TRIGGER WARNING: Please bear in mind that this podcast explores themes across the subjects of self-harm and suicide.
On this Papers Podcast, Dr. Miles Reyes and Dr. Apurva Bhatt focus on their co-authored CAMH journal Particular Challenge paper ‘Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Psychological Well being and Suicide (1999–2021)’ (https://doi.org/10.1111/camh.12708).
There may be an summary of the paper, methodology, key findings, and implications for observe.
This paper was included within the 2024 CAMH journal Particular Challenge on ‘Fairness, Range, and Inclusion in Youngster and Adolescent Psychological Well being’, printed in Could 2024.
Dialogue factors embody:
TRIGGER WARNING: Please bear in mind that this podcast explores themes across the subjects of self-harm and suicide.
- The rationale behind utilizing the time period ‘Breaking the Silence’ within the title of the paper.
- The charges of demise by suicide in Asian American and Pacific Islander youth and gender variations within the charges.
- The gender variations within the charges of self-reporting despair signs, suicidal ideation, and suicide makes an attempt in Asian American and Pacific Islander youth.
- Why this group have been excluded from earlier research and literature.
- Important sub-groups variations inside the findings and the variations in comparison with different demographic teams.
- (TRIGGER WARNING) The findings regarding the strategies of suicide and the way this differs throughout demographic teams.
On this sequence, we communicate to authors of papers printed in one in every of ACAMH’s three journals. These are The Journal of Youngster Psychology and Psychiatry (JCPP); The Youngster and Adolescent Psychological Well being (CAMH) journal; and JCPP Advances.
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Dr. Miles Reyes, M.D. is a resident doctor and first technology, Filipina-Amerian immigrant. She acquired her Bachelor of Science in Psychobiology from the College of California, Los Angeles. She acquired her Doctorate of Drugs from the College of California, Riverside Faculty of Drugs with a chosen emphasis in healthcare management in 2024. She is a psychiatry resident doctor on the Charles R. Drew psychiatry residency coaching program in Los Angeles County, with plans to pursue a toddler and adolescent psychiatry fellowship. Her skilled pursuits embody cultural and social determinants influencing psychiatric diagnoses and outcomes, media and social media affect on youth psychological well being and self-identity, and medical training and coaching reform.
Dr. Apurva Bhatt
Apurva Bhatt, M.D., is a toddler, adolescent and grownup psychiatrist and Scientific Assistant Professor at Stanford College Faculty of Drugs. Her position spans the Basic Grownup Psychiatry Division, Youngster Psychiatry Division, and Middle for Youth Psychological Well being and Wellbeing Division.
Dr. Bhatt makes a speciality of early psychosis analysis and remedy. She at present offers medical care in each the Lucille Packard Youngsters’s Hospital Youngster INSPIRE early psychosis clinic and the Stanford Well being Care INSPIRE clinic. She contributes to early psychosis program improvement in California (by means of EPI-CAL) and nationally (by means of PEPPNET/Westat). She can be co-chair of the American Academy of Youngster and Adolescent Psychiatry Adolescent Psychiatry Committee and Early Psychosis work group.
Dr. Bhatt offers college medical consultations for the Redwood Metropolis Faculty District by means of the Stanford Redwood Metropolis Sequoia Faculty Psychological Well being Collaborative. She additionally offers medical consultations to varsities within the Los Altos Faculty district, and supervises baby and adolescent psychiatry fellows offering session to Los Altos, Redwood Metropolis, and Mountain View faculties.
Dr. Bhatt’s analysis pursuits embody early psychosis measurement devices in pediatric populations, Asian American and South Asian youth psychological well being, and prevention of youth suicide by firearm. She enjoys instructing and mentoring college students and trainees, and at present is a mentor by means of the American Academy of Youngster and Adolescent Psychiatry and the American Psychiatric Affiliation’s FLIPP program.
Transcript
[00:00:01.560] Mark Tebbs: Whats up, and welcome to the Papers Podcast sequence for the Affiliation for Youngster and Adolescent Psychological Well being, or ACAMH for brief. I’m Mark Tebbs. I’ve a background in psychology, psychological well being commissioning, teaching and freelance consulting. On this sequence, we communicate to the authors of papers printed in one in every of ACAMH’s three journals. They’re the Journal of Youngster Psychology and Psychiatry, generally referred to as JCPP, the Journal of Youngster and Adolescent Psychological Well being, referred to as CAMH, and JCPP Advances. For those who’re one of many followers of our Podcast sequence, please subscribe in your most popular streaming platform, tell us how we did, with a score or assessment, and do share with buddies and colleagues.
