Impact of cultural variables on Vietnamese Americans' attitudes toward professional psychological help
4 TABLE OF CONTENTS VITA 9 ABSTRACT 10 CHAPTER I Introduction 11 Statement of the Problem 12 CHAPTER II Literature Review 15 Acculturation 15 Help-seeking 19 Stigma 22 Gender 24 Definition of Terms , 25 Research Hypotheses 25 CHAPTER III Method 28 Participants 28 Design 30 Instruments 30 Asian American Values Scale-Multidimensional 30 Social Stigma for Receiving Psychological Help 31 Attitudes Toward Seeking Professional Psychological Help-Short Form 31 Procedures 22 CHAPTER IV Results 34 Analysis of Demographic Confounds 34 Analysis of Research Hypotheses 34 Additional Analysis 37 CHAPTER V Discussion 40 Discussion of Research Findings 40 Limitations and Implications for Future Research 42 Implications for Clinical Treatment 43
5 REFERENCES 45
6 LIST OF TABLES PAGE Table 1: Demographic Characteristics 29 Table 2: Relationship Between Predictor Variables and Criterion Variable 36 Table 3: Relationship Between Predictor Variables and Criterion Variable by Gender...38
7 LIST OF APPENDICES PAGE Appendix A: Consent forms 47 Appendix B: General Information Questionnaire 53 Appendix C: Attitudes Toward Seeking Professional Psychological Help-Short Form...57 Appendix D: Social Stigma for Receiving Psychological Help 60 Appendix E: Asian American Values Scale-Multidimensional 62
8 ACKNOWLEDGMENTS I would like to express my gratitude toward my committee Drs. Mendoza, Garbanati, and Bloch. This research project would have not been made possible without their expertise and dedication. I am also very thankful for the help that I received from all the dedicated staff at the Alliant International University-California School of Professional Psychology, Los Angeles. Last but not least, I am deeply appreciative of the support and love that my family and friends have shown to me that provided me the spiritual and emotional strengths necessary to complete my doctoral journey.
9 CIRRICULUM VITAE Education History 2005-2010 2008 2004 Clinical Experience 2010-2011 2010-2011 2009-2010 2008-2009 2007- 2008 2007- 2009 California School of Professional Psychology - Los Angeles at Alliant International University, Alhambra, CA Clinical Psychology Ph.D. Program Multicultural and Community Emphasis Area California School of Professional Psychology-Los Angeles at Alliant International University. Alhambra, CA Major: Clinical Psychology (M.A) Thesis: Relationship among religious affiliation, acculturation, and attitudes towards seeking U.S.-based mental health services in Vietnamese Americans. University of San Francisco, San Francisco, CA Major: Psychology (B.A) Minors: Asian American Studies & Philosophy Senior's Thesis: Vietnamese American Adolescent Gangs and Delinquents Post-Doctoral Fellowship California Lutheran University, Thousand Oaks, CA Worability III Counselor Santa Ana College, Santa Ana, CA APPIC-Full-time Pre-Doctoral Internship Santa Ana College - Psychological Services - Santa Ana, CA Half-time Internship Behavioral Health Center Alhambra Hospital- Rosemead, CA Adult Inpatient Practicum Student UCLA - Staff and Faculty Counseling Center, Los Angels, CA Case Manager Pacific Clinics - Asian Pacific Family Center, Rosemead, CA
10 ABSTRACT A correlation study was conducted to examine the relationship between gender, stigma, enculturation and attitudes toward seeking professional psychological help. Data was collected from 138 (45 males, 93 females) Vietnamese American students attending a large community college in Orange County, California. Results indicate that individuals who perceived greater stigma for receiving psychological help were more likely to endorse negative attitudes toward seeking professional psychological help. However, the relationship between gender, enculturation and attitudes toward seeking professional psychological help was found to be statistically insignificant. Findings and implications for future research were discussed.
