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Asian Americans and Pacific Islanders represent very diverse populations in terms of ethnicity, language, culture, education, income level, English proficiency, and sociopolitical experience. Although cultural ties exist among the different AA/PI communities, it is important to recognize the differences among the groups. (Reprinted Surgeon Generals Report).
Much more is known about mental health problems measured by symptom scales as opposed to DSM criteria. In these studies, AA/PIs do appear to have an increased risk for symptoms of depression. Diagnoses of psychiatric disorders rely both on the presence of symptoms and on additional strict guidelines about the intensity and duration of symptoms. In studies of depressive symptoms, individuals are often asked to indicate whether or not they have specific depressive symptoms and how many days in the past week they experienced these symptoms. In several studies, Chinese Americans, Japanese Americans, Filipino Americans, and Korean Americans in Seattle Kuo, 1984; Kuo & Tsai, 1986, Korean immigrants in Chicago (Hurh & Kim, 1990), and Chinese Americans in San Francisco (Ying, 1988) reported more depressive symptoms than did whites in those cities. One interpretation of the findings suggests that AA/PIs show high rates of depression, or simply have more symptoms but not necessarily higher rates of depression. Few studies exist on the mental health needs of other large ethnic groups such as Indian, Hmong, and Pacific Islander Americans.
Even if Asian Americans are not at high risk for a few of the psychiatric disorders that are common in the United States, they may experience so-called culture-bound syndromes (APA, 1994). Two such syndromes are neurasthenia and hwa-byung.
As described earlier, Chinese societies recognize a disorder called neurasthenia. In a study of Chinese Americans in Los Angeles, Zheng and his colleagues (1997) found that nearly 7 percent of a random sample of respondents reported that they had experienced neurasthenia. The neurasthenic symptoms often occurred in the absence of symptoms of other disorders, which raises doubt that neurasthenia is simply another disorder (e.g., depression) in disguise. Furthermore, more than half of those with this syndrome did not have a concomitant Western psychiatric diagnosis from the DSM-III-R. Thus, although Chinese Americans are likely to experience neurasthenia, mental health professionals using the standard U.S. diagnostic system may not identify their need for mental health care.
Koreans may experience hwa-byung, a culture-bound disorder with both somatic and psychological symptoms. Hwa-byung, or “suppressed anger syndrome,” is characterized by sensations of constriction in the chest, palpitations, sensations of heat, flushing, headache, dysphoria, anxiety, irritability, and problems with concentration Lin, 1983; Prince, 1989. A community survey in Los Angeles found that 12 percent of Korean Americans (total N = 109), the majority of whom were recent immigrants, suffered from this disorder Lin, 1983; Lin et al., 1992; this rate is higher than that found in Korea (4%) (Min, 1990).