Suicide Risk Assessment With Asian American College Students

Abstract

Scholars have based their understanding of college-student suicide in the United States largely on the study of European Americans, and therefore, its relevance to making culturally informed decisions with suicidal Asian American college students is unclear. This article explores aspects of suicide assessment potentially unique to Asian American college students and discusses possible ways to handle the process of breaking confidentiality that are more sensitive to Asian American needs. First, the authors briefly review issues of confidentiality, informed consent, and standards of care. Second, they examine several aspects of Asian American college students' experiences in the United States and of Asian cultural values. Specifically, the authors review acculturation and the experience of immigration, intergenerational relationships, collectivistic cultural values, the myth of the “model minority,” and perfectionism. Third, they offer culturally informed considerations for assessing suicidal risk and ways to manage breaking confidentiality. Finally, they suggest the Collaborative Assess-ment and Management of Suicidality model and the Suicide Intervention Response Inventory−2 as potentially useful tools for culturally sensitive work with Asian American college students.

Support, Depressive Symptoms, and the Stigma towards Seeking Mental Health Help

“…Given that the collectivist culture of Asians may engender greater concern about the negative implications of relying on others (Choi, et al, 2009), it is not surprising that relative to Euro-Caucasians, Asian students in the present study perceived greater stigma from others for seeking both mental health as well as academic help. Furthermore, consistent with past research (Kim et al, 2006), it was observed that Asian students perceived lower levels of support availability from their friends and parents compared to Euro-Caucasians.…”

“…This is in keeping with the notion of the 'model minority' among Asians, extolling cultural virtues in educational practice (e.g., strong work ethic, respect for education, high expectations) and high levels of achievement (Dandy & Nettelbeck, 2002;Sue & Okazaki, 2009). In this regard, the model minority expectation can lead to a tendency to perfectionist attitudes, further compromising the well-being of individuals within this cultural group by reducing their overall likelihood of help-seeking (Choi et al, 2009). These findings suggest that the mental health interventions on campus may be more successful in diminishing the relation between depressive symptoms and stigma among mainstream students compared to more specific populations.…”

“…Given the collectivist attitudes among Asians and the emphasis placed on maintaining group harmony and avoiding shame (Choi et al, 2009;Kim, et al, 2006;Ting & Hwang, 2009), as well as the stigma towards mental illness (Mak & Chen, 2006), it is possible that those students with unsupportive parents were more likely to internalize a sense of failure and self-stigma when help was needed. Indeed, Asians tend to experience high levels of parental pressure and when parental expectations are not met are subject to considerable criticism, self-doubt, and anxiety (Choi et al, 2009), leading to feelings of alienation from their parents (Qin, Way, & Mukherjee, 2008). Thus, although parents might feel that they are offering their children the necessary support to success, this support might be perceived as inadequate and not matching what is actually needed, exacerbating the self-stigma these students experience when they turn for help.…”

“…Indeed, despite having intense support networks, the support gleaned from the network is unlikely, or at the very least, less likely to diminish self-and especially perceived other-stigma regarding help-seeking. Consistent with this perspective, there is evidence that Asians and Asian Americans are more reluctant to seek help from close others due to fear of the negative implications this might have on their relationships, including personal shame, fear of bringing shame onto one's family (Choi, Rogers, & Werth, 2009), and disturbing the group harmony (Kim, et al, 2006). These individuals were more likely to minimize emotions, express them in subtle ways (Kim, Atkinson, & Umemoto, 2001), and seek and endorse the support of close others only for general concerns, and not for more personal stressful events (Kim, et al, 2008;Hsu & Alden, 2008).…”

Exploring the Validity of the College Student Reasons for Living Inventory Among Asian American College Students

“…They are among the highest in reporting incidences of suicide ideation (Kisch, Leino, & Silverman, 2005), and Asian American females of college age have one of highest suicide rates (CDC, 2005). However, despite this acknowledgement of the risk for suicide among Asian American students, there has been a dearth of studies examining this issue with Asian American college students, particularly in regard to protective factors for suicide (Choi, Rogers, & Werth, 2009). …”