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. Author manuscript; available in PMC: 2017 Jun 1.
Published in final edited form as: Asian Am J Psychol. 2016 Jun;7(2):120–128. doi: 10.1037/aap0000039

Ethnic Differences in Suicidal Ideation and its Correlates among South Asian American Emerging Adults

Robert Lane 1, Soumia Cheref 2, Regina Miranda 3
PMCID: PMC4978432  NIHMSID: NIHMS767625  PMID: 27525054

Abstract

Prior research on suicidal ideation and its correlates among South Asian American individuals has been limited. Given that South Asian American individuals are a burgeoning ethnic subgroup in the United States population, research regarding these factors is necessary to inform culturally competent suicide screening, prevention, and intervention among this increasingly prominent group. We examined depressive symptoms, hopelessness, and suicidal ideation among a sample of 204 undergraduate South Asian American (96 Bangladeshi American, 67 Asian Indian, and 41 Pakistani American) emerging adult students (66% female), ages 18 to 24 (M = 18.52, SD = 0.93). Participants completed measures of hopelessness, depressive symptoms, and suicidal ideation. Bangladeshi American ethnicity was associated with significantly lower levels of suicidal ideation than Asian Indian ethnicity. There was a non-significant trend for Pakistani American ethnicity to be associated with lower levels of suicidal ideation than Asian Indian ethnicity. Additionally, Bangladeshi American ethnicity and Pakistani American ethnicity each interacted with hopelessness, such that hopelessness was associated with lower levels of suicidal ideation among these groups than among their Asian Indian peers. Being of Asian Indian ethnicity may deleteriously influence vulnerability to suicidal ideation, while being of other South Asian American ethnicities may buffer against suicidal ideation, both independently and in interaction with hopelessness. Such contingencies should be considered during suicide screening, prevention, and intervention.

Keywords: South Asian, Asian Indian, Bangladeshi, Pakistani, suicidal ideation

Across various races and ethnicities, emerging adulthood (ages 18–25; Arnett, 2000), is a period of elevated risk for suicidal behavior (Kessler, Berglund, Borges, Nock, & Wang, 2005). In 2013, suicide was the second leading cause of death among individuals 15 to 24 years of age (CDC, 2015). Among Asian American individuals, those between 20 and 24 years of age have the highest rate of suicide (Hijioka, & Wong, 2012).

Prior study of suicidal thoughts and behaviors (STB) among emerging adults of specific Asian American ethnicities has been limited. South Asian American individuals are a burgeoning Asian American ethnic subgroup. Asian Indian individuals are the largest ethnicity in this subgroup and also comprise the third largest Asian American ethnicity (Hoeffel, Rastogi, Kim, & Shahid, 2012). Other South Asian American ethnicities, such as Bangladeshi American and Pakistani American individuals, are quickly growing, having increased by 203% and 133%, respectively, between 2000 and 2010 (Hoeffel et al., 2012). Despite the growing South Asian American presence within the US, previous domestic research of STB among them has been minimal. The current study sought to address this gap by exploring ethnic differences in suicidal ideation and its correlates among South Asian American groups.

Characteristics of South Asian American Groups

Bangladeshi American Individuals

Among the US population, Bangladeshi American individuals are a historically recent immigrant group, with the lowest level of educational achievement and income among South Asian American groups (Kibria, 2008). Previous Bangladeshi American acculturation research has been minimal, mixed, and primarily qualitative in nature. Two prior studies suggested acculturative conflict among more traditional Muslim Bangladeshi American parents and their children, who were engaged in exploration of the values of the culture at large (Alam, 2013; Alam; 2014). Sources of such conflict specific to women included the wearing of traditional garments such as a hijab and forgoing dating prior to arranged marriage. In contrast, another qualitative study among Muslim Bangladeshi American individuals reported voluntary compliance of most of its male and female participants with traditional garb, grooming, and religious practices, often after participants had been exposed to other cultures and religions (Chaudhury & Miller, 2008). Such exploration was reported by several participants to increase the salience of a Muslim identity. Qualitative research has also reported Muslim self-identification may be increasing in salience among Muslim Bangladeshi American individuals in response to experiences of discrimination (Kibria, 2008). Kibria (2008) suggests these individuals may feel stigmatized by discrimination but simultaneously disconnected from their immigrant parents’ cultural origins in Bangladesh (Kibria, 2008). Consequently they may embrace a more traditional form of Islam and its related tenets than that of their parents (Kibria, 2008). This may increase the salience of various Islamic tenets, such as those opposing suicide, but this possibility requires further study. Prior research has not studied acculturation or discrimination among Bangladeshi American individuals of faiths other than Islam, and as such, the existing literature should be interpreted with caution. A lack of quantitative studies in these areas is also a major gap in the existing literature.

