title: Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting.
abstract: Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients' illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants' illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.
authors.affiliation: Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; South Cove Community Health Center, Department of Behavioral Health, 885 Washington St., Boston, MA 02111, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. Electronic address: jchen37@partners.org.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Chen
authors.affiliation: Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Addiction Medicine, Taipei City Psychiatric Center, Taipei City Hospital, Taiwan. Electronic address: galenhung@tpech.gov.tw.
authors.forename: Galen Chin-Lun
authors.initials: GC
authors.lastname: Hung
authors.affiliation: Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States. Electronic address: sparkin@partners.org.
authors.forename: Susannah
authors.initials: S
authors.lastname: Parkin
authors.affiliation: Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. Electronic address: mfava@partners.org.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Massachusetts General Hospital, Depression Clinical and Research Program, 1 Bowdoin Square 6th Floor, Boston, MA 02114, United States; South Cove Community Health Center, Department of Behavioral Health, 885 Washington St., Boston, MA 02111, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States. Electronic address: ayeung@partners.org.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Yeung
mesh_terms: D000328:Adult; D000368:Aged; D001213:Asian / Q000523:psychology*; D003469:Culture; D003863:Depression / Q000208:ethnology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000208:ethnology* / Q000523:psychology; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D011320:Primary Health Care; D057545:Social Stigma; D013240:Stereotyping; D014481:United States
keywords: Chinese American; Culture; Illness beliefs; Major depressive disorder; Stigma