Help-seeking intentions among Asian American and White American students in psychological distress: Application of the health belief model

Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

BACKGROUND

While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White).

METHOD

Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month.

RESULTS

The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3).

CONCLUSION

Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.

Assessing perceptions of stigmatization by others for seeking help in China: psychometric characteristics and measurement invariance across gender and therapy experience

The stigma of social networks may be more noticeable in collectivist societies like China, but research in this area has largely been overlooked due to a lack of reliable measurement. To address this gap, this study tested the psychometric properties of the Chinese version of the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale in the Chinese general population, and tested its invariance across gender and prior therapy experience. In a national online survey, 640 adults completed the PSOSH and conceptually related scales: Self-stigma of Seeking Help (SSOSH), Stigma of Seeking Professional Psychological Help Scale (SSPPH, i.e., public stigma) and Attitudes toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF). Confirmatory factor analysis supported the unidimensional structure of the original PSOSH. The Cronbach's α coefficient was 0.84 and the 3-week test-retest reliability of was 0.77. The PSOSH showed moderate correlations with the three conceptually related scales, supporting its concurrent validity. Importantly, the PSOSH significantly predicted self-stigma scores, even when considering demographic variables and public stigma, supporting its incremental validity. The scale also demonstrated scalar invariance across gender and across subgroups who had vs. did not have previous therapy experience, supporting comparisons of latent means across these groups. The PSOSH is a reliable and valid instrument for assessing social network stigmatization of professional help-seeking in Chinese community samples.

Chinese undergraduates' mental health help-seeking behavior: the health belief model

The detection rate of mental health problems among undergraduates has recently risen significantly. However, undergraduates underutilize mental health services; approximately a third only of undergraduates in need of treatment use school counseling resources. Based on a social psychological theoretical framework, the health belief model, factors of undergraduates' willingness to seek help when dealing with psychological problems were investigated. A cross-sectional online questionnaire and a snowball sampling method with 446 undergraduates investigated perceived susceptibility, perceived severity, perceived behavioral benefits, perceived barriers, self-efficacy, and cues to action to understand how students' mental health-seeking behaviors are affected. We found that perceived susceptibility (p < 0.01), perceived severity (p < 0.01), perceived benefits (p < 0.01), perceived barriers (p < 0.01), self-efficacy (p < 0.01), and cues to action (p < 0.01) significantly correlated with behavioral intention. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help. In addition, we used a bias-corrected Bootstrap approach to test the significance of the mediating effect, the mediation effect of cues to action between undergraduates' perceived susceptibility and mental health help-seeking behavior was utterly significant [mediation effect value of 0.077, with an SE value of 0.027 and a 95% CI (0.028, 0.133)]. It demonstrated that those who perceived themselves to be at high risk of developing a mental illness and who had received encouragement or counseling to seek mental health help were more likely to be motivated to seek mental health help. Multiple regression analyses indicated that self-efficacy (Z = 5.425, p < 0.01) and cues to action (Z = 6.673, p < 0.01) independently influenced behavioral intentions. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help.

Factors that influence Asian American college students use of mental health services: A systematic mixed studies review

WHAT IS KNOWN ON THE SUBJECT?: Only 8.6% Asian Americans (AAs) report seeking mental health services compared to nearly 18% of the general population. There is a stigma against seeking mental health services among AAs. Mental illness is thought to be caused by a lack of harmony of emotions or evil spirits leading to delay in treatment among AAs. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Asian students are hesitant to use mental health services because they are balancing their desire to be part of the two cultures. Concepts used to define culture were found to have overlapping aspects of how researchers operationally define them, and few studies examined a combination of these concepts as a means of examining interactions between the concepts. AA emerging adults feel pressure through personal stigma from elders to 'save face' by keeping their problems to themselves or within the family to maintain a positive reputation for the family. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overlap of conceptual definitions to understand cultural beliefs and values affecting measurement have complicated the interpretation of the research. Future research should include a multidimensional operationalization of culture that includes acculturation, ethnic identity, personal stigma and their effect on mental health help-seeking attitudes. Differences between South Asian and East Asian philosophical and cultural perspectives could influence access to mental health services; therefore, future studies should consider sampling that would allow for comparison of the groups. Understanding the factors that influence mental health help-seeking behaviours can determine intervention strategies to improve AA emerging adult mental health.

ABSTRACT

INTRODUCTION: Only 8.6% of Asian Americans (AA) sought mental health services compared to 18% of United States population. AA college students report higher levels of mental health concerns compared to White students.

AIM

The purpose of this systematic review was to identify the factors that influence AA students' mental health help-seeking behaviours.

METHOD

Employing a data-based convergent synthesis design. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the sample. Inclusion criteria were peer-reviewed studies published in English, focused on AA college students' mental health seeking attitudes in United States.

RESULTS

The final sample was forty-four studies. Four themes emerged: acculturation, ethnic identity, racism and stigma. There were discrepant findings regarding how acculturation affects mental health help-seeking attitudes. Several studies included more than one theme in their analyses. The different concepts included across studies make it difficult to compare the findings.

DISCUSSION

There is some overlap between acculturation and ethnic identity that could affect the analysis in studies where both concepts are included. Personal stigma negatively influences mental health help-seeking attitudes.

IMPLICATIONS FOR PRACTICE

Defining culture to include acculturation, ethnic identity, personal stigma can help in understanding their effect on mental health help-seeking attitudes.

