Rita Chi-Ying Chung

Predictors of psychological distress among southeast Asian refugees

This paper analyzed data from one of the first needs assessment projects on a representative non-clinical population of Southeast Asian refugees in the United States in order to test two hypotheses: (1) whether or not premigration experiences still have an effect on psychological distress beyond the initial resettlement period and (2) whether or not interethnic group differences existed in the predictors of psychological distress between three Southeast Asian refugee groups, the Vietnamese, Cambodians and Lao. The results of the analysis of 2180 subjects supported both hypotheses. Regardless of ethnicity and the number of years in the U.S., premigration trauma events and refugee camp experiences were significant predictors of psychological distress even 5 years or more after migration and significant group differences in the types of postmigration distress predictors were also found. Acculturation concerns for the Vietnamese and Lao were influenced by both premigration and postmigration variables. In contrast, the primary concerns of the Cambodians were still related to premigration issues. The results also indicated that Vietnamese and Lao women were more likely to experience distress than their male counterparts, but no gender differences emerged for the Cambodians. Age predicted distress for Vietnamese and Cambodians, but not Lao. Similar to previous findings in the literature, Cambodians reported the highest levels of distress, followed by Lao and then Vietnamese. Interpretations of these results for this community sample are proposed.

Interpretation of symptom presentation and distress. A Southeast Asian refugee example.

Symptom expression or the manifestation of distress is greatly influenced by ones cultural background. This exploratory study investigated symptom presentation of distress among a community sample of Vietnamese, Chinese-Vietnamese, Cambodian, and Lao refugees. The study examined whether or not the Western-designed distress measure used in the study was culturally sensitive enough to accurately capture culturally framed expressions of distress. The results of the factor analyses showed that the four Southeast Asian refugee groups did not express distress in three separate factors as devised in the original measure. Instead, a single robust factor emerged. The single factor comprised items from the depression, anxiety, somatic, and psychosocial dysfunction subscales. The items that made up the single factor strongly resemble the construct for the diagnosis of neurasthenia. Researchers have found neurasthenia to be a culturally sanctioned Asian cultural idiom of distress. The findings strongly suggested that this Southeast Asian refugee population expressed distress in a pattern of symptoms more consistent with Asian nosology. The clinical and research implications of the results of this exploratory study axe also discussed.

Help-seeking behavior among Southeast Asian refugees

This study examined the help-seeking behavior of Vietnamese, Cambodians, Lao, Hmong, and Chinese-Vietnamese refugees and compared the help-seeking patterns employed by these groups in their native country with those currently used after resettlement in the United States. There were three major findings: (1) intergroup differences in help-seeking behavior were found in Asia and also in the United States. In Asia, Vietnamese were more likely to utilize Western medicine and the Hmong least likely to do so. In the United States, Cambodians were more likely to utilize mainstream services and again the Hmong were less likely to do so; (2) for all groups there was a dramatic change from prominently utilizing traditional medicine in their home country to a higher usage of mainstream services in the United States; (3) regardless of the significant increase in the use of Western medicine, traditional medicine continued to be important for all five Southeast Asian refugee groups after resettlement. Furthermore, subjects from all five groups reported the use of a dual health care system both in Asia and the United States. The implications of these findings for community services and health care providers are discussed.

A paradigm for culturally based care in ethnic minority populations

Health care practitioners are encouraged to “know the cultures” of the multicultural client population they are serving in the United States. The premise behind this injunction is that the use of culturally sensitive techniques that are tailored to the cultural background of the client would result in effective therapy and produce positive outcomes. However, as reflected in the plethora of terms used to describe the application of this knowledge, it is not made explicit why culture would make a difference in therapy nor how it makes a difference, ultimately, in the outcome. The intent of this paper is to highlight one of the fundamental sources of variation in cultural beliefs that affect individual mental health. We propose a model that penetrates to the core of why culture makes a difference in how problems are perceived and appropriate responses defined. Humans have three basic needs: safety and security, integrity, and a sense of belonging. Yet each culture uniquely frames each of these needs and prescribes the sanctioned means to achieve them. In our struggle to define culturally competent or culturally based care, this fundamental aspect is often overlooked. Instead, the Western worldview, structure, and definitions are used as the template to assess dysfunction, diagnose a disorder, and prescribe appropriate care. The theoretical underpinnings of indigenous concepts of self and symbolic interactionism are integrated to clarify these cultural misconceptions and to construct a new paradigm for providing effective and acceptable mental health care.

