Lawrence H Yang
Lawrence H Yang
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Chair and Professor of Social and Behavioral Sciences
Associate Director, Global Center for Implementation Science
Founding Director, Global Mental Health and Stigma Program
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Professional overview
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Dr. Lawrence Yang is Professor and Chair of the Department of Social and Behavioral Sciences; Associate Director of the Global Center for Implementation Science at NYU; and Founding Director of NYU’s Global Mental Health and Stigma Program. He is also PI of a generous donor gift from the Li Ka Shing Foundation to fund an initiative to promote Global Mental Health and Wellness (see link).
Dr. Yang has received extensive interdisciplinary training, including clinical psychology (Boston University), psychiatric epidemiology (Columbia University) and medical anthropology (Harvard University). Dr. Yang has received six national awards in stigma, including the Maltz Prize for Innovative and Promising Schizophrenia Research in 2021 (Brain and Behavior Research Foundation; see link). Dr. Yang has >170 peer-reviewed publications, including in journals such as JAMA Psychiatry, British Journal of Psychiatry, and the American Journal of Public Health. Regarding currently-funded NIH grants, he is PI of three separate R01 grants (below), is multiple PI of a D43 grant in Vietnam, and is co-investigator on 4 R01 grants and another R34 grant. Lawrence is also applying his expertise to address the novel topic of “Migration Stigma”, where he led a think tank and conference sponsored by the prestigious Ernst Strüngmann Forum (June, 2022; see link), which has resulted in a recently-published book by MIT press (Migration Stigma (mit.edu)).
Brief Research Narrative: If every public health researcher had a calling card, Dr. Lawrence Yang's would be stigma.
What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on how stigma is expressed-- drove the GPH Professor to develop a framework for how stigma acts to impede social recovery that could be applied to cultural groups to improve the lives of countless people with mental illness and their families around the world. Dr. Yang also conducts several ongoing research studies on the forefront of global mental health and implementation science.
Building upon dissertation research conducted in Beijing, China, Lawrence initiated his stigma research via an NIMH K-award (2005-2010). Lawrence conducted a study in New York City of how stigma shapes the course of mental illness among Chinese immigrants. Lawrence formulated how culture relates to stigma--i.e. the “What Matters Most” framework—to help implement interventions to improve recovery for stigmatizing conditions. He learned that upholding face (to achieve lineage obligations) was essential, as it is for Asians in many countries. Lawrence then formulated an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. To inform global programs, Lawrence then applied the ‘what matters most’ approach to HIV stigma in Botswana. Lawrence identified that “womanhood” in Botswana is signified by “having and caring for children” (AJPH, 2021). These cultural imperatives bring pregnant women into contact with free antenatal services, including routine HIV testing, where their HIV status is discovered before their male partners, leading women diagnosed with HIV to be blamed and stigmatized. Lawrence used this framework in a completed NIMH-funded R21 grant to implement an intervention to counter culturally-salient aspects of HIV stigma that impede anti-retroviral treatment. This stigma intervention, by utilizing the perspective that a woman in Botswana who achieves ‘what matters most’ can be protected from HIV stigma, has shown promising results. Lawrence has received a new R01 (R01 TW012402) to expand this intervention for use with women with HIV with serious mental illness in Botswana. He also participated as a Scientific member of the “NIH Office of AIDS Research & NIMH HIV-Related Intersectional Stigma” Working Group (2020).
