Asian American mental health: Longitudinal trend and explanatory factors among young Filipino- and Korean Americans

Willingness to use mental health counseling in diverse groups of Asian Americans

Responding to the underutilization of mental health services in Asian American communities, we examined factors associated with their willingness to use mental health counseling. Applying Andersen's Behavioral Health Service Model, we focused on the role of mental health needs and prior use of mental health counseling in shaping the attitudes toward mental health counseling of diverse groups of Asian Americans. We conducted a secondary analysis of data from 2,609 Asian Americans aged 18 or older who participated in the Asian American Quality of Life (AAQoL) survey conducted in central Texas. Logistic regression models of willingness to use mental health counseling were tested with predisposing (age, gender, marital status, education, nativity, and English-speaking ability), mental health needs (mental distress and self-rated mental health) and enabling (prior use of mental health counseling) variables. About 67% of the overall sample indicated their willingness to use mental health counseling. Individuals who met the criteria for mental distress showed 17% lower odds of willingness to use mental health counseling. The enabling role of prior use of mental health counseling was supported; those who had used counseling were over three times more likely to be willing to use counseling in the future than their counterparts without such an experience. Given the inverse association between mental health needs and the willingness to use mental health counseling, further attention should be paid to improving Asian Americans' recognition of mental health symptoms and awareness of the benefit of mental health services. The enabling role of prior use of counseling also highlights the importance of increasing the exposure to mental health services for Asian Americans. In efforts to promote mental health literacy, reduce cultural stigma, and advocate for mental health service use, consideration of cultural and linguistic diversity within the Asian American population is imperative.

Cultural family processes, depressive symptoms, and suicidal ideation: A longitudinal study of Asian American youths

INTRODUCTION

This prospective study examined the direct and interactive effects of depressive symptoms and cultural family processes (i.e., intergenerational cultural conflict, academic parental control, cultural socialization parenting) on Asian American youths' suicidal ideation from adolescence to young adulthood.

METHODS

We utilized three-wave data of 408 Korean American and 378 Filipino American youths (M = 15.00 years, SD = 1.91 at Wave 1). For each ethnicity, we tested (1) whether depressive symptoms and cultural family processes predicted past-year suicidal ideation; and (2) whether cultural family processes moderated the depressive symptom-suicidal ideation link.

RESULTS

Across ethnicities, depressive symptoms significantly predicted suicidal ideation after controlling for cultural family processes. For Filipino youths, intergenerational cultural conflict significantly predicted suicidal ideation after controlling depressive symptoms and exacerbated the depressive symptom-suicidal ideation link. For Filipino youths, depressive symptoms were significantly associated with suicidal ideation only at lower levels of cultural socialization parenting. For Korean youths, academic parental control exacerbated the depressive symptom-suicidal ideation link.

CONCLUSION

Findings suggest that while depressive symptoms have a robust effect on Asian American youths' suicidal ideation, this effect may be moderated by cultural family processes. Different findings for Korean and Filipino youths highlight the importance of disaggregating analyses by ethnicity to guide prevention efforts.

Acculturation and suicide-related risk in ethnoracially minoritized youth in the US: a scoping review and content analysis of the empirical evidence

PURPOSE

Among Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth, the US born have higher risk of suicidal thoughts and behaviors (attempts and death-by-suicide) than first-generation migrants. Research has focused on the role of acculturation, defined as the sociocultural and psychological adaptations from navigating multiple cultural environments.

METHODS

Using content analysis, we conducted a scoping review on acculturation-related experiences and suicide-related risk in Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth (henceforth described as "ethnoracially minoritized adolescents"), identifying 27 empirical articles in 2005-2022.

RESULTS

Findings were mixed: 19 articles found a positive association between acculturation and higher risk for suicide ideation and attempts, namely when assessed as acculturative stress; 3 articles a negative association; and 5 articles no association. Most of the research, however, was cross-sectional, largely focused on Hispanic/Latinx youth, relied on demographic variables or acculturation-related constructs as proxies for acculturation, used single-item assessments for suicide risk, and employed non-random sampling strategies. Although few articles discussed the role of gender, none discussed the intersections of race, sexual orientation, or other social identities on acculturation.

