Why Mental Health research is important for Asians

Hey guys,

My name is David Yang and I am a second year at Louisiana State University Health Sciences Center in New Orleans. I am also your APAMSA Mental Health co-Chair! I am running an anonymous survey focused on studying the prevalence of Asian American medical students. Since we released this survey a couple weeks ago, I have gotten a lot of questions on why I am doing this. We are closing the survey Wednesday, March 8, 2016! In the hopes that you’ll understand my inspiration for running this survey, I’ve laid out my reasons below.

I first became interested in mental health during college after a friend of mine talked to me about her experience with our school’s mental health services and the pressures she got from her relatives to succeed academically. I started reading about depression and suicide rates amongst college students. In the years since, I became more involved in understanding how the unique experiences of Asians living in America have contributed to our mental health – from how academic stress contributes to depression in Asian American students to the effect of our parents’ immigration history on our mental health to the stigma that kept our communities from talking about mental health and/or neuropsychiatric conditions.

When I entered medical school, I expected to find other Asian Americans who were interested in mental health. While I have connected with so many people who feel as strongly as I do about this issue, I found the research to be lacking. There is such a large focus on the mental well-being of medical students. Why did I only find three papers that reported on depression of Asian American medical students? Since Asian Americans constitute a significant portion of the medical student population, are there programs that medical schools can implement to provide culturally competent mental health care to us?

These two big questions led me to this survey. How can we talk about our mental health without trying to understand the problem? The results of this survey will continue the conversation that was started at last year’s National APAMSA Conference on mental health in the Asian American community. It will give all of us research to better transform our schools and our future practice. And I hope it will inspire you to answer your own questions about mental health in our community!

Please click here to access the survey.

Thanks again for filling out this survey!

APAMSA Feature: “What is APAMSA?” Video

Thank you to our Social Media Director, Linh Vu, for recording and putting together this video!

The aim for this video was to answer the question "What is APAMSA and what does it do?" It goes into the history and establishment of APAMSA and continues to the current day to touch on the wide reach of the organization. 

Interviews were captured at the 2016 National Conference in Chicago, Il. Images were taken from APAMSA events across the country from the past few years. 

This video may be shared and screened at APAMSA affiliated events. 

This media, in its entirety or partiality, may not be used for profit. 

APAMSA Feature: Live In the Moment: A Mindful Countering of Burnout

By Kathleen Tzan

The topic of burnout is huge in today’s medical community. Multiple articles and studies have been published demonstrating that burnout is prevalent in all levels of medical training from the day-one medical student to the most senior practicing attending.

For the student, the reasons for burnout are numerous. From a testing standpoint, exams seem endless. Step 1, Step 2, and beyond tower as immense hurdles one after another. Countless hours, days, and months are spent studying such a wide array of topics that “drinking from the fire hydrant” feels like drowning.

Later in the medical curriculum, the stresses of being constantly watched and evaluated, of being ‘pimped’ on obscure factoids and trivialities (made even worse when the attending does not follow-up with teaching), and of being pressured to show up to unpaid work day every day feigning cool confidence whilst internally panicking about poorly formed assessments and plans only add to the overwhelming feeling of losing oneself to a system that demands every ounce of one’s being. The pressure to perform perfectly indoctrinates students to minimize one’s own needs and even evokes guilt for taking time for oneself—because anything less than cutthroat dedication might be construed by evaluators as ‘not enough.’ Out of this toxic brew of insecurity, remorse and resent, burnout is born.

In these low moments, misery loves company. Discontented conversations on the topic of burnout with fellow students often end with the pacifying mantra of Hang in there. These frustrations are just temporary. When we’re attendings, life will be better. Nights out with sympathetic friends, fatigued and occasional intoxicated, are just enough to ease the depression of burnout with the thought that tomorrow will be a better day. Implicit in these statements is the spark of hope in a better future, a light at the end of the tunnel.

But while nights like these serve their quick purpose as a cooling balm to the ‘burn’, and hope remains a powerful weapon against negativity, recall—attending physicians also suffer from burnout. The struggles of insurance and reimbursement, of patient quotas to meet and patient dissatisfaction to address continue. As significant relationships and perhaps the thoughts of starting a family enter the scene, work-life balance only becomes harder to achieve. Looping back to the idea of ‘not enough,’ even in the attending world, there will always be another achievement to chase, another rung to climb on the way up the academic ladder. Even life as an attending has its struggles, and it would be naïve and ultimately self-destructive to believe that the future will be easy and that in the glorious light of attendinghood, we will suddenly be fulfilled.

