Positive external presentation and mental health service underutilization among Asian and Asian American college students: A national study

Objective: This study examined whether positive external presentation (PEP), defined as reporting no functional impairment across life domains, is differentially associated with lower counseling utilization among Asian and Asian American college students relative to non-Asian peers. Participants: Data came from six waves of the ACHA-NCHA III (Fall 2019–Spring 2022; N = 284,009; 15.9% Asian and Asian American). Methods: Logistic regression tested a three-way interaction among Asian and Asian American status, PEP, and psychological distress. Results: Asian and Asian American students reported lower counseling utilization than non-Asian peers (21.1% vs. 33.0%). A significant three-way interaction (OR = 0.988, 95% CI [0.978, 0.999], p = .025) indicated a weaker distress-to-help-seeking association among Asian and Asian American students with PEP. The gap widened to 20.8 percentage points at high distress and was concentrated among East Asian students. Conclusions: Universities should use proactive outreach that does not rely only on self-identified need.