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Graduate Student Journal of Psychology
Spring 2024 - Vol. 22

Copyright 2024 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Decoding Factors Influencing Mental Health 
Help-Seeking in Asian International Students:

A Correlational Survey Study

	 Mental	 disorders	 have	 a	 significant	 impact	 on	 a	
substantial portion of the global population. Warren 
(2023) noted that approximately 50 million individu-
als	in	the	U.S.	are	affected	by	a	diagnosable	mental	dis-
order. In March 2022, the World Health Organization 
reported a 25% increase in anxiety and depression diag-
noses worldwide, alongside an increased risk of suicidal 
ideation (Kola, 2022). Notably, college students repre-
sent a demographic with a higher incidence of mental 
health issues. A comprehensive study by Auerbach et 
al. (2018) revealed that out of 13,984 American col-
lege students surveyed, 35% tested positive for at least 
one of six mental health disorders. The study further 
indicated a prevalence rate of 31.4% for mental health 
disorders within the past year and a lifetime prevalence 
of 35.3% (Auerbach et al., 2018). More recent data un-
derscores this concern. The American College Health 
Association's (ACHA) 2022 National College Health 
Assessment, which surveyed over 54,000 undergradu-
ate students, found that approximately 77% were ex-
periencing moderate to serious psychological distress.
 While the mental health of college students is 
a broad concern, international students represent 
a particularly vulnerable group. Shadowen (2019) 
discovered that international students often report 
high levels of depression and anxiety. In his study of 
490 individuals, 45.3% met the criteria for clinically 
significant	 depression	 on	 the	 Center	 for	 Epidemio-
logic	 Studies	 Depression	 Scale	 (CES-D),	 and	 24.7%	

showed moderate to severe anxiety symptoms as per 
the Beck Anxiety Inventory (BAI). Further empha-
sizing this issue, Jamshaid (2023) conducted a longi-
tudinal study revealing that international students 
experienced increased levels of depression and anxi-
ety during and following the COVID-19 pandemic.
 Despite the high prevalence of mental disorders, 
the rate at which individuals seek treatment remains 
concerningly low. Khoury and Ammar (2014) found 
that only 23% of individuals with mental illnesses in 
the United States sought treatment. Data from the 
National Health Interview Survey (NHIS) in 2019 
indicated that just 19.2% of adults aged 18 and over 
had received any mental health treatment in the pre-
vious	 12	 months,	 a	 figure	 that	 increased	 slightly	 to	
21.6% by 2021 (Terlizzi, 2022). Although Warren 
(2023) reported a rise in treatment prevalence to 45% 
in	2023,	the	situation	appears	different	within	the	col-
lege student population. According to the American 
College Health Association-National College Health 
Assessment (ACHA-NCHA), only 24% of students 
diagnosed with depression sought treatment, and 
this percentage was even lower among international 
students. Mesidor (2014) found that a mere 17.7% 
of international students (n=34) with mental health 
concerns intended to seek help. Further, a study by 
Zhou	 et	 al.	 (2021)	 highlighted	 a	 significant	 dispar-
ity in service utilization between international and 
domestic students (n=96,567), with respective rates 

This	study	investigates	the	effects	of	gender,	age,	perceived	socioeconomic	status,	and	attitudes	toward	mental	health	
treatment, alongside the awareness and accessibility of mental health services, on the propensity of Asian internation-
al undergraduate and graduate students in U.S. colleges to seek mental health support. Utilizing an online survey, 
responses from a diverse group of 116 participants, aged 18 and above, from universities across the nation were ex-
amined	through	correlation	analysis.	Findings	indicated	no	significant	gender	differences	in	attitudes	toward	mental	
health treatment. However, factors such as higher educational level, superior socioeconomic background, longer 
U.S.	 residency,	 and	 increased	 awareness	 and	accessibility	of	mental	health	 services	positively	 influenced	attitudes.	
This	quantitative	study	extends	previous	qualitative	research	addressing	similar	questions,	filling	a	gap	by	offering	
broader empirical insights into this population’s mental health service utilization. The outcome underscores the need 
for university counseling centers to develop targeted interventions that acknowledge the needs of Asian international 
students. Future research should explore the longitudinal impacts of these factors on mental health help-seeking 
behaviors to inform ongoing service improvement. 
 Keywords: mental health treatment, attitudes toward mental health, Asian international students, awareness   
	 and	accessibility,	socioeconomic	influences

Yuanruo Xu
Derner School of Psychology, Adelphi University



93

of 32.0% and 49.8%. This low prevalence of treat-
ment-seeking behavior in both the broader college 
population and particularly among international stu-
dents remains a major concern for many universities. 
 Given the gap between the need for mental health 
services and the actual rates at which individuals, es-
pecially international students, seek out these services, 
one	cannot	help	but	wonder	what	specific	challenges	
are faced by this population that further complicate 
this scenario. Are cultural perceptions, stigma, or per-
haps the lack of culturally sensitive resources exacer-
bating their reluctance to seek help? Imagine the inter-
nal struggle of a student, thousands of miles away from 
home, facing not only the usual stresses of academic life 
but also navigating a foreign mental health system that 
feels	alien	to	them.	As	we	delve	into	the	specific	men-
tal health issues faced by this group, we must consider 
these unique barriers, and explore how universities can 
bridge the gap between the need for and utilization of 
mental health services among international students.
The Mental Health Landscape of International 
Students
	 Many	existing	studies	have	identified	internation-
al students as particularly vulnerable to mental health 
challenges, arising from a combination of factors in-
cluding academic pressures, language barriers, cultural 
adjustment,	 financial	 stress,	 and	 a	 reluctance	 to	 seek	
help (Dombou et al., 2023; Friday, 2018; Jiang et al., 
2020;	Mohammadifirouzeh	 et	 al.,	 2023).	 These	 stu-
dents face not only intense academic competition but 
also overwhelming stress and anxiety (Asif et al., 2020). 
Furthermore, adapting to new food, climate, and soci-
etal	systems	can	significantly	exacerbate	these	stressors,	
potentially leading to conditions such as depression 
(Cianconi et al., 2020). Prieto-Welch (2016) encapsu-
lates this by noting that “international students face 
unique pressures and struggles which may interact 
with and amplify the expected stressors,” leading to 
grave	 outcomes	 such	 as	 academic	 difficulties,	 addic-
tion, suicidal ideation, and broader health concerns.
 Among these myriad challenges, language barri-
ers emerge as a particularly pivotal issue, exacerbating 
feelings	 of	 isolation	 and	 communication	 difficulties	
(Smith & Khawaja, 2011; Wilczewski & Alon, 2023). 
This sense of isolation extends beyond social aspects, 
potentially impairing international students’ academ-
ic performance as they may struggle to comprehend 
lectures, participate in discussions, or seek assistance 

