Study links internalized racism to increased suicidal thoughts in Asian Americans

A recent study published in Ethnicity & Health has revealed a concerning link between internalized racism and suicidal thoughts among Asian Americans. The study found that even after accounting for common mental health factors like anxiety and loneliness, individuals who had internalized negative stereotypes about their own race were more likely to have suicidal ideation. Interestingly, the effect of internalized racism was not only significant but also stronger than external experiences of racism.

The study, led by Fanhao Nie, an assistant professor of sociology at the University of Massachusetts Lowell, aimed to explore a less studied aspect of racism’s impact on mental health. While prior research has extensively examined how external racism affects mental health and suicide risk, Nie’s study focuses on the internalization of racist attitudes. Internalized racism refers to the process by which individuals from a marginalized group come to accept and integrate negative stereotypes about their own race or ethnicity.

“I was interested in this topic for several reasons. First, suicide rates have worsened since the COVID-19 pandemic. This deteriorating issue is particularly troubling to the U.S. Asian community. For example, according to the CDC data, in 2022, suicide was the leading cause of death for US Asians aged 15 to 24. To make matters even worse, due to structural barriers and cultural stigma surrounding mental health and suicide, U.S. Asians are much less likely than non-Hispanic Whites to receive mental health services to prevent suicide.”

“In my literature reviews of the social determinants of suicide among US Asians, I found that prior research on racism and suicide tended to measure racism as perceived racism from the outside. However, the racially subordinated can also internalize and reproduce racism. Famed theoretical frameworks, such as the Minority Stress Theory, have suggested that internalized racism may lead to a host of undesirable mental health outcomes, including anxiety and depression among the minorities, which are the key predictors of suicides.”

“In addition to the paucity of research on internalized racism and suicide among U.S. Asians, prior research in this subfield has also inadequately assessed the roles of religion. Founders in sociology, such as Emile Durkheim, have argued that religion, through its social integration and control function, may significantly influence individual attitudes and behaviors about suicide, in addition to religious teachings and values about suicide.”

“Regarding race, religion has played a significant role as a social institution in shaping the identity and experiences of racial minorities in the United States. What impact does religion have on suicide among Asians in the United States? Specifically, how does religion interact with race in relation to suicide risks?”

To answer these questions, Nie conducted a national survey of 970 Asian adults living in the United States. Participants were recruited through an online panel and included individuals from various ethnic and religious backgrounds. The sample was designed to be as representative of the U.S. Asian population as possible, following census quotas for key demographics like gender, ethnicity, and education.

Participants completed a survey that measured several variables. Suicidal ideation was assessed using a scale that asked how frequently they had thought about suicide in the past month. Internalized racism was measured using a scale that asked participants to rate their agreement with statements reflecting negative stereotypes about Asians, such as “I sometimes wish I weren’t Asian” or “Asians are less physically attractive than whites.”

The survey also included measures of external racism, anxiety, loneliness, and religious involvement. External racism was assessed by asking participants how often they had experienced overt discrimination, such as being called racial slurs or treated differently because of their race. Religious involvement was measured by how frequently participants attended religious services, prayed, and how important religion was in their lives.

Nie’s analysis revealed several important findings. First, internalized racism was strongly associated with suicidal ideation, even after accounting for other factors.

“This effect was not only robust after controlling a host of sociodemographic variables, but it also had a larger magnitude than other important predictors of suicide, such as anxiety and perceived external racism,” Nie told PsyPost. “Therefore, for readers, particularly those from racial and ethnic minority backgrounds, our internalized racial repression poses a greater threat than observable, external racism. This is probably the area that deserves more public attention and resources in the fight against racism.”

The study also found that the harmful effects of internalized racism were particularly strong among those who attended religious services more frequently. This is an unexpected result, as religion is often thought to provide social support and protection against mental health issues.

“I was surprised by the interactive effect of religious service attendance on internalized racism and suicidal ideation. Contrary to conventional beliefs, the study results indicate that frequent religious service attendance amplified the deleterious internalized racism effect on suicidal ideation.”

However, Nie speculates that for Asian Americans, frequent participation in religious services may heighten awareness of their minority status, especially if they are part of a predominantly non-Asian congregation. Alternatively, if the religious community is predominantly Asian, frequent exposure to cultural values emphasizing emotional restraint and avoidance of mental health discussions might worsen the effects of internalized racism.

“When one is frequently exposed to a religious group where s/he is a racial minority, the racial differences and inequalities within such an organization may possibly exacerbate internalized racism and its effect on suicidal ideation,” Nie explained.

“On the other hand, an Asian-majority religious organization may potentially reinforce cultural values of self-restraint and perpetuate stigmas about mental illnesses among its frequent participants. As a result, one may be less likely to seek help to combat the negative mental health effects of internalized racism. Future research using qualitative methods, such as observation and in-depth interviews, may be better able to illuminate how religion intersects with race across different social contexts.”

While this study provides important insights, it also has limitations. One key limitation is its cross-sectional design, meaning that it cannot establish a direct cause-and-effect relationship.

“It’s possible that U.S. Asian adults with poorer mental health or suicidal thoughts are more likely to perceive their race negatively, leading to internalized racism,” Nie said. “Future research using longitudinal data may help us resolve the issue of causality. Another limitation is that, although the data is quite representative for key demographic variables, such as ethnicity and sex, it may not reflect the actual images of the U.S. Asian population for some other demographic variables. Therefore, readers may want to exercise some degree of caution when generalizing the results to the general U.S. Asian population.”

Nevertheless, the study sheds light on the underexplored relationship between internalized racism and suicidal ideation among Asian Americans. It highlights that internalized racism may be a more powerful predictor of suicidal thoughts than external racism or common mental health issues. Healthcare providers, mental health professionals, and community leaders should be aware of the unique mental health challenges faced by Asian Americans, Nie said.

“Both racism and health are multi-dimensional constructs,” Nie added. “For my long-term goals, I am interested in exploring how race may intersect with other critical demographic variables, such as gender and sexuality, to influence different aspects of health among U.S. Asians. For instance, the meaning of internalized racism may vary depending on an individual’s gender. How might gendered internalized racism impact U.S. Asian males and females differently in terms of various health outcomes? In addition, I would like to adopt a mixed-methods approach to better understand the mechanisms behind these quantitative findings.”

The study, “Devil among us or inside us? Exploring the relationships of internalized racism and suicidal ideation among US Asian adults,” was published online on October 7, 2024.