Lawrence has advanced global mental health research in China as PI of two NIMH-funded R01 studies (R01MH108385; R01 MH127631) with co-PI's, Dr.’s Michael Phillips, William Stone and Matcheri Keshavan, seeking to characterize the cognition of completely untreated psychosis in China. Recently, China has implemented programs to detect untreated psychosis countrywide. Ascertaining participants in rural China, the study has enrolled~ 300 untreated psychosis participants, who are then matched with ~300 treated psychosis participants and an additional ~300 healthy control participants. The study’s first publication shows that cognitive performance may continue to decrease as the duration of untreated psychosis becomes prolonged (JAMA Psychiatry, 2020), thus potentially shifting the scientific thinking about schizophrenia by suggesting possible novel neurodegenerative processes in the natural course of chronic psychosis. A 3-year Supplement also examines the neurobiological markers of untreated psychosis to validate three psychosis subgroups that exhibit neurobiologically distinct differences (or ‘biotypes’). A follow-up longitudinal, 5-year R01 proposal (2021-2026) to capitalize upon this rare cohort has been recently funded by NIMH.
Relevant to implementation science, Lawrence leads a project to help address the gap in global mental health treatment among those who need but do not receive care for mental disorders, which is disproportionately high in low- and middle-income countries. There has been a call to scale-up mental health services via sharing of mental health care with a broader array of nonspecialists (e.g., community health workers). Yet, knowledge on how to successfully implement task-sharing mental health strategies in real-world settings is lacking. Lawrence is PI of a third NIMH-funded R01 (with co-PI, Dr. Judy Bass; R01 MH122851) to validate a newly-developed measure that enables rapid assessment of modifiable critical factors affecting the implementation of task sharing mental health strategies. This R01 is based upon the “Shared Research Project”, where Dr.’s Yang and Bass examined the barriers and facilitators to scale-up task-sharing interventions in four previous, NIMH-funded global regional networks spanning 4 global hubs (i.e., Latin America; Africa, and India/ Pakistan). This current study will validate this measure within three additional, ongoing NIMH-funded task-sharing mental health programs in South Africa, Chile, and Nepal, thus advancing implementation science globally.
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Education
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BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CTPhD, Boston University, Boston, MAClinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)
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Honors and awards
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Maltz Prize for Innovative and Promising Schizophrenia Research -- Brain and Behavior Research Foundation (2021)NIH Fellow-Training Institute for Dissemination & Implementation Research in Health (TIDIRH) (2019)Fellow (Elected), American Psychopathological Association (2018)Award for Emerging Leadership, Americal Psychological Association (2012)Award for Advancing Minority Mental Health, American Psychiatric Foundation (2012)Young Investigator Award, NARSAD/ Brain and Behavior Foundation (2010)Emerging Leader Award for Significant Contributions to the Advancement of Ethnic Minority Psychology, American Psychological Association (2010)Calderone Award for Junior Faculty, Columbia University School of Public Health (2009)REACH for the R01 Award, Columbia University Irving Institute for Clinical and Translational Research (2009)Early Career Research Award, American Psychological Association (2008)Early Career Award, Asian American Psychological Association (2008)Dalmas A. Taylor Outstanding Student Dissertation Award, American Psychological Association (Division of Clinical Psychology- Ethnic Minority Focus) (2002)Outstanding Dissertation Award, American Psychological Association (Division of International Psychology) (2002)
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Areas of research and study
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Cognition and PsychosisGlobal HealthImplementation scienceMental HealthStigma of Health Conditions“At-Risk” States for Psychosis
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Publications
Publications
Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: An empirical question
AbstractYang, L. H., Wonpat-Borja, A. J., Opler, M. G., & Corcoran, C. M. (n.d.).Publication year
2010Journal title
Schizophrenia ResearchVolume
120Issue
1Page(s)
