July 14, 2025 • 29 mins
In this episode of Breaking the Silence: Addressing Youth Suicide, Dr. Krysti Vo is joined by Dr. Poojajeet Khaira, a psychiatry resident and APA Foundation Leadership Fellow, for a powerful discussion on the rising suicide rates among Asian American youth. Together, they explore the systemic and cultural factors behind this alarming trend, the role of stigma and intergenerational dynamics, and how mental health professionals—especially trainees and early career psychiatrists—can be agents of change. They emphasize culturally responsive care, community engagement, and the importance of meeting youth and families where they are. This episode offers both insight and inspiration for those looking to make a meaningful impact.
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Episode Transcript
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(00:03):
And so I think as providers, of course, we have to treat every patient individually.
Every patient is different.
But I think we have to meet families where they are, think, starting these conversations,trying to normalize them as much as possible, trying to make sure that providers
understand the cultural values in their patients, especially AAPI populations.
(00:26):
think a lot of
Providers might not be aware of this high risk in this population.
This is a population known to have the model minority stereotype.
And thus this might not always be something that is at the forefront of providers mindswhen they have an AAPI patient come in.
(00:47):
Welcome to the APA More Equity series, Breaking the Silence, Addressing Youth Suicide.
Our host for this episode is Dr.
Krysti Vo, and joining her is Dr.
Poojajeet Khaira Dr.
Vo is a physician, innovator, and advocate committed to improving care for individualswith psychiatric and neurodevelopmental disorders.
(01:07):
With a background at the intersection of medicine and technology, Dr.
Vo has received over 20 awards,
and led initiatives to organizations like the American Psychiatric Association, A-CAP, andSAMHSA.
She currently serves as the APA Assembly Representative for the Asian American Caucus andChair of the Assembly MUR Committee.
She advises health tech startups on clinical innovation.
(01:30):
From shaping national policy to designing digital solutions, Dr.
brings a powerful blend of research, leadership, and vision to every conversation.
So now, let's break the silence with Dr.
Vo and Dr.
Kyra.
Hi, I'm Dr.
Krysti Vo and joining me today is Dr.
Bhujay Khara.
She's a psychiatry resident and a APA Foundation Leadership Fellow with a strongcommitment to medical education, health equity and reducing workplace violence.
(02:01):
Dr.
Khara, how about you say a few words about yourself?
Sure, thank you so much Dr.
Bowe for having me.
I'm also going to be the incoming chair for the assembly committee of resident fellowmembers.
And I'm currently the area for deputy representative for resident fellow members in theassembly.
(02:21):
And starting in July, I will be the representative for resident fellow members.
So that's really where this topic had started brewing.
Oh, great.
And thank you so from all your work and involvement in the APA and helping building thecommunity with fellows and residents.
It's I know it's a hard task to rally busy residents and fellows.
(02:45):
So I applaud your work.
So yeah, today we're talking about suicide in Asian American youth.
So what led you to be interested in working on this?
Sure.
So last year I had come across an article from JAMA Psychiatry that had shown that suicideis now the leading cause of death amongst Asian-American youths aged 15 to 24.
(03:14):
And this specific study was done over a 22-year period from 1999 to 2021.
And it showed a 72 % increase in suicide rates amongst AAPI male youth.
and 125 % increase amongst AAPI female youth.
And so this was something that I thought was super appalling.
I brought it up at a fellowship meeting and other fellows from the foundation found thisto be appalling as well and felt like we needed to do something about it, approach me and
(03:43):
asked if we wanted to work together to help with this cause.
And I brought it back to my assembly colleagues and there was multiple assembly reps thatwere also very passionate.
And from there, we formed a work group to try to see what we can do as resident fellowmembers to help with this really important cause.
Great.
(04:03):
And this work group, is it APA assembly people or also who does it involve?
It's a mix of assembly, RFM reps and dep reps and uh APA foundation fellows across all thefellowships actually.
So leadership fellows, public psych fellows, child fellows, SAMHSA fellows.
(04:25):
So it's been a mix, but it is all resident fellow members.
Great, great.
I think that's important because one, uh the residents and fellow are closest to the youthin a sense in terms of age and rate related ability.
And I think part of learning about suicide is really take perspective, perspective takingof what's going on in the Asian American youth.
(04:51):
And so from your perspective as a resident, how do you think being a frontline mentalhealth professional really
knowing about the increase in suicide among youth affects you.
Yeah, sure.
I think that's a really hard question to answer.
I think that, you know, I'm not too far from this age group myself.
And so it is something that I think is really sad to see, really shocking to see.
(05:15):
I have many friends that are in this age group and I see patients within this age groupall the time.
And I think it just makes me think that I need to be looking out for this more.
I think even though I identify as an Asian as well,
I don't think that this was always the first thing that came to my mind before I startedlooking into it.
So I think for me, it was a sad thing to see, but it also made me more aware of it andsomething that I like to share with other colleagues.
(05:43):
And I hope that even that brief awareness will help a patient.
Yeah.
And then what do you think are the key drivers to the increase in suicide in youth?
Sure.
So I feel that the COVID pandemic is one of the most important drivers in this increase.
