Research Commentary [6] May 2017

May 1, 2017

This edition focuses on the mental health of Asian youth in New Zealand.

The demography of youth populations in New Zealand are changing, particularly in the Auckland region. Asian populations are now 23% of the region’s peoples and over a third are under the age of 25, (36.6%) (Walker, 2014). Of these, 21% of Asian young people between the ages of 15 and 24 years are born in New Zealand (Walker, 2014).

In 2014/15, 84,856 international students were approved to study in New Zealand, a 16% increase from 73,423 in 2013/14. Many international students stay on to work in New Zealand after they complete their study. In 2014/15, 43% of the skilled migrant category principal applicants were previously on a student visa in New Zealand. Immigration New Zealand states that “To ensure New Zealand continues to benefit from having international students and secure a healthy growth in this sector, we must ensure that international students in New Zealand have a high quality experience, so New Zealand’s reputation as a safe and attractive education destination is maintained” (MBIE, 2016).

References:

Walker, R. (2014). Auckland region DHBs Asian and MELAA (Middle Eastern, Latin American and African): 2013 Census Demographic and Health Profile. Auckland: NRA. http://www.ecald.com/Resources/Resources-Publications/ID/828/Auckland-Region-DHBs-Asian-amp-MELAA-2013-Census-Demographic-and-Health-Profile-2014

The Immigration New Zealand (MBIE, 2016) Migration trends and outlook report 2015-16 shows that http://www.mbie.govt.nz/publications-research/research/migrants---monitoring/migration-trends-and-outlook-2015-16.pdf.

Commentary provided by Dr Annette Mortensen, eCALD® Project Manager: Research & Development.

The following are articles reviewed:

Article 1: Stakeholder views on factors influencing the wellbeing and health sector engagement of young Asian New Zealanders.

This qualitative study explored key stakeholder views on issues that would be most useful to explore on the health and wellbeing of Asian youth and processes that would foster engagement of Asian youth in health research. Six broad themes were identified from the key stakeholder interviews framed as priority areas that need further exploration: cultural identity, integration and acculturation; barriers to help-seeking; aspects to consider when engaging Asian youth in research (youth voice, empowerment and participatory approach to research); parental influence and involvement in health research; confidentiality and anonymity; and capacity building and informing policy.

Most Asian youth use general practitioners as their first point of contact. While recent reviews have highlighted examples of initiatives to improve primary care for young people in New Zealand, the need to address specifically inequitable access for Asian youth is highlighted in this study. Key issues impacting on the wellbeing of Asian New Zealanders are challenges relating to cultural identity and connections to mainstream society; unmet needs in disability, mental and sexual health; and lack of engagement of Asian youth in addressing these concerns. There needs to be concerted efforts in the primary care sector to actively engage young Asians, their families, and for primary care health professionals to collaborate on research and co-design responsive health services for culturally and linguistically diverse populations.

Authors: Peiris-John R, Wong A, Sobrun-Maharaj, Ameratunga S.

Citation: Peiris-John, R., Wong, A., Sobrun-Maharaj, A. & Ameratunga, S. (2016). Stakeholder views on factors influencing the wellbeing and health sector engagement of young Asian New Zealanders. J Prim Health Care, 8(1), 35–43.

Publication

Article 2: A Child Who Sees Ghosts Every Night: Manifestations of Psychosocial and Familial Stress Following Immigration.

“The child who sees ghosts every night: Manifestations of psychosocial and familial stress following immigration (Fang, Lee & Huang, 2013) case study demonstrates how the sociocultural factors and cumulative stressors associated with migration experiences can significantly impact on each family member, as well as the family unit as a whole. Joey and his parents are first-generation immigrants from a suburban area of Southern China. Arriving in the United States at age 6, Joey had only 1 year of preschool education in China and has received most of his formal education in the United States. Joey has acculturated to western culture, while his parents, who moved in their 30s, speak little English and strongly adhere to their traditional cultural values and practices.

The presenting issue in this case, namely ghost-seeing, was understood by the attending clinician from a culturally relevant perspective. Rather than focusing on the boy (Joey) seeing ghosts as the treatment target, the therapist uses Joey’s experiences as a vehicle to assess and identify the possible underlying mechanisms for his symptoms. The case demonstrated the successful strategies used by the therapist to engage with Joey and his parents. The therapist applies cultural assessment skills in making a differential diagnosis. He lays out a tentative case formulation and treatment plan during the initial visits, allowing Joey and his parents to have a clearer sense of treatment goals and plans which consequently results in a shared treatment approach. With the treatment plan focusing on the family as a whole, both Joey and his parents were supported while successfully working toward positive family changes.

