Racism provoked during the COVID-19 pandemic is directly tied to increased firearm purchases among Asian Americans, according to a study led by researchers at the University of Michigan and Eastern Michigan University.
The study, published in the Journal of Racial and Ethnic Health Disparities, is believed to be the first to examine the relationship between racism, mental distress, alcohol use and firearm purchasing behavior among Asian Americans during the pandemic.
Evaluation of the data showed that experiencing racism was both directly and indirectly related to firearm purchases.
"Since the beginning of the COVID-19 pandemic, Asian Americans have experienced multiple threats, including hostile rhetoric, violence, exposure to invectives, negative stories in the media, and anti-Asian hate and incidents," said lead author Tsu-Yin Wu, professor and director of the Center for Health Disparities Innovation and Studies at Eastern Michigan University.
"The study results showed that Asian Americans' racism experience is associated with increased mental distress, alcohol use and firearm purchases. The mechanism further illustrated that mental distress and alcohol use were also linked to firearm purchases, which means racism affects firearm purchase in a heightened way both directly and indirectly."
A major focus of last month's historic mental health summit at the White House, was the Biden-Harris Administration's commitment to improving equity and access to behavioral health care for AA and NHPI communities.
In the wake of the COVID-19 pandemic, rising anti-Asian hate, and the twin public health and public safety epidemic of gun violence, AA and NHPI communities have been deeply impacted by the nation’s mental health crisis. And the task of expanding access to quality and culturally competent medical, including mental health services for AA and NHPI individuals has only grown more urgent.
In 2020, suicide was the leading cause of death among Asian Americans and Pacific Islanders, ages 10 to 19, and the second leading cause of death among those ages 20-34. And AA and NHPIs currently face unique barriers to behavioral health care, including:
Language barriers, which can make it difficult for AA and NHPIs to access behavioral health services;
The White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI) and the US Department of Health and Human Services (HHS) hosted the historic summit in recognition of National Minority Mental Health Awareness Month, building on the Administration’s unprecedented investments to connect more Americans to care.
Through the President’s Mental Health Strategy and other initiatives, the Biden-Harris Administration is leading a whole-of-society approach to transform behavioral health services and bolster support, particularly for underserved communities, including AA and NHPI communities.
Over the past two years, federal agencies have worked to eliminate barriers to care; expand the full continuum of prevention, treatment, and recovery services; and prioritize integration of these services into settings where they can be more easily accessed.
Federal agencies have directed funding to agencies focusing in erasing the gap in mental health care delivery and care. Some of the programs, which range from combating human trafficking, disaggregating data of the diverse AANHIPI communities and fighting hate crimes, include:
The National Network to Eliminate Disparities in Behavioral Health (NNED), a network of more than 1,500 community-based organizations serving underserved communities across the U.S., including AA and NHPI populations, focused on the mental health and substance use issues facing diverse racial and ethnic communities.
$1 million in September 2022, through a cooperative agreement to Pouhana O Na Wahine, to serve as FVPSA’s national technical assistance provider for the Native Hawaiian communities and to establish the first ever Native Hawaiian Resource Center on Domestic Violence (NHRCDV).
The Interagency Island Affairs Council. Launched in 2022, this council convenes federal leaders to identify, coordinate, and advance funding, programmatic, and policy issues to improve health equity in the U.S. Territories and Freely Associated States. CDC also funds the Pacific Island Health Officers Association, which trains the next generation of public health leaders through its Pacific Public Health Fellowship Program. A National Action Plan to Combat Human Trafficking which calls for HHS to provide training and technical assistance for health and human service professionals working with populations at high risk for human trafficking and intersecting with NHPI community programs.
HHS’s Office of Minority Health is the lead response agency for the Memorandum Condemning and Combating Racism, Xenophobia, and Intolerance Against Asian Americans and Pacific Islanders in the United States. HHS and the U.S. Department of Justice (DOJ) jointly issued guidance in May 2022 aimed at raising awareness of hate crimes and incidents committed on the basis of personal or group characteristics.
The mass shootings in Monterey Park and Half Moon Bay were committed by older Asian American men are tragic reminders that many AANHPI elderly are not receiving the care they need.
While loneliness affects elders of all ages, language and cultural barriers and fear caused by the anti-Asian hate attacks exacerbates the problem among AANHPI senior citizens, who would rather sweep the feeling under the rug than to talk to strangers about it.
To bring attention to the issue rarely talked about in the AANHPI communities, Surgeon General Murthy, an Indian American medical professional, issued the following opinion article:
By Vivek H. Murthy United States Surgeon General
Mental health is the defining public health crisis of our time, and for many Americans, loneliness is at the heart of that crisis. At any given moment, about one out of every two of our fellow citizens is experiencing measurable levels of loneliness. It is not something we talk about or easily see: Loneliness is a condition that is hidden in the shadows.
