Mental health of older Asian Americans: Current issues, updates, and future directions

Abstract

As the population of older Asian Americans continues to grow rapidly, understanding their mental health needs has become increasingly critical. This literature review summarizes current issues, developments, and future directions in addressing the mental health challenges faced by older Asian Americans in the last five years. We briefly touch on the comparative prevalence of mental health disorders experienced by ethnic subgroups. Additionally, we review recent studies highlighting the role of the coronavirus disease 2019, racism, social support, cultural stigma, and self-rated health as significant factors influencing mental well-being of this population. We discuss the utilization of health services among older Asian Americans. We conclude with thoughts for future research, emphasizing the importance of longitudinal studies, consideration of diverse Asian American ethnic subgroups, and culturally sensitive diagnostic and treatment approaches.

Key Words: Asian American; Older; Aging; Mental health; Mental illness; COVID-19; Racism; Social support; Stigma; Self-rated health

Core Tip: Recent literature on the mental health of older Asian Americans highlights how discrimination exacerbated by the coronavirus disease 2019 had greater association with depression than before the pandemic, while social support, ethnic resources, and community engagement may mitigate these effects. Older adults receive less needed social support compared to other racial groups with Koreans receiving the least. Older adults are more likely to endorse stigmatizing beliefs about depression, prefer medication and culturally competent providers, and only seek professional services when their need becomes great. This article discusses future directions and the need for culturally sensitive, community-based interventions.

INTRODUCTION

The number of older Asian Americans is rapidly increasing and is expected to constitute a larger proportion of the older United States population. In 2019, there were 2.5 million older Asian Americans making up 4.6% of the older United States population. By 2060, this population is expected to grow to 7.9 million, representing 8% of older adults in the United States - a near doubling of their demographic share[1]. Over the past twenty years, Asian Americans have emerged as the fastest-growing demographic in the country[2]. The rapid growth of the older Asian American population has underscored the urgent need to understand and address their unique mental health challenges. It is increasingly important for health professionals to have a comprehensive understanding of the mental health needs of older Asian American adults as unresolved mental health issues in later life can undermine independent living and elevate the risk of disability and death[3].

Despite growing scholarly attention, research on the mental health of older Asian Americans remains limited in both depth and scope. Previous reviews on older Asian American health, including the most recent and most comprehensive review conducted by Kim et al[4], have covered research up to the year 2020. Kim et al[4] described how the literature from 2000-2020 indicated that older Asian Americans generally reported lower rates of psychiatric disorders compared to other racial groups. These rates could reflect underreporting rather than true lower incidence, especially as older Asian Americans also exhibited higher rates of suicide and greater self-rated cognitive impairment. Mental health outcomes were also shown to vary widely across ethnic subgroups, influenced by factors such as immigration history, socioeconomic status, education, and language proficiency.

However, no existing review has focused on research findings from the past five years, a period marked by profound sociocultural and technological shifts, including the coronavirus disease 2019 (COVID-19) and rising anti-Asian sentiment. The pandemic not only created new stressors (e.g., isolation, fear of infection) but also heightened existing vulnerabilities (e.g., discrimination, limited service access). Technology and social media in this period have also been affecting how older Asian Americans have received mental health knowledge by promoting healthy aging and health literacy and decreasing stigma[5]. For example, there is recent evidence of YouTube’s value as a platform for disseminating mental health education[6]. Longitudinal analysis has also suggested social media along with sharing services like WhatsApp are accessible, culturally and linguistically appropriate methods of increasing health literacy for older Chinese Americans[7]. These recent developments have likely had significant implications for the mental health of older Asian Americans, but their effects have not been synthesized. Therefore, this literature review aims to fill this gap by synthesizing recent research and trends in research from the last five years on the mental health of older Asian Americans, with a focus on the impacts of the COVID-19 pandemic and highlighting salient influential factors such as racism, social support, stigma, self-rated health (SRH), and mental health service utilization.

