Relationship between Mental Health Condition and Self-Rated Mental Health in Asian Americans: The Moderating Role of Acculturation

Background and Purpose: A growing body of literature suggests that the single-item self-rated mental health (SRMH) is a valid indicator of one’s mental health. Studies report close associations of SRMH with psychological symptom measures and diagnosis of mental disorders. In use of SRMH in diverse populations, one interesting finding is that individuals with racial/ethnic minority backgrounds show a weaker association between SRMH and mental health measures compared to non-Hispanic Whites. Given that the ways in which individuals perceive and evaluate their own mental health may vary by race, ethnicity, and culture, the present study focused on Asian Americans and examined how their SRMH would be impacted by mental health conditions and acculturation. We hypothesized that the effect of mental health conditions on SRMH would be modified by the level of acculturation. We anticipated that Asian Americans with high levels of acculturation would have a stronger association between SRMH and mental health conditions than their counterparts with lower levels of acculturation.

Methods: Data came from the 2015 Asian American Quality of Life survey conducted in central Texas. The sample includes 2,609 self-identified Asian Americans aged 18 or older. Regression models of SRMH were examined with the following sets of predictors: (1) background variables (age, gender, marital status, education, ethnicity, years in the U.S., and chronic medical conditions), (2) mental distress (measured with the Kessler 6, alpha = .88), (3) acculturation (measured with two items on English-speaking ability and familiarity with the mainstream culture, alpha = .72), and (4) interaction between mental distress with acculturation.

Results: After controlling for the effects of the background variables, mental distress was found to be a significant predictor to SRMH. Mental distress accounted for 13% of the variance; greater levels of mental distress were associated more adverse SRMH. An additional 4% of the variance was explained by acculturation; higher levels of acculturation were associated with more positive SRMH. Finally, the interaction between mental distress symptoms and acculturation was significant. When the sample was divided into a low acculturation group (acculturation score < 6 (median), n = 1031) and a high acculturation group (acculturation score ≥6, n = 1544), the former group showed a weaker association between mental distress and self-rated mental health (r = .27, p <.001) than the latter group (r = .41, p <.001), and the difference between the two correlation coefficients was statistically significant (z = -3.94, p <.001). The finding suggests that Asian Americans with low levels of acculturation are less likely recognize their mental health symptoms and perceive them as the needs for mental health care.

Conclusions and Implications: This study demonstrates both independent and interactive effects of mental distress and acculturation on SRMH. Findings suggest intervention efforts should attend to Asian Americans with low acculturation. For example, psycho-educational programs that are tailored to their cultural and linguistic needs would be helpful for promoting their knowledge and awareness of mental health issues.