Understanding Psychosis in Asian Diasporas

Background and Purpose. Despite significant need for culturally responsive services, Asian and Pacific Islander (API) communities are vastly underserved by the US mental healthcare system. Even in the presence of diagnosable mental illness, API communities are less likely than other ethnoracial groups to seek mental health treatment. This is of particular concern with early psychosis, where the duration of untreated psychosis is linked with higher severity of symptoms and worse long-term outcomes. Our understanding of the unique needs, experiences, and pathways of API individuals with psychosis continues to be very limited even as our awareness of the inequities faced by these communities continues to grow. The purpose of this qualitative study is to better understand the experiences of Asian diasporas experiencing psychosis in the United States. The goal is to increase awareness of the complexity of this population, amplify their voices and, ultimately, to create more culturally meaningful services and supports for API communities.

Methods. Qualitative interviews were conducted with API participants (n=20) who have experienced psychosis or attenuated psychosis. Voluntary response sampling and snowball sampling were used to recruit participants from listservs and online groups serving individuals with psychosis or API mental health concerns as well as direct referrals from clinicians and other psychosis-focused research projects. A grounded theory approach was used to uncover unique patterns pertaining to API experiences of psychosis. Semi-structured questions focused on emigration and acculturation experiences, the development and onset of psychosis, pathways to/through care, and mental health outcomes and recovery. Interviews were thematically analyzed for emergent themes and patterns.

Results. API participants have a distinctive experience across the continuum of psychosis with several contributing factors. Early experiences around emigration, racism, parental coping mechanisms, and cultural beliefs deeply shaped participants’ perspectives about their own mental health and subsequent engagement with the mental healthcare system. A lack of understanding within the mental healthcare system about the culturally specific needs of API individuals accessing care contributed to barriers in meaningful engagement with services. Participants identified immigrant family social support, school-based mental health awareness, and culturally-tailored psychoeducation for families experiencing psychosis as high-impact interventions to benefit their community.

Conclusions and Implications. Increasing our collective awareness of how API communities experience psychosis and their pathways to and through care is of critical importance in better serving these communities. Dismantling the “model minority” myth and creating more culturally inclusive services are only the beginning of providing culturally relevant and responsive early psychosis services. Future research that focuses on API acculturation, socialization to racism, and the impact of intergenerational migration experiences in families will provide novel pathways for understanding and supporting the API community.