J Youth Adolescence (2011) 40:1453–1464
DOI 10.1007/s10964-011-9701-3
EMPIRICAL RESEARCH
Predictors of Asian American Adolescents’ Suicide Attempts:
A Latent Class Regression Analysis
Y. Joel Wong • Cara S. Maffini
Received: 19 May 2011 / Accepted: 19 July 2011 / Published online: 5 August 2011
Ó Springer Science+Business Media, LLC 2011
Abstract Although suicide-related outcomes among
Asian American adolescents are a serious public health
problem in the United States, research in this area has been
relatively sparse. To address this gap in the empirical lit-
erature, this study examined subgroups of Asian American
adolescents for whom family, school, and peer relation-
ships exerted differential effects on suicide attempts. Data
were drawn from Waves 1 and 2 of the National Longi-
tudinal Study of Adolescent Health dataset and included
responses from a national sample of 959 Asian American
adolescents (48.0% girls; average age at Wave 2 = 16.43).
A latent class regression was used to assess the optimal
number of latent classes (i.e., subgroups of participants)
that explained the associations between family, school, and
peer relationships and subsequent suicide attempts. Three
latent classes were identified. Most participants belonged to
a latent class in which family, school, and peer relation-
ships were protective factors. However, stronger school
relationships and peer relationships were found to be risk
factors in two other latent classes. The three latent classes
also differed significantly in terms of suicide attempts,
gender, and acculturation. The practical implications of this
study, particularly for educators and mental health pro-
fessionals, are discussed.
Keywords Suicide
Asian American
Family

School
Peers
Y. J. Wong (&)
C. S. Maffini
School of Education, Indiana University Bloomington,
201 N. Rose Ave., Bloomington, IN 47405, USA
e-mail: joelwong@indiana.edu
Introduction
Suicide-related outcomes among adolescents are a serious
public health problem in the United States. Among
15–24 year olds, suicide accounts for more deaths than all
natural causes of death combined (US Department of Health
and Human Services 2007). The impact of suicide-related
outcomes becomes more evident when non-lethal out-
comes, such as suicide attempts, are considered. In 2005,
8.4% of US high school students attempted suicide (Eaton
et al. 2006). Indeed, suicide attempts are public health
challenges in their own right because of the resulting
emotional and economic costs (Joiner et al. 2009). Although
there is accumulating research documenting risk and pro-
tective factors predicting adolescents’ suicide-related out-
comes, research on Asian American adolescents has been
sparse compared with other racial/ethnic groups (Goldston
et al. 2008).
The study of Asian American adolescents’ suicide-
related outcomes is important for a number of reasons.
Because of cultural and racial differences, findings on
suicide-related outcomes based on the U.S. (i.e., White-
majority) adolescent population may not necessarily be
generalizable to Asian American adolescents (Choi et al.
2009). In addition, suicide is the second most frequent
cause of death among Asian and Pacific Islander Ameri-
cans aged 15–19 years, compared to the third most fre-
quent cause of death among US adolescents in this age
group (US Department of Health and Human Services
2007). Furthermore, Asian American adolescents have
been found to report higher rates of suicidal ideation than
European American adolescents (Vander Stoep et al.
2009). In sum, there are compelling theoretical and
empirical reasons for greater attention to the study of Asian
American adolescents’ suicide-related outcomes.
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The literature on factors associated with suicide-related
outcomes among Asian American adolescents is charac-
terized by several limitations. First, most studies have
focused on replicating suicide risk factors identified in the
general US population (e.g., Else et al. 2009; Nishimura
et al. 2005), without paying adequate attention to how these
factors might vary across subgroups of Asian American
adolescents (e.g., highly acculturated vs. less acculturated
Asian American adolescents). Indeed, studies have shown
that Asian American adolescents’ psychosocial adjustment
varied as a function of acculturation (Hahm et al. 2003;
Willgerodt and Thompson 2006). Second, from a meth-
odological perspective, studies on Asian American ado-
lescents’ suicide-related outcomes tend to rely on small
samples [e.g., from a community mental health center (e.g.,
Lau et al. 2002) or from a few schools in a particular city
(e.g., Cho and Haslam 2009)]. Consequently, it is unclear
whether the findings from these studies are a function of a
local setting or are generalizable to Asian American ado-
lescents in general.
Moreover, no known study has employed a longitudinal
research design in the study of Asian Americans’ suicidal
behavior, thus limiting researchers’ ability to draw infer-
ences about the temporal order of the link between risk and
protective factors and suicide-related outcomes. Finally,
one criticism of the empirical literature on Asian Ameri-
cans’ suicide-related outcomes, including research on
Asian American adolescents, is that it has consisted mainly
of atheoretical studies that have not been grounded in
suicidology theories (Wong et al. 2011b). To summarize,
our review of the literature on Asian American adoles-
cents’ suicide-related outcomes revealed several empirical,
methodological, and theoretical limitations, which we
sought to address in this study.
