The U.S. Surgeon General's report Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) was arguably the best single scholarly contribution on the mental health of ethnic minority groups in the United States. Over 10 years have now elapsed since its publication in 2001. This article highlights advances and illuminates gaps in the knowledge gained about the mental health and psychotherapeutic treatment of Asian Americans in the past decade. Though larger epidemiological surveys point to lower prevalence rates of mental illness in Asian Americans, further advances are needed in culturally valid assessment and quantification of cultural biases in symptom reporting in order to draw definitive conclusions about the state of Asian American mental health. A focus on prevalence in Asian Americans as a whole also shrouds important subgroup elevations such as heightened suicide risk in Asian elderly women or greater posttraumatic stress disorder in Southeast Asian refugees. Despite important developments in our knowledge about mental health prevalence, help-seeking behaviors, and culturally competent treatments for Asian Americans, it appears that troublingly low rates of service utilization still remain even when one accounts for the seemingly low prevalence rates among Asian Americans. Some progress has been made in the cultural adaptations of psychotherapy treatments for Asian Americans. In order to reduce mental health care disparities, greater efforts are needed to provide outreach at the community level and to bridge the gap between mental health and other medical or alternative health facilities. We call for innovation and provide recommendations to address these issues in the next decade.

Few studies have examined the role of culturally relevant factors in suicidal behavior among Asian Americans. Using the National Latino and Asian American Study (NLAAS) (Alegria et al., 2004;Heeringa et al., 2004), the current study examined the role of culturally related variables (family conflict, perceived discrimination, and ethnic identity) on suicidal ideation and suicide attempts in a nationally representative sample of 2,095 Asian Americans. Important covariates were sociodemographic characteristics (gender, age, marital status, years of education, household poverty, and nativity status), depressive and anxiety disorders, and number of chronic conditions. Gender related correlates were also explored. The lifetime prevalence of suicidal ideation and attempts was 8.8% and 2.5%, respectively. Female gender, family conflict, perceived discrimination, and the presence of lifetime depressive or anxiety disorders were positively correlated with suicidal ideation and attempts. A high level of identification with one's ethnic group was associated with lower rates of suicide attempts. Among Asian men, but not women, the presence of chronic medical conditions was associated with suicidal ideation. Findings highlight the contributions to suicide risk of cultural factors and gender differences in Asian Americans. Keywordssuicide; family conflict; discrimination; ethnic identity; Asian Americans Understanding risk factors for suicide is the first step in developing suicide prevention and intervention strategies for Asian Americans. Although Asian Americans are one of the most Correspondence concerning this article should be addressed to Janice Ka Yan Cheng, Department of Psychology, University of California, Davis, One Shields Avenue, Davis, CA 95616. jancheng@ucdavis.edu. NIH Public Access Author ManuscriptAsian Am J Psychol. Author manuscript; available in PMC 2010 October 13. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript rapidly growing ethnic groups in the United States, few empirical studies on suicide have been conducted on this population. It has been argued that Western theories and findings of suicide may not be generalizable to ethnic minorities in general and Asian Americans in particular. Leenaars (2008) and Lester (2008) highlighted the need for understanding suicide beyond the factors at the individual level. In recent years, researchers have proposed the use of the ecological model for understanding suicide, which emphasizes that behaviors are influenced by the interplay of individual, interpersonal, social, and cultural levels (Bronfrenbrenner, 1979). The model was first applied to understand child abuse, and most recently, it has been effectively applied to the study of suicide in Latina youths and African American adults (Kaslow et al., 2005;Zayas, Lester, Cabassa, & Fortuna, 2005). Demographic characteristics and psychopathology may contribute to suicidal behavior, but behaviors can also be influenced by interpersonal relationships in specific settings (e.g., fam...

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.

This article reports the development and psychometric properties of the Interpersonal Shame Inventory (ISI), a culturally salient and clinically relevant measure of interpersonal shame for Asian Americans. Across 4 studies involving Asian American college students, the authors provided evidence for this new measure’s validity and reliability. Exploratory factor analyses and confirmatory factor analyses provided support for a model with 2 correlated factors: external shame (arising from concerns about others’ negative evaluations) and family shame (arising from perceptions that one has brought shame to one’s family), corresponding to 2 subscales: ISI-E and ISI-F, respectively. Evidence for criterion-related, concurrent, discriminant, and incremental validity was demonstrated by testing the associations between external shame and family shame and immigration/international status, generic state shame, face concerns, thwarted belongingness, perceived burdensomeness, self-esteem, depressive symptoms, and suicide ideation. External shame and family shame also exhibited differential relations with other variables. Mediation findings were consistent with a model in which family shame mediated the effects of thwarted belongingness on suicide ideation. Further, the ISI subscales demonstrated high alpha coefficients and test–retest reliability. These findings are discussed in light of the conceptual, methodological, and clinical contributions of the ISI.

Mitochondrial creatine kinases form octameric structures composed of four active and stable dimers. Octamer formation has been postulated to occur via interaction of the charged amino acids in the N-terminal peptide of the mature enzyme. We altered codons for charged amino acids in the N-terminal region of mature sarcomeric mitochondrial creatine kinase (sMtCK) to those encoding neutral amino acids. Transfection of normal sMtCK cDNA or those with the mutations R42G, E43G/H45G, and K46G into rat neonatal cardiomyocytes resulted in enzymatically active sMtCK expression in all. After hypoosmotic treatment of isolated mitochondria, mitochondrial inner membrane-associated and soluble sMtCK from the intermembranous space were measured. The R42G and E43G/H45G double mutation caused destabilization of the octameric structure of sMtCK and a profound reduction in binding of sMtCK to the inner mitochondrial membrane. The other mutant sMtCK proteins had modest reductions in binding. Creatine-stimulated respiration was markedly reduced in mitochondria isolated from cells transfected with the R42G mutant cDNA as compared with those transfected with normal sMtCK cDNA. We conclude that neutralization of charges in N-terminal peptide resulted in destabilization of octamer structure of sMtCK. Thus, charged amino acids at the N-terminal moiety of mature sMtCK are essential for octamer formation, binding of sMtCK with inner mitochondrial membrane, and coupling of sMtCK to oxidative phosphorylation. Sarcomeric mitochondrial creatine kinase (sMtCK)1 is a member of a gene family of four homologous CK genes (1-4). The M-CK and B-CK genes encode soluble, cytoplasmic homodimeric enzymes necessary for ATP production from creatine phosphate at sites of high energy utilization, such as the contractile apparatus. These cytosolic CKs share about 85% similarity to each other in a particular species, and each has 77-91% homology among vertebrate species. Two additional genes encode different mitochondrial CKs, which are localized on the outer surface of the inner mitochondrial membrane (IMM) (2, 3). sMtCK expression is restricted to heart and skeletal muscle, but ubiquitous MtCK is present in many tissues, especially brain and smooth muscle. Mammalian MtCKs are only 60 -65% similar to cytosolic CKs and about 80% homologous to each other, but sMtCKs share 95% identity across species. This suggests that, in addition to enzymatic functions, ubiquitous MtCK and sMtCK may have slightly different structural roles requiring sequence conservation across species.We previously isolated and characterized cDNA clones encoding human (2, 3) and rat (7) MtCKs. The rat sMtCK cDNA coding region consists of 1260 nucleotides, and the first 117 bp encode the transit peptide, responsible for transport of de novo synthesized precursor sMtCK from cytosol into mitochondria. During this translocation of pre-sMtCK to the intermembranous space, the transit peptide is proteolytically removed, allowing formation of the active, mature subunit (2, 4).Both MtCK proteins can f...