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Mental Illness Public Stigma and Generational Differences Among Vietnamese Americans

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Abstract

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA, 70112, USA

    Mai Do

  2. Department of Social Work, University of Minnesota, Duluth, MN, USA

    Jennifer McCleary

  3. Tulane University School of Social Work, New Orleans, LA, USA

    Jennifer McCleary

  4. New Orleans East Community Health Center, New Orleans, LA, USA

    Diem Nguyen & Keith Winfrey

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  1. Mai Do
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  3. Diem Nguyen
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Correspondence to Mai Do.

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Appendices

Appendix 1: Focus Group Interview Guide

Introduction: Thank you for taking the time to participate in this focus group. I am going to be asking you some questions about thoughts, beliefs, and values related to mental health, mental health treatment, substance use, and substance use treatment. You do not need to talk about your own experiences with mental health or substance use. Instead, we are asking about how you perceive the Vietnamese community in general to perceive these things. You will notice you are in a group with people who are close to your own age and immigration background (came to the US young, came to the US older, or were born in the US). We are especially interested in learning about the variety within the Vietnamese community as it relates to age and immigration experience. When answering these questions you may agree with some things that other people say or you may disagree or have a different experience. This is OK. We want to make sure we are hearing everyone’s opinions and there are no “right” or “wrong” answers to these questions. We just ask that people speak respectfully when they disagree and that people speak honestly. We also ask that you keep these conversations private and not repeat what others say out in the community.

  1. 1.

    How do you define mental health problems?

    1. a.

      What kinds of problems are considered mental health problems?

    2. b.

      What kinds of mental health problems do you see most often in your community?

    3. c.

      How serious do you think mental illness is in your community?

  2. 2.

    How do you define substance use problems?

    1. a.

      What kinds of problems are considered substance use problems?

    2. b.

      What kinds of substance use problems do you see most often in your community?

    3. c.

      How serious do you think substance abuse problems are in your community?

  3. 3.

    Do you think there are any connections between mental illness and substance abuse? If so, how?

    1. a.

      Probe about causes, symptoms and how the problems are managed or treated.

  4. 4.

    How does your community typically respond to someone with mental health or substance use problems?

    1. a.

      How do friends, family, and the community typically respond to people with these problems?

    2. b.

      What are some community beliefs about people with mental health or substance use problems?

  5. 5.

    What kinds of medical, spiritual, or professional treatment is available to your community for these problems?

    1. a.

      How likely are people to seek out this treatment?

  6. 6.

    Do people in your community differentiate between “Western” treatment and “traditional Vietnamese” treatment for these types of problems?

    1. a.

      What are the differences, if any?

    2. b.

      Which type of treatment are people in your community more likely to seek out?

  7. 7.

    Why do you think some people will not seek treatment for these problems?

  8. 8.

    What are the things that might encourage someone to seek help for substance use or mental health problems?

  9. 9.

    Hypothetically, if it were you, how would you like medical, spiritual, or professional personnel to treat substance use or mental health problems?

    1. a.

      What kinds of treatment or help would you like to have?

    2. b.

      How would you like your doctors to ask about mental health or substance use problems?

  10. 10.

    What are some of the things (family, friends, education, media, religion, etc.) that influence your beliefs and values about substance use and mental illness?

  11. 11.

    What do you see as your community’s strengths in solving problems related to mental illness and substance abuse?

  12. 12.

    Is there anything else you want to tell me about substance use and mental health problems in your community?

Appendix 2: Key Informant Interview Guide

Thank you for taking the time to participate in this interview. I am going to be asking you some questions about thoughts, beliefs, and values related to mental health, mental health treatment, substance use, and substance use treatment. I will also be asking about how you think these thoughts, beliefs, and values impact peoples’ willingness to seek treatment for these types of problems in the Vietnamese community. I am especially interested in your response to these questions as a person who provides care to the Vietnamese community. Your role provides critical insight.

  1. 1.

    How do you define mental health problems?

    1. a.

      What kinds of problems are considered mental health problems?

    2. b.

      What kinds of mental health problems do you see most often in your community?

    3. c.

      How serious do you think mental illness is in your community?

  2. 2.

    How do you define substance use problems?

    1. a.

      What kinds of problems are considered substance use problems?

    2. b.

      What kinds of substance use problems do you see most often in your community?

    3. c.

      How serious do you think substance abuse is in your community?

  3. 3.

    Do you think there are any connections between mental illness and substance abuse? If so, how?

    1. a.

      Probe about causes, symptoms and how the problems are managed or treated.

  4. 4.

    What thoughts, beliefs, and values are present in the people you serve about mental illness and substance use?

    1. a.

      What factors (family, community, education, religion, etc.) influence these thoughts, beliefs, and values?

  5. 5.

    In what ways do the thoughts, values, and beliefs discussed above influence willingness to seek treatment for mental health or substance use problems?

  6. 6.

    What are some things that would make it easier to provide or refer to treatment for behavioral health problems to the people you serve?

    1. a.

      What kinds of support would you like to have to provide or refer to treatment?

  7. 7.

    Can you please describe some specific experiences you have had treating or referring for substance use or mental health problems and what those experiences were like?

  8. 8.

    What do you see as the community’s strengths in solving problems related to mental illness and substance abuse?

  9. 9.

    Is there anything else you want to tell me about responding to behavioral health issues in your community?

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Do, M., McCleary, J., Nguyen, D. et al. Mental Illness Public Stigma and Generational Differences Among Vietnamese Americans. Community Ment Health J 56, 839–853 (2020). https://doi.org/10.1007/s10597-019-00545-y

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