Predictors of Mental Health Service Use and the Mediating Role of Stigma Among Filipino and Korean American Young Adults

Purpose: Asian American(AA) young adults report high rates of mental health distress but underutilize mental health services. The culturally infused engagement model suggests that multi-level individual and contextual factors may influence the actual mental health seeking behaviors through perceived public stigma toward mental health service use (herein referred to stigma). However, limited studies have explored these mediating mechanisms with AA young adults. More importantly, few have investigated culturally anchored processes of help seeking that are alternative to the dominant biomedical framework of mental health seeking. To fill these gaps, this study will examine whether stigma mediates the relationships between a set of predictors of the past-year mental health service use that are organized into three factors related to individual mental health status (depressive symptoms), ethnic-cultural values (saving face regarding family matters), and racially minoritized status (model minority stereotype and perpetual foreigner stereotype).

Methods: Data are from the Midwest Longitudinal Study of Asian American Families that survey-interviewed Filipino American (FA) and Korean American (KA) families in the Midwestern U.S. The first wave was collected in 2014 from 378 FA and 408 KA youth (M_age=15, female=51.2%). Retention rates were 77% of Wave 1 at Wave 4 in 2022 (N=612, M_age=21.3, female =53.7%). This study used first and fourth waves of youth data. Adjusting for control variables (age, nativity, biological sex, English proficiency, and family socio-economic status), we examined a mediating effect of stigma in the link between multi-layered contextual predictors and mental health service use across AA ethnic subgroups.

Results: For FAs, the effects of depressive symptoms and internalized model minority stereotype on the past-year mental health service use were significantly mediated by stigma. That is, depressive symptoms (b=0.26, p<.001) and internalized model minority stereotype (b=0.24, p< .05) were associated with more stigma, which in turn predicted fewer mental health service use (b=–0.7, p<.05). For KAs, depressive symptoms, saving face, and internalized model minority stereotype were directly, but not indirectly, associated with the past-year mental health service use. Specifically, depressive symptoms were related to more mental health service use (b=1.0, p< .001), whereas saving face (b= –0.84, p<.05) and internalized model minority stereotype (b=– 0.49, p<.05) were related to less frequent mental health service use in the past year.

Conclusions and Implications: The comprehensive approach in this study points to the need for intervention efforts to go beyond targeting individual or familial level factors, which has largely been of focus in the field. More importantly, we found differential mechanisms linking the individual and contextual factors to mental health service use across AA ethnic subgroups. For example, stigma seems to be a particularly important intervention target for FAs, but not for KAs, as all the significant predictors of mental health service use were mediated by stigma only among FAs. This study highlights the importance of data disaggregation for AAs and the significance of group specific interventions to be effective in addressing unmet mental health needs in AA communities.