Teaching Multicultural Group Counseling: Perspectives for A New Era

The demographics in the United States are rapidly changing. Despite these well-documented shifts in ethnicity and race, there remain gaps in the research, practice, and training that address relevant multicultural issues in group counseling. This article addresses the challenges in incorporating multicultural issues in training group counselors, and discusses socio-ecological and cross-cultural considerations in teaching multicultural group work. The article also provides recommendations for teaching multicultural group counseling.

The effects of welfare status on psychological distress among Southeast Asian refugees

It has been established in the general population that there is a relationship between welfare status and psychological well-being. There are few studies, however, which investigate the effects of welfare dependency on Southeast Asian refugees, a population that is highly dependent on welfare. This study examined the relationship between welfare status and psychological well-being among Vietnamese, Cambodian, Laotian, and Hmong refugees. The study compared three welfare groups: those who have never been on welfare, those who were once dependent on welfare and are no longer on welfare, and those who are still welfare-dependent. The results supported three hypotheses: a) a high percentage of all four refugee groups were still dependent on welfare even after being in the United States for an average of 5 to 6 years, b) a significant relationship was found between welfare dependency and psychological distress, and c) dependence on welfare had long-term effects for all four groups. An interesting finding that emerged for the Vietnamese, Cambodians, and Laotians was that individuals who were once on welfare but who are no longer receiving welfare benefits are at similar risk as their counterparts who are currently on welfare of developing psychological distress. The findings therefore showed that for this population, if individuals had been touched by welfare at any period in their lives, they were at risk of developing psychological distress. There was an unexpected different finding for the Hmong; individuals who were no longer on welfare were more at risk than those who continued to receive or never had received welfare. Reasons for the intergroup differences and why refugees tended to stay on welfare longer than the general population were explored, along with a discussion about the implications of the findings for refugee policy.

Gender differences in psychological distress among Southeast Asian refugees

The focus of this study was to examine gender differences in levels and predictors of psychological distress in a community sample of Southeast Asian refugees. Although previous studies with clinical samples of Southeast Asian refugees have found gender differences in the degree of psychological distress, the few community-based studies have been inconclusive. This community study found that there were gender differences in the predictors of distress and that refugee women reported significantly higher levels of psychological distress than their male counterparts. Implications of the findings are discussed.

Mental health research on Asian Americans

Because of the dramatic increase in the ethnic diversity of Americans and the shrinking world in which international contacts are commonplace, our society is confronted by problems and issues associated with race/ethnic relations. In the fields of community psychology and community mental health, ethnic diversity has posed challenges and opportunities, as well as problems. How can we better understand the cultural, experiential, and psychological sense of different ethnic communities? What means can be found to facilitate ethnic and racial harmony? What kinds of prevention and intervention strategies can be used to promote the well-being, growth, and development of individuals from diverse ethnic groups?

Toward a New Paradigm: A Cultural Systems Approach

Alice was unclear of her destination. Persons suffering from mental illness are often in the same state. However, even when the client is from an ethnic group different than that of the therapist, the therapist often presumes the European American clinical strategies are universally effective and therefore assumes the client wishes to travel down the same road and towards the same destination that the therapist has been trained to travel. Rarely does the therapist or researcher assess the appropriateness of the assumed destination or the means to get there beyond translating the existing road signs into the appropriate language.

Health insurance coverage among Chinese Americans in Los Angeles County.

OBJECTIVES This paper examines the factors associated with health insurance coverage among Chinese Americans in Los Angeles County. METHODS Data were obtained through interviews conducted in 1993 and 1994 with Chinese Americans (aged 18 through 65 years) residing in Los Angeles County. A multistage probability sample was used to select respondents. RESULTS The final sample consisted of 1747 respondents, which represented an 82% response rate. Thirty-nine percent of the respondents in the survey were without health insurance at the time of the survey. CONCLUSIONS Logistic regression analysis showed that marital status, length of residence in the United States, education, employment, and household income were associated with health insurance coverage among Chinese Americans.