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Asian American students' cultural values, stigma, and relational self-construal: correlates of attitudes toward professional help seeking.

In this study, we investigated how adherence to Asian values, stigma of receiving psychological help, relational-interdependent self-construal, age and gender, for Asian American college and graduate students, singly and in concert predicted attitudes toward seeking professional psychological help. We also examined how stigma mediates the effect of adherence to Asian values on help-seeking attitudes. Correlational and multiple regression analyses determined that lower adherence to Asian values, lower levels of stigma, a higher relational-interdependent self-construal were associated with more positive help-seeking attitudes. Also, female and older students possessed more positive help-seeking attitudes. The mediational model was not significant. We discuss potential barriers to seeking professional help across sociocultural levels. We address implications for research and practice in mental health counseling.

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Asian Americans currently constitute approximately 5% of the United States population (13.5 million) and by 2050 this group is projected to make up 10% of the U.S. population (U.S. Bureau of the Census, 2004). Asian international and Asian American students comprise a dramatically growing number of students enrolled in U.S. colleges and universities (U.S. Department of Education, 2004). Asian American students experience many stressors such as intergenerational conflict, negotiating cultural identities, career development, immigration status, and racism related stress. Yet, research findings concerning Asian Americans' attitudes toward the utilization of psychological services have been inconsistent and lacking in relational variables.

Past research has consistently reported that Asian Americans tend to underutilize formal mental health services, prematurely terminate from psychotherapy, and endorse less favorable help-seeking attitudes compared with European Americans (Atkinson, Lowe, & Matthews, 1995; Leong, 1994; Matsuoka, Breaus, & Ryujin, 1997; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). This pattern was found in student (both local and international) as well as adult populations, inpatient and outpatient settings across the United States (Loo, Tong, & True, 1989; Narikiyo & Kameoka, 1992; Snowden & Cheung, 1990). In spite of the "model minority" myth, suggesting that Asian Americans have been successful, function well in society, and have few cultural adjustment difficulties (Sue & Sue, 2003), researchers have identified mental health concerns, adjustment difficulties and a need for mental health services in groups of Asian Americans including local and international students (Leong, Wagner, & Tata, 1995; Yeh & Inose, 2003; Yeh, 2002). The lower rate of help seeking among Asian Americans may stem from a combination of institutional and sociocultural barriers.

Barriers on the institutional level may include a lack of culturally competent personnel, contradictions between values held by the Asian clients and the Western model of counseling (e.g., ethnocentric model of counseling; Sue & Sue, 2003) and lack of culturally responsive services. Barriers on the cultural and social level for Asian internationals and Asian Americans may include historical and cultural influences on coping with personal problems, linguistic issues, limited knowledge about available services, and a high level of social stigma attached to seeking psychological treatment for mental health issues in the Asian community (e.g., Komiya, Good, & Sherrod, 2000; Tsang, Tam, Chan,& Cheung, 2003; Uba, 1994). In this study, we seek to revisit the pattern of underutilization and help-seeking attitudes among Asian American students through examining the specific factors embedded in their sociocultural context.

Asian cultural values are prominent factors in shaping attitudes toward seeking professional psychological help (Kim & Omizo, 2003). Asian cultures emphasize family hierarchy, emotional restraint, avoidance of shame and saving "face" (Flaskerud & Liu, 1990; Uba, 1994; Zane & Yeh, 2002), which may contradict Western norms in counseling such as self-disclosure and emotional expressiveness (Sue & Sue, 2003). Traditionally, Asian Americans are expected to deal with problems by themselves or take them to the family; if this strategy fails, they might turn to churches, physicians, elders, or clan and other ethnic organizations (Inman & Yeh, 2006). Extrafamilial intervention such as seeking professional psychological help is often considered shameful and a violation of the family hierarchy (Sue, 1994) and may bring disgrace to the family (Root, 1985), as seeking outside help may indicate inadequacy on the part of family members, and cause them to lose "face" (Zane & Yeh, 2002).

However, research has suggested that attitudes toward seeking professional help may vary as a function of within-group differences, such as acculturation level. Acculturation refers to the process of adaptation to the behaviors, values, knowledge and identity of the dominant society (Kim & Abreu, 2001). Past studies have found that higher levels of assimilation (i.e., more Americanized) among Asian American students predicted more positive attitudes toward seeking professional psychological help (Atkinson & Gim 1989; Tata & Leong; 1994). And, the most assimilated students are the most likely to recognize personal need for professional psychological help, most tolerant of the stigma associated with psychological help, and most open to discussing their problems with a psychologist (Atkinson & Gim, 1989).