(06:04):
Of course, we are all aware about it, but anti-Asian hate crimes rose by 339%.
And that's not even a fake number.
There is data that backs that up from 2020 to 2021.
And I feel like that has been a major contributor to stress amongst AAPI communities.
Of course, experiencing discrimination and hate crimes can lead to increased risk fordeveloping depression, anxiety, PTSD, and other mental health issues.
(06:29):
I also feel like the COVID pandemic was a time for not just AAPI, but any communities thatare marginalized to increase isolation that is felt across marginalized communities.
feel like especially, you know, when we see youth of color, these are communities that
already have so many characteristics that put them at higher risk of mental health issues.
(06:54):
I also feel like social media has come into play and has been more apparent, especiallyduring COVID time and post COVID time.
And I do feel like that is affecting what we see now.
But you know, also I'm wondering Dr.
Vo, you've been involved um in aspects of this for much longer than me.
You're more experienced practicing.
(07:16):
I'm wondering what
you feel like are the drivers for these increases.
I think there have been some research that shows an increase in social media use.
It's a bell curve where very little social media use can be a sign of mental health,depression, anxiety.
(07:36):
But very high social media use is also correlated with depression and anxiety.
And I think although that's just one study, and don't agree, as well as this observingtrend in our youth and young professional.
the addictive nature of social media that fuels comparison and fuels uh personalidentification, uh as well as any reeling of any insecurities we have, uh drives people to
(08:06):
have more depression, anxiety.
And I think that can lead to an increase in crisis, mental health crisis, and perhapssuicide.
While that's not extrapolated like directly the cause of suicide, I think uh
from the natural progression of the increase in social media leading to increaseddepression and anxiety, I think that can play a factor.
(08:27):
Well, what do you think we can do as mental health professional to help particularlyAsian-American youth to reduce any barriers to seeking care?
Because even though there is a sharp increase in mental health issues in Asian-Americanyouth, it seems they're less likely to access care.
Is that correct?
(08:48):
Yes, for sure.
So there have been studies that have shown that AAPI use face significantly high risk ofparents declining mental health services and that there's also been shown um that there's
a lack of initiation following mental health risk assessments um amongst parents in thispopulation.
(09:09):
And so I think as providers, know, of course we have to treat every patient individually.
Every patient is different.
But I think we have to meet families where they are.
think starting these conversations, trying to normalize them as much as possible, tryingto make sure that providers understand the cultural values in their patients, especially
(09:31):
AAPI populations.
I think raising awareness about this.
think a lot of providers might not be aware of this high risk in this population.
This is a population known to have
the model minority stereotype.
And thus this might not always be something that is at the forefront of providers mindswhen they have an AAPI patient come in.
(09:55):
So I think starting those conversations, I think also developing more cultural resources.
I think also seeing, you know, how can we meet that family where they are and working withthem over time as we build rapport.
to decrease the stigma, also address intergenerational conflicts.
I think there's a lot that still needs to be done.
(10:16):
And you know, this is a population where there's not that much research.
And so I think also looking into that and looking into funding resources for that would bea big help.
Yes, yes, think yes.
uh Education awareness, having those conversations with healthcare professionals canreally be powerful.
(10:40):
In regards to working with healthcare professionals, when it comes to cultural responsivecare, what do you think?
How does that look like in practice?
Yeah, so I feel like this is again going to be different for every patient, but I thinkit's seeing the patient for everything that they are, not just their symptoms.
(11:01):
So, you know, for a PI population, many of them are immigrants, many of them, you know, ummight be first generation, second generation.
And so understanding that that is a part of their story, understanding familyexpectations, cultural beliefs about mental health.
Also recognizing that they might have interacted or faced racism, xenophobia orgenerational trauma and noticing that and then talking about that with the patient and
(11:31):
seeing how that could affect their story and how they're presenting today.
I think of course it's gonna be different for every patient like I said, but just stoppingfor a moment thinking about those aspects, building trust with the patient, involving the
family when it's appropriate.
and validating their experiences will go a long way.
(11:52):
Of course, it's not a one size fits all approach, but I think it's being intentional,being deeply empathetic, and trying to relate to our patients.
Yeah, I agree with that.
so for youth that has multiple identities, maybe say a queer Asian American teen, uh or anundocumented person, what additional layers of support or cultural understanding do you
(12:21):
think are critical in care delivery?
So of course that's gonna put them at a higher risk for mental health, poor mental healthoutcomes.
So I think we have to think about who is their community, who is their support.
And we have to think about aspects beyond just the patient or beyond the family.
We have to think about the schools, other community groups that could provide furthersupport.
(12:45):
We need to think about how all of those aspects of the patient is interfering with theircare or their presentation.
I personally have had
multiple patients who are of this community who also identify as queer or of the LGBTQcommunity.
And I know in practice, we have put a lot of effort at my institution into connecting themwith uh social groups at their university that can add to that support.
(13:14):
But, know, Dr.
Vo, I want to know in your clinical practice, what have you done?
Um, or have you faced this and I want to know more about your experience with this.
think when it comes to multiple marginalized identities that some of these youth identifywith, think referring them to resources for those multiple identities, like for example, a
(13:34):
queer group or community oh of identified identity that they can rely on is great.
