Mental health is an extremely important, but commonly overlooked health topic in Asian American (hereafter, AA) youths. The 2005 Centers for Disease Control and Prevention's ‘10 Leading Causes of Death’ [1
] highlights significant mental health disparities among racial/ethnic groups. Among females 15–24 years old, Asian Americans and Pacific Islanders (AAPIs) have the highest rate of suicide deaths (14.1%) compared to other racial/ethnic groups (White 9.3%, Black 3.3%, and Hispanic 7.4%) [1
]. AAPI males in the same age range have the second highest rate of suicide deaths (12.7%) compared to other racial/ethnic group males in the same age range (White 17.5%, Black 6.7%, and Hispanic 10%) [1
]. Although the recent Virginia Tech shooting incident serves as a reminder of the tragic consequences of untreated mental health problems in youth, these statistics point to the large numbers of youths whose lives are severely impaired by mental health problems but do not come to the attention of the public.
Despite alarming suicide rates and other indicators of mental health problems such as depression, this issue continues to be ignored in AAs in general, and particularly in AA youths. Traditional Asian culture suggests that mental health problems exist because one cannot control oneself, and therefore it is considered shameful to reveal that one has mental health problem or to seek help. Consequently, AAs oftentimes hide the problem because they fear the associated stigma. AA youths may experience additional challenges that stem from their position as 1.5 or 2nd generation immigrants (we define 2nd generation as people who were born in the U.S., 1.5 generation as immigrants who came to the US before age 16, and 1st generation as immigrants who came to the U.S. when they were 16+ years old) [Kim D, 2008, Personal communication]. Since the level of acculturation differs from that of their parents' generation or their non-immigrant friends at school, it often creates stressful situations for them in daily life. However, the difficulties of this generation are rarely recognized and addressed. Considering the significance of untreated mental health concerns for AA and their potentially negative impact on the larger society (e.g., Virginia Tech shooting), it is critical to identify factors affecting mental well-being and mental health care utilization in this group.
In a survey of 1,130 Korean American students aged from 18–29, authors reported negative mental health outcomes associated with the dual pressure of cultivating one's Korean background and values while minimizing one's Korean background in order to adapt to the more individualistic culture of America [2
]. In the Patterns of Youth Mental Health Care in Public Service Systems Survey of 1,715 youths age 6–17, parents expressed that American culture and prejudice/racial discrimination were contributing to the problem behaviors of their children [3
]. Another study of 217 Korean American students (age 13– 18) in Los Angeles reported that ethnic identity (a sense of belonging and positive attachments to one's ethnic groups) was a significant predictor of internalizing and externalizing problems, and perceived discrimination had a stronger positive relationship with adolescents' externalizing problems [4
Previous studies have demonstrated the relationship between perceived discrimination and depressive symptoms [5
] and substance use [6
] among Filipino Americans, and perceived discrimination was also associated with poor mental health [7
] and decreased use of mental health services [8
] among Chinese Americans. Discrimination may lead to sadness which impacts worldview, discrimination may-decrease feelings of control and impact self esteem, and/or discrimination may lead to internalizing negative stereotypes [9
]. In a study of 2,047 participants using the National Latino and Asian American Study, authors found that self-reported racial discrimination was associated with greater odds of having any DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) disorder, depressive disorder, or anxiety disorder within the past 12 months, controlling for sociodemographic characteristics, acculturative stress, family cohesion, poverty, self-rated health, chronic physical condition, and social desirability. Physical health attenuated but did not eliminate effect of discrimination on mental disorders, and social desirability did not play a role in explaining the association [9
A national survey reported that AA children aged 18 and younger were less likely than Whites, Blacks, and Hispanics to receive mental health care [10
]. In a recent study of 2,095 AAs aged 18 years and older, rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation [11
]. Nearly half of AAs have difficulty accessing mental health services because they do not speak English or cannot find services that meet their language needs [12
]. Approximately 70 AA providers are available to every 100,000 AAs in the United States, compared to 173 White providers per 100,000 Whites [12
]. No reliable information is available regarding the Asian language capabilities of mental health providers in the United States. One study found that only 17% of AAs experiencing mental health problems sought care [12
]. Among AAs, the severity of disturbance tends to be high, perhaps because AAs tend to delay seeking treatment until symptoms reach crisis proportions. Shame and stigma are believed to figure prominently in the lower utilization rates of mental health services in AA communities [13
Most previous studies reviewed above used a survey design to collect information. Although surveys explore the breadth of the issues and provide an overall trend, they lack in-depth information. Moreover, most studies examined this matter in one or a few subgroups of Asian Americans that have larger population. Therefore, findings from underrepresented groups are rarely presented. Our study tried to fill this gap by investigating the problem with focus groups in eight different Asian American groups including four underrepresented groups (underrepresented group is defined as people who originated from the Asian countries other than the major six Asian subgroups that are included in the Census (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese)).
This study was a part of the Health Needs Assessment project carried out in 2007 by The University of Maryland School of Public Health research team in collaboration with Center for Asian Health of Temple University, Johns Hopkins School of Public Health, and Asian American community leaders in Montgomery County, Maryland. Through this project, we visited 13 AA communities (Asian Indian, Burmese, Cambodian, Chinese, Filipino, Indonesian, Japanese, Korean, Nepali, Pakistani, Taiwanese, Thai, and Vietnamese), and held 19 focus groups with 174 participants who were age 18 and above. It was during these focus groups that we learned that mental health was one of the most important health concerns for community participants, especially adolescents and young adults who are 1.5 or 2nd generations (12 communities out of 13 communities brought up mental health as one of the top health concerns in their communities). In response to the importance of mental health issues to the community, our research team performed two separate focus groups to specifically discuss mental health concerns. Since our Internal Review Board (IRB) approval for the initial focus groups was only for adults (18 years old and older), we were not able to include adolescents in these mental health focus groups. Nevertheless, we recruited young adults (18– 30 years old) to discuss their current mental health-related experiences as well as those of adolescent period.