Abstract To understand Chinese immigrants' experiences with mental illness stigma and mental health disparities, we integrate frameworks of ‘structural vulnerability’ and ‘moral experience’ to identify how interaction between structural discrimination and cultural engagements might shape stigma. Fifty Chinese immigrants, including 64% Fuzhounese immigrants who experienced particularly harsh socio-economical deprivation, from two Chinese bilingual psychiatric inpatient units in New York City were interviewed from 2006 to 2010 about their experiences of mental illness stigma. Interview questions were derived from 4 stigma measures, covering various life domains. Participants were asked to elaborate their rating of measure items, and thus provided open-ended, narrative data. Analysis of the narrative data followed a deductive approach, guided by frameworks of structural discrimination and “what matters most” – a cultural mechanism signifying meaningful participation in the community. After identifying initial coding classifications, analysis focused on the interface between the two main concepts. Results indicated that experiences with mental illness stigma were contingent on the degree to which immigrants were able to participate in work to achieve “what mattered most” in their cultural context, i.e., accumulation of financial resources. Structural vulnerability – being situated in an inferior position when facing structural discrimination – made access to affordable mental health services challenging. As such, structural discrimination increased healthcare spending and interfered with financial accumulation, often resulting in future treatment nonadherence and enforcing mental health disparities. Study participants' internalizing their structurally-vulnerable position further led to a depreciated sense of self, resulting in a reduced capacity to advocate for healthcare system changes. Paradoxically, the multi-layered structural marginalization experienced by Chinese immigrants with mental illness allowed those who maintained capacity to work to retain social status even while holding a mental illness status. Mental health providers may prioritize work participation to shift service users' positions within the hierarchy of structural vulnerability.

Abstract To determine the lifetime prevalence and diverse profiles of types of childhood maltreatment (CM) in a high-risk clinical sample using standardized assessment tools (Child Trauma Questionnaire, CTQ) in China, Shanghai, 2090 subjects were sampled from the Shanghai Mental Health Centre. Personality disorder (PD) was assessed using the Personality Diagnostic Questionnaire (PDQ-4+) and subjects were interviewed using the Structured Clinical Interview (SCID-II). \{CTQ\} was used to assess \{CM\} in five domains (emotional abuse, EA; physical abuse, PA; sexual abuse, SA; emotional neglect, EN; and physical neglect, PN). The prevalence estimate of \{EA\} in the sample is 22.2%, followed by 17.8% of PA, and 12.5% of SA. The prevalence estimate was more frequent in \{PN\} (65.0%) and in \{EN\} (34.0%) than in childhood abuse (EA, \{PA\} and SA). It seems that males reported more \{PA\} and females reported more SA, the older subjects reported more neglect and the younger subjects reported more abuse. There was a higher prevalence of \{EA\} and \{SA\} in borderline \{PD\} patients (44.4%, 22.5%), \{PA\} in antisocial \{PD\} patients (38.9%). Multi-PD patients reported more forms of \{CM\} in childhood. Additionally, factor analysis of \{CTQ\} items confirmed factorial validity by identifying a five-factor structure that explained 50% of the total variance. These findings support the view that prevalence of \{CM\} was commonly experienced in clinical population during their childhood, especially for subjects with PDs. Factorial validity in \{PN\} needs to be further improved, and can in part be culturally explained.