Asians May Be More Mentally Ill at Hospital Admission

A new Canadian study finds that Chinese and South Asian patients tend to have more severe symptoms of mental illness at the time of hospital admission compared to patients of other ethnicities.

The population-based study is the largest and most rigorous examination of mental illness severity among Asian populations living in a Western country.

“We found that, when compared to patients from other populations, Chinese and South Asian patients were on average much sicker by the time they got to hospital,” said Dr. Maria Chiu, principal investigator and scientist at the Institute for Clinical Evaluative Sciences (ICES).

“While Chinese and South Asian people make up the two largest ethnic minority groups in Canada, to date research on mental illness in these groups has been limited.”

According to the findings, both Chinese and South Asian patients were significantly younger than patients from other populations being hospitalized and also more likely to experience one or more psychotic symptoms. In fact, 55 percent of Chinese and 49 percent of South Asian patients exhibited at least one psychotic symptom, compared to 38 percent of other populations with these diagnoses.

Although immigration itself is often linked to the development and severity of mental illness, this study showed similar severity in both immigrants and Canadian-born patients of Chinese and South Asian descent, suggesting that ethnicity itself is a predictor.

For the study, the researchers had access to a database of adult inpatients in designated mental health beds across all Ontario hospitals. The information covered more than 133,000 patients hospitalized for psychiatric conditions, such as schizophrenia, bipolar disorder, and depression, between 2006 and 2014.

To determine mental illness severity, the researchers looked at four measures: involuntary admissions, aggressive behaviors, and the number and frequency of psychotic symptoms (including hallucinations, delusions, and abnormal thought process).

“Our analysis shows that involuntary admissions were much more common among these ethnic minority groups, with Chinese patients being 80 percent and South Asian patients being 31 percent more likely to be admitted involuntarily,” said Chiu.

Involuntary hospitalization is an important indicator of illness severity because it typically means that the illness has progressed to a degree in which both safety and an individual’s insight into the illness are of concern, she said.

Chiu suggested that stigma and family dynamics could be factors influencing why Chinese or South Asian people might delay treatment for mental illness.

“While Asian people tend to have strong family support, they may also be more likely to experience stigma. Families may try to cope and keep the illness within the family until there is no choice but to go to hospital. Reducing stigma and augmenting culturally sensitive mental health services could help reach people sooner,” she said.

Dr. Paul Kurdyak is a psychiatrist and researcher at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health (CAMH) and a lead scientist for the ICES Mental Health and Addictions Research Program. “Like any other health condition, the longer mental illness goes without treatment, the more difficult it can be to get people back on track,” he said.

“This study highlights that ethnicity and culture are factors that should be considered when developing outreach strategies and treatment approaches, particularly at earlier stages before a patient’s illness worsens and hospitalization becomes necessary.”

The findings are published in the Journal of Clinical Psychiatry.

Source: Centre for Addiction and Mental Health