Predictors of Asian American adolescents' suicide attempts: a latent class regression analysis

Exploring the Lived Experiences of Iranian Adolescents Exhibiting Suicidal Behavior and Ideation

Suicide is a complex phenomenon influenced by various individual and contextual factors that may inform prevention efforts. This research is part of a comprehensive project conducted in the chain clinics of Iris Company (pseudonym) throughout Iran. 1). The objective of the study was to expand the current literature on adolescent suicidality by qualitatively exploring the lived experiences of adolescents with a history of at least one suicide attempt and suicidal ideation through in-depth semi-structured interviews. 2).

PARTICIPANTS

The sample included 69 Iranian adolescents (38 females and 31 males) aged 15-19 years from diverse cultural and societal backgrounds across various regions of Iran. 3).

RESULTS

Data were analyzed using the Colaizzi method of phenomenological analysis (Praveena & Sasikumar, 2021), resulting in six main themes and 14 sub-themes. The main themes were: (1) overwhelming emotional pain, (2) influence of traditional cultural values, (3) desire for stronger connections, (4) openness to treatment, (5) wish to improve life, and (6) feeling trapped in the present. 4).

CONCLUSIONS

This study addresses gaps in prior research and aims to advance the understanding of adolescent suicide prevention. The authors emphasize the importance of family and relational contexts in understanding suicide risk among adolescents and highlight the roles of family therapy and peer support in developing prevention and intervention strategies for at-risk youth.

The association between cultural and linguistic maintenance and mental health in migrant adolescents: A scoping review

BACKGROUND

Although previous reviews have examined the relationship between heritage cultural maintenance and mental health outcomes among migrants, none have focussed specifically on migrant adolescents (i.e. those aged 10-24 years).

AIMS

To examine (1) the focus, scope and nature of quantitative empirical research investigating heritage cultural maintenance - including linguistic maintenance - and mental health outcomes among migrant adolescents globally and (2) the association between cultural and linguistic maintenance and migrant adolescents' mental health outcomes.

METHOD

Following the Arksey and O'Malley methodological framework for scoping reviews, we searched 11 electronic health, medical, social science and language databases from database inception until the search date (6 June 2023), using English search terms. We extracted data from included empirical studies using a template with pre-defined data items, which we present in comprehensive overviews and narrative summaries.

RESULTS

Thirty-four studies met our inclusion criteria. We identified considerable heterogeneity between studies regarding their research foci, methodologies, terminologies, outcomes and findings regarding the association between cultural maintenance and mental health outcomes. We specifically identified mixed findings regarding the latter, which cannot be transferred or generalised.

CONCLUSIONS

The heterogenous nature of methodologies and outcome measures in the published literature, in addition to a scarcity of research from low- and middle-income countries, have hindered meaningful progress in this field. Efforts to address these issues, and to take adolescent context into consideration, will facilitate a more accurate understanding of how cultural maintenance relates to migrant adolescent mental health, and inform future interventions to improve mental health outcomes.

The Longitudinal Impact of Family, Religious, and School Support on the Mental Health of Filipino and Korean American Youth Across Adolescence

Asian Americans, currently the most rapidly expanding racial group in the USA, are experiencing persistent mental health inequities. These inequities are particularly pronounced during adolescence, highlighting the critical need for dedicated focus on this demographic. Social support is a key shield against mental distress among these adolescents, yet little research has examined the collective impact of multiple sources of support over time, across developmental stages, and for different ethnic subgroups. Drawing on the integrated conceptual framework, this longitudinal study is the first to our knowledge to examine how support from families, religious organizations, and schools together predicts mental health over time across adolescents' developmental stages. We further examined how these relationships may be moderated by age groups, distinguishing between the early adolescence cohort and the middle adolescence cohort. Data were from the Midwest Longitudinal Study of Asian American Families (MLSAAF) project that survey-interviewed 378 Filipino American and 408 Korean American adolescents (Mage = 15 years). Findings reveal that family support consistently buffers against mental distress throughout adolescence for both groups. Religious support distinctly aids Filipino American early adolescents, while school support notably benefits early adolescents regardless of ethnicity. These findings emphasize the universal protective effects of social support, while also highlighting the nuanced ways that developmental stage and ethnicity may influence how different sources of support impact mental health. This underscores the need for developmentally and culturally sensitive mental health strategies for Asian American adolescents.

Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review

Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.

Acculturation and suicide-related risk in ethnoracially minoritized youth in the US: a scoping review and content analysis of the empirical evidence

PURPOSE

Among Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth, the US born have higher risk of suicidal thoughts and behaviors (attempts and death-by-suicide) than first-generation migrants. Research has focused on the role of acculturation, defined as the sociocultural and psychological adaptations from navigating multiple cultural environments.

METHODS

Using content analysis, we conducted a scoping review on acculturation-related experiences and suicide-related risk in Asian-American/Pacific Islander, Hispanic/Latinx, and Black youth (henceforth described as "ethnoracially minoritized adolescents"), identifying 27 empirical articles in 2005-2022.

RESULTS

Findings were mixed: 19 articles found a positive association between acculturation and higher risk for suicide ideation and attempts, namely when assessed as acculturative stress; 3 articles a negative association; and 5 articles no association. Most of the research, however, was cross-sectional, largely focused on Hispanic/Latinx youth, relied on demographic variables or acculturation-related constructs as proxies for acculturation, used single-item assessments for suicide risk, and employed non-random sampling strategies. Although few articles discussed the role of gender, none discussed the intersections of race, sexual orientation, or other social identities on acculturation.

CONCLUSION

Without a more developmental approach and systematic application of an intersectional research framework that accounts for racialized experiences, the mechanisms by which acculturation may influence the risk of suicidal thoughts and behavior remain unclear, resulting in a dearth of culturally responsive suicide-prevention strategies among migrant and ethnoracially minoritized youth.

Investigating Asian American Adolescents' Resiliency Factors and Young Adult Mental Health Outcomes at 14-year Follow-up: A Nationally Representative Prospective Cohort Study

There is scant research on how Asian American adolescents' resiliency relates to mental well-being in adulthood. The objective of this study was to determine the prospective associations between resiliency factors (individual, family, and school community) in adolescence and mental health outcomes in adulthood, among a national sample of Asian Americans. We analyzed data from 1020 Asian American adolescents who were followed for 14 years in the National Longitudinal Study of Adolescent to Adult Health. Of the resiliency factors, individual self-esteem (Adjusted Odds Ratio [AOR] 0.54, 95% Confidence Interval [CI] 0.37-0.79) and family connectedness (AOR 0.78, 95% CI 0.65-0.93) in adolescence were found to be protective against adult mental health outcomes in logistic regression models adjusting for sociodemographic factors and baseline mental health. Our study identified individual and family resiliency factors which can be leveraged to help Asian American adolescents and families in cultivating better mental health.

The role of school connectedness in the prevention of youth depression and anxiety: a systematic review with youth consultation

Background

School connectedness reflects the quality of students’ engagement with peers, teachers, and learning in the school environment. It has attracted attention from both the health and education sectors as a potentially modifiable protective factor for common mental health problems. However, the extent to which school connectedness may prevent the onset of youth depression or anxiety or promote their remission is unclear. This systematic review examined evidence for prospective relationships between school connectedness and depression and anxiety, and the effect of interventions to improve school connectedness on depression and anxiety.

Methods

We searched MEDLINE, PsycINFO, PubMed, and ERIC electronic databases for peer-reviewed quantitative longitudinal, or intervention studies published from 2011–21 in English examining relationships between school connectedness and anxiety and/or depression. Participants were 14–24 years old when depression and anxiety outcomes were assessed in any education setting in any country. We partnered with five youth advisers (aged 16–21 years) with lived experience of mental health problems and/or the schooling system in Australia, Indonesia, and the Philippines to ensure that youth perspectives informed the review.

Results

Our search identified 3552 unique records from which 34 longitudinal and 2 intervention studies were ultimately included. Studies were primarily from the United States of America (69.4%). Depression and anxiety outcomes were first measured at 14 years old, on average. Most studies found a significant protective relationship between higher levels of school connectedness and depressive and/or anxiety symptoms; more measured depression than anxiety. A few studies found a non-significant relationship. Both intervention studies designed to increase school connectedness improved depression, one through improvements in self-esteem and one through improvements in relationships at school.

