Effects of Culture on Mental Health Stigma

Student: Dena Nashawati
Major: Psychology
Minors: Anthropology, East Asian Studies
Advisors: Nathaniel Foster, Susan Clayton

This paper discusses the differences in culture and how they relate to mental health stigma and the help-seeking behaviors that follow. Previous studies in the area of mental health stigma have shown that minority and ethnic groups tend to have higher negative stigma regarding people with mental health issues. In turn, people in these minority groups are less likely to seek help when needed, resulting in poor treatment in the community. People tend to give mental health different attributions depending on their background and cultures, with some Eastern cultures emphasizing spiritual and supernatural causes and Western cultures emphasizing biological causes. Not only culture, but parental beliefs and self-stigma also impact mental health attributions and help- seeking. How does culture affect mental health attributions? Also, when presented with a 2nd point-of-view vignette, will the beliefs about mental health change? One hundred of the participants were American students and the other 100 participants were Japanese students. A 2×2 between-subjects ANOVA was run for each attribution measure. Results showed a significant interaction for the normal attribute (p = .042), a significant main effect of culture for the support (p = .004) and stress (p < .001) attributes, and a significant main effect of point-of- view for the personal attribute (p = .048). The results of the study did show some significant differences between culture and point-of-view, but only in certain attributions of mental health and for certain variables. Further studies could expand into different generations and age groups and compare within the culture. The current study failed to show consistent results, so it would be beneficial to solidify the different attributions that can be connected back to mental health stigma and understand the mental health literacy of the population used.

Dena will be online to field comments on May 8:
10am-noon EDT (Asia: late evening, PST 6am-8am, Africa/Europe: late afternoon)

37 thoughts on “Effects of Culture on Mental Health Stigma”

  1. Dena,

    What a fantastic way to incorporate your study abroad experience! As an Asian-American, I appreciate that you brought this topic to light. Well-done!

    Congratulations and welcome to the alumni community!

    Meret Nahas ’10

  2. Dena,

    Thank you for addressing this topic. Did your research suggest any practical steps that a college like ours could take to help international students stay healthy and/or reach out for help when necessary?

    Congratulations and best wishes!

    1. Linda,

      Thank you for your comment and question! I know the college already provides services for mental health, but possibly by incorporating culturally-appropriate options would be helpful. Furthermore, maybe providing a service for educating international students on how mental health should be dealt with and what steps they should take if struggling. So maybe something similar to Let’s Talk, but for increasing knowledge about mental health and getting rid of the negative stigma for international students.

  3. Dena,
    What a fascinating cultural study! Thank you for sharing it with us and all the best to you!
    Congratulations!!!!
    Shirley

  4. It’s great to see you incorporate your project with something you are passionate about. You have very good insight because you have experienced, in person, the stigmas in Japan and America – so I do have questions.

    1. How do you think we should approach the Asian community about mental health while simultaneously being respectful of their culture?
    2. I was wondering if you had any experience with counseling in Japan versus the United States. Are counseling approaches different because the culture and stigma are different?

    Thank you for your presentation and congratulations.

    1. Brian,

      Thank you for your comment and questions!

      Regarding your first question, one of the most important things I believe would help is having health professionals that represent the Asian community and that culture. In doing so, individuals would be receiving help from someone who understands their background and culture and can possibly be more effective in helping those communities.

      For your second question. While I didn’t personally experience mental health services while in Japan, I know that steps have been taken to decrease the negative stigma (especially with schizophrenia) without much success. The approaches are similar, but the society doesn’t respond to it in the same way as here. Nevertheless, my study did show that the population I used (university students) don’t carry as much of a negative stigma and have much more knowledge about mental health and seeking help.

  5. Interesting project! What do you think happens as students are embedded in different cultures, i.e. Japanese students studying in US and American students studying in Japan?

    1. Kent,

      Thank you! I think when it comes to Japanese students studying in the US, there’s some hesitation for seeking help. This could be due to health services that aren’t culturally appropriate for them personally, or simply because of low mental health literacy and knowledge. But I do think, though, that this is changing in recent years as education about mental health improves.

      Also, I think it would be more likely to see an American student using mental health services when in a different culture, as there’s such a lower negative stigma for us when it comes to mental health.

  6. Awesome job Dena! This research topic is very important. Do you plan on continuing to research this? If so, what would you focus on?

    1. Thanks Emily!

      I definitely hope to expand this research sometime in the future. I’d really love to move deeper into the Japanese culture and look at differences in the generations. Since I used such a specific population of university students, they had more knowledge about mental health and therefore carried less negative stigma. Previous studies showed more negative stigma when it came to older generations. So I think it would be interesting to look at those differences!

      I could also see delving into general East Asian stigma as well, so rather than compare Japanese and American stigma, I’d compare Japanese and Korean stigma, for example.

  7. Such an interesting I.S., Dena, and a very important topic! Through your research, did you discover anything that really surprised you?

    1. Dr. Hayward,

      Thank you! I guess I was generally surprised when doing research at the incredibly low rates that minority groups in the United States that use mental health services. It’s really hard to see those rates and know that I myself can’t do anything to help outright, and it’s more of a societal problem overall.

      While this wasn’t surprising, necessarily, both Japanese and American groups gave the biological attribute high rates of effect. My hypothesis, on the other hand, was that the American groups would give it higher rates. I think this happened because the population I used was on that was more educated on mental health and didn’t carry that negative stigma.