CONCLUSION

Without a more developmental approach and systematic application of an intersectional research framework that accounts for racialized experiences, the mechanisms by which acculturation may influence the risk of suicidal thoughts and behavior remain unclear, resulting in a dearth of culturally responsive suicide-prevention strategies among migrant and ethnoracially minoritized youth.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

To Be in Harmony: Chinese American Adolescents' and Parents' Bicultural Integration During the COVID-19 Pandemic

Experiences of racial discrimination have been found to be associated with internalizing problems among ethnic-racial minority youth. However, mediating and moderating processes that might explain this association is less well understood. Thus, the present study aimed to examine whether Chinese American adolescents' bicultural identity integration harmony (BII-Harmony) mediated the association between their experiences of racial discrimination and internalizing behaviors. Furthermore, we examined the moderating role of their parents' BII-Harmony in this mediation model. Chinese American adolescents (Mage = 13.9 years; SD = 2.3; 48% female) reported their experiences of racial discrimination and BII-Harmony, and their parents (Mage = 46.2 years; SD = 5.2; 81% mothers) reported their BII-Harmony and their children's internalizing difficulties. Chinese American adolescents' racial discrimination experiences were negatively associated with BII-Harmony, and in turn, more internalizing problems, but only when their parents also reported low and mean levels of BII-Harmony.

Investigating Asian American Adolescents' Resiliency Factors and Young Adult Mental Health Outcomes at 14-year Follow-up: A Nationally Representative Prospective Cohort Study

There is scant research on how Asian American adolescents' resiliency relates to mental well-being in adulthood. The objective of this study was to determine the prospective associations between resiliency factors (individual, family, and school community) in adolescence and mental health outcomes in adulthood, among a national sample of Asian Americans. We analyzed data from 1020 Asian American adolescents who were followed for 14 years in the National Longitudinal Study of Adolescent to Adult Health. Of the resiliency factors, individual self-esteem (Adjusted Odds Ratio [AOR] 0.54, 95% Confidence Interval [CI] 0.37-0.79) and family connectedness (AOR 0.78, 95% CI 0.65-0.93) in adolescence were found to be protective against adult mental health outcomes in logistic regression models adjusting for sociodemographic factors and baseline mental health. Our study identified individual and family resiliency factors which can be leveraged to help Asian American adolescents and families in cultivating better mental health.

The mental health of Asian American adolescents and young adults amid the rise of anti-Asian racism

Objectives

We describe the perceptions and experiences of anti-Asian racism and violence and depression severity prior to and during the COVID-19 pandemic among a sample of Asian American (AA) adolescents and young adults.

Methods

We used data from the Young Asian American Health Survey (YAAHS), an online-recruited sample of AA adolescents (ages 13-17) and young adults (ages 18-29 years) conducted during May 2021 to March 2022. We presented descriptive statistics examining the univariate distribution and bivariate relationships of depression severity, sociodemographic characteristics, and experiences and perceptions of anti-Asian violence.

Results

Our sample (n = 176) comprised AA adolescents and young adults from 17 Asian ethnicities. A quarter said that the frequency and/or severity of their personal experiences of anti-Asian harassment had increased since the pandemic started. 76% indicated feeling less safe now than before the pandemic. Two-thirds reported that their depressive symptoms have increased since the pandemic started. Participants who reported feeling less safe now than before the pandemic were more likely to report increased personal experiences with anti-Asian harassment and increased depression severity since the pandemic started than those who reported feeling as safe or safer before the pandemic (p < 0.01 for both).

Discussion

Findings illustrate AA adolescent and young adults are experiencing multiple health and social crises stemming from increased anti-Asian racism during the COVID-19 pandemic. We urge policymakers to strengthen data systems that connect racial discrimination and mental health and to institute prevention measures and anti-racist mental health services that are age- and culturally-appropriate for AA adolescent and young adults.

Meta-analysis of the effect of racial discrimination on suicidality

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there have been reports that minorities and marginalized groups exposed to RD are at a higher risk of suicide. Given that RD negatively impacts mental health and that suicide is a major public health concern, we meta-analytically reviewed the literature to investigate whether RD is associated with suicidal ideation (SI) and suicide attempt (SA). We identified 43 eligible articles investigating the association between RD and suicidality through PubMed, Embase, PsycINFO and Scopus, from which we pooled 39 effect sizes for SI (58,629 individuals) and 15 for SA (30,088 individuals). Results demonstrated that RD has a small but significant effect both on SI (r = 0.16, 95% CI: 0.12 to 0.19; p < 0.0001) and on SA (r = 0.13, 95% CI: 0.02 to 0.23; p = 0.018). We found no indication of publication bias, and fail-safe tests confirmed the robustness of the results. Furthermore, we tested the moderating effects of several study characteristics (e.g., age, race, RD and SI time frame assessment, and categorization of RD measures). The only study characteristic to moderate the effect of RD on SI was SI time frame assessment (r = 0.07; 95% CI: 0.015 to 0.12; p = 0.01). Our findings suggest that SI and SA are phenomena that may be influenced by exposure to RD. Thus, individuals that are discriminated based on race may develop more suicidal thoughts and an increased likelihood of attempting suicide. These findings underscore the need for more prevention and intervention efforts to attenuate the effect of RD on suicidality.

