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Cultural factors, such as language, age, gender, and others, can influencethe mental health of Asians, particularly immigrants
Traditional (adhering to native values) Asians place great value on thefamily as a unit. Each individual has a clearly defined role and position inthe family hierarchy and is expected to function within that role, submittingto the larger needs of the family
Social stigma, shame, and saving face often prevent Asians from seekingbehavioral health care
Asian patients are likely to express psychological distress as physicalcomplaints
Asian Americans are the fastest growing racial group in the United States.They are also one of the most diverse, including at least 43 different ethnicgroups who speak more than 100 languages and dialects( box 1 ). The Asian Americanpopulation in the United States has grown from fewer than 1 million (0.5% ofthe total US population) in 1960 to 7.2 million (2.9%) in 1990, to 10,242,998(3.7%) in 2000. This number is expected to double by 2025. Approximately 7.2million (70.7%) Asian Americans are foreign born, and Asian immigrants accountfor 2.6% of the total USpopulation. 3
KEY CULTURAL FACTORS THAT INFLUENCE MENTAL HEALTH
Culture influences the Asian health belief system and has an effect on thediagnosis and treatment of mental disorders. Several key cultural factors thatare relevant to this process are described below. However, there is tremendouscultural variability among groups and heterogeneity within groups. Thesefactors will have differing effects, depending on the individual's degree ofacculturation, socioeconomic status, and immigration status. Our emphasis hereis on new immigrants, who comprise 1% of the USpopulation, 1 andthose who are more traditionally oriented. We have chosen this focus becauseit is these patients who experience the greatest barriers to receiving mentalhealth care. Key cultural factors are:
Language Knowledge of English is one of the most important factorsinfluencing access to care. Asian languages and dialects usually are notwidely spoken outside the individual's ethnic group and, depending on degreeof acculturation, even within it. According to the President's AdvisoryCommission on Asian Americans and Pacific Islanders, 42% of VietnameseAmerican, 41% of Korean American, and 40% of Chinese American households are"linguistically isolated." This designation means that no one inthe household age 14 years or older speaks English "verywell." 4
Level of acculturation Typically, it takes three generations forimmigrants to fully adopt the lifestyle of...