Recent research on Asian values as a correlate of help-seeking attitudes underscores the limitations of using acculturation as a variable (Kim & Abreu, 2001). The commonly used acculturation scale, the Suinn-Lew Asian Self-Identity Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, & Vigil, 1987), is a uni-linear acculturation measure focusing on behavior items (e.g. language preference, identity, friendship choice, behaviors) and does not tap into value-based items. However, changes in cultural behaviors are not synonymous with changes in cultural values (Kim, Atkinson, & Yang, 1999). Individuals who are highly acculturated to the mainstream cultural behaviors in the United States. (e.g. eating American food, speaking fluent English, making friends with Americans) may still endorse a high level of adherence to their indigenous culture. For instance, they may still observe the traditional Asian values such as collectivism, emotional restraint, and social harmony. This process of retaining or socializing to the cultural values, ideas, concepts, knowledge, behaviors and norms of one's indigenous culture is known as enculturation (Berry, Poortinga, Segall, & Dasen, 1992; Kim, Atkinson, & Umemoto, 2001). Multicultural researchers argued that enculturation is an important index of the within group difference among Asian Americans, which may influence their help seeking (Kim & Abreu, 2001; Kim, Atkinson, & Umemoto, 2001). Kim and Omizo (2003) found that Asian American students who have high adherence to Asian cultural values tend to have negative attitudes toward seeking professional psychological help and exhibit lower levels of willingness to see a counselor. The current study attempts to replicate previous studies and investigate how this relatively new cultural values index may predict Asian American students' help-seeking attitudes.

Culture also shapes one's orientation toward constructing the world and making meaning of it, which orchestrates the interpretations of social processes and interpersonal interactions. Stigma has been defined as a flaw resulting from a personal or physical characteristic that is viewed as socially unacceptable (Blaine, 2000); stigma associated with the process of seeking mental health intervention is the negative perception that an individual who receives psychological help is socially undesirable (Vogel, Wade, & Hackler, 2006). Past studies have suggested that Asians tend to attach stigma to mental illness or emotional problems as well as to receiving professional help for these issues, in part due to traditional cultural beliefs about the etiology of mental health problems and feelings of shame (Komiya, Good, & Sherrod, 2000; Ng, 1997). Hence, stigma has been found to predict negative help-seeking attitudes and act as a pervasive barrier to effective mental health intervention within the Asian community (Komiya, Good, & Sherrod, 2000; Tsang et al., 2003). Asian cultural values may influence perceived stigma associated with receiving psychological help, which, in turn, may influence attitudes toward seeking professional psychological help. We are not only interested in examining how stigma per se may predict help-seeking attitudes, but also how stigma may mediate the effect of adherence to Asian values on help-seeking attitudes.

Another salient aspect of Asian culture is the emphasis on collectivism and interdependence. In collectivist Asian cultures, the extended family is prioritized along with values of security, obedience, duty, in-group harmony, and personalized relationships (Ivey, Ivey., & Simek-Morgan, 1997; Tata & Leong, 1994; Zhang, 1994). Individuals in collectivist societies tend to define self in relation to others within social contexts, attend to others' reactions and manage their own feelings and experiences accordingly. Likewise, they assume this process will be reciprocated by close others in their lives (Markus & Kitayama, 1991). Singelis (1994) reported that Asian Americans generally have more interdependent self-construals than European Americans and that European Americans have more independent self-construals than Asian Americans.

Interdependent and independent conceptualizations of self may influence help-seeking attitudes. Researchers have found that being more individualistic was associated with negative attitudes toward seeking professional help (Tata & Leong; 1994), whereas an interdependent self-construal predicted more positive attitude toward help seeking (Yeh, 2002). Yeh suggested that the positive help-seeking attitude may be consonant with what is required in seeking counseling in Western society such as openness to others. However, this research was conducted with a sample of students in Taiwan, and may only reflect the social practices of students living there.

On the other hand, individuals high in interdependence may tend to avoid the intense experience of emotions, especially negative emotions, due to a potential threat to the harmony of a social situation (Markus & Kitayama, 1991). They are more likely to take into account the needs and wishes of close others when making decisions (Cross, Bacon, & Morris, 2000). Because the counseling process may involve exposure to intense emotional experiences and displays of negative feelings, interdependent Asian Americans may decide against seeking professional psychological help due to their concerns for close others and social harmony. Such relational considerations are critical to examine in the context of help-seeking practices (Yeh & Wang, 2000).

Because the current sample is living in the United States and is largely comprised of international students and first-generation immigrant students, we believe that in-groups (e.g., ethnic group loyalties) may be less important than individual relationships (e.g., parents, spouse, best friends) to include in the self-construal. Thus, we use the Relational-Interdependent Self-Construal (RISC) developed by Cross, Bacon, and Morris (2000) to assess how the self is defined in terms of close individual relationships. As cultural values and norms help define and govern social processes and interpersonal interactions, we believe that the effect of adherence to Asian values will be the strongest predictor for help-seeking attitudes when simultaneously examined with other social and interpersonal factors.

Additionally, we have included two demographic variables: gender and age. Gender has been consistently found to be correlated with Asian American students' attitudes toward seeking professional psychological help whereas age has not. Studies on Asian men and women found that female students, regardless of ethnicity and cultural differences, reported a more positive attitude toward seeking professional psychological help than their male counterparts (Gloria, Hird, & Navarro, 2001; Leong & Zachar, 1999; Tata & Leong, 1994; Tracey, Leong, & Glidden, 1986). Yeh (2002) found that age had no predictive effect on help-seeking attitudes across junior high, senior high, and college-age Taiwanese students in Taiwan. Hence, we seek to examine the effect of these demographic factors using a local sample of Asian American college and graduate students to further our understanding of their help-seeking attitudes. Given the limited findings on the relations among interdependent self-construal, age and help-seeking attitudes, we seek to examine how relational-interdependent self-construal correlates with attitudes toward seeking professional psychological help. As well, we seek to examine how age correlates with attitudes toward seeking professional psychological help.

