A 55-year-old Vietnamese man was admitted to a general medicine ward with vague complaints of inability to breathe and swallow. The patient had been living in the United States for 20 years and currently was unemployed, with a wife and two children. He spoke English reasonably well; nevertheless, the history was obtained with a translation service. The patient was anxious and repeatedly stated that he was "dying" from his physical ailments. Extensive workup showed no evidence of cancer, but revealed reflux disease and Zenker diverticulum (an outpouching) of the esophagus. Psychiatric evaluation ruled out major depression. In the midst of a gastroenterology consult (to obtain an esophagogastroduodenoscopy [EGD]) the patient ran to the bathroom, jumped out of the fifth floor window, and killed himself.
After this event, subsequent discussions with the family revealed some relevant details. The patient had lived through the Vietnam War; he and his family had come to the United States on a boat as part of a mass exodus in the late 1970s; there was strife within the family unit, as the patient felt he was an undue burden to them; and the family was "losing face" in their community due to his unemployment.
The psychiatric team concluded that the evaluation had not been sufficiently sensitive to identify important culture-specific clues related to depression and has since taken steps to incorporate culturally sensitive screening tools.
1. Kirmeyer LJ, Dao THT, Smith A. Somatization and psychologization: understanding cultural idioms of distress. In: Okparu SO, ed. Clinical Methods in Transcultural Psychiatry. Washington, DC: American Psychiatric Press; 1998:233-265. ISBN: 9780880487108.
2. Leung PK, Boehnlein JK, Kinzie JD. Vietnamese American families. In: Evelyn Lee, ed. Working with Asian Americans: A Guide for Clinicians. New York, NY: The Guilford Press; 1997:153-162. ISBN: 9781572305700.
3. Kinzie JD, Leung PK. Psychiatric care of Indochinese Americans. In: Gaw AC, ed. Culture, Ethnicity and Mental Illness. Washington, DC: American Psychiatric Press; 1993:281-304. ISBN: 9780880483599.
4. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365:1309-1314. [go to PubMed]
5. Silove D, Steel Z, Bauman A, Chey T, McFarlane A. Trauma, PTSD, and the longer-term mental health burden amongst Vietnamese refugees: a comparison with the Australian-born population. Soc Psychiatry Psychiatr Epidemiol. 2007;42:467-476. [go to PubMed]
6. Kinzie JD, Boehnlein JK, Leung PK, Moore LJ, Riley C, Smith D. The prevalence of posttraumatic disorder and its clinical significance among Southeast Asian refugees. Am J Psychiatry. 1990;147:913-917. [go to PubMed]
7. Oldham J. PTSD and suicide. J Psychiatr Pract. 2008;14:195. [go to PubMed]
8. Mollica RF, McInnes K, Pham T, Smith Fawzi MC, Murphy E, Lin L. The dose-effect relationship between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. J Nerv Ment Dis. 1998;186:543-553. [go to PubMed]
9. Mollica RF Lyoo IK, Chernoff MC, et al. Brain structural abnormalities and mental health sequelae in South Vietnamese ex-political detainees who survived traumatic head injury and torture. Arch Gen Psychiatry. 2009;56:1221-1232. [go to PubMed]
10. Kinzie JD, Manson SM, Vinh DT, Tolan NT, Anh B, Pho TN. Development and validation of a Vietnamese-language depression rating scale. Am J Psychiatry. 1982;139:1276-1281. [go to PubMed]
11. Dinh TQ, Yamada AM, Yee BW. A culturally relevant conceptualization of depression: an empirical examination of the factorial structure of the Vietnamese Depression Scale. Int J Soc Psychiatry. 2009;55:496-505. [go to PubMed]