Violence,Discrimination,and Mental Health Among Asian Americans: Findings From a 2023 Statewide Cross-Sectional Survey From California

Abstract

The COVID-19 pandemic has significantly intensified existing patterns of anti-Asian racism, elevating both the frequency and severity of discriminatory incidents targeting Asian Americans and Pacific Islanders (AAPI Data, 2022; Sims et al., 2022; Zhang et al., 2022). Such discrimination aligns with historical trends of heightened racism during global health crises, driven by scapegoating that unfairly assigns blame for disease spread to specific ethnic groups (Ertorer, 2024; Wenger et al., 2022). Anti-Asian incidents, including verbal harassment, physical assaults, and civil rights violations, have markedly increased, exacerbating racial prejudice, stigmatization, and creating widespread mental health consequences for AAPI communities (Harii et al., 2025; Y. Li & Nicholson, 2021; Sims et al., 2022). This study seeks to understand how pervasive experiences of violence and discrimination are for Asian Americans and the effect such experiences may have on their mental health in the post-COVID period, using a recent survey conducted with Asian Americans in California in 2023.

Experiences of Discrimination and Asian Hate During COVID

Prior to the pandemic, Asian Americans already faced substantial levels of institutional and interpersonal discrimination. A nationally representative survey by McMurtry et al. (2019) found that one in four Asian Americans reported being discriminated against in healthcare, employment, or public life—experiences strongly associated with chronic stress and reduced well-being. These findings highlight the longstanding exclusion of AAPI individuals from equitable systems and public discourse, contradicting pervasive “model minority” narratives (Wong & Halgin, 2006).

With the onset of COVID-19, these patterns sharply intensified. The pandemic triggered a resurgence of anti-Asian sentiment, particularly targeting East Asian and Chinese-identifying individuals, who were scapegoated for the virus’s spread (C. Kim et al., 2023). Consistent with historical racial scapegoating during health crises (Ertorer, 2024; Wenger et al., 2022), AAPI communities experienced a surge in hate incidents and social exclusion. According to Stop AAPI Hate, over 11,500 anti-Asian incidents were documented in 2022 alone (Stop-AAPI-Hate, 2022), while national surveys report that approximately one in three Asian Americans experienced verbal racial abuse in the past year, and 62% felt socially excluded (TAAF, 2024).

These increases in hate incidents have prompted greater public awareness, research, and activism (Jun et al., 2021; H. Li, 2023). However, many incidents remain underreported due to fear, linguistic barriers, and cultural stigma (C. Kim et al., 2023). Hate incidents, including verbal threats, physical attacks, and workplace exclusion, have deepened experiences of racialized fear and community-level trauma. These shifts reflect broader social conditions in which Asian Americans are rendered hyper-visible as targets of hate while remaining structurally invisible in health systems and data surveillance.

Prevalence of Physical and Sexual Violence Among Asian Americans

In addition to experiences of racial discrimination in public life, many Asian Americans are exposed to forms of interpersonal violence that remain underrecognized and underreported. National data suggest that Asian Americans have the lowest rates of reported violent victimization—9.8 per 1,000 persons between 2017 and 2021 (Thompson & Tapp, 2023). However, these figures are widely believed to underestimate true prevalence due to underreporting, cultural stigma, and institutional mistrust (C. Kim & Schmuhl, 2020). Systematic reviews underscore that intimate partner violence (IPV), hate-motivated crimes, and bullying are significant but underexamined issues within AAPI communities (Huang & Vidourek, 2019; C. Kim et al., 2023; C. Kim & Schmuhl, 2020).

State-level data from California further highlight this concern. While Asian Californians generally report lower aggregate rates of violence, intimate partner violence is slightly more common than among non-Asian populations (8% vs. 6%) (Raj et al., 2023, 2024). Disaggregated data reveal disparities within specific subgroups (such as Indian Americans) suggesting that aggregated AAPI statistics mask critical within-group vulnerabilities. California’s vast and diverse AAPI population, including communities of Chinese, Filipino, Indian, Vietnamese, Korean, Japanese, Nepali, and Mongolian heritage, provides an important context for this analysis (AAPI Data, 2022; Budiman et al., 2019; Sumida, 2023; United States Census Bureau, 2023).

National health surveillance systems, including the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), often fail to disaggregate by ethnic subgroup (Centers for Disease Control and Prevention, 2023), further obscuring patterns of risk. These omissions perpetuate a false narrative that violence is rare among Asian Americans, reinforcing systemic neglect in research, policy, and services.