42-48AbstractWhile the "clinical high-risk state" for psychosis has demonstrated good reliability and fair predictive validity for psychotic disorders, over 50% of identified subjects do not progress to psychosis. Despite the benefits that early detection and treatment might offer, debate concerning the official inclusion of a "psychosis risk syndrome" in the upcoming DSM-V frequently involves concerns about the impact of stigma on patients, families and institutions. We add to this debate by providing an analysis of the theoretical and empirical stigma literature to evaluate the potential effects of stigma associated with the psychosis risk syndrome. Theorists' conceptualizations of how stigma exerts its negative effects emphasize internalization of pejorative societal stereotypes ('self-stigma'), negative emotional reactions, harmful behavioral coping strategies, and structural discrimination as key mechanisms. Studies assessing the comparative effects of symptomatic behavior when compared with a psychiatric diagnosis label in predicting rejecting social attitudes indicate that treating symptomatic behaviors is likely to diminish overall stigma. However, any publically held 'preexisting conceptions' about what a psychosis risk syndrome means are still likely to exert negative effects. Additionally, particular features of this syndrome-that it occurs during adolescence when identity formation may be in flux- may also shape manifestations of stigma. Utilizing other well-established 'at-risk' conditions (e.g., genetic susceptibility) to model potential discrimination for this syndrome, we suggest that future discrimination is likely to occur in insurance and family domains. We conclude by proposing stigma measurement strategies, including recommending that field trials prior to DSM-V adopt systematic measures to assess any stigma that this psychosis risk syndrome might confer via future community use.Beliefs in traditional chinese medicine efficacy among chinese americans: Implications for mental health service utilization
AbstractYang, L. H., Corsini-Munt, S., Link, B. G., & Phelan, J. C. (n.d.).Publication year
2009Journal title
Journal of Nervous and Mental DiseaseVolume
197Issue
3Page(s)
207-210AbstractWe examined how community attitudes towards traditional Chinese conceptions of health and Western dichotomization of illness might affect perceptions of traditional Chinese medicine (TCM) efficacy in order to identify factors underlying psychiatric service underutilization among Chinese-Americans. We administered an experimental vignette to assess perceived illness, severity, and beliefs of TCM efficacy for physical and psychiatric disorders among 90 Chinese-Americans ascertained through a national telephone survey. Perceived illness severity was unrelated to assessment of TCM effectiveness. However, psychiatric conditions tended to be viewed as distinct from physical disorders, and TCM use was endorsed as less effective for psychiatric illnesses when compared with physical illnesses. Furthermore, differences in perceived TCM efficacy appeared to be magnified among US-born respondents, with US-born respondents endorsing lower efficacy for psychiatric disorders than foreign-born respondents. These findings suggest that TCM use for psychiatric disorders may decrease with Westernization, but might delay access to psychiatric services among first-generation immigrants.Prenatal malnutrition and adult Schizophrenia: Further evidence from the 1959-1961 chinese famine
AbstractXu, M. Q., Sun, W. S., Liu, B. X., Feng, G. Y., Yu, L., Yang, L., He, G., Sham, P., Susser, E., St. Clair, D., & He, L. (n.d.).Publication year
2009Journal title
Schizophrenia bulletinVolume
35Issue
3Page(s)
568-576AbstractObjective: Evidence from the 1944-1995 Dutch Hunger Winter and the 1959-1961 Chinese famines suggests that those conceived or in early gestation during famines, have a 2-fold increased risk of developing schizophrenia in adult life. We tested the hypothesis in a second Chinese population and also determined whether risk differed between urban and rural areas. Method: The risk of schizophrenia was examined in Liuzhou prefecture of Guangxi autonomous region. Rates were compared among those conceived before, during, and after the famine years. Based on the decline in birth rates, we predicted that those born in 1960 and 1961 would have been exposed to the famine during conception or early gestation. All psychiatric case records in Liuzhou psychiatric hospital for the years 1971 through 2001 were examined and clinical/sociodemographic data extracted by psychiatrists blind to exposure status. Data on births and deaths in the famine years were also available, and cumulative mortality was estimated from later demographic surveys. Evidence of famine was verified, and results were adjusted for mortality. Relative risks (RRs) for schizophrenia were calculated for the region as a whole and for urban and rural areas separately. Results: Mortality-adjusted RR for schizophrenia was 1.5 (1960) and 2.05 (1961), respectively. However, the effect was exclusively from the rural areas RR = 1.68 (1960) and RR=2.25 (1961). Conclusions: We observe a 2-fold increased risk of schizophrenia among those conceived or in early gestation at the height of famine with risk related to severity of famine conditions.Race/ethnicity and incidence of psychosis: new directions for research
