Adolescents from ethnic minority backgrounds are less likely to receive school-based mental health services (SBMHS) than White students, although these services have increased accessibility and produced positive youth outcomes. To reduce barriers and engage minority and immigrant adolescents in SBMHS, it is important to understand parents’ perception as they play an important role in guiding adolescents to seek help for mental health challenges. The current mixed methods study examined Asian immigrant parents’ levels of mental health literacy (MHL; symptoms recognition and knowledge of appropriate treatment options) using case vignettes describing bulimia or depression as well as their perceptions of barriers for utilizing SBMHS. A total of 19 parents (mean age = 45.4 years, SD = 4.5; 89.5% mothers) completed a survey and in-depth interview. All parents were born outside the USA and have been in the USA for an average of 16.8 years (SD = 11.1). Survey results showed that Asian immigrant parents had difficulty recognizing bulimia, and only 36.8% (n = 7) of them rated antidepressants to be helpful for depression. In-depth interviews with parents revealed four major types of barriers to seeking SBMHS for their adolescents, including knowledge, attitudinal, structural/practical, and relational barriers. Furthermore, cultural themes were embedded in parents’ perception, demonstrating the specific cultural influences on barriers related to SBMHS. Implications for engaging immigrant families in SBMHS are discussed.
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Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., et al. (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.
Adelman, H. S., & Taylor, L. (2012). Mental health in schools: Moving in new directions. Contemporary School Psychology, 16, 9–18.
Anyon, Y., Ong, S. L., & Whitaker, K. (2014). School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors, and service use. Asian American Journal of Psychology, 5(2), 134–144.
Atkins, M. C., Hoagwood, K. E., Kutash, K., & Seidman, E. (2010). Toward the integrations of education and mental health in schools. Administration & Policy in Mental Health & Mental Health Services Research, 37, 40–47.
Barlis, J. (2018). Mental health literacy, stigma, and attitudes toward help-seeking at school for Asian- and Latino-American adolescents. Unpublished thesis. University of Maryland, College Park.
Becker, K. D., Buckingham, S. L., & Brandt, N. E. (2015). Engaging youth and families in school mental health services. Child & Adolescent Psychiatric Clinics of North America, 24(2), 385–398.
Bonabi, H., Muller, M., Ajdacic-Gross, V., Eisele, J., Rodgers, S., Seifritz, E., et al. (2016). Mental health literacy, attitudes to help-seeking, and perceived need as predictors of mental health service use: A longitudinal study. The Journal of Nervous and Mental Disease, 204(4), 321–324.
Bowers, H., Manion, I., Papadopoulos, D., & Gauvreau, E. (2013). Stigma in school-based mental health: Perception of young people and service providers. Child and Adolescent Mental Health, 18(3), 165–170.
Braun, V., & Clark, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Breland-Noble, A., Burriss, A., Poole, H. K., & The AAKOMA PROJECT Adult Advisory Board. (2010). Engaging depressed African American adolescents in treatment: Lessons from the AAKOMA PROJECT. Journal of Clinical Psychology, 66, 868–879.
Campbell, J. L., Quincy, C., Osserman, J., & Pedersen, O. K. (2013). Coding in-depth semistructured interviews: Problems of unitization and intercoder reliability and agreement. Sociological Methods & Research, 42(3), 294–320.
Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., et al. (2002). Cultural and contextual influences in mental health help-seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed 1 Dec 2017.
Cheng, H., Wang, C., McDermott, R., Kriedel, M., & Rislin, J. (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling and Development, 96, 64–74.
Costello, E. J., Copeland, W., & Angold, A. (2011). Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? Journal of Child Psychology and Psychiatry, 52(10), 1015–1025.
Gryglewicz, K., Childs, K. K., & Soderstrom, M. F. P. (2018). An evaluation of youth mental health first aid training in school settings. School Mental Health, 10, 48–60.
Gudino, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by type? Journal of Emotional & Behavioral Disorders, 17(1), 3–16.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry. https://doi.org/10.1186/1471-244X-10-113.
Guo, S., Kataoka, S. H., Bear, L., & Lau, A. S. (2014). Differences in school-based referrals for mental health care: Understanding racial/ethnic disparities between Asian American and Latino youth. School Mental Health, 6(1), 27–39.