Joiner’s Interpersonal-Psychological Theory
Against this backdrop, we used Joiner’s (2005) inter-
personal-psychological theory of suicidal behavior as the
main theoretical basis for our study. Joiner posited that
suicidal desire is engendered primarily by the thwarting of
one’s basic interpersonal needs. In particular, suicidal
desire develops as a result of a sense of thwarted belong-
ingness and perceived burdensomeness to others. This
theory may be particularly applicable to Asian American
communities because its emphasis on unmet interpersonal
needs is congruent with Asian cultural norms that empha-
size the centrality of interpersonal relationships (Wong and
Poon 2010). Indeed, research has consistently found that
Asian Americans demonstrated higher levels of interde-
pendent self-construals than White Americans (Lam and
Zane 2004; Okazaki 2000; Singelis 1994). Because one’s
well-being is viewed as strongly linked to one’s
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interpersonal relationships in Asian cultures (Markus and
Kitayama 1991), the deleterious consequences of thwarted
belongingness may be a pernicious suicide risk for Asian
American adolescents. Conversely, a sense of belonging-
ness to a valued social group may be a salient protective
factor. Support for Joiner’s (2005) theory was found in a
recent study showing that a combination of perceived
burdensomeness and thwarted belongingness was associ-
ated with elevated levels of suicidal ideation among Asian
American college students (Wong et al. 2011b). In sum, a
focus on interpersonal needs may be particularly relevant
to the study of Asian Americans’ suicide-related outcomes.
Guided by Joiner’s (2005) interpersonal-psychological
theory, we investigated, in this study, the influence of three
indicators of belongingness—family, peer, and school
relationships—on Asian American adolescents’ suicide
attempts. We focused on these three indicators because
they have been found in prior research to be associated
with suicide-related outcomes (Kidd et al. 2006; Perkins
and Hartless 2002). Several studies have documented the
relevance of family-related variables to suicide-related
outcomes among adolescents (Kidd et al. 2006) as well as
in Asian American communities. Wong et al. (2011a)
found that, among Asian American college students, living
with a family member was uniquely associated with lower
rates of suicidal ideation, after controlling for demographic
and mental health variables. In a recent national study of
Asian American adults (Wong et al. in press), family
cohesion was associated with reduced rates of suicidal
ideation. Conversely, problems in Asian American ado-
lescents’ relationship with their parents have been impli-
cated as a risk factor for suicide-related outcomes (Cho and
Haslam 2009; Lau et al. 2002). Collectively, these studies
suggest that strong family relationships may be an impor-
tant protective factor against Asian American adolescents’
suicide-related outcomes.
Peer and school-related variables have also been shown to
be associated with US adolescents’ suicide-related outcomes
(Perkins and Hartless 2002). A recent study of Korean
American high school adolescents found that perceived
social support from a friend of a different ethnicity was
negatively related to suicidal ideation (Cho and Haslam
2009). Although no known study has examined the link
between school relationships and suicide-related outcomes
among Asian American adolescents, one study found that
attitudes toward school and teachers were significantly and
negatively related to depression among Chinese American
adolescents, but not among European American adolescents
(Zhou et al. 2003). The authors theorized that because
Chinese culture strongly emphasizes the importance of
education, Chinese Americans’ experience of alienation
from schools had a more devastating impact on their well-
being as compared with European Americans.
J Youth Adolescence (2011) 40:1453–1464
Person-Oriented Framework
Although Joiner’s (2005) interpersonal-psychological the-
ory is potentially relevant to the study of Asian American
adolescents’ suicidal attempts, one limitation of this theory
is that it may not fully take into account the complex ways in
which diverse groups of adolescents demonstrate different
profiles of risk and protective factors for suicide-related
outcomes. In contrast, there is growing acceptance of a
holistic, interactionistic view of individuals within the field
of child and adolescent development (Bergman et al. 2006;
Bergman and Magnusson 1997; Van Horn et al. 2009;
Weaver and Kim 2008). This person-oriented framework
focuses on individuals as the unit of analysis in research and
can be contrasted with a variable-oriented research frame-
work which focuses on variables as the main unit of analysis
(Bergman and Magnusson 1997). The person-oriented
framework emphasizes the heterogeneity of child and ado-
lescent development and the need to understand how diverse
subgroups of children and adolescents differ on the basis of a
constellation of characteristics (von Eye and Bogat 2006).
Moreover, such an analysis dovetails with the basic eco-
logical premise that the influence of the environment on
children and adolescents differ on the basis of multiple
characteristics, such as gender and culture (e.g., Bronfen-
brenner 1979, Van Horn et al. 2009).
The person-oriented framework may be particularly rele-
vant to our study because there are theoretical and empirical
reasons to suggest that Joiner’s (2005) theory would not be
universally applicable to Asian American adolescents;
indeed, there might be subgroups of Asian American adoles-
cents who demonstrate different patterns of risk and protective
factors associated with suicide attempts. In particular, previ-
ous research has suggested that the effects of predictors of
suicide-related outcomes vary as a function of participants’
gender and acculturation. With regard to acculturation, Lau
et al. (2002) found that parent–child conflict was more
strongly associated with suicide-related outcomes among less
acculturated Asian Americans than among highly accultur-
ated Asian Americans. In the same vein, Wong et al. (in press)
showed that family cohesion was a protective factor against
suicidal ideation among Asian American adults with low
levels of language acculturation (i.e., English proficiency) but
not among those with greater language acculturation. Applied
to our study, strong family relationships might be a less rele-
vant protective factor for highly acculturated Asian American
adolescents because they might be more concerned about
individuating from their families and are therefore less
affected by the degree to which their family members feel
connected to one another (cf. Lau et al. 2002).
In addition to acculturation, gender has been identified as
a powerful influence on racial and ethnic minority adoles-
cents’ psychosocial functioning because of conflicting
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gender expectations for boys and girls in schools, among
peers, and at home (Pessar 2003). This may be particularly
true for racial and ethnic minority girls, including Asian
American girls (Suarez-Orozco and Qin 2006). Compared
to their male counterparts, Asian American girls tend to
experience stricter parental control over their schooling
activities and social lives, more familial obligations (e.g.,
taking care of younger siblings), and greater parental
expectations to retain Asian cultural traditions (Fuligni et al.
