Mental Illness Public Stigma and Generational Differences Among Vietnamese Americans

  • Mai DoEmail author
  • Jennifer McCleary
  • Diem Nguyen
  • Keith Winfrey
Original Paper


Public stigma is one barrier to accessing behavioral health care among Vietnamese Americans. To explore and identify features of culture and acculturation that influence behavioral health-related stigma, six focus groups were conducted with Vietnamese American participants in three generational groups and eleven key informant interviews were conducted with Vietnamese community leaders, traditional healers, and behavioral health professionals. Data were analyzed using Link and Phelan’s (Annu Rev Sociol 27(1):363–385, 2001) work on stigma as an organizing theoretical framework. Findings underline several key cultural and generational factors that intersect to affect perceptions, beliefs, and stigma about mental health treatment. In particular, participants in the youngest groups highlighted that while they recognized the value of mental health services, they felt culturally limited in their access. This appeared to be closely related to intergenerational communication about mental health. The findings suggest avenues for further research as well as interventions to increase mental health treatment access and adherence.


Vietnamese Immigrants Mental health Public stigma 



This study was supported by the National Center for Advancing Translational Research of the National Institutes of Health under Award Number UL1TR001417 with a sub-contract to Tulane University. The authors would like to express their gratitude to Mily Nguyen and the staff at the New Orleans East Community Health Center for their assistance in recruitment and data collection. The authors thank Thuan Vuong and Chali Temple for their work in the transcription and translation of the interviews.


  1. Abdullah, T., & Brown, T. L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review,31(6), 934–948.PubMedCrossRefGoogle Scholar
  2. Africa, J., & Carrasco, M. (2011). Asian-American and Pacific Islander mental health. Asian American Journal of Psychology,6(2), 107–116.Google Scholar
  3. Anglin, D. M., Link, B. G., & Phelan, J. C. (2006). Racial differences in stigmatizing attitudes toward people with mental illness. Psychiatric Services,57(6), 857–862. Scholar
  4. Augsberger, A., Hahm, H. C., Yeung, A., & Dougher, M. (2015). Barriers to substance use and mental health utilization among Asian-American women: Exploring the conflict between emotional distress and cultural stigma. Paper presented at the Addiction Science & Clinical PracticeGoogle Scholar
  5. Bankston, C. (2012). Amerasian homecoming Act of 1988: Encyclopedia of diversity in education. Thousand Oaks, CA: SAGE.CrossRefGoogle Scholar
  6. Böge, K., Hahn, E., Cao, T. D., Fuchs, L. M., Martensen, L. K., Schomerus, G., et al. (2018). Treatment recommendation differences for schizophrenia and major depression: A population-based study in a Vietnamese cohort. International Journal of Mental Health Systems,12(1), 70.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Bourque, F., van der Ven, E., & Malla, A. (2011). A meta-analysis of the risk for psychotic disorders among first-and second-generation immigrants. Psychological Medicine,41(5), 897–910.PubMedCrossRefGoogle Scholar
  8. Britt, T. W., Greene-Shortridge, T. M., Brink, S., Nguyen, Q. B., Rath, J., Cox, A. L., et al. (2008). Perceived stigma and barriers to care for psychological treatment: Implications for reactions to stressors in different contexts. Journal of Social and Clinical Psychology,27(4), 317–335.CrossRefGoogle Scholar
  9. Bui, Q. N., Han, M., Diwan, S., & Dao, T. (2018). Vietnamese-American family caregivers of persons with mental illness: Exploring caregiving experience in cultural context. Transcultural Psychiatry,55(6), 846–865.PubMedCrossRefGoogle Scholar
  10. Cervantes, R. C., Padilla, A. M., Napper, L. E., & Goldbach, J. T. (2013). Acculturation-related stress and mental health outcomes among three generations of Hispanic adolescents. Hispanic Journal of Behavioral Sciences,35(4), 451–468.CrossRefGoogle Scholar
  11. Chang, J., Natsuaki, M. N., & Chen, C.-N. (2013). The importance of family factors and generation status: Mental health service use among Latino and Asian Americans. Cultural Diversity and Ethnic Minority Psychology,19(3), 236.PubMedCrossRefPubMedCentralGoogle Scholar
  12. Cheung, M., Leung, P., & Nguyen, P. V. (2017). City size matters: Vietnamese immigrants having depressive symptoms. Social Work in Mental Health,15(4), 457–468.CrossRefGoogle Scholar