Conclusions

These findings suggest that school connectedness may be a novel target for the prevention of depression and anxiety. We were not able to determine whether improving school connectedness promotes remission in young people already experiencing depression and anxiety. More studies examining anxiety, diagnostic outcomes, and beyond North America are warranted, as well as intervention trials.

Trial registration

PROSPERO 2021 CRD42021270967.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14364-6.

Race Differences in Opioid Misuse and Adolescent Suicidality

Purpose

The rise of the opioid epidemic coincided with the increased risk of suicide as the leading causes of death among adolescents in the United States. Past research has linked non-medical prescription opioid use (NMPOU) with adolescent suicide. Less focus has been placed on race and ethnic differences among adolescents impacted by the opioid epidemic. This study examined the relationship of adolescent NMPOU and suicidality, stratified by race.

Method

The 2016 National Survey on Drug Use and Health (NSDUH) was used for this study. Weighted multivariate logistic regression analyses were conducted on a sample of 11,489 adolescent respondents to examine the effect of past-year NMPOU with the odds for serious thoughts of suicide, having a suicide plan, and making a suicide attempt.

Results

Findings indicated a higher prevalence of suicidality among adolescents who engaged in NMPOU compared to non-users. Adolescent opioid misuse was associated with 68% higher odds for having a suicide plan in the past year (OR = 1.68, 95% CI: [1.07, 2.63], p < 0.05). Interaction analysis found that among Asian adolescents, NMPOU was associated with higher odds for having a suicide plan compared to other race groups (OR=1.53, 95% CI: [1.04, 2.23], p < 0.05).

Discussion

Results indicated that adolescent opioid misuse is a risk factor for suicide, and Asians compared to other race groups were at greater risk. Social workers can serve as a nexus point in effectively engaging at-risk adolescents in substance use and mental health prevention and recovery services.

School Risk and Protective Factors of Suicide: A Cultural Model of Suicide Risk and Protective Factors in Schools

There are known cultural variations in correlates of and symptoms related to suicide-related thoughts and behaviors; however, the majority of research that informs suicide prevention in school systems has focused on research based on Euro-American/White students. By exploring school-related risk and protective factors in ethnic-racial minoritized students, we expand existing multicultural models of suicide prevention for school settings. Specifically, this systematic literature review identified 33 studies conducted with American Indian and Alaskan Native, Hispanic and Latinx, Black and African American, and Asian American and Pacific Islander students. Findings underscore the importance of building relationships with the school community and fostering a sense of safety for students, the need to approach school-based suicide prevention and intervention with cultural considerations, and the importance of connecting students and families with providers in culturally sensitive and informed ways. Taken together, schools need to build school-family-community partnerships that promote culturally sensitive approaches to suicide prevention.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Acculturation, social support and suicidal ideation among Asian immigrants in the United States

This study examined suicidal ideation among Asian immigrant adults in the United States, with consideration of the roles of acculturation and social support. Using the 2002-2003 National Latino and Asian American Study (NLAAS), I conducted latent class analysis with measures of U.S. cultural orientation and Asian ethnic affiliation to create a multidimensional construct of acculturation. Three acculturation groups were identified (assimilated, integrated, separated) that showed different associations with suicidal ideation. Then I analyzed how the association between acculturation status and suicidal ideation is moderated by social support, distinguishing between perceived versus received support. Findings revealed that the buffering role of social support is gender-specific, with perceived support from friends reducing the risk of suicidal ideation only among assimilated women. Implications for future research include further application of acculturation as a multidimensional construct to various health outcomes and behavior as well as to other immigrant subgroups. Public health intervention efforts aimed at preventing suicide should endeavor to promote perceptions of an available social support system among immigrants and aid in establishing sources of support outside the family particularly for immigrant women.

