Asian American and Pacific Islander Military Veterans in the United States: Health Service Use and Perceived Barriers to Mental Health Services

Jack Tsai; Julia M. Whealin; Robert H. Pietrzak

摘要

Objectives. We (1) compared use of various health services nationally between Asian American and Pacific Islander (AA/PI) veterans and veterans of other racial/ethnic groups and (2) specifically compared perceived barriers and stigma related to mental health services. Methods. Using bivariate and multivariable statistics, we analyzed a population-weighted sample of 8315 veterans from the 2010 National Survey of Veterans and a random sample of 567 recent veterans from Hawaii. Results. A total of 1.5% of veterans were AA/PI compared with 0.4% a decade ago. Compared with other veterans, AA/PI veterans reported higher socioeconomic status and better mental health, although these findings may be specific to AA veterans. Adjusting for sociodemographic and health differences, we found no differences in health service use or perceived barriers or stigma related to mental health services. Conclusions. AA/PIs are a small but fast-growing racial/ethnic group within the veteran population that deserves attention. Although veteran status may be protective against some barriers to mental health care found in the general AA/PI population, efforts to reduce barriers to health care among veterans should be continued. Individuals who identify as Asian American (AA) or Pacific Islander (PI) collectively constitute about 5% of the US population. They are the fastest-growing racial/ethnic minority group in the United States, 1 projected to grow by more than 200% by 2050. 2 Although AA/PIs have served in the military since the early 1800s, there has been very little research on AA/PI veterans. Of particular importance, little is known about how their sociodemographic characteristics, health status, and use of health services differ from those of other veterans. 3 AA/PIs are a diverse racial/ethnic group that actually consists of over 60 different subgroups, but they are typically grouped together because of similar sociocultural backgrounds. Research has shown that AA/PIs in the general population are often stereotyped as a “model minority” with few economic, health, or social problems, despite evidence to the contrary. 4–6 AA/PIs have also been characterized as “perpetual foreigners,” so they have not always been considered an important US population group. 7 Studies examining AA/PIs in the general population have found that although AA/PI adults are generally physically healthier than other adults (e.g., they have lower rates of obesity 8 and greater longevity 9 ), they are also less healthy in other respects—for example, they are more likely to use tobacco 10 and are at greater risk for diabetes, tuberculosis, hepatitis C, and various forms of cancer. 11–13 Disparities in access to medical care have been particularly salient for Asian and Pacific Islander immigrants, who often experience a range of barriers to medical care, including lack of insurance, language barriers, and cultural differences. 14,15 Several national surveys, including the National Latino and Asian American Study, have identified use of and access to mental health services among AA/PIs as a public health problem. AA/PIs have been found to underuse mental health services and often face cultural and institutional barriers to accessing mental health services. 16–19 Some of these barriers may stem in part from stigma related to seeking help for psychological problems 20,21 and may vary by nativity status, 16 whereas other barriers are related to discrimination, socioeconomic disparities, and lack of culturally competent care. 22,23 It is unknown how these findings from AA/PIs in the general population apply to AA/PI veterans. However, some evidence from national data suggest that although AA/PI veterans are younger and have higher incomes than other veterans, they may face particular barriers in accessing mental health care. 3 Veterans as a whole have been found to be at greater risk than the general population for various mental disorders, including posttraumatic stress disorder (PTSD), major depression, and substance use disorders. 24–27 Of particular concern, 36% of veterans who have served in Afghanistan or Iraq receive a mental health diagnosis, but only 67% have had a follow-up mental health visit and only 30% have had 9 or more follow-up visits. 28 Veterans have cited various barriers to accessing mental health care, including stigma, distrust of providers, institutional factors, and logistical barriers such as costs and lack of transportation. 29–31 An understanding of variations in health and help-seeking behavior by veterans’ race/ethnicity may help to better tailor services to targeted subgroups. The need for attention to the mental health of AA/PI military personnel has recently been underscored by preliminary results from the largest study of mental health risk conducted in the military, the Army Study to Assess Risk and Resilience in Servicemembers. 32 This study revealed that AA/PI soldiers had higher suicide rates than all other racial/ethnic g

