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The Influence of Ethnic-Racial Identity and Discrimination on Mental Health Treatment Attitudes among College Students

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Title: The Influence of Ethnic-Racial Identity and Discrimination on Mental Health Treatment Attitudes among College Students
Language: English
Authors: Linda Oshin (ORCID 0000-0001-6308-5521), Stephanie Milan, Annmarie Wacha-Montes
Source: Journal of American College Health. 2024 72(8):2954-2962.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 9
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Ethnic Groups, Racial Identification, Racism, Mental Health, Mental Health Programs, Health Services, Counseling, Diversity, Student Attitudes, Public Colleges, Undergraduate Students, Symptoms (Individual Disorders), Racial Differences, Racial Discrimination
Assessment and Survey Identifiers: Multigroup Ethnic Identity Measure, Brief Symptom Inventory
DOI: 10.1080/07448481.2022.2145894
ISSN: 0744-8481
1940-3208
Abstract: Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1448254
Database: ERIC
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  Value: <anid>AN0180828382;acl01nov.24;2024Nov14.03:52;v2.2.500</anid> <title id="AN0180828382-1">The influence of ethnic-racial identity and discrimination on mental health treatment attitudes among college students </title> <p>Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health.</p> <p>Keywords: mental health; counseling; race/ethnicity; treatment engagement</p> <hd id="AN0180828382-2">Introduction</hd> <p>In the United States, receipt of mental health services varies consistently by race and ethnicity.[<reflink idref="bib1" id="ref1">1</reflink>] Pragmatic barriers that contribute to racial and ethnic disparities in services are well documented.[<reflink idref="bib2" id="ref2">2</reflink>] Several of these barriers, including lack of adequate health insurance, long waiting lists, transportation issues, may impact college students less as many campus offer mental health services on campuses.[<reflink idref="bib3" id="ref3">3</reflink>] Despite the reduction of some of these barriers, there is evidence of racial and ethnic disparities in the use of counseling center services.[<reflink idref="bib4" id="ref4">4</reflink>],[<reflink idref="bib5" id="ref5">5</reflink>] A nationwide study of college students found that Asian, Black, and Hispanic students were less likely than White students to receive mental health treatment.[<reflink idref="bib4" id="ref6">4</reflink>] While there is evidence that counseling center utilization rates are similar to enrollment rates by race and ethnicity, the increased distress among minoritized students suggests that they may be underutilizing services in proportion to their need.[<reflink idref="bib6" id="ref7">6</reflink>],[<reflink idref="bib7" id="ref8">7</reflink>] Thus, an understanding of psychological barriers to treatment among college students with access to campus services is crucial in efforts to reduce racial and ethnic treatment engagement disparities.</p> <p>Treatment engagement is a multidimensional and dynamic process that has been inconsistently operationalized across studies.[<reflink idref="bib8" id="ref9">8</reflink>],[<reflink idref="bib9" id="ref10">9</reflink>] In an effort to refine the concept, Staudt[<reflink idref="bib8" id="ref11">8</reflink>] theorized that there are two components of treatment engagement: behavioral and attitudinal. The behavioral component refers to the tasks that are required to implement treatment and achieve positive mental health outcomes, such as session attendance, premature termination, and homework completion.[<reflink idref="bib10" id="ref12">10</reflink>],[<reflink idref="bib11" id="ref13">11</reflink>] The attitudinal component refers to a commitment to treatment that stems from a belief that treatment will lead to positive outcomes.[<reflink idref="bib8" id="ref14">8</reflink>] This component of engagement distinguishes between clients who are compliant (e.g., just showing up) and those who are fully participating in treatment (e.g., communicating with and trusting in the clinician). Most research on disparities in treatment engagement have focused on behavioral indicators rather than attitudinal indicators. This is unfortunate, as attitudes may drive behavioral engagement and may be more amenable to intervention efforts. Studies examining racial and ethnic differences in attitudinal engagement have focused on subdimensions, such as stigma toward mental health, perceived need for treatment, or help-seeking intention.[[<reflink idref="bib12" id="ref15">12</reflink>], [<reflink idref="bib14" id="ref16">14</reflink>]]</p> <p>The Theory of Planned Behavior is often applied to health-related behaviors, particularly help-seeking behaviors among minoritized populations.[<reflink idref="bib15" id="ref17">15</reflink>],[<reflink idref="bib16" id="ref18">16</reflink>] Specifically, the Theory of Planned Behavior states that the intention to perform a behavior is informed by three factors: (<reflink idref="bib1" id="ref19">1</reflink>) the individual's attitude toward the behavior, (<reflink idref="bib2" id="ref20">2</reflink>) the norms associated with performing the behavior, and (<reflink idref="bib3" id="ref21">3</reflink>) one's perception of their efficacy in performing the behavior. Yasui and colleagues argue that identity-related factors, such as discrimination and ethnic-racial identity (ERI), and institutional factors, such as clinician diversity, influence each of these three factors to impact intentions to engage with mental health services.[<reflink idref="bib17" id="ref22">17</reflink>] Thus, it is important to understand the influence of identity-related and institutional factors on treatment engagement.</p> <p>One identity-related factor that is known to affect treatment engagement among racially and ethnically minoritized individuals is experiences of discrimination.[<reflink idref="bib17" id="ref23">17</reflink>] Experiencing discrimination in a health care setting is related to more unmet health care needs and worse mental health.[<reflink idref="bib18" id="ref24">18</reflink>] Cheng et al.[<reflink idref="bib12" id="ref25">12</reflink>] found that experiences of discrimination among African, Asian, and Latinx American college students predicted perceived stigmatization by others for seeking psychological help.</p> <p>Another identity-related factor that may affect attitudes toward treatment engagement is one's ethnic-racial identity (ERI), or the beliefs and affect one has regarding their ethnic or racial group.[<reflink idref="bib19" id="ref26">19</reflink>] ERI is a multidimensional construct, with dimensions like exploration, commitment, and centrality. While the influence of ERI on treatment engagement has not been directly investigated, it is possible that some dimensions of ERI may influence how minoritized individuals feel about seeking treatment for mental health. For example, Black women reported more exploration of their ERI experienced more anxiety than White women or Black women with low exploration in a virtual health care situation with salient cues about stereotypes.[<reflink idref="bib20" id="ref27">20</reflink>] One important dimension of ERI is public regard, the extent to which one believes others view their group positively or negatively.[<reflink idref="bib21" id="ref28">21</reflink>] Notably, public regard is theorized to influence the extent to which one attends to cues that their social group is under threat.[<reflink idref="bib22" id="ref29">22</reflink>] Public regard has been shown to be related to academic engagement, with students who believe others view their racial or ethnic group negatively reporting less engagement with academic activities.[<reflink idref="bib23" id="ref30">23</reflink>] It is possible that students with lower public regard would also report negative attitudes toward mental health treatment.</p> <p>The diversity of a counseling center may affect minoritized college students' attitudes about treatment engagement. Specifically, lack of diversity in a setting may act as a cue that one may encounter discrimination.