Disaggregating Asian Americans and Pacific Islanders to identify mechanisms of adolescent suicide risk: The role of school stressors, alcohol, sleep, and school/community contexts

摘要 青少年自杀是一个值得立即关注的关键问题，因为它是导致死亡的主要原因 在15-19岁的AAPI青少年中。作为美国最多元化的种族/少数族裔群体之一，AAPI是 往往被忽视，因为作为一个整体，他们似乎比其他种族/族裔群体的比率更低。 当分类时，一些AAPI群体的自杀率明显高于非西班牙裔白人。 继续聚集AAPI只会使青少年自杀的隐藏问题永久化，并掩盖AAPI 不同民族的历史、定居经历、社会经济地位和健康行为 可能会导致更高的自杀风险。认识AAPIs的异质性及其社会文化多样性 背景，这项研究旨在检查个人和背景水平的风险和可能影响的保护因素 并帮助解释了8个AAPI群体中青少年自杀风险的差异：亚洲印度人、中国人、菲律宾人、 日本人、韩国人、太平洋岛民、东南亚人(即苗族人、柬埔寨人、老挝人)和越南人。 在这方面，我们听从了NIMH和NIMHD的呼吁，通过研究确定精神健康差距的驱动因素 多层次镜头，将个人与社会文化环境和宏观层面的影响联系起来。应用社交网络 生态模型，在少数群体和压力过程理论的启发下，本研究调查了显著的学校-- 学业成绩和种族欺凌的相关压力源。我们将研究酒精使用的作用， 吸食大麻和睡眠不足--后两者的流行率上升--可能是对 这些压力源在AAPI亚组和性别之间的流行率也不同。利用调查数据 从美国最大的学校系统和最大的AAPI学生人数来看，这项研究将需要 青少年调查的数据分析与学校管理人员对教师/教职员工的看法调查有关 学校气候、学校学生组成和学习成绩的学校管理数据以及社区 AAPI人口和社会经济状况的数据。对于每个按性别划分的AAPI亚组，这项研究将 解决三个目标：(1)检查与学校有关的压力源(即，成绩不佳、欺凌)之间的关系 和自杀风险，并评估这些关系如何因学校和社区环境而变化(即，学校氛围， 共同种族密度，劣势)，(2)评估酒精使用程度，大麻使用和个人睡眠 修改和调节这些与自杀风险的关联，以及(3)通过估计 人群水平上自杀风险的降低与应激源和危险行为的改变有关，并且 增加了与增强的保护环境相关的减少。这项研究将解决关于 与种族相关的压力源和自杀风险行为，以及这些机制在八个国家中的差异 AAPI群体和性别。研究结果将成为一项将这些应激源和风险联系起来的混合方法R01提案的依据 具有心理病理因素的行为，以便更丰富地了解风险和弹性 学校和社区内的机制，以最好地指导对AAPI青少年的自杀干预。

Abstract Adolescent suicide is a critical issue that warrants immediate attention since it is the leading cause of death among AAPI adolescents ages 15-19. As one of the most diverse U.S. racial/ethnic minority groups, AAPIs are often overlooked because as an aggregate, they appear to have lower rates than other racial/ethnic groups. When disaggregated, some AAPI groups show significantly higher suicide rates than non-Hispanic whites. Continuing to aggregate AAPIs will only perpetuate the hidden problems of adolescent suicide and mask AAPI's different ethnic group histories, settlement experiences, socioeconomic positions, and health behaviors, which may contribute to higher suicide risk. Recognizing the heterogeneity in AAPIs and their diverse sociocultural contexts, this study aims to examine individual- and contextual-level risk and protective factors that may influence and help explain variations in adolescent suicide risk in eight AAPI groups: Asian Indians, Chinese, Filipinos, Japanese, Koreans, Pacific Islanders, Southeast Asians (i.e., Hmong, Cambodians, Laotians), and Vietnamese. In this, we heed the NIMH and NIMHD's call for research to identify drivers of mental health disparities using a multilevel lens that links individuals to sociocultural environments and macrolevel influences. Applying the Social Ecological Model and informed by minority and stress process theories, our study investigates salient school- related stressors of academic performance and race-relevant bullying. We will examine the roles of alcohol use, marijuana use and insufficient sleep – the latter two rising in prevalence – as potentially modifiable responses to these stressors, that also vary in prevalence across AAPI subgroups and gender. Capitalizing on survey data from the largest U.S. school system and with the largest AAPI student population, this study will entail secondary data analysis of adolescent surveys linked with school administrator surveys of teacher/staff perceptions of school climate, school administrative data of student composition and academic performance, and community data of AAPI demographic and socioeconomic conditions. For each AAPI subgroup-by-gender, this study will address three aims: (1) examine the relationships between school-related stressors (i.e., poor grades, bullying) and suicide risk, and assess how these relationships vary by school and community contexts (i.e., school climate, co-ethnic density, disadvantage), (2) assess the extent to which alcohol use, marijuana use and sleep individually modify and mediate these associations with suicide risk, and (3) illuminate intervention levers by estimating the reduction in suicide risk at the population level associated with changes in stressors and risk behaviors, and the added reduction associated with enhanced protective contexts. This research will address novel questions about race-relevant stressors and risk behaviors on suicide risk, and how these mechanisms vary across the eight AAPI groups and gender. Findings will inform a mixed-methods R01 proposal to link these stressors and risk behaviors with psychopathological factors in order to gain a richer understanding of risk and resiliency mechanisms within schools and communities to best guide suicide interventions for AAPI adolescents.