Stigma Associated with Mental Illness Among Asian Men in Vancouver, Canada

Background: Due to racism, xenophobic nationalism, acculturation pressures, and patriarchal social relations, Asian men in Western societies may be particularly susceptible to negative experiences and beliefs regarding mental illness and treatment services.

Methods: Sample. Between 2013 and 2017, 428 self-identified Asian men living in proximity to Vancouver, Canada were recruited and completed two self-administered questionnaires assessing social stigma and self-stigma. Measures. Social Stigma: The 40-item Community Attitude toward Mental Illness (CAMI) was administered to all participants (n=426) to measure social stigma. A summative total CAMI score (ranging from 40–200) was calculated, with higher scores corresponding to greater positive attitudes. The CAMI’s internal reliability (Cronbach’s α) was 0.87. Self Stigma: The 29-item Internalized Stigma of Mental Illness scale (ISMI) was only administered to participants who self-identified as living with a mental illness (n=90). A composite total ISMI score (ranging from 1–5) was calculated, with higher scores corresponding to more self-stigma. We removed the stigma resistance subscale when calculating the composite total ISMI score. The ISMI’s internal reliability (Cronbach’s α) was 0.83. Analysis. We used t-tests and ANOVAs to analyze statistical differences in the mean social stigma (CAMI) and self-stigma (ISMI) scores across sociodemographic variables. Multivariate linear regression analyses were constructed to model the main effects of sociodemographic variables on social stigma and self-stigma. We examined the interactions between the independent variables and their effect on social stigma. Two- and three-way interaction terms were added to the regression models to examine whether the effect of immigration on social stigma varied by age and direct experience with mental illness.

Results: Multivariate regression revealed that social stigma was significantly predicted by age,
immigration, employment status, and experience with mental illness. Together, these variables accounted for 12.36% of variance in social stigma. Interaction terms were added to the regression models to examine whether the effects of immigration on social stigma varied by age and experience with mental illness. None of the interaction terms were statistically significant. Among the 94 Asian men identified as living with mental illness, self-stigma was predicted by age, immigration, and employment status, which together accounted for 14.97% of variance in self-stigma.

Conclusions and Implications: Globally, in 2010, mental, neurological and substance use disorders made up 29% of years lived with a disability (Whiteford, Ferrar, Degenhardt, Feigin & Vos, 2015). Reducing stigma associated with mental illness has critically important public health implications for Asian men, because this group may be especially vulnerable to discrimination, isolation, and social withdrawal. In our study, age, immigration, and employment influenced stigma toward mental illness, so these factors should be considered when designing anti-stigma interventions. Reducing stigma could improve help-seeking behavior and the acquisition of better treatment and supports, which in turn might improve life chances in terms of education and employment.