More than just a bad feeling, loneliness is a corrosive condition with grave consequences. Social disconnection puts us at increased risk for depression, anxiety and suicide, as well as heightening our risk for stress-related physical ailments like heart disease, stroke and dementia. Its impact on our risk of premature death is on par with smoking 15 cigarettes daily.
Why is this so? It is because we evolved to live in community. As hunter-gatherers, we found safety in togetherness. Being isolated from the group put the individual at elevated risk — from predators, from starvation, from exposure — and that created stress. Our survival depended on being a part of something larger than just ourselves.
As much as our circumstances are very different today than they were in our hunter-gatherer days, that basic truth remains: We are hardwired to live in community. Connection is the essential glue of our lives. It is what brings us happiness and fulfillment. We need social connection for our survival and collective well-being.
This epidemic of loneliness has been building over many years. The pandemic made it worse, to be sure, but it is a crisis that has been evolving for a half-century or more. During that time, there has been declining participation in communal life. Fewer people belong to churches or synagogues or other religious institutions or are engaged with civic organizations. We, as a society, move around more. We change jobs more frequently. We don’t put down roots in the same ways as our parents and grandparents.
Too often, we imagine loneliness as a condition of the elderly living in isolation with no one to support them. While that can be true, loneliness in the United States is not limited to older Americans. There are people in marriages who are lonely, CEOs of major companies who are lonely, seemingly happy people posting pictures of their fabulous vacations on social media who are lonely. And far too many young people who are lonely. From the outside, everything looks fine. But inside, they are struggling.
Addressing this national crisis is a profound challenge. We all want to be seen and understood. Sometimes all we need is acknowledgment of our worth and value. This is something we can do for each other — and for ourselves. Taking just 15 minutes a day to reach out to someone you care about can make a huge difference in how connected we feel.
There is nothing more fundamental to the health and well-being of people in our country than ensuring that we are building a moral and spiritual foundation that guides how we interact with each other. Toward that goal, service is one of the greatest antidotes to loneliness. When we help somebody else, two things happen. One is we forge a connection with them. The second is that we remind ourselves that we have value, and that can help us in times of our own loneliness. The less worthy we feel, the harder it is to reach out to other people.
I know this from my own experience. When my first stint as Surgeon General ended abruptly in 2017, I felt profoundly lonely. During my time as Surgeon General, I threw myself into the job at the expense of my friendships. When the job ended, I was left without those relationships that had sustained me before. I was lonely, and also ashamed. I believed it was my fault because I had neglected those relationships. It was a choice I had made, and I felt embarrassed to call my friends and say, “Hey, I’m sorry I wasn’t there for you for the last two-and-a-half years.” It took the urging of my wife, who recognized what was happening to me and that I was withdrawing more and more, to reach out to reconnect.
One of the best definitions of a friend that I ever heard was when I was in college: A friend is somebody who reminds you of who you are when you forget. And we all do forget from time to time. We all go through periods in our life when we feel unworthy or that we fall short. That is when we need our friends to step in. That is why I think that at a time such as we are now experiencing, when as a community we are struggling so much with our mental health, we need these connections in our lives.
Yes, we do need more psychiatrists and better access to psychiatric care to address the mental health crisis that confronts our country. Yes, we do need more psychologists. Yes, we need the technology to bring the care that is needed to people in their homes.
"We need to come up with ways to tip the balance toward love and away from fear, to rebuild the public square so that we can once again speak rationally with each other."
But we also need each other. We need to turn our attention to reinforcing the caring, supportive institutions, communities and relationships that give our lives purpose and meaning. We need to come up with ways to tip the balance toward love and away from fear, to rebuild the public square so that we can once again speak rationally with each other. To address this crisis of loneliness, we need to return to the core values of kindness, generosity and friendship that are so essential to the social fabric of our communities.
Ultimately, it comes down to one thing: Embrace love. It has the extraordinary capacity to heal and is the force we need to reach for each and every day in our lives. Love is our oldest medicine.
FYI: This column is adapted from a conversation Dr. Murthy had with Oprah Winfrey at UCLA’s Royce Hall in May during the 2023 WOW (Wisdom of Wellness) Mental Health Summit to benefit the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA and the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA.
Krystal Ka'ai, Executive Director of the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders.
This year's mass shooters in Monterey Park and Half Moon Bay, the suicide of popular singer Coco Lee, the trauma suffered by Asian American elders in the season of anti-Asian hate are all recent examples of the growing need to address the mental health needs of Asian Americans.
