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Sources of Stress and Barriers to Mental Health Service Use Among Asian Immigrant-Origin Youth: A Qualitative Exploration

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Abstract

Asian immigrant-origin youth (IOY) are a large and growing population within the United States (U.S.). Yet, despite the high prevalence of mental health concerns, limited research has examined sources of stress that may lead to mental health concerns among Asian IOY. Further, despite low levels of mental health service use, no studies have directly explored the perceptions of Asian IOY about barriers to mental health service use generally. Hence, using a qualitative approach, this study sought to examine the perceptions of Asian IOY regarding sources of stress that may contribute to mental health concerns and barriers to mental health service use. Thirty-three (n = 33; 58% female) Asian IOY were directly queried through in-depth focus groups. Data were analyzed using a grounded theory approach. Themes relating to sources of stress that lead to mental health concerns among Asian IOY included (a) pressure to succeed and (b) stressors related to ethnic minority and immigrant status. Themes relating to barriers to mental health service use among Asian IOY included (a) parental reactions, (b) concerns with mental health treatment, (c) stigma against mental health services, (d) mental health literacy, and (e) pragmatic or logistical reasons. Findings provide insight into tailoring appropriate outreach efforts to increase mental health service use among Asian IOY.

Highlights

  • We directly queried Asian IOY to examine sources of stress and barriers to mental health service use.

  • Parental pressure to succeed was the most frequently endorsed stressor.

  • Parents are important gatekeepers to Asian immigrant-origin youth’s access to mental health services.

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References

  • Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., Appel, H., Nicdao, E., & Alegría, M. (2007). Use of mental health-related services among immigrant and U.S.-born Asian Americans: results from the national Latino and Asian American study. American Journal of Public Health, 97(1), 91–98.

    PubMed  PubMed Central  Google Scholar 

  • Alegria, M., Vallas, M., & Pumariega, A. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19(4), 759–774.

    PubMed  PubMed Central  Google Scholar 

  • Allen, K., Kern, M. L., Vella-Brodrick, D. V., Hatie, J., & Waters, L. (2018). What schools need to know about fostering school belonging: a meta-analysis. Educational Psychology Review, 30(1), 1–34.

    Google Scholar 

  • Anyon, Y., Ong, S. L., & Whitaker, K. (2014). School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors, and service use. Asian American Journal of Psychology, 5(2), 134–144.

    Google Scholar 

  • Anyon, Y., Whitaker, K., Shields, J. P., & Franks, H. M. (2013). Help-seeking in the school context: Understanding Chinese American adolescents’ underutilization of school health services. Journal of School Health, 83(8), 562–572.

    PubMed  Google Scholar 

  • Arora, P. G., & Algios, A. (2019). School-based mental health for Asian American immigrant youth: Perceptions and recommendations. Asian American Journal of Psychology, 10(2), 166–181.

    Google Scholar 

  • Asian American Federation. (2014). The state of Asian American children. http://www.aafederation.org/doc/AAF_StateofAsianAmericanChildren.pdf

  • Bear, L., Finer, R., Guo, S., & Lau, A. S. (2014). Building the gateway to success: An appraisal of progress in reaching underserved families and reducing racial disparities in school-based mental health. Psychological Services, 11(4), 388–397.

    PubMed  Google Scholar 

  • Benner, A. D., & Kim, S. Y. (2009). Experiences of discrimination among Chinese American adolescents and the consequences for socioemotional and academic development. Developmental Psychology, 45(6), 1682–1694.

    PubMed  PubMed Central  Google Scholar 

  • Cheng, H., Wang, C., McDermott, R. C., Kridel, M., & Rislin, J. L. (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling & Development, 96(1), 64–74.

    Google Scholar 

  • Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). ThousandOaks, CA: Sage Publications.

  • Crane, D., Ngai, S. W., Larson, J. H., & Hafen, M. (2005). The influence of family functioning and parent-adolescent acculturation on North American Chinese adolescent outcomes. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 54(3), 400–410.

    Google Scholar 

  • Cummings, J. R., & Druss, B. G. (2011). Racial/ethnic differences in mental health service use among adolescents with major depression. Journal of the American Academic of Child and Adolescent Psychiatry, 50(2), 160–170.

    Google Scholar 

  • Deitz, D. K., Cook, R. F., Billings, D. W., & Hendrickson, A. (2009). A web-based mental health program: Reaching parents at work. Journal of Pediatric Psychology, 34(5), 488–494.

    PubMed  Google Scholar 

  • Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522–541.

    PubMed  Google Scholar 

  • Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336–1343.

    PubMed  Google Scholar 

  • Greenbaum, T. L. (1988). The practical handbook and guide to focus group research. Lanham, MD: Lexington Books.

  • Greene, M. L., Way, N., & Pahl, K. (2006). Trajectories of perceived adult and peer discrimination among Black, Latino, Asian American adolescents: patterns and psychological correlates. Developmental Psychology, 42(2), 218–236.