Quantitative research of STB among individuals of Bangladeshi heritage has also been minimal and mixed, with most studies conducted outside the US. Two United Kingdom (UK) studies noted negative psychosocial outcomes to be less frequent among Bangladeshi women than White peers (Weich et al., 2004), and among Bangladeshi youth than among White, Black, and South Asian peers of higher socioeconomic status (Stansfeld et al., 2004). Among individuals of Bangladeshi lineage, suicide rates have also been reported to be lower than among their Asian Indian peers (Ineichen, 1998). Other research suggests people of Bangladeshi lineage may be at risk for negative psychosocial outcomes. For example, a study of Bangladeshi American women in NYC found that 36.5% of its sample was at risk for depression (Patel, Rajpathak, & Karasz, 2012), though this was not in comparison to other South Asian American groups. In the UK, Bangladeshi workers cited less at-work discrimination than peers of other backgrounds (White British, Irish, Black Caribbean, Asian Indian, and Pakistani) but reported a greater association between common mental disorders and racial insults (Bhui, Stansfeld, McKenzie, Karlsen, Nazroo, & Weich, 2005). In summary, research regarding STB among individuals of Bangladeshi descent is extremely limited, and prior studies have not explored STB within the US among Bangladeshi American individuals. This highlights a significant gap in the literature and a need for further study.

Pakistani Individuals

Qualitative research among Pakistani immigrants suggests better access to educational and economic opportunities as a reason for migration, and one study of Pakistani adolescent females reported personal education to be of utmost importance to the adolescents and their parents (Khuwaja et al., 2012). Perhaps correspondingly, Pakistani American individuals have greater levels of educational achievement and income than their Bangladeshi American peers, but lower levels than their Asian Indian peers (Kibria, 2008).

Study of acculturation among Pakistani American individuals has been extremely limited but suggests that parent-child conflict may arise around issues such as requirements that girls avoid socialization outside the family and eschew pre-marital dating (Khuwaja et al., 2012). Cohesive familial behavior in lieu of autonomy among children is encouraged (Mahr, McLachlan, Friedberg, Mahr & Pearl, 2015). A qualitative study suggests Muslim self-identification may be increasing in salience among Muslim Pakistani American individuals in response to experiences of discrimination (Ghaffar-Kucher, 2012), similar to among their Bangladeshi American peers (Kibria, 2008). However, such qualitative research has not been verified with quantitative research.

Prior examination of suicidal ideation and its correlates among Pakistani individuals is also minimal. The suicide rate in Pakistan, compared to other South Asian nations, has been reported to be low, but on the rise (Khan, 2002). Suicide rates among individuals of Pakistani descent in England and Wales have been reported to be lower than among peers of Indian heritage (Ineichen, 1998). However, more recent UK research suggested similar odds for attempted suicide among Indian and Pakistani women, with both groups having greater odds than Bangladeshi women (Crawford, Nur, McKenzie, & Tyrer, 2005). Prior research has suggested that suicide is underreported in Pakistan due to social taboos (Khan, 1998). US research comparing Pakistani American individuals to other South Asian American groups is virtually nonexistent, with but one prior study that reported Pakistani American individuals had higher odds of suicidal ideation, plans, and behaviors than Asian Indian peers (Roberts, Chen, & Roberts, 1997). Given the limited amount of US based research on STB and its correlates among Pakistani American individuals, further study is needed.

Asian Indian Individuals

Asian Indian immigration to the US has had a longer duration than among other South Asian American groups and recently has included mostly professionally skilled and educated individuals (Conrad & Pacquiao, 2005). Education has been reported to be highly valued among Asian Indian individuals (Inman, Tummala-Narra, Kaduvettoor-Davidson, Alvarez, & Yeh, 2015), and perhaps correspondingly, they have higher education and income levels than their South Asian American peers (Kibria, 2008).