from peers and instructors. Smith and Khawaja (2011) 
underscore how these language barriers intensify the 
stress associated with adjusting to a new academic 
environment. However, the journey of adaptation 
for international students does not end with over-
coming language obstacles. The impact of cultural 
adjustment on the mental health of international 
students	 is	 also	 significant	 (Razgulin	 et	 al.,	 2023).	
Mori (2000) posits that adapting to an unfamiliar 
cultural environment is a multifaceted and challeng-
ing process, often resulting in “culture shock.” This 
can manifest as anxiety, confusion, and depression, 
as students attempt to reconcile their cultural norms 
with those of the host country. International students 
commonly experience homesickness, and longing for 
family, friends, and familiar environments (Mekonen 
& Adarkwah, 2023; Sawir et al., 2008). This sense 
of loss can amplify feelings of loneliness and alien-
ation, further exacerbating mental health concerns. 
	 Beyond	 cultural	 and	 social	 challenges,	 financial	
pressures constitute another critical factor impacting 
the mental health of international students. They 
typically incur higher tuition fees and living expens-
es, along with limited work opportunities due to visa 
constraints	(Lee	&	Rice,	2007;	Olatunji	et	al.,	2023).	
Such	financial	burdens	can	induce	considerable	stress	
and	 anxiety,	 as	 students	 grapple	 with	 fulfilling	 both	
their expenses and familial expectations. Compound-
ing these issues is the stigma associated with mental 
health challenges and a lack of familiarity with the 
host country’s mental health services, which often 
leads to reluctance to seek help (Guo et al., 2019; 
Poyrazli & Lopez, 2007). Without timely and appro-
priate intervention, these compounded stresses can 
exacerbate existing mental health conditions, under-
scoring the urgent need for accessible and culturally 
sensitive support systems for international students.
 The majority of international students are vul-
nerable to the repercussions previously mentioned, 
making these issues a primary concern for many higher 
educational institutions. Despite this, the inclination 
to seek professional mental health assistance remains 
notably low among international students, particular-
ly those from Asian backgrounds. Nilsson et al. (2004) 
found	a	significantly	lower	prevalence	of	mental	health	
treatment among international students at university 
counseling centers compared to their domestic U.S. 
counterparts. Wong et al. (2013) highlighted that, 

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ASIAN	INTERNATIONAL	STUDENT	MENTAL	HEALTH	HELP-SEEKING

due to acculturation challenges, Asian international 
students have the lowest rate of mental health treat-
ment	among	all	international	student	groups.	Empir-
ical research further reveals the susceptibility of Asian 
international students to mental health issues. Sun 
et al. (2020) reported that perceived discrimination 
and	cultural	adjustment	difficulties	 significantly	con-
tribute to increased psychological distress in Chinese 
international students. Additionally, Yu et al. (2023) 
identified	language	barriers	and	social	isolation	as	ma-
jor stressors, often resulting in anxiety and depression. 
These	 findings	 gain	 added	 significance	 considering	
the large population of Asian international students 
at U.S. universities, underscoring the urgent need for 
targeted mental health support. Korhonen (2023) re-
ported that the majority of international students in 
the U.S. are from China (289,526), India (268,923), 
and South Korea (43,847), making Asians the most 
populous regional group. As such, Korhonen (2023) 
underscored the critical need to understand and ad-
dress the unique mental health challenges of this sig-
nificant	 portion	 of	 the	 international	 student	 body.
Neglect of Mental Health Importance in Asian 
Cultures
 Many Asian international students face signif-
icant mental health challenges upon their arrival in 
the United States for study, largely due to cultural 
perceptions of mental health in their home coun-
tries (Alegría, 2017). In these cultures, mental health 
issues are often overlooked, and seeking profession-
al help is perceived as a weakness (Martinez, 2020). 
This cultural backdrop may lead to a lack of essential 
understanding among these students about mental 
health, available treatment options, and resources 
in their new environment, potentially discouraging 
them from seeking help or limiting their opportu-
nities to gain mental health education (Jang, 2007). 
 The reluctance to address mental health concerns 
is deeply embedded in the traditional values and so-
cietal norms of many Asian cultures, where stoicism 
and self-reliance are highly valued (Chen & Jiang, 
2022). Mental health issues are frequently viewed 
as personal failings rather than medical conditions 
that require attention, thus perpetuating stigma and 
discouragement from seeking help (Yin et al., 2020). 
This viewpoint is further supported by Zhang et al. 
(2019), who reported that in many Asian societies, 
mental health problems are often not recognized as 

legitimate health issues. Instead, they are seen as a 
source of embarrassment or stigma. Yang et al. (2019) 
expand on this, noting that mental health issues are 
frequently interpreted as a disruption of social harmo-
ny or a sign of weakness. Moreover, studies by Mar-
tinez et al. (2020) reveal that in some Asian cultures, 
there is a strong emphasis on family reputation and 
honor, which often takes precedence over individual 
well-being. As a result, mental health concerns are of-
ten hidden to avoid bringing “shame” to the family. 
 In their qualitative study, Chen and Vivekanan-
da	 (2021)	 found	 that	 this	 leads	 to	 a	 significant	 un-
derreporting of mental health issues among Asian 
populations. In many Asian cultures, mental health 
issues are heavily stigmatized and often concealed 
due to societal perceptions that categorize them as 
personal failures, sources of shame, or burdens to 
the family (Misra et al., 2021). Societal pressures and 
gender expectations can exacerbate these concerns, 
making it particularly challenging for individuals 
to voice their struggles with mental health. For in-
stance, societal norms often impose additional ob-
stacles on women, as they are frequently expected 
to prioritize their family's and community's needs 
over their mental well-being (Kundadak et al., 2020).
 The disparity in mental health awareness between 
Asian communities and Western societies, as noted 
by Tse and Haslam (2021), further complicates the 
situation. Many individuals from Asian backgrounds 
may not recognize symptoms of mental health disor-
ders or know how to seek appropriate help. This lack 
of awareness, alongside a preference for traditional 
healing practices and community support over formal 
mental health care, can limit access to and utilization 
of necessary mental health services (Pham et al., 2021). 
While	 these	 traditional	 methods	 can	 be	 beneficial,	
they	 may	 not	 always	 be	 sufficient	 for	 treating	 com-
plex mental health disorders. Yakunina and Weigold 
(2011) explored the interplay between cognitive vari-
ables	 and	 cultural	 factors	 influencing	Asian	 interna-
tional students' intentions to seek counseling. Their 
findings	 indicated	 that	 participants	 who	 endorsed	
more traditional Asian values reported less favorable 
attitudes toward counseling and lower intentions to 
seek	 help.	 This	 result	 highlights	 the	 significant	 im-
pact of cultural values on mental health help-seek-
ing behavior among Asian international students.
 In summary, the neglect of mental health impor-



95

tance	in	Asian	cultures	is	a	complex	issue,	influenced	
by traditional values, societal norms, family dynamics, 
and a lack of mental health awareness. This further 
complicated as Asian international students navi-
gate the acculturation process in their host countries, 
where the clash between these deeply ingrained cul-
tural norms and the new societal context can create 
significant	barriers	 to	 seeking	mental	health	 support.
Acculturation Issues Preventing Help-Seeking
	 Acculturation	 issues	 pose	 significant	 barriers	 for	
Asian international students seeking mental health 
support in the United States. Ma et al. (2020) identi-
fied	that	the	adjustment	to	social	and	cultural	norms	
of the host country often exacerbates existing mental 
health conditions and deters help-seeking due to fears 
of misunderstanding or judgment. This situation is 
compounded	by	 cultural	dissonance,	where	 conflicts	
between students' native cultural beliefs and those 
of the host country led to increased stress and anxi-
ety, a phenomenon Martinez-Taboada (2018) found 
to be prevalent among these students. The challenge 
of navigating between maintaining one’s cultur-
al identity and conforming to a new environment 
adds another layer of complexity to their experiences.
 Furthermore, language barriers, as Lasauskiene 
and Bagdonaviciute (2023) point out, play a crit-
ical role in intensifying feelings of isolation and 
helplessness, particularly among students with lim-
ited	 English	 proficiency.	 This	 difficulty	 in	 commu-
nicating	 emotional	 and	 psychological	 needs	 effec-
tively	 is	 a	 significant	 hurdle.	 Suh	 et	 al.	 (2023)	 add	
to this narrative by emphasizing the impact of per-
ceived discrimination and stereotyping on these stu-
dents' mental health. Such experiences can foster a 
sense of alienation and reluctance to seek help, for 
fear of further marginalization or stigmatization. 
 Navigating the U.S. mental health care system 
presents its own set of challenges, as highlighted by 
Clough et al. (2018). Asian international students may 
be unfamiliar with how mental health services oper-
ate in the U.S. and lack knowledge about available re-
sources,	significantly	deterring	help-seeking.	Ra	(2023)	
discussed the importance of social support networks 
in the acculturation process, noting that a lack of sup-
portive relationships in the host country can lead to 
increased vulnerability and a decreased likelihood of 
seeking mental health services. The accumulation of 
these factors illustrates the complex interplay between 

