Recursive partitioning analysis of lifetime suicidal behaviors in Asian Americans.

Abstract

Previous studies have shown that multiple factors predict suicidal behavior in Asian Americans but have provided little guidance on how to rate the relative impact of these risks. To increase our understanding of suicide in Asian Americans, recursive partitioning analysis was used to identify risk factors most relevant to predicting suicidal behaviors and enhance the decision-making process of clinicians faced with clients presenting with multiple risk factors. Using a classification and regression tree (CART) and random forest analyses, we examined the role of previously identified correlates of suicidal ideation and suicide attempts in 2,095 Asian Americans from the National Latino and Asian American Study (Alegria et al., 2008). Random forest analysis showed that depressive and anxiety disorder were the best predictors of lifetime suicidal ideation, followed by family conflict and family cohesion. The model correctly classified lifetime suicidal ideation with moderate sensitivity (72%) and specificity (76%). CART analysis found that family conflict predicted suicide attempts in more than half of the individuals with suicidal ideation. Of those who reported low family conflict, 73% attempted suicide if they had low family support. Perceived discrimination was the next best predictor of suicide attempts (63%) when family issues were not a problem. Cross-validation of this model had moderate sensitivity (75%) but low specificity (39%). These findings highlight the importance of considering family relationship when assessing suicide risk in Asian Americans.

Nonsuicidal Self‐injury in Asian Versus Caucasian University Students: Who, How, and Why?

“…Our results also highlighted specific aspects of psychopathology that were uniquely associated with a history of NSSI in Asian students, including obsessive–compulsive symptoms, experiential avoidance, and poor relationships with peers and parents. This is consistent with previous studies suggesting that interpersonal problems differentiate Chinese adolescents with a history of NSSI from those with no such history (You et al., ), and with research suggesting that interpersonal stressors are related to self‐damaging behavior more broadly in Asian populations (Kuroki & Tilley, ; Wong & Maffini, ; Wong et al., ). Further, previous research has highlighted an association between anxiety symptoms and NSSI in minority students (Chesin et al., ).…”

“…Further, collective cultural values may increase the relevance of interpersonal context for NSSI in Asian populations. Consistent with this possibility, previous research shows that poor family relationships are an important precipitant of suicidal behavior in Asians (Kuroki & Tilley, ; Wong & Maffini, ; Wong, Uhm, & Li, ). Together, this suggests that Asian students who engage in NSSI, particularly those who are highly oriented to traditional Asian cultural values, may differ from their Caucasian counterparts with respect to the prevalence and frequency of NSSI, and with respect to their likelihood of seeking mental health services.…”

Ethnic Variations in Suicidal Ideation and Behaviors: A Prominent Subtype Marked by Nonpsychiatric Factors Among Asian Americans

“…Given Chinese cultural values of patriarchy and familial solidarity, suicide may be viewed as an acceptable or even honorable option for Chinese individuals who believe they have shamed or burdened their family (Qin & Mortensen, ). Numerous other research studies have also shown that suicidal ideation and attempts are associated with dysfunctional family dynamics, parent–child conflict, or lack of family cohesion among various Asian American youth, adolescent, and adult samples (e.g., Cheng et al., ; Kim & Kim, ; Kuroki & Tilly, ; Lau, Jernewall, Zane, & Myers, ).…”

The prediction model of suicidal thoughts in Korean adults using Decision Tree Analysis: A nationwide cross-sectional study

“…When it is deficient, people may experience suicidal thoughts. Especially, family cohesion and family conflict have been identified as important predictors of suicide [5,11]. In addition, the single household family might induce suicidal ideation because they may lack social connectedness [12].…”