Caught Between Two Cultures: Understanding Mental Health and Help-Seeking among Australian-Indian Families

Caught Between Two Cultures: Understanding Mental Health and Help-Seeking among Australian-Indian Families | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Caught Between Two Cultures: Understanding Mental Health and Help-Seeking among Australian-Indian Families Bindu Joseph, Robeena Emmanuel, Michael Olasoji This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6265191/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Sep, 2025 Read the published version in Journal of Immigrant and Minority Health → Version 1 posted 5 You are reading this latest preprint version Abstract More than 75% of mental illness emerges before the age of 25 and suicide continues to cause the largest loss of life of young people in Australia. Mental illness is highly prevalent among migrants with delayed help-seeking. The Indian–born population is the second-largest migrant community in Australia. The parents and caregivers of this population group are highly involved in their children’s overall well-being. This study aimed to explore and understand the mental health awareness and help-seeking behaviour of Indian parents and caregivers in Australia and its impact on their children. Data was collected through semi-structured interviews involving n=14 adults who are Indian migrant parents and caregivers. The data was analysed using thematic analysis. The findings highlighted the themes of 'Living and Parenting in a Dual Culture’, ‘Understanding about Mental Health and Well-being’, ‘The Challenge of Seeking Help in New Cultures', and ‘Connecting migrants to Mental Health Resources: the Enablers'. The responses from participants highlighted a limited understanding of mental health and available support. Figures Figure 1 BACKGROUND Mental health literacy refers to individuals' understanding, beliefs, and practices regarding mental health conditions, their causes, and the pathways to seeking help [ 18 ]. This concept is particularly crucial for migrant populations, where cultural, social, and systemic factors can significantly influence mental health outcomes [ 10 ]. Moving to another country brings cultural unfamiliarity and a loss of social connections and support systems [ 36 ]. Cultural diversity worldwide has multidimensional impacts on mental health, from how health and illness are perceived to help-seeking behaviours and overall attitudes [ 15 ]. The 2021 census reveals that 976,000 people in Australia have Indian ancestry (1). Furthermore, among these migrants, only 1.5 percent self-identified that they had any mental health conditions [ 1 ]. In the cultural context of India, interdependence with family members and collectivism are significant aspects of life [ 19 ]. India-born people may associate mental illness with severe stigma and shame, or denial will lead to reluctance to access mental health services [ 8 ]. Research also highlights that separation from the interdependent family system can impact emotional well-being [ 11 ]. It is assumable that multiple aspects of migrant experiences impact mental health and access to support services. Many Indian migrants may not be fluent in English, making it challenging to understand mental health resources or articulate their needs effectively [ 28 , 5 ]. Due to negative attitudes towards mental illness, seeking help for mental health problems usually only occurs in severe cases and may start with the pursuit of traditional treatment options [ 8 ]. Furthermore, a possible gap in health literacy and the difficulty in finding appropriate terms and phrases to express symptoms can further complicate this issue [ 29 , 27 , 16 ]. This communication gap may lead to feelings of inadequacy and negatively impact mental health and well-being. Research suggests that in the host country, navigating mental health services or understanding what constitutes appropriate care can be challenging for migrants [ 12 ]. This unfamiliarity can delay help-seeking and contribute to the chronicity and deterioration of symptoms [ 2 ]. This also can lead to a general distrust towards formal mental health systems [ 16 ]. This distrust could be rooted in previous experiences or cultural beliefs about health and illness [ 2 ]. Furthermore, family members, including parents and caregivers, who provide emotional support to young people play a vital role in identifying mental health issues and accessing and engaging with mental health services [ 22 ]. Given these complexities, it is essential to explore the factors influencing the mental health awareness and help-seeking of Indian migrants. The study aimed to explore the mental health awareness and help-seeking behaviour of Indian adults in Australia and its impact on their children. THEORETICAL/CONCEPTUAL FRAMEWORK The study utilised a qualitative exploratory, descriptive approach, which allows for exploring, describing, and providing a phenomenon of interest that moves beyond mere observation [ 17 ]. This design is beneficial when there is a gap in the available literature, as it helps uncover new knowledge and gain an understanding of the meanings of the phenomena under study [ 9 ]. Two theories, Social Constructivism, and the Health Belief Model, support the framework for understanding the mental health awareness and help-seeking behaviour of Indian Australians and how this impacts the mental health of their children. Please refer to the figure below. INSERT FIGURE 1 METHODS Participants and Data Collection Participants (n 14) were recruited using a purposive sampling technique. Purposive sampling is used to subjectively select and recruit information-rich participants who can provide in-depth responses to questions [ 9 ]. Recruitment was done via advertisements through various cultural organisations. Data was collected through semi-structured, in-depth interviews involving n = 14 adult Indian migrant parents and caregivers in Australia. Each interview lasted from 45 minutes to one hour. The research team consisted of three academic researchers with expertise in qualitative design and content analysis. The research team also has Culturally and Linguistically Diverse (CALD) backgrounds and interview experience. Data Analysis The thematic analysis was undertaken through multiple reiterations of each transcript using constant comparison to generate themes. There was an initial familiarisation with the data to elicit initial codes and to search for and review the themes. The themes were then defined, named, and documented [ 7 ]. A theme indicates a recurring idea or significant point within the data set. It includes relevant data related to the research question [ 7 ]. This study took an inductive approach to the data set; the themes identified were strongly linked to the data themselves. RESULTS Fourteen participants (3 males and 11 females) were included in this study. All the participants had children between 9 and 20 years old. All participants were migrants from India. The average post-migration time was 8 years. INSERT TABLE: 1 Theme 1: Living and Parenting in the Dual Culture All participants in this study highlighted that parenting in a dual culture has multiple impacts on children’s mental health. This includes cultural and intergenerational conflicts with children and challenges associated with running a family without extended support. Cultural intergenerational conflicts with children Many participants reported experiencing conflicts with children, particularly regarding cultural practices and expectations. “Cultural diversity is affecting our kids' mental health….. confused about whether