Cultural barriers to social support seeking among Asian Americans with depression

¶ … Social Support and Depression

Among Asian-American Adults

The Relationship between Social Support and Depression among Asian-American Adults

There is evidence to suggest that Asian-Americans are less likely than European-Americans to seek social support for depression. As several studies suggest a direct link to perceived social support and depression recovery, it is important to address the reasons why Asian-Americans are reluctant to seek support. Specifically, the more social support perceived -- to include support from family, friends, and spiritual or religious beliefs -- the more likely a person is to recover from depression; however, there is also evidence to suggest that certain types of support can actually exacerbate depression in Asian-Americans.

For the purposes of this paper, I will present a literature review of five academic articles addressing the subject of social support and depression among Asian-Americans. The primary concerns of the articles include:

What cultural differences inform the reluctance to seek social support in general?

What cultural differences inform the reluctance to seek support for depression specifically?

How do attitudes regarding mental health and mental health services affect the likelihood of seeking social support for depression?

What are the barriers to providing effective social support for depression to Asian-Americans?

Are certain types support more beneficial for Asian-Americans than others?

How can mental health services be customized to better support Asian-American depressives?

Explicit vs. Implicit Social Support

For the purposes of this paper, social support is defined as that validation that one is esteemed, cared for, and valued as a component of the social communication system (Kim et al., 2008). Social support encompasses a variety of resources, to include family, friends, religious or spiritual organizations and, in some cases, mental health service providers. In the article entitled "Culture and Social Support," Kim et al. makes the distinction between explicit social support -- requiring direct disclosure of personal information -- and implicit social support, requiring only exposure to support resources in the absence of disclosure. Kim et al. goes on to assert and provide evidence that Asian-Americans are less likely to seek explicit social support, largely due to their concern that direct disclosure will place strain on interpersonal relationships and "group harmony" (Kim et al., 2008). Specifically, Asian nationals and early generation immigrants are less likely to seek explicit social support due to the fear of relational repercussions. These repercussions include -- but are not limited to -- social criticism, alienation, direct disapproval and resulting feelings of shame, which can potentially exacerbate depression (Kim et al., 2008).

These findings were supported by a series of tests designed to gauge Asian-Americans' response to implicit and explicit support. In the first study, test subjects were asked to consider a group of persons with whom they were close and then write a letter to that group. While the purpose of the letter was to attain support in a time of stress or depression, subjects were instructed to complete the letter without directly disclosing any personal information regarding their depression or stress levels. Conversely, a second group of subjects was asked to write a letter directly requesting advice on how to handle a stressful situation. After completing the letters, test subjects provided a saliva sample used to measure cortisol levels indicative of stress levels. By and large, test subjects involved in the implicit writing exercise presented with lower stress levels that those in the explicit group, providing biological evidence that stress levels are often exacerbated in Asian-Americans by seeking explicit social support (Kim et al., 2008).

The claim that Asian-Americans are less likely than European-Americans to seek explicit social support was supported by a second test designed to measure test subjects' response to daily stressors. In this test, test subjects consisting of Korean and European-Americans were asked to complete an online survey regarding the most stressful event of their day for seven days. In addition to recording the event, test subjects recorded the number of people they communicated with after the event, and also the number of people with whom they directly discussed the event. The overwhelming results of this test indicated that European-Americans were more likely to discuss a stressful event directly with others, while Korean-Americans were more likely to simply surround themselves with supportive individuals.

That Asian-Americans are reluctant to disclose personal stressor information in part explains the reluctance to seek mental health support, the Western model of which is intensely disclosure-based. Another factor that informs this reluctance is the difference in how Asian-Americans define mental health, in addition to how they evaluate persons who seek mental health services.

Defining and Evaluating Mental Health and Mental Health Services

According to researchers Jang, Chariboga and Okazaki, authors of "Attitudes toward mental health services: Age-group differences in Korean-American adults," Asian-Americans -- and Korean-American Adults in particular -- do not typically identify depression as a medical condition, but rather as a state of mind that can be avoided or changed by thinking positively. For this reason, the vast majority of Korean-Americans are inclined to think negatively about people who seek mental health services for depression, as the overwhelming opinion -- particular among Korean-Americans over the age of 60 -- is that depression is the result of mental or emotional weakness and a lack of willpower (Jang et al., 2009).

Furthermore, Jang et al. found a direct correlation between the responsiveness or openness to seeking social support for depression and the evaluation of mental health as a medical condition. Specifically, Korean-Americans who viewed depression as a medical condition -- typically younger adults between the ages of 20 and 45 -- were more likely to seek social support for the purpose of treating depression. Conversely, Korean-Americans who did not view depression of a medical condition were not likely to seek the support of mental health services for depression, and tended to think negatively of persons who did (Jang et al., 2009).

Perceived Social Support and Depression Recovery

According to researchers Nasser, Overholser and Barbour, the likeliness of recovery from depression is directly related to the perception of social support (Nasser & Overholser, 2004; Barbour, 1994). In a study conducted by Nasser and Overholser involving 62 in-patients diagnosed with depression, patients were asked to describe their perceived social support systems upon intake, after which they were treated for a period of three months and then evaluated for progress/recovery. The consistent findings of this study indicated that people with elevated perceptions of social support are more likely to recover from depression than those with lower perceptions of support. Furthermore, in a study conducted by Alton Barbour, impaired or "dysfunctional" communication was shown to impede the attainment of social support (Barbour, 1994). Barbour's findings are conducive with Leong & Lau's findings that a lack of multi-cultural resources, in addition to ineffective treatment methods relying on disclosure -- a form of communication many Asian-Americans are not comfortable with -- directly informs the reluctance to seek social support for depression and often results in premature termination of treatment. Once again, in order to effectively treat depression in Asian-Americans, implicit methods of treatment must take precedence of explicit methods (Leong & Lau, 2001).