Schizophrenia in Asian Americans: Why Medical Representation is Necessary

✍🏽 Aaditi Kumbhar | MPH Epidemiology Graduate from New York University

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What is Schizophrenia? 🧠

Schizophrenia is a rare chronic disease that significantly negatively alters quality of life.

Schizophrenia can be primarily defined as a significant reduction in grey matter, the part of the brain that houses most neurons. However, recent research demonstrates that schizophrenia can also be a cause of increased grey matter function.

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Distribution of Schizophrenia 📊

15.2 people per 100,000 people a year are diagnosed on the schizophrenic spectrum.

Schizophrenia symptom onset occurs in early adulthood, and symptoms can still be present even after treatment. Although schizophrenia is a rare disease, men are 1.4 times more likely and migrants are 4.6 times more likely to develop schizophrenia than the average population internationally. These individuals more commonly live in urban areas, and can be affected by risk factors such as stress related to socioeconomic status, exposure to poor mental health services, and racial bias in medical treatment.

Asian American populations specifically suffer from a lack of representation and access to mental health resources to accurately combat schizophrenia. This severe limitation underrepresents the burden of schizophrenia within the United States population, and calls for a more inclusive and culturally sensitive diagnosis and treatment process for affected individuals.

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Burden and Racial Data 👩🏽‍💻

To better understand the burden of schizophrenia in the United States, measures such as point prevalence and lifetime prevalence have been used across varying systematic reviews.

Schizophrenia is a slow developing disorder, so measurements such as point and period prevalence can help identify the current total number of individuals being affected by schizophrenia at a given time. Environmental factors and social constructs within that time period can explain potential reasons why schizophrenia develops within specific demographics.

Burden Measurement	Definition	Schizophrenia Data
POINT PREVALENCE	proportion of people with schizophrenia in 2013	2.6 to 6.7 people per 1,000 persons
LIFETIME PREVALENCE	proportion of people that experience schizophrenia throughout their lifetime	4.0 people per 1000 persons

RACE	Lifetime Rate of Psychotic Symptoms
Asian Americans	9%
Latino Americans	13%
African Americans	15%

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Medical Representation in Asian American Populations 👩🏽‍⚕️

Enrolment in schizophrenia research such as randomised trials for antipsychotic medications showed as little as 2% of the overall selected participants as Asian.

Factors Affecting Racial Representation in Research

Lack of Diversity: In predominantly white parts of the United States, there is less representation of Asian Americans due to the lack of diversity within the area. Lack of nuance in Asian nationality can also cause generalization of schizophrenia research, overlooking differences in Asian minorities.

Language Barriers: Researchers implementing a study that does not offer translation services deter Asian Americans with limited English proficiency from enrolling.

Participation Incentive: Monetary incentives for participating in mental health research studies could bring in an over-representative sample of Asian Americans in an otherwise uniformly Caucasian community. For individuals with low or moderate socioeconomic status, a monetary incentive increases the likelihood of participating in research studies. This sample increase may not always be reflective of the true population of Asian Americans in the area.

Stigma and Cultural Factors: Cultural stigma, community opinion, and social structure within the Asian American population plays a role in the likelihood of patients reporting and receiving treatment for schizophrenia. Asian individuals with mental illnesses such as schizophrenia are often ostracized from society, making their diagnosis feel shameful for themselves and their families. Individuals suffering from this disease are less likely to seek out mental health resources or participate in research studies promoting treatment. Identifying as a minority Asian American subpopulation is a risk factor for schizophrenia, but there is more research needed in understanding the reasoning behind poor diagnosis and treatment within the racial demographic.

Why Does Representation Matter?

The lack of racial and ethnic representation within the diagnosed patient population deters further culturally inclusive research within the psychiatric field. More specific cross sectional studies are required to address the Asian American subpopulations affected by schizophrenia because of the lack of overall representation in systematic reviews conducted across the United States. The representative sample of Asian American schizophrenia patients within the United States is poor, therefore generalizations of schizophrenia burden cannot be accurately made.

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What Can be Done? 🤨

There is currently no cure for schizophrenia.

To address this problem, Asian American patients should be randomly selected according to a quote proportional to their population size in different systematic reviews. This will allow for a more accurate representation of the schizophrenic burden affecting the Asian American community in various parts of the United States. Although expensive, randomised controlled trials with stratified Asian subpopulation samples are the most comprehensive way to test treatment options. By doing so, future researchers can ensure accurate, expansive results within their studies.

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Edited by: Olivia Laughton | Content Editor | Microbiology BSc at the University of Leeds

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