People of Asian descent are one of the fastest-growing racial and ethnic groups in the United States. In 2008, they represented 4.4% of the total U.S. population, but their numbers are expected to grow by 213% by 2025, rising from 10.7 million to 33.4 million (1
). Despite the rapid increase in population and need for provision of mental health services, there is a dearth of empirical research about mental health service utilization patterns among Asians and how they compare with those of other racial and ethnic groups (2
Persons from racial and ethnic minority groups are less likely to utilize mental health services compared with whites (4
). Previous studies reported that Asians have a low rate of mental health service use compared with the general population (5
). Recent nationally representative studies that used DSM-IV
diagnostic criteria reported lower prevalence of mental disorders among Asians compared with members of other racial and ethnic groups (2
). Therefore, some researchers have suggested that low prevalence of mental health service utilization among Asians may be due to lower prevalence of mental disorders among Asians (12
). Other researchers, on the basis of a conventional belief that Asians are a “model minority,” speculated that greater mental and emotional resiliency among Asians may lead to less need for mental health services (13
However, the supposition that low mental health service use among Asians is the result of their having fewer mental health needs remains questionable because of a paucity of well-designed studies about mental health service utilization among Asians. Lower mental health service use among Asians has been found to be associated with less perceived need for or awareness of mental health services (5
), limited English proficiency (15
), and foreign-born status (7
). Furthermore, people who experienced unfair treatment due to limited English proficiency preferred to use informal services or to seek help from friends or families (17
Study results of mental health service use patterns among subethnic groups have been mixed, but a few studies suggested that Southeast Asians have greater mental health needs and mental health service use compared with other Asian groups (20
). Comparing patterns of mental health service use among Asians with mental disorders with those of other racial and ethnic groups based on a nationally representative sample is important in elucidating whether efforts to lower the potential health disparity are necessary.
Comprehensive national data about the prevalence of mental health service utilization among Asians have become available through the National Latino and Asian American Study (NLAAS) (3
). Abe-Kim and others (18
) reported that during a 12-month period, 34.1% of Asians with DSM-IV
mental disorder diagnoses used any type of mental health services, compared with 41.1% of all individuals in the National Comorbidity Survey Replication (NCS-R) sample with DSM-IV
mental disorder diagnoses (18
). Le Meyer and others (23
) also reported that on the basis of the NLAAS, Asians with mental disorders utilized specialty mental health services at a significantly lower rate than did NCS-R participants with mental disorders. Xu and others (11
) reported that Asian females underutilized mood and anxiety services compared with non-Hispanic whites.
Even as Abe-Kim and Le Meyer’s studies suggest underutilization of mental health services among Asians with mental disorders, generalizabilty of their findings are compromised by the use of an external, general population sample such as the NCS-R as the comparison group. Differences in sampling strategies and adherence to assessment protocols between the two studies may have introduced bias in their findings. Also, these studies did not stratify and compare mental health service use between Asians and other ethnic groups across specific mood, anxiety, and substance use diagnostic groups. Therefore, discrete patterns of mental health service utilization among Asians across specific mental disorder diagnoses have remained unclear.
This study used a nationally representative sample of participants from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine the rate of mental health service utilization by Asians according to specific diagnoses (24
). To address that aim, this study compared the lifetime mental health service utilization among Asians to that of other racial and ethnic groups, including whites, blacks, Hispanics, and Native Americans, who had been diagnosed as having lifetime mood, anxiety, and substance (alcohol and drug) use disorders.