  13. Chu, J. P., & Sue, S. (2011). Asian American mental health: What we know and what we don't know. Online Readings in Psychology and Culture,3(1), 4.CrossRefGoogle Scholar
  14. Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist,59(7), 614–625. Scholar
  15. Corrigan, P. W. (2007). How clinical diagnosis might exacerbate the stigma of mental illness. Social Work,52(1), 31–39.PubMedCrossRefPubMedCentralGoogle Scholar
  16. Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review,30(8), 907–922.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Corrigan, P. W., & Watson, A. C. (2007). The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver. Community Mental Health Journal,43(5), 439–458.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Cox, M. (2018). An exploratory study on mental illness perspectives in Hanoi.Google Scholar
  19. Dinh, M.-H. N. (2018). Vietnamese buddhist Monks'/Nuns' and Mediums' views on attribution and alleviation of symptoms of mental illness. San Diego: Alliant International University.Google Scholar
  20. Do, M. P., Hutchinson, P. L., Mai, K. V., & Vanlandingham, M. J. (2009). Disparities in health care among vietnamese new orleanians and the impacts of Hurricane Katrina. Research in the Sociology of Health Care,27, 301–319. Scholar
  21. Do, M., Pham, N. N. K., Wallick, S., & Nastasi, B. K. (2014). Perceptions of mental illness and related stigma among Vietnamese populations: Findings from a mixed method study. Journal of Immigrant and Minority Health,16(6), 1294–1298.PubMedCrossRefGoogle Scholar
  22. Fancher, T. L., Ton, H., Le Meyer, O., Ho, T., & Paterniti, D. A. (2010). Discussing depression with Vietnamese American patients. Journal of Immigrant and Minority Health,12(2), 263–266.PubMedCrossRefGoogle Scholar
  23. Fong, T. W., & Tsuang, J. (2007). Asian-Americans, addictions, and barriers to treatment. Psychiatry (Edgmont),4(11), 51.Google Scholar
  24. Gallina, A., & Rozel Farnworth, C (2016). Gender dynamics in rice-farming households in Vietnam: A literature review.Google Scholar
  25. Goffman, E. (1986). Stigma: Notes on the management of spoiled identity. New York: Touchstone.Google Scholar
  26. Han, M., Cao, L., & Anton, K. (2015). Exploring the role of ethnic media and the community readiness to combat stigma attached to mental illness among Vietnamese immigrants: The pilot project Tam An (Inner Peace in Vietnamese). Community Mental Health Journal,51(1), 63–70.PubMedCrossRefPubMedCentralGoogle Scholar
  27. Haque, A. (2010). Mental health concepts in Southeast Asia: Diagnostic considerations and treatment implications. Psychology, Health & Medicine,15(2), 127–134.CrossRefGoogle Scholar
  28. Herrick, C. A., & Brown, H. N. (1998). Underutilization of mental health services by Asian-Americans residing in the United States. Issues Ment Health Nurs,19(3), 225–240.PubMedCrossRefPubMedCentralGoogle Scholar
  29. Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology,52(2), 196.CrossRefGoogle Scholar
  30. Hovey, J. D., Kim, S. E., & Seligman, L. D. (2006). The influences of cultural values, ethnic identity, and language use on the mental health of Korean American college students. The Journal of Psychology,140(5), 499–511.PubMedCrossRefGoogle Scholar
  31. Jang, Y., Chiriboga, D. A., & Okazaki, S. (2009). Attitudes toward mental health services: Age-group differences in Korean American adults. Aging and Mental Health,13(1), 127–134.PubMedCrossRefGoogle Scholar
  32. Jimenez, D. E., Bartels, S. J., Cardenas, V., & Alegría, M. (2013). Stigmatizing attitudes toward mental illness among racial/ethnic older adults in primary care. International Journal of Geriatric Psychiatry,28(10), 1061–1068.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Kamimura, A., Trinh, H. N., Johansen, M., Hurley, J., Pye, M., Sin, K., et al. (2018). Perceptions of mental health and mental health services among college students in Vietnam and the United States. Asian Journal of Psychiatry,37, 15–19.PubMedCrossRefPubMedCentralGoogle Scholar
  34. Keyes, K., Hatzenbuehler, M., McLaughlin, K., Link, B., Olfson, M., Grant, B., et al. (2010). Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology,172(12), 1364–1372.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Kim, I., Keovisai, M., Kim, W., Richards-Desai, S., & Yalim, A. C. (2019). Trauma, discrimination, and psychological distress across Vietnamese refugees and immigrants: A life course perspective. Community Mental Health Journal,55(3), 385–393.PubMedCrossRefGoogle Scholar
