According to Siddiqui (2022), South Asians are a growing ethnic group in the US. With about 5.4 million South Asians in the US, the racial and ethnic group constitutes a significant part of the US immigrant population. It is a diverse group religiously, ethnically, and linguistically. While research shows immigrant groups such as South Asian Americans come to the US with better health, it erodes with time because of the challenge brought by their efforts to integrate their values and practices into US society. Scholars have noted that South Asian Americans have been especially understudied, and as the group’s population increases, so too do this group’s mental healthcare needs (Arora et al., 2016; Inman et al., 2014). A content analysis of 133 empirical articles published between 1980 and 2012 found only 33 articles (18.77%) pertaining to South Asian American mental health and psychotherapy experiences (Inman et al., 2014). Notably, among the articles that have been published on South Asian American mental health issues, results suggest that South Asian individuals living in the U.S. hold negative attitudes toward professional psychological help-seeking and therefore underuse mental health services (Kim & Lee, 2021).
Addressing these mental issues is challenging because South Asian Americans are part of the widespread racial and ethnic minority marginalization that brings various challenges to people looking for mental care. In the US, South Asian Americans struggle with issues such as discrimination, linguistic barriers, stigma, and different cultural approaches to their mental care services. These issues arise from acculturation, which is defined as the process through which minority groups engage in an attempt to integrate the beliefs, behaviors, and values of a majority group after prolonged contact, as discussed by Siddiqui (2023). The challenge begins when South Asians struggle to adjust to a new language, new healthcare procedures, way of life, and values of mainstream America. Recent studies suggest that the stress of acculturation discourages South Asians in the United States from accessing professional healthcare services due to conflicting beliefs, ethnic-based limitations, and varied cultural values. As a result, the research is looking to explore how behavioral and values acculturation impact the attitudes and intentions of South Asian Americans towards seeking help, highlighting the barriers impacting their intention to seek health services.
Acculturation and Enculturation
Culture plays a crucial role in understanding the behavior of a community. Enculturation describes the process through which people take on the customs, values, and behaviors of their culture. Enculturation involves preserving individual cultural background instead of assimilating a new culture (Kim, 2007). Acculturation and enculturation are opposite extremes of a single dimension, implying that while a person embraces the dominant culture, they simultaneously renounce their own culture. Later, scholar conceptualizations of these concepts characterize these cultural processes as distinct, implying that an individual can go through enculturation to retain elements of their original culture or adopt elements of the dominant culture simultaneously and independently of one another. Because different cultural norms are subjective, it might not be easy to measure acculturation and enculturation. For instance, merely copying or engaging in particular behaviors is frequently not the same as accepting and believing in a culture’s way of life. Additionally, there is a propensity to integrate the core cultural norms and beliefs of the foreign society more slowly than to embrace the behavioral features of the host culture (Kim, 2007). The study involves an in-depth evaluation of the impacts of acculturation to American values and enculturation of South Asian values on professional psychological help-seeking behavior.
Behavioral Acculturation
Professional help-seeking behavior in this context refers to a request for professional assistance when facing mental issues (Markova et al., 2020). The behavioral model is used in public health to analyze patterns of help-seeking among immigrant ethnic groups in the United States, such as South Asians. The number of Asians living in America is increasing and becoming more diversified, with Kim and Omizo (2010) estimating that the figure will double by 2050. This growth makes it increasingly important for mental health professionals to gain a better grasp of behavioral acculturation, which represents an attempt to conform to the values, practices, and beliefs of the majority group. When understanding help-seeking attitudes, behavioral acculturation reflects the adaptation of South Asian Americans to the cultural norms of mainstream America, a dominant group. South Asian Americans’ acculturation to American society can greatly affect their likelihood of seeking psychological help (Kim & Omizo, 2010). This process transforms personal identity, values, and fitness comprehension, making them have different help-seeking tendencies. Lack of alignment between individual and traditional values creates barriers to health-seeking tendencies. It is important to recognize these differences as part of culturally sensitive interventions that create a climate for help-seeking behavior in this rapidly growing community.
Values Acculturation
Value acculturation refers to members of a minority group adopting the norms and values of a dominant group but retaining their original culture. Understanding value acculturation is crucial in shaping attitudes toward help-seeking behavior, according to Zhou et al. (2019). It involves understanding the complex relationship between adapting to new host cultural values while preserving indigenous cultural beliefs, which can impact the willingness to seek mental health assistance. Value acculturation influences health-seeking attitudes through differing perceptions, cultural stigma, and compatibility between host and individual indigenous cultural values. Understanding this crucial interplay is crucial in ensuring the effective development of culturally sensitive and inclusive mental health interventions, addressing the needs of diverse populations as they settle into new host cultures.
Methods
A systematic strategy was used to find suitable articles, given the unique study’s focus on the impacts of acculturation on help-seeking behaviors among South Asian Americans. This required conducting a thorough search of the APA PsycINFO database using a specific set of search phrases in order to find relevant research on the topics of acculturation, help-seeking behaviors, and mental health in Asian American communities. The key search terms used to find the articles include South Asian Americans, acculturation, mental health and enculturation, help-seeking, and mental and psychological well-being.
