Stigma, Sense of Belonging, and Help-Seeking Among East Asian Students

Background and Purpose: Despite high levels of psychological distress, East Asian postsecondary students—both domestic and international—seek professional mental health support at significantly lower rates than other racial and ethnic groups. Mental health stigma, shaped by internalized shame and cultural values (e.g., Confucianism, collectivism, and emotional restraint), contributes to psychological distress and deters help-seeking among East Asian students. Sense of belonging supports mental health and social integration by helping students feel valued and connected to their community. However, stigma can erode sense of belonging through alienation and social exclusion, which in turn may reduce help-seeking, suggesting a mediating role for belonging. However, little is known about how these mechanisms differ between East Asian subgroups. This study addresses this gap by examining whether sense of belonging mediates the relationship between perceived stigma and help-seeking intentions, and whether this pathway differs between domestic and international East Asian students.

Methods: This study analyzed data from the 2023–2024 Healthy Minds Study, a web-based survey of postsecondary students across U.S. institutions. We focused on a subsample of Asian-identifying students (N = 12,054), identified through self-reported race/ethnicity. Perceived stigma, sense of belonging, and help-seeking intentions were measured using validated scales. Using multi-group structural equation modeling (SEM), we tested a mediation model in which perceived stigma predicts help-seeking through sense of belonging and examined whether this relationship differs between domestic and international students. We controlled for age, gender, financial stress, degree level, year in program, and field of study.

Results: SEM supported the hypothesized relationships. Perceived stigma significantly predicted lower help-seeking behaviors (β = –0.08, p < .001). It also negatively predicted sense of belonging (β = 0.13, p < .001), which in turn was associated with reduced help-seeking (β = –0.31, p < .001). The indirect effect of stigma on help-seeking through belonging was significant (standardized indirect effect = –0.04, p < .001), confirming the mediating role of belonging. Multi-group SEM showed a significant moderation by nationality (Δχ² = 12.66, Δdf = 3, p = .005). The path from stigma to help-seeking was stronger among domestic students (β = –0.09, p < .001) than international students (β = –0.06, p = .031). Similarly, stigma’s negative impact on belonging was greater for domestic (β = 0.17, p < .001) than international students (β = 0.11, p = .001). These findings support both mediation and moderation hypotheses, suggesting stigma impacts help-seeking partially through reduced belonging, with variations by subgroup.

Conclusions and Implications: This study underscores the dual impact of stigma—both direct and indirect via reduced sense of belonging—on help-seeking among East Asian students. Importantly, the strength of these associations differs by nationality, suggesting that domestic and international students may experience and respond to stigma in distinct ways. These findings call for targeted social work interventions. Social workers can address internalized stigma and enhance peer support for domestic students while supporting cultural adjustment and campus integration for international students. Culturally responsive, strengths-based approaches are essential to improving mental health access and outcomes in both groups.