Mental Health in Asian American Communities

The rise in racial discrimination and underrecognized interpersonal violence has had profound effects on the mental health of Asian Americans. Studies consistently show that exposure to hate crime victimization and fear of racial targeting are associated with elevated rates of depression, anxiety, and trauma-related stress (Ertorer, 2024; Sims et al., 2022; Wenger et al., 2022). Wenger et al. (2022) found that experiences of hate crime victimization during the pandemic were closely linked to severe depressive symptoms. Ertorer (2024) describes how chronic exposure to racial hostility leads to “racial battle fatigue,” characterized by hypervigilance, stigma consciousness, and psychological strain. Harii et al. (2025) further highlight community-wide “spillover effects” of anti-Asian hate crimes, noting that both direct and vicarious exposure to violence can lead to widespread anxiety, depressive disorders, and social fragmentation.

Despite these heightened risks, Asian Americans report some of the lowest levels of mental health service use among all racial and ethnic groups (H. J. Kim et al., 2015; S. B. Kim & Lee, 2022). Barriers include cultural stigma, limited access to culturally competent providers, and internalized norms of self-restraint and self-reliance (Hwang, 2021; S. B. Kim & Lee, 2022; Sue, 2020). While awareness of AAPI mental health challenges is growing, significant research gaps remain regarding how violence and discrimination specifically impact psychological well-being. Most mental health research assumes that Asian Americans are less vulnerable to these exposures, reinforcing underrepresentation in trauma-related interventions (Huey & Tilley, 2018).

This study responds to those gaps by using data from the 2023 California Violence Experiences Survey (Raj et al., 2023), which intentionally oversampled AAPI participants. The survey allows for a closer examination of the relationships between violence, discrimination, and mental health outcomes in a diverse AAPI population. In doing so, we aim to provide evidence to guide targeted policy responses and culturally tailored mental health and violence prevention programs.

Method

The survey research firm NORC at the University of Chicago conducted an online survey with N = 3560 California adults over the period of March to May 2023, with the goal of assessing experiences of violence, discrimination, and mental health concerns with a sample that was weighted to be representative for the state adult population. An oversample of Asian Californians was included to provide insight into this population, resulting in a total of 711 Asian participants in the survey, including at least 50 participants from each of the four largest Asian Californian subgroups: Chinese, Japanese, Filipino, and Indian. This oversample approximately doubled the expected number of Asian respondents based on the distribution of participants in prior waves of the survey.

The California Violence Experiences Survey (CalVEX) is a 15-minute survey that asks participants about their experiences with physical and sexual violence, everyday and institutional discrimination, mental health, and a range of other related constructs. NORC used their AmeriSpeak Panel (NORC, 2022), which is a nationally-representative probability-based sample, and supplemented those respondents with participants of their non-probability panels in California. All participants provided written consent at the time of panel enrollment and received the cash equivalent of approximately $4 USD in accordance with panel participation for their time. NORC offered the survey in English and Spanish but not in any Asian-specific languages, as prior research from NORC only yielded minimal additional survey responses via inclusion of diverse languages. Given the nature of the questions asked, we provided all participants, regardless of their responses, referrals (links, hotline numbers) to mental health services, domestic violence services, and rape crisis services.

NORC provided the partnering university deidentified data for this analysis, as well as survey weights constructed to yield population-based estimates for all study findings at the level of the state. Survey weights were designed to ensure representativeness of the sample regarding several census measures among the total population and racial/ethnic groups with at least 100 respondents, including age, education, income, metropolitan area residence, and five-level region of the state for California. The weighted overall sample and the weighted sample of Asian respondents underrepresent foreign-born (15% vs. 26% overall; 35% vs 55% among Asian Californians) and non-citizen Californians (5% vs. 15% overall; 8% vs. 19% among Asian Californians) (United States Census Bureau, 2021, 2023); other differences between the weighted data and official state figures are not substantial (Raj et al., 2023).

All study procedures were reviewed and approved by institutional review boards at the University of Chicago and University of California San Diego. Details on survey procedures can be found in the CalVEX 2023 survey report (Raj et al., 2023).

Measures

Sociodemographics

We assessed participants’ age, nativity (U.S. born or foreign born), education (less than a high school education, high school diploma/GED, some college education, college degree, graduate school), income (four categories from low income [<$30k/year] to high income [$100k+]), and whether they have a disability (yes/no). Additionally, we asked about gender identity using two items: (a) whether the participant identified as woman, man, non-binary, or another gender identity, and (b) “Do you have any lived experience as a trans person?” For all Asian-identifying participants, we assessed Asian ethnicity by providing a list of common Asian ethnicity groups, largely based on country of heritage. As noted above, we had the following categories for our largest subgroups: Chinese, Filipino, Japanese, and Indian. We collapsed the remaining subgroups based on region, where possible. These included: Other East Asian [Korean, Mien, Taiwanese], Southeast Asian [Burmese, Cambodian, Hmong, Indonesian, Khmer, Laotian, Malaysian, Singaporean, Thai, Vietnamese], and Multiple Asian [individuals with more than one Asian heritage (for example, Chinese and Indian)]. All others and those who did not specify a heritage (n = 28) were collapsed into a single group identified as Other/Unspecified.

