My postdoctoral training was in the intersection of mental health, data science, and health informatics. I was supported by a NIH-funded study, “Predicting Self-Harm, Suicide Attempt, and Suicidal Death using Longitudinal EHR, Claims and Mortality Data” (R01 MH119177). The majority of my work and training was focused on using health insurance claims data to study suicidal ideation (SI) and suicide attempts (SA) at the US national level. Specifically, I summarized the US national level healthcare utilization patterns of patients before and after a psychiatric hospitalization admitted through the emergency department (ED), and found that SI was highly prevalent at the time of the index event (29.88%). To further investigate the geographic variation and the neighborhood impact, I studied the effects of geographic regions and neighborhood-level social deprivation level on the clinical and demographic risk factors for SI and SA among US youth and adults (details in the neighborhood section below). While working on these projects, I became aware of the difference between the youth and the adult populations, and started to focus more on studying STBs in youth.

In the summer of 2022, I independently mentored three master-level students on their capstone project, which focused on identifying behavioral factors associated with Black youth’s suicidal thoughts and behaviors (STBs) using the 2019 Youth Risk Behavior Survey (YRBS) data. We found that feeling sad or hopeless and being bullied at school or electronically were positively associated with Black youth’s suicidal ideation, suicide planning, and suicide attempts, whearas ever use of cocaine or heroin was positively associated with Black youth’s attempt-related injuries. In the past two decades, among all racial/ethnic groups, Black youth have experienced the fastest increase in the suicide rate. To understand the unique factors contributing to the rise of Black youth suicide, from 2022-2023, I independently mentored another master-level student on her portfolio project, which studied the temporal trends of risk factors for Black youth STBs in the US from 1991 to 2021. Using LASSO regressions, we found that factors identified for all four outcomes (ideation, planning, attempts, injuries) were similar and consistent overtime, including violent behaviors, substance use, body image concerns, and sex. The effects of all factors, however, remained unchanged overtime, indicating that the increase in prevalence might be driven by other factors not captured by the study. A senior-authored manuscript is currently under revision.

Building upon my experiences, my K99 focuses on using EHR data to study Black youth suicide and STBs in NYC. I found that, among youth who contacted the healthcare system for the first SA diagnosis, compared to White youth, Black youth were younger, had more all-cause healthcare encounters before and after the first SA, but fewer mental-health related encounters after the SA. In addition, Black youth reported more physical comorbidities, especially pain and breathing related diagnoses, both before and after the first SA. To better pinpoint the root of youth suicidality, I started collaborating with child social worker Dr. Xiafei Wang, to study the effects of Adverse Childhood Experiences (ACEs) on youth mental health and STBs. In a recent study, I conducted a moderated mediation analysis to study how the mediation effect of mental health problems are moderated by race. I found that mental health problems fully mediated between ACEs and STBs in White and Black youth, partially mediated in Latinx youth, and had no mediation effects in Asian youth.8 We have submitted one R21 grant proposal on this topic.

People with substance use disorders have an elevated risk of STBs. However, engagement with health care services among this vulnerable population remains under-investigated. Using EHR data, we examined patterns of health care use, identified risk factors in seeking treatment, and assessed associations between outpatient service use and ED visits. We found that opioid use disorder (OUD) was associated with an increased use of outpatient, ED, and inpatient services, yet only one in ten OUD patients received medications for OUD (MOUD) treatment. Using outpatient mental health services was associated with reduced suicide-related ED visits.

In the summers of 2021 and 2024, I mentored three undergraduate students on studying the temporal trends and associations between STBs and substance use in US adolescents. We identified an upward trend in the effects of electronic vaping and marijuana use on STBs, and the associations were consistent across all racial/ethnic groups. In addition, we found that STBs were most prevalent among adolescents with illicit substance use, and least prevalent among those without substance use, suggesting that substance use is positively associated with STBs, with illicit substances having the strongest effect. An earlier version of the results was presented at the 2022 American Psychiatric Association Annual Meeting, and a senior-authored manuscript is in preparation (analysis complete).

Very recently, I started collaborating with social worker Dr. Jonathan Prince to (1) identify communities with high needs of naloxone access, and (2) evaluate the awareness and comfort level of non-traditional first responders who received training to administer naloxone during an opioid overdose.

My interest at the intersection of neighborhood/geography and health disparities (i.e., neighborhood-level social determinants of health) is deeply rooted in my pre-doctoral research on the adverse effects of social and racial segregation on youth’s short- and long-term health, as well as my PhD training in spatial statistics and network analysis. My dissertation research on identifying ecological communities revealed that residents of predominantly White neighborhoods of the city are more attached to an ecological community compared to residents of Black or mixed-race neighborhoods

In tobacco regulatory research, my work has found that rural adolescents had higher self-reported tobacco marketing exposures, however, urban adolescents and those living in neighborhoods with a higher percentage of poverty had more potential exposures to tobacco retailers in their path between home and school.

Using claims data, I investigated the geographic variations of risk factors for suicidal ideation and attempts, as well as the impact of neighborhood-level social disparities on COVID-19 hospitalization and STBs among commercially insured psychiatric patients. I found that neighborhood social deprivation level affected STBs youth and adults’ populations differently, suggesting future community-based suicide prevention initiatives need to be tailored according to participants’ age and neighborhood deprivation level – more attention should be paid on youth residing in middle neighborhoods, a demographic group usually being ignored in suicide prevention.

Recently, we developed a data-driven methodology for defining ethnic enclaves using the readily available neighborhood-level survey/census data. By implementing our methodology, we identified Asian and Latinx enclaves in NYC and studied the effects of ethnic enclaves on self-reported depression and anxiety among senior Asian and Latinx residents. The analysis is complete and the manuscript is currently in preparation.

In an ongoing project, where I am the senior author of an invited paper, we are studying the effects of individual neighborhood-level social determinants on STBs in youth with schizophrenia.

Since the summer of 2023, I have joined, as a spatial epidemiologist, a cross-disciplinary research team consisting of physicians, urban environmental engineers, climatologists, foresters, environmentalists, and geographers, with the common goal of protecting the health of vulnerable communities during extreme heat events by developing evidence-based urban greening strategies. As a team effort, we have submitted one R21 (as a co-I), one F32 (as a collaborator), and one co-authored manuscript (currently under revision).