Angelin, D., Lee, R., Yang, L., & Lo, G. (n.d.). In Social Science in Health Care and Practice (1–).Publication year
2009'Face' and the embodiment of stigma in China: The cases of schizophrenia and AIDS
AbstractYang, L. H., & Kleinman, A. (n.d.).Publication year
2008Journal title
Social Science and MedicineVolume
67Issue
3Page(s)
398-408AbstractThe majority of theoretical models have defined stigma as occurring psychologically and limit its negative effects to individual processes. This paper, via an analysis of how 'face' is embodied in China, deepens an articulation of how the social aspects of stigma might incorporate the moral standing of both individual and collective actors defined within a local context. We illustrate (1) how one's moral standing is lodged within a local social world; (2) how one's status as a 'moral' community member is contingent upon upholding intrapersonal and social-transactional obligations; and (3) how loss of face and fears of moral contamination might lead to a 'social death'. We first draw from Chinese ethnographies that describe the process of human cultivation before one can achieve fully 'moral' status in society. We integrate findings from empirical studies describing how social-exchange networks in China are strictly organized based on the reciprocation of favors, moral positioning, and 'face'. We further ground these Chinese constructs within a theoretical framework of different forms of capital, and discuss the severe social consequences that loss of face entails. By utilizing the examples of schizophrenia and AIDS to illustrate how loss of moral standing and stigma is interwoven in China, we propose a model highlighting changes in moral status to describe how stigma operates. We suggest that symbolic restoration of moral status for stigmatized groups takes place as local-level stigma interventions. By analyzing the moral aspects of 'face', we propose that across cultures, stigma is embedded in the moral experience of participants, whereby stigma is conceived as a fundamentally moral issue: stigmatized conditions threaten what matters most for those in a local world. We further propose that stigma jeopardizes an actor's ability to mobilize social capital to attain essential social statuses.Stigma and Beliefs of Efficacy Towards Traditional Chinese Medicine and Western Psychiatric Treatment Among Chinese-Americans
AbstractYang, L. H., Phelan, J. C., & Link, B. G. (n.d.).Publication year
2008Journal title
Cultural Diversity and Ethnic Minority PsychologyVolume
14Issue
1Page(s)
10-18AbstractIn this study we examined community attitudes of efficacy and shame to investigate the factors that may underlie mental health service underutilization among Chinese Americans. We administered an experimental vignette to assess beliefs of efficacy and shame toward using traditional Chinese medicine (TCM) as opposed to Western health services in a sample of 90 Chinese Americans obtained through a national telephone survey. Contrary to predictions, beliefs of efficacy for treating mental disorders were found to be greater for Western psychiatric services when compared with TCM. As predicted however, Chinese Americans perceived greater community attitudes of shame when accessing Western psychiatric services as opposed to TCM to treat a mental disorder. Furthermore, these differences in community attitudes of shame only occurred among respondents who received a psychiatric condition vignette, but not with respondents who were administered a vignette of a physical disorder. These findings suggest that perceived shame may play an important role in help seeking and that integration of TCM with Western psychiatric care may have implications for reducing shame for Chinese Americans.Stigma Measurement Approaches
Yang, L. H., Link, B. G., & Phelan, J. C. (n.d.). In Understanding the Stigma of Mental Illness: Conceptual Origins and Current Applications (1–).Publication year
2008Page(s)
175-192Stigma of mental illness
AbstractYang, L. H., Cho, S. H., & Kleinman, A. (n.d.). In International Encyclopedia of Public Health (1–).Publication year
2008Page(s)