11 CHAPTER I Introduction Although extensive research shows that Asian Americans underutilize mental health services (Abe-Kim et al., 2007; Sue, 1977; Sue et al., 1991), the underutilization is not accounted for by less need for these mental health services. In fact, the literature suggests Asian Americans may have a high or higher rate of psychopathology as compared to their white counterparts (Chun, Eastman, Wang & Sue 1999; as cited in Zane & Lee, 1999). Needs assessment among Asian Americans indicated that they have high mental health needs with Southeast Asians particularly more vulnerable to depression and other mental disorders (as cited in Sue et al., 1994). This phenomenon has been understood as the conflict between Asian American traditional values and the psychotherapy process as well as well as lack of culturally sensitive mental health treatment available to Asian Americans. In addition, Asian Americans' actual help- seeking behaviors are influenced by their attitudes toward seeking mental health treatment. Although the need for mental health services among Asian Americans is great, seeking those services are affected by cultural barriers. These cultural barriers include but are not limited to unfamiliarity with psychotherapy, feelings of shame and stigma, and the lack of English proficiency (Chin, J.L., 1999; as cited in Lee & Zane). Subsequently, scholars have pursued research in order to gain more knowledge about Asian Americans' help-seeking behaviors through the study of this groups' attitudes toward seeking professional mental health treatment and cultural influences such as stigma and acculturation styles. The sections that will be discussed within the chapter include statement of problem, summary of literature, definition of terms, and hypothesis.
12 Statement of Problem Though existing literature provides insight into Asian American attitudes toward seeking mental health services in relation to cultural variables such as acculturation and stigma, it is largely inconclusive and would benefit from further investigation of these constructs especially with Vietnamese Americans. Vietnamese Americans are the fastest growing ethnic group in the United States. According to the U.S. Census 2000, there were 1,122,528 people identified as Vietnamese alone or 1,223,736 in combination with other ethnicities. An American Community Survey also conducted by the US Census Bureau in 2005 estimated that Vietnamese American population has increased to 1,418,334. Given this apparent demographic significance, it is surprising that very few studies have focused primarily on Vietnamese Americans' experiences that potentially shape help-seeking attitudes. Though noticeable efforts have been made over the past few decades by researchers to gain understanding of Asian Americans help-seeking attitudes, Vietnamese Americans were largely underrepresented in those studies (Atkinson & Gim, 1989; Sheu & Sedlacek, 2004; Shea & Yeh, 2008). While there are immeasurable values to studies that highlight the similarities among different Asian ethnic groups under the larger Asian American umbrella, it is equally valuable to capture individual group differences and experiences. Though Asian Americans are often viewed as a monolithic group, each subgroup differs in language, cultural background, history of migration, and acculturation status (Ying & Hu, 1994). For example, Vietnamese Americans resettled in the United States relatively recently in comparison to other Asian ethnic groups. Moreover, their migration history differed
13 vastly from that of other Asian Americans. The literature has described Vietnamese Americans' settlement in the United States in terms of immigration waves. The first migration wave carried 125,000 Vietnamese to the United States from the end of the Vietnam War in 1975 through the late 1970's. This group came from a more privileged background, was generally more educated and highly skilled compared to the Vietnamese Americans who came later. The second wave began in 1978 and lasted until the mid 1980's with an even larger population of Vietnamese immigrants (Chan, 1991). Unlike many other Asian American ethnic groups, Vietnamese Americans involuntarily left their home country to seek political asylum in the United States. Vietnamese Americans' experiences were unique due to a series of traumas resulting from pre- migration and migration conditions. In addition to trauma brought about by the war, Vietnamese Americans were further traumatized by horrendous exodus experience such as attacks by pirates, rape, and death on the high seas. Consequently, Vietnamese Americans in particular were thought to have greater mental health needs as the result of "severe war and migration traumas" (Ying & Hu, 1994; p. 452). Another limitation of existing studies on Asian Americans' attitudes toward help- seeking is the use of convenience sampling. With the exception of one study, most research accessed college students who attended traditional four-year university institutions. Nguyen and Anderson (2005) examined cultural variables that may influence Vietnamese Americans' attitudes toward help-seeking. Gleaning from Nguyen and Anderson' study, the current study sought to expand the literature on Vietamese Americans by utilizing students from a community college in Orange County, California, which is the single geographic location in the United States with the most Vietnamese
14 outside of Vietnam (135,545; 30.7% of Vietnamese Americans in the United States). As community colleges tend to have an open-enrollment policy that allows for a diverse student body more representatives of the community at large, gathering data from a community college increases the chance of a cross-sectional sample. In light of the uniqueness of Vietnamese American experience, the lack of equal representation in traditional research on Asian Americans' help-seeking attitudes, and the use of convenience sampling methodology, the current study sought to substantiate the very small existing literature on Vietnamese Americans attitudes toward seeking professional psychological help. The study examined Vietnamese Americans' attitudes both toward seeking professional psychological help and its relationship to relevant cultural variables.
