Promoting mental and physical health of Vietnamese immigrants through a cultural movement intervention.

OBJECTIVES: Older Vietnamese adults are among the most underserved groups in the United States, despite being at high risk for stress and other negative experiences (e.g., access to same-language practitioners, transportation barriers, lack of health care). Minimal progress has been made in decreasing treatment barriers for this underserved population. One promising approach involves using indigenous, culturally based interventions to enhance psychological and physical well-being. Such interventions may reduce utilization and quality of care disparities because they emphasize a more holistic approach to health, thereby limiting the shame and face loss often experienced due to the stigma associated with mental illness. The present study examined the efficacy of lishi, a traditional East Asian movement form of exercise, in promoting mental and physical health outcomes for older Vietnamese immigrant adults. METHOD: Seventy-one older Vietnamese adults participated in this randomized waitlist control study. Participants were between 60 and 75 years old. Multivariate analysis of covariance was used to determine posttest outcomes differences between the intervention and control groups. RESULTS: Intervention group participants experienced significantly higher levels of self-efficacy and physical energy, less bodily pains, and better body balance at posttest compared to the control group. CONCLUSIONS: Lishi may be an effective culturally valid intervention for older Vietnamese adults and demonstrated promise at engaging this hard-to-reach population in treatment and services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining risk and protective predictors of substance use among low-income Native Hawaiian and Pacific Islander adolescents.

Substance use (SU) among adolescents is a critical public health concern that increases the risk for negative outcomes. Although Asian American (AA) adolescents tend to report low rates of SU, Native Hawaiian and Pacific Islander (NH/PI) adolescents often report significantly higher rates of use. Yet, NH/PI youth are seldom studied as a separate group. Consequently, little is known about the factors involved in SU among NH/PI adolescents and how to prevent it. This prospective study investigated the effect of ecological risk and protective factors at the individual, family, and school levels on SU for NH/PI adolescents. This prospective study utilized longitudinal data from 120 NH/PI adolescents who were7 part of an SU prevention program. Information was collected at two time points-Time 1 and Time 2 (32 weeks later)-and included adolescents' SU behaviors and individual, family, and school factors. The parents of these adolescents also provided data; all information was self-report. Positive academic attitudes at Time 1 were negatively associated with alcohol and other drug (e.g., marijuana) use at Time 2. Specifically, NH/PI adolescents who had more positive attitudes toward their school, peers, and teachers reported less alcohol and other SU. Prevention efforts may be most effective for NH/PI adolescents if addressed within the school context. This may include programs implemented in schools, utilizing teachers as role models, and/or promoting prosocial peer relationships to support positive behaviors. Additional implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reducing mental health disparities by increasing the personal relevance of interventions.

One of the most persistent health disparities is the underutilization of mental health services by people of color. Neither evidence-based treatments (universal focus) nor culturally adapted treatments (group focus) have reduced these disparities. We propose the personal relevance of psychotherapy (PROP) model, which integrates universal, group, and individual dimensions to determine the personal relevance of interventions. A cultural example of personal relevance among people of East Asian ancestry involves "face" (i.e., one's prestige and position in society), which may moderate treatment outcomes. Pragmatic intervention approaches focused on helping individuals cope with specific external problems, compared to managing a "personal" disease, can effectively "restore" face. Thus, social problem-solving interventions may be more personally relevant to many people of East Asian ancestry than are approaches that are internally focused. In addition, we posit that social neuroscience can offer unique opportunities above and beyond self-report measures when assessing the impact of PROP and the personal relevance of interventions for diverse populations. Our preliminary evidence upon testing this hypothesis indicated that among Asian Americans, exposure to problem-solving therapy content elicited significantly greater neural activity in brain areas associated with personal relevance compared to exposure to cognitive-behavioral therapy content. Identifying personally relevant interventions has the potential to reduce mental health disparities by increasing engagement with mental health services for diverse groups. The increased client engagement produced by personally relevant interventions also has the potential to make mental health services more effective for diverse groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cultural Adaptations of Psychotherapy: Therapists' Applications of Conceptual Models with Asians and Asian Americans.

Although conceptual models of cultural adaptations of psychotherapy have been developed, little is known about how therapists apply these models in clinical practice. The purpose of the current study was to examine, using a directed content analysis, how therapists culturally adapt cognitive-behavioral therapy (CBT), one of the most widely used evidence-based approaches, for application with clients of Asian ancestry. The study also examined if there were major differences in adaptation strategies between therapists who practice in the United States (N = 9), a predominantly individualistic society as opposed to those who practice in Japan (N = 6), a predominantly collectivistic society. Semi-structured, open-ended interviews revealed that interdependent conceptualizations of the self and indirect communication were addressed by therapists in both countries, and therapist credibility issues were addressed only by therapists in the United States. These results imply that when culturally adapting psychotherapy, therapists incorporate elements of conceptual models that are relevant to their clients' cultures.