[<reflink idref="bib24" id="ref31">24</reflink>] Indeed, Hayes and colleagues[<reflink idref="bib6" id="ref32">6</reflink>] found that mental health service utilization rates by race and ethnicity among college students were predicted by racial and ethnic representation of the counseling staff and the student body, suggesting that minoritized college students may be more comfortable using counseling services when staffs are more diverse.</p> <hd id="AN0180828382-3">Current study</hd> <p>As reviewed above, much of the literature on treatment engagement has focused on behavioral measures of engagement rather than underlying attitudes that may contribute to disparities in engagement. The goal of the current study was to better understand attitudinal treatment engagement among a diverse sample of college students from four racial and ethnic groups (Black, Asian, Hispanic, and White). We first test whether racial and ethnic group and identity-related factors (i.e., discrimination and ERI) are associated with attitudinal engagement, and then in an experimental design determine whether associations between identity-related factors and attitudinal engagement vary based on diversity of services providers. The hypotheses are: (<reflink idref="bib1" id="ref33">1</reflink>) Black, Asian, and Hispanic participants will report more negative attitudes toward a hypothetical student mental health service in comparison to White participants. (<reflink idref="bib2" id="ref34">2</reflink>) Black, Asian, and Hispanic participants who view a website that does not indicate diverse clinicians will express more negative attitudes toward engaging in treatment relative to those who view a website with diverse clinicians; (<reflink idref="bib3" id="ref35">3</reflink>) Identity-related factors will influence attitudes toward treatment such that participants with more negative ERI and high discrimination will have less desire to engage and more negative attitudes toward treatment; (<reflink idref="bib4" id="ref36">4</reflink>) Black, Asian, and Hispanic participants with more negative ERI and high discrimination will report more negative attitudes about treatment when viewing a website without diverse clinicians in comparison to Black, Asian, and Hispanic participants with more positive ERI and low discrimination and White participants.</p> <hd id="AN0180828382-4">Methods</hd> <p></p> <hd id="AN0180828382-5">Participants</hd> <p>The participants in this study (<emph>n</emph> = 250) were students recruited from a public university in the Northeast United States through the psychology participant pool and advertisements to student groups. Participants were screened by race and ethnicity to ensure a diverse sample and were compensated with either course credit or entered into a raffle for a gift card. The sample by race and ethnicity was: non-Hispanic White <emph>n</emph> = 113, Asian <emph>n</emph> = 53, Hispanic <emph>n</emph> = 57, Black <emph>n</emph> = 27. Average age was 19 years (<emph>SD</emph> = 1.15, <emph>Range</emph> = 17 − 25), with a majority of students identifying as female (female <emph>n</emph> = 182, male <emph>n</emph> = 68). In terms of college year, 42% were freshmen, 34% sophomores, 16% juniors, 6% seniors, and 2% were fifth year or transfer students. About 20% reported that they were not born in the United States, and 54% reported that at least one of their parents was not born in the United States. First time college students constituted 14% of the sample.</p> <hd id="AN0180828382-6">Procedures</hd> <p>The study was presented as an online survey regarding students' opinions on various student services (e.g., career counseling, medical services, mental health services), although all participants were only asked about mental health services. Participants first completed their demographics, then were randomly assigned, stratified within racial and ethnic group, to one of two versions of a website for a mental health clinic. The website was designed to look like a typical school counseling center website with various information (e.g., types of services, hours of operation). The websites were identical except for the pictures of the eight staff members. In the not diverse condition, each staff member appeared to be White. In the diverse condition, four of the eight clinicians appeared to be either Black, Asian, or Hispanic. The same pictures were used across conditions. Participants were told to, "Imagine you are having an extremely difficult semester and you came across this website. Please look carefully at the website and consider how comfortable you would feel using the services offered." They were required to look at the website for a minimum of 45 seconds and maximum of two minutes. After viewing the website, participants completed the remainder of the questionnaires. All procedures were approved by the Institutional Review Board (IRB) at the University of Connecticut.</p> <hd id="AN0180828382-7">Measures</hd> <p></p> <hd id="AN0180828382-8">Demographic information</hd> <p>Participants were asked to provide detailed information about their racial and ethnic background, their immigration history, gender identity, whether they were a first-generation college student, and history of mental illness or treatment.</p> <hd id="AN0180828382-9">Therapy expectations</hd> <p>The Milwaukee Psychotherapy Expectations Questionnaire (MPEQ)[<reflink idref="bib25" id="ref37">25</reflink>] was used as an indicator of attitudinal engagement. This measure assesses individuals' expectations about therapy. The measure consists of 13 items that are rated on a 10-point Likert scale from 1 (not at all) to 10 (very much so). The measure contains two subscales. The <emph>process</emph> subscale (9 items) measures expectations about the therapeutic relationship, change during therapy, and treatment structure (Ex. "I will feel comfortable with my therapist."). The <emph>outcome</emph> subscale (4 items) measures expectations about the consequences of engaging in therapy (Ex. "I anticipate being a better person as a result of therapy."). A total therapy expectations score was created by summing all items, <emph>α</emph> =.94.</p> <hd id="AN0180828382-10">Therapy readiness</hd> <p>Two subscales of the Readiness for Psychotherapy Index (RPI)[<reflink idref="bib26" id="ref38">26</reflink>] were used to assess aspects of attitudinal engagement. Both subscales consist of five items each. The <emph>openness</emph> subscale consists of items assessing one's comfort with discussing and being vulnerable with a therapist (Ex. "I will have no trouble being completely honest and open in therapy.") and the <emph>perseverance</emph> subscale consists of items assessing one's willingness to maintain effort in therapy (Ex. "Even if therapy makes me uncomfortable, I will continue with it."). All items were rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), <emph>α</emph> =.79. This measure was modified to ask for anticipation of a relationship with a clinician with website the participant viewed. For example, the first item said, "I would have no trouble being completely honest and open in therapy."</p> <hd id="AN0180828382-11">Ethnic-racial identity</hd> <p>Participants' ethnic-racial identity (ERI) was measured using two scales. First, using the Multigroup Ethnic Identity Measure-Revised (MEIM).[<reflink idref="bib26" id="ref39">26</reflink>] This measure consists of 6 items rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The measure contains two subscales. The <emph>exploration</emph> subscale examines the extent to which one seeks information or experiences related to one's group (Ex. "I have often talked to other people in order to learn more about my ethnic group"), and <emph>commitment</emph> subscale measures the sense of belonging that one feels with their group (Ex. "I have a strong sense of belonging to my own ethnic group"). The measure demonstrated good internal consistency <emph>α</emph> =.93.