15 CHAPTER II Literature Review Acculturation Acculturation is a widely studied area in the psychological literature on Asian Americans. Berry (1989) defined acculturation as the process of cultural change when two or more cultures come into sustained contact. Psychological literature has primarily looked at psychological acculturation which is defined as an individual's process of adjustment and acceptance of certain cultural aspects of the host country. Thus acculturation may manifest in four different styles: assimilation, segregation, marginalization, and integration. With an assimilation acculturation style, individuals gradually shed their original cultural values and practices to take on and embrace cultural values of the host society. On the contrary, individuals who manifest a segregation acculturation approach tend to disengage and are disinterested in adopting cultural values of the host society. Moreover, these individuals continue to maintain close ties with their heritage of origin. Individuals who marginalize themselves are in a unique space where they neither adopt the cultural values of the host society nor retain the values and practices of their culture of origin. Finally, individuals whose acculturation style is regarded as integration tend to incorporate and adopt cultural values and practices of both host and origin societies. Although no studies on Vietnamese American acculturation and its effects on mental health help seeking currently exist, early research with Asian Americans has demonstrated a trend suggesting that the more acculturated an individual, the more he or she is likely to endorse positive attitudes about seeking mental health treatment. Seminal
16 research conducted by Atkinson and Gim (1989) on attitudes toward mental health services among Asian Americans found a strong correlation between acculturation level and attitudes toward mental health services. The study sampled a large undergraduate student population consisting of 557 Chinese, Japanese, and Korean Americans. The results indicated that individuals who were highly acculturated endorsed more positive attitudes toward mental health services. These students were found to be more likely to recognize personal needs for professional help and were predicted to be more open to discussing their problems with a mental health professional. Tata and Leong (1994) replicated Atkinson and Gim's study with Chinese American students. The study concurred with previous results, suggesting that Chinese American students who were higher in acculturation level were more likely to view mental health treatment favorably compared to other students who were lower on acculturation. The authors stated that acculturation is one cultural variable that strongly predicts Asian American, particularly Chinese American attitudes toward seeking mental health. More recent literature on acculturation has explored the limitations of the earlier acculturation scales such as the Suin-Lew Asian Self-Identity Acculturation Scale, that were commonly administered to Asian Americans in studies exploring Asian Americans' acculturation. B.S.K. Kim (2007) argued that acculturation is a complex process that might not have been adequately captured in the SL-ASIA Scale. This scale "main'y assessed construct domain of behaviors.. .with little attention to the domain of values" (B.S.K. Kim, 2007; p. 475). Furthermore, the SL-ASIA is a uni-linear measurement with high scores corresponding to higher acculturation to Western culture and low score to
17 lower acculturation with the middle range being ambiguous. The SL-ASIA only measures the degree to which an individual has acquired the norms and values of the host country (increased acculturation). However, it did not measure the degree to which an individual retained his or her heritage norms and values. B.S.K. Kim argued that though acculturation has been conceptualized as a bidirectional process whereby it places emphasis on both the retention of one's indigenous culture and adaptation to the host culture, acculturation research has essentially only measured acculturation as an adaptation toward mainstream culture. Hence, B.S.K. Kim proposed the construct enculturation to distinguish it from acculturation. Kim defined enculturation as "the process of being socialized into and retaining one's indigenous cultural norms for both immigrant, first-generation Asian Americans and those who are farther removed from migration" (p. 474). B.S.K. Kim (2007) examined the relationship between enculturation and acculturation with attitudes toward seeking professional psychological help. The study consisted of a sample of 146 Asian American college students. The Asian Values Scale (AVS) (B.S.K. Kim, Atkinson & Yang 1999) was used to measure enculturation, and the European American Values Scale for Asian Americans to measure levels of acculturation. The enculturation or retention of heritage culture was more predictive than acculturation of attitudes toward seeking professional psychological help. Contrary to previous research that suggested a direct relationship between acculturation level and attitudes toward seeking mental health services, B.S.K. Kim' study found no correlation between acculturation and attitudes toward seeking professional mental health services. The author posited that previous studies, utilizing the SL-ASIA, may perhaps have