This reality check is not meant to discourage one from hoping for better tomorrows; rather, it should serve as a gentle reminder to not place empty hope in a false endpoint. In striving to prevent a mental bubble of unrealistic expectations from bursting down the line, recognize early that in this highly revered and highly regulated field of medicine, expectations of perfection will continue to prevail; stress in some form or another will always be present.

So stop chasing this fantasy of future happiness. Stop seeking a perfect ending to the long path of medical training; there is no end to the work of medicine. There will always be a million external pressurizing forces in medicine that push you to do more, to be better. If you chase an ideal goal, you will never be happy. Of course continue to hold yourself to high standards of aptitude and professionalism, but know that there is no such thing as perfection. Realize that in this atmosphere of god-like expectations, we are only human. Be kind to yourself, allow yourself to live life now, or you may find your once-pure altruism and motives for entering medicine soured with resent.

After a hard day’s studies, instead of dwelling on all the work left to do, choose to enjoy a night out on the town. After a long shift at the hospital, allow yourself the time to relax. Refuse to allow others to dictate your needs and your priorities, refuse to lose yourself to the endless work of medicine, and refuse to be part of the perpetuating force that makes future generations feel that they are ‘not doing enough.’

At the end of the day, stop and smell the roses. Reflect on the supportive people and moments in life that have touched you, and reach back to those roots—reconnect with your loved ones, seek those moments again. Be mindful what you need to be happy and take a stand for your right to leisurely pursuits, your right to be carefree. You need not wait for the light at the end of the tunnel. Live in the moment so that ten years from now, you can look back fondly with no regret of a life spent discontentedly looking for something more.

APAMSA Feature: Widening the Discussion on Mental Health

Widening the Discussion on Mental Health
Kathleen Tzan
Kxt034@jefferson.edu

I was up late in the midst of an intense Infectious Disease cram session when my phone buzzed alive. Glancing down at the light of my iPhone, I noted the caller’s name with surprise—it was a friend across the country with whom I had not spoken for months. I wondered why he was calling now; maybe it was a butt dial?

“Hello?” I asked questioningly. The voice that responded was calm and polite as usual, but also embarrassed—“Hey sorry to bother you… I’m at the hospital, but don’t worry, I’m okay. Can I just talk to you for a second?”

My heart sank with the comprehension that I would probably be pulling an all-nighter, but despite the cavalier tone and apologetic chuckles coming through the phone, there was a nervous uneasiness to my friend’s voice that caught my attention; this was not a phone call I could turn down. “Yea sure, of course. What’s up?”


The Jay I knew in high school had always been a wallflower—someone who ambled through high school with decent grades and a few leadership positions, never all that ambitious, but not for lack of intelligence—it was just his personality to be mild-mannered. In our gigantic class of 800+ competitive students, Jay blended right in, somewhere in the top 10 percent, but nothing outstanding. We were close friends but drifted in opposite directions after graduation. I moved out of state, graduated college early and stayed out of state for medical school; Jay attended community college for two years before transferring to a larger state university.

As a transfer student, Jay struggled to fit in. Academics were tough, but it was his social life that really took a hit. Many students had bonded as freshmen in the dorms and had already discovered their own niches in clubs and extracurricular activities. Cliques had formed. People were polite enough, but he was the new kid on the block, on the outside looking in.

Seeking camaraderie and exercise, Jay joined the judo club. The first few club sessions went well; the basic framework for new friendships and judo were laid down. Unfortunately at the third session, the club members were teamed up to practice throws, and Jay was thrown forcefully over his partner’s back, landing awkwardly with his foot smacking the floor off the mat. Subsequent X-rays showed a lateral malleolus fracture, and Jay had to take a break from judo. Budding friendships shriveled up, and he found himself lying in bed with a cast on his left ankle, unable now to even to climb the expansive hilly campus to his classes. Assignments and tests passed quickly, and Jay’s grades plummeted. At the end of the quarter, Jay was put on academic probation, which threatened not only his status as a provisional transfer student, but also his financial aid.

