The Impact of Cultural and Structural Barriers on Mental Health Service Utilization Among Asian American Young Adults

Background: Despite reporting mental health needs comparable to those of Whites, Asian Americans (AAs) are the least likely of all racial groups to seek mental health services. This low utilization rate is attributed to various factors, including limited access to services, economic or financial constraints, cultural stigma surrounding mental health, language barriers, and a lack of culturally appropriate services. Previous research has primarily focused on the independent effects of cultural beliefs and structural barriers on mental health service utilization among AAs. However, there has been limited examination of the interplay between these factors. This study aims to explore the relationship between cultural and structural barriers and their impact on the help-seeking attitudes and behaviors of AA young adults.

Method: This study analyzes data from a sample of 254 Chinese American young adults recruited for a larger study on mental health help-seeking behaviors. An online survey was administered to assess the impeding effects of cultural barriers (e.g., not discussing mental health, hiding distress, enduring distress, internalizing stigma, denial, inaction) and structural barriers (e.g., mistrust of service providers, concerns about racial discrimination, cost burdens, transportation difficulties, challenges in establishing connections) on mental health service utilization. Stepwise regression models were used to assess (1) the independent effects of cultural and structural barriers and (2) the interaction effects (cultural x structural barriers) on attitudes toward seeking professional psychological help.

Results: Preliminary analysis indicated that perceived structural barriers were negatively associated with attitudes toward seeking professional help. In the interaction model, the presence of cultural barriers intensified the negative impact of structural barriers on these attitudes. For instance, the adverse effect of mistrust in mental health service providers on attitudes toward seeking mental health services was more pronounced among individuals exhibiting higher levels of denial. Similar patterns were observed with other structural barriers, such as concerns about racial discrimination by service providers and the financial costs of using mental health services.

Conclusion and Implication: The study's findings suggest that addressing both cultural and structural barriers are crucial to promoting mental health service utilization among Asian Americans. Clinical interventions should focus on these areas to increase access to mental health services. Given that AA are often viewed as a "model minority" with high achievement and unrestricted mobility, it is especially important to address structural barriers to mental health services when serving AA young adults.