COVID-19 Racism Takes Toll on Chinese Americans’ Mental Health

Chinese Americans are experiencing more racial discrimination and it appears to be affecting their mental health, according to a convenience sample survey.

Among 543 Chinese-American parents, the proportion who reported experiencing racial discrimination in-person and online due to COVID-19 was 50.9% and 31.7%, respectively, reported Charissa S. L. Cheah, PhD, of the University of Maryland, Baltimore County, and colleagues.

In a group of 230 of their children, ages 10-18 years, who were also surveyed, 50.2% and 45.7% said they had experienced racial discrimination in-person and online, respectively, they wrote in Pediatrics.

"Preparation for bias and talking to children proactively about potential responses and coping strategies so they don't internalize [racial discrimination] is really important," Cheah told MedPage Today.

For both parents and children, experiencing direct discrimination, either online or in-person, was significantly associated with poorer psychological well-being and more anxiety symptoms. Parents who experienced discrimination also reported more depressive symptoms, while youth who experienced discrimination reported more internalizing problems, the authors noted.

Moreover, parents experiencing in-person or online racial discrimination was correlated with significantly more anxiety symptoms and internalizing problems among children.

Cheah noted that Asian Americans have one of the lowest rates of mental-health seeking and that providers should be mindful of these potential experiences, as well as prepared to provide appropriate resources and referrals.

Asian Americans have increasingly reported racial slurs during the pandemic, with about 2,600 hate incidents recorded in the Stop AAPI Hate reporting forum at the time of the study's writing, Cheah reported. Early in the pandemic, President Trump insisted on calling the coronavirus the "China virus" and has continued to blame China for the pandemic's toll in the U.S.

The World Health Organization has urged against mislabeling the virus in this way, saying it perpetuated negative stereotypes and drove people away from getting help or seeking treatment.

In a solicited commentary, Tina L. Cheng, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, and her daughter, Alison M. Conca-Cheng, a third-year medical student at Warren Alpert Medical School of Brown University in Providence, write that they too, have experienced bias and "sinophobia" in and out of healthcare settings since the pandemic began.

Racism is a "twin pandemic" co-occurring with COVID-19, but it is not new, Cheng and Conca-Cheng wrote. Anti-Asian racism in the U.S. traces back to the Chinese Exclusion Act of the 19th century, and has continued through the Japanese-American internment camps during World War II and the media's racialization of the 2003 SARS outbreak.

"A critical first step is to learn about the history of racism and how it might affect our patients and families, both individually and structurally," Cheng and Conca-Cheng wrote. "Parents and schools must teach children about bias and racism; crucially, this requires acknowledging our country's fraught history of exploiting racial and ethnic minorities."

Cheng and Conca-Cheng recommended healthcare providers address their own implicit biases. The American Academy of Pediatrics (AAP) also has a policy statement related to the impact of racism on child and adolescent health that outlines how providers can optimize patient care for families experiencing racism.

For this survey, ethnically Chinese parents with at least one child were recruited from phone calls and online flyers from March 14 to May 31. The survey was available in English and Chinese, and participants received gift cards for completing it.

Most parents to respond were mothers (77.9%), born outside the U.S. (95.9%), with at least a college degree (80.7%), who were employed as administrators, professionals, or large business owners (53%). About two-thirds of respondents resided in the Southern U.S. (67.8%).

Some 76% of parents and children reported witnessing vicarious racial discrimination at least once online, and closer to 90% reported experiencing vicarious racial discrimination in-person at least once. One-quarter of parents and children said they experienced both in-person and online vicarious racial discrimination almost every day.

Health-related sinophobia, or the stereotype that Chinese people are considered a threat to public health, was perceived to be present in the U.S. by 71.1% of children in the survey and 49.1% of parents, the authors reported. About half of parents and children said this was perpetuated by the media.

The study is not nationally representative and responses were self-reported, which are limitations, the authors noted.

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