The Role of Culture in Help-Seeking During Adolescence
- Author(s): Guo, Sisi
- Advisor(s): Chung, Anna S
- et al.
The notable disparity between need for and use of mental health services among youth, particularly ethnic minority adolescents, has prompted research on the barriers and facilitators to help-seeking. Although a number of practical, institutional and family factors have been shown to influence treatment utilization, there is a dearth of research on adolescent attitudes and behaviors toward help-seeking. Given that adolescence is a period marked by increasing autonomy and rising mental health needs – many of which go undetected by adult caregivers – youth perspectives are particularly important to consider in order to reduce disparities in mental health care. This dissertation used data from a large prospective study to examine predictors of support seeking behavior and intervention preferences in two ethnocultural groups (i.e., Vietnamese Americans and European Americans). Specifically, we examined how traditional indicators (i.e., race/ethnicity and perceived mental health need) interacted with adolescents’ larger social and cultural environment (e.g., cultural values, social supports) to shape attitudes and behaviors related to help-seeking. Study 1 sought to identify factors that influenced the recruitment of formal and informal support for mental health need. Findings showed that the positive link between mental health need and formal help-seeking was attenuated among Vietnamese Americans relative to European Americans, and among youth who endorse high family obligation values. Study 2 built upon Study 1 by assessing youth evaluations of help-seeking experiences once support had been obtained. Adolescents rated multiple sources of support as helpful in addressing their emotional difficulties, though satisfaction with received adult support was significantly lower than peer support for Vietnamese Americans. We also found that adolescents’ helpfulness ratings varied depending on their cultural values and perceived social support from friends and family. While Study 2 explored youth attitudes toward support from formal and informal supports, Study 3 concentrated on adolescent preferences toward specific evidence-based interventions. Specifically, we examined factors that influenced preferences toward one of two preventive interventions for depression among a sample of adolescents with elevated internalizing symptoms. Findings showed that treatment preference was aligned with youth indicated risk factors and the cultural value of emotional restraint; adolescents who engaged in more avoidant coping and who valued the downregulation of emotional expression preferred a mindfulness-based intervention that teaches healthy engagement with thoughts and emotions. Conversely, adolescents who reported more family stressors preferred an intervention that targets interpersonal stress through the cultivation of communication and relationship skills. Taken together, the three studies in this dissertation underscored the importance of taking youth perspectives into consideration when examining barriers and facilitators in the help-seeking pathway. Adolescent help-seeking and treatment preferences were related to their cultural norms and values, source and availability of social support, and risk profiles. To effectively engage youths in needed treatment, greater attention must be paid to how sociocultural factors interact with more traditional indicators such as race/ethnicity and perceived mental health need.