Suicide by suffocation among Asian American, Native Hawaiian and Pacific Islander Veterans in the USA (2012–2018)

Abstract

Background Suicide rates have increased substantially among Asian American, Native Hawaiian and Pacific Islander (AANHPI) Veterans who are more likely to use suffocation as a suicide method than Veterans overall. This study examined demographic, healthcare and injury characteristics of AANHPI Veterans who died by suicide through suffocation and examined the contexts of these deaths. Analyses further examined if there were differences between AANHPI and non-AANHPI Veterans who died by suffocation suicide. Methods This mixed methods analysis used National Violent Death Reporting System (NVDRS) data from AANHPI (n=44) and non-AANHPI (n=3090) Veterans who died by suicide through suffocation (2012–2018). Results Hanging comprised nearly all suffocation deaths, although ligature types varied extensively. Residence was the most common location of injury and death, with basements a more common location of death within the home among AANHPI Veterans, relative to a matched, non-AANHPI Veteran sample. There was a significantly higher proportion of females among AANHPI decedents. Additionally, AANHPI decedents were significantly less likely to have emergency medical services present, relative to non-AANHPI decedents. The majority of AANHPI decedents were discovered by family or an intimate partner. Conclusions Addressing ligature suicide among AANHPI Veterans is necessary to ensure an equitable suicide prevention approach. Lethal means safety initiatives and postvention strategies that consider salient contextual factors (eg, location of death, discovery by loved ones) are warranted for this population. Considering the ubiquity of ligatures and ligature points, upstream suicide prevention approaches that address drivers of suicide risk are particularly important for preventing suicide among AANHPI Veterans.