Abstract
Focusing on diverse ethnic groups of Asian Americans, the present study examined the prevalence, ethnic variations, and predictors of stigmatizing beliefs about depression (beliefs that associate depression with a sign of weakness, shame to the whole family, and family disappointment, and beliefs that antidepressant medicines are addictive). Data were drawn from 2609 participants (age range 18–98) in the 2015 Asian American Quality of Life survey that includes Chinese, Asian Indian, Korean, Vietnamese, Filipinos, and other Asians. Results of a series of logistic models indicated that age, gender, ethnicity, length of stay in the U.S., English proficiency, and acculturation were significantly associated with stigmatizing beliefs about depression. Ethnic variations in beliefs were also observed. Implications for research and practice are discussed.
Similar content being viewed by others
References
Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review,31(6), 934–948.
Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C. N., Takeuchi, D., … & Meng, X. L. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264–1272. https://doi.org/10.1176/appi.ps.59.11.1264
Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Services Research,15(1), 542. https://doi.org/10.1186/s12913-015-1191-7.
Beiser, M. (1999). Strangers at the gate: The “Boat People’s” first ten years in Canada. Toronto, ON: University of Toronto Press.
Carney, R. M., Freedland, K. E., Miller, G. E., & Jaffe, A. S. (2002). Depression as a risk factor for cardiac mortality and morbidity: A review of potential mechanisms. Journal of Psychosomatic Research,53(4), 897–902. https://doi.org/10.1016/s0022-3999(02)00311-2.
Chen, S. X., & Mak, W. W. (2008). Seeking professional help: Etiology beliefs about mental illness across cultures. Journal of Counseling Psychology,55(4), 442–450. https://doi.org/10.1037/a0012898.
Cheng, H. L., Wang, C., McDermott, R. C., Kridel, M., & Rislin, J. L. (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling & Development,96(1), 64–74. https://doi.org/10.1002/jcad.12178.
City of Austin. (2017). Asian american quality of life. Retrieved May 5, 2019, from http://austintexas.gov/sites/default/files/files/Communications/4.2_FINAL_AA_in_Austin_report_from_UT.pdf.
Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services,63(10), 963–973. https://doi.org/10.1176/appi.ps.201100529.
Dalky, H. F. (2012). Mental illness stigma reduction interventions: Review of intervention trials. Western Journal of Nursing Research,34, 520–547. https://doi.org/10.1177/0193945911400638.
Deen, T. L., & Bridges, A. J. (2011). Depression literacy: Rates and relation to perceived need and mental health service utilization in a rural American sample. Rural Remote Health,11(4), 1803.
Fancher, T. L., Lee, D., Cheng, J. K. Y., Yang, M. S., & Yang, L. (2014). Interventions to improve adherence to psychotropic medication in clients of Asian descent: A systematic review. Asian American Journal of Psychology,5(1), 22–34.
Fancher, T. L., Ton, H., Le Meyer, O., Ho, T., & Paterniti, D. A. (2010). Discussing depression with Vietnamese American patients. Journal of Immigrant and Minority Health,12(2), 263–266. https://doi.org/10.1007/s10903-009-9234-y.
Fogel, J., & Ford, D. E. (2005). Stigma beliefs of Asian Americans with depression in an internet sample. The Canadian Journal of Psychiatry,50(8), 470–478. https://doi.org/10.1177/070674370505000807.
Givens, J. L., Houston, T. K., Van Voorhees, B. W., Ford, D. E., & Cooper, L. A. (2007). Ethnicity and preferences for depression treatment. General Hospital Psychiatry,29(3), 182–191. https://doi.org/10.1016/j.genhosppsych.2006.11.002.
Han, M., Cao, L., & Anton, K. (2015). Exploring the role of ethnic media and the community readiness to combat stigma attached to mental illness among Vietnamese immigrants: The pilot project Tam An (Inner Peace in Vietnamese). Community Mental Health Journal,51(1), 63–70. https://doi.org/10.1007/s10597-014-9745-4.
Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine,11(3), 353–363. https://doi.org/10.1080/13548500600595327.
Ho, S. C., Jacob, S. A., & Tangiisuran, B. (2017). Barriers and facilitators of adherence to antidepressants among outpatients with major depressive disorder: A qualitative study. PLoS ONE,12(6), e0179290. https://doi.org/10.1371/journal.pone.0179290.
Islam, N. S., Khan, S., Kwon, S., Jang, D., Ro, M., & Trinh-Shevrin, C. (2010). Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: Historical challenges and potential solutions. Journal of Health Care for the Poor and Underserved,21, 1354–1381. https://doi.org/10.1353/hpu.2010.0939.
Jang, Y., Chiriboga, D. A., & Okazaki, S. (2009). Attitudes toward mental health services: Age-group differences in Korean American adults. Aging and Mental Health,13(1), 127–134. https://doi.org/10.1080/13607860802591070.
Jimenez, D. E., Bartels, S. J., Cardenas, V., & Alegría, M. (2013). Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. International Journal of Geriatric Psychiatry,28(10), 1061–1068. https://doi.org/10.1002/gps.3928.
Jung, H., von Sternberg, K., & Davis, K. (2016). Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure. Psychiatry Research,243, 278–286. https://doi.org/10.1016/j.psychres.2016.06.034.
