J Immigrant Minority Health (2014) 16:12941298

DOI 10.1007/s10903-014-0018-7

BRIEF COMMUNICATION

Perceptions of Mental Illness and Related Stigma Among

Vietnamese Populations: Findings from a Mixed Method Study
Mai Do Nhu Ngoc K. Pham Stacy Wallick
Bonnie Kaul Nastasi

Published online: 10 April 2014

 Springer Science+Business Media New York 2014

Abstract Mental-illness-related (MIR) stigma is recognized as a major barrier to health care. Yet very little is
known about mental illness and stigma among Vietnamese
populations, or how emigration and acculturation processes
might affect traditional views. Focus group discussions
were conducted with Vietnamese Americans in New
Orleans (Louisiana) and Vietnamese nationals in Bui Chu
(Vietnam), who shared historical and cultural backgrounds,
in 2010 to assess differences in their perceptions of mental
illness and stigma. Results show several significant differences in mental illness perceptions between Vietnamese
Americans and Vietnamese nationals, while MIR stigma
seemed prevalent and understanding of mental illness was
low among both groups.
Keywords Mental illness
Stigma
Vietnamese

Vietnamese Americans

Introduction
Vietnamese Americans, like other Asian immigrants,
reportedly underutilize mental health services. Discussions
with Vietnamese immigrants in the United States and
elsewhere and with health professionals have pointed to
stigma as a major impediment to care [13]. Yet, little
M. Do
N. N. K. Pham (&)
S. Wallick
Department of Global Health Systems and Development,
School of Public Health and Tropical Medicine, Tulane
University, New Orleans, LA, USA
e-mail: npham2@tulane.edu
B. K. Nastasi
Department of Psychology, Tulane University,
New Orleans, LA, USA

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research has investigated mental-illness-related (MIR)

stigma among this population. This study explored perceptions of mental illness and stigma among Vietnamese in
New Orleans and Vietnamese nationals in Bui Chu (Ninh
Binh province), who never left the country.
The two groups share a socio-cultural heritagea significant proportion of Vietnamese in New Orleans came
from Bui Chubut differ in recent cultural environment.
Many Vietnamese in New Orleans first moved from Bui
Chu in the north to South of Vietnam at the end of the First
Indochina War (1954). Twenty years later, the Vietnam
War ended, they made the second move to the United
States. Yet, the hardship did not end there. Vietnamese in
New Orleans once again experienced the traumas of Hurricane Katrina (2005) and the Deepwater Horizon (BP) oil
spill (2010), reigniting similar traumas of the past. Surprisingly, previous studies did not find long-lasting impacts
of disasters on the mental health status of Vietnamese in
New Orleans [4]. One of the questions raised was whether
living in a different culture has shifted the perceptions of
mental health and stigma, which may have affected how
mental illness was reported. This study attempts to address
this question by comparing mental illness perceptions
among Vietnamese Americans and Vietnamese nationals,
through a mixed-method approach.

Methods
Approved by the Internal Review Board of Tulane University, in 2010, eight focus group discussions (FGDs)
were conducted among Vietnamese in eastern New Orleans
and Vietnamese nationals from Bui Chu (Vietnam). On
average, ten individuals participated in each FGD; a total
of 81 participants aged 2570 took part in the FGDs in both

J Immigrant Minority Health (2014) 16:12941298

locations (41 in New Orleans, 40 in Bui Chu), participants

were equally divided between genders. In each FGD, participants were first asked to complete a short questionnaire
indicating their opinions towards MIR statements, and then
the discussion was conducted.