A literature search for (mental health) AND (Asian American) along with the “Aged: 65 + years” filter was conducted on PubMed, PsycINFO, and Google Scholar from 2020 to February, 2025. The most relevant articles were selected for review and their references were also used to further search for other studies adding to the pool of knowledge on this subject. Articles addressing overall Asian Americans and specific ethnicities such as Chinese, Korean, Filipino, Japanese, and Vietnamese Americans were included. Findings from these articles and how they have advanced our understanding of mental illness prevention, diagnosis, and clinical management in older Asian Americans will be described along with a discussion of future research directions to conclude. Such findings on clinical management include recommendations to increase clinician engagement with older Asian Americans in discussions of mental health and the effects of hate incidences, to assess for perceived need for mental health care and SRH for further insight on patient viewpoint, and to employ clinical approaches that both respect cultural traditions and promote evidence-based understanding of mental health. Findings also call for research practices that generate larger-scale sub-group analyses in order to draw more comprehensive and comparative conclusions.

COMPARATIVE PREVALENCE

Over the last five years, research about prevalence and types of mental health disorders within the older Asian American group was very limited, with a significant lack of studies comparing prevalence rates among ethnic groups. Most studies examined depression suggesting that it is a highly prevalent mental illness among older Asian Americans[8]. Mental health, in particular, depressive symptoms, affect other aspects of health like cognitive health. A study by Lee et al[8] found depressive symptoms were significantly associated with Subjective Memory Impairment (SMI), which is defined as a self-reported cognitive problem characterized by complaints of decline in memory, attention, language, and problem-solving skills. Older Vietnamese Americans had the highest SMI score compared to African and East Asian Americans (Chinese and Korean). In all three groups, depressive symptoms were associated with SMI however, Vietnamese American participants with greater depressive symptoms were significantly more likely to experience SMI compared to other ethnic groups. The long-term accumulated emotional and traumatic stress experienced during immigration, could explain this strong association in older Vietnamese Americans[9]. Likewise, older Vietnamese immigrants in Texas were found to experience similar health conditions to other older Americans but had higher rates of depressive symptoms and cognitive impairment[10]. High levels of depressive symptoms reported by older Vietnamese Americans may be related to adverse life experiences and serve as a prominent risk factor for SMI in this group. Further research is needed to accurately assess the current prevalence of psychiatric disorders and to examine ethnic differences in mental health among the many ethnic groups of older Asian Americans.

AFFECTS OF THE COVID-19 PANDEMIC ON OLDER ASIAN AMERICAN MENTAL HEALTH

During the COVID-19 pandemic, discrimination and racism against Asian Americans surged, with older Asian Americans disproportionately targeted in hate crimes and racist incidents[11]. Previous research has shown that racial discrimination is linked to poorer mental health outcomes, such as increased anxiety and depression[12,13].

Recent studies highlight the impact of pandemic-related racism on older Asian Americans' psychological well-being. McGarity-Palmer et al[14] found that although older Asian American adults (aged ≥ 65 years) had lower odds of unmet mental health needs and psychological distress than younger adults, the pandemic still impacted their mental health. Zhang et al[15] revealed that the daily discrimination older Asian Americans reported during the pandemic, had a significantly stronger influence on depression when compared with before the pandemic. There was greater association with worse anxiety, depression, and functional impairment. Social support and social cohesion helped to buffer this effect, underscoring the importance of implementing public health interventions to reduce discrimination and increase social support.

When analyzing survey data of Korean American older adults with probable dementia and their caregivers, Han et al[16] found that nearly a quarter of their sample feared for their safety due to pandemic-related anti-Asian racism, with 47% altering daily routines-avoiding outdoor activities, public spaces, and even healthcare visits. Those who made such changes were at least five times more likely to report negative mental health symptoms, emphasizing the need for interventions to address pandemic-driven racial discrimination.

A cross-sectional survey study of community-dwelling older Asian American adults (mostly Vietnamese and Chinese) from the San Francisco Bay Area by Li et al[17] further demonstrated the extensive toll of anti-Asian hate on older Asian Americans’ mental health. Nearly one-third of participants experienced direct anti-Asian hate, while over 90% endorsed worrying about hate incidents. Of 38% reported anxiety and 36% reported depression. Those deeply worried about or directly affected by hate incidents had significantly higher rates of anxiety, loneliness, and changes in daily activities compared with their counterparts. Notably, while 72% of participants felt comfortable discussing hate incidents with clinicians, only 11% had a clinician bring it up, indicating a critical role for healthcare providers in addressing these concerns.