acculturation stress, systemic barriers, and individual 
challenges in hindering the mental health help-seek-
ing process among Asian international students.
	 The	 findings	 of	 Miller	 et	 al.	 (2011)	 enrich	 our	
understanding of the intricate dynamics between 
acculturation,	 enculturation,	 and	 their	 effects	 on	
mental health and attitudes toward seeking profes-
sional psychological help among Asian international 
students. Their study revealed that higher levels of 
acculturation were linked to improved mental health 
outcomes, while a strong sense of behavioral encul-
turation was positively correlated with mental health. 
	 This	 research	 unearthed	 significant	 differenc-
es in the experiences of foreign-born and U.S.-born 
students, particularly concerning the impact of ac-
culturative stress on mental health. Such distinct 
finding	 underscores	 the	 complex	 challenges	 faced	
by Asian international students in the U.S., not 
only in navigating their mental health concerns but 
also in their attitudes toward seeking help. This 
complexity points to the necessity for a nuanced 
approach to providing culturally sensitive mental 
health services tailored to their unique experiences. 
Study Aims
 Building upon these insights, the present study aims 
to delve deeper into the underexplored terrain of Asian 
international students’ perspectives on mental health 
treatment	in	the	United	States.	Specifically,	it	seeks	to:	
(1) Quantitatively assess the attitudes of Asian inter-
national students towards mental health treatment, ex-
amining factors such as gender, the duration of study 
in the U.S., education level, subjective socioeconomic 
status, and awareness and accessibility to mental health 
treatment options. (2) Propose targeted interventions 
based	on	the	findings,	aimed	at	improving	access	and	
effectiveness	of	mental	health	services	for	Asian	inter-
national students. While related studies in Australia 
(Lamontagne,	 2023;	 Mulder,	 2015;	 Redfern,	 2016)	
have begun to address this topic, the unique experienc-
es of Asian students in the U.S.  remain less explored. 
 Our research is inspired by Xu's (2023) qualitative 
study,	 which	 examined	 the	 factors	 influencing	 Chi-
nese international students' barriers to psychother-
apy	 in	 the	 U.S.	 Interestingly,	 Xu	 identified	 cultural	
differences	 as	 significant	 factors	 affecting	 attitudes	
toward mental health treatment, rather than as bar-
riers. Xu also found that accessibility and knowledge 
about mental health were positively correlated with 

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ASIAN	INTERNATIONAL	STUDENT	MENTAL	HEALTH	HELP-SEEKING

treatment attitudes. As a quantitative extension of this 
work, our study seeks to enhance understanding of the 
factors	 influencing	 the	mental	 health	 treatment	 atti-
tudes of Asian international students more broadly.
	 We	 hypothesize	 that	 several	 factors	 significantly	
influence	 Asian	 international	 students'	 attitudes	 to-
ward seeking mental health treatment. These include 
gender, which may shape help-seeking behaviors due 
to societal norms and expectations prevalent in some 
Asian cultures. The duration of study in the U.S. is 
also	considered	a	crucial	 factor,	as	 it	could	affect	 lev-
els of acculturation and, subsequently, attitudes to-
ward mental health care. Furthermore, the level of 
education	might	 influence	 such	attitudes,	with	high-
er education potentially linked to increased mental 
health awareness. Subjective socioeconomic status 
is	 expected	 to	 play	 a	 role,	 affecting	 both	 the	 afford-
ability	 of	 treatment	 and	 its	 perceived	 value.	 Equally	
important are the awareness of and accessibility to 
mental health treatment options; a lack of these may 
prevent Asian international students from seeking 
the help they need. By identifying these factors and 
understanding	precisely	how	they	 influence	attitudes	
towards mental health treatment, this study aims to 
uncover the nuances of mental health care percep-
tions and identify potential areas for improvement 
in accommodating Asian international students, 
particularly	 for	 whom	 English	 is	 a	 second	 language.
	 Our	findings	are	expected	to	lead	to	the	develop-
ment of culturally sensitive and accessible outreach pro-
grams and interventions tailored to the unique needs of 
Asian international students within college counseling 
settings. The goal is to bridge between these students 
and the mental health services available to them, en-
suring that interventions are designed with an accurate 
awareness of the challenges they face. By customizing 
outreach	efforts	and	services	to	address	the	identified	
factors, we aim to foster more positive attitudes toward 
mental health treatment among Asian international 
students. Ultimately, this study seeks to enhance the 
overall mental health and well-being of this student 
population in the United States, contributing to a 
more inclusive and supportive academic environment. 

Methods
 This study focused on participants who met in-
clusion criteria. They had to be 18 years of age or 
older, enrolled full-time in a U.S. educational insti-

tution	 as	 international	 students,	 and	 self-identified	
as	 ethnically	Asian.	There	were	no	 specific	 exclusion	
criteria. Participants were recruited from a selection 
of one hundred universities across the U.S., which 
were randomly chosen from a comprehensive list of 
U.S. institutions. Our research team approached the 
International	 Student	Office	of	 each	 selected	univer-
sity via email to request permission to disseminate 
the recruitment email through their international 
student listservs. Upon receiving consent from the 
International	 Students	 Office,	 we	 distributed	 a	 re-
cruitment email to the listservs. This email included 
a brief overview of the study and a link to the on-
line	 survey,	which	was	also	accessible	via	a	QR	code.	
 Interested participants, upon accessing the sur-
vey, encountered a series of self-report question-
naires. These questionnaires were designed to gather 
socio-demographic data, including gender, age, and 
subjective socio-economic status. Additionally, the 
survey included the Attitudes Toward Seeking Pro-
fessional	 Psychological	Help	 (ATSPPH)	 and	 specific	
items to assess participants' awareness and accessi-
bility of mental health treatment options. To gain 
a comprehensive understanding of the participants' 
mental health context, the survey also inquired 
about any existing mental health diagnoses and pre-
vious experiences with mental health treatment. 
 The study was conducted under the supervision 
of	a	university’s	Institutional	Review	Board	to	ensure	
ethical compliance. All participants were informed 
that they could withdraw from the study at any time 
without any penalty, ensuring their autonomy and 
respect for their decision-making. Additionally, data 
protection measures were implemented, with all sur-
vey responses stored in a password-protected electron-
ic	format	on	Qualtrics,	and	personal	identifiers	such	as	
IP addresses were not collected. This approach guaran-
tees	that	participants'	confidentiality	is	maintained,	and	
their contributions are securely managed, fostering an 
environment of ethical integrity in the research process.
 A self-administered online questionnaire was de-
veloped via Qualtrics, encompassing two sections. The 
first	 section	 solicited	 sociodemographic	 information,	
including age, gender, ethnicity, nationality, and family 
income. Additionally, it comprised queries concerning 
the participants' current visa status, their educational 
institution's location, their year in college, their major, 
the number of years they have spent in the U.S., and 



