Health: Asians Get Depressed, Too

U.S.-born, those who immigrated before age 12, have higher rates of depression and substance abuse than do other Asian Americans

By M. Thang, Sampan

Dec 16, 2005 - About 8% of the adult population suffers from major depression, which is a leading cause of disability. While these facts and perhaps even depression itself may seem insignificant, the consequences are not. Furthermore, Asian Americans are not "mentally healthier" than other groups in the US, reports the Surgeon General.

Left untreated, depression can severely reduce one’s quality of life, says Albert S. Yeung, MD, ScD, a psychiatrist at Massachusetts General Hospital who studies depression in Asians. Insomnia, withdrawal from family and social activities, irritability, chronic sadness, appetite loss, and difficulty concentrating are some symptoms of depression. The illness can precipitate emotional and physical conflict that results in job loss, marital and parenting problems, and academic failure.

Suicide can result from untreated depression, too. Of all women in the US over the age of 65, Asians have the highest suicide rate, reports the Surgeon General. Asian American women ages 15 to 24 have a higher suicide rate than do white, black, and Hispanic women in the same age group.

But diagnosis must occur for treatment to begin. In Asians, depression can be especially hard to diagnose. First, says Dr. Yeung: “Depression is a fairly Euro-American concept...so many Asian Americans [with depression] don’t actively seek treatment.” They tend to focus on physical problems -- headaches or dizziness,
for example -- rather than more emotional symptoms such as sadness and depressed moods.

Second, primary-care doctors may be so busy that they lack the time or inclination, in addition to the training, to explore the emotional aspects of patients who have depression.

Stigma exists with depression, too, so Asian Americans are less likely to get mental health services. Instead, they try to handle their depression within their families. They seek medical help “only when [the depression] gets severe and disrupts family life,”
says David Takeuchi, a medical sociologist at the Univ. of Washington. Asians also tend to associate any psychiatric problems with insanity, of which they have a strong negative perception, says Dr. Yeung, and they may view depression as a sign of weakness or lack of willpower.

Language barriers and culturally-inappropriate health services may be obstacles as well.

Some persons with depression may recover spontaneously. However, if not treated early on, depressed persons can take much longer to recover - with the course of depression drawn out over an extremely long period, even two years, says Dr. Yeung.

The illness has other implications as well. Both minor and major depression are strongly associated with increased mortality (rate of death) in persons with diabetes, according to a study in the Nov. 2005 “Diabetes Care.” Diabetes -- which can lead to blindness and leg amputations -- disproportionately afflicts Asian Americans.

Persons with depression may be at a greater risk for developing diabetes, too. Fortunately, treatment for depression helps with the management of symptoms of both diseases, and improves quality of life.

Some illnesses may hide the symptoms of depression, says the American Association for Geriatric Psychiatry. When a depressed person has physical symptoms from a stroke, gastrointestinal problem, heart disease, arthritis or another ailment, he or she may believe depressive symptoms are due to an existing physical illness and completely ignore the symptoms.

Moreover, US-born Asians, as well as Asian immigrants who arrived in the US before the age of 12, have higher rates of depression and substance abuse than do other Asian Americans, says Dr. Takeuchi.

You can help friends or family members with depression to get medical help by being completely supportive. With some Asians, it can help also to not focus on the word “depression” because of its possible stigma, says Dr. Yeung. Gently urge the patient to notice his different appearance or impaired functioning. Suggest he or she has been looking unwell or tired. Inform the rest of the family, and suggest professional help.

Here are other tips as well, adapted from those offered by the American Association for Geriatric Psychiatry:

• Discuss your feelings or when you were depressed. Knowing that you understand may help loved ones to talk about their feelings.

• During the holidays, acknowledge that things can be difficult.

• If your loved one isn’t eating or has lost weight, gently ask about his appetite or disinterest in food.

• Once you’ve gotten past the initial awkwardness, your loved one may want to talk to you. At that point, listen -- even to unpleasant or “boring” aspects. Offer support.

• Offer specific suggestions or help implement them -- for example, offer to go with your loved one to the family doctor or make an appointment with a psychiatrist.

Be aware that it may take many weeks to get the person to agree to get help. Among older people, common triggers for depression are medical illnesses as well as genetics and biochemical changes in the brain.

Persons reluctant to seek medical help may be willing to “screen” themselves for depression. By searching with the key words “depression screening” using a Web site like Google, says Dr. Yeung, people can find out their depression scores and if they have clinical depression. Some sites are in Chinese and Vietnamese.

But most important is getting medical help -- even if persons are treating themselves with herbs or traditional Chinese therapies such as acupuncture and tai chi. Depression can be treated effectively with drugs and counseling.

Moreover, say Drs. Yeung and Takeuchi, there’s nothing shameful about having -- or seeking medical help for -- depression.

Other Readings of Interest

• Inside the Asian Pressure Cooker
  By Pueng Vongs, Pacific News Service
  Asian immigrants' drive for material success and shame-based culture may be causing many to place impossibly strict expectations on their children.  Health and social workers say rates of depression are disproportionately high among Asian youths, and in some cases this results in suicide.

This health article was funded by the Asian Health Initiative of Tufts-New England Medical Center