Asian Indian immigrant individuals have favored a bicultural mode of acculturation that maintains heritage culture values in private life and adopts values of the culture at large in public life (Sodowsky & Carey, 1988). Prior research suggests this straddling of two cultures creates stress (Inman, Howard, Beaumont, & Walker, 2007). Additional research has suggested that such stress arises from parent/child acculturative discrepancy. One study reported that the breadth of the acculturative gap between Asian Indian adolescents and their parents was negatively related to self-esteem and positively related to anxiety and family conflict (Farver, Narang, & Bhadha, 2002). Another study found that second-generation unmarried Asian Indian women reported greater maternal control and cultural value conflict than first generation or married peers, and that this conflict mediated a relation between perceptions of maternal control and depressive symptoms (Varghese & Jenkins, 2009). Such cultural value conflict may arise from divergent expectations about sex roles, such as the expectation that one should eschew dating before parentally arranged marriage (Varghese & Jenkins, 2009).

A notable difference between South Asian groups is that individuals of Asian Indian descent are primarily practitioners of Hinduism, and their South Asian peers are primarily practitioners of Islam (Hackett & Grim, 2012). Islam condemns suicide (Ineichen, 1998) and may provide a means of religious coping against distress. For example, using religious coping to reduce the magnitude of personal problems has been found to be negatively related to depression among Pakistani individuals (Khan & Watson, 2006). In contrast, qualitative research suggests that Hinduism considers hopelessness and depressive states as valuable because they grant insight into human existence (Conrad & Pacquiao, 2005). In addition, in accordance with beliefs that are integral to Hinduism, mental and physical illness are often viewed as a consequence of personal wrongdoing, and this may be associated with self-blame for mental illness and a reluctance to seek treatment among practitioners of Hinduism (Conrad & Pacquiao, 2005). One prior study that compared Muslim and Hindu individuals found that Muslim individuals endorsed overall reasons for living and survival and coping mechanisms more strongly than did Hindu peers (Kamal & Loewethal, 2002). Thus, religion is one possible factor among many that may influence differences in STB between South Asian American groups.

With regard to suicide, its frequency has been reported to be increasing in India and greatest among those between 20 and 30 years of age (Khan, 2002). However, study of STB and its correlates among Asian Indian individuals generally has been limited. One study reported greater levels of depression and hopelessness among Indian college students versus US peers (Upmanyu, Upmanyu, & Lester, 2000). High rates of STB have also been reported among Asian Indian individuals living outside of India in many locales (Ineichen, 1998; Lester, 2000). One prior review of studies of suicide among South Asian immigrants suggested rates of suicide among Indian immigrants 15 years of age or older were higher in the countries to which they immigrated (including North American countries) than in India (Patel & Gaw, 1996). This trend was especially pronounced among women. A US study, however, found that Asian Indian individuals had lower odds of suicide than peers of other Asian, but not South Asian, ethnicities (Wong, Vaughan, Liu, & Chang, 2014). The sole study in the US to compare Asian Indian individuals to another group of South Asian origin, Pakistani American individuals, found that Asian Indian individuals had lower odds of suicidal ideation, plans, and attempts than their Pakistani American peers (Roberts et al., 1997). Such contrasting findings (Patel & Gaw, 1996; Roberts et al., 1997) and the overall lack of US-based STB research elucidates a need for further study of STB specifically among Asian Indian individuals in the US, and also of potential differences in STB among South Asian American groups.

Hopelessness, Depression, and Suicidal Ideation

Hopelessness

Hopelessness is defined as believing desired ends will not occur, and/or that undesired outcomes will occur, and that such outcomes are unavoidable (Abramson, Metalsky, & Alloy, 1989). Hopelessness has been found to independently predict suicidal ideation (Smith, Alloy, & Abramson, 2006) and to be positively associated with suicidal ideation through interactions with social isolation and feeling oneself to be a burden on others (Christensen, Batterham, Soubelet, & Mackinnon, 2013). Hopelessness has further been found to be positively associated with suicidal ideation and negatively associated with reasons for living among Asian American individuals (Choi & Rogers, 2010). Study of hopelessness among South Asian American individuals as a correlate of STB has been minimal and merits inquiry.

