Lawrence H. Yang

Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese-Americans.

In this study we examined community attitudes of efficacy and shame to investigate the factors that may underlie mental health service underutilization among Chinese Americans. We administered an experimental vignette to assess beliefs of efficacy and shame toward using traditional Chinese medicine (TCM) as opposed to Western health services in a sample of 90 Chinese Americans obtained through a national telephone survey. Contrary to predictions, beliefs of efficacy for treating mental disorders were found to be greater for Western psychiatric services when compared with TCM. As predicted however, Chinese Americans perceived greater community attitudes of shame when accessing Western psychiatric services as opposed to TCM to treat a mental disorder. Furthermore, these differences in community attitudes of shame only occurred among respondents who received a psychiatric condition vignette, but not with respondents who were administered a vignette of a physical disorder. These findings suggest that perceived shame may play an important role in help seeking and that integration of TCM with Western psychiatric care may have implications for reducing shame for Chinese Americans.

Culture, threat, and mental illness stigma: identifying culture-specific threat among Chinese-American groups.

We incorporate anthropological insights into a stigma framework to elucidate the role of culture in threat perception and stigma among Chinese groups. Prior work suggests that genetic contamination that jeopardizes the extension of ones family lineage may comprise a culture-specific threat among Chinese groups. In Study 1, a national survey conducted from 2002 to 2003 assessed cultural differences in mental illness stigma and perceptions of threat in 56 Chinese-Americans and 589 European-Americans. Study 2 sought to empirically test this culture-specific threat of genetic contamination to lineage via a memory paradigm. Conducted from June to August 2010, 48 Chinese-American and 37 European-American university students in New York City read vignettes containing content referring to lineage or non-lineage concerns. Half the participants in each ethnic group were assigned to a condition in which the illness was likely to be inherited (genetic condition) and the rest read that the illness was unlikely to be inherited (non-genetic condition). Findings from Study 1 and 2 were convergent. In Study 1, culture-specific threat to lineage predicted cultural variation in stigma independently and after accounting for other forms of threat. In Study 2, Chinese-Americans in the genetic condition were more likely to accurately recall and recognize lineage content than the Chinese-Americans in the non-genetic condition, but that memorial pattern was not found for non-lineage content. The identification of this culture-specific threat among Chinese groups has direct implications for culturally-tailored anti-stigma interventions. Further, this framework might be implemented across other conditions and cultural groups to reduce stigma across cultures.

Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples

BACKGROUND Prior research with racially/ethnically homogeneous samples has demonstrated widespread co-occurrence of psychotic experiences (PEs) and common mental health conditions, particularly multi-morbidity, suggesting that psychosis may be related to the overall severity of psychiatric disorder rather than any specific subtype. In this study we aimed to examine whether PEs are associated with the presence of specific disorders or multi-morbidity of co-occurring disorders across four large racially/ethnically diverse samples of adults in the USA. METHOD Data were drawn from the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and separately from the Asian and Latino subsamples of the National Latino and Asian American Study (NLAAS). Logistic regression models were used to examine the relationship between PEs and individual subtypes of DSM-IV disorder, and to test for a linear dose-response relationship between the number of subtypes and PEs. RESULTS Prevalence of PEs was moderately greater among individuals with each subtype of disorder in each data set [odds ratios (ORs) 1.8-3.8], although associations were only variably significant when controlling for clinical and demographic variables. However, the sum of disorder subtypes was related to odds for PEs in a linear dose-response fashion across all four samples. CONCLUSIONS PEs are related primarily to the extent or severity of psychiatric illness, as indicated by the presence of multiple psychiatric disorders, rather than to any particular subtype of disorder in these data. This relationship applies to the general population and across diverse racial/ethnic groups.

