Mental health burdens among North American Asian Adults living with chronic conditions: a systematic review

Asians are likely to experience a high burden of chronic conditions, including but not limited to, diabetes, cardiovascular disease, and cancer, due to differences in biologic, genetic, and environmental factors across Asian ethnic groups. A diagnosis of any chronic condition can contribute to increased mental health burdens, including depression, psychological distress, and post-traumatic stress disorder (PTSD). However, few studies have examined these co-morbidities across distinct Asian ethnic groups, an important limitation given the differences in social, cultural, and behavioral drivers of mental health burdens within and across Asian ethnicities. To understand the disparities in mental health burdens among Asians living with a chronic health condition, we conducted a systematic literature review of relevant peer-reviewed databases to identify studies reporting on mental health burdens (e.g., depression, anxiety, distress, and PTSD) in distinct Asian ethnic groups in North America. Thirteen studies met the inclusion criteria for this review and collectively demonstrated a high burden of depression, psychological distress, and PTSD among Asians living with chronic conditions. Moreover, there were distinct disparities in mental health burdens across chronic condition and across Asian ethnic group. Despite the detrimental impact of poor mental health on chronic disease specific outcomes, such as mortality and poor quality of life, a dearth of data exists characterizing mental health outcomes among Asian ethnicities living in North America with chronic conditions. Future work should prioritize estimating national prevalence of mental health outcomes among adults with chronic conditions by Asian ethnicities to inform culturally tailored interventions to address this public health burden. Abbreviations: BDI-II, Beck's Depression Inventory; BRFSSS, Behavioral Risk Factor Surveillance System; CES-D, Center for Epidemiological Studies-Depression; CHQ-9, 9-question Chinese Health Questionnaire; CINAHL, Cumulative Index to Nursing and Allied Health Literature; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders Text Revision Fourth Edition; ESAS, Edmonton Symptom Assessment Scale; GDS-SF, Geriatric Depression Scale-Short Form; JBI, Joanna Briggs Institute; NHANES, National Health and Nutrition Examination Survey; NHIS, National Health Interview Survey; NLAAS, National Latino and Asian American Study; PHQ-9, 9-question Patient Health Questionnaire; PHQ-9K, 9-question Korean Patient Health Questionnaire; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; PTSD, Post-traumatic stress disorder; SD, Standard deviation; T2D, Type-2 diabetes mellitus; U.S., United States.