Past-Year Experiences of Violence

Participants were asked whether they had experienced various forms of physical or sexual violence, both across the life course and specifically in the past year. Physical violence included three items: physical abuse, threat or use of a knife, and threat or use of a gun. Sexual violence included five items: (a) verbal sexual harassment, (b) transphobic or homophobic sexual harassment, (c) cyber sexual harassment, (d) physically aggressive sexual harassment, and (e) quid pro quo sexual harassment. For analytic purposes, we followed standard practice in public health surveillance and CalVEX reporting by collapsing these eight items into a single binary measure indicating any experience of physical or sexual violence in the past 12 months.

Experiences of Everyday Discrimination

We assessed everyday discrimination using a modified version of the Everyday Discrimination Scale (Williams et al., 1997). Participants were asked whether they experienced any of the following in public spaces (yes/no) in a typical week: (a) poorer service in restaurants or stores; (b) being treated as if unintelligent; (c) people acting afraid of them; (d) being treated as dishonest; (e) being treated as if others were superior. For the purposes of this study, we created a binary indicator where any affirmative response was coded as experiencing everyday discrimination. This dichotomization was employed to enhance interpretability in regression models and to align with public health frameworks that emphasize exposure presence. Additionally, due to the skewed distribution of responses, collapsing the measure into a binary variable minimized sparse cell sizes while preserving meaningful group comparisons.

Depression/Anxiety

Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-4 (PHQ-4), a validated four-item instrument. Participants reported how often they experienced each of the following symptoms in the past 2 weeks: (a) feeling nervous, anxious, or on edge; (b) not being able to stop or control worrying; (c) feeling down, depressed, or hopeless; and (d) having little interest or pleasure in doing things (Kroenke et al., 2009). Each item was rated from 0 (“not at all”) to 3 (“nearly every day”), producing a total score ranging from 0 to 12. Following validated clinical thresholds, we dichotomized this measure to identify individuals with severe symptoms (scores 9–12) versus those with none, mild, or moderate symptoms (0–8). This approach is commonly used in population-level mental health monitoring and enables clear interpretability regarding high-risk individuals.

Suicidality

Suicidality was assessed using the following item: “During the past 12 months, did you ever seriously consider attempting suicide?” Self-reported serious consideration of suicide in the past year, or suicidality, was categorized as yes/no.

Substance Misuse

Substance misuse was defined based on self-reported binge drinking or non-prescribed drug use within the past 30 days. Participants responded to two binary (yes/no) items: (a) whether they had consumed more than four drinks in a day (for women) or more than five drinks in a day (for men) (Bohm et al., 2021), and (b) whether they had used any illicit or non-prescribed drugs (excluding marijuana) during the same 30-day period. An affirmative response to either question was coded as engaging in past-month substance misuse. This operationalization aligns with established public health definitions for population-level surveillance, including those from the CDC and other federal agencies (Bohm et al., 2021). We recognize that this is a simplified measure and does not capture the full clinical spectrum of substance use disorders; however, a more detailed diagnostic assessment was beyond the scope of this study.

Statistical Analyses

All statistical analyses were conducted using STATA 18.0. To account for the complex survey design and produce state-representative estimates, we applied survey weights using the svy command suite for all descriptive and inferential analyses. We first present weighted frequencies and descriptive statistics for all study variables. Bivariate associations between the two primary predictors—past-year violence and everyday discrimination—and each outcome of interest (depression/anxiety, suicidality, and substance misuse) were assessed using Pearson’s chi-squared tests. Missing data were minimal (<1% for all variables), with the exception of the PHQ-4 depression/anxiety scale, which had 4.5% missing in the weighted sample (unweighted n = 26). Given the low overall rate of missingness and per convention with prior CalVEX analyses, we used listwise deletion in all regression models and excluded missing cases from descriptive analyses.

We then conducted a series of survey-weighted logistic regression models to examine the adjusted associations between predictors and outcomes. Model 1 examined the association between past-year experience of violence and each outcome, adjusting for sociodemographic covariates. Model 2 examined the association between experiences of everyday discrimination and each outcome, also adjusting for covariates. Model 3 included both predictors—violence and discrimination—in the same model to assess their independent effects. This three-step approach was chosen to explore both individual and combined contributions of each predictor to mental health outcomes.

All predictors (e.g., violence exposure, discrimination experience) and outcomes (e.g., depression/anxiety, suicidality, substance misuse) were coded as binary variables (1 = presence, 0 = absence). Sociodemographic covariates—age, gender identity, sexual identity, education, income, disability status, nativity, and Asian ethnicity—were included based on a priori selection informed by existing literature linking these factors to both exposures and outcomes. Multicollinearity was assessed using variance inflation factors and was not detected; no additional model selection procedures were applied. Statistical significance was determined at p < .05, and 95% confidence intervals were reported for all adjusted odds ratios (AORs).