Results
Through FGD coding based on thematic responses coupled
with surveys guideline questions and issues discussed,
important similarities and differences between the two
sample groups were noticed.
Similarities
Everyone agreed that mental illness was a departure from
the norms, as people with MIR problems did weird stuff,
or that they were anti-social. Many participants in New
Orleans used the word crazy to describe mental illness.
Both groups clearly distinguished the mentally ill, them,
from normal people like us, referring to the mentally ill
in third person while keeping both physical and social
distance, in fear of violent behaviors.
I am scared of it. If I see someone with mental illness,
I do not want to come near them. (Man, 50-70, New
Orleans)
Worries were a commonly cited cause of mental illness
among all participants, where one would become mentally
ill if he/she spent too much time thinking about his/her
problems, not sharing them with family members and
friends. Both groups distinguished long-term mental health
issues caused by major stressors from problems due to
daily stress. Sudden mental or emotional shocks, especially
from the wars, had long-lasting impacts in both locations.
I had 7 siblings and I was the only one who joined the
military. I almost lost my leg. My older brother died
in the North. Later on another brother died. Altogether I lost 5 siblings After fighting in the North,
my siblings and I evacuated from the war zone, we
lost contact with each other Without a family, no
wife, no children, I feel depressed. (Man, 50-70, New
Orleans)
In New Orleans, recent disasters were among leading
stressors. Not many communities suffered from repeat
traumas as did this communityfirst the wars, then
Hurricane Katrina, and more recently the BP Oil Spill.
Many Vietnamese Americans had barely recovered from
Hurricane Katrina, only to be worried again about their
financial situation as a result of the oil spill. The long-term
impacts are palpable:

1295

In my case, it was after Hurricane Katrina. I felt that

my body and my health changed after that incident. I
have not confirmed that I have mental illness. But
psychologically, my life changed tremendously. Now
my life is not happy, healthy, exciting, and hopeful
It [Katrina] was the worst experience I have gone
through since I came to the U.S. I suspect that
someday I may have mental illness if I do not find a
way out. (Man, 50-70, New Orleans)
As hinted above and apparent from the quote below, repeat
traumas may have caused many participants to shy away
from talking about their mental distressa possible reason
for the low prevalence of mental health issues found in
recent surveys [4].
I have much sadness I very much want to speak out.
But I still keep it to myself; I still endure and do not share
it with other That is why when the doctors investigate;
they find that very few Vietnamese have mental illness.
For example, I am depressed, but it takes many people to
come to find that out. (Man, 50-70, New Orleans)

Differences
Important differences were observed between the two
groups. Vietnamese Americans were less likely than Vietnamese nationals to attach mental illness to a specific
physical health problem, but had a harder time describing it.
They made clear distinctions between mental and physical
health, in which mental health dealt with the state of mind.
In contrast, Vietnamese nationals often equated mental illness with physical problems, where causes of mental illness
were physical health and behaviors, including not being able
to eat or sleep.
Table 1 shows significant differences between the two
groups regarding to MIR stigma, based on data from the
quantitative measure of stigma. First, Vietnamese Americans were much more likely than Vietnamese nationals to
report no opinion to statements relating to MIR stigma,
which may indicate their reluctance to discuss stigma.
Second, for many statements indicating a stigmatizing
attitude toward the mentally ill, a significantly greater
proportion of Vietnamese Americans reported agreement
or no opinion than Vietnamese nationals. For example,
Vietnamese Americans were more likely than Vietnamese
nationals to not have an opinion or agree that families and
individuals with mental disorders should hide their illness
(67.6% compared to 22.5%), indicating stigmatizing attitudes towards those with MIR issues. Consistent with data
collected from the FGDs, quantitative data point to the
publics not-so-friendly perceptions towards those with
mental illness.

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Table 1 MIR stigma among
FGD participants in New
Orleans and Bui Chu

J Immigrant Minority Health (2014) 16:12941298

Statement

New Orleans (%)

Bui Chu (%)

