Access to mental health treatment is often negatively impacted by cultural bias. This may relate to non-acceptance of psychiatric diagnoses as true illnesses, perceived shame by patient or family, or even fear of ostracism. As a result, treatable patients remain untreated with unnecessary morbidity, direct costs, indirect costs, and potential mortality. This case addresses depression and overdose in a Chinese patient.

Case analysis with literature review.

20-year-old Chinese single female was admitted for multidrug overdose (zolpidem/acetaminophen/clonazepam). When seen in psychiatric consultation, patient met DSM-IV criteria for Bipolar Disorder NOS, Anxiety Disorder NOS, and Polysubstance Dependence and was upset that overdose was unsuccessful. Patient described how parents were focused on performance success and would not accept her emotionality or depression stating “Depression, failure and suicide are not acceptable in China.” Patient summarized parental response to overdose: “they threw me in the basement with a basin where I kept vomiting for one day…then they thought that it was serious enough. They would come to the basement periodically and ask why I couldn't stop crying. They said it was my fault.” Mother instructed medical team patient needed to “sleep, eat, and exercise” and insisted patient be told she was responsible for hospital bill and her decision. After treatment with N-acetylcysteine, elevated transaminases stabilized and the patient was transferred to an inpatient psychiatric hospital.

Cultural themes focusing on success and lack of acceptance of psychiatric illness can lead to increased morbidity and potential mortality.