Decreases in implicit self-esteem explain the racial impact of microaggressions among Asian Americans.

Asian Americans are commonly perceived as perpetual foreigners and, therefore, not "true" Americans. Asian Americans report inquiries about nationality and English abilities as the most common forms of racial microaggressions perpetrated by White Americans (Sue, 2015). Race theorists assert that these microaggressions are race-related and marginalize Asian Americans. Scholars have claimed that these subtle acts are harmful, yet only a few studies have uncovered the mechanisms by which racial microaggressions affect mental and physical well-being (Ong, Burrow, Fuller-Rowell, Ja, & Sue, 2013; Wong, Derthick, David, Saw, & Okazaki, 2013). The current study conceptualized racial microaggressions as a stressor to address the major gaps in research. Specifically, this study (a) experimentally tested the race-related nature of the microaggression event to determine whether a White American perpetrator would elicit more stress in Asian Americans compared to an Asian American perpetrator and (b) examined threats to explicit and implicit self-esteem as possible mediators of microaggression-generated stress. Findings confirmed that the race of the perpetrator did have an impact on stress among Asian Americans. In the multiple meditation analysis, experience with a White American perpetrator, compared to an Asian American perpetrator, lowered implicit self-esteem, which resulted in more stress. Implications and strategies for counseling Asian American clients are discussed. (PsycINFO Database Record

Counseling services for Asian, Latino/a, and White American students: Initial severity, session attendance, and outcome.

OBJECTIVE: The current study examined racial/ethnic differences in initial severity, session attendance, and counseling outcomes in a large and diverse sample of Asian American, Latino/a, and White student clients who utilized university counseling services between 2008 and 2012. METHOD: We used archival data of 5,472 clients (62% female; M age = 23.1, SD = 4.3) who self-identified their race/ethnicity as being Asian American (38.9%), Latino/a (14.9%), or White (46.2%). Treatment engagement was measured by the number of counseling sessions attended; initial severity and treatment outcome were measured using the Outcome Questionnaire-45. RESULTS: Asian American clients, particularly Chinese, Filipino/a, Korean, and Vietnamese Americans, had greater initial severity compared with White clients. Asian Indian, Korean, and Vietnamese American clients used significantly fewer sessions of counseling than White clients after controlling for initial severity. All racial/ethnic minority groups continued to have clinically significant distress in certain areas (e.g., social role functioning) at counseling termination. CONCLUSIONS: These findings highlight the need to devote greater attention to the counseling experiences of racial/ethnic minority clients, especially certain Asian American groups. Further research directions are provided. (PsycINFO Database Record

Help-seeking intentions among Asian American and White American students in psychological distress: Application of the health belief model.

OBJECTIVE: Underutilization of needed mental health services continues to be the major mental health disparity affecting Asian Americans (Sue, Cheng, Saad, & Chu, 2012). The goal of this study was to apply a social psychological theoretical framework-the health belief model (Rosenstock, 1966)-to understand potential reasons why Asian Americans underutilize mental health services relative to White Americans. METHOD: Using a cross-sectional online questionnaire, this study examined how perceived severity of symptoms, perceived susceptibility to mental health problems, perceived benefits of treatment, and perceived barriers to treatment influenced intentions to seek help among a sample of 395 Asian American and 261 White American students experiencing elevated levels of psychological distress. RESULTS: Analyses using structural equation modeling indicated that Asian Americans in distress had relatively lower intentions to seek help compared with White Americans. Perceived benefits partially accounted for differences in help-seeking intentions. Although Asian Americans perceived greater barriers to help seeking than did White Americans, this did not significantly explain racial/ethnic differences in help-seeking intentions. Perceived severity and barriers were related to help-seeking intentions in both groups. CONCLUSIONS: Outreach efforts that particularly emphasize the benefits of seeking mental health services may be a particularly promising approach to address underutilization. The findings have implications in help-seeking promotion and outreach. (PsycINFO Database Record

Cultural influences in mental health treatment.

Research on mental health treatments from 2010 to 2015 has continued to highlight the critical role of culture on treatment services, processes, and outcomes for racial/ethnic minority groups. Studies showed that factors such as acculturation and phenotypic appearance were associated with risk for psychopathology. Issues such as face concern and acculturation level were associated with the quality of client-therapist relationships and the amount of information clients disclosed in sessions. While racial/ethnic minority clients generally preferred same-ethnicity therapists, findings showed relatively small effects for racial/ethnic match and positive treatment outcomes. Several studies provided additional evidence for the effectiveness of culturally-adapted, evidence-based treatments compared to non-adapted treatments for minority clients, and more researchers are beginning to delineate the processes involved in making these successful adaptations.