Behavioral Addiction from the Asian Americans Perspective: Exploration of Public and Help-Seeking Stigma

Asian Americans have been unlikely to seek mental health services despite their needs for treatment, particularly when experiencing significant gambling or Internet gaming problems. Stigma is often considered to be a barrier to seeking help. To understand how stigma impacts Asian Americans' willingness to seek mental health services, the present study used an online survey to investigate the public stigma associated with addictive behaviors and help-seeking stigma among Asian Americans. Participants (N = 431) who self-identified as Asian American, reside in the US. Using a between-groups vignette study design, it was found that the individual with a behavioral addiction received more stigma compared to the individual who experienced a financial crisis. In addition, participants were more likely to seek help if they experienced addictive behavioral problems rather than financial problems. Lastly, this study did not reveal a significant relation between public stigma attached to addictive behaviors and Asian Americans' willingness to seek help, but it found that participants' willingness to seek help was positively associated with public stigma of help seeking (β = 0.23) and negatively associated with self-stigma attached to help-seeking (β = - 0.09). Based on these findings, recommendations are provided to inform community outreach to reduce stigma and promote mental health service utilization among Asian Americans.

Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7-11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed.

Inclusive mental health support for international students: Unveiling delivery components in higher education

This study examines the delivery components of inclusive mental health services in higher education, centering on international university students. Through interviews with 32 participants at a state university in the United States, including students, counseling staff, and faculty, six key themes emerged: mental health professionals' multicultural self-awareness, focus on reparative services, mainstream mental health theories and approaches, professionals' cultural background, faculty involvement and physical space and confidentiality. These findings underscore the importance of training for professionals, expansive mental health offerings, incorporation of diverse approaches, confidentiality, active faculty participation and suitable physical environments. By addressing these components, universities can enhance the quality of mental health support for international student populations, promoting their overall well-being and academic success.

Understanding ADHD in AAPI College Students: Prevalence, Comorbidities, Impairments, and Treatment Utilization

OBJECTIVE

Asian American and Pacific Islander (AAPI) students with ADHD may face increased risk for college maladjustment due to cultural factors and a tendency to delay treatment. This is the first study to examine ADHD prevalence, ADHD-related impairments and comorbidities, and ADHD treatment utilization in AAPI college students.

METHOD

AAPI, White, Hispanic, and Black undergraduates (n = 258,005) from the American College Health Association-National College Health Assessment II survey were included in the study.

RESULTS

AAPI students had lower ADHD prevalence rates than White and Black students, and similar prevalence to Hispanic students. AAPI students with ADHD had significantly higher risk for comorbidities and social and academic impairments, compared to White students with ADHD. Approximately half of AAPI students with ADHD did not utilize treatment despite experiencing psychiatric comorbidities and functional impairments.

CONCLUSION

AAPI college students with ADHD are underutilizing treatment despite elevated psychiatric comorbidities and functional impairment.

Substance use disorders and treatment in Asian American and Pacific Islander women: A scoping review

BACKGROUND AND OBJECTIVES

Asian American Pacific Islanders (AAPIs) face unique barriers in seeking treatment for substance use disorders (SUD) and are less likely than the general population to receive treatment. Barriers specific to AAPI women may be especially significant given identified gender and racial differences in SUD prevalence and treatment. This review examines rates of SUD in AAPI women and summarizes the literature on SUD treatment for AAPI women.

METHODS

Data from 2016 to 2019 National Survey on Drug Use and Health (NSDUH) surveys were extracted to summarize rates of SUD. A scoping review of the literature on AAPI women and SUD treatment was conducted; eight articles published from 2010 to present were reviewed.

RESULTS

The prevalence of SUDs among AAPI women increased overall, although rates of SUDs were generally lower in AAPI women compared to their male counterparts. Patterns of gender differences in SUDs varied for subpopulations of AAPI women. There is limited research on treatment utilization and access for AAPI women. The few studies that examined treatment outcomes found favorable outcomes for AAPI women; research on culturally adapted interventions was promising but nascent.

DISCUSSION AND CONCLUSIONS

Literature on SUD treatment for AAPI women is limited. The availability of more culturally tailored treatments addressing the specific needs of AAPI women may lead to more acceptability and treatment utilization for this group. Additional research is needed to elucidate the unique barriers to treatment AAPI women face.

SCIENTIFIC SIGNIFICANCE

With rising rates of substance use in AAPI women, there is a need to develop and test effective SUD treatments adapted for AAPI women.

Perceived COVID-19 threat, perceived healthcare system inequities, personal experiences of healthcare discrimination and their associations with COVID-19 preventive behavioral intentions among college students in the U.S

College students are often reluctant to follow U.S. preventive guidelines to lower their risk of COVID-19 infection, despite an increased risk of transmission in college settings. Prior research suggested that college students who perceived greater COVID-19 severity and susceptibility (i.e., COVID-19 threat) were more likely to engage in COVID-19 preventive behaviors, yet there is limited research examining whether perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination collectively influence college students' COVID-19 preventive behaviors. This study identified latent classes of perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination, examined whether latent classes were associated with COVID-19 preventive behavioral intentions, and assessed whether latent class membership varied across racial/ethnic groups.Students from the University of Maryland, College Park (N = 432) completed the Weighing Factors in COVID-19 Health Decisions survey (December 2020-December 2021). Latent class analysis identified latent classes based on perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination. Regression analyses examined associations between the latent classes and COVID-19 preventive behavioral intentions (i.e., social distancing, mask-wearing, COVID-19 vaccination) and whether latent class membership varied across racial/ethnic groups.Students in Latent Class 1 (27.3% of the sample) had high perceived COVID-19 threat and U.S. healthcare system inequities and medium probability of experiencing personal healthcare discrimination. Students in Latent Class 1 had higher social distancing, mask-wearing, and vaccination intentions compared to other latent classes. Compared to Latent Class 4 (reference group), students in Latent Class 1 had higher odds of identifying as Hispanic or Latino, Non-Hispanic Asian, Non-Hispanic Black or African American, and Non-Hispanic Multiracial versus Non-Hispanic White.Latent classes of higher perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination were associated with higher COVID-19 preventive behavioral intentions and latent class membership varied across racial/ethnic groups. Interventions should emphasize the importance of COVID-19 preventive behaviors among students who perceive lower COVID-19 threat.

