Bridging the Gap: Examining Acculturative Family Distancing and Its Association with Mental Well-Being in South Asian American Women in College

1. Introduction

Asian Americans are frequently characterized as a “model minority,” a stereotype that frames this population as uniformly healthy and socioeconomically successful [1,2]. However, this narrative obscures substantial disparities in both physical and mental health, including underdiagnosis and lower healthcare utilization compared to other populations [3]. South Asian populations, in particular, experience a disproportionate burden of chronic disease, including earlier onset and higher prevalence of diabetes, hypertension, and cardiovascular disease compared to other racial and ethnic groups [4,5,6,7,8,9]. These conditions often develop at lower body mass index thresholds and are shaped by unique physiological and psychosocial risk factors [7,10]. Despite this elevated burden of physical health conditions, South Asian Americans demonstrate some of the lowest rates of mental health service utilization in the United States, contributing to persistent underdiagnosis and underreporting. Some studies suggest utilization rates as low as 8.6%, compared to 18% in the general population [3,11,12,13]. This underutilization is especially concerning given that untreated mental health conditions are strongly associated with the development and progression of chronic disease, highlighting a critical and often overlooked link between psychological and physical health in this population [3,12,13].

Nationally representative data from the NLAAS and NESARC indicate that the lifetime prevalence for any mood, anxiety, or substance use disorder is approximately 24.5% among South Asian Americans [14,15,16]. The lifetime prevalence of mood and anxiety disorders among South Asian Americans is 13.1% and 11.4%, respectively [14,17]. Furthermore, women in this demographic often report higher rates of psychological distress. Low extended family support has been shown to significantly predict increased levels of distress in South Asian American women [14]. Compared to those who immigrated to the United States as adults, U.S.-born South Asians tend to report higher 30-day psychological stress rates, indicating an acculturation effect [14].

Among South Asian youth, these disparities are particularly pronounced. College-aged individuals experience a convergence of academic pressure, identity formation, and cultural expectations, creating a critical period of vulnerability for mental health challenges. Research has described a “silent crisis” among Asian students, with studies suggesting 40% of individuals report masking emotional distress due to stigma and cultural expectations [18].

Suicide remains a leading cause of death among Asian Americans aged 15-24, and emerging evidence suggests disproportionately high and underreported risk among South Asian youth, with some studies indicating rates of suicide ideation exceeding 30% in community samples [13,19]. This underscores the urgency of identifying culturally specific risk factors in this population [13,19].

While national studies on South Asian youth are limited, recent research indicates that South Asian adolescents face a 17-fold increase in the risk for suicide attempt when experiencing intense parental conflict [20]. This is often driven by the model minority pressure to meet high academic and cultural expectations [20]. Furthermore, studies indicate that 55% of South Asian suicide cases are misclassified as other races, illuminating significant underreporting of suicide in South Asians [21].

These mental health risks are shaped by sociocultural frameworks that influence how psychological distress is experienced and expressed [20]. Psychological symptoms are often somatized, with individuals presenting physical symptoms such as headaches, fatigue, or chest pain rather than explicitly reporting psychological distress [22]. The colloquial term ‘tension’ is commonly used among South Asian women as a cultural idiom encompassing both emotional and physical symptoms, including persistent sadness, insomnia, and fatigue [22]. However, such expressions are not often recognized as requiring formal treatment, contributing to delays in care [23,24].

A key mechanism underlying these disparities is acculturative stress, measured with the acculturative family distancing (AFD) scale, which reflects gaps in communication and cultural values between immigrant parents and their children [25]. AFD extends beyond typical intergenerational conflict and has been associated with increased psychological distress, feelings of isolation, and elevated risks of suicidal ideation [20,26,27]. Limited communication within families may restrict opportunities for emotional support and reduce the likelihood that individuals will seek care [28].

Beyond South Asian populations, research in Chinese and Latino/a/x families demonstrates how culture-driven communication gaps within a family unit, or AFD, can serve as a primary driver for increased risk of mood and anxiety disorders. These studies reflect a statistically significant relationship between higher AFD scores and increased prevalence of mental health struggles [28,29]. Correlational studies in broader Asian American youth have found significant positive associations between acculturation-based familial conflict and symptoms of depression and anxiety [26]. Further evidence also shows an increased risk of suicidal ideation in youth who experience high rates of acculturative distancing with their parents, especially when family is considered to be the adolescent’s primary source of social support [27]. Collectively, these findings across diverse immigrant cultures highlight the validity of AFD as a predictor of mental health struggles in growing individuals.