97

any previous experiences with mental health treatment. 
A copy of this measure can be found in Appendix A.
 The questionnaire's second portion included 
items designed to elicit students' attitudes toward men-
tal illness and treatment, utilizing Fischer and Turner's 
Attitudes Toward Seeking Professional Psychological 
Help (ATSPPH) scale from 1970. This is a 29-item 
measure	 comprised	 of	 four	 factors:	 recognition	 of	
the need for professional psychological help, stigma 
tolerance associated with psychological help, interper-
sonal	openness	about	one's	problems,	and	confidence	
in mental health professionals. This scale is frequent-
ly used in the U.S. to examine help-seeking attitudes 
among diverse racial and ethnic groups, immigrants, 
and	international	students.	Sample	statements	include:	
"I would want to see a counselor if I was worried or 
upset for a long period of time" and "There are experi-
ences in my life I would not discuss with anyone." Par-
ticipants rated these statements on a four-point Likert 
scale, ranging from "Strongly Agree" to "Strongly Dis-
agree." The scoring was such that "Strongly Agree" 
responses were assigned three points, while "Strongly 
Disagree" responses received one point. The total score 
for each participant was calculated by summing the 
points	 of	 each	 item's	 response.	 Eighteen	 items	 were	
reverse-coded, with a higher score signifying a more 
positive attitude toward mental health treatment.
 The ATSPPH has demonstrated internal con-
sistency,	with	 coefficients	 ranging	 from	 0.82	 to	 0.84	
(Elhaiet	al.,	2008).	Its	reliability	and	validity	have	been	
established in several studies; for instance, Fischer and 
Farina (1970) reported high internal consistency reli-
ability	coefficients	(Cronbach's	alpha)	ranging	from	.82	
to .93 across various samples. Vogel et al. (2006) found 
good 1-month test-retest (.80) and internal consistency 
(.84) reliabilities for the ATSPPH, as it correlated sig-
nificantly	with	measures	of	mental	health	stigma	and	
help-seeking behavior. Furthermore, the application of 
the ATSPPH in diverse research settings underscores 
its versatility and relevance in exploring attitudes to-
ward mental health. By employing this validated scale, 
researchers can draw insights into the complex dynam-
ics of stigma, cultural variability, and educational im-
pacts on mental health behaviors (McAndrew et al., 
2019; Park et al., 2018; Vogel et al., 2013). The deci-
sion to utilize the ATSPPH in this research is ground-
ed in its proven capacity to provide reliable and valid 
measures	 across	 different	 populations	 and	 settings.	

This	choice	reflects	a	methodological	commitment	to	
employing tools that not only have strong psychomet-
ric	properties,	but	also	offer	the	potential	to	contrib-
ute	 significantly	 to	our	understanding	of	 key	 factors	
influencing	 mental	 health	 help-seeking	 behaviors.
	 The	questionnaire's	final	 section	 aimed	 to	 ascer-
tain students' familiarity with counseling or psycho-
therapy treatment options. The items in this section 
were divided into two key areas, encompassing four 
items on awareness and three items on accessibility. 
Sample	statements	included:	"I	am	aware	of	the	mental	
health services available for students on campus" and "I 
can access mental health services when needed." Partic-
ipants rating these statements as "Strongly Agree" were 
assigned four points, while "Strongly Disagree" re-
sponses were given one point. The total score for each 
participant was calculated by summing the points of 
each item's response. A higher score indicated greater 
awareness and accessibility to mental health treatment 
options.	Given	the	lack	of	a	validated	scale	specifical-
ly designed to assess the awareness and accessibility of 
mental health resources in a university setting, we de-
veloped our own concise survey. This decision ensured 
our inquiry precisely targeted our research objectives, 
examining the nuances of students' awareness and ac-
cess to mental health support within their academic en-
vironments. This bespoke approach aligns closely with 
our research methodology, ensuring that we captured 
the	specific	aspects	of	mental	health	resource	accessi-
bility and awareness among university students, there-
by enhancing the study's relevance and accuracy. This 
measure's full version can be found in Appendix B.
 To evaluate the internal consistency reliability, 
Cronbach’s alphas were calculated. We compared 
ATSPPH scores and awareness and accessibility 
scores according to participants’ characteristics using 
an independent t-test or one-way analysis of variance 
(ANOVA). SPSS Statistics 28 (IBM Corp., Armonk, 
NY) was used to perform all statistical analyses, 
chosen for its widespread acceptance and reliability 
within the psychological research community. This 
software is particularly favored for its comprehensive 
set of tools that facilitate a broad range of statistical 
tests, including those employed in our study, thereby 
ensuring	accuracy	and	efficiency	in	our	data	analysis.	
A	 p-value	 less	 than	 .05	 was	 considered	 significant.

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98

Results
 Of the 208 survey responses collected, 47 records 
were excluded since they did not satisfy the criteria for 
international students. Additionally, three responses 
were removed because they did not identify as Asian. 
Furthermore, 37 participants discontinued the sur-
vey after providing demographic information, and 
five	participants	bypassed	more	than	eight	questions.	
These instances were regarded as invalid responses 
and were consequently excluded from the analysis.
 After eliminating invalid responses, a total of 
116 participants provided valid data for the analy-
sis. The majority (85.3%, n=99) were aged between 
18 and 26 years old, including 43.1% (n=50) in the 
18-22 age group and 42.2% (n=49) in the 23-26 age 
group. Meanwhile, 14.7% (n=17) were over 27 years 
old, with 9.5% (n=11) in the 27-30 age group and 
5.2% (n=6) aged 30 or above, indicating their educa-
tional level. Approximately 51.7% (n=60) of partici-
pants were enrolled in graduate schools, slightly more 
than the 44.8% (n=52) who were college students.
 In terms of ethnicity, 91.4% (n=106)	identified	as	
Chinese, 2% (n=4) as Vietnamese, 2% (n=4) as South 
Korean, 1% (n=1) as Pakistani, while the rest did not 
specify their ethnicity. Of the participants, 69.8% 
(n=81)	 identified	 as	 female,	 25%	 (n=29) as male, 
and 5.2% (n=6) as nonbinary or preferred not to dis-
close their gender. Geographically, 44.8% (n=52) of 
participants were studying in New York State, with 
another 12.9% (n=15) in California. The top three 
majors were Psychology (30.2%), Business Manage-
ment,	 Marketing,	 and	 Related	 Support	 (12.1%),	
and	 Education	 (9.5%),	 covering	 18	major	 categories.
	 Regarding	 mental	 health	 history,	 36.2%	 (n=42) 
reported prior mental health treatment, 18.1% (n=21) 
had a previous diagnosis of a mental disorder, and 
12.1% (n=14) reported receiving ongoing mental 
health treatment. The study participants rated their 
subjective	socioeconomic	status	(SES)	on	a	scale	of	1	
to 10, where 10 represented the highest status with 
the most wealth, education, and prestigious jobs, and 
1 represented the lowest status with the least wealth, 
education, and low-paying jobs or unemployment. On 
average,	participants	rated	their	subjective	SES	at	6.35,	
with a standard deviation of 1.41, and a mode of 7.
 Table 2 presents the ATSPPH scores based on 
the participants' characteristics. One-way ANOVA 
suggested	 no	 significant	 difference	 was	 found	 be-