2002; Qin 2009). Additionally, Asian American girls may
face gendered social pressures in school (e.g., wearing
fashionable clothes and showing an interest in boys) that are
antithetical to the cultural values of their parents, which
emphasizes modesty and more conservative dating attitudes
(Qin 2009). Accordingly, high levels of peer and school
relationships could, ironically, engender stress for Asian
American girls via parental disapproval or internalized guilt
because they may reflect activities that conflict with tradi-
tional Asian parental expectations. Although there are no
known studies on gender differences in the predictors of
Asian American adolescents’ suicide-related outcomes, one
study of adolescents’ suicide attempts in Oregon found
differential gender effects; specifically, family support
negatively predicted suicide attempts among girls, whereas
support from friends negatively predicted suicide attempts
among boys (Lewinsohn et al. 2001). Based on the fore-
going literature review, we surmised that peer and school
relationships would not be protective factors against suicide
attempts for Asian American girls as compared to their male
counterparts.
Following the example of previous developmental
research (Van Horn et al. 2009), we used latent class
regression (also known as regression mixture models) to
test a person-oriented approach to understanding suicide
attempts among Asian American adolescents. Latent class
regression combines the strengths of cluster analysis and
regression models by testing, within a single analysis, dif-
ferential relationships between predictor and outcome vari-
ables across several latent classes (Wedel and DeSarbo
1994). Participants who are classified in the same latent class
tend to be similar to one another in terms of the associations
between predictor and outcome variables. Consistent with
growing acceptance of the person-oriented framework (e.g.,
Weaver and Kim 2008), latent class regression has been
increasingly applied in diverse areas of child and adolescent
research; such research includes the study of differential
environmental influences on children’s cognitive behavior
(Bouwmeester et al. 2004) and academic outcomes (Van
Horn et al. 2009), as well as differential risk and protective
factors for marijuana use (Reboussin et al. 2007) and suicide-
related outcomes among adolescents (Jiang et al. 2010).
Latent class regression confers several methodological
benefits as compared to conventional regression methods.
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For one, unlike conventional regression methods which
assume that all individuals belong to a single population,
latent class regression relaxes the assumption of population
homogeneity to allow for parameter differences across
unobserved subpopulations (Ding 2006). Additionally,
conventional regression methods rely on interaction terms
to test differential effects (i.e., whether the effects of one
variable on another are consistent across a population).
However, the testing of interaction terms are typically
confined to only two- or three-way interactions and require
separate interaction terms for each specific interaction
effect, thus limiting its ability to identify complex patterns
of differential effects (Van Horn et al. 2009). In contrast,
latent class regression does not rely on interaction effects
and can provide a global evaluation of differential effects
based on complex patterns of associations between pre-
dictor and outcome variables that vary across subgroups
(Van Horn et al. 2009; Wedel and DeSarbo 1994). Simply
put, latent class regression is particularly well-suited to
address research questions from a person-oriented frame-
work (Bergman and Magnusson 1997).
Research Hypotheses
The current study sought to address limitations in the
empirical literature by identifying subgroups of Asian
American adolescents who demonstrated different profiles
of risk and protective factors for suicide attempts using
longitudinal data from the National Longitudinal Study
of Adolescent Health (Add Health). Specifically, we
used latent class regression to assess the optimal number
of latent classes (i.e., subgroups of participants) that
explained differential associations between family, school,
and peer relationships and subsequent suicide attempts
among Asian American adolescents. Although non-fatal
suicide-related outcomes lie on a continuum, ranging
from suicidal ideation to suicide plans to suicide attempts,
we focused on suicide attempts because it is the outcome
that most closely resembles completed suicides and is one
of the strongest predictors of completed suicides among
adolescents (Spirito and Esposito-Smythers 2006).
Depressive symptoms and previous year suicidal ideation
and attempts were assessed as control variables because
of previous research documenting that they are robust
predictors of adolescents’ attempted suicide (Spirito and
Esposito-Smythers 2006). Additionally, we examined
whether class membership, as identified by the latent class
regression, would be associated with suicide attempts,
gender, and acculturation.
In light of previous research on the differential effects
of gender and acculturation on adolescents’ suicide-related
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outcomes (Lau et al. 2002; Lewinsohn et al. 2001), we
expected that our latent class regression would identify at
least two latent classes of participants that differ from each
other in terms of gender and acculturation. Guided by
Joiner’s (2005) theory on the protective nature of
belongingness, our first hypothesis predicted that in the
latent class with the most number of participants, family,
school, and peer relationships would all be protective
factors predicting lower rates of suicide attempts. On the
basis of our foregoing literature review on acculturation
(e.g., Lau et al. 2002), our second hypothesis predicted
that compared to less acculturated participants, highly
acculturated participants would have greater odds of being
in a latent class in which family relationships were not a
significant protective factor against suicide attempts. In
light of our earlier review of the literature on gender (Fu-
ligni et al. 2002; Lewinsohn et al. 2001; Qin 2009), our
third hypothesis stated that compared to Asian American
boys, Asian American girls would have lower odds of
being in a latent class in which peer relationships and
school relationships were protective factors against suicide
attempts.
Method
Participants and Procedures
The data in this study were drawn from Waves 1 and 2 of
the Add Health dataset. The original sample consisted of
adolescents from 80 high schools and 52 middle schools
across the U.S. By using systematic sampling methods and
implicit stratification, the sample was representative of US
schools with regard to region of country, urbanicity, school
size, school type, and ethnicity (Harris et al. 2009). The
data were collected through in-home interviews in Wave 1
and approximately 1 year later in Wave 2. We focused
only on Asian American adolescents who participated in
Waves 1 and 2. Although there were 1,548 Asian American
participants in Wave 1, the final sample was 959 (48.0%
girls, 58.2% US born), due to the aging out of Wave 1 high
school seniors. At Wave 2, participants’ average age was
16.43 (SD = 1.52). Among participants, 64.9% reported
that they spoke English at home; 29.5% identified as
Chinese American, 44.1% identified as Filipino American,
and the remainder identified with other Asian American
ethnicities. At Wave 2, 17.9% were in 10th grade, 35.2%
were in 11th grade, 38.9% were in 12th grade, and the
remainder (7.9%) did not have a grade classification (e.g.,
they were not attending school or they belonged to a school
that did not have a grade classification).
