Stop Asian Hate: The Mental Health Impact of Racial Discrimination Among Asian Pacific Islander Young and Emerging Adults during COVID‐19

RESEARCH OBJECTIVE: There has been a documented rise of racism and hostility towards Asian Pacific Islanders (API) groups across the nation. With the anticipated population‐level increase in mental health issues as a result of COVID‐19, API college students are an especially high risk group to consider as API young and emerging adults tend to report similar levels of depression and anxiety symptoms compared with their peers, but underutilize service relative to their level of need. The objective of this presentation is to understand the impact of the pandemic on API mental health using large‐scale data, by evaluating pre‐pandemic (Fall 2019), initial months of the pandemic (March‐May 2020) and recent pandemic (Fall 2020) trends in API mental health and treatment utilization, as well as discussing the public health implications in higher education settings for API student populations. STUDY DESIGN: Data comes from 3 administrations of the Healthy Minds Study: Sept‐Dec 2019 (n=33,372 students across 32 campuses), March‐May 2020 (n=12,039 students across 7 campuses) and Sept‐Dec 2020 (n=15,949 students across 28 campuses). This data represents the largest and most comprehensive nationally recognized assessment of API student mental health symptoms, help‐seeking behavior and experiences of discrimination directly related to COVID‐19. We used bi‐variate analyses to compare mental health symptoms and treatment utilization across API students who identified as international students and those who reported US citizenship or permanent residency in the US. We used cross‐sectional logistic regression models to assess the association between discrimination and mental health symptoms and help‐seeking behavior. POPULATION STUDIED: Young and emerging adults who identify as Asian or Pacific Islander and are enrolled at a college or university in the United States. PRINCIPAL FINDINGS: Comparing Fall 2019 to Fall 2020, we found that API non‐international students reported a 23% increase in severe anxiety, a 10% increase in moderate or severe anxiety, and a 9% increase in severe depression; API international students reported a 16% increase in severe depression and a 12% increase in severe anxiety. In Spring 2020, 22% of API students experienced COVID‐related discrimination or hostility (25% in Fall 2020). COVID‐related discrimination or hostility was associated with greater odds of meeting the criteria for one or more clinically significant mental health conditions [aOR: 1.83; 95% CI: 1.35‐2.49; p=0.000]. Treatment utilization among Asian students with at least one clinically significant mental health condition decreased by 26% between Fall 2019 and Spring 2020. CONCLUSIONS: Throughout the COVID‐19 pandemic, both API international and non‐international students reported increases in mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID‐related discrimination is correlated with greater odds of clinically significant mental health symptoms as well decreased help‐seeking. IMPLICATIONS FOR POLICY OR PRACTICE: The racialization of COVID‐19 has the potential to produce long‐lasting effects on attitudes towards API populations. Culturally tailored psychoeducation, collaborative care models and active recruitment of diverse and culturally‐competent mental health providers are potential avenues to facilitate help‐seeking. Given the mental health challenges that API populations are facing, it will be crucial to make an active effort towards resolving mental health treatment disparities already looming in API communities.