Confidentiality Literacy and Mental Health Help-Seeking Confidence Among Older Eritrean and Salvadoran Immigrants: A Comparative Pilot Study

Background: Immigrant communities face compounded barriers to mental health service utilization, including cultural stigma, accessibility, and limited capacity to navigate health care systems. A cornerstone concept in American systems, confidentiality, codified in legal and ethical frameworks, underscores the Social Work Code of Ethics. As frontline mental health clinicians, practitioners work to build confidence in immigrant communities within an increasingly hostile data tracking and surveillance environment. Yet a gap exists in the literature concerning the value immigrant communities place on confidentiality as a contributing factor in increasing help-seeking behaviors. This pilot study examined the relationship between understanding the Western construct of confidentiality and confidence in seeking mental health help from professionals, and whether such relationships vary between Eritrean and Salvadoran Immigrants, given their respective histories of government interference and forced displacement.

Method: Cross-sectional survey data were collected from a combined sample of Eritrean (n=19) and Salvadoran (n=30) immigrants (N=49) living in the greater D.C area. Independent variable was mental health confidentiality literacy, assessed using two items from the Mental Health Literacy Scale, measuring participants’ beliefs about circumstances under which a mental health professional may breach confidentiality: (1) immediate risk of harm to self or others, and (2) involving others to provide better support when the problem is not life-threatening. Higher scores in both measures indicate higher literacy. The dependent variables are confidence of helping seeking (1-5) for (1) information, (2) using computer, (3) without perceiving mental health as a stigma, and (4) seeking mental health in general, where higher scores indicate higher level of confidence. Pearson correlations and Spearman nonparametric correlations were conducted for the full sample and by stratified samples of Eritrean and Salvadoran immigrants.

Results: Participants ranged in age from 45 to 71 years (M=59, SD=5.7), with 70.2% reporting elementary-level education or less. The sample showed a moderately low level of mental health confidence literacy. In the full sample (N=49), higher mental health confidentiality literacy is significantly related to lower confidence in help-seeking without perceiving mental health as a stigma (r=−.476 to −.540 with two independent variables respectively, p<.001) or seeking mental health in general (r=−.395 to −.455, p<.01). However, in general, mental health confidentiality literacy is not related to confidence of help-seeking for information or using a computer in the full sample. We didn’t observe any significant differences in the relationships between the two groups.

Conclusions and Implications: This pilot study found that confidentiality is a concept not clearly understood by immigrant populations. More concerningly, contrary to common service provider assumptions, higher confidentiality literacy may lower confidence in seeking mental health, potentially indicating the need for culturally-grounded educational intervention in these populations. For social workers, who stand between service industries and communities, future research is needed to examine mechanisms linking data safeguarding confidence, stigma reduction, and help-seeking behavior.