Variables such as stigma, weak ethnic identity, and cultural mistrust have been linked to the underutilization of therapy amongst ethnic minority populations. As such, ethnic minority populations may reach a higher threshold of distress-including areas such as anxiety and depression-before seeking professional help. While there is substantial research documenting ethnic differences among various ethnic minority populations (e.g., African Americans, Asian Americans, Hispanics) very little research has been conducted exploring differences among individuals from Native Hawaiian and Pacific Islander (NHPI) backgrounds. For the current study, we explored differences in distress upon intake as well as the change in anxiety and depression scores over the course of 12 therapy sessions for NHPI college students compared to college students from other ethnic groups. We also explored the effect that spirituality and religiosity had on depression and anxiety among NHPI college students. We collected data from the Center for Collegiate Mental Health (CCMH), a practice research network that has aggregated data from hundreds of university counseling centers across the United States, from the years 2012-2015. Our total sample was N = 256,242; of that sample, n = 452 identified as NHPI. We selected independent variables from the Standardized Data Set (i.e., ethnicity, age, gender, estimated socioeconomic status, importance of spirituality and religiosity) and dependent variables from the Counseling Center Assessment of Psychological Symptoms-62 and -34 (i.e., depression, social anxiety, generalized anxiety). We analyzed data using latent growth modeling and computed a conceptual effect size by comparing the change in standard deviation between treatment effects. Results yielded significant differences (p < .05) between both intercept and slope estimates for NHPIs compared to African Americans, Hispanics, Asian Americans, and Whites. Notably, NHPI depression scores improved at the highest rate over time compared to other ethnic groups, while anxiety scores among NHPIs improved at the lowest rate. The effect of spirituality and religiosity on anxiety and depression was statistically insignificant. The results of this study indicated that NHPI college students experience psychotherapy outcomes differently than other ethnic groups, including Asian Americans, with moderate-to-large magnitudes of effect. Considering substantial meta-analytical research supporting the benefits of culturally adapted treatment, results of this study suggest the need to disaggregate the combined demographic Asian Americans and Pacific Islanders (AAPI), as research conducted on this broader group provides questionable validity when applied to clinical settings for NHPIs.



College and Department

David O. McKay School of Education; Counseling Psychology and Special Education



Date Submitted


Document Type





Native Hawaiian and Pacific Islanders, ethnic and racial differences, college students, psychotherapy outcomes, latent growth modeling