</p> <p>The second scale used to measure ERI was the public regard subscale of the Multidimensional Inventory of Black Identity.[<reflink idref="bib27" id="ref40">27</reflink>] Past studies have shown that the scale can be used with participants of other races and ethnicities by changing the phrase <emph>Black people</emph> to <emph>my ethnic group.</emph>[<reflink idref="bib28" id="ref41">28</reflink>] This measure consists of 6 items, such as "In general, others respect my ethnic group," and "My ethnic group is not respected by the broader society," that were rated on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). The measure demonstrated good internal consistency <emph>α</emph> =.86.</p> <hd id="AN0180828382-12">Experiences with discrimination</hd> <p>Participants were asked about their experiences with and stress attributed to discrimination using the General Ethnic Discrimination Scale. The GEDS[<reflink idref="bib29" id="ref42">29</reflink>] asks about experiences with discrimination in specific domains of life (e.g., teachers, supervisors, and neighbors). The measure contains 17 questions, each requires three responses (i.e., if experienced in the past year, in one's lifetime, and the stress these experiences cause). All items are rated on a 6-point Likert scale from 1 (never/not at all stressful) to 6 (almost all the time/extremely stressful) and demonstrated good internal consistency <emph>α</emph> =.98.</p> <hd id="AN0180828382-13">Emotional distress</hd> <p>Because emotional distress may affect attitudes toward mental health treatment, general emotional distress was measured for each participant using the Brief Symptom Inventory (BSI-S).[<reflink idref="bib30" id="ref43">30</reflink>] The BSI-S contains 18 items that are rated on a scale from 1 (not at all) to 5 (extremely), indicating how much the participant felt bothered by the problem in the past seven days. The measure demonstrated good internal consistency <emph>α</emph> =.94.</p> <hd id="AN0180828382-14">Data analysis</hd> <p>Correlations and t-tests were used to determine if demographic variables should be used as control or predictor variables. ANOVAs were used to examine differences in attitudinal engagement by race/ethnicity and ANCOVAs were used when covariates were included. These tests were conducted with the full-scale measure and with each subtest, as racial/ethnic differences in one subtest may be obscured in the full-scale and there are subtest differences in associations to behavioral engagement.[<reflink idref="bib25" id="ref44">25</reflink>],[<reflink idref="bib26" id="ref45">26</reflink>] Multiple linear regression was used to test for the relationship between treatment engagement variables and the MEIM, public regard, and discrimination. To test if racial/ethnic group moderated the relationship between individual level racial/ethnic factors and attitudinal engagement, nested multigroup path analyses were run in AMOS Version 26. An omnibus test was conducted for each analysis in which a model with all paths freely estimated across racial/ethnic group was compared to a model with all paths constrained to be equal. Regarding power, minimum samples of 150 and 200 are recommended for path models with only observed variables and are appropriate for multi-group analyses testing for moderating effects.[<reflink idref="bib31" id="ref46">31</reflink>],[<reflink idref="bib32" id="ref47">32</reflink>] Individual groups with fewer than 100 participants may be underpowered to detect significance of specific parameters. Thus, the Black group was likely underpowered to detect anything less than large effect sizes. We therefore also considered the magnitude of effect sizes and not only statistical significance when interpreting results.</p> <hd id="AN0180828382-15">Results</hd> <p></p> <hd id="AN0180828382-16">Preliminary analyses</hd> <p>Correlations between emotional distress and engagement variables were calculated to determine if emotional distress should be used as a covariate. Emotional distress was not related to the RPI but was negatively correlated with the MPEQ, <emph>r</emph> = −.21, <emph>p</emph> =.001, and its subscales: process <emph>r</emph> = −.22, <emph>p</emph> <.001; outcome <emph>r</emph> = −.18, <emph>p</emph> =.005. Emotional distress did not significantly differ by race or condition. There was a significant negative correlation between emotional distress and public regard, <emph>r</emph> = −.15, <emph>p</emph> =.02, and emotional distress was not significantly correlated with the MEIM or discrimination. These preliminary analyses demonstrated that public regard and the MPEQ and its subscales were significantly related to emotional distress. Hence, emotional distress was included as a control variable in analyses including public regard and the MPEQ or its subscales.</p> <hd id="AN0180828382-17">Racial and ethnic group differences in attitudinal treatment engagement</hd> <p>Three 2 × 3 factorial ANCOVAs were conducted to examine the main effect of website condition, main effect of racial and ethnic group, and interaction between group and condition on the MPEQ and its subscales, controlling for emotional distress. Neither the main effects nor the interactions were significant for total MPEQ or the outcome subscale. There was a significant main effect of racial and ethnic group on the MPEQ process subscale, <emph>F</emph>(<reflink idref="bib3" id="ref48">3</reflink>,<reflink idref="bib242" id="ref49">242</reflink>) = 2.92, <emph>p</emph> =.04, partial <emph>η<sups>2</sups></emph>=.04. Post-hoc LSD analyses demonstrate that Black participants had lower MPEQ process scores compared to White participants, <emph>p</emph> =.006, <emph>d</emph> = −.58, and Hispanic participants, <emph>p</emph> =.04, <emph>d</emph> = −.47; there was no difference between Black and Asian participants, <emph>p</emph> =.19, <emph>d</emph> = −.30. The ANOVAs testing for a group X condition interaction relationship with the RPI and its subscales was not significant. Treatment engagement variables are presented by race and ethnicity in Table 1.</p> <p>Table 1. Racial/ethnic group means and standard deviations of treatment engagement variables.</p> <p> <ephtml> <table><thead><tr><td /><td>White</td><td>Asian</td><td>Black</td><td>Hispanic</td><td>Total</td></tr></thead><tbody valign="top"><tr><td>MPEQ</td><td char=".">116.58 (19.56)</td><td char=".">112.25 (20.71)</td><td char=".">107.48 (22.33)</td><td char=".">114.37 (18.54)</td><td char=".">114.04 (20.04)</td></tr><tr><td>MPEQ Process</td><td char=".">82.39 (12.94)<sup>a</sup></td><td char=".">78.64 (14.31)<sup>a</sup></td><td char=".">74.33 (14.77)<sup>b</sup></td><td char=".">80.74 (12.57)<sup>a</sup></td><td char=".">80.35 (13.52)</td></tr><tr><td>MPEQ Outcome</td><td char=".">34.18 (7.41)</td><td char=".">33.47 (7.69)</td><td char=".">32.81 (8.76)</td><td char=".">33.02 (7.74)</td><td char=".">33.62 (7.67)</td></tr><tr><td>RPI</td><td char=".">34.99 (6.14)</td><td char=".">35.32 (5.30)</td><td char=".">36.15 (4.39)</td><td char=".">35.88 (6.60)</td><td char=".">35.40 (5.88)</td></tr><tr><td>RPI Perseverance</td><td char=".">18.72 (3.86)</td><td char=".">18.70 (3.38)</td><td char=".">19.52 (3.17)</td><td char=".">19.51 (4.02)</td><td char=".">18.98 (3.73)</td></tr><tr><td>RPI Openness</td><td char=".">16.32 (3.31)</td><td char=".">16.62 (2.60)</td><td char=".">16.63 (2.39)</td><td char=".">16.37 (3.26)</td><td char=".">16.43 (3.06)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. Significant differences indicated by differences in letters in superscript, RPI = Readiness for Psychotherapy Index, MPEQ = Milwaukee Psychotherapy Expectations Questionnaire.