219-230AbstractStigma is a pervasive force that has powerful consequences and reduces the life opportunities of those that it affects. Society also becomes burdened by the costs of those who neglect adequate treatment and whose illness conditions worsen due to fears of stigma. The concept of stigma includes internal psychological processes within the person, interpersonal social processes between individuals and groups, and large-scale processes on the level of culture and politics. These models identify different mechanisms by which stigma exerts its negative effects on others. Further, current anti-stigma interventions have drawn upon these conceptualizations to reduce stigma and its effects. © 2008Application of mental illness stigma theory to Chinese societies: Synthesis and new directions
AbstractYang, L. H. (n.d.).Publication year
2007Journal title
Singapore Medical JournalVolume
48Issue
11Page(s)
977-985AbstractThe rapidly-evolving literature concerning stigma towards psychiatric illnesses among Chinese groups has demonstrated pervasive negative attitudes and discriminatory treatment towards people with mental illness. However, a systematic integration of current stigma theories and empirical findings to examine how stigma processes may occur among Chinese ethnic groups has yet to be undertaken. This paper first introduces several major stigma models, and specifies how these models provide a theoretical basis as to how stigma broadly acts on individuals with schizophrenia through three main mechanisms: direct individual discrimination, internalisation of negative stereotypes, and structural discrimination. In Chinese societies, the particular manifestations of stigma associated with schizophrenia are shaped by cultural meanings embedded within Confucianism, the centrality of "face", and pejorative aetiological beliefs of mental illnesses. These cultural meanings are reflected in severe and culturally-specific expressions of stigma in Chinese societies. Implications and directions to advance stigma research within Chinese cultural settings are provided.Application of stigma theory to Chinese groups with mental illness: synthesis and new directions
Yang, L. (n.d.).Publication year
2007Journal title
Singapore Medical JournalVolume
48Issue
11Page(s)
977Culture and stigma: Adding moral experience to stigma theory
AbstractYang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. (n.d.).Publication year
2007Journal title
Social Science and MedicineVolume
64Issue
7Page(s)
1524-1535AbstractDefinitions and theoretical models of the stigma construct have gradually progressed from an individualistic focus towards an emphasis on stigma's social aspects. Building on other theorists' notions of stigma as a social, interpretive, or cultural process, this paper introduces the notion of stigma as an essentially moral issue in which stigmatized conditions threaten what is at stake for sufferers. The concept of moral experience, or what is most at stake for actors in a local social world, provides a new interpretive lens by which to understand the behaviors of both the stigmatized and stigmatizers, for it allows an examination of both as living with regard to what really matters and what is threatened. We hypothesize that stigma exerts its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value. We utilize two case examples of stigma-mental illness in China and first-onset schizophrenia patients in the United States-to illustrate this concept. We further utilize the Chinese example of 'face' to illustrate stigma as having dimensions that are moral-somatic (where values are linked to physical experiences) and moral-emotional (values are linked to emotional states). After reviewing literature on how existing stigma theory has led to a predominance of research assessing the individual, we conclude by outlining how the concept of moral experience may inform future stigma measurement. We propose that by identifying how stigma is a moral experience, new targets can be created for anti-stigma intervention programs and their evaluation. Further, we recommend the use of transactional methodologies and multiple perspectives and methods to more fully capture the interpersonal core of stigma as framed by theories of moral experience.Statistical validation of the criteria for symptom remission in schizophrenia: Preliminary findings
AbstractOpler, M. G., Yang, L. H., Caleo, S., & Alberti, P. (n.d.).Publication year
2007Journal title
BMC psychiatryVolume