Cross-race and cross-ethnic friendships and psychological well-being trajectories among Asian American adolescents: Variations by school context

Asian American adolescents' cross-race friendships are poorly understood, partially due to the model minority stereotype. Using data from 915 Asian American adolescents from the National Longitudinal Study for Adolescent to Adult Health, the present study examined the influence of cross-race friendships (based on peer nomination data) on Asian American adolescents' psychological well-being trajectories, as well as the moderating role of school context (numeric marginalization, school prejudice). Results showed that cross-race friendships promoted Asian American adolescents' psychological well-being, particularly in early adolescence and in schools where adolescents lacked critical mass of same-race peers or where prejudice was widespread. Similar findings were observed for cross-race friendships with the majority group, and more evident effects emerged for cross-ethnic friendships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Learning from suicide deaths in Harris County, Texas

This study examined individual and community demographic characteristics surrounding suicides in one of the most populous counties in the United States. We paired medical examiner records with U.S. Census data and analyzed them using geospatial software. The majority of decedents were non-Hispanic, white males who died primarily of gunshot wounds. Salient age characteristics included interpersonal violence and depression among ages younger than 40. Despite lower incomes and education levels, areas with higher population density and racial/ethnic minorities had fewer suicides. Additional research should address depression among males and the elderly, interpersonal violence, firearm access, and culture.

Suicidal Behavior in Adolescents: A Latent Class Analysis

The main goal of the present study was to identify and validate latent classes of suicidal behavior in a representative sample of adolescents. The sample comprised a total of 1506 students, including 667 males (44.3%), selected through a sample stratified by clusters. The mean age was 16.15 years (SD = 1.36). The instruments used evaluated suicidal behavior, positive and negative affect, emotional and behavioral problems, prosocial behavior, and subjective well-being. Using the Paykel Suicide Scale, the latent class analysis identified four homogeneous subgroups: “low risk”, “suicidal act”, “suicidal ideation”, and “high risk for suicide”. These subgroups presented a differential pattern in terms of their social-emotional adjustment. The subgroups with the highest theoretical risk showed lower scores on subjective well-being and positive affect as well as higher scores on emotional and behavioral problems and negative affect compared to the non-risk subgroups. This study contributes to an understanding of the typologies of suicidal behavior among adolescents and the relationship with psychopathological adjustment. Ultimately, these findings may promote the development or improvement of early detection and prevention strategies in the suicidal behavior field in order to reduce the socio-economic burdens associated with suicide in young populations.

Immigration and Language Factors Related to Depressive Symptoms and Suicidal Ideation in Asian American Adolescents and Young Adults

This study examined the effects of immigration and language factors on depressive symptoms and suicidal ideation among Asian American adolescents and young adults during three developmental periods. Using the National Longitudinal Study of Adolescent to Adult Health, linear regression and linear probability models were used for the data analyses. A significant group difference was observed in suicidal ideation between Asian American youth who were born in the U.S. and whose families spoke English at home and all other Asian American youth. Differences between ethnic groups were found in the mean scores of depressive symptoms and the probabilities of suicidal ideation between Asian American youth and non-Hispanic white (NHW) youth. The findings of this study reveal mental health disparities between Asian American youth and NHW youth in the U.S. These results emphasize the importance of implementing culturally sensitive mental health interventions for Asian American adolescents and young adults.

Feasibility, preliminary efficacy, and safety of a randomized clinical trial for Asian Women's Action for Resilience and Empowerment (AWARE) intervention

To our knowledge, Asian Women's Action for Resilience and Empowerment (AWARE) is the first gender- and culture-specific and trauma-informed group psychotherapy intervention designed for Asian-American young women with histories of interpersonal violence and trauma and/or Post-Traumatic Stress Disorder (PTSD) diagnosis. We employed a 2-arm randomized controlled trial. Sixty-three women who met clinical criteria for trauma were randomized to the intervention (n = 32) or waitlist control (n = 31) group. We documented retention rates, preliminary efficacy for sexual risk behaviors and depressive symptoms (overall and stratified by PTSD at baseline), and safety in terms of suicidality at baseline, postintervention, and 3-month follow-up. AWARE demonstrated high retention rates, in that 87.50% of those enrolled in the program completed at least 6 out of the 8 sessions. Although there were no differences overall for sexual risk behaviors or depressive symptoms, among women with PTSD, significant reductions in depressive symptoms were observed in treatment compared to control, with an effect size of .84. Suicidal ideation and intent were reduced in both the treatment and control groups, with no attempts during the trial. AWARE is uniquely tailored to serve a pressing clinical need. These results support its feasibility and safety. A large-scale trial targeted at women with PTSD is recommended to further explore the efficacy of AWARE. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suicide risk around the world: a meta-analysis of longitudinal studies

PURPOSE

Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred.