</p> <hd id="AN0180828382-18">Identity-related factors and treatment engagement</hd> <p>The second primary research question was whether there was a relationship between identity-related factors and treatment engagement. A series of multiple linear regressions were run to determine unique relations between the MEIM subscales, discrimination, and public regard on MPEQ and RPI scores (Table 2). Results showed that the four variables accounted for 10.8% of the variance in RPI total scores, with MEIM commitment subscale, <emph>β</emph> =.21.5, <emph>p</emph> =.02, and public regard, <emph>β</emph> =.20, <emph>p</emph> =.005, emerging as uniquely significant. Similar results were found for the MPEQ total scores, the four variables accounted for 12.7% of the variance, with MEIM commitment subscale, <emph>β</emph> =.20, <emph>p</emph> =.03, and public regard, <emph>β</emph> =.24, <emph>p</emph> <.001, uniquely significant. Together, these results suggest that ERI variables (MEIM and public regard) are distinctly related to treatment engagement attitudes, but discrimination experiences do not contribute further to variability in treatment engagement.</p> <p>Table 2. Multiple regression with MEIM subscales, public regard, and discrimination associated with treatment engagement.</p> <p> <ephtml> <table><thead><tr><td /><td><italic>B (SE)</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>R</italic><sup>2</sup></td></tr></thead><tbody valign="top"><tr><td>RPI</td><td /><td /><td /><td char=".">.108</td></tr><tr><td> MEIM Commitment</td><td char=".">.28 (.12)</td><td char=".">.22</td><td char=".">.02</td><td /></tr><tr><td> MEIM Exploration</td><td char=".">.08 (.11)</td><td char=".">.07</td><td char=".">.45</td><td /></tr><tr><td> Public Regard</td><td char=".">.15 (.05)</td><td char=".">.20</td><td char=".">.005</td><td /></tr><tr><td> Discrimination</td><td char=".">.77 (.51)</td><td char=".">.11</td><td char=".">.13</td><td /></tr><tr><td>MPEQ</td><td /><td /><td /><td char=".">.127</td></tr><tr><td> MEIM Commitment</td><td char=".">.89 (.40)</td><td char=".">.20</td><td char=".">.03</td><td /></tr><tr><td> MEIM Exploration</td><td char=".">.30 (.36)</td><td char=".">.08</td><td char=".">.41</td><td /></tr><tr><td> Public Regard</td><td char=".">.61 (.18)</td><td char=".">.24</td><td char="."><.001</td><td /></tr><tr><td> Discrimination</td><td>−1.93 (1.72)</td><td>-.08</td><td char=".">.26</td><td /></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. RPI = Readiness for Psychotherapy Index, MPEQ = Milwaukee Psychotherapy Expectations Questionnaire, MEIM = Multi-group Ethnic Identity Measure.</p> <hd id="AN0180828382-19">Identity-related factors moderated by race/ethnicity</hd> <p>Next, we examined if the relationship between identity-related factors (i.e., ERI and discrimination), differed significantly by racial and ethnic group (Table 3). These differences were investigated using a series of nested multigroup path analyses. Specifically, a model was run with the MEIM associated with the MPEQ and RPI, then a model with public regard associated with the MPEQ and RPI, and finally a model with discrimination associated with the MPEQ and RPI (Figure 1). Models were then run again with the same predictor variables and the subscales of the MPEQ and RPI separately (Figure 2). Because there was no main effect of clinician diversity on treatment engagement, these variables were excluded from the model. Emotional distress was included as a control variable in all analyses. Paths between emotional distress and outcome variables were constrained across racial/ethnic groups, which allowed for the calculation of fit statistics. The only models that demonstrated a better fit when paths were freely estimated were models with public regard as the predictor. In all other models, fit did not significantly improve when paths were freely estimated by group. In other words, there was no indication of race or ethnicity moderating relations between the MEIM or discrimination and treatment engagement variables. Critical ratios were calculated to test for racial and ethnic group differences in specific paths, only significant critical ratios are reported.</p> <p>Graph: Figure 1. Model of MEIM/public regard/discrimination associated with MPEQ and RPI. Note. Separate models were run with the MEIM, public regard, and discrimination as predictors. Dashes indicate path was constrained equal across groups in both freely estimated and constrained model. RPI = Readiness for Psychotherapy Index, MPEQ = Milwaukee Psychotherapy Expectations Questionnaire, MEIM = Multigroup Ethnic Identity Measure.</p> <p>Graph: Figure 2. Model of MEIM/public regard/discrimination associated with MPEQ and RPI subscales. Note. Separate models were run with the MEIM, public regard, and discrimination as predictors. Dashes indicate path was constrained equal across groups in both freely estimated and constrained model RPI = Readiness for Psychotherapy Index, MPEQ = Milwaukee Psychotherapy Expectations Questionnaire, MEIM = Multigroup Ethnic Identity Measure.</p> <p>Table 3. Racial and ethnic group means and standard deviations of ERI and discrimination.</p> <p> <ephtml> <table><thead><tr><td /><td>White (<italic>n</italic> = 113)</td><td>Asian (<italic>n</italic> = 53)</td><td>Black (<italic>n</italic> = 27)</td><td>Hispanic (<italic>n</italic> = 57)</td><td>Difference</td></tr></thead><tbody valign="top"><tr><td>Public Regard</td><td char=".">32.55 (5.26)<sup>a</sup></td><td char=".">29.26 (5.93)<sup>b</sup></td><td char=".">18.78 (7.23)<sup>c</sup></td><td char=".">22.79 (6.91)<sup>d</sup></td><td><italic>F</italic>(3, 245) = 54.50, <italic>p</italic> <.001</td></tr><tr><td>MEIM</td><td char=".">4.01 (1.41)<sup>a</sup></td><td char=".">5.37 (1.29)<sup>b</sup></td><td char=".">5.43 (1.10)<sup>b</sup></td><td char=".">5.35 (1.50)<sup>b</sup></td><td><italic>F</italic>(3, 245) = 20.05, <italic>p</italic> <.001</td></tr><tr><td>MEIM Exploration</td><td char=".">11.07 (4.76)<sup>a</sup></td><td char=".">15.79 (4.42)<sup>b</sup></td><td char=".">16.22 (3.33)<sup>b</sup></td><td char=".">15.68 (5.24)<sup>b</sup></td><td><italic>F</italic>(3, 245) = 21.38, <italic>p</italic> <.001</td></tr><tr><td>MEIM Commitment</td><td char=".">12.99 (4.40)<sup>a</sup></td><td char=".">16.42 (4.10)<sup>b</sup></td><td char=".">16.33 (4.16)<sup>b</sup></td><td char=".">16.44 (4.34)<sup>b</sup></td><td><italic>F</italic>(3, 245) = 12.98, <italic>p</italic> <.001</td></tr><tr><td>Discrimination</td><td char=".">1.28 (.43)<sup>a</sup></td><td char=".">2.07 (.83)<sup>bc</sup></td><td char=".">2.65 (1.03)<sup>bd</sup></td><td char=".">1.98 (.82)<sup>bc</sup></td><td><italic>F</italic>(3, 244) = 36.70, <italic>p</italic> <.001</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note</emph>. Significant differences indicated by differences in letters in superscript, MEIM = Multi-group Ethnic Identity Measure.</p> <p>The model in which public regard was associated with the MPEQ and RPI demonstrated better fit when paths freely estimated by group, Δχ<sups>2</sups>(<reflink idref="bib6" id="ref50">6</reflink>) = 15.11, <emph>p =</emph>.02, and the freely estimated model demonstrated good fit, χ<sups>2</sups>(<reflink idref="bib6" id="ref51">6</reflink>) = 7.46, <emph>p</emph> =.28, CFI =.99, NFI =.96, RMSEA =.03 [0,.09]. Similarly, the model in which public regard was associated with the subscales of the MPEQ (outcome and process) and the RPI (openness and perseverance) also demonstrated better fit with freely estimated paths, Δχ<sups>2</sups> (<reflink idref="bib11" id="ref52">11</reflink>) = 20.95, <emph>p =</emph>.03, and good overall fit, χ<sups>2</sups>(<reflink idref="bib27" id="ref53">27</reflink>) 38.18, <emph>p</emph> =.08, CFI =.98, NFI =.93, RMSEA =.04 [0,.07]. The magnitude of this relationship was significantly larger for Asian participants in comparison to White participants, <emph>z</emph> = 2.48, <emph>p</emph> <.05.</p> <p>Public regard was significantly associated with the RPI for Asian participants, <emph>β</emph> =.35, <emph>p</emph> =.007, <emph>R<sups>2</sups></emph>=.13, which seems to have been driven by the perseverance subscale, <emph>β</emph> =.36, <emph>p</emph> =.004, <emph>R<sups>2</sups></emph>=.15, as the openness subscale was not significantly related to the RPI for Asian participants. Among White participants, public regard was significantly associated with the openness subscale, <emph>β</emph> =.18, <emph>p</emph> =.04, <emph>R<sups>2</sups></emph>=.02.