Mental Health Help-Seeking Among Asian Older Adults in the United States: A Scoping Review

Background and Purpose: Help-seeking plays a critical role in maintaining and improving older adults’ health and mental health. Among older adults (65 years+) in the United States (U.S.), Asians are projected to increase by 93% between 2020-2040. Compared with their white counterparts, Asian older adults have equivalent rates of experiencing mental health challenges but lower frequencies of seeking formal help from health professionals. Although some studies suggested that Asian older adults prefer seeking informal mental health support from family and friends, few systematic syntheses examined Asian older adults’ mental health help-seeking behavior within and beyond the healthcare system. Additionally, the information on factors contributing to Asian older adults’ help-seeking patterns remains fragmented. To address these gaps, this scoping review adapts the Health Belief Model to examine: (1) How Asian older adults’ mental health help-seeking has been operationalized in the existing literature; (2) What predisposing, psychological, structural factors, and interpersonal cues to action have been associated with mental health help-seeking among different groups of Asian older adults. Methods: Guided by the Joanna Briggs Institute (JBI) Reviewer’s framework for scoping reviews, a systematic literature search was conducted using PsycINFO, SOCindex, CINAHL, and AgeLine. Only peer-reviewed original studies on Asian older adults conducted in the U.S. and published in English after 2010 were included. The reporting of this scoping study adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Results: Of our initial 2800 references, we assessed the full texts of 132 articles. Ten studies on mental health help-seeking among Asian older adults were included. Eight studies included Chinese, five included Korean, six included Filipino or Vietnamese older adults; three included Japanese older adults, and one included those from India, Bangladesh, Bhutan, Cambodia, Indonesia, Pakistan, Singapore, Sri Lanka, and Thailand. Eight studies measured formal mental health help-seeking from psychologists, psychiatrists, social workers, spiritual leaders, and primary care providers. Two studies measured informal mental health help-seeking from family, friends, colleagues, and neighbors. All included studies examined the predisposing factors (e.g., demographics, acculturation) of mental health help-seeking. For example, female Chinese older adults were more than twice as likely to seek help informally than male Chinese older adults. Similarly, all ten studies examined psychological factors (e.g., psychological distress, stigma). For instance, viewing depression as a family shame was negatively associated with seeking help from healthcare professionals among older Koreans. In contrast, only three included studies examined structural barriers: lack of interpretation services and health insurance. Moreover, high-quality social support was an interpersonal cue to action that facilitated both formal and informal mental health help-seeking. Conclusions and Implications: Practitioners and researchers shall further recognize and evaluate alternative mental health support (e.g., spiritual leaders) as well as informal help from family and friends. Enhancing Asian older adults’ social networks can promote formal and informal mental health help-seeking. More studies should examine how structural factors (e.g., model minority myth, ageism) within and beyond the healthcare system shape the mental health help-seeking among Asian older adults in the U.S.