  8. Dena,
    Thank you for this important work. I work with incarcerated people as part of my professional work, so many of whom have a mental health diagnosis. When I offer counseling, I try to do so in a manner that resonates with a person’s culture as they have explained it to me. I’ve been aware of differences in the stigmas, and your work helps me further than awareness.
    Thanks,
    Mother of a Wooster ’13 grad

    1. Moira,

      Thank you for what you do! That’s such important work, and I’m glad my research was able to help in some way.

  9. I find it incredibly interesting how you compared United States and Japan considering how different most people assume the culture in two countries can be. Fantastic potential for innovating mental health treatment to fit specific sub cultures’ schemas.

  10. Nice presentation. I appreciated the so what aspect. It’s powerful when research has real-world implications. Will you carry on your interests in graduate school?

    1. Michelle,

      Thank you! I’ll be moving to Japan in September to teach English through the JET Program. Afterwards, I’m definitely hoping to carry on my interests, whether it’s through continuing my research or graduate school.

  11. Hi,

    This is an interesting project. How did you think of it in the first place?

    1. Jessica,

      Thank you! I knew I really wanted to incorporate my experience with Japan and my minors into my research, and abnormal psychology is what I’m really interested in! It just kind of came to me, that if I wanted to look at mental illness, why not compare how it’s dealt with in different countries?

      A lot of previous studies in the field specifically compared race or ethnicity, so I wanted to move away from that and really focus on culturally-driven research.

  12. This is such an invaluable research topic! The topic of mental health needs to be brought out into the open so much more than it is, and certainly within all cultures. There are so many stereotypes and misperceptions and I applaud you for focusing your research such as you have. Congratulations on a job well done and for contributing to the professional research for the field of mental health! Best of luck beyond Woo!

  13. Very nice presentation. Thank you. I wish you well next year.

  14. Hi Dena,
    It’s great to visit the Symposium today to learn more about your IS work, which is really interesting. Congratulations on a job well done, and thank you for sharing your work here today. I would like to read your entire IS at some point, if possible. Again, congratulations and thank you for sharing your work!
    🙂

    1. Hi Dr. Graham!

      I’m glad you got a chance to visit my page and enjoyed my study! I’d be happy to e-mail you my full IS if you’d like to read it.

  15. Dear Dena, thanks for this interesting project. I am glad your semester at Waseda has somehow worked its way into your I.S. Congrats on your completion. Best wishes for the next phase.

  16. This is a very interesting topic, Dena. Congratulations on a job well done!

  17. Hi Dena, the underutilization of services is such a compelling topic. Underutilization often has to do in part (along with many other causes) with a lack of culturally-congruent psychotherapy options. Forty years ago David Reynolds translated twin Japanese psychotherapies known as Morita and Naikan for Western practitioners. Did you come across these models in your research? These and other international psychotherapies provide a framework that makes them more acceptable for some (not all!) international students. Many western clinicians have read Reynolds’ books — but almost none of us are competent to apply the models professionally. Congratulations, Dena, and best wishes in all your endeavors!

    1. Hi Ari,

      Thank you for your comment! I did not come across those models while researching, but it seems really interesting and important. I’ll definitely look more into it, I’d be interested to see how those models connect to the results and research that I found.

  18. Congratulations Dena! An interesting study that clearly combined all of your academic interests – not always easy. As an anthropology major who also included Japanese students in her IS (and works in public health), I’m always so happy to see others conducting important cross-cultural studies that tackle significant population health challenges. Especially now, we’ll need more of this in the years to come. Best of luck with your next chapter! -Hannah Graff ’06

  19. Very interesting! Cultural aspects that affect stigmas surrounding mental health is an issue that I would likely not have learned about otherwise! Your research is impressively far-reaching in its potential applications, which brings to my main question of what American cultural values do you see as most challenging to combating mental health stigmas, and what can/should be done to compensate for those values?

    1. Hey Tim!

      Thanks for your comment, I’m glad my research was able to show you something completely new and important. When it comes to American cultural values, our society is very individualistic. I feel as if the most challenging would be the normalization attribute, where people are convinced that nothing is wrong and they don’t need help. Furthermore, many may feel as though it’s a problem they can solve on their own. It’s very different from Japan, where not relying on friends and family may mean that those relationships aren’t important or aren’t strong enough, causing harm among the community.

  20. Hi Dena,
    thanks for sharing your fascinating research! I particularly enjoyed how you wove your major and double minor into the investigation.
    Congratulations on completion of this fine project!

  21. Dena,

    Great work! This is a fascinating research topic, and I hope that your work contributes to better understanding of what mental health resources are needed for international students coming from/going to Japan. Best of luck with the JET Program!

    Karin Tompkins

  22. Dear Dena,

    Congratulations on completing IS! Very interesting topic and it is good to know you investing a lot of time engulfing in Japanese culture before writing it.

    I wonder how often did you feel stigma on the family unit around mental health. I know Asian societies are more communal and word spreads fast. So it is tougher to stay anonymous while seeking help. I don’t know if that to say there is less stigma in America which is a more individualist society. Maybe, anonymity might be a factor in more help seeking behaviors with the similar levels of stigma?

    Looking forward to hearing more.

    1. Hi Unnati,

      Thanks for your comment! It’s definitely true that Asian societies are more communal. Through my research, some emphasized the reliance on support systems and relationships with others in Japan. Using family and friends for support helps maintain group harmony, and not doing so reflects poorly on the relationships. But on the other hand, depending on someone outside of the family can even be seen as shameful. It’s a really tough situation when it comes to asking the people close to you for support, and I would argue that it carries a lot more weight in group-driven societies such as Japan.

  23. Such an important topic, I cannot emphasize that enough! Thank you so much for digging into this and sharing it with us. Congratulations, Dena and I wish you the best!

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