Abstract
Little is known about Asian Americans treated for serious psychiatric disorders in the public mental health system. We characterized 75 Asian Americans seen at community mental health centers for a diagnosis of schizophrenia spectrum disorder to anticipate likely clients and gain insights into their service needs. Participants completed in-person interviews and self-report questionnaires on their demographic and social characteristics. The ethnically diverse sample featured mostly foreign-born individuals with long-standing schizophrenia. Findings highlighted participants’ differential experience of social adversities and stressful events, but also revealed salient cultural resources that shielded some from the social sequelae of schizophrenia. Recovery-oriented mental health programs staffed by culturally and linguistically compatible providers remain key to engaging this marginalized population in service. Findings also uphold a holistic management of schizophrenia spectrum disorder among racial and ethnic minorities, taking into account the complex social needs of afflicted individuals.
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Alegría, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X.-L., et al. (2004). Considering context, place, and culture: The National Latino and Asian American Study. Internal Journal of Methods and Psychiatric Research, 13, 208–220. https://doi.org/10.1002/mpr.178.
Barreto, R. M., & Segal, S. P. (2005). Use of mental health services by Asian Americans. Psychiatric Services, 56, 746–748. https://doi.org/10.1176/appi.ps.56.6.746.
Brekke, J. S., Prindle, C., Bae, S. W., & Long, J. D. (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services, 52, 1358–1366. https://doi.org/10.1176/appi.ps.52.10.1358.
Brislin, R. W. (1980). Translation and content analysis of oral and written materials. In H. C. Triandis & J. W. Berry (Eds.), Handbook of cross-cultural psychology: Methodology (pp. 389–444). Boston, MA: Allyn & Bacon.
Cervantes, R. C., Padilla, A. M., Napper, L. E., & Golbach, J. T. (2013). Acculturation-related stress and mental health outcome among three generations of Hispanic adolescents. Hispanic Journal of Behavioral Sciences, 35, 451–468. https://doi.org/10.1177/0739986313500924.
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., et al. (2018). Global epidemiology and burden of schizophrenia: Findings from the Global Burden Disease Study 2016. Schizophrenia Bulletin, 44, 1195–1203. https://doi.org/10.1093/schbul/sby058.
Chuang, H. T., Williams, R., & Dalby, J. T. (1987). Criminal behavior among schizophrenics. Canadian Journal of Psychiatry, 32, 255–258. https://doi.org/10.1177/070674378703200401.
Cohen, S., Tyrrell, D. A., & Smith, A. P. (1993). Negative life events, perceived stress, negative affect, and susceptibility to the common cold. Journal of Personality and Social Psychology, 64, 131–140. https://doi.org/10.1037/0022-3514-64-1-131.
Colby, S. L., & Ortman, J. M. (2015). Projections of the size and composition of the U.S. population: 2014 to 2060. Washington, DC: U.S. Census Bureau.
Durvasula, R., & Sue, S. (1996). Severity of disturbance among Asian American outpatients. Cultural Diversity and Mental Health, 2, 43–51. https://doi.org/10.1037/1099-9809.2.1.43.
Gong, F., Xu, J., Fujishiro, K., & Takeuchi, D. T. (2011). A life course perspective on migration and mental health among Asian immigrants: The role of human agency. Social Science and Medicine, 73, 1618–1626. https://doi.org/10.1016/j.socscimed.2011.09.014.
Harry, B., & Steadman, H. J. (1989). Arrest rates of patients treated at a community mental health center. Psychiatric Services, 39, 862–866. https://doi.org/10.1176/ps.39.8.862.
Hiday, W. A., Swartz, M. S., Swanson, J. W., Borum, R., & Wagner, H. R. (1999). Criminal victimization of persons with severe mental illness. Psychiatric Services, 50, 62–68. https://doi.org/10.1176/ps.50.1.62.
Jeste, D. V., Palmer, B. W., Appelbaum, P. S., Golshan, S., Gloriosa, D., Dunn, L. B., et al. (2007). A new brief instrument for assessing decisional capacity for clinical research. Archives of General Psychiatry, 64, 966–974. https://doi.org/10.1001/archpsyc.64.8.966.
Kane, J. M., Leucht, S., Carpenter, D., & Docherty, J. P. (2003). Expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: Methods, commentary, and summary. Journal of Clinical Psychiatry, 64(Suppl. 12), 5–19.
Kim, B. S. K., & Omizo, M. M. (2003). Asian cultural values, attitudes toward seeking professional psychological help and willingness to see a counselor. Counseling Psychologists, 31, 343–361. https://doi.org/10.1177/0011000003031003008.
Kinzie, J. D., & Tseng, W.-S. (1978). Cultural aspects of psychiatric clinical utilization: A cross-cultural study in Hawaii. International Journal of Social Psychiatry, 24, 177–188. https://doi.org/10.1177/002076407802400305.
Koenig, H. G., & Büssing, A. (2010). The Duke University Religion Index (DUREL): A five-item measure for use in epidemiological studies. Religions, 1, 78–85. https://doi.org/10.3390/rel1010078.
Kung, W. (2003). The illness, stigma, culture, or immigration? Burdens on Chinese American caregivers of patients with schizophrenia. Families in Society, 84, 547–557. https://doi.org/10.1606/1044-3894.140.
Lafayette, J. M., Frankie, W. G., Pollock, A., Dyer, A., & Goff, D. C. (2003). Clinical characteristics, cognitive functioning, and criminal histories of outpatients with schizophrenia. Psychiatric Services, 54, 1635–1640. https://doi.org/10.1176/appi.ps.54.12.1635.
Levkoff, S. E., Levy, B. R., & Weitzman, P. F. (2000). The matching model of recruitment. Journal of Mental Health & Aging, 6, 29–38.
Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M., Rosenheck, R. A., Perkins, D. O., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209–1223. https://doi.org/10.1056/NEJMoa051688.
Lueck, K., & Wilson, M. (2010). Acculturative stress in Asian immigrants: The impact of social and linguistic factors. International Journal of Intercultural Relations, 34, 47–57. https://doi.org/10.1016/j.ijintrel.2009.10.004.
McEvoy, J. P. (2007). The costs of schizophrenia. Journal of Clinical Psychiatry, 68, 4–7.
Mohr, S., Borras, L., Nolan, J., Gillieron, C., Brandt, P.-Y., Eytan, A., et al. (2012). Spirituality and religion in outpatients with schizophrenia: A multi-site comparative study of Switzerland, Canada, and the United States. International Journal of Psychiatry in Medicine, 44, 29–52. https://doi.org/10.2190/PM.44.1.c.
National Institute of Mental Health. (2009). Schizophrenia (NIH Publication No. 09-3517). Retrieved from http://www.nimh.nih.gov/health/publications/schizophrenia/nimh-schizophrenia-booklet.pdf.
Newport, F. (2016, Dec 23). Five key findings on religion in the U.S. Retrieved from http://www.gallup.com/poll/200186/five-key-findings-religion.aspx.
Nuechterlein, K. H., Subotnik, K. L., Turner, L. R., Ventura, J., Becker, D. R., & Drake, R. E. (2008). Individual placement and support for individuals with recent-onset schizophrenia: Integrating supported education and supported employment. Psychiatric Rehabilitation Journal, 31, 340–349. https://doi.org/10.2975/31.4.2008.340.349.
Okazaki, S. (2000). Treatment delay among Asian-American patients with severe mental illness. American Journal of Orthopsychiatry, 70, 58–64. https://doi.org/10.1037/h0087751.
Pew Research Center (2013, April 4). The rise of Asian Americans. Retrieved from http://www.pewsocialtrends.org/2012/06/19/the-rise-of-asian-americans/.
Robertson, G., Pearson, R., & Gibb, R. (1996). The entry of mentally disordered people to the criminal justice system. British Journal of Psychiatry, 169, 172–180. https://doi.org/10.1192/bjp.169.2.172.
Rumbaut, R. G. (2004). Ages, life stages, and generational cohorts: Decomposing the immigrant first and second generations in the United States. International Migration Review, 38, 1160–1205. .
Shin, C.-N., Dirksen, S. R., & Suh, B. (2017). Acculturative stress in Korean Americans. Applied Nursing Research, 38, 70–75. https://doi.org/10.1016/j.apnr.2017.09.010.
Stueve, A., Vine, P., & Struening, E. L. (1997). Perceived burden among caregivers of adults with serious mental illness: Comparison of Black, Hispanic, and White families. American Journal of Orthopsychiatry, 67, 199–209. https://doi.org/10.1037/h0080223.
Sue, S., Fujino, D. C., Hu, L.-T., Takeuchi, D. T., & Zane, N. W. S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59, 533–540. https://doi.org/10.1037/0022-006x.59.4.533.
Takeuchi, D. T., Hong, S., Gile, K., & Alegría, M. (2007). Developmental contexts and mental disorders among Asian Americans. Research in Human Development, 4, 49–69. https://doi.org/10.1080/15427600701480998.
Tepper, L., Rogers, S. A., Coleman, E. M., & Malony, H. N. (2001). The prevalence of religious coping among persons with persistent mental illness. Psychiatric Services, 52, 660–665. https://doi.org/10.1176/appi.ps.52.5.660.
Tsai, J., Stroup, T. S., & Rosenheck, R. A. (2011). Housing arrangements among a national sample of adults with chronic schizophrenia living in the United States: A descriptive study. Journal of Community Psychology, 39, 76–88. https://doi.org/10.1002/jcop.20418.
Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36, 360–376. https://doi.org/10.2307/2137325.
U.S. Census Bureau. (2016). Asian/Pacific American heritage month: May 2016 (Report No. CB16-FF.07). Retrieved from https://www.census.gov/newsroom/facts-for-features/2016/cb16-ff07.html.
U.S. Census Bureau. (2017). American Community Survey 1-year estimates. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk.
Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771–778. https://doi.org/10.1001/archpsyc.55.9.771.
Weisman, A. G., Nuechterlein, K. H., Goldstein, M. J., & Snyder, K. S. (1998). Expressed emotion, attributions, and schizophrenia symptom dimensions. Journal of Abnormal Psychology, 107, 355–359. https://doi.org/10.1037/0021-843X.107.2.355.
Wheaton, B. (1994). Sampling the stress universe. In W. Avison & I. Gotlib (Eds.), Stress and mental health: Contemporary issues and prospects for the future (pp. 77–114). New York: Plenum Press.
White, M. C., Chafetz, L., Collins-Bridge, G., & Nickens, J. (2006). History of arrest, incarceration and victimization in community-based severely mentally ill. Journal of Community Health, 31, 123–135. https://doi.org/10.1007/s10900-005-9005-1.
Acknowledgement
This research was supported by the Okura Mental Health Scholarship awarded to Caroline Lim by the Asian Pacific Islander Social Work Educator Association. Funding from the University of Southern California Suzanne Dworak-Peck School of Social Work supported the article preparation. The authors gratefully acknowledge the contributions of mental health providers and study participants. The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.
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Lim, C., Hernandez, M., Gaona, L. et al. A Sociodemographic Profile of Asian Americans Served in Community Mental Health Centers for a Diagnosis of Schizophrenia Spectrum Disorder. Adm Policy Ment Health 46, 555–567 (2019). https://doi.org/10.1007/s10488-019-00935-0
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DOI: https://doi.org/10.1007/s10488-019-00935-0