David T. Takeuchi

Ethnic minority adolescents and the use of community mental health care services.

Examined the utilization rates, treatment dropout rates, and length of treatment for minority adolescents in the mental health care system. Data from the Los Angeles County Department of Mental Health from 1983 to 1988 were used. Ss were 853 African Americans, 704 Asian Americans, 964 Hispanics, and 670 whites. Analyses showed that Asian Americans and Hispanics are underrepresented in existing public mental health facilities while African Americans are overrepresented. For dropout rates, no ethnic differences are found between minority groups and whites; but, for length of treatment, Asian Americans tend to stay longer in treatment while African Americans tend to stay in treatment for a shorter period of time than whites. African Americans also have more outpatient episodes than whites. Implications of the results are discussed, and recommendations for future research are suggested.

Predictors of help seeking for emotional distress among Chinese Americans: family matters.

Using data from the Chinese American Psychiatric Epidemiological Study, the authors examined longitudinal predictors of help seeking for emotional distress in a community sample of 1,503 Chinese Americans. Specifically, they assessed the relative contribution of family relational variables (e.g., levels of family support and family conflict) in predicting help seeking for medical, mental health, and informal services. After traditional need, predisposing, and enabling factors were controlled for in hierarchical logistic regression analyses, family conflict predicted both mental health and medical service use, whereas family support was not predictive of help seeking. In addition to family conflict, mental health service use was predicted by negative life events, emotional distress, and insurance coverage. Implications of the findings for assessing and treating Asian American clients are explored.

Ethnic differences in the perception of barriers to help-seeking

SummaryThis paper explores differences among ethnic groups in their perception of barriers to help-seeking. Data for this analysis were drawn from a Hawaii statewide survey conducted in 1984. A total of 2503 adult residents were interviewed. Four ethnic groups were selected for study in this particular analysis: Caucasian, Filipino, Japanese and Native Hawaiian. The major dependent variable was the perception of barriers for two distinct types of problems: alcoholism and severe emotional problems. Caucasians perceived less barriers for both types of problems than the three minority ethnic groups. A logistic regression analysis found that this ethnic difference held when controlled for other demographic variables. Additional analyses were conducted to determine the types of barriers perceived for each problem by the ethnic groups.

Age of first onset major depression in Chinese Americans.

Using data from the Chinese American Epidemiological Study, risk for experiencing an initial episode of major depression across the life course was examined. Data were collected on 1,747 U.S.-born and foreign-born Chinese Americans (ages 18-65 years). Results suggest that Chinese American women did not evidence higher risk than Chinese American men for experiencing a 1st major depressive episode. Risk for experiencing a 1st depressive episode decreased as length of residence in the United States increased. Although those who immigrated at younger ages evidenced greater overall risk, those who came at later ages were more likely to become depressed at or soon after arrival. Competing theories of acculturation-related risk are discussed and directions for future research are proposed.

Community mental health services for ethnic minority groups

This study investigated services received, length of treatment, and outcomes of thousands of Asian-American, African-American, Mexican-American, and White clients using outpatient services in the Los Angeles County mental health system. It tested the hypothesis that therapist-client matches in ethnicity and language are beneficial to clients. Results indicate that Asian Americans and Mexican Americans underutilized, whereas African Americans overutilized, services. African Americans also exhibited less positive treatment outcomes. Furthermore, ethnic match was related to length of treatment for all groups. It was associated with treatment outcomes for Mexican Americans. Among clients who did not speak English as a primary language, ethnic and language match was a predictor of length and outcome of treatment. Thus, the cultural responsiveness hypothesis was partially supported.

Mental health services for Asian Americans and pacific islanders

Inquiries over the past three decades have shown that ethnic minorities drop out of treatment early and tend to have poorer outcomes in psychotherapy. Despite the widespread acceptance that culturally responsive therapy and programs will produce better treatment outcomes for ethnic minorities, few studies have empirically tested this proposition. This paper reviews two types of interventions, ethnic match and parallel programs, to make the mental health system more responsive to the needs of Asian Americans and Pacific Islanders.

Psychiatric symptom dimensions among asian americans and native hawaiians: An analysis of the symptom checklist

Standardized instruments are often used to assess the need for mental health services in a community. Such instruments are usually standardized on Caucasian samples and are generally assumed to be appropriate for different ethnocultural minorities. However, this assumption may be in error because cultural groups vary in their expression, manifestation, and reporting of symptoms. This article analyzes the responses to a standardized instrument, the Symptom Checklist (SCL), for four ethnic groups in Hawaii: Caucasians, Filipinos, Japanese, and Native Hawaiians. Factor analysis using a procrustes rotation was used to force the data to fit into the five hypothesized factors of the SCL (somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety). It showed that the scale item loadings generally did not correspond to the hypothesized factors. Among the ethnic groups, Caucasians appeared to have the best fit between the empirical and hypothesized factors whereas Native Hawaiians had the worst fit. Our results reinforce the importance of assessing established psychiatric symptom scales prior to their use on different ethnocultural minorities.

Mental Illness in a Multicultural Context

How does culture affect the expression and prevalence of mental illness? This question reflects a critical tension in scientific investigations of mental health and illness that is revealed in the history of the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM provides a description of different “accepted” mental disorders and the clinical criteria for assessing each. Since the American Psychiatric Association (APA) first published the DSM in 1952, it has become widely used by clinicians psychiatric researchers, and social scientists for different purposes. As a foundation, DSM assumes that mental disorders are discrete biomedical entities that are explained by biomedical processes. It is often implicitly assumed that psychiatric symptoms or syndromes are universally distributed and uniformly manifested. This assumption is unwarranted, because groups vary in how they define such constructs as “distress,” “normality,” and “abnormality.” These variations affect definitions of mental health and mental illness, expressions of psychopathology, and coping mechanisms (White & Marsella, 1982).

Factor Validity of Scores on a Social Support and Conflict Measure among Chinese Americans

Data collected from the Chinese American Psychiatric Epidemiological Study (CAPES) were used to examine the factor validity of selected social support and conflict indices among 1,152 married Chinese Americans. Gender, age, and a 36-item social interaction scale consisting of six separate indices of social support and social conflict (spouse, family, and friend) were factor analyzed. As expected, cross-cultural validity of scores on all six social interaction indices was confirmed, lending empirical support to the notion that social support and conflict from different sources are distinct constructs in Chinese Americans.