J Youth Adolescence (2011) 40:1453–1464
Measures
With the exception of suicide attempts (our outcome var-
iable), which was assessed at Waves 1 and 2, all other
variables in our study were only assessed at Wave 1.
Suicidal Ideation and Attempts
Suicidal ideation and attempts were assessed by two items
on whether participants seriously considered committing
suicide and whether they attempted suicide in the past
12 months (coded 1 for yes and 0 for no). The use of 1-item
dichotomous measures of suicidal ideation and suicide
attempts is a common practice in large scale epidemio-
logical studies, including studies on suicide-related out-
comes among adolescents (e.g., Jiang et al. 2010; Kidd
et al. 2006; Perkins and Hartless 2002). In our sample,
15.7% (n = 151) reported suicidal ideation at Wave 1.
Among participants, 4.1% (n = 39) at Wave 1 and 3.1%
(n = 30) at Wave 2 reported a suicide attempt.
Depressive Symptoms
The 19-item version of the Center for Epidemiologic Studies
Depression Scale (Radloff 1977) was used to assess depres-
sive symptoms. Participants reported how many times in the
past week they had experienced each symptom. Responses
ranked from 0 (never or rarely) to 3 (most or all of the time). A
prior Add Health study demonstrated that this measure was
negatively associated with a measure of family closeness
among Chinese and Filipino American adolescents (Willg-
erodt 2008).The Cronbach’s alpha for our sample was .86.
Family Relationships
A four-item scale was used to assess family relationships,
i.e., the degree to which participants felt that family mem-
bers were connected and attentive to each others’ needs
(Willgerodt 2008). Higher scores indicated stronger family
connectedness. A sample item is: ‘‘How much do you feel
that you and your family have fun together?’’ Responses
ranged from 1 (not at all) to 5 (very much). A prior Add
Health study found that this measure was strongly associated
with a measure of emotional family bonds among Chinese
and Filipino American adolescents (Willgerodt 2008). The
Cronbach’s alpha for our sample was .77.
School Relationships
School relationships were assessed by three items on how
connected students felt with their schools. The items were:
‘‘You feel close to people at your school,’’ ‘‘You feel like you
are part of your school,’’ and ‘‘You are happy to be at your
1457
school.’’ Responses ranged from 1 (strongly agree) to 5
(strongly disagree). This measure has been used in several
previous Add Health studies (Crosnoe et al. 2004; Johnson
et al. 2006; Ueno 2005, 2009). Ueno (2009) showed that this
measure of school relationships was significantly and
inversely related to the proportion of same-race friends
among Asian American adolescents. The Cronbach’s alpha
for our sample was .74.
Peer Relationships
Peer relationships were assessed through 10 dichotomous
items (scored as 1 for yes and 0 for no) about spending time
and talking with participants’ identified best friends (5
items on their best female friend and 5 similarly worded
items on their best male friend). Sample items include,
‘‘Did you meet {NAME} after school to hang out or go
somewhere during the past 7 days?’’ and ‘‘Did you talk to
{NAME} about a problem during the past 7 days.’’ The
overall score, determined by averaging responses to all
items, represents the level of peer support received by
participants. By examining participants’ best friends, this
measure focuses on the quality of participants’ friendships
rather than the quantity of participants’ friends. This mea-
sure has been used in previous Add Health studies (Crosnoe
and Elder 2004; Henrich et al. 2006; Kidd et al. 2006). In
particular, Kidd et al. (2006) utilized this measure of peer
relationships to assess predictors of adolescents’ suicide
attempts. Crosnoe and Elder (2004) showed that among
Asian American adolescents, this measure was a protective
factor against problematic academic behavior when parent-
adolescent emotional distance was high. The Cronbach’s
alpha for our sample was .70.
Acculturation
Because there were no items directly measuring accultur-
ation in the Add Health survey, we followed the example
of Hahm et al. (2003) who developed an acculturation
measure based on language use and place of birth in a
previous Add Health study that also focused on Asian
American adolescents. The Add Health survey assessed
language and place of birth with the questions, ‘‘What
language is usually spoken in your home?’’(English vs.
other language), and ‘‘Which country were you born in?’’
(US vs. other country), respectively. Using a combination
of responses to these two questions, acculturation was
measured on a 4-point scale (0–3) from least acculturated
to most acculturated: (a) born in another country, speaks a
non-English language at home (24.1%), (b) born in U.S.,
speaks a non-English language at home (11.1%), (c) born
in another country, speaks English at home (17.7%); and
(d) born in U.S., speaks English at home (47.1%).
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Following Hahm et al. (2003), participants in group
(c) were considered more acculturated than group (b) due
to previous research indicating that language is a more
accurate indicator of acculturation than place of birth
(Phinney 1990). Evidence for the predictive validity of
this acculturation measure was demonstrated through a
positive association with greater alcohol use among Asian
American adolescents in Hahm et al.’s (2003) study.