At present, I’m delighted to be speaking to Dr. Miles Reyes and Dr. Apurva Bhatt, who’re the Lead Authors of a paper entitled, “Breaking the Silence: An Epidemiological Research on Asian American and Pacific Islander Youth Psychological Well being and Suicide (1999–2021),” which was lately printed within the CAMH Journal. This paper varieties a part of the 2024 CAMH Journal Particular Challenge on “Fairness, Range and Inclusion in Youngster and Adolescent Psychological Well being.”
Earlier than we begin, I simply need to make it possible for listeners are conscious that this episode will probably be masking the subjects of suicide and self-harm, so some listeners could discover the dialogue distressing, so we do encourage you to practise self-care. Miles, Apurva, thanks for becoming a member of me.
[00:01:29.969] Dr. Miles Reyes: Thanks a lot for having us.
[00:01:32.011] Mark Tebbs: Actually pretty to be chatting with you each. Let’s begin with some introductions, Miles, possibly you would go first. For those who might inform us about your self, somewhat bit about your profession up to now and your analysis pursuits.
[00:01:42.545] Dr. Miles Reyes: Positive. Hello, everybody, my title is Miles Reyes. I’m a first-generation Filipina-American, and I’m additionally a Doctor-in-Coaching right here within the US. I’ve my Bachelor’s in Science Psychobiology from UCLA. I’m additionally a number of days away from graduating with my Doctorate of Drugs from the College of California, Riverside. I’m additionally an incoming Resident Doctor on the Charles R. Drew, LA County Basic Psychiatry Residency Coaching Programme, and with excessive hopes to enter Youngster Adolescent Psychiatry Fellowship sooner or later. A few of my analysis pursuits are cultural and social determinants influencing psychiatric diagnoses and end result, in addition to media and social media’s affect on youth psychological well being and self-identity formation. I’ll transition it now to my mentor, Dr. Apurva Bhatt.
[00:02:27.514] Dr. Apurva Bhatt: Hello, everybody, my title is Dr. Apurva Bhatt, and I’m a Youngster and Adolescent and Grownup Psychiatrist, and Scientific Assistant Professor at Stanford College Faculty of Drugs. I’m actually excited to be right here and share our work. Just a bit bit about me. I concentrate on early psychosis analysis and remedy, and I work in each the Youngster Early Psychosis Clinic and Grownup Early Psychosis Clinic right here at Stanford, referred to as the INSPIRE Clinics. I additionally do college medical consultations for a number of of our native college districts, the place I present medical consultations in serving to college students.
A few of my analysis pursuits embody early psychosis measurement devices, particularly taking a look at paediatric populations. I’m additionally fascinated about taking a look at Asian American/South Asian youth psychological well being, particularly suicide fee and suicide prevention. I’ve additionally printed and actually labored laborious on an advocacy degree on prevention of youth suicide by firearm and taking a look at statewide firearm insurance policies, and I’m additionally a mentor. Miles is one in every of my superb ACAT mentees. I actually get pleasure from mentoring college students and trainees, and I’m actually excited to be right here.
[00:03:29.211] Mark Tebbs: Proper, thanks for the introductions. So, let’s flip to the paper. It will be actually useful when you might simply give us a quick overview.
[00:03:36.402] Dr. Miles Reyes: Yeah, so our paper touches on a really ignored Asian American and Pacific Islander inhabitants. It’s a cross-sectional examine, focusing particularly on the Asian American and Pacific Islander youth inhabitants in america. We checked out publicly accessible information by means of the CDC WONDER and YRBSS, right here in america, and we regarded on the years 1999 by means of 2021. We trended and analysed the info and located a rise within the suicide fee of this inhabitants, in addition to a number of different findings particular to this group and subgroups inside the inhabitants.
Simply in case anybody listening isn’t conscious what CDC stands for, is the “Facilities of Illness Management and Prevention.” It’s a US Authorities organisation, and is the nation’s main science-based, information pushed service organisation that protects public well being. And YRBSS stands for “Youth Threat Conduct Surveillance System,” right here in america. You’ll find the CDC web site at CDC dot G-O-V, which is .gov.
[00:04:38.906] Mark Tebbs: Good, that’s a fantastic overview. So, let’s get into somewhat bit extra element. So, I’m , the title of the paper, or the start a part of the – is “Breaking the Silence.” Might you inform us why you select that title and whether or not it offers us somewhat little bit of an perception in why you wished to check this specific space?