Intergenerational conflict within first- and second-generation immigrant families can create an additional layer of dissonance for a growing adolescent. Second-generation South Asian women who experience racial identity and religiosity dissonance are also extremely likely to experience conflict regarding sex-role expectations [30]. Although different generations within most families are likely to experience occasional gaps in communication, the AFD scale specifically measures the impact of distal risk factors caused by immigration. Incorporating two dimensions, “Incongruent Cultural Values” and “Communication Gaps,” allows this scale to explore factors specific to parents who may not speak the same language as their child or hold drastically different beliefs about autonomy, dating, career choices, and gender roles. AFD is associated with individuals feeling that they do not “fit” in their own home, which the Interpersonal-Psychological Theory of Suicide posits is a primary driver of suicidal ideation [20].

These dynamics are especially salient for South Asian American college women, who often navigate competing cultural expectations related to gender roles, family obligations, and independence. As students transition to college and experience reduced parental oversight, the protective aspects of family structure may diminish, while communication gaps and unmet expectations persist. This combination of reduced support and ongoing pressure may increase vulnerability to depression, anxiety, and self-harm [31].

Despite these risks, limited research has examined the effects of acculturative stress on South Asian American women in college or how these dynamics may contribute to longer-term health trajectories. This study addresses this gap by examining the relationship between AFD and depression and anxiety, with implications for understanding pathways linking early mental health challenges to later physical health outcomes.

2. Materials and Methods

Study Design and Study Sample

A quantitative, cross-sectional, anonymous survey was administered via Qualtrics to South Asian female college students across the United States. Inclusion criteria required participants to be at least 18 years old, self-identified as female and South Asian, and be currently enrolled in a U.S.-based higher education institution.

Participants were offered the chance to enter a raffle for a $50 Amazon gift card. The survey collected sociodemographic data, assessed acculturative family distancing and depression, and used validated instruments. Participant confidentiality was protected by ensuring survey anonymity and by not recording any personally identifiable information. Participants provided written consent to conduct and publish findings from this study before completing the survey. Any participants who reported experiencing distress at any point of the questionnaire were provided with mental health resources, including university counseling services and culturally appropriate support organizations. The study protocol was approved by The George Washington University Institutional Review Board (IRB #NCR25631).

Data Collection Process

Data collection occurred between February 19, 2025, and March 31, 2025. Recruitment targeted institutions in U.S. cities with large South Asian populations, identified using the South Asian Americans Leading Together (SAALT) database, including New York City, Chicago, Washington, DC, Los Angeles, and San Francisco. Within each city, two universities with high enrollment were selected for initial outreach.

The survey was disseminated to South Asian student organizations via email, listservs, and social media platforms (e.g., Instagram, GroupMe, LinkedIn, Facebook). Snowball sampling was subsequently used to expand recruitment across additional institutions, supplemented by outreach to personal networks. The survey took approximately 15-20 minutes to complete.

A total of 955 responses were received. To ensure data quality, responses from individuals who failed to meet eligibility requirements, completed the survey in less than 5 minutes, or had a completion rate below 50% were excluded. Bots and duplicate entries were also removed. After data cleaning, the analytical sample included 673 responses.

Sociodemographic Data

Participants reported demographic information, including age, nativity (U.S.-born vs. foreign-born), length of U.S. residency, sexual orientation, relationship status, college region, and year in college.

Depression

Participants were screened for Major Depressive Disorder (MDD) using PHQ-9, a validated instrument developed by Kroenke et al. based on the DSM-5 criteria for major depressive disorder [32]. Items were scored on a four-point scale, where 0 represented “not at all,” and 3 represented “nearly every day.” The PHQ-9 instrument contained nine items. Aggregate and average scores were calculated to determine symptom severity. Total scores ranged from 0-27 and were categorized according to established thresholds: 0-4 indicated no depression, 5-9 indicated mild depression, 10-14 indicated moderate depression, 15-19 indicated moderately severe depression, and 20-27 indicated severe depression. Participants with a score of 10 or more meet the criteria for depression, as outlined by the APA [32]. Internal consistency in this sample was high (Cronbach’s α = 0.90).

Anxiety

Anxiety was measured using the Generalized Anxiety Disorder (GAD-7), a validated self-reported instrument assessing symptom frequency over the past two weeks using a 4-point Likert scale where 0 represented “not at all” and 3 represented “nearly every day” [33]. The instrument contained seven items. Total scores ranged from 0 to 20 and were categorized as the following: 0-4 indicated minimal anxiety, 5-9 indicated mild anxiety, 10-14 indicated moderate anxiety, and 15-20 indicated severe anxiety. Scores greater than or equal to 10 were considered indicative of probable generalized anxiety disorder. Internal consistency was high (Cronbach’s α = 0.92).

