Clinical Outcomes of Asian Americans with Schizophrenia Spectrum Disorder

Background and Purpose: Significant progress has been made in understanding Asian Americans’ use of mental health services, but knowledge of users’ response to mental health treatment remains poor. We implemented an observational study to examine symptoms and functional outcomes of Asian Americans treated in urban community mental health centers for a diagnosis of schizophrenia spectrum disorder. We also determined whether outcomes differed between East and Southeast Asians. We hypothesized that Southeast Asians would evidence poorer clinical outcomes compared to East Asians. Methods: This pilot observational study drew on quantitative data gathered cross-sectionally from 75 participants recruited from six community mental health centers. Participants were recruited using a purposive sampling method. Eligible clients were aged 18 or older; received a chart diagnosis of schizophrenia spectrum disorder; self-identified as a person of Asian or Asian American descent; could speak and read English or an Asian language (Chinese, Cantonese, Vietnamese, or Khmer); and received services at one of the participating sites during the recruitment period, between February 2016 and February 2017. Participants completed semi-structured interviews and self-report questionnaires. The presence and severity of symptoms were assessed using the Positive and Negative Syndrome Scale. The Strauss and Carpenter Outcome Scale was used to assess different areas of functioning including participation in life activities, frequency of social interactions, and duration of hospitalization for psychiatric treatment. We used data on symptoms severity and functioning levels to determine the proportion of participants who met criteria for symptomatic remission, adequate occupational functioning, acceptable social activity, and clinical recovery. To compare the clinical outcomes between East and Southeast Asians, we fit a multivariable logistic regression model that statistically adjusted for the estimated effects of age, sex, and age at onset for each examined outcome. Results: The study sample featured 51 participants diagnosed with schizophrenia (68.00%) and 24 participants diagnosed with schizoaffective disorder (32.00%). The study sample was ethnically diverse with an even split in gender. Participants’ ages ranged from 19 to 66 years (M = 43.03; SD = 12.61). Seven in 10 participants were foreign born (70.67%) and more participants were East Asians (68.00%). On average, participants had an age-onset of 22.62 years (SD = 8.38, range = 11–51) and had been diagnosed with schizophrenia for 14.41 years (SD = 12.32, range = 0–51). The majority of participants (90.67%) reported continuous or regular use of antipsychotic medication during the previous 6 months. The data suggest poor clinical outcomes in this sample, as evidenced by the modest number of participants who experienced symptomatic remission (30.67%), role restoration (34.67%), and clinical recovery (21.33%). The proportion of participants who achieved social restoration was more promising (68.00%). In general, age, age at onset of illness, or their combination differentiated between participants with favorable clinical outcomes from those with poor outcomes, whereas ethnicity and sex did not. Conclusions: Findings underscore the need for interventions that improve symptoms control to increase the likelihood of other favorable clinical outcomes.