The Interplay of Cultural and Structural Barriers in Mental Health Service Utilization Among Chinese American Young Adults

Asian Americans have consistently underutilized mental health services despite documented mental health needs, and this pattern is also evident among Chinese American young adults (Abe-Kim et al., 2007; Kung, 2003; Yang et al., 2020). Prior research has often explained this underutilization through either cultural barrier, such as stigma, family reputation, loss of face, emotional restraint, and preferences for private coping, or structural barriers, such as cost, insurance, appointment availability, and provider accessibility. However, this separation may obscure how help-seeking decisions are made. Guided by the Theory of Planned Behavior, the Socio-Cultural Framework for Health Service Disparities, and the Culturally Infused Engagement model, this dissertation conceptualizes mental health service use as a culturally embedded and structurally constrained process shaped by attitudes, perceived control, family and community meanings, and broader conditions of access, trust, and racial equity (Alegría et al., 2011; Fishbein & Ajzen, 2011; Yasui et al., 2017).

This three-paper dissertation examines how cultural and structural barriers shape attitudes regarding mental health services and decision-making among Chinese American young adults. Data were drawn from a survey of mental health beliefs and help-seeking behaviors among Asian American young adults conducted between 2022 and 2023. Study 1 developed and validated the Perceived Structural Barriers to Mental Health Services Scale, a multidimensional measure of logistical and racial barriers to mental health service use. Study 2 used this measure to examine whether cultural barriers and perceived structural barriers were independently and interactively associated with attitudes toward seeking professional psychological help. Study 3 extended the dissertation through an experimental vignette design that examined how cultural, logistical, and racial barriers affected the likelihood of using mental health services in response to depressive symptoms.

Across the three studies, the findings show that mental health service underutilization among Chinese American young adults cannot be explained by cultural stigma or individual reluctance alone. Study 1 demonstrated that perceived structural barriers include not only practical access constraints, but also racial distrust, fear of racial discrimination, and concerns about unequal treatment. Study 2 showed that denying distress, silencing distress, and racial distrust were especially important predictors of less favorable help-seeking attitudes, and that cultural and structural barriers interacted. Study 3 showed that cultural, logistical, and racial barriers each reduced the likelihood of using mental health services, with logistical barriers having the largest effect in a decision-making context. Together, these findings suggest that cultural and structural barriers operate independently, conditionally, and cumulatively. Improving mental health service use among Chinese American young adults therefore requires more than encouraging individual help-seeking. It requires services that are affordable, accessible, culturally responsive, trustworthy, and racially equitable.