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Creating a shared definition of mental health in the Pilipinx community: a comparative focus group analysis
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Creating a shared definition of mental health in the Pilipinx community: a comparative focus group analysis
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Content
CREATING A SHARED DEFINITION OF MENTAL HEALTH IN THE PILIPINX COMMUNITY:
A COMPARATIVE FOCUS GROUP ANALYSIS
By
Dean Mason Coffey
A Thesis Presented to the
FACULTY OF THE KECK SCHOOL OF MEDICINE OF USC
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF SCIENCE
CLINICAL BIOMEDICAL AND TRANSLATIONAL INVESTIGATIONS PROGRAM
August 2020
Copyright 2020 Dean Mason Coffey
ii
Epigraph
I do not write for this generation. I am writing for other ages. If this could read me, they would
burn my books, the work of my whole life. On the other hand, the generation which interprets
these writings will be an educated generation; they will understand me and say: 'Not all were
asleep in the nighttime of our grandparents.'
--José Rizal, Noli Me Tángere
iii
Dedication
I wish to dedicate this thesis to my husband, Steven A. Moss,
who inspires me with his love of books, his creative teaching and his unwavering love and support.
iv
Acknowledgements
Support for this thesis was provided in part by the Robert Wood Johnson Foundation. The views
expressed here do not necessarily reflect the views of the Foundation. I wish to thank the members of
the Robert Wood Johnson Foundation Clinical Scholars Team Kapwa for their contributions to this work
by conducting focus groups in the Filipino community of Los Angeles County and for their review of
earlier drafts: Joyce R. Javier; Jed David; Aviril Sepulveda; and Horacio Lopez. I also wish to thank
Research Assistants Angela Reyes, Kamil Bantol and Jocelyn Castro for their support in the transcription
of the focus group recordings, coding and data analysis; and Community Partner Ana Jayme, LMFT who
helped moderate the focus groups. I am thankful as well for our organizational community partners
Filipino American Service Group, Inc.; Search to Involve Pilipino Americans; and Holy Family Catholic
Church for hosting our focus groups. Special thanks to my mentors: Thesis Committee Chair Cecilia
Patino-Sutton and members, Wendy Mack and Joyce R. Javier for their support and valuable
contributions to this work.
v
TABLE OF CONTENTS
Epigraph…………………………………………………………………………………………………………………………………………………..ii
Dedication..…………………………………………………………………………………………………………………………………………….iii
Acknowledgements………………………………………………………………………………………………………………………………..iv
List of Tables…………………………………………………………………………………………………………………………………………..vi
List of Figures…………………………………………………………………………………………………………………………………………vii
Abstract…………………………………………………………………………………………………………………………………………………viii
Introduction…………………………………………………………………………………………………………….………………………………1
Colonial Mentality…………………………………………………………………………………………………………..2
Stigmatization and Shame………………………………………………………………………………………………3
Purpose of the Present Study…….…….…………………………………………………………………………….3
Chapter 1: Method…………………………………………………………………………………………………………………………………4
Setting and Participants……………………………………………………………………………………………….…4
Focus Group Facilitators…………………………………………………………………………………………………6
Instruments……………………………………………………………………………………………………………………6
Study Design/Procedures……………………………………………………………………………………………….9
Analysis…………………………………………………………………………………………………………………………10
Chapter 2: Results………………………………………………………………………………………………………………………….……..12
Supportive Family…………………………………………………………………………………………………………12
Compassionate Community………………………………………………………………………………………….14
Mutual Acceptance and Understanding of Other Generations……………………………………..15
Valued Social Position that Allows the Individual to Achieve Their Full Potential.…………16
Definitions of Mental Health for Children and Youth Rating Form………………………………..18
Word Cloud Summaries…….………………………………………………………………………………………….20
Chapter 3: Discussion……………………………………………………………………………………………………………………………22
Shared Definition of Mental Health……………………………………………………………………………..22
Addressing Colonial Mentality, Stigmatization and Shame…………………………………………..27
Implications…………………………………………………………………………………………………………………28
References…………………………………………………………………………………………………………………………………………….30
vi
List of Tables
Table 1. Participant Demographics (N = 37)…………………………………………………………………………………………..…5
Table 2. Rankings of Widely Accepted Definitions of Child and Adolescent Mental Health Surveys
(N = 33)………………………………………………………………………………………………………………………………………………19
vii
List of Figures
Figure 1. Four Major Themes Integral to the Shared Definition of Mental Health………………………………….12
Figure 2. Pre-Focus Group Impressions of Mental Health in the Filipino Community…………………………….20
Figure 3. Post-Focus Group Impressions of Child and Adolescent Mental Health…………………………………..21
viii
Abstract
In 2018, suicide became the leading cause of death for 10 to 14-year-old and 15 to 24-year-old
Asian/Pacific Islanders and the second leading cause of death for 25 to 34-year-old Asian/Pacific
Islanders. Our research team conducted five focus groups (N = 37) in Los Angeles County to develop a
shared definition of mental health. The Pilipinx group is psychologically different from population groups
in the rest of Asia due to their history of oppression through western colonization. Definitions of mental
health are culturally determined beliefs that will impact a person’s willingness to engage in help seeking
behaviors. We used narrative and content analyses of our focus groups for explicit theory construction
as summarized by Charmaz (1995) to develop a shared definition of mental health. Four major integral
themes emerged from the focus groups: 1) supportive family; 2) compassionate community; 3) mutual
acceptance and understanding of other generations; and 4) having a valued social position to achieve
one’s potential. A highly relational definition, that was both developmental and generational, was
developed: Pilipinx mental health is having a valued social position within a supportive family and
compassionate community that includes mutual acceptance and understanding of other generations and
allows the individual to achieve their full potential. We concluded that this shared definition of mental
health is consistent with Filipino core values, such as kapwa, which is defined as “the core Filipino
psychological construct in which all individuals feel a sense of togetherness or connectedness to each
other” (Nadal, 2011).
Keywords: Filipino, Pilipinx, mental health, colonial mentality, kapwa
1
Creating a Shared Definition of Mental Health in the Pilipinx Community:
A Comparative Focus Group Analysis
Filipinos and Filipino Americans in the United States have disproportionately higher rates of
mental health disparities and treatment gaps that result in greater disease burden in comparison to
other ethnic groups (Javier et al., 2007; 2010). Of these disparities, the high suicide rate among Pilipinx
1
adolescents and young adults is likely the most serious. Suicide became the leading cause of death for
10 to 14-year-old and 15 to 24-year-old Asian/Pacific Islanders in 2018; and the second leading cause of
death for 25 to 34-year-old Asian/Pacific Islanders (Centers for Disease Control and Prevention [CDC],
2018). This is the only racial/ethnic group for which suicide is the leading cause of death at these early
ages. Despite the burden of this mental health disparity, Pilipinx families have low rates of mental health
care and preventive care in the United States (Javier et al., 2010; Sanchez & Gaw, 2007; Stella et al.,
2004; Yu et al., 2010).