But at the same time, it's also about educating the family.
I think sometimes we should outreach families at these community centers.
Like let's say the local
(13:54):
grocery store or that local, you know, Lunar New Year festival.
I think there should be more mental health awareness being raised.
Let's say there's a boost, let's just have education about mental health and suicide inAsian American teens, right?
I think targeting the parents and the family is educating them about the increased mentalhealth crisis in these youth is one of a key factor because sometimes
(14:24):
Parents aren't aware or they have too much going on to pay attention.
And having a conversation with the parent to say, have you talked to your kid recently?
Can be powerful.
Because sometimes these kids already felt, feels unheard, unseen by their parents.
(14:45):
So if we educate their families and parents to have a conversation with their youth, thatcan be powerful.
I was just going to add that I do think that even though there's so much more work thatneeds to be done for this population, I think that there are people across the country um
doing some projects related to this.
(15:08):
I would have from what I've read or what I've attended, I have seen them trying to focuson that conversation between the parent and the youth or the child on how to bring up a
mental health concern or, you know, the parent might not know what's going on with thechild.
And they don't, you know, they see it more as like the child maybe um being secluded ormaybe uh isolating themselves, but they don't recognize that, these are symptoms of
(15:37):
depression.
So I definitely think that education piece can go a long way.
And of course, with helping with stigma, we need that education piece.
Yes, and I wonder if schools is the natural environment to educate the parents throughbecause a lot of parents are involved or at least they monitor their Asian American kids
(15:59):
performance.
And I wonder if programs through the school to engage the parents in some of these uhraising awareness of these issues could go through the school so that the parents can pay
attention to more.
I'm wondering.
out loud here.
But ah yeah, perhaps other people are working on this as well.
(16:22):
And with you, I know that you would do a lot of work with trying to have trainees andearly career psychiatrists work in this suicide prevention space.
How has that been going?
And what have you guys been doing?
Yeah,
I think we've really been trying to make a dent in this and make um people aware of thisissue.
(16:43):
I think that often trainees might not realize their power and I don't think that um alltrainees have this perspective that at the trainee level they can make a difference.
But that has been something that has been a driving force for me and a lot of thecolleagues that I work with is showing trainees that their opinions matter and
(17:04):
that they can make a difference.
think trainees bring fresh perspectives and live experience that often reflect thecommunities we serve.
We are often the frontline workers in our clinics.
And I think that there's a lot of new things happening that are coming from trainees.
I think this push for curriculums about cultural humility, trauma-informed care, a lot ofthat is coming from these younger generations.
(17:30):
think, you know, we are people that are speaking out about
burnout, racism, and access issues, and that impacts both our patients, but alsoourselves.
And so I think from what I've seen from all of my colleagues who are resident fellowmembers, there has been a strong push about getting us out there and focusing on advocacy
and what we can do to truly make a difference.
(17:52):
So I think it's not just being a great clinician and knowing all of the pathology, butalso being able to advocate for our patients.
And I know Dr.
Vo that
My understanding is you're an early career psychiatrist, right?
And so I would love to hear your perspective too on, you know, what you feel like earlycareer psychiatrists bring to the table because resident fellow members to early career
(18:17):
psychiatrist is such a big transition, but also we share so many similarities.
Yes, yes.
So speaking of advocacy, I was just at ACAP uh at this legislative conference, is today,today, being on Capitol Hill and learning about what policy is affecting the current uh
(18:41):
federal landscape right now.
And then we also go and talk to senators and House of Representatives to uh tell them tosupport things like Medicaid for children.
uh to support things like that would help children mental health.
So I think as an early careers psychiatrist, I think it's easy for us to just getengrossed into our work, but sometimes taking some time off to really be an advocate for
(19:12):
their patients going to Capitol Hill, or if not just joining the local APA branch in theirdistrict or ACAP branch in their district.
and participate in local advocacy is also very important.
Or, you know, just simply just joining the APA pack where we have advocacy alerts.
(19:37):
It's a newspaper that you get where it tells you what's going on in policy and also giveyou easy way to contact your representatives or senators to tell them
what you support and that helps move forward, know, psychiatry and mental health and aswell as child psychiatry.
(20:00):
I think those are things that early career psychiatrists can do em as well as if they'repart of RENSE training programs, right?
And they can also think about how can they teach in culturally responsive care fordifferent minority groups and marginalized groups and they can be involved with the.
(20:21):
those curriculum or being involved in the trainees uh in medical school curriculum aswell.
Given that, given this discussion, what do you think is one systemic shift that psychiatryshould take upon to try to prevent suicide and youth of color?
(20:41):
uh It could be grand vision, it could be unrealistic.
But uh yeah, we
What do you think is one wish that you have that can be a great shift in how we preventsuicide?
So I think you touched upon it a little bit before, but I think bringing mental health towhere people are.
(21:07):
So not just in our clinics, but also going to the community centers, the schools,churches, online platforms, making sure that we're raising awareness about mental health
and mental health in marginalized communities or communities that we don't often thinkabout.
I think, you know, often these communities are
ones that don't come to the clinic unless it's an emergency or the last resort.