Help-seeking for mental health services in Asian American college students: an exploratory qualitative study

Objective: To understand how the college environment might influence mental health help-seeking in Asian American undergraduates. Participants: Participants were 19 Asian American undergraduates recruited through Facebook. Methods: Participants were interviewed about attitudes toward mental health and mental health help-seeking, and thematic analysis with both inductive and deductive codes was used to analyze interview transcripts. Results: Several factors specific to the college environment encourage students to seek help: social support provided by peers and by campuses, psychological distance from home, and physical distance from home. However, other Asian American-specific factors discourage students from seeking help, such as cultural factors and stigma surrounding mental health issues. Conclusions: The college environment may encourage help-seeking, while Asian American-specific factors may discourage it. Potential interventions based on these findings may increase help-seeking rates by focusing on these encouraging factors in a culturally-sensitive way.

Mental Health Care Access and Individual Help-Seeking During the Covid-19 Pandemic

The UJA Covid-19 Jewish Impact Study constitutes a random sample of 4403 adults in Jewish households in the New York area. Collected between February and May 2021, the data include symptoms of depression and anxiety and the use of professional help. Via respondents' zip code tabulation areas (ZCTAs), these data are linked to contextual measures of mental health care access from two data sources: the SAMHSA Locator on specialty community treatment clinics, and the Zip Code Business Patterns database on solo and small group practices. Both treatment facilities and office practices are added to multilevel logistic regression models as density rates (per 10,000 people) and as binary indicators of presence. While we find no meaningful relationship between the general presence of mental health care services and help-seeking behavior, the ZCTA-level density of office practices is significantly associated with service utilization among the socially isolated, foreign-born and Hispanics or non-white respondents.

Issues behind the Utilization of Community Mental Health Services by Ethnic Minorities in Hong Kong

This study collected data on the utilization rates of community mental health services among ethnic minorities and explained the results from the frontline social workers' perspective. Information about users' ethnicity was collected from 11 community mental health service providers from 2015 to 2018. This was followed by two sessions of focus groups conducted with 10 frontline social workers from six community mental health centers in Hong Kong. A hybrid analysis model was employed to analyze the qualitative data. The average utilization rates of community mental health services by ethnic minorities were 0.49%, 0.58%, and 0.68% in the years 2015-16, 2016-17, and 2017-18, respectively, showing that ethnic minorities who comprised 8% of the population were significantly underrepresented. It is worth noting that supply-side and demand-side factors are interrelated, suggesting the low utilization rate may be overcome by implementing a proactive social work service strategy.

University students’ help seeking intention for depression from health professionals; a cross sectional study

Objectives

To assess University students’ intention to seek help for depression from health professional and associated factors among University of Gondar students, Northwest, Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 487 students. Multistage sampling technique was used to select study participants. Self-administered questionnaire was employed to collect the data. General help seeking questionnaire with major depressive disorder case vignette was used to assess students’ intention to seek help for depression. The collected data was analyzed using SPSS version 20. Simple and multiple linear regression analysis were performed to identify factors for intention to seek help for depression. Association was described by using adjusted unstandardized β coefficient along with 95% confidence interval. Finally, P-values < 0.05 in adjusted analysis were taken as a cut off for significant association.

Results

The mean score of intention to seek help from health professionals was 3.84 (±0.76)with a range of (1 “very unlikely” to 5 “very likely”). About 67.8% of the study participants would seek help from health professionals if they would have depressive symptoms which was depicted in the case vignette. In the multiple linear regression analyses, student age (unstandardized ß = 0.07, 95% CI: (0.05, 0.10)), good attitude towards seeking professional help (ß = 0.03, 95% CI: (0.02, 0.04)) were factors positively associated with intention to seek help.

Conclusion

The current study showed that more than three-fifth of the study participants reported they were likely or very likely to seek help for depression from health professionals. Increased age and favorable attitude were factors associated with intention to seek help for depression. Working on awareness creation and attitude change towards depression would be necessary to increase students’ intention to seek help for depression from health professional.

Asian Americans’ Perceived Knowledge of State Vocational Rehabilitation Services for People With Mental Illness

Given the significant role of employment on independent living and well-being among individuals with disabilities, such as those with mental illness, it is important to examine the experiences of racially and ethnically diverse cultural groups, including Asian Americans. However, little research focus has been made toward Asian Americans with disabilities in the rehabilitation counseling field. This study examined knowledge of state vocational rehabilitation (VR) services and the perceived importance and likeliness of receiving VR services in a sample of 315 Asian Americans. Survey questions were developed to ask participants’ perceived importance of receiving various VR services provided within state VR agencies and the likeliness of receiving or recommending each service if they or their family members had a mental illness. The results showed that most participants were not familiar with state VR services. Although slightly different patterns were identified in the participants’ importance and likeliness ratings, the top important and preferable service was diagnosis and treatment. The information gathered in this study has important implications for crafting culturally sensitive and effective outreach and marketing strategies in Asian American communities.

