Psychosocial factors predicting adult help seeking behaviors in ethnic and racial minorities

Sophia I. Sánchez Author

04/05/2021 Added

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Mainstream acculturation mediates and moderates the relationships between perceived parental attitudes, understanding of psychotropic medications, and help-seeking behaviors in young adult ethnic and racial minorities.

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[00:00:01.710]Hello, and thank you for joining me.
[00:00:03.530]My name is Sophia Sanchez.
[00:00:05.150]I am a senior undergrad in the psych department
[00:00:07.190]here at the university
[00:00:08.560]and undergraduate research assistant
[00:00:10.210]in the Women Immunity and Sexual Health Lab
[00:00:12.550]working under the direction of Dr. Tierney Lorenz.
[00:00:15.410]We are here today to discuss my honors thesis
[00:00:17.410]which is titled psychosocial factors
[00:00:19.150]predicting adult help seeking behaviors
[00:00:20.860]in ethnic and racial minorities.
[00:00:25.010]To begin young folks aged 18 to 25 experience
[00:00:28.020]mental illness at higher rates than those 25 and older,
[00:00:31.220]29% of the 18 to 25 age group reported any sort
[00:00:34.610]of mental illness diagnosis while only 25%
[00:00:37.740]of the 26 to 49 age group and 14%
[00:00:40.890]of the 50 or older age group self-reported any type
[00:00:43.690]of these diagnoses.
[00:00:46.260]College students also experience
[00:00:47.880]disparate levels of mental illness.
[00:00:49.790]42% of the college students surveyed by the APA in 2013
[00:00:53.410]experienced some form of anxiety
[00:00:55.500]and 36% had been diagnosed with some form of depression.
[00:00:59.986]Of these young college students, Black, Indigenous
[00:01:02.500]and People of Color have been found to be less
[00:01:04.350]likely to disclose their symptoms
[00:01:05.930]or engage in help seeking behaviors to alleviate them.
[00:01:09.150]This suggests that there are additional barriers in place
[00:01:11.210]for this group likely related to cultural differences.
[00:01:15.300]The present study surveyed exactly that.
[00:01:17.470]This was a mixed methods analysis of psychosocial factors,
[00:01:20.630]including acculturation, religion
[00:01:22.810]and perceived attitudes towards mental healthcare
[00:01:24.990]among others as predictors of help seeking behaviors
[00:01:27.980]in emerging adults who also identify as ethnic
[00:01:30.450]and racial minorities.
[00:01:34.070]To survey racial and ethnic minority status,
[00:01:36.150]we used an item from the US Census
[00:01:37.930]which separates socially constructed race from nationality
[00:01:40.780]and Hispanic or Latino ethnicity.
[00:01:43.930]To survey acculturation which is a synonym for assimilation,
[00:01:47.370]we use the Vancouver Index of Acculturation
[00:01:49.490]which allowed us to survey both heritage
[00:01:51.180]and mainstream acculturation with heritage being the culture
[00:01:54.090]in which our respondent grew up in and mainstream culture
[00:01:56.800]being the environment in which they live and work in now.
[00:02:00.970]Religiosity was also separated into two facets
[00:02:03.610]being extrinsic and intrinsic.
[00:02:06.150]Extrinsic religiosity is conceptualized
[00:02:08.060]as behaviors, which aren't necessarily rooted
[00:02:10.110]in actual belief, like the physical act of going to church.
[00:02:13.740]Intrinsic religiosity on the other hand
[00:02:15.530]is the extent to which folks
[00:02:16.670]actually believe in the doctrine that they follow.
[00:02:20.620]Perceived parental attitudes were measured
[00:02:22.370]using an adapted form of the Parental Attitudes
[00:02:24.810]Towards Psychological Services Inventory.
[00:02:27.290]This measure was originally created to be administered
[00:02:29.610]to parents, but since we surveyed college students,
[00:02:31.790]we changed the language to reflect
[00:02:33.200]our respondent's perceptions
[00:02:34.460]about their parents' attitudes towards psychotherapy.
[00:02:38.610]Help seeking propensity was measured with a single question.
[00:02:41.570]How likely would you be to do psychotherapy or counseling
[00:02:44.130]if it were affordable or accessible?
[00:02:46.290]You'll notice that the question is phrased to not take
[00:02:48.150]into account barriers to care
[00:02:49.440]like transportation or finances,
[00:02:51.440]so this gives us a pretty accurate measure
[00:02:53.180]of people's actual attitudes towards psychotherapy
[00:02:55.330]without that confound.
[00:02:57.690]Lastly we have qualitative understanding of the mechanism
[00:03:00.230]behind psychotropic medications.
[00:03:02.290]We use this as a proxy for health literacy,
[00:03:04.400]but we also recognize that this may not be reflective
[00:03:06.990]of overall health literacy.
[00:03:10.510]In order to analyze that qualitative question
[00:03:12.930]a lead researcher chose 15 exemplars from the responses
[00:03:15.720]to one free response question.
[00:03:17.530]How do you think psychiatric medications
[00:03:19.340]like antidepressants work?
[00:03:22.180]Those exemplars were then sent off to seven researchers
[00:03:24.720]who created and defined several levels
[00:03:26.550]of understanding which range from low to high.
[00:03:29.970]And then based on the average number of categories
[00:03:32.140]across those researchers
[00:03:33.260]we created our final coding criteria.
[00:03:36.330]The first level was, I don't know, folks who said something
[00:03:38.750]that fall into this category said, I don't know
[00:03:41.080]or gave us a personal anecdote or something about how
[00:03:43.550]those meds work behaviorally
[00:03:44.820]but nothing about the actual mechanism.
[00:03:47.920]The low category was conceptualized
