more likely to present with somatic symptoms,
which are more socially acceptable.
4
Mental health
concerns are particularly salient for Southeast Asian
immigrants who left their home countries following
the war in Vietnam. These now-elderly patients ap-
pear to be at higher risk for psychological problems,
including depression and post-traumatic stress dis-
order, due to their experiences and because they of-
ten lack the coping strategies of younger patients.
5
A number of Asian folk illnesses are related to this
tendency to experience mental illness or stress as
bodily symptoms. For example, Hwabyung is a Korean
culture-bound illness that occurs in individuals who
have suppressed anger or have endured a tragic situa-
tion. It occurs more commonly in women, and symp-
toms include a perceived stomach mass, palpitations,
heat sensation, insomnia, and flushing.
7
The complaint
of a stomach mass can lead clinicians to order GI test-
ing before suspecting a psychiatric condition.
2
Perceptions of Asians as
a "model minority."
Another potential obstacle
to appropriate health care
for Asians is the perception
that Asians are the "model
minority" and are generally
healthy and prosperous.
6
However, 12.5% of Asians in
the United States live below
the poverty line.
2
Poorer
Asian immigrants are vulner-
able to the same health sta-
tus impacts associated with
low-wage jobs, long working
hours, and lack of health
benefits as other ethnic minorities. In terms of health
Certification Q&A;
Continued on page 5