Journal of Immigrant and Minority Health

, Volume 17, Issue 6, pp 1679–1686 | Cite as

Help Seeking Attitudes Among Cambodian and Laotian Refugees: Implications for Public Mental Health Approaches

  • Manivone Thikeo
  • Paul Florin
  • Chee Ng
Original Paper


This is a pilot study of demographic and acculturation factors in relation to attitudes toward seeking psychological help among Lao and Cambodian refugees and immigrants in the United States of America. Cambodian and Laotian American adults in the United States of America were approached to complete help-seeking attitudes and acculturation scales. T test and hierarchical multiple regression analyses were used to analyze the relationships between the demographic and acculturation variables, and attitudes toward seeking psychological help. Out of 270 target subjects approached there were 108 respondents. Of the demographic variables, gender was associated with favorable attitudes towards psychological help-seeking. As expected, women were significantly more likely than men to recognize the need for help, to seek psychological help, to be more open to discussing mental health problems, and have more confidence in professional services. Acculturation was more powerfully associated with help- seeking attitudes than any of the demographic variables. In hierarchical multiple regression, acculturation contributed significant unique variance over and beyond the entire set of demographic variables to openness to discussing problems and having confidence in professional help. The findings of this pilot study suggest that there are significant barriers to seeking psychological help among Lao and Cambodian Americans. Attention to the issues of gender and levels of acculturation may improve access.