Depressive Symptoms

Depressive symptoms have previously been found to be associated with suicidal ideation at every level of symptom severity (Cukrowicz et al., 2011), and have been found to be significantly more severe among college students with current suicidal ideation than among those without (Garlow et al., 2008). Elevated levels of depressive symptoms have been linked to wanting to die as a reason for suicidal behavior, with wanting to die being the most prominent reason for the most recent suicide attempt among repeat attempters (Jacobson, Batejan, Kleinman, & Gould, 2013). A British study found that South Asian individuals reported lower levels of depressive symptoms than White peers, but that both groups were more likely to report depressive symptoms before a completed suicide than Black peers (Bhui, Dinos, & McKenzie, 2012). Research on the relation between depressive symptoms and suicidal ideation and/or behavior among South Asian American individuals is limited. Further inquiry is needed.

The Current Study

The current study is intended to be a first step towards addressing the gaps, the lack of consensus, and the deficit of quantitative research among the prior studies of STB among South Asian American individuals. Prior research has suggested potential differences in suicidal behavior between different South Asian immigrant groups (Patel & Gaw, 1996) and South Asian American groups (Roberts et al., 1997). Given this prior research, we conducted a quantitative analysis comparing levels of suicidal ideation and ethnic predictors of suicidal ideation between South Asian American groups. We also examined potential interactions between specific ethnic statuses, hopelessness, and depressive symptoms, as predictors of suicidal ideation, to expand knowledge of suicidal ideation and its correlates among South Asian American individuals.

Method

Participants

First- and second-year college undergraduate emerging adults (N = 204; 66% female), ages 18 to 24 (M = 18.52, SD = 0.93) were recruited from an urban public university and other colleges in the NYC metropolitan area to participate for fulfillment of a research requirement in an Introduction to Psychology course or for monetary compensation ($25). Participants were South Asian American individuals recruited from an ongoing study of predictors of suicidal ideation and attempts among emerging adults. The ethnic composition of the sample was 47% (n = 96) Bangladeshi American, 33% (n = 67) Asian Indian, and 20% (n = 41) Pakistani American (see Table 1 for the racial/ethnic, gender, and age characteristics of each ethnic group).

Table 1.

Means and Standard Deviations for Age and Study Variables among South Asian American Groups

Asian American Ethnic Statuses
South Asian Bangladeshi Asian Indian Pakistani
N % N % N % N %
N by Group 204 100% 96 47% 67 33% 41 20%
    Immigrant 109 53% 57 59% 30 45% 22 54%
    Non-Immigrant 95 47% 39 41% 37 55% 19 46%
    Male 69 34% 37 39% 24 36% 8 20%
    Female 135 66% 59 61% 43 64% 33 80%
Means and SDs M SD M SD M SD M SD
    Age 18.52 0.93 18.53 0.92 18.52 0.86 18.49 1.08
    Depressive Symptoms 12.35 9.11 11.67 8.88 13.31 9.51 12.39 9.08
    Hopelessness 4.13 4.22 3.98 4.42 4.49 4.28 3.88 3.68
    Suicidal Ideation 0.82 2.32 0.53 1.72 1.34 3.19 0.66 1.64
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Measures

Demographic Information

Participants responded to a self-report questionnaire by providing their race/ethnicity, age, gender, sexual orientation, country of origin, and parental countries of origin. Participant ethnic groups (Bangladeshi American, Pakistani American, or Asian Indian) were assigned based on responses about their ethnicity and their parental countries of origin. The optional ethnicity item enabled participants to provide detail about their ethnicity beyond their parental countries of origin. For all but two participants, their parental countries of origin (and ethnicity when provided) matched, and they were assigned to the corresponding group. For the remaining participants, one reported that one parent was born in Pakistan and the other in Bangladesh, and was assigned to the Pakistani American group, because he/she self-reported his/her ethnicity as Pakistani. The other participant reported Bangladesh as the birth country for one parent and did not provide a response for the other parent, but self-reported his/her ethnicity was Bangladeshi and was assigned to the Bangladeshi American group.

Hopelessness

The Beck Hopelessness Scale (BHS; Beck & Steer, 1988) measures expectations regarding negative future outcomes with 20 (11 negatively and 9 positively phrased) true/false statements. Scores ranged from 0 to 20. The BHS has shown strong internal consistency reliability in past research (α ranges from .82 to .93; Beck & Steer, 1988), and strong internal consistency reliability in the current study (α = .89).

