Lay Experiences of Mental Health: Assessing Culturally Ground Responses to Mental Distress and Help Seeking Among Asian American Young Adults

Introduction: Despite apparent clinical need, Asian Americans are the least likely, of all racial and ethnic groups, to seek mental health care. While there are numerous reasons for poor engagement in mental health services, culturally construed understandings of mental distress may be one primary factor that contributes to this underutilization. Within Asian cultures, mental health issues are often considered counter cultural, and individuals with mental health struggles may be stigmatized, perceived as weak, morally fallen, and damaged. These culturally based views likely influence how Asian American young adults respond to their own experiences of distress and help seeking. Yet, current conventional measures of mental health fail to adequately assess culturally derived experiences of mental health. To address this gap, we developed a new measure of culturally derived response to mental distress, drawn from community voices of Asian American youth, parents, and grandparents, gathered through focus groups. The new measure was then tested and validated in a sample 486 Asian American young adults.

Method: This study examined cross-sectional data on a newly developed measure of cultural illness response socialization from a sample of 486 Asian American young adults (Mean Age 21.12 years, Female 54.12%). The sample was randomly split into two subsamples for factor analyses. Exploratory factor analyses were conducted with Sample 1 (n=243).Confirmatory factor analyses were then conducted with Sample 2 (n=241) on the 6-factor model that was derived from the EFA. To determine concurrent validity, bivariate correlations and linear and hierarchical regression analyses were performed to examine associations with attitudes towards professional help seeking.

Result: The EFA with Sample 1 (n=243) indicated that a 6-factor solution demonstrated adequate fit. The 6 factors are: silencing distress, hiding mental distress from others, enduring and tolerating distress, internalization of mental health stigma, denial of distress, and ignoring distress. Using Sample 2 (n=241), CFA confirmed that a correlated six-factor model fit the data well. All six scales were positively associated with stigma towards mental illness and negatively correlated with attitudes towards seeking professional help. Linear regressions with each individual factor indicated that all factors except for hiding mental distress from others was associated with less positive attitudes to seeking help. Finally, hierarchical regressions including all 6 factors revealed that two factors (silencing distress and enduring/tolerating distress) were related to less positive attitudes towards help seeking above and beyond the effects of stigma attitudes and young adult mental health symptoms.

Conclusion: The current findings suggest that the new measure of culturally derived response to mental distress is a valid and reliable measure of assessing the culturally grounded lived illness experiences of Asian American young adults. The positive associations between young adult cultural responses to distress (enduring distress, silencing distress) with stigma and attitudes towards seeking professional help highlight the importance of understanding community-informed, culturally determined responses to mental health problems. Our findings have significant implications for practice, particularly the need to consider community driven responses to mental health in the development and implementation of interventions with Asian American communities.