Mental Health Service Use and Perceived Unmet Needs for Mental Health Care in Asian Americans

Mental Health and Service Utilization Among Asian Indians in the United States: A Scoping Review

BACKGROUND

Asian Indians living in the United States (US) are severely underrepresented in mental health research. Though there are more studies on Asian Indian mental health now than there was a decade ago, much remains unknown including the experience and prevalence of mental health disorders, service utilization, impact of cultural influences, and barriers and facilitators in seeking mental health support and treatment. The purpose of this scoping review was to examine mental health and mental health service utilization among Asian Indians in the US.

METHODS

We conducted a scoping review of published literature. Two reviewers independently screened 2965 articles for potential inclusion-2205 were excluded based on title and abstract review alone and 690 on full-text review. An additional 8 articles identified during full-text review resulted in a total of 45 articles included in the scoping review.

RESULTS

Of the 45 studies, 33 used a quantitative design, 4 studies used a multiple or mixed methods design, and 8 used a qualitative design. Given the broad theme of our research question and since the final list of studies included varied widely in their focus and methods, we present our results using descriptive, narrative synthesis.

CONCLUSIONS

Cultural values, familial roles and support, and stigma significantly impact both mental health and help-seeking behaviors of Asian Indians. There are major gaps in the literature surrounding child and youth mental health, mental health disorders, and pathways to mental health care. These findings are discussed in the context of relevance for practice, policy, and the need for high-quality research.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

A Systematic Review of the Influence of Social Determinants of Health on Mental Health Service Utilization and Outcomes Among Asian American Cancer Survivors

OBJECTIVE

The purpose of this review was to identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

METHODS

We performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. We extracted data using a table of evidence, and we assessed study quality using the Johns Hopkins Evidence-Based Practice.

RESULTS

Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

CONCLUSION

We identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.

Treatment Outcomes for Asian Americans Diagnosed with Schizophrenia Spectrum Disorder

We implemented a pilot study to investigate symptoms and functional outcomes of Asian Americans treated in urban community mental health centers for a diagnosis of schizophrenia spectrum disorder. Furthermore, we investigated whether these outcomes differed between East and Southeast Asians. We collected quantitative data from 75 participants recruited using a nonprobability sampling strategy from six urban community mental health centers. We used the Positive and Negative Syndrome Scale (Kay et al. in Schizophrenia Bulletin 13(2):261-276, 1987) and the Strauss and Carpenter Outcome Scale (Strauss and Carpenter in Archives of General Psychiatry 27(6):739-746, 1972) to measure their symptoms and functional outcomes. To compare the outcomes between East and Southeast Asians, we used a multivariable logistic regression model, which adjusted for the estimated effects of age, sex assigned at birth, and age at onset of illness for each outcome examined. The data shows that the treatment outcomes for this group are poor. Only a small number of participants experienced symptomatic remission (30.67%), role restoration (34.67%), and clinical recovery (21.33%). The majority of those who did not experience clinical recovery had difficulties sustaining symptomatic remission and restoring role functioning (54.67%). However, more participants achieved social restoration (68.00%). The results did not vary by national origin groups and sex assigned at birth. However, the participant's age, the age at which the illness began, or both determined whether the treatment outcomes were favorable. Findings underscore the need for interventions that improve symptom control to increase the likelihood of other favorable outcomes.

Mental health needs and barriers to service in the Chinese American community: insights gained from focus groups

OBJECTIVES

Mental health remains an unmet need among Chinese Americans. This study aims to identify specific needs and strategies that may address the needs.

DESIGN

A total of 55 Chinese Americans consented and participated in online focus groups conducted in either Chinese or English using nominal group technique. Participants discussed the following questions, achieved themes, and provided ranking of themes in importance for each: (1) In general, what do people in the Chinese American community think about mental health or emotional well-being? (2) What have you found to be helpful for accessing mental health or emotional well-being services or care in the Chinese American population? And (3) What actions would you suggest to improve mental health and emotional well-being in the Chinese American population?

