Inclusiveness of the Concept of Mental Disorder and Differences in Help-Seeking Between Asian and White Americans

Abstract

Ethnic and racial group differences in help-seeking are a barrier to the effective and equitable delivery of mental health services. Asian American populations demonstrate relatively low levels of help-seeking. Explanations for this effect typically point to elevated levels of stigma in these populations. An alternative explanation is that low help-seeking might also reflect holding a relatively circumscribed concept of mental disorder. Individuals and groups with less inclusive concepts of disorder may be less likely to identify problems as appropriate for mental health treatment. This study aimed to test whether group differences in the breadth of the mental disorder concept account for group differences in help-seeking attitudes. A sample of 212 American participants (102 Asian Americans and 110 White Americans) were assessed on personal stigma, help-seeking attitudes, and mental disorder concept breadth. Mediation analyses examined whether stigma and concept breadth mediated group differences in attitudes. Compared to White Americans, Asian Americans reported higher levels of stigma and narrower concepts of mental disorder, both of which were associated with less positive help-seeking attitudes. Stigma and concept breadth both partially mediated the group difference in attitudes. Theoretical and practical implications for mental health promotion and culturally sensitive clinical practices are explored.

Psychological distress and mental health service utilization disparities in disaggregated Asian American populations, 2006–2018.

“…Having or reporting a mental health issue is a culturally stigmatizing issue in many AA communities, and these issues are often felt to be a sign of personal weakness which may bring dishonor or “shame” to a family’s reputation (Augsberger et al, 2015; Choi et al, 2016; Kim, 2011; Kim et al, 2015; Sue et al, 2012; Tse & Haslam, 2021; Woo, 2017; Yang et al, 2020). As such, the increase in reported rates of mental health distress might be due to a greater willingness to report psychological distress, or a true increase in psychological distress.…”

“…They also have the “best” self-reported personal health status, with over 40% claiming to be “excellent.” Despite this, however, South Asian women have some of the highest suicide ideation and depression rates in the United States (Augsberger et al, 2015; Choi et al, 2016; Karasz et al, 2019; Sue et al, 2012). Asian Indians have the largest immigrant population out of all groups studied, with over 90% being foreign born, indicating this group to be susceptible to acculturation issues—most prominently, stigma against acknowledgment of mental health issues (Augsberger et al, 2015; Choi et al, 2016; Derr, 2015; Sue et al, 2012; Tsai-Chae & Nagata, 2008; Tse & Haslam, 2021). With a large immigrant population, Asian Indians may experience difficulty in assimilating to the new host culture, which can include the concealment of mental health issues, utilization of alternative resources, and beliefs that American mental health professionals may not understand their problems and experiences (Augsberger et al, 2015; Choi et al, 2016; Derr, 2015; Sue et al, 2012; Tsai-Chae & Nagata, 2008).…”

“…As a single group, Asian Americans (AA) have significantly lower utilization of mental health services than almost all other racial and ethnocultural groups, except for African Americans (Augsberger et al, 2015; Cheng et al, 2017; Kim, 2011; Lee et al, 2011; Sue et al, 2012; Tse & Haslam, 2021; Yang et al, 2020). AAs generally report lower prevalence of mental health disorders as compared to other racial groups (Alvarez et al, 2019; Cheng et al, 2017; Lee et al, 2011; Sue et al, 2012; Woo, 2017; Yang et al, 2020).…”

Concept Creep and Psychiatrization

“…Recent work by Tse and Haslam (2021) indicates that the breadth of these lay concepts has implications for mental health help-seeking. They showed that people who held more inclusive concepts of mental illness, categorizing a wider variety of experiences and actions as disordered, had more favorable help-seeking attitudes.…”

“…The work of Tse and Haslam (2021) is a case in point, providing a detailed account of how concept creep might have specific benefits. They demonstrated that holding favorable attitudes to mental health help-seeking is associated with more inclusive concepts of mental disorder, and that cultural differences in the inclusiveness of these concepts are associated with differences in help-seeking.…”