</p> <p>Public regard significantly related to the MPEQ for Asian, <emph>β</emph> =.38, <emph>p</emph> =.002, <emph>R<sups>2</sups></emph>=.20, and Black participants, <emph>β</emph> =.35, <emph>p</emph> =.047, <emph>R<sups>2</sups></emph>=.14, and was marginally significant for Hispanic participants, <emph>β</emph> =.22, <emph>p</emph> =.08, <emph>R<sups>2</sups></emph>=.09. This finding seems to be driven by the MPEQ process subscale, as the relationship between public regard and the MPEQ outcome subscale was not significant for any group. The relationship between public regard and the process subscale was also significant for Asian, <emph>β</emph> =.40, <emph>p</emph> <.001, <emph>R<sups>2</sups></emph>=.22, and Black participants, <emph>β</emph> =.34, <emph>p</emph> =.049, <emph>R<sups>2</sups></emph>=.14, and was marginally significant for Hispanic participants, <emph>β</emph> =.24, <emph>p</emph> =.06, <emph>R<sups>2</sups></emph>=.10. The magnitude of this relationship was significantly larger for Asian participants in comparison to White participants, <emph>z</emph> = 2.63, <emph>p</emph> <.05.</p> <p>In summary, the results demonstrated that the relationship between public regard and engagement variables differed by race and ethnicity, and that these relations were strongest for Asian students in comparison to other groups.</p> <hd id="AN0180828382-20">Discussion</hd> <p>The Theory of Planned Behavior is often applied to health-related behaviors, particularly help-seeking behaviors among minoritized populations.[<reflink idref="bib15" id="ref54">15</reflink>],[<reflink idref="bib16" id="ref55">16</reflink>] One of the components of the Theory of Planned Behavior is that perceived behavioral control, or the perceived difficulty of performing a behavior, will impact one's intention to engage in the behavior. The purpose of the current study was to investigate racial and ethnic differences in attitudes toward therapy among college students, and to understand how identity-related factors such as ethnic-racial identity and discrimination may influence attitudes toward therapy. By understanding how these factors influence attitudes toward therapy, we can better understand how minoritized college students may be more reluctant to seek mental health services.</p> <p>While this study's findings demonstrated no racial or ethnic differences in overall readiness for psychotherapy (RPI) or full-scale expectations for psychotherapy (MPEQ), there were some differences when examining the subscales of the MPEQ separately. There were no significant racial and ethnic differences in therapy outcome expectations, which is encouraging given research that belief in treatment efficacy is strongly related to treatment utilization.[<reflink idref="bib33" id="ref56">33</reflink>] This is compared to the MPEQ process subscale, which targets expectations regarding the therapeutic relationship and incorporates items about client perceptions of the therapist (e.g., "I will feel comfortable with my therapist") and beliefs about how the therapist will perceive the client (e.g., "My therapist will be interested in what I have to say").</p> <p>The current study found that Black participants' ratings on the MPEQ process subscale were significantly lower than White and Hispanic participants, suggesting that Black participants had more negative expectations about the therapeutic relationship. There are several reasons why this may be the case for Black college students. Research demonstrates that Black Americans often have negative experiences with mental health providers and experience racial microaggressions in mental health settings.[<reflink idref="bib15" id="ref57">15</reflink>] Additionally, there is evidence that provider communication often differs when interacting with racially minoritized patients, such as spending less time establishing rapport or being more verbally dominant.[<reflink idref="bib34" id="ref58">34</reflink>] The anticipation of difficulties communicating with providers may be particularly impactful for Black patients, who are less likely to trust medical and mental health providers.[<reflink idref="bib35" id="ref59">35</reflink>] Concerns about negative experiences, microaggressions, or difficulty communicating would decrease intentions to seek treatment as they would increase the perceived difficulty of obtaining effective treatment. This concern about communicating with mental health providers may be addressed through informal drop-in services by an embedded counselor located within departments or cultural centers (e.g., "Let's Talk").</p> <hd id="AN0180828382-21">Clinician diversity</hd> <p>This study hypothesized that Black, Asian, and Hispanic students would have more positive expectations of psychotherapy if clinicians appeared diverse. The results did not support the hypothesis, as clinician diversity had no significant associations with treatment engagement. This may be due to the experimental manipulation, which manipulated the pictures of clinicians who were available in the clinic but did not assign an individual clinician to the participant. When searching for clinicians, patients typically search for individual clinicians rather than looking at the diversity of a clinic. Clinician diversity may be more impactful when a patient is searching for an individual clinician, as research demonstrates that patients prefer to be matched with a therapist of their racial or ethnic group.[<reflink idref="bib36" id="ref60">36</reflink>] In college mental health centers, however, students are typically not allowed to pick their clinician, so the current study was more closely replicating the college mental health center experience. Future research may demonstrate different results if matching individual therapists with the college student.</p> <p>Websites for clinics sometimes have a statement of diversity ideology, which was not included on the website for the current study. When studying Black professionals, Purdie-Vaughns et al.[<reflink idref="bib24" id="ref61">24</reflink>] found that multicultural ideology espoused by a potential employer was associated with increased comfort with the employer. Given that college students are often not allowed to pick their clinician, a diversity statement on a website that promotes multiculturalism may be impactful in reducing treatment engagement disparities. It is also possible that clinician diversity does not affect intentions to seek treatment but does affect willingness to engage in help-seeking behaviors. Previous research has shown that student body diversity is more predictive of counseling center utilization rates by minoritized students than counselor diversity.[<reflink idref="bib6" id="ref62">6</reflink>]</p> <hd id="AN0180828382-22">Identity-related factors</hd> <p>ERI (including public regard) was hypothesized to be positively associated and discrimination was hypothesized to be negatively associated with treatment engagement. ERI commitment was related to more positive attitudes toward treatment, but ERI exploration was not. This suggests that those who have a more internalized sense of connection with their racial or ethnic group may have more positive views of treatment. ERI commitment refers to a sense of belongingness to one's racial or ethnic group, while ERI exploration is the extent to which one seeks experiences related to one's identity. While these two constructs are related, commitment refers more to the content of one's ERI while exploration refers more to the process by which one forms and maintains their ERI. Research demonstrates that college is an important time for the development of ERI exploration while commitment develops consistently throughout the lifespan and may be more influenced by individual experiences.