During the COVID-19 pandemic, both direct and indirect experiences with anti-Asian racism and discrimination had major implications for older Asian Americans’ mental health. These findings underscore the need for culturally sensitive interventions, public health initiatives to combat everyday discrimination, and greater clinician engagement to support the mental health of older Asian Americans. Future research should explore the mechanisms linking routine disruptions to mental health outcomes and develop language-concordant screening tools for effective assessment and advocacy of patient well-being.

AFFECTS OF RACISM AND DISCRIMINATION ON OLDER ASIAN AMERICAN MENTAL HEALTH

Perceived racial discrimination in healthcare and daily life is a significant predictor of psychological distress among older Asian Americans. In a retrospective cross-sectional study, Li et al[18] found that about 10% of older Asian Americans reported healthcare discrimination over their lifetime. Perceived healthcare discrimination was linked to higher psychological distress levels over the past 30 days and the worst month in the past year. Improving the quality of health care services requires the eradication of such discrimination.

Cho et al[19] reported that in a sample of 2609 Asian Americans, racial discrimination is associated with higher odds of mental distress, and that association was greater among those who were 60 or older, less educated, and Vietnamese. Their results similarly lend support to the idea that older Asian Americans’ mental health is more affected by perceived racial discrimination than that of their younger counterparts. The heightened mental distress in older Asian Americans may stem from language barriers, financial insecurity, and limited social networks, which reduce coping resources[20].

Ethnic resources and community engagement play a crucial role in mitigating these mental health effects of perceived racial discrimination. Jang et al[21] found that while perceived racial discrimination correlated with greater mental distress among older Korean Americans, a strong sense of ethnic identity and community weakened this relationship. These findings highlight the significance of cultivating a sense of community and strengthening ethnic identities as essential strategies for mitigating mental distress, especially in the face of racial discrimination. Similarly, Park et al[22] established an association between lower acculturation and greater psychological distress in older Korean Americans, intensified by perceived low social cohesion and negative social interactions. Likewise, Kim and Silverstein[23] lends support to the importance of ethnic resources, discussing perceived receipt of filial piety from adult children and ethnic community engagement as two resources associated with psychological wellbeing and less depression and loneliness of older Chinese American immigrants. Additionally, community engagement buffered the negative effects of low filial piety on depression and loneliness, compensating for culturally weak intergenerational ties.

These findings emphasize the importance of interventions that foster social capital, strengthen ethnic identity, and promote community engagement to protect older Asian Americans from the psychological toll of racism and discrimination.

SOCIAL SUPPORT IMPACTS MENTAL HEALTH OF OLDER ASIAN AMERICANS

Social support plays a pivotal role in the mental health of older Asian Americans, yet disparities in access, quality, and effectiveness persist across subgroups. Research consistently highlights the protective benefits of social connections, but the levels of social support seem to vary based on ethnicity. The following findings are summarized in Table 1.

Table 1 Summary of findings across Asian American ethnicities related to effects of social support on mental health.

Ref.	Ethnicity	Location	Findings
Qi et al[24]	Chinese	HI, United States	Social isolation is associated with increased psychological distress and decreased life satisfaction and happiness. Resilience is associated with lower amounts of psychological distress and higher amounts of life satisfaction and happiness
Miyawaki et al[25]	Vietnamese	Houston, TX, United States	Greater social support helped reduce the impact of disability on loneliness
Kim et al[26]	Japanese and Korean	Honolulu, HI; Los Angeles, CA, United States	Social support significantly affected depression in both groups
Park et al[27]	Chinese, Korean, Vietnamese, Asian-Indian, Filipino, Hmong, Japanese, native Hawaiian, other/mixed	All of the United States	Low social support was associated with greater self-reported mental health symptoms (depression and anxiety) overall, although there was a greater impact of social support among younger adults compared to those 60 years and older
Shimkhada et al[28]	Korean, Filipino, Vietnamese, Chinese	CA, United States	Levels of social and emotional support and life satisfaction among Asian American older adults in 2018 were lower than those of non-Asian American populations
Li et al[29]	Chinese	Chicago, IL, United States	Older adults with three to five close network members, moderate contact, and strong emotional bonds were less likely to experience depression than others

