Interview-Study Background & Demographic

Our Interview Study

Abstract

This study examines the relationships between cultural stigma, willingness to seek help from a mental health professional, intrapersonal and interpersonal perspectives on mental health within various groups. They are: students, community members, healthcare professionals, and mental health organizations. Data on perspectives of stigma and barriers to mental healthcare were obtained by 34 participants in the San Francisco Bay area who completed responses through a combination of online (video) and written responses along with other demographics.

Method

Participants

For this study, 43 participants were recruited. Originally, 49 responded but six responses were taken out due to a lack of clarity and depth. These participants were recruited through one of three modes of communication: cold-call emails, Facebook Messenger, and text message. Means of recruitment were primarily by peer pressure and social persuasion, as well as a call to a cause for the greater good—furthering a cause to destigmatize and spread awareness about the importance of mental health care. Out of the 43, four of the responses came from healthcare professionals, six of the responses came from community members, two of the responses came from organizations, and 31 responses came from students. All participants identified as AAPI, as this study was designated to reflect this group’s perspective.

Procedures

In this study, participants were asked to respond to interview questions that were tailored according to which category they placed in. Mental health professionals and organizations responded to questions regarding accessibility, the complications they face in treating Asian-American patients, accommodations for Asian-Americans regarding language barriers, and the types of advocacy done to promote mental health awareness, whether as a healthcare practitioner or as part of an organization. Community members engaged in questions revolving on community stances towards mental health, resource accessibility and knowledge, and how cultural factors impact the decisions and mentalities which influence the deterioration thereof. Lastly, students provided insight on the difficulties of sharing with family and community, the problem in acknowledging mental health (both inter and intrapersonal experiences), influencing factors of their mental health, the reactions and methods in which they cope. These interviews took place via Zoom Meetings, and participants were able to alternatively be able to choose to provide written responses.

Measures & Manipulations

The study examines the relationship between willingness to seek help from a mental health professional, perceived cultural stigma, and community supportiveness of mental health treatment, alongside other barriers to healthcare. This study was distributed primarily amongst Bay Area high school and university students ranging from 15 y/o through 26 y/o, residents, and local professionals and organizations.

Limitations

Restrictions that limit this study are the ethnicity of participating individuals. Other limitations include cultural-specific barriers and stigma which can differ in the responses to the interview questions. For the purposes of this study, we have utilized a pan-Asian approach, effectively taking out how different ethnicities may face different barriers to mental healthcare. Instead, we focused on broad and common themes that individuals faced despite differences in gender, ethnicity, age, and profession. Likewise, male and female responses were not distinguished, as the data sample was too small to make a substantial analysis thereof. Notably, our interviews were native to the San Francisco Bay Area, and therefore it may not apply this data analysis to a larger or different group.

Findings

Barriers to Healthcare

What can be shown from the data collected is that there are a variety of barriers that come into play when seeking care: language, cultural, socioeconomic, and racial barriers are a huge obstacle. Out of 37 student and community member interviews, 23/37 [62.16%] mentioned language barriers, citing a lack of translations available to a family member's native language, 25/37 [67.57%] cultural differences, primarily the gap between immigrant and first-generational assimilation, 30/37 [81.81%] mentioned socioeconomic reasons, including a lack of access and knowledge in healthcare or of available resources, and 27/37 [72.92%] mentioned racial barriers that stemmed from the Model Minority Myth and discriminatory practices. Healthcare professionals and organization members similarly brought up the topic in their interviews: [50%] attributed barriers to healthcare to both language barriers, 100% agreed with cultural nuance, [83.33%] mentioned the struggles of socioeconomic, and [33.33%] mentioned racial discrimination.

Notably, students and community members repeatedly cited reasons for not seeking help due to a belief that they ‘should be able to be strong by myself and not rely on anyone...it’s considered to show weakness.’ This quote from a student who chose anonymity delves into the impacts of cultural expectations. An overwhelming majority of 32 out of the 37 students and community members [91.89%] touched upon the barrier of internalization due to cultural background, and of those, [84.38%] pinpointed the pressure to be reliable, high achieving, and “saving face” of themselves and their families. This goes into the stigma analysis which will be discussed later.

On the other hand, healthcare professionals cited a lack of trust and knowledge of the formal healthcare system, in addition to linguistic isolation, biomedical distrust, and high time consumption, which predominantly “stems from the experiences of the immigrant in America, and being treated as an outsider with discriminatory practices” explained healthcare professional Tiffany Ho, a Vietnamese psychiatrist from San Jose.

