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.

Transcript for Audio

[00:03] Dr. Poojajeet Khaira: 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. 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 minds when they have an AAPI patient come in.

[00:47] Fatima Reynolds: 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 individuals with psychiatric and neurodevelopmental disorders. 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, and SAMHSA. She currently serves as the APA Assembly Representative for the Asian American Caucus and Chair of the Assembly MUR Committee. She advises health tech startups on clinical innovation. 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.

[01:44] Dr. Krysti Vo: 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 strong commitment to medical education, health equity and reducing workplace violence. Dr. Khara, how about you say a few words about yourself?

[02:04] Dr. Poojajeet Khaira: 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 fellow members. And I'm currently the area for deputy representative for resident fellow members in the assembly. And starting in July, I will be the representative for resident fellow members. So that's really where this topic had started brewing.

[02:30] Dr. Krysti Vo: Great. And thank you so from all your work and involvement in the APA and helping building the community with fellows and residents. It's I know it's a hard task to rally busy residents and fellows. 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?

[02:59] Dr. Poojajeet Khaira: Sure. So last year I had come across an article from JAMA Psychiatry that had shown that suicide is now the leading cause of death amongst Asian-American youths aged 15 to 24. 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 this to be appalling as well and felt like we needed to do something about it, approach me and 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 that were also very passionate.

And from there, we formed a work group to try to see what we can do as resident fellow members to help with this really important cause.

[04:02] Dr. Krysti Vo: Great. And this work group, is it APA assembly people or also who does it involve?

[04:11] Dr. Poojajeet Khaira: It's a mix of assembly, RFM reps and dep reps and APA foundation fellows across all the fellowships actually. So leadership fellows, public psych fellows, child fellows, SAMHSA fellows. So it's been a mix, but it is all resident fellow members.

[04:30] Dr. Krysti Vo: Great, great. I think that's important because one, the residents and fellow are closest to the youth in a sense in terms of age and rate related ability. And I think part of learning about suicide is really take perspective, perspective taking of what's going on in the Asian American youth. And so from your perspective as a resident, how do you think being a frontline mental health professional really knowing about the increase in suicide among youth affects you.

[05:03] Dr. Poojajeet Khaira: 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. I have many friends that are in this age group and I see patients within this age group all 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 started looking into it. So I think for me, it was a sad thing to see, but it also made me more aware of it and something that I like to share with other colleagues. And I hope that even that brief awareness will help a patient.

[05:49] Dr. Krysti Vo: Yeah. And then what do you think are the key drivers to the increase in suicide in youth?

[05:56] Dr. Poojajeet Khaira: Sure. So I feel that the COVID pandemic is one of the most important drivers in this increase. 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 for developing depression, anxiety, PTSD, and other mental health issues. I also feel like the COVID pandemic was a time for not just AAPI, but any communities that are 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. I also feel like social media has come into play and has been more apparent, especially during 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 in aspects of this for much longer than me. You're more experienced practicing. I'm wondering what you feel like are the drivers for these increases.

[07:22] Dr. Krysti Vo: 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. 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 observing trend in our youth and young professional the addictive nature of social media that fuels comparison and fuels personal identification, as well as any reeling of any insecurities we have, drives people to have more depression, anxiety. And I think that can lead to an increase in crisis, mental health crisis, and perhaps suicide. While that's not extrapolated like directly the cause of suicide, I think from the natural progression of the increase in social media leading to increased depression and anxiety, I think that can play a factor. Well, what do you think we can do as mental health professional to help particularly Asian-American youth to reduce any barriers to seeking care? Because even though there is a sharp increase in mental health issues in Asian-American youth, it seems they're less likely to access care. Is that correct?

[08:48] Dr. Poojajeet Khaira: Yes, for sure. So there have been studies that have shown that AAPI use face significantly high risk of parents declining mental health services and that there's also been shown that there's a lack of initiation following mental health risk assessments amongst parents in this population. 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, trying to make sure that providers understand the cultural values in their patients, especially 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 minds when they have an AAPI patient come in. 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 with them 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. 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 be a big help.

