Many Chinese elders battle depression, but few talk about it: Only one percent of Chinese immigrants go to a mental health professional when they need help, researchers say.

Zhizhen Huang, 68, had battled depression for years when she decided to see a therapist three years ago. She became one of more than 40 subjects to participate in San Francisco’s first study on depression among senior Chinese immigrants.

Huang says she has felt very unhappy for a long time. She used to cry a lot and has even tried to commit suicide.

After undergoing counseling, Huang told the Sing Tao Daily that she hasn’t resolved all of her problems, but she has learned to seek help from social workers and talk to people about the issues that weigh her down.

The study, conducted by the Family Service Association and UCSF’s Department of Psychiatry, focused on Chinese immigrants over 60 who were battling depression.

Past studies have found that only one percent of Chinese immigrants go to a mental health professional when they need help, according to social worker Cizhong Huang. 

This figure is even lower than that of the larger Asian community, who tend to keep depression to themselves. Twelve percent of Asian immigrants say they talk to family members or friends about their depression. Only four percent seek help from mental health professionals. In contrast, more than 20 percent of white people in the United States turn to therapists when experiencing depression.

But silence doesn’t cover up the need for help in the Chinese community. Many people wait until their depression gets very serious before they see a doctor.

Joyce Chu, co-researcher of the study on elderly Chinese immigrants and depression, and a post-doctoral fellow at UCSF’s Department of Psychiatry, says that among people who are in therapy, about 80 percent say they sought help because they ran into something beyond their ability to handle. They may be totally unaware of their depression, she adds. Another 11 percent go to therapists on the advice of social workers, but they don’t understand why they need counseling.

Many elderly Chinese immigrants refuse counseling. Of those who suffer from depression, 42 percent deny being depressed. Sixteen percent say they can take care of themselves and have no need for help. Another 16 percent predict that counseling will only make their situations worse.

When visiting the doctor, many Chinese elders do not mention depression, and instead describe other physical ailments such as heart problems, according to researchers.

They say elderly people often feel isolated and experience insomnia, which indeed are symptoms of depression. 

Zhizheng Huang says she used to keep all of her unhappiness to herself. “I couldn’t do anything but cry at home alone,” Huang recalls. “But after being in therapy, I got to know other people with the same experience.” 

In her group therapy, Huang meets with other elders in a small group, sharing their thoughts and concerns. She says they trust each other not to tell their stories to outsiders. Gradually, Huang realized that she was not the only one with problems. “My situation wasn’t really so bad,” she says, “and the blue feeling is going away.”

Researchers believe the reason many Chinese elders refuse treatment is that they are afraid to “lose face.” 

In fact, many may not even be aware that they have depression in the first place, due to linguistic and cultural barriers that keep them from understanding their condition. 

“For elderly immigrants, translation services are key in counseling,” Cizhong Huang says. “Translation and outreach are extremely important to help more elderly immigrants.”