The purpose of this study was to examine the specific likely reasons for increased stress levels among ethnic minorities in Hong Kong. By using the means of a survey and focus group, this study used reasons for elevated stress levels that have been identified somewhere through the use of the literature. The reasons that were identified through the review of the literature including the following: (a) discrimination, (b) struggling to adapt to the local culture and language, (c) low socioeconomic status, (d) lower social position and impaired family functioning. Before conducting the survey, the author distributed a validated scale to measure stress levels among ethnic minorities. Those whose stress levels were more than 150 points using the scale measurement were included in this study. The survey was then sent to them which had seven questions, and four of them were touching on the four reasons listed above. Eighty-Nine (N=89) ethnic minorities responded to the survey without skipping any question. The survey responses were analysed using SPSS 20.0 whereby it was determined that the elevated stress levels among ethnic minorities were significantly contributed by the struggle to adapt to the local culture and learn Cantonese. A focus group of ten members was conducted to reinforce the survey findings where it was discovered that struggling to speak Cantonese and adapt to the local language and discrimination are significant contributors. Therefore, it was concluded that struggling to adjust to the local culture and language contributed majorly to the increased stress levels among ethnic minorities and that discrimination also played a role even if it is insignificant. Therefore, strategies focusing on how to reduce stress levels among ethnic minorities should be specific and focused on the particular reasons identified.
CHAPTER ONE: INTRODUCTION
1.1 Background
According to the World Health Organisation (WHO, 2018), mental health is an essential aspect of a high-quality life in the modern world. Life has become more complicated than before in the recent times, and people require a functional ability to stay well and be able to successfully cope up with the normal stresses of life as well as complete daily tasks productively. Therefore, countries should be able to detect mental illness like high stress levels promptly, promote mental health in public, prevent mental health illnesses as well as offer timely treatment and rehabilitation for those in need. However, building a mental-health friendly environment is extremely challenging because the seriousness of mental health problem might differ from one geographical location to another and from one social group to another.
According to a 2017 mental health review report that was published by the Food and Health Bureau of Hong Kong Special Administrative Region, despite a well organised and well equipped public health system in Hong Kong, mental health problems are not uncommon. As WHO (2018) maintained, mental health is always beyond typical medical attention. It is also all over the news that Hong Kong is currently facing a mental health crisis because of its high population (more than 7 million inhabitants) hence immense day-to-day challenges that most people fail to cope up with (Heifetz, 2016). More particularly, a survey that was conducted between 2010 and 2013 revealed that the typical mental illnesses in this city that are affecting about 13% of Chinese adults aged between 16 and 75 years are anxiety and depressive disorders that express in different ways such as a mix of both or individual occurrences (Lam et al., 2015). Moreover, according to a report by the Department of Health (2015), about 4.8% of residents aged between 16 and 64 years were suffering from a diagnosable severe mental health problem in 2014. The number of mental health patients has also been on the rise; for example, between 2011 and 2016 alone, there was an increase of around 30,000 patients demanding for the services of the Hospital Authority (HA) (Hong Kong Special Administrative Region, 2017) which shows that mental health is a significant concern in this city.
Conversely, studies (e.g., Leung et al., 2008) have shown that the seriousness of mental health problems in this region depends on ethnicity, age, and social class. For instance, among children and adolescents, the problem is of more concern because they suffer from a wide range of mental health illnesses such as conduct disorders, attention deficit hyperactive disorder, depressive disorders, oppositional defiant disorder, etc. (Leung et al., 2008). In 2005, Kessler and his colleagues released an article that established that promotion of mental health and prevention of mental health illnesses before the age of 14 years reduces psychological health problems like elevated stress levels in adulthood by more than 50%. Therefore, the current mental health crisis for children and adolescents in Hong Kong suggests that this problem will persist for a longer duration than expected despite the ongoing efforts of the Government.
Several American and UK studies (e.g., Corrigan & Watson, 2007; Jimenez et al., 2013; McGuire & Miranda, 2008) have also confirmed that mental health and ethnicity are intimately connected. In a study that utilised evidence from South Asia, it was also discovered that psychiatric disorders vary significantly between ethnic groups among rural Asian population (Hawes, Axinn & Ghimire, 2016). More particularly, the main reason behind mental health differences among different ethnic groups (in most countries such as America and Europe) is the issue of disparity of mental health services. Hawes et al. (2016), however, did not identify the main reasons for mental health ethnic variations in rural Asia hence one can tentatively claim that the reasons might differ from one geographical region to another which is why it is essential to investigate different reasons for each specific area.
1.2 Statement of the Problem
Mental health such as high stress levels can result in stigma (Knaak, Mantler & Szeto, 2017). Studies (e.g., Clement et al., 2014) have confirmed that this stigma can impede mental health illness patients from seeking professional help. This can worsen mental health cases hence the need for timely intervention and treatment of those in need. Stigmatisation in healthcare is closely related to discrimination (Henderson et al., 2014) which implies that ethnic minorities who are at risk of bias in the society are more likely to have less access to high-quality healthcare than their majority counterparts. In Hong Kong, discrimination against ethnic minorities (immigrants from Mainland China and South and Southeast Asia) is prevalent today and is becoming even more severe because of racial and cultural differences (Ye, 2016). Ethnic minorities are discriminated almost in every sector ranging from banking to healthcare (Lee & Chung, 2018), which shows that they are the most affected by mental health problems besides the fact that high levels of stigmatisation prevent most of them from seeking professional help. From a psychiatric perspective, the evidence base for mental health problems among the minorities is rigorous. However, from a sociological perspective, little is known about the stress levels of ethnic minorities in Hong Kong. Instead, surveys have only established the severity of mental health illness at a regional level, e.g., the number (or proportion) of Hong Kong residents suffering from mental health problems (Moon, 2017).
It is parallel with the natural law that an ethnic group of the few in the society is prone to discrimination, but it is against the tenets of human rights that everybody in the community is equal. Therefore, it is unacceptable for ethnic minorities to be discriminated and stigmatised as they are barriers to access to quality healthcare. As this is problematic, it is the responsibility of policymakers to ensure ethnic minorities in Hong Kong receive the same level of quality of mental health care to their majority counterparts. Furthermore, it is typical that finding a solution to a problem starts with investigating the causes of the problem. A new approach to doing this is to look into the factors causing stressful life among ethnic minorities in Hong Kong. Therefore, based on the best level of knowledge of the author, no study has investigated the proposed problem in Hong Kong hence this will be the first research study to examine the problem.
1.3 Aims and Objectives
The main aim of this study is to determine factors contributing to stressful life among ethnic minorities in Hong Kong. In order to fulfil this aim, this research study focused on the following objectives:
i. Determine if discrimination on ethnic grounds is a contributing factor to stress levels among ethnic minorities in Hong Kong.
ii. Determine if socioeconomic status is a contributing factor to stress levels among ethnic minorities in Hong Kong.
iii. Determine if struggling to adopt to the local culture is a contributing factor to stress levels among ethnic minorities.
iv. Determine if lower social position and poor family functioning are contributing factors to stress levels among ethic minorities in Hong Kong.