O2102: Suicidal Ideation Among Youth Asylum Seekers With a History of Sexual Violence at an Urban Medicolegal Clinic

Background: Youth asylum seekers and refugees are at high risk for psychiatric disorders like PTSD and suicidal ideation (SI) due to persecution and geopolitical conflicts in their home countries. SI prevalence among asylum seekers varies widely in the literature, ranging from 0.17% to 70%. Rape and sexual violence (SV) are also highly prevalent in these populations, particularly among female youth. Victims of childhood SV are especially susceptible to SI and dissociative episodes (DE). Studies have found a direct association between SV and SI into adulthood and suggest that DE mediates the impact of SV on the number of suicide attempts. To further investigate the relationship between SV and SI in asylum-seeking youth, we examined asylum seekers' forensic medical evaluations (FMEs).

Methods: Data were assessed for clients who underwent FMEs (n=69) at a San Francisco Bay Area Pediatric Asylum Clinic from January 2022 to December 2024. Attorneys completed a referral form with client demographics and legal case information. Clients were split into two groups: those filing under persecution based on SV (mean age = 21.5 years) or other types of persecution (e.g., political beliefs, gang violence). Self-reported past and current SI and DE were compared across groups using a two-proportion z-test. Differences between past and current SI in both groups were analyzed using McNemar’s test.

Results: Of clients undergoing FMEs, mainly composed of adolescents/young adults, 24.6% of cases were filed based on SV, of whom 88.2% were female-identifying (Table 1). Past SI reported among SV cases (64.7%) was nearly two-fold higher than in non-SV cases (32.7%; z=2.33, p< 0.01). Self-reported DE among SV cases (52.9%) was roughly three-fold higher than in non-SV cases (19.2%; z=2.70, p< 0.01). Upon medical examination in the United States (US), current SI reported in SV (5.88%), and non-SV (7.69%) cases dropped to comparably low rates (z=-0.24, p=0.40). The change in prevalence from past to current SI across both groups was statistically significant (2=9.6, p=0.0019).

Conclusion: These findings demonstrate the severe risk adolescent/young adult asylum seekers who experience SV have for SI and DE. The significant decrease in SI suggests that positive factors in the post-migration environment and/or removing negative factors from home countries contribute to symptom reduction. Nonetheless, high rates of suicidality in this population emphasize the need for trauma-informed care, targeted mental health interventions, and legal pathways for asylum seekers in the US. Further research is needed to ascertain the prevalence of suicidality in youth asylum seekers with a history of SV upon arrival in the US, gender differences, and the effects of protective factors on improved mental health outcomes.