Several studies have investigated Asian American attitudes toward mental health use. However, this study is unique in that it examines cultural, social and self/interpersonal factors as they relate to help seeking attitudes. In addition, the RISC is a relatively new scale and has not been used in the help-seeking literature. Because previous research has revealed inconsistencies in the relations between independent and interdependent self-construal and help-seeking, the RISC will provide more clarity about the role of culture and self in help-seeking attitudes. Our exploration of the mediating role of stigma in the relation between Asian cultural values and attitudes towards professional help seeking is among the first efforts to test this supposed relation experimentally.

Specifically, our hypotheses include: (1) There will be an inverse relationship between adherence to Asian cultural values and attitudes toward seeking professional psychological help; (2) there will be an inverse relationship between stigma for receiving psychological help and attitudes toward seeking professional psychological help; (3) female students will have a more positive attitude toward seeking professional psychological help than male students; (4) adherence to Asian values will predict attitudes toward seeking professional psychological help above and beyond the effects of age, gender, stigma and self-construal; (5) the effect of adherence to Asian values on help-seeking attitudes will be mediated by stigma.

METHOD

Participants

The sample consisted of 219 Asian American undergraduate and graduate students (76 males and 143 females) at a private institution in the Northeast. The mean age of the sample was 24.56 years (SD = 4.09), with participants ranging in age from 18 to 35 years. The ethnicity distribution was as follows: 45.7% (n = 100) were Chinese, 24.7% (n = 54) were Korean, 8.7% (n = 19) were Japanese, 7.3% (n = 16) were Taiwanese, 4.6 % (n = 10) were Indian, 1.8% (n = 4) were Vietnamese, 1% (n = 9) were Filipino, 3.2% (n = 7) were of other ethnicity, and 3.2% (n = 7) did not report their ethnicity. The majority of participants (69.4%, n = 153) were born outside of the United States, 27.4% (n = 60) were second generation Asian Americans, 0.5% (n = 1) were third generation, 1.4% (n = 3) were fourth generation, 1% (n = 2) did not indicate their status. The average length of residence of the participants in the United States. was 11.26 years, with a range from less than 6 months to more than 30 years. In terms of social class, 21% (n = 46) identified as coming from a working class background, 42.9% (n = 94) were from middle class, 27.4% (n = 60) were from upper-middle class, 2.7% (n = 6) were from upper class and 5.9% (n = 13) did not indicate their socioeconomic status.

Instruments

Demographic information. Participants provided information regarding their gender, age, race, ethnicity, generational status, years in the United States, education, field of study, religious affiliation, socioeconomic status, history of mental health care, and the format of counseling services they prefer.

Asian Value Scale (AVS). This scale developed by Kim et al. (1999) was used to measure participants' adherence to Asian cultural values. It is a 36-item scale with 18 positively stated and 18 negatively stated items reflecting various dimensions of Asian cultural values, and uses a 7-point Likert-type scale (1 = strongly disagree, 7 = strongly agree). Negatively stated items are reverse scored and items are summed then averaged to obtain a scale score; high scale scores indicate stronger adherence to Asian cultural values. The scale consists of six factors: Conformity to Norms, Family Recognition Through Achievement, Emotional Self-Control, Collectivism, Humility, and Filial Piety. However, Kim et al. recommended that only the AVS total score be used, as the reliability of the six subscales was too low to justify using them singly. Kim et al. (1999) reported internal consistency (coefficient alphas) of .81 and .82, based on two separate samples of Asian students, and a 2-week test-retest reliability of .83. The data from the present study yielded an alpha coefficient of .84.

Stigma Scale for Receiving Psychological Help (SSRPH). This scale designed by Komiya et al. (2000) measures participants' perceptions of how stigmatizing it is to receive psychological treatment. The SSRPH is a single-factor, uni-dimensional scale consisting of five questions, using a 4-point Likert-type scale (0 = strongly disagree, 3 = strongly agree). A high score indicates greater perception of stigma. Komiya et al. (2000) reported an internal consistency of .72. A previous study with Asian American college and graduate students using SSRPH yielded an alpha coefficient of .80 (Chang & Chang, 2004). The data from the present study yielded an alpha coefficient of .67.

The Relational-Interdependent Self-Construal (RISC) scale (Cross et al., 2000) assesses participants' relational-interdependent self-construal. It consists of 9 positively stated items and 2 negatively stated items using a 7-point likert-type scale (1 = strongly disagree, 7 = strongly agree). Negatively stated items are reverse scored and items are summed then averaged to obtain an average score. A higher score on this instrument indicates a tendency to view important relationships as closer and more committed, and to take others' needs and wishes into account when making decisions (Cross et al., 2000). Cross et al. reported a test-retest reliability ranging from .63 to .73 over a 2-month period and internal consistency coefficients ranging from .84 to .94. Previous research with Asian immigrant students yielded an alpha coefficient of .84 (Ma & Yeh, 2005). The alpha coefficient of the present study is .88.

