Overview Mental Health needs Barriers to care Solutions
I. Mental illness is not exotic National Latino and Asian American Study (Takeuchi) 2095 Asian Americans nationwide Overall lifetime rate of any disorder = 17.3% 12 month rate = 9.19% Men – poor English proficiency had higher rates Women – native born had higher rates than immigrants of most disorders Source: Takeuchi, DT et al. Immigration-related factors and mental disorders among asian americans. Am J Public Health; Jan 2007; 97, 1.
Depression CAPES Study – 1993-1994 1700 Chinese Americans LA 6.9% lifetime prevalence dep. 16.9% in national sample adults Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.
Suicide Lester 1994: suicide rates per 100,000 Caucasian 12.8 Asian Americans overall 7.0 Japanese American 9.1 Chinese American 8.3 Filipino American 3.5 1999 DHHS - APA women > 65 have highest suicide mortality rate of all groups Young women from southern India? Source: Mental Health: Culture, Race, and Ethnicity US Dept Health Human Services 2001.
Suicides in young people in rural southern India Worldwide suicide rate in 2000: 14.5 per 100,000 Vellore India– population 108,000 10 year mortality rates 1992-2001 for age group10-19 Female suicides: 152 per 100,000 Male suicides: 69 per 100,000 Source: Aaron et al. Suicides in young people in rural southern India. Lancet 2004. 363:1117-18.
PTSD Southeast Asia Cambodia Khmer Rouge > 1.5 million deaths 1975-1979 Vietnam War 1965-1973 US soldiers: > 58,000 killed ~5 million dead – all sides 50% population homeless 1/5 farmland & forests devastated Source: Beiser, Psychological Medicine, 2004
PTSD in SE Asian Refugees Blair 2000 – Cambodian American community sample N = 124 45% PTSD Kroll et al. 1989: 404 SE Asian refugees initial psych eval 73% major depression 14% PTSD 6% anxiety & somatoform disorder
New PTSD generation? Indonesia Thailand Sri Lanka Maldives India
Intimate Partner Violence China – 13% of new moms had experienced IPV Boston Chinese Am. Women 181 women survey 1996-1997 42% knew an abused Chinese woman 14% had experienced IPV themselves Conflicts with relatives, alcohol Source: Hicks, Madelyn Hsiao-Rei. Prevalence and characteristics of intimate partner violence in a community study of Chinese American women. J Interpersonal Violence Vol 21 No 10, October 2006, 1249-1269.
IPV: South Asian Women How common? 2 in 5 ever had sexual/physical IPV 208 Boston S.A. women (91% immigrant) 21% reported IPV in current relationship Victims at higher risk of: Poor physical health Depression & suicidal ideation Anxiety Source: Himelfarb Hurwitz, EJ et al. Intimate partner violence associated with poor health outcomes in US South Asian Women. J of Immigrant & Minority Health, Vol. 8, No. 3, July 2006.
II. Underutilization Underrepresented in mental health clinics Seattle 1977 – 1 st documented LA County 1991 – similar results Treatment delay? Controversial 1982 study longer treatment delay than African Americans & Caucasians 2000 study by Okazaki in LA – average delay 17.34 months
III. Barriers to Care Language Lack of culturally competent practitioners Stigma
A. Language Barriers 61.9% of APA are foreign born APA population speaks over 100 languages and dialects Linguistically isolated households Definition Breakdown: 35% Asian Americans 61% Hmong, 56% Cambodian, 52% Laotian, 44% Vietnamese, 41% Korean, 40% Chinese
B. Culturally competent practitioners 1998 study: 70 APA mental health providers available per 100,000 Asian Americans in US (1/2 ratio caucasians) Utilization rates increased in outpatient centers tailored to Asian Americans
C. Stigma Stigma against mental illness in APA community Leads to lower utilization May delay treatment
IV. Solutions Language – CLAS guidelines 1964 Civil Rights Act Title VI CLAS standards 2000 Free Written & verbal rights No minors Stigma – Education More culturally competent mental health practitioners
V. What you can do Remain culturally sensitive Attitude Knowledge Skill Advocate in your family and your community Use the model minority Educate others Refer
In conclusion Confucius says: “I hear and I forget I see and I believe I do and I understand”