That is not to say that they didn’t cite other barriers such as stigma; however, a clear distinction can be made in differentiating perspectives of those who are in the know of other factors, as opposed to students who are primarily exposed to linguistic and cultural hurdles. By and large, however, the tallest hurdle was the lack of knowledge in accessing available resources. The graph below shows the disparity in comprehension, be it understanding health insurance coverage, support in a university/academic setting, how to seek therapy, and navigation through the healthcare system. The majority of students only know about school-related health services, but nothing about care covered by a provider, or, if they must pay-out-of-pocket. Healthcare professionals/organizations, on the other hand, are extremely knowledgeable. From this, we are able to see a correlation to the lack of prominence and visibility within the community on educating and accessing mental health care.

Our ‘Barriers to Healthcare Page’ offers further insight and deeper analyses of interviews and research conducted.

Stigma in Mental Health

While all groups recognized that stigma was another dominant component in the denial of mental health illness, we singled out students and community members for this part of the study, as their experiences best matched with the demographic. The stigmatic challenges have been divided into the following two categories for the purpose of this study: personal stigma and group (family, community) stigma. Characteristic traits that stood out when addressing personal stigma were the sense of intense pressure to be academically successful, accompanied by negative emotions. Of the 37 interviews combined, 34 out of 37 [91.89%] cited intense academic pressure, while 30 out of 37 [81.08%] cited emotions of selfishness and guilt. The inability to high-achieving academically not only contributes to the feeling of inferiority, but places additional burden to keep one’s mental health issues to themselves.

A supplementary analysis shows the top emotional reaction. When asked about stigmatic factors preventing them from talking to their parents or seeking treatment, 27 out of 37 interviewees [72.97%] cited a feeling of selfishness due to hearing stories of their parents struggles growing up Here, the typical immigrant experience comprised of refugee and immigrant struggles in adapting to America, escaping a country, the lengths they’d do get an education, and so forth. Compared to their parents' struggles, responses felt that their own struggles were insignificant. 15 out of 37 responses [40.54%] also pinpointed a secondary feeling of guilt in placing an additional burden on their parents, whether financially or personally. 17 out of 37 respondents [45.95%] cited fear of their parents' reaction following this, while 26 out of 37 [70.27%] cited a preference to not discuss due to the ‘pointlessness.'

We should note here that what is perceived as ‘normal’ is an image of a successful student under the model minority myth which provides a significant amount of contribution to intense academic pressure. The full case study is covered in the ‘Personal Stigma’ page.

The other category is group stigma. Here, participating individuals brought up a culture of collectivism, as well as a combination of other cultural and linguistic barriers that contributed to the stigma surrounding mental health. Cultural expectations such as academic success, filial piety, and a hard-working attitude, combined with a poor understanding of the English language in understanding terms such as ‘mental health,’ result in the intergenerational divide which is prevalent in many Asian Americans familial relationships. A feeling of shame in individual responses could be taken from the data collected. All interviewees associated a feeling of shame; whether it was towards a feeling of inability to take care of themselves, inability to meet ‘ideal’ standards/expectations (academically and otherwise), burdening their family members, and ruining the family’s ‘face.’ When analyzing where the source of shame stemmed from, 34 out of 37 interviewees [94.59%] cited the admittance of being unable to take care of themselves as initial thought. This was followed up by 32 responses in shame in being unable to meet family expectations [86.48%], followed by the burdening of family members in 36 responses [97.29%]. Additionally, 28 responses [75.67%] emphasized on the importance of saving the face of their family (reflecting poorly on family and being viewed in bad standing by the community). What’s seen here is the burden of family image and harmony placed upon those with mental health problems, which in itself poses another problem.

Conclusion

While limitations of the data collected included the locations of those we interviewed as we utilized our local areas (predominantly SF Bay Area), a small-scaled data sample, and other factors of availability and accessibility, what’s shown from this study are two identified obstacles in progressing the normalization of mental health awareness. A common theme in barriers to healthcare and the stigma of mental health was a lack of starting the conversation and the sense of feeling ostracized by the surrounding community. What would be great to explore, but unfortunately out of the scope of this study, was an in-depth analysis of female-identifying and male-identifying responses. From our interview study, we hope that visitors to our website will be able to gain more understanding of, and knowledge to, combat various barriers that hinder taking care of one’s mental health.