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Harnessing the Strengths of Immigrant Communities to Prevent Suicide


Joyce R. Javier, MD, MPH, MS, FAAP
September 27, 2019

“Do you know what the leading cause of death is for Asian teens and young adults in the United States?” I asked the parents of a young Filipino boy in my clinic during his annual physical.

Sadly, the mother did.

“Suicide,” she replied. “I have a teenage family member who was depressed and tried to commit suicide.”

Then, she added: “And yet in our family we never discuss it.”

This is a common story I hear from the Filipino families I see in the federally-qualified health center where I practice. Many immigrant parents of my Asian and Asian American patients tell me about young relatives or loved ones who recently attempted suicide or died by suicide. A 12-year-old girl who took her own life after reportedly being cyber-bullied. A college student who died by suicide during finals week. Yet, there remains a lack of public awareness and programs to address this highly stigmatized issue.

As a pediatrician and public health scientist, @JoyceJavierMD forged community partnerships to address critical health issues such as high suicide rates among immigrant patients she treats. #AAPvoices

Partnering with communities to find solutions
I am the daughter of immigrants from the Philippines. Growing up in an immigrant family, I witnessed firsthand Filipino families struggling with depression and suicide. I decided to become a pediatrician and public health scientist to give back to the community that raised me and partner with them to come up with solutions the community could recognize, understand and share. Over the last 18 years, I’ve worked with a myriad of stakeholders to implement multiple approaches described in the new AAP Policy statement “Providing Care for Children in Immigrant Families,” published in the September 2019 Pediatrics.

In a program called the Filipino Family Health Initiative, for example, we used community-based participatory research that engaged Filipino teens, parents, grandparents, health and mental health providers, teachers, clergy and community-based leaders by asking, “What are the mental health issues affecting our youth and how can we prevent them?”

The community’s answer was to build on Filipino cultural values such as “kapwa”—a term meaning shared identity, faith and family—by offering parenting resources to Filipino families in churches. This recommendation focused on reaching out to parents during the school-age years, before their children reach adolescence.

Many immigrant parents of my Asian and Asian American patients tell me about young relatives or loved ones who recently attempted suicide or died by suicide. A 12-year old girl who took her own life after reportedly being cyber-bullied. A college student who died by suicide during finals week. Yet, there remains a lack of public awareness and programs to address this highly stigmatized issue.”


Promoting the power of positive parenting
One of those resources created was a workshop held at a local church during the weekends. We used an evidence-based parent training program at the workshop that treats parents as experts, giving them the skills to use positive parenting to promote resilience and good communication. This program was specifically chosen as a community-identified, grassroots solution to the problem of high suicide and depression rates among Filipino immigrant youth.

To date, over 100 Filipino families have participated in our programs. Many of them have volunteered their time to serve on our community advisory board and encouraged other families to participate. In a project funded by the AAP Community Access to Child Health (CATCH) program, families have shared testimonials in a culturally tailored, theory-based video aimed at increasing enrollment in our parenting programs. We were fortunate to evaluate the video in a randomized controlled trial that was recently published in Pediatrics.


As a parent myself, I have learned so much from the families who have participated in these programs. Parenting is not a skill we are born with; rather it is a set of skills we can learn. Growing up in an immigrant family, I can embrace and adapt these skills without sacrificing our culture or heritage. Using positive discipline has helped me pass on my cultural values to my children and promote their ethnic identity and self-esteem. Family outings to festivals celebrating Filipino American History Month each October, for example, emphasizes the power of spending quality time together. Freely sharing words like “I love you” and “I’m proud of you” reinforces the value of talking about your feelings and supporting positive behavior.


While we cannot control everything that happens to our children, we can control our relationships with them. My hope is that if my children are being bullied or have thoughts of harming themselves, they will feel comfortable enough to come to me for help. This is the same message I share with all the families I see in my clinic and in the community.


As pediatricians, we are in a prime position to help break down barriers to improving the health and well-being of children in immigrant families. In addition to our work with Filipino families, my clinic—a partnership between Children’s Hospital Los Angeles and AltaMed Health Services—offers parenting programs to a predominantly immigrant population in both Spanish and English. We offer these programs during the evenings and provide free child care, which has improved attendance by working parents.

By integrating mental health prevention services into the medical home and the community, we can reduce stigma and encourage participation. This is a critical strategy to promote the emotional well-being of all children in the U.S., especially children growing up in immigrant families.  

* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.


About the Author


Joyce R. Javier, MD, MPH, MS, FAAP, is a practicing pediatrician and public health researcher at Children’s Hospital Los Angeles, in partnership with AltaMed Health Services. She also holds an academic appointment at Keck School of Medicine of USC. She currently serves as an Executive Committee Member on the AAP Council on Community Pediatrics and is a member of the Provisional Section on Minority Health, Equity, and Inclusion. In 2018, she received the AAP Local Hero Award and was named one of the 100 Most Influential Filipina Women in the World by the Filipina Women’s Network. Follow her on Facebook @filipinofamilyhealthLA or on Twitter at @JoyceJavierMD.