Contextualizing Depression in Pacific Islander Sexual and Gender Minority Youth—Location, History, and Culture

To the Editor The study by Rider et al identified high rates of depressive symptoms among groups of Asian American and Native Hawaiian and Other Pacific Islander youth of sexual and gender minority identities who experienced bias-based bullying. We applaud the authors for investigating a vital intersection of pediatric, sexual and gender minority, and mental health. They implemented the χ2 automatic interaction detection technique—a decisional tree approach developed in the 1980s that was foundational to modern-day gradient boosting machine learning techniques used in health care research. Using surveys from California and Minnesota, they found depressive symptoms among the aggregate grouping of Filipinx, Korean, and Japanese youth. As Indigenous Native Hawaiian and Other Pacific Islander physicians and researchers, we share concerns about the transparency, generalizability, and aggregation of Native Hawaiian and Other Pacific Islander data.