18 overestimated the influence of acculturation and underestimated the importance of enculturation in which enculturation may have confounded the results. Moreover, the scale only assessed behaviors but not cultural values. Contrary to B.S.K. Kim's (2007) findings, P.Y. Kim and Park' (2009) study did not support the hypothesis that there is a relationship between Asian cultural values and attitudes toward seeking professional psychological services. The authors noted this is due to the difference in the scales that were employed in both studies. B.S.K. Kim s (2007) utilized an older version of the author's Asian Values Scale (AVS: B.S.K. Kim et al., 1999) whereas P.Y. Kim and Park tested a revised version of the AVS called, Asian American Values Scale-Multidimensional (AAVS-M; B.S.K. Kim et al., 2005). The AVS contained a. filial piety subscale whereas the AAVS-M did not. This might have accounted for the difference in P.Y. Kim and Park's findings. Ting and Hwang (2009) examined the relationship between acculturation and help-seeking attitudes in Asian American college students, using the Vancouver Index of Acculturation (VIA), which is a 20-item measure of acculturation to assess student's acculturation. The study did not support the common understanding that individuals with a higher acculturation level held a more positive view toward help-seeking. The authors concurred with B.S.K. Kim (2007), noting the difficulty in measuring and conceptualizing acculturation and the lack of a good scale that truly assesses cultural values as opposed to behaviors such as the Suin-Lew Asian Self-Identity Acculturation Scale. On the other hand, Shea and Yeh (2008) examined the importance of the enculturation index in their study which supported B,S.K. Kim's findings (2007). Asian
19 Americans higher in enculturation viewed help-seeking more negatively compared to their counterparts who were lower in their enculturation level. Help-seeking Asian Americans have historically underutilized mental health services. A common hypothesis put forth by scholars to explain such a phenomenon is the possible influence of Asian cultural values on attitudes toward seeking mental health services, which in turn affect actual help-seeking behaviors. Again, Vietnamese Americans are not represented in this literature. Duan and Tyler (1990) compared mental health values and preference for mental health resources between Japanese American and Caucasian students and demonstrated that Japanese students were more likely to confide in their close friends or to rely on themselves when negotiating personal difficulties. Japanese American students also reported underutilization of mental health resources for themselves and their families. The authors noted that the result reflected attitudes regarding appropriate help-seeking behaviors among Asian Americans. Another study conducted by Gong, Gage and Tacata (2003) on help seeking behavior among Filipino Americans illustrated that Filipino Americans more frequently utilized the lay system as a source of care than professionals. The authors examined Filipino Americans' help-seeking behaviors in relation to cultural variables. The study specifically looked at how cultural variables of loss face and language influenced individuals' utilization of one of the four systems of care: lay, mental health specialty, general practitioner, and folk systems. The study showed that individuals who had greater concern regarding loss of face were less likely to seek help from mental health professionals. Moreover, the issue of face did not seem to affect Filipino Americans help
20 seeking with general practitioners. The study also compared help seeking behaviors among mono-Filipino, bilingual and mono-English speakers. The results indicated that mono-English speakers and bilingual speakers were more likely to prefer the professional sectors to the lay system of care. Thus, help seeking behaviors could be explained by language capacity increasing accessibility to professional care and greater familiarity with mental health services. In a cross-cultural study, Sheu and Sedlacek (2004) explored help seeking attitudes and coping strategies among Caucasian, African American and Asian college students. The authors discovered that African American students were more willing to seek study skills and time management training but not counseling-related services. More significantly, Asian American students tended to hold more positive attitudes for study skills training compared to Caucasian students. Asian Americans were more likely to seek non-counseling services like study skills and time management than counseling compared to African and Caucasian students. P.Y. Kim and Park (2009) looked at how an individual's subjective norm and intention influenced his or her attitudes toward seeking professional psychological help. The authors recruited 110 Asian American undergraduate students from a Midwestern University for the study. Subjective norm is defined as the "individual's perception of the social pressure to seek or not seek mental health services and his or her willingness to comply with that pressure" (p. 295). The authors asserted that subjective norm is a worthwhile area to pursue in examining the cultural factors influencing Asian American help-seeking behaviors. Asian Americans are strongly affected by group norms and expectations. For example, Asian Americans may be deterred from seeking help due to