METHODS

We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma.

RESULTS

Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors.

CONCLUSIONS

Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.

Suicide Risk across Latent Class Subgroups: A Test of the Generalizability of the Interpersonal Psychological Theory of Suicide

It remains unclear whether the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, ) is generalizable to the population or holds more explanatory power for certain subgroups compared to others. The aim of this study was to (1) identify subgroups of individuals who endorsed suicide ideation in the past month based on a range of mental health and demographic variables, (2) compare levels of the IPTS constructs within these subgroups, and (3) test the IPTS predictions for suicide ideation and suicide attempt for each group. Latent class, negative binomial, linear, and logistic regression analyses were conducted on population-based data obtained from 1,321 adults recruited from Facebook. Among participants reporting suicide ideation, four distinct patterns of risk factors emerged based on age and severity of mental health symptoms. Groups with highly elevated mental health symptoms reported the highest levels of thwarted belongingness and perceived burdensomeness. Tests of the IPTS interactions provided partial support for the theory, primarily in young adults with elevated mental health symptoms. Lack of support found for the IPTS predictions across the subgroups and full sample in this study raise some questions around the broad applicability of the theory.

The Relationship Between Intimate Partner Violence and Suicidal Ideation among Young Chinese, Korean, and Vietnamese American Women

High depression and suicide rates are critical problems that have a significant impact on the lives of young Asian American women. Intimate partner violence (IPV) has been identified as a predictor of suicidality in general female samples, but no research study has examined the relationship between IPV and suicidality in a sample of 1.5 and second-generation Chinese, Korean, and Vietnamese American women. We used data collected from 173 women (aged 18-35 years) who were screened for eligibility to participate in the development and efficacy study of Asian American Women's Action for Resilience and Empowerment (AWARE). We measured the prevalence of (a) IPV, (b) lifetime suicidal ideation/intent, and (c) childhood abuse and tested the association between IPV and lifetime suicidal ideation/intent among study participants who completed the clinical screening assessments. The results indicated that seven out of 10 women in our sample experienced lifetime suicidal ideation/intent, psychological aggression was the most commonly reported form of IPV during the last six months, followed by sexual coercion, and history of physical and/or sexual partner violence had the most robust association with lifetime suicidal ideation/intent after controlling for demographic factors and childhood abuse. Our study suggests that suicide prevention and intervention programs for young 1.5 and second-generation Asian American women should not only address experiences of childhood abuse, but also incorporate culturally adapted behavioral health approaches to identify and target physical and sexual partner violence. Furthermore, any such programs need to integrate a systemic approach in addressing IPV within the context of various marginalized experiences of Asian American women.

Explicating Acculturation Strategies among Asian American Youth: Subtypes and Correlates across Filipino and Korean Americans

Acculturation strategy, a varying combination of heritage and mainstream cultural orientations and one of the significant determinants of youth development, has been understudied with Asian American youth and particularly at a subgroup-specific level. This study used person-oriented latent profile analysis (LPA) to identify acculturation strategy subtypes among Filipino American and Korean American adolescents living in the Midwest. Associations between the subtypes and numerous correlates including demographics, family process and youth outcomes were also examined. Using large scale survey data (N = 1580; 379 Filipino American youth and 377 parents, and 410 Korean American youth and 414 parents; M_AGE of youth = 15.01), the study found three acculturation subtypes for Filipino American youth: High Assimilation with Ethnic Identity, Integrated Bicultural with Strongest Ethnic Identity, and Modest Bicultural with Strong Ethnic Identity; and three acculturation subtypes for Korean American youth: Separation, Integrated Bicultural, and Modest Bicultural with Strong Ethnic Identity. Both Filipino American and Korean American youth exhibited immersion in the host culture while retaining a strong heritage identity. Although bicultural strategies appear most favorable, the results varied by gender and ethnicity, e.g., integrated bicultural Filipino Americans, comprised of more girls, might do well at school but were at risk of poor mental health. Korean American separation, comprised of more boys, demonstrated a small but significant risk in family process and substance use behaviors that merits in-depth examination. The findings deepen the understanding of heterogeneous acculturation strategies among Asian American youth and provide implications for future research.