I am right or they are right. You know, like that's a conflict of matching concepts and culture that's affecting the mental health that's struggling” (p10). “My child seems caught between two worlds” (p3). Another participant expressed concerns about cultural differences, intergenerational conflict, and related tensions. “The main worry is about the cultural difference. Sometimes as parents, we make strict rules about cultural practices, and kids object to it. That creates tension” (p2). “As parents, we follow certain cultural practices at home, and my teenage children question them” (p6). Other participants highlighted intergenerational conflicts related to cultural practices, too. Challenges associated with running a family without extended support. Multiple participants highlighted that running a family in the host country was challenging without the support of extended family and social support. “As a migrant parent, I feel like social interaction is limited, and we don't have many family members or grant parents here, which affects their social skills, so it affected their mental well-being” (p1). Yes, they don’t have any close relatives here, so that may affect their mental health (p6). More participants reflected similar views. “Thinking about my childhood, we had everyone around us. This is different for our kids. They can talk to their grandparents and relatives over the phone, but sometimes they are reluctant to talk just because they don't have that much language” (p13). “We’re far from our extended family, and it’s hard for all of us. I worry about how this separation affects my child and how they miss their grandparents and cousins” (p3). Other participants also remarked on challenges associated with living in the host country without extended family. Theme 2: Understanding Mental Health and Wellbeing. Being happy Participants were asked about their perspectives on mental health and well-being. Many highlighted ‘being happy’, ‘having social connections and similar themes. “Happy and being normal to others and in the interaction is good mental health” (p6). “Being happy and having a peaceful life with little stress” means feeling relaxed, spending time with the family, and having meals with the family” (p10). Other participants also had similar views about the outward expressions that others can see. “They will have to be happy and open to things. They should be socially active and doing their things, not moody or sitting in one place doing nothing” (p12). “They look happy, in a happy mood with happy faces, engage in their activities, and perform what they are meant to perform properly and communicate with others” (p13). In their perspective, many participants expressed that being happy is good for mental health. Having Social connections Participants in this study identified that having social connections is an essential factor contributing to good mental health and well-being. They indicated what elements of their lives should include such connections. “I would say they need to have a good, you know, positive relationship with their friends, their family, friends, or their school friends, having some good positive connections” (p1). Another participant also made a similar point. “Connections with others are critical, for example, friends, neighbours, church, etc. My church members supported and connected with me when I came here first” (p13). Many participants perceived good social connections as essential to good mental health. Theme 3: The Challenge of Seeking Help in New Cultures All participants discussed various challenges they perceived and came across when they sought mental health services. This ranged from dealing with stigma, privacy concerns, and financial implications. Many of the participants in this research also highlighted the stigma associated with mental health and seeking help for mental health-related problems. Stigma Stigma was highlighted as a significant barrier in disclosing about mental health and seeking help by multiple participants. “I have seen some people with mental health issues, but they used to suppress, or they used to hide because they worried about others” (p4). Another participant also shared similar views about this and how it impacts how they are perceived within their community. “You know, that kind of issue in my community because they consider, oh, this is, this is a shame for our family, you know, good name for the family if you have any mental health issues. I am reluctant to open up to others, like I am scared. Getting an appointment with the doctor is also a shame” (p6). Similar views were shared again, “I think from the migrant perspective, the stigma is a significant barrier, and everything about mental health is sealed within the family” (p4). The impact of disclosing mental illness within the community, according to some of the participants, could also limit their ability to interact with their community. “You will not be married to another family when you're having these mental health issues when it’s when something is labelled, and you know when this family got this mental health mince that is a significant stigma” (p11). Stigma was pointed out as a major barrier to accessing mental health services by all participants. Privacy-related issues and implications Some participants shared their concerns about privacy and confidentiality-related issues. They believed that community members might not be confidential about privately shared information within the community. “I worry that if anyone from my community sees me in the mental health clinic, they think I have problems; they talk about me” (p3). “We are a connected community, so if someone comes to know I have a mental issue, everyone will know. In the Indian community, if you have an illness, you don't get a good husband or wife” (p4). Another participant also shared concerns about having the information documented and possible future implications related to that. “Someone told me it would be in the records, and it might be bad to have it recorded. Yeah, that's one of the main things” (p9). Financial implications The cost associated with accessing mental health and psychological consultations was viewed as one of the main barriers for multiple participants. “Money is a huge issue; we have to pay a lot of money for psychology and mental health appointments” (p5). Other participants also highlighted the expenses and financial implications related to seeking mental health and counselling support. “Counselling was too expensive, so I couldn't continue. They will put means in the, you know, history as like mental health. Are there issues or something”? (p8). Another participant also highlighted that, “It's not free and very expensive. I paid $ 160 per session after the GP rebate, but I couldn't afford it” (p3). High expenses associated with mental health services, especially psychological counselling, were a theme highlighted by any participants. Theme 4: Connecting Migrants to Mental Health Resources: The Enablers Participants also mentioned facilitators and enablers related to accessing mental health resources. MH Awareness programs, through the Community Participants highlighted the importance and benefits of conducting local community-based awareness programs, possibly in their language. “We all need to have a sense of belonging. Education sessions during community gatherings. These sessions need to be organised without discussing mental health—awareness sessions in own language like within that community” (p13). Another participant also highlighted that, “Local GP centres are significant for raising awareness of things like when we