In a recent interview with the MGH Research Institute, Albert Yeung, MD ScD, Associate Director of Depression Clinical and Research Program at Mass General Hospital (MGH), discusses his cultural and professional background and his efforts to improve the treatment of depression in Asian American populations.
Dr. Yeung’s cultural background has shaped his perspective on mental health. Born in Hong Kong, he completed medical school in Taiwan before coming to the United States for research training. After completing his psychiatry residency training at Massachusetts General Hospital, he dedicated much of his career to serving Asian American patients in Boston’s Chinatown. Recognizing that Western concepts of psychiatry and psychology are often new or unfamiliar to Asian Americans, his clinical work and research have focused on developing culturally relevant approaches to improving access to and engagement in treatment.
Research from Dr. Yeung and his colleagues has observed that depression is common in Asian-American primary-care patients, and the prevalence of major depressive disorder (MDD) is comparable to or higher than observed in nonminority populations. Because Asian-American patients more commonly present with somatic symptoms, such as loss of appetite, fatigue, or insomnia, rather than reporting emotional complaints, they are likely to bring these concerns to their primary care provider. However, traditional screening tools for depression may miss many depressed Asian-Americans in this setting and thus must be combined with culturally sensitive interviewing to improve the detection of depression in this patient population.
Previous studies have noted that Asian-Americans are between two and five times less likely to receive mental health services than their White peers, even after controlling for the prevalence of mental health disorders. Dr. Yeung’s research supports the use of culturally sensitive collaborative care (CSCT) as a means of improving the recognition of depression and enhancing engagement in care in Chinese-American primary care clinics. In a randomized controlled trial Yeung’s team found that CSCT resulted in a nearly 7-fold increase in treatment rates among depressed patients in primary care. In another study, Yeung’s research team documented that CSCT delivered virtually is also effective in improving treatment outcomes of Chinese immigrants with MDD.
Dr. Yeung notes that cultural beliefs and stigma are major barriers to treatment; many Asian- American patients are unfamiliar with psychiatric terminology or worry about stigma; effective care requires eliciting illness beliefs and addressing treatment concerns in culturally meaningful ways. The Engagement Interview Protocol (EIP), a semi-standardized protocol developed by Yeung and colleagues Nhi-Ha Trinh, MD, Trina Chang, MD MPH, and Maruizio Fava, MD incorporates cultural components into a standard psychiatric evaluation and has been shown to improve acceptance of treatment.
While depression in Asian Americans may be manifested primarily as physical symptoms; Western medicine does not specifically address the treatment of physical distress experienced as a symptom of depression. Especially among older patients, Asian Americans take a more holistic view of health in which the mind-body dichotomy does not exist. Instead, finding balance is the key to successful health. Consequently, Asian Americans may not accept the Western medical model of mental illness, which conceptualizes these conditions as brain diseases requiring professional treatment.
To improve treatment engagement and success among Asian Americans, Dr. Yeung has been interested in incorporating traditional mind-body practices into psychiatric treatment. His research has demonstrated that mind-body approaches – for example, tai chi and qigong — are feasible and acceptable adjuncts or alternative strategies for the treatment of depression in Asian American populations and have been shown in pilot studies to reduce depressive symptoms.
Dr. Yeung has been conducting a study funded by the National Institute of Health that will combine Stress Management and Resiliency Training (SMART), a comprehensive program which provides training on meditation, problem-solving and positive thinking, with Qigong/Tai Chi for the treatment of Asian Americans with depression and physical symptoms. By incorporating cultural sensitivity in the understanding of psychiatric disorders and their treatment, Dr. Yeung hopes to broaden the reach of mental health services and make them more accessible to Asian Americans so that more can benefit from the contemporary treatment available in psychiatry.
Read More
Yeung A, Chan R, Mischoulon D, Sonawalla S, Wong E, Nierenberg AA, Fava M. Prevalence of major depressive disorder among Chinese-Americans in primary care. Gen Hosp Psychiatry. 2004 Jan-Feb;26(1):24-30.
Yeung A, Shyu I, Fisher L, Wu S, Yang H, Fava M. Culturally sensitive collaborative treatment for depressed chinese americans in primary care. Am J Public Health. 2010 Dec;100(12):2397-402.
Yeung A, Trinh NH, Chang TE, Fava M. The Engagement Interview Protocol (EIP): improving the acceptance of mental health treatment among Chinese immigrants. Int J Cult Ment Health. 2011 Dec 1;4(2):91-105.
Yeung A, Martinson MA, Baer L, Chen J, Clain A, Williams A, Chang TE, Trinh NH, Alpert JE, Fava M. The Effectiveness of Telepsychiatry-Based Culturally Sensitive Collaborative Treatment for Depressed Chinese American Immigrants: A Randomized Controlled Trial. J Clin Psychiatry. 2016 Aug;77(8):e996-e1002.
Albert Yeung, MD, ScD is Associate Director of Depression Clinical and Research Program at Mass General Hospital, Professor of Psychiatry (part-time) at Harvard Medical School, and Co-Medical Director of the South Cove Community Health Center which focuses on serving Asian immigrants. His major research interests include Asian mental health issues and the use of holistic approaches including acupuncture, tai chi, qigong, and other mind body interventions in treating anxiety and depressive disorders.
