Migration, sociocultural factors, and local cultural worlds among Fuzhounese Chinese immigrants: implications for mental health interventions

Abstract

The last two decades have seen a rapid increase of Fuzhounese immigrants (from Fujian Province, China) to the USA. This group spurred the interest of researchers because of their new immigrant status and their demographic and sociocultural background that places them at a significant disadvantage compared with the majority of already established Chinese immigrants. This paper synthesizes existing research on the Fuzhounese's historical/cultural and migration experiences and examines ways in which sociocultural forces interact with postmigration stressors to impact the onset, manifestation, diagnosis, and treatment of symptoms in this group. From prior ethnographic work, we suggest that the pursuit of four core social goals plays a key role in interfering with psychiatric treatment adherence: (1) To payoff their smuggling debt (often >$80,000); (2) To send money to their natal families to improve social standing; (3) To save money for a dowry to perpetuate the familial lineage by marrying and producing offspring; and (4) To attain legal status. To offer more insight on how these core social motivations impact psychiatric disability, we present a case vignette of a Fuzhounese man diagnosed with schizophrenia. We relate his treatment issues to specific fundamental values that infuse both the lived experience of mental illness and inform clinical and community treatment strategies for this group. We also extend relevant treatment recommendations to migratory workers from other ethnic groups.

Keywords:

• Chinese
• culture
• mental health
• Asian American
• immigration
• psychiatric treatment

Acknowledgements

This study was supported in part by NIMH grant K01-MH73034-01 which has been awarded to Dr Yang, the Asian American Center on Disparities Research (National Institute of Mental Health grant: P50MH073511), and the New York State Office for Mental Health Policy Scholar Fellowship. We would also like to thank the staff at the Asian Bicultural Clinic of Gouverneur Healthcare Services for their support, special thanks to Dr Diana Chen, Wei-Yeung Ng, Noel Ching-Sum Leung, and Elaine Ho.

Notes on contributors

Grace Ying-Chi Lai is currently a Ph.D. candidate at New York University, Silver School of Social Work. After receiving her MSW from Columbia University, she worked with immigrants and minority population with mental health disorders in New York City. In addition, she is a Registered Play Therapist with an interest in working with children with adjustment and behavioral issues. Her research focuses on Asian American mental health and community-based treatment. Mr. Lai is fluent in Cantonese and Mandarin.

Hong Ngo is currently a Clinical Psychology Ph.D. Candidate at Fordham University. Her clinical and research interests pertain to the exploration of cultural factors affecting service utilization, development of culturally competent interventions, and providing mental health services for underserved populations.

Born and raised in Taiwan, Yuwen Chou is a bilingual and bicultural psychologist licensed in both NY and NJ, she has had gained her experience working with Fuzhounese immigrants at Gouverneur Healthcare Services, a hospital serving approximately 25% of Chinese immigrants in the Lower East Side and Chinatown. With the knowledge and expertise, she later worked with Dr. Lawrence Yang on his research project interviewing caregiving family members of individuals with mental illness at Bellevue Hospital regarding mental health stigma and psychosocial factors impacting the course of illness. Now, she joins a group private practice and provides therapy to people with a wide range of age, cultural and linguistic background.

Graciete Lo is currently a clinical psychology Ph.D. candidate at Fordham University. Her professional interests include health disparities among racial/ethnic minorities, mental health stigma and ethnocultural and spirituality issues in clinical practice. She is completing a pre-doctoral internship at the Honolulu Veteran Affairs in Hawaii and anticipates to graduate in August 2012. Upon graduation, she will be starting a two-year position at the National Center for PTSD-Pacific Islands Division.

Dr. Lawrence Yang is an Assistant Professor of Epidemiology at Columbia University. Dr. Yang studies the social processes that shape the course of schizophrenia within diverse cultural, and specifically Chinese immigrant, groups. He has thirty-one peer-reviewed papers plus 7 book chapters (60% first-authored), including publications in the Journal of Abnormal Psychology and The Lancet. Dr. Yang is an affiliated researcher at the NIH-funded, National Asian-American Center on Health Disparities at U.C. Davis and is the sole intervention researcher to study psychotic disorders among Asian-Americans nationally. Dr. Yang has received six Early Career Awards, four of which are national, for this work. He has received a 5-Year K01-award from NIMH, and is scheduled to receive a 5-year, R01 grant from NIMH to study the stigma of the newly-developed “high-risk” for psychosis diagnosis.

Notes

1. Some demographic details have been changed, and a pseudonym is used to protect this client's anonymity. The first and fourth authors both worked with Mr. X from 2001 to 2007 in a community mental health clinic in New York City.