The influence of psychological symptoms on mental health literacy of college students.

Psychological problems, such as depression and anxiety, are common among college students, but few receive treatment for it. Mental health literacy may partially account for low rates of mental health treatment utilization. We report 2 studies that investigated mental health literacy among individuals with varying degrees of psychological symptoms, using cross-sectional online survey methodology. Study 1 involved 332 college students, of which 32% were categorized as high depressed using an established measure of depression, and mental health literacy for depression was assessed using a vignette. Logistic regression results showed that high depressed individuals were less likely to recognize depression compared to low depressed individuals, and depression recognition was associated with recommendations to seek help. Study 2 replicated and extended findings of Study 1 using a separate sample of 1,321 college students with varying degrees of psychological distress (32% no/mild distress, 55% moderate distress, and 13% serious distress) and examining mental health literacy for anxiety in addition to depression. Results indicated that compared to those with no/mild distress, those with moderate distress had lower recognition of depression, and those with moderate and serious distress were less likely to recommend help-seeking. In contrast, there were no differences in mental health literacy for anxiety, which was low across all participants. These findings suggest that psychological symptoms can impact certain aspects of mental health literacy, and these results have implications for targeting mental health literacy to increase mental health services utilization among individuals in need of help. (PsycINFO Database Record

Domain identification moderates the effect of positive stereotypes on Chinese American women's math performance.

We examined whether an individual difference factor, math domain identification, moderated performance following positive stereotype activation. We hypothesized that positive stereotype activation would improve performance for those more math identified (compared to a control condition), but would hinder performance for those less math identified. We examined 116 Chinese American women (mean age = 19 years). Participants were assigned to the positive stereotype activation condition or to the control condition before completing a math test. Positive stereotype activation led more math identified participants to perform significantly better than the control condition, whereas it led less math identified participants to perform significantly worse than the control condition. Domain identification moderates the effect of positive stereotype activation. Educators should consider how testing situations are constructed, especially when test takers do not identify highly with the domain.

Personal gambling expectancies among Asian American and White American college students.

Many college students are involved in gambling behavior as a recreational activity. Their involvement could potentially develop into problem gambling, an issue of increasing concern to student health. At the same time, evidence suggests that Asian Americans are overrepresented amongst problem gamblers in this age period. Research on factors related to initiation and development of problem gambling in college students is necessary to inform the development of effective and culturally-sensitive prevention efforts against gambling. The relationships between personal gambling expectancies at two levels of specificity (two general and six specific types of expectancies) and college student gambling at two levels of behavior (initiation and problems) were examined in a sample of 813 Asian American and White American college students. The study aimed to address (a) whether expectancies explained ethnic differences in gambling, (b) ethnic similarities and differences in the pattern of relationships between expectancies and gambling, and (c) whether expectancies that emerged in both ethnic groups have a greater risk or protective effect for one group than another. Results showed that Asian American students reported more problem gambling than White American students, but expectancies did not account for this group difference. Risk and protective factors for initiation were relatively similar between groups, but different patterns of risk emerged for each group for problem gambling. Implications for college primary prevention and harm reduction programs are discussed.

Therapist Ethnicity and Treatment Orientation Differences in Multicultural Counseling Competencies.

This study examined the relationship between therapist characteristics, therapeutic orientations, person-level and agency-level practices with cultural competency among 221 Los Angeles County community mental health clinicians. Results from an online survey indicated that compared to White therapists, ethnic minority therapists were more personally involved in communities of color, more likely to use a cultural framework in clinical practice, and perceived their agencies to be more culturally sensitive. Ethnic minority therapists also reported greater multicultural (MC) awareness and better MC counseling relationships with their clients than White therapists. Personal involvement in communities of color accounted for ethnic differences in MC awareness and MC counseling relationships. Compared to therapists with a strictly non-behavioral (psychodynamic or humanistic) orientation, therapists with an eclectic (or integrative) therapy orientation reported having a higher level of community knowledge. Therapists with an eclectic orientation reported greater MC awareness than therapists with a non-behavioral orientation, while both eclectic and behavioral (cognitive behavioral or behavior modification) therapists recounted better MC counseling relationships with their clients than therapists with a non-behavioral orientation. Community knowledge mediated eclectic vs. non-behavioral therapeutic orientation differences in MC awareness. Agency resources/linkages and outreach both moderated the relationship between therapeutic orientation and MC skills. Results suggest that if therapists become more personally involved with diverse populations, they will feel more culturally aware and feel like they have a better relationship with ethnic minority clients.

Patterns of Utilization and Outcomes of Inpatient Psychiatric Treatment in Asian Americans.