first start or approaching someone like, "What is the process?" (p12). “Getting awareness of, like, when we first start or approach someone, what is the process”? (p6). Additionally, another participant highlighted. “I feel like I'm more informative sessions because I do not think nowadays, we don't have many informative sessions on mental health happening in my culture in my community, so awareness about mental health” (p11). Other participants also highlighted mental health awareness programs as facilitators. “Education sessions for families, separately for kids and men, men go through a lot. Teachers need to be aware of the various services available” (p13). Another participant also shared similar views. “The government has to arrange education for Indians because they see mental health problems very negatively” (p14) Participants also highlighted the importance of openly talking about mental health within the community. “Knowing where to seek help is essential, what the symptoms, etc, should be spoken about openly without any shame, and mental health awareness programs will help us” (p2). Culturally appropriate services A few study participants stated that culturally appropriate service delivery is essential when providing care for multicultural community members, as Western care delivery might not necessarily work for people from an ethnic background. “It is important to understand our help so that healthcare clinicians understand the symptoms and how we express them. Multicultural people won’t be the same as Australian people” (p1). Additionally, another participant stated, “Sometimes, people don’t know whether to talk about everything or if the mental health doctors ask more questions or encourage them in a culturally appropriate way, people will trust them and open up” (p13). Other participants highlighted the need for culturally appropriate services, too. “Sometimes psychology people don’t understand our culture, and some things are every day in our culture, which might not be appropriate in Aussie culture” (p11). More participants also expressed that culturally appropriate services will improve access to mental health services by CALD communities. DISCUSSION To the best of our knowledge, no study has investigated the mental health literacy of Indian migrants in Australia and their help-seeking behaviours. The current study sought to provide a perspective on the mental health literacy and awareness of parents and caregivers of young people from Indian backgrounds and the factors impacting their attitude towards mental health and help-seeking behaviours. Help-seeking behaviour is a determining factor for any disease's overall outcome and progression [ 24 ]. In the present study, a purposive sample of fourteen (n = 14) migrant Indian parents, there were four main findings: (1) Living and Parenting in a Dual Culture, (2) Understanding of Mental Health and Well-being, (3) The Challenge of Seeking Help in New Cultures, (4) Connecting Migrants to Mental Health Resources: The Enablers. Participants reported significant challenges with running a family without extended support and having inter-generational cultural conflicts with their children. The parents worried about not spending time with their children due to workload may lead to poor mental health. Differences in acculturation levels and language barriers are the main reasons for intergenerational conflict between parents and children. Growing up in Australian culture may allow children to learn and be exposed to information related to mental health. However, significant stigma in Indian society makes children avoid seeking help. Previous studies reported that stigma is a barrier to help-seeking [ 30 ]. The researchers reported a high prevalence of mental illness seen in second-generation migrants whose acculturation levels are lower [ 32 ], and one of the factors contributing to this is intergenerational conflict. Adolescents generally acculturate to the values of the new society faster than their parents [ 33 ]. Similarly, a previous study reports that migrating individuals have a lack of social support, and underlying stigma and attitude towards mental illness prevent them from seeking support [ 6 ]. Loss of extended family and kinship networks can adversely affect the migrants’ mental health [ 26 ]. The findings of this study provided insight into how Indian parents perceive mental health. Being happy, relaxed, and having good relationships with others were perceived as good mental health and well-being among most participants in this study. The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community” [ 34 , 35 ]. Like the findings in this study, another research also identified that one of the components of good mental health is the ability to establish meaningful relationships with family members and other important people in our lives [ 13 ]. The participants were unsure about signs of mental illness, when to be concerned, and when to seek help. This research findings align with prior research demonstrating that increased stigma, privacy-related issues, financial implications, and worries about the future among Culturally and Linguistically diverse populations (CALD) are barriers to seeking help for mental health issues. Much research on various CALD populations has been conducted in different parts of Australia. There is no research on the Indian population. Across many studies, the most frequently reported barrier was self and public stigma [ 27 , 31 , 23 ]. The findings of qualitative research among Asian community members/leaders and healthcare professionals highlighted that people from Asia are unwilling to access help from mainstream services because of their beliefs about mental illness, stigma, and shame [ 36 ]. Previous studies reported that different migrant communities did not seek help or were hesitant to use interpreter services due to concerns about confidentiality [ 3 , 4 ]. All the participants in this study expressed concerns about other people in the same community knowing and judging them if they talk about mental health issues. Some are worried about their future and do not get good relationships and marriage proposals for their children. Private mental health services in Australia were often financially out of reach for many migrants [ 20 ]. Three participants in this study would prefer private mental health services and were worried about the cost, however, others said they would seek help from public services where they do not need to pay despite a lack of awareness about the public mental health system. One participant talked about paying to see a psychologist and was not aware of a GP mental health plan for subsidised sessions. Raising awareness and knowledge of mental illness and available services is crucial because individuals often rely on family, friends, and religious leaders for support when affected. Family, social, community, and religious networks play an important role in managing mental illness among the CALD population [ 21 ]. 