Statistical Analyses
For our latent class logistic regression analysis, we used
Latent Gold 4.5 (Vermunt and Magidson 2008), which can
handle skewed dichotomous outcomes and take into
account the cluster sampling, probability sampling weights,
and stratification of the Add Health data. Wave 2 suicide
attempt was the dichotomous outcome variable. The pre-
dictor variables were Wave 1 family, school, and peer
relationships, depressive symptoms, suicidal ideation, and
suicide attempts. Since our focus was on the differential
effects of the three indicators of belongingness, Wave 1
depressive symptoms, suicidal ideation, and suicide
attempts were control variables constrained to be class
independent. We selected the optimal number of latent
classes by comparing the relative fit of the models via the
model fit likelihood ratio chi-square statistic (L2) and
Akaike information criterion (AIC) values. The lower the
L2 and AIC estimates, the better the model fits the data.
Results
Preliminary Analyses
Multiple imputation (through the use of five imputed
datasets) was used to handle missing data (Schafer 1999).
The means, standard deviations, and intercorrelations of
the main measures are presented in Table 1. At the bivar-
iate level, family relationships were the only indicator of
belongingness that was significantly and negatively asso-
ciated with Wave 2 suicide attempts.
Main Analyses
The results of the model fit for 1–4-class models are pre-
sented in Table 2. The 2-class model was a significantly
better fit to the data than the 1-class model, and the 3-class
model was a significantly better fit to the data than the
2-class model. However, the 4-class model was not sig-
nificantly different from the 3-class model (p = .074).
Moreover, among the four models, the 3-class model had
the lowest AIC values. Accordingly, we concluded that the
3-class model was the optimal and most parsimonious
representation of the data. Classes 1–3 consisted of 57%
(n = 547), 32% (n = 310), and 11% (n = 102) of partic-
ipants, respectively.
The parameter estimates for the 3-class latent class regres-
sion are shown in Table 3. Across the three latent classes, the
three indicators of belongingness differed significantly in their
influence on Wave 2 suicide attempts (Wald = 36.08,
p \ .001 for family relationships, Wald = 45.02, p \ .001 for
school relationships, and Wald = 41.70, p \ .001 for peer
relationships). Wave 1 depressive symptoms and suicide
attempts significantly and positively predicted Wave 2 suicide
attempts. In support of our first hypothesis, the majority of
participants were in Class 1, in which stronger family, school,
and peer relationships all significantly predicted lower rates of
Wave 2 suicide attempts. Because all three indicators of
belongingness were protective factors against suicide attempts,
we labeled Class 1 Protective Relationships Class. In Class 2,
family and peer relationships did not significantly predict Wave
2 suicide attempts. However, stronger school relationships

Table 1 Means, standard deviations, and intercorrelations of the main measures

Measure M (SD) 1 2 3 4 5 6 7 8 9

1. Gender – – .07* -.001 -.12*** -.01 -.09** -.09** -.04 -.07*

2. Acculturation 1.88 (1.24) – -.07* .004 -.02 -.06* .04 .02 .10**
3. Family relationships 3.96 (.71) – -.13*** .24*** -.36*** -.14** -.11** -.27***
4. Peer relationships .53 (.27) – -.04 .20*** .07* .04 .07*
5. School relationships 3.18 (.75) – -.26*** -.11** -.05 -.16***
6. Depressive .68 (.38) – .22*** .13*** .30***
symptoms
7. W1 suicide attempt – – .12*** .48***
8. W2 suicide attempt – – .19***
9. Suicidal ideation – –
W1 Wave 1, W2 Wave 2. With the exception of Wave 2 suicide attempt, all other variables were examined at Wave 1. Gender: 0 girl, 1 boy;
suicidal ideation: 0 no ideation, 1 ideation; suicide attempt: 0 no attempt, 1 attempt
* p \ .05; ** p \ .01; *** p \ .001

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Table 2 Model fit statistics for four latent class models
Model AIC L 2 2
L difference
1-class model 276.36 262.36
2-class model 257.64 227.64 34.73*
3-class model 235.84 189.84 37.79*
4-class model 237.54 175.54 14.31
2 2
L difference refers to the difference between the L value for a
particular model and that of the preceding model (e.g., 2-class model
vs. 1-class model)
* p \ .01
significantly predicted higher rates of suicide attempts. Given
that none of the three indicators of belongingness were pro-
tective factors and school relationships appeared to be a risk
factor, we labeled Class 2 Non-Protective Relationships Class.
Class 3 was similar to Class 1 in that stronger family and school
relationships significantly predicted lower rates of suicide
attempts. However, stronger peer relationships significantly
predicted higher rates of suicide attempts. Because peer rela-
tionships were a risk factor, whereas family and school rela-
tionships were protective factors, we labeled Class 3 Mixed
Relationships Class.
To examine differences among the latent classes on the
main study measures related to our research questions, we
used ANOVAs and chi-square for continuous and dichot-
omous measures, respectively (see Table 4). The latent
classes did not differ significantly in the levels of family,
school, and peer relationships [F(2, 956) B 1.64, p C .194
for all three measures]. In contrast, we found significant
differences among the latent classes in their levels of
acculturation, [F(2, 956) = 184.91, p \ .001], Wave 2
suicide attempts [v2(2) = 25.19, p \ .001], and gender
[v2(2) = 199.98, p \ .001].
Next, we explored the specific nature of the associations
between class membership and Wave 2 suicide attempts,
gender and acculturation. These findings are summarized in
Table 5. A logistic regression model with class member-
ship predicting Wave 2 suicide attempts was significant,
v2(2) = 26.14, p \ .001, Nagelkerke R2 = .11. Class
membership significantly predicted Wave 2 suicide
attempts. Class 1 had significantly lower odds of Wave 2
suicide attempts than Class 2 and Class 3, but Class 2 did
not differ significantly from Class 3 in the odds of Wave 2
suicide attempts. These findings indicate that among the
three latent classes, Class 1 (Protective Relationships
Class) participants had the lowest rate of suicide attempts.
