Transcultural psychiatry and ethnic minority mental health research have made significant gains toward our understanding of mental health problems among Asian-Americans (e.g., Kurasaki et al., 2002). However, relatively little is known about the manifestation of social anxiety and social phobia among Asian-Americans. This article summarizes the available empirical literature on social anxiety and social phobia in this population group and highlights clinical implications.
Symptoms Versus Diagnosis
Cumulative evidence suggests that compared to their white American counterparts, Asian-Americans report higher distress on various measures of social anxiety and social phobia (Norasakkunkit and Kalick, 2002; Okazaki, 2002, 2000, 1997; Okazaki et al., 2002; Sue et al., 1990, 1983). Only one study to date has failed to find this pattern: Leung et al. (1994) found no differences between Chinese-American and non-Chinese-American community residents on measures of social anxiety, social phobia, shyness and public self-consciousness. It should be noted that Chinese-American community residents in this sample were screened for the absence of psychopathology and counseling experience. Moreover, unlike the other studies cited, the subjects were non-college students; studies with Asian-American student populations indicate higher reports of social anxiety.
These findings of elevated social anxiety reports among Asian-Americans mirror the cross-cultural differences between East Asians and North Americans on a variety of self-report measures of personality, well-being, self-esteem and psychopathology. However, the interpretation that Asian-Americans are more socially anxious than white Americans, based on symptom report measures, runs counter to the available evidence regarding the low prevalence of social phobia in Asian-American and East Asian populations.
A review of psychiatric epidemiologic studies of social phobia suggested that the lifetime prevalence of social phobia in Western countries is between 7% and 13% (Furmark, 2002). However, the estimates in this study varied widely depending on the diagnostic criteria, assessment methods and population. Estimates of social phobia in East Asia are much lower than those in the West, with estimated lifetime prevalence in Korea of 0.5% (Lee et al., 1990) and in Taiwan of 0.6% (Hwu et al., 1989).
Another cross-national epidemiologic study also indicated that the lifetime prevalence of social phobia was much lower in Korea than in the United States (Weissman et al., 1996). There has only been one psychiatric epidemiologic study of Asian-Americans published to date (Takeuchi et al., 1998). Using data from approximately 1,700 Chinese-Americans in Los Angeles County, the Chinese American Psychiatric Epidemiologic Study (CAPES) estimated the lifetime prevalence of social phobia in this population to be 1.2% (Chang, 2002).
Analyses of psychiatric epidemiological data have shown that in the United States, people with social phobia seldom seek professional treatment unless they also suffer from some other comorbid disorder (Kessler et al., 1999). No data exist on treatment-seeking among Asian-Americans with social anxiety disorder. However, an analysis of the CAPES data indicated that only 3.6% of 1,503 Chinese-American community residents reported seeking treatment for emotional problems in the previous 12 months, a rate lower than the 5% to 7% range for help-seeking in the general population (Abe-Kim et al., 2002). Other studies have also shown that Asian-Americans tend to underutilize both inpatient and outpatient mental health care services (Snowden and Cheung, 1990; Ying and Hu, 1994). It is likely, then, that few Asian-Americans seek treatment specifically for social phobia, although they may be suffering from social anxiety symptoms.
