Nonspecific Psychological Distress Among the Three Largest Asian American Subgroups: Social Determinants of Health Approach

Background: Although Chinese-, Filipino-, and Asian Indians are the three largest Asian American subgroups in the United States, there is a lack of information on comparing psychological distress across the three Asian American subgroups Using the social determinants of health (SDH) and acculturation framework, this study is to examine similarities and differences in SDH and acculturation factors associated with psychological distress among these three ethnic subgroups.

Methods: To evaluate psychological distress in the three subgroups, we analyzed a sample of 6,431 Asian Americans from the 2011-2015 National Health Interview Survey (NHIS).The NHIS is a nationally representative sample of adults at 18 years or older and covers psychosocial distress (K6 scale), SDH factors (poverty, employment, food security, built environment, education, and health insurance), acculturation, and demographics. Odds ratio and 95% confidence intervals from logistic regression modeling were used to examine factors associated with psychological distress.

Results: More than one-tenth (11%) of the sample have reported psychological distress (cut-off = 5 or above). The Filipino American subgroup has the highest levels (12%), followed by Chinese American (11%) and Asian Indian American (9%) subgroup. With respect to SDH factors, single marital status and unemployment were common predictors of psychological distress across the three subgroups. Food insecurity was a unique predictor among Chinese Americans; living in Northeast regions, less than high school education, and being non-U.S. citizens were unique predictors among Filipino Americans; and being older was a unique predictor among Asian Indian Americans.

Conclusions and Implications: Although Asian Americans have reported substantially lower psychological distress, intragroup discrepancies in psychological distress have existed. As the differences in psychological distress are multifaceted, a multi-sectoral approach addressing the SDH and acculturation factors is needed to tackle psychological distress across the subgroups (e.g., job training, improving food security, assisting issues relating to non-US citizenship status). It requires increased collaboration among public, private, and non-profit sectors and various stakeholders, including state and local agencies.