The Supplement to the Surgeon General's Report on Mental Health indicates that, """"""""It is imperative that more research be conducted on the AA/PI (Asian-American/Pacific Islander) population. Priority should be given to investigations that focus on particular AA/PI groups...(and) culturally competent forms of intervention"""""""" (p. 121-122) (1). Chinese-American patients with schizophrenia constitute a diagnostic group that suffers from a multitude of obstacles to recovery stemming from cultural, linguistic, and structural barriers. Although research has illustrated how particular emotional reactions of family members towards the patient (termed 'expressed emotion' or EE) influences patient relapse, this process has yet to be understood among any of the Asian-American ethnic groups. In addition, patients with schizophrenia and their families in the Chinese-American community experience stigma originating from Chinese cultural beliefs that may further influence illness and recovery. This study aims to investigate the extent to which factors associated with culture and immigration affect manifestations of EE among Chinese-Americans. Further, this study will explore how cultural influences in this population influence experiences of stigma. The knowledge gained from these contextual levels of analysis will ultimately be used to formulate a culturally competent family intervention for Chinese-Americans who have a family member with schizophrenia. My research proposal is divided into two distinct but related studies where we will interview a total of 50 Chinese American patients who have schizophrenia and their associated family members.
The specific aims of Study 1, """"""""EE among Chinese-American Families"""""""", are: 1) To examine how the manifestation of expressed emotion (EE) is influenced by cultural norms among Chinese-American immigrants and; 2) To examine how the distribution of EE types is influenced by cultural norms.
The specific aims of Study 2. """"""""The Impact of Culture on Stigma among Chinese-Americans with Schizophrenia"""""""", are: 1) To design a semi-structured interview to assess how culture influences the patient's experience of stigma and; 2) To pilot and validate a novel measure of stigma-related emotions (e.g., shame) experienced by Chinese-Americans with schizophrenia. The assessment of these emotions will be modeled after EE measurement. The proposed training plan will enable the applicant to study factors that will ultimately contribute to a culturally appropriate treatment of schizophrenia among an underserved ethnic minority population. The applicant's broad goals are: 1) To achieve a clear understanding of the complex familial and social factors that shape course of schizophrenia among culturally diverse populations and; 2) To develop the skills needed to implement culturally-competent family interventions for schizophrenia patients globally. The career development award would enable the applicant to receive training in: 1) standardized training to become a certified EE rater and; 2) studying medical anthropology through formal coursework and supervised research to learn qualitative theory, methods, and analysis.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research & Training (K01)
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Behavioral Genetics and Epidemiology Study Section (BGES)
Program Officer
Mayo, Donna J
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Columbia University (N.Y.)
Public Health & Prev Medicine
Schools of Public Health
New York
United States
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Yang, Lawrence; Lo, Graciete; Tu, Ming et al. (2015) Effects of Increased Psychiatric Treatment Contact and Acculturation on the Causal Beliefs of Chinese Immigrant Relatives of Individuals with Psychosis. J Immigr Refug Stud 13:19-39
Cheng, Zhen Hadassah; Tu, Ming-Che; Li, Vanessa A et al. (2015) Experiences of Social and Structural Forms of Stigma Among Chinese Immigrant Consumers with Psychosis. J Immigr Minor Health 17:1723-31
Yang, Lawrence H; Lai, Grace Y; Tu, Ming et al. (2014) A brief anti-stigma intervention for Chinese immigrant caregivers of individuals with psychosis: adaptation and initial findings. Transcult Psychiatry 51:139-57
Yang, Lawrence H; Chen, Fang-Pei; Sia, Kathleen Janel et al. (2014) ""What matters most:"" a cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma. Soc Sci Med 103:84-93
Yang, Lawrence H; Purdie-Vaughns, Valerie; Kotabe, Hiroki et al. (2013) Culture, threat, and mental illness stigma: identifying culture-specific threat among Chinese-American groups. Soc Sci Med 88:56-67
Lai, Grace Ying-Chi; Lo, Graciete; Ngo, Hong et al. (2013) Migration, Socio-cultural Factors, and Local Cultural Worlds among Fuzhounese Chinese Immigrants: Implications for Mental Health Interventions. Int J Cult Ment Health 6:141-155
Chen, Fang-Pei; Lai, Grace Ying-Chi; Yang, Lawrence (2013) Mental illness disclosure in Chinese immigrant communities. J Couns Psychol 60:379-91
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WonPat-Borja, Ahtoy J; Yang, Lawrence H; Link, Bruce G et al. (2012) Eugenics, genetics, and mental illness stigma in Chinese Americans. Soc Psychiatry Psychiatr Epidemiol 47:145-56
Yang, Lawrence H; Wonpat-Borja, Ahtoy J (2012) Causal Beliefs and Effects upon Mental Illness Identification Among Chinese Immigrant Relatives of Individuals with Psychosis. Community Ment Health J 48:471-6

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