  36. Kim-Mozeleski, J. E., Tsoh, J. Y., Gildengorin, G., Cao, L. H., Ho, T., Kohli, S., et al. (2018). Preferences for depression help-seeking among vietnamese American adults. Community Mental Health Journal,54(6), 748–756.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Kinzie, J. D. (1985). Overview of clinical issues in the treatment of Southeast Asian refugees (pp. 113–135). Southeast Asian Mental Health: Treatment, Prevention, Services, Training, and Research.Google Scholar
  38. Kumin, J. (2008). Orderly departure from Vietnam: Cold war anomaly or humanitarian innovation? Refugee Survey Quarterly,27(1), 104–117.CrossRefGoogle Scholar
  39. Laqua, C., Hahn, E., Böge, K., Martensen, L. K., Nguyen, T. D., Schomerus, G., et al. (2018). Public attitude towards restrictions on persons with mental illness in greater Hanoi area, Vietnam. International Journal of Social Psychiatry,64(4), 335–343.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Leahy, C., Winterford, K., Nghiem, T., Kelleher, J., Leong, L., & Willetts, J. (2017). Transforming gender relations through water, sanitation, and hygiene programming and monitoring in Vietnam. Gender & Development,25(2), 283–301.CrossRefGoogle Scholar
  41. Lee, S., Juon, H.-S., Martinez, G., Hsu, C. E., Robinson, E. S., Bawa, J., et al. (2009). Model minority at risk: Expressed needs of mental health by Asian American young adults. Journal of Community Health,34(2), 144.PubMedPubMedCentralCrossRefGoogle Scholar
  42. Leong, F. T., Kim, H. H., & Gupta, A. (2011). Attitudes toward professional counseling among Asian-American college students: Acculturation, conceptions of mental illness, and loss of face. Asian American Journal of Psychology,2(2), 140.CrossRefGoogle Scholar
  43. Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian Americans. Mental Health Services Research,3(4), 201–214.PubMedCrossRefPubMedCentralGoogle Scholar
  44. Leu, J., Walton, E., & Takeuchi, D. (2011). Contextualizing acculturation: Gender, family, and community reception influences on Asian immigrant mental health. American Journal of Community Psychology,48(3–4), 168–180.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Leung, P., Cheung, M., & Cheung, A. (2010). Vietnamese Americans and depression: A health and mental health concern. Social Work in Mental Health,8(6), 526–542.CrossRefGoogle Scholar
  46. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology,27(1), 363–385.CrossRefGoogle Scholar
  47. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health,89(9), 1328–1333.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin,30(3), 511–541.PubMedCrossRefGoogle Scholar
  49. Logan, D. G. (2017). Tips for mental health providers working with Southeast Asian Immigrants/Refugees [English and Vietnamese versions]. Psychiatry Information in Brief,14(5), 1.CrossRefGoogle Scholar
  50. Masood, N., Okazaki, S., & Takeuchi, D. T. (2009). Gender, family, and community correlates of mental health in South Asian Americans. Cultural Diversity and Ethnic Minority Psychology,15(3), 265.PubMedCrossRefPubMedCentralGoogle Scholar
  51. Masuda, A., & Boone, M. S. (2011). Mental health stigma, self-concealment, and help-seeking attitudes among Asian American and European American college students with no help-seeking experience. International Journal for the Advancement of Counselling,33(4), 266–279.CrossRefGoogle Scholar
  52. Montazer, S., & Wheaton, B. (2011). The impact of generation and country of origin on the mental health of children of immigrants. Journal of Health and Social Behavior,52(1), 23–42.PubMedCrossRefPubMedCentralGoogle Scholar
  53. Ngo, D., Tran, T. V., Gibbons, J. L., & Oliver, J. M. (2000). Acculturation, premigration traumatic experiences, and depression among Vietnamese Americans. Journal of Human Behavior in the Social Environment,3(3–4), 225–242.CrossRefGoogle Scholar
  54. Nguyen, A. (2003). Cultural and social attitudes towards mental illness in Ho Chi Minh City, Vietnam. Seattle University Research Journal, Spring,2, 27–31.Google Scholar
  55. Nguyen, D., Parker, L., Doan, M., & Brennan, L. (2012a). 2012. Paper presented at the ANZMAC: Decision making dynamics within the Vietnamese family unit.Google Scholar
  56. Nguyen, H. T., Yamada, A. M., & Dinh, T. Q. (2012b). Religious leaders’ assessment and attribution of the causes of mental illness: An in-depth exploration of Vietnamese American Buddhist leaders. Mental Health, Religion & Culture,15(5), 511–527.CrossRefGoogle Scholar
  57. Nguyen, Q., & Anderson, L. P. (2005). Vietnamese Americans' attitudes toward seeking mental health services: Relation to cultural variables. Journal of Community Psychology,33(2), 213–231.CrossRefGoogle Scholar
