All Aboard the “Suicide Train” Alarming Suicide Rate among Young Latinas

At a recent panel discussion held in Brooklyn, NY, U.S. Sen. Kirsten Gillibrand stated that “too many of our young Latinas across the county are contemplating and attempting suicide.” The panel discussion was prompted by an alarming rate of teenage Latinas in Brooklyn attempting suicide in 2013: 16.4%; a sizeable increase from 11.6% in 2011. See:

http://www.brooklyneagle.com/articles/2014/10/13/experts-struggle-prevent-latina-suicides-brooklyn

Reportedly, Hispanic girls are twice as likely to take their lives:

The latest report from the U.S. Centers for Disease Control and Prevention revealed that 26 percent of Hispanic teenage girls contemplated suicide in 2013, compared to 21 percent in 2011.

In New York City, the rate went up 3 percent in only two years. In Queens, that number almost doubled (20 percent) during the same period.

In Brooklyn and Staten Island, close to a quarter of the Hispanic teenage population contemplated suicide last year. In both boroughs, the suicide attempt rate increased 5 percent.

http://www.voicesofny.org/2014/07/suicide-haunts-latina-youth-in-nyc/

According to Dr. Rosa Gil, president of Comunilife (http://comunilife.org/), a non-profit organization that runs a program for suicidal teens, 17 percent of Latina adolescents in New York are actively considering suicide. See:

http://www.aljazeera.com/indepth/features/2013/07/20137217262714490.html

Some statistics (http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF):

  • Suicide was the 10th leading cause of death for all ages in 2010.
  • There were 38,364 suicides in 2010; an average of 105 per day.
  • Suicide was the 3rd leading cause of death among persons aged 15-24 years.
  • Suicide was the 2rd leading cause of death among persons aged 25-34 years.

Far, far greater – of course – are the numbers of individuals surveyed during the time period 2008-2009 reporting having had suicidal thoughts (an estimated 8.3 million adults), having made suicide plans (an estimated 2.2 million adults), and having made a suicide attempt (an estimated 1 million adults).

There are racial and ethnic, gender, and age differences. Among youths:

  • 13.5 % of Hispanic female students in grades 9-12 admitted attempting suicide – significantly higher than their black (8.8 per cent) and non-Hispanic (7.9 percent) peers.

Some reasons offered for the high Latina suicide rate:

  • Acculturation gap: Latina girls become acculturated much faster than their mothers creating conflict and friction re traditional values and new values and peer exposure and pressure.
  • Bullying: one study indicates that Latina girls who have been bullied were 1.5 times more likely to attempt suicide. See

http://hjb.sagepub.com/content/35/2/159.abstract

  • Stigma of mental illness: among Latinos may prevent girls from seeking professional help.

More on cultural values:

Suicidal Behavior in Latinas: Explanatory Cultural Factors and Implications for Intervention

Luis H. Zayas, PhD and Allyson M. Pilat, BA

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662359/

The lack of culturally and linguistically appropriate mental health services doesn’t help. See the following 2012 report by UC Davis Center for Reducing Health Disparities, page 9:

http://www.ucdmc.ucdavis.edu/newsroom/pdf/latino_disparities.pdf

Perceptions of mental illness may be different and warrant close scrutiny:

Latinos were less likely to seek out advice from a friend for another suicidal friend and to characterize those who die by suicide as mentally ill.

http://www.suicidology-online.com/pdf/SOL-2012-3-124-130.pdf

Suffering in silence:

Too many Hispanic girls are being allowed to suffer in silence. Frustrated and perplexed by their circumstances, discouraged about their futures and unable to find an outlet to express everything they have been thinking and feeling, at one point or another almost one in seven Latinas have become so depressed and hopeless that she has tried to kill herself—and of course many of them have succeeded, leaving behind shattered and devastated families.

http://www.lucidatreatment.com/blog/mental-health/high-level-women-hispanic-suicide/

See this important work by Luis H. Zayas, Ph.D.:

Why Latinas Attempt Suicide and What we Can do About It:

http://www.texassuicideprevention.org/wp-content/uploads/2013/06/Why-Latinas-Attempt-Suicide-and-What-We-Can-Do-About-It.pdf

Context, of course, dictates the kinds of assessments and interventions that will be rendered. Drawing from my own asylum case files, each of the following young Latina women suffered life-threatening experiences resulting in depression and PTSD. All reported suicidal ideation at some point in time:

1)  Silvia, from El Salvador, escaped a brief relationship with a man who kept her locked in a room with no windows until she was so sick from an infection that she could not move. When Silvia met Guillermo, he was sweet and very attentive. Silvia was smitten with him, but despite her mother’s admonitions, moved in with him after dating briefly.

The “honeymoon” ended soon enough. Guillermo drank a lot, degraded her and told her she was “fea” (ugly) and that other women were better. He pushed her and repeatedly threatened her. He would not let her leave and told her that he owned her. Guillermo assaulted her sexually. Silvia feared he would hit her and engaged in non-consensual sex (intercourse and oral) to placate him and avoid problems. Guillermo locked Silvia in a room whenever he went out. He threatened to hurt her and her family if she left him. Guillermo took Silvia to her mother’s home only after she became very ill and was getting worse because he deprived her of medical attention. It was at this time, amidst his threats, that Silvia was able to escape and come to the U.S. She was only 21 years old when she left her family behind.

Silvia’s psychological evaluation revealed symptoms of depression and anxiety, disturbed sleep and appetite, insecurity, low self-esteem, recurrent intrusive recollections and flashbacks of the abusive relationship, and feelings at times that things are unreal.

Silvia’s PTSD was in partial remission, largely due to the curative effect of living with an uncle who had sponsored her. But the emotional scars ran deep and recovery likely would be a long process.

2)  30-year old Nereida, from Honduras, suffered from clinically significant symptoms of anxiety and depression. She cried during the psychological evaluation and conveyed how scared she was that she would be killed like her sister was if she returned to Honduras. She had flashbacks of a picture of her deceased sister that had appeared in a local newspaper and harbored feelings of insecurity and experienced a sense of loss of control in her life. And like Silvia, Nereida was hypervigilant, looking over her shoulder, fearing that she was being watched or followed.

3)  25-year old Marisol fled from her abusive husband in El Salvador because she feared for her life. She had been beaten numerous times and went to the police after he held a machete to her throat and threatened to kill her. He was detained for three days. He found her on the street after he was released and ran her over with his car. Marisol was hospitalized for several months and was confined to a wheelchair for half a year. Marisol hid at a friend’s home. When he found her, he threatened her at gunpoint that she better return with him. Marisol did, and the next day while he was out, she fled the country leaving her two young children behind.

Her diagnosis was Major Depressive Disorder and Posttraumatic Stress Disorder. Neuropsychological testing also revealed a number of neurocognitive impairments stemming from the pedestrian-motor vehicle accident.

4)  18-year old Paola left Ecuador because of persistent sexual molestation by her stepfather. Her mother did not believe her and Paola had no one to turn to. She traveled across Central America to Mexico with money she took from home and a small amount she earned waitressing for two days in Guatemala. She paid the ultimate price to the coyotes, however, and was raped twice because she did not have all the money they demanded.

Paola also was diagnosed with Major Depressive Disorder and Posttraumatic Stress Disorder.

Some concluding suggestions for clinicians:

  • You need the tools (education, training, experience, etc.).
  • You need to have what it takes to be “reasonably culturally competent”, at least with the population(s) served.
  • You need to be aware of and stay on top of the research in the area(s) in which you provide or will provide services.
  • You need to consider that skills and knowledge are not cast in stone. They are in a constant state of flux and evolution and are driven by many factors that may change over time.
  • You need to remember that you will never be culturally competent. It is a lifelong learning experience.
  • Context dictates assessment and interventions.

Roy

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