Attitudes toward Seeking Professional Psychological Help-Short form (ATSPPH-S; Fischer & Farina, 1995). This scale is based on the original 29-item version developed by Fischer and Turner (1970). It consists of 10 items assessing attitudes toward seeking professional help for psychological problems and uses a 4-point Likert-type scale (0 = disagree, 3 = agree). Higher scores reflect a more positive attitude toward seeking professional psychological help. The ATSPPH-S showed a coefficient alpha of .84 and a test-retest reliability of .80 over a 4-week interval. Previous research with a predominantly Asian American student sample yielded an alpha coefficient of .80 (Vogel, Wade, & Hackler, 2007). The data from the present study yielded an alpha coefficient of .77.

Power Analysis

For the current investigation, a medium effect was desired at an alpha level of .05 with a selected level of power at .95. The G*Power 2 (Erdfelder, Faul, & Buchner, 1996) program determined that 124 participants would be required to identify a medium effect using multiple regression analyses.

Procedure

Participants were recruited from academic classes, Asian American student organizations, and ethnic and religious organizations on a large, urban, university campus. This study was reviewed and approved by the IRB at Columbia University. During survey administration, we explained the purpose of the study to participants and asked them to complete a packet of questionnaires containing a consent form and the instruments. Participation was voluntary and participants were not provided any monetary compensation. We informed participants that they could discontinue participation at any time and could refuse to answer any of the questions. The order of the surveys varied to account for potential ordering effects.

RESULTS

Research analyses followed procedures established in the help-seeking literature (i.e., Tata & Leong, 1994) and for mediation analyses (Barron & Kenny, 1986; Frazier, Tix, & Barron, 2004). Pearson correlation coefficients were assessed to determine potential multicolinearity in the analysis. Following the correlation analyses, regression analyses were performed to asses the explanatory effects of the five variables and mediational correlations were conducted to determine the strength of the relation among the independent (adherence to Asian values), mediator (stigma), and dependent (attitudes toward seeking professional psychological help) variables.

Findings (see Table 1) indicated significant correlations between ATSPPH-S scores and AVS scores (r = -0.24, p < .01), SSRPH scores (r = -0.22, p < .01) and gender (r = 0.21, p < .01). Adherence to Asian values and stigma for receiving psychological help were significantly inversely related to attitudes toward seeking professional psychological help, whereas being female was associated with more positive help-seeking attitudes. A correlation between ATSPPH-S scores and relational-interdependent self-construal (r = 0.16, p < .05), and between ATSPPH-S scores and age (r = 0.19, p < .01), was also found. The independent variables of relational interdependent self-construal and age positively and significantly correlate with the dependent variable of attitudes toward seeking professional psychological help.

Multiple regression analyses were performed to assess the effects of gender, age, adherence to Asian values, relational-interdependent self-construal and stigma on attitudes toward seeking professional psychological help. The results indicated that the overall regression model was significant F(5, 213) = 7.53, p < .001 (see Table 2). Adherence to Asian values was most significantly related to attitudes toward seeking professional psychological help ([beta] = 0.19,p < .01) as compared with gender, age, stigma and relational-interdependent self-construal.

To assess the mediation hypothesis, a multiple regression was performed on attitudes toward seeking professional psychological help with adherence to Asian values as the independent variable, stigma as the mediating variable, and gender and age as covariates; F(4, 214) = 7.51, p < 0.001; [R.sup.2] = .11 (see Table 3). The results showed that after controlling for age and gender, the negative direct effect of adherence to Asian values on attitudes toward seeking professional psychological help was reduced when stigma was entered into the regression equation ([beta] = 0.19 versus [beta] = -0.15). The significance of the mediated effect was tested utilizing standard procedures for testing mediation effects (Barron & Kenny, 1986; Frazier, Tix, & Barron, 2004). The significance test yielded a z score of -l.76, which was not significant at the p < .05 level. Thus, stigma does not serve as a statistically significant mediator between adherence to Asian values and attitudes toward seeking professional psychological help.

DISCUSSION

Our primary objective in this study was to understand demographic, socio-cultural, and relational factors influencing Asian American students' attitudes toward seeking professional psychological help. Results showed an inverse relation between adherence to Asian values and attitudes toward seeking professional psychological help, above and beyond the effects of stigma, gender, age, and relational interdependent self-construal, which supported our hypotheses and yielded a consistent trend with previous study using the same enculturation index (Kim & Omizo, 2003). Asian American students may find seeking professional psychological help contradictory to their belief system due to significant differences between the Asian and Western perspectives of self, general human experiences, and conceptions of psychological problems. The historical, cultural and Eastern philosophical influences (e.g., Confucianism, Collectivism, Buddhism, Taoism) may encourage Asian American students to withhold their strong emotions and exercise restraints to avoid embarrassment and shame in public; conform to family and social norms by not focusing on personal issues to preserve social harmony; or, to accept and endure problems (Yeh, 2000).

