1. Asian-American Mental Health Jason Cheng APAMSA Mental Health Coordinator

2. 2000 Census 11.9/281.4 million Asian(4.2%) –10.2 million only Asian (3.6%) –1.7 million Asian+other race(s) (0.6%) 43 ethnicities 100 languages Asian and Native American races separated

3. Surgeon General Says: Mental health fundamental to health and productivity Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2001.

4. Minority Mental Health Disparities Less access to services Less likely to receive needed services Decreased quality of care Underrepresented in research

5. Possible Reasons Doctor-patient communication even more vital than in other specialties Cost, fragmentation, low availability Mistrust and fear of discrimination

6. Asian American Access to Mental Health Care Almost half experience language barriers 21% lack insurance (vs. 16% all Americans) AA/PI providers proportionally < ½ whites Lower utilization regardless of gender, age, and location –only 17% who need help actually seek it

7. Asian American Mental Health Significant prevalence rates (CAPES study) –6.9% major depression –5.2% dysthmia More psychiatric symptoms of depression More somatic manifestations

8. Special populations AA/PI girls have higher incidence of depressive disorders than white girls Among women over 65 yo, Asian Americans have highest risk of suicide Refugees have a high incidence of PTSD Kim LS, Chun CA. Ethnic differences in psychiatric diagnoses among Asian American adolescents. J Nerv Ment Dis 1993;181:612-617 National Center for Health Statistics. Health, United States, 2006. Hyattsville, MD: US Public Health Service; 2006. Mental Health: Culture, Race and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, Office of the Surgeon General; 2001.

9. Why Asian-American women? Women in general have higher incidence of mood and anxiety disorders Traditional expectations differ from Western ideals of independence and achievement Expectation to withdraw from conflicts

10. Cultural Factors I Stigma of Mental Illness –Familial shame –Lower chances of employment, marriage Provider Stigma –Asians supposedly more mentally healthy –Providers less comfortable overcoming cultural barriers to talk about mental health Chung, H. The challenges of providing behavioral treatment to Asian Americans. WJM. 2002;176:222-223.

11. Cultural Factors II Diagnostic complexity –Non-classic somatic presentations Language and culture –Self vs. society –Body vs. mind –Culture-bound syndromes such as neurasthenia

12. Cultural Factors III Expectations of patients –Doctor is authority, not partner –Family is involved in healthcare Traditional treatments –Unknown effects –Potential drug-drug interactions

13. Lower required psychotropic doses Slower activity of P-450 isoenzymes –CYP2D6J mutation Traditional neuroleptics Tricyclic antidepressants –CYP2C19 mutation: diazepam Increased responsiveness of lithium receptors Lin, KM and Cheung FK. Mental Health Issues for Asian Americans. Psychiatric Services. 1999;50:774-780.

14. Research Diversity makes research difficult Few large studies available Chinese American Psychiatric Epidemiological Study National Latino & Asian American Study Primary Care Research in Substance Abuse and Mental Health for the Elderly

15. Specialized Program in NYC Primary Care & Mental Health Bridge Program –Patients more likely to accept mental health care in primary care setting –Bilingual / bicultural staff with special training –Community education Seitz, PM. Building a bridge between two cultures of care. WJM. 2002;176:220-221.

16. Results Increased detection of disorders and utilization of resources Decreased delay between onset of symptoms and seeking treatment Federal “Models that Work” winner –Similar programs in Boston, NY, LA, SF, Portland, Seattle

17. APAMSA Contacts National Asian American Pacific Islander Mental Health Association APA Committee of Asian American Psychiatrists –Yujuan Choy, M.D., Columbia Relevant Research –Francis Lu, M.D., UCSF