The Pilipinx population is the second largest Asian subgroup in the United States and the largest
detailed Asian subgroup (self-identified on 2010 census) in the states of Alaska, Arizona, California,
Hawaii, Idaho, Montana, Nevada, New Mexico, South Dakota, Washington, and Wyoming (Hoeffel et al.,
2012). Nevertheless, the Pilipinx group continues to be aggregated with other Asian groups in research
(dela Cruz, et al, 2002; Javier et al., 2007); a social and political convenience (DHHS, 2001) that does not
permit researchers to draw clear conclusions from aggregated data. Over time, this large population has
been described as “forgotten Asian Americans” (Cordova, 1983, p. xiii) and “invisible minorities”
(Cimmarusti, 1996, p. 206), due to this aggregation with other Asian groups. In a re-examination and
__________________
1
The term, Pilipinx, is used as a gender-neutral adjective that is inclusive of all persons of
Philippine origin. The capital P is intended to honor the indigenous language used in the Philippines prior
to the Spanish colonial period, which had no symbol or sound for the letter /f/.
2
definition of census terms, Filipinos and Filipino Americans were excluded from the census term, Native
Hawaiian and Other Pacific Islanders, which was defined by the U.S. Office of Management and Budget
as “a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific
Islands” (1997). The Pilipinx group with origins in the Philippine Islands was defined as Asian with an
additional option for individual Pilipinx census completers to self-identify as Filipino in the 2010 U.S.
Census.
Colonial Mentality
The Pilipinx group is psychologically different from population groups in the rest of Asia due to
their history of oppression through colonization by Spain for 350 years followed by almost 50 years of
colonization by the United States. Psychology as a science of mentalities has neglected the concept of
colonial mentality (CM) or internalized oppression of colonized peoples (David, 2013). This mentality
may impact the self-concept of generations of Filipino descendants and the quality of their mental
health. The process of oppression in the Philippines involved the depletion of natural resources, the
suppression of the indigenous culture of the native peoples, and the introduction of a false narrative
that the culture of the conquering colonizers was superior to that of the indigenous culture. This
oppression resulted in what became an internalized sense of inferiority (Prilleltensky & Gonick, 1996) or
CM for a large percentage of the Pilipinx population after centuries of subjugation and exposure to this
false narrative by the dominant group (for a review see David, 2013). In an early trial of the Colonial
Mentality Implicit Associations Test, David estimated that about 56% of the sample tested had
responses consistent with covert CM, implying that the 4 to 5 out of 10 Filipinos do not have covert CM
(2010). This psychological colonialism may continue to exist in part through intergenerational
socialization (David & Okazaki, 2006b; Espiritu, 2003). Suicidal behavior is theorized to become the
ultimate step on the path of intrapersonal oppression (Prilleltensky & Gonick, 1996).
3
Stigmatization and Shame
In contrast to these belief systems, stigmatization associated with mental disorders is pervasive,
transcending race, social class, and appears to be a primary deterrent to getting help. Stigma was
identified as the most challenging barrier to future progress in the arena of mental illness and health
(U.S. Department of Health and Human Services [DHHS], 2001); and “may be as harmful [to a person’s
life] as the direct effects of the disease” (Corrigan & Penn, 1999, p. 765), causing an estimated two-
thirds of persons with mental illness to not seek treatment (Kessler et al., 1996). For Asian
Americans/Pacific Islanders (AA/PIs) in particular, stigma, shame and lack of service providers who speak
Asian languages were identified as major deterrents to mental health service utilization in the U.S.
Surgeon General’s report Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health:
A Report of the Surgeon General (DHHS, 2001).
Purpose of the Present Study
The definition of mental health for those generations with internalized oppression, including
Filipinos who have immigrated to the United States, should consider this internalized oppression or
sense of inferiority. In 2017, in collaboration with the Pilipinx community in Los Angeles County, our
research team sought to address the serious problem of teen suicide among Pilipinx youth through
creating a culture of mental health in the community as part of the Robert Wood Johnson Foundation
Clinical Scholars Program (RWJF-CS). We conducted focus groups with Pilipinx participants from diverse
backgrounds and age groups with the primary aim of creating a shared definition of mental health that
incorporates a comprehensive understanding of the community’s thoughts of what mental health is for
Pilipinx persons living in the United States.
4
Chapter 1:
Method
Setting and Participants
The target population included Filipino parents, grandparents, and stakeholders living or
working in Los Angeles County. Prospective study participants for focus groups were identified through
various techniques including 1) announcements at regularly scheduled Filipino organization events with
parents and providers; 2) emails to electronic mailing lists (i.e. listservs for the Asian American
Psychology Association, listservs of partnering organizations, and participants of prior research studies);
and 3) snowball sampling techniques.
A total of 37 participants were recruited. All participants were of Filipino descent. Youth under
age 18 years were excluded. The groups were conducted in English since it is one of the primary
languages of the Republic of the Philippines, and in previous focus groups conducted by the principal
investigator (PI), the group participants preferred communication in English. However, multilingual
group facilitators offered interpretation and would interpret their own statements and those made by
participants if needed. The sample was predominantly female (62%), well-educated with 84% having
college degrees, and ranged in age from 18 to 79 years. Seventy-three percent of the sample was born
in the Philippines. Young adults, ages 18-24 years (n = 2) made up 5.4% of the sample (Table 1).
Participants were familiar with the reason for doing the research “to create a shared definition of
mental health in the Filipino community” and received credit card stipends of $20. USD for participating
in the focus groups.
Five focus groups were conducted between March 27 and April 8, 2017 at three different
community-based organization sites in Los Angeles County. The largest group had 12 participants and
5
contained all the participants in the 65 to 79 years age range (n = 5) with all but one participant born in
the Philippines. Most participants in another group were mental health professionals. The groups were
Table 1
Participant Demographics (N = 37)
Characteristic n %
Gender
Male 14 37.8
Female 23 62.2
Age
18-24 2 5.4
25-39 16 43.2
40-64 14 37.8
65-79 5 13.5
Place of birth
United States 10 27
Philippines 27 73
Highest educational level
Less than high school 1 2.7
Some college 5 13.5
College graduate 31 83.8
Los Angeles County, CA
Residence 35 94.6
Employment 31 83.8
Consideration of mental health as a problem
a
Not a problem at all 1 2.9
Only a minor problem 6 17.1
Somewhat a problem 14 40.0
A major problem 12 34.3
The number one problem 2 5.7
a
n = 35, Range 1-5, Mdn = 3
6
moderated by two or three facilitators in each group. The number of participants in each focus group
ranged from 6 to 12.
