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Social Issues

Help-seeking Behaviors in Vietnamese with Mental Health Problems

History of the Problem

Mental health problems are a global concern that affects people of all races, cultures and ethnicities. This is a universal fact with all groups of people. However, when it comes to mental health services utilization, help-seeking behaviors are not so universal among these groups. When it comes to seeking help for mental health problems, some individuals are receptive to the idea and some are not. This is true of groups of people in various races, cultures and ethnicities, as well as with individuals. Help-seeking behaviors related to mental health services utilization is influenced by various factors such as race, gender, age, mental disorder status, language barriers, or possibly discrimination. However, stigmas associated with mental health problems play a significant role in mental health help-seeking behaviors within specific races and cultures. Views and behaviors toward seeking help for mental issues are a factor of what someone believes based on the environment in which someone was raised. Mental health services help-seeking behaviors among people of certain races are tied to perceptions and attitudes imposed on them, and this can lead to underutilization of mental health services and disparities in care (Lannert, B. K., 2010).

On a global scale, studies show that over 70 percent of people with mental health problems do not receive professional treatment, due to avoidance or delay on the part of the mentally ill person. The reasons for this vary but could include: lack of knowledge, barriers to access, distrust of mental health professionals, or discrimination and stigmatization fears (Henderson, Evans-Lacko, & Thornicroft, 2013). As this is a global concern, this research focuses on one particular ethnicity, which is Vietnamese, and how mental health care help-seeking behaviors among this group is influenced by various factors.

Statement of the Problem

Mental health disorders affect individuals differently, but no matter how a person is affected, mental disorders alter the person’s cognitive functioning and thinking ability. This has an effect on a person’s social skills and productivity at home, work and in the community. Mental illness is a disabling condition that may last an entire lifetime, and this affects a person’s socio-economic status as well as their emotional ties with the family members and friends.  Globally, mental illness is rising, and many who have mental health problems are in developing countries, such as Vietnam, where disparities in mental health care exists, despite the availability of care. It is in developing countries where mental illness is often stigmatized (Van der Ham, et al., 2011). This contributes to incidences of the people not seeking out help from mental healthcare services.

Significance of the Study

The study focuses on assessing how mental health issues among Vietnamese adults, and their behaviors toward help-seeking for these issues is perceived. The significance of this is identifying how people identify mental illness and its characteristics, such as someone talking or laughing aloud to themselves, wandering around, or communicating nonsense. Also, the study aims at identifying perceptions about mental illness that results from misinformation and learned views. Van der Ham, et al. (2011) states, “Help-seeking behavior of the Vietnamese is influenced by Vietnamese concepts of mental illness and health, which are based on a mix of traditional and modern beliefs” (p. 574).

Review of Literature

This review of literature aims at examining the problem of help-seeking behavior disparities in the Vietnamese population, reviewing a classic study related to the problem, and estblishing findings that are consistent with the problem.

Mental Health Help-seeking Behavior Disparities

Lannert, B. K. (2011). Predictors of Help-Seeking in a National Sample of Asian Americans: The Effects of Demographics, Language, Disorder, Distress, and Ethnicity. UMI Dissertation Publishing.

The research focuses on mental health issues affecting people from all over the globe, particularly Asian Americans such as those from Vietnam, and how different people seek out help for their mental illness. Some may not. The study attributes the cause of this as possibly being related to demographic factors, mental disorder status, language barriers, distress, discrimination, cultural beliefs and norms. These factors often influence behaviors toward seeking help-seeking for their mental issues at professional mental health services. Mental health behaviors among a race may be associated with the perceptions, attitudes, values as well as the beliefs of those affected. This is also subjective to individual experiences for those who deal with mental health problems, which is specific to underutilization of mental health services and disparities in care.

The study examines mental health services utilization disparities among Asian Americans. The research theory focuses on identifying predictor variables related to help-seeking behaviors to predict prevalence. Predictor variables assessed the following: 1) health services use, 2) formal health services use, 3) informal health services use, and 4) speciality mental health services use, among study participants (4,649 Asian and Latino American adults for comparison). Research method was via survey questionnaires. Results of the survey found that Asian Americans underutilized mental health services due to factors such as stress, distress, discrimination, and language insufficiency, as well as factors related to culture and perceptions of other people.

Classic Study Related to the Problem

Chen, S. X., & Mak, W. W. S., (2008) Seeking professional help: Etiology beliefs about     mental illness across cultures.  Journal of Counseling Psychology, 55(4), 442-450.

This research examines how cultural beliefs relating to the etiology of mental illness influences help-seeking from mental health professionals. Student participants were European Americans, Chinese Americans, Hong Kong Chinese, and Mainland Chinese college students. The study focused on cross-cultural patterns in people from these four Asian groups as it relates to seeking help for mental illness from professionals. The study explains that cultural factors affect mental health services utilization among Asians, due to conflicts in values between Asians and those in the westernized world. According to the research, most Asian cultures see mental health problems as a weakness and they are concerned about shame and loss of face.

