"What Will People Say?": Mental Health Stigmatization as a Barrier to Eating Disorder Treatment-Seeking for South Asian American Women

What is the public significance of this article? In this qualitative study, South Asian (SA) American women were asked to discuss their perceptions of barriers to and facilitators of eating disorders (EDs) treatment-seeking for their group. Findings indicate that SA women living in the United States face multiple family, community, and institutional barriers to treatment-seeking for all mental health issues, including EDs, which intersect to perpetuate treatment disparities. This study used focus group methodology to identify culturally specific barriers to, and facilitators of, eating disorder (ED) treatment-seeking for South Asian (SA) American women. Seven focus groups were conducted with 54 participants (M (age) = 20.11 years, SD = 2.52), all of whom had lived in the United States (U.S.) for at least 3 years (63.0% of the sample was born in the U.S.). Transcripts were independently coded by a team of researchers (n = 4) and the final codebook included codes present in at least half of the transcripts. Thematic analysis identified salient themes (barriers, n = 6; facilitators, n = 3) for SA American women. Barriers to ED treatment-seeking were inextricable from barriers to mental health treatment, more broadly. In addition to generalized mental health stigma, participants cited social stigma (i.e., a pervasive fear of social ostracization), as a significant treatment-seeking barrier. Additional barriers were as follows: cultural influences on the etiology and treatment of mental illness, parents' unresolved mental health concerns (usually tied to immigration), health care providers' biases, general lack of knowledge about EDs, and minimal SA representation within ED research/clinical care. To address these obstacles, participants recommended that clinicians facilitate intergenerational conversations about mental health and EDs, partner with SA communities to create targeted ED psychoeducational health campaigns, and train providers in culturally sensitive practices for detecting and treating EDs. SA American women face multiple family, community, and institutional barriers to accessing mental health treatment generally, which limits their ability to access ED-specific care. Recommendations to improve ED treatment access include (a) campaigns to destigmatize mental health more systematically, (b) collaboration with SA communities, and (c) training providers in culturally sensitive care.