Abstract
The present study examined subgroups of Asian Indians in the USA based on endorsed mental health symptoms and their relations with mental health treatment parameters (treatment history, internal/institutional barriers to mental health treatment seeking, and treatment preferences [therapist directiveness, emotional intensity, past orientation, and support]). The sample included 296 Asian Indians (60.10% females; Mage = 34.12) recruited from the community. Latent profile analyses indicated a best-fitting three-class solution: Low Mental Health Symptom Severity (Class 1), High Mental Health Severity: Predominantly Internalizing Symptoms (Class 2), and High Mental Health Severity: Predominantly High-Risk Symptoms (Class 3). Multinomial logistic regressions indicated that (1) internal barriers to mental health treatment seeking significantly associated with being in Class 2 vs. 1 and 3; (2) preferences for therapist directiveness and for past orientation significantly associated with being in Class 3 vs. 1; and (3) institutional barriers to mental health treatment seeking and preference for past orientation significantly associated with being in Class 3 vs. 2. Our findings highlight heterogeneity in mental health symptom patterns, disparities in mental health treatment utilization, internal/institutional barriers to seeking mental health treatment among individuals reporting more mental health symptom severity, and cultural-specific treatment preferences. Culturally adapted mental health treatments need to be tailored to the heterogeneous subgroups of Asian Indians based on their mental health symptom patterns.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from A.A.C upon reasonable request.
References
Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., ..., & Alegría, M. (2007). Use of mental health–related services among immigrant and US-born Asian Americans: Results from the National Latino and Asian American study. American Journal of Public Health, 97(1), 91–98. https://doi.org/10.2105/AJPH.2006.098541
Ananth, J. (1984). Treatment of immigrant Indian patients. The Canadian Journal of Psychiatry, 29(6), 490–493. https://doi.org/10.1177/070674378402900607
Asparouhov, T., & Muthén, B. (2014). Auxiliary variables in mixture modeling: Three-step approaches using M plus. Structural Equation Modeling: A Multidisciplinary Journal, 21(3), 329–341. https://doi.org/10.1080/10705511.2014.915181
Atkinson, D. R., & Gim, R. H. (1989). Asian-American cultural identity and attitudes toward mental health services. Journal of Counseling Psychology, 36(2), 209–212. https://doi.org/10.1037/0022-0167.36.2.209
Bastiaens, L., & Galus, J. (2018). The dsm-5 self-rated level 1 cross-cutting symptom measure as a screening tool. Psychiatric Quarterly, 89(1), 111–115. https://doi.org/10.1007/s11126-017-9518-7
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological), 57(1), 289–300. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
Bravo, A. J., Villarosa-Hurlocker, M. C., & Pearson, M. R. (2018). College student mental health: An evaluation of the DSM–5 self-rated Level 1 cross-cutting symptom measure. Psychological Assessment, 30(10), 1382–1389. https://doi.org/10.1037/pas0000628
Brunet, A., Boucher, C., & Boyer, R. (1996). Social desirability in the assessment of trauma. Psychological Reports, 79(2), 511–514. https://doi.org/10.2466/pr0.1996.79.2.511
Caldwell-Harris, C. L., & Aycicegi, A. (2006). When personality and culture clash: The psychological distress of allocentrics in an individualist culture and idiocentrics in a collectivist culture. Transcultural Psychiatry, 43(3), 331–361. https://doi.org/10.1177/1363461506066982
Carlson, E. B., Dalenberg, C., & McDade-Montez, E. (2012). Dissociation in posttraumatic stress disorder part 1: Definitions and review of research. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 479–489. https://doi.org/10.1037/a0027748
Chandarana, P., & Pellizzari, J. R. (2001). Health psychology: South Asian perspectives. In S. S. Kazarian & D. R. Evans (Eds.), Handbook of Cultural Health Psychology (pp. 441–444). Academic Press. https://doi.org/10.1016/B978-012402771-8/50017-9
Chandra, R. M., Arora, L., Mehta, U. M., Asnaani, A., & Radhakrishnan, R. (2016). Asian Indians in America: The influence of values and culture on mental health. Asian Journal of Psychiatry, 22, 202–209. https://doi.org/10.1016/j.ajp.2015.09.011