Pills, a bridge, a gun? No, he wasn’t going to shoot himself, but in desperation Jay found himself spewing suicidal thoughts in his student counselor’s office, where he was subsequently given the choice to either commit himself to the hospital’s psych ward voluntarily or in restraints; either way, a police escort was involved. Jay described the ride through campus in the police car as surreal. He made small talk with the police officers who apologized for the hassle, Sorry, kid, for the embarrassment. You aren’t allowed to walk to the hospital yourself, strict protocol. Hours of waiting, paperwork and orientation later, Jay was finally left to himself in the quiet of his own patient room. A couple of days later, he called me.

Jay was discharged on SSRIs with orders to see a therapist weekly. He returned to school briefly, but the stress of classes, therapy, his still-broken foot and academic/financial aid probation was too much, and Jay decided to drop out of school for a while. He and I stayed in touch through phone calls and met up whenever I was home on break from school. He always seemed so calm and unaltered on the surface, but deeper probing would reveal still gaping holes in confidence and happiness.

In a sense, what happened to Jay could have happened to anyone. There was nothing to be ashamed of. Yet I saw how easy it was for friends and family to avoid talking about the taboo subject, act as if nothing happened and move on with their own lives. Even those friends like myself who wanted to be supportive were busy with our own stressful lives, and it was easy to go months without talking about the issue, which made me wonder.


Why is mental health faced with such silence? Why is it that students like Jay are not warned or made adequately aware of the immense toll that academic studies and social pressures can take on the mind, to the point that the first indication of anything out of the ordinary is emergent hospitalization, or even worse—suicide? According to the National Institute of Mental Health, in 2014 about 6.7 percent of U.S. adults experienced at least one major depressive episode in past year. So why is it that even in cases of completed suicide today the overwhelming reaction is still disbelief, as if mental illness is rare?

A fellow student writer recently wrote that she wondered if depression were “just part of life as a medical student.” One of her professors had given a lecture on depression asking students to “think of how many people we knew with the signs of depression listed on his lecture slide”—excluding medical students of course, “because you’ve all got some of these.” There is something so terrible and inherently wrong with that statement.

This student writer argued that “if medical students are just expected to show signs of depression at some point during their education, there’s something wrong with the system.” And while I echo that statement wholeheartedly, I would additionally argue that medical student or not, no one should ever be expected to show signs of depression for the sake of self-development or career training. No one deserves to fall through the cracks. And when someone like Jay falls victim to mental illness, the situation deserves attention, not a taboo label. We all suffer varying degrees of mental stress from our paths in life, and it is time that we start to talk about it.

At my medical school, there has been a huge push from the Student Health and Wellness Department to break the stigma of mental health. All students are allowed three free consultations with a psychologist, and efforts are made to promote mindfulness meditation, a balanced lifestyle and other methods for stress relief. Even so, and even among medical students who should arguably be some of the most aware people on mental health issues, the pressures of academia trump balanced lifestyles, and the stigma of mental illness remains very real. Medical students remain afraid to use certain services for fear of negative repercussions. Who knows what could be written or seen by someone through the EMR? What if a residency director somehow found out about a mental health diagnosis? True or not, horror stories are passed around of admissions committees flat out refusing to review residency applicants’ files after finding out about certain medical conditions. The potential repercussions are too risky to seek mental help. And yet, if even we as future healthcare workers (with all the evidence-based medicine and education to back us up) cannot confront the stigma associated with mental illness and demand the help we need, how can we ever expect our patients to?
A fellow classmate suggested that all students be mandated to attend at least one session with a psychiatrist simply to demystify the experience, as well as destigmatize the process for students who want to see a psychiatrist but fear judgment. In my opinion, this may not be a bad idea. I understand that not everyone wants or needs to talk about their struggles, but in an education system where we spend so many hours studying and agonizing over grades, a one-hour break to check in with a caring, nonjudgmental healthcare professional could do everyone some good.

Society is constantly reminded to eat healthily and exercise to take care of one’s body. In comparison, when was the last time you seriously talked to someone about improving your mental health? If social media and the movements on my campus are any indicator, the door to discussing mental health has been opened, but it is impossible to deny that further progress still needs to be made. We all need to be more self-aware of any unhealthiness we bear in our minds, to reexamine our thoughts and to be honest about our approaches to mental stress. Whether in a group setting or an internal dialogue, it is time to be courageous and widen the discussion—how are you truly doing today?