Asian-American women demonstrate a high rate of suicide when compared with women of other ethnicities, California State-Fullerton researcher Eliza Noh found in a recent empirical study.

Noh and Stanford mental health professionals Alejandro Martinez, the director of Counciling and Psychological Services (CAPS) and Rona Hu, director of the Acute Inpatient Unit at Stanford Hospital, told The Daily that parental pressure, cultural differences between the United States and Asian countries and avoidance of mental health issues in Asian-American families can contribute to the prevalence of mental health problems.

Following the death of graduate student Mengyao “May” Zhou earlier this year and the recent revelation that Azia Kim had been squatting in Stanford dorms for eight months despite the fact that she was not a student, suicide and mental health issues in the Asian-American community have become widely-discussed on the Stanford campus.

Citing the ongoing study, Noh said that the tendency of Asian-American women to ignore or deny stress, depression and other mental health problems can cause the larger anxieties that lead to suicide.

“There are multiple factors that contribute to suicidality,” Noh said. “[For Asian-American women] there is this pressure to do well in school and that pressure comes from their family members. There is a miscommunication or a lack of communication with their parents. There is a cultural division between them and their parents.”

“They are expected to listen to their parents,” she said, “to do well in school, not to ask questions and not to talk back.”

All those cultural pressures can lead Asian-American women to treat mental health issues like an elephant in the room, exacerbating existing problems and generating others.

Hu argued that, for many Asian-American women, culturally-related issues can contribute directly to mental health problems. She cited young women she knew who had been disowned by their families because of circumstances that parents interpreted as failures.

“The whole concept in the Asian family is that the family is not a democracy,” Hu said. “Parents feel entitled to make decisions for their children, including what major or career to chose, or whom to marry. There’s a line from a movie where they say, ‘There’s no word for privacy in Chinese.’”

“The sense of shame can be a big part of Asian-American culture and that’s something that Americans don’t understand so much,” she added. “If Hugh Grant is caught doing something [shameful] he apologizes and goes on with his movie career. In Asia, shame can endure for generations. The default Asian coping mechanism is denial.”

Martinez added that differences between education systems in America and Asian countries can lead to misunderstandings within families.

“Specifically in some Asian countries, people have to make career decisions almost when they get to high school,” Martinez said. Coming from such a background, parents often misinterpret their childrens’ decision to explore different fields in college.

“If someone did that in their country of origin it would be a dramatic setback,” he said. “They may not be familiar with how much flexibility is possible in the United States.”

Martinez cited Korea’s suicide rate, which is far higher than the United States.

“The consequences of someone getting a ‘B’ in a class at Stanford really aren’t that great in the context of career decisions and career opportunities,” he said. “In other cultures they can be significant.”

Noh said that open discussion of mental health issues in the community, along with the availability of resources that can cater specifically to Asian Americans, can be used to counter the problem.

“There has to be some serious commitment on the part of the community,” Noh said. “[Resources] need to be appropriate for Asian-American students. Councilors should be trained in the languages that they speak and have some level of cultural awareness of [students’] backgrounds.”

Without those specially tailored resources, she said, Asian-American women in her study often chose to reject counseling and therapy altogether.

“The big fear was that they didn’t want to go to strangers who didn’t know about their situation,” she said. “Asian Americans have the lowest rates of utilization of mental health services. There is something about traditional mental health services that doesn’t appeal to Asian Americans.”

Hu and Martinez said that Stanford has resources for Asian-Americans available at campus mental health facilities.

“We address this in two ways,” Martinez said. “An important one is to have diversity on our staff. In addition to that, we do commit some of our resources to making sure that all of our staff have sensitivity to the communities that make up Stanford students.”

Hu said that at the Stanford Hospital, some of the attending physicians and residents in psychiatry are Asian, and that staff members fluent in Mandarin are available.

Hu and Noh both said that in addition to providing ethnicity-specific resources, fostering discussion of suicide and mental health is important because avoidance of the issue is pervasive in the Asian-American community.

“Helping to de-stigmatize things is very helpful,” Hu said. “I don’t see people disowned so frequently in other cultures.”

“The number one factor that [study participants] felt in terms of contributing to suicide is that they felt alone and helpless and that they didn’t have any place to turn,” Noh said. “I’ve received lots of emails of thanks [...] from people happy that there is dialogue taking place.”