Conrad, M. M., & Pacquiao, D. F. (2005). Manifestation, attribution, and coping with depression among Asian Indians from the perspectives of health care practitioners. Journal of Transcultural Nursing, 16, 32–40. https://doi.org/10.1177/1043659604271239
Contractor, A. A., Caldas, S., Fletcher, S., Shea, M. T., & Armour, C. (2018). Empirically-derived lifespan polytraumatization typologies: A systematic review. Journal of Clinical Psychology, 74(7), 1137–1159. https://doi.org/10.1002/jclp.22586
Contractor, A. A., Weiss, N. H., Schick, M. R., Batley, P. N., Forkus, S. R., & Sharma, R. (2020). Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US. Journal of Anxiety Disorders, 70, 102195. https://doi.org/10.1016/j.janxdis.2020.102195
Contractor, A. A., Rafiuddin, H. S., Kaur, K., & Asnaani, A. (2022). Asian Indians in the United States and posttraumatic stress disorder interventions: A narrative literature review. Trauma, Violence, & Abuse. https://doi.org/10.1177/15248380221097435
Cooper, M., & Norcross, J. C. (2016). A brief, multidimensional measure of clients’ therapy preferences: The Cooper-Norcross Inventory of Preferences (C-NIP). International Journal of Clinical and Health Psychology, 16(1), 87–98. https://doi.org/10.1016/j.ijchp.2015.08.003
Cooper, M., Norcross, J. C., Raymond-Barker, B., & Hogan, T. P. (2019). Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it? Psychotherapy, 56(2), 205–216. https://doi.org/10.1037/pst0000226
Cornelius, B. L., Groothoff, J. W., van der Klink, J. J., & Brouwer, S. (2013). The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants. BMC Public Health, 13(1), 128. https://doi.org/10.1186/1471-2458-13-128
Das, A. K., & Kemp, S. F. (1997). Between two worlds: Counseling South Asian Americans. Journal of Multicultural Counseling and Development, 25(1), 23–33. https://doi.org/10.1002/j.2161-1912.1997.tb00313.x
DiBartolo, P. M., & Rendón, M. J. (2012). A critical examination of the construct of perfectionism and its relationship to mental health in Asian and African Americans using a cross-cultural framework. Clinical Psychology Review, 32(3), 139–152. https://doi.org/10.1016/j.cpr.2011.09.007
DiStefano, C., & Kamphaus, R. W. (2006). Investigating subtypes of child development: A comparison of cluster analysis and latent class cluster analysis in typology creation. Educational and Psychological Measurement, 66(5), 778–794. https://doi.org/10.1177/0013164405284033
Diwan, S., Jonnalagadda, S. S., & Balaswamy, S. (2004). Resources predicting positive and negative affect during the experience of stress: A study of older Asian Indian immigrants in the United States. The Gerontologist, 44(5), 605–614. https://doi.org/10.1093/geront/44.5.605
Durvasula, R. S., & Mylvaganam, G. A. (1994). Mental health of Asian Indians: Relevant issues and community implications. Journal of Community Psychology, 22(2), 97–108. https://doi.org/10.1002/1520-6629(199404)22:2%3c97::AID-JCOP2290220206%3e3.0.CO;2-#
El-Gabalawy, R., Tsai, J., Harpaz-Rotem, I., Hoff, R., Sareen, J., & Pietrzak, R. H. (2013). Predominant typologies of psychopathology in the United States: A latent class analysis. Journal of Psychiatric Research, 47(11), 1649–1657. https://doi.org/10.1016/j.jpsychires.2013.07.028
Forkus, S. R., Raudales, A. M., Rafiuddin, H., Weiss, N. H., Messman, B. A., & Contractor, A. A. (2022). The PTSD Checklist for DSM-5: A systematic review of existing psychometric evidence. Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000111
Futa, K. T., Hsu, E., & Hansen, D. J. (2001). Child sexual abuse in Asian American families: An examination of cultural factors that influence prevalence, identification, and treatment. Clinical Psychology Science & Practice, 8, 189–209. https://doi.org/10.1093/clipsy.8.2.189
Gangadhar, B. N., & Thirthalli, J. (2009). Differential outcome of schizophrenia: Does cultural explanation suffice? Asian Journal of Psychiatry, 2(2), 53–54. https://doi.org/10.1016/j.ajp.2009.04.001
Gilmoor, A. R., Adithy, A., & Regeer, B. (2019). The cross-cultural validity of post-traumatic stress disorder and post-traumatic stress symptoms in the Indian context: A systematic search and review. Frontiers in Psychiatry, 10, 439. https://doi.org/10.3389/fpsyt.2019.00439
Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60(1), 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530
Gupta, V. B. (2010). Impact of culture on healthcare seeking behavior of Asian Indians. Journal of Cultural Diversity, 17(1), 13–19.