A study by Qi et al[24] on older Chinese Americans in Hawaii revealed that social isolation was linked to increased psychological distress and decreased life satisfaction and happiness, while resilience not only helped to mitigate these effects but was also associated with lower distress and greater overall well-being. In older Vietnamese immigrants, Miyawaki et al[25] found that greater physical disability was linked to increased depressive symptoms and loneliness, but higher social support lessened the impact of disability on loneliness. While this study did not find a strong association between social support and depressive symptoms for older Vietnamese immigrants, another study by Kim et al[26] examined data from 207 Japanese and 210 Koreans in Honolulu and Los Angeles and showed that lack of social support was strongly associated with high depressive symptoms in both groups in long-term care settings. From a cross-sectional national survey with Asian American adults conducted during the COVID-19 pandemic, Park et al[27] found that low social support was associated with increased depression and anxiety symptoms overall, although there was a greater impact of social support among younger adults compared to those 60 years and older.

While the previous four studies established the detriments of low social support on older Asian American mental health, Shimkhada et al[28] uncovered how Asian American older adults reported lower life satisfaction and received less needed social and emotional support compared to other racial groups in a survey on older adults in California. Older Asian American adult life satisfaction was 54%, whereas for all other races it was 80%. Relatedly, while 80% of all other races usually or always received social/emotional support when needed, only 56% of Asian American older adults reported the same. In particular, Korean older adults reported significantly lower social/emotional support when compared with Chinese and Filipino older adults. Correspondingly, Korean older adults were found to experience the poorest well-being.

Given the mounting evidence for social support aiding in older Asian American mental health, it is important to investigate what kind of social support helps. Li et al[29] found that older Chinese Americans who had three to five social network members with strong ties, a high amount of emotional closeness, and a moderate contact frequency, were less likely to experience depression than their counterparts. These findings support the need for intervention programs that enhance the quality of social networks among older Asian American adults.

Overall, recent findings (Table 1) discussed above have emphasized the need for preventive and interventional programs that enhance social connections and resilience to promote psychological well-being in older Asian Americans. Future research should be directed towards developing culturally and linguistically appropriate care centers, social workers, and community-based services that could be valuable in addressing loneliness and reducing depression in this population through enhancing social support.

AFFECTS OF STIGMA ON OLDER ASIAN AMERICAN MENTAL HEALTH

In addition to the external impacts of discrimination and racism on older Asian American mental health, there is also the challenge of intragroup stigmatization, with internalized cultural biases further reinforcing the stigma surrounding mental illness.

One study by Jung et al[30] indicated that older age, male gender, ethnicity, shorter years in the United States, limited English proficiency, and lower levels of acculturation predicted stigmatizing beliefs about depression. Compared to younger adults aged 18 to 39 years, older adults, especially those aged 60 years or above presented higher odds of endorsing stigmatizing beliefs about depression such as believing depression is a sign of personal weakness, antidepressants are addictive, that having a depressed family member brings shame to the family, and that it would disappoint their family if they had depression. One possible explanation is that older Asian Americans and immigrants may have less knowledge about depression or may be less acculturated, having been in the United States for less time, making them more likely to have stigmatizing beliefs. De-stigmatizing campaigns and interventions should target older Asian Americans, especially as mental illness stigma poses a substantial barrier to seeking help.