The research hypothesis proposed environmental and heredity factors influence mental health help-seeking behaviors in Asians. The study sample consisted of 747 undergraduate students from the above groups, and was administered by questionnaires and focus groups. Findings showed that the likelihood of future mental health help-seeking behaviors depended on past help-seeking history as well as environmental, hereditary and social/personal factors. This is also related to cultural beliefs.

Findings Consistent with the Problem

Groleau, D., Nadeau, L. & Pluye, P. (2007).  A mix-method approach to the cultural understanding of distress and the non-use of mental health services.  Journal of Mental Health, 16 (6), 731-741.

This research examines how mental health problems affect people of all races, and how specific cultures have specific tendencies toward seeking out help for mental problems. The study claims that subjective experiences influence mental health problems, and this has a bearing mental health prognosis and self-care on how patients stick to their clinical and medicinal protocols. This also relates to mental health services underutilization.

This research study highilghts the effectiveness of mixed-method designs for identifying mental health behaviors in a community with mixed cultures. Mixed-methods include both qualitative and quantitative research. The theoretical framework of this research makes assessments about relationships between qualitative and quantitative studies as they pertain to mental health.

The research questions are qualitative and are integrated into social quantitative research, as well as behavioral quantitative research.  This is known as mixed-method research. The research design and method included examining the implementation of quantitative and qualitative project phases to illustrate the type of design for both internal and external confirmation of research result validity. This is for the purpose of identifying and understanding specific community health issues and assisting in developing customized mental health services for the community. Data was collected from a sample out of the culturally diverse community of 2,400 residents via quantitiative telephone surveys.  Questions asked focused on mental health services utilization and reasons for not using the services of mental health organizations.  Quantitative information was also collected through literature review searches. After the quantatitive phase was completed, then the qualitative stage was started.  This stage focused on determining the influence of social and cultural contexts related to mental health behaviors, particularly among distressed participants. The participants for this phase were members of one of three immigrant groups – West Indian, Vietnamese or Filipino. Participants of the study reported being in distress or having medically unexplained symptoms and were not users of mental health services.

Results of the study showed immigrants were non-users of mental health services, and there was no definitive explanation of this occurrence, inspite of the fact that the first phase of the project showed good external validity. Both the quantitative and qualitaive methods contribute to the research and prove that mixed-method approaches to study is significant for developing and implementing more focused research and also for better tailoring of mental health utilization interventions.  This allows for better understanding of cultural barriers to mental health utilization and evaulation of cultural perspectives as it pertains to change in this area. The research concluded that a mixed-method study approach to initiating utilization of mental health services among specific cultural groups is a viable option. As well, the effectiveness in the mixed-method approach is influential in predicting human behavior as it pertains to making health choices.

Conceptual Framework

According to Van der Ham, et al., (2011), a mental disorder prevalence exists in Vietnam; however, there is a low percentage of people with mental disorders seeking professional treatment. For example, a health clinic study done in Minh City, Vietnam showed a 33 percent prevalance of post-birth mothers feeling suicidal. Consequently, only 42 percent of these women received mental health treatment, but just 5 percent of them exercised help-seeking initiatives by seeking treatment at professional mental health services.

As it relates the conceptual framework of the study, a model called, The Health Belief Model is examined and used in the study. This model focuses on predicting help-seeking behavior for mental health issues, based on two components which are (1) perceived severity and (2) perceived barriers. These two aspects of The Health Belief Model relates to mental health perceptions and their relationship to help-seeking behavior. This is the basis of the conceptual framework for the methodology and analyses of the study (Van der Ham, et al., 2011).

The study model relates to the research topic of Help-seeking Behaviors in Vietnamese with Mental Health Problems by establishing possible causes of underutilization of professional mental health services by Vietnamese mental health disorder sufferers. This outlines their help-seeking behaviors and what influences them. The research model gives descriptions of community and family members perceptions of mentally ill patients and mental health workers in Vietnam. Perceptions are also described about mental health, in general, and whether or not these patients have appropriate help-seeking behavioral tendencies toward mental health care (Van der Ham, et al., 2011).

In summary, the model used is The Health Belief Model and it deals with the idea that people in Vietnam have preconceived perceptions about mental illness and the people who suffer with it. These perceptions are based on modern beliefs and traditional beliefs about perceived barriers or perceived severity of the illness. In addition, it is noted that the Vietnamese are influenced in their help-seeking behaviors by what they feel others might think about their illness and seeking help.

Research Questions and Hypothesis

Three general research questions of this study include (1) how much relevant knowledge do people have about mental illness; (2) what attitudes exists about mental illness and the mentally ill; and (3) what influences help-seeking behaviors of those needing mental health treatments? The two variables examined in the research are perceived severity and perceived barriers. Variables are attitudes and beliefs, symptoms, causes, treatment, lack of knowledge, and family burden imposed. Mental health literacy was also highlighted as a significant variable to this research. This includes the recognition of specific disorders within mental health issues, and also their management and prevention. In addition, knowledge on how to find information about mental health, risk factors, self-treatments and professional help.