Kim, H. S., Sherman, D. K., Ko, D., & Taylor, S. E. (2006). Pursuit of comfort and pursuit of harmony: Culture, relationships, and social support seeking. Personality and Social Psychology Bulletin,32(12), 1595–1607. https://doi.org/10.1177/0146167206291991.
Kim, B. S., Yang, P. H., Atkinson, D. R., Wolfe, M. M., & Hong, S. (2001). Cultural value similarities and differences among Asian American ethnic groups. Cultural Diversity and Ethnic Minority Psychology,7(4), 343–361.
Kramer, E. J., Kwong, K., Lee, E., & Chung, H. (2002). Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine,176(4), 227–231.
Lannin, D. G., Guyll, M., Vogel, D. L., & Madon, S. (2013). Reducing the stigma associated with seeking psychotherapy through self-affirmation. Journal of Counseling Psychology,60(4), 508–519. https://doi.org/10.1037/a0033789.
Lee, S., & Jang, Y. (2016). Factors associated with willingness to use mental health services in Korean immigrants. Social Work in Public Health,31(3), 196–203. https://doi.org/10.1080/19371918.2015.1125319.
Leong, F. T. L., Kim, H. H. W., & Gupta, A. (2011). Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face. Asian American Journal of Psychology,2(2), 140–153. https://doi.org/10.1037/a0024172.
Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research,3(4), 201–214. https://doi.org/10.1023/A:1013177014788.
López, G., Ruiz, N. G., & Patten, E. (2017). Key facts about Asian Americans, a diverse and growing population. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/08/key-facts-about-asian-americans/.
National Institute of Mental Health (2017). Major depression. Retrieved May 5, 2019, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml.
Nieuwsma, J. A., Pepper, C. M., Maack, D. J., & Birgenheir, D. G. (2011). Indigenous perspectives on depression in rural regions of India and the United States. Transcultural Psychiatry,48(5), 539–568.
Pandya, C., McHugh, M., & Batalova, J. (2011). Limited English proficient individuals in the United States: Number, share, growth, and linguistic diversity. Washington, DC: Migration Policy Institute.
Park, N. S., Jang, Y., & Chiriboga, D. A. (2018). Willingness to use mental health counseling and antidepressants in older Korean Americans: The role of beliefs and stigma about depression. Ethnicity & Health,23(1), 97–110. https://doi.org/10.1080/13557858.2016.1246429.
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs,2(4), 328–335.
Sayegh, P., & Knight, B. G. (2013). Crosscultural differences in dementia: the Sociocultural Health Belief Model. International Psychogeriatrics, 25(4), 517–530.
Substance Abuse and Mental Health Services Administration. (2015). Racial/ethnic differences in mental health service use among adults. HHS Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.integration.samhsa.gov/MHServicesUseAmongAdults.pdf.
Sue, S., Cheng, J. K. Y., Saad, C. S., & Chu, J. P. (2012). Asian American mental health: A call to action. American Psychologist,67(7), 532.
Sun, F., Gao, X., & Coon, D. W. (2015). Perceived threat of alzheimer’s disease among chinese american older adults: The role of alzheimer’s disease literacy. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 70(2), 247–257. https://doi.org/10.1093/geronb/gbt095.
U.S. Census Bureau. (2012). The Asian population: 2010. Retrieved May 5, 2019, from https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf.
Wong, Y. J., Kim, S.-H., & Tran, K. K. (2010a). Asian Americans’ adherence to Asian values, attributions about depression, and coping strategies. Cultural Diversity and Ethnic Minority Psychology,16(1), 1–8. https://doi.org/10.1037/a0015045.
Wong, Y. J., Tran, K. K., Kim, S. H., Van Horn Kerne, V., & Calfa, N. A. (2010b). Asian Americans’ lay beliefs about depression and professional help seeking. Journal of Clinical Psychology,66(3), 317–332. https://doi.org/10.1002/jclp.20653.
World Health Organization (2018). Key facts. Retrieved from http://www.who.int/en/news-room/fact-sheets/detail/depression
Wu, I. H., Bathje, G. J., Kalibatseva, Z., Sung, D., Leong, F. T., & Collins-Eaglin, J. (2017). Stigma, mental health, and counseling service use: A person-centered approach to mental health stigma profiles. Psychological Services,14(4), 490–501. https://doi.org/10.1037/ser0000165.
Yeung, A., Shyu, I., Fisher, L., Wu, S., Yang, H., & Fava, M. (2010). Culturally sensitive collaborative treatment for depressed Chinese Americans in primary care. American Journal of Public Health,100(12), 2397–2402. https://doi.org/10.2105/AJPH.2009.184911.
Funding
The support for data collection was provided by the City of Austin’s Asian American Quality of Life initiative (Contract No. 26-8275-39, PI–Yuri Jang, Ph.D.).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no known conflicts of interest. All authors certify responsibility.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jung, H., Cho, Y.J., Rhee, MK. et al. Stigmatizing Beliefs About Depression in Diverse Ethnic Groups of Asian Americans. Community Ment Health J 56, 79–87 (2020). https://doi.org/10.1007/s10597-019-00481-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-019-00481-x