[<reflink idref="bib37" id="ref63">37</reflink>]</p> <p>Analyses demonstrated that racial and ethnic group moderated the relationship between public regard and treatment engagement variables (RPI and MPEQ). Specifically, the relationship between public regard and the MPEQ was significant for both Asian and Black participants, which seems to have been driven by the process subscale. This suggests that the extent to which one has expectations about the therapeutic relationship varies according to public regard for Black and Asian participants, such that those with greater public regard have more positive expectations and those with lower public regard have more negative expectations. This finding was expected for Black participants, who had more negative expectations for the therapeutic relationship on average. If Black participants are more concerned about discrimination or difficulty communicating with mental health providers,[<reflink idref="bib15" id="ref64">15</reflink>],[<reflink idref="bib34" id="ref65">34</reflink>] it would follow that Black participants with lower public regard would be more likely to report negative expectations about the therapeutic relationship. It is surprising that expectations for the therapeutic relationship varied by public regard for Asian participants as they did not have lower average expectations, which was the case for Black participants. Additionally, the relationship between public regard and RPI was only significant for Asian participants, which seems to have been driven by the perseverance subscale. The RPI perseverance subscale targets how hard the participant is willing to work in treatment, especially when treatment is difficult (e.g., "Even if it's hard for me to do some things in therapy, I will stick with it to the end."). These findings suggest that Asian participants who have lower public regard are less likely to express positive expectations about working hard in treatment when it is difficult or to have positive expectations about the therapeutic relationship.</p> <p>Previous studies on Asian and Asian American college students' use of mental health services suggest that they initiate services at a higher level of emotional distress and attend fewer sessions overall.[<reflink idref="bib7" id="ref66">7</reflink>],[<reflink idref="bib38" id="ref67">38</reflink>] Kim and colleagues[<reflink idref="bib7" id="ref68">7</reflink>] suggest that this may be due to acculturative stress. Plausibly, acculturative stress may be reflected in public regard in this study, as concerns about adjusting to the mainstream culture may be influenced by perceptions of how other groups view one's ethnic group. If acculturative stress is related to public regard, then it would follow that Asian college students who have struggled with acculturation and are concerned about others' perception of their group may be worried about being understood by mental health providers. Thus, acculturative stress and public regard would be related to more negative attitudes regarding treatment. The Model Minority Myth, or the expectation that Asians are more successful in comparison to other racial/ethnic groups, may also attribute to more negative attitudes toward treatment engagement.[<reflink idref="bib39" id="ref69">39</reflink>] Studies show that internalization of this stereotype is related to minimizing psychological distress and more negative attitudes toward seeking help for mental health, and that the Model Minority Myth interacts with experiences of discrimination to negatively impact attitudes toward mental health treatment.[<reflink idref="bib39" id="ref70">39</reflink>],[<reflink idref="bib40" id="ref71">40</reflink>] This effect might be particularly relevant among Asian college students, who are navigating academic and social stressors that might challenge their internalization this myth. It is possible that Asian college students with lower public regard are more likely to adhere to the Model Minority Myth, and therefore less likely to seek out resources that are viewed for those who are weak or for those who are in the majority group (i.e., mental health).</p> <hd id="AN0180828382-23">Limitations</hd> <p>This study had several limitations. The study had limited power for Black participants. While main effects were found, the small group size likely affected the ability to test for moderating effects of race and ethnicity on how ERI and discrimination related to treatment engagement. Additionally, while the study found significant findings for Asian participants, there was not a large enough sample to investigate these findings by sub-groups or immigration histories, which has been shown to be very important in previous studies.[<reflink idref="bib7" id="ref72">7</reflink>],[<reflink idref="bib41" id="ref73">41</reflink>] Finally, this study measured public regard among White participants even though this construct has not been investigated among this population. While research demonstrates that White people develop an ERI,[<reflink idref="bib42" id="ref74">42</reflink>] this particular construct has not been investigated and comparisons between White people and other groups in ERI should must be made with caution.</p> <p>The study did not investigate the relationship between attitudinal and behavioral treatment engagement. Both measures of attitudinal engagement have unique associations with treatment engagement behavior.[<reflink idref="bib25" id="ref75">25</reflink>],[<reflink idref="bib26" id="ref76">26</reflink>] Thus, differences in treatment engagement attitudes may not correspond directly with differences in treatment engagement behaviors. Additionally, the study was not limited to students with mental health needs. Plausibly, attitudes about therapy may change when a person needs mental health services personally. Finally, as this study is a cross-sectional study, causal inferences cannot be made based on these findings alone.</p> <hd id="AN0180828382-24">Future directions</hd> <p>This study investigated racial and ethnic differences in attitudes toward treatment engagement among college students. While this study found significant associations between ERI and attitudinal treatment engagement for Asian participants, there is evidence to suggest that some groups that fall under the Asian American descriptor (Indian, Korean, and Vietnamese Americans) attend fewer counseling sessions and other groups have greater initial severity when seeking mental health services (Chinese, Filipinx, Korean, and Vietnamese Americans).[<reflink idref="bib7" id="ref77">7</reflink>] As with all racial and ethnic groups, these categories often obscure rich diversity within groups. Also, we found that public regard may be a particularly important within-group characteristic among Asian and Asian American students. Future research should investigate within group variability associated with subgroup nationalities, cultural factors, and racial/ethnic identity to better understand treatment engagement.</p> <hd id="AN0180828382-25">Conclusion</hd> <p>This study expands the literature on treatment engagement disparities by elucidating attitudes toward treatment among a diverse sample of college students. Black students had more negative expectations about the therapeutic relationship in comparison to White students. Interestingly, while there were no mean differences in attitudes toward therapy for Asian students, how they felt about their ethnic-racial identity was related to their attitudes toward therapy in ways that were not evident in most other groups. By focusing on treatment attitudes rather than treatment behaviors, the findings can help inform clinical interventions targeting treatment engagement among minoritized young adults and adolescents. Interventions that target attitudes rather than behaviors may also improve clinical outcomes, as students who are attitudinally engaged may be more committed to treatment, thus experiencing more positive outcomes. In an effort to increase positive treatment attitudes, counseling centers should provide outreach services such as presentations, informal consultation such as Let's Talk with embedded counselors, and on-going diversity, equity, and inclusion training for professional development for counseling center clinicians to assess their competence and clients experience around diversity, equity and inclusion. As campuses become increasingly diverse, it is imperative that clinicians and clinical researchers understand how to engage with and provide mental health services to students from marginalized backgrounds.