[00:03:49.960]as an attempt to answer the question
[00:03:51.510]but with factually incorrect information.
[00:03:54.840]Medium was mostly correct with some inaccuracies
[00:03:58.790]and high was an accurate explanation, understanding
[00:04:01.370]of medical terminology beyond buzzwords, and a mention
[00:04:04.260]of the importance of pairing meds with therapy
[00:04:06.220]for ultimate efficacy.
[00:04:09.770]For quantitative analysis
[00:04:11.010]we use ordinal regressions instead of a regular Pearson's r
[00:04:13.940]to take into account our ordinal variables.
[00:04:17.350]For mediation analysis we used a bootstrap analysis
[00:04:20.230]that looks at two different paths
[00:04:21.650]one is a direct path between the predictor
[00:04:23.410]and outcome variable
[00:04:24.770]and the other is the indirect path which takes
[00:04:26.740]into account the mediator.
[00:04:29.760]For moderation analysis we use interaction models,
[00:04:32.730]basically these take into account
[00:04:34.060]multiple independent variables' effect
[00:04:35.950]on the outcome variable.
[00:04:37.330]And then we can compare the strength of the relationship
[00:04:39.410]between one independent variable and the dependent variable
[00:04:42.210]at different levels of another independent variable.
[00:04:46.770]So as we discussed previously, mainstream acculturation
[00:04:49.610]is essentially assimilation to the environment
[00:04:51.730]in which one lives in works.
[00:04:53.370]So for example, I'm Latina specifically Colombian.
[00:04:56.110]So my heritage culture is largely Colombian
[00:04:58.900]but my mainstream culture is mostly American
[00:05:01.090]and more specifically Nebraskan.
[00:05:04.340]So involving mainstream acculturation, we hypothesized that
[00:05:07.210]at lower levels of mainstream acculturation
[00:05:09.430]the relationship between ethnic minority status
[00:05:11.700]and understanding of psychotropic meds will be stronger.
[00:05:15.440]And we found that higher levels of mainstream acculturation
[00:05:17.930]were associated with higher health literacy for BIPOC folks
[00:05:21.400]while the opposite was true for our White respondents.
[00:05:23.870]And we can see that differential relationship there.
[00:05:29.820]Another one involving mainstream acculturation
[00:05:32.030]at lower levels of mainstream acculturation
[00:05:34.140]the relationship between perceived parental receptivity
[00:05:36.610]and help seeking behaviors will be stronger.
[00:05:40.020]We found a marginally significant relationship between
[00:05:42.540]parental receptivity and adult help-seeking behaviors
[00:05:45.490]only when we took into account mainstream acculturation
[00:05:47.960]and not heritage acculturation.
[00:05:50.220]We'd also like to note that this analysis was conducted
[00:05:52.500]with a smaller number of respondents at only one university,
[00:05:55.720]so we think that a larger sample with greater power
[00:05:57.910]would find a truly significant effect.
[00:06:01.420]Lastly, just one about religiosity, those who identify
[00:06:04.420]as more religious will be less likely to seek
[00:06:06.230]out mental healthcare.
[00:06:07.330]And we found that that was true.
[00:06:08.610]More religious people were significantly less likely to seek
[00:06:11.220]out mental health care.
[00:06:13.960]Here we have a smattering of null results.
[00:06:16.450]The largest trend throughout here
[00:06:17.560]is that heritage acculturation
[00:06:19.040]does not mediate or moderate any of the relationships
[00:06:21.930]between our predictor and outcome variables.
[00:06:24.540]Also parental receptivity is only significant
[00:06:28.030]in predicting adult help seeking behaviors
[00:06:29.940]when we take into account mainstream acculturation.
[00:06:34.670]We also wanted to discuss some
[00:06:35.820]of our most interesting findings
[00:06:37.470]so with regards to acculturation we found
[00:06:39.640]that mainstream acculturation strengthened the relationship
[00:06:42.130]between our predictor and outcome variables.
[00:06:44.220]The majority of the time
[00:06:45.820]while heritage acculturation did not significantly mediate
[00:06:48.853]or moderate any of the relationships
[00:06:51.230]between our independent and dependent variables.
[00:06:54.738]This suggests that the environment in which we live
[00:06:56.580]and work has a larger effect
[00:06:57.830]on us than the culture in our home
[00:06:59.560]even for folks who have only been engrossed
[00:07:01.270]in this mainstream culture
[00:07:02.260]for a few months or years.
[00:07:05.070]In terms of religiosity
[00:07:06.330]we found that more religious folks were less likely to seek
[00:07:08.650]out mental healthcare.
[00:07:10.070]We don't think this is necessarily reflective
[00:07:11.880]of religious attitudes towards psychological interventions.
[00:07:15.020]This may just be because religion is actually protective,
[00:07:17.500]so religious folks have a lesser need to seek
[00:07:19.400]out mental healthcare.
[00:07:20.900]Also religious folks might also just lean
[00:07:22.750]on their church community more so than on clinicians.
[00:07:27.610]We'd like to acknowledge that this work was supported
[00:07:29.550]by the RDAR Center at the University of Nebraska - Lincoln.
[00:07:32.520]And I'd also like to thank the researchers
[00:07:34.330]in the WISH Lab for always being willing to venture
[00:07:36.570]into the qualitative realm with me.
[00:07:38.430]We couldn't do this without you.
[00:07:39.770]Thank you and thank you for sticking with me
[00:07:41.610]through this presentation.

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Psychosocial factors predicting adult help seeking behaviors in ethnic and racial minorities

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