Drug use and suicidality among Asian American women who are children of immigrants

Suicidal behaviors associated with psychosocial stressors and substance use among a national sample of Asian American college students

Suicide is the second leading cause of death for Asian American (AA) young adults, yet few studies have focused on AA college students. This study examines the link between suicidal behaviors, psychological stressors, and substance use among AA men, women, and transgender and gender nonconforming (TGNC) college students. Data from the Healthy Minds Study (HMS) between September 2020 and May 2023 (n = 28,856) were analyzed to estimate the three-year weighted prevalences of suicidal behaviors among AA students. Adjusted multivariable logistic regression assessed the odds of suicidal behaviors in relation to psychosocial stressors and substance use. Social isolation significantly increased the odds of suicidal ideation and planning among AA women, while sexual assault significantly increased the odds of suicide attempts. For AA men, social isolation was the only significant predictor of suicidal ideation. Addressing social isolation and sexual violence is crucial for suicide prevention among AA women. Further mixed methods, culturally grounded research is needed to improve mental health interventions on campuses.

Prevalence of Suicide in Immigrants/Refugees: A Systematic Review and Meta-Analysis

OBJECTIVE

In recent years, there has been an increase in immigrant populations worldwide. This study aims to present the global prevalence of suicide between immigrants and refugees as well as to report the prevalence of suicide ideation, suicide mortality, suicide attempts, and plan of suicide.

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA's) rules were used as a guide in the current research path. PubMed and EMBASE were targeted for the study until December 2019. After collecting the data, the number of events and sample size extracted for each study and also pooled odds ratio and confidence interval (CI) were used to investigate the suicide ratio among immigrants and refugees compared to the native population.

RESULTS

Fifty-one studies were included in the meta-analysis to investigate suicide prevalence or suicide odds ratio. The prevalence of suicidal ideation was 16% (CI: 0.12-0.20, I2 = 99.4%), for attempted suicide was 6% (CI: 0.05-0.08, I2 = 98.0%), and for suicide plan prevalence was 4% (CI: 0.00-0.08, I2 = 96.8%). The prevalence of suicidal ideation was 10% (CI: 0.04-0.17, I2 = 0.0%) in men and 17% (CI: 0.10-0.24, I2 = 96.8%) in women. The prevalence of attempted suicide was 1% (CI: 0.01-0.02, I2 = 0.0%) in men and 7% (CI: 0.03-0.10, I2 = 94.4%) in women. The odds ratio of suicide mortality among immigrants was 0.91 (CI: 0.90-0.93, p < 0.001; I2 = 97.6%) and for attempted suicide was 1.15 (CI: 1.10-1.20, p < 0.001; I2 = 92.0%). Begg's test (p = 0.933) (Egger test; p = 0.936) rejected publication bias.

CONCLUSION

Given the high prevalence of suicide, especially suicide ideation and suicide attempts in immigrants, increased attention needs to be paid to the mental health of this population.

Socioeconomic and environmental contexts of suicidal rates in a latitudinal gradient: Understanding interactions to inform public health interventions

Suicide results from complex interactions between biological, psychological, and socioeconomic factors. At the population level, the study of suicide rates and their environmental and social determinants allows us to disentangle some of these complexities and provides support for policy design and preventive actions. In this study we aim to evaluate the associations between environmental and socioeconomic factors and demographically stratified suicide rates on large temporal and spatial scales. Our dataset contains information about yearly suicides rates by sex and age from 2000 through 2017 along a 4000 km latitudinal gradient. We used zero-inflated negative binomial models to evaluate the spatio-temporal influence of each environmental and socioeconomic variable on suicide rates at each sex/age combination. Overall, we found differential patterns of associations between suicide rates and explanatory variables by age and sex. Suicide rates in men increases in middle and high latitude regions and intermediate age classes. For adolescent and adult women, we found a similar pattern with an increase in suicide rates at middle and high latitudes. Sex differences measured by the male/female suicide ratio shows a marked increase with age. We found that cloudiness has a positive effect on suicide rates in both men and women 24 years old or younger. Regional poverty shows a major impact on men in age classes above 35 years old, an effect that was absent in women. Alcohol and marijuana consumption showed no significant effect sizes. Our findings support high spatio-temporal variability in suicide rates in interaction with extrinsic factors. Several strong differential impacts of environmental and socioeconomic variables on suicide rates depending on sex and age were detected. These results suggest that the design of public policies and interventions to reduce suicide prevalence need to consider the local social and environmental contexts of target populations.

Guest editors' introduction to the special section: Cultural adaptation of mental health interventions for Americans of East Asian descent

Overall, this special section makes a timely and significant contribution to providing various types of culturally specific interventions as well as the evidence of clinical trials. Although the sample size of each study is rather small, each intervention illustrates innovative methods in both reaching and treating underserved and understudied populations. Moreover, these interventions provide critical groundwork for building an evidence base of interventions tailored specifically to Asian Americans (AAs). These articles demonstrate the significance of development and testing of culturally adapted or culturally grounded interventions for intervention science that effectively treat and engage culturally diverse and hard-to-reach populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom

OBJECTIVE

The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.