Depression

The Beck Depression Inventory (BDI-II; Beck, Brown, & Steer, 1996) was used to assess levels of depressive symptoms. Participants were asked to answer the BDI-II while reviewing the two-week period prior to participation. Potential item responses ranged from 0 to 3, and total scores from 0 to 63. The BDI-II has shown strong internal consistency reliability among college students in past research (α = .93; Beck, Brown, & Steer, 1996), and strong internal consistency reliability in the current study (α = .91).

Suicidal Ideation

Suicidal ideation was assessed with the Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1993), a 21-item self-report measure that assesses the wish to die (e.g., “I have a moderate to strong desire to kill myself”), along with severity of suicidal ideation, including suicidal plans and preparations. Participants were asked to report suicidal ideation during the week prior to participation. BSS item responses had point values ranging from 0 to 2. Summing the first 19 items yields a total score ranging from 0 to 38. The BSS has shown strong internal consistency reliability in past research (α = .87; Beck & Steer, 1993), and strong internal consistency reliability in the current study (α = .91).

Procedure

Participants completed a series of surveys including the DIQ, BDI-II, BHS, and BSS, either individually or in small groups. They were then assessed with a suicide risk evaluation procedure and debriefed. Those reporting suicidal ideation with a plan (as assessed by the BSS) were further evaluated by either a licensed clinical psychologist or a licensed clinical social worker and referred for additional evaluation to a student-counseling center, as needed.

Statistical Analyses

An analysis of variance (ANOVA) was conducted to examine whether the South Asian American ethnic groups differed in means on study measures. South Asian American ethnic group membership was assigned based on a participant’s responses to the race/ethnicity and parental country of origin items in the DIQ. A moderated regression analysis was also conducted with SPSS 22. Moderation occurs when a correlate of suicidal ideation differs in its effect on suicidal ideation based on specific South Asian American ethnic group membership. Variables entered in our moderated regression model were: depressive symptoms, hopelessness, two dummy variables representing Bangladeshi American and Pakistani American ethnic status, and four interaction terms computed by multiplying hopelessness and depressive symptoms by both ethnic status dummy variables. Asian Indian individuals were our reference group. We also entered two more dummy variables to control for the effects of gender and immigration status, because of differences reported in prior research among South Asian American individuals related to gender (Alam, 2013; Alam, 2014; Khuwaja et al., 2012; Varghese & Jenkins, 2009) and immigration and acculturative experiences (Alam, 2013; Alam, 2014; Farver et al., 2002; Khuwaja et al., 2012; Patel & Gaw, 1996; Varghese & Jenkins, 2009). Brooding and reflective rumination, as measured by the Ruminative Response Scale (Nolen-Hoeksema & Morrow, 1991), were also originally included in our model as predictors, both separately and in interaction terms with the previously noted ethnic status dummy variables, to explore their effects on suicidal ideation. None of these predictors were significant, and they were all dropped from the model to improve power and will not be further discussed. Continuous predictors were also centered around their means (Jacard, 2001).

Per the recommendation of Cohen, Cohen, West, and Aiken (2003), we examined our data for potential outliers that would exert undue influence upon the moderated regression equation. In doing so, we used both index plots and recommended threshold values in conjunction with tests of global influence (DDIFTS; difference in fitted values), and tests of specific influence on regression coefficients (DFBETAS; standardized difference of the beta; Cohen et al., 2003). These methods identified two potential outliers that we truncated from our dataset. Statistically significant predictors did not vary between the analyses of original versus truncated data. In addition, the moderated regression analysis was conducted with bootstrapping, a method that has been recommended for regression models in small samples with heteroscedastic residuals, to ensure compliance with the assumptions underlying multiple linear regression (IBM, 2013).

All significant interactions were probed using the Johnson-Neyman procedures via the PROCESS script for SPSS (Hayes, 2013). This technique identifies regions of significance of the moderator for the conditional effect of the predictor on the dependent variable and allows for a more accurate inspection of the moderator’s effect on the predictor-outcome relation. It is superior to methods identifying arbitrary low, mean, and high moderator values (Hayes, 2013).

Results

Table 1 displays means and standard deviations for study variables. Table 2 displays correlations among continuous study variables across the sample and within each ethnic group.

Table 2.