To test the link between gender and acculturation and
class membership, we used a multinomial logistic regres-
sion with class membership (Class 1 vs. Class 2 vs. Class 3)
as the outcome variable (see Table 5). The model pre-
dicting class membership was significant, v2(4) = 691.08,
p \ .001, Nagelkerke R2 = .61. Our second hypothesis
predicted that highly acculturated participants would have
greater odds of being in a latent class in which family
relationships were not a significant protective factor against
suicide attempts. We found that less acculturated partici-
pants had greater odds of being in Class 3 (Mixed Rela-
tionships Class) than in Classes 1 and 2. In contrast, highly
acculturated participants had greater odds of being in Class
2 (Non-Protective Relationships Class) than in the other
two latent classes. This finding provides support for our
second hypothesis, given that among the three latent clas-
ses, Class 2 was the only one in which family relationships
were not significantly related to suicide attempts.
Our third hypothesis predicted that Asian American girls
would have lower odds of being in a latent class in which
peer and school relationships were protective factors
against suicide attempts. This hypothesis received some
support. Compared to boys, girls had lower odds of being
in Class 1 (the only latent class in which peer relationships
were a protective factor) than in Class 3. Moreover, girls

Table 3 Latent class regression predicting Wave 2 suicide attempt

Class 1 Class 2 Class 3
Protective Relationships Class 57% Non-Protective Relationships Class 32% Mixed Relationships Class 11%
(n = 547) (n = 310) (n = 102)
B SE OR B SE OR B SE OR

Family relationships -4.45 1.23 .01* .29 .26 1.33 -3.16 .64 .04*
School relationships -4.66 .97 .01* 1.35 .30 3.87* -2.27 .87 .10*
Peer relationships -5.51 1.63 .004* -.98 .95 .37 8.24 1.89 3,778.94*
Depressive symptoms 1.07 .30 2.92* 1.07 .30 2.92* 1.07 .30 2.92*
Suicidal ideation 0.47 .32 1.60 0.47 .32 1.60 0.47 .32 1.60
Suicide attempt 1.86 .51 6.41* 1.86 .51 6.41* 1.86 .51 6.41*
Suicidal ideation: 0 no ideation, 1 ideation; suicide attempt: 0 no attempt, 1 attempt. All predictor variables were assessed at Wave 1
* p \ .001

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1460 J Youth Adolescence (2011) 40:1453–1464

Table 4 Group comparisons among latent classes on the main study Discussion
measures
Measures Class 1 57% Class 2 32% Class 3 11% Although suicide-related outcomes among Asian American
(n = 547) (n = 310) (n = 102) adolescents are a serious public health problem in the United
States, research in this area has been relatively sparse com-
M (SD)
pared to other racial/ethnic groups (Goldston et al. 2008).
Family relationships 3.96 (.70) 3.94 (.70) 4.08 (.74)
Limitations in the extant empirical literature include a rela-
School relationships 2.82 (.74) 2.77 (.81) 2.88 (.66)
tive lack of emphasis on suicidology theory and subgroup
Peer relationships .53 (.27) .54 (.26) .49 (.25)
differences among Asian American adolescents, a tendency
Acculturation 1.97 (1.18) 2.32 (.96) .04 (.28)
to rely on small, local samples, and the use of cross-sectional
Frequencies (n)
research designs (e.g., Cho and Haslam 2009; Else et al.
W2 suicide attempt 4 18 8
2009; Lau et al. 2002; Nishimura et al. 2005). Against this
Gender: girls/boys 215/322 240/70 5/97
backdrop, our study breaks new ground in being the first
W2 Wave 2. Class 1 Protective Relationships Class, Class 2 known suicidology study to focus exclusively on a national
Non-Protective Relationships Class, Class 3 Mixed Relationships sample of Asian American adolescents through the use of a
Class. With the exception of Wave 2 suicide attempt, all other vari-
ables were examined at Wave 1
longitudinal research design. Guided by Joiner’s (2005)
interpersonal-psychological theory of suicidal behavior
and the person-oriented framework in developmental
Table 5 Binary and multinomial logistic regression analyses
research (Bergman and Magnusson 1997), we assessed the
optimal number of latent classes that explained the associ-
Outcome OR 95% CI ations between family, school, and peer relationships and
Binary logistic regression subsequent suicide attempts among Asian American
Wave 2 suicide attempt adolescents.
