26-09-2016, 12:35 PM
Mental Health Help-Seeking Behaviors Among Asian
American Community College Students: The Effect
of Stigma, Cultural Barriers, and Acculturation
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According to the 2008 U.S. Census, there are
15.5 million Asian Americans in the United
States, and 17% are students enrolled in a
university (Shea & Yeh, 2008). Asian American
college students in higher education are oftentimes
perceived as the “model minority” with high
academic achievements and few mental and/or
behavioral problems (Park, 2010). In contrast
to this general assumption, studies have shown
that many Asian American college students suffer
from psychological distress (Abe-Kim et al., 2007;
Breaux, Matsuoka, & Ryujin, 1997; Lee et al.,
2009; Mallinckrodt, Shigeoka, & Suzuki, 2005;
Nguyen & Anderson, 2005). In fact, the Centers
for Disease Control and Prevention (2008)
highlighted considerable disparities in mental
health among racial/ethnic groups, including
the fact that Asian Americans 15–24 years old
have significantly higher suicidal rates than do
other racial/ethnic groups of the same age range.
Researchers have attributed this mental health
disparity to Asian students’ underutilization of
professional services. Consequently, a growing
number of empirical studies have been conducted
to identify the contributors to low mental health
service utilization (Abe-Kim et al., 2007;
Kim & Park, 2009; Lee et al., 2009; Nguyen
& Anderson, 2005; Umemoto, 2004). These
studies have found that acculturation, cultural
barriers, and stigma attached to mental health
problems are common factors that significantly
contribute to Asian American college students’
low mental-health-seeking behaviors. However,
based on the authors’ knowledge, these studies have focused on Asian American students who
attend 4-year colleges. There is very little known
about Asian American students attending 2-year
community colleges, who comprise over 40%
of Asian American undergraduates enrolled in
higher education (Park, 2010).
As Bailey and Morest (2006) affirmed, community
colleges are a critical avenue for lowincome
and first-generation ethnic minorities
to access higher education. Students of low
socioeconomic status and from immigrant
families are known to experience excessive
pressure to succeed academically for the
purpose of social and economic mobility,
which may put them at a higher risk for
developing mental health problems (Suzuki,
2002). By taking an exploratory approach
and borrowing from the literature on Asian
Americans and 4-year university students,
the current study examined whether welldeveloped
cultural contributing factors, such
as stigma, acculturation, and preference for
racially/ethnically concordant counselors,
among Asian American 4-year college students
might also predict help-seeking behaviors for
mental health issues among Asian American
community college students. Identifying
the factors that hinder or promote helpseeking
behaviors is crucial for the helping
professions to assist underserved Asian
American community college students to
succeed in higher education and become
productive citizens.
Culture, Stigma of Mental Health
Illness, and Mental Health Seeking
Behaviors
Despite the high prevalence of mental health–
related problems, mental health is commonly
overlooked in Asian communities, and cultural
barriers have been identified as the most
imperative factor (Lee et al., 2009). For
instance, Nguyen and Anderson (2005)
stated that some Asians hold the belief that
individuals who have mental illness may be
possessed by supernatural entities such as
demons or spirits. Therefore, mental illness is
highly stigmatized in many Asian cultures, and
the root of mental illness stigma can be found
in Asians’ cultural beliefs toward mental health
(Kung, 2004; Lee et al., 2009; Masuda et al.,
2009; Nguyen & Anderson, 2005).
Empirical studies have shown that the
identification, expression and acknowledgment
of psychiatric problems are influenced by
culture. For example, studies show that many
Asians believe that emotional anguish is seen
as the consequence of bad thoughts, a lack of
will power and self-control, and personality
weakness, and therefore disclosing that one
has mental illness is considered to be shameful
(Kung, 2004; Lee et al., 2009). These beliefs
may deter individuals from seeking help
for their symptoms. Furthermore in Asian
cultures, mental illness often is not considered
as an individual problem. Rather, mental illness
potentially represents a negative reflection on
the immediate family as well as their ancestors.
For Asian immigrants, stigma attached to
mental illness is a multifaceted phenomenon
which is related to loss of face and status that
is beyond the individual level. It is likely that
such an intense and complex stigma attached
to mental health issues further exacerbates
disparities in mental health service utilization.
Indeed, among Asian immigrants, extrafamilial
intervention (e.g., professional help) is often considered shameful, as it indicates
the inadequacy of family members and causes
them to “lose face” within their community.
Consequently, instead of seeking professional
help, Asians may try to change this behavior
through self-control and willpower or may
try to keep out bad thoughts by keeping busy
(A. Y. Zhang, Snowden, & Sue, 1998). When
these attempts fail, they may choose to address
problems and needs first within the family
system (i.e., immediate nuclear family, then
extended family; Hsu, Davies, & Hansen,
2004). External help is sought only after all
other resources are exhausted or when legal
or social services force the issue. Even when
seeking mental health services, many Asians
might first seek medical services or traditional
resources such as herbalists, acupuncturists,
fortunetellers, or religious/spiritual leaders
for help, which are less stigmatized sources of
help (Nguyen & Anderson, 2005). Depending
on the severity of their illness, they may then
seek a mental health professional (Kung,
2004). If the Asian culture and stigma play
a significant role in help-seeking behaviors,
given the interconnected nature of culture,
stigma, and the acculturation process among
ethnic minorities (Hsu et al., 2004), it
follows that acculturation might predict helpseeking
behaviors.
Acculturation, Preference for
Counselors, and Help-Seeking
Behaviors
Another culture-bound contributor to low
mental health service utilization is one’s level
of acculturation. Acculturation is a process
of changing one’s culture by incorporating
elements of another culture and entails a mutual
blending of culture, both psychologically and
behaviorally (Berry, 1997). Thus, acculturation
reflects the extent to which individuals learn
the psychological (e.g., values) and behavioral
(e.g., behaviors, life styles, and language) aspects of the dominant culture (Zane & Mak,
2002). With regard to Asian American college
students’ help-seeking behaviors in relation
to acculturation, Shea and Yeh (2008) found
that higher levels of assimilation (i.e., more
embracing of American cultural values) among
Asian American students predicted more
positive attitudes toward seeking professional
psychological help. Other studies also found
that Asian American students who maintain
a strong adherence to Asian cultural values
tend to have negative attitudes and a lower
level of willingness toward seeking professional
psychological help than do their counterparts
because seeking mental health services can be
viewed as bringing disgrace to themselves and
to their families (Lee et al., 2009; N. Zhang
& Dixon, 2003). Asian Americans’ reluctance
to seek professional help and their lack of
acceptance of Western psychotherapy, based
on their level of acculturation, is known as
a contributor to barriers in seeking mental
health services (Wong et al., 2006).
Studies also show that many Asian
Americans, in addition to the cultural factors
such as stigma and acculturation, do not
feel comfortable speaking to a mental health
professional who does not share their same
ethnic background, primarily due to cultural/
language differences (Lee et al., 2009). For
example, Fraga and colleagues (2004) found
that Asian American undergraduate students,
in comparison to European American and
Hispanic undergraduate students, have distinct
preferences for particular counselor attitudes
or beliefs, knowledge, and skills. Other studies
also found that Asian American college
students generally would prefer a counselor
with similar values, but there are very few
bicultural and/or bilingual Asian American
counselors available (Akutsu & Chu, 2006;
Atkinson & Gim, 1989; Gim, Atkinson,
& Whiteley, 1990; Gloria, Castellanos,
Park, & Kim, 2008).