The aim of this study was to investigate risk and protective factors for suicidal ideation among Asian American adults by age, as well as differences in suicidal ideation and health care needs across age and subethnic groups. This cross-sectional study used data from the 2021–2022 California Health Interview Survey (CHIS) and included adults aged 18 and older who self-identified as Asian. Measured variables included age, sex, subethnicity (Chinese, Korean, Japanese, Vietnamese, Filipino, South Asian, Southeast Asian, Other Asian), suicide risk factors, mental health care barriers, and protective social environment indicators. Suicidal ideation and behavioral healthcare needs (i.e., for mental illness or substance use) were the outcomes of interest.

Findings: Of 7,240 participants, the largest subgroups were Chinese and Filipino respondents. Older adults reported lower levels of suicide ideation and behavioral healthcare needs compared to the younger age group. Among Asian subethnic groups, Other Asian and Korean Americans reported the highest levels of suicidal ideation (23.1% and 20.7%) and behavioral healthcare needs (20.5% and 18.4%). Healthcare discrimination was uniquely associated with suicidal ideation among older Asian adults. Other risk factors included a history of intimate partner violence, household mental health history, psychological distress, chronic pain, and healthcare costs. Authors conclude that despite having a lower overall risk, older Asian adults remain susceptible to healthcare discrimination and ongoing mental distress that elevates their risk for suicidality.

Supported decision-making (SDM) offers an alternative to guardianship or conservatorship for individuals with disabilities, preserving their autonomy while providing tailored support for important life decisions. California recently enacted legislation recognizing SDM as a formal legal alternative to conservatorship; however, full implementation of SDM requires accessible resources on what SDM is and how to use it. This policy brief presents findings from a gap analysis of digital SDM resources in California.

Findings: Digital information about supported decision-making (SDM) has significant gaps. Authors recommend development of materials tailored for various languages, cultures, and disability types and expansion of sector-specific guidance for full implementation of SDM to serve the needs of populations at high risk for conservatorships.

Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure.

An observational study of 5,089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status.

Findings: Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0 % of patients had received an influenza vaccine, 76.2 % had received a pneumococcal vaccine, and 83.3 % had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza, pneumococcal, and COVID compared to patients with HFpEF.

Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.
 

Authors identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

Authors performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. They extracted data using a table of evidence and assessed study quality using the Johns Hopkins Evidence-Based Practice.

Findings: Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

Researchers identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.