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It’s important to recognize that the term “AAPI” (Asian American and Pacific Islanders) encompasses a wide range of countries, ethnicities, nationalities, and identities. Many different communities within AAPI label face their own unique challenges: from the trauma faced by those who survived wars in Laos, Cambodia, and Vietnam;  Japanese Americans who remember the internment camps of the WW2 era; or the anxiety felt by the children of first-generation immigrants to reconcile their cultural heritage with American life. The struggles faced by Filipinx Americans vary from the experiences of Indian Americans (not to be confused with Native Americans). Additionally, Native Hawaiians, who are grouped into the category of AAPI as Pacific Islanders, still experience generations of historical trauma from the colonialization of the islands of Hawaii.

AAPI communities in the United States (U.S.) have had to struggle to reconcile their identities and challenges while recognizing the privilege that comes with the “model minority” myth. The "model minority" myth is a microaggression known as “ascription of intelligence,” where one assigns intelligence to a person of color on the basis of their race. It’s important to recognize how the “model minority” myth plays into complex systems that hold up white supremacy by allowing Asian Americans to benefit from systems of power at the expense of the wellbeing of Black people.

Other race-based issues that impact the mental health of AAPIs include but are not limited to:

The Perpetual Foreigner stereotype: This occurs when someone is assumed to be foreign-born or doesn’t speak English. Some questions that perpetuate this stereotype include “Where are you from?” “Where are you really from?” and “How do you say (or write) _____ in your language?” This increases feelings of isolation and loneliness by being presumed as an outsider based on your race.

Trauma: First-generation immigrants - particularly from conflict areas – may experience trauma. This trauma can be passed down to their children and subsequent generations. AAPIs with a long family history in the US may have compounded trauma due to racial discrimination.

Stigma: Asian Americans are the least likely racial group to take actions on their mental health and are more likely to reach out to friends and family. [1] However, not all AAPIs have a strong support system and can have difficulty expressing their challenges due to guilt, shame, or even not being able to speak the same language.

Expectations: Criticizing appearance, comparing successes, not being _______ enough. Children of first-generation immigrants are particularly expected to serve as cultural and linguistic liaisons for older family members in addition to serving as a caregiver for younger children and attending school.

Religious intolerance: Religious minorities, for example Muslims and Sikhs, are often discriminated against for their appearance and beliefs, bearing the brunt of racial profiling due to Islamophobia (It’s important to note that Sikhism is not the same as Islam). There is also the assumption of criminal status where someone is presumed to be dangerous, criminal, or deviant based on their race.

Demographics/Societal Issues

  • There are over 20 million people in the United States who identify as Asian/Pacific Islander (6.1 percent of the overall population). [2] 
  • As of 2018 there were 5.2 million people of Chinese descent, 4.5 million of (Asian) Indian descent, and 4.1 million of Filipino descent, followed by 2.2 million of Vietnamese descent, 1.9 million of Korean descent, and 1.5 million of Japanese descent. [3]
  • Over 420,000 (2.5 percent) of Asian Americans and more than 76,000 (7.6 percent) Native Hawaiian and Pacific Islanders are veterans. [4] [5]
  • Nearly 54 percent of Asian Americans and 24.4 percent of Native Hawaiian and Pacific Islanders have at a bachelor’s degree or higher. [4] [5]
  • In 2018, 10.8 percent of Asian Americans lived at or below poverty level, and 6.2 percent were without health insurance. Hawaiian Natives and Pacific Islanders fared slightly worse with 14.8 percent at or below poverty level, and 8.6 percent without health insurance. [4] [5]

Attitudes

Knowledge of the mental health needs and attitudes of Asian Americans/Pacific Islanders regarding mental illness is limited. Few epidemiological studies have included Asian Americans or people whose English is limited.

The National Asian Women’s Health Organization (NAWHO) sponsored a study, Breaking the Silence: A Study of Depression Among Asian American Women, that found [6]:

  • Conflicting cultural values are impacting Asian-American women's sense of control over their life decisions
  • Feeling responsible, yet unable to meet biased and unrealistic standards set by families and society, contributes to low self-esteem among Asian-American women
  • Asian-American women witness depression in their families, but have learned from their Asian cultures to maintain silence on the subject
  • Asian-American women fear stigma for themselves, but more so for their families

Prevalence

According to SAMHSA’s National Survey on Drug Use and Health, mental health issues are on the rise for Asian American/Pacific Islander/Native Hawaiian young adults. [7]

  • Serious mental illness (SMI) rose from 2.9 percent (47,000) to 5.6 percent (136,000) in AAPI people ages 18-25 between 2008 and 2018.
  • Major depressive episodes increased from 10 percent-13.6 percent in AAPI youth ages 12-17, 8.9 percent to 10.1 percent in young adults 18-25, and 3.2 percent to 5 percent in the 26-49 age range between 2015 and 2018.
  • Suicidal thoughts, plans, and attempts are also rising among AAPI young adults. While still lower than the overall U.S. population aged 18-25, 8.1 percent (196,000) of AAPI 18-25 year-olds had serious thoughts of suicide in 2018, compared to 7.7 percent (122,000) in 2008. 2.2 percent (52,000) made a plan in 2018, compared to 1.8 percent (29,000) in 2008, and 7,000 more AAPI young adults made an attempt in 2018, compared to 2008.
  • Binge drinking, smoking (cigarettes and marijuana), illicit drug use and prescription pain reliever misuse are more frequent among AAPI adults with mental illnesses.