tween the mean ATSPPH scores of females, males, 
and the nonbinary/prefer not to say gender group 
(1.96 vs. 1.85 vs. 1.70, p=.31).	 However,	 a	 signifi-
cant correlation was observed between educational 
level	 and	 ATSPPH	 scores.	 Specifically,	 an	 indepen-
dent t-test suggested that participants enrolled in 
graduate	 school	 exhibited	 significantly	 higher	 mean	
ATSPPH scores compared to their undergraduate 
counterparts respectively (2.01 vs. 1.82, p=.004).
 Moreover, the analysis, conducted using one-way 
ANOVA,	 revealed	 a	 significant	 correlation	 between	
age groups and ATSPPH scores (p=.036). Partici-
pants aged 30 and above reported the highest mean 
ATSPPH score of 2.14, with a standard error of the 
mean	 (SEM)	 of	 .16,	 suggesting	 a	more	 positive	 atti-
tude towards mental health treatment. This was fol-
lowed by the 23-26 age group, which had a mean score 
of	 2.02	 and	 an	 SEM	of	 .04.	Notably,	 the	 18-22	 and	
27-30 age groups displayed comparable mean scores 
of	1.84,	with	SEMs	of	.06	and	.12,	respectively.	These	
findings	 further	 emphasize	 the	 potential	 influence	
of age on attitudes towards mental health treatment.
 Although the independent t-test results were 
not	 statistically	 significant,	 participants	 with	 a	 his-
tory of mental health treatment, either past or 
current, exhibited slightly higher mean ATSPPH 
scores compared to those without such histo-
ry (2.00 vs. 1.88, p=.077). This observation war-
rants further investigation in future studies.
 Table 3 showcases the item-total correlations and 
Cronbach's alpha values related to the awareness and 
accessibility of mental health treatment. The Cron-
bach's alpha for this entire section was found to be .903, 
indicating high internal consistency within the section.
 Table 4 illustrates the two-tailed Pearson cor-
relation associations between socio-demographic 
characteristics and ATSPPH scores. Univariate anal-
yses	revealed	significant	positive	associations	between	
family income (r=.243, p=.009) and years spent in 
the US (r=.245, p=.008) with ATSPPH scores. Fur-
thermore, the table presents the Pearson correlation 
between socio-demographic factors and ATSPPH 
scores, as well as between the awareness and acces-
sibility of mental health treatment. Notably, the 
number of years spent in the US (r=.230, p=.014) 
showed	 a	 significant	 positive	 association	with	 aware-
ness. Additionally, both awareness (r=.331, p<.001) 
and accessibility (r=.234, p=.012) displayed signif-



99

icant positive correlations with ATSPPH scores. 
Moreover,	 awareness	 was	 significantly	 and	 positively	
associated with accessibility scores (r=.826, p<.001).

Discussion
	 Our	 findings	 suggest	 that	 certain	 factors,	 in-
cluding higher family income, longer duration spent 
in the US, enhanced awareness of mental health 
treatment, and improved accessibility to mental 
health services, are associated with more positive 
attitudes towards seeking professional psycho-
logical help among Asian international students.
Redefining Gender Norms 
	 The	 findings	 of	 the	 current	 study	 indicate	 that	
gender	 does	 not	 significantly	 influence	 the	 attitudes	
of Asian international students toward seeking psy-
chological help, with female, male, and nonbinary 
or	 unspecified	 gender	 groups	 exhibiting	 similar	 ten-
dencies regarding mental health treatment. This ob-
servation contracts traditional views within Asian 
cultures, which often depict men as stoic and deci-
sive, burdened with greater social expectations and 
responsibilities (Kramer, 2002). Such gender norms 
have been linked to social stigma, potentially inform-
ing negative attitudes among men toward mental 
health treatment (Chatmon, 2020; Livingston, 2018). 
However, our results indicate a departure from these 
conventional beliefs, especially among the younger 
generation of Asian international students. Zhang and 
Hui (2021) provide corroborating evidence, suggest-
ing that exposure to Western norms among Asian in-
ternational	students	might	attenuate	the	influence	of	
traditional gender roles on their help-seeking behavior.
 Contemporary research emphasizes the role that 
educational settings play in transforming beliefs and 
attitudes. Scholz et al. (2016) assert that environments 
fostering gender equality and mental health aware-
ness can lessen the impact of deep-seated cultural 
stereotypes	 on	 help-seeking	 behavior.	 This	 finding	
is supported by Tse and Haslam (2021), who found 
that Asian international students are likely to adopt 
help-seeking behaviors within supportive and inclu-
sive academic communities, irrespective of gender. 
In addition, advancements in mental health advocacy 
and the proliferation of information through digital 
media have likely contributed to this trend. Both Nie-
derkrotenthaler et al. (2014) and Kim (2022) stress the 
role of online platforms and media in normalizing dis-

cussions around mental health, potentially narrowing 
the gender gap in attitudes toward seeking assistance.
	 Given	 these	 findings,	 it	 seems	 that	 the	 young-
er, globally-minded Asian international students are 
embracing more progressive views on mental health, 
consistent with the inclusive attitudes prevalent in 
their host nations. This shift implies that while con-
ventional cultural expectations might continue, they 
are	being	 reshaped	by	 the	 combined	effects	of	 accul-
turation,	 the	 influence	 of	 educational	 environments,	
and the worldwide discourse on mental health. 
 However, it is important to point out that the 
gender imbalance in the study sample, with a higher 
number of female participants, may suggest inherent 
differences	 in	help-seeking	attitudes	between	genders	
among Asian international students. This imbalance 
could indicate that female students are more willing 
or able to participate in studies about mental health, 
reflecting	 a	 broader	 openness	 towards	 seeking	 help	
or discussing mental health issues. For the study's 
results, this means conclusions drawn about gender 
effects	on	help-seeking	attitudes	might	not	 fully	 rep-
resent the male and nonbinary perspectives, poten-
tially skewing the perceived shift towards more pro-
gressive views on mental health. Further research with 
balanced and diverse gender representation is crucial 
to accurately assess these attitudes and their implica-
tions in the context of cultural and acculturation in-
fluences	 on	Asian	 international	 students	 in	 the	U.S.
Influence of Education on Mental Health Help-  
Seeking
	 Our	results	reveal	differences	in	the	willingness	to	
seek mental health assistance across various education-
al levels, reinforcing the well-established correlation 
between higher educational attainment and more pro-
active attitudes toward seeking mental health support 
(Eisenberg	 et	 al.,	 2007;	 Eisenberg	 et	 al.,	 2013;	 Jorm,	
2004;		Wong	et	al.,	2017).	Specifically,	our	data	indicate	
that individuals engaged in graduate school education 
are more likely to hold and express favorable attitudes 
toward utilizing mental health services. This tendency 
is likely due to the increased exposure to mental health 
discussions that higher education provides, fostering 
comfort in seeking help (Farley, 2023). Institutional 
initiatives, such as university-led mental health aware-
ness campaigns and accessible counseling services, 
create an environment that normalizes help-seeking 
behavior (Pace et al., 2016). The academically stimulat-

