Chinese-, Korean-, and Vietnamese-American Women with Traumatic Event History Do Not Seek Mental, Physical, and Sexual Healthcare

Background and Purpose:  Exposure to traumatic events, such as sexual or physical assaults, increases the risks of PTSD, depression, and long-term behavioral consequences. Appropriate and timely health care utilization is necessary to treat and to prevent the devastating consequences of trauma. However, few studies have examined the relationship between trauma history and healthcare utilization among young Asian American women. This study aims to (1) document the prevalence of different types of trauma history and (2) to examine how different types of trauma are associated with outpatient mental health use, HIV testing, and failure to seek needed health care.

Methods:  We used cross-sectional data collected from 173 unmarried Chinese-, Korean-, and Vietnamese-American women (aged 18-35 years) who were screened for the eligibility to participate in the development and efficacy of Asian American Women’s Action for Resilience and Empowerment (AWARE), a group psychotherapy intervention. We measured five dimensions of lifetime trauma history using the Traumatic Life Events Questionnaire (TLEQ) (categories shown in Results). Healthcare utilization was assessed in three dimensions: (a) outpatient mental health care and counseling in the last year and last 5 years; (b) lifetime HIV testing; and (c) failure to receive needed medical care in the last year. The prevalence of traumatic event types was documented, and associations between trauma history and healthcare-seeking behavior were examined using logistic regression.

Results:  Ninety percent (n = 155) of participants reported having experienced some type of trauma. These include sudden death of a loved one (40%), childhood physical assault (49%), childhood sexual assault (30%), adult physical assault (27%), and adult sexual assault (20%). In contrast, we found relatively low health care utilization rates, with outpatient mental health service utilization rate of 23% in the past 12 months and 35% in the past 5 years and 44% reporting lifetime HIV testing. Additionally, 38% reported failure to receive needed medical care. Logistic regression models, controlling for age, family income, and sexual orientation, revealed that all 7 categories of trauma history were not significantly associated with outpatient mental health utilization. Adult physical assault history was associated with higher odds of failure to seek needed health care (OR = 2.2; 95% CI 1.03 - 4.76). Childhood sexual assault history was negatively associated with lifetime HIV testing (OR = 0.34, 95% CI 0.13 - 0.85).

Conclusions and Implications:  Our study shows that young Asian American women who sought to participate in the AWARE intervention had substantially high prevalence of trauma experience in all categories. However, healthcare utilization was poor across mental, physical, and sexual health dimensions. Even after controlling for other predisposing and enabling factors, there was no association between any type of trauma history and outpatient mental health use. This demonstrates a clear gap and potential barriers between healthcare need and utilization. Future research should seek to elucidate the cultural, familial, social, and systemic barriers against healthcare utilization for Asian American women with trauma history.