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

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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.