机译：目标。我们（1）比较了亚裔美国人和太平洋岛民（AA / PI）退伍军人与其他种族/族裔退伍军人在全国范围内对各种卫生服务的使用，并且（2）具体比较了与精神卫生服务相关的感知障碍和污名。方法。使用双变量和多变量统计数据，我们分析了2010年全国退伍军人调查中的8315名退伍军人的人口加权样本以及来自夏威夷的567名新近退伍军人的随机样本。结果。总计1.5％的退伍军人是AA / PI，而十年前为0.4％。与其他退伍军人相比，AA / PI退伍军人报告了更高的社会经济地位和更好的心理健康，尽管这些发现可能是针对AA退伍军人。根据社会人口统计学和健康差异进行调整后，我们发现在卫生服务使用方面没有差异，也没有发现与精神卫生服务相关的障碍或污名。结论。 AA / PIs是经验丰富的小型/快速成长的种族/族裔群体，值得关注。尽管退伍军人身份可能会免受一般AA / PI人群中精神保健的某些障碍的影响，但应继续努力减少退伍军人中的医疗保健障碍。被确定为亚裔美国人（AA）或太平洋岛民（PI）的个人约占美国人口的5％。它们是美国增长最快的种族/族裔群体，1预计到2050年将增长200％以上。2尽管自1800年代初期以来，AA / PI已在军队中服役，但对AA / PI老兵。特别重要的是，人们对他们的社会人口统计学特征，健康状况以及对医疗服务的使用与其他退伍军人的区别知之甚少。 3 AA / PI是一个不同的种族/族裔群体，实际上由60多个不同的亚组组成，但是由于相似的社会文化背景，它们通常被组合在一起。研究表明，尽管有相反的证据，但一般人群中的AA / PIs常被定型为“模范少数民族”，几乎没有经济，健康或社会问题。 4-6名AA / PI也被称为“永久外国人”，因此并不总是被视为美国重要的人口群体。 7研究普通人群中AA / PI的研究发现，尽管AA / PI成年人通常比其他成年人身体健康（例如，肥胖率较低8，寿命更长9），但在其他方面，他们的健康状况也较差-例如，他们更可能使用烟草10，罹患糖尿病，结核病，丙型肝炎和各种形式癌症的风险更高。 11-13对于亚洲及太平洋岛民移民而言，获得医疗服务方面的差异尤为突出，他们经常会在医疗保健方面遇到一系列障碍，包括缺乏保险，语言障碍和文化差异。 14,15几项全国性调查，包括《全国拉丁美洲和亚裔研究》，已将AA / PI中使用和获得精神卫生服务列为公共卫生问题。已经发现，AA / PI不能充分利用精神卫生服务，并且在获取精神卫生服务时常常面临文化和体制障碍。 16-19这些障碍中的某些可能部分源于与寻求心理问题的帮助有关的污名20,21，并且可能因出生状态而异16，而其他障碍则与歧视，社会经济差异和缺乏文化上的称职关怀有关。 22,23尚不清楚普通人群中AA / PI的这些发现如何适用于AA / PI的退伍军人。但是，来自国家数据的一些证据表明，虽然AA / PI的退伍军人比其他退伍军人年轻并且收入更高，但他们在获得心理保健方面可能面临特殊的障碍。 3已发现，从总体上来说，退伍军人面对各种精神障碍，包括创伤后应激障碍（PTSD），重度抑郁和药物滥用等疾病的风险要高于一般人群。 24–27特别值得关注的是，在阿富汗或伊拉克服役的退伍军人中有36％接受了精神健康诊断，但是只有67％接受了精神健康随访，只有30％接受了9次以上随访。 28名退伍军人列举了获得心理保健的各种障碍，包括污名，对服务提供者的不信任，体制因素以及后勤障碍，例如成本和运输不足。 29–31了解退伍军人的种族/民族对健康和寻求帮助行为的变化，可能有助于更好地为目标人群提供服务。最近，在军队中进行的最大规模心理健康风险研究，即陆军评估服役人员风险和抵御能力的陆军研究的初步结果强调了对AA / PI军事人员心理健康的关注。 32该研究表明，AA / PI士兵的自杀率高于所有其他种族/民族

Asian American and Pacific Islander Military Veterans in the United States: Health Service Use and Perceived Barriers to Mental Health Services

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