacific Islanders were more likely to have more persistent disorders than non-Hispanic whites. Compared to non-Hispanic white females, Asian American/Pacific Islander females had lower rates of treatment-seeking for any mood/anxiety disorders. Although less prevalent than among non-Hispanic whites, psychiatric disorders are not uncommon among Asian Americans/Pacific Islanders. The lower treatment-seeking rates for mood/anxiety disorders in Asian American/Pacific Islander females underscore the unmet needs for psychiatric service among this population.

Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review

The current literature on the problem of mental illness stigma in the United States must be expanded to better account for the role of culture. This article examines the relationship between mental illness stigma and culture for Americans of American Indian, Asian, African, Latino, Middle Eastern, and European descent. In this review, culture refers to the shared beliefs, values, and norms of a given racial or ethnic group. The reviewed literature indicates that there are differences in stigma among the various cultural groups; however, explanations as to why these differences exist are scant. Qualitative and quantitative studies indicate that cultural values are important with regard to stigma, particularly for Asian Americans and African Americans. Less is known about the interaction between cultural values and mental illness stigma for other cultural groups. Continued research in the area requires better organization and more exploration of the role of cultural history and values as they relate to mental illness stigma. To that end, a detailed, systematic approach to future research in the area is proposed.

Addressing stigma of depression in Latino primary care patients

OBJECTIVES

To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients.

METHOD

Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items, empirical methods were used to develop a stigma checklist from this primary care sample and patient information was used to demonstrate construct validity.

RESULTS

Patients reporting higher levels of perceived stigma using the stigma checklist were less likely to disclose their depression diagnosis to their family and friends (P<.05) and also less likely to be taking depression medication (OR=.78; 95% CI, .62-.99). Patients with stigma were less likely to be able to manage their depression (OR=.79; 95% CI, .65-.96) and more likely to have missed scheduled appointment visits (OR=1.44; 95% CI, 1.03-2.02).

CONCLUSION

Given the strong relationship between stigma and care of depression, primary care clinicians should be aware of and address stigma among their depressed Latino patients. The stigma checklist presented for treating Spanish-speaking Latino patients in primary care may be used to assess depressed patients for stigma to help inform clinical management of patients.

Inpatient stays of Asian patients with psychiatric diagnoses in New York City

This study examines whether race, specifically Asian, contributes to longer inpatient stays for patients with psychiatric diagnoses in a large American city. Secondary data analyses were conducted using Statewide Planning and Research Cooperative System data sets for 983,584 inpatient discharges with psychiatric diagnoses in New York City between 1995 and 1999. Asians were admitted more often through the emergency room and showed a higher incidence of emergency admission than non-Asians. Greater percentages of Asians were diagnosed with schizophrenic disorders and affective psychoses compared to non-Asians. Furthermore, Asians were about 70% less likely to utilize inpatient services but stayed considerably longer than non-Asians when hospitalized. Study findings will assist in development of policy to improve service utilization for this vulnerable population.

Reducing health disparities in depressive disorders outcomes between non-Hispanic Whites and ethnic minorities: a call for pragmatic strategies over the life course

There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points -- system, community, provider, and individual patient -- in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future research should focus on identifying key components of case management and sociocultural tailoring that are essential for effective interventions and developing new low-cost dissemination mechanisms for treatment and preventive programs that could be tailored to racial and ethnic minorities.