Depression in Young Asian-American Women

“Michelle Lin” (Photo by Ke “April” Xu for Voices of NY)

In a mental health workshop at a recent conference sponsored by the Asian American Federation, Michelle Lin (not her real name) started crying silently when a young Chinese participant rose to tell about his struggles with depression. At the end of the session, Lin, 25, walked up to one of the speakers, Alexis Confer, the executive director of ThriveNYC. She couldn’t hold her tears anymore as she said to Confer, “Thank you so much for saving my life.”

At around 2 a.m. on a weekday in the fall in 2016, Lin couldn’t fall asleep because of feeling so depressed that she didn’t think she could keep going. Thoughts of taking her own life gripped her. “I googled ‘I need help’ or ‘I’m feeling very depressed, what should I do?’ It led me to the ThriveNYC hotline,” Lin recalled. “There was a nice lady who picked up, she really listened to me. I told her everything. I kept talking for 15 to 30 minutes, I felt she cared a lot, which really helped me. I remembered her saying that, you know, I’m worth a lot. I matter.”

Lin had suffered from mental health issues for a long time and had suicide ideation. She was diagnosed with depression and anxiety in her second school year at the University of Vermont in 2013 and she thinks this problem probably had existed since she was in middle school, when she started realizing that she had trouble getting along with other classmates.

Dealing with depression and anxiety made it hard for Lin to finish college, but she made it with the help of a psychiatrist and professors. However, things got worse when Lin first came to New York City to work after she graduated in 2016.

“I was struggling because I had already been struggling in general with my mental health. I feel like when you go to a new place, you just have a new set of things to adjust to. I just moved to an apartment, the environment wasn’t very ideal, my job was stressful, and that’s why I was at a very bad place,” Lin said.

Meanwhile, she wasn’t getting enough emotional support from family or friends. Being in a new city, Lin didn’t have anyone to understand and help her. “People don’t understand and [mental illness has] stigma. It brings a lot of problems. I can show up to work because I am highly functional, but then inside it feels like I am dying.” At the same time, Lin wasn’t able to derive any support from her family. “Basically, I’m not really in a mainstream professional field, a lot of times all I get from my family is this subtle wave of disapproval,” she said. “Who I am and whatever I care about doesn’t matter.” Lin was working for a nonprofit organization in Queens to help low-income people solve housing issues.

The sleepless nights almost overwhelmed her. Fortunately, Lin made the phone call and she survived. But many young Asian women in America who experience depression and don’t get immediate and appropriate help may not be that lucky.

A workshop held by the Esther Ha Foundation in NYC (Photo provided by the Esther Ha Foundation)

Although most depressed people will never attempt suicide, most people who attempt or die by suicide are depressed. According to the Asian American Federation’s 2017 report Overcoming Challenges to Mental Health Services for Asian New Yorkers, Asian-American adolescent girls have the highest rates of depression among all racial/ethnic groups in the U.S., with young Asian American women ages 15-24 having some of the highest rates of suicide across all racial groups.

Yonghwa Ha, founder of the Esther Ha Foundationlooked sad when he recalled his daughter Esther Ha’s death from suicide. On the cold morning of Jan. 17, 2014, Esther, 22, abandoned her car on the Throgs Neck Bridge and jumped to her death off the bridge. Before that, Esther had been receiving therapy to treat depression for two years.

“Esther was always very active, she was a cheerleader and leader in her class,” Ha said. So when Esther told her father that she didn’t feel well and wanted to see a doctor, he didn’t understand in the very beginning, but nonetheless found a doctor for her.

Esther’s situation became worse due to being bullied by other interns during her internship, being separated from her boyfriend and other factors. She couldn’t fall asleep at night, didn’t pick up her phone, and she smoked and drank alcohol, which she had rarely done before. Ha noticed the changes in his daughter, but he didn’t fully understand what was happening. “I didn’t recognize how dangerous the disease was until she passed away.” Mr. Ha paused. “It takes people’s lives.”

Two months after Esther’s death, her father decided to establish a foundation in memory of his daughter and to raise awareness of depression and help prevent suicide in the Korean community in the U.S. The foundation supports Korean immigrant families in many ways, such as by launching campaigns about mental health issues, scholarship programs, running “healing camps” for teens and more. It also aims to build up a culture of respect and working together with experts in various areas.

In the past four years, the Esther Ha Foundation has helped many Korean immigrants who have mental health issues, but Ha still feels there is a long way to go to raise the awareness of depression in the Asian community. According to the AAF report, Asian Americans with suicidal thoughts were less likely to seek help and perceive a need for treatment.

