How symptom manifestations affect help seeking for mental health problems among Chinese Americans

Trends and Disparities in Mental Health Use Among Asian American Sub-groups, 2013-2019

OBJECTIVE

The objective of this study was to characterize and compare national estimates of mental healthcare use among White and Asian American groups to provide an update using post Affordable Care Act data.

METHODS

We analyzed yearly cross-sectional data from the 2013-2019 Medical Expenditure Panel Survey, including White (n = 112,590) and Asian American (n = 10,210) individuals, and examined rates of mental healthcare use for Asian (overall), Asian Indian, Chinese, Filipino, and Other Asian individuals relative to White individuals. Using multivariable logistic regression models and predictive margin methods, we estimated overall Asian disparities and Asian subgroup disparities compared to White group rates in mental health care (outpatient, specialty, psychotropic medication) among adults with and without elevated risk for mental illness. Regression models were adjusted for variables related to need for treatment, demographic, and socioeconomic status variables.

RESULTS

Asian individuals had lower rates of mental healthcare use than White individuals. Unadjusted results and adjusted regression model predictions are consistent in identifying wide disparities in mental health care treatment across risk for mental illness, Asian subgroups, and types of treatment.

CONCLUSIONS

Asian Americans have significantly lower rates of mental healthcare use than White Americans, even among those with elevated risk for mental illness. There is small variation by Asian subgroups but disparities persist across subgroups and types of treatment. Our results imply interventions are needed to improve linguistically, culturally, and ethnically tailored outreach and engagement in treatment services, as well as examining treatment and its effectiveness for Asian American individuals living with psychological distress.

An Examination of Psychological Stress, Fatigue, Sleep, and Physical Activity in Chinese Americans

Chinese Americans comprise the largest Asian subgroup in the U.S. Yet, little research has focused on the well-being of this population. This study aimed to (1) examine psycho-physiological health (psychological stress and fatigue) and lifestyle behaviors (sleep and physical activity) between Chinese Americans and whites, and (2) investigate whether race and lifestyle behaviors were independent predictors of psycho-physiological health. This study included 87 middle-aged healthy adults (41 Chinese Americans, 46 whites). Each participant underwent a two-night actigraphy-based sleep assessment. Chinese Americans reported higher psychological stress and fatigue, had poorer objective sleep outcomes (shorter sleep duration, lower sleep efficiency, and longer sleep onset), and engaged in lower physical activity levels than whites. Race and poor perceived sleep quality were independently associated with high psychological stress and fatigue. The findings warrant further exploration of social and cultural determinants of health in this minority group to reduce health disparities.

Factors Associated with Mental Health Help-Seeking Among Asian Americans: a Systematic Review

OBJECTIVE

Asian Americans are underutilizing mental health services. The aim of the current systematic review was to identify protective and risk factors of mental health help-seeking patterns among the disaggregated Asian Americans and to classify types of help.

METHODS

A systematic literature review was conducted using the PRISMA guidelines. The Health Belief Model served as the theoretical framework for this review. Thirty-four articles were reviewed, and the studies investigated one of the following Asian ethnic subgroups: Chinese, Filipino, Asian Indian, Korean, or Vietnamese. Data were extracted based on the study characteristics, sample characteristics, and protective and risk factors to mental health help-seeking patterns.

RESULTS

Predisposing factors like female gender, higher levels of English proficiency, and history of mental illness increased the likelihood for help-seeking across several ethnic groups. Interestingly, cues to action and structural factors were under-examined. However, cues to action like having a positive social network did increase the likelihood of using formal support services among Chinese and Filipinx participants. Structural factors like lacking ethnic concordant providers and access to healthcare served as barriers for Korean and Vietnamese participants.

DISCUSSION

The findings showed a need for ethnic tailored approaches when supporting mental health help-seeking patterns. Asian ethnic group's immigration status, acculturation level, and psychological barriers to help-seeking should continue to be emphasized. Psychoeducational groups can be beneficial to expand the knowledge base surrounding mental illness and to link group members to culturally responsive resources.