Results

Participants were aged 18 to 87 years old (median age: 41 years [SD 15 years]). One in seven participants (14%) had less than a high-school education, 28% had a high school diploma or GED, 29% had a 4-year college degree, and 30% held a graduate degree. Over half (53%) reported an annual household income of at least $100,000, and 15% had household incomes <$30k. More than one in eight individuals (13%) identified as lesbian, gay, bisexual, or other self-described sexual identity, while 87% identified as heterosexual. Twenty-three percent reported having a disability. The largest subgroups were: Chinese (29%), Filipino (18%), Indian (10%), and Japanese (10%). One-third (35%) of our participants were born outside the US (see Table 1).

Table 1.

Demographic Statistics.

Variables	Total (N = 711)	Weighted %
Experiences of violence and discrimination
Past-year physical and/or sexual violence
No	631	85.8%
Yes	79	14.2%
Everyday discrimination in a typical week
No	514	72.4%
Yes	192	27.6%
Sociodemographic characteristics
Asian heritage
Chinese	203	31.1%
Filipino	128	14.9%
Japanese	75	10.5%
Indian	70	8.3%
Other East Asian	66	10.6%
Southeast Asian	101	11.3%
Multiple Asian heritages	40	9.3%
Other/unspecified	28	4.1%
Education
Less than high school education	37	13.6%
High school diploma/GED/some college/AD	218	28.0%
BA/4-year college degree	242	28.8%
Graduate degree	214	29.7%
Income
<$30,000	121	15.5%
$30,000 to under $60,000	129	16.9%
$60,000 to under $100,000	119	15.1%
$100,000 or more	342	52.6%
Sexual identity
LGB/other	85	13.4%
Heterosexual	626	86.6%
Gender identity
Cisgender woman	345	41.4%
Cisgender man	342	52.9%
Transgender woman, transgender man, or nonbinary	24	5.8%
Disability
No	560	77.4%
Yes	149	22.6%
Nativity (birth country)
U.S. born	441	64.9%
Foreign born	264	35.1%
Age
Age in years, continuous [mean (SD)]	41.4 (15.2)
Outcome measures
Severe depression/anxiety symptoms
No	644	93.5%
Yes	41	6.5%
Past-year serious consideration of suicide
No	661	92.5%
Yes	46	7.5%
Past 30 days substance use
No	533	72.1%
Yes	175	27.9%

Fourteen percent of Asian Californians reported physical and/or sexual violence in the past year, and 28% of participants reported experiences of everyday discrimination in a typical week, with 9% reporting both. Among those reporting everyday discrimination, we asked what characteristic (e.g., gender, race, appearance) respondents thought incited their experiences of discrimination. Characteristics most often reported were race/ethnicity (35%), physical appearance (20%), and immigrant status (13%), demonstrating that this type of discrimination was largely racial. In terms of our study outcomes, 7% of participants reported severe depression/anxiety in the past 2 weeks, 7% reported past-year suicidality, and 28% reported substance misuse in the past 30 days. Among those who reported past-year violence, 7% reported severe depression/anxiety in the past 2 weeks, 25% reported past-year suicidality, and 62% reported substance misuse in the past 30 days (see Table 2). Among those who reported everyday discrimination, 12% reported severe depression/anxiety in the past 2 weeks, 22% reported past-year suicidality, and 43% reported substance misuse in the past 30 days. As shown in Table 2, bivariate associations revealed significant relationships between both past-year violence and experiences of everyday discrimination and all three outcomes (severe depression/anxiety symptoms, suicidality, and substance misuse) in chi-square tests. These preliminary associations provided the rationale for subsequent multivariable regression analyses.

Table 2.

Cross-Tabulation Between the Predictor and Outcomes.

Variables	Past-year physical and/or sexual violence			Everyday discrimination in a typical week
Variables	No (weighted %)	Yes (weighted %)	Chi-squared p-value	No (weighted %)	Yes (weighted %)	Chi-squared p-value
Outcome measures
Severe depression/anxiety symptoms			0.94			0.20
No	93.5%	93.3%		96.1%	87.5%
Yes	6.5%	6.7%		3.9%	12.5%
Past-year serious consideration of suicide			<0.001			<0.001
No	95.4%	74.8%		98.0%	77.8%
Yes	4.6%	25.2%		2.0%	22.2%
Past 30-day substance use			<0.001			<0.001
No	77.6%	38.5%		78.3%	56.9%
Yes	22.4%	61.5%		21.7%	43.1%
Experiences of violence and discrimination
Past-year physical and/or sexual violence			–			<0.001
No	–	–		93.0%	66.1%
Yes	–	–		7.0%	33.9%
Everyday discrimination in a typical week			<0.001			–
No	78.7%	35.0%		–	–
Yes	21.3%	65.0%		–	–