    PubMed  Google Scholar 

  • Guo, S., Kataoka, S. H., Bear, L., & Lau, A. S. (2014). Differences in school-based referrals for mental health care: Understanding racial/ethnic disparities between Asian American and Latino youth. School Mental Health: A Multidisciplinary Research and Practice Journal, 6(1), 27–39.

    Google Scholar 

  • Heron, M. (2018). Deaths: Leading causes for 2016. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf

  • Hoeffel, E. M., Rastogi, S., Kim, M. O., & Shahid, H. (2012). The Asian Population: 2010: 2010 Census Briefs. https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf

  • Hoagwood, K. E., Serene Olin, S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning. Journal of Emotional and Behavioral Disorders, 15(2), 66–92.

    Google Scholar 

  • Hoppe, M. J., Wells, E. A., Morrison, D. M., Gillmore, M. R., & Wilsdon, A. (1995). Using focus groups to discuss sensitive topics with children. Evaluation Review, 19(1), 102–114.

    Google Scholar 

  • Javier, J. R., Supan, J., Lansang, A., Beyer, W., Kubicek, K., & Palinkas, L. A. (2014). Preventing Filipino mental health disparities: perspectives from adolescents, caregivers, providers, and advocates. Asian American Journal of Psychology, 5(1), 316–324.

    PubMed  PubMed Central  Google Scholar 

  • Juang, L., Syed, M., & Cookston, J. T. (2012). Acculturation-based and everyday parent adolescent conflict among Chinese American adolescents: Longitudinal trajectories and implications for mental health. Journal of Family Psychology, 26(6), 916–926.

    PubMed  Google Scholar 

  • Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia, 166(4), 182–186.

    PubMed  Google Scholar 

  • Kim, S. Y., Chen, Q., Wang, Y., Shen, Y., & Orozco-Lapray, D. (2013). Longitudinal linkages among parent-child acculturation discrepancy, parenting, parent-child sense of alienation, and adolescent adjustment in Chinese immigrant families. Developmental Psychology, 49(5), 900–912.

    PubMed  Google Scholar 

  • Lee, S. J. (1996). Unraveling the “model minority” stereotype: Listening to Asian American youth. New York, NY: Teachers College Press.

  • Lee, S. J. (2009a). Unraveling the “model minority” stereotype: Listening to Asian American youth (2nd ed.). New York, NY: Teachers College Press.

  • Lee, S., Juon, H., Martinez, G., Hsu, C. E., Robinson, E. S., Bawa, J., & Ma, G. X. (2009b). Model minority at risk: Expressed needs of mental health by Asian American young adults. Journal of Community Health, 34(2), 144–152.

    PubMed  PubMed Central  Google Scholar 

  • Li, C., & Li, H. (2016). Longing for a balanced life: Voices of Chinese-American/immigrant adolescents from Boston, Massachusetts, USA. In B. K. Nastasi & A. P. Borja (Eds), International handbook of psychological well-being in children and adolescents: Bridging the gaps between theory, research, and practice (pp. 247–269). New York, NY: Springer Publishing.

  • Li, C., & Li, H. (2017). Chinese immigrant parent’s perspectives on psychological well-being, acculturative stress, and support: Implications for multicultural consultation. Journal of Educational and Psychological Consultation, 27(1), 245–270.

    Google Scholar 

  • Li, C., Li, H., & Niu, J. (2016). Intercultural stressors of Chinese immigrant students: Voices of Chinese-American mental health professionals. Asian American Journal of Psychology, 7(1), 64–73.

    Google Scholar 

  • Li, H., & Seidman, L. (2010). Engaging Asian American youth and their families in quality mental health services. Asian Journal of Psychiatry, 3(4), 169–172.

    PubMed  PubMed Central  Google Scholar 

  • Ling, A., Okazaki, S., Tu, M.-C., & Kim, J. J. (2014). Challenges in meeting the mental health needs of urban Asian American adolescents: Service providers’ perspectives. Race and Social Problems, 6(1), 25–37.

    Google Scholar 

  • Meshvara, D. (2002). Mental health and mental health care in Asia. World psychiatry: official journal of the World Psychiatric Association (WPA), 1(2), 118–120.

    Google Scholar 

  • Neale, J., Miller, P., & West, R. (2014). Editorial: reporting quantitative information in qualitative research: guidance for authors and reviewers. Addiction, 109(2), 175–176.

    PubMed  Google Scholar 

  • Ouellette, P. M., Briscoe, R., & Tyson, C. (2004). Parent-school and community partnerships in children’s mental health: Networking challenges, dilemmas, and solutions. Journal of Child and Family Studies, 13(1), 295–308.

    Google Scholar 

  • Pew Research Center. (2017). Key facts about Asian Americans, a diverse and growing population. https://www.pewresearch.org/fact-tank/2017/09/08/key-facts-about-asian-americans/

  • Rao, A., Myszkowski, N., & Arora, P. G. (2019). The acceptability and perceived effectiveness of a psychoeducational program on positive parent-adolescent relationships for Asian immigrant parents. The School Psychologist, 73(1), 11–20.