Focus Group Facilitators
Group facilitators were members of the RWJF-CS research team led by PI Joyce Javier, MD, MPH,
MS. Dr. Javier and her team have over 10 years of conducting community-based participator research
(Flores et al., 2012; Javier, 2018; Javier, Coffey Palinkas et al., 2019; Javier, Coffey, Schrager et al., 2016;
Javier, Galura, Aliganga et al., 2018; Javier, Reyes, Coffey et al., 2019; & Javier, Supan, Lansang et al.,
2014) and developing community-academic partnerships in this large urban community . She trained
team members in qualitative focus group methods. Dr. Javier is a second generation, American born
Filipina pediatrician researcher who is an English speaker. Other members of the team included Dean
Coffey, PsyD, a white American clinical psychologist and Incredible Years® Parent Program certified
Agency Mentor, who had conducted evidence-based parent training groups with Dr. Javier in the Pilipinx
community and is a bilingual English/Spanish speaker. Aviril Sepulveda, OTD is a first generation,
Philippines born occupational therapist, who is a trilingual English/Cebuano/Tagalog speaker. Jed David,
MSOT is a first generation, Philippines born occupational therapist who is a trilingual
English/Cebuano/Tagalog speaker; and Horacio Lopez, MD, is a first generation, Philippines born
community pediatrician who is a trilingual English/Cebuano/Tagalog speaker. Community partner Ana
Jayme, LMFT is a first generation, Philippines born psychotherapist, who is a bilingual English/Tagalog
speaker.
Instruments
Demographic Questionnaire
7
A demographic questionnaire was used to collect information about the participants that
included gender, age range, cities of residence and employment, country of birth, highest level of
education, and a Likert-type question that asked the participants to rate if mental health was a problem
among Filipinos by choosing one of the following responses: Not a problem at all (1); Only a minor
problem (2); Somewhat a problem (3); A major problem (4); The number one problem (5).
Definitions of Mental Health for Children and Youth Ranking Form
Definitions of mental health are culturally determined beliefs that will also impact a person’s
willingness to engage in help seeking behaviors, accept recommendations of health care providers and
take determined action to prevent or treat illness. Five widely accepted definitions of child and
adolescent mental health were used in this study to stimulate thinking and discussion to create a shared
definition of mental health.
The first definition of mental health was that of the World Health Organization (WHO) and is
intended to be aspirational to guide policy making, to promote screening, identification and intervention
for the estimated 20% of children believed to be affected by mental health disorders, and to reduce the
burden associated with mental disorders. The definition can be used to inform strategy selection,
targets for intervention and indicators to measure progress:
Children and adolescents with good mental health are able to achieve and maintain optimal
psychological and social functioning and well-being. They have a sense of identity and self-
worth, sound family and peer relationships, an ability to be productive and to learn, and a
capacity to tackle developmental challenges and use cultural resources to maximize growth.
Moreover, the good mental health of children and adolescents is crucial for their active social
and economic participation (2005, p. 18)
The second definition was developed by the Centers for Disease Control and Prevention (CDC;
Avenevoli et al., 2013) and focuses on normal development and functioning in various domains and is
8
used to set a clear contrast with “serious deviations from expected cognitive, social, and emotional
development” that make up the criteria for diagnosable mental disorders:
Mental health in childhood is characterized by the achievement of development and emotional
milestones, healthy social development, and effective coping skills, such that mentally healthy
children have a positive quality of life and can function well at home, in school, and in their
communities (p. 4)
Achievement of developmental milestones, competence and range of abilities is the focus of the
third definition. This definition forms the foundation for the Positive Youth Development movement
that is a strengths-based approach to prevention, while promoting resilience and leadership
development:
Mental health is not just the absence of a disease or mental health disorder, it is much more. As
youth grow and mature, they achieve mental and emotional milestones. This process can be
described as achieving developmental competence, or the ability to navigate social, emotional,
cognitive, and behavioral tasks at different developmental stages. A part of achieving
developmental competence is adhering to cultural and social norms and developing a positive
sense of identity, efficacy, and well-being (Eccles et al., 2009).
The fourth definition of mental health is from a proposed bill in the Philippine Senate in 2015
that was not adopted until 2017 and signed into law in 2018 (Lally, Samaniego & Tully, 2019). This bill
defines mental health as a state of well-being with ability to cope with normal stressors so that the
individual person can achieve their full potential and contribute to their community. The bill was
proposed for the purpose of incorporating and institutionalizing comprehensive mental health services
into the national health system:
“Mental Health” refers to a state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to his or her community (Senate of the Philippines, 2015).
Mental health as “peace of mind” was the final definition of mental health and is used as a motto of the
Philippine Mental Health Association (PMHA, 2019) with the goal of raising awareness of mental health
and preventing mental health disorders through educational, capacity building events.
9
The five definitions of mental health for children and youth were listed without attribution or
reference in a rating format with the instruction to read the five definitions; think about which definition
would resonate with Filipino parents; rank their definitions from 1 (favorite) to 5 (least favorite); and
then discuss the reasons for their rankings.
Study Design/Procedure
All procedures were approved by the Institutional Review Board of Children’s Hospital Los
Angeles. Participants completed written consent prior to participation in their groups. The 90-minute
focus groups were audio recorded for later transcription and coding. Prior to the start of each group, the
demographic questionnaire was completed by participants, and each participant received a pack of 3 in.
x 3 in. blank post-it notes and was asked to write their impressions of mental health in the Filipino
community and place them on a large easel pad in the meeting room prior to the start of the group.
At the beginning of the group, the group leaders introduced themselves and facilitated
introductions among the group members. A uniform set of open-ended questions was asked of each
focus group about individual perceptions of what mental health is and how child and adolescent mental
health might be different from adult mental health. These questions included: 1) When someone talks
about mental health, what words come to mind; both positive and negative? What kinds of things come
to mind for you when we say child and adolescent mental health? 2) What is your definition of mental
health? 3) In your opinion, what are the beliefs or opinions about youth who seek mental health services
in the Filipino community? 4) In your opinion, how can we decrease mental health stigma?