Research Method

The method used for the study was conducted via questionnaire with study participants pulled from a network of 25 quarters and commiunes in Vietnam Community Health Centers (CHCs) in Hue City in central Vietnam. For the study, four randomly selected quarters were selected from the network. The target population for the study consisted of adults 18 years old and over. Fifty respondents were selected from each of the four randomly selected quarters, which brought the total sample size to 200 participants. The random selection of the adults was by selecting an adult from every 5th household. The household information was pulled from the health center registration lists. Table 1 below shows the demographic data of the 200 respondents (Van der Ham, et al., 2011).

Table 1

Demographic data of the 200 questionnaire respondents

Age (M) 46.0 (SD = 15.7)
Sex Male = 50% / Female = 50%
Occupation Sales = 21% / Civil servant = 15% / Housewife = 13.5% / Retired = 13.5%

Worker = 6%/Student = 6%

Education Illiterate = 5% / Reading & writing = 4.5% / Primary school = 15.5% / Secondary school = 26.5%

High school = 28.5%/University and over = 20%

Religion Buddhist = 70% / Catholic = 4.5% / Not religious = 25.5%

(Van der Ham, et al., 2011)

Research Instruments

The quesionnaire consisted of both open-ended and closed-ended questions about respondents, and their perceptions and attitudes about mental health were assessed by a semi-structured, four-part questionnaire. The four parts were as follows:

  1. Demographic data – gender, age, occupation, marital status, level of education, religion and ethnicity.
  2. Awareness/Knowledge – mental illness and its symptoms, causes and treatment options.
  3. Attitudes – toward the mentally ill and the perceived severity of the illness, which was measured by Linkert scale analysis.
  4. Personal experience – with mental illness.

The questionnaire used was a product development of local mental health professionals. The questionnaire was originally written in English and translated into Vietamese. Data collection method used for the questionnaire was via interviews, which respondents given informed consent for the interview. Data collected was translsated from Vietnamese into English for analysis and results purposes (Van der Ham, et al., 2011).

Research Results

The research results answer the three research questions of (1) how much relevant knowledge do people have about mental illness; (2) what attitudes and beliefs exist about mental illness and the mentally ill; and (3) what influences help-seeking behaviors of those needing mental health treatments, as follows.

Research results revealed that people, in general, had little knowledge about mental illness, aside from schizophrenia. Some of the respondents named the neurological disease, epilepsy, as a mental illness. For instance, most of the participants were unable to name specific mental illnesses and referred to the mentally ill as “mad” or “insane”.  It is noted that it is generally the case that many people do not accurately recognize the names or symptoms of mental disorders, and they also do not understand psychiatric terms (Van der Ham, et al., 2011).

Results showed that attituds and beliefs about mental illness is often influenced by a combination of traditional and modern viewpoints. Many believed that too much studying, thinking or tension caused mental illness. These are the perceptions common inVietnam as culturally specific viewpoints about mental health. Results also showed that Vietnamese people basically think that stress, depression and anxiety are the same thing. Attitudes toward mental illnesses were more negatively seen with alcoholism and schizophrenia, among the participants (Van der Ham, et al., 2011).

Results for help-seeking behavior showed that most of the participants preferred modern medical treatment for conditions such as schizophrenia, and this was mainly the perceptions of each. In addition, partipants favored at-home care with the support of family and friends. Perceptions and attitudes toward seeking professional care in psychiatric facilities were related to perceptions about severe mental health symptoms and issues there were viewed as worse than schizophrenia. It is interesting to note that the study concluded that Vietnamese people seldom identified treatment options other than care at home for schizophrenia, and this means they are likely to undertutilize mental healthcare services for mental illnesses (Van der Ham, et al., 2011).

Conclusion

Mental health problems are universal; however, mental healthcare help-seeking behaviors are a product cultures and ethnicities, and how people perceive the problem. Underutilization of healthcare services is an issue in Asian cultures, such as the Vietnamese. This is due, in part, to how they view mental illness and behaviors associated with seeking help for mental issues. However, disparities can be changed with more awareness, education and training.

 

References

Chen, S. X., & Mak, W. W. S., (2008) Seeking professional help: Etiology beliefs about     mental illness across cultures.  Journal of Counseling Psychology, 55(4), 442-450.

Groleau, D., Nadeau, L. & Pluye, P. (2007).  A mix-method approach to the cultural understanding of distress and the non-use of mental health services.  Journal of Mental Health, 16 (6), 731-741.

Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013, May). Mental Illness Stigma, Help Seeking, and Public Health Programs. American Journal of Public Health, 103(5), pe1-e4.

Lannert, B. K. (2011). Predictors of Help-Seeking in a National Sample of Asian Americans: The Effects of Demographics, Language, Disorder, Distress, and Ethnicity. UMI Dissertation Publishing.

Van der Ham, L., Wright, P., Vo Van, T., Don, V. K., & Broerse, J. W. (2011, October). Perceptions of Mental Health and Help-Seeking Behavior in an Urban Community in Vietnam. Community Mental Health Journal, 47(5), 574-582.