By Suzan Song
Suzan Song MD MPH is a Harvard-trained adult psychiatrist and Stanford-trained child/adolescent psychiatrist, currently working at the Asian Americans for Community Involvement mental health clinic in the Bay Area. She is a former White House Asian Pacific Islander American Initiative fellow, and was a George Soros fellow, working with domestically abused Asian immigrant women in New York City.
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May is both Asian Pacific American Heritage Month and Mental Health Month. Combining these themes into one month, let us look closer at mental health issues specific to Asian American youth and their parents. May (and the special month festivities) are coming to an end, so now is a good time to focus on what individuals can do – specifically parents – to promote the mental health of their Asian American children.
Asian Americans are not only Asian and American. We are a sub-culture with unique needs and experiences. Because of this, we have some mental health needs that are different from other majority or ethnic minority groups.
Depression is the leading cause of disability in the world. And depression is a risk factor for suicide. About 1 million people complete suicide per year, and more than half occur in Asia. Suicide is the leading cause of death for young people (15-24 years old) in Hong Kong, South Korea, and Japan.
Here in U.S., Asian/Pacific Islander American females have the highest rate of suicide among females between 15-24 years old. There are many factors at play, starting with depression.
Typical warning signs for depression in teens are slipping grades, an increase in drug use, and problematic behaviors, like truancy from school or fighting peers. But depression in Asian American adolescents is different.
Asian American students report more depressive feelings, but do not have the same red warning flags, as our Harvard research team found. We studied all high school students in the Cambridge, MA public school system over a number of years, and found that Asian American teens who report more depressed moods seem to have mostly A’s, but are more concerned about their grades than others. They have lower rates of drug use, less problematic behavior, and continue to attend school and extra-curricular activities. These depressed Asian Americans thought their parents were interested in their academic grades, but not their emotional and social lives.
This perceived lack of interest by parents will be discussed below, so let’s look at other factors that play into depression.
The model minority myth for Asians states that we are smart, hard-working and overcome the difficulties of acculturation. This stereotype can also promote depression, as it’s difficult to live up to, and can hinder teachers and parents from identifying youth to help. Asian American girls, for example, are positively rewarded for being compliant, persevering without complaint, and putting others’ needs before their own. So parents and teachers may overlook their isolation or withdrawal. This creates a difficult dynamic for the child who has learned to withhold emotions. Shame, a sense of low self-control, and a culture that limits expressing emotions lead to helplessness and isolation.
On top of this is the cultural layering of fatalism – making the best out of a situation without trying to change it. To suffer and persevere is supposed to build character. Asian American youth are taught that self-reliance is strength and asking for help is a weakness.
Asian Americans have some of the lowest use of mental health care. Most initially go to a family member, friend, church, or primary care doctor (in that order), and typically last in the running is a mental health professional.
It is true that Asian Americans are a diverse, heterogenous group. Separating their needs from non-Asian American peers does not imply that they have completely different needs. Asian Americans have the same needs to individuate and form their own identity, and successfully separate from parents in a healthy maturation process.
But Asian Americans have an additional layer of cultural experiences, are the least likely to seek treatment, and are understudied in mental health research despite their unique mental health needs. We are losing young Asian Americans to suicide, unnecessarily. More than half of the suicides at Cornell since 1996 have been Asian or Asian American. Three Asian American students at CalTech (California Institute of Technology) committed suicide last year. We cannot afford to continue ignoring the needs of Asian American youth.
Parents can emphasize the parent-child relationship by focusing on showing interest in your child’s social and emotional growth, not only academic success or disciplining. Many Asian American parents are immigrants, work long hours which decrease the amount of face-to-face interaction, or may have language barriers that prevent the discussion of complex issues such as depression. Non-immigrant parents can foster the model minority stereotype as well, by emphasizing a professional job and academic grades. In an achievement-oriented culture, where failure is not an option, depression will linger. With depression difficult to express, and self-worth wrapped in pleasing parents academically, the main solution that many look towards is suicide.
Asian American girls have additional needs. Oftentimes parents can be stricter with girls than boys, expecting Asian American girls to have less freedom to be social or experiment with their independence as other same-aged teens. Girls are asked, directly or not, to be a good caretaker -- cooking and cleaning well and putting aside one’s needs. In part, these are Confucious ideals -- a woman’s role is defined in relation to a man, as a daughter, wife, and mother.
We should also consider that apples don’t fall far from trees. Asian American women over the age of 65 have the highest female suicide mortality rate among women, and domestic violence is high in Asian cultures, though not discussed. This can lead to isolation, depression, and a trans-generational passing of their trauma and stress of being a primary caretaker onto their children.
Parents should seek assistance if they are having difficulties in inter-generational and cultural differences in settling disagreements. Mental health professionals can assist with more effective conflict resolution and communication styles to show their children they care. By eliciting help and opening communication, we can help our youth by modeling strength and resiliency. Though the Asian Pacific Heritage and Mental Health month of May is coming to an end, Asian American parents are thinking year round about how to help their children reach their potential. It starts in the home.
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