[00:04:56.183] Dr. Miles Reyes: Sure, so, it was simply so vital for us to finish the shortage of printed literature on this topic and break the silences, if you’ll, as a Asian American girls doctor workforce. We wished to focus particularly on this inhabitants, the Asian American and Pacific Islander inhabitants as a result of there’s simply a lot literature surrounding suicide and youth suicide, however a lot of it doesn’t embody, or purposely excludes, this inhabitants. And that’s notably regarding, on condition that suicide was the main reason behind demise for the Asian American/Pacific Islander youth inhabitants in 2021.
[00:05:30.000] Mark Tebbs: Yeah, it was fairly surprising that that inhabitants was actively excluded from any research. So, are you able to inform us the way you went in regards to the examine? Have been there any specific challenges or analysis limitations that you’d be capable of share with us?
[00:05:42.795] Dr. Miles Reyes: So, as I discussed, it’s a cross-sectional examine and it utilises publicly accessible information. So, anybody can entry this information in america. It’s by means of the CDC WONDER database and the Youth Behavioral Threat Evaluation Surveillance System, which is a self-reported survey kind of knowledge that’s distributed to highschool college students right here within the US. The info’s already deidentified and we have been capable of simply obtain it and analyse it thereafter.
The obstacles that we’re working with have been all actually particular to the info we got. So, for instance, the YRBSS information is barely reported each different 12 months, and it’s by means of survey information. So, you’re topic to a variety of, you realize, self-bias-y, self-reported information there, as effectively, and also you’re additionally solely given data each different 12 months. So, for instance, there was a big world pandemic that occurred in 2020, however we weren’t capable of get the info from 2020. Nevertheless, we have been capable of get the info from 2021.
And one other impediment that we confronted was that Asia, or Asian youth, is such a giant, overarching umbrella time period, nonetheless, we’re not capable of analyse the only races which can be discovered underneath Asia till 2018. So, the CDC solely began reporting single-race information in 2018 and thereafter. So, we solely had three years of these counts to report and once more, whether or not you’re Indian, Japanese, Vietnamese, Filipino or Hawaiian, you’re lumped collectively as “Asian” up till 2018. So, these are some issues to take into accounts.
[00:07:13.858] Mark Tebbs: Thanks for that. The info confirmed actually alarming will increase in Asian American and Pacific Islander youth suicide charges over the interval of examine. Might you simply describe these key findings from the examine?
[00:07:26.241] Dr. Miles Reyes: Sure, so, we had a number of key findings from the examine. We have been in a position to have a look at charges, in addition to gender variations and strategies of suicide, in addition to self-reported emotions of misery, suicidal ideation, and issues like that. So, for instance, one in every of our predominant findings was the charges of demise by suicide in Asian American and Pacific Islander youth have doubled within the final decade, with charges reported from 2017 to 2021 as the very best reported fee since information assortment started in 1999. The charges of suicide is larger in Asian American and Pacific Islander male youth versus feminine youth, however each noticed their highest fee and peak fee in 2021, each post-pandemic.
The YRBSS information confirmed {that a} larger p.c of Asian American and Pacific Islander females self-report signs of despair, corresponding to feeling unhappy or hopeless, in addition to suicidal ideation and suicide makes an attempt. But, we simply mentioned earlier that the charges of suicide is larger in males, versus females. These are some attention-grabbing findings that we had.
[00:08:35.268] Mark Tebbs: With these charges of suicide, I’m simply questioning why this group have been excluded from earlier research. Is there something within the earlier literature that gave a rationale for why that exclusion occurred?
[00:08:48.853] Dr. Miles Reyes: So, among the earlier literature that we checked out really confirmed that they have been solely going to be taking a look at numerous different racial minority teams right here in america, so, for instance, Black versus white suicide charges inside the youth inhabitants, or Latinx versus white, or American Indian. However particularly, there weren’t that many research taking a look at Asian youth, simply because they mentioned that the counts have been suppressed or too low.
[00:09:15.490] Dr. Apurva Bhatt: The opposite factor so as to add to that’s, after we have a look at these prior reviews, I ponder – you realize, I don’t assume we’ll ever actually know why the CDC or different large epidemiological reporting teams particularly exclude Asian American youth. However one factor to consider is there may be ample literature displaying that the mannequin minority fable actually perpetuates a variety of exclusionary behaviour, particularly in analysis, the place there may be this, type of, inappropriate assumption that Asian People don’t have psychological well being points.