86% (n = 12) of the participants believe mental health awareness programs for this community will be beneficial, and they suggested conducting these programs by collaborating with religious leaders or cultural programs. This is due to their confidence that Indian migrants will be hesitant to attend programs related to mental health because of stigma and shame. Mental health training for key services within the multicultural sector, such as settlement services, religious leaders, and churches, the people access found to be facilitators for the CALD population [ 25 ]. Furthermore, the participants did not demonstrate awareness about available mental health services in Australia despite all participants being educated at a minimum graduate level. Some of the participants are aware of GP care plans to access psychology services and employee assistance programs at their work. No participants mentioned public mental health services, and researchers are unsure if this is due to a lack of knowledge or stigma to discuss this. Many studies previously highlighted that having culturally appropriate services is an enabler in seeking mental health services for migrants [ 20 , 21 , 14 ]. A similar theme emerged in this study, and one participant mainly believed that having culturally appropriate service may be a channel for open communication. New Contribution to the Literature Mental health awareness and help-seeking behaviours among people of culturally and linguistically diverse populations differ from mainstream Australians. Indian migrant parents and carers highlighted the impact of challenges they face in dual culture on their children’s mental health. They also discussed stigma about mental illness, confidentiality, and financial implications as barriers to seeking help. These participants also voiced concerns about a possible lack of privacy in their closely-knit communities. All these factors can delay and hinder accessing help. Most of the participants expressed the need for mental health awareness programs at the community level and the necessity for culturally appropriate services. Understanding how cultural perceptions, social support networks, and access to resources shape their help-seeking behaviours can inform the development of targeted interventions to address their specific needs. Declarations Acknowledgements We acknowledge all the participants in this study. Funding We thank the Collaborative Evaluation & Research Centre (CERC) for the academic seed grant for this project. Ethics Declaration Competing Interests The authors declare no competing interests. Ethics approval This study was approved by the human research ethics committee of Federation University (blinded for review) (reference 2023/110). 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Int J Ment Health Nurs. 2005;14(2):88–95. Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Published Journal Publication published 17 Sep, 2025 Read the published version in Journal of Immigrant and Minority Health → Version 1 posted Reviewers agreed at journal 27 Apr, 2025 Reviewers invited by journal 24 Apr, 2025 Editor assigned by journal 20 Mar, 2025 Submission checks completed at journal 20 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6265191","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447539882,"identity":"3c528fec-3f3e-4c03-8897-dc8bf6fbdccf","order_by":0,"name":"Bindu Joseph","email":"data:image/png;base64,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","orcid":"","institution":"Federation University","correspondingAuthor":true,"prefix":"","firstName":"Bindu","middleName":"","lastName":"Joseph","suffix":""},{"id":447539883,"identity":"f3f10a79-a630-4fe6-b645-c79db15c6191","order_by":1,"name":"Robeena Emmanuel","email":"","orcid":"","institution":"Federation University","correspondingAuthor":false,"prefix":"","firstName":"Robeena","middleName":"","lastName":"Emmanuel","suffix":""},{"id":447539884,"identity":"fbf067c1-1ca7-4459-8a1c-0a6fb54ea5ba","order_by":2,"name":"Michael Olasoji","email":"","orcid":"","institution":"Federation University","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Olasoji","suffix":""}],"badges":[],"createdAt":"2025-03-20 01:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6265191/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6265191/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10903-025-01777-9","type":"published","date":"2025-09-17T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82147500,"identity":"a75f8f20-b10b-4dcf-9105-8bbe5d1e1a51","added_by":"auto","created_at":"2025-05-07 07:00:59","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":685103,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual Framework\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6265191/v1/4fb1e0221cc1402ec3dd2389.jpeg"},{"id":91889862,"identity":"b043f3d8-805e-4f2b-b78c-7c296fe469f7","added_by":"auto","created_at":"2025-09-22 16:02:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1334715,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6265191/v1/ca8f18a0-2a07-4ce4-b680-08573993af57.pdf"},{"id":82145428,"identity":"4268cd16-511b-42cb-9cbe-623ff9ba8772","added_by":"auto","created_at":"2025-05-07 06:52:59","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16201,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6265191/v1/4eecf8bf560f847a0ae21e02.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCaught Between Two Cultures: Understanding Mental Health and Help-Seeking among Australian-Indian Families\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMental health literacy refers to individuals' understanding, beliefs, and practices regarding mental health conditions, their causes, and the pathways to seeking help [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This concept is particularly crucial for migrant populations, where cultural, social, and systemic factors can significantly influence mental health outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moving to another country brings cultural unfamiliarity and a loss of social connections and support systems [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Cultural diversity worldwide has multidimensional impacts on mental health, from how health and illness are perceived to help-seeking behaviours and overall attitudes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 2021 census reveals that 976,000 people in Australia have Indian ancestry (1). Furthermore, among these migrants, only 1.5 percent self-identified that they had any mental health conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the cultural context of India, interdependence with family members and collectivism are significant aspects of life [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. India-born people may associate mental illness with severe stigma and shame, or denial will lead to reluctance to access mental health services [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Research also highlights that separation from the interdependent family system can impact emotional well-being [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It is assumable that multiple aspects of migrant experiences impact mental health and access to support services.\u003c/p\u003e \u003cp\u003eMany Indian migrants may not be fluent in English, making it challenging to understand mental health resources or articulate their needs effectively [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to negative attitudes towards mental illness, seeking help for mental health problems usually only occurs in severe cases and may start with the pursuit of traditional treatment options [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, a possible gap in health literacy and the difficulty in finding appropriate terms and phrases to express symptoms can further complicate this issue [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This communication gap may lead to feelings of inadequacy and negatively impact mental health and well-being.