“Asian Americans, Native Hawaiians, and Pacific Islanders face unique barriers to behavioral health care, and today’s summit is a critical step in destigmatizing psychological needs, improving health outcomes, and expanding access to quality, affordable mental health services for our communities,” said Krystal Ka‘ai, Executive Director of the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders.
July is Minority Mental Health Awareness Month and last week, the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the US Department of Health and Human Services (HHS) hosted an in-person summit focused on improving equity and access to behavioral health care for Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) communities.
“Our national survey data shows that Asian Americans, Native Hawaiians and Pacific Islanders have significant mental health needs and concerns,” said Dr. Miriam Delphin-Rittmon, HHS Assistant Secretary for Mental Health and Substance Use and leader of SAMHSA, which co-hosted the July 20 mental health summit.
Held in recognition of National Minority Mental Health Awareness Month, the historic event featured officials from key federal agencies, mental health professionals, researchers, federal policymakers, community organizations, and Biden-Harris Administration leaders -- including members of President Biden’s Cabinet. Through five issue-specific conversations, attendees worked to identify innovative federal and local solutions for the unique behavioral health challenges AA and NHPIs face.
“The well-being of Asian American, Native Hawaiian, and Pacific Islander individuals and families hold tremendous significance in our efforts to build a healthier nation,” said Secretary of Health and Human Services Xavier Becerra.
“At HHS, we embrace cultural competency and are committed to making behavioral health services accessible to underserved communities. This inaugural event will help to strengthen our efforts around behavioral health for AA and NHPIs,” said Becerra.
AA and NHPI communities have been deeply impacted by America’s mental health crisis, with the COVID-19 pandemic and anti-Asian sentiment fueling a rise in depression, anxiety, stress, and physical symptoms.
According to federal data, in 2020, suicide was the leading cause of death among Asian Americans and Pacific Islanders, ages 10 to 19, and the second leading cause of death among those ages 20-34.
The political and cultural conditions that have generated anti-Asian hate has created a shaky mental health environment for AA and NHPIs.
The mental health woes are compounded because AA and NHPIs are some of the least likely communities to seek mental health treatment due to longstanding barriers – including cultural stigma, the lack of culturally competent care providers, and language barriers.
HEALTH AND HUMAN SERVICES
HHS Secretary Xavier Becerra spoke at the first ever AA and NHPI mental health summit held at the White House.
The July 20 event, the first AA and NHPI mental health summit ever convened the Biden-Harris Administration, is the direct result of a May 2022 recommendation from the President’s Advisory Commission on AA and NHPIs. It also follows the release of the Administration’s first-ever national strategy to advance equity and opportunity for AA and NHPI communities in January 2023, and builds on President Biden’s comprehensive national strategy to transform how mental health is understood and treated.
In May 2021, President Joe Biden re-established and reinvigorated the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders through Executive Order 14031. The Initiative engages federal agencies to improve interagency policymaking, program development, and outreach, and address barriers impacting AA and NHPIs across the country.
“If we want to raise the bar in education, we must ensure our students feel safe, seen, and supported while at school. Yet the pandemic led to troubling declines in mental health for all students, including our Asian American, Pacific Islander, and Native Hawaiian students,” said US Secretary of Education Miguel Cardona.
“Because the AA and NHPI population is not monolithic, it is important to not only recognize the health disparities the whole community faces, but also the specific, distinct health inequities among these communities.”
Suicide is the leading cause of death among young Asian Americans. Native Hawaiians and Pacific Islanders, ages 15-24.
The convergence of AANHPI Heritage Month and Mental Health Awareness Month allows for the timely discussion of the two topics. For a number of reasons, mental health is little talked about in the AANHPI community. Its time we change that.
Below, we reprint an article from The Conversation penned by Amelia Noor-Oshiro on a topic that will surprise many of our readers and hopefully bring some attention to this disturbing topic.
AAPI young adults are the only racial group with suicide as their leading cause of death, so why is no one talking about this?
Racially motivated violence looks like the mass shootings that killed Xiaojie Tan, Daoyou Feng, Chung Park, Hyun Grant and Suncha Kim in Atlanta on March 16, 2021. Racially motivated violence also looks like suicide, which is defined as a deliberate act of self-directed violence in order to cause injury to oneself that results in death.
According to data from the Centers for Disease Control and Prevention, suicide is the 10th leading cause of death in the United States. When broken down by race, suicide is the first leading cause of death among Asian American young adults age 15-24. This is true of no other racial group in this age range in America.
