Behavioral Health Service Use Among First-Generation Emerging Adult Immigrants: Implications for Higher Education Policy and Practice

Background and Purpose

Although transitioning to adulthood may provide many growth opportunities, emerging adults often face challenges in educational and professional pursuits. These challenges are even more pronounced for first-generation immigrant college students. They can face economic barriers, immigration issues, and cultural identity stressors, all of which may hinder their well-being and pursuit of higher education. Some of these barriers may be ameliorated by mental health treatment, but this raises questions about their access to services—including their willingness to seek help.

Prior research investigating emerging adults’ behavioral health help-seeking has largely been limited to homogeneous convenience samples of college students and assessment of attitudes or willingness to seek treatment rather than actual service utilization. These gaps were addressed by examining factors associated with behavioral health service use across a diverse national sample of emerging adults that allows us to compare first-generation and U.S.-born populations.

Methods

A subsample of emerging adults (N = 6,696) from the 2012 Agency for Healthcare Research and Quality Medical Expansion Panel Study were used to identify predictors of behavioral health service utilization. Hierarchical binomial logistic regression analyses were performed to determine which factors (predisposing, enabling, and need) predicted patterns of behavioral health service use among first-generation and U.S.-born emerging adults. Predisposing factors included demographic (e.g., age, gender) and social structure variables (e.g., education, employment). Enabling factors included poverty level, health insurance coverage, and region. Need factors included perceived mental health status and psychological distress. 

Results

Emerging adults had a mean age of 23.46, about 4% used services in the past year, 56% identified as non-Hispanic White, and 15% were first-generation immigrants. Employed (immigrant first-generation) and non-Hispanic Black (U.S.-born) emerging adults were less likely to use behavioral mental health services compared to unemployed and non-Hispanic White emerging adults, respectively. Having insurance for U.S.-born emerging adults was associated with service use. Having higher self-perceived mental health status and higher general mental health status predicted less service use for both groups.

Conclusions and Implications

Consistent with prior research, findings suggest overall low behavioral health service use among emerging adult populations. Although certain factors were consistently predictive of behavioral health service use among emerging adults, there were differences for first-generation immigrants that necessitate further research. Greater awareness and consideration of factors that increase emerging adults’ service use on health reform as well as college campus-based policies and interventions targeted at increasing access to services for immigrant student populations are needed, especially as they relate to promoting health and education equity.