Stigma vs. Support: Factors that Affect Mental Health Treatment-Seeking Behaviors in Middle-Aged Immigrant South Asian American Women Open Access

Shemontee, Mirza (Spring 2022)

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Introduction: South Asian Americans are a growing demographic, rising from 3.5 million in 2010 to 5.7 million in 2019. Although often viewed as part of the “model minority,” this community experiences significant unique stressors, such as acculturative stress, that indicate the possibility of high rates of mental distress. However, data on the prevalence of mental health disorders in this population is outdated and often only available as disaggregated data for all Asian Americans. Studies on the South Asian diaspora in other countries suggest that middle aged women, in particular, are especially at risk for mental health distress. Yet, mental health service use among South Asian American middle aged women is extremely low. Currently, there are limited studies exploring this specific demographic and their attitudes towards mental health. This qualitative study seeks to close this gap by examining the factors that influence mental health treatment-seeking behaviors among immigrant South Asian American women between the ages of 45 and 65.


Methods: This study used thematic analysis of semi-structured interviews to yield findings about mental health treatment-seeking behaviors. South Asian American women between the ages of 45 and 65 were recruited to participate in hour-long in-depth interviews discussing their experiences and opinions to better understand their viewpoint of mental health. These interviews were then analyzed via MAXQDA software to find commonalities in participants’ mental health experiences. Feminist theory was used as a major philosophical foundation of analysis to generate themes. These themes were then used to modify the Theory of Planned Behavior to apply to mental health treatment-seeking behaviors in South Asian American women.


Results: A total of fifteen interviews were conducted with South Asian American women ranged in age from 45 to 65 years of age, with the average age of participants being 57 years old. Participants immigrated to America between the years of 1974 and 2006, from eleven different South Asian cities. Four main themes emerged: mental health understanding, positive support systems, negative influence of cultural values, and structural barriers. These themes all contribute to institutional and attitudinal barriers that may be related to low mental health service use. Modification of the Theory of Planned Behavior shows that subjective norms are a powerful predictor of mental health treatment-seeking behavior within this general population.

Conclusions: Interventions that emphasize positive social support to counteract negative cultural influence, as well as interventions to reduce structural barriers, would both be particularly effective to increase mental health treatment-seeking behavior. Future directions for research should include examining the effect of migration year on acculturative stress experiences, as well as gathering more accurate prevalence data for this demographic.

Table of Contents

Chapter I: Introduction and Statement of the Problem and Purpose                                                                                                1

Chapter II: Review of the Literature                                               5

South Asian American Immigrants                                                5

Asian American Mental Health                                                      7

Acculturative Stress                                                                        9

Prevalence of Stigma                                                                    10

Theoretical Framework - Feminist Theory                                  11

Theoretical Framework - Theory of Planned Behavior                12

Figure 1: The Theory of Planned Behavior Conceptual Model                                                                                                13

Chapter III: Methodology                                                               15

Introduction                                                                                  15

Population and Sample                                                                 15

Recruitment and Eligibility                                                          16

Procedures and Privacy Measures                                                17

Data Analysis Methodology                                                         18

Chapter IV: Results                                                                          20

Theme 1: Mental Health Understanding                                      20

Experiences with Mental Health                                            21

Knowledge Acquisition                                                          25

Theme 2: Positive Support Systems                                             27

Individual Mental Health Management                                  28

Seeking Professional Treatment                                             30

Theme 3: The Negative Influence of Cultural Values                 31

Stigma Against Mental Health                                               32

Treatment of Women                                                              34

Stigma Against Divorce                                                         35

Image-Consciousness                                                             36

Theme 4: Structural Barriers                                                        37

Financial Barriers                                                                   37

Logistical Barriers                                                                  38

Chapter V: Conclusions, Implications and Recommendations   41

Figure 2: TPB Conceptual Model Modified for South Asian American Women’s Mental Health                                        41

Discussion of Key Results                                                            41

Recommendations                                                                        47

Create Interventions Using Support Systems                         47

Recruit Volunteers to Act as Mental Health Treatment Guides                                                                                                48

Increase Telehealth Service Options                                      48

Research Cultural Freezing                                                    49

Examine Effect of Migration Year on Acculturative Stress Experiences                                                                             49

Update Prevalence Data                                                         49

Repeat Study with More Representative Sample                   50

Strength and Limitations                                                              50

Conclusion                                                                                    52

References                                                                                         53

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