</p> <hd id="AN0180828382-26">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the University of Connecticut.</p> <hd id="AN0180828382-27">Funding</hd> <p>No funding was used to support this research and/or the preparation of the manuscript.</p> <ref id="AN0180828382-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Substance Abuse and Mental Health Service Administration. Racial/Ethnic Differences in Mental Health Service Use among Adults. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2015 : 49.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> McKay MM, Bannon WM. Engaging families in child mental health services. Child Adolesc Psychiatr Clin N Am. 2004; 13 (4): 905 – 921, vii. doi: 10.1016/j.chc.2004.04.001</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> Wu IHC, Bathje GJ, Kalibatseva Z, Sung D, Leong FTL, Collins-Eaglin J. Stigma, mental health, and counseling service use: a person-centered approach to mental health stigma profiles. Psychol Serv. 2017; 14 (4): 490 – 501. doi: 10.1037/ser0000165</bibtext> </blist> <blist> <bibl id="bib4" idref="ref4" type="bt">4</bibl> <bibtext> Eisenberg D, Hunt J, Speer N. Mental health in American colleges and universities: variation across student subgroups and across campuses. J Nerv Ment Dis. 2013; 201 (1): 60 – 67. doi: 10.1097/NMD.0b013e31827ab077</bibtext> </blist> <blist> <bibl id="bib5" idref="ref5" type="bt">5</bibl> <bibtext> Lipson SK, Kern A, Eisenberg D, Breland-Noble AM. Mental health disparities among college students of color. J Adolesc Health. 2018; 63 (3): 348 – 356. doi: 10.1016/j.jadohealth.2018.04.014</bibtext> </blist> <blist> <bibl id="bib6" idref="ref7" type="bt">6</bibl> <bibtext> Hayes JA, Youn SJ, Castonguay LG, Locke BD, McAleavey AA, Nordberg S. Rates and predictors of counseling center use among college students of color. J Coll Couns. 2011; 14 (2): 105 – 116. doi: 10.1002/j.2161-1882.2011.tb00266.x</bibtext> </blist> <blist> <bibl id="bib7" idref="ref8" type="bt">7</bibl> <bibtext> Kim JE, La A, Park SS, Chang J, Zane N. Counseling services for Asian, Latino/a, and White American students: initial severity, session attendance, and outcome. Cultur Divers Ethnic Minor Psychol. 2016; 22 (3): 299 – 310. doi: 10.1037/cdp0000069</bibtext> </blist> <blist> <bibl id="bib8" idref="ref9" type="bt">8</bibl> <bibtext> Staudt M. Treatment engagement with caregivers of at-risk children: gaps in research and conceptualization. J Child Fam Stud. 2007; 16 (2): 183 – 196. doi: 10.1007/s10826-006-9077-2</bibtext> </blist> <blist> <bibl id="bib9" idref="ref10" type="bt">9</bibl> <bibtext> Yatchmenoff DK. Measuring client engagement from the client's perspective in nonvoluntary child protective services. Res Soc Work Pract. 2005; 15 (2): 84 – 96. doi: 10.1177/1049731504271605</bibtext> </blist> <blist> <bibtext> Chavira DA, Golinelli D, Sherbourne C, et al. Treatment engagement and response to CBT among Latinos with anxiety disorders in primary care. J Consult Clin Psychol. 2014; 82 (3): 392 – 403. doi: 10.1037/a0036365</bibtext> </blist> <blist> <bibtext> Ofonedu ME, Belcher HME, Budhathoki C, Gross DA. Understanding barriers to initial treatment engagement among underserved families seeking mental health services. J Child Fam Stud. 2017; 26 (3): 863 – 876. doi: 10.1007/s10826-016-0603-6</bibtext> </blist> <blist> <bibtext> Cheng HL, Kwan KLK, Sevig T. Racial and ethnic minority college students' stigma associated with seeking psychological help: examining psychocultural correlates. J Couns Psychol. 2013; 60 (1): 98 – 111. doi: 10.1037/a0031169</bibtext> </blist> <blist> <bibtext> Busby DR, Zheng K, Eisenberg D, et al. Black college students at elevated risk for suicide: Barriers to mental health service utilization. J Am Coll Health. 2021; 69 (3): 308 – 314. doi: 10.1080/07448481.2019.1674316</bibtext> </blist> <blist> <bibtext> Tang Y, Masicampo EJ. Asian American college students, perceived burdensomeness, and willingness to seek help. Asian Am J Psychol. 2018; 9 (4): 344 – 349. doi: 10.1037/aap0000137</bibtext> </blist> <blist> <bibtext> Taylor RE, Kuo BCH. Black American psychological help-seeking intention: an integrated literature review with recommendations for clinical practice. J Psychother Integr. 2019; 29 (4): 325 – 337. doi: 10.1037/int0000131</bibtext> </blist> <blist> <bibtext> Mesidor JK, Sly KF. Mental health help-seeking intentions among international and African American college students: an application of the theory of planned behavior. JIS. 2014; 4 (2): 137 – 149. doi: 10.32674/jis.v4i2.474</bibtext> </blist> <blist> <bibtext> Yasui M, Pottick KJ, Chen Y. Conceptualizing culturally infused engagement and its measurement for ethnic minority and immigrant children and families. Clin Child Fam Psychol Rev. 2017; 20 (3): 250 – 332. doi: 10.1007/s10567-017-0229-2</bibtext> </blist> <blist> <bibtext> Benjamins MR, Whitman S. Relationships between discrimination in health care and health care outcomes among four race/ethnic groups. J Behav Med. 2014; 37 (3): 402 – 413. doi: 10.1007/s10865-013-9496-7</bibtext> </blist> <blist> <bibtext> Umaña-Taylor AJ, Quintana SM, Lee RM, et al. Ethnic and racial identity during adolescence and into young adulthood: an integrated conceptualization. Child Dev. 2014; 85 (1): 21 – 39. doi: 10.1111/cdev.12196</bibtext> </blist> <blist> <bibtext> Abdou CM, Fingerhut AW. Stereotype threat among Black and White women in health care settings. Cultur Divers Ethnic Minor Psychol. 2014; 20 (3): 316 – 323. doi: 10.1037/a0036946</bibtext> </blist> <blist> <bibtext> Sellers RM, Smith MA, Shelton JN, Rowley SAJ, Chavous TM. Multidimensional model of racial identity: a reconceptualization of African American racial identity. Pers Soc Psychol Rev. 1998; 2 (1): 18 – 39. doi: 10.1207/s15327957pspr0201_2</bibtext> </blist> <blist> <bibtext> Steele CM, Spencer SJ, Aronson J. Contending with group image: the psychology of stereotype threat and social identity threat. In: Zanna MP, ed. Advances in Experimental Social Psychology. Vol. 34. San Diego, CA: Academic Press; 2002 : 379 – 440.</bibtext> </blist> <blist> <bibtext> Rivas-Drake D, Seaton EK, Markstrom C,, et al. Ethnic and racial identity in adolescence: implications for psychosocial, academic, and health outcomes. Child Dev. 2014; 85 (1): 40 – 57. doi: 10.1111/cdev.12200</bibtext> </blist> <blist> <bibtext> Purdie-Vaughns V, Steele CM, Davies PG, Ditlmann R, Crosby JR. Social identity contingencies: how diversity cues signal threat or safety for African Americans in mainstream institutions. J Pers Soc Psychol. 2008; 94 (4): 615 – 630. doi: 10.1037/0022-3514.94.4.615</bibtext> </blist> <blist> <bibtext> Norberg MM, Wetterneck CT, Sass DA, Kanter JW. Development and psychometric evaluation of the Milwaukee psychotherapy expectations questionnaire. J Clin Psychol. 2011; 67 (6): 574 – 590. doi: 10.1002/jclp.20781</bibtext> </blist> <blist> <bibtext> Ogrodniczuk JS, Joyce AS, Piper WE. Development of the readiness for psychotherapy index. J Nerv Ment Dis. 2009; 197 (6): 427 – 433. doi: 10.1097/NMD.0b013e3181a61c56</bibtext> </blist> <blist> <bibtext> Sellers RM, Rowley SAJ, Chavous TM, Shelton JN, Smith MA. Multidimensional inventory of Black identity: a preliminary investigation of reliability and construct validity. J Pers Soc Psychol. 1997; 73 (4): 805 – 815. doi: 10.1037/0022-3514.73.4.805</bibtext> </blist> <blist> <bibtext> Johnson TM, Robinson Kurpius SE, Rayle AD, Arredondo P, Tovar-Gamero ZG. The Multidimensional Inventory of Black Identity: its use with Euro-American, Latino, and Native American undergraduates. Meas Eval Couns Dev. 2005; 38 (2): 92 – 103. doi: 10.1080/07481756.2005.11909771</bibtext> </blist> <blist> <bibtext> Landrine H, Klonoff EA, Corral I, Fernandez S, Roesch S. Conceptualizing and measuring ethnic discrimination in health research. J Behav Med. 2006; 29 (1): 79 – 94. doi: 10.1007/s10865-005-9029-0</bibtext> </blist> <blist> <bibtext> Derogatis LR. Brief Symptom Inventory: Administrative, Scoring, and Procedures Manual. 4. Minneapolis, MN : National Computer Systems. 1993.</bibtext> </blist> <blist> <bibtext> Kline RB. Principles and Practice of Structural Equation Modeling. 