During the groups, the Definitions of Mental Health for Children and Youth Ranking Form was
presented, rated and rankings discussed. At the conclusion of the group, each participant was asked to
use post-it notes from the first exercise to write their impressions of child and adolescent mental health
10
and put them on another large easel pad in the meeting room. Participants were thanked and were
mailed their stipends at the end of the groups.
Analysis
We used a methodology rooted in grounded theory (Glaser & Strauss, 1967) referred to by
Willms et al. as “Coding Consensus, Co-occurrence, and Comparison” (1990). Two transcripts were
independently coded by three investigators (JJ, KB, and a research assistant) in order to condense the
data into analyzable units. Segments of transcripts ranging from a phrase to several paragraphs were
assigned codes based on a priori and emergent themes. Themes were generated independently from
the narrative summaries by KB, a research assistant, and the senior researcher (JJ) on the project. The
final list of codes, constructed through a consensus of the steering committee, consisted of a numbered
list of themes, issues, accounts of behaviors, and opinions that related to creating a shared definition of
mental health in the Filipino community. Two investigators (KB and a research assistant) independently
coded the remaining transcripts. Disagreements in assignment or description of codes were resolved
through discussion between investigators until consensus was reached.
In addition to coding, the first author read the transcript and did memo-writing as an
intermediate step between coding and finalizing results as recommended by Charmaz. This narrative
analysis used the following questions as a guide for “understanding the processes, actions and beliefs
expressed or taking place: 1) What is going on? 2) What are people doing? 3) What is the person saying
4) What do these actions and statements take for granted? 5) How do structure and context serve to
support, maintain, impede or change these actions and statements?” (1995, p. 38). Since a narrative
analysis is more subject to potential biases, the results of the narrative analysis were reviewed and
revised by the research team.
11
At the conclusion of the five focus groups, word clouds were generated to summarize the
frequency of words used to describe pre-group impressions of mental health in the Filipino community
and post-group impressions of child and adolescent mental health. Descriptive statistics were calculated
to summarize the demographic questionnaire and ranking form data.
12
Chapter 2
Results
Four major integral themes emerged from the responses offered by study participants to the
interview questions about their conceptions of mental health (Figure 1). Three of these themes were
explicit and arose from the analysis and coding of the transcripts as necessary for mental health: 1)
supportive family; 2) compassionate community; and 3) mutual acceptance and understanding of other
generations. A fourth implicit theme that resulted from the narrative analysis of all the groups was the
importance of having a valued social position to achieve one’s potential. Each of these major themes is
presented in the following section.
Figure 1
Four Major Themes Integral to the Shared Definition of Mental Health
Supportive Family
The importance of having a supportive family was a topic that provoked a range of viewpoints
that emerged with seeming contradictory perspectives based on the experiences of the participants who
offered comments. One participant described her childhood:
Valued
Social
Position
Achieving
Potential
Supportive
Family
Mutual
Acceptance and
Understanding of
Other
Generations
Compassionate
Community
13
For me [growing up] was like isolation and neglect through, I guess, minimizing dialogue and
behaviors where you weren’t really noticed; like they never asked, how you are feeling? There
were never those exchanges. It was mostly about academics and just that; not really focused on
what you want and how you’re feeling.
Another participant described his own family:
Let me tell you, the first-generation Filipinos who migrated here, one of the reasons we wanted
to be here is because of the opportunity that we can give you a better life than we started with
back home. Now their thing is about the material things, so that you do not fall into the same
situation as us growing up. Our thing for you is academics, because when you have education . .
. it will better your status in your life. And you will be one step ahead in the game. So what they
do is they force themselves, and they work maybe odd jobs, two jobs, perhaps three just to get
that education to you; and therefore, you might perceive that that is neglect. . . One of the
things that I saw in the video, one of the kids is saying, “I don’t even see my folks because
they’re working day and night.” But the kids now . . . are with their peers. It’s so heavy already;
so burdensome for them. And then they see their parents having a hard time coping and trying
to get more funds to be able to put their family through school.
One participant commented about how she had similar feelings about her working parents and was
raised “in a family of extended family”:
This idea of neglect, this idea of it is that, because we pretty much all were born here and so
were most of my cousins, and everyone’s parents worked full-time. At one point in time, I used
to think, I had full-time working parents, they didn’t watch me, they didn’t raise me, and there
was this certain animosity for that. But then I became a parent, and I sort of did the same thing
because you want to provide. But if I look back at my childhood, and we’re doing this now
because we are at the age where we have kids and families, what may have been construed as
neglect at one point, we look at now and think, we were so free to do whatever we wanted as
kids. There was a sort of independence that came with that because we sort of just monitored
each other’s behavior. But we were lucky because we were in a family of extended family that
we all got to grow up here, and there was a Filipino community around.
A single parent described her family and how she has to manage the multiple roles of being a single
parent:
I think we beat up ourselves because we have an image of who we’re supposed to be. I mean
I’m a single mom; I’m trying to do everything. It’s like herding cats. And then one day, you think,
you know what? Be the best that you can be and keep being better. And that’s the conversation I
have with my children, too. When we have these things when . . . . I didn’t deal with that in the
best way, and I ask, how do you think we could do better with this? And we talk about how we’re
going to try our best as a family to help each other. And me being a parent and them being who
they need to be; to do their thing and be responsible for their part. So that’s the way we work. I
14
mean we were in this parent-child [relationship], and we talked about the struggle of day to day.
It’s not easy because you have these expectations, especially being a woman; it’s like, you’re
superwoman. And you’re trying to work towards that, and you know you’re never going to get
it, and you just have to step back and say, you’re trying your best.
A father described his family growing up in the Philippines and what it’s like to be a family in the United
States:
I think neglect is like a whack a mole; they’re trying to cover some gaps . . . For example, again
just to summarize what I’ve been hearing is in the Philippines I, too, had an extended family
from my dad’s. Every Sunday was like going to grandma’s; it was like really tight within the
family, a suck it up son kind of thing, which was okay at the time. But they wanted the education
and the spirituality and then we moved [to the United States], and as you mentioned, you start
comparing. So I think today’s generation . . . . ‘cause I live with my in-laws ‘cause we can’t afford
living so we live in the bottom part of their big house. Thank God we’ve been blessed with that. I
have three girls and, this house is pretty big. And my kids would say, Daddy, our house is so
small. I’m like, girl… You don’t know what small is. But I think it’s the perspective that depends
on where you’re looking at in terms of neglect. So I would say right now for me as a dad, I feel
like I should be having my own place ‘cause I’m a dad and supposed to have my own family. I
feel like actually I’m not adequate enough to provide that.
