enculturation and stigma against mental illness in … · intro rol rqs/ hypotheses methods results...

ENCULTURATION AND STIGMA AGAINST MENTAL ILLNESS IN AN ASIAN AMERICAN/PACIFIC ISLANDER POPULATIONEdison Ho

Introduction Purpose:

1. Relationship - AAPI enculturation + attitudes towards mental illness?

2. Other factors?

3. Implications for AAPI mental health interventions

IntroROLRQs/ HypothesesMethodsResultsDiscussionConclusionThanksBiblio

The AAPI Population

• Diverse across sociodemographic levels

– Average household income similar to Caucasians, poverty levels higher (U.S. Census,

2010)

• Need for mental health services same as other groups (Lowe, 1991)

• Cultural values (Erickson, 2014)

– Place importance on community, ‘face’, and ‘standing-status’

– Central to AAPI cultural construct

h t t p : / / w w w . s t o r e b r a n d s . in f o / s it e s / d e f a u lt / f i le s / s t y le s / a r t ic le - f u l l / p u b l ic / S B / A s ia n F a m ily . j p g ? it o k = d X p r k 4 V L


KEEPING THE CULTURAL VALUES, BEHAVIORS AND NORMS OF ONE’S INDIGENOUS CULTURE (KIM ET AL., 2001)

Not to be confused with acculturationCan influence AAPI help seeking (Kim and Abreu, 2001; Kim et al., 2001)


ENCULTURATION:

AAPIs + Mental Health

Services

•Lower rates of mental health service

use compared to Caucasian

Americans (Leong et al., 2001; Gudiño et al., 2008;

Lee et al., 2009; David, 2010)

•Commonly seek treatment only when

problems become very serious and/or

chronic (Uba, 1994; Torch and Ma, 2000; Wilson and Erdur-

Baker, 2006; Yoshikawa, 2007)

•Stigma and shame major deterrents (Uba, 1994; Hughes, 2004; Miville and Constantine, 2007; Leong et

al., 2011, Yang et al, 2013)

h t t p : / / b lo g . d o c t o r o z . c o m / w p - c o n t e n t / u p lo a d s / 2 0 1 3 / 1 0 / b lo g - m e n t a l- h e a lt h - 6 3 8 x 4 2 5 . j p g

Intro

ROLRQs/ HypothesesMethodsResultsDiscussionConclusionThanksBiblio

AAPI + Mental Illness

Stigma

• Discussion of mental illness avoided (Leong et al., 2001)

• Model minority myth (Lowe, 1991)

– Shameful and embarrassing

• Can cause stigma and prejudice

• Pressure to keep quiet (Hanzawa et al., 2010)

h t t p : / / w w w . b u . e d u / t o d a y / 2 0 1 5 / m o d e l- m in o r it y - p r e s s u r e s - t a k e - m e n t a l- h e a lt h - t o l l /


Consequences of Stigma

• Increased self-stigma, lowered self-esteem, increased alienation (Ritsher and Phelan, 2004; Lysaker et al., 2007; Watson et al., 2007; Livingston et al. 2010)

• >> Decreased social function in society (Lysaker et al., 2007)

• Culturally specific– Unwillingness to label oneself as “mentally ill”

(Torsch and Ma, 2000 ; Thoits, 2011)


Research Questions

•What is the relationship in between AAPI enculturation and attitudes towards mental illness?•What other factors could influence

this correlation?


Hypotheses

• H0: AAPI enculturation does not show any correlation with AAPI families’ stigma toward mental illness and/or disorders.

• H1: AAPI enculturation shows a positive correlation with stigma toward mental illness and/or disorders.

• H2: Factors that influence this correlation include ethnicity, history of positive mental illness diagnosis, and education levels.


Participants • Contacting methods– Social media– Email - request distribution– Cultural centers

• Restrictions– Full/partial AAPI ethnic background and

upbringing– 14+– Home zip code in United States


Survey • Cross-sectional• National-level online survey - Google

Forms• Ethical considerations

– Approval to conduct study through my high school

– Consent/assent form


InstrumentsSociodemographic

questionnaire

Gender, age, education, ethnicity, household

incom e, zip code, U.S. citizenship status,

em ploym ent

Clinical variables

Mental illness history, treatm ent status,

obstacles faced acquiring treatm ent


Instruments Cont.