C1 (vs. C3) .09* .03, .29 Results from our latent class regression analysis uncov-
C2 (vs. C3) .72 .31, 1.72 ered a 3-class model. Across the three latent classes, the three
C2 (vs. C1) 8.37* 2.81, 24.96 Wave 1 indicators of belongingness exerted significantly
Multinomial logistic regression different effects on Wave 2 suicide attempts, after control-
C2 (vs. C1) ling for Wave 1 depressive symptoms, suicidal ideation, and
Gender .12* .09, .18
suicide attempts. The majority of participants (57%) were in
Acculturation 1.76* 1.52, 2.05
the Protective Relationships Class, which demonstrated the
lowest rate of suicide attempts as compared with the other
C3 (vs. C1)
two latent classes. These findings also provide support for
Gender 155.99* 52.30, 465.27
our first hypothesis, given that this was the only latent class in
Acculturation .01* .003, .03
which family, school, and peer relationships were all pro-
C2 (vs. C3)
tective factors predicting lower odds of subsequent suicide
Gender .001* .0003, .002
attempts. Moreover, these findings align with Joiner’s (2005)
Acculturation 208.90* 64.32, 678.55
interpersonal-psychological theory, which proposes that a
C1 Class 1 (Protective Relationships Class), C2 Class 2 (Non-Protective sense of belongingness to a valued social group is a salient
Relationships Class), C3 Class 3 (Mixed Relationships Class), Gender: protective factor against suicidal desire. Slightly less than a
0 girl, 1 boy, OR odds ratio. For the multinomial logistic regression,
OR [ 1.00 indicates that boys and more acculturated participants had third of participants were in the Non-Protective Relation-
greater odds of being in a particular class versus the other class listed in ships Class—in this latent class, family and peer relation-
parentheses; OR \ 1.00 indicates that girls and less acculturated par- ships did not significantly predict subsequent suicide
ticipants had greater odds of being in a particular class versus the other attempts. However, participants who reported stronger
class listed in parentheses
school relationships had higher rates of suicide attempts,
* p \ .001
suggesting that school relationships were a risk factor for this
latent class. Eleven percent of participants were in the Mixed
had lower odds of being in the two latent classes in which Relationships Class. In this latent class, family and school
school relationships were protective factors (i.e., Class 1 relationships predicted lower rates of suicide attempts, but
and Class 3) as compared to Class 2. Put differently, girls peer relationships were a risk factor predicting higher rates of
had higher odds of being in Class 2 (Non-Protective suicide attempts.
Relationships Class), the only latent class in which stronger Among the three indicators of belongingness, family
school relationships predicted higher rates of suicide relationships appeared to be a relatively salient protective
attempts. factor against suicide attempts because it was a protective

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J Youth Adolescence (2011) 40:1453–1464
factor in two latent classes and the only indicator of
belongingness that was not a significant risk factor in any
of the latent classes. These results dovetail with previous
scholarship identifying the importance of family processes
as a factor associated with suicide-related outcomes among
adolescents (Kidd et al. 2006) and in Asian American
communities (Cho and Haslam 2009; Lau et al. 2002;
Wong et al. 2011a, in press; Wong and Poon 2010).
Because the family is viewed as one’s main source of self-
esteem in many Asian American cultures (Inman and Yeh
2007), strong family relationships might provide Asian
American adolescents with a sense of security that buffers
against suicide attempts.
Although Joiner’s (2005) theory on the protective nature
of belongingness appears to apply to the majority of our
participants (i.e., those in the Protective Relationships
Class), there was a minority of participants in the other two
latent classes for whom peer relationships and school
relationships were potential risk factors. These findings
challenge the universal applicability of Joiner’s (2005)
interpersonal-psychological theory of suicidal behavior.
What follows is a discussion of how differences in gender
and acculturation might explain the differential effects of
family, school, and peer relationships on suicide attempts
across latent classes, including the counter-intuitive find-
ings that school and peer relationships were risk factors in
two latent classes.
In support of our second hypothesis, we found that
highly acculturated participants had greater odds of being
in the Non-Protective Relationships Class than in the other
two latent classes. Among the three latent classes, the Non-
Protective Relationships Class was the only latent class in
which family relationships were not a significant protective
factor against suicide attempts. These findings dovetail
with those of previous studies showing that family vari-
ables were less strongly associated with suicide-related
outcomes among highly acculturated Asian Americans as
compared to less acculturated Asian Americans (Lau et al.
2002; Wong et al. in press). Family relationships might be
a less relevant protective factor for highly acculturated
Asian American adolescents because they might be more
concerned about individuating from their families and are
therefore less affected by the degree to which their family
members feel connected to one another (cf. Lau et al.
2002).
Additionally, less acculturated participants had greater
odds of being in the Mixed Relationships Class than in the
other two latent classes. The distinctive feature of the
Mixed Relationships Class is that peer relationships were a
risk factor for suicide attempts. Perhaps this finding reflects
the psychosocial stressors that less acculturated Asian
American adolescents experience. Less acculturated Asian
American adolescents who spend a lot of time with their
1461
close friends may feel culturally marginalized because they
are potentially more acculturated than their parents, but
less acculturated than their friends (Chao and Tseng 2002).
Alternatively, less acculturated participants may experi-
ence cognitive dissonance because of the different cultural
messages they receive from their family and peers (Tadmor
and Tetlock 2006). Spending more time with peers can
reinforce this awareness of cultural differences, thereby
increasing their experience of acculturative stress and
vulnerability to suicide attempts.
Our third hypothesis predicted that girls would have
lower odds of being in a latent class in which peer rela-
tionships and school relationships were protective factors
against suicide attempts. We found some support for this
hypothesis. Compared to boys, girls had lower odds of
being in the Protective Relationships Class than in the
Mixed Attachment Class; the Protective Relationships
Class was the only latent class in which peer relationships
significantly and negatively predicted suicide attempts.
Additionally, girls had lower odds of being in the two
latent classes in which school relationships were protective
factors (Protective Relationships Class and the Mixed
Relationships Class) as compared to the Non-Protective
Relationships Class. In other words, compared to boys,
girls had higher odds of being in the Non-Protective
Relationships Class, the only latent class in which stronger
school relationships predicted higher rates of suicide
attempts. These findings are somewhat consistent with
those of Lewinsohn et al. (2001), who also found that the
effects of family support and peer support on suicide
attempts differed between adolescent boys and girls.
