ANXIETY DISORDERS IN APIA ADOLESCENTS
API Adolescents & Anxiety Disorders
DEFINITION:
Anxiety disorders in the U.S. are diagnosed using the Diagnostic and Statistical Manual-IV Text Revision (DSM-IV TR). 12 distinct disorders are classified as Anxiety disorders under the DSM classification system. These include:
- Panic Disorder (PD)
- Generalized Anxiety Disorder (GAD)
- Social Phobia
- Specific Phobia
- Obsessive Compulsive Disorder (OCD)
- Acute Stress Disorder and Post Traumatic Stress Disorder (ASD and PTSD)
The specific criteria for each disorder can be quite detailed and complex. However, all of the Anxiety Disorders have the following characteristics:
Some aspect of excessive worrying or anxiety that is either very extreme or out of context.
Both psychological symptoms (e.g. you are convinced you are going to fail an upcoming test and can’t stop thinking about it) and physical symptoms (e.g. when you are in social situations you start to sweat, your mouth gets dry, and you feel your heart start to beat very fast).
Symptoms must be persistent, usually over a period of several months
Symptoms must be causing the person significant impairment in one or more important areas of functioning (e.g. school or social settings). (APA, 2000)
OVERVIEW:
Anxiety disorders are the most common class of disorders in adults in the U.S. Half of people who develop an anxiety disorder have symptoms by age 11. In the U.S. the rate of anxiety and mood disorders has been increasing in recent generations (Kessler, et al., 2005). In short, anxiety disorders affect adolescents! It is critical to understand how and to what degree anxiety disorders affect API youth.
Unfortunately, there is little research on anxiety disorders in ethnic minorities, including APIs. The research that does exist is often flawed or makes many assumptions (Safren et al., 2000). Some common problems include:
- Grouping all APIs together into one very diverse “Asian” category
- Not including enough API participants to really be able to detect differences with statistics.
- Assuming that the same tests that look for anxiety disorders in White, Western populations can be used verbatim with API (i.e. API might experience anxiety with different words or sensations that aren’t asked about on the test)
There is even less research on API adolescents. With these limitations in mind, this article will explore what is known about anxiety disorders in API youth and suggest some further resources for you to explore on your own.
IMPORTANCE:
What can we learn from studies with adult APIs?
1. Large national surveys have shown that Adult APIs have a lower rate of Anxiety Disorders compared to White Americans.
- Keep in mind that this was grouping all APIs together and using the same diagnostic test for everyone! (Grant et al., 2006; Grant et al., 2005a; Grant et al., 2005b)
2. There may be significant differences between API subgroups in rates of anxiety disorders.
A large Canadian national survey found that a group of Asian participants who represented a number of Asian subgroups, had a higher rate of anxiety disorders than a group Chinese participants.
- This emphasizes the need for studies that compare different API groups, especially longer studies that look at these differences over time. (Tiwari & Wang, 2006)
3. However, the lower rates of anxiety disorders may be because we are just measuring the wrong things! APIs may be experiencing anxiety in a different (but still very distressing) way from established Western criteria.
- The same studies that find low rates of diagnosable Anxiety Disorders in APIs often also find high rates of anxiety that come close but do not meet diagnostic criteria or high proportions of APIs who rate their mental health as poor. (Tiwari & Wang, 2006)
- There is evidence that some Anxiety Disorders previously thought to be “culturally-bound” to only affecting people in Asian countries, actually affect APIs groups in the U.S. These symptoms may not be detected by traditional Western psychiatric tests. (Choy, Schneier, Heimberg, Oh, & Liebowitz, 2007).
What can we learn from studies with adolescent APIs?
1. Asian American middle school students have higher rates of test anxiety (if severe could be diagnosed as social phobia) than White students. Asian students are also more concerned about pleasing their parents (Pang, 1991).
2. One study conducted with Hawaiian students of mixed Asian heritage found that 1 in 10 had either GAD or Social phobia. This is within the general range for all adolescents and reflects that Anxiety Disorder do affect APIs! (Hishinuma et al., 2001).
3. Asian American high school students interpret the physical sensations associated with anxiety (e.g. sweaty hands) as more severe and negative than White students.
- The clinical significance of this, such as future development of Panic Disorder, has not been well studied (Weems, Killen, & Taylor, 2002).
