Date of Award

2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)

Department

Clinical Psychology

First Advisor/Committee Member

Lynette H. Bikos, Ph.D.

Second Advisor/Committee Member

John W. Thoburn, Ph.D.

Third Advisor/Committee Member

Jacob A. Eide, Psy.D.

Abstract

Behavioral health models improve access to mental health care by integrating psychology and medicine. While integrated care is supported among the general population, less research focuses on the model with Asian American and Pacific Islanders (AAPIs). AAPIs are low treatment-seeking due to various barriers (e.g., limited English proficiency, stigma, insurance) and acculturation stressors. Using hierarchical linear modeling, this study examined longitudinal depression (PHQ-9) and anxiety (GAD-7) growth trajectories among AAPIs within a behavioral health model and the moderating impact of acculturation and frequency of behavioral health visits. The best fitting model was from a sample who (N = 354; 71.5% female) met the following inclusion criteria: (a) AAPI, (b) over 18 years of age, (c) engaged in three or more behavioral health visits, (d) PHQ-9 and GAD-7 scores at three or more time points, (e) proxy acculturation data. The sample was 39% Vietnamese, mean age was 55.84 (SD = 16.92), and behavioral health visits ranged from 3 to 12. Depression and anxiety growth trajectories indicated significant cubic functions (PHQ-9, β30 = -.077, p < .001; GAD-7, β30 = -.045, p < .001). For depression, there was a non-significant moderating effect of acculturation (β11 = .163, p = .468, β21 = -.005, p = .931, β31 = -.001, p = .770), but significant effect of frequency of behavioral health visits (β12 = .252, p = .005, β22 = -.080, p = .004, β32 = .005, p = .010). For anxiety, there was a non-significant moderating effect of acculturation (β11 = .255, p = .148) and frequency of behavioral health visits (β12 = .126, p = .075) on instantaneous rate of change (i.e., slope). There was a non-significant moderating effect of acculturation (β21 = -.018, p = .687) but significant effect of frequency of behavioral health visits (β22 = -.044, p = .035) on change to the rate of change. Both moderators were non-significant at the cubic level (β31 = -.008, p = .822, β32 = .003, p = .057). Depression and anxiety outcomes among AAPIs improved within the behavioral health model. Moderation by acculturation and frequency of behavioral health visits varied.

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