    Google Scholar 

  • Rhee, S., Chang, J., & Rhee, J. (2003). Acculturation, communication patterns, and self-esteem among Asian and Caucasian American adolescents. Adolescence, 38(152), 749–768.

    PubMed  Google Scholar 

  • Shin, J. Y., D’Antonio, E., Son, H., Kim, S. A., & Park, Y. (2011). Bullying and discrimination experiences among Korean-American adolescents. Journal of Adolescence, 34(5), 873–883.

    PubMed  Google Scholar 

  • Soleimanpour, S., Brindis, C., Geierstanger, S., Kandawalla, S., & Kurlaender, T. (2008). Incorporating youth-led community participatory research into school health center programs and policies. Public Health Reports, 123(1), 709–716.

    PubMed  PubMed Central  Google Scholar 

  • Strauss, A. L., & Corbin, J. M. (Eds). (1997). Grounded theory in practice. Sage Publications, Inc.

  • Suárez-Orozco, C., Onaga, M., & De Lardemelle, C. (2010). Promoting academic engagement among immigrant adolescents through school-family-community Collaboration. Professional School Counseling, 14(1), 15–26.

    Google Scholar 

  • van Nes, F., Abma, T., Jonsson, H., & Deeg, D. (2010). Language differences in qualitative research: Is meaning lost in translation? European Journal of Ageing, 7(1), 313–316.

    PubMed  PubMed Central  Google Scholar 

  • Vaughn, S., Schumm, J. S., & Sinagub, J. M. (1996). Focus group interviews in education and psychology. Thousand Oaks, CA: Sage Publications, Inc.

  • Vazquez-Nuttall, E., Li, C., & Kaplan, J. P. (2006). Home-school partnerships with culturally diverse families: Challenges and solutions for school personnel. Journal of Applied School Psychology, 22(2), 81–102.

    Google Scholar 

  • Wei, Y., Hayden, J. A., Kutcher, S., Zygmunt, A., & McGrath, P. (2013). The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth. Early Intervention in Psychiatry, 7(1), 109–121.

    PubMed  Google Scholar 

  • Wang, C., Do, K. A., Frese, K., & Zheng, L. (2019a). Asian immigrant parents’ perceptions of barriers preventing adolescents from seeking school-based health services. School Mental Health, 11(2), 364–377.

    Google Scholar 

  • Wang, C., Marsico, K. F., & Do, K. A. (2020). Asian American parents’ beliefs about helpful strategies for addressing adolescent mental health concerns at home and school. School Mental Health: A Multidisciplinary Research and Practice Journal. Advance online publication.

  • Wang, C., Shao, X., Do, K. A., Lu, H., O’Neal, C., & Zhang, Y. (2019b). Using participatory culture-specific consultation with Asian American communities: Identifying challenges and solutions for Asian American immigrant families. Journal of Educational & Psychological Consultation, 1-21.

  • Wong, A., Wong, Y. J., & Obeng, C. S. (2012). An untold story: A qualitative study of Asian American family strengths. Asian American Journal of Psychology, 3(4), 286–298.

    Google Scholar 

  • Wyatt, L. C., Ung, T., Park, R., Kwon, S. C., & Trinh-Shevrin, C. (2015). Risk factors of suicide and depression among Asian American, Native Hawaiian, and Pacific Islander Youth: a systematic literature review. Journal of Health Care for the Poor and Underserved, 26(2 Suppl), 191–237.

    PubMed  PubMed Central  Google Scholar 

  • Yeh, C. J., Arora, A. K., Inose, M., Okubo, Y., Li, R. H., & Greene, P. (2003a). The cultural adjustment and mental health of Japanese immigrant youth. Adolescence, 38(151), 481–500.

    PubMed  Google Scholar 

  • Yeh, C. J., Kim, A. B., Pituc, S. T., & Atkins, M. (2008). Poverty, loss, and resilience: The story of Chinese immigrant youth. Journal of Counseling Psychology, 55(1), 34–48.

    Google Scholar 

  • Yeh, C., & Inose, M. (2002). Difficulties and coping strategies of Chinese, Japanese, and Korean immigrant students. Adolescence, 37(145), 169–182.

    Google Scholar 

  • Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003b). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5(2), 65–77.

    PubMed  Google Scholar 

  • Zhou, Z., Peverly, S. T., Xin, T., Huang, A. S., & Wang, W. (2003). School adjustment of first generation Chinese-American adolescents. Psychology in the Schools, 40(1), 71–84.

    Google Scholar 

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Correspondence to Prerna G. Arora.

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Arora, P.G., Khoo, O. Sources of Stress and Barriers to Mental Health Service Use Among Asian Immigrant-Origin Youth: A Qualitative Exploration. J Child Fam Stud 29, 2590–2601 (2020). https://doi.org/10.1007/s10826-020-01765-7

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