Asian American Mental Health: Looking Beyond the COVID-19 Pandemic

The COVID-19 pandemic represents one of the most challenging times in the modern era. For the Asian American and Pacific Islander (AAPI) communities in this country, COVID-19 has further ushered in a secondary epidemic of hate incidents. While national interest in anti-Asian hate crimes has been centered on a handful of highly publicized tragedies, 1 in 5 AAPIs have reported experiences with hate incidents, which included discrimination, harassment, and assault. These adverse experiences have led to suicidal ideation and depressive symptoms, as well as susceptibility to substance use disorder and traumatic symptoms. With the ongoing COVID-19 pandemic and continued reports of anti-AAPI activities, the long-term impact on the victims of these hate activities cannot be understated.

The relationship between anti-AAPI racism and AAPI mental health is complex and nuanced. While the COVID-19 pandemic may have been the main driver behind most of the hateful rhetoric against AAPIs in the past two years, anti-AAPI racism is deeply entwined in the history of our nation. Long before COVID-19, harmful stereotypes of AAPIs as “perpetual foreigners” or “model minorities,” for example, have created a system of institutional racism and social policies that deprive AAPIs of equitable access to economic, health care, and political resources. The effects of structural racism on the mental health of this population, compounded by the inadequacies of health care resources, have been felt by AAPI communities for generations. The COVID-19 pandemic certainly did not create anti-AAPI racism, but it has laid bare the long-standing shortcomings in our approach to AAPI mental health and created opportunities for us to learn and improve.

The mental health of AAPI individuals has long been plagued by, among others, three primary failings—the lack of research, the limitation on cultural-concordant mental health diagnosis and treatment paradigms, and the shortage in allocation of public health resources for AAPI communities. The research on AAPI mental health and health care utilization has been hamstrung by limitations in data gathering, as prior research studies have often failed to reflect the heterogeneity and intersectionality of AAPI groups who have diverse backgrounds in ethnicity, country of origin, immigration status, educational status, economic status, and so on. Our current understanding of psychiatric diagnosis and treatment is also influenced by a Western worldview, which often does not consider culture-specific symptoms and is limited in culturally informed treatment options (DSM-5-TR addresses these issues). Finally, marginalization of AAPIs as the “invisible minority” leads to underrepresentation in politics and lack of political influence, which in turn lead to underallocation of public health resources.

In consideration of some of the progress made in the past two years, there are reasons for cautious optimism for the future of AAPI mental health. Legislation signed by New York Gov. Kathy Hochul in December 2021 requires state agencies to desegregate data into individual AAPI ethnic groups. In New Jersey, Gov. Phil Murphy established the AAPI Commission to, among other objectives, provide better understanding of the health needs of AAPI communities. Professional organizations such as APA and the National Alliance on Mental Illness have continued to advocate for mental health resources for AAPI communities. The White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders promises to eliminate health disparities and expand access to culturally competent mental health care to AAPI communities. In fall 2021, AAPIs secured key victories in mayoral and city council races in large U.S. cities including Boston, Cincinnati, New York, and Seattle, perhaps reflecting a larger societal shift calling for increased AAPI representation in politics.

The recent developments hold early promise for progress in improving AAPI mental health with sustained, concerted advocacy efforts. The road ahead is still long and arduous, and AAPI communities still desperately need physician champions who can propel the movement to reduce AAPI mental health disparities. It is important to keep in mind that physicians are well positioned to advocate for their patients and that advocacy actions, big or small, can be immensely rewarding. To that end, we implore you to consider the following advocacy actions and principles to improve the mental health of AAPI communities:

The COVID-19 pandemic has generated renewed examinations of the AAPI experience in the United States and created opportunities to overcome the societal issues that have harmed the mental health of AAPI communities for generations. Advocacy efforts in the past year have led to legislative actions and other early promises. It is imperative to expand the conversations on AAPI mental health beyond the COVID-19 pandemic and sustain the existing momentum in advancing mental health research, diagnosis, treatment modalities, and policymaking. As psychiatrists, we have an important responsibility to utilize our expertise and voices and advocate with our allies to better the present and future of mental health for the AAPI communities. ■

APA acknowledges the work of Dora Calott Wang, M.D., M.A., who early on in the pandemic worked to bring attention to hate crimes against the AAPI community.