EE and Stigma among Chinese-Americans with Schizophrenia

说明(申请人提供)：《卫生局局长精神健康报告补编》指出，“必须对亚裔美国人/太平洋岛民(AA/PI)人群进行更多的研究。应优先考虑侧重于特定AA/PI群体的调查……(和)具有文化能力的干预形式”(第121-122页)(1)。华裔精神分裂症患者构成了一个诊断群体，由于文化、语言和结构障碍，康复面临着许多障碍。尽管研究已经说明了家庭成员对患者的特定情绪反应(称为“表达的情绪”或EE)如何影响患者的复发，但这一过程在任何亚裔美国人群体中都还没有被理解。此外，华裔美国人社区中的精神分裂症患者及其家人经历着源于中国文化信仰的耻辱，这可能会进一步影响疾病和康复。本研究旨在调查与文化和移民相关的因素在多大程度上影响华裔美国人的EE表现。此外，这项研究将探索该人群中的文化影响如何影响耻辱体验。从这些背景层面的分析中获得的知识最终将被用于为有精神分裂症家庭成员的华裔美国人制定一项具有文化能力的家庭干预措施。 我的研究计划分为两个不同但相关的研究，我们将采访总共50名患有精神分裂症的华裔美国患者及其相关家庭成员。研究一《华裔美国家庭中的情感表达》的具体目的是：1)考察文化规范对华裔美国移民情感表达的影响；2)考察文化规范对情感表达类型分布的影响。研究的具体目的2。《文化对精神分裂症华裔美国人污名的影响》是：1)设计半结构化访谈，评估文化如何影响患者的污名体验；2)试验和验证华裔精神分裂症患者与污名相关的情绪(例如羞耻)的新测量。对这些情绪的评估将在EE测量之后模拟。拟议的培训计划将使申请者能够研究最终将有助于在服务不足的少数民族人口中进行文化上适当的精神分裂症治疗的因素。申请者的广泛目标是：1)清楚地了解在不同文化背景的人群中影响精神分裂症进程的复杂的家庭和社会因素；2)发展在全球范围内为精神分裂症患者实施符合文化能力的家庭干预所需的技能。职业发展奖将使申请者能够接受以下培训：1)标准化培训，成为合格的EE评分员；2)通过正规课程和监督研究学习医学人类学，学习定性理论、方法和分析。

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.