Consistent with previous studies, we also found that Asian American students with a higher level of perceived stigma for receiving psychological help tended to harbor negative help-seeking attitudes. The stigma may stem from the discrepancy between the Western notion of counseling and traditional Asian values in dealing with psychological problems. Asians may perceive receiving professional help as a sign of weakness (Narikiyo & Kameoka, 1992), personal immaturity (Uba, 1994), or even an indicator of hereditary flaws that shame the family (Flaskerud & Liu, 1990; Yeh, 2000). Furthermore, the process of discussing psychological problems with a mental health professional may suggest inadequacies in family support, thus bringing disgrace to the family (Zane & Yeh, 2002). The high level of stigmatization of mental health problems may discourage Asian American students from seeking professional psychological help despite the availability of services on campus. The stigma may also reinforce their tendency to define mental health problems in physical terms and utilize services provided by physicians instead of psychologists, as the former form of service is more socially and culturally acceptable (Tsai, Butcher, Munoz, & Vitousek, 2001).

We hypothesized that Asian cultural values would lead to a negative internalization of stigma to receive psychological help, which, in turn, would lead to negative help-seeking attitudes. However, the proposed mediation model in the present study was not statistically significant and did not support this idea. This finding contradicts previously held assumptions of the role of stigma in Asian American help seeking patterns of use. Our contradictory findings underscore the possibility that other factors may contribute to negative attitudes towards seeking out mental health services. Specifically, our measure of Asian values included measures of Conformity to Norms, Family Recognition Through Achievement, Emotional Self-Control, Collectivism, Humility, and Filial Piety. These Asian values may contribute to negative help seeking attitudes but not through stigma.

Our results add to the help-seeking literature by providing empirical evidence that Asian American students with a higher relational-interdependent self-construal have a more positive attitude toward seeking professional help. High relational individuals tend to have more positive cognitive associations for relationships (Greenwald & Banaji, 1995) and are more likely to take an open and accepting stance toward establishing new relationship with others (Cross, Morris, & Gore, 2002), including those with the helping professionals. Furthermore, Asian American students with a relational-interdependent self-construal may be more likely to experience reverence for authority or value someone with wisdom information and develop a positive affinity toward counselors who they see as knowledgeable experts.

This study also supports previous findings that Asian female students tend to have more positive attitudes toward seeking professional help (Gloria, Hird, & Navarro, 2001; Leong & Zachar, 1999; Tata & Leong, 1994; Tracey, Leong, & Glidden, 1986; Yeh, 2002). This finding may be due to expectations and processes surrounding counseling (e.g., disclosure of emotions) that are more culturally congruent for Asian females; whereas Asian males, on the other hand, are expected to be emotionally restricted, logical, and counter-dependent under the cultural and social influences (Chang, Yeh, & Krumboltz, 2001). Asian men learn at young age to not display emotions in front of others and to be responsible for maintaining the family name and reputation. Hence, seeking counseling may reflect poorly upon Asian American males as well as on their families (Sue, 1994), and they are less willing to express emotional upset overtly as compared to European American males (Chia, Moore, Lam, & Chuang, 1994). This gender-role socialization while culturally mandated, may hinder the development of positive help-seeking attitudes and inhibit the actual help-seeking behavior (Komiya et al., 2000).

In contrast to the results found in the Vogel et al. study (2007), we did not find gender differences in the perception of stigma. This inconsistency may be related to the different populations being examined, as the participants in the Vogel et al. study were primarily European American and the participants in our study were exclusively Asian American. The interaction of culture, gender, stigma, and help seeking is a complex one. Future research should focus on the role of gender on stigma and help seeking especially within the context of cultural values.

In addition, our study sheds light on previously inconsistent findings related to age and help-seeking attitudes, in that older students have more positive help-seeking attitudes. It is possible that older students have more knowledge about available mental health resources, they may be more likely to seek information about problems, and they may have developed coping strategies that include seeking professional psychological help (Kliewer, Lepore, Broquet, & Zuba, 1990).

Implications for Practice

We wish to highlight several relevant implications for mental health counseling with Asian American students. First, we found that adherence to Asian values may be a deterrent to having more positive help-seeking attitudes. Specifically, talking with a stranger and sharing personal information outside of the family boundaries is contradictory to Asian values which highlight family privacy and keeping feelings to oneself (Uba, 1994; Yeh, 2000). Hence, mental health counselors need to be trained and equipped with multicultural knowledge and competencies, which would help to identify, acknowledge and appreciate Asian coping strategies that involve family and close social networks (Yeh & Wang, 2000).

Because many Asian American college students associate stigma with seeking professional help, mental health counselors may need to broaden outreach services to include culturally congruent forms of healing. Specifically, outreach efforts to Asian American communities may include collaborations with ethnic churches, ethnic organizations, and primary health care services; such sites could also act as referral sources for mental health care. For example, a previous study seeking to modify college students' opinions about psychotherapy reported more positive help-seeking attitudes after the intervention (Gonzalez, Tinsley, & Kreuder, 2002). Problems may be viewed less shamefully when individuals are provided with explanations for their symptoms and a possible course of treatment. Workshops and psycho-educational groups on campus may be avenues to share information in this regard. Groups could focus on barriers (e.g., language, cultural norms/beliefs) commonly faced by Asian American and Asian international students. This strategy may help familiarize Asian American students with mental health concepts and inform them about options in counseling or psychotherapy.

