Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders Giyeon Kim a, b, * , Claudia X. Aguado Loi c , David A. Chiriboga c , Yuri Jang c , Patricia Parmelee a, b , Rebecca S. Allen a, b a Center for Mental Health and Aging, The University of Alabama, Box 870315, 35487-0315 Tuscaloosa, AL, USA b Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA c Department of Aging and Mental Health Disparities, University of South Florida, Tampa, FL, USA article info Article history: Received 6 October 2009 Received in revised form 23 April 2010 Accepted 30 April 2010 Keywords: Limited English Proficiency (LEP) Immigrants Language barriers Mental health service utilization Latino Asian abstract Language barriers pose problems in mental health care for foreign-born individuals in the United States. Immigrants with psychiatric disorders may be at particular risk but are currently understudied. The purpose of this study was to examine the effect of limited English proficiency (LEP) on mental health service use among immigrant adults with psychiatric disorders. Drawn from the National Latino and Asian American Study (NLAAS), Latino and Asian immigrant adults aged 18e86 with any instrument- determined mood, anxiety, and substance use disorder (n ¼ 372) were included in the present analysis. Results from hierarchical logistic regression analyses showed that having health insurance, poor self-rated mental health, and more psychiatric disorders were independently associated with higher probability of mental health service use in the Latino group. After controlling for all background char- acteristics and mental health need factors, LEP significantly decreased odds of mental health service use among Latino immigrants. None of the factors including LEP predicted mental health service use among Asian immigrants, who were also the least likely to access such services. LEP was a barrier to mental health service use among Latino immigrants with psychiatric disorders. This study suggests that future approaches to interventions might be well advised to include not only enhancing the availability of bilingual service providers and interpretation services but also increasing awareness of such options for at least Latino immigrants. In addition, further investigation is needed to identify factors that can enhance access to mental health care services among Asians. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction The growth of the immigrant population in recent years has been phenomenal: current statistics shows that more than one in every eight U.S. residents are immigrants (U.S. Census Bureau, 2004). In 2007, 54.6 percent of foreign-born people in the U.S. were from Central and Latin America, 23.1 percent were from Asia, and the remaining 20.3 percent were from Europe and other regions of the world (Camarota, 2007). The United States grew not only racially and ethnically but also linguistically diverse. According to a recent U.S. Census Bureau (n.d.), over 54 million (19.5 percent of the U.S. pop- ulation) reported that they spoke a language other than English at home and 8.6 percent of the U.S. population reported they spoke English less than “very well.” Additionally, more than half (51.0%) of the U.S. immigrant population appeared to have less than “very well” English-speaking ability (U.S. Census Bureau, 2005), referred to as limited English proficiency (LEP) population. LEP exerts a pervasive impact. Language barriers not only can lead to miscommunication with health care providers but also can have deleterious effects on navigating the health care system and on understanding health information and treatment (DuBard and Gizice, 2008; Flores, 2006; Ponce et al., 2006). Given that mental health treatment relies on direct verbal communication rather than objective tests as for physical illness, language barriers may be especially important in mental health care settings (Sentell et al., 2007). Previous studies have reported that LEP is associated with lower use of general health care services (Abe-Kim et al., 2007; DuBard and Gizice, 2008; Jacobs et al., 2005; Ponce et al., 2006). With respect to mental health care services there is less evidence. However, a recent study using the 2001 California Health Interview Survey found that LEP Latinos and Asians were less likely to receive * Corresponding author. Center for Mental Health and Aging, and Department of Psychology, The University of Alabama, Box 870315, USA. Tel.: þ1 205 348 7517; fax: þ1 205 348 7520. E-mail address: Giyeon.Kim@ua.edu (G. Kim). Contents lists available at ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/psychires 0022-3956/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2010.04.031 Journal of Psychiatric Research 45 (2011) 104e110