METHODS

This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.

RESULTS

Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).

CONCLUSION

There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.

Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BACKGROUND

To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame.

METHODS

From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame.

RESULTS

Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001).

CONCLUSIONS

Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Asian Women's Action for Resilience and Empowerment Intervention: Stage I Pilot Study

This study describes the development and pilot test of Asian Women's Action for Resilience and Empowerment (AWARE), a culturally informed group psychotherapy intervention designed to reduce depressive symptoms, suicidality, substance use, and HIV and sexual risk behaviors among 1.5 and second generation Asian American (AA) women. To participate, AA women had to meet the criteria for posttraumatic stress disorder (PTSD) or have a history of exposure to interpersonal violence (IPV) as determined using the Clinician-Administered PTSD Scale (CAPS) and Traumatic Life Events Questionnaire (TLEQ). This article also presents the preliminary feasibility and acceptability of AWARE from its Stage I pilot study of nine Chinese, Korean, and Vietnamese American women. To foster holistic treatment, AWARE was developed based on original research findings from Stage 0 and integrated theoretical models including fractured identity theory, empowerment theory, cognitive behavioral therapy (CBT), mindfulness-based techniques, and the AIDS Risk Reduction Model (ARRM). The development of AWARE was an iterative process informed by participant feedback, which led to frequent intervention modifications for a future randomized controlled trial (RCT) in Stage II. A qualitative analysis of participant feedback informed the following modifications: further exploration of feelings, improvements in technology delivery, learning and practicing coping skills, more specific cultural tailoring related to sexual health, decreased number of sessions and increased time per session. Findings provide support for the acceptability and feasibility of AWARE as "culturally informed" for AA young women with IPV histories, high-risk behaviors, and mental health issues.

The Associations Between Forced Sex and Severe Mental Health, Substance Use, and HIV Risk Behaviors Among Asian American Women

We examined the association between forced sex history and mental health, sexual health, and substance use among Asian American women ( n = 720); 14.3% of our sample ( n = 103) reported forced sex experiences. Multiple logistic regression analyses revealed that participants with forced sex histories were 2-8 times more likely to have higher rates of mental health problems, HIV risk behavior, and substance use. Qualitative analysis was used to supplement the quantitative results and give depth to our findings. Our results suggest that interventions for Asian American women who experienced forced sex should integrate mental health, substance use, and sexual health treatments.

Intersection of suicidality and substance abuse among young Asian-American women: implications for developing interventions in young adulthood

PURPOSE

The purpose of this paper is to provide a review of the current literature uncovering specific factors associated with self-harm and suicidality among young Asian American women, as well as to present the Fractured Identity Model as a framework for understanding these factors. This paper offers concrete suggestions for the development of culturally competent interventions to target suicidality, substance abuse, and mental illness among young Asian American women.

DESIGN/METHODOLOGY/APPROACH

Empirical studies and theory-based papers featured in peer-reviewed journals between 1990 and 2014 were identified through scholarly databases, such as PubMed, MEDLINE, PsycINFO, JSTOR, and Google Scholar.

FINDINGS

We identified several factors associated with suicidality among young Asian American women: (1) family dynamics, or having lived in a household where parents practice "disempowering parenting styles," (2) substance use/abuse, and (3) untreated mental illness(es), which are exacerbated by the stigma and shame attached to seeking out mental health services. The Fractured Identity Model by Hahm et al. (2014) is presented as a possible pathway from disempowering parenting to suicidal and self-harm behaviors among this population, with substance abuse playing a significant mediating role. Research limitations/implications - Our review focused on Asian American women, substance use among Asian Americans, and mental health among Asian Americans. Literature that focused on Asians living in Asia or elsewhere outside of the USA was excluded from this review; the review was limited to research conducted in the USA and written in the English language.

PRACTICAL IMPLICATIONS

The complex interplay among Asian American culture, family dynamics, gender roles/expectations, and mental health justifies the development of a suicide and substance abuse intervention that is tailored to the culture- and gender-specific needs of Asian Pacific Islander young women. It is imperative for professionals in the fields of public health, mental health, medicine, and substance abuse to proactively combat the "model minority" myth and to design and implement interventions targeting family dynamics, coping with immigration/acculturative stresses, mental illnesses, suicidal behaviors, and substance abuse among Asian-American populations across the developmental lifespan.

ORIGINALITY/VALUE

This paper provides specific suggestions for interventions to adequately respond to the mental health needs of young Asian-American women. These include addressing the cultural stigma and shame of seeking help, underlying family origin issues, and excessive alcohol and drug use as unsafe coping, as well as incorporating empowerment-based and mind-body components to foster an intervention targeting suicidality among Asian-American women in early adulthood.

Fractured Identity: A Framework for Understanding Young Asian American Women's Self-harm and Suicidal Behaviors

Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of "disempowering parenting styles" that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents' expectations as well as societal expectations and to simultaneously rebel against the image of "the perfect Asian woman." Torn by the double bind, these women developed a "fractured identity," which led to the use of "unsafe coping" strategies. Trapped in a "web of pain," the young women suffered alone and engaged in self-harm and suicidal behaviors.