Summary of Correlations of Study Variables across South Asian American Ethnic Groups

Asian American
Ethnic Statuses		 N Variable 1 2 3
South Asian 204 (1) Depressive Symptoms - .63*** .42***
(2) Hopelessness - .42***
(3) Suicidal Ideation -
Bangladeshi 96 (1) Depressive Symptoms - .57*** .32**
(2) Hopelessness - .28**
(3) Suicidal Ideation -
Asian Indian 67 (1) Depressive Symptoms - .71*** .53***
(2) Hopelessness - .72***
(3) Suicidal Ideation -
Pakistani 41 (1) Depressive Symptoms - .63*** .38*
(2) Hopelessness - −.11
(3) Suicidal Ideation -
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Notes.

*

p < .05,

**

p < .01

***

p < .001

No statistically significant omnibus differences were found between South Asian American ethnic groups, immigrant status groups, or gender groups, on the primary study variables of depressive symptoms, hopelessness, and suicidal ideation. Age, however, did differ by immigrant status. Immigrant individuals (M = 18.67, SD = 1.12) were significantly older than their non-immigrant peers (M = 18.35, SD = 0.60), t(202) = 2.61, p = .01, d = .36, a moderate effect size (Cohen, 1988). No additional differences in mean levels of continuous variables were found.

South Asian American Ethnic Statuses and Suicidal Ideation

We conducted a moderated regression analysis, as outlined above. Bangladeshi American ethnic status (b = −0.66, p = .044) was significantly and negatively associated with suicidal ideation, while hopelessness (b = 0.51, p = .001) was significantly and positively associated with suicidal ideation. There was a non-significant trend towards a negative association between Pakistani American ethnic status and suicidal ideation (b = −0.60, p = .084). Two interactions were also negatively associated with suicidal ideation: Bangladeshi American ethnic status x hopelessness (b = −0.46, p = .001), and Pakistani American ethnic status x hopelessness (b = −0.78, p = .001). These predictors each exerted small effects on suicidal ideation (Cohen, 1988). The overall model accounted for substantial variability in suicidal ideation, adjusted, R2 = .39, F(10, 193) = 13.95, p < .001, and exerted a large effect upon it, f2= .64 (see Table 3; Cohen, 1988).

Table 3.

Summary of Linear Regression Predicting Suicidal Ideation

Predictor B S.E. β p-value Partial r
Depressive Symptoms 0.02 0.05 0.06 .712 .03
Hopelessness** 0.51 0.11 0.92 .001 .44
Pakistani AES+ −0.60 0.34 −0.10 .084 −.12
Pakistani AES x Depressive Symptoms 0.12 0.08 0.20 .150 .16
Pakistani AES x Hopelessness** −0.78 0.18 −0.55 .001 −.41
Bangladeshi AES* −0.66 0.32 −0.14 .044 −.16
Bangladeshi AES x Depressive Symptoms 0.03 0.05 0.09 .518 .06
Bangladeshi AES x Hopelessness** −0.46 0.12 −0.60 .001 −.34
Gender −0.16 0.26 −0.03 .547 −.04
Immigrant+ 0.47 0.25 0.10 .069 .13
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Notes.

+

p < .10,

*

p < .05,

**

p < .01

Adjusted R2 = .39

f2 = .64

AES = American Ethnic Status

B = Unstandardized regression coefficient

β = Standardized regression coefficient

S.E. = Standard error

Next, via the Johnson-Neyman technique outlined above, we probed the two significant two-way interactions from this moderated regression using PROCESS model 1 (Hayes, 2013). For Pakistani American students, hopelessness transitioned from being a non-significant to a significant moderator at a score of 4.29 (72nd percentile in the current sample), b = −0.72, SE = 0.37, p = .05, 95% CI [-1.44, 0.00]. Hopelessness scores above 4.29 were associated with lower levels of suicidal ideation among Pakistani American students versus Asian Indian peers. For Bangladeshi American students, hopelessness transitioned from being a non-significant to a significant moderator at a score of 3.94 (67th percentile in the current sample), b = −0.58, SE = 0.29, p = .05, 95% CI [−1.15, 0.00]. Hopelessness scores above 3.94 were associated with lower levels of suicidal ideation among Bangladeshi American students versus Asian Indian peers. See Figure 1 for a graphical depiction of these significant two-way interactions.

Figure 1.

Figure 1

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Interactions of ethnic group status and hopelessness. Low hopelessness is plotted at one standard deviation below the mean. High hopelessness is plotted at one standard deviation above the mean.