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ASIAN	INTERNATIONAL	STUDENT	MENTAL	HEALTH	HELP-SEEKING

ing environment of higher education, which promotes 
critical	 thinking	 and	 self-reflection,	 may	 heighten	
students' awareness of their mental health needs, and 
encourage proactive help-seeking (Liu et al., 2021).
 Furthermore, in a 2021 report by The National 
Academies	of	Sciences,	Engineering,	and	Medicine	ti-
tled “Mental Health, Substance Use, and Wellbeing in 
Higher	 Education:	 Supporting	 the	Whole	 Student,”	
the importance of integrating topics of psychological 
well-being and mental health literacy into the curricu-
lum and classes within higher education institutions is 
emphasized, further strengthening students' attitudes 
towards mental health services. The impact of this ed-
ucation is particularly pronounced among Asian in-
ternational students, who may originate from cultures 
where open discussions about mental health are less 
prevalent (Dessauvagie et al., 2022). The study result 
underscores	the	significant	role	that	educational	envi-
ronments play in shaping the mental health-seeking 
behaviors	of	students,	with	a	notable	effect	on	Asian	
international students who may face cultural barriers 
to acknowledging and addressing mental health issues.
 While it has been observed that higher education 
levels correlate with positive attitudes toward mental 
health, and a longer stay in the U.S. enhances men-
tal health awareness among Asian international stu-
dents, the relationship between these two factors is 
complex. It is not straightforward to link prolonged 
U.S. residency with higher education levels due to 
varied arrival times in the U.S. for education. For ex-
ample, an individual who came to the U.S. solely for 
a	Ph.D.	program	might	have	a	five-year	 stay,	whereas	
another person who arrived during middle school 
and only completed a bachelor's degree could have 
resided in the U.S. for a longer duration. Since de-
tailed data on the duration of stay relative to educa-
tional	 attainment	 is	 not	 available,	 making	 definitive	
assumptions about their relationship is challenging. 
Future research could explore how the length of stay 
and educational level together impact mental health 
awareness, considering the diverse educational path-
ways of Asian international students in the U.S.
Wealth and Wellness
	 Our	 study	 uncovered	 a	 significant	 positive	 as-
sociation between family income and Attitudes 
Toward Seeking Professional Psychological Help 
(ATSPPH) scores. Students from higher-income 
families showed more positive attitudes toward seek-

ing mental health treatment. This observation aligns 
with	 existing	 research	 suggesting	 that	 financial	 ca-
pabilities often improve access to mental health care 
services (Cummings et al., 2013). Families with high-
er	 incomes	 not	 only	 have	 the	 financial	 resources	 to	
afford	 mental	 health	 treatment,	 but	 their	 children	
are also more likely to receive a higher level of educa-
tion. This educational advantage typically fosters a 
more informed and proactive attitude towards men-
tal health help-seeking (Mackinnon et al., 2010).
 The correlation between family income and at-
titudes towards mental health can be attributed to 
broader socio-economic factors that shape an individ-
ual's access to healthcare and information. According 
to a longitudinal survey study by Bialowolski (2021), 
economic stability often correlates with improved 
mental health literacy, a critical factor in recognizing 
mental health issues and seeking appropriate help. 
Additionally,	the	financial	security	provided	by	high-
er-income families may reduce the stress and anxiety 
associated	with	financial	constraints,	which	are	known	
barriers to mental well-being (Knapp & Wong, 2020). 
Ryu	 and	 Fan	 (2023)	 found	 that	 financial	 stress	 sig-
nificantly	impacts	students'	mental	health,	indicating	
that higher family income can indirectly contribute 
to better mental health by alleviating such stressors.
	 Furthermore,	 students	 from	 affluent	 families	
might have earlier and more frequent exposure to 
mental health discussions and treatments, either 
through their family network or community, nor-
malizing the concept of seeking help for mental 
health issues. Cultural perceptions within one’s im-
mediate	 social	 circle,	 including	 family,	 significantly	
influence	 attitudes	 towards	 mental	 health	 services	
(Aarons & Sawitzky, 2006; Turner et al., 2015).
 In summary, family income emerges as a piv-
otal factor in shaping attitudes towards men-
tal health treatment among Asian interna-
tional students. This underscores the need for 
comprehensive mental health strategies that consid-
er the socio-economic backgrounds of students to 
ensure equitable access to mental health resources.
Acculturation and Mental Health Attitudes
 Our results indicate that a prolonged stay in the 
U.S. leads to increased mental health awareness among 
Asian international students. This increase is not 
merely a byproduct of time, but is intricately linked 
to	 the	 influence	 of	 the	 American	 education	 system,	



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which prioritizes mental health education and sup-
port.	 U.S.	 educational	 institutions	 proactively	 offer	
resources aimed at student well-being, ranging from 
admission orientations that introduce mental health 
topics to ongoing support services. Such consistent 
exposure not only deepens students' understanding 
of mental health issues but also cultivates a proactive 
attitude	towards	seeking	help	(Eisenberg	et	al.,	2009).
 Acculturation plays a pivotal role in this dynam-
ic, serving as a bridge between mere exposure and ac-
tive integration of healthier attitudes toward mental 
health. Over time, Asian international students assim-
ilate	not	just	superficial	elements	of	American	culture	
but	also	its	progressive	stances	on	mental	health.	Re-
search by Knaifel et al. (2022) found that increased 
acculturation correlates with decreased stigma around 
mental health, thereby facilitating help-seeking be-
haviors. The social networks that students develop 
over	time	in	the	U.S.	can	also	influence	their	attitudes	
toward mental health. Peer interactions, especial-
ly with students who embody more liberal views on 
mental health, serve as a catalyst for changing percep-
tions and reducing the stigma associated with seeking 
psychological help (Makhmud et al., 2022; Sun et 
al., 2022). Moreover, increased familiarity with the 
U.S. healthcare system over time can reduce barriers 
to accessing mental health services. As students be-
come more knowledgeable about available resourc-
es and how to navigate the system, their willingness 
to seek help may increase (Alqassim et al., 2022).
 The observed changes suggest that cultural com-
petence in mental health strategies is not just ben-
eficial,	 but	 essential.	 The	 process	 through	 which	
students' attitudes toward mental health evolve 
highlights the critical need for culturally sensitive ap-
proaches to mental health support. It points to the 
necessity of designing mental health interventions 
and resources that are not only accessible, but also 
resonate with the diverse cultural backgrounds of in-
ternational students. This perspective encourages a 
more nuanced understanding of how cultural factors 
influence	 mental	 health	 awareness	 and	 help-seeking	
behaviors. By fostering an environment that values 
cultural competence, educational institutions can 
play a transformative role in supporting the mental 
well-being of international students, making a case 
for the integration of cultural sensitivity into all levels 
of mental health strategy and intervention planning.

 We recognize that the predominance of Chinese 
international students in our sample presents a limita-
tion that may not fully encapsulate the diverse experi-
ences and attitudes toward mental health found across 
different	Asian	cultures.	This	sampling	bias	indeed	re-
stricts	our	ability	to	generalize	our	findings	to	all	Asian	
international students. However, it also provides a 
unique	opportunity	to	reflect	on	the	differences	with-
in Asian cultures, especially concerning mental health 
perspectives. For instance, cultural attitudes toward 
mental	health	in	Chinese	society,	which	are	often	influ-
enced by Confucian values emphasizing stoicism and 
familial	harmony,	might	differ	significantly	from	those	
in other Asian cultures where religion and individu-
alism play a more substantial role (Tung & Li, 2014). 
 While our study's limited sample size of partici-
pants from other ethnicities constrains the statistical 
power to make broad comparisons, preliminary ob-
servations suggest that Chinese international students 
may exhibit particular coping strategies, stigma per-
ceptions, and help-seeking behaviors that are shaped 
by their cultural background (Chen et al., 2020). The 
influence	of	collectivist	values	in	Chinese	culture	may	
lead to a greater emphasis on maintaining social har-
mony	and	face,	potentially	affecting	students'	willing-
ness to seek mental health support (Gao et al., 2022). 
In contrast, students from South Asian cultures, where 
there	 is	 a	 different	 interplay	 between	 individualism	
and collectivism, or from Southeast Asian countries, 
where community support systems and religious be-
liefs	might	offer	alternative	coping	mechanisms,	could	
exhibit distinct attitudes and behaviors towards mental 
health challenges (Kim & Lee, 2022; Singal & Chopra, 
2023). Given these considerations, it becomes evident 
that future research must strive for a more diverse rep-
resentation of Asian international students to explore 
the	 intricate	ways	 in	which	cultural	 factors	 influence	
mental health perceptions and help-seeking behaviors.
 In summary, the duration of stay in the U.S. is a 
significant	 factor	 in	developing	mental	health	 aware-
ness among Asian international students. This rela-
tionship underscores the need for educational insti-
tutions to continuously engage with international 
students throughout their educational journey, foster-
ing an environment conducive to mental health aware-
ness and help-seeking. However, it is essential to em-
pirically	 validate	which	 specific	 elements	 of	 the	U.S.	
education	system	contribute	most	significantly	to	this	