COVID-19 Racism, Internalized Racism, and Psychological Outcomes among East Asians/East Asian Americans

The present study investigated the psychological effects of racism on East Asians and East Asian Americans (EAEAAs) living in the United States during the COVID-19 pandemic using a mixed-methods approach. First, using an autoregressive cross-lagged panel analysis, we investigated the relations between COVID-19 racism, internalized racism, psychological distress, and social isolation among EAEAAs. We then examined the impact of the COVID-19 pandemic on EAEAAs using consensual qualitative research-modified. Quantitative findings showed that COVID-19 racism at Time 1 was associated with greater subsequent psychological distress, and COVID-19 racism at Time 2 was associated with greater levels of subsequent psychological distress and social isolation at Time 3, suggesting that COVID-19 racism predicted psychological distress and social isolation over time. Qualitative findings highlighted the prevalence of racism towards EAEAAs and the associated negative consequences. Findings demonstrate that EAEAAs living in the United States are at great risk due to the detrimental effects of racism during COVID-19.

Differential Effects of Parental and Self-Stigma on Intentions to Seek Counseling

Using hierarchical regression, the authors investigated the hypotheses that parental and self-stigma would differentially and negatively predict intentions to seek counseling for White American (n = 318), Asian American (n = 153), and Asian international students. (n = 312). The online study was cross-sectional. Parental stigma positively predicted intentions to seek counseling among Asian international students. The magnitude of this association was significantly greater than it was among White and Asian American students. As expected, self-stigma negatively predicted intentions to seek counseling among White and Asian American students. The magnitude of this association was significantly greater for White American students than it was for Asian international students, for whom self-stigma was not a significant predictor of intentions to seek counseling. This research suggests that the processes through which (a) stigma is felt and (b) stigma impacts psychological help seeking may be associated with one’s ethnicity and culture of origin.

Qualitative content analysis of cultural formulations of clients suffering from conversion disorder in North India

INTRODUCTION

Conversion disorder is easily one of the least understood neuropsychiatric disorders. There is a great deal of ambiguity with respect to symptom presentation, assessment, etiology, diagnosis, and treatment. However, a common clinical practice associated with the assessment and management of the conversion disorder is the evaluation of a stressor. Recent studies in India have indicated that family stressors are the most frequent. Sociocultural aspects of the client's environment and the illness experience thus form an important part of the client's diagnostic formulation. These aspects also determine help-seeking, treatment adherence, and thus, the outcomes.

MATERIALS AND METHODS

Fifteen clients suffering from conversion disorder in a tertiary mental health setting in North India, recruited through purposive sampling, were interviewed in-depth. Data were elicited using the cultural formulation interview (CFI). Qualitative content analysis was carried out.

RESULTS

The content analyses summarized the cultural experiences of clients suffering from conversion disorder under structured domains of the CFI. The results are presented in tables along with content examples and represent individual client experiences and conceptualizations of diagnosis, treatment, and implications of suffering from conversion disorder. The findings of this study aim to describe and highlight the cultural experiences of clients with respect to their psychopathology. The most striking recurrent theme in the cultural formulations were the lack of understanding of the nature and cause of illness both in the client as well as the clinician, and therefore a lack of trust and hope in the treatment.

CONCLUSION

The findings of the current study shed light on the cultural experiences of clients with conversion disorder. These findings emphasize the need for clinicians to incorporate the individual and collective cultural experiences of clients and cultural sensitivity in addition to the clinical diagnoses. The Cultural Formulation Interview of the DSM-5 was found to be very helpful in this regard and we encourage its use by clinicians, especially with clients suffering from conversion disorder, given the strong influences of socio-cultural experiences on psychopathology as well as the intervention.

Short-Term Changes in Internalizing Symptoms and Help-Seeking Attitudes During the Coronavirus Pandemic

Introduction: Existing data suggest that American adults experience added emotional difficulties amid the coronavirus disease outbreak. Psychotherapy can help mitigate mental health concerns; still, many individuals with unmet mental health needs refrain from professional help-seeking. According to theory of reasoned action, negative help-seeking attitudes are key barriers to engagement with mental health services. Given that individuals with severe distress are more likely to seek therapy than individuals with mild psychopathology symptoms, greater initial and increasing levels of internalizing symptoms amid the coronavirus outbreak likely are linked to increasingly favorable attitudes toward professional help-seeking. Method: In the early months of the coronavirus pandemic, American community adults, N = 831 [49.0% Asian Americans], Mage = 46.78, 50.2% women, were recruited for a panel survey study conducted over the course of three weeks. At each time point, participants completed questionnaires to assess their internalizing symptoms associated with depression and anxiety as well as their openness to and perceived value/need in treatment seeking. Results: Very few participants—especially Asian Americans —were seeking counseling during the study period. Latent growth curve results showed a general decline in internalizing symptoms, and no changes in openness to and perceived need in professional help-seeking. Whereas there were no time-varying correlations between internalizing symptoms and help-seeking attitudes, individuals with greater baseline internalizing symptoms generally were more open to seeking professional help and perceived less value in mental health services. Sensitivity analyses showed patterns in the Asian American subsample similar to those in the overall sample. Discussion: Implications for research and clinical practice are discussed.

A Decision Tree Analysis on the Impact of a Technology-Based Program on Symptom Distress: Asian American Breast Cancer Survivors

Using a decision tree analysis, this study aimed to identify the characteristics of the groups within Asian American breast cancer survivors whose symptom distress scores were effectively improved by a technology-based program. This was a secondary analysis of the data from an ongoing randomized controlled trial among 115 Asian American breast cancer survivors. The instruments were questions on background factors; the Memorial Symptom Assessment Scale-Short Form; the Cancer Behavior Inventory; the Questions on Attitudes, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using chi-square tests, t tests, repeated measurement analyses, and decision tree analyses. The decrease in the global distress index scores was the largest (1.253 points) among those with high psychological support needs. The decrease in the physical symptom distress scale scores was the largest (1.133 points) among those with high physical and daily living support needs who had a short US residence period and who were young. The decrease in the psychological symptom distress scores was the largest (1.511) among those with high psychological support needs. The findings suggest several characteristics of the groups within Asian American breast cancer survivors whose symptom distress could be highly improved by a technology-based intervention.

