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As a behavioral therapist, I have received a referral from the client’s physician as he presumes that the client may be suffering from depression. Therefore, I have conducted an assessment on the client. The client’s name is Dai Wu who is currently 68 years old. Mr. Wu is currently married, and they have one son together. Mr. Wu has retired few years ago, but he once was a former chief operating officer of a famous Chinese company. As the company got bigger in China, they wanted to branch out worldwide, so he migrated to the United States at the age 26 with other employees of the company. Mr. Wu’s migration history is considered a nonnormative life event especially because of his age at the time. Nonnormative life events which are life events that influences and is unique to a person (Bjorklund, 2015). In fact, it is also a life-changing event for him which is an event that changes one’s life and could create stress reactions. The migration process created challenges and stress for Mr. Wu as he had to adapt to a new environment with different culture and language.
As he got older, Mr. Wu started noticing the decline in his health as he currently deals with type 2 diabetes as well as hypertension. The major issue here is that Mr. Wu lives a sedentary lifestyle as he never exercises. Also, Mr. Wu has a poor eating habits as he enjoys going out to eat especially at a Chinese restaurant. Mr. Wu has mentioned to his physician that he has been having difficulty sleeping at night and have been gain weight at a rapid pace. Moreover, that he has been feeling very tired and worthless for the past month.
Hypertension, Type 2 Diabetes and Physical Activity
One of the health conditions that Mr. Wu deals with is hypertension. Hypertension has the global prevalence rate of 28.4% for males (Lopes, Mesquita-Bastos, Alves & Ribeiro, 2018). Hypertension can lead to severe complications as it is the “…major risk factor for the development of cardiovascular diseases” (Lopes et al., 2018). However, high blood pressure can be managed by adapting a healthy lifestyle which would incorporate physical activity and having a healthy diet as well as reducing sodium intake.
Mr. Wu also suffers from type 2 diabetes. Similar to hypertension, the prevention and management of type 2 diabetes getting regular exercises that includes aerobic exercises and strength training is found to be effective (Hu et al., 2018). However, majority of Chinese immigrants suffering from type 2 diabetes do not get enough exercises. Moreover, it was found that those who did exercise tend to do so at a lower intensity than what is recommended by American Diabetes Association. A study conducted by Hu et al. (2018) found that one of the reasons behind Chinese American immigrant’s low engagement in physical activity relates to not getting enough education about physical activity. Even if they do exercise, they were more likely to engage in light forms of exercises as they believed that too much physical exercise is actually bad for one’s health (Chun & Chesla, 2004).
Further research has found that Chinese people have lack of knowledge about diabetes. The biggest assumption among Chinese people about diabetes is that they believe diabetes, or any type of illness is caused by the imbalance of hot and cold in one’s body (Chun & Chesla, 2004). Therefore, consuming certain kind of foods, herbs or medications will counterbalance it. Chinese people also believed that specific behavioral methods such as taking a cool bath or wearing less clothes will lower the body temperature which creates equilibrium in one’s body. Another strong perception is that unlimited eating of Western junk food leads to diabetes and Chinese people do not recognize that diabetes results from body’s inability to make insulin to process sugar (Chun & Chesla, 2004).
As Mr. Wu grew up in China until age 26, he holds a strong Chinese belief. Mr. Wu does not realize that his diabetes is due to his body is incapable of making insulin to process sugar. Instead believes that he has been eating too much Western food, so he has been doing his best to avoid Western junk food. However, his eating style is not healthy as he eats a lot of processed and high sodium foods in his diet. Moreover, Mr. Wu does not make the effort to exercise as he simply is unmotivated to do so, believing that more exercise will only make his health worse.