• The Attribution Questionnaire (AQ) - 9

items (Brown, 2008)

– Mental illness stigma

• Asian American Values Scale-

Multidimensional (AAVS-M) - 42

items (Kim et al., 2005)

– Enculturation

• Behavioral Risk Factor Surveillance

System (BRFSS) - 2 items (CDC, 2014)

– Risk factors for mental illness

• Kessler 6-Scale (self administered) - 6

items (Kessler et al., 2003)

– Psychological distress

Intro

ROLRQs/ HypothesesMethodsResultsDiscussionConclusionThanksBiblio

Instruments Cont.AAVS-M AQ


Participants • 240 contacted• 190 participants -> 176 valid responses

– 14 responses excluded - <98 percent response rate for the AQ or AAVS-M

• Overall response rate = 73.33%


Data Analysis

• Microsoft Excel

• AAVS-M (enculturation) and AQ (mental illness stigma) analyzed

1. Data/subgroupcleaning and recoding

2. Aggregate + subgroup summary scores of AAVS-M and AQ

3. Correlation calculation

4. PCA (principal component analysis) + question weightings


About Principal

Component Analysis

• Variance on responses of individual questions >> principal component

• 1st principal component explains most of variance

• Why?

– Some questions more statistically important than others than contributing to validity of measure

– More accurate measure

– Shown to be effective in other studies (Suykens

et al., 2003; Vyas and Kumaranayake, 2006)


ResultsFigure 1: Unweighted correlation between AQ and AAVS-M summary scores

Figure 4: Weighted correlation between AQ and AAVS-M summary scores

Table 1: Weighted and unweighted correlation of AAVS-M and AQ summary scores

r2 N p-value Significant 1% Confirms H1?

unweighted 24.69% 176 0.000955 0.000955 Yes

weighted 26.06% 176 0.0004777 0.0004777 Yes

ResultsFigure 2: Factor Loadings of 1st Principal Component of AAVS-M.

ResultsFigure 3: Factor Loadings of 1st Principal Component of AQ.

Table 2: Unweighted Summary Scores and Correlations For All Subgroups.

Results

Table 3: Weighted Summary Scores and Correlations For All Subgroups.

Results

ResultsTable 4: Significant Correlations Without PC Analysis

Table 5: Significant Correlations With PC Analysis

Subgroup Subgroup # SubgroupCorrelation

Complement #

ComplementCorrelation

Subgroup vs. Complement Corr.

Fisher Z-score

1-Sided P-Score

Significant at 5%

Other (ethnicity)

53 5.57% 123 33.63% Lower than Complement

1.75 0.040 Yes

$0-75,000 40 1.77% 136 31.61% Lower 1.67 0.048 Yes

Subgroup Subgroup # SubgroupCorrelation

Complement # ComplementCorrelation

Subgroup vs. Complement Corr.

Fisher Z-score

1-Sided P-Score

Significant at 5%

Other (ethnicity)

53 4.10% 123 36.56% Lower than Complement

2.03 0.0212 Yes

$150,001 and up

48 56.20% 128 15.54% Higher 2.76 0.0029 Yes

50+ (age) 45 47.53 131 17.94% Higher 1.89 0.0294 Yes

Discussion • Significant positive correlation between enculturation and stigma toward mental illness• Similar studies conducted on

connections between willingness to see a counselor and acculturation (Kim

and Omizo, 2007; Baello and Mori, 2007; Gloria et al. 2008)

• Novel finding - first study to be conducted on enculturation and mental illness stigma


Discussion Cont.

Limitations

• Personal contact

• Confirmation bias

– Purposes had to be made clear in consent/assent form


Conclusion •Family environment hostile toward the mental illness of the patient >> Obstacle to treatment success•Treatment supplemented

with intervention and additional follow-up or monitoring


Future Research

• Better reporting for underreported subgroups•Multivariate models•Questionnaire correction• Target particular groups within

AAPI community for intervention•New area of research into

culturally-tailored mental health interventions


Acknowledgements

• My mentor Dr. Elyn Saks

• Mr. Inglis

• My high school science research program

• My parents and my aunt


(1996), The Influence of Cultural Individualism-Collectivism, Self Construals, and Individual Values on Communication Styles Across Cultures. Human Communication Research, 22: 510–543.

342–352. B. S. K., & Omizo, M. M. (2003). Asian cultural values, attitudes toward seeking professional psychological help, and willingness to see a counselor. The Counseling Psychologist, 31, 343–361.Andrews, G., & Slade, T. (2001). Interpreting scores of the Kessler Psychological Distress Scale (K10). Australian & New Zealand Journal of Public Health, 25(6), 494-497.

Atkinson, Donald R., and Ruth H. Gim. "Asian-American cultural identity and attitudes toward mental health services." Journal of Counseling Psychology 36.2 (1989): 209.Baello, Jon, and Lisa Mori. "Asian values adherence and psychological help-seeking attitudes of Filipino Americans." Journal of Multicultural, Gender and Minority Studies 1.1 (2007): 1-14.