Who seeks help online? Comparing online and offline help-seeking preferences amongst youths with suicidal ideation

BACKGROUND

Research consistently report an inverse relationship between suicide risk and help-seeking. The increasingly available internet-based support potentially offers an attractive alternative to traditional forms of assistance. The study compared the characteristics of suicidal youths in Hong Kong and their online and offline help-seeking behaviours.

METHODS

Participants (N = 1214, age-range = 15-24 years) responded to the anonymous 2018 Hong Kong Online Survey on Youth Mental Health and Internet Usage. Respondents with suicidal thoughts were classified into those who sought help online and offline, or online only ("online-help"); those who sought help offline only ("offline-help"); and those who never sought help ("no-help"). They responded to questions concerning mental health, perception towards online support, internet use, help sources, and demographic information.

RESULTS

The online-help group differed significantly from other groups, with greater suicidal ideation, distress, risk behaviours, and spent more time online for non-work-related purposes. Their perceived benefits of online support include anonymity, avoiding embarrassment, and social support. They are more likely to seek help from a combination of informal and formal sources.

LIMITATIONS

No data on whether participants sought help online or offline first, and their current treatment status is available. Our study adopted conveniences sampling, and few respondents have sought help online exclusively.

CONCLUSION

Online support offers an alternate way of engaging at-risk youths. Future clinical practice should consider online platforms as a complement, rather than a replacement, of offline platforms.

Korean Immigrants' Perception of Mental Well-Being and Help-Seeking Behaviors

This article describes a study that investigated Korean immigrants' perception of mental well-being and help-seeking behaviors with particular focus on those with mental illness. Participants with probable diagnoses of anxiety or depression were more likely to recognize their mental health problems and their impact than those without such diagnoses. However, many of them did not acknowledge experiencing mental health problems and did not show high likelihood of seeking professional mental health services. The cultural beliefs and the lack of culturally competent mental health services appeared to contribute to the low levels of recognition of mental health problems and also the low rates of mental health service utilization. The participants listed mental health professionals' ability to communicate in the language of their preference, confidentiality, and affordability as significant factors in their decision to seek professional help. The study findings emphasize the great need of mental health educational programs within the Korean immigrant community. The findings also suggest that resources and infrastructures be secured for the provision of culturally competent mental health services for this population.

Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study

OBJECTIVES

To investigate the prevalence of depression in college students and determine how social support and healthy lifestyle factors are associated with depression in this population.

DESIGN

A cross-sectional design.

SETTING

A comprehensive university in Changsha, Hunan, South China. The study was conducted from May to June 2019.

PARTICIPANTS

A total of 541 students at the comprehensive university.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Zung Self-Rating Depression Scale, Social Support Rating Scale and Health-Promoting Lifestyle Profile-II (HPLP-II) were used to evaluate depression, social support and lifestyles, respectively, and analyse the mutual relationships among them.

RESULTS

Among the 541 participants, 161 (29.8%) experienced depressive symptoms, and there were significant gender-related and academic discipline-related differences in self-rated depression. The average social support score was 38.06 (38.06±7.52). The average HPLP-II score was 71.09 (71.09±11.47). A monofactor analysis showed that depression was correlated with social support and a healthy lifestyle. As demonstrated by logistic regression analysis, being a woman (OR=2.613, 95% CI: 1.541 to 4.43), inadequate social support (OR=0.912, 95% CI: 0.877 to 0.948), poor nutrition (OR=0.87, 95% CI: 0.775 to 0.977) and lack of self-actualisation (OR=0.644, 95% CI: 0.572 to 0.724) were significantly correlated with depression.

CONCLUSIONS

Owing to the high prevalence of depression among Chinese university students, educational institutions must take measures such as providing compulsory mental health education courses and improving the psychological counselling services available to students.

Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students

The current study sought to understand the influence of cultural values on mental health attitudes and help-seeking behaviors in college students of diverse ethnic backgrounds. Asian and Latinx college students (N = 159) completed an online survey in which they reported on their adherence to cultural values as measured by ethnicity-specific cultural values and general attitudes towards mental health. Factor analysis revealed two common factors of cultural values irrespective of ethnicity: Interdependent Orientation (IO) and Cultural Obligation (CO). Regardless of ethnicity, the more students endorsed IO values, the less likely they were to perceive a need for mental health treatment. IO value adherence was also predictive of more negative attitudes towards mental health. CO values were not predictive of perceived need or help-seeking behaviors. Findings highlight the importance of understanding shared cultural values across ethnic-racial groups and considering how the multidimensionality of culture may help explain shared mental health behaviors crossing lines of ethnic group membership.

Using the health belief model to assess racial/ethnic disparities in cancer-related behaviors in an NCI-designated comprehensive cancer center catchment area

BACKGROUND

Racial and ethnic minorities experience well-documented disparities across the cancer trajectory. However, factors underlying these disparities may vary regionally. The Health Belief Model (HBM) was developed to explain and predict health-related prevention and early detection behaviors, particularly uptake of health services. Our goal was to use the HBM to guide an exploration of factors that contribute to racial/ethnic health disparities in the catchment area of a large National Cancer Institute-designated Comprehensive Cancer Center in the Southeastern United States.