Acculturative Family Distancing

Acculturative Family Distancing (AFD) was measured using an abbreviated version of the AFD scale, which assesses communication difficulties and cultural value discrepancies between parents and children [34]. This study focused on the communication difficulties dimension, which involves breakdowns in verbal and non-verbal communication [34]. Items were rated on a 7-point Likert Scale (1 = strongly agree to 7 = strongly agree), with higher scores indicating greater distancing. The instrument contained 17 items; positive statements were reverse-coded. The Cronbach’s alpha for the scale was 0.917, indicating excellent reliability.

Self-Harm

Self-harm was measured through a binary response; participants selected either “Yes” or “No” in response to the question: “Have you ever had thoughts of harming yourself?” with 0 representing “No” and 1 representing “Yes.”

Statistical Analysis

All statistical procedures, including the multivariate logistic regressions, were performed using IBM SPSS Statistics (Version 31.0.0 (117)). Frequencies and percentages were calculated for all categorical variables of interest. For all scales, items were summed for a scale score and divided by the number of items to retain the original response range for descriptive purposes. Specifically, for the AFD scale, positive statements were reverse-coded, and items were summed for a scale score and divided by the number of items to retain the original response range for descriptive purposes. Cronbach’s alpha was calculated for all scales to report on reliability.

Multivariate linear regression models were estimated for the dependent variables (depression and anxiety) and AFD as the independent variable. Multivariate logistic regression models were also estimated for the dependent variable self-harm, with AFD as the independent variable. The linear and logistic models were adjusted for age, sexuality, HHS Region, U.S.-born status, and AFD score to provide a more robust and meaningful analysis of the data. Bivariate analysis identified significant differences by age, sexuality, U.S.-born status, and AFD score; therefore, the multivariate analyses included these measures as covariates.

3. Results

Table 1 represents the demographic characteristics of the study sample. Most of the participants were born in the United States (75.1%), between the ages of 20 and 24 (59.4%), single (45.5%), heterosexual (79.2%), and in their second year of college (26.4%). Of those who were not born in the United States (24.9%), most had lived in the United States for less than 5 years (48.8%). Data on the universities attended were grouped into regions defined by the U.S. Department of Health and Human Services (HHS). A majority of participants attended universities in region 3 (21.8%), which contains the states of Delaware, Maryland, Pennsylvania, Virginia, and West Virginia.

Table 2 represents the rates of depression, anxiety, and thoughts of self-harm in the survey sample. The largest proportion of participants (40.6%) reported no depressive symptoms and minimal anxiety (44.6%), with mean scores for depression (M=6.68, SD=5.44) and anxiety (M=6.11, SD=4.98) falling within range.

Despite this, a notable proportion of participants reported elevated symptoms. Approximately 24.8% met criteria for probable generalized anxiety disorder (score ≥ 10), and 24.9% reported moderate to severe depressive symptoms. Additionally, 35.9% of participants had thoughts of self-harm.

Table 3 presents mean scores for the individual statements in the AFD communication among the study sample. Overall, participants reported moderate levels of communication with parents on positively framed items, with mean scores ranging from 2.94 to 3.32. In contrast, higher mean scores were observed for negatively framed items reflecting communication barriers, including difficulty discussing emotions (mean = 4.61; SD = 1.61) and challenges in engaging in deeper emotions (mean = 4.66; SD = 1.59).

Participants also reported similar patterns when assessing their parents’ communication, with moderate scores for general communication, mean scores ranging from 3.10 to 3.52, and higher scores for barriers related to emotional expression, with mean scores ranging from 4.21 to 4.38. Language-related communication barriers were comparatively lower (mean = 3.13, SD = 1.90). The overall AFD score (α = .917) indicates high internal consistency.

Table 4 presents the multivariate models examining the associations between acculturative family distancing (AFD) and mental health outcomes. After adjusting for age, U.S.-born, HHS region, and sexuality, higher AFD scores were significantly associated with greater depressive symptoms (β = 0.122, 95% CI: 0.099, 0.144; p<0.001) and anxiety symptoms (β = 0.102, 95% CI: 0.081, 0.124; p<0.001). AFD was also significantly associated with increased odds of self-harm (OR=1.064, 95% CI: 1.049, 1.080; p<0.001), indicating a consistent relationship between greater parent-child communication distance and psychological distress across outcomes.