People with mental illness are fearful

Strongly disagree

.000
2.8

27.5

Disagree

27.8

50.0

No opinion

36.1

2.5

Agree

22.2

15.0

Strongly agree

11.1

5.0

5.3

12.5

People with mental illness are often pitied

Strongly disagree
Disagree

.000
2.6

30.0

No opinion

42.1

0.0

Agree

31.6

50.0

Strongly agree

18.4

7.5

2.6

17.5

Disagree
No opinion

31.6
42.1

50.0
2.5

Agree

15.8

25.0

7.9

5.0

People with mental health problems are dangerous

Strongly disagree

Strongly agree

.000

Families of people with mental health problems

should be embarrassed of themselves

.000

Strongly disagree

44.4

17.5

Disagree

16.7

62.5

No opinion

30.6

2.5

Agree

8.3

10.0

Strongly agree

0.0

7.5

People are not understanding of

those with mental health problems

.001

Strongly disagree

2.6

30.0

Disagree

7.9

17.5

No opinion

42.1

7.5

Agree

26.3

25.0

Strongly agree

21.1

20.0

People with mental illness are usually talked down to

because of their mental health problems
Strongly disagree

.000
2.7

15.0

Disagree

13.5

52.5

No opinion
Agree

43.2
27.1

5.0
20.0

Strongly agree

13.5

7.5

2.6

17.5

Disagree

10.3

52.5

No opinion

41.0

7.5

Agree

35.9

15.0

Strongly agree

10.3

7.5

People usually avoid those with mental health problems

Strongly disagree

.000

.000

It is a sign of personal weakness to receive

treatment for emotional or mental problems

123

p-value

Strongly disagree

35.2

12.5

Disagree
No opinion

24.3
29.7

47.5
5.0

J Immigrant Minority Health (2014) 16:12941298

Table 1 continued

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Statement
Agree
Strongly agree

New Orleans (%)

Bui Chu (%)

10.8

15.0

0.0

20.0

People tend not to like those who seek help

for emotional or mental problems

.001

Strongly disagree

32.4

15.0

Disagree

18.9

55.0

No opinion

37.9

10.0

Agree

8.1

5.0

Strongly agree

2.7

15.0

Discussion
This study highlights varying levels of understanding and
perceptions toward mental illness among Vietnamese
populations. None of the participants seemed to have a
good understanding of mental illness. Worries and
sudden traumatic experiences were cited as common causes for mental illness by both groups. In both locations,
participants indicated that sudden mental or emotional
shocks, such as wars or natural disasters, could result in
mental illness, not only among those directly involved but
possibly among the next generations as well.
However, there are also critical differences between the
two groups. Vietnamese nationals were more likely than
Vietnamese Americans to maintain the traditional view and
see the body and the mind as two parts of a unitary model
[5]; they were also more able to describe mental illness and
person(s) with such illness. Many participants also
emphasized the tendency of Vietnamese to keep problems
inside rather than talking about them, not wanting to be
reminded of the many repeat traumas that they have
endured. This finding is consistent with an earlier report on
the post-Katrina resilience of Vietnamese in New Orleans
[6]. Another possible explanation for reluctance to talk
about mental illness could be stigmatizing attitudes
towards those with mental issues. Living in the United
States, where privacy and the capacity for independent
living are highly valued, may have also contributed to
Vietnamese Americans view of mental illness as a personal matter, creating unwillingness to admit to or share
emotional troubles.
The study did not provide strong evidence that Vietnamese in New Orleans had less stigmatizing attitudes
toward mental illness than their counterparts in Bui Chu.
Life in a second culture did not substantially change the
Vietnamese Americans ideas about mental health; instead
it seemed to encourage them to hold back their opinions in
discussing MIR issues.

p-value

41

40

This early investigation opens opportunities for further

research on other issues surrounding mental illness and MIR
stigma among Vietnamese populations, such as cultural
effects on MIR stigmahow they may vary between sites
and between generations. While disasters were reported as
major causes of mental disorders, their long-term impacts on
mental illness, particularly among the offspring of those
directly involved, and related stigma are not clear.
To our knowledge, this is the only study that has compared Vietnamese nationals with Vietnamese Americans
on perceptions of mental illness and stigma. Its strengths
include the use of mixed methods to gain insight to a highly
sensitive topic. The study highlights a lack of understanding of mental illness and a potentially high level of
stigma in both groups. Much work is needed to reduce the
stigma and negative perceptions of mental illness among
the overall Vietnamese population.
Acknowledgments This study is supported by the Gulf Coast
Transdisciplinary Research Recover Center for Community Health
(NIH 1RC2MD004783-01; Principal Investigator: Maureen Litchveld). We also thank Mark VanLandingham for his inputs and comments on earlier drafts of the report.

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