21 the fear that such behavior will bring shame and stigma to their family as they believe their family members may hold negative perceptions toward professional psychological services. Intention was operationalized as the willingness to see a counselor. P.Y. Kim and Park found a strong relationship between subjective norm and intention to seek mental health services. In one of the rare studies focused on exploring Vietnamese Americans' attitudes toward help-seeking, Nguyen and Anderson (2005) investigated the correlation between attitudes toward seeking mental health services and cultural variables such as traditional beliefs about mental illness, help seeking preferences, problem prioritizing, and disclosure. The study recruited community members from a large Southwestern city, finding that individuals who placed higher priority on mental and emotional concerns viewed seeking mental health services more positively. A positive trend on attitudes toward seeking professional psychological help was also present among individuals who ranked professional services higher than family or community resources. These individuals also had faith in professional help and believed that they would benefit from such services. The study also found that individuals who were more willing to disclose personal concerns with others viewed seeking professional mental health services as viable resources. Similarly, traditional beliefs of mental illness causes such as ghost, spirit, or demon bore little or no impact on Vietnamese Americans' attitudes toward seeking professional psychological help. Although new literature on Asian Americans as a homogeneous group suggests that enculturation may be more predictive of attitudes than acculturation toward seeking professional psychological help, enculturation has not been studied among Vietnamese
22 Americans. The present study examined the relationship between enculturation and attitudes of Vietnamese Americans toward seeking professional psychological help. Stigma Stigma is one of the most pertinent cultural values that scholars have studied in relation to attitudes toward seeking mental health services among Asian Americans as a homogeneous group. Asian Americans fear that seeking mental health services not only stigmatizes them on an individual level, but also brings shame and embarrassment to their family. Sue (1994) stated, "Asian Americans tend to avoid using mental health services because of the shame and stigma associated with using such services, because Asian Americans may have culturally biased views of mental health and illness and appropriate sources of treatment that are inconsistent with Western views..." (Sue et al., 1994, p. 63). These cultural values such as shame and stigma, and preferences for seeking help present psychological barriers to seeking professional mental health help. Asian Americans are also more likely to seek help by talking to family and friends, seeking medical attention or indigenous healing, or consulting with religious leaders. Seeking help from mental health professionals for personal issues is seen as a last resort. The literature demonstrates a common trend suggesting that stigma strongly predicts Asian Americans' attitudes toward mental health treatment (Atkinson & Gim, 1989; Shea & Yeh, 2008). Asian Americans who attributed higher stigma to receiving psychological help were more likely to endorse negative views toward professional help- seeking (Atkinson & Gim, 1989; Shea & Yeh, 2008). Miville and Constantine (2008) investigated gender difference and the relationship between perceived stigma toward counseling and its correlation with intentions to seek counseling. Asian American female
23 college students who had higher perceived stigma toward counseling were less likely to seek counseling services. Another study, looking at stigma beliefs of Asian Americans towards depression demonstrated that Asian Americans had a stronger stigma belief compared to their Caucasian counterparts (Fogel & Ford, 2005). In particular, the authors investigated the relationship between stigma with different referent groups (i.e. family, friends, and employers). If the fear of being stigmatized by seeking mental health help deters Asian Americans from seeking mental health services, then the ability to tolerate such stigma makes intuitive sense in predicting Asian Americans' attitudes and willingness to do so. A study examining Asian American students' stigma tolerance found a strong relationship between one's ability to tolerate stigma with positive help-seeking attitudes (Ting & Hwang, 2009). Contrary to previous findings with respect to Asian Americans as a homogeneous group, Nguyen and Patterson (2005) did not find a correlation between stigma and attitudes toward seeking professional psychological help among their sample of 148 Vietnamese Americans. The authors attributed this finding to the fact that perhaps Vietnamese Americans in the study were more acculturated due to the 8-year residency in the United States cut-off criteria of the study. The present study sought to substantiate the literature on stigma and attitudes toward seeking professional psychological help among Vietnamese Americans. One objective of the study was to provide a more comprehensive picture of the Vietnamese- American by including participants who have resided in the United States less than eight years as well as longer than eight years.