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We conducted a meta-analysis of 62,349 individuals.

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We pooled effect sizes from 43 studies from seven countries.

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Racial discrimination has a statistically significant effect on suicidal ideation (r = 0.16, p < 0.0001).

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Racial discrimination has a statistically significant effect on suicide attempt (r = 0.13, p = 0.018).

Upholding Familism Among Asian American Youth: Measures of Familism among Filipino and Korean American Youth

Although it is one of the core cultural values of Asian American families and an influential determinant of youth development, familism remains under-studied among Asian Americans and, despite crucial within-group heterogeneity, lacks subgroup specificity. This study describes the ways in which two major Asian American subgroups of youth, i.e., Filipino Americans and Korean Americans, maintain traditional familism. Specifically, this study constructed six self-report subscales of familism utilizing underused and new survey items and tested their psychometric properties. Using data collected from Filipino American (n=150) and Korean American (n=188) adolescents living in a Midwest metropolitan area, the measures were examined for validity and reliability for each group and, when appropriate, for measurement invariance across the groups. The main findings are that the finalized scales demonstrated solid reliability and validity (e.g., content and construct) in each group and some invariance and that core traditions, in the form of familism values and behaviors, persevere among second-generation Asian Americans, although familism was more evident among Filipino American youth than in Korean American youth. In both groups, subdomains of familism were not as discrete as found among their parents, who were predominantly foreign-born first-generation immigrants. The finalized familism scales were associated differently with several correlates including acculturation variables and youth outcomes. The findings are discussed with a call for further empirical research of diverse ethnic groups and immigrant generations to more accurately account for how family process interacts with cultural origin and acculturation.

Racial Stereotypes and Asian American Youth Paradox

Asian Americans are simultaneously stereotyped as a perpetual foreigner and a model minority. This cross-sectional study of 308 Filipino American youth (mean age 18 years; 47% emerging adult; 72% U.S.-born; 57% female) and 340 Korean American youth (mean age 18 years; 39% emerging adult; 59% U.S.-born; 49% female) is the first to investigate both the direct and interactive effects of these seemingly opposite stereotypes on internalizing and externalizing outcomes, and how these relations differ by ethnicity, age group (adolescence vs. emerging adulthood), and nativity (foreign-born vs. U.S.-born). The results confirm that the perpetual foreigner stereotype predicts more internalizing problems, whereas aspects of the model minority stereotype (i.e., achievement orientation and unrestricted mobility) had different effects by ethnicity. Those who deeply internalize the model minority stereotype were found to be particularly vulnerable. Furthermore, the interactive effects of these stereotypes were more prominent during emerging adulthood than in adolescence, regardless of ethnicity. These nuanced and complex mechanisms need to be thoroughly understood in order to develop appropriate and effective public health or school interventions that can support Asian American young people in dealing with the harmful effects of racial stereotypes.

Racial discrimination and the moderating effects of racial and ethnic socialization on the mental health of Asian American youth

This study investigates trajectories of racial discrimination, racial and ethnic socialization (RES), and their interaction effects with social positions (nativity and gender) on mental health. A longitudinal study of 786 Filipino American (FA) and Korean American (KA) youth from the Midwestern United States (M_age.Wave1  = 15) confirmed that discrimination increased and significantly contributed to the upward trend of mental health distress, whereas the impact of RES differed by its type and by ethnicity. For example, promotion of mistrust and ethnic-heritage socialization were protective among U.S.-born FA youth, but for KA youth, preparation for bias was protective regardless of nativity and gender. This study highlights the importance of considering social positions to better understand the role of RES in youth psychological adjustment.

Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review

Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community violence. Collectively, the majority of included studies suggest that depressive symptoms were more likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such findings offer a starting point to examine what factors should be necessarily included in related depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms.