To the Editor:
We have read with interest the article by Molloy et al. (2020), “Culture, the Stigma of Mental Illness, and Young People,” which was published in the November 2020 issue of the Journal of Psychosocial Nursing and Mental Health Services. It is integral to discuss the role that culture plays in mental health and how stigma can prevent access to much needed therapeutic intervention. We appreciate the discussion of this issue in the context of younger adults; however, this trend is also prevalent in the older adult population. This trend is worth investigating especially because older adults are at least 40% less likely to receive or seek treatment for mental health problems than their younger counterparts (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019). In addition, suicide attempts, a sign of poor mental health, are “more likely to result in death in older adults than among younger people” (SAMHSA, 2019, p. 3).
Currently, the number of older adults is increasing worldwide, and these individuals are living longer. In 2030, 20% of U.S. residents will be older than 65 years, and it is estimated that 4.8% of these individuals will have a serious mental illness (SAMHSA, 2019). In addition, the older adult population is becoming more diverse, as older racial and ethnic minority populations, including Asian, Hispanic, African American, and American Indian and Native Alaskan, are estimated to increase by 89% (SAMHSA, 2019). It is imperative, for youth and older adults, to have culturally competent health care professionals to provide much needed mental health services.
Stigma is “commonly reported as a barrier to young people seeking help and accessing mental health–related services” (Molloy et al., 2020, p. 16). The same theme reigns true for older adults. Numerous older adults in the community are nervous about public stigma related to mental health (Sirey et al., 2014). However, stigma is different across cultures. In particular, African American older adults are less likely to engage in treatment for mental health as a result of stigma compared to Caucasian older adults, which may be due to discriminatory practices in medicine that have persisted for a multitude of years (Sirey et al., 2014).
Moreover, understanding an individual's cultural background is essential to understanding their mental health. For example, family support is “more important in preventing depression and loneliness for Chinese older adults than for American older adults in general because filial piety, the core of Chinese family culture, emphasizes the importance of family support for elders, particularly from children” (Liu et al., 2017, p. S114). Therefore, understanding the idea of filial piety will help health care professionals gain a better understanding of one's depression.
We concur with Molloy et al. (2020) in that it is unlikely for health care professionals to be aware of every cultural nuance that may be related to mental illness. However, we must understand that this theme spans generations, and research must be expanded for a more intergenerational approach to the issue.