Despite this disparity, very little attention is paid by society and by gatekeeping institutions like academe and private and public funding agencies as to what causes suicidal behavior among racial minorities like Asian Americans. There is not enough research on how to prevent suicide among Asian Americans in particular. What makes this research more challenging to do is that Asian Americans are also the least likely racial group to seek and utilize mental health services.
I am a doctoral candidate studying public health, with a focus on minority mental health disparities research. Here’s what I think is important to know about how violence, suicide and disparities all connect to affect Asian American lives.
Beyond risk factors
When an Asian American death occurs by suicide, it is not simply because that person experienced risk factors. Sure, the evidence suggests that the risk of a suicide attempt increases if there are easily accessible means such as guns in the home or if the person knows someone who died by suicide. But is that the full picture for Asian Americans, or even for other racial minorities?
The truth is, the people who study suicide are still trying to come up with a profile of who is “at risk” in order to precisely predict, and ultimately prevent, suicidal behavior and death. Today, many research dollars go into the development of computer algorithms and genetic biomarkers to precisely calculate who is at risk. Will these methods do justice to the racialized experience of being Asian American in the U.S.?
Only one national study targeting Asian American mental health
So the question now becomes: How can research scientists better understand and develop suicide prevention efforts that precisely address racial minorities like Asian Americans? To answer this question, there must first be research on Asian Americans to study.
Unfortunately, the first, only and last study that assesses national epidemiological prevalence estimates of mental disorders in the Asian American community occurred and was published in the early 2000s, nearly two decades ago. Since these data were collected, the U.S. Asian population grew 72% by 2015, making Asians the fastest-growing racial or ethnic group, surpassing Hispanics.
In my view, suicide among Asian Americans is a seriously unaddressed problem that could become endemic in a rapidly growing community with little to no direction on how to stop it.
Centuries of stigma
What if there was a way to scientifically account for racism as the fundamental cause of health disparities? The answer lies in understanding stigma.
Stigmatized identity is arguably a universal phenomenon. People who are stigmatized are unwanted by society, negatively stereotyped, rejected and excluded, and ultimately othered. Asian Americans have experienced this kind of stigmatization institutionally since the early years of modern America as racial categorizations began to solidify.
As America continues to racialize Asian Americans, it continues a legacy of structural violence and historical trauma. This means that anti-Asian violence exists within the very fabric of American society. It is this societal oppression and violence that becomes internalized into self-hatred, self-harm and ultimately the self-directed violence that is suicide.
When it comes to being Asian in America, though, the story is incomplete with looking only at race. There are plenty of violently oppressive systems that Asian Americans face that pile on the risk of self-directed violence. These are intersecting in nature. It is the intersectionality, or cross-sections, of Asian American identity that must be closely investigated to uncover insights into suicide prevention for this incredibly diverse community.
Being an immigrant and experiencing xenophobia, for example, is a dominant experience for many Asian Americans. Although many have lived in the United States for several generations, Asian Americans do account for a large portion of today’s adult second generation. Second-generation immigrants are people who are native-born citizens in the United States and have at least one parent who is foreign-born.
What makes this important to know?
Current trends indicate that the U.S. is explosively growing into an immigrant-rich nation. More than 36% of all Americans are projected to be of immigrant origin – that’s first- or second-generation – by 2050. By that time, the overwhelming majority – 93% – of the country’s working-age population will be of immigrant origin, too. Here’s the problem: Second-generation immigrants are considered an at-risk group for suicidal behavior and death by researchers across the world. Researchers aren’t fully sure why yet, and that’s why this research is so timely.
A complicated and time-consuming issue
Research takes decades to implement. It also takes decades to figure out the problem and how to address it. The public health scientists who work on disparities research are aware of the complex problems facing minority populations like Asian Americans. If there were an intervention to end racism and xenophobia, perhaps many Asian American lives would be saved both from homicide and suicide.
The reality is that white supremacy runs so deep in America that even reversing racism would not undo the disparities in health outcomes such as suicide. This is because assimilation is “traumagenic.” That means the traumatic exposures of racist and xenophobic violence and discrimination hold the power to disrupt psychological and physiological functioning and alter genetic code for generations to come. Race-based traumatic stress holds the power to predispose entire populations, entire communities like Asian Americans, to self-directed violence.
In my view, what is left to do is to work to change the norms of inclusion. It won’t take years of research to do that. Just start now. Act locally. Here’s a first step.
ABOUT THE AUTHOR: Amelia Noor-Oshiro, Ph.D. Candidate, Public Health: Social & Behavioral Sciences, Johns Hopkins University
EDITOR'S NOTE: For additional commentary, news and views from an AANHPI perspecitve, follow @DioknoEd on Twitter.