Kim et al[31] interviewed community leaders to analyze their perceptions on the mental health of older Korean Americans, since older Korean Americans tend to favor culturally aligned community services, making community leaders pivotal in both advocacy and service development[32,33]. Significant barriers were found to hinder effective mental health support: Many older adults do not perceive a need for help often due to lack of knowledge, there is a shortage of professionals, and a deep-rooted stigma discourages acknowledging depression. Despite their cultural insights, community leaders often failed to recognize depression as a treatable medical condition. Instead, they tended to view depressive symptoms as personal flaws such as distrust or anger issues, expecting older adults to simply change their inherent personalities. This negative attitude not only impedes provision and referrals by community leaders to mental health services but also discourages older adults from seeking professional help.

Critically, this situation underscores a dual challenge. On the one hand, there is a pressing need for culturally sensitive training that bridges the gap between traditional perceptions and modern clinical approaches. On the other hand, the entrenched stigma and negative attitudes among key community figures risk perpetuating under-treatment and isolation among older adults. Addressing these issues requires a nuanced approach that respects cultural traditions while promoting an evidence-based understanding of mental health that helps overcome stigma. Overall, the findings suggest that community-based educational training is essential to augment the understanding of depression and overcome stigma among both older Korean Americans and community leaders[31].

One potential culturally adapted intervention that circumvents stigma was studied by Huang et al[34]. The study evaluated Lishi - a traditional East Asian movement exercise - as a culturally based intervention to enhance mental and physical health among Vietnamese older adults aged 60 to 75 years. Results revealed that intervention participants not only exhibited significantly higher self-efficacy at posttest but also reported increased energy and less bodily pain. Prior research indicates that self-efficacy is linked to a robust and enduring sense of personal competence, as well as to feelings of self-worth and empowerment suggesting the potential mental health benefits of incorporating culturally relevant practices[35,36]. This approach may help bypass the stigma concerns linked to conventional mental health treatments, offering a holistic way to improve well-being and reduce utilization disparities. However, while promising, the findings also call for caution: Outcomes such as anxiety and depression were not significantly impacted by the treatment, thus further research is needed to determine what specific mental illnesses such treatment methods can improve. Future research should also investigate other potential culturally compatible treatments for older Asian American mental illness and compare with other interventions to confirm its efficacy across diverse settings.

SRH INFLUENCES ON OLDER ASIAN AMERICAN MENTAL HEALTH

Recent studies have highlighted the significant role of SRH in shaping the mental health of older Asian immigrants. One study[37] demonstrated a significant correlation between Self-Rated Mental Health (SRMH) and Self-Rated Cognitive Health (SRCH). Notably, the association between SRCH and mental distress exceeded that with cognitive function, suggesting that mental distress may more powerfully influence perceptions of cognitive health. Factors such as advanced age, lower education, higher levels of mental distress, poorer cognitive function, lower acculturation, and smaller social networks were associated with more adverse ratings of SRMH. Indeed, this relationship between cognitive and mental health is supported by a study on Japanese older Americans where lower rates of cognitive functioning was a significant determinant of increased rates of depression[38]. These findings echo the literature that underscores the benefits of greater acculturation and robust social networks in support of older Asian American Mental health.

One study examined the mediating role of SRH in the relationship between physical conditions and depressive symptoms in older Chinese and Korean Americans and found that in both groups, negative self-assessments of health significantly mediated the impact of chronic diseases and functional disabilities on depression. This mediation effect was stronger in older Korean Americans compared to older Chinese Americans, highlighting potential ethnic distinctions in the mind-body connection[39]. Similarly, another study[40] on older Asian Americans found that the significant risks posed by chronic conditions on psychological distress is mediated by subjective health perception. The findings suggest subjective health perception plays a critical role in bridging physical and mental health, making subjective health assessment a potentially useful tool for health promotion.

Importantly, a study[41] done on older Korean Americans explored reasons for the gap between those with mental distress and mental health service utilization. Despite experiencing mental distress, many did not seek professional help unless they subjectively acknowledged their mental health issues. Greater mental distress was linked to poorer SRMH, which in turn prompted individuals to seek professional help. These findings indicate that personal evaluations of one’s mental health critically influences the decision to pursue mental health services. Consequently, many individuals may not view their distress as severe enough to warrant intervention, contributing to the low utilization of professional support. This suggests that enhancing self-awareness and reducing stigma could be key to bridging the gap between distress and treatment.

