Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting

Abstract

Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients’ illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants’ illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.

Perceptions of stigma and its correlates among patients with major depressive disorder: A multicenter survey from China

“…Subjects of MDD in our sample showed a mean stigma score of 17 ± 9, basically consistent with the mean score of 16 ± 8 observed in an earlier study (Chen et al, ) evaluating the EMIC stigma scores in 190 depressed Chinese American immigrants and the mean stigma score of 19.7 ± 7.2 in another study (Chowdhury et al, ) conducted in MDD patients in India. Together, these studies suggest a high stigma level in Asian MDD populations.…”

“…The EMIC has been confirmed to have good validation and reliability for the investigation of stigma in cross-cultural applicability, as shown in the studies of onchocerciasis in Nigeria (Brieger, Oshiname, & Ososanya, 1998), MDD (Chowdhury et al, 2001), leprosy (Van Brakel et al, 2012), and mental health and HIV (Stevelink, Van Brakel, & Augustine, 2011) in India. A study (Chen, Hung, Parkin, Fava, & Yeung, 2015) had applied EMIC to examine the illness beliefs of MDD patients among Chinese American immigrants. These patients showed a high stigma level; nearly half of them reported they would conceal the name of their problem from others.…”

Depression‐linked beliefs in older adults with depression

“…Mental illness, such as depression, is said to be influenced by illness beliefs formed based on cultural and individual values (Chen, Hung, Parkin, Fava, & Yeung, ; Juhasz, Eszlari, Pap, & Gonda, ; Syrén & Hultsjö, ). Illness beliefs bolster disease and distress (Wright & Bell, ).…”

Treatment recommendation differences for schizophrenia and major depression: a population-based study in a Vietnamese cohort

“…In various studies, schizophrenia was perceived as the more severe mental disorder [ 51 – 53 ] followed by alcohol abuse, anxiety disorders and lastly depression, a perceived hierarchy that persists also in the Vietnamese context [ 22 ]. Contrasting to schizophrenia, causes of depression, especially in the Asian cultural sphere, were perceived as being rooted in psychosocial or interpersonal related stressors rather than in biochemical dysbalances, [ 22 , 54 – 56 ], thus interpersonal treatment providers were more often favoured. These differences between causal beliefs about schizophrenia and depression could also account for the substantial difference in recommendation between schizophrenia and depression for psychiatrists in Vietnam.…”

“…At the same time, self-help strategies and person of trust were recommended more frequently for the depression than for the schizophrenia vignette. Chen and colleagues [ 54 ] reported that 75% of Asian American participants with depression endorsed self-management as favorable over pharmacological interventions. The authors also embedded the findings in the understanding of the etiology of depression as being of psychosocial rather than biochemical origin [ 54 ].…”