That they don’t wrestle with suicide. That possibly the inhabitants is so small that we shouldn’t even fear about them. And that’s actually problematic, as our report exhibits that that is really an enormous concern on this neighborhood and one thing that needs to be checked out. And what the mannequin minority fable, what that alludes to is that this inhabitants is excessive reaching, their wellbeing is ok, there is no such thing as a drawback right here, and let’s give attention to different teams, fairly than really together with this group.
And the opposite factor to consider is as a result of, traditionally, this was a minority inhabitants when it comes to sheer inhabitants numbers, nonetheless, in the previous couple of years, Asian American youth are the quickest rising minority inhabitants within the USA. And so, that’s one other factor to consider as future Researchers embark on taking a look at seeing how we will enhance analysis research on this inhabitants and tailor interventions.
[00:10:36.238] Mark Tebbs: Good, thanks. You’ve already talked about and, type of, said the – among the difficulties when it comes to amassing the info, and clearly, Asian American and Pacific Island shouldn’t be a homogenous group. So, have been there any vital subgroup variations inside your findings?
[00:10:54.062] Dr. Miles Reyes: Trying on the subgroups, to preface, we’re trying particularly at counts, not charges, largely as a result of the subgroup information assortment solely started in 2018, so the CDC WONDER doesn’t do a inhabitants fee till the info is way bigger. So, simply taking a look at counts particularly, however there have been 1,269 deaths from 2018 to 2021, and the very best variety of suicide deaths have been seen within the “Different Asian, Chinese language, Asian Indian,” and “Filipino” youth subgroups in america.
[00:11:27.480] Mark Tebbs: And what have been the variations in Asian American and Pacific Islander suicide charges in comparison with different demographic teams?
[00:11:35.597] Dr. Miles Reyes: We don’t have the precise charges in entrance of us, however in 2021, suicide was the main reason behind demise of Asian American, native Hawaiian and Pacific Islander youth, age group ten to 19-years-old. Which differs from different racial teams, the place suicide is the second main reason behind demise present in Asian Indian or white populations, or the third main reason behind demise present in Black populations. And this may all be discovered on the CDC web site and positioned within the 12 months 2021.
[00:12:03.480] Mark Tebbs: Yeah, I’d simply, type of, prefer to remind listeners somewhat bit about that, type of, warning in the beginning of the podcast, and the tough, type of, nature of the subject. Your paper additionally talks in regards to the methodology of suicide. So, what did the examine discover in relation to strategies of suicide for younger folks from Asian American and Pacific Island background?
[00:12:24.786] Dr. Miles Reyes: Yeah, so our paper noticed that suffocation and demise by asphyxiation was the main methodology of suicide for Asian American and Pacific Islander youth, age 5 by means of 24 years of age, with firearms, really, as quantity two. And suffocation is definitely primary methodology for each men and women, and that is really fairly distinctive to this inhabitants, as different teams have firearms as their main methodology of suicide. And it’s really fairly distinctive as a result of we counsel fairly closely on firearms and firearm prevention and security in paediatric care visits right here in america. However with suffocation and demise by asphyxiation being the main methodology of suicide for Asian American and Pacific Islander youth, it results in the query, how can we make prevention and preventative care visits extra particularly tailor-made to varied cultural teams?
[00:13:15.887] Mark Tebbs: And there have been some gender variations, as effectively, notably within the charges of suicide and reported ranges of despair. Might you simply clarify that somewhat bit for us?
[00:13:24.378] Dr. Miles Reyes: There have been larger charges of suicide present in AAPI males as in comparison with AAPI females. Nevertheless, based on the YRBSS outcome survey despatched out to highschool college students, a better p.c of AAPI females are self-reporting signs of despair and emotions of disappointment or hopelessness, suicidal ideation and suicide makes an attempt. And that is fairly attention-grabbing, as a result of extra AAPI females are self-disclosing these signs and makes an attempt, regardless of there really being extra recorded deaths in AAPI males. And this may be as a result of numerous issues, however there may be constant prior reviews of Asian males reporting extra cultural and psychological well being stigma that forestall them from in search of care. So, that may be one of many elements that we think about.
[00:14:09.777] Mark Tebbs: Thanks for actually going into various element in regards to the outcomes. I feel that’s actually, actually useful. What would you prefer to occur on account of the findings?
