In the days following the Atlanta spa shootings that left eight people dead, including six Asian women, clinical psychologist Aileen Lee broached the subject of the killings with her Asian American clients. It was hard to talk about. Her clients were frightened for their safety and the safety of their families. And they were furious that in the year preceding the shooting spree, Asian Americans had been brutalized, harassed, and blamed for the pandemic, and that the wider public had barely paid attention.
“People became more and more scared, more and more angry,” said Lee, who is based in Brookline. “And the worst part of it all is the silence.”
The devastation wrought by COVID-19 has triggered a mental health crisis among millions of Americans. But Asian Americans are also wrestling with the added stress of anti-Asian racism fueled by the pandemic — and the consequences are profound. The results of three new studies, released in late May, on the effects of anti-Asian racism on mental health, indicate that Asian Americans are grappling with high rates of psychological distress.
According to one study, one in three Asian Americans surveyed demonstrated clinically elevated symptoms of depression and anxiety amid the pandemic, and one in four was diagnosed with post-traumatic stress disorder. These findings, from the COVID-19 Adult Resilience Experiences Study, were drawn from a survey of 1,002 young adults, including 211 Asians or Asian Americans, living in the United States. Led by researchers at Boston University, Brigham and Women’s Hospital, and Massachusetts General Hospital, the study found that Asian Americans who experienced pandemic-related prejudice also were three times more likely to exhibit symptoms of PTSD, compared with those who did not.
About 68 percent of Asian Americans surveyed said they or their family members had experienced covert or overt discrimination during the first three months of the pandemic.
“When you’re being hollered at or accused or physically attacked, of course you’re feeling threatened, and it’s actually that experience of dread that leaves one to experience these subsequent symptoms,” said Cindy Liu, a clinical psychologist at Brigham and Women’s and one of the study’s lead investigators. “So it’s no surprise that these events would potentially produce these types of symptoms for Asian Americans.”
The study’s results were published May 27 in a new report by Stop AAPI Hate, a data tracking center that has recorded more than 6,600 incidents of anti-Asian violence and harassment nationwide since March 2020. The report on Asian American mental health also described findings from two additional research projects, including the organization’s own survey of 413 Asian Americans who submitted reports to its hate-incident database.
According to the Stop AAPI Hate follow-up survey, 72 percent of Asian Americans who reported a hate incident felt anti-Asian discrimination was a greater source of stress than the pandemic itself, and one in five had symptoms of “racial trauma,” such as intrusive thoughts, hypervigilance, and loss of self-esteem.
The Stop AAPI Hate report also published the results of the National Anti-Asian American Racism Survey, a longitudinal study of 656 Asian Americans. Conducted by psychology professors at Wheaton College in Illinois, this survey similarly found that Asian Americans who experienced discrimination were more likely to suffer from depression (155 percent increase), stress (94 percent increase), anxiety (93 percent increase), and physical complaints (78 percent increase) than those who did not.
“It makes everything feel unsafe,” said Dr. Justin Chen, a psychiatrist at Mass. General, of the impact of racial discrimination on mental health. “That’s, of course, the risk of trauma. You start to feel at any moment danger could happen. And that’s a huge detriment to quality of life.”
These new studies did not compare Asian Americans’ mental health outcomes with those from other racial and ethnic groups. But research shows Asian Americans are consistently less likely to report psychological problems. According to the Census Bureau’s most recent Household Pulse Survey, which has been tracking the impact of COVID-19 on Americans’ lives, 25 percent of Asian adults reported symptoms of anxiety or depressive disorder, compared with 28 percent of white, 34 percent of Black, and 36 percent of Latino adults.
But Hyeouk “Chris” Hahm, chair of social research at the Boston University School of Social Work, warned that these figures may not capture the full picture of Asian Americans’ mental health due to the survey’s methodology. The Household Pulse Survey is available only in English and Spanish, and one-third of Asian Americans have limited English proficiency.
Experts say stigma and stereotypes, coupled with cultural and language barriers and inequitable resource allocation, prevent many Asian Americans from accessing psychotherapy. Asian Americans are the least likely of any racial or ethnic group to receive mental health treatment, according to federal data. And although Asian Americans are the fastest growing racial and ethnic group in the United States, research on their health needs is staggeringly low: Between 1992 and 2018, the National Institutes of Health spent just 0.17 percent of its clinical research budget on studies devoted specifically to Asian Americans, Native Hawaiians, and Pacific Islanders.
“There is a mismatch between what the patients or Asian American clients want, and the available psychotherapists in the system,” Hahm said. Even when Asian Americans seek out mental health services, she explained, they often struggle to find a therapist who speaks their language or understands the nuances of their cultural background.
“That’s part of the reason why when Asian American people finally to come to the system ... the severity [of their mental health issue] is higher than other ethnic groups,” said Hahm, who is also collaborating with Liu on the COVID-19 Adult Resilience Experiences Study. “People wait until the last minute, when they experiencing full-blown depression, full-blown mania, full-blown bipolar disorder.”
Many Asian Americans also endure strong cultural pressure to “save face” and keep their problems hidden, or risk harming their families’ reputation, Hahm said. They are also more likely to manifest mental health symptoms through physical ailments, such as stomach aches or back pain, and so “sometimes it takes longer for them to recognize they actually are depressed,” she added.
Lee, the Brookline psychologist, said Asian Americans may have a hard time asking for help because of the perception that they “don’t have it as bad” as other communities of color that have been historically marginalized or mistreated.
“As Asians, we feel like we’re taking too much space,” she said. “So we get silenced, forgetting that it’s a huge stigma to ask for mental health support within our community.”
Liu and Chen are working with Stop AAPI Hate and their colleagues at the Center for Cross-Cultural Student Emotional Wellness at Mass. General to develop mental health resources for Asian Americans who have endured racist hate. Sharing their stories with groups such as Stop AAPI Hate is one strategy they can use to cope with discrimination, Liu said. Indeed, according to Stop AAPI Hate’s follow-up survey, Asian Americans who reported a hate incident to the organization also experienced a marked decrease in their racial trauma symptoms, with 28 percent no longer meeting the criteria for race-based trauma.
“People want to feel heard and they want to feel safe while being heard, and Stop AAPI Hate provides that safety,” Liu said. “So it seems like Stop AAPI Hate itself may be an intervention, but we can’t just stop there. ... We need to really think of more of long-term solutions for this.”