RESULTS

Across the focus groups, we observed high consistency of top ranked themes including lack of knowledge and awareness, negative impression, lack of Chinese-speaking providers, and that the most helpful factor toward access to care was education and increased awareness. Seminars and trainings was the top actionable suggestion.

CONCLUSION

The findings are consistent with previous findings and continue to show that Chinese Americans need more education and training and that providers who can speak the language and understand the culture would be very helpful to increase access to care. This study emphasizes addressing mental health disparities in the Chinese American community through awareness, tailored interventions, and barrier removal. Promoting equal access also underscores the need for ongoing assessment and responsive strategies.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Distress, multimorbidity, and complex multimorbidity among Chinese and Korean American older adults

BACKGROUND

Studies suggest that distress is associated with various health conditions such as hypertension, asthma, diabetes, and coronary heart disease. However, only few studies focused on Asian Americans and little is known about the association with multiple comorbidity.

METHODS

We conducted a cross-sectional analysis among 400 Chinese and Korean American participants (aged 50-75 years) of the STOP CRC randomized controlled trial. Perceived distress was assessed using the distress thermometer scale (range 0-10). Disease diagnosis was self-reported by the participants. Multimorbidity (MM) was defined as having ≥2 chronic conditions. Complex multimorbidity (CMM) was defined as having ≥3 of the following body system disorders: circulation disorder, endocrine-metabolic disorder, cancer, anxiety or depression, breathing problem, and other health problems. We performed logistic regression for CMM and Poisson regression with robust error variance for MM to estimate associations with distress, adjusting for potential confounders.

RESULTS

The mean age was 58.4 years and mean distress score was 3.65. One-unit increase in distress score was associated with a 1.22-fold increase in the odds of having CMM (95% CI: 1.04-1.42). The magnitude of association slightly increased after additional adjustment for socioeconomic factors and health insurance status (OR: 1.29; 95% CI: 1.10-1.52). Higher distress score was positively associated with MM but the association was only marginally significant (PR: 1.04; 95% CI: 0.99-1.10), adjusting for socioeconomic factors and health insurance status.

CONCLUSION

Our data suggest that higher perceived distress may be associated with simultaneous dysfunction of multiple distinct body systems among Chinese and Korean American older adults.

COVID-19 Experiences and Mental Health Among Graduate and Undergraduate Nursing Students in Los Angeles

BACKGROUND

Nurses and nursing students are at risk for negative mental health as a result of significant work stressors from the COVID-19 pandemic.

AIMS

The purpose of this study was to (1) describe the mental health of nursing students during the COVID-19 pandemic, (2) investigate relationships between stressful COVID-19 experiences and mental health, and (3) examine correlates of mental health service use.

METHOD

This observational study used a web-based survey to assess COVID-19 experiences, self-reported mental health, and mental health service utilization among nursing students in Los Angeles in spring 2021 (N = 174, 30.1% response rate). The survey used measures of stressful COVID-19 experiences (personal COVID-19 illness, hospitalization of close friends or family, and death of close friends or family), loneliness, resilience, depression, anxiety, COVID-19-related traumatic stress, and utilization of campus and noncampus mental health services.

RESULTS

Students had high levels of depression (30%), anxiety (38%), and traumatic stress (30%). There was no relationship between stressful COVID-19 experiences and mental health, but loneliness was associated with higher odds of mental health problems and resilience with lower odds. Mental health problems were not associated with use of campus or noncampus mental health services. Students with primary caregiving responsibilities (OR = 0.22, 95% CI [0.05, 0.87]) and students who identified as Asian/Pacific Islander (OR = 0.24, 95% CI [0.09, 0.70]) had lower odds of mental health service utilization.

CONCLUSIONS

Resilience and loneliness affect nursing student risk for negative mental health as a result of the COVID-19 pandemic. Targeted, accessible mental health support within nursing education programs may be warranted.