Guo, S., Nguyen, H., Weiss, B., Ngo, V. K., & Lau, A. S. (2015). Linkages between mental health need and help-seeking behavior among adolescents: Moderating role of ethnicity and cultural values. Journal of Counseling Psychology, 62(4), 682–693.
Hart, L. M. (2010). Mental health first aid for eating disorders: The development of first aid guidelines and interventions for the public. PhD thesis, Medicine, Dentistry & Health Sciences, Centre for Youth, Mental Health, The University of Melbourne.
Ho, J., Yeh, M., McCabe, K., & Hough, R. L. (2007). Parental cultural affiliation and youth mental health services. Journal of Youth and Adolescence, 36(4), 529–542.
Hook, J. N., Farrell, J. E., Davis, D. E., DeBlaere, C., Van Tongeren, D. R., & Utsey, S. O. (2016). Cultural humility and racial microaggressions in counseling. Journal of Counseling Psychology, 63(3), 269–277.
Jorm, A., Korten, A., Jacomb, P., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia, 166(4), 182–186.
Jorm, A. F., Morgan, A. J., & Wright, A. (2010). Actions that young people can take to prevent depression, anxiety and psychosis: Beliefs of health professionals and young people. Journal of Affective Disorders, 126, 278–281.
Jorm, A. F., & Wright, A. (2007). Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Australian and New Zealand Journal of Psychiatry, 41, 656–666.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
Kung, W. (2004). Cultural and practical barriers to seeking mental health treatment for Chinese Americans. Journal of Community Psychology, 32(1), 27–43.
Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.
Lee, A., & Khawaja, N. G. (2013). Multicultural training experiences as predictors of psychology students’ cultural competence. Australian Psychologist, 48, 209–216.
Leong, F. T., & Lau, A. S. (2001). Barriers to providing effective mental health services to Asian American. Mental Health Services Research, 3(4), 201–214.
Li, C., & Li, H. (2017). Chinese immigrant parent’s perspectives on psychological well-being, acculturative stress, and support: Implications for multicultural consultation. Journal of Educational & Psychological Consultation, 27(3), 245–270.
Lindsey, M. A., Chambers, K., Pohle, C., Beall, P., & Lucksted, A. (2013). Understanding the behavioral determinants of mental health service use by urban, under-resourced Black youth: Adolescent and caregiver perspectives. Journal of Child and Family Studies, 22(1), 107–121.
Lindsey, M. A., Korr, W. S., Broitman, M., Bone, L., Green, A., & Leaf, P. J. (2006). Help-seeking behaviors and depression among African American adolescent boys. Social Work, 51(1), 49–58.
Lindsey, M. A., & Marcell, A. V. (2012). “We’re going through a lot of struggles that people don’t even know about”: The need to understand African American males’ help-seeking for mental health on multiple levels. American Journal of Men’s Health, 6(5), 354–364.
Liu, P. P. (2015). Intergenerational cultural conflict, mental health, and educational outcomes among Asian and Latino/a Americans: Qualitative and meta-analytic review. Psychological Bulletin, 141(2), 404–446.
Logan, D. E., & King, A. C. (2002). Parental identification of depression and mental health service use among depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 296–304.
Lyon, A. R., Ludwig, K. A., Stoep, A. V., Gudmundsen, G., & McCauley, E. (2013). Patterns and predictors of mental healthcare utilization in schools and other service sectors among adolescents at risk for depression. School Mental Health, 5, 155–165.
McCabe, K., Yeh, M., & Hough, R. (1999). Racial/ethnic representation across five public sectors of care for youth. Journal of Emotional and Behavioral Disorders, 7, 72–82.
Mcluckie, A., Kutcher, S., Wei, Y., & Weaver, C. (2014). Sustained improvements in students’ mental health literacy with use of a mental health curriculum in Canadian schools. BMC Psychiatry, 14, 379–384.
Mendenhall, A. N., & Frauenholtz, S. (2015). Predictors of mental health literacy among parents of youth diagnosed with mood disorders. Child and Family Social Work, 20, 300–309.
Na, S., Ryder, A. G., & Kirmayer, L. G. (2016). Toward a culturally responsive model of mental health literacy: Facilitating help-seeking among East Asian immigrants to North America. American Journal of Community Psychology, 58(1–2), 211–225.
