The relationship between violence and youth suicide indicators among Asian American and Pacific Islander youth

Abstract

The literature documents a relationship between interpersonal violence and suicide. One tool used to understand interpersonal violence is the Power Wheel, developed from clinical experience and originally used in domestic violence education. We examine the relationship between Teen Power and Control Wheel domains and suicidal indicators (seriously considered suicide, made a suicide plan, and attempted suicide) among Asian American and Pacific Islander high school students, in terms of both victimization and perpetration. Data from a 2007 survey of two multi-ethnic high schools on the island of O'ahu, Hawai'i were used. The survey assessed interpersonal youth violence and a multitude of risk and protective factors. It found that females were significantly more likely to seriously consider suicide and attempt suicide, compared to males. There were no statistically significant differences in seriously considering suicide, making a suicide plan, and attempting suicide by ethnic group, employment status, or hours worked per week. Using the Wheel, we found that all dimensions for victimization and perpetration were associated with the three suicidal indicators. However, the magnitude of this association was dramatically higher for victims than for perpetrators. School- and healthcare-based prevention strategies should ensure that both suicide and violence intervention components are addressed. Professionals who work with youth should be trained to feel comfortable, confident, and competent in discussing suicide and violence, and be willing and capable to assess and intervene.

Introduction

Suicide and interpersonal violence are leading health problems for youth in the United States. Although a strong relationship between them has been shown, most studies treat these outcomes separately. This study examines the impact of interpersonal violence among youth on suicide behaviors, specifically for Asian American and Pacific Islander (AAPI) populations.

Over the past six decades, suicide has become the fastest growing cause of death of American youth, with rates nearly tripling between the 1950s and the mid-1990s (U.S. Public Health Service, 1999). After nearly a decade of declining rates, there was an 8% increase in youth suicides from 2003 to 2004, with elevated rates continuing into 2004 and 2005, indicating the increased rate was not a one-year anomaly (Centers for Disease Control and Prevention [CDC], 2007). In 2005, the overall age-adjusted suicide rate was 10.85 per 100,000 persons, while the rate for youth aged 15–19 years was lower, at 7.66 per 100,000 (CDC, 2008a). Suicide is the third leading cause of death for youth aged 15–19. Else, Andrade and Nahulu (2007) conducted a literature review on AAPI populations, finding that disaggregated suicide data were very limited. Where data are disaggregated, Asian groups have been found to have substantially lower rates of completed suicide than Whites (U.S. Department of Health and Human Services [DHHS], 1999), whereas rates of completed suicide among Pacific Island populations were some of the highest in the world (Booth, 1999). Furthermore, suicide among Native Hawaiians is clearly a phenomenon of adolescents and young adults (Else et al., 2007). Mortality reflects only a small portion of suicidal behavior, particularly among youth. For every suicide death, 32 adolescents are treated for self-inflicted injuries (Ikeda, Mahendra, Saltzman, Crosby, Willis, Mercy et al., 2002) and one in six U.S. high school students report seriously considering suicide in the past year (Grunbaum, Kann, Kinchen, Ross, Hawkins, Lowry et al., 2004). Although the percentage of youth in Hawai'i who contemplated suicide has decreased significantly since 1993 (27.8% in 1993 versus 18.5% in 2007), it remains consistently higher than the U.S. average (14.5%; CDC, 2008b). The percentage of youth in Hawai'i who attempted suicide also remains higher than the U.S. average (12.0% versus 6.9%). Native Hawaiian youth have higher rates of suicide behaviors than non-Hawaiian youth. Using Youth Risk Behavior Survey (YRBS) data for Hawai'i by ethnic group, Nishimura et al. (2005) found that Native Hawaiian youth had higher rates of considering (27.2%), planning (21.4%), and attempting suicide (13.2%) than Other Asian/Pacific Islanders (23.1%, 18.2%, and 10.1%) and Caucasians (24%, 16.5%, and 8.7%). Additionally, a community epidemiologic survey of youth in Hawai'i found that Native Hawaiian youth have higher rates of attempted suicide than their non-Hawaiian peers (12.9% versus 9.6%; Yuen, Nahulu, Hishinuma, & Miyamoto, 2000).

In the 15–19 age group, homicide surpasses suicide as a leading cause of death, ranking second (CDC, 2008a). This pattern is also found among AAPI adolescents. For every youth homicide in the U.S., there are 127 violence-related injuries resulting in emergency room visits, and countless others go untreated. Interpersonal youth violence can take many forms, including fighting, pushing, name-calling, ignoring, and gossiping (Van der Wall, De Wit & Hirasing, 2003). For example, one in three high school students report being in a physical fight in the past year (Grunbaum, Kann, Kinchen, Williams, Ross, Lowry, et al., 2002). In fact, more than one in two (54.8%) Hawai'i youth reported that bullying by other students was a problem at their school (Saka, 2008). Among young adolescents, roughly three of four youth experienced bullying by their peers (Bosworth et al., 1999, Nansel et al., 2001), victimization resulting in poor school outcomes (Juvonen, Nishina, & Graham, 2000), and dating violence becoming an increasing concern (CDC, 2006). These rates have been shown to vary significantly among AAPI adolescents. Mayeda et al. (2006) reported that Samoan adolescents engaged in violence-related behaviors at rates that exceeded all other groups. Hishinuma et al. (2005) found that Pacific Islander and Caucasian youth had the highest victimization rates, whereas Asian American youth had the lowest rates. Given that interpersonal violence and suicide occur at high rates among youth, adolescence is clearly a period of elevated risk behavior.

Several adolescent studies have shown that suicide attempts are related to interpersonal violence, irrespective of gender and ethnic subsamples (Borowsky et al., 2001, Orpinas et al., 1995, Sosin et al., 1995). Both violence victimization and violence perpetration are robust risk factors for attempting suicide (Borowsky et al., 2001). These studies have focused on a specific form of violence and have not investigated the breadth of interpersonal youth violence in relation to suicide behaviors.

The purpose of this study is to examine the relationship between interpersonal violence and suicide indicators among AAPI youth, using the teen version of the Power and Control Wheel. The Wheel is a conceptual aid to understanding the impact of multiple violence domains used by perpetrators to attain control over their victims. In our model, we explore the relationships between these violence domains and suicide behaviors in adolescents.