Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders
Introduction
The growth of the immigrant population in recent years has been phenomenal: current statistics shows that more than one in every eight U.S. residents are immigrants (U.S. Census Bureau, 2004). In 2007, 54.6 percent of foreign-born people in the U.S. were from Central and Latin America, 23.1 percent were from Asia, and the remaining 20.3 percent were from Europe and other regions of the world (Camarota, 2007). The United States grew not only racially and ethnically but also linguistically diverse. According to a recent U.S. Census Bureau (n.d.), over 54 million (19.5 percent of the U.S. population) reported that they spoke a language other than English at home and 8.6 percent of the U.S. population reported they spoke English less than “very well.” Additionally, more than half (51.0%) of the U.S. immigrant population appeared to have less than “very well” English-speaking ability (U.S. Census Bureau, 2005), referred to as limited English proficiency (LEP) population.
LEP exerts a pervasive impact. Language barriers not only can lead to miscommunication with health care providers but also can have deleterious effects on navigating the health care system and on understanding health information and treatment (DuBard and Gizice, 2008, Flores, 2006, Ponce et al., 2006). Given that mental health treatment relies on direct verbal communication rather than objective tests as for physical illness, language barriers may be especially important in mental health care settings (Sentell et al., 2007). Previous studies have reported that LEP is associated with lower use of general health care services (Abe-Kim et al., 2007, DuBard and Gizice, 2008, Jacobs et al., 2005, Ponce et al., 2006). With respect to mental health care services there is less evidence. However, a recent study using the 2001 California Health Interview Survey found that LEP Latinos and Asians were less likely to receive mental health services compared to those with English proficiency (Sentell et al., 2007). This study was limited in that the investigators used self-reported mental health problems rather than diagnosed mental health problems when they identified people with a mental health need.
Previous studies with immigrants reported that mental health service use varied by immigration-related characteristics such as nativity status, English proficiency, years lived in the U.S., and age at time of immigration (e.g., Abe-Kim et al., 2007, Le Meyer et al., 2009). A recent investigation on mental health service use among Asian Americans found that the most important indicators of within-group differences in service use were nativity status (US-born vs. foreign-born) and generation status (first vs. second vs. third or more) (Abe-Kim et al., 2007). Immigrants were less likely than US-born individuals to use mental health services (6.19% vs. 2.17%) and rates of mental health service use among third-generation Asians were more than three times higher than those of second- or first-generation Asians (10.10% vs. 3.51% vs. 2.17). In the same study, English-speaking ability (excellent/good vs. fair/poor) was also associated differently with use of mental health services among Asians. The English proficient were more likely than those with LEP to use mental health services (3.50% vs. 2.25%).
While LEP has received considerable attention, its particular relevance to immigrant populations remains relatively understudied. The stresses and strains generally associated with the immigrant experience have been well-documented and may last for extended periods of time (e.g., Beiser, 1999, Birman and Taylor-Ritzler, 2007, Chiriboga et al., 2002). There is also some evidence that immigrants with LEP have relatively high levels of emotional distress, and are less likely than native-borns to access mental health services (e.g., Abe-Kim et al., 2007, Chiriboga et al., 2002). Since these individuals with LEP are primarily concentrated among racial/ethnic minorities, studying the health care of Latino and Asian immigrants without paying attention to English proficiency may carry the potential of overlooking racial/ethnic disparities.
For these reasons, and because previous studies of mental health and service utilization among immigrants have rarely evaluated evidence for specific disorders, the current study focused on Latino and Asian immigrants who have instrument-determined diagnoses for psychiatric disorders. The latter individuals represent a population with an identified need for mental health care services. Due to the lack of appropriate national data, it has proved difficult to adequately address access barriers to mental health services faced by Latino and Asian immigrants with mental health problems.
Our underlying hypothesis was that immigrant adults with LEP would be less likely to use mental health services compared to those with good English proficiency. Using a national dataset, findings from this study will help to explain whether LEP is a barrier to mental health service use among immigrants with psychiatric disorders.
Section snippets
Sample
Data were drawn from the National Latino and Asian American Study (NLAAS), which is a national survey of household residents (18 and older) in the non-institutionalized Latino and Asian populations residing in the contiguous United States. A total of 4649 Latino and Asian Americans were recruited between 2002 and 2003 for the NLAAS survey. All participants were interviewed by trained bilingual interviewers. Interviews were conducted face-to-face, unless the respondent specifically requested a
Descriptive information of the sample and study variables
Table 1 summarizes the descriptive profiles of the sample, all of whom had CIDI scores indicating the presence of one or more psychiatric disorders. The sample consisted of 249 Latinos (66.9%) and 123 Asians (33.1%). The selected sample was 11.4% of the total immigrants in the NLAAS. Their age ranged from 18 to 86 with an average age of 43.0 years (SD = 15.72 years) and the Latino sample being older than the Asian sample (p < .05). Over half of both groups were female and married, but the
Discussion
The present study focused on adult Latino and Asian immigrants with any instrument-determined mood, anxiety, and substance use disorder, a group generally known to be vulnerable and to be understudied in the mental health arena. To our knowledge, this is one of only a few national, population-based, comprehensive studies of immigrant adults with probable psychiatric disorders to investigate the effect of limited English proficiency on mental health service use.
In agreement with previous
Role of funding source
None.
Contributors
Giyeon Kim: Conceptualization, study design, data analysis, and preparation of manuscript.
Claudia X. Aguado Loi: Conceptualization, study design, and preparation of manuscript.
David A. Chiriboga: Conceptualization, study design, and preparation of manuscript.
Yuri Jang: Conceptualization, study design, and preparation of manuscript.
Patricia Parmelee: Conceptualization and preparation of manuscript.
Rebecca S. Allen: Conceptualization and preparation of manuscript.
Conflict of interest statement
Giyeon Kim: None.
Claudia X. Aguado Loi: None.
David A. Chiriboga: None.
Yuri Jang: None.
Patricia Parmelee: None.
Rebecca S. Allen: None.
Acknowledgements
None.
References (30)
- et al.
Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study
American Journal of Public Health
(2007) - et al.
Considering context, place and culture: the National Latino and Asian American Study
International Journal of Methods in Psychiatric Research
(2004) - et al.
Cultural relevance and equivalence in the NLAAS instrument: integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos
International Journal of Methods in Psychiatric Research
(2004) - et al.
Use of mental health services by Asian Americans
Psychiatric Services
(2005) Strangers at the gate: The “Boat People’s” first ten years in Canada
(1999)- et al.
Acculturation and psychological distress among adolescent immigrants from the former Soviet Union: exploring the mediating effect of family relationships
Cultural Diversity and Ethnic Minority Psychology
(2007) Immigrants in the United States, 2007: a profile of America’s Foreign-born population
(2007)- et al.
Stress and depressive symptoms among Mexican American elders
Journal of Gerontology: Psychological Sciences
(2002) - et al.
Immigrants and health care: sources of vulnerability
Health Affairs
(2007) - et al.
Physical and mental health characteristics of U.S. – and foreign-born adults: United States, 1998–2003
Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics
American Journal of Public Health
Language barriers to health care in the United States
New England Journal of Medicine
Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys
International Journal of Methods in Psychiatric Research
Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES)
International Journal of Methods in Psychiatric Research
Limited English proficiency and breast and cervical cancer screening in a multiethnic population
American Journal of Public Health
Cited by (190)
Self-reported stressors experienced by migrant youth in Canada
2023, Children and Youth Services Review“What's your accent, where are you from?”: Language and belonging among older immigrants
2023, Journal of Aging Studies“How's your mood”: Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits
2023, Patient Education and Counseling