Factors Associated with Mental Health Service Use Among Latino and Asian Americans

Background: Current literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans.  Both are immigrant communities who may possess commonly identified barriers to accessing existing mainstream MHS, such as cultural differences, limited English proficiency, and lack of culturally sensitive services available for their communities.  This study aims to use Andersen’s model of health service access to examine whether Latinos and Asians have indeed different factors facilitating or preventing the MHS use.

Methods: Data from the National Latino and Asian American Study (NLAAS) were analyzed.  The NLAAS survey used a national area probability sampling frame to recruit participants representative of the population according to 2000 Census.  Interviews were conducted in respondents’ preferred language using a computer-assisted instrument in person or over the telephone. This study selected three Latino ethnic groups (Cuban, Mexican, and Puerto Rican; n=1896) and three Asian Ethnic groups (Chinese, Filipino, and Vietnamese; n=1589) from the data to examine the association among predisposing (socio-demographics), enabling (ethno-sociocultural), and need (mental health) factors based on Andersen’s model of health service access.  The outcome measure was MHS use in the past 12 months for any mood, anxiety, or substance-related disorders.  Sequential logistic regressions were used to examine factors associated with the use of MHS for overall sample, and Latino and Asian groups separately. Weight variable was used to take into account multi-stage probability sample selection and to correctly estimate standard errors. 

Results: The results from overall analyses indicated that all predisposing factors (older age, female, Latino, and high education) were associated with significantly higher odds of MHS use, and an enabling factor (having health insurance) was associated with significantly higher odds of MHS use. Of need factors, having any DSM-IV diagnosis and high psychological distress were associated with significantly higher odds of MHS use, while high self-rated mental health status was associated with significantly lower odds of MHS use, after controlling for other factors in the model. Separate analyses by racial subgroup revealed that Latinos and Asians have different predisposing and enabling factors associated with MHS use, even after controlling for mental health need factors. For instance, education and health insurance were associated with Latinos’ MHS, while ethnicity and nativity were associated with Asians’. Interaction analyses between nativity status and ethnicity further revealed that effect of nativity status was only significant for Filipinos.

Implications: Latino and Asian Americans seem to have similar barriers to MHS use as immigrants (e.g., education and insurance), but they also appear to have different predisposing and enabling factors associated with their likelihoods of MHS use. These results suggest that while addressing common barriers to MHS use across immigrant communities might be a powerful public health approach, racial and ethnic differences need to be considered to improve the effectiveness of the approach. Finally, future research needs to explore characteristics of MHS organizations that increase the likelihood of MHS utilization by these cultural and linguistic minorities.