  58. Nguyen, T.-N. (2019). Mental Health Perceptions in a Vietnamese American College Student Population (Doctoral dissertation)Google Scholar
  59. O'Mahony, J. M., & Donnelly, T. T. (2007). The influence of culture on immigrant women's mental health care experiences from the perspectives of health care providers. Issues in Mental Health Nursing,28(5), 453–471.PubMedCrossRefGoogle Scholar
  60. Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research,40(5), 384–399.PubMedCrossRefGoogle Scholar
  61. Park, M., Chesla, C. A., Rehm, R. S., & Chun, K. M. (2011). Working with culture: Culturally appropriate mental health care for Asian Americans. Journal of Advanced Nursing,67(11), 2373–2382.PubMedCrossRefGoogle Scholar
  62. Pedersen, E. R., & Paves, A. P. (2014). Comparing perceived public stigma and personal stigma of mental health treatment seeking in a young adult sample. Psychiatry Research,219(1), 143–150.PubMedPubMedCentralCrossRefGoogle Scholar
  63. Pescosolido, B. A., Fettes, D. L., Martin, J. K., Monahan, J., & McLeod, J. D. (2007). Perceived dangerousness of children with mental health problems and support for coerced treatment. Psychiatric Services,58(5), 619–625.PubMedCrossRefGoogle Scholar
  64. QSR International Pty Ltd. (2015). NVivo qualitative data analysis software, Version 11.Google Scholar
  65. Sadavoy, J., Meier, R., & Ong, A. Y. (2004). Barriers to access to mental health services for ethnic seniors: The Toronto study. The Canadian Journal of Psychiatry,49(3), 192–199.PubMedCrossRefGoogle Scholar
  66. Shannon, P. J., Wieling, E., Simmelink-McCleary, J., & Becher, E. (2015). Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and Trauma,20(3), 281–296.CrossRefGoogle Scholar
  67. Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Stigma as a barrier to recovery: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services,52(12), 1615–1620.PubMedCrossRefPubMedCentralGoogle Scholar
  68. Sobowale, K., Nguyen, M., Weiss, B., Van, T. H., & Trung, L. (2016). Acceptability of internet interventions for youth mental health in Vietnam. Global Mental Health, 3 Google Scholar
  69. Spencer, M. S., Chen, J., Gee, G. C., Fabian, C. G., & Takeuchi, D. T. (2010). Discrimination and mental health-related service use in a national study of Asian Americans. American Journal of Public Health,100(12), 2410–2417. Scholar
  70. Sue, S., Cheng, J. K. Y., Saad, C. S., & Chu, J. P. (2012). Asian American mental health: A call to action. American Psychologist,67(7), 532.PubMedCrossRefGoogle Scholar
  71. Ta, T. M. T., Böge, K., Cao, T. D., Schomerus, G., Nguyen, T. D., Dettling, M., et al. (2018). Public attitudes towards psychiatrists in the metropolitan area of Hanoi, Vietnam. Asian Journal of Psychiatry,32, 44–49.PubMedCrossRefGoogle Scholar
  72. Ta, V. M., Holck, P., & Gee, G. C. (2010). Generational status and family cohesion effects on the receipt of mental health services among Asian Americans: Findings from the national Latino and Asian American study. American Journal of Public Health,100(1), 115–121.PubMedPubMedCentralCrossRefGoogle Scholar
  73. Umemoto, D. (2004). Asian American mental health help seeking: An empirical test of several explanatory frameworks (Doctoral dissertation, ProQuest Information & Learning)Google Scholar
  74. U.S. Census Bureau. (2012). The Asian population: 2010. Retrieved from
  75. Vu, L., & VanLandingham, M. J. (2012). Physical and mental health consequences of Katrina on Vietnamese immigrants in New Orleans: A pre-and post-disaster assessment. Journal of Immigrant and Minority Health,14(3), 386–394.PubMedCrossRefGoogle Scholar
  76. Wong, Y. J., Kim, S.-H., & Tran, K. K. (2010). Asian Americans’ adherence to Asian values, attributions about depression, and coping strategies. Cultural Diversity and Ethnic Minority Psychology,16(1), 1.PubMedCrossRefGoogle Scholar
  77. Wynaden, D., Chapman, R., Orb, A., McGowan, S., Zeeman, Z., & Yeak, S. (2005). Factors that influence Asian communities' access to mental health care. International Journal of Mental Health Nursing,14(2), 88–95. Scholar
  78. Yeh, M., Hough, R. L., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child & Adolescent Psychiatry,43(5), 605–612.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew OrleansUSA
  2. 2.Department of Social WorkUniversity of MinnesotaDuluthUSA
  3. 3.Tulane University School of Social WorkNew OrleansUSA
  4. 4.New Orleans East Community Health CenterNew OrleansUSA

Personalised recommendations