Is It Cultural Context or Cultural Value? Unpackaging Cultural Influences on Stigma Toward Mental Illness and Barrier to Help-Seeking

There have been growing interests in sampling underrepresented populations to test whether psychological processes are universal. The present cross-sectional study examined cultural influences on stigma toward mental illness and perceived barrier to help-seeking among Hong Kong Chinese, Chinese Americans, and European Americans ( N = 555 university students). Significant cultural differences were found in the mean levels, with the two Chinese groups reporting higher levels of stigma toward mental illness and perceived barrier to help-seeking than European Americans, and these cultural differences were accounted for by face concern. In addition, the strengths of paths from face concern to stigma toward mental illness and perceived barrier to help-seeking were equivalent across the three cultural groups. These findings tease apart the source of cultural influences and underscore the importance of comparing cultural differences both at the mean level and the structural level, but more importantly, to unpackage the observed differences by testing the mediating role of cultural values.

Parent perceptions of mental illness in Chinese American youth

BACKGROUND

Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth.

METHODS

Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking.

RESULTS

While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences.

DISCUSSION

These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.

The Relationship Between Depressive Symptoms and Health Services Utilization in U.S. Chinese Older Adults

BACKGROUND AND OBJECTIVES

Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization.

RESEARCH DESIGN AND METHODS

Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization.

RESULTS

U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44-2.28) and hospitalization (OR = 1.9, 95% CI = 1.47-2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation.

DISCUSSION AND IMPLICATIONS

Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services.

Unmet Mental Health Care Needs among Asian Americans 10⁻11 Years After Exposure to the World Trade Center Attack

This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.

Characterizing Mental Health Treatment Utilization among Individuals Exposed to the 2001 World Trade Center Terrorist Attacks 14⁻15 Years Post-Disaster

Following the World Trade Center (WTC) attacks in New York City (NYC) on 11 September 2001 (9/11), thousands in NYC experienced significant stress reactions and disorders, presenting an immediate need for counseling and treatment. While other studies documented post-9/11 mental health treatment utilization, none have data more than two years post-disaster. We used data from 35,629 enrollees of the WTC Health Registry, a longitudinal cohort study of those exposed to the WTC attacks, to examine predictors of counseling after 9/11, the types of practitioners seen, and the perceived helpfulness of therapy up to 15 years post-disaster. Among enrollees, 37.7% reported receiving counseling at some time after 9/11. Predictors of seeking counseling included race/ethnicity, age at 9/11, education level, exposure to the WTC attacks, other traumatic experiences, mental health symptomology, and pre-9/11 counseling. Whites and Hispanics, those who were children on 9/11, and those with high levels of exposure to the WTC attacks sought counseling soonest after 9/11. Among those who sought counseling, Blacks, Asians, and those with lower education and income were less likely to see mental health specialists and more likely to see general practitioners or religious advisors. Finally, among those who sought recent counseling, women, Blacks, those aged ≥65 years, and those with very high WTC exposures were more likely to rate their recent counseling as very helpful. This study used data up to 15 years post-disaster to document mental health treatment utilization patterns, trends, and disparities that have implications for future preparedness plans and needs assessments.

Posttraumatic stress disorder in the short and medium term following the World Trade Center attack among Asian Americans

This study investigated patterns of probable posttraumatic stress disorder (PTSD) and their predictors among 2,431 Asian American and 31,455 non-Hispanic White World Trade Center (WTC) Registry participants 2-3 years and 5-6 years after the WTC attack. Participants were divided into four PTSD pattern groups: resilient, remitted, delayed onset, and chronic. Asians had a lower proportion in the resilient group (76.5% vs. 79.8%), a higher proportion in the chronic (8.6% vs. 7.4%) and remitted (5.9% vs. 3.4%) groups, and a similar proportion in the delayed onset group (about 9%) compared to Whites. In multinomial logistic regression analyses, disaster exposure, immigrant status, lower income, pre-attack depression/anxiety, and lower respiratory symptoms were associated with increased odds of chronic and delayed onset PTSD (vs. resilience) among both races. Education and employment were protective against chronic and delayed onset PTSD among Whites only. These results can inform targeted outreach efforts to enhance prevention and treatment for Asians affected by future events.

