Vietnamese Family Caregivers of Persons with Mental Illness: Exploring Caregiving Experience within the Cultural Context

Purpose: Mental illness (MI) affects many areas of people’s lives, including their daily functioning, employment, relationships, and overall health. However, individuals with MI can recover with proper treatment and family involvement. Although family involvement has positive impacts on the recovery process of people with mental illness (PMI), existing studies show that family members of PMI experience chronic psychological and emotional distress, poor health, and decreased quality of life. These challenges tend to be even greater for Vietnamese immigrant families due to cultural values (e.g., familism) and stigma. However, very few empirical studies have addressed the caregiving experience of Vietnamese immigrant caregivers of PMI. To address this gap, this study was aimed at exploring the following question: How does cultural context influence caregiver distress among family caregivers of PMI in the Vietnamese immigrant community in the United States?

Methods: A phenomenological approach utilizing grounded theory was used to develop a framework for understanding how Vietnamese caregivers experience distress related to caring for PMI. The study participants were 21 Vietnamese family caregivers of PMI. The majority were female (76.2%), and their average age was 56 (SD = 13.00). All participants reported that they had immigrated to the United States and settled in California between 1980 and 2009. Focus groups were conducted in Vietnamese, and the transcripts were recoded, translated, and back-translated. In addition, cross-examinations of the English transcription were performed to increase the accuracy and consistency of translation across the bilingual researchers.

Results: Three main themes emerged from the thematic analysis of the transcripts: (1) the negative impact of caregiving on the Vietnamese immigrant caregivers’ overall well-being, including on their social and family life; (2) the influence of cultural and religious factors related to caregiving on caregivers; and (3) the stigma attached to mental health and its impacts on the caregiving experience. More specifically, participants shared that intensive monitoring of and constant exposure to PMI’s behaviors negatively impacted their emotional health and social functioning. However, cultural norms (e.g., familism) motivated participants to make sacrifices and fulfill their responsibilities to PMI. The religious frameworks of Buddhism and Catholicism/Christianity provided a coping strategy to alleviate caregivers’ emotional pain and helped them construct a purposeful explanation for the root causes of mental illness and understand the meaning of their suffering. Stigma appeared as an especially important factor, which participants suggested contributed to their avoidance of seeking services due to negative feelings of shame.

Discussion: This study offers implications to assist mental health practitioners in tailoring culturally appropriate and effective services for Vietnamese immigrant caregivers. The findings suggest the importance of informing caregivers about available resources and providing them with coping strategies for commonly experienced caregiver stress. Caregivers’ tendency to use religion as a coping strategy emphasizes the potential for collaborative efforts between mental health practitioners and religious institutions to develop support services for caregivers and promote educational campaigns to reduce the social stigma of MI in the Vietnamese immigrant community.