Reducing stigma among Chinese immigrant caregivers of persons with psychosis: A pilot intervention
Chinese-Americans constitute the largest Asian-American group, with an estimated 1 million Chinese immigrants living in New York City. Members of this ethnic group who develop a psychotic disorder are particularly susceptible to treatment disruption imposed by stigma. Because family members play a key role in this group's help-seeking process, decreasing stigma among caregivers is critical to ultimately increase treatment-seeking and strengthening consumer's treatment adherence.
To successfully engage this group, we developed and pilot-tested an innovative, short-term treatment designed to minimize stigma among family caregivers and provide education on their relative's disorder. Based on previously empirically supported principles, we developed a brief, three-session antistigma intervention for Chinese immigrant relatives of individuals with psychosis. Each session was 90 minutes long, with all groups being conducted in Mandarin Chinese. The intervention trial was led by Lawrence Yang, PhD, assistant professor of epidemiology at Columbia Mailman School of Public Health with funding from the Center of Excellence for Cultural Competence at the New York State Psychiatric Institute.
A total of 11 caregivers participated in the pilot intervention. The mean age of caregivers was 59 years; 10 participants were parents and 1 was a spouse of a person with psychosis. Caregivers were assessed on the level of internalized stigma one week prior to the intervention and immediately postintervention. In addition, we asked participants for feedback for this pilot study: "What did you find most helpful about the intervention?" and "What would you change about the intervention to better address stigma?"
Quantitative results indicated that, overall, caregivers' internalized stigma was not significantly reduced postintervention when compared with pre-intervention scores. However, when examining the subgroup of six caregivers who evidenced at least some internalized stigma pre-intervention, we found caregivers' internalized stigma to be significantly reduced postintervention when compared with pre-intervention scores. In addition, clinical case material showed that caregiver co-leader and participants were able to provide support and strategies to cope with stigma with each other, thereby improving their understanding of their relatives' illness, instilling hope to their relatives' situation and augmenting their strategies in dealing with discrimination.
In response to "What was most helpful?" participants commonly identified how the two co-leaders complemented one another. Participants stated that the caregiver co-leader would supplement the information provided by the clinician with problem solving strategies and sharing of their real-life experiences. In response to "What would you change?", several caregivers voiced that they would have preferred even more time to process information and to share experiences with one another. For example, one relative suggested extending each session to two hours and expanding the number of meetings from three to five to share more deeply. Another suggested having one follow-up meeting at three or six months to review material with caregivers and how they applied it in their lives.
Limitations in this preliminary study included the small sample size and self-selected nature of the participants. To further refine the intervention, we plan to utilize a larger sample size and to recruit participants from more diverse sources. Furthermore, we will expand the intervention to a total of five sessions as some participants have suggested in order to have more time to process the course material. After further refinement of the intervention, we plan to test it in a randomized clinical trial to demonstrate its efficacy so that it might be disseminated to Chinese immigrant groups nationally, and eventually adapted for other racial/ethnic groups.
This initial pilot study shows that it is possible to reduce stigma among Chinese immigrant caregivers who had previously demonstrated internalized stigma. Reducing stigma can make it easier for caregivers to help their relatives access needed mental health care and help support recovery.
About the guest editor
Dr. Lawrence Yang is an assistant professor of epidemiology at Columbia University. Yang received his PhD in clinical psychology from Boston University and completed his clinical internship at Massachusetts Mental Health Center/Harvard Medical School. Yang studies the social processes that shape the course of schizophrenia within diverse cultural, and specifically Chinese immigrant, groups. He has 35 peer-reviewed papers plus seven book chapters (60 percent first-authored), including publications in the Journal of Abnormal Psychology® and The Lancet. Yang is an affiliated researcher at the NIH-funded, National Asian-American Center on Health Disparities at U.C. Davis and is the sole intervention researcher to study psychotic disorders among Asian-Americans nationally. Yang has received eight Early Career Awards, six of which are national, for this work. He has received a five-year K01-award from NIMH, and has received a five-year, R01 grant from NIMH to study the stigma of the newly developed "high-risk" for psychosis diagnosis.