(21:32):
And so how do we get to them um outside of the clinic?
So of course, we're gonna do that.
We have to bring it to these areas.
And so if there were to be one shift, I think is having these conversations in these otherforums.
whether that means different places of worships, having faith leaders talk about this.
(21:54):
having teachers, guidance counselors, uh classes about this, places where people will haveto see it, places where people really take what um the people who are there are saying um
as high regard.
So people, of course, uh view their faith leaders as people that they trust, theirteachers as people they trust.
(22:17):
And so those are people that we need to have talking about this.
think we can talk about it as much as we can.
in our clinics, but really to have a huge shift, we need our teachers, coaches, spiritualleaders, all talking about this and being able to recognize the warning signs and how to
respond with compassion.
(22:38):
I think that will make the biggest dent in suicide prevention.
Yes, I think I agree.
And I think that shows that we have to be partners to those local community organizations.
And I think perhaps being that partner, uh be their consultant, be their advisor, be theirway for a resource for these community to call upon us if needed is important.
(23:10):
in that case, I think
Perhaps what we're asking or having our listeners to consider is to be one of thoseresources.
Outreach your local school, outreach your local church or local grocery store, right?
Popular Asian American grocery store.
And it's like, hey, you know, I'm a psychiatrist.
(23:31):
You know, if you have any event, I would love to come talk to your community, things likethat.
Maybe that's what we're...
uh
We're kind of encouraging people to do, is that what you think is a good thing to say?
Yeah, I think so for sure.
um You know, I was talking to someone who's from the UK, their psychiatrist there, andthey work with marginalized communities and trying to help with stigma.
(23:55):
And I asked them, like, you know, how have they improved communities um where the stigmawas really high?
And how did they start those conversations?
Because, you know, some communities might not even want to talk about this.
So how do you start with those types of communities?
And they said first, they contacted people that were
(24:15):
revered to be very high in that community.
So like faith leaders, for example, had discussions with them, meetings with them, then itgrew bigger.
Like, okay, can I talk with your congregation?
So I think it has to start there.
I think people that actually people of this community trust need to be talking about this.
(24:35):
Why would they trust an outsider?
We need to learn from them.
It's not just a one way street.
for them to learn from us, we need to also learn from them.
There's a lot that we can learn from every person.
And so I think starting those conversations in any arena is really what's gonna make thechange happen.
Yes, yes.
And if any of our listeners are medical students, I also want to encourage you to thinkabout being that uh reach out to your own community.
(25:04):
I remember when I was in medical school, I actually started the Heavatize Dallas FortWorth Heavatize Bee Free project.
And we collaborated with the local organization and fairs and community events where wewould come to their community events and do we actually take their blood there.
and do a screening for hepatitis B and C.
(25:26):
And in that process, we also had educational booths and things like that.
And hepatitis B3 project is actually a national thing.
And it's part of a PAMSA, Asian Pacific American Medical Student Association.
And so if you're a listener and you're a medical student, try to start a PAMSA chapter inyour school and then build a mental health.
(25:53):
uh fair, you know, it can be have a ties be but now now we can do Asian American mentalhealth fair, right.
So there's many strategies that I encourage people to think about.
And if they're passionate about this, you know, I'm here as a resource that they cancontact I am in my work as the chair of the of the Minority Under Representative uh
(26:19):
Caucus, I can definitely provide
some resources and if I can't, I can lead them to the right person to help them withthings.
so, Pooja, is there other things you would like to mention?
uh
Yeah, so since you bring up a PAMSA, I'll say that our work group that we createdourselves um has a connection with a PAMSA.
(26:42):
We've been working with them over the past year on how we can collaborate.
And they just started a mental health committee within a PAMSA within the past year or so.
And so I know that that is something that I guess they felt that a lot of their membershipuh valued, which is great.
(27:03):
And they felt like there was a lot of interest amongst medical students.
And definitely we see psychiatry becoming more and more competitive with more and morepeople interested.
But they noticed this and we had talked to them about these statistics and they wereshocked and they were like, okay, we need to do more.
So I think that it is becoming more and more aware and there are so many organizations outthere.
(27:25):
And I think, like you said, starting from your med school is a great way to start.
I think you do have to start local.
to make a change happen.
think, you know, even in my own personal career, when I've been passionate aboutsomething, some of the feedback I've gotten is like, okay, what have you done at your
hospital about it?
And I think I really have used that to um just make decisions for myself or, you know,guide what I do.
(27:50):
And I think that is something that I hope people take away when listening to this.
Yes, thank you so much.
And yeah, so if you're listening to this, thank you for tuning in and I hope you foundsome of our discussion helpful for you and I hope that it encouraged you to be engaged and
(28:10):
connect with your own organization around you, whether that's medical school, RNC, orbeyond.
And thank you for talking with me, Bhuja.
I truly appreciate your time.
Thank you for joining us on Breaking the Silence, Addressing Youth Suicide.
Please visit the Medical Minds podcast homepage at psychiatry.org for more information anda resource document related to this episode.
(28:37):
We also invite you to visit psychiatry.org slash more equity, M-O-O-R-E-E-Q-U-I-T-Y formore information on the APA More Equity in Mental Health Initiative.