4. Asian American undergraduates may have higher rates of subclinical worry than African American or White students. Asian American students worry about more areas of their lives than White or African American students. (Scott, Eng, & Heimberg, 2002).
5. One small study with undergraduates found that Asian American and White students had the same number of social phobia events but the Asian American students rated them much more negatively.
- Again, this suggests that Asian Americans may experience anxiety differently from Whites. (Lee, Ozazaki, Yoo, 2006)
Conclusions
Clearly much more research is needed on anxiety disorders in Asian Americans. In fact, it is difficult to find any research on Asian Americans adolescents and several important anxiety disorders such as Specific Phobia and Post Traumatic Stress Disorder. From the research that has been done we know that Anxiety Disorders as defined in the U.S. definitely do affect Asian American adolescents! In addition, different types of anxiety that are not yet well understood by western medicine may be significantly affecting Asian American youth.
ONLINE RESOURCES:
Medline Plus Asian-American Health
Clearinghouse of general and specific health information related to APIs.National Asian Women’s Health Organization
This site is dedicated to providing information to Asian women and their families about important health topics including mental health.Asian and Pacific Islander American Health Forum
This is a national advocacy organization dedicated to the promotion of API health.The National Association of Asian American Professionals
This is a policy and networking focused group working to advance Asian Americans in corporate America.
REFERENCES:
APA, (2000). Diagnostic and Statistical Manual, Text Revision, 4th ed. Washington, DC; APA.
Choy, Y., Schneier, F.R., Heimberg, R.G., Oh, K.S., & Liebowitz, M.R. (2007). Features of the offensive subtype of Taijin-Kyofu-Sho in US and Korean patients with DSM-IV social anxiety disorder. Depression and Anxiety, 0, 1-11.
Grant, B.F., Hasin, D.S., Stinson, F.S., Dawson, D.A., Goldstein, R.B., Smith, S., et al. (2006). The epidemiology of DSM-IV panic disorder and agoraphobia in the in the United States: Results form the National Epidemiological Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 363-374.
Grant, B.F., Hasin, D.S., Blanco, C., Stinson, F.S., Chou, P., Goldstein, R.B., et al. (2005a). The epidemiology of social anxiety disorder in the United States: Results form the National Epidemiological Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 1351-1361.
Grant, B.F., Hasin, D.S., Stinson, F.S., Dawson, D.A., Ruan, W.J., Goldstein, R.B., et al. (2005b). Prevalence, correlates, co-morbidity and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results form the National Epidemiological Survey on Alcohol and Related Conditions. Psychological Medicine, 35, 1-13.
Hishinuma, E.S., Miyamoto, R.H., Nishimura, S.T., Goebert, D.A., Yuen, N.Y., Makini, G.K., et al. (2001). Prediction of anxiety disorders using the state-trait anxiety inventory for multiethnic adolescents. Anxiety Disorders, 15, 511-533.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593-602.
Lee, M.R., Okazaki, S., & Yoo, H.C. (2006). Frequency and intensity of social anxiety in Asian Americans and European Americans. Cultural Diversity and Ethnic Minority Psychology, 12, 291-305.
Pang, V.O. (1991). The relationship of test anxiety and math achievement to parental values in Asian-American and European-American middle school students. Journal of Research and Development in Education, 24, 1-10.
Safren, S.A., Gonzalez, R.E., Horner, K.J., Leung, A.W., Heimberg, R.G., & Juster, H.R. (2000). Anxiety in ethnic minority youth: Methodological and conceptual issues and review of the literature. Behavior Modification, 24, 147-183.
Scott, E.L., Eng, W., & Heimberg, R.G. (2002). Ethnic differences in worry in a nonclinical population. Depression and Anxiety, 15, 79-82.
Tiwari, S.K., & Wang, J.L. (2006). The epidemiology of mental and substance use-related disorders among White, Chinese. And other Asian populations in Canada. Canadian Journal of Psychiatry, 51, 904-911.
Wang, P.S., Berglund, P., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 603-613.
Weems, C.F., Hayward, C., Killen, J., & Taylor, B. (2002). A longitudinal investigation of anxiety sensitivity in adolescence. Journal of Abnormal Psychology, 111, 471-477.
HOME
[Substance Abuse] [Anxiety Disorders] [Eating Disorders] [Depression] [Learning Disorders] [Utilization]