[10:27] Dr. Krysti Vo: Yes, yes, think yes. Education awareness, having those conversations with healthcare professionals can really be powerful. In regards to working with healthcare professionals, when it comes to cultural responsive care, what do you think? How does that look like in practice?

[10:49] Dr. Poojajeet Khaira: Yeah, so I feel like this is again going to be different for every patient, but I think it's seeing the patient for everything that they are, not just their symptoms. So, you know, for a PI population, many of them are immigrants, many of them, you know, might be first generation, second generation. And so understanding that that is a part of their story, understanding family expectations, cultural beliefs about mental health.

Also recognizing that they might have interacted or faced racism, xenophobia or generational trauma and noticing that and then talking about that with the patient and 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 stopping for 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. 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.

[12:02] Dr. Krysti Vo: Yeah, I agree with that. so for youth that has multiple identities, maybe say a queer Asian American teen, or an undocumented person, what additional layers of support or cultural understanding do you think are critical in care delivery?

[12:25] Dr. Poojajeet Khaira: So of course that's gonna put them at a higher risk for mental health, poor mental health outcomes. 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 further support. We need to think about how all of those aspects of the patient is interfering with their care or their presentation. I personally have had multiple patients who are of this community who also identify as queer or of the LGBTQ community. And I know in practice, we have put a lot of effort at my institution into connecting them with social groups at their university that can add to that support. But, know, Dr. Vo, I want to know in your clinical practice, what have you done, or have you faced this and I want to know more about your experience with this.

[13:25] Dr. Krysti Vo: I think when it comes to multiple marginalized identities that some of these youth identify with, think referring them to resources for those multiple identities, like for example, a queer group or community 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 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 in Asian American teens, right? I think targeting the parents and the family is educating them about the increased mental health crisis in these youth is one of a key factor because sometimes 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. So if we educate their families and parents to have a conversation with their youth, that can be powerful.

[14:55] Dr. Poojajeet Khaira: I was just going to add that I do think that even though there's so much more work that needs to be done for this population, I think that there are people across the country doing some projects related to this. I would have from what I've read or what I've attended, I have seen them trying to focus on 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 the child.

And they don't, you know, they see it more as like the child maybe being secluded or maybe isolating themselves, but they don't recognize that, these are symptoms of 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.

[15:45] Dr. Krysti Vo: Yes, and I wonder if schools is the natural environment to educate the parents through because a lot of parents are involved or at least they monitor their Asian American kids performance. And I wonder if programs through the school to engage the parents in some of these raising 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 yeah, perhaps other people are working on this as well. And with you, I know that you would do a lot of work with trying to have trainees and early career psychiatrists work in this suicide prevention space. How has that been going? And what have you guys been doing?

[16:36] Dr. Poojajeet Khaira: I think we've really been trying to make a dent in this and make people aware of this issue. I think that often trainees might not realize their power and I don't think that all trainees 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 the colleagues that I work with is showing trainees that their opinions matter and that they can make a difference. think trainees bring fresh perspectives and live experience that often reflect the communities 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 of that is coming from these younger generations. think, you know, we are people that are speaking out about burnout, racism, and access issues, and that impacts both our patients, but also ourselves. And so I think from what I've seen from all of my colleagues who are resident fellow members, 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. So I think it's not just being a great clinician and knowing all of the pathology, but also 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 early career psychiatrists bring to the table because resident fellow members to early career psychiatrist is such a big transition, but also we share so many similarities.

