Methods: AWARE is a culturally informed psychotherapy intervention designed to improve Asian American women’s mental and sexual health. The study sample consisted of 173 Asian American women who completed demographic and clinical screening for AWARE. The Columbia-Suicide Severity Rating Scale (C-SSRS) were used to examine levels, frequency, motivation, and lethality of suicidal ideation and behavior. Descriptive statistics were used to calculate the proportion of suicidal ideation and intent. Content analysis of open-ended survey questions were used to assess suicide risk factors, motivations, and plans. Finally, a lethality scale was developed to determine the level of severity in suicide plans.
Results: Among 173 participants who volunteered to participate in AWARE, 110 (68.8%) reported having at least one episode of suicidal ideation in their lifetime, and 32 (18.5%) reported an intent to die by suicide. Content analysis identified six risk factors for suicidal ideation. Three of the risk factors were determined to be common risk factors in the literature for suicidal ideation: health and mental health issues, social isolation, and an inability to cope. The other three factors were identified by the participants as related to Asian American culture: pressures to achieve and perform, restrictive and controlling parents, and unhealthy romantic relationships. Of those participants who endorsed suicide plans, almost half (43.7%) reported plans of moderate to extremely high lethality.
Conclusions and Implications: Participants demonstrated substantial proportions of suicidal ideation and intent and discussed risk factors related to Asian American culture. Findings have important clinical implications for identifying at-risk Asian American women and illustrate the need for culturally tailored mental health services. Asian American women are under extremely high pressure to achieve perfection in their lives. When participants struggled to meet parental expectations, internalized parental pressure can lead to negative perceptions, such as feelings of inadequacy, low self-esteem, and contemplation of dying by suicide. Intervention efforts must focus on decreasing internalized needs for perfectionism, promoting family and community support, and establishing healthy romantic relationships.