Understanding clinician perception of common presentations in South Asians seeking mental health treatment and determining barriers and facilitators to treatment

Background: Little is known about the presentation of mental health symptoms among South Asians living in the US. Objective: To explore mental health symptom presentation in South Asians in the US and to identify facilitators and barriers to treatment. Design: Focus group study. Participants: Four focus groups were conducted with 7-8 participants in each group. All participants (N= 29) were clinicians who had been involved in the care of South Asian patients with emotional problems and/or mental illness in the US. Approach: Qualitative content analysis. Results: Key themes identified included: generational differences in symptom presentation, stress was the most common symptom for younger South Asians (<40 years of age), while major mental illnesses such as severe depression, psychosis and anxiety disorder were the primary symptoms for older South Asians (>40 years of age). Substance abuse and verbal/physical/sexual abuse were not uncommon but were often not reported spontaneously. Stigma and denial of mental illness were identified as major barriers to treatment. Facilitators for treatment included use of a medical model and conducting systematic but patient-centered evaluations. Conclusions: South Asians living in the US present with a variety of mental health symptoms ranging from stress associated with acculturation to major mental illnesses. Facilitating the evaluation and treatment of South Asians with mental illness requires sensitivity to cultural issues and use of creative solutions to overcome barriers to treatment.