APA Expert Opinion
An APA expert answers common questions about mental health

Surinder S. Nand, M.D.,Professor of Clinical Psychiatry, Associate Director, Psychiatry Residency Training and Education Program University of Illinois at Chicago and Chair of APA Committee of Asian American Psychiatrists, answers questions about mental health within the Asian American/Pacific Islander community.

Q1. Why should we be concerned about the mental health of Asian Americans/Pacific Islanders (AAPI’s) in the U.S.?

The population of the Asian Americans and Pacific Islanders in the U.S. is rapidly growing. It is estimated that by 2020 their population it will reach 20 million. Asian Americans and Pacific Islanders are a very diverse group and includes over 40 different nationalities.

Asian Americans /Pacific Islanders have many strengths in its diverse community, including; family cohesion, spirituality, academic excellence, willingness to work hard and motivation for upward mobility. However, difficulty with the English language and culture conflict are two major reasons that make it hard for the first generation AAPIs to go through a smoother acculturation process. This can lead to anxiety, grief, dissociation, and a longing for their native countries. Those who migrated because of political upheavals are considered refugees often suffer from Post Traumatic Stress Disorder.

The second generation Asian Americans and Pacific Islanders often take on the role of translators and drivers for older family members, leading to a role reversal. Peer pressure versus family expectations can lead to internal conflicts as well as conflict with family members.

Mental illness has a major stigma among Asian Americans and Pacific Islanders and as a result, they often do not seek mental health care.

Q2. How do Asian Americans/Pacific Islanders compare to other ethnic groups in mental health needs?

There is little research in mental health involving large numbers of AAPIs which make it difficult to ascertain the prevalence of mental illnesses in this ethnic group. In one particular study 30% of Asian Americans and Pacific Islanders girls in grades 5 through 12 reported depressive symptoms as compared to 17 % of African American girls, 27% Hispanics and 22% Caucasian girls. Native Hawaiian youth have significantly higher rates of suicide attempts as compared to other youth in Hawaii.

Southeast Asians have significant emotional and behavioral problems. Rates of poverty are fairly high in this group of Asian Americans. The rates of depression, anxiety and PTSD are 40 %, 35% and 14 % respectively among the Southeast Asian refugees.

Suicide rates among Chinese American elderly women are four times higher than those of white elderly women.

The majority of Asian Americans and Pacific Islanders tend to express emotional distress through somatic (or physical) symptoms, probably because Asian culture does not make a distinction between mind and body and tend to seek treatment from primary care physicians rather than mental health workers.

Q3. What are some of the key issues that affect Asian Americans and Pacific Islanders communities?  

Since mental illnesses carries enormous stigma, Asian Americans and Pacific Islanders often do not seek treatment. They remain hidden behind the veil of shame, secrecy and silence. Although considered a model society, there are significant problems like domestic violence and gambling in this community.

Some of the risk factors for domestic abuse in this group include social isolation, unemployment or underemployment leading to financial insecurity, trauma of immigration, breakdown of the traditional family structure, patriarchal and hierarchical family structure, and substance abuse. Asian Americans and Pacific Islander women often do not report domestic abuse because of certain cultural norms where suffering is seen as a value, endurance and acceptance of fate.

Q4. Where can I get more information on Asian Americans and Pacific Islanders health issues?

There are a variety of excellent resources available regarding Asian Americans and Pacific Islanders mental and general health, including:

• National Asian American Pacific Islander Mental Health Association (NAAPIMHA)
• Asian & Pacific Islander American Health Forum (APIAHF)
• National Asian Women’s Health Organization

For information about Asian American Pacific Islander Mental Health, please contact the Office of Minority and National Affairs at omna@psych.org or call (703) 907-7300.

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