Asian American students' cultural values, stigma, and relational self-construal: correlates of attitudes toward professional help seeking.(Report)

In this study, we investigated how adherence to Asian values, stigma of receiving psychological help, relational-interdependent self-construal, age and gender, for Asian American college and graduate students, singly and in concert predicted attitudes toward seeking professional psychological help. We also examined how stigma mediates the effect of adherence to Asian values on help-seeking attitudes. Correlational and multiple regression analyses determined that lower adherence to Asian values, lower levels of stigma, a higher relational-interdependent self-construal were associated with more positive help-seeking attitudes. Also, female and older students possessed more positive help-seeking attitudes. The mediational model was not significant. We discuss potential barriers to seeking professional help across sociocultural levels. We address implications for research and practice in mental health counseling.

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Asian Americans currently constitute approximately 5% of the United States population (13.5 million) and by 2050 this group is projected to make up 10% of the U.S. population (U.S. Bureau of the Census, 2004). Asian international and Asian American students comprise a dramatically growing number of students enrolled in U.S. colleges and universities (U.S. Department of Education, 2004). Asian American students experience many stressors such as intergenerational conflict, negotiating cultural identities, career development, immigration status, and racism related stress. Yet, research findings concerning Asian Americans' attitudes toward the utilization of psychological services have been inconsistent and lacking in relational variables.

Past research has consistently reported that Asian Americans tend to underutilize formal mental health services, prematurely terminate from psychotherapy, and endorse less favorable help-seeking attitudes compared with European Americans (Atkinson, Lowe, & Matthews, 1995; Leong, 1994; Matsuoka, Breaus, & Ryujin, 1997; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). This pattern was found in student (both local and international) as well as adult populations, inpatient and outpatient settings across the United States (Loo, Tong, & True, 1989; Narikiyo & Kameoka, 1992; Snowden & Cheung, 1990). In spite of the "model minority" myth, suggesting that Asian Americans have been successful, function well in society, and have few cultural adjustment difficulties (Sue & Sue, 2003), researchers have identified mental health concerns, adjustment difficulties and a need for mental health services in groups of Asian Americans including local and international students (Leong, Wagner, & Tata, 1995; Yeh & Inose, 2003; Yeh, 2002). The lower rate of help seeking among Asian Americans may stem from a combination of institutional and sociocultural barriers.

Barriers on the institutional level may include a lack of culturally competent personnel, contradictions between values held by the Asian clients and the Western model of counseling (e.g., ethnocentric model of counseling; Sue & Sue, 2003) and lack of culturally responsive services. Barriers on the cultural and social level for Asian internationals and Asian Americans may include historical and cultural influences on coping with personal problems, linguistic issues, limited knowledge about available services, and a high level of social stigma attached to seeking psychological treatment for mental health issues in the Asian community (e.g., Komiya, Good, & Sherrod, 2000; Tsang, Tam, Chan,& Cheung, 2003; Uba, 1994). In this study, we seek to revisit the pattern of underutilization and help-seeking attitudes among Asian American students through examining the specific factors embedded in their sociocultural context.

Asian cultural values are prominent factors in shaping attitudes toward seeking professional psychological help (Kim & Omizo, 2003). Asian cultures emphasize family hierarchy, emotional restraint, avoidance of shame and saving "face" (Flaskerud & Liu, 1990; Uba, 1994; Zane & Yeh, 2002), which may contradict Western norms in counseling such as self-disclosure and emotional expressiveness (Sue & Sue, 2003). Traditionally, Asian Americans are expected to deal with problems by themselves or take them to the family; if this strategy fails, they might turn to churches, physicians, elders, or clan and other ethnic organizations (Inman & Yeh, 2006). Extrafamilial intervention such as seeking professional psychological help is often considered shameful and a violation of the family hierarchy (Sue, 1994) and may bring disgrace to the family (Root, 1985), as seeking outside help may indicate inadequacy on the part of family members, and cause them to lose "face" (Zane & Yeh, 2002).

However, research has suggested that attitudes toward seeking professional help may vary as a function of within-group differences, such as acculturation level. Acculturation refers to the process of adaptation to the behaviors, values, knowledge and identity of the dominant society (Kim & Abreu, 2001). Past studies have found that higher levels of assimilation (i.e., more Americanized) among Asian American students predicted more positive attitudes toward seeking professional psychological help (Atkinson & Gim 1989; Tata & Leong; 1994). And, the most assimilated students are the most likely to recognize personal need for professional psychological help, most tolerant of the stigma associated with psychological help, and most open to discussing their problems with a psychologist (Atkinson & Gim, 1989).

Recent research on Asian values as a correlate of help-seeking attitudes underscores the limitations of using acculturation as a variable (Kim & Abreu, 2001). The commonly used acculturation scale, the Suinn-Lew Asian Self-Identity Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, & Vigil, 1987), is a uni-linear acculturation measure focusing on behavior items (e.g. language preference, identity, friendship choice, behaviors) and does not tap into value-based items. However, changes in cultural behaviors are not synonymous with changes in cultural values (Kim, Atkinson, & Yang, 1999). Individuals who are highly acculturated to the mainstream cultural behaviors in the United States. (e.g. eating American food, speaking fluent English, making friends with Americans) may still endorse a high level of adherence to their indigenous culture. For instance, they may still observe the traditional Asian values such as collectivism, emotional restraint, and social harmony. This process of retaining or socializing to the cultural values, ideas, concepts, knowledge, behaviors and norms of one's indigenous culture is known as enculturation (Berry, Poortinga, Segall, & Dasen, 1992; Kim, Atkinson, & Umemoto, 2001). Multicultural researchers argued that enculturation is an important index of the within group difference among Asian Americans, which may influence their help seeking (Kim & Abreu, 2001; Kim, Atkinson, & Umemoto, 2001). Kim and Omizo (2003) found that Asian American students who have high adherence to Asian cultural values tend to have negative attitudes toward seeking professional psychological help and exhibit lower levels of willingness to see a counselor. The current study attempts to replicate previous studies and investigate how …