Gender differences in perceived stigma of dementia in Chinese Americans

Stigma surrounding dementia continues to plague ethnic minorities and serves as a major impediment to early detection and management of the disease. Despite the biomedical model being available, ethnic minorities tend to rely on folk models to explain the symptomology of Alzheimer’s disease (Ayalon and Areán, 2004). The Chinese language has no medical term for Alzheimer’s diseases, instead describing the associated symptoms as chi dai with chi translating to “confused or stupid” and dai meaning “losing one’s mind or catatonic” (Gerdner and Yeo, 2013). These cultural misconceptions are alarming considering that Asian Americans are the fastest growing minority group in the older population and are thus becoming increasingly vulnerable to the disease (Siri and Woo, 2014). Compounding the matter, there exists a disproportionate burden of dementia on women that crosses cultural and geographic lines. Average life expectancy is generally higher for women than men, and recent studies support the evidence of higher incidence of dementia in women than men (Bamford and Walker, 2012). Even when they are not directly afflicted with dementia, women’s strong role as caregivers for family members who suffer from dementia subject them to mental and physical stress as well as financial hardships (Bamford and Walker, 2012). Targeting the stigma in an attempt to more effectively educate this group requires recognizing the implications gender differences may play in the perceptions of dementia held by these members. The present study explored sex-related differences in perceived stigma as it pertains to dementia symptomology, course, and healthcare coverage. One hundred and eighty-two Chinese American men and women were surveyed to evaluate differences in their preconceived stigmas related to dementia. Of the 182 participants, 117 (64.3%) were female and 65 (35.7%) were male. No significant differences were found between age groups, level of education, immigration status, and family history of dementia. Participants were asked the following three questions: (1) A patient with this illness is impulsive and unpredictable (False); (2) Patients with this illness should be institutionalized (False); and (3) Health insurance policies should not cover any costs of this illness (False). Demographics were characterized through descriptive statistics, and categorical variables were compared using χ test. A majority of both sexes failed to answer Question 1 correctly (women: 28%; men: 40%, χ = 2.65, p= 0.103). Despite their preconceived notions of the behavioral implications of dementia, the majority of both sexes correctly answered Question 2 (women: 61%; men: 52%, χ = 1.20, p= 0.273). Of note, Question 3 showed significant difference (p= 0.0126) between the two groups with more women answering correctly than men (women: 87%, men: 72%, χ = 6.23). Although both genders exhibited misconceptions regarding the behavioral symptoms of dementia, they however agreed that these patients did not need to be institutionalized as a result. Interestingly, there was a significant difference between genders in relation to whether they believed health coverage policies should provide for the cost of dementia. The women surveyed were more likely to believe that healthcare policies should cover dementia-related expenses as compared with their male counterpart. This is consistent with established research that women are more likely to utilize health services and have higher medical expenditures even when factors such as health status are controlled for (Bertakis, 2000). Despite their perceived stigma of neurocognitive disease, the fact that the women surveyed were more apt to believe health insurance policies should provide coverage for the care associated with it seems to imply an underlying necessity for access to healthcare resources and possibly mental health resources specifically. In addition to supporting earlier research pertaining to preconceived stigmas related to dementia in the Asian American community, our study brings to light gender differences in the perceived socioeconomic implications of this mental illness. Women, and in particular Chinese American women, will disproportionately bear the burden of dementia either as patients themselves or as caregivers of family members, yet they are still likely to utilize health services as a result despite public stigma that pervades