Engaging Asian American youth and their families in quality mental health services

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.

Racial and Ethnic Disparities in Childhood ADHD Treatment Access and Utilization: Results From a National Study

OBJECTIVE

The study examined racial-ethnic disparities in access to and utilization of treatment for attention-deficit hyperactivity disorder (ADHD) and other psychiatric diagnoses among children with ADHD.

METHODS

Nationally representative, cross-sectional data from the Household Component of the Medical Expenditure Panel Survey 2011-2019 were used to examine racial-ethnic disparities in access to and utilization of treatment by children ages 5-17 with ADHD (N=5,838). Logistic regression models were estimated for access outcomes, and generalized linear models were estimated for utilization outcomes. Multivariable regression models adjusted for race-ethnicity, age, sex, and treatment need in accordance with the Institute of Medicine definition of health care disparities.

RESULTS

In adjusted analyses, compared with White children with ADHD, Black, Hispanic, and Asian children with ADHD had significantly lower rates of any past-year treatment visit for ADHD or for other psychiatric diagnoses. They also had lower rates of having accessed ADHD medication. Compared with White children, Black and Asian children with ADHD used fewer ADHD medications, and Black and Hispanic children with ADHD had lower overall mental health treatment expenditures.

CONCLUSIONS

Disparities in ADHD treatment among children from racial-ethnic minority populations may be driven primarily by disparities in access rather than in utilization. Once treatment had been accessed, disparities in utilization were largely accounted for by differences in socioeconomic status. These findings suggest that interventions targeting access to treatment among children from racial-ethnic minority populations may help close existing care gaps.

The status of depression literacy and its relationship with quality of life among Iranian public population: a cross sectional study

BACKGROUND

This study was designed and conducted to determine the status of depression literacy (D-Lit) and its relationship with the quality of life across the Iranian population.

METHODS

This cross-sectional study was conducted in 2020 among 1382 participating from the general population in Gonabad, Iran. Participants were selected and recruited using a multistage sampling method. Data were collected using three sets of questionnaires (demographic section, D-Lit scale, and quality of life questionnaire). Data were analyzed by SPSS software version 24 and using independent samples t- test, Chi-square test, One-way ANOVA, and Pearson correlation.

RESULTS

Based on the results, the mean (± standard deviation) of D-Lit and quality of life were 44.14 (± 4.69) and 35.81 (± 5.17), respectively. Based on the results of Pearson correlation coefficient, there was a significant positive correlation between D-Lit and quality of life (r = 0.104, p < 0.001). D-Lit was significantly higher in those who reported having consulted with a psychiatrist compared with those who did not (p < 0.001). Participants with a family history of mental illness and those whose family members were referred to a psychologist for psychological issues had significantly higher levels of D-Lit than others (p < 0.001).

CONCLUSION

Based on the results of this study, some D-Lit projects should be improved. Also, the results revealed that D-Lit is a potential factor that can affect people's mental health status and enhance their quality of life. Therefore, it is necessary to develop appropriate educational programs to enhance D-Lit in the community and ultimately improve the quality of life in the community by reducing mental illness.

Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

Mobile health applications for mental illnesses: An Asian context

Advances in digital technologies have created unprecedented opportunities to assess and improve health behavior and health outcomes. Evidence indicates that a majority of the world's population, including traditionally underserved populations and low- and middle-income countries, has access to mobile technologies (phones, tablets, mobile devices). Given the widespread access to mobile technology worldwide, health behavior-change tools delivered on mobile platforms enable broader reach and scalability of evidence-based assessment and interventions, especially for addressing the growing burden of mental health disorders globally. The purpose of this article was to present a qualitative review of mobile mental health applications in an Asian context. We searched on-line databases and included 22 articles in this review. We have identified mobile health applications that address eight categories of mental illnesses. These applications were developed in only six countries and regions in Asia. Future studies from more diverse countries for diverse cultures should be conducted to examine the advantages and disadvantages of mobile health technology.

Mental health literacy about depression among rural left-behind children in China: a comparative and cross-sectional study

BACKGROUND

Mental health literacy (MHL) is vital for raising mental health awareness, reducing stigma, and improving health-related decision making, which may have lifelong consequences for patients with mental disorders.

AIMS

To examine MHL about depression among rural left-behind children (LBC) in China and explore differences between LBC and non-left-behind children (NLBC).

METHODS

A total of 3456 rural school children (mean age = 13.02 years) in fourth to ninth grades who were living in Sichuan, Anhui, and Henan provinces were surveyed in April and July 2018 using stratified random cluster sampling.

RESULTS

More NLBC correctly recognized depression compared with LBC (p < 0.05). The most common sources of mental health information were the TV and the Internet. LBC felt more uneasy if they asked for help (p < 0.01). Statistical differences in help-seeking barriers were observed between LBC and NLBC (p < 0.05).

CONCLUSIONS

Respondents showed low levels of depression-related MHL compared with peer groups in other countries, LBC showed lower MHL than NLBC in terms of the correct recognition rate of depression, attitude toward seeking help, etc. More school-based interventions should be implemented in rural schools, and parent involvement and digital-based educational strategies should be considered.

Psychosis risk stigma and help-seeking: Attitudes of Chinese and Taiwanese residing in the United States

AIM

Intervention during the clinical high-risk phase for psychosis (CHR) can reduce duration of untreated psychosis and associated negative outcomes. Early treatment access and sustained engagement are important to understand for effective intervention. Understanding stigma and help-seeking processes is particularly important for groups that experience mental healthcare disparities such as those of Chinese heritage living in the United States.

METHODS

Chinese and Taiwanese participants (N = 215) residing in the United States were randomly assigned to one of three CHR vignette conditions based on the "what matters most" stigma framework for Chinese groups, which identifies capacities that define "personhood" and thereby shapes stigma for members of a particular cultural group. Participants completed measures of help-seeking attitudes, family stigma and individual stigma.

RESULTS

More stigma towards the CHR vignette character's family was associated with positive CHR help-seeking attitudes. Participants who read the vignette describing CHR affecting family obligations, "what matters most" and participants who read the vignette describing CHR symptomology only had more positive CHR help-seeking attitudes compared to participants who read the vignette describing CHR affecting individual aspirations.

CONCLUSIONS

Chinese and Taiwanese residing in the United States may perceive professional mental healthcare to be especially relevant for persons with CHR when symptoms are particularly stigmatizing for the person's family and when symptoms threaten the person's ability to fulfil family obligations (ie, "what matters most"). Clinical implications of findings include the importance of emphasizing positive treatment outcomes that increase an individual's ability to engage in valued life domains.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

BACKGROUND

Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized.

METHOD

We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs.

RESULTS

NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system.

CONCLUSIONS

Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

Working with Asian American youth at clinical high risk for psychosis: a case illustration

The idea of a clinical high risk (CHR) for psychosis has focused attention on early intervention to prevent or attenuate psychosis. However, many clinicians may still not be very familiar with the concept of CHR. Current studies have not allowed for an in-depth examination of the challenges and the strategies of working with youth from the range of racial/ethnic minority families, Asian American families in particular. The purpose of this article was three-fold. First, we critically review Asian cultural values and beliefs about mental illness, psychosis in particular, while highlighting specific challenges that Asian American families encounter. Second, we provide a clinical case to illustrate these challenges and inform clinical practice when working with Asian youth at risk for psychosis and their families. Third, practical and easy-to-follow clinical strategies are provided. Implications for clinical practice and directions for future research are presented.