Beliefs about Depression in Diverse Ethnic Groups of Asian Americans

Background and Purpose: Despite the high needs for mental health care, many Asian Americans are known to avoid or delay the use of mental health services.  One critical factor that contributes to their service underutilization is stigmatizing beliefs about mental illness. Focusing on the four types of beliefs about depression (depression is a sign of personal weakness; having a depressed family member brings a shame to the whole family; if you have a depression, your family would be disappointed; and antidepressant medicines are addictive), the goal of the present study was to examine how these beliefs would be associated with socio-demographic variables and immigration-related variables. Given the diversity within the broad category of the Asian American, we attended to ethnic variations in beliefs about depression.  

Methods: Data were drawn from 2,609 participants (age range = 18−98) in the 2015 Asian American Quality of Life (AAQoL) survey, conducted in Central Texas. The sample includes Chinese (n=640), Asian Indian (n=574), Korean (n=471), Vietnamese (n=513), Filipino (n=265), and other Asians (n=146). Descriptive statistics and a series of logistic regression models were conducted to explore variations in four types of beliefs about depression by ethnicity and examine factors associated with these beliefs. Factors included in logistic regressions are socio-demographic variables (age, gender, marital status, education, and ethnicity) and immigration-related variables (length of stay in the U.S., English proficiency, and acculturation).

Results: The results indicated variations in beliefs about depression by ethnicity. In general, Asian Indians and Koreans were shown to be quite prone to negative beliefs: more than 40% of each ethnic group viewed depression as a sign of personal weakness and more than 20% associated depression with family disappointment. The results of the logistic regression analyses indicated that age, gender, ethnicity, length of stay in the U.S., English proficiency, and acculturation are significantly associated with stigmatizing beliefs about depression. Compared to younger adults (18-39), older adults (60 and over) presented higher odds of endorsing all four negative beliefs. Limited English proficiency and low levels of acculturation increased the odds of endorsing the items on personal weakness and shame. Compared to Chinese, Asian Indians and Koreans presented higher odds of endorsing the belief on personal weakness, and Vietnamese showed reduced odds of believing that antidepressant is addictive.  

Conclusions and Implications: Findings indicate that differences in stigmatizing beliefs about depression exist within Asian American groups. This result adds support to previous literature suggesting that Asian Americans are heterogeneous groups and there is need for culturally sensitive approach to address diversity within this group. In addition, the results suggest that stigmatizing beliefs about depression significantly differ by various factors. Such findings may help prioritize groups that would mostly benefit from mental health education and tailor the education to meet their specific needs.