Cross-Cultural Approaches to Mental Health Challenges Among Students

Abstract

Teresa is the 18-year-old American-born daughter of Asian immigrant parents who both work in a scientific field. An only child, she is a perfectionist who shares her parents' high standards and somewhat rigid thinking style. She began to exhibit symptoms of anxiety and depression as a junior at an academically rigorous high school and experienced frequent suicidal ideation. However, she and her parents were skeptical of mental illness and did not seek treatment at that time. Despite her symptoms, she continued to perform at a high level academically and took on leadership roles in several intensive extracurricular activities, but outside of school she was socially isolated and exhibited significant anxiety and avoidance. The summer before matriculating at an elite New England university, her anxiety became so paralyzing that she could not complete basic tasks, including sending emails and completing required paperwork for the fall semester. She became increasingly isolated, spending most of her time in her room watching TV or surfing the web. She could not imagine starting school in the fall, but feared if she didn't, she would end up working at a fast food restaurant. Her suicidal thoughts increased, and her parents brought her to a psychiatrist for evaluation. The psychiatrist was alarmed by the severity and duration of Teresa's untreated symptoms and recommended regular psychotherapy and initiation of a selective serotonin reuptake inhibitor to treat depression and anxiety, with possible escalation to a higher level of care if her suicidal thoughts worsened. Both the student and her family were reluctant to conceptualize her symptoms in terms of a mental illness that might benefit from psychiatric treatment despite being provided with medical literature by the psychiatrist, who had hoped that this approach might appeal to their scientific backgrounds. Ultimately, the family declined all recommendations for intervention and expressed a belief that once she started school she would improve on her own. Midway through her first semester, she presented to the university's student health service complaining of an asthma exacerbation and abdominal discomfort. During her evaluation by the medical nurse practitioner, she also acknowledged heightened anxiety and suicidal thoughts. She was referred back to the same psychiatrist, and at that time, she and her parents agreed to psychiatric hospitalization.