7AbstractBackground: Published methods for assessing remission in schizophrenia are variable and none have been definitively validated or standardized. Andreasen et al (2005) suggest systematic operational criteria using eight PANSS items for which patients must score ≤ 3 (mild) for at least six months. Methods: Using data from a one year, multi-site clinical trial (n = 675) remission criteria were compared to total PANSS scores and other endpoints and demonstrate excellent agreement with overall clinical status. Results: Compared to total PANSS score of 60 points and other criteria, at time points > 6 months (8 and 12 months) the specificity of the remission criteria was 85%, i.e. of the patients who had a total score >60, 85% were classified as "not in remission." Sensitivity was also very high; 75% of patients with scores of <60 were classified as "in remission. "Patients who dropped out of the trial were more likely not to be in remission prior to dropping out. Conclusion: These findings indicate that the remission criteria are both sensitive and specific indicators of clinical status. Additional analyses are required to determine if remission status predicts other outcomes, such as employment, independent living, and prognosis.Effects of attributing serious mental illnesses to genetic causes on orientations to treatment
AbstractPhelan, J. C., Yang, L. H., & Cruz-Rojas, R. (n.d.).Publication year
2006Journal title
Psychiatric ServicesVolume
57Issue
3Page(s)
382-387AbstractObjective: Professional services for persons with serious mental illnesses are underutilized. The genetics revolution has the potential to increase professional help seeking by increasing biomedical interpretations of mental illness among the public. The objective of this study was to assess whether genetic attributions for serious mental illnesses are associated with more positive orientations to professional treatment among members of the general public. Methods: Data from two nationally representative surveys were analyzed. First, associations between perceptions of genetic causes of both schizophrenia and depression and treatment recommendations and perceived treatment effectiveness were assessed in a vignette study that was part of the 1996 General Social Survey (GSS). Second, the effect of various descriptions of the role of genetic factors in schizophrenia and depression on perceived treatment effectiveness was assessed in a vignette experiment conducted in 2002-2003. Results: Perception of genetic causes was associated with more recommendations for mental hospitalization and prescription medication but not with more recommendations to see a psychiatrist, a therapist, or a general medical practitioner. Perception of genetic causes was not related to perceived treatment effectiveness in the GSS, and genetic causes as described in the vignette were associated with lower perceived effectiveness of treatment. Conclusions: Increasing emphasis on genetic causes of mental illnesses may have multifaceted effects on orientations to professional treatment. Genetic attributions appear to direct people's help seeking toward the most extreme or biological forms of intervention, possibly because people view genetically influenced disorders as more serious and chronic. At the same time, such attributions lead to pessimism that intervention will be effective.Introduction
Leong, F., Inman, A., Ebreo, A., Yang, L., Kinoshita, L., & Fu, M. (n.d.). In The Handbook of Asian American Psychology (2nd eds., 1–).Publication year
2006Psychopathology among Asian-Americans
Yang, L., & Wonpat-Borja, A. (n.d.). In The Handbook of Asian American Psychology (2nd eds., 1–).Publication year
2006The Handbook of Asian American Psychology
Leong, F., Inman, A. G., Ebreo, A., Yang, L., Kinoshita, L., & Fu, M. (n.d.). (2nd eds., 1–).Publication year
2006Causal attributions about schizophrenia in families in China: Expressed emotion and patient relapse
AbstractYang, L. H., Phillips, M. R., Licht, D. M., & Hooley, J. M. (n.d.).Publication year
2004Journal title
Journal of abnormal psychologyVolume
113Issue
4Page(s)
592-602AbstractPrevious studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect.Measuring mental illness stigma
AbstractLink, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (n.d.).Publication year
2004Journal title
Schizophrenia bulletinVolume
30Issue
3Page(s)
511-541AbstractThe effectiveness of efforts designed to address mental illness stigma will rest on our ability to understand stigma processes, the factors that produce and sustain such processes, and the mechanisms that lead from stigmatization to harmful consequences. Critical to such an understanding is our capacity to observe and measure the essential components of stigma processes. This article is designed to assist researchers in selecting or creating measures that can address critical research questions regarding stigma. Our conceptualization of stigma processes leads us to consider components of labeling, stereotyping, cognitive separating, emotional reactions, status loss, and discrimination. We review 123 empirical articles published between January 1995 and June 2003 that have sought to assess mental illness stigma and use these articles to provide a profile of current measurement in this area. From the articles we identify commonly used and promising measures and describe those measures in more detail so that readers can decide whether the described measures might be appropriate for their studies. We end by identifying gaps in stigma measurement in terms of concepts covered and populations assessed.Causal Attributions, Expressed Emotion, and Patient Relapse: Recent Findings and Application to Chinese Societies
