Premature Treatment Dropout Among Asian American Adults in Community Mental Health Centers

Background and Purpose: Growing evidence indicates that Asian American (AA) adults are at higher risk of mental health (MH) problems but least likely to receive MH treatment among all racial/ethnic groups in the U.S. The underutilization of MH services among AA adults is exacerbated by their tendency to withdraw prematurely from treatment. Although minority status has historically been associated with premature termination of MH treatment, little is known about patterns and predictors of this trend among Asian Americans. This study aims to clarify the mechanism underlying AA adults’ premature termination of MH treatment.

Methods: In collaboration with a major multiservice agency serving diverse racial/ethnic populations in New York City, we analyzed the archived electronic health records for clients of community mental health clinics with treatment ending during the years 2017 through 2019. The sample was cleaned to avoid sparsity. For each client, we only considered their first episodes of care to avoid duplicate, resulting in a dataset of client treatment episodes (n=1240) with 30 variables relating to demographics, diagnoses, and providers visited. Logistic regression was used to identify predictors of a binary treatment completion outcome, i.e., noncompliance or achieving goals.

Results: Factors that helped AA clients achieve treatment goals included client-clinician ethnicity matching (OR = 0.421, p = 0.013), a client being younger than 65 years old (OR=0.599, p = 0.002), and having every additional visit with a social worker (OR = 0.74, p < 0.001). Factors related to noncompliance (i.e., early dropout from treatment) included clients having diagnoses of mild hallucinogen use-disorder (OR = 7.028 , p = 0.001), other specified depressive disorders (OR = 2.621, p = 0.014), generalized anxiety disorder (OR = 2.519, p = 0.013), oppositional defiant disorder (OR = 6.252, p = 0.006), having Medicaid (OR = 2.616, p = 0.048), and having every additional visit in total (OR = 1.308, p < 0.001) inclusive of all staff (social workers, nurse practitioners, prescribers, etc.).

Conclusions and Implications: Findings show that Asian Americans have idiosyncratic protective factors that facilitate treatment adherence, as well as vulnerability factors that contribute to premature treatment termination from community-based mental health services. Community mental health programs should develop culturally sensitive interventions to address early treatment dropouts and improve mental health outcomes among Asian Americans.