Compassionate Community
Several participants alluded to a possible difference of approach to Filipino mental health that
might exist between group members born in the Philippines and those born in the United States. One
participant described it this way:
I think when we’re in the Philippines, there’s a strong system of friendship and family, and
there’s . . . . always someone to talk to, and there’s always someone ready to give you an ear.
It’s easy to talk to someone and talk your problems out, get advice, have someone as a sounding
board, even if it’s just to rant and rave. People are generally forgiving, and they allow you to do
that.
But you come here [U.S.], and people are indifferent. All of the sudden, people don’t like talking
about problems. The perception is that when you talk about your problems, you’re airing out
your dirty laundry, and when you’re airing out your dirty laundry, from a Filipino perspective, it’s
a shame. You’re coming from a point of shame because you don’t do that. That’s not part of the
culture.
One participant stated, “I work with college-aged students so for me when I think of mental
health, it’s hesitation, maybe anxiety and fear.” When asked to explain further, she said:
15
A lot of times, college students are wary about seeking that help so . . . . with some of my
students, I’d have to actually sit down with them and [say], “Are you cool? Let me make that
phone call for you, let me make that initial thing for you, let me walk you over to the Center. . . .
make sure you’re okay.” Now, I do like regular follow ups just to ensure are you okay? how’s
that going? are you making your visits? just to ensure they’re on top of it. (Facilitator: Taking
extra steps?) Yeah, kind of like handholding just because I think culturally, we were never
encouraged.
A high school teacher shared a similar story about making a daily connection with his students:
I’m a high school teacher . . . . [and] I had this high school teacher who everyone loved, but he
was very quiet . . . . I found out he actually shook hands with every kid, every time they came to
class . . . . So, I shook their hands every day; every day even ‘til now. I experimented with it by
myself just to see . . . and that’s when all the students that needed the help started. Just by
shaking their hand every day and saying, how are you doing? Simple right? I even get teared up
because they started coming up to me and they go, Hey, you know who I can talk to somebody
about this? And I’m even getting chills just talking about this. . . . Everything else flows once you
make that simple connection.
Another participant explained community in terms of culture:
We’re pakikisama, we adhere. That’s culture, that’s who we are. We look at what’s okay. We
assimilate really well within groups; what’s in our environment. We adjust and adapt based on
environment. We don’t want to stick out . . . Also, it’s like we’re open to talking about it. I think
that open communication within your families, within your friends, within your community, that
it’s okay because when I went through that parenting class, I didn’t feel like I was alone. That
was it. I didn’t feel like I was alone in what I was experiencing. In that methodology, we were
going through it together.
Mutual Acceptance and Understanding of other Generations
The need for mutual generational acceptance was sometimes expressed in description of one’s
own childhood history or those of other family members. One father described the older generation:
As you said they [older generation] went through their own ordeals and victories, like a high
school class. . . . maybe they themselves, during their time, they weren’t acknowledged. Just
keep it to yourself; successes keep to yourself; your pains keep it to yourself; don’t tell anybody.
So from the Filipino point of view, what I’ve acquired for myself, too, is that; don’t celebrate
your victories but be ashamed of your mistakes.
Another parent offered an alternative way for Filipino parents to respond to their children:
All of us parents, and now just budding parents, we work, right? As much as we can, but my
suggestion or my words of wisdom is always communicate. Always communicate even if you
only have one minute in a day, hug your child. Let them know that you love them and talk to
them. That’s it. I mean it’s always; they will not forget that until you’re gone.
16
A mental health provider commented:
I’m seeing a lot of Fil Am clients [age 18-21 years] who wanted to get treatment earlier, told
their parents about it, were not provided that because… for the many reasons, but also because
it will reflect negatively on them [the parents]. And then they come to college, and we tell the
parents this, and it’s still dismissed because they bought into this idea [accessing services
reflects badly on the parents] for so long.
Another parent suggested open discussion of generational differences:
I feel like in my generation, it’s harder to seek mental health. In my family, I think my parents
encouraged that open discussion in general. So, it seems like with my generation that’s having
kids now, they’re more accepting of it. So, an example, with my sister who just had a baby, she’s
very open for if she needs to address mental health in her own family. But I think in generations,
there’s definitely been a shift. So, I think you can see the difference between someone in my
generation having parents that grew up in the Philippines versus now, children that are Filipino,
but are being raised/born in America.
Valued Social Position that Allows the Individual to Achieve their Full Potential
Growing up I didn’t learn about the culture until I was 8 and came out here. But it was very
judgmental, critical, that whole nurse thing, you had to be smart. What I got from growing up
was it was really more of your reputation. . . . So really, it’s more about get a job, get security,
take care of your reputation and that’s it. That’s the good life for the most part. You have a good
heart to instill in your children to be that way, but everything else is neglected. But I think that
it’s the reputation because it seems like all I hear about Filipinos is that everyone is a hard
worker, but obviously it’s for a reason. So, all of the pressure that’s put on a kid . . . even as a kid
I was just like, man I don’t want to deal with this. But I feel like it’s coming from all that, because
they don’t have anything else.
A mental health provider had this to say about being a Filipino adolescent:
As a person growing up, trying to figure themselves out, they [adolescents] don’t know who
they are. And as a youth it’s pressure being a Filipino, it’s pressure of what’s your future
professions going to be, or I wanted to be this, but I’m told to be this. I think the socialization,
even the parenting part, plays a role in adolescent mental health.
Another participant stated:
I came here when I was 15 years old, and I came from a culture of parents are the law. And
everything they say, you have to follow. . . . From a generational standpoint, when I myself had
my daughter, although I learned a lot of good parenting from my parents, I also learned a lot
about what not to do, so I think my generation is a little bit more accepting of our children and
how they are instead of imposing our will on them. . . . And I have noticed that they are even a
lot more accepting of who they are, of the developing of the innate and the individual
personalities of their children as opposed to trying to shape their children into how they believe
17
that the children should grow. So, you know, that [imposing our will on them] could lead to a
lot of crazy thinking.
One elder participant described how he raises his own family:
In my house, I am supposed to be the head, so I do not suppress the thinking or the will of my
children. I just want them to ventilate what they want in my house. I don’t impose my will to
them. That’s what I do. They tell me, why is Daddy not getting angry to anyone? No, I really
don’t get mad because I let them air their opinions or whatever problem they have. Or in the
house, while we are eating, we can talk. But to impose what I want, never in my house. I will let
them ventilate their ideas.