24 Gender Past research on the relationship between gender and attitudes toward seeking psychological help has yielded some inconsistent findings. In particular, Asian American female college students were more likely to view seeking psychological services positively than their male counterparts (Miville & Constantine, 2007; Shea & Yeh, 2008; Suan & Tyler, 1990; Tata & Leong, 1994). On the other hand, a few studies showed that there is no significant relationship between gender and attitudes toward seeking professional psychological services (Atkinson & Gim, 1989; Ting & Hwang, 2009. No discemable patterns or differences were observed between the two groups of studies. The present study examined the relationship between gender and attitudes toward seeking professional psychological help specifically among Vietnamese Americans. The current study also examined attitudes toward seeking professional psychological help relation to culture. In particular, the study focused on cultural variables that are pertinent to Asian Americans in general and Vietnamese Americans in particular, as suggested in the literature. These cultural variables include enculturation, stigma, and gender. Specifically, the current study looked at three independent variables: gender, enculturation, and stigma and one dependent variable, attitudes toward seeking professional psychological help. Three hypotheses were tested: 1) there is a significant relationship between gender and attitudes toward seeking psychological help, such that Vietnamese American females will hold a more positive views toward help-seeking compared to their male counterparts, 2) there is significant relationship between enculturation and attitudes toward seeking professional psychological, such that as enculturation decreases attitudes toward seeking professional psychological help will
25 increase, and 3) there is a significant relationship between stigma and help-seeking attitudes, such that as stigma increases, negative attitudes toward seeking professional psychological also increase. Definition of Terms Enculturation. Enculturation will be operationalized in the proposed study through Asian Values Scale-Multidimensional (Kim, Li& Ng, 2005). Attitudes toward seeking mental health. It will be measured by using the Attitudes Toward Seeking Professional Psychological Help-Shortened Form (ATSPPH- SF; Fischer & Farina, 1995). Stigma. This study will measure stigma using the Stigma Scale for Receiving Psychological Help (Komiya et al., 2000). Research Hypotheses The current study attempted to investigate attitudes toward seeking professional psychological helping relation to culture. It primarily focused on cultural variables that are pertinent to Asian Americans in general and Vietnamese Americans in particular, as suggested in the literature. These cultural variables include enculturation, stigma, and gender. Specifically, the current study looked at three independent variables: gender, enculturation, and stigma and one dependent variable, attitudes toward seeking professional psychological help. Enculturation as compared to acculturation was found to be more predictive of attitudes toward seeking professional psychological help. However, to date, no studies have examined enculturation and its relationship to attitudes toward seeking professional psychological help among Vietnamese Americans. There is a dearth of literature that specifically investigated the relationship between stigma and attitudes
26 toward seeking professional psychological help among Vietnamese Americans. Of the study that is available, the authors only included Vietnamese Americans who have resided in the United States for at least eight years or more. Lastly, existing research have not examined gender and attitudes toward seeking professional psychological help among Vietnamese Americans. Thus, the current study had attempted to investigate attitudes toward seeking professional psychological help in relation to culture. The study primarily focused on cultural variables that were pertinent with Asian Americans in general and Vietnamese Americans in particular as suggested in the literature. These cultural variables include enculturation as relating to acculturation, stigma, and gender. Specifically, the study sought to explore the following: Hypothesis 1: It is hypothesized that there will be a significant relationship between gender and attitudes toward seeking psychological help. In particular, the current study proposed that Vietnamese American females will hold a more positive view toward help-seeking compared to their male counterparts. Hypothesis 2: It is hypothesized that there will be a significant relationship between enculturation and attitudes toward seeking professional psychological help. Particularly, the study predicted that Vietnamese Americans who are highly enculturated will view help-seeking more negatively than their counterparts who were less enculturated. Gender differences will also be examined for enculturation if gender effect is found in hypothesis one. Hypothesis 3: It is hypothesized that there will be a significant relationship between stigma and help-seeking attitudes. Specifically, it is predicted that Vietnamese Americans who attached greater stigma to seeking help for mental health concerns will
27 hold more negative views of help-seeking than those individuals who had higher stigma tolerance. Gender differences will also be examined for stigma if gender effect is found in hypothesis one.
28 CHAPTER III Method The purpose of the current study was to substantiate the existing literature on Vietnamese Americans attitudes toward seeking professional psychological help In addition, it sought to explore cultural values such as acculturation, stigma, and gender that may shape help seeking attitudes The sections that will be discussed within the chapter include Research Participants, Design, Instrumentation, Procedures, and Proposed Data Analysis Participants This study was designed to examine enculturation, stigma, gender difference and attitudes toward seeking professional psychological help The sample consisted of 138 Vietnamese American students (45 males and 93 females) at a community college in Orange County, California (see table 1 for detail) Participants ranged in age from 18 to 71 with a median age of 30 00 (SD = 15 42, n = 131) 7 participants (5 1%) did not indicate their age The majority of participants (94 9%) were born in Vietnam and seven participants (5 1%) were born in the United States Years of residency in the United States for participants who were born in Vietnam ranged from less than one year to 45 years with the median of 5 00 years (SD = 915) In terms of highest education level achieved, participants reported a range from junior high to doctorate with the majority participants reported high school (48 6%, n = 67), Associate-level or two-year college (31 2%, n = 43), and Bachelor or four-year college (12 3%, n= \1)