Most of the knowledge of racial/ethnic disparities in mental health treatment utilization comes from studies examining outpatient services, and less is known about these disparities in inpatient services. This empirical gap may limit our understanding of these disparities since inpatient treatment is the most intensive form of specialty mental health care for patients with psychological disorders. We conducted a systematic chart review of 129 Asian American and 198 White American psychiatric inpatients to examine patterns of inpatient psychiatric treatment utilization. Demographic and clinical data were extracted from admission and discharge records during a two-year timeframe. Patterns of diagnoses revealed that Asian American patients utilized inpatient services for more severe psychiatric diagnoses compared to White American patients. Despite this, there were no racial/ethnic differences in levels of functional impairment at admission, and there were no racial/ethnic differences in length of treatment stay. For Asian American patients, level of psychosocial functioning at admission predicted length of stay. A better understanding of patterns of inpatient treatment use is needed to meet the clinical needs of Asian Americans with psychiatric disorders.

Examining gender differences for gambling engagement and gambling problems among emerging adults.

Gambling is fast becoming a public health problem in the United States, especially among emerging adults (18-25 year olds). Since 1995, rates have recently doubled with around 7-11 % of the emerging adult population having problems with gambling (Shaffer et al. in Am J Public Health 89(9):1369-1376, 1999; Cyders and Smith in Pers Individ Diff 45(6):503-508, 2008). Some states have lowered their gambling age to 18 years old; in turn, the gambling industry has recently oriented their market to target this younger population. However, little is known about the gender variation and the factors placing emerging adults at risk for getting engaged and developing problems with gambling. The purpose of the study was to determine the risk factors accounting for gender differences at the two levels of gambling involvement: engagement and problems. Mediation analyses revealed that impulsive coping and risk-taking were significant partial mediators for gender differences on engagement in gambling. Men took more risks and had lower levels of impulsive coping than women, and those who took more risks and had lower levels of impulsive coping were more likely to engage in gambling. Risk-taking and social anxiety were the significant mediators for gender differences in problems with gambling. Men took more risks and were more socially anxious than women, and greater risk-taking and more socially anxious individuals tended to have more problems with gambling. Implications for counseling preventions and intervention strategies are discussed.

THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS' EXPERIENCES OF MENTAL HEALTH TREATMENT.

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.

Client predictors of short-term psychotherapy outcomes among Asian and white American outpatients.

PURPOSE: To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients. METHOD: Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pretreatment, and outcomes were measured postfourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators. RESULTS: Higher levels of somatic symptoms predicted lower psychosocial functioning at posttreatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style. CONCLUSIONS: Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes.

Patients' reports about medical doctors' inquiries on their mental health: do generational status, ethnicity and mental health/substance use disorders matter?

Immigrants are less likely than others to use mental health (MH) services. Physicians' limited time often precludes inquiry about MH. This study investigated the influence of generational status, ethnicity, and mental/substance use disorders on physicians' inquiries about Asian American (AA) MH. Data from the National Latino and Asian American Study were analyzed (n=1,853). The outcome was past year physician's inquiry regarding MH. Results revealed that AA with U.S.-born parents had significantly greater odds compared to AA born outside the U.S. to report that their doctors inquired about their MH (OR=218, 95% CI: 1.28, 3.73). Past year mental/substance use disorder increased the odds of AA reporting that their doctors inquired about their MH (OR=8.41; 95% CI: 3.28, 21.66). This increase differed by ethnicity, with Chinese less affected than Vietnamese (OR=0.17; 95% CI: 0.05, 0.59). The reasons for these associations warrant further exploration.

Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies.

The development of effective treatments for Asian Americans is important because treatment disparities continue to exist for this population. Because of their theoretical grounding in East Asian philosophies, mindfulness and acceptance-based psychotherapies appear to constitute promising ways to provide culturally responsive mental health care to Asian Americans. However, in practice these approaches often reflect conceptions of mental health that are more consistent with Western world views. We review points of intersection and divergence between Western-based mindfulness and acceptance psychotherapies and Asian American cultural values. We then propose a culturally syntonic approach that accentuates certain components of mindfulness and acceptance psychotherapies and adapts other components of these approaches to be more consistent with Asian American cultural values.

Understanding the psychological processes of the racial match effect in Asian Americans.

Some studies on mental health outcomes research have found that when clients and therapists are ethnically or racially matched, this tends to be related to greater satisfaction and better outcomes. However, the precise underlying mechanism for the match effect has not been extensively examined. In this experimental study, we tested the effect of racial match on critical counseling processes (i.e., therapist credibility and the working alliance) using a sample of 171 Asian American respondents. We also examined Asian ethnic identification as a potential moderator of the racial match effect. Structural equation modeling analyses indicated that racially matched individuals perceived greater experiential similarity with the therapist than nonmatched individuals, and experiential similarity was positively associated with therapist credibility. Although racial match did not predict attitudinal similarity, attitudinal similarity was strongly related to the working alliance and therapist credibility. Counseling implications are discussed.