Self-Rated Mental Health or Diagnosed Internalizing Disorder? Determinants of Daily Functioning Limitation Among Asian Americans

Background
Self-rated mental health is widely used as an indicator of well-being in population research. However, among Asian Americans, relatively high self-rated mental health may not consistently align with daily functioning, raising questions about its validity as a measure of daily functioning. This study examines self-rated mental health as a predictor of functioning, comparing it with clinical indicator, diagnosis of an internalizing disorder, to assess how the two indicators compare.

Methods
Data included the 2,083 Asian American respondents in the National Latino and Asian American Study (NLAAS). A zero-inflated negative binomial (ZINB) regression model was estimated to examine predictors of the number of days per month with functional limitations. Key predictors included self-rated mental health (excellent, good, poor) and diagnosed DSM-5 internalizing disorders (dichotomous). Covariates included sociodemographic characteristics across different ethnicity subgroups(Chinese, Vietnamese, Filipino).

Results
Those with a diagnosed internalizing disorder(e.g. depression, anxiety and panic disorder) had higher expected counts of functional limitation days (IRR = 1.93, p = .001). Self-rated mental health was not a significant predictor, with neither good (IRR = 0.70, p = .155) nor excellent (IRR = 0.87, p = .599) ratings differing from poor.

In the inflation component, which models the odds of reporting zero days of functional limitations, those with an internalizing disorder had 62.2% lower odds of reporting zero days of activity limitations (OR = 0.38, p < .001). Compared to poor self-rated mental health, excellent mental health was associated with 2.63 times higher odds of reporting zero limitation days (OR = 2.63, p < .001), while good mental health was not significant (OR = 1.34, p = .225). Compared to Chinese, Filipinos (OR = 0.53, p = .003) and individuals from other Asian subgroups (OR = 0.50, p = .002) had lower odds of reporting zero limitation days. No significant differences were observed across groups in diagnosed internalizing disorders.

Post-estimation marginal effects indicated that individuals reporting poor self-rated mental health had a higher predicted number of functional limitation days (M = 2.11, p < .001) compared to those reporting good (M = 1.21, p < .001) or excellent mental health (M = 0.92, p < .001). Individuals without an internalizing diagnosis had a predicted 0.79 days of functional limitation ( p < .001), whereas those with a diagnosis had a substantially higher predicted 3.08 days ( p < .001).

Conclusions
Diagnosed internalizing conditions and self-rated mental health were both associated with daily functioning, with diagnosed conditions as the stronger predictor among Asian Americans. Findings suggest that distress may be interpreted and reported differently across subgroups, with Chinese individuals less likely to identify distress as a mental health concern or as affecting daily functioning, rather than experiencing lower levels of distress.As a result, self-rated mental health may not fully capture functional limitations in this group. These findings highlight the need for more clinically grounded, culturally responsive assessments to better identify functional limitations and inform intervention efforts, as broader factors such as norms around emotional expression, model minority pressures, and structural barriers may shape reporting and help-seeking.