Inman, A. G., Howard, E. E., Beaumont, R. L., & Walker, J. A. (2007). Cultural transmission: Influence of contextual factors in Asian Indian immigrant parents’ experiences. Journal of Counseling Psychology, 54(1), 93–100. https://doi.org/10.1037/0022-0167.54.1.93
Inman, A. G., Devdas, L., Spektor, V., & Pendse, A. (2014). Psychological research on South Asian Americans: A three-decade content analysis. Asian American Journal of Psychology, 5(4), 364–372. https://doi.org/10.1037/a0035633
Jin, L., Sharma, R., Hall, B. J., NatesanBatley, P., Alghraibeh, A. M., Aljomaa, S. S., & Contractor, A. A. (2022). Ethnic cultural value typologies and mental health parameters among Indians. International Journal of Intercultural Relations, 86, 95–108. https://doi.org/10.1016/j.ijintrel.2021.11.008
Kato, T. (2021). Measurement invariance in the center for epidemiologic studies- depression (CES-D) scale among english-speaking Whites and Asians. International Journal of Environmental Research and Public Health, 18(10), 1–10. https://doi.org/10.3390/ijerph18105298
Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., ..., & Diwan, S. (2019). Mental health and stress among South Asians. Journal of Immigrant and Minority Health, 21(1), 7–14. https://doi.org/10.1007/s10903-016-0501-4
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., ..., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. https://doi.org/10.1017/S0033291702006074
Khera, G. S., & Nakamura, N. (2018). Substance use, gender, and generation status among Asian Indians in the United States. Journal of Ethnicity in Substance Abuse, 17(3), 291–302. https://doi.org/10.1080/15332640.2016.1201715
Kim, B. S., & Hong, S. (2004). A psychometric revision of the Asian Values Scale using the Rasch model. Measurement and Evaluation in Counseling and Development, 37(1), 15–27. https://doi.org/10.1080/07481756.2004.11909747
Kramer, E. J., Ivey, S. L., & Ying, Y. W. (1999). Immigrant women’s health: Problems and solutions (p. 256). Jossey-Bass.
Kumar, A., & Nevid, J. S. (2010). Acculturation, enculturation, and perceptions of mental disorders in Asian Indian immigrants. Cultural Diversity and Ethnic Minority Psychology, 16(2), 274–283. https://doi.org/10.1037/a0017563
Lee, H. K., Han, B., & Gfroerer, J. C. (2013). Differences in the prevalence rates and correlates of alcohol use and binge alcohol use among five Asian American subpopulations. Addictive Behaviors, 38(3), 1816–1823. https://doi.org/10.1016/j.addbeh.2012.11.001
Lee, S., Martins, S., & Lee, H. (2014). Mental Disorders and Mental Health Service Use Across Asian American Subethnic Groups in the United States. Community Mental Health Journal, 51, 153–160. https://doi.org/10.1007/s10597-014-9749-0
Madathil, J., & Singh Sandhu, D. (2008). Infidelity in Asian Indian marriages: Implications for counseling and psychotherapy. The Family Journal, 16(4), 338–343. https://doi.org/10.1177/1066480708323086
Masood, N., Okazaki, S., & Takeuchi, D. T. (2009). Gender, family, and community correlates of mental health in South Asian Americans. Cultural Diversity & Ethnic Minority Psychology, 15, 265–274.
Masyn, K. E. (2013). Latent class analysis and finite mixture modeling. The Oxford Handbook of Quantitative Methods, 2, 551.
Meade, A. W., & Craig, S. B. (2012). Identifying careless responses in survey data. Psychological Methods, 17(3), 437–455. https://doi.org/10.1037/a0028085
Mehta, S. (1998). Relationship between acculturation and mental health for Asian Indian immigrants. Genetic, Social, and General Psychology Monographs, 24(1), 61–78.