Our results also indicate that Asian males in general have more negative attitudes than Asian females toward seeking professional help. Mental health counselors may need to develop creative alternatives for engaging Asian American males in therapy. For example, previous research has found that online support groups are an effective means of engaging Asian American men in discussions about their race and ethnicity (Chang et al., 2001). This group relied on the use of anonymity in reducing stigma associated with emotional expression and provided a forum where Asian American males could discuss specific cultural values and strategies for coping with mental health concerns.

Limitations and Future Research

There are several limitations associated with this study. First, survey packets were administered to a few colleges and universities in the specific geographic location of New York City. These sites were selected due to convenience and student age populations. Moreover, the urban setting provided a culturally diverse sample of Asian Americans.

The research is also limited in its relatively small sub-samples of specific ethnic groups of Asian American students. Thus we were unable to compare across ethnic groups. The sample was largely Chinese and Korean American which may have reflected specific East Asian cultural values and practices.

Data were entirely self-report in nature and may reflect socially desirable response sets. Moreover, the data were entirely quantitative in nature and relied on forced choice responses by the participants. Additional research may include more open ended and exploratory questions that provide more in depth answers about the relation between cultural values and stigma.

REFERENCES

Atkinson, D. R., & Gim, R. H. (1989). Asian-American cultural identity and attitudes toward mental health services. Journal of Counseling Psychology, 36, 209-212.

Atkinson, D. R, Lowe, S., & Matthews, L. (1995). Asian-American acculturation, gender, and willingness to seek counseling. Journal of Multicultural Counseling and Development, 23, 130-138.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.

Berry, J. W., Poortomga. Y. H., Segall, M. H., & Dasen, P. R. (1992). Cross-cultural psychology: Research and application. New York: Cambridge University Press.

Blaine, B. E. (2000). The psychology of diversity: Perceiving and experiencing social difference. Mountain View, CA: Mayfield Publishing.

Chang, T., & Chang, R. (2004). Counseling and the Internet: Asian American and Asian international college students' attitudes toward seeking online professional psychological help. Journal of College Counseling, 7, 140-150.

Chang, T., Yeh, C. J., & Krumboltz, J. D. (2001). Process and outcome evaluation of an online support group for Asian American male college students. Journal of Counseling Psychology, 48, 319-329.

Chia, R. C, Moore, J. L., Lam, K. N., & Chuang, C. J. (1994). Cultural differences in gender role attitudes between Chinese and American students. Sex Roles, 31, 23-30.

Cross, S. E, Bacon, P. L, & Morris. M. L. (2000). The relational-interdependent self-construal and relationships. Journal of Personality & Social Psychology, 78, 791-808.

Cross, S. E., Morris, M. L., & Gore, J. S. (2002). Thinking about oneself and others: The relational-interdependent self-construal and social cognition. Journal of Personality and Social Psychology, 82, 399-418.

Erdfelder, E., Faul, F., & Buchner, A. (1996). GPOWER: A general power analysis program. Behavior Research Methods, Instruments & Computers, 28, 1-11.

Fischer, E. H., & Farina, A. (1995). Attitudes toward seeking professional psychological help: A shortened form and considerations for research. Journal of College Student Development, 36, 368-373.

Fischer, E. H., & Turner, J. (1970). Orientations to seeking professional help: Development and research utility of an attitude scale. Journal of Consulting and Clinical Psychology, 35, 79-89.

Flaskerud, J. & Liu, P.Y. (1990). Influence of therapist ethnicity and language on therapy outcomes of Southeast Asian clients. The International Journal of Social Psychiatry, 36, 18-29.

Frazier, P.A., Tix, A.P., & Barron, K.E. (2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology, 51, 115-134.

Gloria, A. M., Hird, J. S., & Navarro, R. L. (2001). Relationships of cultural congruity and perceptions of the university environment to help-seeking attitudes by sociorace and gender. Journal of College Student Development, 42, 545-562.

Gonzalez, J. M., Tinsley, H. E. A., & Kreuder, K. R. (2002). Effects of psychoeducational interventions on opinions of mental illness, attitudes toward help seeking, and expectations about psychotherapy in college students. Journal of College Student Development, 43(1), 51-63.

Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: Attitudes, self-esteem, and stereotypes. Psychological Review, 102, 4-27.

Inman, A. G., & Yeh, C. (2006). Stress and Coping. In F. Leong, A. G. Inman, A. Ebreo, L. Lang, L. Kinoshita, M. Fu (Eds.), Handbook of Asian American Psychology (pp. 323-340). Thousand Oaks, CA: Sage.

Ivey, A. E., Ivey, M. B., & Simek-Morgan, L. (1997). Counseling and psychotherapy: A multicultural perspective (4th ed.). Boston: Allyn & Bacon.

Kim, B. S. K., & Abreu, J. M. (2001). Acculturation measurement: Theory, current instruments, and future directions. In J. G. Ponterotto, J. M. Casas, L. A., Suzuki, & C. M. Alexander (Eds). Handbook of multicultural counseling (2nd ed., pp. 394-424). Thousand Oaks, CA: Sage.