\u003c/p\u003e \u003cp\u003eResearch suggests that in the host country, navigating mental health services or understanding what constitutes appropriate care can be challenging for migrants [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This unfamiliarity can delay help-seeking and contribute to the chronicity and deterioration of symptoms [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This also can lead to a general distrust towards formal mental health systems [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This distrust could be rooted in previous experiences or cultural beliefs about health and illness [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Furthermore, family members, including parents and caregivers, who provide emotional support to young people play a vital role in identifying mental health issues and accessing and engaging with mental health services [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Given these complexities, it is essential to explore the factors influencing the mental health awareness and help-seeking of Indian migrants. The study aimed to explore the mental health awareness and help-seeking behaviour of Indian adults in Australia and its impact on their children.\u003c/p\u003e\n\u003ch3\u003eTHEORETICAL/CONCEPTUAL FRAMEWORK\u003c/h3\u003e\n\u003cp\u003eThe study utilised a qualitative exploratory, descriptive approach, which allows for exploring, describing, and providing a phenomenon of interest that moves beyond mere observation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This design is beneficial when there is a gap in the available literature, as it helps uncover new knowledge and gain an understanding of the meanings of the phenomena under study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo theories, Social Constructivism, and the Health Belief Model, support the framework for understanding the mental health awareness and help-seeking behaviour of Indian Australians and how this impacts the mental health of their children. Please refer to the figure below.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eINSERT FIGURE \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/h2\u003e \u003c/div\u003e "},{"header":"METHODS","content":"\u003ch2\u003eParticipants and Data Collection\u003c/h2\u003e\u003cp\u003eParticipants (n 14) were recruited using a purposive sampling technique. Purposive sampling is used to subjectively select and recruit information-rich participants who can provide in-depth responses to questions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Recruitment was done via advertisements through various cultural organisations. Data was collected through semi-structured, in-depth interviews involving n = 14 adult Indian migrant parents and caregivers in Australia. Each interview lasted from 45 minutes to one hour. The research team consisted of three academic researchers with expertise in qualitative design and content analysis. The research team also has Culturally and Linguistically Diverse (CALD) backgrounds and interview experience.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe thematic analysis was undertaken through multiple reiterations of each transcript using constant comparison to generate themes. There was an initial familiarisation with the data to elicit initial codes and to search for and review the themes. The themes were then defined, named, and documented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A theme indicates a recurring idea or significant point within the data set. It includes relevant data related to the research question [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study took an inductive approach to the data set; the themes identified were strongly linked to the data themselves.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFourteen participants (3 males and 11 females) were included in this study. All the participants had children between 9 and 20 years old. All participants were migrants from India. The average post-migration time was 8 years.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eINSERT TABLE: 1\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003eTheme 1: Living and Parenting in the Dual Culture\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAll participants in this study highlighted that parenting in a dual culture has multiple impacts on children\u0026rsquo;s mental health. This includes cultural and intergenerational conflicts with children and challenges associated with running a family without extended support.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eCultural intergenerational conflicts with children\u003c/h3\u003e\n\u003cp\u003eMany participants reported experiencing conflicts with children, particularly regarding cultural practices and expectations.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Cultural diversity is affecting our kids' mental health\u0026hellip;.. confused about whether I am right or they are right. You know, like that's a conflict of matching concepts and culture that's affecting the mental health that's struggling\u0026rdquo; (p10).\u003c/p\u003e \u003cp\u003e\u0026ldquo;My child seems caught between two worlds\u0026rdquo; (p3).\u003c/p\u003e \u003cp\u003eAnother participant expressed concerns about cultural differences, intergenerational conflict, and related tensions.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The main worry is about the cultural difference. Sometimes as parents, we make strict rules about cultural practices, and kids object to it. That creates tension\u0026rdquo; (p2).\u003c/p\u003e \u003cp\u003e\u0026ldquo;As parents, we follow certain cultural practices at home, and my teenage children question them\u0026rdquo; (p6).\u003c/p\u003e \u003cp\u003eOther participants highlighted intergenerational conflicts related to cultural practices, too.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eChallenges associated with running a family without extended support.\u003c/span\u003e \u003c/p\u003e \u003cp\u003eMultiple participants highlighted that running a family in the host country was challenging without the support of extended family and social support.\u003c/p\u003e \u003cp\u003e\u0026ldquo;As a migrant parent, I feel like social interaction is limited, and we don't have many family members or grant parents here, which affects their social skills, so it affected their mental well-being\u0026rdquo; (p1).\u003c/p\u003e \u003cp\u003eYes, they don\u0026rsquo;t have any close relatives here, so that may affect their mental health (p6).\u003c/p\u003e \u003cp\u003eMore participants reflected similar views.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Thinking about my childhood, we had everyone around us. This is different for our kids. They can talk to their grandparents and relatives over the phone, but sometimes they are reluctant to talk just because they don't have that much language\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003e\u0026ldquo;We\u0026rsquo;re far from our extended family, and it\u0026rsquo;s hard for all of us. I worry about how this separation affects my child and how they miss their grandparents and cousins\u0026rdquo; (p3).\u003c/p\u003e \u003cp\u003eOther participants also remarked on challenges associated with living in the host country\u003c/p\u003e \u003cp\u003ewithout extended family.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 2: Understanding Mental Health and Wellbeing.\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBeing happy\u003c/h2\u003e \u003cp\u003eParticipants were asked about their perspectives on mental health and well-being. Many highlighted \u0026lsquo;being happy\u0026rsquo;, \u0026lsquo;having social connections and similar themes.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Happy and being normal to others and in the interaction is good mental health\u0026rdquo; (p6).