METHODS

We conducted a secondary analysis of data collected by the cancer center for its triennial Community Health Needs Assessment, which sampled adults from the center's 15-county catchment area. White non-Hispanics (WNHs; n = 887), Black non-Hispanics (BNHs; n = 78), Hispanics/Latinxs (H/Ls; n = 185), and those identifying as another race/ethnicity ("Others"; n = 39) were compared across key HBM variables, including demographic/psychosocial information, perceived benefits and barriers to preventive health behaviors, risk perception, and health behavior outcomes.

RESULTS

Controlling for annual household income, relationship status, and age (for certain screening behaviors), significant differences were seen in information-seeking behaviors, risk perception, community attributes, discrimination, and distress. Non-WNH groups reported worse community attributes, higher everyday discrimination, lower health literacy, less confidence in their ability to get health information, and lower perceived risk of cancer.

CONCLUSION

This analysis presents a better understanding of how HBM factors may influence health disparities in the cancer center's catchment area. Results describe the needs of community members from racial and ethnic minority groups, which will inform future research, education, outreach, and service activities.

An Analysis of Help-Seeking Patterns Among College Student Victims of Sexual Assault, Dating Violence, and Stalking

Despite the negative outcomes associated with sexual assault (SA), dating violence (DV), and stalking victimization, many victims, particularly college students, do not seek help for these crimes. To date, the majority of help-seeking research has focused on one form of victimization, despite substantial evidence that many victims experience more than one form of interpersonal violence. In addition to consideration of such polyvictims, intervention efforts to increase help-seeking to improve victim outcomes may benefit from a clearer understanding of overlapping predictors of help-seeking across victimization types. Using the health belief model (HBM) as a guiding framework, the current study examined predictors of help-seeking for SA, DV, and stalking in a college student sample. Data were collected via a multiyear anonymous email survey of general health and well-being. Demographic predictors of help-seeking and severity indicators informed by the HBM were evaluated across violence types. In addition to replicating previous work, results provided support for the HBM, such that a number of severity indicators, particularly those representing overlap across victimization types, predicted help-seeking at the multivariate level. Results also provide new evidence for overlap of barriers to help-seeking across violence types, with victim's belief that the incident was not serious enough the most commonly reported reason for not seeking help across all three types of victimization. This overlap may provide opportunities for consolidating prevention and intervention efforts across victimization types.

Somatic presentation of mental health concerns, stigma, and mental health treatment engagement among college students

Objective: To identify mental health and treatment utilization correlates of somatic symptoms.Participants: Undergraduate students (N = 184) were recruited through an online research portal from November 2017 to May 2018. Methods: Cross-sectional survey. Results: Somatic symptoms were significantly correlated with public stigma, depression, and anxiety. Controlling for demographics, somatic symptoms, depression scores, and belief in the effectiveness of therapy emerged as concurrent predictors of mental health treatment use in logistic regression analyses. Conclusions: Given the detrimental effects of somatic symptoms on health outcomes and academic performance, universal screening of somatic and psychiatric symptoms in primary care and mental health settings serving college students is warranted. Future research should differentiate between patients who experience somatic versus affective symptoms of depression. In addition, researchers should examine the degree to which addressing the relationship between somatic and psychological symptoms can help lessen the added burden of somatic symptoms on individuals' functioning.

The Behavioral Model of Health: Education, Behavioral Health Factors, and Stigma as Predictors of Help-Seeking Attitudes

Per the behavioral model of health, help-seeking attitudes (and even behavioral health service use) are a function of predisposing and enabling individual characteristics (e.g. demographic characteristics, health beliefs), as well as contextual characteristics (resources, social structures such as education etc.). While researchers have examined how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, psychological factors, and internal barriers relate to help-seeking attitudes, the majority of these works have investigated how different variables independently act on help-seeking attitudes in lieu of more comprehensively investigating how they operate in tandem. The purpose of the current study was to examine how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, behavioral health factors, and internal barriers relate to help-seeking attitudes in a diverse sample of primary care patients. We also sought to examine differences in demographic and socioeconomic characteristics in mental health literacy, stigma, and help-seeking attitudes. Participants were 286 primary care patients. Results from this study indicate that a combination of socioeconomic characteristics (i.e. education), behavioral health factors (level of distress and history of behavioral health service utilization), and internal barriers (personal stigma) predicted help-seeking attitudes among primary care patients. There was an inverse relationship between education and personal stigma and help-seeking attitudes such that higher levels of education and higher levels of personal stigma were associated with more negative help-seeking attitudes.

Improving Mental Health Help-Seeking Behaviours for Male Students: A Framework for Developing a Complex Intervention

Men are less likely to seek help for mental health difficulties and this process is often used to help explain the disproportionally higher suicide rates compared to women. Furthermore, university students are often regarded as a vulnerable population group with a lower propensity to seek help. Thus, male students are a very high-risk group that is even more reluctant to seek help for mental health difficulties, placing them at high risk of suicide. Often, student mental health problems are highlighted in the media, but very few evidence-based solutions specifically designed for male students exist. The current paper seeks to provide a comprehensive framework about how to better design mental health interventions that seek to improve male students' willingness to access psychological support. The Medical Research Council's (MRC's) framework for developing a complex intervention was used to develop an intervention relevant to male students. In this paper, previous help-seeking interventions and their evaluation methods are first described, secondly, a theoretical framework outlining the important factors male students face when accessing support, and thirdly, how these factors can be mapped onto a model of behaviour change to inform the development of an evidence-based intervention are discussed. Finally, an example intervention with specific functions and behaviour change techniques is provided to demonstrate how this framework can be implemented and evaluated. It is hoped that this framework can be used to help reduce the disparity between male and female students seeking mental health support.