Regression models show that everyday discrimination is significantly associated with severe depression/anxiety in the past 2 weeks (AOR = 3.34, 95% CI [1.17, 9.49]), but past-year violence was not associated with this outcome (see Table 3). Even after adjusting for violence in the model, effects of discrimination were sustained (AOR = 3.40, 95% CI [1.22, 9.52]). For the past-year suicidality outcome, both past-year violence (AOR = 8.30, 95% CI [1.77, 38.88]) and everyday discrimination (AOR = 5.96, 95% CI [1.46, 24.30]) were associated with suicidality, and effects were sustained in the model that included both independent variables (past-year violence AOR = 6.21, 95% CI [1.39, 27.74]; everyday discrimination AOR = 5.23, 95% CI [1.46, 18.74]) (see Table 3). Past-year violence was significantly associated with past 30-day substance misuse (AOR = 2.75, 95% CI [1.34, 5.67]), but not everyday discrimination (see Table 3). Even after adjusting for discrimination in the model, effects of violence were sustained (AOR= 2.92, 95% CI [1.35, 6.29]).

Table 3.

Regression Models.

Variables/Models	Model 1. Past-Year Experience of Violence * Outcomes			Model 2. Past 2-Week Depression * Outcomes			Model 3. Past-Year Experience of Violence and Past 2-Week Depression * Outcomes
	Severe depression/ anxiety	Suicidality	Substance use	Severe depression/ anxiety	Suicidality	Substance use	Severe depression/ anxiety	Suicidality	Substance use
	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]	OR [95% CI]
Past-year physical and/or sexual violence (ref. no)
Yes	0.58 [0.13, 2.62]	8.30** [1.77, 38.88]	2.75** [1.34, 5.67]				0.72 [0.18, 2.92]	6.21* [1.39, 27.74]	2.92** [1.35, 6.29]
Everyday discrimination in typical week (ref. no)
Yes				3.34* [1.17, 9.49]	5.96* [1.46, 24.30]	1.00 [0.58, 1.75]	3.40* [1.22, 9.52]	5.23* [1.46, 18.74]	0.85 [0.46, 1.57]
Covariates
Asian heritage (ref. Chinese)
Filipino	1.85 [0.51, 6.76]	1.34 [0.23, 7.86]	2.87* [1.00, 8.22]	1.01 [0.23, 4.51]	0.76 [0.13, 4.59]	2.49 [0.84, 7.42]	0.97 [0.23, 4.07]	1.1 [0.15, 8.02]	2.77 [0.97, 7.92]
Japanese	2.86 [0.36, 22.72]	5.63 [0.42, 76.06]	1.78 [0.62, 5.10]	2.42 [0.41, 14.28]	3.23 [0.30, 35.30]	1.63 [0.58, 4.54]	2.34 [0.40, 13.59]	4.53 [0.33, 62.59]	1.75 [0.61, 5.02]
Indian	4.5 [0.91, 22.34]	1.92 [0.18, 20.78]	2.87* [1.17, 7.08]	2.95 [0.71, 12.27]	1.36 [0.11, 17.38]	2.89* [1.18, 7.09]	3.05 [0.70 13.37]	1.44 [0.08, 24.91]	2.87* [1.18, 6.99]
Other East Asian	0.8 [0.12, 5.13]	1.48 [0.24, 9.17]	2.68* [1.10, 6.55]	0.84 [0.14, 5.14]	0.87 [0.13, 5.85]	2.26 [0.92, 5.58]	0.83 [0.14, 5.03]	1.05 [0.15, 7.59]	2.31 [0.94, 5.68]
Southeast Asian	1.29 [0.26, 6.37]	2.36 [0.39, 14.30]	2.53* [1.05, 6.13]	0.83 [0.17, 4.05]	2.09 [0.27, 16.23]	2.25 [0.94, 5.39]	0.79 [0.16, 3.91]	2.51 [0.33, 19.31]	2.46* [1.01, 6.04]