Interestingly, Chinese immigrants have the prevalence rate of 7.4% for type 2 diabetes while it is 2.9% for non-Hispanic Whites. In fact, 70% of the Chinese Americans who suffer from diabetes are first-generation immigrants (Chun, Kwan, Strycker & Chesla, 2016). The reasons as to why Chinese immigrants have high prevalence rate for diabetes could be due to acculturation stress. The stress increases hormones that contributes to visceral adiposity and insulin resistance which leads to diabetes. Limited proficiency in English contributes to the acculturational stress among Chinese immigrants. This is especially the case for first-generation immigrants such as Mr. Wu. This emphasizes the need for providers that understands Chinese which will help patients’ understanding the management of diabetes (Hu et al., 2018).
Challenges Faced as An Immigrant
Immigrants face multiple challenges as they need to adapt to the new environment and learn about the new culture and languages of the new country (Li, Xu & Chi, 2018). Additionally, loneliness, discrimination and limited access to public transportation and health services are stressors for immigrants. Among Chinese immigrants, the three major stressors were language barriers, loneliness and limited use of social services (Li, Xu & Chi, 2018). Language is a barrier not only seen in everyday life practices, but it has the potential to even lower one’s self-esteem and creates a sense of isolation. Language barrier cause Asian Americans to be less inclined to seek help from health services (Singh, McBride & Kak, 2015). Furthermore, immigrating to a new country means they have abandoned their previous social network in China so they are more inclined to feel isolated (Li, Xu & Chi, 2018). Moreover, the immigrant process increases the risk for mental health issues as well as psychological distress among immigrants (Singh, McBride & Kak, 2015). This is due to acculturative stress as well as the loss of protective factors such as family relations and social networks.
Depression Among Chinese Immigrants
According to Bjorklund, it is predicted that major depression will become the fourth leading cause of disease-related disability in the world. Some of the consequences of depression includes fatigue, change in sleep patterns, changes in weight, and feelings of worthlessness (Bjorklund, 2015). Depression is very common among Asian American as it was found that, “…prevalence (for depression among Asian Americans) ranged from 18% to 31%, higher than the 10%-15% prevalence rate estimated for the general older population” (Haralambous et al., 2016). Despite its high prevalence, Asian immigrants lack knowledge about depression and have stigma towards the illness.
Many Chinese older adults view mental health as weakness rather than an illness. Moreover, due to the perception that mentally ill people are “crazy or mad” (Haralambous et al., 2016), immigrants with mental health issues are less inclined to seek for help. Even if they do express their health problems, it is more likely that they will mention physical health symptoms related to depression such as loss of energy and lack of appetite rather than psychological symptoms. Furthermore, research conducted by Haralamnous et al. (2016), has found that Chinese older adults who immigrated at a later age tends to be more at risk for depression and anxiety (Haralambous et al., 2016).
One of the common risk factors associated with depression is suicide (Mui, 1996). In fact, there is a high level of suicide among Chinese adults particularly Chinese immigrants as they are three times more likely to commit suicide from depression compared to U.S. born Chinese Americans. Study conducted by Mui, 1996 showed that Chinese American immigrants reported fatigue as major issues and also reported fewer emotions than Caucasians (Mui, 1996). This could be due to the Chinese culture of high tolerance of adversity and moderation in the expression of emotions.
Intergenerational conflicts are one of the major emotional issues for Chinese older adults especially because Chinese culture puts emphasis on filial responsibility and family solidarity (Mui, 1996). In China, it is the norm for adult children to continue living with their parents until marriage and even after marriage, they are expected to take care of their aging parents by living with them (Mui, 1996). Mr. Wu has a son who is currently 36 years old. His son was born in the U.S. therefore he is more accultured than Mr. Wu. The difference in culture has created tension as his son has decided to leave home for college against Mr. Wu’s will and has been living with his wife even to this day. Mr. Wu feels abandoned by his son and because his son is not following the traditional Chinese style, Mr. Wu is having conflicts with his son which is contributing to his depression.
Strengths of Mr. Wu
Mr. Wu has a been with his wife for over 40 years and has maintained a quite stable marriage life. This has contributed to his strength as married people are significantly healthier than unmarried people (Bjorklund, 2015). Moreover, married people tend to have increased longevity than single people. Possibly due to marital crisis effect which states that married people are healthier because “…they have not endured the crisis of being divorced or widowed” (Bjorklund, 2015, pg. 147). Mr. Wu’s wife has been a great support for him as she has always been there for him through ups and downs.