Brown, Seth A. "Factors and measurement of mental illness stigma: A psychometric examination of the Attribution Questionnaire." Psychiatric Rehabilitation Journal 32.2 (2008): 89.Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014.David, E. J. R. "Cultural mistrust and mental health help-seeking attitudes among Filipino Americans." Asian American Journal of Psychology 1.1 (2010): 57.Erdur-Baker, Ozgur, et al. "Nature and severity of college students' psychological concerns: A comparison of clinical and nonclinical national samples." Professional Psychology: Research and Practice 37.3 (2006): 317.Erickson, Jennifer L. "Saving face, looking good, and building international reputation in East and West." Power in a Complex Global System. London: Routledge (2014): 180-193.Flores, Glenn, and Sandra C. Tomany-Korman. "The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children." Pediatrics 121.6 (2008): e1703-e1714.

Gloria, Alberta M., et al. "Adherence to Asian cultural values and cultural fit in Korean American undergraduates' help-seeking attitudes." Journal of Counseling & Development 86.4 (2008): 419-428.Gudiño, Omar G., et al. "Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type?." Journal of Emotional and Behavioral Disorders (2008).Hanzawa, Setsuko, et al. "Personal stigma and coping strategies in families of patients with schizophrenia: Comparison between Japan and Korea." Asia-Pacific Psychiatry 2.2 (2010): 105-113.Hughes, Claire K. "Factors associated with health-seeking behaviors of Native Hawaiian men." Pac Health Dialog 11.2 (2004): 176-82.Johnson, Richard Arnold, and Dean W. Wichern. Applied multivariate statistical analysis. Vol. 5. No. 8. Upper Saddle River, NJ: Prentice hall, 2002.Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population Archives of General Psychiatry. 60(2), 184-189.Kim, B. S. K., & Abreu, J. M. (2001). Acculturation measurement: Theory, current instruments, and future Handbook directions. of multicultural In J. G. Ponterotto, counseling (2 J. and M. ed., Casas, pp. 394–424).

Kim, B. S. K., Atkinson, D. R., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current knowledge and directions for future research. The Counseling Psychologist, 29, 570–603.Kim, Bryan SK, and Michael M. Omizo. "Asian cultural values, attitudes toward seeking professional psychological help, and willingness to see a counselor." The Counseling Psychologist 31.3 (2003): 343-361.Lee, Sunmin, et al. "Model minority at risk: Expressed needs of mental health by Asian American young adults." Journal of community health 34.2 (2009): 144-152.Leong, Frederick TL, and Anna SL Lau. "Barriers to providing effective mental health services to Asian Americans." Mental health services research 3.4 (2001): 201-214.Leong, Frederick TL, and Zornitsa Kalibatseva. "Cross-cultural barriers to mental health services in the United States." Cerebrum 5 (2011): 2011.Livingston, James D., and Jennifer E. Boyd. "Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis." Social science & medicine 71.12 (2010): 2150-2161.Lowe, Lisa. "Heterogeneity, hybridity, multiplicity: marking Asian American differences." Diaspora: A Journal of Transnational Studies 1.1 (1991): 24-44.

Lysaker, Paul H., et al. "Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months." Psychiatry Research 149.1 (2007): 89-95.Miville, Marie L., and Madonna G. Constantine. "Cultural values, counseling stigma, and intentions to seek counseling among Asian American college women." Counseling and Values 52.1 (2007): 2-11.

Press, William H. Numerical Recipes in Pascal: The Art of Scientific Computing. Cambridge: Cambridge UP, 1989. Print.Ritsher, Jennifer Boyd, and Jo C. Phelan. "Internalized stigma predicts erosion of morale among psychiatric outpatients." Psychiatry research 129.3 (2004): 257-265.

Rüsch, Nicolas, et al. "A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal." Schizophrenia research 110.1 (2009): 59-64.Stebnicki, Mark. A. "ASIAN." The Professional Counselor's Desk Reference (2008): 219.Suykens, Johan AK, et al. "A support vector machine formulation to PCA analysis and its kernel version." IEEE Transactions on neural networks 14.2 (2003): 447-450.

Thoits, Peggy A. "Resisting the stigma of mental illness." Social Psychology Quarterly 74.1 (2011): 6-28.Torsch, Vicki L., and Grace Xueqin Ma. "Cross-cultural comparison of health perceptions, concerns, and coping strategies among Asian and Pacific Islander American elders." Qualitative Health Research 10.4 (2000): 471-489.

Uba, Laura. Asian Americans: Personality Patterns, Identity, and Mental Health. New York: Guilford, 1994. Print.United States Census Bureau. "Poverty." Income, and Health Insurance in the United States: 2010. 2010. Web. 8 Jan. 2016.

Vyas, Seema, and Lilani Kumaranayake. "Constructing socio-economic status indices: how to use principal components analysis." Health policy and planning 21.6 (2006): 459-468.Watson, Amy C., et al. "Self-stigma in people with mental illness." Schizophrenia bulletin (2007).Yang, Lawrence H., et al. "Culture, threat, and mental illness stigma: identifying culture-specific threat among Chinese-American groups." Social Science & Medicine 88 (2013): 56-67.

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