The study requested peer-reviewed publications on how cultural adaptation affects South Asian Americans’ use of mental health services. Only scholarly journal articles were considered to ensure a comprehensive peer review and reliable findings. The search yielded a wide range of papers on the topic and closely related topics, prompting inclusion criteria to help pick the best possibilities for the study. The inclusion criteria were articles written in English, a measure of acculturation and enculturation, a measure of psychiatric help-seeking, and a survey of South Asians.
The study involves 10-11 articles that were selected after an in-depth search. Selecting the article involved looking through its abstract to establish relevance and ensure it is within the scope of the topic. Only peer-reviewed articles are selected to ensure the findings are well-examined and provide a better understanding of acculturation on mental health help-seeking attitudes for the selected population. The study does not include dissertation papers because their results are generalized and not tested. The final collection of studies 11 through 15 provides an overview of current research on acculturation and its impact on access to psychological support services, with the exception of studies that did not focus on South Asians or did not examine help-seeking behaviors.
Literature Review
Mental Health of South Asian populations
According to Kim and Omizo (2010), the Asian American population in the US is around 15.5 million, representing 5% of the entire population. This number is expected to double to 9% by 2050. The growth is a cause of concern because the group consists of numerous ethnic groups with different values and cultures, ranging from Vietnamese, Japanese, Asian Indian, Chinese, and Korean, among others (Kim & Omizo, 2010). Adapting to the values and cultures of the mainstream US is a challenge and risk factor for South Asian populations. Jha et al. (2022) agree that understanding the differences in their values and cultures helps identify how a lack of proper integration contributes to risky mental health behaviors such as depression, suicide, and acculturative stress.
Jha et al. (2022) said that accumulative stress influences the mental status of South Asian Americans, increasing the risk of depression. This group struggles to integrate their cultural values with those of the dominant American society. Markova et al. (2020) agree that the differences in cultural identities and values between South Asian groups and the dominant US values not only cause serious mental health issues but also make assimilation more difficult. Jha (2001) emphasizes the multidimensional nature of cultural pressures, identifying social, behavioral, and environmental stressors involved in building pressures to maintain cultural norms for suicidal ideation in American society.
Addressing the mental health challenges of South Asian Americans requires a multifaceted approach that takes into account the unique interactions between cultural oppression and racism (Siddiqui, 2022). There is a need to explore and develop culturally sensitive mental health programs. Such interventions should not only mitigate the effects of cultural and racial discrimination but also support the well-being of South Asian Americans by acknowledging and managing the specific cultural stressors they face (Kim, 2007). Understanding these developments is important in order to provide effective services and improve the mental health and well-being of these rapidly growing and challenging populations in the United States.
Behavioral acculturation/enculturation in help-seeking
Behavioral acculturation is often understood as an act of taking up the host country’s behaviors, especially in regard to healthcare. Markova et al. (2020) discussed that the patterns of help-seeking among immigrants were culturally divergent, with the level of acculturation playing a significant role. The individuals who had assimilated into the majority cultural lifestyle were more receptive to the more structured and formal help sources such as the Internet and medical experts. This would imply that behavioral assimilation leads to acceptance of the host country’s beliefs about how mental problems should be addressed. This means that the more South Asian Americans adapt to the new host American values and beliefs, the more likely they will be receptive to American approaches and interventions to mental healthcare needs.
However, in enculturation, where value for one’s culture and traditions were maintained from generation to generation, the individuals showed a preference for traditional mental health healers and informal support from relatives or supernatant spirits (Markova et al., 2020). People of Pakistani and Somali descent who displayed stronger maintenance of their ethnic culture suggested a higher level of attraction towards the traditional help sources such as religious figures and elders of the community. This means that enculturation will be one of the major factors in preserving the tradition of culturally based help-seeking behaviors in the new cultural environment.
Kim & Omizo (2010) further emphasize the necessity of culturally competent mental health services that respect and cater to different cultural traits, facilitating the integration of indigenous beliefs while offering care. Behavioral acculturation and enculturation play a significant role in determining an immigrant’s help-seeking process, and hence, mental health practitioners and policymakers should consider these elements in delivering services that are designed to be appealing to people from different cultural backgrounds and which can be easily accessed (Markova et al., 2020). This provides for a variety of helpful resources that are drawn from both the traditional and formal sources of support, as well as avenues where local customs and culture are incorporated into the information given and services offered. Kim (2007) emphasizes the fact that mental health services need to be accommodated by the flexible and informed cultural approach so that this diverse population will get the right mental support. By recognizing and incorporating diverse help-seeking behaviors learned by immigrants due to cultural background and acculturation experiences, mental health services would become inclusive, responsive, and effective.
Value acculturation/enculturation in help-seeking
The term value acculturation signifies a process where people from different cultural backgrounds adopt the ethics and values of the other culture that they are prevailingly exposed to, either through immigration or long-term contact with another culture (Zhou et al., 2019). The process itself always brings about substantial change to the individuals in almost all facets of their lives, especially their attitude and actions towards psychological illness, for instance, mental health problems. The effect of this value acculturation on help-seeking behaviors is very complicated and multifaceted, being affected by a number of factors like cultural stigma, perceptions of mental health, and compatibility of cultural values with those of the host culture.
