Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide.

Astraea Augsberger,Albert Yeung,Meaghan Dougher,Hyeouk Chris Hahm

doi:10.1186/s12913-015-1191-7

Astraea Augsberger, Albert Yeung + Show 2 more

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https://doi.org/10.1186/s12913-015-1191-7

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Abstract

BackgroundDespite the substantially high prevalence of depression, suicidal ideation and suicide attempts among Asian American women who are children of immigrants, little is known about the prevalence of mental health utilization and the perceived barriers to accessing care.MethodsThe data were from the Asian American Women’s Sexual Health Initiative Project (AWSHIP), a 5-year mixed methods study at Boston University. The quantitative analysis examined the differential proportion of mental health utilization among 701 survey participants based on their mental health risk profile determined by current moderate to severe depression symptoms and lifetime history of suicidality. Mental health risk groups were created based on participants’ current depression symptoms and history of suicide behaviors: Group 1–low-risk; Group 2–medium-risk; Group 3–high-risk. Mental health care utilization outcomes were measured by any mental health care, minimally adequate mental health care, and intensive mental health care. The qualitative analysis explored the perceived barriers to mental health care among 17 participants from the medium and high-risk groups.ResultsAmong 701 participants, 43 % of women (n = 299) reported that they either suffered from current moderate to severe depression symptoms or a lifetime history of suicidal ideation or suicide attempt. Although the high-risk group demonstrated statistically significant higher mental health utilization compared to the low and medium-risk groups, more than 60 % of the high-risk group did not access any mental health care, and more than 80 % did not receive minimally adequate care. The qualitative analysis identified three underutilization factors: Asian family contributions to mental health stigma, Asian community contributions to mental health stigma, and a mismatch between cultural needs and available services.ConclusionsDespite the high prevalence of depression and suicidal behaviors among young Asian American women in the sample, the proportion of mental health care utilization was extremely low. The qualitative analysis underscores the influence of Asian family and community stigma on mental health utilization and the lack of culturally appropriate mental health interventions. Prevention and intervention efforts should focus on raising mental health awareness in the Asian American community and offering culturally sensitive services.

Highlights

Despite the substantially high prevalence of depression, suicidal ideation and suicide attempts among Asian American women who are children of immigrants, little is known about the prevalence of mental health utilization and the perceived barriers to accessing care
We addressed the research limitations by examining barriers to specialty mental health care utilization among 1.5 or second generation young AsianAmerican immigrant women reporting a history of depression symptoms, suicidal ideation, and suicide attempts
The high risk group (Group 3 who had both current moderate or severe depression symptoms and a lifetime history of suicidal ideation or suicide attempt) were statistically significantly more likely to use any mental health care, minimally adequate mental health care, and intensive mental health care compared to the low risk or medium risk groups, less than 20 % of them reported minimally adequate mental health services and intensive mental health care

Summary

Introduction

Despite the substantially high prevalence of depression, suicidal ideation and suicide attempts among Asian American women who are children of immigrants, little is known about the prevalence of mental health utilization and the perceived barriers to accessing care. Among subgroups of Asian Americans, young Asian American women have emerged as the highest risk in terms of mental health status. Despite the substantial risk of depression and suicide among young Asian American women, the current literature is limited in providing information about mental health utilization patterns in this population. Alegria and colleagues reported that among Asian Americans diagnosed with any depressive disorder, two out of three (69 %) did not seek mental health treatment, compared to Hispanics (64 %), African Americans (59 %), and White Americans (40 %) [4]. Le Meyer and colleagues reported that among Asian Americans with a diagnosable mental health disorder, only 28 % used specialty mental health services (i.e., services delivered by a psychiatrist, psychologist, or other mental health professional) [5]

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