Post-Secondary Stress and Mental Well-Being: A Scoping Review of the Academic Literature

Post-secondary students have been identified as an at-risk population for chronic stress and poor mental health. We conducted a scoping review of the academic literature surrounding student stress and mental well-being as the first phase of research in the development of Canada’s National Standard for the Psychological Health and Safety of Post-Secondary Students. Major thematic findings included student stress, resilience through effective coping and help-seeking, and programs or strategies to improve campus mental health. Recommendations include a call for increased mental health promotion and mental illness prevention activities that are sensitive to diverse cultures, ethnicities, religions, and sexualities.

Reducing mental health disparities by increasing the personal relevance of interventions

One of the most persistent health disparities is the underutilization of mental health services by people of color. Neither evidence-based treatments (universal focus) nor culturally adapted treatments (group focus) have reduced these disparities. We propose the personal relevance of psychotherapy (PROP) model, which integrates universal, group, and individual dimensions to determine the personal relevance of interventions. A cultural example of personal relevance among people of East Asian ancestry involves "face" (i.e., one's prestige and position in society), which may moderate treatment outcomes. Pragmatic intervention approaches focused on helping individuals cope with specific external problems, compared to managing a "personal" disease, can effectively "restore" face. Thus, social problem-solving interventions may be more personally relevant to many people of East Asian ancestry than are approaches that are internally focused. In addition, we posit that social neuroscience can offer unique opportunities above and beyond self-report measures when assessing the impact of PROP and the personal relevance of interventions for diverse populations. Our preliminary evidence upon testing this hypothesis indicated that among Asian Americans, exposure to problem-solving therapy content elicited significantly greater neural activity in brain areas associated with personal relevance compared to exposure to cognitive-behavioral therapy content. Identifying personally relevant interventions has the potential to reduce mental health disparities by increasing engagement with mental health services for diverse groups. The increased client engagement produced by personally relevant interventions also has the potential to make mental health services more effective for diverse groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Examination of the Roles of Mental Health Literacy, Treatment-Seeking Stigma, and Perceived Need for Care in Female Veterans' Service Use

OBJECTIVE

Little is known about the role of mental health literacy in military veterans' treatment-seeking stigma and service use, or the impact of these factors on perceived need for mental health care. In addition, most research has focused on mixed-gender samples. This study examined the relationships among mental health literacy, treatment seeking stigma, perceived need for mental health care, and service use in a national, longitudinal study of female veterans.

METHODS

A sample of 171 female veterans were drawn from a larger three-wave prospective national survey conducted between 2014 and 2017.

RESULTS

Path analyses revealed that treatment seeking stigma had a direct negative effect on service use and an indirect effect that was mediated by perceived need for care, such that higher treatment seeking stigma was associated with lower perceived need for mental health care. Mental health literacy had an indirect effect on service use via its inverse association with treatment-seeking stigma. In contrast, mental health literacy was not associated with perceived need.

CONCLUSIONS

Mental health literacy, treatment-seeking stigma, and perceived need for care affect female veterans' service use in unique ways. Further longitudinal research is needed to better understand these pathways in diverse samples.

The myth of knowledge within a robust nutrition online training course

Purpose

The purpose of this paper was to develop a predictor model for an online nutrition course on sugar reduction. The proposed model is based on health knowledge, healthy behavior, social support, self-efficacy, attitude and the health belief model in relation to people’s behavior within a Facebook group. Subsequently, the model can be used to design a robust online training course for human resources, thereby reducing the training costs which managers have experienced as being expensive.

Design/methodology/approach

A single pre-post experimental group design was used. Pre and post data were collected from 100 Facebook users using an online questionnaire, within a three-week intervention.

Findings

The results show a significant difference between pre- and post-test scores of health knowledge and healthy behavior, indicating an effective intervention. In addition, perceived barriers, attitude, self-efficacy and emotional support were significant predictors of the healthy behavior model, predicting 70 percent of healthy behavior. However, knowledge had no significant relationship with any of the three dependent variables (self-efficacy, attitude and healthy behavior) proposed.

Practical implications

This model has proved to be an effective intervention which can be used in online training of human resources, because the content of the training is known from the predictor model, thereby greatly reducing the training cost, since everything is done online. Moreover, the provided model and predictors show that the content to be delivered in the training program is not knowledge but perceived barriers, attitude, self-efficacy and emotional support.

Originality/value

This study is one of the first to propose an integrative model that suggests attitude and self-efficacy as key predictors of healthy behavior whereas knowledge is not.

Cultural Adaptations of Psychotherapy: Therapists' Applications of Conceptual Models with Asians and Asian Americans

Although conceptual models of cultural adaptations of psychotherapy have been developed, little is known about how therapists apply these models in clinical practice. The purpose of the current study was to examine, using a directed content analysis, how therapists culturally adapt cognitive-behavioral therapy (CBT), one of the most widely used evidence-based approaches, for application with clients of Asian ancestry. The study also examined if there were major differences in adaptation strategies between therapists who practice in the United States (N = 9), a predominantly individualistic society as opposed to those who practice in Japan (N = 6), a predominantly collectivistic society. Semi-structured, open-ended interviews revealed that interdependent conceptualizations of the self and indirect communication were addressed by therapists in both countries, and therapist credibility issues were addressed only by therapists in the United States. These results imply that when culturally adapting psychotherapy, therapists incorporate elements of conceptual models that are relevant to their clients' cultures.