Methikalam, B., Wang, K. T., Slaney, R. B., & Yeung, J. G. (2015). Asian values, personal and family perfectionism, and mental health among Asian Indians in the United States. Asian American Journal of Psychology, 6(3), 223–232. https://doi.org/10.1037/aap0000023
Molina, K. M., Little, T. V., & Rosal, M. C. (2016). Everyday discrimination, family context, and psychological distress among Latino adults in the United States. Journal of Community Psychology, 44(2), 145–165. https://doi.org/10.1002/jcop.21747
Moore, T. J., & Mattison, D. R. (2017). Adult utilization of psychiatric drugs and differences by sex, age, and race. JAMA Internal Medicine, 177(2), 274–275. https://doi.org/10.1001/jamainternmed.2016.7507
Muthén, L. K., & Muthén, B. O. (2017). Mplus: Statistical Analysis with Latent Variables: User’s Guide (Version 8). Los Angeles, CA: Authors.
Nadimpalli, S. B., Kanaya, A. M., McDade, T. W., & Kandula, N. R. (2016). Self-reported discrimination and mental health among Asian Indians: Cultural beliefs and coping style as moderators. Asian American Journal of Psychology, 7(3), 185–194. https://doi.org/10.1037/aap0000037
Nieuwsma, J. A., Pepper, C. M., Maack, D. J., & Birgenheir, D. G. (2011). Indigenous perspectives on depression in rural regions of India and the United States. Transcultural Psychiatry, 48(5), 539–568. https://doi.org/10.1177/1363461511419274
Nugent, N. R., Koenen, K. C., & Bradley, B. (2012). Heterogeneity of posttraumatic stress symptoms in a highly traumatized low income, urban, African American sample. Journal of Psychiatric Research, 46(12), 1576–1583. https://doi.org/10.1016/j.jpsychires.2012.07.012
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569. https://doi.org/10.1080/10705510701575396
Nylund, K., Bellmore, A., Nishina, A., & Graham, S. (2007). Subtypes, severity, and structural stability of peer victimization: What does latent class analysis say? Child Development, 78(6), 1706–1722. https://doi.org/10.1111/j.1467-8624.2007.01097.x
Nylund-Gibson, K., & Choi, A. Y. (2018). Ten frequently asked questions about latent class analysis. Translational Issues in Psychological Science, 4(4), 440–461. https://doi.org/10.1037/tps0000176
Olino, T. M., Klein, D. N., Farmer, R. F., Seeley, J. R., & Lewinsohn, P. M. (2012). Examination of the structure of psychopathology using latent class analysis. Comprehensive Psychiatry, 53(4), 323–332. https://doi.org/10.1016/j.comppsych.2011.05.008
Pepin, R., Segal, D. L., Klebe, K. J., Coolidge, F. L., Krakowiak, K. M., & Bartels, S. J. (2015). The barriers to mental health services scale revised: Psychometric analysis among older adults. Mental Health & Prevention, 3(4), 178–184. https://doi.org/10.1016/j.mhp.2015.09.001
Pew Research Center. (2012, June 19). The rise of Asian Americans [Report]. https://www.pewresearch.org/social-trends/2012/06/19/the-rise-of-asian-americans/
Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A., ..., & Tiet, Q. Q. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211.
Raftery, A. E. (1995). Bayesian model selection in social research. Sociological Methodology, 25, 111–163. https://doi.org/10.2307/271063
Raguram, R., Weiss, M. G., Keval, H., & Channabasavanna, S. M. (2001). Cultural dimensions of clinical depression in Bangalore, India. Anthropology & Medicine, 8(1), 31–46. https://doi.org/10.1080/13648470120063889
Rastogi, P., Khushalani, S., Dhawan, S., Goga, J., Hemanth, N., Kosi, R., ..., & Rao, V. (2014). Understanding clinician perception of common presentations in South Asians seeking mental health treatment and determining barriers and facilitators to treatment. Asian Journal of Psychiatry, 7, 15–21. https://doi.org/10.1016/j.ajp.2013.09.005
Rastogi, M., & Wadhwa, S. (2006). Substance abuse among Asian Indians in the United States: A consideration of cultural factors in etiology and treatment. Substance Use & Misuse, 41(9), 1239–1249. https://doi.org/10.1080/10826080600754470
Ruzek, J. I., Schnurr, P. P., Vasterling, J. J., & Friedman, M. J. (Eds.). (2011). Caring for veterans with deployment-related stress disorders. American Psychological Association. https://doi.org/10.1037/12323-000
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177. https://doi.org/10.1037/1082-989X.7.2.147
Segal, U. A. (1998). The Asian Indian-American family. In C. H. Mindel, R. W. Habenstein, & R. Wright Jr. (Eds.), Ethnic families in America: Patterns and variation (4th ed., pp. 331–360). Upper Saddle River, NJ: Prentice Hall.
Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice. John Wiley & Sons.
Sue, S., Sue, D. W., Sue, L., & Takeuchi, D. T. (1995). Psychopathology among Asian Americans: A model minority? Cultural Diversity and Mental Health, 1(1), 39–51. https://doi.org/10.1037/1099-9809.1.1.39
Sunderaraman, P., Irani, F., Krishnan, K., & Hundal, J. S. (2021). A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning. The Clinical Neuropsychologist, 1–19. https://doi.org/10.1080/13854046.2021.1987524
Tewary, S. (2005). Asian Indian immigrant women: A theoretical perspective on mental health. Journal of Human Behavior in the Social Environment, 11(1), 1–22. https://doi.org/10.1300/J137v11n01_01
Tripathi, S., & Azhar, S. (2020). A systematic review of intimate partner violence interventions impacting South Asian Women in the United States. Trauma, Violence, & Abuse, 23(2), 523–540. https://doi.org/10.1177/1524838020957987
Tummala-Narra, P., Sathasivam-Rueckert, N., & Sundaram, S. (2013). Voices of older Asian Indian immigrants: Mental health implications. Professional Psychology: Research and Practice, 44(1), 1–10. https://doi.org/10.1037/a0027809
Tummala-Narra, P., & Deshpande, A. (2018). Mental health conditions among South Asians in the United States. In M. J. Perera & E. C. Chang (Eds.), Biopsychosocial Approaches to Understanding Health in South Asian Americans. Springer International Publishing/Springer Nature. https://doi.org/10.1007/978-3-319-91120-5_9
Turner, E. A., & Mohan, S. (2016). Child mental health services and psychotherapy attitudes among Asian Indian parents: An exploratory study. Community Mental Health Journal, 52(8), 989–997. https://doi.org/10.1007/s10597-015-9976-z
Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved three-step approaches. Political Analysis, 18(4), 450–469. https://doi.org/10.1093/pan/mpq025
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P., (2013). The PTSD Checklist for DSM-5 (PCL-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov
Wong, Y. J., Vaughan, E. L., Liu, T., & Chang, T. K. (2014). Asian Americans’ proportion of life in the United States and suicide ideation: The moderating effects of ethnic subgroups. Asian American Journal of Psychology, 5(3), 237–242. https://doi.org/10.1037/a0033283
Wu, K. D., & Wyman, S. V. (2016). Examination of racial differences in assessment of OCD symptoms and obsessive beliefs. Journal of Obsessive-Compulsive and Related Disorders, 10, 10–18.
Zane, N., & Yeh, M. (2002). The use of culturally-based variables in assessment: Studies on loss of face. In K. S. Kurasaki, S. Okazaki, & S. Sue (Eds.), Asian American Mental Health: Assessment Theories and Methods (pp. 123–138). Kluwer Academic/Plenum Publishers. https://doi.org/10.1007/978-1-4615-0735-2_9
Acknowledgements
We acknowledge the contributions of Dr. Rachita Sharma, Dr. Megan Dolan, Dr. Stephanie Caldas, Ms. Fallon Keegan, Ms. Shelby Thornton, Ms. Christina Cantu, Ms. Seanne Ohara, and Mr. Bhargav Muppaneni for aiding participant recruitment. We thank Dr. Rachita Sharma for their help in obtaining funding for this project.
Funding
This work was supported by funding from the University of North Texas India Venture Fund (Dr. Ateka A. Contractor and Dr. Rachita Sharma). The funding agency had no role in the study design, the data collection, analysis or interpretation, writing of the manuscript, or the decision to submit the paper for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval and Consent to Participate
The current project was approved by the University of North Texas’s Institutional Review Board. Participants provided informed consent before attempting the survey.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Jin, L., Compton, S.E., Sameen, De. et al. Mental Health Symptom Profiles and Treatment Parameters Among Asian Indians: Latent Profile Analyses. Int J Ment Health Addiction (2023). https://doi.org/10.1007/s11469-023-01040-y
Accepted:
Published:
DOI: https://doi.org/10.1007/s11469-023-01040-y