AbstractYang, L. H. (n.d.).Publication year
2003Journal title
Hong Kong Journal of PsychiatryVolume
13Issue
2Page(s)
16-25+30AbstractFor more than 30 years, a measure of the family environment termed expressed emotion has enhanced our understanding of how family psychosocial factors influence psychiatric relapse. This article reviews research addressing relatives' causal attributions, expressed emotion, and patient relapse, which support a model in which relatives' attributions are causally related to expressed emotion. A mediational model of attribution-expressed emotion outcome is evaluated as a theoretical framework to understand how attributions and expressed emotion contribute to patient relapse. Research addressing this topic in China, where relatives' behaviours towards patients differ greatly from their western counterparts, is reviewed. Relatives of patients with schizophrenia in China demonstrated a more situational attribution bias than relatives of patients from western cultures, yet Chinese relatives' controllable and personal attributions still related to high expressed emotion types of criticism and hostility. Expressed emotion partially mediated controllability attributions in predicting relapse. Contrary to expectations, personal attributions, particularly relatives' causal beliefs of 'xiao xin yan' ('narrow-mindedness'), protected against relapse in a manner unexplained by expressed emotion. These results further support the hypothesised causal relation between attributions and expressed emotion, and provide a new pathway to explore how relatives' behaviours ameliorate patient illness course. Future directions for research utilising attributions and expressed emotion in Chinese societies are provided.Grief, psychosis, and panic intervention with a psychotic patient: Integrating psychodynamic and cognitive-behavioral approaches
Yang, L. H., Apfel, R. J., & Hofmann, S. G. (n.d.).Publication year
2002Journal title
Harvard Review of PsychiatryVolume
10Issue
2Page(s)
100-108Stigma and expressed emotion: A study of people with schizophrenia and their family members in China
AbstractPhillips, M. R., Pearson, V., Li, F., Xu, M., & Yang, L. (n.d.).Publication year
2002Journal title
British Journal of PsychiatryVolume
181Page(s)
488-493AbstractBackground: The most damaging effect of stigma is the internalisation of others' negative valuations. Aims: To explore the factors that mediate patients' emotional and cognitive responses to stigma. Method: Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000. Results: Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area. Conclusions: Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.Understanding families in their own context: Schizophrenia and structural family therapy in Beijing
AbstractYang, L. H., & Pearson, V. J. (n.d.).Publication year
2002Journal title
Journal of Family TherapyVolume
24Issue
3Page(s)
233-257AbstractEvidence from a number of family intervention strategies demonstrates a beneficial impact on the course of schizophrenia. It appears that different family interventions have generic features that aid the patient to avoid relapse and improve functioning. A significant challenge for researchers is to modify these generic strategies to be sensitive to different cultural groups in order to ensure their effectiveness. Chinese culture, with its distinct cultural norms governing family interaction and intense stigma towards the mentally ill, would seem to raise a particular challenge. This paper offers an account of an eclectic model of structural family therapy that incorporates psychoeducation and behavioural treatments for schizophrenia as a theoretical guide to working in a cross-cultural context. A Beijing family, consisting of parents and their daughter with schizophrenia, were seen for sixteen months during a trial of family intervention in China. Through structural family concepts, China's sociocultural context of treatment resource constraints, population policy and stigma are examined and the impact of the illness on family organization is explored.Ethnography in health research and practice
Yang, L., & Fox, K. (n.d.).Publication year
1999Journal title
Ambulatory Child HealthVolume
5Issue
4Page(s)
339The social course of schizophrenia: local and societal factors
Hicks, M., Kleinman, A., & Yang, L. (n.d.).Publication year
1998Journal title
Kaohsiung Journal of Medical SciencesPage(s)
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