Letter

Reducing Barriers to Care by Looking Closely at Stigma

To the Editor: I read with interest the article "Perceived Stigma and Mental Health Care Seeking" ( 1 ) by Golberstein and colleagues in the April issue. This is a timely study in light of recent recommendations from a midcourse review of the Healthy People 2010 initiative to address barriers to mental health care ( 2 ). I agree with the authors' recognition that their study is unique in its focus on a specific population—namely, students from one public university. I propose that this level of focus may be what we need in order to examine the social and personal factors that might influence the decision to seek mental health care. The continued call to reduce disparities in mental health care requires us to more closely examine individual subpopulations, including those defined by ethnic groups. We must look at service utilization by population subgroups in order to advance the nation's efforts in improving access to high-quality mental health care.

One of the major findings of the study by Golberstein and colleagues is that Asians were less likely to perceive a need for mental health care, as measured by self-reported claims of needing help for mental health problems. It is not uncommon for Asians to express symptoms of depression through somatic means that may be better understood within their social environment ( 3 ). Although recognizing that the choice of independent variables may have been limited to items contained in the survey, I suspect that the study would have produced much different findings had the authors been able to use more than one indicator for perceived need, such as how frequently poor mental health affected the respondents' ability to perform in everyday life functions, such as work and recreation. I also suspect that the results for service use would have been much different had the authors been able to use multiple measures to describe persons from ethnically diverse populations. Some of these measures may include the respondents' nativity or generational status, length of time in the United States, age at which they arrived in the United States, and cultural identity.

The next challenge is to interpret these findings so that they become meaningful to program administrators and policy makers.