Date of Award


Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Robert A. Rosenheck


Introduction: In the United States, Asian American/Pacific Islander (AAPI) people, and in particular AAPI immigrants, utilize mental health services at consistently lower rates than other ethnic populations, even when adjusting for perceived need or actual diagnoses. Methods: This study used data from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to compare Immigrant AAPIs, U.S. born AAPIs and U.S. born non-Hispanic Whites on mental health service utilization rates as well as examine differences in sociodemographic, behavioral, and psychiatric/substance use disorder (SUD) diagnostic characteristics that may account for these differences. Effect sizes were used to evaluate bivariate between-group differences, and multivariable logistic regression analysis was used to identify factors that independently differentiated each pair of groups’ comparison. Multivariable logistic regression analysis was then used to examine the effects of variables differentiating the three groups on differences in psychiatric, SUD, and overall mental health service use. In a separate analysis, Immigrant AAPIs were separated into two groups based on lifetime mental health service use, and bivariate analyses compared the two groups along the same characteristics as the first analysis, in addition to measures specific to immigrants, such as how long they had lived in the US and language preferences. A final multivariable logistic regression was used to identify factors independently associated with lifetime mental health service use in Immigrant AAPIs. Results: This analysis supports the “healthy migrant hypothesis” for AAPIs, because Immigrant AAPIs were found to have fewer adverse childhood experiences, lower rates of violence and incarceration, and lower burdens of psychiatric illness and SUDs to some degree than U.S. born AAPIs and to a large degree from non-Hispanic Whites. Adjusting for these factors, Immigrant AAPIs were still the least likely to use mental health services; U.S. born AAPIs were less likely than U.S. Whites to use psychiatric services, but were not less likely to use SUD services. This study found notable trends towards, but no significant effects of, recent immigration (fewer than 8 years lived in the U.S.) or limited English proficiency to be associated with limited mental health service use among Immigrant AAPIs (p=.06 aand p=.11, respectively). Conclusions: Both immigrant and, to some degree, native born AAPIs were less likely than non-Hispanic Whites to use mental health service even after adjusting for a wide variety of possible explanatory factors. Future research should focus on unmeasured cultural factors that may facilitate understanding of these differences.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/30/2024