(PS2-C68) Perceptions of Depression Among Asian vs. American Adults

Research suggests differential depression prevalence and symptoms in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) vs. non-WEIRD samples [1]. However, few studies have examined cross-cultural differences in beliefs about causes or appropriate treatments for depression, even though mental health literacy is linked with stigma [2] and service use [3]. In this study, we tested differences in stigma and beliefs about depression and examined the role of acculturation in adults from the United States and three Asian cultures (China, Korea, Pakistan).

Participants completed a Qualtrics survey (M = 9.09 minutes) assessing demographics, mental health literacy (including an adapted vignette [4]), mental health stigma (Attribution Questionnaire, AQ [5]), and acculturation (adapted Brief Acculturation Scale for Hispanics [6]). We used Prolific with prescreening for recruitment. This helped ensure validity of demographic inclusion criteria. Data were analyzed using chi-squares, one-way ANOVAs, and bivariate correlations. P-values were adjusted for multiple comparisons. Participants were 411 adults (age 18+, n = 251 female); 310 reported Asian ethnicity and fluency in Chinese (n = 94), Korean (n = 106), or Urdu (n = 110), and 101 reported White ethnicity, monolingual English, and living in America.

There were no between-group differences in identifying depression in the vignette, perceived common symptoms or effective treatments for depression, or expressions of pity (AQ) towards someone with depression (all p > .05). Compared to the other samples, the American sample was more likely to report a personal history of mental illness (χ2(3, N = 411) = 37.44, p < .001) and to endorse “chemicals in the brain” as the most likely cause of depression (χ2(21, N = 411) = 82.21, p < .001). The American sample was also less likely to attribute depression to personal responsibility (AQ) (F(3, 404) = 8.51, p < .001); less likely to feel anger (AQ) (F(3, 404) = 6.78, p < .001) or fear (AQ) (F(3, 405) = 14.17, p < .001) towards someone with depression; and less likely to try to avoid (AQ) (F(3, 405) = 13.74, p < .001) or coerce/segregate (AQ) (F(3, 405) = 12.16, p < .001) someone with depression. Higher subgroup acculturation was associated with: lower identification of depression in the vignette within the Chinese sample; lower identification of motivation loss as a depression symptom within the Urdu sample; and higher endorsement of at least one aspect of stigma (AQ) within each Asian sample (all p < .01).

Contact-based interventions may reduce stigma [7] and are recommended in communities where personal experience is low and/or stigma is high. Our data suggest acculturation may impact stigma and beliefs about depression, at least among certain Asian groups. White Americans’ greater endorsement of the “chemical imbalance” theory of depression is troubling; recent work has debunked this myth [8] and such beliefs are correlated with more severe symptoms and worse treatment adherence [9]. Psychoeducation on psychosocial risk factors is critical. Study limitations include an unrepresentative (computer- and English-proficient) sample and a possible history effect of the COVID-19 pandemic.