Take care.
The views and opinions expressed in this podcast are those of the individual speakers onlyand do not necessarily represent the views of the American Psychiatric Association.
(29:02):
The content of this podcast is provided for general information purposes only and does notoffer medical or any other type of professional advice.
If you are having a medical emergency, please contact your local emergency responsenumber.
And so I think as providers, of course, we have to treat every patient individually.
Every patient is different.
But I think we have to meet families where they are, think, starting these conversations,trying to normalize them as much as possible, trying to make sure that providers
understand the cultural values in their patients, especially AAPI populations.
(00:26):
think a lot of
Providers might not be aware of this high risk in this population.
This is a population known to have the model minority stereotype.
And thus this might not always be something that is at the forefront of providers mindswhen they have an AAPI patient come in.
(00:47):
Welcome to the APA More Equity series, Breaking the Silence, Addressing Youth Suicide.
Our host for this episode is Dr.
Krysti Vo, and joining her is Dr.
Poojajeet Khaira Dr.
Vo is a physician, innovator, and advocate committed to improving care for individualswith psychiatric and neurodevelopmental disorders.
(01:07):
With a background at the intersection of medicine and technology, Dr.
Vo has received over 20 awards,
and led initiatives to organizations like the American Psychiatric Association, A-CAP, andSAMHSA.
She currently serves as the APA Assembly Representative for the Asian American Caucus andChair of the Assembly MUR Committee.
She advises health tech startups on clinical innovation.
(01:30):
From shaping national policy to designing digital solutions, Dr.
brings a powerful blend of research, leadership, and vision to every conversation.
So now, let's break the silence with Dr.
Vo and Dr.
Kyra.
Hi, I'm Dr.
Krysti Vo and joining me today is Dr.
Bhujay Khara.
She's a psychiatry resident and a APA Foundation Leadership Fellow with a strongcommitment to medical education, health equity and reducing workplace violence.
(02:01):
Dr.
Khara, how about you say a few words about yourself?
Sure, thank you so much Dr.
Bowe for having me.
I'm also going to be the incoming chair for the assembly committee of resident fellowmembers.
And I'm currently the area for deputy representative for resident fellow members in theassembly.
(02:21):
And starting in July, I will be the representative for resident fellow members.
So that's really where this topic had started brewing.
Oh, great.
And thank you so from all your work and involvement in the APA and helping building thecommunity with fellows and residents.
It's I know it's a hard task to rally busy residents and fellows.
(02:45):
So I applaud your work.
So yeah, today we're talking about suicide in Asian American youth.
So what led you to be interested in working on this?
Sure.
So last year I had come across an article from JAMA Psychiatry that had shown that suicideis now the leading cause of death amongst Asian-American youths aged 15 to 24.
(03:14):
And this specific study was done over a 22-year period from 1999 to 2021.
And it showed a 72 % increase in suicide rates amongst AAPI male youth.
and 125 % increase amongst AAPI female youth.
And so this was something that I thought was super appalling.
I brought it up at a fellowship meeting and other fellows from the foundation found thisto be appalling as well and felt like we needed to do something about it, approach me and
(03:43):
asked if we wanted to work together to help with this cause.
And I brought it back to my assembly colleagues and there was multiple assembly reps thatwere also very passionate.
And from there, we formed a work group to try to see what we can do as resident fellowmembers to help with this really important cause.
Great.
(04:03):
And this work group, is it APA assembly people or also who does it involve?
It's a mix of assembly, RFM reps and dep reps and uh APA foundation fellows across all thefellowships actually.
So leadership fellows, public psych fellows, child fellows, SAMHSA fellows.
(04:25):
So it's been a mix, but it is all resident fellow members.
Great, great.
I think that's important because one, uh the residents and fellow are closest to the youthin a sense in terms of age and rate related ability.
And I think part of learning about suicide is really take perspective, perspective takingof what's going on in the Asian American youth.
(04:51):
And so from your perspective as a resident, how do you think being a frontline mentalhealth professional really
knowing about the increase in suicide among youth affects you.
Yeah, sure.
I think that's a really hard question to answer.
I think that, you know, I'm not too far from this age group myself.
And so it is something that I think is really sad to see, really shocking to see.
(05:15):
I have many friends that are in this age group and I see patients within this age groupall the time.
And I think it just makes me think that I need to be looking out for this more.
I think even though I identify as an Asian as well,
I don't think that this was always the first thing that came to my mind before I startedlooking into it.
So I think for me, it was a sad thing to see, but it also made me more aware of it andsomething that I like to share with other colleagues.
(05:43):
And I hope that even that brief awareness will help a patient.
Yeah.
And then what do you think are the key drivers to the increase in suicide in youth?
Sure.
So I feel that the COVID pandemic is one of the most important drivers in this increase.
(06:04):
Of course, we are all aware about it, but anti-Asian hate crimes rose by 339%.
And that's not even a fake number.
There is data that backs that up from 2020 to 2021.
And I feel like that has been a major contributor to stress amongst AAPI communities.
Of course, experiencing discrimination and hate crimes can lead to increased risk fordeveloping depression, anxiety, PTSD, and other mental health issues.