4. Discussion

This study examined the relationship between acculturative family distancing (AFD) and mental health outcomes among South Asian college women. Findings indicate that higher AFD is significantly associated with increased depressive symptoms, anxiety, and self-harm, even after adjusting for key demographic factors. These results reinforce prior research identifying acculturative family processes as critical determinants of mental health and position AFD as a central mechanism linking sociocultural context to psychological distress.

These findings can be understood within established theoretical frameworks. Acculturative family distancing reflects a form of acculturative stress arising from differences in cultural values and communication styles between immigrant parents and their children [29,35]. This stress may disrupt family cohesion and limit access to emotional support [29,36]. Additionally, the Interpersonal-Psychological Theory of Suicide posits that feelings of thwarted belongingness and perceived isolation are key drivers of self-harm [37]. The elevated AFD scores observed in this study, particularly in relation to emotional communication, suggest that parent-child disconnection may contribute to these mechanisms, increasing vulnerability to depression, anxiety, and self-harm.

Importantly, our findings suggest that AFD reflects more than general communication difficulties. It captures a specific form of emotional disconnection with the parent-child relationship. While participants reported moderate levels of general communication, substantially higher scores on items related to emotional expression and depth indicate that the primary gap lies in the ability to communicate feelings rather than basic needs. This distinction is critical, as functional communication may mask underlying emotional isolation.

This dynamic may be particularly salient during the college transition. For many South Asian women, family serves as a primary source of social and emotional support. As students move away from home, the support structure becomes physically distant while existing communication barriers persist. In the absence of strong emotional communication or alternative support systems, students may become increasingly vulnerable to internalizing symptoms, including depression, anxiety, and self-harm.

These findings also challenge the ‘model minority’ narrative by highlighting unmet mental health needs within this population. The presence of functional communication alongside emotional disconnection may contribute to the appearance of stability, while distress remains unrecognized and unaddressed. This underscores the importance of disaggregating South Asian populations from broader Asian American categories, as culturally specific dynamics such as AFD may be obscured in aggregated analyses.

AFD may also help explain patterns of low mental health service utilization. Cultural norms emphasizing self-reliance and family-based support may limit help-seeking behaviors, particularly when communication within the family is strained. In this context, individuals experiencing high AFD may have reduced access to familial and formal sources of support, increasing vulnerability to adverse mental health outcomes.

From a clinical and public health perspective, these findings suggest that interventions must move beyond addressing language barriers alone and instead target emotional communication within families. Strategies that support intergenerational dialogue, improve emotional literacy, and address culturally rooted expectations around communication may be critical for reducing mental health risk. Addressing AFD early may also serve as a preventative approach to more severe outcomes, including self-harm.

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to establish causality or temporal relationships between acculturative family distancing and mental health outcomes. While AFD was significantly associated with depression, anxiety, and self-harm, it is not possible to determine directionality, and bidirectional relationships may exist. Second, data were collected through self-reported measures, which may be subject to recall bias and social desirability bias, particularly given the stigma surrounding mental health in South Asian communities. Third, the use of convenience and snowball sampling may limit generalizability, as participants may differ systematically from those not captured in the sample, including individuals less connected to student organizations and social networks.

Additionally, the study focused exclusively on South Asian women enrolled in U.S. colleges, which may limit the applicability of findings to men, non-binary individuals, or those not pursuing higher education. While this focus is intentional given the unique vulnerabilities of this population, it narrows the scope of inference. The measure of self-harm was assessed using a single binary item, which may not capture the full spectrum or severity of self-harm behaviors. Finally, although the study adjusted for several demographic covariates, unmeasured confounding factors, such as family structure, parental mental health, or prior trauma, may also influence both AFD and mental health outcomes.

5. Conclusions

This study highlights acculturative family distancing (AFD) as a critical and underrecognized factor influencing mental health among South Asian college women. Findings demonstrate that greater parent-child communication gaps, particularly in emotional expression, are consistently associated with higher levels of depression, anxiety, and self-harm. These results suggest that AFD is not simply a reflection of cultural difference, but a meaningful form of psychological disconnection with important implications for well-being.

By identifying AFD as a key mechanism linking sociocultural context to mental health, this study underscores the need for culturally responsive interventions that address emotional communication within families. Efforts to improve mental health in this population should move beyond individual-level approaches and consider the broader family and cultural dynamics shaping emotional support and help-seeking behaviors. Addressing AFD may offer a promising pathway for reducing mental health disparities and improving outcomes among South Asian college women.