\u003c/p\u003e \u003cp\u003e\u0026ldquo;Being happy and having a peaceful life with little stress\u0026rdquo; means feeling relaxed, spending time with the family, and having meals with the family\u0026rdquo; (p10).\u003c/p\u003e \u003cp\u003eOther participants also had similar views about the outward expressions that others can see.\u003c/p\u003e \u003cp\u003e\u0026ldquo;They will have to be happy and open to things. They should be socially active and doing their things, not moody or sitting in one place doing nothing\u0026rdquo; (p12).\u003c/p\u003e \u003cp\u003e\u0026ldquo;They look happy, in a happy mood with happy faces, engage in their activities, and perform what they are meant to perform properly and communicate with others\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003eIn their perspective, many participants expressed that being happy is good for mental health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eHaving Social connections\u003c/h2\u003e \u003cp\u003eParticipants in this study identified that having social connections is an essential factor contributing to good mental health and well-being. They indicated what elements of their lives should include such connections.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I would say they need to have a good, you know, positive relationship with their friends, their family, friends, or their school friends, having some good positive connections\u0026rdquo; (p1).\u003c/p\u003e \u003cp\u003eAnother participant also made a similar point.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Connections with others are critical, for example, friends, neighbours, church, etc. My church members supported and connected with me when I came here first\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003e Many participants perceived good social connections as essential to good mental health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: The Challenge of Seeking Help in New Cultures\u003c/h2\u003e \u003cp\u003e All participants discussed various challenges they perceived and came across when they sought mental health services. This ranged from dealing with stigma, privacy concerns, and financial implications. Many of the participants in this research also highlighted the stigma associated with mental health and seeking help for mental health-related problems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStigma\u003c/h2\u003e \u003cp\u003eStigma was highlighted as a significant barrier in disclosing about mental health and seeking help by multiple participants.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I have seen some people with mental health issues, but they used to suppress, or they used to hide because they worried about others\u0026rdquo; (p4).\u003c/p\u003e \u003cp\u003eAnother participant also shared similar views about this and how it impacts how they are perceived within their community.\u003c/p\u003e \u003cp\u003e\u0026ldquo;You know, that kind of issue in my community because they consider, oh, this is, this is a shame for our family, you know, good name for the family if you have any mental health issues. I am reluctant to open up to others, like I am scared. Getting an appointment with the doctor is also a shame\u0026rdquo; (p6).\u003c/p\u003e \u003cp\u003eSimilar views were shared again,\u003c/p\u003e \u003cp\u003e\u0026ldquo;I think from the migrant perspective, the stigma is a significant barrier, and everything about mental health is sealed within the family\u0026rdquo; (p4).\u003c/p\u003e \u003cp\u003eThe impact of disclosing mental illness within the community, according to some of the participants, could also limit their ability to interact with their community.\u003c/p\u003e \u003cp\u003e\u0026ldquo;You will not be married to another family when you're having these mental health issues when it\u0026rsquo;s when something is labelled, and you know when this family got this mental health mince that is a significant stigma\u0026rdquo; (p11).\u003c/p\u003e \u003cp\u003eStigma was pointed out as a major barrier to accessing mental health services by all participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePrivacy-related issues and implications\u003c/h2\u003e \u003cp\u003eSome participants shared their concerns about privacy and confidentiality-related issues. They believed that community members might not be confidential about privately shared information within the community.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I worry that if anyone from my community sees me in the mental health clinic, they think I have problems; they talk about me\u0026rdquo; (p3).\u003c/p\u003e \u003cp\u003e\u0026ldquo;We are a connected community, so if someone comes to know I have a mental issue, everyone will know. In the Indian community, if you have an illness, you don't get a good husband or wife\u0026rdquo; (p4).\u003c/p\u003e \u003cp\u003eAnother participant also shared concerns about having the information documented and possible future implications related to that.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Someone told me it would be in the records, and it might be bad to have it recorded. Yeah, that's one of the main things\u0026rdquo; (p9).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFinancial implications\u003c/h2\u003e \u003cp\u003eThe cost associated with accessing mental health and psychological consultations was viewed as one of the main barriers for multiple participants.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Money is a huge issue; we have to pay a lot of money for psychology and mental health appointments\u0026rdquo; (p5).\u003c/p\u003e \u003cp\u003eOther participants also highlighted the expenses and financial implications related to seeking mental health and counselling support.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Counselling was too expensive, so I couldn't continue. They will put means in the, you know, history as like mental health. Are there issues or something\u0026rdquo;? (p8).\u003c/p\u003e \u003cp\u003eAnother participant also highlighted that,\u003c/p\u003e \u003cp\u003e\u0026ldquo;It's not free and very expensive. I paid \u003cspan\u003e$\u003c/span\u003e160 per session after the GP rebate, but I couldn't afford it\u0026rdquo; (p3).\u003c/p\u003e \u003cp\u003eHigh expenses associated with mental health services, especially psychological counselling, were a theme highlighted by any participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Connecting Migrants to Mental Health Resources: The Enablers\u003c/h2\u003e \u003cp\u003e Participants also mentioned facilitators and enablers related to accessing mental health resources.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMH Awareness programs, through the Community\u003c/h2\u003e \u003cp\u003e Participants highlighted the importance and benefits of conducting local community-based awareness programs, possibly in their language.\u003c/p\u003e \u003cp\u003e\u0026ldquo;We all need to have a sense of belonging. Education sessions during community gatherings. These sessions need to be organised without discussing mental health\u0026mdash;awareness sessions in own language like within that community\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003eAnother participant also highlighted that,\u003c/p\u003e \u003cp\u003e\u0026ldquo;Local GP centres are significant for raising awareness of things like when we first start or approaching someone like, \"What is the process?\" (p12).\u003c/p\u003e \u003cp\u003e\u0026ldquo;Getting awareness of, like, when we first start or approach someone, what is the process\u0026rdquo;? (p6).