[18:23] Dr. Krysti Vo: Yes, yes. So speaking of advocacy, I was just at ACAP at this legislative conference, is today, today, being on Capitol Hill and learning about what policy is affecting the current federal landscape right now. And then we also go and talk to senators and House of Representatives to tell them to support things like Medicaid for children 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 get engrossed into our work, but sometimes taking some time off to really be an advocate for their patients going to Capitol Hill, or if not just joining the local APA branch in their district 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. It's a newspaper that you get where it tells you what's going on in policy and also give you 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 as well as child psychiatry. I think those are things that early career psychiatrists can do as well as if they're part of RENSE training programs, right? And they can also think about how can they teach in culturally responsive care for different minority groups and marginalized groups and they can be involved with the those curriculum or being involved in the trainees in medical school curriculum as well. Given that, given this discussion, what do you think is one systemic shift that psychiatry should take upon to try to prevent suicide and youth of color? It could be grand vision, it could be unrealistic.

What do you think is one wish that you have that can be a great shift in how we prevent suicide?

[20:59] Dr. Poojajeet Khaira: So I think you touched upon it a little bit before, but I think bringing mental health to where people are. 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 think about. 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. And so how do we get to them 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 other forums. whether that means different places of worships, having faith leaders talk about this having teachers, guidance counselors, classes about this, places where people will have to see it, places where people really take what the people who are there are saying as high regard. So people, of course, view their faith leaders as people that they trust, their teachers as people they trust. 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, spiritual leaders, all talking about this and being able to recognize the warning signs and how to respond with compassion. I think that will make the biggest dent in suicide prevention.

[22:43] Dr. Krysti Vo: 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, be their consultant, be their advisor, be their way for a resource for these community to call upon us if needed is important. in that case, I think perhaps what we're asking or having our listeners to consider is to be one of those resources. 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. You know, if you have any event, I would love to come talk to your community, things like that. Maybe that's what we're we're kind of encouraging people to do, is that what you think is a good thing to say?

[23:44] Dr. Poojajeet Khaira: Yeah, I think so for sure. You know, I was talking to someone who's from the UK, their psychiatrist there, and they work with marginalized communities and trying to help with stigma. And I asked them, like, you know, how have they improved communities where the stigma was 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 revered to be very high in that community. So like faith leaders, for example, had discussions with them, meetings with them, then it grew 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. 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 the change happen.

[24:54] Dr. Krysti Vo: Yes, yes. And if any of our listeners are medical students, I also want to encourage you to think about being that reach out to your own community. I remember when I was in medical school, I actually started the Heavatize Dallas Fort Worth Heavatize Bee Free project. And we collaborated with the local organization and fairs and community events where we would come to their community events and do we actually take their blood there and do a screening for hepatitis B and C. 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 in your school and then build a mental health fair, you know, it can be have a ties be but now now we can do Asian American mental health 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 can contact I am in my work as the chair of the of the Minority Under Representative Caucus, I can definitely provide some resources and if I can't, I can lead them to the right person to help them with things. so, Pooja, is there other things you would like to mention?

[26:33] Dr. Poojajeet Khaira: Yeah, so since you bring up a PAMSA, I'll say that our work group that we created ourselves has a connection with a PAMSA. 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 membership valued, which is great.

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 more people interested. But they noticed this and we had talked to them about these statistics and they were shocked 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 out there. 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 about something, 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 just make decisions for myself or, you know, guide what I do. And I think that is something that I hope people take away when listening to this.

[27:56] Dr. Krysti Vo: Yes, thank you so much. And yeah, so if you're listening to this, thank you for tuning in and I hope you found some of our discussion helpful for you and I hope that it encouraged you to be engaged and connect with your own organization around you, whether that's medical school, RNC, or beyond. And thank you for talking with me, Bhuja. I truly appreciate your time.

[28:25] Fatima Reynolds: 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 and a resource document related to this episode. We also invite you to visit psychiatry.org slash more equity, M-O-O-R-E-E-Q-U-I-T-Y for more information on the APA More Equity in Mental Health Initiative. Take care.

[28:51] Dr. Poojajeet Khaira: The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.