(06:29):
I also feel like the COVID pandemic was a time for not just AAPI, but any communities thatare marginalized to increase isolation that is felt across marginalized communities.
feel like especially, you know, when we see youth of color, these are communities that
already have so many characteristics that put them at higher risk of mental health issues.
(06:54):
I also feel like social media has come into play and has been more apparent, especiallyduring COVID time and post COVID time.
And I do feel like that is affecting what we see now.
But you know, also I'm wondering Dr.
Vo, you've been involved um in aspects of this for much longer than me.
You're more experienced practicing.
(07:16):
I'm wondering what
you feel like are the drivers for these increases.
I think there have been some research that shows an increase in social media use.
It's a bell curve where very little social media use can be a sign of mental health,depression, anxiety.
(07:36):
But very high social media use is also correlated with depression and anxiety.
And I think although that's just one study, and don't agree, as well as this observingtrend in our youth and young professional.
the addictive nature of social media that fuels comparison and fuels uh personalidentification, uh as well as any reeling of any insecurities we have, uh drives people to
(08:06):
have more depression, anxiety.
And I think that can lead to an increase in crisis, mental health crisis, and perhapssuicide.
While that's not extrapolated like directly the cause of suicide, I think uh
from the natural progression of the increase in social media leading to increaseddepression and anxiety, I think that can play a factor.
(08:27):
Well, what do you think we can do as mental health professional to help particularlyAsian-American youth to reduce any barriers to seeking care?
Because even though there is a sharp increase in mental health issues in Asian-Americanyouth, it seems they're less likely to access care.
Is that correct?
(08:48):
Yes, for sure.
So there have been studies that have shown that AAPI use face significantly high risk ofparents declining mental health services and that there's also been shown um that there's
a lack of initiation following mental health risk assessments um amongst parents in thispopulation.
(09:09):
And so I think as providers, know, of course we have to treat every patient individually.
Every patient is different.
But I think we have to meet families where they are.
think starting these conversations, trying to normalize them as much as possible, tryingto make sure that providers understand the cultural values in their patients, especially
(09:31):
AAPI populations.
I think raising awareness about this.
think a lot of providers might not be aware of this high risk in this population.
This is a population known to have
the model minority stereotype.
And thus this might not always be something that is at the forefront of providers mindswhen they have an AAPI patient come in.
(09:55):
So I think starting those conversations, I think also developing more cultural resources.
I think also seeing, you know, how can we meet that family where they are and working withthem over time as we build rapport.
to decrease the stigma, also address intergenerational conflicts.
I think there's a lot that still needs to be done.
(10:16):
And you know, this is a population where there's not that much research.
And so I think also looking into that and looking into funding resources for that would bea big help.
Yes, yes, think yes.
uh Education awareness, having those conversations with healthcare professionals canreally be powerful.
(10:40):
In regards to working with healthcare professionals, when it comes to cultural responsivecare, what do you think?
How does that look like in practice?
Yeah, so I feel like this is again going to be different for every patient, but I thinkit's seeing the patient for everything that they are, not just their symptoms.
(11:01):
So, you know, for a PI population, many of them are immigrants, many of them, you know, ummight be first generation, second generation.
And so understanding that that is a part of their story, understanding familyexpectations, cultural beliefs about mental health.
Also recognizing that they might have interacted or faced racism, xenophobia orgenerational trauma and noticing that and then talking about that with the patient and
(11:31):
seeing how that could affect their story and how they're presenting today.
I think of course it's gonna be different for every patient like I said, but just stoppingfor a moment thinking about those aspects, building trust with the patient, involving the
family when it's appropriate.
and validating their experiences will go a long way.
(11:52):
Of course, it's not a one size fits all approach, but I think it's being intentional,being deeply empathetic, and trying to relate to our patients.
Yeah, I agree with that.
so for youth that has multiple identities, maybe say a queer Asian American teen, uh or anundocumented person, what additional layers of support or cultural understanding do you
(12:21):
think are critical in care delivery?
So of course that's gonna put them at a higher risk for mental health, poor mental healthoutcomes.
So I think we have to think about who is their community, who is their support.
And we have to think about aspects beyond just the patient or beyond the family.
We have to think about the schools, other community groups that could provide furthersupport.
(12:45):
We need to think about how all of those aspects of the patient is interfering with theircare or their presentation.
I personally have had
multiple patients who are of this community who also identify as queer or of the LGBTQcommunity.
And I know in practice, we have put a lot of effort at my institution into connecting themwith uh social groups at their university that can add to that support.
(13:14):
But, know, Dr.
Vo, I want to know in your clinical practice, what have you done?
Um, or have you faced this and I want to know more about your experience with this.
think when it comes to multiple marginalized identities that some of these youth identifywith, think referring them to resources for those multiple identities, like for example, a
(13:34):
queer group or community oh of identified identity that they can rely on is great.
But at the same time, it's also about educating the family.
I think sometimes we should outreach families at these community centers.
Like let's say the local
(13:54):
grocery store or that local, you know, Lunar New Year festival.
I think there should be more mental health awareness being raised.
Let's say there's a boost, let's just have education about mental health and suicide inAsian American teens, right?