Overall, these findings underscore the importance of interventions that not only address physical and cognitive health but also promote accurate self-assessment and awareness. Such strategies are essential for improving mental health outcomes and encouraging service uptake among older Asian Americans.

HELP SEEKING AND UTILIZATION OF SERVICES

In a cross-sectional analysis of data from a randomized control trial conducted at senior day centers, greater anxiety, depressive, and posttraumatic stress disorder (PTSD) symptoms increased odds of service use[42]. As a whole and especially at lower levels of symptom severity, Asian older adults were found to have lower odds of service use than their non-Latinx White counterparts. It is noteworthy however, that Asian older adults with higher anxiety and depression symptoms or with at least one PTSD symptom were more likely than Whites with the same symptomatology to use mental health services. The findings indicate that White older adults may be more inclined to seek mental health care at lower levels of perceived need, whereas Asian older adults tend to pursue services only when their need becomes more pronounced. Asian participants may delay seeking treatment until their symptoms substantially interfere with daily functioning.

Chao et al[43] found that among older Chinese immigrants in New York, older individuals were less likely to use mental health services possibly due to less mental health literacy and less perceived need. Younger individuals, those with less than a high school education, and those exhibiting higher depressive symptoms were more likely to use mental health services. The collapse of support systems, language barriers, and financial hardships contributed substantially to psychological distress. Initially, participants tended to turn to family and friends for mental health support; however, negative attitudes, a lack of awareness about mental health issues, and both perceived and internalized stigma discouraged the pursuit of professional help. Furthermore, while there was a clear preference for culturally competent providers who share similar language and background, the scarcity of such professionals presented an additional barrier to utilization of services. The reliance on informal support networks may provide short-term relief but likely fails to address long-term needs highlighting the importance of early screening programs.

A study[44] examining older Asian Americans’ views on mental health treatment revealed that they were more likely to endorse the need for suicide screening and less likely to endorse the need for depression screening when compared to their African American counterparts. Furthermore, this group was less likely to seek help from primary care physicians and showed a stronger preference for medications over psychotherapy. These patterns may be attributed to limited English proficiency-which hinders effective communication in mental health settings-and a higher degree of stigma surrounding psychiatric treatment[45]. Such language barriers, compounded by a scarcity of bilingual professionals, may lead older Asian Americans to opt for medication as it reduces the need for frequent interactions with psychotherapists and minimizes the exposure of their mental health status.

Critically, these findings underscore the importance of aligning mental health services with the specific cultural and linguistic needs of older Asian Americans. The reliance on medications over psychotherapy might indicate a compromise driven by external barriers rather than genuine treatment preference. This calls for tailored interventions that not only address language and stigma-related obstacles but also promote a broader acceptance of various treatment modalities to improve overall mental health service utilization in this population.

DISCUSSION AND FUTURE DIRECTIONS

This review highlights the trends, advancements, and pressing concerns in the complex mental health landscape of older Asian Americans, revealing the profound impact of discrimination, social determinants, and cultural influences on their well-being. Several key factors influencing older Asian American mental health emerge from the literature: The compounding effects of racism-particularly during the COVID-19 pandemic-the underutilization of mental health services, and the dual role of social support as both a protective factor and an area of disparity. Another recurring topic of interest in recent research has been the interplay between external stressors-such as racism, language barriers, and sociocultural challenges-and internal factors, including internalized stigma, cognitive health, and self-perception of health.

Many of the recent studies included in this review relied on cross-sectional data, limiting the ability to assess causal relationships between factors like discrimination, social support, and mental health outcomes. Longitudinal research is needed to track changes in mental health status over time[46]. Given that the findings of many of the studies reviewed were merely associational and not causational, more research is needed to establish causation and elucidate many of the mechanisms of associations found such as how routine disruptions worsen mental health.

Many of the studies’ findings also indicate more research is needed on culturally adapted mental health interventions that align with older Asian Americans' preferences, including non-traditional therapeutic modalities. Future studies should examine the effectiveness of technology and social media in promoting such culturally and linguistically adapted interventions. Research should explore how policy reforms-such as expanding bilingual mental health services and implementing anti-racism initiatives in healthcare settings-can improve service accessibility and quality. Community-Based Participatory Research: Partnering with community organizations and faith-based groups can enhance trust and engagement in mental health interventions for older Asian Americans[47].

