Cultural factors influencing the mental health of Asian Americans.

Culture and MedicineCultural factors influencing the mental health of Asian Americans Asian Americans are the fastest growing racial group in the United States.They are also one of the most diverse, including at least 43 different ethnic groups who speak more than 100 languages and dialects (box 1).The Asian American population in the United States has grown from fewer than 1 million (0.5% of the total US population) in 1960 to 7.2 million (2.9%) in 1990, to 10,242,998 (3.7%) in 2000.This number is expected to double by 2025.Approximately 7.2 million (70.7%) Asian Americans are foreign born, and Asian immigrants account for 2.6% of the total US population. 2 KEY CULTURAL FACTORS THAT INFLUENCE MENTAL HEALTHCulture influences the Asian health belief system and has an effect on the diagnosis and treatment of mental disorders.Several key cultural factors that are relevant to this process are described below.However, there is tremendous cultural variability among groups and heterogeneity within groups.These factors will have differing effects, depending on the individual's degree of acculturation, socioeconomic status, and immigration status.Our emphasis here is on new immigrants, who comprise 2.6% of the US population, 1 and those who are more traditionally oriented.We have chosen this focus because it is these patients who experience the greatest barriers to receiving mental health care.Key cultural factors are:• Language Knowledge of English is one of the most important factors influencing access to care.Asian languages and dialects usually are not widely spoken outside the individual's ethnic group and, depending on degree of acculturation, even within it.According to the President's Advisory Commission on Asian Americans and Pacific Islanders, 42% of Vietnamese American, 41% of Korean American, and 40% of Chinese American households are "linguistically isolated."This designation means that no one in the household age 14 years or older speaks English "very well." 4 • Level of acculturation Typically, it takes three generations for immigrants to fully adopt the lifestyle of the dominant culture.This interval is about the amount of time it takes to accept Western medical care more readily than traditional care.5 Box 1 Distribution of the Asian American/Pacific Islander population by subgroup reporting only one race in 2000* According to the 2000 census, the distribution of the Asian American and Pacific Islander population in the United States is as follows (Census Bureau 2001a): • Chinese (25.4%) • Filipino (19.3%) • Asian Indian (17.6%) • Vietnamese (11.7%) • Japanese (8.3%) • Korean (8.3%) • Other Asian (13.4%) • Pacific Islander (4.2%) *From US Bureau of the Census. 1 Summary points• Cultural factors, such as language, age, gender, and others, can influence the mental health of Asians, particularly immigrants• Traditional (adhering to native values) Asians place great value on the family as a unit.Each individual has a clearly defined role and position in the family hierarchy and is expected to function within that role, submitting to the larger needs of the family• Social stigma, shame, and saving face often prevent Asians from seeking behavioral health care• Asian patients are likely to express psychological distress as physical complaints