I think targeting the parents and the family is educating them about the increased mentalhealth crisis in these youth is one of a key factor because sometimes
(14:24):
Parents aren't aware or they have too much going on to pay attention.
And having a conversation with the parent to say, have you talked to your kid recently?
Can be powerful.
Because sometimes these kids already felt, feels unheard, unseen by their parents.
(14:45):
So if we educate their families and parents to have a conversation with their youth, thatcan be powerful.
I was just going to add that I do think that even though there's so much more work thatneeds to be done for this population, I think that there are people across the country um
doing some projects related to this.
(15:08):
I would have from what I've read or what I've attended, I have seen them trying to focuson that conversation between the parent and the youth or the child on how to bring up a
mental health concern or, you know, the parent might not know what's going on with thechild.
And they don't, you know, they see it more as like the child maybe um being secluded ormaybe uh isolating themselves, but they don't recognize that, these are symptoms of
(15:37):
depression.
So I definitely think that education piece can go a long way.
And of course, with helping with stigma, we need that education piece.
Yes, and I wonder if schools is the natural environment to educate the parents throughbecause a lot of parents are involved or at least they monitor their Asian American kids
(15:59):
performance.
And I wonder if programs through the school to engage the parents in some of these uhraising awareness of these issues could go through the school so that the parents can pay
attention to more.
I'm wondering.
out loud here.
But ah yeah, perhaps other people are working on this as well.
(16:22):
And with you, I know that you would do a lot of work with trying to have trainees andearly career psychiatrists work in this suicide prevention space.
How has that been going?
And what have you guys been doing?
Yeah,
I think we've really been trying to make a dent in this and make um people aware of thisissue.
(16:43):
I think that often trainees might not realize their power and I don't think that um alltrainees have this perspective that at the trainee level they can make a difference.
But that has been something that has been a driving force for me and a lot of thecolleagues that I work with is showing trainees that their opinions matter and
(17:04):
that they can make a difference.
think trainees bring fresh perspectives and live experience that often reflect thecommunities we serve.
We are often the frontline workers in our clinics.
And I think that there's a lot of new things happening that are coming from trainees.
I think this push for curriculums about cultural humility, trauma-informed care, a lot ofthat is coming from these younger generations.
(17:30):
think, you know, we are people that are speaking out about
burnout, racism, and access issues, and that impacts both our patients, but alsoourselves.
And so I think from what I've seen from all of my colleagues who are resident fellowmembers, there has been a strong push about getting us out there and focusing on advocacy
and what we can do to truly make a difference.
(17:52):
So I think it's not just being a great clinician and knowing all of the pathology, butalso being able to advocate for our patients.
And I know Dr.
Vo that
My understanding is you're an early career psychiatrist, right?
And so I would love to hear your perspective too on, you know, what you feel like earlycareer psychiatrists bring to the table because resident fellow members to early career
(18:17):
psychiatrist is such a big transition, but also we share so many similarities.
Yes, yes.
So speaking of advocacy, I was just at ACAP uh at this legislative conference, is today,today, being on Capitol Hill and learning about what policy is affecting the current uh
(18:41):
federal landscape right now.
And then we also go and talk to senators and House of Representatives to uh tell them tosupport things like Medicaid for children.
uh to support things like that would help children mental health.
So I think as an early careers psychiatrist, I think it's easy for us to just getengrossed into our work, but sometimes taking some time off to really be an advocate for
(19:12):
their patients going to Capitol Hill, or if not just joining the local APA branch in theirdistrict or ACAP branch in their district.
and participate in local advocacy is also very important.
Or, you know, just simply just joining the APA pack where we have advocacy alerts.
(19:37):
It's a newspaper that you get where it tells you what's going on in policy and also giveyou easy way to contact your representatives or senators to tell them
what you support and that helps move forward, know, psychiatry and mental health and aswell as child psychiatry.
(20:00):
I think those are things that early career psychiatrists can do em as well as if they'repart of RENSE training programs, right?
And they can also think about how can they teach in culturally responsive care fordifferent minority groups and marginalized groups and they can be involved with the.
(20:21):
those curriculum or being involved in the trainees uh in medical school curriculum aswell.
Given that, given this discussion, what do you think is one systemic shift that psychiatryshould take upon to try to prevent suicide and youth of color?
(20:41):
uh It could be grand vision, it could be unrealistic.
But uh yeah, we
What do you think is one wish that you have that can be a great shift in how we preventsuicide?
So I think you touched upon it a little bit before, but I think bringing mental health towhere people are.
(21:07):
So not just in our clinics, but also going to the community centers, the schools,churches, online platforms, making sure that we're raising awareness about mental health
and mental health in marginalized communities or communities that we don't often thinkabout.
I think, you know, often these communities are
ones that don't come to the clinic unless it's an emergency or the last resort.
(21:32):
And so how do we get to them um outside of the clinic?
So of course, we're gonna do that.
We have to bring it to these areas.
And so if there were to be one shift, I think is having these conversations in these otherforums.
whether that means different places of worships, having faith leaders talk about this.
(21:54):
having teachers, guidance counselors, uh classes about this, places where people will haveto see it, places where people really take what um the people who are there are saying um
as high regard.
