Psychosocial Determinants of Behavioral Health Among Asian Americans: A Systematic Review with a Focus on Strengths

Background and purpose: Over the past two decades, the Asian American population has grown substantially, increasing from approximately 11.9 million in 2000 to 24.8 million in 2023. This rapid expansion has made Asian Americans one of the fastest-growing racial and ethnic groups in the United States. However, this demographic shift has not been matched by proportional representation in behavioral health research. There remains a notable lack of attention to mental and behavioral health conditions such as anxiety (ANX), depression (DEP), and substance use disorders (SUDs) within this population. Existing studies did not adequately capture the complex interplay of cultural, social, and contextual factors that shape their mental and behavioral health outcomes. The National Latino and Asian American Study (NLAAS) is the first national population-based mental health study of Asian Americans and is the most comprehensive resource for understanding their behavioral health. This systematic review aims to synthesize peer-reviewed publications using the NLAAS dataset to identify psychosocial determinants of the three key outcomes.

Method: We followed PRISMA to search for English peer-reviewed articles published in EBSCO, Embase, PsycINFO, Web of Science, and PubMed. Inclusion criteria were as follows: (1) Asian Americans in the NLAAS database; (2) ANX, DEP, or SUD; (3) risk or protective factors; and (4) peer-reviewed publications in English. Search terms such as Asian Americans, anxiety, depressive symptoms, substance abuse, and NLAAS were used to search for relevant articles. Two authors screened the articles independently and extracted data from each study.

Results: Forty studies published between 2007 and 2025 were included in our final review. Among them, 25 studies examined DEP, 19 studies investigated ANX, and 15 studies focused on SUD. Twenty-four studies assessed protective factors. Seventeen articles assessed multiple key outcomes. All risk factors were grouped into three categories: negative interpersonal relationships (e.g., negative family relationship, family conflict, family strain), acculturation- and immigration-related factors (e.g., nativity, acculturation stress, discrimination, younger immigration age), and sociodemographic and social participation factors (e.g., education, employment status, income level, social engagement). Protective factors such as family cohesion, family support, ethnic identification, neighborhood cohesion, and education were also identified.

Conclusion and Implications: This review provides integrated evidence derived from the NLAAS dataset, highlighting the multidimensional nature of behavioral health determinants among Asian Americans. The findings underscore that mental health outcomes in this population are shaped by a combination of interpersonal dynamics, immigration-related experiences, and broader social and economic conditions. This review pointed the need of culturally informed approaches that take family context, acculturation experiences, and social environments into consideration when designing prevention and intervention strategies. Future research should continue to build on these findings by exploring underlying mechanisms and addressing gaps in longitudinal and intervention-based evidence. This review contributes to advancing a comprehensive and culturally responsive understanding of behavioral health among Asian Americans, with implications for both research and practice aimed at reducing health disparities and improving their overall quality of life.