4th Ed. New York, NY: Guilford Publications; 2015.</bibtext> </blist> <blist> <bibtext> Tabachnick BG, Fidell LS. Using Multivariate Statistics. 4th ed. Boston, MA: Allyn & Bacon; 2001.</bibtext> </blist> <blist> <bibtext> Gonzalez JM, Alegría M, Prihoda TJ, Copeland LA, Zeber JE. How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education. Soc Psychiatry Psychiatr Epidemiol. 2011; 46 (1): 45 – 57. doi: 10.1007/s00127-009-0168-4</bibtext> </blist> <blist> <bibtext> Alegria M, Ali N, Fuentes L. Strategies for promoting patient activation, self-efficacy, and engagement in treatment for ethnic and racial minority clients. In: Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care across Settings. Oakland, CA: Context Press; 2019 : 61 – 78.</bibtext> </blist> <blist> <bibtext> Turner EA, Malone CA, Douglas C. Barriers to mental health treatment for African Americans: applying a model of treatment initiation to reduce disparities. In: Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care across Settings. Oakland, CA: Context Press; 2019 : 27 – 42.</bibtext> </blist> <blist> <bibtext> Cabral RR, Smith TB. Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes. J Couns Psychol. 2011; 58 (4): 537 – 554. doi: 10.1037/a0025266</bibtext> </blist> <blist> <bibtext> Williams CD, Byrd CM, Quintana SM, et al. A lifespan model of ethnic-racial identity. Res Hum Dev. 2020; 17 (2-3): 99 – 129. doi: 10.1080/15427609.2020.1831882</bibtext> </blist> <blist> <bibtext> Kearney LK, Draper M, Barón A. Counseling utilization by ethnic minority college students. Cultur Divers Ethnic Minor Psychol. 2005; 11 (3): 272 – 285. doi: 10.1037/1099-9809.11.3.272</bibtext> </blist> <blist> <bibtext> Tummala-Narra P, Li Z, Chang J, et al. Developmental and contextual correlates of mental health and help-seeking among Asian American college students. Am J Orthopsychiatry. 2018; 88 (6): 636 – 649. doi: 10.1037/ort0000317</bibtext> </blist> <blist> <bibtext> Gupta A, Szymanski DM, Leong FTL. The "model minority myth": Internalized racialism of positive stereotypes as correlates of psychological distress, and attitudes toward help-seeking. Asian Am J Psychol. 2011; 2 (2): 101 – 114. doi: 10.1037/a0024183</bibtext> </blist> <blist> <bibtext> Abe-Kim J, Takeuchi DT, Hong S, et al. Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. Am J Public Health. 2007; 97 (1): 91 – 98. doi: 10.2105/AJPH.2006.098541</bibtext> </blist> <blist> <bibtext> McDermott M, Samson F. White racial and ethnic identity in the United States. Annu Rev Sociol. 2005; 31 (1): 245 – 261. doi: 10.1146/annurev.soc.31.041304.122322</bibtext> </blist> </ref> <aug> <p>By Linda Oshin; Stephanie Milan and Annmarie Wacha-Montes</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref13"></nolink> <nolink nlid="nl3" bibid="bib12" firstref="ref15"></nolink> <nolink nlid="nl4" bibid="bib14" firstref="ref16"></nolink> <nolink nlid="nl5" bibid="bib15" firstref="ref17"></nolink> <nolink nlid="nl6" bibid="bib16" firstref="ref18"></nolink> <nolink nlid="nl7" bibid="bib17" firstref="ref22"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref24"></nolink> <nolink nlid="nl9" bibid="bib19" firstref="ref26"></nolink> <nolink nlid="nl10" bibid="bib20" firstref="ref27"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref28"></nolink> <nolink nlid="nl12" bibid="bib22" firstref="ref29"></nolink> <nolink nlid="nl13" bibid="bib23" firstref="ref30"></nolink> <nolink nlid="nl14" bibid="bib24" firstref="ref31"></nolink> <nolink nlid="nl15" bibid="bib25" firstref="ref37"></nolink> <nolink nlid="nl16" bibid="bib26" firstref="ref38"></nolink> <nolink nlid="nl17" bibid="bib27" firstref="ref40"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref41"></nolink> <nolink nlid="nl19" bibid="bib29" firstref="ref42"></nolink> <nolink nlid="nl20" bibid="bib30" firstref="ref43"></nolink> <nolink nlid="nl21" bibid="bib31" firstref="ref46"></nolink> <nolink nlid="nl22" bibid="bib32" firstref="ref47"></nolink> <nolink nlid="nl23" bibid="bib242" firstref="ref49"></nolink> <nolink nlid="nl24" bibid="bib33" firstref="ref56"></nolink> <nolink nlid="nl25" bibid="bib34" firstref="ref58"></nolink> <nolink nlid="nl26" bibid="bib35" firstref="ref59"></nolink> <nolink nlid="nl27" bibid="bib36" firstref="ref60"></nolink> <nolink nlid="nl28" bibid="bib37" firstref="ref63"></nolink> <nolink nlid="nl29" bibid="bib38" firstref="ref67"></nolink> <nolink nlid="nl30" bibid="bib39" firstref="ref69"></nolink> <nolink nlid="nl31" bibid="bib40" firstref="ref71"></nolink> <nolink nlid="nl32" bibid="bib41" firstref="ref73"></nolink> <nolink nlid="nl33" bibid="bib42" firstref="ref74"></nolink>
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Influence of Ethnic-Racial Identity and Discrimination on Mental Health Treatment Attitudes among College Students
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Linda+Oshin%22">Linda Oshin</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6308-5521">0000-0001-6308-5521</externalLink>)<br /><searchLink fieldCode="AR" term="%22Stephanie+Milan%22">Stephanie Milan</searchLink><br /><searchLink fieldCode="AR" term="%22Annmarie+Wacha-Montes%22">Annmarie Wacha-Montes</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(8):2954-2962.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ethnic+Groups%22">Ethnic Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Identification%22">Racial Identification</searchLink><br /><searchLink fieldCode="DE" term="%22Racism%22">Racism</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health+Programs%22">Mental Health Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Counseling%22">Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Diversity%22">Diversity</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Colleges%22">Public Colleges</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Differences%22">Racial Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Discrimination%22">Racial Discrimination</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Multigroup+Ethnic+Identity+Measure%22">Multigroup Ethnic Identity Measure</searchLink><br /><searchLink fieldCode="SU" term="%22Brief+Symptom+Inventory%22">Brief Symptom Inventory</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2022.2145894
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1448254
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1448254
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2022.2145894
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 2954
    Subjects:
      – SubjectFull: Ethnic Groups
        Type: general
      – SubjectFull: Racial Identification
        Type: general
      – SubjectFull: Racism
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Mental Health Programs
        Type: general
      – SubjectFull: Health Services
        Type: general
      – SubjectFull: Counseling
        Type: general
      – SubjectFull: Diversity
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Public Colleges
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: Racial Discrimination
        Type: general
      – SubjectFull: Multigroup Ethnic Identity Measure
        Type: general
      – SubjectFull: Brief Symptom Inventory
        Type: general
    Titles:
      – TitleFull: The Influence of Ethnic-Racial Identity and Discrimination on Mental Health Treatment Attitudes among College Students
        Type: main
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            NameFull: Linda Oshin
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            NameFull: Stephanie Milan
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            NameFull: Annmarie Wacha-Montes
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            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
            – Type: issn-electronic
              Value: 1940-3208
          Numbering:
            – Type: volume
              Value: 72
            – Type: issue
              Value: 8
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            – TitleFull: Journal of American College Health
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