Parent-Adolescent Acculturation Gap and Suicidal Ideation among Adolescents from an Emergency Department

The objective of this article is to examine the impact of parent-adolescent acculturation gap on vulnerability to suicidal ideation among adolescents presenting to an emergency department with suicidal behavior. A multiethnic sample of adolescents (n = 43) and their parents (n = 43) completed an acculturation measure, and adolescents reported on emotion reactivity, hopelessness, depressive symptoms, and suicidal ideation. The direction of the association between suicidal ideation and vulnerability variables varied depending on the size of the acculturation gap. Emotion reactivity was more negatively associated with suicidal ideation the larger the parent-adolescent acculturation gap, while hopelessness was more strongly associated with suicidal ideation the smaller the gap, adjusting for depressive symptoms. Assessments of racial/ethnic minority adolescents at risk for suicidal behavior should address parent-adolescent acculturation gaps.

Circumstances preceding the suicide of Asian Pacific Islander Americans and White Americans

This study examined the circumstances preceding suicide among Asian and Pacific Islander Americans (APIAs) and White American decedents using data from the National Violent Death Reporting System in the United States. After controlling for gender and age, APIAs had lower rates of recent disclosure of suicide ideation, recent mental health treatment, recent mental health problems, and intimate partner problems, but higher rates of school problems than White Americans. There were also significant Race × Age moderation effects for recent mental health, financial, and school problems and a significant Race × Gender moderation effect for intimate partner problems.

Risk Factors of Suicide and Depression among Asian American, Native Hawaiian, and Pacific Islander Youth: A Systematic Literature Review

Suicide has become an increasing public health challenge, with growing incidence among Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) youth. Using an ecological framework, the purpose of this systematic review was to explicate risk and protective factors for depression or suicide among AA and NHPI youth from available peer reviewed research. The ecological framework provides a useful blueprint for translating social determinants of health to explain the experience of depression and suicidal behaviors among AA and NHPI youth. Sixty-six studies were extracted from PsychInfo, Ovid Med-line, EMBASE, CINAHL, and Web of Science. Policy and practice recommendations are offered in light of relevant themes that emerged. Further research and data disaggregation is needed to develop and strengthen population health strategies, interventions, and policies that address the underlying social conditions and cultural contexts of mental health disparities associated with depression and suicide among AA and NHPI youth.

Impact of an equality constraint on the class-specific residual variances in regression mixtures: A Monte Carlo simulation study

Regression mixture models are a novel approach to modeling the heterogeneous effects of predictors on an outcome. In the model-building process, often residual variances are disregarded and simplifying assumptions are made without thorough examination of the consequences. In this simulation study, we investigated the impact of an equality constraint on the residual variances across latent classes. We examined the consequences of constraining the residual variances on class enumeration (finding the true number of latent classes) and on the parameter estimates, under a number of different simulation conditions meant to reflect the types of heterogeneity likely to exist in applied analyses. The results showed that bias in class enumeration increased as the difference in residual variances between the classes increased. Also, an inappropriate equality constraint on the residual variances greatly impacted on the estimated class sizes and showed the potential to greatly affect the parameter estimates in each class. These results suggest that it is important to make assumptions about residual variances with care and to carefully report what assumptions are made.

