Demographic, Contextual, and Cultural Barriers to Mental Healthcare Seeking Behavior in the United States Among Southeast Asian Women Refugees: A Systematic Review Open Access
DiVitale, Sandra (Summer 2020)
Abstract
Little is known about Southeast Asian refugees’ American mental healthcare seeking behavior. Previous research has indicated that Southeast Asian refugees underutilize American mental healthcare services. However, the reasons for this underutilization are not fully understood. This systematic review examines the relationship between contextual, cultural, and demo graphic factors and their influence as barriers to accessing these services among Southeast Asian American refugees, especially women. An index search was conducted for peer-reviewed journals published from 1975 to 2019 using PubMed, EMBRACE, Web of Science, PsychInfo, and Anthropology Plus databases. This search was followed by manual handsearching and snowballing techniques to identify gray literature. Sixteen publications in total were included in the final analysis.
Results from the review suggest that Southeast Asian women refugees have more positive attitudes toward and willingness to use American mental healthcare than men. Women refugees’ experiences of greater pre-migration and resettlement psychological distress are accredited for their motivation in having a more favorable view of American mental healthcare services. Review studies challenge previous research findings that Southeast Asian refugee underutilize these services. Findings suggest instead that American standards for minimally adequate mental healthcare do not meet the needs of Southeast Asian refugees when they do present for care. Southeast Asian women refugees who experienced domestic violence indicated a preference for community, peer-based support groups that provide instrumental learning and psychoeducation instead of seeking outside mental healthcare. Cultural barriers are found to be less influential through time than structural/contextual barriers such as continued extreme poverty with limited access to transportation and health insurance. Recommendations include multi-level interven-tions that address decreasing barriers to accessing American mental healthcare at the individual/ family, community, and societal levels.
Table of Contents
List of Tables x
List of Figures x
Select of Abbreviations x
Chapter One: Introduction
Background 1
Problem Statement 2
Purpose Statement 2
Research Objectives 2
An Overview: Southeast Asian (SEA) Refugee Countries of Origin 3
SEA History of Migration to the U.S. 5
Overview 5
Vietnamese Refugees 5
Cambodian Refugees 6
Laotian Refugees 7
Current Migration Patterns within the U.S. 8
Understanding Migrant Status in Relation to Potential Mental Health Outcome 9
Overview 9
Refugee Status 9
Immigrant Status 10
Contribution to Different Mental Health Outcomes 10
Theoretical Framework: Social Identity Theory in Relation to Southeast Asian American Refugee (SEAA) Mental Healthcare Utilization 12
Significance Statement 14
Chapter Two: Review of the Literature
Definitions of Select Terms and Constructs 16
Prevalence and Social Determinants of SEAA Refugee Unaddressed Mental Health Issues 20
Overview 20
Gender Differences 22
Intergenerational Transmission of Unresolved 25
Conclusion 27
Current SEAA Refugee U.S. Mental Healthcare Usage Patterns 27
Overview 27
SEAA Mental Healthcare Utilization 29
Gender Differences 30
Minimally Adequate Care 31
Conclusion 34
Current Research on Overall Barriers to SEAA Mental Healthcare Seeking Behaviors 35
Overview 35
Barriers for Asian Americans (AAs) 36
2.1 Contextual Barriers 37
2.2 Cultural Barriers 39
2.3 Demographic Barriers 46
Summary Remarks on Barriers to Mental Healthcare Access for SEAA Refugees 49
Chapter Three: Methodology—Data Collection and Analysis
Overview 51
Literature Search Methodology 51
Data Extraction 57
Analysis Plan 58
Quantitative and Mixed-Methods Study Analysis 58
Qualitative Study Analysis 59
Chapter Four: Results
Overview: Study Selection 61
Systematic Review Study Characteristics 61
Analysis of Major Themes and Findings 64
Overview 64
4.1 Levels of Psychological Distress 65
4.2 Gender-Based Violence: Domestic Violence 68
4.3 American Mental Healthcare Seeking Behavior 70
4.4 Barriers to Accessing American Mental Healthcare Utilization 75
Summary Comments 83
Chapter Five: Discussion
Overview 86
Discussion of Review Studies’ Key Findings 86
5.1 Objective One: Gender, Ethnicity, and Cultural Influences on Help-Seeking 86
Summary Comments on Research Objective One 92
5.2 Objective Two: Barriers to SEAA Refugee Women Mental Health Help-Seeking 94
Summary Comments on Research Objective Two 96
5.3 Objective Three: Barrier Predictor Variables across SEAA Ethnic Groups 98
Summary Comments for Research Objective Three 100
5.4 Objective Four: Rethinking Acculturation as a Cultural Barrier 101
Summary Comments for Research Objective Four 103
Strengths and Limitations of Review Studies 105
Strengths 105
Limitations 105
5.5 Objective Five: Current Interventions Intended to Increase Engagement in
Mental Healthcare Services 108
5.6 Objective Six: Recommendations for Intervention Approaches 110
Implications for U.S. Public Health 113
Suggested Future Research 115
Conclusions 118
References 121
Appendices 141
Appendix A: National Demographics: SEAA by County (2010) 142
Appendix B: General Characteristics of Systematic Review Selected Studies 143
Appendix C: Methodological Characteristics of Systematic Review 149
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