Wednesday, January 8, 2014

School-Based Mental Health Prevention for Asian American Adolescents: Risk Behaviors, Protective Factors, and Service Use

Research has shown that prevention programs addressing multiple risk and protective factors may be highly beneficial in reducing mental health problems in Asian American adolescents.1-3 However, emerging evidence demonstrates this population tends to underutilize community-based mental health services.4 In the present study, authors Anyon, Ong, & Whitaker evaluate a school-based mental health (SBMH) prevention program. Specifically, the authors aimed to evaluate the effectiveness of engaging target populations, paying particular attention to Asian American youth.

Though school-based programming can reduce barriers (e.g., transportation, insurance) to services, research has shown Asian youth are underrepresented in SBMH prevention programs.5,6 For the present study, the authors relied on a model of ethnic minority youth mental health help-seeking, which posits that youths’ risk and protective factors, as well as their help-seeking paths, are influenced by social, cultural, organizational, and structural contexts and involve multiple persons (e.g., family, peers, teachers).7

Methods and Sample

Data was collected between 2008 and 2009 from public high school students taking part in a district-city-county collaborative SBMH initiative. Staff at each initiative site included, at minimum, a coordinator, school nurse, outreach worker, and behavioral health counselor. These staff worked in conjunction with community-based organizations to provide universal services (e.g., health education) school-wide and select services (e.g., support groups) to students demonstrating moderate need. Counseling and case management were offered to students presenting with mental health issues.
The California Healthy Kids Survey (CHKS) was administered to all students at each study site to assess health risk and protective factors.8 A 71% response rate resulted in an unweighted sample of 8,466 students. Select characteristics are as follows:
  • Race/Ethnicity: 58% Asian, 15% Latino, 9% Black, 6% White, 3% Pacific Islander, 11% multiracial
  •  Largest Asian Ethnic Subgroups: 67% Chinese, 7% Cambodian, 4% Filipino, 4% Vietnamese
  • Gender: 54% female, 46% male
  • Used services: Asian, 34%; White 44%; Multiracial/Other, 52%; Pacific Islander, 53%; Latino, 60%; Black, 63%; All students, 42%


Generally, Asian youth reported lower levels of most risk factors for mental health problems, notably excluding depressive symptoms, in comparison to other racial minority groups. Initial findings indicate self-reported risk factors targeted by the SBMH programs increased youths’ odds of service use; however, this did not hold true for self-reported depressive symptoms among Asian youth. The authors suggest that both the stigma associated with mental health treatment-seeking and the tendency to depend on family and friends for support may be higher for Asian youth.9 In examining specific Asian ethnicity subgroups, the authors found that SBMH programs particularly underserve Cambodian and Chinese students.


The authors suggest that prevention program providers cannot assume that high-risk youth will access services. Given that Asian students, and Cambodian and Chinese students in particular, are underserved in SBMHs, more attention must be paid to culturally responsive interventions. Program suggestions include:
  • Relying less on teacher referrals for SBMH services
  • School-wide campaigns to normalize help-seeking
  • School-based screenings for protective and risk factors

For More Information

For more a more in-depth look at the racial and ethnic disparities in SBMHs, check out the full article now in press in the Asian American Journal of Psychology. For more on school-based programming, be sure to read our previous blog posts featuring Dr. Anyon’s work.


Anyon, Y., Ong, S.L., & Whitaker, K. (in press). School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors and service use. Asian American Journal of Psychology.

1 Lee, S., Juon, H., Martinez, G., Hsu, C.E., Robinson, E.S., Bawa, J., & Ma, G.X. (2009). Model minority at risk: Expressed needs of mental health by Asian American young adults. Journal of Community Health, 34, 144–152.
2 Costello, D.M., Swendsen, J , Rose, J.S., & Dierker, L.C. (2008). Risk and protective factors associated with trajectories of depressed mood From adolescence to early adulthood. Journal of Consulting and Clinical Psychology, 76(2), 173–183.
3 Zhou, Q., Tao, A., Chen, S.H., Main, A., Lee, E., Ly, J., Hua, M., & Li, X. (2012). Asset and protective factors for Asian American children’s mental health adjustment. Child Development Perspectives, 6, 312-319. doi:
4 Abe-Kim, J., Takeuchi, D. T. , Hong, S., Zane, N., Sue, S., Spencer, M. S, & Alegria, M. (2007). Use of mental health-related services among immigrant and U.S.-born Asian Americans: Results from the National Latino and Asian American Study. American Journal of Public Health, 97, 91–98.
5 Amaral, G., Geierstanger, S., Soleimanpour, S., & Brindis, C.D. (2011). Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers. Journal of School Health, 81, 138-145.
6 Walker, S.C., Kerns, S.E.U., Lyon, A.R., Bruns, E.J., & Cosgrove, T.J. (2010). Impact of school-based health center use on academic outcomes. Journal of Adolescent Health, 46, 251–257.
7 Cauce, A.M., Domenech-Rodriguez, M., Paradise, M., Chochran, B.N., Shea, J.M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Counseling and Clinical Psychology, 70, 44-55.
8 Hanson, T.L., & Kim, J. (2007). Measuring resilience and youth development: the psychometric properties of the Healthy Kids Survey. (Issues & Answers Report, REL 2007–No. 034). Washington, DC.: Department of Education, Institute of Education Sciences, National Center for Education Evaluation and Regional Assistance, Regional Educational Laboratory West.
9 Kuhl, J., Jarkon-Horlick, L., & Morrissey, R. F. (1997). Measuring barriers to help-seeking behavior in adolescents. Journal of Youth and Adolescence, 26, 637-650.

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