Colonial Mentality (Internalized Oppression)
A participant highlighted the problem of racial discrimination and how that reinforces the
inferiority associated with CM when discussing the five definitions of mental health:
Certain words that I liked: sense of identity or self-worth just because, like the whole African
American comparison, I don’t know if you’ve heard of this. I had an ex who said Filipinos are the
Chinese-Mexicans [of Asia] or we’re the blacks of Asia. When it comes to identity, maybe also
the old generation, it’s like we’re always fighting. That’s the survival thing. We’re trying to get
out poverty. We’re trying to do well with ourselves, not just within the [Filipino] culture but
within the culture as an Asian whole. Then when you come to the U.S., you’re also fighting that.
It doesn’t help because we’re not Chinese, not math whizzes, not light [skin] enough, all that
kind of stuff. There’s always something wrong, especially with being Filipino.
One participant introduced herself, saying, “I’m a bad child. I didn’t have a good relationship
with my mom. But then I did everything that I could do to escape and find opportunities for me.” She
migrated from the Philippines, what she described as her “long journey:”
Because after I was able to take care of all of my papers, and I’m a divorcee, I brought my
parents here. My parents were “kumuha ka ng bato’ng ipupokpok sa ulo mo” [get a stone to hit
your head with] ‘cause they know the dynamic of our family, but then it’s cultural, right? So
with my mom, she didn’t change [after coming to U.S.], so I told my dad, I think she needs help. .
. . It [his response] was like, “No.” It was life changing for me, and I was able to, I don’t know. I
just wanted to, I try to run away from the culture [familial].
When I got pregnant and I had my daughter, I had no help raising her. I strongly relied on books;
self-help books, scientific studies and research … What I did with raising her is I had to
concentrate more on her as a child rather than looking into a cultural aspect. It’s more of how
am I gonna address to her when she does something [wrong], how am I gonna react? . . . And
18
her culture is me, and I’m her family, and I don’t want my culture affecting her because there’s
just so many things that’s stopping me to reach my full potential.
Stigmatization and Shame
One participant shared how her nephew who went to rehabilitation for substance abuse was
treated by his mother:
[My sister] makes fun of her own son. It becomes a joke sometimes, ‘cause you can just shrug it
off, and say oh this is just funny, we’re gonna get through this and it’s gonna be funny. Let me
make fun of this problem, this major problem … She makes fun of her son all the time. Yeah, she
makes fun of Filipinos all the time, it’s self-hatred, I think that carried over to another
generation. And that this has to do with colonial [oppression].
In this same context another parent commented about the use of humor to minimize discomfort in a
positive or negative way:
What I also noticed is that one of Filipinos’ coping mechanisms is to make fun of things, certain
things, even their own selves. Because they make light of the situation that even the heaviest
one. And it can be both on the negative side or the positive side. But that making fun of, to
make light of, so that instead of frowning, you have that perception of being gleeful.
When another participant was asked to explain what they meant by using the word, stigma, one
participant responded in this way:
I think Filipinos are so unique in their western influence. They’re not exactly embracing western
acceptance of therapy, but they really buy into a lot of the negative judgments of therapy
without ever having experienced it themselves. It’s all hearsay, I heard this person went on
medication, and it’s bad. It’s very much that story-telling piece without having actual
experience, and I think it builds on this perception of mental health because of hearsay. And it’s
not really doing much to support the individuals that need it. [She later qualified her response
and expressed the belief that] younger Filipino parents will get therapy for their children but not
tell the rest of the family about it.
Definitions of Mental Health for Children and Youth Rating Form
Participants in the focus groups were asked to read the five widely accepted definitions; think
about which definition would resonate with Filipino parents; rank their definitions from 1 (favorite) to 5
(least favorite); and then discuss reasons for rankings. A total of 31 completed rating forms were
collected (Table 2). Thirty percent (n = 10) of participants chose the first definition from the WHO, as
19
Table 2
Rankings of Widely Accepted Definitions of Child and Adolescent Mental Health Surveys (N = 33)
Organization Definition Highest Ranking
n %
World Health Organization Children and adolescents with good mental health are able to
achieve and maintain optimal psychological and social functioning
and well-being. They have a sense of identity and self-worth,
sound family and peer relationships, an ability to be productive
and to learn, and a capacity to tackle developmental challenges
and use cultural resources to maximize growth. Moreover, the
good mental health of children and adolescents is crucial for their
active social and economic participation (WHO, 2005, p. 18)
10 30
Philippines Senate Bill "Mental Health" refers to a state of well-being in which every
individual realizes his or her own potential, can cope with the
normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to his or her community (Senate of the
Philippines, 2015)
7 21
U.S. Centers for Disease
Control and Prevention
Mental health is not just the absence of a disease or mental health
disorder, it is much more. As youth grow and mature, they achieve
mental and emotional milestones. This process can be described as
achieving developmental competence, or the ability to navigate
social, emotional, cognitive, and behavioral tasks at different
developmental stages. A part of achieving developmental
competence is adhering to cultural and social norms and
developing a positive sense of identity, efficacy, and well-being
(Eccles et al., 2009)
6 18
Philippines Mental Health
Association
Mental health is peace of mind (PMHA, 2019) 6 18
Positive Youth Development
movement (Eccles et al.,
2009)
Mental health is not just the absence of a disease or mental health
disorder, it is much more. As youth grow and mature, they achieve
mental and emotional milestones. This process can be described as
achieving developmental competence, or the ability to navigate
social, emotional, cognitive, and behavioral tasks at different
developmental stages. A part of achieving developmental
competence is adhering to cultural and social norms and
developing a positive sense of identity, efficacy, and well-being
(Eccles et al., 2009)
2 6
Note. Definitions were ranked prior to discussion of rankings.
their favorite to resonate with Filipino parents. Participants identified the inclusion of a sense of identity
and self-worth as parts of what they liked about the definition. The remaining participants were fairly
equally spread in their first rankings among the definitions from the Philippines Senate bill, the CDC
definition, and the Philippines Mental Health Association and frequently commented on the aspects of
20
definitions related to achievement of one’s full potential. These definitions served as a springboard for
discussion and development of a shared definition of child and adolescent mental health.
Word Cloud Summaries
Word clouds were generated to summarize the frequency of words put on post-it notes and
used to describe pre-group impressions of mental health in the Filipino community (Figure 2) and post-
group impressions of child and adolescent mental health (Figure 3). Words provided with greater
frequencies appear in larger fonts while words used less frequently appear in smaller fonts.
Figure 2.
Pre-Focus Group Impressions of Mental Health in the Filipino Community
21
Figure 3.
