Seunghye Hong

Use of Mental Health–Related Services Among Immigrant and US-Born Asian Americans: Results From the National Latino and Asian American Study

OBJECTIVES We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. METHODS Data were derived from the National Latino and Asian American Study (2002-2003). RESULTS About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. CONCLUSIONS Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

Immigration-related factors and mental disorders among Asian Americans.

OBJECTIVES We examined lifetime and 12-month rates of any depressive, anxiety, and substance abuse disorders in a national sample of Asian Americans. We focused on factors related to nativity and immigration as possible correlates of mental disorders. METHODS Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of Asian Americans in the United States. RESULTS The relationships between immigration-related factors and mental disorders were different for men and women. Among women, nativity was strongly associated with lifetime disorders, with immigrant women having lower rates of most disorders compared with US-born women. Conversely, English proficiency was associated with mental disorders for Asian men. Asian men who spoke English proficiently generally had lower rates of lifetime and 12-month disorders compared with nonproficient speakers. CONCLUSIONS For Asian Americans, immigration-related factors were associated with mental disorders, but in different ways for men and women. Future studies will need to examine gender as an important factor in specifying the association between immigration and mental health.

Developmental Contexts and Mental Disorders Among Asian Americans

In this article, we use age of immigration as a proxy for the developmental context for understanding the association between immigration experiences and mental health. Generation defines the context under which immigrants arrive in the United States. We drew data from the National Latino and Asian American Study (N = 2,095), the first ever study conducted on the mental health of a national sample of Asian Americans. Our findings reveal that age of immigration is linked to lifetime and 12-month rates of psychiatric disorder: Immigrants who arrive earlier in life are more likely to have both lifetime and 12-month disorders. U.S. born and immigrants who arrive as children are much more likely to have a mental disorder in their lifetimes than other immigrant generations.

Correlates of Suicidal Behaviors Among Asian Americans

This study examines the correlates of suicidal ideation, suicide plan and suicide attempt among Asian Americans focusing on nativity and gender. Analyses are performed on data from the National Latino and Asian American Study (N = 2095), the first ever study conducted on the mental health of a national sample of Asian Americans. The sample is comprised of adults with 998 men (47%) and 1,097 (53%) women. Analysis of weighted lifetime prevalence of suicidal behaviors revealed that U.S.-born Asian American women had higher prevelance of suicidal ideation and suicide plan than U.S.-born Asian American men and immigrant Asian American men and women. In multivariate analyses controlling for socio-demographic differences such as ethnicity, marital status and income, differences in suicidal behaviors are found only between U.S.-born women and U.S.-born men. The findings demonstrate the need to disaggregate data by immigrant status as well as socio-demographic correlates.

Telephone-Based Cognitive-Behavioral Therapy for Latino Patients Living in Rural Areas: A Randomized Pilot Study

OBJECTIVE This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings. METHODS A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data. RESULTS In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over the six-month follow-up period compared with patients who received enhanced usual care (β=-.41, t=-2.36, df=219, p=.018, for the SCL; and β=-3.51, t=-2.49, df=221, p=.013, for the PHQ-9). A greater proportion of patients in the CBT group than in the group that received enhanced usual care achieved treatment response at three months (p=.017), as indicated by a 50% improvement in SCL depression score or a score <.75, and reported high satisfaction with treatment (p=.013). CONCLUSIONS Although limited by small sample size, pilot results suggest culturally tailored, telephone-based CBT has the potential to enhance access to psychotherapy in an underserved Latino population with little access to mental health services.

Limited English proficiency and psychological distress among Latinos and Asian Americans

English proficiency is increasingly recognized as an important factor that is related to the mental health of immigrants and ethnic minorities. However, few studies have examined how the association between English proficiency and mental health operates and whether the pattern of association is similar or different among various ethnic minority groups. This paper investigates how limited English proficiency directly and indirectly affects psychological distress through pathways of discrimination for both Latinos and Asian Americans in the United States. Findings suggest that, for Asian Americans, limited English proficiency has an independent relationship with psychological distress over and above demographic variables, socioeconomic and immigration-related factors and discrimination. For Latinos, however, socio-demographic variables and discrimination show a stronger association than limited English proficiency in affecting psychological distress. Different forms of discrimination - everyday discrimination and racial/ethnic discrimination - are equally important for both ethnic groups. Findings underscore the differential role of limited English proficiency for the mental health of Asian Americans and Latinos and suggest the distinctive racial experiences and backgrounds of these two ethnic groups.

Neighborhoods and Mental Health: Exploring Ethnic Density, Poverty, and Social Cohesion among Asian Americans and Latinos

This study examines the associations of neighborhood ethnic density and poverty with social cohesion and self-rated mental health among Asian Americans and Latinos. Path analysis is employed to analyze data from the 2002-2003 National Latino and Asian American Study (NLAAS) and the 2000 U.S. Census (N = 2095 Asian Americans living in N = 259 neighborhoods; N = 2554 Latinos living in N = 317 neighborhoods). Findings reveal that neighborhood ethnic density relates to poor mental health in both groups. Social cohesion partially mediates that structural relationship, but is positively related to ethnic density among Latinos and negatively related to ethnic density among Asian Americans. Although higher neighborhood poverty is negatively associated with mental health for both groups, the relationship does not hold in the path models after accounting for social cohesion and covariates. Furthermore, social cohesion fully mediates the association between neighborhood poverty and mental health among Latinos. This study highlights the necessity of reconceptualizing existing theories of social relationships to reflect complex and nuanced mechanisms linking neighborhood structure and mental health for diverse racial and ethnic groups.

Social support and the use of mental health services among Asian Americans: results from the national Latino and Asian American study

Objective: Our study examines the association between social support and use of mental health services in Asian American men and women. Specifically, we report on the association between types of social support and types of health services used (general medical care and specialty mental health care). Method: We use data from the National Latino and Asian American Study, a nationally representative survey of the US household population of Latino and Asian Americans. Our present study is based on data from the sample of Asian Americans (N = 2,095). Results: Overall, our findings suggest that Asian Americans use general medical care services more than specialty mental health care. Our findings also showed variations in levels of social support, and the use of health services among different Asian subgroups (Vietnamese, Filipino, Chinese, and Other Asian) and nativity status (US-born versus foreign-born Asians). Specific types of social support influenced the use of specialty mental health care services, while other types of social support inhibited use of specialist services. Conclusion: Compared to using generalist services, Asian Americans demonstrated lower rates of using specialist services. Our results emphasize the importance of considering other social factors to explain between group differences as well as factors contributing to the underutilization of specialty mental health services by Asian Americans.

Perceived Discrimination and Psychological Distress Among Asian Americans: Does Education Matter?

Using data from the National Latino and Asian American Study, this work examines if and how perceived everyday discrimination is associated with psychological distress among Asian Americans and whether this association varies by important structural factors as education and place of education. Findings reveal that perception of discrimination is associated with increased levels of psychological distress. Most importantly, education moderates the discrimination-distress association such that the detrimental effect of discrimination is stronger for Asian Americans with college or more levels of education than for Asian Americans with less than college levels of education. Place of education further conditions the moderating effect of education: The foreign-educated Asian Americans with higher levels of education are affected most negatively by discrimination compared to others. This study highlights (1) the significant joint role of education and place of education in conditioning the relationship between perceived discrimination and psychological distress, and (2) unique features of education in improving our understanding of Asian Americans’ mental health.