So people, of course, uh view their faith leaders as people that they trust, theirteachers as people they trust.
(22:17):
And so those are people that we need to have talking about this.
think we can talk about it as much as we can.
in our clinics, but really to have a huge shift, we need our teachers, coaches, spiritualleaders, all talking about this and being able to recognize the warning signs and how to
respond with compassion.
(22:38):
I think that will make the biggest dent in suicide prevention.
Yes, I think I agree.
And I think that shows that we have to be partners to those local community organizations.
And I think perhaps being that partner, uh be their consultant, be their advisor, be theirway for a resource for these community to call upon us if needed is important.
(23:10):
in that case, I think
Perhaps what we're asking or having our listeners to consider is to be one of thoseresources.
Outreach your local school, outreach your local church or local grocery store, right?
Popular Asian American grocery store.
And it's like, hey, you know, I'm a psychiatrist.
(23:31):
You know, if you have any event, I would love to come talk to your community, things likethat.
Maybe that's what we're...
uh
We're kind of encouraging people to do, is that what you think is a good thing to say?
Yeah, I think so for sure.
um You know, I was talking to someone who's from the UK, their psychiatrist there, andthey work with marginalized communities and trying to help with stigma.
(23:55):
And I asked them, like, you know, how have they improved communities um where the stigmawas really high?
And how did they start those conversations?
Because, you know, some communities might not even want to talk about this.
So how do you start with those types of communities?
And they said first, they contacted people that were
(24:15):
revered to be very high in that community.
So like faith leaders, for example, had discussions with them, meetings with them, then itgrew bigger.
Like, okay, can I talk with your congregation?
So I think it has to start there.
I think people that actually people of this community trust need to be talking about this.
(24:35):
Why would they trust an outsider?
We need to learn from them.
It's not just a one way street.
for them to learn from us, we need to also learn from them.
There's a lot that we can learn from every person.
And so I think starting those conversations in any arena is really what's gonna make thechange happen.
Yes, yes.
And if any of our listeners are medical students, I also want to encourage you to thinkabout being that uh reach out to your own community.
(25:04):
I remember when I was in medical school, I actually started the Heavatize Dallas FortWorth Heavatize Bee Free project.
And we collaborated with the local organization and fairs and community events where wewould come to their community events and do we actually take their blood there.
and do a screening for hepatitis B and C.
(25:26):
And in that process, we also had educational booths and things like that.
And hepatitis B3 project is actually a national thing.
And it's part of a PAMSA, Asian Pacific American Medical Student Association.
And so if you're a listener and you're a medical student, try to start a PAMSA chapter inyour school and then build a mental health.
(25:53):
uh fair, you know, it can be have a ties be but now now we can do Asian American mentalhealth fair, right.
So there's many strategies that I encourage people to think about.
And if they're passionate about this, you know, I'm here as a resource that they cancontact I am in my work as the chair of the of the Minority Under Representative uh
(26:19):
Caucus, I can definitely provide
some resources and if I can't, I can lead them to the right person to help them withthings.
so, Pooja, is there other things you would like to mention?
uh
Yeah, so since you bring up a PAMSA, I'll say that our work group that we createdourselves um has a connection with a PAMSA.
(26:42):
We've been working with them over the past year on how we can collaborate.
And they just started a mental health committee within a PAMSA within the past year or so.
And so I know that that is something that I guess they felt that a lot of their membershipuh valued, which is great.
(27:03):
And they felt like there was a lot of interest amongst medical students.
And definitely we see psychiatry becoming more and more competitive with more and morepeople interested.
But they noticed this and we had talked to them about these statistics and they wereshocked and they were like, okay, we need to do more.
So I think that it is becoming more and more aware and there are so many organizations outthere.
(27:25):
And I think, like you said, starting from your med school is a great way to start.
I think you do have to start local.
to make a change happen.
think, you know, even in my own personal career, when I've been passionate aboutsomething, some of the feedback I've gotten is like, okay, what have you done at your
hospital about it?
And I think I really have used that to um just make decisions for myself or, you know,guide what I do.
(27:50):
And I think that is something that I hope people take away when listening to this.
Yes, thank you so much.
And yeah, so if you're listening to this, thank you for tuning in and I hope you foundsome of our discussion helpful for you and I hope that it encouraged you to be engaged and
(28:10):
connect with your own organization around you, whether that's medical school, RNC, orbeyond.
And thank you for talking with me, Bhuja.
I truly appreciate your time.
Thank you for joining us on Breaking the Silence, Addressing Youth Suicide.
Please visit the Medical Minds podcast homepage at psychiatry.org for more information anda resource document related to this episode.
(28:37):
We also invite you to visit psychiatry.org slash more equity, M-O-O-R-E-E-Q-U-I-T-Y formore information on the APA More Equity in Mental Health Initiative.
Take care.
The views and opinions expressed in this podcast are those of the individual speakers onlyand do not necessarily represent the views of the American Psychiatric Association.
(29:02):
The content of this podcast is provided for general information purposes only and does notoffer medical or any other type of professional advice.
If you are having a medical emergency, please contact your local emergency responsenumber.
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