Preferences for Depression Help-Seeking Among Vietnamese American Adults

Culture impacts help-seeking preferences. We examined Vietnamese Americans' help-seeking preferences for depressive symptoms, through a telephone survey (N = 1666). A vignette describing an age- and gender-matched individual with depression was presented, and respondents chose from a list of options and provided open-ended responses about their help-seeking preferences. Results showed that 78.3% would seek professional help, either from a family doctor, a mental health provider, or both; 54.4% preferred to seek help from a family doctor but not from a mental health provider. Most (82.1%) would prefer to talk to family or friends, 62.2% would prefer to look up information, and 50.1% would prefer to get spiritual help. Logistic regression analysis revealed that preferences for non-professional help-seeking options (such as talking to friends or family, looking up information, and getting spiritual help), health care access, and perceived poor health, were associated with increased odds of preferring professional help-seeking. This population-based study of Vietnamese Americans highlight promising channels to deliver education about depression and effective help-seeking resources, particularly the importance of family doctors and social networks. Furthermore, addressing barriers in access to care remains a critical component of promoting professional help-seeking.

The efficacy of cognitive behavioral therapy for Chinese people: A meta-analysis

OBJECTIVE

Over the past decade, cognitive behavioral therapy has been applied to an increasingly wider range of disorders and problems in Chinese societies. However, no meta-analysis has been conducted to synthesize the studies on cognitive behavioral therapy for Chinese clients. The purpose of this meta-analytic study was to examine the overall efficacy of cognitive behavioral therapy for Chinese people.

METHOD

A literature search was conducted using electronic databases, including Web of Science, PsycINFO and PubMed. Pooled mean effect sizes were calculated using the random-effects model.

RESULTS

The literature search identified 55 studies with 6763 Chinese participants. The overall short-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Effect sizes were medium for anxiety, depression/well-being and caregiving stress and small for psychotic symptoms and addictive behaviors. The effects of cognitive behavioral therapy on process variables, dysfunctional thoughts and coping, were in the small range. The overall longer-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Moderator analyses showed that the short-term effect was stronger for culturally adapted cognitive behavioral therapy than for unadapted cognitive behavioral therapy. Type of primary outcome, type of control group, recruitment method, study design, the format of delivery and region were found to moderate the efficacy of cognitive behavioral therapy.

CONCLUSION

The findings of this study provide evidence for the overall efficacy of cognitive behavioral therapy for Chinese people and the benefit of cultural adaptation of cognitive behavioral therapy to Chinese culture.

Exploring Challenges in Conducting E-Mental Health Research Among Asian American Women

In this discussion paper, we explore the challenges of conducting e-mental health intervention research among Asian American women and propose a model for addressing these barriers. Based on an extensive literature review, we identify two main types of barriers to conducting e-mental health intervention research among Asian American women: recruitment barriers and adherence barriers. Recruitment barriers are further subcategorized into those related to (1) stigmatized cultural beliefs about mental illness and mental health services; (2) lack of awareness about mental health services; and (3) language barrier. As to adherence barriers, the two identified subtypes concern (1) acuity and severity of mental health condition; and (2) lack of time. In order to enhance recruitment and adherence in e-mental health intervention research among the studied population, we formulate the following three main research strategies, namely: (1) considering the cultural and social contexts of Asian American women in the development of e-mental health interventions; (2) determining appropriate program length; and (3) conducting feasibility studies to test e-mental health interventions. We suggest that nurse researchers integrate our proposed model in conducting e-mental health interventions among Asian American women. Our proposed model also implies that nurses play an important role in encouraging Asian American women's acceptance of and adherence to e-mental health interventions. In order to overcome the obstacles to conducting e-mental health research among Asian American women, we recommend that nurses familiarize themselves with credible, relevant, and evidence-based e-mental health resources and integrate online mental health services and information within their nursing practice.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Predictors of the Self-Reported Likelihood of Seeking Social Worker Help among People with Physical Disabilities

The current study assesses the association between demographic factors, attitudes toward social workers, the stigma attached to seeking social worker help, perceived social support, and psychological distress-and the self-reported likelihood of seeking social worker help, among people with physical disabilities in Israel. Data collection utilized structured questionnaires, administered to a sample of 435 people with physical disabilities. The findings suggest that women, older respondents, people with more positive attitudes toward social workers, with higher levels of psychological distress and of social support, and with a lower level of stigma, reported a greater likelihood of seeking social workers help. The study's conclusion is that there are certain avoidance factors among people with physical disabilities that might discourage them from seeking social workers' help. Therefore, it is important that social workers identify these factors and develop interventions aimed at encouraging people with physical disabilities to seek social workers help in case of need, and also develop practices adjusted to the unique needs of people with physical disabilities.

College Women’s Subjective Femininity Stress, Gender Solidarity, and Psychological Help-Seeking Intentions

Female gender has been consistently associated with positive psychological help-seeking attitudes and behaviors; however, surprisingly few empirical studies have examined how femininity-related variables impact women’s help-seeking decision making. Informed by the theory of reasoned action (Ajzen & Fishbein, 1980), the purpose of this study was (a) to investigate the associations between two femininity constructs—subjective femininity stress and gender solidarity—and psychological help-seeking intention, and (b) to explore the mediating roles of help-seeking attitudes and social stigma using structural equation modeling. Participants were 451 college-enrolled women in Southern California. Results revealed that all the mediation relationships involving help-seeking attitudes and stigma were significant. Subjective femininity stress was positively related to help-seeking intention via help-seeking attitudes, but was negatively related to intention via social stigma. Gender solidarity was positively related to help-seeking intention via positive attitudes and reduced social stigma. Implications for future research, prevention programs, and practice are discussed.