Gaps in Primary Care Suicide Screening for Asian American Adults in Honolulu Hawaii
Authors: Chum William 
Published: January 2024

Introduction/background: Asian Americans have experienced worsened mental health outcomes and increased rates of suicidality since the COVID-19 pandemic. Suicide screening in primary care settings need to be re-evaluated to properly screen mental health needs while accounting for barriers related to cultural norms and stigma.

Who is it for? Asians are a fast growing racial group in the United States, and a majority racial group in the state of Hawaii. Increased cultural awareness and understanding of how suicidality presents in this group would benefit primary care providers (PCPs) to improve screening and treatment. Cultural norms, stigma, attitudes towards mental health and suicidality contribute to barriers to reporting needs to providers, and increased understanding of these barriers will support providers in regions around the world where there is an increasing Asian population assimilating with the majority cultural group.

Who did you involve? A focus group was created to ensure the study reflects the perspectives of the Asian American community. Three individuals were recruited on the criteria of identifying as Asian, report of past or present suicidality, and having ever experienced barriers to discussing suicidality with their PCPs. The group’s responses support the design of the study in gathering personal experiences with navigating care, personal and cultural stigma of mental health and suicide, and ideas on how suicide screening could be improved to meet their needs considering their culture and values.

What did you do? This study aims to identify the barriers that Asian Americans in Hawaii face in discussing or reporting suicidality with their PCPs through qualitative interviews with Asian individuals to assess for past or present suicidality. Those who report past or present suicidality will be interviewed further to determine whether they were able to discuss the topic with their PCP and what they feel could have improved their experience of the screening process or encouraged them to share more. Taking a person-centered approach, individual experiences are collected through a qualitative format with results to be presented as testimonials to help the audience better understand the thoughts, expectations, and needs of this community when presenting with suicidality in primary care.

What results did you get? It is expected that a percentage of the people interviewed will report some suicidality consistent with the national average for Asian Americans in the United States. Based on the literature review, it is expected that there will be barriers to the comfort level of reporting or discussing suicidality with PCPs and identified barriers related to limitations in language access, stereotypes or cultural stigma, settings of care delivery, and concerns with discrimination. Interviews are in process and results are expected in summer 2023.

What is the learning for the international audience? Providers in communities where the Asian population is not the majority cultural group need to consider the unique barriers that Asian patients experience in reporting suicidality to provide effective and culturally-sensitive treatment. Identifying these gaps will provide insight for primary care practices to adapt the suicide screening process in a supportive way for Asian patients.