Predicting the Behavioral Health Needs of Asian Americans in Public Mental Health Treatment: A Classification Tree Approach

Given the fact that experiencing pandemic-related hardship and racial discrimination worsen Asian Americans' mental health, this study aimed to identify unique characteristics of behavioral health needs among Asian Americans (N = 544) compared to White Americans (N = 78,704) and Black Americans (N = 11,252) who received publicly funded behavioral health services in Indiana before and during the COVID-19 pandemic. We used 2019-2020 Adults Needs and Strengths Assessment (ANSA) data for adults eligible for Medicaid or funding from the state behavioral health agency. Chi-squared automatic interaction detection (CHAID) was used to detect race-specific differences among demographic variables, the pandemic status, and ANSA items. Results indicated that, regardless of age, gender, or pandemic status, Asian Americans who received behavioral health services, struggled more with cultural-related factors compared to White and Black individuals. Within this context, intersections among behavioral/emotional needs (psychosis), life functioning needs (involvement in recovery, residential stability, decision making, medical/physical health), and strengths (job history, interpersonal, and spiritual) further differentiated the mental health functioning of Asian from White and Black Americans. Classification tree algorithms offer a promising approach to detecting complex behavioral health challenges and strengths of populations based on race, ethnicity, or other characteristics.

The mediation role of self-esteem and hope on the relationship of quality of life and unmet needs of elderly with psychiatric disorders

BACKGROUND

Self-esteem is one of the factors affecting the quality of life. On the other hand, quality of life decreases in people with psychiatric disorders. The aim of the present study was to evaluate the mediating role of self-esteem and hope on the relationship between unmet needs and quality of life of the elderly with psychiatric disorders.

MATERIALS AND METHODS

This descriptive-analytical study was performed on 112 chronic psychiatric patients hospitalized in the geriatric ward of (blinded) 2020. Based on the inclusion criteria, a total of 100 samples were entered into the study by census. The World Health Organization (WHO) quality of life questionnaire, Rosenberg Self-Esteem Scale, Snyder Hope Scale, and Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) were used to collect data. The research model was tested using the path analysis technique. Data was analyzed using Statistical Package for the Social Sciences (SPSS) Ver. 26 and LISREL Ver. 2/9.

RESULTS

Unmet needs were negatively related to the other three variables of the study, namely, self-esteem, hope, and quality of life. There was a significant relationship between unmet needs and quality of life with a mediating role of self-esteem and hope (P < 0.05). Quality of life was also negatively related to unmet needs and directly related to self-esteem and hope.

CONCLUSION

Based on the findings of this study, it is essential that health-care providers consider planning to provide programs to improve self-esteem and hope in order to reduce unmet needs and increase the quality of life.

Mental health service needs and mental health of old adults living alone in urban and rural areas in China: The role of coping styles

This study aimed to explore the level and relationship between the mental health service needs (MHSN), coping styles (CS), and mental health (MH) of old adults living alone in urban and rural, and to explore the moderating effects of coping styles. A cross-sectional study was conducted with 717 older adults living alone. The survey measured MHSN, CS, and MH. Data were analyzed using a structural equation and bootstrapping method. There were significant differences in the MHSN, CS, and MH between urban and rural old adults living alone (P < 0.05). The model of the impact of MHSN on MH in urban and rural old adults living alone showed a good fit. These findings highlighted the importance of high MHSN and positive CS as potential protective factors of mental health in old adults living alone. This provides a theoretical basis for psychological nursing for old adults living alone in the community.

'He is just getting old, you know': the role of cultural and health beliefs in shaping the help-seeking process of family members caring for persons with dementia in Vietnam

OBJECTIVES

This study aims to examine the help-seeking process of family caregivers for persons with dementia (PWD) in Vietnam, and how health and cultural beliefs shape this process.

