Participants and Data Collection
Stigma and Face
“… it seems that the term [depression] is too harsh at this point for [the patient]. You can use something similar but a little lighter … some people associate every [mental health] thing with crazy.”
Social Functioning and the Role of the Family
“… the Vietnamese community…treats these problems within the home and/or kinship network first. And I do not think they look at depression as such [a problem]. It might be: this person is not getting work… then they would attack those issues one at a time in the kinship network, aunts and uncles and cousins and very good friends trying to help out.”
Traditional Healing and Beliefs about Medications
“Vietnamese, especially immigrants and/or those who have some experience living abroad from other countries and are coming here, tend… to value Eastern medicine if not more than equally or at least have some belief in its uses… they want to seek that sort of medication first, because it is seen as more organic and something that they are familiar with and something they grew up [with]”
Language and Culture
“I think that people will get help…[from] a Vietnamese doctor so they can explain their problems… That way, they can [give a] full explanation to the doctor [rather] than go …to the hospital where they speak to the doctor …[who does not speak]…in their language.”
To minimize stigma and help patients find face-saving communication strategies
• Explore the somatic complaints of depression (insomnia, poor appetite) before exploring the emotional components.
• Replace particularly stigmatizing terms e.g. “mental illness,” “depression,” and “suicide” with “feelings,” “stress,” and “giving-up.”
To address social functioning and family roles
• Ask the patient about their role in the family, the ways their illness affects life as experienced by the family and to identify key family decision makers.
• Encourage the family to recount their efforts to help the patient.
• Validate the family’s efforts and reassure them that one would expect even the “best” of families would need expert help to treat the patient’s condition.
To incorporate traditional beliefs into the treatment plan
• Use stress to explain depression: “You’ve been through a lot of stress in your life, more so than most people. The stress has worn you down, and that is why you have problems with sleep, concentration, energy, and even sadness. Even the strongest of people would be affected by the stresses that you have experienced.”
• Consider starting an anti-depressant that has an immediate effect (e.g. sedating antidepressant for insomnia or a combination of a sedative and an antidepressant) at a very low dose and increase the dosage slowly.
To optimize language concordance and cultural understanding
• Explore local or telehealth sources of bilingual and bicultural staff.