The cultural stigma that is associated with mental health issues in the help-seeking process among individuals undergoing value acculturation is one of the major hindrances to help-seeking behavior. In some societies, mental health issues are portrayed as a manifestation of weakness and shame, not only to an individual but also to their family. The stigma is likely to be even stronger during the acculturation period since people may find themselves in a clash of cognitive dissonance resulting from the possible conflict of values they bring with them. For instance, some cultures, such as those in the West, might want their citizens to turn to mental health practitioners, while others, say those from cultures that value privacy and family harmony, would be opposed to such disclosures because of the negative impact on the family reputation.
Value internalization also affects people’s mindset of mental illness, and then this makes people unwilling to look for help. People from collectivist societies, which value community and family more than an individual, may take a mental health problem as a whole society’s concern and not an individual’s issue. Hence, they will likely turn to their families or the community network for support instead of seeking professional services. Another fact is that the understanding of mental health could differ between cultures, where some cultures would highlight the psychological symptoms, and others would bring forward psychological or emotional aspects. A consequence of these perceptions is that the individual may not consider herself/himself to fit the definitions of mental disorders widely stated in the target culture and, thereby, may not take the chance to seek mental health services.
The degree to which an individual’s native cultural beliefs are similar to those of the host culture can also be positive relationship-seeking behaviors. Those who live out a great quantity of value acculturation, including the matching of their beliefs and customs with those of the host culture, may maintain more propensity towards the acceptance of mental health services such as consulting professionals in the host country. On the other hand, patients and family members who have a tight attachment to the native cultural norms may seek support from the traditional or communal nature. Compatibility of cultural values not only promotes seeking help, but people also choose particular treatment based on their cultural perception.
From a cultural perspective, the issue of acculturation of values must be tackled through culturally sensitive approaches that respect the diverse backgrounds of individuals. These strategies range from cultural competence training, community interventions, and cultural awareness to integration of native cultural practices. Educating providers to become aware of and value diversity in mental health perception and treatment-seeking can increase the availability and responsiveness of services. Also, designing mental health interventions and support systems inside cultural societies can help to bridge the gap between traditional cultural values and the idea of professional mental health help. Educational programs that focus on mental health-related stigmas and promote the advantages of searching for help aid in attitude change among the population in the long run. Yoon et al. (2020) also suggest that incorporating culture-specific treatments into mental health services for people with acculturation values can make those services more attractive and acceptable for these people. Recognizing the influence of value acculturation on seeking out help is important for creating mental health support systems that will adopt the cultural needs of various groups. By establishing the barriers and facilitators to help-seeking that stem from the process of cultural value acculturation, mental health professionals can provide people with tools and context to navigate the complexities of cultural adaptation.
References
Jha, A., Ahuja, M., & Wani, R. J. (2022). Suicide among South Asians in the United States: A Growing Public Health Problem. SAGE Open, 12(4), 215824402211403. https://doi.org/10.1177/21582440221140378
Kim, B. S. (2007). Adherence to Asian and European American Cultural Values and Attitudes toward Seeking Professional Psychological Help among Asian American College Students. Journal of Counseling Psychology, 54(4), 474-480. https://doi.org/10.1037/0022-0167.54.4.474
Kim, B. S., & Omizo, M. M. (2010). Behavioral Enculturation and Acculturation, Psychological Functioning, and Help-Seeking Attitudes Among Asian American Adolescents. Asian American Journal of Psychology, 1(3), 175-185. https://doi.org/10.1037/a0021125
Kim, S. B., & Lee, Y. J. (2021). Factors Associated with Mental Health Help-Seeking Among Asian Americans: a Systematic Review. Journal of Racial and Ethnic Health Disparities, 9(4), 1276-1297. https://doi.org/10.1007/s40615-021-01068-7
Markova, V., Sandal, G. M., & Pallesen, S. (2020). Immigration, acculturation, and preferred help-seeking sources for depression: Comparison of five ethnic groups. BMC Health Services Research, 20(1), 1-11. https://doi.org/10.1186/s12913-020-05478-x
Siddiqui, S. M. (2022). Acculturative stress, everyday racism, and mental health among a community sample of South Asians in Texas. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.954105
Yoon, E., Cabirou, L., Galvin, S., Hill, L., Daskalova, P., Bhang, C., Ahmad Mustaffa, E., Dao, A., Thomas, K., & Baltazar, B. (2020). A Meta-Analysis of Acculturation and Enculturation: Bilinear, Multidimensional, and Context-Dependent Processes. The Counseling Psychologist, 48(3), 342–376. https://doi.org/10.1177/0011000019898583
Zhou, E., Kyeong, Y., Cheung, C., & Michalska, K. J. (2019). Shared Cultural Values Influence Mental Health Help-Seeking Behaviors in Asian and Latinx College Students. Journal of Racial and Ethnic Health Disparities, 9, 1325–1334. https://doi.org/10.31234/osf.io/674h9
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