Factors Related to the Probable PTSD after the 9/11 World Trade Center Attack among Asian Americans

Despite the fact that Asians constituted a sizeable proportion of those exposed to the World Trade Center attack on September 11, 2001 due to its proximity to Chinatown and many South Asians working in the nearby buildings, no study had focused on examining the mental health impact of the attack in this group. Based on data collected by the World Trade Center Health Registry from a sample of 4721 Asians 2-3 years after the disaster, this study provides a baseline investigation for the prevalence and the risk and protective factors for PTSD among Asian Americans directly exposed to the attack and compared this population against 42,862 non-Hispanic Whites. We found that Asians had a higher prevalence of PTSD compared to Whites (14.6 vs 11.7%). "Race-specific factors" significantly associated to PTSD in the multivariate analyses were noted among sociodemographics: higher education was protective for Whites but a risk factor for Asians; being employed was protective for Whites but had no effect for Asians; and being an immigrant was a risk factor for Whites but had no effect for Asians. However, income was a protective factor for both races. Other "universal factors" significantly increased the odds of PTSD symptoms but showed no racial differences, including exposure to the disaster and the presence of lower respiratory symptoms which intensified odds of PTSD by the greatest magnitude (3.6-3.9 times). Targeted effort to reach out to Asians is essential for prevention and follow up treatment given this group's striking history of underutilization of mental health services.

Depression as seen through the eyes of rural Chinese women: Implications for help-seeking and the future of mental health care in China

BACKGROUND

As part of a larger epidemiological study of depression among rural Chinese women, we sought to understand their explanatory models of depression. We explored how participants describe depression, to what cause they attribute depression, and what sources of treatment they would recommend.

METHODS

Participants first were assessed with the Center for Epidemiological-Depression scale (CES-D), with a cut-point of 16 or greater indicative of depression. The Short Explanatory Model Interview (SEMI), a semi-structured questionnaire, was our primary tool for exploring participants' explanatory models relating to a vignette describing a rural Chinese woman with depression.

RESULTS

Among the 416 women who consented and completed the SEMI, 277(66.6%) reported that the woman in the vignette had something wrong with her health. Among these, only 8(2.9%) women provided a specific psychiatric name for the condition, while 150(54.2%) provided non-specific psychiatric disease names or affective symptoms, and 78(28.2%)of the sample provided physical disease names. Participants attributed causes largely to internal factors (41.5%) or external factors (36.8%). In terms of help-seeking, 101(36.4%) said the woman in the vignette should see a doctor, 70(25.3%) indicated that she should solve the problem herself, and 42(15.2%) recommended seeking support from family members and friends. We did not find any differences in recognition, causal attribution, and help-seeking suggestions between women with a CES-D ≥ 16 and those with CES-D < 16.

LIMITATIONS

The use of a vignette to prompt discussion was not the same as talking about real-life personal situations.

CONCLUSION

Our results point to potential challenges and opportunities that lay ahead as China develops mental health services in its vast rural areas among women who may be at risk for developing depression. We found that our participants often attributed their symptoms to internal or external social causes, and preferred not speaking with family members and friends. Our findings suggest that rural Chinese women may be reticent to recognize or describe categorical concepts such as "depression" as a health problem, and they invite further consideration about how best to develop new health services in China's rural regions.

Cross cultural variations in psychiatrists' perception of mental illness: A tool for teaching culture in psychiatry

A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.

Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth

Misdiagnoses of racial/ethnic minority youth's mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: 1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth's mental health problems are misdiagnosed? 2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included "race", "ethnicity", "minority", "culture", "children", "youth", "adolescents", "mental health", "psychopathology", "diagnosis", "misdiagnosis", "miscategorization", "underdiagnosis", and "overdiagnosis". Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth's emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.

Mental Health Help-Seeking Intentions and Preferences of Rural Chinese Adults

PURPOSE

We aimed to investigate mental health help-seeking intentions and preferences of rural Chinese adults and determine predictors of the intentions.

METHODS

A total of 2052 representative rural residents aged 18-60 completed a cross-sectional survey by face-to-face interviews. The survey included seven questions asking about respondents' help-seeking intentions and preferences, and a series of internationally validated instruments to assess self-perceived health status, depression, anxiety, alcohol abuse, mental health literacy, and attitudes towards mental illness.

RESULTS

Nearly 80% of respondents were willing to seek psychological help if needed, and 72.4% preferred to get help from medical organizations, yet only 12% knew of any hospitals or clinics providing such help. A multivariate analysis of help-seeking intention revealed that being female, having lower education, higher social health, higher mental health knowledge, and physical causal attribution for depression were positive predictors of help-seeking intention.

CONCLUSION

A huge gap exists between the relatively higher intention for help-seeking and significantly lower knowledge of helpful resources. Predictors of help-seeking intention for mental problems in the current study are consistent with previous studies. Interventions to increase help-seeking for mental problems by Chinese rural adults may be best served by focusing on increasing public awareness of help sources, as well as improving residents' mental health literacy and social health, with special focus on males and those more educated.

A community-based study of the relationship between somatic and psychological distress in Hong Kong

Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.

Association between depressive symptoms and changes in sleep condition in the grieving process

PURPOSE

Bereaved families often suffer from insomnia and depression. However, the associations between depressive state and changes in sleep condition during the grieving process have not been investigated. This study aimed to clarify the prevalence of insomnia symptoms and to explore associations between present depressive state and changes in sleep condition in the grieving process in bereaved families of Japanese patients with cancer.

METHODS

A cross-sectional, multicenter survey was conducted in 103 certified palliative care units. A questionnaire asking insomnia symptoms and depressive symptoms by the Center for Epidemiological Studies Depression Scale (CES-D) was mailed to bereaved families (N = 987). The association between present depressive state (CES-D ≥7) and sleep conditions in the grieving process were analyzed.

RESULTS

A total of 561 families were enrolled for analysis. Fifty-three percent of family members were considered to be in a depressive state at the time of the investigation. Prevalence of past insomnia was 86.5% at "within a few weeks before the patient's death" (T1) and 84.5% at "within 6 months after the patient's death" (T2) in all bereaved family members. However, in contrast to decreased severity of insomnia between T1 and T2 in the non-depressive group (p < 0.05), severity of insomnia was unchanged in the depressive group during this period (p = 0.139).

CONCLUSIONS

Insomnia symptoms are highly prevalent and may be associated with posthumous depressive state in bereaved Japanese families. These results suggest the need for careful observation of changes in sleep condition during the grieving process.

Racial and ethnic differences in depressive subtypes and access to mental health care in the United States

OBJECTIVES

Racial and ethnic minorities in the U.S. underutilize mental health service for mood disorders. This study sought to identify depressive subtypes associated with low use of mental health services across racial and ethnic groups based on a large, nationally representative sample of adults in the U.S.

METHODS

Based on latent class analysis, we identified the latent profile of depressive symptoms among those who endorsed lifetime depressed mood or anhedonia in the 2001-2002 National Epidemiological Survey on Alcohol and Related Condition (302 Asian Americans; 8602 Whites; 2266 Blacks; 2254 Hispanics). Proportions and types of lifetime mental health service use across depressive symptom subtypes were assessed and compared across the racial and ethnic categories.