\u003c/p\u003e \u003cp\u003eAdditionally, another participant highlighted.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I feel like I'm more informative sessions because I do not think nowadays, we don't have many informative sessions on mental health happening in my culture in my community, so awareness about mental health\u0026rdquo; (p11).\u003c/p\u003e \u003cp\u003eOther participants also highlighted mental health awareness programs as facilitators.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Education sessions for families, separately for kids and men, men go through a lot. Teachers need to be aware of the various services available\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003eAnother participant also shared similar views.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The government has to arrange education for Indians because they see mental health problems very negatively\u0026rdquo; (p14)\u003c/p\u003e \u003cp\u003e Participants also highlighted the importance of openly talking about mental health within the community.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Knowing where to seek help is essential, what the symptoms, etc, should be spoken about openly without any shame, and mental health awareness programs will help us\u0026rdquo; (p2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCulturally appropriate services\u003c/h2\u003e \u003cp\u003eA few study participants stated that culturally appropriate service delivery is essential when providing care for multicultural community members, as Western care delivery might not necessarily work for people from an ethnic background.\u003c/p\u003e \u003cp\u003e\u0026ldquo;It is important to understand our help so that healthcare clinicians understand the symptoms and how we express them. Multicultural people won\u0026rsquo;t be the same as Australian people\u0026rdquo; (p1).\u003c/p\u003e \u003cp\u003eAdditionally, another participant stated,\u003c/p\u003e \u003cp\u003e\u0026ldquo;Sometimes, people don\u0026rsquo;t know whether to talk about everything or if the mental health doctors ask more questions or encourage them in a culturally appropriate way, people will trust them and open up\u0026rdquo; (p13).\u003c/p\u003e \u003cp\u003eOther participants highlighted the need for culturally appropriate services, too.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Sometimes psychology people don\u0026rsquo;t understand our culture, and some things are every day in our culture, which might not be appropriate in Aussie culture\u0026rdquo; (p11).\u003c/p\u003e \u003cp\u003eMore participants also expressed that culturally appropriate services will improve access to mental health services by CALD communities.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo the best of our knowledge, no study has investigated the mental health literacy of Indian migrants in Australia and their help-seeking behaviours. The current study sought to provide a perspective on the mental health literacy and awareness of parents and caregivers of young people from Indian backgrounds and the factors impacting their attitude towards mental health and help-seeking behaviours.\u003c/p\u003e \u003cp\u003eHelp-seeking behaviour is a determining factor for any disease's overall outcome and progression [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the present study, a purposive sample of fourteen (n\u0026thinsp;=\u0026thinsp;14) migrant Indian parents, there were four main findings: (1) Living and Parenting in a Dual Culture, (2) Understanding of Mental Health and Well-being, (3) The Challenge of Seeking Help in New Cultures, (4) Connecting Migrants to Mental Health Resources: The Enablers.\u003c/p\u003e \u003cp\u003eParticipants reported significant challenges with running a family without extended support and having inter-generational cultural conflicts with their children. The parents worried about not spending time with their children due to workload may lead to poor mental health. Differences in acculturation levels and language barriers are the main reasons for intergenerational conflict between parents and children. Growing up in Australian culture may allow children to learn and be exposed to information related to mental health. However, significant stigma in Indian society makes children avoid seeking help. Previous studies reported that stigma is a barrier to help-seeking [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The researchers reported a high prevalence of mental illness seen in second-generation migrants whose acculturation levels are lower [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and one of the factors contributing to this is intergenerational conflict. Adolescents generally acculturate to the values of the new society faster than their parents [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Similarly, a previous study reports that migrating individuals have a lack of social support, and underlying stigma and attitude towards mental illness prevent them from seeking support [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Loss of extended family and kinship networks can adversely affect the migrants\u0026rsquo; mental health [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this study provided insight into how Indian parents perceive mental health. Being happy, relaxed, and having good relationships with others were perceived as good mental health and well-being among most participants in this study. The World Health Organization (WHO) defines mental health as \u0026ldquo;a state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community\u0026rdquo; [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Like the findings in this study, another research also identified that one of the components of good mental health is the ability to establish meaningful relationships with family members and other important people in our lives [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The participants were unsure about signs of mental illness, when to be concerned, and when to seek help.\u003c/p\u003e \u003cp\u003eThis research findings align with prior research demonstrating that increased stigma, privacy-related issues, financial implications, and worries about the future among Culturally and Linguistically diverse populations (CALD) are barriers to seeking help for mental health issues. Much research on various CALD populations has been conducted in different parts of Australia. There is no research on the Indian population. Across many studies, the most frequently reported barrier was self and public stigma [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The findings of qualitative research among Asian community members/leaders and healthcare professionals highlighted that people from Asia are unwilling to access help from mainstream services because of their beliefs about mental illness, stigma, and shame [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Previous studies reported that different migrant communities did not seek help or were hesitant to use interpreter services due to concerns about confidentiality [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. All the participants in this study expressed concerns about other people in the same community knowing and judging them if they talk about mental health issues. Some are worried about their future and do not get good relationships and marriage proposals for their children. Private mental health services in Australia were often financially out of reach for many migrants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Three participants in this study would prefer private mental health services and were worried about the cost, however, others said they would seek help from public services where they do not need to pay despite a lack of awareness about the public mental health system. One participant talked about paying to see a psychologist and was not aware of a GP mental health plan for subsidised sessions.