Authors: Fang, Lin; Lee, Eunjung; Huang, Frederick Y.

Citation: Fang, L., Lee, E. & Huang, F.Y. (2013). A Child Who Sees Ghosts Every Night: Manifestations of Psychosocial and Familial Stress Following Immigration. Cult Med Psychiatry, 37, 549-564.

Publication

Article 3: Suicide in Asian Communities: An exploratory study in NZ-2015.

A study of suicide in Asian communities in New Zealand highlights youth as a vulnerable group for suicide risk (Ho, Au & Amerasinghe, 2015). Academic pressures, unrealistic parental expectations, parent-child conflicts and possible identity and sexuality crises, are noted as risk factors for Asian youth, with international students being mentioned as a high-risk group (Ho, Au & Amerasinghe, 2015). Academic pressures from family, which generated an intense fear of failure, were mentioned repeatedly by some informants, as a dominant factor influencing suicidal behaviours for Asian youth communities (Ho, Au & Amerasinghe, 2015). International students are a high-risk group as reduced social support and English language difficulties, in addition to academic pressures can increase the risk of suicide. Concerns were voiced particularly for Chinese international students as they were likely to come from one-child families and therefore be the sole point of focus of parental pressures. During exam times, there is an increase in referrals of international students to Child and Adolescent Mental Health Services (CAMHS) and it is recognised that this is a high-risk period for suicidal behaviours, as the outcomes of exams could determine their further stay in the country.

With regard to early intervention, informants suggested, in particular, the need to address underlying mental health issues at an early stage. Because of the stigma associated with mental illness in Asian communities, even where specialist mental health services are available, many Asian people with depression and related mental health conditions may choose to visit GPs where they are more likely to report physical complaints rather than psychiatric symptoms. General practitioners were believed to have a particularly important role to play in the recognition and treatment of vulnerable youth.

Reference: Mehta, S. (2012). Health needs assessment of Asian people living in the Auckland region. Auckland: Northern DHB Support Agency. Retrieved from: http://www.ecald.com/Resources/Resources-Publications/ID/808/Health-Needs-Assessment-of-Asian-People-Living-in-the-Auckland-Region-2012.

Authors: Elsie Ho, Patrick Au and Dumindri Amerasinghe

Citation: Ho, E., Au, P. & Amerasinghe, D. (2014). Suicide in Asian Communities: An exploratory study in NZ-2015. Auckland: Auckland District Health Board

Publication

Article 4: The role of socio-cultural factors in the course of anorexia nervosa: a case of anorexia nervosa in a Chinese- American adolescent.

With the realisation of eating disorders outside of westernised societies, it is clear that body image and western cultural ideals are not the only aetiologies for anorexia nervosa across cultures. Using a retrospective chart review of a single medical record, a case study is presented to illustrate that eating disorders are context-bound with multiple factors playing a role in the pervasive existence of anorexia nervosa among various societies and cultures. As the existence of eating disorders across diverse cultures continues to be identified and recognised, it is necessary to consider family, developmental, social and cultural factors in order to accurately formulate and effectively treat anorexia nervosa.

As Asian females attempt to integrate into Western culture and society, they also may be adopting Western ideals of thinness and beauty. Additionally, the stress of assimilating to a new society and exposure to different and sometimes conflicting cultural norms may lead to the development of eating disorders. Disordered eating is higher in less acculturated Asian females than in those that are more acculturated.

This case study exemplifies the need for the consideration of multiple factors in order to accurately formulate and effectively treat the underlying aetiologies of anorexia nervosa within the context of family, development, socialization and culture. As the existence of eating disorders across various cultures continues to be identified and recognised, the need for further examination into cultural contexts and practices becomes more and more crucial to the true understanding of the phenomenon and its successful treatment across a diversity of cultures and populations.

Authors: Selene Luk and Ruby Agoha

Citation: Luk, S. & Agoha, R. (2014). The role of socio-cultural factors in the course of anorexia nervosa: a case of anorexia nervosa in a Chinese- American adolescent. International Journal of Culture and Mental Health, 7 (3), 236-245.

Publication