Another strength of Mr. Wu has been his spirituality. Mr. Wu is a lifelong Catholic and considers himself as a spiritual person. This is beneficial for him because according to Bjorklund (2015), spirituality has been proved to lower the levels of cortisol responses. In fact, his spirituality is strong that he has used religious coping when he first migrated from China. Religious coping refers to relying on religious and spiritual beliefs to reduce one’s stress levels (Bjorklund, 2015). In particular, Mr. Wu used positive religious coping as he told himself that there is a purpose for his suffering and that God will take care of him. Additionally, he used proactive coping in order to “…prevent or mute the impact of a stressful event that will happen in the future” (Bjorklund, 2015, pg. 318). Mr. Wu has prepared for his migration by learned English and the American culture prior to arrival. Moreover, he has studied the U.S. business culture as he wanted his company to succeed in America.
Additionally, resilience is a strength that Mr. Wu possess. Resilience is defined as, “…the maintenance of healthy functioning following exposure to potential trauma” (Bjorklund, 2015).
The reason behind his resilience is due to Mr. Wu’s strong sense of himself. In fact, those who have a strong sense of self experience less stress than those who do not have a sense (Bjorklund, 2015). Although migration was a stressful event that disrupted his routines and resources were unavailable, with his strong self of himself, he believed that he could overcome this challenge.
One beneficial community resource for Mr. Wu is the Association of American Cancer Institutes (AACI) which host Senior Wellness Program at their institute. This program is designed to foster health, wellness, and independence. They also help participants to overcome language barriers, adjust to a new culture and establish a social support network as well as increase the knowledge of community resources. Senior day program includes activities such as chair yoga, ping pong, ESL classes, social dance. They also provide healthy lunch options which includes steamed fish and baked chicken. In fact, Asian cuisine is served four days a week so people with Asian background will be familiar with the food. Majority of the staff at the program are bilingual in English and Cantonese. AACI also hosts workshops on elderly safety and health awareness as well as diet and nutrition. Furthermore, blood pressure screening is offered at the program center monthly.
Another community resources that would be beneficial is the NICOS Chinese Health Coalition. NICOS works to enhance the health and well-being of the Chinese community in San Francisco. They host the Chinatown Community Health Fair which provides health information and free screening for blood pressure, cholesterol, aging and memory assessment, cancer risk assessment, etc. The health fair allows residents to receive details about public resources such as health and social services offered in the community.
Lastly, Oakland St. Leo Chinese Catholic Community is a great resource for Mr. Wu. Although Mr. Wu has been a lifelong Catholic, he does attend church hence being in this Catholic community will help Mr. Wu to establish a strong social support network. St. Leo holds Masses in Cantonese every Sunday and their regular activities include Bible study, workshops, retreats, health talks, intercommunity relationship building, and community services. Aside from attending all these activities, Mr. Wu can contribute by helping out in the ministries. There are different areas of ministries such as spiritual development, faith formation, choir, and liturgical ministry that Mr. Wu can be part of. There are even opportunities for him to become one of the servant leaders as election happens every two years. As a former CEO who possess a great leadership skill, Mr. Wu would be a perfect candidate for servant leader if he wishes.
Being part of the Oakland St. Leo Chinese Catholic Community will give him an opportunity to be involved in the community and to guide the younger generation who also identify themselves as Catholics. It will provide a purpose and meaning to his life. Attending religious services is beneficial to people because according to Bjorklund (2015), adults who attend religious services tend to live longer. Furthermore, religion has been linked to “…promote healthy behavior, provide social support, teach coping skills and promote positive emotions” (Bjorklund, 2015, pg. 280).