Discussion

Neither Asian American nor South Asian American individuals are monolithic. Unique cultural factors and interpersonal stressors among these groups may influence STB and related correlates. Prior research, however, has largely neglected to examine how suicidal ideation and its correlates may vary among specific South Asian American ethnic groups, despite their growing presence in the US (Hoeffel et al., 2012). The current study is one of the first to do so.

There were no significant differences in mean levels of suicidal ideation between South Asian American groups. However, after adjusting for other correlates, Bangladeshi American ethnic status and Pakistani American ethnic status were associated with lower levels of suicidal ideation, relative to Asian Indian ethnic status, with the latter relationship present as a non-significant trend.

Bangladeshi American and Pakistani American ethnic statuses also each moderated separate significant interactions between hopelessness and suicidal ideation, such that high levels of hopelessness were associated with lower levels of suicidal ideation among Bangladeshi American and Pakistani American individuals, relative to Asian Indian individuals (although it should be noted that, overall, hopelessness was positively associated with suicidal ideation among Asian Indian and Bangladeshi American individuals but not among Pakistani American individuals). Each of these interactions exerted small effects (Cohen, 1988) and thus require cautious interpretation. However, these are among the first findings relating interactions between South Asian American ethnicity and hopelessness to suicidal ideation.

Our findings extend prior research that suggests Asian Indian individuals are subject to cultural value conflict and specific stresses that may differ from other South Asian American peers (Farver et al., 2002; Varghese & Jenkins, 2009), who, in contrast, may be experiencing polarization and stereotyping of their identity in reaction to discrimination (Ghaffar-Kucher, 2012; Kibria, 2008). Although speculative, given that we did not measure religious affiliation or practice, it is possible that Muslim self-identification – more characteristic of Bangladeshi and Pakistani American individuals – may help protect against STB by increasing the salience of religious tenets opposing suicide. This may occur even among those who are not strictly devout, given that religious tenets may affect cultural norms, regardless of religious practice. This interpretation requires further study.

Relatedly Hinduism has been suggested to protect against STB less actively than Islam (Kamal & Loewethal, 2002). Moments of hopelessness regarding life prospects in Hinduism are considered sacred, distress related to depressed states is believed to clarify the nature of reality, and karmic beliefs that are part of Hinduism have been reported to be related to self-blame for mental illness among Asian Indian individuals (Conrad & Pacquiao, 2005). Such concepts could help explain how hopelessness may increase depressed and suicidal states among those who follow Hindu tenets, especially if such hopelessness focuses upon one’s life and place in the world. We did not assess religious beliefs in our study, and thus this speculation requires further inquiry. This does, however, align with prior STB research from throughout the Asian Indian diaspora that suggests Asian Indian individuals practicing Hinduism experience higher rates of STB than adjacent Muslim peers (Ineichen, 1998; Khan, 2002; Lester, 2000).

Strengths, Limitations, and Future Directions

Our study is among the first to examine ethnic influences on suicidal ideation and its correlates among South Asian American individuals, a fast growing Asian American ethnic subgroup (Hoeffel et al., 2012), during a developmental span noted for suicide risk among Asian American individuals (Hijioka, & Wong, 2012). Despite its strengths, our study has limitations. First, we did not explicitly measure ethnocultural factors such as religious beliefs and practices, but used ethnicity as a proxy instead. Second, it is possible other factors related to ethnicity, religious tenets, and acculturation affected our results. For example, Bangladeshi American and Pakistani American individuals may have underreported suicidal ideation due to social desirability bias and fears of stigma, given cultural prohibitions against suicide. Such stigma has been posited to relate to underreporting of suicide in Pakistan (Khan, 1998). Third, hopelessness was negatively associated with suicidal ideation among Pakistani American individuals, although this association was not statistically significant. The direction of this relation was dictated solely by the responses of female Pakistani American participants, as their male peers did not endorse any symptoms of suicidal ideation. Prior qualitative research among Pakistani American families has noted that children are actively discouraged from behaving autonomously (Mahr et al., 2015). Furthermore, Pakistani American female adolescents have previously reported a preference for relying on same-gendered family members, such as mothers and sisters, to assist in problem-solving (Khuwaja et al., 2012). The adaptiveness of avoidant coping and relying on male family members to deal with threats such as racism has further been suggested across a mixed group of South Asian American women (Liang, Nathwani, Ahmad, & Prince, 2010). One potential explanation for our finding is that responses to the BHS by our female Pakistani participants were expressing these tendencies to eschew autonomous reactions to negative future contingencies and instead rely on family in times of stress. For example, an affirmative response to the second question of the BHS, “I might as well give up because there's nothing I can do about making things better for myself” (Beck & Steer, 1988), may reflect a reaction to the pronoun “I” rather than an abrogation of hope for the future, and may further reflect the idea that problems may only be solved with familial assistance. Several BHS questions may be confounded by such a cultural perspective, and this may explain why greater BHS scores were associated with lower levels of suicidal ideation among this group. This explanation is speculative, however, and requires further inquiry.