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ASIAN	INTERNATIONAL	STUDENT	MENTAL	HEALTH	HELP-SEEKING

heightened awareness. Future research should aim to 
dissect these aspects to better understand and enhance 
the support systems available to international students.
Navigating Mental Health Pathways
 Our study revealed that heightened awareness 
and accessibility to mental health services are crucial 
in shaping positive attitudes toward mental health 
treatment among Asian international students. 
Specifically,	 students	 who	 are	 well-informed	 about	
available mental health resources, possess the ability 
to	 effectively	 navigate	 these	 resources,	 and	 have	 un-
obstructed access to services, tend to exhibit more 
favorable attitudes toward seeking mental health 
treatment. This correlation underscores the vital role 
that educational institutions play in providing com-
prehensive mental health education and ensuring the 
availability of robust support systems (Lipson, 2014).
 Awareness and accessibility are interconnect-
ed	 factors	 that	 significantly	 influence	 mental	 health	
outcomes. A study by Shim et al. (2022) highlighted 
that knowledge about mental health issues and fa-
miliarity	with	 treatment	options	 can	 significantly	 re-
duce the stigma associated with seeking help. When 
institutions	make	a	concerted	effort	 to	provide	easily	
accessible mental health services, they normalize the 
process of seeking help, thereby encouraging students 
to take proactive steps toward their mental health. 
The unique challenges faced by Asian international 
students, such as cultural barriers and unfamiliar-
ity with the host country's healthcare system, fur-
ther accentuate the need for targeted mental health 
initiatives. Martirosyan et al. (2019) suggested that 
tailored	 programs	 that	 address	 the	 specific	 needs	 of	
international	 students	 can	 effectively	 increase	 their	
awareness and utilization of mental health services.
 Another critical aspect is the use of technol-
ogy in improving accessibility. Digital platforms 
and	 telehealth	 services	 have	 been	 identified	 as	 effec-
tive means to overcome geographical and logistical 
barriers, providing students with easier access to 
mental health care (Bulkes et al., 2022; McBain et 
al.,	 2023).	 This	 approach	 is	 particularly	 beneficial	
for international students who may face language 
barriers or have limited transportation options.
 In conclusion, our study highlights the sig-
nificance	 of	 awareness	 and	 accessibility	 in	 fos-
tering positive attitudes toward mental health 
treatment among Asian international students. 

Educational	 institutions	 play	 a	 crucial	 role	 in	 en-
hancing these factors through strategic initiatives 
and resource allocation, ultimately contributing to 
the mental well-being of this student population.
Conclusion
 The current study elucidates the multifaceted fac-
tors shaping Asian international students' attitudes 
toward seeking professional psychological help in the 
U.S.	 It	 reveals	 not	 only	 the	 significance	 of	 socioeco-
nomic status, duration of stay, gender norms, educa-
tional attainment, and acculturation but also under-
scores the paramount importance of mental health 
awareness	and	accessibility.	Our	findings	demonstrate	
a progressive shift away from traditional gender norms, 
reflecting	a	broader	cultural	adaptation	among	Asian	
international	students	influenced	by	supportive	educa-
tional environments and acculturation processes. The 
positive correlation between socioeconomic status and 
attitudes towards mental health help-seeking high-
lights it as a critical factor in access to mental health care. 
 Moreover, the study brings to light how height-
ened awareness and unimpeded accessibility to mental 
health services are indispensable in cultivating positive 
attitudes toward mental health treatment. Students 
who are well-informed about and able to navigate 
mental	health	resources	effectively	show	a	greater	pro-
pensity to seek professional help. This emphasizes the 
critical role of educational institutions in promoting 
mental health literacy and ensuring the availability of 
comprehensive	support	systems.	These	findings	advo-
cate for a departure from traditional cultural norms 
and underscore the necessity of implementing sup-
portive, inclusive, and culturally competent mental 
health strategies within both educational and health-
care settings. As we pivot to the clinical and research 
implications of our study, it becomes crucial to lever-
age these insights in devising targeted interventions 
that address the unique needs of Asian international 
students. This approach necessitates a nuanced un-
derstanding of how cultural, socioeconomic, edu-
cational,	 and	 systemic	 factors	 converge	 to	 influence	
mental health help-seeking behaviors, aiming to foster 
environments that enhance mental health awareness 
and ensure equitable access to mental health services.
Clinical and Research Implications
	 Drawing	 upon	 our	 study's	 findings,	 we	 recom-
mend that university counseling centers and therapists 
who work with Asian international students imple-



103

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ment outreach programs aimed at boosting mental 
health awareness through comprehensive, culturally 
sensitive	 education	 and	 resources.	 Emphasizing	 the	
significance	of	mental	well-being	and	reducing	stigma	
around seeking help is pivotal, with initiatives poten-
tially encompassing orientation programs, workshops, 
informational materials, and online resources, as ad-
vocated	by	Reavley	et	al.	 (2012).	To	meet	the	diverse	
needs	 of	 this	 demographic	 effectively,	 it	 is	 essential	
to	 tailor	 services	 by	 offering	 varied	 workshops	 or	
support groups and collaborating with departments 
such as International Student Services to develop a 
unified	 support	 strategy,	 as	 echoed	 by	 Pedersen	 and	
Pave	 (2014).	Enhancing	 services’	 accessibility	 and	 af-
fordability,	 addressing	 financial	 constraints	 through	
information	on	insurance	and	financial	aid,	and	sim-
plifying the access process is critical to overcoming bar-
riers to care, as noted by Komiya et al. (2000). More-
over, partnering with student organizations can lead 
to more targeted, culturally attuned programming, 
enhancing	 the	 effectiveness	 of	 mental	 health	 educa-
tion for Asian international students. This holistic 
approach, integrating varied services and collabora-
tive	efforts,	promises	a	more	supportive	and	inclusive	
environment conducive to their mental health needs. 
	 To	address	these	challenges	effectively,	we	propose	
the	following	detailed	action	plans	and	strategies:
Step 1: Developing Culturally Informed 
Outreach Programs
 Assessment of Needs. Conduct surveys and 
focus groups with Asian international students to 
understand	 their	 specific	 mental	 health	 concerns,	
preferences for receiving information, and barriers to 
accessing services.
 Program Design. Based on the assessment, de-
sign outreach programs that incorporate culturally 
sensitive materials and resources. These should address 
common mental health issues, debunk myths and stig-
ma associated with seeking help, and highlight the im-
portance of mental wellness.
 Implementation. Launch the programs through 
various channels, including orientation sessions for 
new students, workshops throughout the academic 
year, and online platforms that provide 24/7 access to 
resources.
Step 2: Tailoring Services to Diverse Needs
 Service Diversification. Expand	 the	 range	 of	
services to include not only traditional one-on-one 

