Geographic and Spatial Determinants of Suicidal Behaviors among Asian Americans

Background and Purpose: While studies have demonstrated that completed suicides are strongly related to spatial and geographic characteristics, it is unclear if this holds true for non-fatal suicidal behaviors. Although research on the general population has shown strong linkages between spatial or geographic characteristics and completed suicides, prior studies have either omitted Asian Americans or have included very small sample sizes of Asian Americans. Given these limitations, it is unclear if the spatial and geographic correlates of suicidal behaviors among Asian Americans are similar to the general population or if there are significant differences. This study examines the spatial and geographic correlates of suicidal ideation, plan and attempt among a national sample of Asian Americans.

Methods: Analyses consisted of weighted bivariate and multivariate logistic regression using data from the Asian American sample (N=2095) of the National Latino and Asian American Study (NLAAS) conducted May 2002-November 2003. Due to the multistage cluster sampling design of the study, all analyses were conducted using SAS-callable SUDAAN. Suicidal behaviors are measured using a modified version of the World Mental Health CIDI. Geographic and spatial determinants are represented by four categorical variables: neighborhood safety, household density, rural and urban location, and ethnic density.

Results: Asian Americans living in suburban and rural areas were more likely than those living in urban areas to experience suicidal ideation (OR=1.5, CI=1.02, 2.20; OR=2.0, CI=1.18, 3.37) and suicide attempt (OR=1.83, CI=1.10, 3.04; OR=3.86, CI=1.33, 11.20). Asian Americans who lived alone were also more likely to have suicidal ideation (OR=2.77, CI=1.26, 6.10) and attempt suicide (OR=4.65, CI=1.20, 18.07) than those living in larger households. Those living in unsafe neighborhoods were less likely than those living in safe neighborhoods to have suicidal ideation and suicide attempt, although these differences were not statistically significant. There were also no statistically significant differences between Asian Americans living in areas highly populated by Asians and those who lived in areas marked by lower Asian density. Further analyses examining gender showed that Asian American women who lived alone and in suburban areas were also more likely to have suicidal thoughts and attempt suicide than women in urban areas and living in larger households.

Conclusion: This study yielded important findings with regard to how certain geographic or spatial characteristics can serve as possible protective factors against suicide for Asian Americans. Urban living appears to be a protective factor, which could be due to urban areas traditionally being centers for Asian American immigration and settlement. Rural living is also a risk factor for suicidal thoughts and suicide attempts. This could be due to low population density and lack of social integration or the fact these areas are correlated with Asian Americans who live alone. Asian American women who live alone and those who do not live in urban areas also appear to be at greater risk for suicidal thoughts and attempts compared to their male counterparts. This may be attributable in part to cultural beliefs that emphasize close emotional and spatial proximity to family members, particularly for women.