National Association of School Psychologists (NASP). (2010). National Association of School Psychologists model for comprehensive and integrated school psychological services. School Psychology Review, 39, 320–333.
Ohan, J., Seward, R., Stallman, H. M., Bayliss, D., & Sanders, M. R. (2015). Parents’ barriers to using school psychology services for their child’s mental health problems. School Mental Health, 7(4), 287–297.
Olsson, D. P., & Kennedy, M. G. (2010). Mental health literacy among young people in a small US town: Recognition of disorders and hypothetical helping responses. Early Intervention in Psychiatry, 4(4), 291–298.
Pew Research Center. (2013). The rise of Asian Americans. Retrieved from http://www.pewsocialtrends.org/2012/06/19/the-rise-of-asian-americans/. Accessed 1 Dec 2017.
Pinto-Foltz, M. D., Logsdon, M. C., & Myers, J. A. (2011). Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents. Social Science and Medicine, 72, 2011–2019.
Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Advances in Mental Health, 4, 218–251.
Rogers-Sirin, L., Melendez, F., Refano, C., & Zegarra, Y. (2015). Immigrant perception of therapists’ cultural competence: A qualitative investigation. Professional Psychology: Research & Practice, 46(4), 258–269.
Shin, R. Q., Smith, L. C., Welch, I., & Ezeofor, I. (2016). Is Allison more likely than Lakisha to get a call back from counseling professionals: A racism audit study. The Counseling Psychologist, 44(8), 1187–1211.
Teagle, S. E. (2002). Parental problem recognition and child mental health service use. Mental Health Services Research, 4(4), 257–266.
Vanderbleek, L. M. (2004). Engaging families in school-based mental health treatment. Journal of Mental Health Counseling, 26(3), 211–224.
Vitale, M., & Bailey, C. (2012). Assessing barriers to health care services for Hispanic residents in rural Georgia. Journal of Rural Social Sciences, 27(3), 17–45.
Vogel, D. L., Wade, N. G., & Ascheman, P. L. (2009). Measuring perceptions of stigmatization by others for seeking psychological help: Reliability and validity of a new stigma scale with college students. Journal of Counseling Psychology, 56, 301–308.
Walcott, C. M., Charvat, J., McNamara, K. M., & Hyson, D. M. (2016). School psychology at a glance: 2015 member survey results. Paper presented at National Association of School Psychologists convention, New Orleans, LA.
Wang, C., Cramer, K., Cheng, H., & Do, K. A. (2018). Factors predicting adolescents’ help-seeking behavior for mental health services at school and outside of school among a diverse sample of high school students. Manuscript submitted for publication.
Wang, C., Xia, Y. R., Li, W., Wilson, S., Bush, K., & Peterson, G. (2016). Parenting behaviors, adolescent depressive symptoms, and problem behavior: The role of self-esteem and school adjustment difficulties among Chinese adolescents. Journal of Family Issues, 37, 520–542. https://doi.org/10.1177/0192513X14542433.2015.
Weist, M. D., Evans, S. W., & Lever, N. A. (2003). Handbook of school mental health: Advancing practice and research. Issues in clinical child psychology. New York, NY: Kluwer.
Yap, M. B. H., Reavley, N., & Jorm, A. F. (2012). Young people’s beliefs about preventive strategies for mental disorders: Findings from two Australian national surveys of youth. Journal of Affective Disorders, 136(3), 940–947.
Yeh, M., Hough, R. L., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 605.
Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health Services Research, 5(2), 65–77.
Support for the project came from a grant from the American Psychological Association Promoting Psychological Research and Training on Health Disparities Issues at Ethnic Minority Serving Institutions (ProDIGS). The authors also want to thank Dr. Shawn Bediako and Dr. Alfiee Breland-Noble for being the mentors for this project.
This study was funded by American Psychological Association ProDIGS grant.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Wang, C., Do, K.A., Frese, K. et al. Asian Immigrant Parents’ Perception of Barriers Preventing Adolescents from Seeking School-Based Mental Health Services. School Mental Health 11, 364–377 (2019). https://doi.org/10.1007/s12310-018-9285-0