Post-Focus Group Impressions of Child and Adolescent Mental Health
22
Chapter 3:
Discussion
Our discussion is organized around five major themes that emerged from our study and that we
believe are relevant to optimizing the mental health of this and other Pilipinx communities: 1)
supportive family; 2) compassionate community; 3) mutual acceptance and understanding of other
generations; 4) valued social position to achieve one’s potential; and 5) addressing stigmatization and
shame. We discuss the broader implications of these findings in our conclusions.
These first four themes enabled us to develop a highly relational shared definition of mental
health, that was both developmental and generational:
Pilipinx mental health is having a valued social position within a supportive family and
compassionate community that includes mutual acceptance and understanding of other
generations and allows the individual to achieve their full potential.
This shared definition of mental health is consistent with Filipino core values, such as kapwa, which is
defined as “the core Filipino psychological construct in which all individuals feel a sense of togetherness
or connectedness to each other” (Nadal, 2011, p. 38). This definition may also impact a person’s
willingness to engage in help seeking behaviors, accept recommendations of health care providers and
take determined action to prevent or treat illness.
Shared Definition of Mental Health
Supportive Family
The first theme we identified was supportive family. Children are not necessarily born with a
valued social position, but through relationship and caring conversations with their parents, families and
23
caregivers willing to listen to them, they receive social capital and develop their initial self-esteem,
feelings that they are valued and loved by having their voices heard (Enrile, 2006). In the absence of this
caring connection, it is not surprising that they may feel minimized, isolated, and neglected (Kuroki,
2015; Redaniel, Lebanan-Dalida, & Gunnell, 2011; Wolf, 1997). However, feelings of neglect expressed
by younger group members did not appear to persist through the lifespan.
Not all Filipino families are the same (Garcia & de Guzman, 2017). The traditional Filipino family
has a vertical hierarchical structure with authority and obligations distributed by age. Children are
socialized to accept an obligation to their parents for their birth and upbringing, and parents assume an
obligation to make sacrifices to provide their children with the best education available. Sometimes this
includes the parents imposing their career choice on the adolescent or young adult. This can be a source
of intergenerational conflict and psychological distress (Heras & Patacsil, 2001).
This conflict was evident in our focus groups. The participant who described her childhood using
the words, isolation and neglect, and complained about her parents’ focus on academics was just one
example of this. The group participants reframed this perception in a number of ways by pointing out: 1)
the good intentions of parents to provide a better life for their child; 2) life experience will bring an
appreciation for growing up in a family of extended family of the surrounding Filipino community; 3)
accept the day to day struggles and work together to be the best you can be and keep getting better;
and 4) instead of thinking of the experience as neglect, consider that one’s parents may be covering the
gaps in meeting the family’s basic needs.
Our definition recognizes the importance of the supportive family as we saw in the example
above, the extended family of the surrounding Filipino community offered their support to this young
person. However, when immigrant families experience a divergence between new social norms in the
United States and the cultural values of the Philippines, parents will often try to preserve the most
24
meaningful aspects of their own cultural values they were raised with (Garcia & de Guzman, 2017). This
may result in adolescents having multiple conflicts with nowhere to go to resolve them. These inner
conflicts may include being perceived as disrespectful if not adhering to the expectation to keep any
conflict with authority unspoken; defaulting on the obligation to the family created by one’s birth and
upbringing to give back to the family; lack of control over career choices; and perceived injustice on the
part of the next generation that contributes to intergenerational conflict and psychological distress from
both the inner conflict of cultural values and interpersonal conflict of not conforming to the social
expectations of the family and extended family. The importance of a supportive family in understanding
mental health is consistent with previous studies that have highlighted the role of family in improving
the well-being of Filipino youth (Javier, Galura, Aliganga et al., 2018; Maramba, 2013) and the role of
family conflict and problems as risk factors and correlates for suicide behavior among Filipino adults and
youth. (Enrile, 2006; Kuroki, 2015; Redaniel, Lebanan-Dalida, & Gunnell, 2011; Wolf, 1997).
Compassionate Community
Our shared definition of mental health is essentially relational in that it is impossible to have a
valued social position without social connectedness or trusting relationships with others who are
available and accepting of the individual as a compassionate community. This sense of community
represents social capital in that it “implies a sense of trust, of reciprocal responsibility, community
connectedness and obligation” (Christiansen, Baum & Bass, 2015, p. 1). The college advisor who saw her
students experiencing hesitation, anxiety and fear became a source of well-being, recognizing her
students as being worthy of her time and attention, to help each student get the assistance they
needed. Her time became social capital when she accepted the obligation for her students’ well-being to
encourage them to get help. The high school teacher who shook the hands of his students every day,
who learned this practice from being the student of a high school teacher who did the same. In this case,
25
being a compassionate community was transmitted from teacher to student and in turn, from one
generation to the next.
Participants endorsed differences in social relationships that promoted mental health in the
Philippines in contrast to the shame they experienced when trying to speak about their problems in the
United States as if they aired their dirty laundry. For these participants mental health was having a
valued social position within a compassionate community and family support; not an inferior standing,
not judged as shameful but in relationship with people who care about each other to be available to
listen, who are easy to talk with, and who offer advice and acceptance, even if a person is upset and
angry.
Mutual Acceptance and Understanding of Other Generations
The mutual generational acceptance aspects of our shared definition of mental health are key to
understanding the intergenerational trauma that has resulted from 350 years of Spanish colonialization
and almost 50 years of colonization by the United States. Acceptance is spending time with a person,
giving them full attention to listen to them and understand them, even if their point of view is different
from one’s own. It is treating the person, old or young with respect; without belittling or devaluing their
thoughts or opinions. Loving recognition, listening to and understanding what the earlier generation has
gone through; perhaps a lifelong lack of acknowledgement for their contributions and sacrifices for
others, or even a covert lack of acknowledgement to themselves, can help younger generations be more
understanding with their elders. This mutual acceptance is similar to unconditional positive regard,
which is well-established in the field of psychology as necessary for therapeutic change (Rogers, 1957).
David and Okazaki recommend that CM be considered an individual differences variable in their
review of the topic (2006a; 2006b). Individual differences are the relatively stable psychological
characteristics that distinguish one person from another and thus help to define each person's
26
individuality (Williamson, 2017, p.1; Baumeister & Vohs, 2007). David clarified that the existence and
strength of such a variable may vary among Filipinos and Filipino Americans (2013). The nature of CM as
a more-or-less stable trait would suggest that an approach of acceptance and understanding of the
individual within their generation while seeking to promote the valued social position of individuals in
succeeding generations by sharing social capital in the form of “reciprocal responsibility, community
connectedness and obligation” (Christiansen, Baum, & Bass, 2015) would be an effective approach to
heal generational gaps within the community.