Kim, B. S. K., Atkinson, D. R., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current knowledge and directions for future research. The Counseling Psychologist, 29, 570-603.

Kim, B. S. K., Atkinson, D. R., & Yang, P. H. (1999). The Asian Values Scales: development, factor analysis, validation and reliability. Journal of Counseling Psychology, 46, 342-352.

Kim, B. S. K., & Omizo, M. M. (2003). Asian cultural values, attitudes toward seeking professional psychological help, and willingness to see a counselor. The Counseling Psychologist, 31, 343-361.

Kliewer, W., Lepore, S. J., Broquet, A., & Zuba, L. (1990). Developmental and gender differences in anonymous support-seeking: Analysis of data from a community help line for children. American Journal of Community Psychology, 18, 333-339.

Komiya, N., Good, G. E., & Sherrod, N. B. (2000). Emotional openness as a predictor of college students' attitudes toward seeking psychological help. Journal of Counseling Psychology, 47, 138-143.

Leong, F. T. L. (1994). Asian Americans' differential patterns of utilization of inpatient and outpatient public mental health services in Hawaii. Journal of Community Psychology, 22, 82-96.

Leong, F. T. L., Wagner, N. S., & Tata, S. P. (1995). Racial and ethnic variation in help-seeking attitudes. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 415-438). Thousand Oaks, CA: Sage.

Leong, F. T. L., & Zachar, P. (1999). Gender and opinions about mental illness as predictors of attitudes toward seeking professional psychological help. British Journal of Guidance & Counselling, 27, 123-132.

Loo, C., Tong, B., & True, R. (1989). A bitter bean: Mental health status and attitudes in Chinatown. Journal of Community Psychology, 17, 283-296.

Ma, P. W., & Yeh, C. J. (2005). Factors influencing the career decision status of Chinese American youths. Career Development Quarterly, 53, 337-347.

Markus, H. R. & Kitayama, S. K. (1991). Culture and self: implications for cognition, emotion, and motivation. Psychological Review, 98, 224-253.

Matsuoka, J. K., Breaux, C., & Ryujin, D. H. (1997). National utilization of mental health services by Asian Americans/Pacific Islanders. Journal of Community Psychology, 25, 141-145.

Narikiyo, T. & Kameoka, V. (1992). Attributions of mental illness and judgments about help seeking among Japanese-American and White American students. Journal of Counseling Psychology, 39, 363-369.

Ng, C.H. (1997). The stigma of mental illness in Asian cultures. Australian and New Zealand Journal of Psychiatry, 31, 382-390.

Root, M. P. (1985). Guidelines for facilitating therapy with Asian American clients. Psychotherapy, 22, 349-356.

Singelis, T. M. (1994). The Measurement of Independent and Interdependent Self-Construals Personality and Social Psychology Bulletin, 20, 580-591.

Snowden, M. H., & Cheung, F. H. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 45, 247-355.

Sue, D. W. (1994). Asian-American mental health and help seeking behavior: Comments on Solberg et al. (1994), Tata and Leong (1994), and Lin (1994). Journal of Counseling Psychology, 41, 292-295.

Sue, D. W., & Sue, D. (2003). Barriers to effective multicultural counseling/therapy. In D.W. Sue & D. Sue (Eds.), Counseling the culturally diverse: theory and practice (pp. 95-121). New York: John Wiley and Sons.

Sue, S., Fujino, D. C., Hu, L., Takeuchi, D. T., & Zane, N. (1991). Community mental health services for ethnic minority groups: a test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59, 533-540.

Suinn, R. M., Rickard-Figueroa, K., Lew, S., & Vigil, P. (1987). The Suinn-Lwe Asian Self-Identity Acculturation Scale: An initial report. Educational and psychological help among Chinese Americans. Journal of Counseling Psychology, 41, 280-287.

Tata, S. P., & Leong, F. T. L., (1994). Individualism-collectivism, social-network orientation, and acculturation as predictors of attitudes toward seeking professional psychological help among Chinese Americans. Journal of Counseling Psychology, 41, 280-287.

Tracey, T. J., Leong, F. T. L., & Glidden, C. (1986). Help seeking and problem perception among Asian Americans. Journal of Counseling Psychology, 33, 331-336.

Tsai, J. L., Butcher, J. N., Munoz, R. F., & Vitousek, K. (2001). Culture, ethnicity, and psychopathology. In P. B. Sutker and H. E. Adams (Eds), Comprehensive handbook of psychopathology (pp. 105-127). New York: Plenum Press.

Tsang, H.W., Tam, P.K., Chan, F., & Cheung, W.M. (2003). Stigmatizing attitudes towards individuals with mental illness in Hung Kong: implications for their recovery. Journal of Community Psychology, 31(4), 383-396.

Uba, L. (1994). Asian Americans: Personality patterns, identity, and mental health. New York: Guilford Press.

