Low mental health treatment participation and Confucianist familial norms among East Asian immigrants: a critical review

This article applies the stress process model to navigate and evaluate the familial norms embodied in the East Asian culture, grounded on Confucianist principles, in terms of its impact on East Asian immigrants’ mental health and low rates of participation in mental health services. Explicating the cultural principles at work in East Asian familial norms, the interplay between demands for preserving the “face” of the family and the stigmatization of mental health complicates acculturation by imposing restrictions on social behaviours conducive to networking. The institution of family, which operates as coping resource through social support, also intriguingly acts as the locus of these Confucianist principles and norms, becoming a site where mastery is challenged by notions of maturity that mandate emotional suppression. Depression, social anxiety, and externalizing problems arise in the absence or failure of these coping resources, which percolate into issues of abuse. Implicated is the need for health care reform to encourage treatment among East Asian immigrants by navigating unhealthy behaviors and familial expectations anchored in culture. To this end, this review articulates a more efficient, adaptive, complex system (global patterns) through self-organization inspired by complexity theory and achieved by introducing reflexivity in health education (local interactions).