Patching a hole in health care

In 2001, when Yu Mui Wan was a doctoral student at the Harvard Graduate School of Education, she came across evidence of a hole in the medical care of Chinese-Americans. Wan, who is now a Switzer Fellow at the Sargent College Center for Psychiatric Rehabilitation (CPR), was coordinating a study at the New England Medical Center of depression among Chinese-Americans aged 18 to 65 who visited their primary care doctors. 

“What we found,” she says, “is among the 500 adult Chinese-Americans we surveyed, 10 percent of them had had depression in the past 12 months, and 41 percent had experienced depression in their lifetime.” 

Follow-up phone interviews after six months revealed that most of the patients identified with major depression disorder had received no antidepressant treatment.

By comparison to the numbers from the study of Chinese-Americans, 15 percent of Americans suffer from major depression at one point in their lives, according to the U.S. Department of Health and Human Services.

Now, five years later, Wan is trying to find ways to make sure that Chinese-Americans who are depressed get the care that they need. Recently awarded a Mary E. Switzer Fellowship from the National Institute on Disability Rehabilitation Research, she will conduct in-depth interviews with 20 Chinese-Americans who have depression, but have never received mental health services, or who have received mental health services before but are not receiving services at the time of the study.

“I am especially interested in how their understanding of depression, how their beliefs surrounding traditional Chinese medicine, and how levels of social support play out in deciding when and where they seek help for depression,” Wan says. Accordingly, in upcoming interviews for her latest study, she will talk to family members who are instrumental in the process of seeking help, exploring the dynamics surrounding decision-making.

Wan believes that Chinese-Americans are less likely to take advantage of the mental health system for several cultural reasons. She cites studies by Yu-Wen Ying, a professor at the School of Social Welfare at the University of California at Berkeley, which suggest that American culture sees the body and mind as two separate entities, while Chinese culture views the mind and body more holistically: physical illness and psychological illness cannot be separated. As a consequence, when depressed, Chinese-Americans tend to complain to their primary care physician about their physical symptoms, but do not seek mental health treatment. 

“Yu-Wen Ying states that these cultural differences lead to differences in conceptions of depression between Chinese and American cultures, and that Chinese Americans’ beliefs about depression are likely to be an integration of the body, the mind, and social relationships, and mainstream Americans tend to separate them,” says Wan.

Wan also points out that while individualism is the norm in American culture, collectivism and interdependence are key elements in Chinese culture. She suspects that Chinese-Americans may tend to avoid treatment because of fear of a stigma associated with depression.

“According to my conversations with subjects during the follow-up interviews of the study I coordinated at the New England Medical Center,” she says, “stigma does play a critical role in avoiding treatment among Asian-Americans, including Chinese-Americans. A recent study comparing Asian-Americans’ and whites’ beliefs associated with depression treatment among friends, employers, and family found that Asian-Americans had significantly greater stigma beliefs than their white counterparts in all stigma outcomes, especially those related to family.”

Wan also sees two other common belies among Chinese-Americans that may contribute to their reluctance to seek treatment. One, she says, is the belief that western medications are too strong for them. Another is the widespread opinion that talking about problems is not helpful, so treatment that involves psychotherapy is not given consideration.

Wan, who was a postdoctoral fellow at CPR in 2003 and 2004, says that she has been moved by the dedication of the center’s researchers, training staff, and service staff in their efforts to improve the lives of people with psychiatric disabilities.

“This experience has strengthened my interest in studying Chinese-Americans with depression,” she says. “I hope my research can contribute to increasing the knowledge base of Asian mental health and the improvement of mental health services for Asian-Americans with depression and other psychiatric disorders.”