Sociocultural Factors and Mental Health Service Utilization of Asian Americans

Purpose: While Asian Americans (AA) make up the fastest growing racial/ethnic minority group in the United States, studies have highlighted the unmet service needs and use in their mental health. Much research on racial/ethnic disparities in mental health service use adopted the framework of Andersen’s Behavioral Model (ABM), categorizing the barriers into predisposing factors (such as sex, age, education, or perceived discrimination), enabling factors (such as health insurance coverage or income), and need factors (such as clinical status, subjective mental health). Meanwhile, the unique sociocultural aspects relevant to AA were overlooked. In response to this call for action, this study explored the role of sociocultural factors in mental health service utilization. As Asian Americans are consisted of subgroups with heterogeneous cultural/ethnic heritages and historic background, group variation was addressed as well.

Methods: The study used the National Latino and Asian American study, the first national epidemiological household survey that collected information on the mental health service use in the AAs. Accounting for the impacts of the predisposing (demographics, discrimination, acculturation stress), need (self-rated mental health), and enabling factors (English proficiency, income and insurance)’ under ABM, the contributions of sociocultural factors (racial/ethnic identity, family cohesion, social support, and religiosity) to the utilization of mental health services among Chinese, Vietnamese, Filipinos and other Asian subgroups (N=2095) were explored. Two step logistic regression analysis was conducted for each subgroup.

Results: Overall, the variables of major interests and the controlled variables showed different pattern of relationships among different subgroups. In the first step of the logistic regression analyses, high self-rated mental health predicted higher chance of using mental health services in every subgroups. However, for Vietnamese, English Proficiency and discrimination were also found to have significant impacts. In model 2, after the impact of the sociocultural factors varied among different subgroups. Chinese showed lower chance of using mental health services when having higher level of racial/ethnic identity and lower level of social support. While the effect of social support was consistent, family cohesion was a very strong predictor for mental health service utilization in Filipinos, instead of racial/ethnic identity. Family cohesion was the only significant sociocultural factor in Vietnamese and other Asian American subgroups.

Conclusion and Implications: Compared to the mental health services utilization studies of other racial/ethnic groups, the findings of this study underlines the necessity of cultural competent approach for this issue. First of all, many of the strong predictors verified in Whites and African Americans did not have significant impact on the mental health service use of AAs. In addition, the unique impact of some predictors requires explanation according to sociocultural contexts. Lastly, the inconsistent findings by subgroups suggest avoiding a uniform approach to increase mental health service utilization for the whole population.

Keywords: mental health service use; racial/ethnic identity; family cohesion; religiosity; discrimination and acculturation stress; sub-cultural differences; Asian American subgroups, NLAAS