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Among Asian-American women, a little known battle with depression

When Kristina Wong was struggling with depression as a teenager, she couldn’t turn to her family for help.

“I definitely grew up in a family where it was extremely important not to let anyone know that anything was ever going wrong,” said Wong. “The conversations at my family get-togethers always frustrate me because they always have to do with my work or school, who won what award, and who got a raise.”

A Chinese-American performer, writer and self-described “culture jammer,” Wong just completed a four-year tour of her humorous one-woman show aimed at helping Asian-American women with depression.

The inspiration for the show, “Wong Flew Over the Cuckoo’s Nest,” occurred during a 2005 trip to Wellesley College, an all-woman campus. She was walking around the picturesque campus lake with a group of Asian-American students when the conversation turned to the topic of suicide attempts.

“I had remembered reading that Asian-American women had some of the highest rates of depression and suicide,” said Wong. “It felt so impossible that something so sick could be happening to women so perfect. Yet simultaneously, I think part of me instinctively understood why.”

Depression has taken a quiet toll on the Asian-American community, and particularly women.

According to the Department of Health and Human Services, depression is the second leading cause of death for Asian-American and Pacific Islander (AAPI) women between 15 and 24, who consistently have the highest suicide rates among women in that age group. AAPI women over 65 have the highest rates of suicide among all races in that age group.

Some Asian immigrants have fled violence and turmoil, putting them at risk for posttraumatic stress disorder. China and other Asian countries place a great emphasis on the family unit rather than the individual, and mental illness and depression often reflect poorly on family lineage. The resulting stigma associated with mental illness often prevents these conditions from being addressed within Asian-American communities.

The cultural pressure of homeland values, combined with the feelings of stress and loss common among immigrant communities, has led to what Dr. Shinhee Han, a private practitioner in New York, sees as a mental health crisis facing first- and second-generation AAPI communities.

Han said that first-generation Asian-Americans are often pressured to remove themselves from their family’s struggles and become the image of American success. One of her clients, the youngest of three in a family of first-generation Korean-Americans, had a name that translated into “Last Hope.”

“Often times I have clients whose parents were absent growing up, working nonstop, and telling their kids to study no matter what their family was going through,” said Han. “Many children grew up in a house filled with sadness and too little laughter.”

Girls are more likely to bear the brunt of this pressure.

According to Dr. Dung Ngo, a researcher in the psychology department at University of Wisconsin- La Crosse, Asian-American parents are often stricter with girls than with boys. “The cultural expectations are that Asian women don’t have that kind of freedom to hang out, to go out with friends, to do the kinds of things most teenagers growing up want to do.”

A 2009 study by the University of Washington found that nearly 16 percent of U.S.-born AAPI women have contemplated suicide in their lifetimes. That’s compared with 13 percent of all Americans.

Wong stressed that her experiences do not reflect all Asian-American families. For families like Wong’s, however, the cultural restraint in talking about emotions often results in depression for girls, said Ngo. “For boys, it’s more likely to turn outwards into rebellious behavior and behavioral problems like drinking and fighting,” he said.

Society’s model stereotype of the highly successful, well-educated and upwardly mobile person can also make it difficult for Asian women to accept their “flaws,” according to the National Alliance on Mental Illness (NAMI). In some traditional Asian cultures, women are supposed to be perfect daughters, wives, mothers and nurturers, always putting others before themselves.

Han, who spent 20 years as a mental health counselor at several American universities, believes that the alarming rate of depression-related suicides among college-age Asian-American women is underreported by the media and underserved by mental health professionals.

“Since I began 20 years ago to now, [having] one Asian-American counselor at a university means we are diverse,” said Han. She emphasized that in addition to staff diversity, a curiosity in mental health counselors to go out into the community and learn about the populations they serve is most important.

When Han does outreach specifically geared toward parents of Asian-American students, she characterizes the seminars as ways to help children become more successful. “The goals of the students and parents are the same,” she said, “but the way it’s expressed and the style of achieving these goals are different.” Han tells parents that a mentally healthy child will do better in school and in life.

“Starting earlier is best but college is a great place [to seek professional mental health guidance]” Han says, “because the women are physically away from their parents and making important decisions about their lives.”

While depression is a common and treatable disorder affecting 17 to 20 million Americans annually,  NAMI reported that the pressures AAPI women sometimes feel compound and complicate their ability to get help; only 27 percent seek help or treatment. Han said that most Asian-American students who come to her wait until they are in crisis mode, and they are initially ashamed to discuss their personal problems.

Last month the Journal of the American Medical Association (JAMA) published a commentary by federal policy medical consultant Dr. Chandak Ghosh that pointed to a lack of federal resources and information specific to the health of Asian Americans and Pacific Islanders. Ghosh recommended a national AAPI health agenda to address health disparities relative to the rest of the U.S. population; one area identified was mental health.

After each show of “Wong Flew Over the Cuckoo’s Nest,” Wong, whose tour reached many college campuses and has been released on DVD to educators, opened the floor for questions and answers. She wanted to provide a platform for young women to talk about depression in a natural setting.

“It feels at times that you have to ‘prove your craziness’ to get free help immediately,” said Wong. “There needs to be more mental health services, not just for people in high crisis but for those who just want to talk to someone.”