This project allowed me to realize that characteristics such as socioeconomic status, health, religion and ethnicity are all intertwined with each other. For example, Chinese immigrants have lack of knowledge in diabetes as they do not see the importance of physical activity and believe that eating too much junk food leads to the illness. I believe these misunderstandings that they have contributes to the reason why they have such a high prevalence rate for diabetes. Similarly, they have misconceptions toward depression. Due to their cultural influence, they feel unable to seek help or even acknowledge their illness. This may be the reason why they have a high rate of suicide as they feel that they need to hide their illness. It was really interesting to see how all these characteristics such relate to each other.
Through my empirical research, I found the need of culturally competent health services. Immigrants especially those who migrated at an older age, they tend to have language and cultural barriers. There needs to be a provider that not only understands the language but also the culture of the client because that could affect the discovery, diagnosis and treatment process. Moreover, they have limited access to health services especially for those with low socioeconomic status.
We tend to assume that as we get older, we are useless and burden to our society. Indeed, we do face more challenges as we get older but our strengthens are something that cannot ignored. Despite having health conditions that prevents him from living a comfortable life, my client, Mr Wu, has strong belief in Catholic. Therefore, he can help others through his religious belief. By contributing to the society, not only the society is benefitting but also Mr. Wu because he is building his own social network and a community where he can belong to. Overall, this project gave me a whole new perspective of what aging in adulthood is like.
- Bjorklund, B. R. (2015). The Journey of Adulthood (Eighth ed.). Boston, MA: Pearson.
- Chun, K. M., & Chesla, C. A. (2004). Cultural issues in disease management for Chinese Americans with type 2 diabetes. Psychology & Health, 19(6), 767–785. doi: 10.1080/08870440410001722958
- Chun, K. M., Kwan, C. M. L., Strycker, L. A., & Chesla, C. A. (2016). Acculturation and bicultural efficacy effects on Chinese American immigrants’ diabetes and health management. Journal of Behavioral Medicine, 39(5), 896–907. doi: 10.1007/s10865-016-9766-2
- Haralambous, B., Dow, B., Goh, A., Pachana, N. A., Bryant, C., LoGiudice, D., & Lin, X. (2016). ‘Depression is not an illness It’s up to you to make yourself happy’: Perceptions of Chinese health professionals and community workers about older Chinese immigrants’ experiences of depression and anxiety. Australasian Journal on Ageing, 35(4), 249–254. doi: 10.1111/ajag.12306
- Hu, S. H., Mei R. Fu, Shan Liu, Yen-Kuang Lin, & Wen-Yin Chang. (2018). Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes: Findings from this mixed-methods study reveal deficits and suggest areas for change. AJN American Journal of Nursing, 118(2), 24–41. doi: 10.1097/01.naj.0000530221.87469.86
- Li, J., Xu, L., & Chi, I. (2018). Challenges and resilience related to aging in the United States among older Chinese immigrants. Aging & Mental Health, 22(12), 1548–1555. doi: 10.1080/13607863.2017.1377686
- Lopes S, Mesquita-Bastos J, Alves AJ, & Ribeiro F. (2018). Exercise as a tool for hypertension and resistant hypertension management: current insights. Integrated Blood Press Control, Volume 11, 65-71. doi: 10.2147/ibpc.s136028
- Mui, A. C. (1996). Depression among elderly Chinese immigrants: An exploratory study. Social Work, 41(6), 633–645.
- Mychurchwebsite.net. (2019). Chinese Pastoral and Cultural Center – The Roman Catholic Bishop of Oakland. Retrieved from https://www.oaklandccc.org/
- Singh, S., McBride, K., Kak, V. (2015). Role of social support in examining acculturative stress and psychological distress among Asian American immigrants and three sub-groups: Results from NLAAS. Journal of Immigrants and Minority Health, 17(6), 1597-1606. doi: 10.1007/s10903-015-0213-1
- Senior Wellness Center – AACI. (2018). Retrieved from https://aaci.org/wellness/senior/
- www.nicoschc.org. (2019). Retrieved from http://www.nicoschc.org/
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