Social Determinants of Self-Rated Mental Health in Asian Americans: The Role of Immigration, Family, and Community Factors

Background and Purpose: Self-rated mental health (SRMH) measures a person’s mental health status by asking “How would you rate your mental health at the present time?” Although the single-item SRMH measure is known to be a critical indicator of mental health, relatively little attention has been paid to its associated factors. Responding to the rapid growth of Asian American population and increased prevalence of mental health issues, this study aimed to examine the factors associated with SRMH in diverse ethnic groups of Asian Americans. Inspired by the model of social determinants’ of health, the focus was placed on the role of immigration, family, and community factors.

Methods: Data were drawn from the 2015 Asian American Quality of Life survey which included a total of 2,609 self-identified Asian residents in Texas aged 18 years or older. Taking culturally and linguistically sensitive approach, data were collected from six ethnic groups: Chinese (n=640), Asian Indians (n=574), Koreans (n=471), Vietnamese (n=513), Filipinos (n=265), and other Asian group (n=146). Also, nearly half (48.5%) of the sample completed the survey using their native language. Logistic regression model of SRMH (fair/poor rating) was estimated with immigration-related variables (length of stay in the U.S., English proficiency, and acculturation), family-related variables (family network and solidarity), community-related variables (community cohesion and safety). The analyses were performed after controlling for the effects of demographic and health variables (age, gender, marital status, education, ethnicity, financial status, chronic health condition, and mental distress).

Results: While the level of mental distress was high (more than 44% of the sample scored 6 or higher in Kessler 6 scale), only about 9% rated their mental health either as ‘fair’ or ‘poor.’ With regard to immigration-related variables, a low level of acculturation increased the odds of reporting a fair/poor SRMH by 1.6 times. As for the family factors, family solidarity significantly reduced the odds of reporting a fair/poor SRMH. None of the community-related variables reached statistical significance. Ethnic variations were also observed: compared to Chinese, Asian Indians, Vietnamese, and Filipino had reduced odds of reporting a fair/poor SRMH.

Conclusions and Implications: Findings highlight the significant impact of immigration and family related factors on SRMH in Asian Americans. Considering the substantial proportion of the foreign-born in Asian Americans and their family-oriented culture, interventions and services to promote Asian Americans’ mental health should incorporate these contextual factors. Also, the discrepancy between mental health status and SRMH calls attention to the gap between objective and subjective status of mental health. Closing such gap should be prioritized in efforts to promote the awareness of mental health issues and timely access to mental health services among Asian Americans.