Deos Residence of State Matters? State Factors Influencing Immigrants' Use of Mental Health Care

Background: Immigrants' good health selection is widely recognized, however, this selection effect does not retain over time during their length of residence in the United States (Frisbee, Cho, & Hummer, 2001). One of the reasons could be explained by immigrants' under use of mental health services compared to U.S.-born citizens. While prior literature identifies various individual barriers, contextual influence, particularly state factors have not been widely examined. Adapted from Andersen’s Behavior Model of Health Service Use, this study examines the associations between state factors (state-funded health programs for immigrants and state immigrant concentration)and immigrants ‘mental health care use after controlling for individual-level factors among Latino and Asian immigrants, the major growing immigrant populations. This study further examines whether the associations of mental health service use are moderated by immigrants’ citizenship statuses and their race and ethnicity.

Methods:Data were obtained from the public and restricted data set of the National Latino and Asian American Survey (NLAAS), which consists of a sample of 4,254 Latino and Asian immigrant adults from 18 to 64 years of age living in the U.S. household across 50 states during 2002 and 2003. Binary logistic regression models were estimated to address the questions above based on a final sample of 2,942. Sampling weights, strata and cluster variables were applied.

Results:Findings from the study indicated that immigrants who were male, younger (18-30 years old), married, or living in poverty were more likely to receive counseling or therapy after adjusting for individual-level factors. Those who were employed, Asian immigrants, naturalized citizens or those who perceived to have excellent health and mental health condition had greater odds of seeking mental health professionals’ help. Immigrants who lived in states with moderate immigrant concentration (10-14.9%) had 3.64 times greater odds for receiving mental health care than those who lived in non-traditional immigrant states. Community cohesion and living in states that offered state-funded health programs to immigrants had no effect on immigrants’ mental health care use after controlling for individual-level factors.

In the analyses for the interactions between citizenship status and state immigrant concentration, naturalized citizens who lived in states with a higher percentage of immigrants (15-19%) were nearly 20 times more likely to receive counseling than their US-born counterparts. In the interactions between race/ethnicity and state concentration of immigrants, compared to Latino immigrants, Asian immigrants’ odds for going to counselors or therapists decreased by 90% when they lived in states such as Illinois, Arizona, Washington, and DC (10-14.9% of immigrants). Neither of the interactions, between citizenship status and state generosity or race/ethnicity and state generosity, were significant.

Conclusion and Implications: The current study makes contributions to understanding state context's influence on immigrants' mental health care use. The findings also identify how citizenship status and race/ethnicity differences could buffer Asian and Latino immigrants' use of therapy or counseling in state contexts and how practitioners could respond to this disparity of access from a socio-cultural and structural approach.