EE and Stigma among Chinese-Americans with Schizophrenia

描述（由申请人提供）：《卫生局局长心理健康报告补编》指出，“有必要对AA/PI（亚裔美国人/太平洋岛民）人群进行更多的研究。应该优先考虑针对特定AA/PI群体的调查……（和）具有文化能力的干预形式”（第121-122页）。美籍华人精神分裂症患者是一个遭受文化、语言和结构障碍等诸多障碍的诊断群体。虽然研究已经说明了家庭成员对患者的特定情绪反应（称为“情绪表达”或EE）是如何影响患者复发的，但这一过程在任何亚裔美国人群体中都尚未被理解。此外，美籍华人社区的精神分裂症患者及其家人经历了源自中国文化信仰的污名，这可能进一步影响疾病和康复。本研究旨在探讨与文化和移民相关的因素在多大程度上影响美籍华人情感表达的表现。此外，本研究将探讨文化影响如何影响这一人群的耻辱体验。从这些背景层面的分析中获得的知识最终将用于为有精神分裂症家庭成员的华裔美国人制定具有文化能力的家庭干预。

DESCRIPTION (provided by applicant): 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.