Public Stigma Associated With Psychosis Risk Syndrome in a College Population: Implications for Peer Intervention

OBJECTIVES This study compared stigma associated with the psychosis risk label and diagnostic labels for nonpsychotic and psychotic mental disorders among young adult peers. METHODS Urban college respondents (N=153) read an experimental vignette describing a young adult experiencing prodromal symptoms who was randomly assigned a diagnostic label (major depression, generalized anxiety disorder, schizophrenia, or psychosis risk with and without accurate information about the psychosis risk label) and answered questions about stigma toward the individual in the vignette. RESULTS Compared with labels for nonpsychotic disorders, schizophrenia elicited more negative stereotyping and the at-risk label invoked greater social distance and less willingness to help. Any increased social distance appeared to be reduced by accurate information about the at-risk state. No differences in stigma were found for the psychosis risk and schizophrenia labels. CONCLUSIONS The psychosis risk label alone appeared to evoke greater status loss and discrimination. Accurate information may minimize some stigmatizing attitudes among college peers.

Beliefs in traditional Chinese medicine efficacy among Chinese Americans: implications for mental health service utilization.

We examined how community attitudes towards traditional Chinese conceptions of health and Western dichotomization of illness might affect perceptions of traditional Chinese medicine (TCM) efficacy in order to identify factors underlying psychiatric service underutilization among Chinese-Americans. We administered an experimental vignette to assess perceived illness, severity, and beliefs of TCM efficacy for physical and psychiatric disorders among 90 Chinese-Americans ascertained through a national telephone survey. Perceived illness severity was unrelated to assessment of TCM effectiveness. However, psychiatric conditions tended to be viewed as distinct from physical disorders, and TCM use was endorsed as less effective for psychiatric illnesses when compared with physical illnesses. Furthermore, differences in perceived TCM efficacy appeared to be magnified among US-born respondents, with US-born respondents endorsing lower efficacy for psychiatric disorders than foreign-born respondents. These findings suggest that TCM use for psychiatric disorders may decrease with Westernization, but might delay access to psychiatric services among first-generation immigrants.We examined how community attitudes towards traditional Chinese conceptions of health and Western dichotomization of illness might affect perceptions of Traditional Chinese Medicine (TCM) efficacy to examine factors underlying psychiatric service underutilization among Chinese-Americans. We administered an experimental vignette to assess perceived illness severity and beliefs of TCM efficacy for physical and psychiatric disorders among 90 Chinese-Americans ascertained through a national telephone survey. Perceived illness severity was unrelated to assessment of TCM effectiveness. However, psychiatric conditions tended to be viewed as distinct from physical disorders, and TCM use was endorsed as less effective for psychiatric illnesses when compared with physical illnesses. Furthermore, differences in perceived TCM efficacy appeared to be magnified among U.S.-born respondents, with U.S.-born respondents endorsing lower efficacy for psychiatric disorders than foreign-born respondents. These findings suggest that TCM use for psychiatric disorders may decrease with Westernization, but might yet delay access to psychiatric services among first-generation immigrants.

Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States

Previous studies have shown variation in the prevalence and incidence of psychosis across immigrant groups, but the underlying mechanisms are not fully understood. Stress related to acculturation may increase risk for psychosis among immigrant groups. In this study we examine the association between acculturative stress and psychotic-like experiences in a sample of Latino- and Asian-American immigrants to the United States in the National Latino and Asian American Study (n=2434). Acculturative stress was associated with visual and auditory hallucinations among Asians, but only with hearing voices among Latinos. Increased risk for psychotic-like experiences among Latinos was primarily associated with younger age of immigration. Acculturative stress appears to be a promising candidate mechanism explaining the relationship between immigration and psychosis, particularly among Asian Americans. Ethnic differences may reflect variability between groups that integrate more readily into the host culture and those that are subject to greater discrimination and environmental adversity.

