摘要：Objectives. We examined rates of mental health–related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. Methods. Data were derived from the National Latino and Asian American Study (2002–2003). Results. About 8.6% of the total sample (n=2095) sought any mental health–related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health–related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. Conclusions. Asian Americans demonstrated lower rates of any type of mental health–related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans. Most Asian Americans were born outside the United States, which results in a tremendous amount of cultural and linguistic diversity within this population. 1 The high proportion of immigrants in the Asian American population presents challenges for mental health systems in many communities, particularly in determining whether current services can adequately meet the needs of diverse Asian American groups. Asian immigrants may have unique patterns of help-seeking and may receive a different quality of care from mental health service providers than do their US-born counterparts. 1 , 2 Without adequate data on the differences between Asian immigrants and US-born Asian Americans, it is difficult to plan for appropriate mental health services. Empirical findings on the association between immigration-related variables and mental health service use are somewhat mixed, 3 – 5 although they suggest that US-born Asian Americans may be more likely to use mental health services than Asians who have immigrated to the United States. 6 – 8 Information regarding Asian Americans’ satisfaction with mental health care is scarce. However, data on perceptions of general health services suggest that Asian Americans are less satisfied with their medical care than their European American counterparts. 9 – 12 Levels of mental health service need and corresponding rates of service use may vary across different Asian American groups, 13 , 14 as well as being affected by the availability of culturally responsive services. 15 , 16 Nonetheless, in general, Asian Americans seem reluctant to seek services in response to their emotional distress. 17 – 19 Even among Asian Americans who have a probable mental disorder (i.e., they met criteria for a diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] , 20 based on a structured interview, the World Health Organization Composite International Diagnostic Interview 21 ), only a small proportion (17%), according to the US Department of Health and Human Services, appear to seek services. 1 Barriers identified as negatively affecting the use of mental health–related services include cultural barriers (e.g., stigma, loss of face, causal beliefs), 2 , 22 , 23 culturally unresponsive services (lack of language match, lack of ethnic match, poor cross-cultural understanding), 18 limited access to care (cost, lack of insurance coverage), 24 and lack of awareness or understanding of services. 1 , 25 – 27 Indeed, for this population, familiarity with Western modes of treatment for mental health problems may be associated with more positive attitudes toward counseling, but not necessarily a greater willingness to seek help. 28 Previous studies of Asian Americans have been largely based on unrepresentative samples of that population, including (1) treated populations seen in public sector mental health service settings, 18 , 29 , 30 (2) college students seen in university counseling settings, 3 , 5 , 31 , 32 and (3) convenience samples of nonclinical community-based populations. 4 , 33 , 34 Help-seeking, immigration factors, and treatment experiences have typically not been the major focus of these investigations. These studies have focused on a limited number of psychiatric disorders, usually major depression or psychological distress, and hence could miss the effects of other mental health conditions on service use among immigrant and US-born Asian American populations. We addressed some of these limitations by using a national sample of Asian Americans that included a wide range of psychiatric disorders among both Asian immigrants and US-born Asian Americans. We examined use of mental health–related services during a 12-month period, as well as the associations among different immigration-related characteristics, including nativity status, years in the United States, age at time of immigration, and generational status, on the basis of data from the first national epidemiological household survey of Asian Americans in the United States: the National Latino and Asian American Study (NLAAS). 35 – 37 The objectives of our study were to (1) examine rates of mental health–related service use among immigrant and US-born Asian Americans during a 12-month period, (2) identify patterns of help seeking as they varied by need and immigration-related characteristics, (3) explore perceptions of satisfaction with care and helpfulness, and (4) compare differences in patterns of mental health–related service use among individuals who had a probable need for services (i.e., a DSM-IV diagnosis within the 12 months on the basis of the structured interview 21 ) and those who had no probable need for services (because the need for treatment is a major factor in seeking help 38 ). These analyses were made in coordination with the broader Collaborative Psychiatric Epidemiology Studies effort, which provided the opportunity to compare how immigration-related factors are associated with use of mental health services across 3 major racial/ethnic populations (Asians, Blacks, and Latinos). 37
