Mental Health Stigma Among Korean Immigrants: Role of Culture and De-Stigmatization Strategies

Purpose: Despite the apparent need for mental health services, Korean immigrants are consistently among those with low rates of utilization of such services. Cultural values, such as saving face and a strong stigma attached to mental illness, have been documented as prominent factors in low service utilization, which precipitates a downward cycle of worsening symptoms and delayed treatment. While some information exists regarding how cultural values and beliefs intersect with mental health stigma, little is known about how that stigma is manifested and how to develop effective anti-stigma programs for Korean immigrants living in the United States. To address this gap, this pilot study was aimed at answering the following research questions: 1) How do Korean immigrants view people with mental illness? 2) How do cultural values influence these views? 3) How can mental illness be destigmatized in the Korean immigrant community?

Methods: In this qualitative study with an exploratory design, purposeful sampling and semi-structured focus group interviews were used. Three focus groups were conducted with 18 community informants in the Bay Area of California. Of participants, 61.1% were female, and the average age was 64.94 (SD = 11.37). The focus groups were conducted in Korean, recoded, and translated. Back-translation and cross-examinations of the English transcription were performed to ensure the accuracy, credibility, and consistency of translation.

Results: Content analysis yielded the following key findings, categorized into four main themes with corresponding sub-themes: (1) stigmatizing beliefs (being dangerous and out-of-control or abnormal), (2) stigmatizing behaviors (willingness to impose social distance and restrictions), (3) Confucian cultural values (saving face and familism), and (4) step-by-step community education about mental health in the Korean language. The findings show that the Korean American community holds strong stigmatizing attitudes toward people with mental illness, perceiving them as dangerous, out of control, and abnormal. Such prevalent public stigma can create practical disadvantages for individuals with mental illness and their family members. For example, widely accepted misconceptions about the dangerousness and unpredictability of people with mental illness seem to be associated with a preference for increased social distance and are often used to justify further stigmatization and restrictions of those living with mental illnesses. In addition, Korean immigrants have a desire for more information about mental illness, and acknowledge that the tendency to save face inhibits those with mental illness from seeking help.

Discussion: The findings point to the urgent need to ameliorate the stigma attached to mental illness within the Korean community. This study shows that traditional educational methods (e.g., workshops, public forums) may not be effective to deliver an anti-stigma program to the Korean community. Instead, a step-by-step, less obvious approach with in-group association (e.g., ethnic local media) should be a key strategy when developing an anti-stigma program addressing mental illness among Korean immigrants. Developing anti-stigma programs for particular cultural contexts could produce effective, wide-reaching programs that tackle the mental health disparity among Koreans and other people from various cultural and ethnic backgrounds.