RESULTS

A four class model of depressive subtypes was examined across race and ethnicity ("mild," "cognitive," "psychosomatic," and "severe"). Asian Americans, blacks, and Hispanics with "severe" subtype of depression had significantly lower odds of mental health service use compared to whites with "severe" subtype of depression. While Asian Americans did not have higher proportion of "psychosomatic" subtype than other race and ethnic groups, Asian Americans with "cognitive" subtype of depression significantly underused mental health services compared to Asian Americans with "psychosomatic" subtype of depression (Odds ratio:0.34, 95% Confidence interval:0.13,0.91).

LIMITATION

We were unable to account for heterogeneity of the subethnic group compositions based on country of origin and other socio-demographic factors.

CONCLUSIONS

A targeted outreach intervention to raise awareness among Asian Americans, blacks, and Hispanics with "severe" subtype and Asian Americans with "cognitive" subtype of depression may reduce disparity in mental health service utilization across racial and ethnic groups.

Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5

The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.

Japanese Americans' health concerns and depressive symptoms: implications for disaster counseling

This study examined factors contributing to depressive symptoms among Japanese Americans. Data were collected in Houston, Texas, in 2008, before the March 2011 Japan earthquake, through a community survey including demographic and mental health questions and the Hopkins Symptoms Checklist. Among 43 Japanese American respondents in this convenience sample, the depression prevalence was 11.6 percent. Chi-square results found that having anxiety symptoms and holding a master's degree had statistically significant relationships with depressive symptoms. An independent sample t test found that those having depressive symptoms experienced significantly more health issues than those without depressive symptoms. When these statistically significant variables were entered into a logistic regression model, the overall effect of having health issues, anxiety symptoms, and a master's degree collectively predicted depressive symptoms. It was also found that Japanese Americans rarely consult mental health professionals; in particular, female Japanese American respondents tend to seek help from religious leaders. As implied by these findings, the reluctance of Japanese Americans to seek formal help can be explained by social stigma, a health-oriented approach to treatment, and other cultural considerations. Practice implications focus on disaster counseling with a connection between mental health needs and health care support.

Do patient characteristics, prenatal care setting, and method of payment matter when it comes to provider-patient conversations on perinatal mood?

To examine factors associated with provider-patient conversations regarding prenatal and postpartum depressed mood. This study included 3,597 White, African American, Hispanic, and Asian/Pacific Islander NYC resident women who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 2004-2007, a population-based assessment of patient and health care characteristics. Social determinants including race, nativity, maternal age, prenatal health care setting, and payment type were associated with patient report of having had a conversation about perinatal mood with their provider. Compared to Whites, Asian/Pacific Islanders were less likely to have this conversation (OR = 0.7, CI = 0.5-0.9). Older (OR = 0.6, CI = 0.4-0.9), non-US born (OR = 0.6, CI = 0.5-0.8), and women receiving care from a private doctor or HMO clinic (OR = 0.7, CI = 0.6-0.9) were less likely to have this conversation compared to their respective counterparts. Those who paid for their prenatal care primarily through personal income or through an expanded Medicaid program for prenatal care compared to those who did not were more likely to have had a conversation about mood with their providers. Health care providers and public health advocates should be aware that non-US born women were less likely to have conversations about mood than US born women. However, young mothers shown to be at risk for perinatal depression were more likely to have these conversations compared to older women. Protocols for assessing and educating patients about perinatal mood should be evaluated to improve conversation rates for those receiving care through private doctors and managed care organizations. Income and prenatal care assistance funds may play separate and important roles in provider-patient conversations.