As a child is born with only the social capital afforded to them by the shared attention, love,
time and affection the parents or caregivers can provide, so this definition recognizes the
developmental aspects related to the child becoming a social being. All children need their parents or
caregivers for their psychological well-being. Not only does a child take their first steps and say their first
words to their parents, but the delight and enjoyment of parents are the first steps early in a child’s life
toward a healthy self-image and self-confidence. Nurturing acceptance and interest shown by parents
provide the building blocks for the child to develop healthy relationships with others and achieve a
valued social position. This investment in a child’s life requires a significant investment of the parent or
caregiver’s time every day and is as important or more so, than higher educational achievement to live a
fulfilled life.
It is important that the earlier generations recognize that they have significant social capital to
share with the younger generation. Family connectedness and other adult caring are well-established
protective factors against suicide. In 2011, the CDC adopted the theme of Promoting individual, family,
and community connectedness to prevent suicidal behavior as a strategic direction for the prevention of
suicidal behavior (CDC, 2011). Generational acceptance needs to be given to children and youth who will
make mistakes as part of growing up. Asking for the young person’s feedback and listening can enhance
27
understanding and connection needed to possibly prevent the tragedy of suicide that is all too common
among Pilipinx youth and young adults.
Valued Social Position that Allows the Individual to Achieve their Full Potential
The four integral themes within our shared definition of Pilipinx mental health are foundational
for building mental health on the positive values of supportive family, compassionate community, and
mutual acceptance and understanding of other generations that form protective bonds for development
of a valued social position and growth to achieve one’s full potential. We conceptualized CM,
internalized oppression, stigmatization and shame as burdens in that they create weight that may hold a
person back and makes achieving one’s full potential more difficult, yet not impossible.
In our focus groups, having a career choice imposed on participants as adolescents or young
adults was a shared experience reported by several participants and a topic of concern for mental health
providers participating as well. Participants complained of the heavy weight of the family expectation to
become a nurse or having their own career aspirations and being told they must prepare for a different
career. There were, however, parents who observed that this practice may be changing as parents
decided to let their children speak their minds and not impose their will on their child’s career choice.
Addressing Colonial Mentality, Stigmatization and Shame
In our endeavor to create a shared definition of mental health, many acknowledged
stigmatization and shame as significant barriers for Filipinos to utilize mental health services or admit
use of services to family members. This is consistent with prior studies (Corrigan & Penn, 1999; Kessler
et al., 1996; U.S. DHHS, 2001). In addition, teasing or joking humor was described as a coping
mechanism and was also interpreted as internalized oppression that is passed on from generation to
generation. These factors together create a perfect storm for misunderstanding between younger and
older generations. Youth may not understand that CM has affected their parents’ way of coping with
28
mental illness and interpret it as intentional humiliation. This may decrease social capital and de-value
social position. In turn, youth may then further internalize their thoughts and feelings and ultimately
reject their culture, making them more vulnerable to lower self-esteem, mental illness, and suicidal
behavior. This cycle can be interrupted by increasing awareness of the effects of internalized oppression
and promoting the positive core values in the Filipino community. The importance of acknowledging
historical trauma, promoting positive cultural identity, and incorporating cultural values in the
conceptualization of mental health in order to achieve healing has been described in previous studies of
Filipinos and other communities (David, 2008; del Prado & Church, 2010; Nadal, 2011; Sangalang,
Ngouy, & Lau, 2015; Umaña-Taylor & Updegraff, 2007; West et al., 2012).
Our study had several limitations. First, our recruitment relied on self-selection, and the sample
may represent a small fraction of the total community. Thus, our sample may not be representative of
the Filipino population in Los Angeles. Observations shared by our focus group participants on which we
based our analysis, should not be taken as generalizations for the entire Pilipinx community or applied
as stereotypes. We encourage our readers to treat and accept each person in the Pilipinx community as
a unique individual and to regard this definition as aspirational to provide options for makers of social
policy and to promote connectedness among family members of different generations and development
of compassionate community networks. Next, young adults, ages 18 to 24 years, were not well
represented in our sample, and our shared definition may not represent the entirety of their views.
Future studies should explore these concepts with a larger sample of young adults as they play an
important role in a Filipino American’s experience with distress and help-seeking behavior.
Implications
Despite these limitations, our results have important implications for the Pilipinx community, a
large, growing, and understudied population with unmet mental health needs. The wicked problem of
29
suicide becoming the leading cause of death among Asian/Pacific Islanders that include Pilipinx pre-
teens, adolescents, and young adults in the United States in 2018 is a public health challenge that our
research team sought to address by conducting focus groups to create a shared definition of mental
health in the Pilipinx community. The changes in the frequency of words between initial offering of
words that came to mind when describing Pilipinx mental health in general at the beginning of the
groups to more positive words that came to mind when discussing child and adolescent mental health,
give one reason to hope that change is possible. In the brief time of five 90-minute focus groups over a
two-week period, thinking changed, and a new theory was conceived of what mental health could be for
the Pilipinx community. Whether it was the outcome of participant reflection on their own mental
schemas or mentalities that led to a rejection of distorted thinking from centuries of colonialism; or
community conversations about culture and generational differences; or exposure to strong, positive
definitions of mental health, the word clouds show evidence that change is possible.
Future interventions are needed to focus on building supportive families, strengthening mutual
acceptance and understanding between older and younger generations, and increasing awareness of
CM. For instance, results from this study were shared in a community conversations event focused on
Filipino Family Wellness, multiple outreach presentations to encourage parents to enroll in programs
aimed at improving parent-child relationships, and in a toolkit on creating a culture of mental health in
the Filipino community (Sepulveda et al. 2019). In the context of previous research, the current study
adds support to the notion that in order to meet the mental health needs of diverse communities,
research needs to be conducted from a community perspective and findings interpreted in a way that
reflect core values. Given our findings are consistent with studies of other diverse communities, it is
likely that our findings may have relevance beyond Pilipinx communities. Creating a shared definition of
mental health may represent the critical next step for transforming systems of care so that they meet
the needs of diverse communities and ultimately produce positive outcomes for youth and families.
30
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Coffey, Dean Mason
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Core Title
Creating a shared definition of mental health in the Pilipinx community: a comparative focus group analysis
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Keck School of Medicine
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Master of Science
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Clinical, Biomedical and Translational Investigations
Publication Date
07/26/2020
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colonial mentality,Filipino,kapwa,Mental Health,OAI-PMH Harvest,Pilipinx
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colonial mentality
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