Social Determinants of Mental Health Among Asian Americans: Did COVID-19 Make a Difference?

Background and Purpose: Previous studies have substantiated that mental health is determined not only by biological and psychological factors, but also to a great extent by the social determinants of health. Therefore, it is imperative to clearly understand the social, environmental, and political factors that affect mental health. It is also important to reduce the longstanding disparities in mental illnesses and mental health care, and consider racial differences and minority status when addressing the social determinants of mental health. Although Asian Americans are one of the fastest growing racial groups in the United States, little research has been undertaken on the social determinants of mental health in this particular population. This study examines the social determinants of mental health identified as critical factors that impact Asian Americans' mental health by considering potential impacts of the COVID-19 pandemic.

Methods: In collaboration with a major multiservice agency serving Asian American ethnic subgroups in New York City, we analyzed the data from their social determinants of health questionnaires. Out of 8,286 participants who completed the questionnaire between the years 2019 to 2022, 1,428 who identified as Asian were included in the analysis. The data included measures of the symptoms of mental health problems and social determinants. These analyses focused specifically on identifying the differences in mental health conditions and social determinants before and after the outbreak of COVID-19. Finally, the study examined the impact of each identified social determinant on the mental health of Asians and sought to verify whether the outbreak of COVID-19 made a difference in their health.

Results: The data suggested there was a significant rise in potential mental health problems among Asian Americans after the pandemic. While 27.1% of the respondents reported having symptoms of depressive or anxiety disorders before the pandemic, 47.1% showed symptoms of these disorders after the outbreak of COVID-19 (χ²=61.293, p<.001). The multiple logistic regression showed that Gender (‘being female’; Exp(B)=1.557, p<.001), Housing Insecurity (Exp(B)=2.744, p=.012), Job Insecurity (Exp(B)=2.621, p<.001), and Exposure to Violence (Exp(B)=4.400, p<.001) were significantly associated with having mental health symptoms. There was no meaningful difference in the impact of the social determinants of mental health before and after the COVID-19 outbreak. Especially, ‘exposure to violence’ was the strongest factor for mental health problems, regardless of the pandemic. It is also important to note that the rate of exposure to violence has significantly increased from 3.2% before the pandemic to 5.3% after the pandemic (χ²=4.612, p=.032).

Conclusions and Implications: These findings indicate that Asian Americans’ mental health problems have significantly increased following the pandemic. Although there was no noteworthy difference caused by the pandemic, this study did identify significant social determinants that can affect the risks of mental health among Asian Americans. This result suggests the importance of addressing specific social structural hardships among Asian Americans so as to promote their better overall mental health conditions. Especially, practical and immediate steps are needed to respond more effectively to the increased violence against the Asian American community in the middle of any pandemic.