In addition, our study recruited emerging adult college students, and our results may not apply to those who are in other age groups, who did/do not attend college, and who are in clinical populations. Furthermore, women comprised about 66% of our sample and 80% of the Pakistani American participants. We adjusted for potential gender effects in our analyses and found no significant gender differences. This could be due, however, to a large presence of women in our sample and low statistical power for specific ethnic groups (e.g. the relatively low number of Pakistani American individuals in the sample). Given the higher reported prevalence of suicidal ideation among women (Crosby, Han, Ortega, Parks, & Gfroerer, 2011), this may limit the applicability of our results to men. Moreover, about half of our participants were immigrants. We found no significant mean differences in study variables by immigrant status. However, there was a non-significant trend towards a positive association with suicidal ideation in our regression, and, thus, our results may have been affected by this large immigrant presence.

Future research should assess potential social desirability bias and stigma regarding reporting STB among South Asian American individuals, and use additional assessment methods besides self-report. It should also explicitly measure religious beliefs, practices, coping, and identity, and how these factors affect STB and its correlates among South Asian American individuals. Examining acculturative strategies (Berry, 2007) may also help clarify how ethnic status may affect STB and its correlates among these individuals. It may further reveal potential differences in study variables between South Asian American immigrant individuals and their other generation peers, among whom prior research has noted parent/child acculturative discrepancy (Alam, 2013; Alam, 2014; Farver et al., 2002; Khuwaja et al., 2012; Varghese & Jenkins, 2009), and among whom we found a non-significant trend towards greater levels of suicidal ideation. Replicating the current study with samples from Bangladesh, India, and Pakistan, as well as with samples from corresponding ethnic groups residing in other countries, could also help clarify if our results apply to South Asian individuals outside the US.

Conclusions

This is one of the first studies of which we are aware to examine suicidal ideation and its correlates among individuals of Asian Indian, Pakistani American, and Bangladeshi American background. Our findings suggest that Asian Indian emerging adults have higher levels of suicidal ideation than their Bangladeshi American and Pakistani American peers, when adjusting for hopelessness and depressive symptoms, and that hopelessness may be particularly deleterious in conferring vulnerability to suicidal thoughts among Asian Indian emerging adults relative to both Bangladeshi American and Pakistani American peers. Thus, treatment to reduce suicidal ideation among Asian Indian emerging adults should focus on decreasing hopelessness, whereas such a focus may be less critical among Bangladeshi and Pakistani American emerging adults. Our findings should not be construed to overemphasize risk for suicidal ideation among Asian Indian individuals, as suicidal behavior among them occurs at a lower rate compared to Asian American peers of non-South Asian origin (Wong et al., 2014). However, given the increasing presence of Asian Indian individuals and of their peers of South Asian descent among the US population (Hoeffel et al., 2012), awareness of ethnocultural factors and their influence on STB and its correlates among South Asian American individuals may be crucial to providing the best standard of prevention, intervention, and care.

Acknowledgments

This study was funded by NIH grant 5SC1 MH091873 to Regina Miranda. Thanks to Alyssa Wheeler, Valerie Khait, Kaerensa Craft, Eileen Fener, Nargus Harounzadeh, Justyna Jurska, Amy Kephart, Giulia Landi, Jessica Silver, Lauren Uss, and Jorge Valderrama for their assistance with data collection.

Contributor Information

Robert Lane, Hunter College, City University of New York.

Soumia Cheref, Hunter College, City University of New York.

Regina Miranda, Hunter College and The Graduate Center, City University of New York.

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