The winter holiday brings the season of family reunification, bond and love. For some Asian American and Pacific Islander (AAPI) immigrants and elders suffering with mental health however, memories of loss and grief may intensify during this time of year. Although situations can vary, AAPI immigrants and refugees often share the unique experiences of poverty, discrimination and war traumas that increase the risk of mental health issues.
While the winter festivities of gleaming lights and frosting scenes bring joyous reflections to many, those with a mental health illness may feel at turmoil as they are reminded of loved ones from a distance away.
“For the APIA population suffering with mental health illness, the intensity or severity may increase during Christmas and Lunar New Year,” said Jacob Eide, Behavioral Health Supervisor at Seattle’s International Community Health Services, who cited the clinical experience of his behavioral health team. “We think it has a lot to do with the sense of isolation, being away from family and away from support. Or, not having the financial capacity to visit people.”
Within the Asian community that values self-reliance, there’s a fear of placing a burden on families during the holiday and instead, they may keep their emotions hidden. But the best way to beat depression, said Yoon Joo Han, Director of Behavioral Health at Asian Counseling and Referral Service, is whether one can reframe a bad memory or negative situation into something positive.
“Holidays can remind you of good or bad memories from your home. Even good memories can be difficult because it reminds you of losses,” said Han. “But if you can reframe yourself, your chance of beating depression is great.”
Labeled as the “model” ethnic group, AAPIs are not frequently linked with mental health issues. But according to the American Psychiatric Association, Asian Americans have some of the highest rates of social anxiety, social phobias and trauma-related disorders. The tensions and conflict with the mainstream culture may be the strongest contributing factor leading to their mental health. However, cultural and linguistic barriers along with stigmatization may limit Asians from seeking mental health treatments. The American Psychiatric Association identifies addiction, gambling and family violence as factors in aggravating or developing mental health issues.
- Substance Abuse: Compared with other ethnic groups, AAPIs have the overall lowest rate of drug use. But when statistics are disaggregated, Pacific Islanders have a 9.1 percent higher rate than any other group to participate in illicit drugs.
- Gambling: About 5 percent of the general population suffers from a gambling addiction. But in the Chinese American community, 20 percent are problem gamblers while Southeast Asian Americans reveal the highest prevalent rate of pathological gambling.
- Domestic Violence: Due to family traditions to avoid conflict and avoid dishonor, domestic violence among AAPI families are usually underreported. Thirty-eight percent of Asian Pacific Islander Americans surveyed knew a woman who experienced domestic violence by their partners.
These contributing factors can reflect the coping mechanisms that Asians use when suffering from isolation and stress from their immigration experience.
“Substance use and gambling may not be the cause of other mental illnesses, but can be a co-occurring condition,” said Eide. “Sometimes people with mental health illnesses may use substances to medicate themselves instead of seeking treatment.”
For Southeast Asian refugees having the highest rate of pathological gambling, this form of coping may have been a source of outlet after dealing with war trauma, combat and torture. According to the National Alliance on Mental illness, many Southeast Asian refugees are usually at risk for post-traumatic stress disorder (PTSD) associated with trauma before and after their immigration experience.
Other high risk groups include AAPI elders, due to stronger cultural and language barriers. When loneliness hits and sense of worth dies — elders can have higher vulnerabilities of depression.
“Many elders experience loss of mobility or independence because of health issues,” said Han.
According to the Department of Health and Human Services, Asian Pacific Islander American women over 65 have the highest rates of suicide among all races. Also, older Asian Pacific Islanders show greater rates of dementia than the general population.
Generational and cultural differences with elders and an inability to communicate effectively with their languages make treatment difficult when the full story of a client’s background is not gathered. At International Community Health Services, the agency serves over 50 languages but finding trained and culturally competent interpreters can still be challenging.
“The differences in language and culture are one of the most difficult aspects of mental health treatment,” said Eide. “Some of our providers do speak other languages but we rely heavily on interpreters.”
But with an added interpreter in the clinic’s room, clients may feel uncomfortable or reluctant to speak about their history or even go in depth about their experiences.
“Sometimes obtaining a mental health or traumatic experience history can be very difficult because the APIA population may not like to talk about these things,” said Eide. “Many times they deny difficulties because they don’t want to admit anything is wrong. It’s about saving face.”
The need for family and friends are important and the key element for those trying to recover from mental health. The holiday season can aggravate feelings of isolation as others busily prepare for family feasts and social gatherings.
This season, bring a little more love, attention and awareness, and hope for your family member or friend recovering or still suffering with a mental health condition. Providing the social support by simply listening or spurring up a simple conversation may be the first steps towards bringing some comfort, peace and healing.