Multiple Asian heritages	1.47 [0.25, 8.55]	– –	3.01 [0.99, 9.17]	1.83 [0.33, 10.04]	– –	2.63 [0.88, 7.84]	1.72 [0.33, 9.09]	– –	2.88 [0.96, 8.65]
Other/Unspecified	0.75 [0.07, 7.43]	3.72 [0.61, 22.52]	2.03 [0.39, 10.63]	0.66 [0.08, 5.52]	4.26 [0.71, 25.71]	1.89 [0.38, 9.27]	0.65 [0.08, 5.38]	6.46 [0.92, 45.17]	2.01 [0.38, 10.69]
Education (ref. Less than high school)
Completed high school/some college/AD	1.53 [0.34, 6.78]	1.79 [0.45, 7.20]	0.42 [0.15, 1.19]	3.89 [0.58, 26.12]	1.26 [0.35, 4.58]	0.38 [0.13, 1.07]	3.60 [0.49, 26.23]	1.7 [0.44, 6.51]	0.43 [0.15, 1.24]
Bachelor/4yr college degree	1.42 [0.32, 6.27]	0.04** [0.00, 0.39]	0.31 [0.09, 1.06]	3.10 [0.49, 19.41]	0.07** [0.01, 0.45]	0.32 [0.10, 1.00]	2.92 [0.44, 19.32]	0.06* [0.01, 0.53]	0.33 [0.10, 1.12]
Graduate degree	0.58 [0.11, 3.05]	0.6 [0.07, 5.07]	0.32 [0.10, 1.06]	1.29 [0.17, 9.60]	0.77 [0.10, 5.90]	0.32 [0.10, 1.01]	1.23 [0.16, 9.41]	0.67 [0.07, 6.78]	0.34 [0.10, 1.13]
Income (ref. <$30,000)
$30,000 to under $60,000	1.27 [0.27, 5.98]	0.09* [0.01, 0.75]	2.24* [1.01, 4.98]	1.26 [0.34, 4.72]	0.19 [0.02, 1.46]	2.90** [1.33, 6.36]	1.31 [0.36, 4.85]	0.10* [0.02, 0.70]	2.44* [1.10, 5.41]
$60,000 to under $100,000	0.76 [0.15, 3.83]	0.28 [0.02, 3.68]	0.9 [0.37, 2.17]	0.4 [0.08, 1.97]	0.65 [0.09, 4.55]	1.07 [0.45, 2.55]	0.42 [0.09, 1.93]	0.28 [0.02, 3.70]	0.92 [0.36, 2.36]
$100,000 or more	0.90 [0.24, 3.34]	1.33 [0.27, 6.48]	0.94 [0.36, 2.41]	0.83 [0.25, 2.73]	1.29 [0.31, 5.48]	1.03 [0.40, 2.66]	0.81 [0.24, 2.69]	1.23 [0.28, 5.42]	1.01 [0.39, 2.59]
Sexual identity (ref. LGB/other)
Heterosexual	0.35 [0.10, 1.18]	2.17 [0.41, 11.41]	1.03 [0.47, 2.28]	0.57 [0.16, 2.01]	1.62 [0.39, 6.63]	1.09 [0.49, 2.42]	0.56 [0.15, 2.00]	2.21 [0.48, 10.22]	1.11 [0.49, 2.48]
Gender identity (ref. Cisgender woman)
Cisgender man	0.50 [0.20, 1.23]	0.75 [0.23, 2.48]	1.93* [1.06, 3.51]	0.55 [0.21, 1.39]	0.38 [0.10, 1.49]	1.77 [0.98, 3.19]	0.53 [0.21, 1.32]	0.48 [0.13, 1.85]	1.93* [1.07, 3.49]
Transgender woman, transgender man, or nonbinary	0.08* [0.01, 0.63]	1.54 [0.18, 12.92]	2.38 [0.68, 8.37]	0.06* [0.01, 0.53]	2.42 [0.36, 16.05]	4.00* [1.11, 14.45]	0.07* [0.01, 0.59]	1.38 [0.18, 10.57]	2.65 [0.72, 9.80]
Disability (ref. no)
Yes	3.52* [1.30, 9.54]	16.85*** [4.57, 62.20]	2.54** [1.27, 5.06]	2.78* [1.30, 9.54]	14.21*** [3.46, 58.28]	2.88** [1.45, 5.70]	2.81* [1.06, 7.45]	12.20*** [3.28, 45.43]	2.64** [1.33, 5.25]
Birth country (ref. US)
Outside the US	2.53 [0.93, 6.88]	3.55 [0.61, 20.54]	1.27 [0.68, 2.38]	2.99* [1.16, 7.68]	2.77 [0.40, 19.25]	1.13 [0.61, 2.10]	2.79* [1.01, 7.73]	4.22 [0.53, 33.93]	1.24 [0.66, 2.33]
Age
Age in years, continuous	0.94** [0.90, 0.98]	0.90** [0.84, 0.97]	0.98* [0.95, 1.00]	0.94** [0.90, 0.98]	0.91** [0.86, 0.98]	0.98* [0.95, 1.00]	0.94** [0.90, 0.98]	0.90** [0.84, 0.97]	0.97* [0.95, 1.00]

Bolded odds ratios indicate statistically significant associations. p < .05 (*), p < .01 (**).