\u003c/p\u003e \u003cp\u003eRaising awareness and knowledge of mental illness and available services is crucial because individuals often rely on family, friends, and religious leaders for support when affected. Family, social, community, and religious networks play an important role in managing mental illness among the CALD population [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. 86% (n\u0026thinsp;=\u0026thinsp;12) of the participants believe mental health awareness programs for this community will be beneficial, and they suggested conducting these programs by collaborating with religious leaders or cultural programs. This is due to their confidence that Indian migrants will be hesitant to attend programs related to mental health because of stigma and shame. Mental health training for key services within the multicultural sector, such as settlement services, religious leaders, and churches, the people access found to be facilitators for the CALD population [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, the participants did not demonstrate awareness about available mental health services in Australia despite all participants being educated at a minimum graduate level. Some of the participants are aware of GP care plans to access psychology services and employee assistance programs at their work. No participants mentioned public mental health services, and researchers are unsure if this is due to a lack of knowledge or stigma to discuss this. Many studies previously highlighted that having culturally appropriate services is an enabler in seeking mental health services for migrants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A similar theme emerged in this study, and one participant mainly believed that having culturally appropriate service may be a channel for open communication.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eNew Contribution to the Literature\u003c/h2\u003e \u003cp\u003eMental health awareness and help-seeking behaviours among people of culturally and linguistically diverse populations differ from mainstream Australians. Indian migrant parents and carers highlighted the impact of challenges they face in dual culture on their children\u0026rsquo;s mental health. They also discussed stigma about mental illness, confidentiality, and financial implications as barriers to seeking help. These participants also voiced concerns about a possible lack of privacy in their closely-knit communities. All these factors can delay and hinder accessing help. Most of the participants expressed the need for mental health awareness programs at the community level and the necessity for culturally appropriate services. Understanding how cultural perceptions, social support networks, and access to resources shape their help-seeking behaviours can inform the development of targeted interventions to address their specific needs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Collaborative Evaluation \u0026amp; Research Centre (CERC) for the academic seed grant for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the human research ethics committee of Federation University (blinded for review) (reference 2023/110).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided consent for data to be collected at the time of data collection\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBJ: Research concept, Lead, HREC, Data Collection, Data Analysis, Main manuscript text, Table and FiguresRE: Research idea, HREC, Data Collection, Data Analysis, Main manuscript text, Table and FiguresMO: Overview and supervisionAll authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics. 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Int J Ment Health Nurs. 2005;14(2):88\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-immigrant-and-minority-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joih","sideBox":"Learn more about [Journal of Immigrant and Minority Health](http://link.springer.com/journal/10903)","snPcode":"10903","submissionUrl":"https://submission.springernature.com/new-submission/10903/3","title":"Journal of Immigrant and Minority Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6265191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6265191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"More than 75% of mental illness emerges before the age of 25 and suicide continues to cause the largest loss of life of young people in Australia. Mental illness is highly prevalent among migrants with delayed help-seeking. The Indian–born population is the second-largest migrant community in Australia. The parents and caregivers of this population group are highly involved in their children’s overall well-being. This study aimed to explore and understand the mental health awareness and help-seeking behaviour of Indian parents and caregivers in Australia and its impact on their children. Data was collected through semi-structured interviews involving n=14 adults who are Indian migrant parents and caregivers. The data was analysed using thematic analysis. The findings highlighted the themes of 'Living and Parenting in a Dual Culture’, ‘Understanding about Mental Health and Well-being’, ‘The Challenge of Seeking Help in New Cultures', and ‘Connecting migrants to Mental Health Resources: the Enablers'. The responses from participants highlighted a limited understanding of mental health and available support. \n \n","manuscriptTitle":"Caught Between Two Cultures: Understanding Mental Health and Help-Seeking among Australian-Indian Families","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 06:52:55","doi":"10.21203/rs.3.rs-6265191/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"72799041859900510518957610939173335211","date":"2025-04-28T03:11:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-24T14:23:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-20T10:25:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-20T10:22:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Immigrant and Minority Health","date":"2025-03-20T01:25:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-immigrant-and-minority-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joih","sideBox":"Learn more about [Journal of Immigrant and Minority Health](http://link.springer.com/journal/10903)","snPcode":"10903","submissionUrl":"https://submission.springernature.com/new-submission/10903/3","title":"Journal of Immigrant and Minority Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c898fa8e-bdbd-4f3f-b3c2-47f8bc4d0d70","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T16:00:38+00:00","versionOfRecord":{"articleIdentity":"rs-6265191","link":"https://doi.org/10.1007/s10903-025-01777-9","journal":{"identity":"journal-of-immigrant-and-minority-health","isVorOnly":false,"title":"Journal of Immigrant and Minority Health"},"publishedOn":"2025-09-17 15:57:15","publishedOnDateReadable":"September 17th, 2025"},"versionCreatedAt":"2025-05-07 06:52:55","video":"","vorDoi":"10.1007/s10903-025-01777-9","vorDoiUrl":"https://doi.org/10.1007/s10903-025-01777-9","workflowStages":[]},"version":"v1","identity":"rs-6265191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6265191","identity":"rs-6265191","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}