From Silence to Expression: A Mixed-Methods Photovoice Study of Mental Health, Coping, and Barriers to Care Among Asian American/Asian College Students

Background: With 75% of mental illnesses emerging by age 25, higher education is increasingly prioritizing support and service access for students of color. Asian American/Asian college students navigate a unique intersection of stressors, including cultural stigma, racial discrimination, and the lingering effects of the COVID-19 pandemic (Macaranas et al., 2023). Despite these challenges, this population often underutilizes mental health services due to a lack of culturally responsive care. Utilizing Photovoice, this mixed-methods study visualizes mental health challenges, coping, and healthcare barriers among Asian American/Asian students.

Methods: This study employed a mixed-methods design to capture both the prevalence and depth of student experiences at a New York City college. Participants (n = 30) were recruited via purposive and snowball sampling to complete an online cross-sectional survey. Inclusion criteria required participants to be at least 18 years old, currently enrolled in the college, and self-identified as Asian American/Asian. Most participants were East Asian (76.6%), with 50% born in the United States. The mean age was 22, and the sample was 53% female, 43% male, and 3% non-binary. Additionally, 42% reported an annual household income between $25,000 and $50,000.

The survey assessed demographics (e.g., age, gender, immigrant generation, English proficiency, citizenship, parental education, and income), mental health outcomes (e.g., flourishing, depression, anxiety, and suicidal ideation), and barriers to service use (e.g., knowledge, attitudes, and help-seeking). The study also employed Photovoice using the SHOWED method (Wang & Burris, 1997). Data collection included a 30-minute orientation and a two-hour focus group (n = 4), during which students shared images and narratives of their mental health experiences, coping strategies, and cultural contexts. Quantitative data were analyzed using SPSS v.29, and qualitative data were analyzed using thematic analysis.

Results: Quantitative findings indicated moderate depression (M = 16.29) and anxiety (M = 13.57), with 10% reporting suicidal ideation. Notably, 86% had not received counseling in the past year, and over half were unsure about insurance coverage for mental health services. Students also reported low levels of flourishing, suggesting limited protective factors such as strong relationships, self-esteem, and sense of purpose. Qualitative themes revealed multiple forms of pressure linked to the Model Minority myth, first-generation expectations, and cultural stigma, with silence often used as a coping strategy. Students sought safe spaces for shared experiences and belonging, citing journaling and campus ethnic clubs as key coping strategies. They also identified systemic barriers, including limited therapist diversity, low awareness of campus resources, and inadequate cultural responsiveness, contributing to feelings of being unseen and unheard.

Implications: These findings highlight the need to move beyond standard care models toward more accessible, culturally responsive services. They underscore the importance of providing protective emotional resources to support resilience and well-being in this marginalized population. To align with core social work values, institutions should prioritize the recruitment of bilingual and bicultural professionals and incorporate cultural humility training. The findings also support the use of strengths-based approaches to enhance student well-being. Interventions such as peer support programs and wellness workshops can foster emotional development and resilience.