Discussion

Discrimination and violence are increasingly recognized as urgent public health concerns for Asian American communities, particularly in the wake of the COVID-19 pandemic (McGarity-Palmer et al., 2024; Zhang et al., 2022). While a growing number of studies have examined the effects of discrimination on mental health among AAPI populations, fewer have used population-level data or examined how experiences of both discrimination and violence independently and jointly contribute to psychological outcomes. Most existing studies focus on adolescents, college students, or national samples lacking subgroup representation. In contrast, this study uses state-representative data from California, with intentional oversampling of Asian adults, to examine the association between discrimination, violence, and mental health across multiple outcomes.

This study draws on a subset of respondents from the CalVEX 2023 statewide dataset. While the full sample includes participants from a range of racial and ethnic backgrounds, the present analyses focus exclusively on Asian-identifying individuals. Although a prior public report provided basic descriptive statistics from the broader CalVEX sample, including this subgroup, this is the first peer-reviewed publication to examine the Asian subsample independently and to investigate associations between discrimination, violence, and mental health using multivariable methods. The analyses and interpretations presented here are unique to this manuscript. Our findings contribute new evidence to the literature by showing that both everyday discrimination and past-year violence are associated with elevated mental health risks among Asian Californians, though these exposures appear to operate differently depending on the specific outcome examined. Discrimination was significantly associated with greater odds of moderate-to-severe depression and anxiety, whereas violence was more strongly associated with past-month substance misuse. Both exposures were associated with increased risk for past-year suicidality. These results underscore the distinct yet intersecting pathways through which experiences of marginalization affect psychological health.

The lack of overlap in associations between exposures and specific outcomes is notable. While discrimination was a strong predictor of depression/anxiety, it was not associated with substance misuse. Conversely, violence was linked to substance misuse but not depression/anxiety. This divergence may reflect different mechanisms of harm, different coping responses, or differences in timing and chronicity. For example, substance misuse may be more closely tied to acute physical or sexual trauma, while depression and anxiety may be more sensitive to ongoing interpersonal devaluation or social exclusion. These patterns are consistent with prior work on trauma and coping in diverse populations (Bhavsar & Ventriglio, 2017; Soyka, 2000; Victor & Hedden-Clayton, 2023), though they remain understudied in AAPI communities.

The study also contributes to a growing body of research on suicidality in Asian American populations. Approximately 7% of Asian Californians in our sample reported past-year suicidality, a rate consistent with national estimates for the general U.S. adult population (approximately 6.5%) (CDC, 2025). While this figure is lower than rates reported for other ethnic groups ranging from 8% to 24% (CDC, 2025), it nonetheless represents a significant public health concern, particularly given the historical under recognition of suicidality within AAPI communities. Both discrimination and violence were associated with increased odds of suicidality, suggesting that these exposures may play a more central role in suicide risk among AAPI populations than is typically acknowledged. Much of the prior literature on suicide among Asian Americans has focused on acculturative stress, academic pressure, and intergenerational conflict (H. J. Kim et al., 2015; Leong et al., 2007; Srinivasa et al., 2022; Sue et al., 2012). Our findings suggest that interpersonal violence and discrimination should be more fully integrated into public health suicide prevention efforts.

Although perceived immigration-related discrimination was frequently reported, it did not emerge as a significant predictor of adverse mental health outcomes in regression models. This may reflect the complexity of how immigration stigma is internalized or the limitations of single-item measures in capturing its mental health impact.

Another important limitation of this study is the inability to disentangle whether the reported experiences of violence were bias-motivated or non-bias in nature (e.g., interpersonal or intimate partner violence). This distinction is critical, as prior research has shown that bias-motivated violence—particularly when tied to racial or ethnic identity—can elicit psychological responses more akin to discrimination than to general forms of violence. Given the observed patterns in our findings, future studies should aim to include measures that directly assess the perceived motivations behind violence in order to examine whether discriminatory violence operates as a distinct mechanism of harm with unique mental health consequences.

This study also has methodological limitations. Its cross-sectional design precludes causal inference, and reliance on self-report may introduce recall or social desirability bias. The survey was administered online and only in English and Spanish, which likely resulted in under-representation of non–English-speaking and foreign-born Asian Californians—populations that may be particularly vulnerable to discrimination and mental health challenges. As a result, our findings may be conservative estimates of the actual burden. Additionally, our sample was not powered to detect or compare differences across Asian ethnic subgroups. While subgroup variation is important, disaggregated reporting must be done cautiously to avoid pathologizing any one group. Future studies with larger samples and multistate designs could provide the basis for more nuanced subgroup analyses.

In summary, this cross-sectional study highlights the distinct and compounding mental health burdens associated with discrimination and interpersonal violence among Asian Californians in the post-pandemic period. Discrimination was strongly linked to depression and anxiety symptoms, while violence was more closely associated with substance misuse, and both exposures significantly predicted suicidality. These findings emphasize the need for comprehensive mental health assessments and culturally responsive interventions that account for both discrimination and violence in Asian American communities. Public health partnerships with AAPI community organizations can play a pivotal role in promoting prevention, trauma-informed care, and community-centered healing to address these escalating concerns.