Comparison of treated and untreated major depressive disorder in a nationwide sample of Korean adults

We examined factors associated with lifetime treatment of major depressive disorder (MDD) in a nationwide sample of Korean adults. Of the 6,510 subjects aged 18-64 years who participated in the Korean Epidemiologic Catchment Area study, 362 (5.6%) with a lifetime diagnosis of MDD were analyzed. Diagnostic assessments were based on the Korean version of the Composite International Diagnostic Interview administered by lay interviewers. Of the 362 respondents with a lifetime diagnosis of MDD, 117 (32.3%) had been treated for psychiatric problems. Treated individuals with MDD were more likely to have chronic episode(s), more symptoms of depression, insomnia, and suicidal ideation, and were less likely to have feelings of guilt. In addition, treated individuals were more likely to have comorbid anxiety disorders, especially obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder. Treatment-seeking by individuals with MDD is affected by socio-cultural factors such as misconception and stigma of mental illness, as well as severity of depression and comorbid conditions.

A research agenda to assure equity during periods of emergency department crowding

The effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities. To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms. A research agenda is proposed to understand mechanisms that may threaten equity during periods of crowding and design and test potential interventions that may ensure the equitable aspect of quality of care.

Use of indigenous cultural idioms by Chinese immigrant relatives for psychosis: impacts on stigma and psychoeducational approaches

Indigenous interpretations of mental illness might negatively impact treatment adherence. However, psychiatric "labeling" potentially leads to stigma among Chinese groups, thus encouraging the use of indigenous idioms. We examined how relatives' use of indigenous labeling varied with the consumers' experience of illness and whether indigenous labeling protected relatives from internalized and experienced forms of stigma. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Although consumers had progressed to the middle stages of psychosis, 39% of relatives used indigenous idioms to label psychosis. Indigenous labeling decreased when illness duration increased and when visual hallucinations were present. Indigenous labeling further predicted lower internalized stigma among relatives. Relatives who used indigenous labeling also reported fewer indirect stigma experiences, although not after controlling for illness severity. The frequency of direct discrimination among relatives did not differ by labeling. These forms of felt stigma might be embedded into relatives' psychoeducation programs to mitigate adverse consequences of psychiatric labeling.

Cultural aspects in social anxiety and social anxiety disorder

To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and SAD. This has direct relevance for the upcoming DSM-V.

Asian Americans' lay beliefs about depression and professional help seeking

Guided by a culturally informed illness representation self-regulation model (CIRSRM), this study analyzed the relations among 223 Asian Americans' lay beliefs about depression, enculturation to Asian values, and their likelihood of seeking professional help for depression. Participants' lay beliefs were assessed through an analysis of written responses to open-ended questions about depression. Enculturation as well as beliefs in biological causes, situational causes, and a short duration of depression were significantly related to the likelihood of professional help seeking. In addition, enculturation moderated the association between several lay beliefs and the endorsement of professional help seeking. The findings are discussed in light of how clinicians can incorporate mental illness lay beliefs in their work with Asian Americans.

Increasing mental health awareness and appropriate service use in older Chinese Americans: a pilot intervention

OBJECTIVE

This study evaluated the effectiveness of a community intervention in increasing awareness of mental health issues and available resources among elderly Chinese Americans.

METHODS

Twenty-seven members of a community church received a 1-h didactic presentation, in English and Mandarin, and completed surveys regarding their help-seeking preferences before and after the intervention. Results were analyzed using a series of Wilcoxon matched-pair signed rank tests and comparing pre- and post-test scores.

RESULTS

Findings indicated an increase (p<.05) in intention to consult a mental health professional for psychiatric symptoms at post-test. A significant increase also was found in preference for consulting a physician for physical symptoms.

CONCLUSION

The pilot educational intervention increased awareness of mental health and treatment issues and the role of mental health professionals, lending support to evaluate the intervention on a larger scale.

PRACTICE IMPLICATIONS

Greater awareness of mental health among Chinese Americans can be promoted via education forums provided through faith-based organizations. Stigma of mental illness leads many Chinese individuals to seek help for psychiatric problems from primary care physicians. Integrating mental health practitioners in primary care settings may help decrease stigma and encourage appropriate help-seeking behavior.