Modeling predictors of latent classes in regression mixture models

The purpose of the current study is to provide guidance on a process for including latent class predictors in regression mixture models. We first examine the performance of current practice for using the 1-step and 3-step approaches where the direct covariate effect on the outcome is omitted. None of the approaches show adequate estimates of model parameters. Given that the step-1 of the three-step approach shows adequate results in class enumeration, we suggest using an alternative approach: 1) decide the number of latent classes without predictors of latent classes and 2) bring the latent class predictors into the model with the inclusion of hypothesized direct covariates effects. Our simulations show that this approach leads to good estimates for all model parameters. The proposed approach is demonstrated by using empirical data to examine the differential effects of family resources on students' academic achievement outcome. Implications of the study are discussed.

Nonsuicidal self-injury in Asian versus Caucasian university students: who, how, and why?

The correlates of nonsuicidal self-injury (NSSI) among Asian and Caucasian university students; differences in the rates, frequency, forms, severity, and emotional contexts of NSSI among self-injuring students; and whether Asian students who are highly oriented toward Asian culture differed from those less oriented toward Asian culture in NSSI characteristics were investigated. University students (N = 931), including 360 Caucasian students (n = 95, 26.4%, with a history of ≥ 1 episode of NSSI) and 571 Asian students (n = 107, 18.7%, with a history of NSSI), completed questionnaires assessing NSSI, acculturation, and putative risk factors for NSSI. Caucasian students were more likely to report NSSI, particularly cutting behavior, self-injured with greater frequency and versatility, and reported greater increases in positively valenced, high arousal emotions following NSSI, compared to Asian students. Among Asian students, obsessive-compulsive symptoms, experiential avoidance, and anger suppression increased the likelihood of reporting a history of NSSI. Among Caucasian students, lack of emotional clarity and anger suppression increased likelihood of NSSI. Finally, some tentative findings suggested potentially important differences in rates and frequency of NSSI among Asian students who were highly oriented toward Asian culture compared with those less oriented toward Asian culture.

A mediation model of professional psychological help seeking for suicide ideation among Asian American and white American college students

This study examined professional psychological help seeking among 1,045 white American and Asian American students from 70 U.S. colleges and universities who had seriously considered attempting suicide. The authors found that Asian American college students had lower rates of professional psychological help seeking for their suicide ideation than White American college students. Guided by social network perspectives on professional psychological help seeking, the authors also tested mediators of this racial disparity. Relative to white Americans, Asian Americans were advised by fewer people (especially fewer family members) to seek professional help, which was, in turn, associated with lower rates of professional psychological help seeking for suicide ideation. These findings underscore the importance of gatekeeping as a suicide prevention strategy for Asian American college students.

Finite Mixtures for Simultaneously Modelling Differential Effects and Non-Normal Distributions

Regression mixture models have been increasingly applied in the social and behavioral sciences as a method for identifying differential effects of predictors on outcomes. While the typical specification of this approach is sensitive to violations of distributional assumptions, alternative methods for capturing the number of differential effects have been shown to be robust. Yet, there is still a need to better describe differential effects that exist when using regression mixture models. The current study tests a new approach that uses sets of classes (called differential effects sets) to simultaneously model differential effects and account for non-normal error distributions. Monte Carlo simulations are used to examine the performance of the approach. The number of classes needed to represent departures from normality is shown to be dependent on the degree of skew. The use of differential effects sets reduced bias in parameter estimates. Applied analyses demonstrated the implementation of the approach for describing differential effects of parental health problems on adolescent body mass index using differential effects sets approach. Findings support the usefulness of the approach which overcomes the limitations of previous approaches for handling non-normal errors.

The Racial-Cultural Framework

Suicide-related outcomes are a major public health challenge in communities of color in the United States. To address these challenges, this Major Contribution makes theoretical, empirical, and practice-related contributions to scholarship on suicide-related outcomes among people of color. In this article, the authors present a new framework to conceptualize previous suicidology scholarship, address existing literature gaps, and inform counseling psychologists’ future work on suicide-related outcomes in U.S. communities of color. The framework consists of three components and nine principles that highlight the types of constructs, populations, and preventive interventions that should be emphasized in theory, research, and practice addressing suicide-related outcomes in communities of color. The authors explain why suicide-related outcomes in communities of color deserve attention, describe the framework, and discuss implications of the framework for future practice and training. It is hoped that this framework can serve as a resource and impetus for new paradigms of suicidology work in communities of color.