The Importance of Enabling Factors in Mental Health Service Access Among Asian and Latino Americans

Background: Underutilization of mental health services by Asian and Latino communities exemplifies enduring racial and ethnic disparities in the U.S. mental health system. Despite experiencing psychological distress, many never engage with professional care, leaving their symptoms untreated. This study investigated factors associated with service access, particularly psychosocial enabling factors as outlined in Andersen’s Behavioral Model of Health Services Use. Specifically, this study sought to explore how predisposing, enabling, and need factors affect mental health service access by addressing two questions: (1) What factors are associated with mental health service access within each racial/ethnic group? (2) Do these factors differ between Asian and Latino Americans?

Methods: Prior research has largely relied on data from the early 2000s, limiting insights into current trends. To address this gap, this secondary analysis used 2022 Behavioral Risk Factor Surveillance System data collected from adults ages 18 or older (n=6,231). Mental health service access was defined as ever being diagnosed by a health professional with a mental health condition. Independent variables included predisposing (age, gender, education, marital status, geography), enabling (insurance, income, racial discrimination, social support), and need (poor mental health days). We estimated separate multivariable logistic regression models for Asian and Latino Americans. Goodness-of-fit diagnostics were assessed for each model. Group differences in predictor effects were tested using Seemingly Unrelated Estimation (SUEST). All analyses were conducted using Stata 18.5 using complete case analysis owing to the small amount of missing data (< 5%).

Results: Overall, 10.7% of Asians and 17.9% of Latinos reported accessing mental health services. In both groups, being female (AA: aOR=2.00, p=.002; LA: aOR=2.20, p< .001), perceiving higher levels of racial discrimination (AA: aOR=1.20, p=.007; LA: aOR=1.08, p=.008), and experiencing more days of poor mental health (AA: aOR=1.002, p<.001; LA: aOR=1.003, p< 001) were associated with greater service access. Several additional facilitators were statistically significant but exclusive to Latino study participants: being a college or graduate student (aOR=1.77, p=.001; aOR=1.61, p=.009) and having insurance (aOR=3.11, p=.004). In contrast, insurance status significantly differed across groups (χ²(1)=5.55, p = .019), serving as a strong predictor for Latinos but not Asians.

Conclusion: Mental health services remain substantially underutilized among Asian and Latino populations in the United States, highlighting the need for differentiated approaches across these groups. Both groups show low levels of service access relative to need, with Asians reporting even lower rates than Latinos. For Latino individuals, improving access through structural factors such as education and health insurance coverage may be critical. In contrast, for Asians, fewer significant facilitating predictors were identified, suggesting that cultural factors such as clear family hierarchies, emotional restraint, and the value placed on "saving face" may serve as substantial barriers to seeking professional mental health support but which were unmeasured in this study. Accordingly, psychosocial approaches that account for these familial and cultural dynamics may be necessary when trying to reach Asian Americans in need of mental health services.