“What will people say?”: Mental health stigmatization as a barrier to eating disorder treatment-seeking for South Asian American women.

Abstract

This study used focus group methodology to identify culturally specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (M age = 20.11 years, SD = 2.52), all of whom had lived in the United States (U.S.) for at least 3 years (63.0% of the sample was born in the U.S.). Transcripts were independently coded by a team of researchers (n = 4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, n = 6; facilitators, n = 3) for SA American women. Barriers to ED treatment-seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited social stigma (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were as follows: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), health care providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities, and (c) training providers in culturally sensitive care. What is the public significance of this article?In this qualitative study, South Asian (SA) American women were asked to discuss their perceptions of barriers to and facilitators of eating disorders (EDs) treatment-seeking for their group. Findings indicate that SA women living in the United States face multiple family, community, and institutional barriers to treatment-seeking for all mental health issues, including EDs, which intersect to perpetuate treatment disparities.

Eating Disorder Examination‐Questionnaire: Evaluating factor structures and establishing measurement invariance with Asian/Hawaiian/Pacific Islander, Black, and White American college men

“…Our results also raise the question of whether the EDE-Q is the optimal measure to assess ED symptomatology in racially diverse young men, particularly given the considerable lack of research support for the original four-factor model with various groups (e.g., Peterson et al, 2007) and differing attitudes and beliefs surrounding food (Goel et al, 2021;Goel, Thomas, et al, 2022;Rodgers et al, 2018;Yu et al, 2019). Current results suggest that Asian/Hawaiian/Pacific Islander college men might also be at elevated risk for ED psychopathology.…”

“…Another limitation is that Latinx, indigenous groups, and other populations were not included (Mikhail & Klump, 2020). Furthermore, considering the heterogeneity within and across Asian/Hawaiian/Pacific Islander sub‐groups (Cummins et al, 2005; Goel et al, 2021; Goel, Thomas, et al, 2022) future research should assess ED behaviors within distinct Asian/Hawaiian/Pacific Islander groups. We restricted analyses to individuals self‐identifying as male, limiting generalizability to other gender groups (Nagata, Ganson, et al, 2020), and our samples of Asian/Hawaiian/Pacific Islander and Black men were below conventional recommendations for CFA (Kline, 2011).…”

“…Most ED research with Asian/Hawaiian/Pacific Islander populations has focused on women (e.g., Yu et al, 2019), and has suggested that multiple factors might contribute to ED onset and maintenance in this group, including acculturative stress, conflicting appearance ideals (e.g., Asian/Hawaiian/Pacific Islander versus Eurocentric beauty standards), cultural value conflicts (e.g., collectivistic versus individualistic), and differing attitudes and beliefs surrounding food (Goel et al, 2021; Goel, Thomas, et al, 2022; Rodgers et al, 2018; Yu et al, 2019). Current results suggest that Asian/Hawaiian/Pacific Islander college men might also be at elevated risk for ED psychopathology.…”

“…Men and people of color are underrepresented in the ED literature and disparities in the prevention, assessment, and treatment of these conditions in these groups persist (Egbert et al, 2022; Goel, Thomas, et al, 2022, Murray et al, 2017). To optimize ED screening and detection, it is imperative that our most widely used measurement tools are validated within and across groups, and invariance is established to enhance confidence in the validity of score interpretations and comparisons.…”

An exploratory study of South Asian women’s experiences of mental health services in England: a thematic analysis of cultural sensitivity

“…Recently, Changing Our Lives (2021) Beyond the Stigma campaign raises awareness into similar and other cultural factors necessary to consider regarding MH experiences. Globally, Goel et al (2022) provide similar recommendations regarding culturally sensitive eating disorder services for SA American women; Naeem et al (2021) argue for the implementation of culturally sensitive therapy to suit the experiences of Canadian SA populations.…”