DESIGN

Twenty family caregivers of PWD at a geriatric hospital in Northern Vietnam were recruited. A total of 30 face-to-face, semi-structured interviews, including 10 follow-up interviews, were conducted. Structural coding was used first to guide data analysis through four structural codes consistent with the four stages of the help-seeking model: (1) disease and symptom experience; (2) explanatory models for symptom appraisal; (3) decision to seek help; and (4) contact with the sources of help. Then thematic coding was used for more detailed and data-driven initial codes to emerge from the data.

RESULTS

Cultural and health beliefs, particularly collectivist values, such as familism and filial piety, shaped each stage of Vietnamese family caregivers' help-seeking process. Caregivers experienced different PWD's symptoms and adopted a mixed explanatory model combining biomedical and folk beliefs to explain the causes of dementia. They highly valued independence, autonomy, devotion to their family, and self-sacrifice, making these values the driving force underlying their self-reliance regime in caregiving. Help-seeking was often delayed until caregivers considered the situation to be beyond their own capacity to manage independently. The family was always the primary informal source of support for caregivers, with additional help sought from friends, neighbors, and religious facilities. Health professionals, if available, were also an important formal source for medical advice.

CONCLUSIONS

The results highlight the importance of culture and health beliefs in shaping caregivers' help-seeking process, and advocate the needs of service development targeting not only Vietnamese family caregivers for PWD, but also caregivers sharing similar collectivist culture in different areas. Interventions and services that are consistent with their values of self-sacrifice, devotion to family, autonomy, and self-reliance are much needed.

Community leaders' perceptions of depression and the perceived barriers in seeking mental health services for older Korean Americans

OBJECTIVES

This study explored community leaders' understanding of depression among older Korean Americans and barriers to seeking mental health services. Depression is prevalent among older Korean Americans, but they are less likely to seek help from professionals and prefer to use informal methods. Older Korean Americans strongly prefer to maintain their ethnic traditions and use community service agencies provided by their same ethnicity. In this regard, community leaders who provide services for older adults play a significant role in not only advocating for the population but also in developing services and programs for their communities.

DESIGN

In this qualitative study, 12 Korean community leaders who provide services for older adults were interviewed. Data were analyzed thematically, and Nvivo 12 was used to organize the data and to detect relevant themes.

RESULTS

Findings showed that community leaders had an in-depth understanding of the causes of depression from environmental and cultural contexts including isolation, losing independence, cultural factors, and lack of family support. However, although the leaders were aware of the severity of depression among older Korean Americans, they did not understand biologically-based factors; rather, they considered it a natural part of aging. Findings indicated that they were biased towards older adults like older Korean Americans, attributing depressive symptoms to personality issues. They also heavily rely on personal experiences to understand depression instead of on having educational training. Barriers to getting help for older adults include lack of the perceived need of older adults, lack of professionals, and a prevalent stigma against depression that encourages individuals to hide their illness.

CONCLUSIONS

The findings indicated that community-based educational training is necessary to increase understanding of depression not only for the community leaders but also for individuals and families.

Cultural Considerations for Working with South Asian Youth

South Asian American (SAA) youth are culturally diverse with respect to migration patterns, language, religion, and social determinants of health. Culturally specific stressors related to family, acculturation, discrimination, and intersectionality converge during developmentally sensitive periods, impacting mental health and identity development. "Model minority" stereotypes and somatic expressions of distress contribute to underdetection and limited perceived need for treatment. SAA families navigate structural barriers, including limited access to culturally tailored services, limited English proficiency, referral bias, and stigma, resulting in underutilization of services. Cultural considerations must be integrated into diagnostic conceptualization and treatment recommendations to effectively engage SAA youth and families in treatment.

The Association Between Moderate and Serious Mental Health Distress and General Health Services Utilization Among Chinese, Filipino, Japanese, Korean, and Vietnamese Adults in California

INTRODUCTION

A growing body of literature has indicated that disaggregated analyses using distinct Asian subgroups allow for identification of varying mental health challenges and health services utilization. In this study, we examined the associations between distress and health services utilization among five Asian subgroups: Chinese, Korean, Japanese, Filipino, and Vietnamese adults in California.

