Younger Cohort Appears Most Affected
Click to Enlarge: Suicide rates for Veterans overall were obtained from the 2001-2019 National Data Appendix. AANHPI = Asian American, Native Hawaiian, and Pacific Islander. Source: American Journal of Preventive Medicine
AURORA, CO — Growing suicide rates among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) veterans are of increasing concern, according to a new study. Researchers pointed out that knowledge about the trend is limited, even though both young males and young females in the cohort appear to be at higher risk of taking their own lives compared to other veterans in their age group.
“Lethal means safety strategies for AANHPI veterans should consider distinctions in suicide methods compared to the overall veteran population,” wrote researchers from the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, the University of Colorado and colleagues. “Research is warranted to understand the lower magnitude sex difference in suicide rates among AANHPI veterans.”
An article in the American Journal of Preventive Medicine reported the results of a study looking at age- and sex-specific suicide rates, methods, and trends among AANHPI veterans and comparing those with rates for all veterans.1
For the population-based retrospective cohort study, the researchers calculated average annual suicide rates (2005-2019) in 2023 using population (United States Veterans Eligibility Trends and Statistics) and mortality (National Death Index [NDI]) data. The cohort included 416,454 AANHPI veterans—356,146 males, 60,229 females—separated from military service and alive as of Jan. 1, 2005.
The study team determined suicide from NDI underlying cause-of-death ICD-10 codes, finding that the age-adjusted average annual suicide rate among AANHPI veterans increased 36.85% from 2005-2009 to 2015-2019 (2015-2019: 30.97/100,000). “Relative to other ages, 2015-2019 suicide rates were highest among AANHPI veterans 18-34 (overall: 53.52/100,000; males: 58.82/100,000; females: 32.24/100,000) and exceeded those of similarly-aged veterans in the overall veteran population (overall: 44.71/100,000; males: 50.59/100,000; females: 19.24/100,000),” the researchers pointed out.
Click to Enlarge:Source: American Journal of Preventive Medicine
In addition, they found that the sex difference in suicide rates was lower among AANHPI veterans than in veterans overall (relative risk [males to females]=1.65 and 2.33, among those 18-54). Furthermore, the study advised that firearms were used less and suffocation was more common among AANHPI veterans compared to veterans overall.
167.3% Increase From 2001-2020
Background information in the article stated that 2.4% of the Asian American (AA) and 6.8% of the U.S. Native Hawaiian/Pacific Islander (NHPI) adult populations were veterans. “AANHPI veterans comprised 2.0% of the U.S. veteran population in Fiscal Year (FY) 2020 and this is expected to increase over time,” the authors wrote. “Concerningly, the suicide rate among AANHPI veterans increased 167.3% from 2001-2020, from 11.3 to 30.2 per 100,000 person-years. This magnitude of increase was not observed for any other racial or ethnic group of veterans, in which increases ranged from 11.2%-55.4%.”
The article noted that the 2022 National Veteran Suicide Prevention Annual Report and its associated Data Appendix reported crude suicide rates among AANHPI veterans from 2001-2020, and rates by age and sex for veterans in general, adding “however, age-adjusted, age-specific, and sex-specific rates were not reported for AANHPI veterans. Age adjustment is vital for making unbiased within- and between-group population comparisons, as the age distribution of such groups may differ and/or change over time. Additionally, sex- and age-specific rates are important to assess, as sex and age differences in suicide rates are commonly observed within the veteran population.”
“Further, insight into these differences can inform prevention approaches (e.g., targeting messaging, awareness of need for and approaches to gender-sensitive strategies).”
Also concerning, the researchers said, is that, while information is available regarding use of different suicide methods among veterans who died by suicide, the data has not been disaggregated by race or ethnicity. “Thus, the extent to which those findings apply to AANHPI veterans is unknown. As the beliefs, expectations, and meanings associated with different suicide methods vary across cultures, distinctions in suicide methods among AANHPI veterans, relative to veterans overall, are plausible and would maximize lethal means safety relevance and effectiveness for AANHPI veterans,” they wrote.
The bottom-line issue, according to the report, is that the AANHPI veteran population is expected to grow over the next decade but rarely has been a focus of suicide research.
“Age-adjusted suicide rates among AANHPI veterans increased from 2005-2009 to 2010-2014 and remained high in 2015-2019,” the authors emphasized. “For context, in both the overall veteran and non-veteran adult populations, age- and sex-adjusted suicide rates increased from 2001-2018, then declined from 2019-2020. However, among AANHPI females and males within the U.S., the age-adjusted suicide rate did not significantly increase from 1999-2014 or 1999-2017, despite increasing in all other racial/ethnic groups among females and some or all racial/ethnic groups among males. Yet the suicide rate among AANHPI individuals increased from 2014-2019 and between 2018-2019, despite decreasing between 2018-2019 among white and American Indian/Alaska Native individuals.”
The study noted that, from 2018-2021, the age-adjusted suicide rate among AA and NHPI populations did not significantly change except among AA individuals ages 45-64, with a decrease of 15.9%. “This suggests that AANHPI veterans have experienced different epidemiological trends in suicide rates over time compared to the overall veteran and AANHPI populations; research is warranted to better understand reasons for this,” the researchers wrote.
They added, “Notably, the most recent age-adjusted rate (30.97/100,000 in 2015-2019) among AANHPI veterans far exceeded 2021 rates among Asian (6.8/100,000) and Pacific Islander (12.6/100,000) individuals within the U.S. This suggests that, within the AANHPI population, those who are veterans are at particularly elevated risk and warrant targeted intervention.”
The study added that suicide rates among older age groups of AANHPI veterans (35-54, 55-74, ≥75) were lower than comparable age groups in the overall veteran population. Some specific age groups showed notable increases (89.52% among those 55-74 from 2005-2009 to 2010-2014; 61.02% among those 75+ between 2010-2014 to 2015-2019, however.
Fewer Sex Differences
Male veterans are much more likely to commit suicide, but the magnitude of sex differences was lower for AANHPI veterans. In explaining why that might be the case, the authors wrote, “This appears to be due to a combination of factors, including particularly high rates of suicide among female AANHPI veterans, relative to the overall female veteran population. Importantly, the age-adjusted suicide rate among AANHPI veterans 18-54 increased more among females than males. Thus, effective gender-sensitive suicide prevention programming for AANHPI veterans is critical, as is elucidating sex and gender differences in experiences that exacerbate and mitigate suicide risk among AANHPI veterans.”
The issue of means also requires explanation, the study authors said, adding that “firearms accounted for the largest percentage of suicide deaths among AANHPI veterans—used in nearly half (49.69%) of suicide deaths from 2005-2019 and 40.8% in 2019. While firearms also represent the most common suicide method in the overall veteran population (69.2% of deaths in 2019), firearms accounted for a lower proportion of suicide deaths among AANHPI veterans. In contrast, the proportion of AANHPI veteran suicide decedents who used suffocation as their suicide method was double that of veterans overall (38.5% versus 16.9% in 2019). Among female AANHPI veterans, suffocation was among the most common suicide methods, a finding that differs from the overall female veteran population.”
The researchers recounted how other research has reported hanging to be particularly prevalent among AANHPI populations but said “lethal means safety initiatives specific to suffocation remain limited, relative to strategies to address firearms or medications. Thus, this remains a crucial area for future research to ensure that suicide prevention strategies for AANHPI veterans are comprehensive and culturally sensitive.”
They urged more studies to better understand suicide drivers among AANHPI veterans, including racially-based stressors, stress associated with racial and gendered microaggressions, interpersonal factors, decreased use of mental health services, structural racism and “hidden” suicidal ideation.
- Monteith LL, Kittel JA, Schneider AL, Miller CN, Gaeddert LA, Holliday R, Brenner LA, Hoffmire CA. Suicide among Asian American, Native Hawaiian, and Pacific Islander Veterans: Rates and Methods, 2005-2019. Am J Prev Med. 2023 Sep 11:S0749-3797(23)00353-7. doi: 10.1016/j.amepre.2023.09.006. Epub ahead of print. PMID: 37703953.