Perceived discrimination and psychotic experiences across multiple ethnic groups in the United States

OBJECTIVE The objective of this study was to examine the relationship between perceived discrimination and psychotic experiences (PE) using validated measures of discrimination and a racially/ethnically diverse population-level sample. METHODS Data were drawn from two population-level surveys (The National Latino and Asian American Survey and The National Survey of American Life), which were analyzed together using survey weights and stratification variables. The analytic sample (N=8990) consisted of Latino, Asian, African-American, and Afro-Caribbean adults living in the United States. Separate unadjusted and adjusted multivariable logistic regression models were used, first to examine the crude bivariate relationship between perceived discrimination and PE, and second to examine the relationship adjusting for demographic variables. Adjusted logistic regression models were also used to examine the relationships between perceived discrimination and specific sub-types of PE (auditory and visual hallucinatory experiences, and delusional ideation). RESULTS When compared to individuals who did not report any discrimination, those who reported the highest levels of discrimination were significantly more likely to report both 12-month PE (Adjusted OR=4.590, p<0.001) and lifetime PE (adjusted OR=4.270, p<0.001). This held true for visual hallucinatory experiences (adjusted OR=3.745, p<0.001), auditory hallucinatory experiences (adjusted OR=5.649, p<0.001), and delusional ideation (adjusted OR=7.208, p<0.001). CONCLUSION Perceived discrimination is associated with the increased probability of reporting psychotic experiences in a linear Fashion in the US general population.

Addressing Stigma Relating to Mental Illness in Low- and Middle-Income Countries

Mental health disorders (especially psychotic disorders such as schizophrenia) constitute the leading cause of disability-adjusted life years (DALYs) from all non-communicable diseases (1). These disorders relate to severe social, educational and occupational impairment, physical illness, and premature mortality (2). Approximately, three-quarters of the burden of mental illness comes from low- and middle-income countries (LMICs) (3). Governments from LMICs spend the lowest percentages on mental health worldwide (4). Most of these countries model their mental health systems based on care that is primarily delivered through psychiatric institutions. Hence, the implementation of community mental health models has been extremely difficult, given that attaining the additional funds required to establish outpatient services has frequently not been available in these countries. Additionally, human resources are limited and inequitably distributed. This explains why in LMICs more than 75% of people that require mental health care do not receive any kind of intervention (5). This statistic refers to the “treatment gap”: the proportion of people who need but do not receive care. The World Health Organization (WHO) has reported that the treatment gap for serious mental disorders is 35–50% in developed countries and 76–90% in LMICs (6). Stigma comprises a major problem related to help seeking in people with mental health difficulties in developing countries. Stigmatized individuals may anticipate devaluation and discrimination from others, leading them to adopt harmful coping mechanisms such as secrecy or withdrawal (7). Studies conducted in LMIC such as Ethiopia and India have reported this tendency, whereby consumers prefer to not disclose their problems or symptoms with health professionals or even with their own relatives (8). Such harmful coping strategies further obstruct effective treatment use. Several authors have recommended the implementation of national public education campaigns and local interventions to increase mental health literacy to reduce discrimination in these countries (9).

Comparing diagnostic methods for mental disorders in China

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Employment outcome for people with schizophrenia in rural v. urban China: population-based study

BACKGROUND Although outcomes among people with schizophrenia differ by social context, this has rarely been examined across rural v. urban settings. For individuals with schizophrenia, employment is widely recognised as a critical ingredient of social integration. AIMS To compare employment for people with schizophrenia in rural v. urban settings in China. METHOD In a large community-based study in four provinces representing 12% of Chinas population, we identified 393 people with schizophrenia (112 never treated). We used adjusted Poisson regression models to compare employment for those living in rural (n = 297) v. urban (n = 96) settings. RESULTS Although rural and urban residents had similar impairments due to symptoms, rural residents were three times more likely to be employed (adjusted relative risk 3.27, 95% CI 2.11-5.07, P<0.001). CONCLUSIONS People with schizophrenia have greater opportunities to use their capacities for productive work in rural than urban settings in China. Contextual mechanisms that may explain this result offer a useful focus for future research.