Eva Wong (left) and Wen Juan Huang (Photo by Ke “April” Xu for Voices of NY)

And the nature of the treatment Asian Americans seek and accept varies. Older patients who have a comfortable relationship with family doctors they trust may receive prescriptions for anti-depressants, but for many young people the first step is getting them to a therapist who can help them recognize, accept and talk about their mental health problems. Furthermore, said Eva Wong, LMHC, director of Programs and Engagement at University Settlement and president of the Asian Health and Social Service Council, “medication may work quickly, but it never treats the root [problem]. Talk therapy may not work as quickly as medication, the improvement may come a little bit slower, but [it is more] long-lasting.”

One major factor that prevents Asian Americans from taking even the initial step of getting medical help for depression relates to culture and the stigma attached to mental illness. Wong noted that “in the upbringing of most Asians, there is a lack of a support system at home where they are allowed to talk about negative emotions like anger or sadness. Also, when some Asian youth suffer from depression, their parents are not willing to get help from professionals. They feel ashamed of having mental health issues.”

Parenting style is also blamed for high depression among Asian-American youth. Dr. Feng Liu, MD, a child and adolescent psychiatrist, pointed out that Asian parents “have high academic expectations for their kids and they often have social development tasks for kids.” Wen Juan Huang, associate clinical director of the Consultation Center and director of the Home Based Crisis Intervention program at University Settlement, agreed. Huang said many Asian parents have high expectations for their kids, which involve expecting them to be strong, hardworking and successful. She pointed out that Asian parents offer their children the best living conditions they can to help their kids get a good education, food and access to success, but ignore their kids’ emotional needs. Meanwhile, children somehow understand that talking to anyone about negative feelings they may have is shameful. “Asian parents work very hard to raise the kids and try to give them the best resources. There is no doubt that Asian parents love their children, but not in a way that the kids can feel their love.”

Ethnic identity also contributes to the stress that Asian Americans face. Lin mentioned that after she moved to America from Hong Kong when she was 18, she “always felt isolated” and it was difficult to make friends or feel a sense of belonging. “I feel a lot of people go through this as immigrants in this country. No matter how old or young they are, they tend to struggle with the feeling of being isolated. No one really understands what they have gone through.” Esther Ha’s father feels the same way: “Even for our second or third generation, American life is still tough. Because even though we are stable, we are still a kind of stranger, we are not the majority.”

For young Asian-American women ages 15-24, the situation is especially challenging. Kunsook Bernstein, professor at the School of Nursing at Hunter College, said those years are a sensitive period: “They graduate from school, enter college and leave their safety net. When they seek freedom, they are also exposed to drugs, alcohol, sex, study pressures and stress from work after graduation.” Bernstein added, “Depression is across the world, not only in the Asian community, but Asian culture is affected by Confucianism, which tends to put women down. Women are twice as likely as men to be depressed especially in Asian culture.”

Kunsook Bernstein (Photo by Ke “April” Xu for Voices of NY)

To address the stigma and mental health issues in the Asian-American community, one of the priorities is to raise awareness. “Mental health illness is the same as other illnesses, no one should be ashamed about having mental health issues. It should be and can be treated,” Dr. Liu said. Eva Wong and Wen Juan Huang said that education about mental health should be pushed more in the schools and that Asian parents should be informed and gain more knowledge about mental health issues and how parenting style matters. “We shouldn’t underestimate the scale of our challenges,” Lin said. “One wrong thought could take you all the way to the top of a tower. Don’t feel shame to feel not OK and ask for help.”

What’s more, Bernstein of the Hunter College School of Nursing, suggests having more culturally and linguistically competent practitioners to help the Asian-American community. “You don’t need to find the best doctors around the world, you need to find the doctor that you can click with,” she said. “We don’t have enough practitioners for Asian Americans. The very limited number of bilingual practitioners causes difficulty to communicate.”

To increase the workforce in mental health services, funding from the community and government is important. Wong pointed out that the city should continue funding the existing community organizations which already have systematic and comprehensive services. It is also important to centralize all the resources so that they can be accessed by different Asian subethnic groups. “Each subethnic group represents their own people, own needs and own subculture, but we cannot remove the stigma only one community at a time,” Bernstein said. “Everyone should get engaged. It’s time for Asian-American communities to centralize how we can target this issue for New York Asian Americans.”

Ke “April” Xu is a reporter for Sing Tao Daily. This article was written as part of the 2018 Health Reporting Fellowship of the Center for Community and Ethnic Media at the Craig Newmark Graduate School of Journalism at CUNY and funded by a grant from News Corp.

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