Expressed Emotion and Stigma among Chinese-Americans with Schizophrenia

描述（由申请人提供）：外科医生关于精神健康的报告的补充指出，“必须对AA/PI（亚裔美国人/太平洋岛民）人群进行更多的研究。应优先调查特定的AA/PI群体. (and)文化上适当的干预形式”（第121-122页）（1）。美籍华人精神分裂症患者构成了一个诊断群体，他们遭受着来自文化，语言和结构障碍的众多障碍。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“表达情绪”或EE）如何影响患者复发，但这一过程尚未在任何亚裔美国人群体中得到理解。此外，精神分裂症患者和他们的家庭在华裔美国人社区的经验来自中国的文化信仰，可能会进一步影响疾病和康复的耻辱。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了华裔美国人的EE表现。此外，本研究将探讨如何在这个人口的文化影响影响的耻辱的经验。从这些背景层次的分析中获得的知识最终将用于制定一个文化上胜任的家庭干预，为有精神分裂症家庭成员的华裔美国人。 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名华裔美国精神分裂症患者及其相关家庭成员。研究一“华裔美国家庭情绪表达”的具体目的是：1）考察文化规范对华裔美国移民情绪表达的影响; 2）考察文化规范对华裔美国移民情绪表达类型分布的影响。研究2的具体目标。“文化对精神分裂症华裔美国人污名化的影响”，是：1）设计一个半结构化的访谈，以评估文化如何影响患者的污名化体验; 2）试点和验证一种新的污名相关情绪的测量（例如，羞耻感）。这些情绪的评估将在EE测量后建模。拟议的培训计划将使申请人能够研究最终有助于在服务不足的少数民族人口中以文化上适当的方式治疗精神分裂症的因素。申请人的主要目标是：1）明确了解在文化多样性人群中形成精神分裂症病程的复杂家庭和社会因素; 2）发展为全球精神分裂症患者实施文化胜任家庭干预所需的技能。职业发展奖将使申请人能够接受以下方面的培训：1）标准化培训，成为认证的EE评估员; 2）通过正式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.