Asian Americans struggle with suicide Suicide Traditions, stigma make many reluctant to seek help

Jeannie Wong is assisted by Margaret Chao after describing her struggle with suicidal thoughts in San Francisco, Calif. on Wednesday, Jan. 16, 2013. Chao was one of the researchers on a study which focuses on suicide among the Chinese American senior population. less Jeannie Wong is assisted by Margaret Chao after describing her struggle with suicidal thoughts in San Francisco, Calif. on Wednesday, Jan. 16, 2013. Chao was one of the researchers on a study which focuses on ... more Photo: Paul Chinn, The Chronicle Photo: Paul Chinn, The Chronicle Image 1 of / 7 Caption Close Asian Americans struggle with suicide 1 / 7 Back to Gallery

(01-24) 11:31 PST SAN FRANCISCO --

Jeannie Wong arrived in the United States with the hope of starting fresh away from her native Hong Kong. But life in America has been hard.

Four decades ago, during a visit to San Francisco, she met the man who would become her husband. She married him at age 30, and they had two sons. She worked as a cashier at a Chinese restaurant in Chinatown.

The good years faded fast. Her husband beat her and called her names, she said. They divorced. She got along with her sons less as they grew up, making her think she was a poor mother, she said.

With a family across the ocean, few friends and a limited grasp on English, Wong sank into depression. She was prescribed antidepressants and antipsychotic drugs, but thoughts of suicide still entered her mind.

"I wanted to just walk across the street and be hit by a car, but finally I didn't have the courage to do it," said Wong, 72, a Western Addition resident who spoke through a Cantonese interpreter.

Wong may feel alone, but many elderly Asians silently suffer from depression and consider suicide, researchers say.

According to the Centers for Disease Control and Prevention, Asian American women ages 65 and older had a higher suicide rate - 6.5 per 100,000 - than any other racial or ethnic group in that age bracket between 2004 and 2007. White women had the next highest suicide rate: 4.3 per 100,000.

Feelings of isolation

Even decades after arriving in the United States, many Asian immigrants, like Wong, feel isolated, finding it difficult to adjust to challenges such as linguistic and cultural barriers, discrimination, limited economic opportunities and social isolation, mental health experts say.

If these problems are not addressed, the experts say, they seem certain to grow since Asians - a group that spans a wide swath of languages and cultures - are the fastest-growing ethnic group in the country.

"Suicide is happening," said Joyce Chu, an assistant clinical psychology professor at Palo Alto University. "Can we understand what puts them at risk for it, and what it means for them to consider suicide so we can help people to better manage it, better prevent it?"

Until recently, Asian Americans' mental health has not been closely studied, in part because some subgroups find it shameful to air such issues.

"Traditionally, in Chinese culture, if you have a mental health problem, you tend to try to deal with it yourself or within your family," Chu said. "If someone has a serious mental illness like schizophrenia or bipolar (disorder), that family member is not talked about or kind of hidden."

To better understand the factors behind depression and suicide, Chu and a group of researchers recently surveyed 56 elderly Chinese adults and 26 non-Chinese adults at Stepping Stone Adult Day Health in San Francisco.

In the survey, the results of which were released last week, 15 percent of the Chinese participants said they'd attempted suicide.

What's behind it

Behind the thoughts of suicide were physical illness and family conflict, the researchers found. When faced with stress, the participants reported feeling hopeless and dwelling on problems instead of solving them.

When that happens, problems fester, said Benny Wong, program director at Stepping Stone's Golden Gate Avenue branch, one of four locations in San Francisco. About 65 percent of the clinic's 300 clients are Chinese, he said.

"They are confused, they have memory problems, they have mental health problems, they have medical problems," he said. "It shames them to get help."

In a 2007 study led by Loyola Marymount University, researchers found that less than 9 percent of Asians nationwide seek mental-health services. That's much lower than the 18 percent of the general population who do.

U.S.-born Asians are more likely to use medical services in general and mental-health services in particular than those born outside the country, according to the analysis, which was based on data from a 2002-03 survey.

For many Asian Americans, immigrants in particular, racial discrimination is a significant factor in depression, said David Takeuchi, a professor of sociology and social work at the University of Washington who studies minority health disparities. Social status - both real and perceived - is intertwined with a sense of success.

The toll of bigotry

That relationship became clear in a 2008 study of more than 2,000 Asian Americans. Takeuchi and other researchers asked participants to indicate whether and how often they experienced situations in which "people dislike you" or "treat you unfairly" due to race. Participants also answered questions about their mental state.

Not surprisingly, the more often the subjects experienced discrimination, the more distressed they felt.

In general, immigrants often struggle when they don't feel like they belong to their new community, Takeuchi said.

"Part of the issue for immigrants is how comfortable and how much meaning they find in a new location," he said. "That attachment or detachment can, over time, lead to kind of a good quality of life, or if you're not so attached, you may find a poor quality of life, including poor health, poor mental health, lots of suicide and so on."

Reaching out to Asian Americans requires a high sensitivity to these cultural values, said Stanley Sue, a psychology professor at Palo Alto University who specializes in Asians' mental health and was not involved with the latest study.

Finding solutions

First, it's important to emphasize that mental health problems are common and often won't get better on their own, Sue said.

In addition, medical providers should use bilingual therapists, connect patients with similar community members and use phrases like "positive growth" instead of "mental health" in their program names, to reduce the sense of stigma, he said.

And it's best to use role models who can relate to the patients' perspectives, Sue said.

"What's also very nice sometimes is to bring a recovering patient who says, 'You know, I had these experiences, look at how my life has changed,' " he said. "Those kinds of things really sink in to a lot of Chinese because it shows they're willing to talk about it, be open about it, overcome these kinds of difficulties, and I think it's very inspirational to a lot of Chinese."

For Jeannie Wong, the Hong Kong immigrant, Stepping Stone serves as that outlet. The clinic offers therapy, dietitians, medical care, and activities such as field trips and music - things that make her feel like she belongs somewhere.

"After I come here, I can talk to the social workers about my feelings," she said. "I also can make friends here so I won't feel alone."