Asian Americans/Pacific Islanders

Approximately 4% of the U.S. population – over 11 million people – identify themselves as Asian Americans or Pacific Islanders (AA/PIs). The AA/PI population is expected to double in the next 25 years. About 54% of AA/PIs live in western States, especially California and Hawaii. 18% live in the Northeast, 17% in the South, and 11% in the Midwest.

The AA/PI category is extremely diverse, with about 43 different ethnic subgroups. While the majority of AA/PIs were born outside of the U.S., a large proportion of Chinese and Japanese Americans are 4th and 5th generation Americans. Since the mid-1960s, the AA/PI population has grown rapidly with high rates of immigration from China, India, the Philippines, Korea, Vietnam, and Southeast Asia. Most Pacific Islanders are not immigrants, but are descendants of the original inhabitants of land taken over by the United States – Hawaii, Tonga, Guam, American Samoa, the Northern Mariana Islands, the Marshall Islands, the Caroline Islands, and Palau.

AA/PIs speak over 100 languages and dialects, and about 35% live in households where there is limited English proficiency in those over age 13. Some subgroups have more limited English proficiency than others: 61% of Hmong-, 56% of Cambodian-, 52% of Laotian-, 44% of Vietnamese-, 41% of Korean-, and 40% of Chinese-American households are linguistically isolated.

There is a range of educational attainment in the AA/PI population. In 2000, 44% of Asian American adults had a college or professional degree compared to 28% of white Americans. 58% of South Asian Americans (from India, Pakistan, Bangladesh, and Sri Lanka) fell into this group. In contrast, in 1990 only 12% of Hawaiians and 10% of other Pacific Islanders had completed college, and 2 out of 3 Cambodian-, Hmong-, and Laotian-American adults had not completed high school.

The average family income for AA/PIs is higher than the national average. However, AA/PIs still have a lower per capita income and higher rate of poverty than non-Hispanic white Americans. In 1990, about 14% of the whole AA/PI group was living in poverty, compared to 13.5% of all Americans, and 9% of non-Hispanic whites. Among subgroups, poverty rates ranged from a low of 6% for Filipino Americans to a high of 64% among Hmong Americans.

Need for Mental Health Care

Our knowledge of the mental health needs of AA/PIs is limited. National epidemiological studies have included few AA/PIs or people whose English is limited. The largest study to focus on AA/PIs (i.e., the CAPES study) examined the prevalence of mood disorders in a predominantly immigrant Chinese American sample. This study found lifetime and one-year prevalence rates for depression of about 7% and 3%, respectively. These rates are roughly equal to general rates found in the same urban area.

While overall prevalence rates of diagnosable mental illnesses among AA/PIs appear similar to those of the white population, when symptom scales are used, AA/PIs show higher levels of depressive symptoms than do white Americans. Furthermore, Chinese Americans are more likely to exhibit somatic complaints of depression than are African Americans or non-Hispanic whites. Small studies of symptoms of emotional distress have found few differences between AAPI youth and white youth.

AA/PIs may experience culture-bound syndromes such as neurasthenia and hwa-byung Neurasthenia is characterized by fatigue, weakness, poor concentration, memory loss, irritability, aches and pains, and sleep disturbances. Hwa-byung, or "suppressed anger syndrome," is characterized by symptoms such as constriction in the chest, palpitations, flushing, headache, dysphoria, anxiety, and poor concentration.

Compared to the suicide rate of white Americans (12.8 per 100,000 per year), the rates for Filipino (3.5), Chinese (8.3), and Japanese (9.1) Americans are substantially lower. However, Native Hawaiian adolescents have a higher risk of suicide than other adolescents in Hawaii, and older Asian American women have the highest suicide rate of all women over age 65 in the United States. There is also a growing concern about increasing suicide rates in the Pacific Basin.

High-Need Populations

AA/PIs are not overrepresented among high-need, vulnerable populations such as people who are homeless, incarcerated, or have substance abuse problems. However, they are heavily represented among refugees. Many Southeast Asian refugees are at risk for post-traumatic stress disorder (PTSD) associated with trauma experienced before and after immigration to the U.S. One study found that 70% of Southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD. In a study of Cambodian adolescents who survived Pol Pot's concentration camps, nearly half experienced PTSD and 41% suffered from depression 10 years after leaving Cambodia.

Availability of Mental Health Services

Nearly 1 out of 2 AA/PIs will have difficulty accessing mental health treatment because they do not speak English or cannot find services that meet their language needs. Approximately 70 AAPI providers are available for every 100,000 AA/PIs in the U.S., compared to 173 per 100,000 whites. No reliable information is available regarding the Asian language capabilities of mental health providers in the U.S.

Access to Mental Health Services

Overall about 21% of AA/PIs lack health insurance, compared to 16% of all Americans. The rate of Medicaid coverage for eligible AA/PI families is well below that of whites. For example, among families with incomes below 200% of the Federal poverty level, whites are twice as likely as Chinese Americans to enroll in Medicaid. It has been suggested that lower Medicaid participation rates are, in part, due to widespread but mistaken concerns among immigrants that enrolling in Medicaid jeopardizes applications for citizenship.

Use of Mental Health Services

AA/PIs appear to have the extremely low utilization of mental health services relative to other U.S. populations. For example, in the CAPES study, only 17% of those experiencing problems sought care. Among AA/PIs who use services, severity of disturbance tends to be high, perhaps because AA/PIs tend to delay seeking treatment until symptoms reach crisis proportions. While more research is needed, shame and stigma are believed to figure prominently in the lower utilization rates of AA/PI communities. AA/PIs tend to use complementary therapies at rates equal to or higher than white Americans.

Appropriateness and Outcomes of Mental Health Services

Few studies examine the response of minorities to mental health treatment. One study found that AAPI clients had poorer short-term outcomes and less satisfaction with individual psychotherapy than did white Americans. Another study found that older Chinese Americans with symptoms of depression responded to cognitive-behavior therapy as did other multiethnic populations. AA/PI clients matched with therapists of the same ethnicity are less likely to drop out of treatment than those without an ethnic match. Preliminary studies suggest that AA/PIs respond clinically to psychotropic medicines in a manner similar to white Americans but at lower average dosages. Research is needed to identify key components of culturally appropriate services for AA/PIs.