Treatment Issues

  • Language barriers make it difficult for Asian Americans to access mental health services. Discussing mental health concerns is considered taboo in many Asian cultures. Because of this, Asian Americans tend to dismiss, deny, or neglect their symptoms. [8]
  • Lack of awareness of the resources and services that are available, as well as the stigma surrounding mental health issues, are the biggest deterrents in seeking professional help. [8]
  • Most young Asian Americans tend to seek out support from personal networks such as close friends, family members, and religious community members rather than seek professional help for their mental health concerns. [8]

Access/Insurance

  • Historically, AAPIs have had challenges in accessing health care and insurance.
  • 7.4 percent of Asian Americans and 9.4 percent of Pacific Islanders do not have health insurance. [9]
  • Language barriers may contribute to difficulty finding healthcare and other services. Overall, 32.6 percent of Asian Americans do not speak English fluently. [10]
  • AAPIs adults are the racial group least likely to seek mental health services - 3 times less likely than their white counterparts. [11]
  • Of AAPI adults with a mental illness, 73.1 percent did not receive treatment compared to 56.7 percent of the overall population. [7]

Mental Health Resources for Asian American and Pacific Islander Communities

Partnerships and Resources

Mental Health Screening Resources

National Asian Women’s Health Organization 

National Asian American Pacific Islander Mental Health Association


 

Sources

[1] American Psychological Association. (2012). Mental Health Among Asian-Americans. Retrieved from https://www.apa.org/pi/oema/resources/ethnicity-health/asian-american/article-mental-health.

[2] United States Census Bureau. (2019). Quick facts. Retrieved from https://www.census.gov/quickfacts/fact/table/US/PST120219

[3] United States Census Bureau – American Community Survey. (2018). Asian Alone or in Any Combination by Selected Groups. Retrieved from https://data.census.gov/cedsci/table?q=B02018&g=&lastDisplayedRow=23&table=B02018&tid=ACSDT1Y2018.B02018&hidePreview=true

[4] United States Census Bureau – American Community Survey. (2018). Retrieved from https://data.census.gov/cedsci/table?q=S0201%3A%20SELECTED%20POPULATION%20PROFILE%20IN%20THE%20UNITED%20STATES&g=&lastDisplayedRow=344&table=S0201&tid=ACSSPP1Y2018.S0201&hidePreview=true&vintage=2017&t=031%20-%20Asian%20alone%20or%20in%20combination%20with%20one%20or%20more%20other%20races%20%20%28400-499%29%20%26%20%28100-299%29%20or%20%28300,%20A01-Z99%29%20or%20%28400-999%29

[5] United States Census Bureau – American Community Survey. (2018). Retrieved from https://data.census.gov/cedsci/table?q=S0201%3A%20SELECTED%20POPULATION%20PROFILE%20IN%20THE%20UNITED%20STATES&hidePreview=true&tid=ACSSPP1Y2018.S0201&t=060%20-%20Native%20Hawaiian%20and%20Other%20Pacific%20Islander%20alone%20or%20in%20combination%20with%20one%20or%20more%20other%20races%20%20%28500-599%29%20%26%20%28100-299%29%20or%20%28300,%20A01-Z99%29%20or%20%28400-999%29

[6] National Asian Women's Health Organization. (2001). Breaking the silence: A study of depression among Asian American women. San Francisco, Calif: National Asian Women's Health Organization.

[7] SAMHSA. 2018 National Survey on Drug Use and Health (NSDUH): Asians/Native Hawaiians and Other Pacific Islanders (NHOPI). https://www.samhsa.gov/data/sites/default/files/reports/rpt23248/3_Asian_NHOPI_2020_01_14.pdf

[8] Spencer, M., Chen, J., Gee, G., Fabian, C., Takeuchi, D. (2010). "Discrimination and Mental Health-Related Service Use in a National Study of Asian Americans." American Journal of Public Health, 100(12), 2410-2417.

[9] CDC National Center for Health Statistics. Summary Health Statistics: National Health Interview Survey, 2018. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_P-11.pdf

[10] Office of Minority Health, HHS. (2019). Profile: Asian Americans. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=63.

[11] Substance Abuse and Mental Health Services Administration, Racial/Ethnic Differences in Mental Health Service Use among Adults. HHS Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. Retrieved from https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4906.pdf.