This study assessed serious psychological distress (SPD), unmet mental health treatment needs, and help-seeking among Asian American adults (AAs) in New York City (NYC), examining their associations with psychosocial factors. We also identified barriers to mental health treatment access and help-seeking sources. The 2023 Neighborhood Wellness Survey data, a representative sample of NYC adults, were analyzed. SPD was assessed using the Kessler Psychological Distress Scale (K6≥13). Multivariable regression models, adjusted for demographics, examined associations between psychosocial factors, SPD, unmet needs, and help-seeking. Among 6,648 AAs, the weighted and age-adjusted prevalence of SPD, unmet needs, and help-seeking were 7.4 %, 9.2 %, and 39.1 %, respectively. Racial/ethnic discrimination and social isolation were linked to higher odds of SPD and unmet needs, as well as greater probabilities of help-seeking. Financial strain was only associated with higher odds of SPD; stop/search/questioning by police was only associated with higher odds of unmet needs; and witnessing neighborhood violence was only associated with higher likelihood of help-seeking. Intimate partner violence and higher psychological distress severity were associated with higher odds of unmet needs and higher probabilities of help-seeking. Main barriers to mental health care among those with unmet needs were self-reliance without treatment (51.1 %), cost (46.4 %), and unawareness of available resources (41.7 %). Family/friends (30.0 %) were the primary support sources. AAs with higher levels of psychological stressors and psychological distress reported higher unmet needs and greater help-seeking. Enhancing mental health literacy and awareness of resources, reducing stigma, and improving access to affordable, culturally competent care is crucial, particularly for AAs facing violence, racial/ethnic discrimination, and police interactions.