Refugee health Acculturation Help seeking attitudes Asian mental health 


  1. 1.
    Abe-Kim J, Takeuchi DT, Hong S, Zane N, Sue S, Spencer MS, Appel H, Nicdao E, Alegría M. Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. Am J Public Health. 2007;97:91–8. doi: 10.2105/AJPH.2006.098541.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Atkinson DR, Kim RH. Asian American cultural identity and attitude toward mental health services. J Couns Psychol. 1989;38:473–8.Google Scholar
  3. 3.
    Berry JW. Acculturative stress. In: Organista PB, Chun KM, Marin G, editors. Reading in ethnic psychology. New York: Routledge; 1998.Google Scholar
  4. 4.
    Berry JW, Sam D. Acculturation and adaptation. In: Berry JW, Segall MH, Kagitcibasi C, editors. Hand book of cross-cultural psychology, vol. 3. Boston: Allyn and Bacon; 1997. p. 291–326.Google Scholar
  5. 5.
    Chin LJ, Liem HJ, Cheng-Ham DM, Hong KG. Transference and empathy in Asian American psychotherapy: cultural values and treatment needs. Connecticut: Praeger; 1993.Google Scholar
  6. 6.
    Choi JB, Thomas M. Predictive factors of acculturation attitudes and social support among Asian Immigrant in the USA. Int J Soc Welf. 2009;18:76–84.CrossRefGoogle Scholar
  7. 7.
    Chu JP, Sue S. Asian American Mental Health: what we know and what we don’t know. Online Read Psychol Cult. 2011;. doi: 10.9707/2307-0919.1026.Google Scholar
  8. 8.
    Chung R, Kagawa-Singer M. An interpretation of symptom presentation and distress: a Southeast Asian example. J Nerv Ment Dis. 1995;183(10):639–48.CrossRefPubMedGoogle Scholar
  9. 9.
    Hatfield E, Rapson RL, Le YCL. Ethnic and gender differences in emotional ideology, experience, and expression. Int J Pers Relationsh. 2009;3(1):30–57.Google Scholar
  10. 10.
    Fischer HE, Turner LB. Orientation to seeking professional help: development and research utility of an attitude scale. J Consult Clin Psychol. 1970;35(1):79–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Gim RH, Atkinson DR, Whitley S. Asian culture values, attitudes toward seeking professional psychological health and willingness to see a counselor. J Counsel Psychol. 1990;37:281–5.CrossRefGoogle Scholar
  12. 12.
    Indo-Chinese Culture & Services Center. Southeast Asian health care. Portland: Indochinese Cultural & Services Center; 1982.Google Scholar
  13. 13.
    Johnson ME. Influences of gender and gender role orientation on attitudes. J Psychol. 1988;122(3):237–41.CrossRefGoogle Scholar
  14. 14.
    Kelly AE, Achter JA. Self-concealment and attitudes in university students. J Counsel Psychol. 1995;42:40–6.CrossRefGoogle Scholar
  15. 15.
    Kim KMS, Omizo MM. Asian culture values, attitudes toward seeking professional psychological health and willingness to see a counselor. Counsel Psychol. 2003;31(3):343–61.CrossRefGoogle Scholar
  16. 16.
    Kinzie JD, Fredrickson R, Ben R, Fleck J, Karls W. Posttraumatic stress disorder among survivors of cambodian concentration camps. Am J Psychiatry. 1984;141:645–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Kinzie JD. Overview of Clinical issues in the treatment of Southeast Asian refugees. In: Owan TC, editor. Southeast Asian mental health: treatment, prevention, services, training and research. Washington, DC: NIMH; 1985. p. 113–35.Google Scholar
  18. 18.
    Kinzie J, Boehnlein JK, Leung PK, Moore LJ, Reily C, Smith D. The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees. Am J Psychiatry. 1990;147:913–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Kleinman A. The illness narratives. New York: Basic books; 1983.Google Scholar
  20. 20.
    Kunz EF. The refugee in flight: kinetic models and forms of adjustment. Int Migrat Rev. 1973;7:126–46.CrossRefGoogle Scholar
  21. 21.
    Leong F, Glidden L. Counseling and psychotherapy with Asian Americans: review of the literature. J Counsel Psychol. 1986;33:196–206.CrossRefGoogle Scholar
  22. 22.
    Lese KP, Robbins SB. Relationship between goal attributes and the academic achievement of Southeast Asian adolescent refugees. J Counsel Psychol. 1994;41:45–52.CrossRefGoogle Scholar
  23. 23.
    Ma GX. Between Two World: the use of traditional and Western health services by Chinese immigrants. J Community Health. 1999;24:421–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Marshall NG, Schell LT, Elliot NM, Berthold MS, Chun Ch-Ah. Mental health of Cambodian refugees two decades after resettlement in the United States. J Am Med Assoc. 2005;295(5):571–9.CrossRefGoogle Scholar
  25. 25.
    Marshall NGM, Berthold MS, Schell LB, Schell LT, Elliot N, Chun Ch-Ah, Hambarsoomian K. Rates and correlates of seeking mental health services among Cambodian refugees. Am J Public Health. 2006;96(12):1829–35.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Mollica RF, Lavell J. The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry. 1987;144(12):567–72.Google Scholar
  27. 27.
    Moon A, Tashima N. Help-seeking behavior and attitudes of Southeast Asian refugees: San Francisco: Pacific Asian Mental Health Research Project; 1982Google Scholar
  28. 28.
    Nam SK, Chu HJ, Lee MK, Lee JH, Kim N, Lee SM. A meta-analysis of gender differences in attitudes toward seeking professional psychological help. J Am Coll Health. 2011;59(2):110–6.CrossRefGoogle Scholar
  29. 29.
    Ng CH. Stigma of Mental Illness in Asian Cultures. Aust NZ J Psychiatry. 1997;31:382–90.CrossRefGoogle Scholar
  30. 30.
    Nicholson BL. The influence of pre-emigration and post migrations stressors on mental health: a study of Southeast Asian refugees. Soc Work Res. 1997;21(1):19–31.CrossRefGoogle Scholar
  31. 31.
    Nicassio PM. The psychological adjustment of Southeast Asian refugee. J Cross Cult Psychol. 1985;16(2):153–73.CrossRefGoogle Scholar
  32. 32.
    Nguyen QCX, Anderson PL. Vietnamese Americans’ attitudes toward seeking mental health services: relation to cultural variable. J Community Psychol. 2005;33(2):213–31.CrossRefGoogle Scholar
  33. 33.
    Ponterotto JG, Baluch S, Carielli D. Measurement & Evaluation in Counseling & Development. Am Counsel Assoc. 1998;32(2):p109.Google Scholar
  34. 34.
    Reeves TJ, Bennett CE. We the people: Asians in the United States, Census 2000 Special Reports. Washington, DC: U.S. Census Bureau; 2004.Google Scholar
  35. 35.
    Root MP. Guidelines for facilitating therapy with Asian American clients. Psychotherapy. 1985;22:349–56.Google Scholar
  36. 36.
    Sato M. The shame factor: counseling Asian Americans. J Asian Am Psychol Assoc. 1975;5(1):20–4.Google Scholar
  37. 37.
    Sue S, McKinney H. Asian-Americans in the community mental health care system. Am J Orthopsychiatry. 1975;45:111–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Suinn RM, Richard-Figueroa K, Lew S, Vigil P. The Suinn-Lew Asian Self Identity Acculturation Scale: an initial report. Educ Psychol Measur. 1987;47:401–7.CrossRefGoogle Scholar
  39. 39.
    Uba L. Asian Americans: personality patterns, identity and mental health. New York: Guilford Press; 1994.Google Scholar
  40. 40.
    U.S Bureau of Census (2010). Current population survey. pdf.
  41. 41.
    Westermeyer J. Motivations for uprooting and migration. In: Holtzman WH, Bornemann WH, editors. Mental health of immigrants and refugees. Austin, TX: Hogg Foundation for Mental Health; 1990. p. 78–89.Google Scholar
  42. 42.
    Wong HZ. Mental health services in Asian and Pacific American communities. In L. R. Snowden (Ed.), Reaching the underserved: Mental health needs of neglected populations. Annual review of community mental health. Newbury Park, CA: Sage;1982Google Scholar
  43. 43.
    Yamamoto J. Therapy for Asian Americans. J Natl Med Assoc. 1978;70:267–70.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Zhang AY, Snowden LR, Sue S. Differences between Asian and white Americans’ help-seeking and utilization patterns in the Los Angeles area. J Community Psychol. 1998;26:317–26.CrossRefGoogle Scholar
  45. 45.
    Zhang N, Dixon DN. Acculturation and attitude of Asian international student toward seeking professional psychological help. J Multicult Counsel Dev. 2003;31(3):205–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of PsychologyUniversity of Rhode IslandKingstonUSA
  3. 3.KingstonUSA
  4. 4.Department of PsychiatryUniversity of Melbourne, The Melbourne ClinicRichmondAustralia

Personalised recommendations