counseling, but also support groups, workshops, and 
seminars that focus on issues pertinent to Asian inter-
national students.
 Language and Cultural Competency. Ensure	
that	counseling	staff	are	trained	in	cultural	competen-
cy and, where possible, provide services in multiple 
languages	or	offer	interpreter	services	to	mitigate	lan-
guage barriers.
 Feedback Mechanism. Establish	 a	 system	 for	
collecting feedback on the services provided, enabling 
continuous improvement and adaptation to student 
needs.
Step 3: Enhancing Accessibility and Affordabili-
ty of Mental Health Services
 Financial Support Information. Clearly com-
municate information about the cost of services, in-
surance	coverage,	and	financial	aid	options	for	mental	
health care, including partnerships with community 
providers	for	affordable	treatment	options.
 Simplified Access. Streamline the appointment 
scheduling process and reduce wait times by leveraging 
technology	 for	 booking	 sessions	 and	 offering	 virtual	
counseling options.
 Community Provider Partnerships. Develop 
partnerships with local mental health providers to of-
fer extended services to students, ensuring continuity 
of care for those requiring long-term support.
Step 4: Collaborating with Campus and Student 
Organizations
 Partnership Development. Foster collabora-
tions with campus departments, such as international 
student	services	and	diversity	and	inclusion	offices,	to	
create	a	unified	approach	to	supporting	Asian	interna-
tional students' mental health.
 Student Organization Engagement. Active-
ly work with student organizations, including any 
Asian student organizations and international student 
groups, to co-host events, provide culturally relevant 
programming, and facilitate peer support networks.
Step 5: Integrating Culturally Informed
 Practices
 Training for Counselors and Staff. Implement 
ongoing training programs on cultural competence, 
focusing on the unique challenges faced by Asian in-
ternational students, including those with advanced 
degrees	and	other	specific	groups.
 Incorporation of Cultural Practices.	 Explore	
the integration of traditional Asian mental health 



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ASIAN	INTERNATIONAL	STUDENT	MENTAL	HEALTH	HELP-SEEKING

practices and perspectives into counseling services, of-
fering	a	blend	of	Western	and	Eastern	approaches	 to	
treatment.
 By systematically implementing these strategies, 
university	counseling	centers	can	significantly	improve	
the mental health support system for Asian interna-
tional students, fostering a more inclusive, supportive, 
and culturally sensitive environment. This tailored ap-
proach	not	only	aligns	with	our	study's	findings,	but	also	
sets a foundation for future research and continuous 
improvement in the delivery of mental health resources. 
	 To	 ensure	 these	 interventions	 remain	 effective	
and responsive, it is crucial to establish mechanisms 
for	 ongoing	 evaluation	 and	 improvement.	 Regu-
lar	 feedback	 collection	 from	 students,	 staff	 training	
updates based on the latest research, and continu-
ous assessment of program outcomes are essential. 
Incorporating a cycle of evaluation, feedback, and 
refinement	 will	 enable	 counseling	 centers	 to	 adapt	
their strategies to meet the evolving needs of Asian 
international students, demonstrating a commit-
ment to providing the highest level of mental health 
support. This proactive stance towards constant 
enhancement ensures that mental health initiatives 
remain aligned with student needs, cultural shifts, 
and advancements in psychological research, thereby 
sustaining	 a	 dynamic	 and	 effective	 support	 system.
Strengths and Limitations
 Several limitations may impact the generaliz-
ability	 of	 the	 findings	 from	 this	 study,	 necessitating	
caution when extending these results beyond the 
sampled population. Primarily, the recruitment of 
participants	 was	 confined	 to	 a	 limited	 number	 of	
universities, predominantly located in New York and 
California. Given the unique sociocultural and edu-
cational environments of these states, the relatively 
large percentage of the sample drawn from these lo-
cations may introduce a selection bias, limiting the 
representativeness of the study. This geographic con-
centration may not fully capture the varied experienc-
es and perspectives of Asian international students 
across	the	U.S.,	making	it	prudent	to	apply	these	find-
ings to other regions or demographics with caution.
 The overrepresentation of Chinese internation-
al students within our sample poses another signif-
icant limitation. While providing variable insights 
into this subgroup, it might not accurately portray 
the attitudes and experiences of students from other 

Asian countries, potentially skewing the results to-
wards the perspectives prevalent within Chinese stu-
dent communities. This disproportionate representa-
tion underscores the need for a more diverse sample 
that includes a wider array of nationalities, to ensure 
a more comprehensive understanding of the men-
tal health attitudes of Asian international students. 
 Moreover, the cross-sectional nature of this study 
limits the ability to infer causality or track changes 
in attitudes over time. The reliance on a survey that, 
while informative, may not have undergone extensive 
validation or been widely used in previous research to 
assess mental health awareness and accessibility among 
Asian international students, presents a limitation in 
accurately	 gauging	 the	 effectiveness	 of	 existing	 sup-
port structures. The use of a non-validated survey 
can introduce biases or inaccuracies in measuring 
the intended constructs, limiting the reliability and 
generalizability of the results. Potential confounding 
variables, such as the participants' prior exposure to 
mental health education, variations in cultural back-
ground, and personal experiences with mental health 
services, were not fully controlled in our method. 
These	 factors	 could	 influence	participants'	 responses	
and interpretations of the survey questions, thereby 
affecting	the	study's	overall	conclusions.	Longitudinal	
studies would be required to understand the evolution 
of mental health attitudes and behaviors as students 
adapt to their host country's culture and education 
system. Such an approach would also allow for the ex-
amination of how prolonged exposure to the U.S. ed-
ucation system and its mental health resources impacts 
students from various Asian backgrounds over time. 
 By acknowledging these limitations, we empha-
size the need for caution in generalizing the study's 
findings	 beyond	 the	 specific	 universities	 or	 states	
in our sample, or the predominant representation 
of Chinese students. This acknowledgment is cru-
cial for readers to understand the study's contextu-
al limitations, ensuring a nuanced interpretation of 
the results. Future research should aim to employ 
more robust sampling methods to ensure a broader 
and more representative sample of Asian interna-
tional students from multiple states and countries. 
	 Implementing	stratified	or	random	sampling	tech-
niques could help mitigate some of the biases inher-
ent in convenience sampling. Additionally, expand-
ing the geographic scope of the study and including 



105

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ing the geographic scope of the study and including 
longitudinal elements could provide a richer, more 
nuanced understanding of the mental health atti-
tudes and needs of this diverse student population. 
Incorporating qualitative research methods such as 
focus	 groups	 or	 interviews	 can	 significantly	 enhance	
our	 understanding	 of	 the	 intricate	 factors	 influenc-
ing Asian international students' attitudes toward 
mental health treatment. For instance, insights into 
the	 specific	 cultural	 misconceptions	 about	 mental	
health can inform targeted educational campaigns, 
while understanding preferences for certain types 
of support can guide the development of more ef-
fective, culturally sensitive counseling approaches.
	 Despite	the	outlined	limitations,	this	study	offers	
data about international students of Asian descent 
studying in the U.S., explicitly examining their atti-
tudes toward seeking mental health assistance. The 
research	fills	a	gap	in	the	existing	literature,	which	pre-
dominantly focuses on domestic college students. This 
study's	findings	illuminate	the	attitudes	of	a	distinctive	
group of students who grapple with unique cultural 
and linguistic barriers. These students may be reluc-
tant to seek mental health assistance due to factors 
like	 social	 stigma.	Consequently,	 the	 insights	 offered	
by the current research are vital for understanding 
the help-seeking behaviors of Asian international stu-
dents. They can inform the design of targeted interven-
tions and services to address their mental health needs.

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Appendix A

Eligibility Screening Questions

Demographic Information

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Demographic Information (cont.)

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Demographic Information (cont.)

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Appendix B

Awareness and Accessibility to Mental Health Treatment

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Table 1

Social-demographic characteristics and SES of respondents

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Table 2

Comparison of ATSPPH according to participants’ characteristics

Note. *p < .05, **p < .01

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Table 3

Item-total correlations and Cronbach’s alphas for awareness and accessibility for mental health treatment (N=116)

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Table 4

Association between characteristics variable and ATSPPH scores

Note. *p < .05, **p < .01

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