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Background: First-generation Korean American elderly immigrants face a growing mental health burden, characterized by high levels of psychological distress and low utilization of mental health services. However, this population remains underrepresented in research. Several factors may be contributing to this gap. Language barriers can make participation in research as well as access to care more challenging. Cultural stigma regarding mental health, along with traditional Korean values emphasizing emotional restraint, may impact individuals to internalize distress rather than openly express it, making symptoms less visible. Finally, current Western diagnostic frameworks may not fully capture the culturally specific expression of distress, such as the tendency for depression to present through somatic symptoms. Thus, even when care is sought, symptoms may go unrecognized. These factors contribute to a lack of research focused on first-generation Korean American elderly populations, leading to limited understanding of culturally aligned mental health interventions.

Methods: This narrative review addresses this gap by examining structural, cultural, and linguistic barriers to mental health care in this population and evaluating therapeutic letter writing as a potential intervention. Relevant literature was identified through database searches of PubMed and Google Scholar using terms such as “Asian American,” “Korean American,” “first-generation,” “mental health,” “somatization”, and “letter writing.”

Results: Prior studies show that therapeutic letter writing can reduce symptoms of shame, anxiety, depression, and interpersonal distress between generations. However, most of this research has been conducted in younger, non-immigrant populations, limiting its applicability to older immigrant groups with unique and more nuanced cultural backgrounds.

Conclusions: Therapeutic letter writing may represent a cost-effective and culturally appropriate approach that aligns with traditional Korean values of introspection and indirect emotional expression, which first-generation elderly immigrants often carry. This paper argues that providing space for self-reflection and intergenerational communication may help reduce stigma and promote culturally appropriate mental health support. Further research is needed to evaluate its effectiveness in first-generation Korean American elderly populations and to explore its potential as a community-building intervention that fosters shared understanding and connection.