Manifestations of psychopathology

International and New Zealand research varies on reports about whether migrated Asians/Asian Americans have higher or lower rates of mental health issues (including drug and alcohol addiction) than their European/Western counterparts. Some report a higher incidence amongst Asians, whilst most report significantly lower rates. Lower rates are attributed by some researchers to the many confounding factors in the research process. These include the way in which Asians tend to present psychological issues, as well as to the limited sensitivity of Western psychological tests for CALD clients.

What is consistent however, is that the profile for mental health issues increases with the psychosocial stressors that result from migration and dislocation, and that they are also dependent on the circumstance of the migration experience.

Chan and Parker (2004) suggest that some of the low rates of mental health issues reported for Asian migrants (and depression in particular) may be attributed to under-reporting for the following reasons:

• the stigma and shame associated with mental health labels;
• the view that emotional illness is part of 'life';
• the stoicism in Asian family values (which may be a protective factor as well as a deterrent to seeking help);
• the tendency for traditional families to work as a unit in the healing process creates reluctance in approaching a Western doctor who is seen to deal with physical problems;
• idiomatic reporting of illness and distress (e.g. neurastheniaand 'shenjing shuairuo' in Chinese culture - see table on Culture-Bound syndromes) which creates less stigma and more socially acceptable labels than psychiatric ones (ibid.);
• a tendency to 'somatize' (see below).

Lack of recognition of mental illness may also be a reason for underreporting. Boodman (2007) relates a story of Korean parents who struggled with their son's behaviour and after two years brought him to emergency services hallucinating and having assaulted them. He was diagnosed with schizophrenia. When asked why they hadn't brought him earlier, they said that they thought he was just spoiled and so they kept him at home because they were embarrassed by his behaviour.

Lee (1997) reports that the most common mental health problems amongst Asian Americans are depression, somatization, anxiety disorder, adjustment disorder, and suicide. Uba (2003) adds substance abuse and conduct disorder. Ferguson (2012) adds post-natal depression and suggests that it is under-diagnosed in Asian clients [in New Zealand]. Puthenpadath & Culbertson (2012) report that Indians tend to express their distress through conversion of symptoms, somatization, and in more extreme cases, histrionic symptoms or compulsive behaviours.

Many Vietnamese, Cambodian, Burmese and Laotian families are from refugee backgrounds. Clients from these backgrounds may be at risk for PTSD because of high levels of trauma prior to migration; this group shows a higher rate of psychiatric problems in general. Uba (2003) notes a high incidence of affective, conversion, anxiety and dissociative disorders, as well as paranoia and organic brain syndromes for these refugee populations.

New Zealand research on South East Asian refugees has included Cambodian, Vietnamese, Laotian and more recently Burmese refugees. While Cambodian, Vietnamese and Laotian refugees arrived in New Zealand in the 1970s and 1980s many still suffer poor mental health after many years of resettlement here. For smaller refugee groups, lack of community support, social isolation and difficulty communicating with the host society contributes to poor mental health.

Although problem gambling is not as significant amongst Asians in New Zealand as compared with European, Maori, Pacific and other (MELAA) groups, Te Pou (2010) highlights that it is a problem in the Chinese community where gambling is traditionally an acceptable past-time (in moderation). It tends to be lower in Muslim Asian communities where gambling is strictly forbidden. Those most at risk are shift workers, young Asians studying English and those with co-morbid substance or alcohol abuse and mood disorders (ibid.).