One finding from this review is the lack of comparative prevalence data across different Asian American ethnic subgroups. While most recently research suggests that depression is highly prevalent among older Asian Americans, especially among Vietnamese immigrants, the absence of large-scale, disaggregated research prevents a comprehensive understanding of subgroup-specific mental health burdens. Many of the most recent large-scale data analysis studies were based on the National Latino Asian American Study from over two decades ago as it remains the most comprehensive and representative set of data with information on older Asian American mental health[48]. Many of the studies discussed in this review analyzed data from a few or one state and were limited to only a few or one ethnicity. For example, five of the studies reviewed used the Study of Older Korean Americans (n = 2150)[49] which represented only five states from 2017-2018. Many other studies were smaller scale, collecting data in just one city, for example the Vietnamese Aging and Care Survey was only in Houston, TX, United States (n = 132)[10]. The limited ethnicities or states studied make results less generalizable as they are often inconsistent. Most data collection for larger scale studies discussed in this review also took place before 2020, making the data possibly outdated.

Thus, to obtain more accurate and current data on older Asian American mental health, future research should be directed towards gathering large data sets that represent not only older Asian Americans on a national level, but also each ethnic subgroup through comparison to other racial and ethnic groups. Ideally the data collected would allow for analysis of prevalence rates of different types of mental illness experienced and analysis of treatment utilization types and frequency, as large-scale representative analysis is currently lacking in these areas. Future studies must employ methodologies that account for ethnic differences to ensure that mental health interventions are effectively tailored to subgroup-specific needs.

Ideally, a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) study would be necessary to improve rigor, including a clear outline of database selection, search strategy (with Boolean operators and expanded keywords), inclusion and exclusion criteria, and screening processes. Additionally, this type of future research should include a PRISMA flow diagram illustrating the study selection process and a table summarizing key characteristics of the included studies (e.g., study design, sample size, population, main findings) to facilitate interpretation of the results[50].

Future research and reviews on the mental health of older Asian Americans would also benefit from integrating conceptually grounded models to more systematically examine the complex interplay of risk and protective factors. The social-ecological and life-course perspectives provide a valuable lens through which to assess how experiences across the lifespan-including immigration, acculturation, and exposure to discrimination-shape mental health trajectories in late life[51-54]. Additionally, the National Institute on Aging Health Disparities Research Framework[55] offers a multilevel approach that emphasizes the role of sociocultural (e.g., stigma), environmental (e.g., community characteristics), behavioral (e.g., help-seeking, coping styles), and biological variables (e.g., chronic illness, neurocognitive changes). Applying these models in future studies can help identify modifiable factors, uncover mechanisms underlying disparities, and inform the development of culturally tailored interventions that address both individual and structural determinants of mental health.

CONCLUSION

This review sheds light on the multifaceted challenges affecting the mental health of older Asian Americans, emphasizing the need for a culturally nuanced approach to diagnosis, treatment, and community support. The COVID-19 pandemic amplified existing vulnerabilities among older Asian Americans, as rising anti-Asian hate was associated with increased anxiety and depression. Although culturally aligned social support helped mitigate these effects, disparities in support remain, necessitating targeted community engagement. Addressing these issues requires an approach that respects cultural traditions while promoting an evidence-based understanding of mental health that helps overcome stigma. Findings also support considering the accuracy of SRH in diagnosis and treatment procedures, as subjective acknowledgement of mental health issues may be necessary for help seeking. Mental health disparities among older Asian Americans cannot be understood in isolation but must be examined through the lens of historical trauma, cultural stigma, racial discrimination, and healthcare barriers. As the population of older Asian Americans continues to grow, ensuring their mental well-being must become a national priority. Future efforts should focus on developing tailored culturally competent interventions, increasing awareness, and fostering inclusive policies that bridge the gap between mental health needs and utilization of services.