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CULTURAL ASPECTS OF PSYCHIATRIC CLINIC UTILIZATION A CROSS-CULTURAL STUDY IN HAWAII

J. DAVID KINZIE, M.D. Professor, Department ofPsychiatry, University ofOregon Health Sciences Centre, Portland, Oregon Associate

and WEN-SHING TSENG,

M.D.

Professor, Department ofPsychiatry, University ofHawaii School ofMedicine, Honolulu, Hawaii ABSTRACT

Data

obtained

ethnic

from 411 outpatients at a psychiatric clinic by in Honolulu, Hawaii, and were then analyzed according to demographic variables, welfare status, source of referral, primary compliants or symptoms, diagnosis, and duration of treatment received. Clinic utilization was highly related to ethnicity, with Caucasians highly over-represented in proportion to the population, and other groups, especially Japanese, being greatly under-represented. The Caucasians were more likely to be self-referred, to have subjective symptoms of anxiety and depression" and to receive a neurotic diagnosis. The Japanese, and to some extent all other groups, were more often referred after a crisis or severe mental illness, displayed more socially disruptive symptoms, and had a higher percentage of schizophrenic diagnoses. Ethnicity was thus highly related to utilization of mental health services; however, once entry into the system was made, review of therapist case loads and analysis of duration of treatment revealed no ethnic difference in the clinic’s response to patients. was

status

INTRODUCTION

One of the major concerns of both transcultural and community psychiatry is to study the ways in which people of different cultures perceive and utilise mental health services. The population of Hawaii consists of an exceptional array of different cultural groups - Caucasian, Hawaiian, Japanese, Chinese, Filipino, Portuguese, and many others - who have managed to retain much of their original culture, but live in a relatively limited space of an island community and share the common language. This situation provides a unique laboratory for such a study.27 In this paper, through reviewing histories of patients who visited the Mental Health Clinic at The Queen’s Medical Center, a major psychiatric outpatient clinic in Honolulu, we intend : (1) to describe a clinic population in a multi-ethnic setting with emphasis on ethnic differences in the patients; (2) to determine the major routes taken to the clinic by patients from these various groups; (3) to analyze the differences in symptom patterns and diagnoses in each group; (4) to review the patient response to the clinic in terms of follow-up treatment; and (5) to discuss the implications of these findings in terms of the cultural perspectives on mental illness and the subsequent acceptance and utilisation of mental health services. THE SETTING

Honolulu, Hawaii, is the largest city of the Hawaiian Islands, having a population of about 325,000 people, representing diverse cultural and ethnic groups, a wide time span of immigration and settlement in the islands, and large socioDownloaded from isp.sagepub.com at EMORY UNIV on August 26, 2015

178 economic differences. The various cultural groups maintain varying degrees of isolation from each other, with a corresponding lack of mutual interaction. Some groups maintain their identity to a great extent, while others have lost major portions of it. Nevertheless, there seem to be some consistent differences in their cultural traits and traditional values, on which to base a meaningful comparison of the ways in which they perceive mental illness and react to treatment. The largest single ethnic group is composed of ’whites’ or Caucasians, who perhaps are also the most diverse group. They comprise about one-third of the population, and include ’kamaainas’ - an old and established group of families, the more recently established professional class, military and governmental employees, a large transient young population, some of whom can be described as having a ’hippie’ life style, and a small but distinct group of Portuguese, who have a long history of retaining a unique identity in Hawaii. The Japanese are another large group and are perhaps the most homogeneous in their socio-economic status and in their cultural values. They are highly represented in the governmental and educational employment. The Chinese are the oldest group of immigrants, who came to Hawaii to work in the labouring fields during the latter part of the 19th century, and at this time represent third, fourth, and fifth generations. Their cultural identity is more diffuse than that of the Japanese, and many have achieved high professional and business

standing. The Hawaiians represent a sizeable group of the native people. Most of them have intermarried with members of other cultures at this time. In this study we have designated the one category ’Hawaiian’ to include ’full-blooded’ Hawaiians and ’part-Hawaiians.’ Although they may be of mixed or cosmopolitan racial backgrounds, there is a distinct identity in being part-Hawaiian, and therefore ’local’ in orientation. Filipinos are a more recent immigrant group in Hawaii, and have had less opportunity for success in the business and educational fields than the preceding groups. Their identity as Filipinos is often firmly established, and they represent

10% of the population. As expected in a mixed group living together during this length of time, there are a number of people of mixed racial background, in which the parents are different ethnically, or an even more mixed background which is truly cosmopolitan in its racial derivation. Although they may be classified in different ways in a census, we have placed this group together as a ’mixed’ group for the purposes of this study. Other groups are only represented to a small extent in Hawaii, and we have designated this the ’other’ category. These include Koreans, Samoans, Puerto Ricans, American Indians, and Blacks.

over

THE CLINIC

The mental health clinic of this study is on the grounds of a private general in downtown Honolulu; it functions as a major outpatient clinic on the island. The therapists are primarily University-affiliated psychiatric residents. Social workers, psychologists, and social work students also saw patients during the year of this study. Patients are referred by themselves, private physicians, social agencies, or are admitted through the emergency room, or are seen for follow-up treatment after being treated as inpatients. All patients are initially screened by a social worker; then

hospital

t-11.11

Cultural aspects of psychiatric clinic utilization a cross-cultural study in Hawaii.

177 CULTURAL ASPECTS OF PSYCHIATRIC CLINIC UTILIZATION A CROSS-CULTURAL STUDY IN HAWAII J. DAVID KINZIE, M.D. Professor, Department ofPsychiatry, Un...
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