Cultural Factors in Mental Health Referral Among Asian Americans

Epidemiological studies have shown that disparities in mental health service utilization still exist among ethnic minority groups in the United States. This study looks specifically at the lay referral system and what factors influence the likelihood of an individual referring a friend to mental health services. Since college student populations have fewer barriers than most to seeking treatment, 60 Asian American and 49 White American college students were sampled for the purposes of this study. They evaluated one of four vignettes in which cultural competency of the potential therapist and type of symptoms being presented were manipulated. Though there was no significant interaction found, implications of the current findings and corrections to the methodology for future research are discussed. CULTURAL DIFFERENCES IN MENTAL HEALTH REFERRAL 3 Cultural Factors in Mental Health Referral Among Asian Americans In the last decade, the Asian American population was the fastest growing minority group in the United States (Humes, Jones, & Ramirez, 2011). While the total US population is projected to grow by about 36% in the next 50 years, Asian Americans will increase their numbers by a staggering 127% (US Census Bureau, 2012). As they make up more of the population, it is increasingly important to be cognizant of cultural differences that distinguish this group from the general American population, particularly with regards to mental health. One of the major contrasts between Asian and American cultures is where they fall on the scale of collectivism and individualism. Broadly speaking, Asian cultures are more collectivist than their European and American counterparts (Triandis, 2012). Collectivists define themselves in relationship to a group, and prioritize group norms, goals, and relationships (Triandis, 2012). Meanwhile individualistic cultures, like the United States, define the self as independent of any group and prioritize individual attitudes and needs (Triandis, 2012). Because their culture of origin is collectivist but their present environment is individualistic, many Asian Americans exist at the intersection of these two conflicting constructs. As a result of these dual influences, Asian Americans have been shown to be more collectivist than European Americans (Coon & Kemmelmeier, 2001). But this is only the most basic of dissimilarities. Psychological differences between Asian Americans and White Americans have been found in everything from problem-solving (Kim, 2002), to raising children (Jambunathan, Burts, & Pierce, 2000), to a preference for different shapes and objects (Kim & Markus, 1999). Over many decades of research it has become apparent that regardless of shared CULTURAL DIFFERENCES IN MENTAL HEALTH REFERRAL 4 American nationality, most Asian Americans are constantly being influenced in some way by their culture of origin, including effects on their mental health. Prevalence of Mental Illness in the United States Within the field of mental health, influences of race and culture can be demonstrated by how mental illness manifests among subgroups in the United States population. This information is easily found by looking at any one of the recent epidemiological studies conducted by the National Institute of Mental Health. One of the most well known of these studies was the National Comorbidity Survey Replication (NCS-R), a two-phase, nationally representative survey conducted from 2001 to 2003 with over 9000 adult participants (Kessler & Merikangas, 2004). In order to make accurate diagnoses, the NCS-R drew from the World Health Organization Composite International Diagnostic Interview (CIDI), which is compliant with both the International Classification of Diseases, 10 th Revision, and the DSM-IV (Kessler et al., 2004). Among the 5692 individuals who completed both parts of the NCS-R, there was a 46.4% lifetime prevalence of one or more DSM-IV disorder (Kessler et al., 2005a). The 12-month prevalence among the same sample was a little more than half of that at 26.2% (Kessler, Chiu, Demler, & Walters, 2005b). These percentages, however, are for the general population, and do not address whether or not there is any variation by race and ethnicity. A closer look at 12-month prevalence rates disaggregated by racial group reveals that Whites had a significantly higher prevalence rate than Blacks and a rate similar to Latinos (Ault-Brutus, 2012). Yet neither the NCS-R nor its predecessor, the NCS, present disaggregated data on Asian Americans, despite the fact that they are the third largest minority group in the United States. This was rectified through the National Latino and Asian American Study, a nationwide epidemiological study that used the CIDI instrument CULTURAL DIFFERENCES IN MENTAL HEALTH REFERRAL 5 from the NCS-R but targeted only members of those two minority groups (Takeuchi et al., 2007). Of the approximately 2000 Asian Americans who participated in the survey, the lifetime prevalence of having at least one DSM-IV disorder was 17.3%, while the 12month prevalence was 9.19% (Takeuchi et al., 2007). Not only are these rates lower than those of the general population, they are also lower than the rates of the three racial groups surveyed by the NCS-R. Over a 12-month period, a mere 8.6% of Asian Americans used any sort of service for mental health issues compared to 17.9% of the general population (Abe-Kim et al., 2007; Wang, Lane, Olfson, Pincus, & Kessler, 2005). However, among those diagnosed with a DSM-IV disorder by the CIDI, only 34.1% of Asian Americans sought professional help, versus 41.1% of the general population (AbeKim et al., 2007; Wang et al., 2005). These findings seem to indicate conflicting messages: Asian Americans are reporting fewer symptoms of mental illness than the general population, but those who could benefit from treatment are less likely to seek it. So while Asian Americans might be psychologically healthier, their help-seeking behaviors are poorer than average. It is also possible that Asian Americans have the same incidence rate of disorders as the national average, but are failing to report. A common cultural trait like shame may be leading to less reporting as well as less help seeking than White Americans. Regardless of the reason, Asian American service usage is lower than the norm for a reason other than the actual incidence rate.