MATERIALS AND METHODS

Using a combined dataset using the 2011-2018 cross-sectional cycles of the California Health Interview survey, we assessed moderate and serious distress and four health services utilization indicators in a set of disaggregated analyses among adults 18 years of age and older in five Asian subgroups. We performed bivariate and multivariable analyses.

RESULTS

The prevalence of and associations between moderate and serious distress and gaps in health services utilization varied among each Asian subgroup. Koreans had the highest prevalence of moderate and serious distress and the most gaps in health services utilization. Compared to those without moderate distress (p < .05), Japanese adults were more likely to delay care. Compared to those without serious distress (p < .05), Chinese adults who experienced serious distress were more likely to delay both medications and care, whereas Filipino and Vietnamese adults were more likely to delay medications.

DISCUSSION

Disaggregating health data elucidates the impact of mental distress on healthcare-seeking behaviors among specific Asian subgroups. Identifying these influences can facilitate future tailored interventions, yet fully understanding the mechanism linking mental distress and healthcare usage will necessitate a comprehensive assessment of structural influences and Asian American experiences without otherization.

Perceived discrimination, psychosocial resources, and mental distress in Vietnamese Americans

This study examines how the mental health of Vietnamese Americans is influenced by a life stressor (perceived discrimination) and psychosocial resources (social network, religiosity, and acculturation). Data came from 513 Vietnamese Americans who were subsample of the Asian American Quality of Life (AAQoL) survey (total N = 2,614). The AAQoL survey was conducted with self-identified Asian Americans aged 18 or older in Central Texas in 2015. More than 32% of the Vietnamese sample reported perceived discrimination. A higher level of mental distress was associated with younger age, unmarried status, unmet financial status, poorer ratings of health, fewer years of stay in the U.S., perceived discrimination, smaller social network, and lower levels of acculturation and religiosity. In a multivariate analysis, the experience of discrimination (β = 0.16, p < .01), smaller social network (β = −.10, p < .05), and lower acculturation (β = −.17, p < .05) were found to be significant predictors to mental distress. No significant interaction was found. These identified risks and resources should be addressed in developing and implementing culturally sensitive mental health interventions targeted to Vietnamese American communities.

The role of self-rated mental health in seeking professional mental health services among older Korean immigrants

OBJECTIVES

The gap between mental health needs and service use in racial/ethnic minorities continues to be a major public health concern. Focusing on older Korean immigrants, the present study examined linkages among mental distress, self-rated mental health (SRMH), and the use of professional mental health services. We hypothesized that SRMH would play a mediating role in the relationship between mental distress and the use of professional mental health services.

METHOD

Using data from the Study of Older Korean Americans (SOKA; N = 2,150, Mean age = 73.4), the direct and indirect effect models were tested.

RESULTS

Nearly 30% of the sample fell within the category of experiencing mental distress, but only a small proportion (5.7%) had used professional mental health services. Supporting our hypothesis, the pathway from mental distress to the use of professional mental health services was influenced by an individual's subjective perception of mental health status: the indirect effect of mental distress on service use through SRMH (.04 [.01]) was significant (bias-corrected 95% confidence interval for the indirect effect = .02, .06).

CONCLUSION

The findings of this study not only contribute to our understanding of help-seeking processes in a group at high mental health risk but also suggest avenues to promote their use of mental health services.

Experiences of violence and mental health outcomes among Asian American transgender adults in the United States

PURPOSE

We addressed prevalence and factors associated with mental health outcomes (suicidal behavior and psychological distress) among Asian Americans (AA), who identify as transgender, a key group among sexual and gender minorities that is overlooked and understudied.

METHODS

We used data from 2015 United States Transgender Survey during 2019-2020 with our population as census defined AA. Outcomes included suicidal ideation, suicidal thoughts, and serious psychological distress (SPD). Independent variables included any abuse, partner abuse, bathroom-related abuse, and additional covariates. Adjusted odds ratio and 95% confidence interval (aOR; 95% CI) for each outcome are adjusted for age, marital status, citizenship status, education level, employment status, as well as poverty status.