Moreover, the emergence of school relationships as a risk
factor in the Non-Protective Relationships Class might
reflect Asian American girls’ experience of acculturative
stress. Compared to their male counterparts, Asian Amer-
ican girls tend to experience stricter parental control over
their schooling activities and social lives, more familial
obligations, and greater parental expectations to retain
Asian cultural traditions (Fuligni et al. 2002; Qin 2009). On
the other hand, Asian American girls also face gendered
social pressures in school (e.g., wearing fashionable clothes
and showing an interest in boys) that are antithetical to the
cultural values of their parents (Qin 2009). Accordingly,
high levels of connectedness to school could, ironically,
engender parental disapproval or internalized guilt for
some Asian American girls because they may reflect
activities that conflict with traditional Asian parental
expectations.
Strengths and Limitations
Several strengths in our study were notable. The Add
Health dataset enabled us to use a large, nationally-
123
1462
representative sample of Asian American adolescents as
well as a longitudinal research design. We were also able to
use measures with prior validity evidence in Asian Amer-
ican adolescent samples because the Add Health data have
been used in several published studies (e.g., Crosnoe and
Elder 2004; Hahm et al. 2003; Willgerodt 2008). Further-
more, our use of latent class regression is a methodological
strength. Our bivariate analyses found that only one of the
three indicators of belongingness—family relationships—
was significantly and negatively related to Wave 2 suicide
attempts. In contrast, because latent class regression is not
bound by the assumption of population homogeneity in
traditional regression methods (Ding 2006), we were able
to identify distinct subgroups, each of whom demonstrated
different effects of family, peer, and school relationships
on subsequent suicide attempts.
Despite these strengths, several limitations in this study
should be noted. First, although suicide attempts have been
shown to be a robust predictor of suicide deaths among
adolescents (Spirito and Esposito-Smythers 2006), only a
small proportion of individuals who attempt suicide even-
tually die by suicide. Therefore, our findings cannot be
generalized to suicide deaths. Second, our research ques-
tions were limited by the paucity of culture-related items in
the Add Health questionnaires. Place of birth and language
spoken at home do not fully capture the complexities of
Asian Americans’ acculturative experiences. Future
research should use measures that reflect the multidimen-
sional and bilinear nature of Asian Americans’ cultural
experiences (Gim Chung et al. 2004). Third, we focused
only on gender and acculturation differences among the
latent classes; future research should address other demo-
graphic differences, such as socioeconomic status and
family structure. Fourth, the magnitude of the odds ratio in
the latent class regression should be interpreted cautiously.
Sparse data biases might have inflated the size of the odds
ratio for some predictors (e.g., OR = 3,779 for peer rela-
tionships in the Mixed Relationships Class) due to the low
frequency of suicide attempts across the latent classes
(Greenland et al. 2000). Finally, future research should
identify the pathways through which school and peer
relationships might increase the risk of suicide attempts for
some Asian American adolescents. As earlier discussed,
acculturative stress might be a potential mediating variable
that explains the link between school and peer relationships
and suicide attempts.
Practical Implications
Our findings present several practical implications. Given
the importance of family relationships as a protective factor
in our study, a useful suicide-related prevention strategy for
123
J Youth Adolescence (2011) 40:1453–1464
Asian American adolescents would be to strengthen Asian
American parent–child relationships (Leong et al. 2011;
Wong et al. 2011c). Interventions may include family
therapy and psychoeducational classes to bridge intergen-
erational cultural gaps between Asian American parents
and children (Kim 2003; Ying 2009). For instance, family
therapists and educators can help Asian American families
view parent–child conflicts as an acculturative stressor
confronting the entire family rather than as a problem
associated with a specific member of the family (Kim
2003). However, a one-size-fits-all approach to the pre-
vention of suicide-related outcomes may be problematic;
for some Asian American adolescents, stronger school and
peer relationships may be risk factors for suicide attempts.
Accordingly, educators and mental health professionals
need to tailor their interventions to address the psychoso-
cial needs of specific Asian American subgroups (e.g.,
Asian American female adolescents or highly acculturated
Asian American adolescents). For instance, given our
finding that less acculturated Asian American adolescents
were more likely to be found in a latent class of partici-
pants in which peer relationships were a risk factor for
suicide attempts, preventive interventions can focus on
identifying and addressing problematic aspects of friend-
ships and strengthening healthy friendships among these
adolescents.
Conclusions
The goal of this study was to identify subgroups of Asian
American adolescents who demonstrated different profiles
in the influence of family, school, and peer relationships on
suicide attempts. We found that across three latent classes,
these three indicators of belongingness exerted signifi-
cantly different effects on Asian American adolescents’
suicide attempts. Our findings provide support for the
person-oriented framework, which emphasizes a holistic
and interactionistic view of adolescent development and
the importance of understanding how diverse groups of
adolescents differ on the basis of a constellation of char-
acteristics (Bergman and Magnusson 1997; von Eye and
Bogat 2006). From a prevention perspective, the main take-
home message from our findings is the need for educators
and mental health professionals to tailor suicide-related
prevention programs to address the unique developmental
needs of specific subgroups of Asian American adolescents
(e.g., Asian American girls). Overall, the findings of our
study underscore the heterogeneity and complexities of
Asian American adolescent development.
Acknowledgments This study was funded by a grant provided by
the Maris M. Proffitt and Mary Higgins Proffitt Endowment Grants.
J Youth Adolescence (2011) 40:1453–1464
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Author Biographies
Y. Joel Wong is Assistant Professor in the Counseling and
Educational Psychology Department at Indiana University Bloom-
ington. Dr. Wong received his Ph.D. in counseling psychology from
the University of Texas at Austin. His research interests include Asian
American mental health, especially suicide-related outcomes.
Cara S. Maffini is a doctoral student at Indiana University
Bloomington. Her areas of interest include Asian American adoles-
cent mental health, risk and protective factors associated with violent
behaviors, and identity development.