Predicting the use of campus counseling services for Asian/Pacific Islander, Latino/Hispanic, and White students: problem severity, gender, and generational status.(Research)(Report)

The purpose of the current study was to identify predictors of counseling center use among Asian/Pacific Islander, Latino/Hispanic, and White college students. Findings indicated that female and 2nd-generation students report the most severe difficulties. Problem severity and gender predicted counseling center use for White and Asian/Pacific Islander students, whereas only problem severity predicted use for Latino/Hispanic students. Generational status was not a significant predictor of use for any group.

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The underutilization of mental health services by people of color has been clearly demonstrated by more than 3 decades of research (e.g., Abramowitz & Murray, 1983; Diala et al., 2000; Leong, Wagner, & Tata, 1995; Vega, Kolody, Aguilar-Gaxiola, & Catalano, 1999). Comparative studies have indicated that a persistent pattern of underutilization has been shown for Asian Americans in community samples (Bui & Takeuchi, 1992; A. Y. Zhang, Snowden, & Sue, 1998), and studies of college students have demonstrated that Asian students are less willing to access psychological services compared with White students (Arnemann, 1996; Mau & Jepsen, 1988; Narikiyo & Kameoka, 1992; Suan & Tyler, 1990; S. Sue & Sue, 1974). There is also evidence that Latinos underutilize services compared with Whites in community (McMiller & Weisz, 1996) and college samples (Sanchez & King, 1986). These findings have prompted researchers to evaluate why people of color have comparatively underutilized services.

In one of the most comprehensive reviews of reasons for underutilization, Leong et al. (1995) reported that, for both Asian Americans and Latinos, acculturation, a lack of culturally appropriate treatment approaches, and institutional barriers were factors that contributed to underutilization of services. Other factors were keeping personal information within the family and avoiding the stigma associated with seeking counseling. Of those who did use mental health services, many did not return after the initial visit (Cheung & Snowden, 1990). This suggests that, for both Asian Americans and Latinos, cultural factors may have predisposed them to not seek services and that when they did seek services, they may have encountered obstacles to treatment.

Although the reasons for underutilization were compelling, some studies (Atkinson, Jennings, & Liongson, 1990; Johnson-Browne, 2002) have produced inconsistent results with regard to underutilization. Neither Atkinson et al. (1990) nor Johnson-Browne found differences ha use of services in comparing across a sample of ethnic college students. The divergent findings may have been a function of the comparison groups used in the study. Thus, when people of color were compared with a White sample, there was a trend toward underutilization; however, when ethnic groups were compared with one another, few differences were found. A change in methodology from between-groups to within-group differences may have also accounted for the mixed results.

Studies using within-group designs (Atkinson, Lowe, & Matthews, 1995; D. W. Sue & Kirk, 1975; Tracey, Leong, & Glidden, 1986) have found that Asian students were more willing to seek services for academic difficulties than for personal or emotional difficulties. Among Latinos, community studies (e.g., Vega et al., 1999) have found utilization differences depending on whether individuals were born in the United States. Recent immigrants were less likely to use services than were U.S.-born Latinos. In addition, other within-group studies have begun to identify variables that are related to use of counseling services in students of color, including symptom severity (Constantine, Wilton, & Caldwell, 2003), gender (Atkinson et al., 1990), and generational status (Chang & Chang, 2004; Shibazaki, 1999; N. Zhang & Dixon, 2003). The latter three were of interest in the current study.

As these studies highlight, comparative studies, although critical in illuminating the problem of underutilization of counseling services among people of color, are limited in their usefulness for understanding the variables that predict help seeking in people of color. Identifying within-group factors related to utilization would make a significant contribution to the research in understanding the range of diversity that exists within ethnic groups. Another important limitation in past research is that attitudes toward help seeking, rather than actual help-seeking behavior, were typically assessed (e.g., Atkinson & Gim, 1989; Atkinson et al., 1995; Gim, Atkinson, & Whitely, 1990).