Asian Pacific Islander Mental Health

In the 2010 Census, the Native Hawaiian and Pacific Islander communities in the United States surpassed the 1 million population marker. Population totals were as follows:

• Total NHPI population in the United States. 1,225,195 people with full or mixed NHPI heritage.
• In California. 286,145, which is the largest population outside of Hawaii.
• Within California. Almost 10 million NHPIs in Los Angeles and over 3 million NHPIs in San Diego (largest populations in a state by far).
• Top states. Including California and Hawaii, 10 states held 78% of the NHPI population:
  • Washington
  • Texas
  • Florida
  • Utah
  • New York
  • Nevada
  • Oregon
  • Arizona

AAPI Women Lead reports other significant findings:

• Around 37% of Native Hawaiians in the United States earned a high school diploma.
• About 18% earned a bachelor’s degree or higher.
• Nearly 18% of NHOPI community members live below poverty.

According to a 2011 report from a National Alliance on Mental Illness (NAMI) listening session:

• Many Asian Americans are born in foreign countries, but NHPIs are predominantly born in the United States.
• NHPI and Vietnamese people experience mental distress at higher rates than other API groups.
• Many APIs work in small businesses or service industries that don’t offer health insurance. As a result, 15% of NHPIs didn’t have health insurance.
• In California, more Asian Americans and NHPIs reported experiencing discrimination compared with the state average.

NAMI states that these experiences could add mental distress to an already challenging life situation as part of an underrepresented and underserved community in the United States.

San Francisco professor of psychiatry Dr. Janice Tsoh‘s research work investigated the impact of the COVID-19 pandemic on mental health in the NHPI community.

In 2021, her team found:

• Almost 38% of NHPI respondents stated they had either depression or anxiety symptoms.
• 50% of Marshallese respondents reported symptoms of depression or anxiety (highest rates).
• 18% of Tongan respondents reported symptoms of depression or anxiety (lowest rates).
• 46% of NHPIs ages 18–24 reported depression or anxiety symptoms (highest among all age groups).

NHPIs appear to be less likely than non-Hispanic white people to live with serious psychological distress, experience a mental health episode, or report a diagnosed disorder.

But the real numbers may be greater, due to:

• APIs being three times less likely to seek mental health treatment
• lack of research funding
• lack of data on NHPI-specific mental health issues
• few API researchers

Marriage and family therapist Angela Wu of Glendora, California also cautions that since APIs only make up a relatively small population in the United States, it’s difficult to estimate the prevalence of mental health conditions for this population.

What little research there is suggests the prevalence of mental health conditions in the API community may be much higher than projected, depending on the specific ethnic group.

In a small study of 223 NHPIs, for example, researchers noted the following rates of mental health conditions, which seem high when compared with the general population.

“Depression and anxiety and adjustment disorders are some of the most common conditions that I see in my practice,” says Tsoh. She suspects that’s likely the case for most practices.

The following trends were seen for APIs in the 2019 National Survey on Drug Use and Health:

• a spike in suicide plans by people ages 26–49
• more substance use in APIs living with mental health conditions
• substance use disorder (SUD) significantly increased suicidality among adults
• reports that self-help groups were more beneficial than outpatient rehabilitation facilities for SUD

Other 2019 API mental health statistics from the Office of Minority Health indicate:

• Overall, the available behavioral health statistics for APIs is limited.
• Suicide was the leading cause of death among APIs ages 15–24.
• APIs were three times less likely than non-Hispanic white people to receive prescription treatments or services for mental health.
• About 10% of APIs experienced significant psychological distress within the previous year.
• Around 3.5% of API adults had a major depressive episode during the previous year.
• Just above 16% of API adults have experienced a mental health condition within the previous year.

Physician and life coach Dr. Cindy Tsai, out of San Diego, says the emphasis in Asian culture on excellence, education, and achievement can lead to:

• people-pleasing tendencies
• low self-esteem
• enmeshed family dynamics
• poor boundaries

These qualities can then contribute to:

• anxiety
• depression
• obsessive-compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)

Mental health challenges experienced by people in the API community can often be the result of barriers to mental health care.

These barriers can include:

• stigma
• immigration status
• religion and spirituality (as NAMI explains here)
• difficulty getting health insurance, including historical government-sanctioned controversies
• cultural health practices
• acculturation, which creates challenges for younger generations such as:
  • code-switching
  • imposter syndrome
• discrimination, like that felt by 60% of Native Hawaiian and 59% of Pacific Islanders surveyed in 2021
• performance pressure
• lack of culturally competent care that recognizes nuances in a population, for example, this older research demonstrates that Maori and Samoan folks have thicker bone structure and leaner muscle mass compared with people of European descent, so they may need separate body mass index (BMI) categories that account for this
• media stereotypes

Tsoh, Tsai, and Wu all believe there’s hope for improving API mental health outcomes by:

• increasing API-focused mental health research
• encouraging NHPIs to pursue healthcare-oriented careers
• reducing stigma around mental health care
• creating opportunities for culturally-relevant care in API communities
• increasing availability of job funding for API candidates
• acknowledging that grouping so many ethnicities under one umbrella term makes it difficult to provide relevant mental health care or obtain accurate statistics
• improving accessibility of mental health care services though community centers and telehealth (virtual services)
• combining primary care with mental health care options

In its 2008 national health agenda, the Native Hawaiian and Pacific Islander Alliance recommended one of the top action items folks can do for mental well-being is “reclaim health for NHPI families and as a community.”

Mental health challenges can affect anyone, in any ethnic group.

While cultural factors, stigma, and discrimination are some of the major barriers to mental health care for Asian Pacific Islanders, help is available.

For more information on supporting the API community, you can visit:

• Office of Hawaiian Affairs
• Asian & Pacific Islander American Health Forum (APIAHF)
• GAPIMNY
• National Queer Asian Pacific Islander Alliance (NQAPIA)
• Asian American Pacific Islander Women Lead (AAPI)
• National Asian American Pacific Islander Mental Health Association (NAAPIMHA)
• National AA and NH/PI Health Response Partnership for COVID-19 support