[00:14:19.360] Dr. Apurva Bhatt: So, before everything, that is an understudied inhabitants. Like talked about earlier than, many epidemiological reviews on youth suicide particularly exclude AAPI populations, and this may occasionally additionally perpetuate myths, such because the mannequin minority fable that I discussed earlier than, or that AAPI people don’t have psychological well being struggles. So, I’d prefer to see extra change and for extra analysis to give attention to this inhabitants, and for Researchers to be extra inclusive of their demographic populations. We’d additionally prefer to see enhancements within the range of the psychological well being workforce, with elevated give attention to how our psychological well being system can present culturally knowledgeable and delicate care.
I’d additionally prefer to see extra give attention to stigma discount in communities, particularly for AAPI communities, not only for youth, but additionally focused interventions for fogeys, particularly immigrant mother and father who’ve moved from totally different nations. In order that if their baby is struggling, they’ll establish the indicators early and search assist with out having to face the extra barrier of stigma. That is notably vital on condition that many youngsters of immigrants could also be dealing with assimilation and acculturative stress, and that will result in psychological well being signs, that if there are layers of stigma could forestall that baby from receiving psychological well being care. Though that baby could recognise that they might profit from care, you realize, the stigma could forestall the dad or mum from really in search of care till a lot later within the time course of sickness.
[00:15:44.348] Mark Tebbs: You talked about about desirous to see extra analysis, I’m simply questioning whether or not you’re planning any follow-up analysis or if there’s something within the pipeline that you simply’d prefer to share with us?
[00:15:53.184] Dr. Apurva Bhatt: So, since publishing this examine, you realize, Miles and I’ve been fascinated by a variety of various things. I do know, no less than in my work right here in California, I’ve actually shifted my give attention to lowering stigma in my neighborhood, right here within the Bay. I work in Chi – Stanford’s Youngster Early Psychosis Clinic, as I discussed, and my clinic serves a a lot larger proportion of AAPI youth residing with psychosis and their households. And I’ve been capable of see their psychological well being journey and among the limitations that they face in in search of care, particularly the extent of stigma, that basically prevents some households from in search of care early. I actually really feel obsessed with making it higher for these younger folks, and particularly youth residing with psychosis signs.
And in seeing their psychological well being journey, I’ve actually gotten a really shut glimpse of the extent of intense stigma that these households face earlier than they’re capable of search care, and even whereas they’re in search of care. I really feel actually obsessed with making it higher for these younger folks, in order that they’ll search care sooner and so, that stigma doesn’t pose as an enormous barrier. You realize, within the USA the typical length of untreated psychosis is eighteen months, and I’m seeing that quantity be even longer for some South Asian and AAPI people that my clinic serves. And so, we’ve actually acquired to do higher as a nation when it comes to lowering stigma and providing culturally knowledgeable care, and that begins with area people work.
[00:17:16.409] Dr. Miles Reyes: Sorry, I wished so as to add on. So, I’m really at present engaged on a mission taking a look at psychological well being service in search of behaviour in dependancy, within the Filipino Inland Empire inhabitants, taking a look at utilising focus teams. And we really – you realize, Apurva did such a deep-dive into stigma, however every cultural subgroup additionally has their very own limitations into delaying care till it’s acutely vital. So, I’m hoping to do a dive into {that a} bit extra with my future tasks, as effectively.
[00:17:44.148] Mark Tebbs: Thanks. We’re coming to the tip of the podcast. I’m simply questioning whether or not you’ve acquired a last take-home message.
[00:17:52.196] Dr. Miles Reyes: Sure, so, a lot of psychological well being and psychiatric care entails cultural and social elements, and I’m so grateful to everybody taking the time to hear and improve their consciousness on how we will higher display for these at-risk younger folks. It’s additionally, on the time that we’re recording this, it’s AAPI Heritage Month right here within the USA, so we will take this information, and I hope that we will utilise it to advocate for elevated visibility for youth of all backgrounds.
[00:18:16.782] Dr. Apurva Bhatt: I’d additionally like so as to add, you realize, I do know that this can be a difficult subject to speak about, and in case you are a doctor battling psychological well being, know that there’s assist obtainable by means of a free service that’s utterly nameless and confidential referred to as the Doctor Help Line, and that telephone quantity is 888 409 0141. For all different listeners, you should use 988 within the USA to entry help.
[00:18:41.668] Mark Tebbs: Thanks a lot in your work and for the podcast at the moment. It’s been a extremely attention-grabbing dialogue on a extremely vital topic, so, thanks a lot. For extra particulars relating to Dr. Miles Reyes and Dr. Apurva Bhatt, please go to the ACAMH web site, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t neglect to comply with us in your most popular streaming platform, tell us when you benefit from the podcast, with a score or assessment, and do share with buddies and colleagues.
