The Mental Health Consequences of Discrimination Against Asian American/Pacific Islanders

TO THE EDITOR: According to a 2020 report by the Pew Research Center, since the start of the COVID-19 pandemic, 39% of Asian American/Pacific Islanders (AAPIs) believed people were acting uncomfortably around them, 31% reported being subjected to slurs and jokes, and 26% feared that someone might threaten or physically attack them because of their race or ethnicity (1). These fears became realized as hate crimes against AAPIs have surged. In New York, a man shoved a 65-year-old Filipino American woman to the ground, stomping on her face, while shouting racial slurs; in Georgia, a man gunned down six women of Asian descent in a single day; in Texas, a man stabbed three members of an Asian American family (including a 2-year-old); the list goes on and on (2). These crimes have been fueled by the belief that AAPIs are responsible for the COVID-19 pandemic. In times of economic and social turmoil, it is not surprising that “model minorities” can become viewed as “yellow peril” (3); in times of crisis, AAPI groups are often conflated and treated as outsiders, if not outright enemies.

Empirical evidence has shown that racial-ethnic discrimination is linked to a host of negative mental health outcomes (4). Our research on AAPI university students (N=1,697) from across the country revealed that at the time the survey was administered (September–December 2020), about a quarter of the nonprobability sample reported COVID-19–related racial-ethnic discrimination, which was associated with significantly greater odds of exhibiting depression, anxiety, nonsuicidal self-injury, binge drinking, and suicidal ideation (5). These findings are particularly concerning given the tendency for AAPIs to underutilize services: a majority (∼70%) of AAPI students who had a mental health problem did not receive mental health services.

During this pandemic, AAPIs (and other communities of color) endure an additional burden of racial-ethnic discrimination, and providers must elicit these experiences to identify risk and inform treatment. Hate crimes can be violent and life-threatening, and simply bearing witness to these incidents through the media can be stressful and vicariously traumatizing. Moreover, many hate crimes go unreported, especially among those with limited English proficiency. Finally, racism is a pervasive and toxic exposure that denigrates mental health of communities of color, and it is long overdue for the field of psychiatry to explicitly embrace antiracism as a guiding principle of research and practice.