Supplemental Material

sj-docx-1-jiv-10.1177_08862605251368818 – Supplemental material for Violence, Discrimination, and Mental Health Among Asian Americans: Findings From a 2023 Statewide Cross-Sectional Survey From California

Supplemental material, sj-docx-1-jiv-10.1177_08862605251368818 for Violence, Discrimination, and Mental Health Among Asian Americans: Findings From a 2023 Statewide Cross-Sectional Survey From California by Annika Huilin Li, Nicole E. Johns, Gennifer Kully, Sabrina C. Boyce, Mai P. Do, Jakana L. Thomas and Anita Raj in Journal of Interpersonal Violence

Supplemental Material

sj-docx-2-jiv-10.1177_08862605251368818 – Supplemental material for Violence, Discrimination, and Mental Health Among Asian Americans: Findings From a 2023 Statewide Cross-Sectional Survey From California

Supplemental material, sj-docx-2-jiv-10.1177_08862605251368818 for Violence, Discrimination, and Mental Health Among Asian Americans: Findings From a 2023 Statewide Cross-Sectional Survey From California by Annika Huilin Li, Nicole E. Johns, Gennifer Kully, Sabrina C. Boyce, Mai P. Do, Jakana L. Thomas and Anita Raj in Journal of Interpersonal Violence

Footnotes

Appendix 1

Appendix 2 Declaration of Conflicting Interests

The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research and/or authorship of this article: Blue Shield of California Foundation Grants RP-1907-13755 & P-2006-14747; Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation Grants 20202903 & 118910

ORCID iDs

Annika Huilin Li

Gennifer Kully

Sabrina C. Boyce

Anita Raj

Author Biographies

Annika Huilin Li MS, is a PhD candidate in Education Studies and a pre-doctoral fellow at the Center on Gender Equity and Health at the University of California San Diego. Her research focuses on gender-based violence and its impact on child development. Specifically, her focus lies in investigating the relationship between intimate partner violence exposure/witnessing and children/young adolescents’ development, with an emphasis on maternal and women’s empowerment.

Nicole E. Jones, MPH, is a research data analyst within the Center on Gender Equity and Health at the University of California San Diego. She leads data-related activities for a range of studies across the Center. She brings a background in global and domestic quantitative health research related to maternal and sexual and reproductive health. She believes strongly in creating and conveying rigorous evidence for policy and practice, and is particularly passionate about finding ways in which research may be informed by and leveraged to achieve reproductive justice.

Gennifer Kully, MPH, is a clinical research coordinator at the Center on Gender Equity and Health at the University of California San Diego. Her prior experience includes sexual health education curriculum development for high school students in the Dominican Republic. Gennifer’s research interests include adolescent health, health education, and the promotion of reproductive justice locally and globally.

Sabrina C. Boyce, PhD, is an assistant professor in Maternal, Child, and Adolescent Health in the Community Health Sciences Division in the School of Public Health at University of California, Berkeley. Her research addresses gender inequity as an upstream determinant of poor health among women, adolescents, and sexual and gender minorities. Her observational research illuminates community and societal-level determinants of reproductive health and gender-based violence, with a focus on social norms and community connection. Additionally, Dr. Boyce’s research provides evidence from experimental and quasi-experimental trials on the effectiveness of real-world public health interventions, especially those addressing community and societal-level levers for prevention.

Mai P. Do, PhD, is an associate professor and Vice Chair in the School of Public Health and Tropical Medicine at Tulane University. She has research interests in access, quality, and utilization of health care services primarily in the areas of family planning, reproductive health, and maternal and child health. She is also interested in the investigations of stigma as a barrier to accessing quality care for mental illness and cancer among immigrant populations.

Jakana L. Thomas, PhD, is an associate professor in the School of Global Policy and Strategy at the Department of Political Science at the University of California San Diego. She is an expert on political violence with an emphasis on the behavior of violent non-state actors. Her recent projects examine women’s participation in rebel, terrorist, and community-based violent organizations, how violence influences conflict resolution, the correlates of terrorist lethality, and the determinants of successful peace processes.

Anita Raj, PhD, is the executive director of the Newcomb Institute and the Nancy Reeves Dreux Endowed Chair in the School of Public Health and Tropical Medicine at Tulane University. She is a research scientist trained in developmental psychology and public health with a multi-disciplinary research focus on gender equity in global health and development. She has led federal grant and foundation-funded studies on gender theory and measurement science, sexual and reproductive health, maternal and adolescent health, women’s empowerment, and gender inequalities, including gender-based violence and child marriage.

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