RESULTS

Nearly 67% reported experiencing any abuse, 52% reported abuse from romantic/sexual partner(s), while 29% reported harassment/abuse when trying to use bathrooms. Moreover, 82% reported suicidal thoughts, 40% reported suicidal attempts, and 39% had SPD. Results demonstrated that any abuse/violence had higher odds of suicidal thoughts (adjusted odds ratio [aOR] = 2.67, 95% confidence interval (CI):[1.98-3.58], suicidal attempts (aOR = 2.83, 95% CI:[2.18-3.68]), and SPD (aOR = 1.56, 95% CI:[1.20, 2.04]). Abuse from romantic/sexual partners had higher odds of suicidal thoughts (aOR = 2.47, 95% CI:[1.76-3.47]), suicidal attempts (aOR = 2.17, 95% CI:[1.68-2.80]), and SPD (aOR = 2.72, 95% CI:[2.03-3.63]). Experience of harassment/abuse during bathroom use had increased odds of suicidal attempts (aOR = 1.81, 95% CI:[1.41-2.31]).

CONCLUSION

Exposure to violence is common among AA transgender individuals and related to negative mental health outcomes. Initiatives to reduce exposure to abuse and providing resources for trauma-informed care are imperative to improve health outcomes.

Self-rated health as a mediator between physical health conditions and depressive symptoms in older Chinese and Korean Americans

In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans. Using harmonized data (N = 5,063) from the Population Study of Chinese Elderly (PINE) and the Study of Older Korean Americans (SOKA), we tested direct and indirect effect models. In both groups, chronic diseases and functional disability were closely associated with negative ratings of health and symptoms of depression. Analyses with the PROCESS macro showed that the effect of chronic diseases and functional disability on depressive symptoms was mediated by self-rated health in both groups; the indirect effect was greater in the Korean American sample than in the Chinese American sample. These findings contribute to the understanding of the psychological mechanisms that underlie the mind–body connection and highlight the potential importance of subjective health assessment as a useful tool for health promotion.

Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) among Three Ethnic Groups of Older Asian Americans

BACKGROUND AND OBJECTIVES

The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, Vietnamese) of older Asian Americans, addressing both within- and cross-group validations.

RESEARCH DESIGN AND METHODS

We selected 605 participants aged 50 or above (242 Chinese, 150 Koreans, 213 Vietnamese) from the 2015 Asian American Quality of Life (AAQoL) survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators.

RESULTS

LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered.

DISCUSSION AND IMPLICATIONS

The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.

Socioeconomic Disparities in Unmet Need for Student Mental Health Services in Higher Education

BACKGROUND

Mental health problems are highly prevalent among college students in many countries. However, evidence suggests that many at-risk students do not receive professional help.

OBJECTIVE

We aimed to understand which students are most likely to have unmet need for mental health services. Given increasing and widening participation in higher education, we focused attention on disparities by socioeconomic background.

METHODS

We analysed data from a recent survey of over 6000 students enrolled in higher education in Ireland. Using three separate measures of mental health problems, namely stress, anxiety, and depression, we developed and modelled an indicator of unmet need.

RESULTS

We found that students from the lowest social class and students with the greatest difficulty in making ends meet have higher rates of unmet need overall, but that these disparities disappear once we control for mental ill-health. For those with mental health problems, unmet need is shown to be independently higher for students who are younger, male, heterosexual, and studying for a Ph.D. We also found a strong independent association between unmet need and self-stigma, as well as considerable differences in unmet need across institutions.

CONCLUSION

Socioeconomic disparities in unmet need are driven by higher rates of mental ill-health among those from lower socioeconomic backgrounds. Our findings have implications for the targeting of services, as well as the provision of information about mental health and associated services.