Asian Americans have been called the "model minority" because overall they have done well economically and have relatively low levels of social pathology. With regard to mental health, they show low overall rates of service utilization, leading to the speculation that they have lower rates of psychopathology. Sue, Sue, Sue, and Takeuchi (1995) have challenged this assumption, saying that from the information available at the time it was not possible to make accurate comparisons. Aside from the inclusion of small numbers Asian Americans in the ECA and NCS, and the larger sample in WANAHS, we have been able to locate only one large diagnostic community survey of Asian Americans. That is the Chinese American Psychiatric Epidemiological Study (Takeuchi et al., 1998). Most other studies are smaller, focus on specific Asian groups, and use symptom scales rather than diagnostic assessments. There are several possible reasons for the small number of diagnostic surveys in the U.S. Asian community. The first of these is the degree of cultural and linguistic difference among Asian cultures and the differences between them and the U.S. mainstream. This necessitates not only translation of instruments, but also some degree of adjustment to differing conceptions of mental disorder.
There are approximately twenty distinct groups designated as Asian. Another is the difficulty in developing sampling frames to identify persons distributed sparsely across larger communities. Thus, there is a tendency to focus on communities with larger Asian populations. Another reason is that a large proportion of Asians are recent immigrants from areas with differing recent histories. Many persons have come from Southeast Asia as refugees from Vietnam, Cambodia, and Laos, but each of these has a somewhat different experience and period of arrival. Within those coming from Vietnam are minority groups such as Hmong who have differing language, culture, and problems from the majority Vietnamese. All this has led studies to focus on particular groups that have been highly visible as refugees. Less visible have been the Chinese Americans, some of whom who have been in the United States for a century, whereas others are new waves of immigration from Hong Kong, Taiwan, and the Chinese mainland. A final factor making it difficult to do large Asian studies has been the reluctance of some Asian groups to permit intrusive questioning about mental illness, which is typically highly stigmatized. As a consequence of these reasons, there appear to be more attempts to conduct studies of Asians in Asia than in the United States. Examples are the study of Compton and colleagues (1991), which compared results from a survey in Taiwan to the ECA and found much lower rates for most disorders.
There are a number of studies that document symptoms among refugees and immigrants from southeast Asia. These have included the work by a number of investigators, including Kinzie, Westermeyer, and Beiser. Many studies have been conducted in conjunction with refugee-oriented treatment programs rather than being representative community samples. Many studies have used adaptations of standard symptom scales such as the SCL-90, the CES-D, and the Hopkins Symptom Checklist. In our own work with refugees, we have used a translation of the DIS with Vietnamese, although with a small sample (Holzer et al., 1988). Typically, the studies of refugee samples are able to document substantial trauma in the countries of origin. There is frequently additional trauma while a displaced person is in refugee camps. Adaptation to life in the United States is frequently an additional burden, with loss of status and economic means at the same time that one needs to adapt to a new culture. Thus, although rates of service utilization have been relatively low, higher symptom levels are often found than in other Asian groups or the U.S. population at large. Yet this is variable depending on the circumstances of becoming a refugee.
In marked contrast to most of the refugee studies is the Chinese American Psychiatric Epidemiological Study (CAPES, Takeuchi et al., 1998), a large survey of Chinese Americans in Los Angeles. Based on a community probability sample of 1747 Chinese Americans ages 18 to 65, CAPES interviewers were fluent in English and either Mandarin or Cantonese and administered translated versions of the CIDI. Results were weighted for the sampling probabilities.
The prevalence rates for major depression was 6.9% for lifetime and 3.4% for the past year (Takeuchi et al., 1998). The lifetime rates for dysthymia was 5.2%, whereas the 1-year prevalence was only 0.9%. These rates are much lower than found in either the NCS or the WANAHS, which used comparable instrumentation and slightly higher than the rates found in the ECA (see Table III).
Most other studies of Asians groups, such as the Chinese, Japanese, or Koreans, especially studies of those who have been in the United States for a longer time or have come as immigrants rather than refugees, report lower symptom levels than the rates for refugees or other U.S. groups. These findings fit into a more generalized understanding of Asian culture in which mental disorder is severely stigmatized. Deviations in psychological symptoms or functioning are often hidden or else seen in a more holistic view of health than the Western focus on psychological processes. Such views have been shown to influence patterns of help seeking and generally result in lower levels of utilization of Western-style mental health services.
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