U.S. Bureau of the Census. (2004). Asian/Pacific American Heritage Month May 2005. Retrieved on April 2, 2007 from http://www.census.gov/Press-Release/www/releases/archives/ facts for features_special_editions/004522.html

U.S. Department of Education (2004). Digest of education statistics: International comparisons of education. Retrieved March 12, 2007, from http://nces.ed.gov/programs/digest/d04/ch_6.asp

Vogel, D. L., Wade, N. G., & Hackler, A. H. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53, 325-337.

Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54, 40-50.

Yeh, C. J. (2000). Depathologizing Asian-American perspectives of health and healing. Asian American and Pacific Islander Journal of Health, 8, 138-149.

Yeh, C. J. (2002). Taiwanese students' gender, age, interdependent and independent self-construal, and collective self-esteem as predictors of professional psychological help-seeking attitudes. Cultural Diversity & Ethnic Minority Psychology, 8, 19-29.

Yeh, C. J., & Inose, M. (2003). International students' reported English fluency, social support satisfaction, and social connectedness as predictors of acculturative stress. Counselling Psychology Quarterly, 16(1), 15-28.

Yeh, C. J. & Wang, Y. W. (2000). Asian American coping attitudes, sources, and practices: Implications for indigenous counseling strategies. Journal of College Student Development, 41, 94-103.

Zane, N., & Yeh, M. (2002). The use of culturally-based variables in assessment: Studies on loss of face. In K.S. Kurasaki, S. Okazaki et al. (Eds), Asian American mental health: Assessment theories and methods. International and cultural psychology series. (pp. 123-138). New York: Kluwer Academic/Plenum Publishers.

Zhang, W. Y. (1994). American counseling in the mind of a Chinese counselor. Journal of Multicultural Counseling and Development, 22, 79-85.

Munyi Shea is affiliated with the Department of Counseling and Clinical Psychology at Teachers College, Columbia University. Christine J. Yeh is affiliated with the Department of Counseling Psychology at University of San Francisco. Correspondence regarding this article can be addressed to Munyi Shea at the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th St., New York, NY 10027. E-mail: ms2445@columbia.edu.
Table 1. Means, Standard Deviations, and Intercorrelations of Study
Variables

Variable M SD 1 2 3 4

1. ATSPPH-S 1.69 0.53 -- -0.24** -0.21 ** 0.16 *
2. AVS 4.07 0.62 -- 0.36 ** 0.05
3. SSRPH 1.17 0.47 -- 0.09
4. RISC 5.16 0.93 --
5. Gender 1.65 0.48
6. Age 24.56 4.09

Variable 5 6

1. ATSPPH-S 0.21 ** 0.19 **
2. AVS -0.07 0.02
3. SSRPH -0.07 -0.08
4. RISC 0.15 * -0.01
5. Gender -- 013
6. Age --

Notes. ATSPPH-S = Attitudes toward Seeking Professional Psychological
Help-Short form (Fischer & Farina, 1995). AVS = Asian Value Scale
(Kim, Atkinson & Yang, 1999). SSRPH = Stigma Scale for Receiving
Psychological Help (Komiya, Good & Sherrod, 2000).
RISC = Relational-Interdependent
Self Construal Scale (Cross, Bacon & Morris, 2000).
The mean scores correspond to results on a Likert-type scale.

** p < .01

* p < .05

Table 2. Summary of Multiple Regression Analyses for Variables
Explaining Attitudes Toward Seeking Professional Psychological
Help (N = 219)

Variable B SE B p t

1. AVS -0.158 0.057 -0.185 -2.76 **
2. SSRPH -0.161 0.075 -0.144 -2.145 *
3. RISC 0.0946 0.036 0.167 2.611 *
4. Gender 0.168 0.07 0.154 2.406 *
5. Age 0.0138 0.006 0.137 2.166 *

Notes. AVS = Asian Value Scale (Kim, Atkinson & Yang, 1999).
SSRPH = Stigma Scale for Receiving Psychological Help (Komiya,
Good & Sherrod, 2000). RISC = Relational-Interdependent
Self-Construal Scale (Cross, Bacon & Morris, 2000).

** p <.01

* p <.05

Table 3. Regression for Adherence to Asian Values, Stigma, Gender and
Age Predicting Attitudes Toward Seeking Professional
Psychological Help (N = 219)

 Model One

Variables [beta] SE B [beta] t

AVS -.188 .055 -.221 -3.439 ***
Stigma -- -- -- --
Gender .206 .07 .188 2.936 **
Age .0136 .006 .135 2.105 *

 Model Two

Variables B SE B [beta] t

AVS -.151 .058 -.177 -2.619 **
Stigma -.143 .076 -.128 -1.889
Gender .198 .07 .181 2.836 **
Age .0129 .006 .128 2.006 *

Note. ATSPPH-S = Attitudes toward Seeking Professional Psychological
Help-Short form (Fischer & Farina, 1995). AVS = Asian Value Scale
(Kim, Atkinson & Yang, 1999). SSRPH = Stigma Scale for
Receiving Psychological Help (Komiya, Good & Sherrod, 2000).

*** p .001

** p .01

* p .05
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Author:Shea, Munyi; Yeh, Christine J.
Publication:Journal of Mental Health Counseling
Article Type:Report
Geographic Code:1USA
Date:Apr 1, 2008
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