Chinese American Stigma Reduction Project

May is not only Mental Health Matters Month, but also Asian Pacific American Heritage Month. According to the 2014 U.S. Census, 19 million people in the U.S. identify as Asian/Pacific Islander (API) with the overwhelming majority of the API community  (6 million people) living in California.

Nearly 13.9 percent of the API community is reported to be living with a mental health condition and face critical issues such as less access to treatment, language barriers, and higher levels of stigma. Historical, cultural, philosophical, and religious values that are deeply held by many (and in particular, first-generation) Chinese Americans, such as “loss of face (or honor),” contribute to severe stigma for mental health challenges in this group.

To address this barrier, a Chinese American stigma reduction project was recently conducted here in California by Lawrence Yang, Ph.D., faculty at Columbia University Mailman School of Public Health, in collaboration with the Alameda County Behavioral Health Care stigma reduction campaign “Everyone Counts” operated by PEERS in Oakland.

We talked with Dr. Yang to learn more about this project and its potential impact for the Chinese American community in California:

Q: What are the goals of the project, and why is it important?

A: The primary objectives of our project are to implement a new stigma group curriculum to cope with experienced discrimination, reduce internalized stigma, and to improve social support among Chinese Americans with serious mental health challenges in the Bay Area. This intervention is the first of its kind to reduce stigma among Chinese Americans.

Q: Who participated in the study?

A: Two 14-session groups have been completed to reduce stigma in this group, with 13 individuals total participating. First-generation Chinese Americans with experiences of depression and psychosis were targeted for this group because they experience severe culture-specific forms of stigma, such as “loss of face” and “loss of social exchange networks.”

Q: What are the findings of your research?

A: Main results indicated that the key stigma concept of, ‘Self-respect loss due to Stereotypes’ (e.g., ‘I currently respect myself less because I am unable to work’) changed significantly from pre-to post-assessment. Also, group members’ social contact increased from pre- to post-intervention on all four measures (being close to family members, spending time with others, talking with friends/relatives on the phone, and attending social meetings).

Q: What impact did you see from the project and what will happen with this new approach?

A: Some consumers disclosed for the first time the mental health challenges they had been facing regarding experiences they had not even disclosed to their family members.  Most striking, 7 individuals out of the 13 either returned to work or volunteering after participating in our groups, which indicates that our groups helped people to successfully reintegrate with the community. Also, several individuals who had not formally joined the mental health treatment system decided to do so after participating in these groups.

This novel intervention is the first to show substantial decreases in stigma, increased social support, and increased work and social integration among Chinese American mental health consumers. This model might be used to reduce stigma among other Chinese (Mandarin- and English-speaking) groups, and other Asian American groups.


 

Lawrence H. Yang, Ph.D., focuses on research in several key areas of psychiatric epidemiology. First, from his NIMH K-award, he has formulated defining theoretical work on how culture relates to stigma and implementing interventions to improve recovery for different stigmatizing conditions (mental illness and HIV), with a focus on Chinese groups. Second, Dr. Yang is PI of a 5-year NIMH R01 grant examining the neurocognitive and social cognitive underpinnings of the new “clinical high risk state for psychosis” designation, a potentially transformative new syndrome to detect psychotic signs before symptoms develop into a full psychotic disorder. Third, Dr. Yang has incorporated these research areas into his work in global mental health. He has 75 publications, including publications in Psychological Medicine, the British Journal of Psychiatry and The Lancet. Dr. Yang has received eight Early Career Awards, six of which are national, for his work.

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