Understanding the Suicide Attempts of Young Latinas

Luis H. Zayas, Ph.D.

Long Island Crisis Center Breakfast and Educational Forum

March 27, 2015

Not a new phenomenon

Earliest evidence of Latinas attempting suicide—late 1950s

The “Suicidal Fit” South Bronx, NY (Trautman, 1961)

impulsive escapes from stressful situations ingested pills or household cleansers disturbances in family relations spouse or mother no thought of death not aware of their thoughts no psychotic symptoms

No public health attention until 1990s

Research lagged until mid-1980s CDC launches Youth Risk Behavior Surveillance

System in 1991 Proves that Latinas ideate, plan, and attempt more Spurred research

SAMHSA’s National Household Survey on Drug Abuse (2003) Latinas 12-17 at higher risk for attempts than others US-born Latinas at higher risk than foreign-born Highest risk in small metropolitan areas

% of Adolescent Girls’ Reporting Suicide Attempts on YRBSS (1995-2013)

1991 1993 1995 1999 2001 2003 2005 2007 2009 2011 2013

10.411.3 10.4 9 10.3 10.3 9.3 7.7

6.57.9 8.59.4 11.2 10.8

97.8 9

9.8

9.9 10.48.8

10.711.6

19.7 21

18.9

15.915

14.914

11.1

13.515.6

White Black Latinas

Historical Core: >400,000 in 1990

38.8 million Hispanics in 201077% of all Hispanics

Why it Matters:Core Hispanic States (9)

Emerging Hispanic States (19)New Hispanic: >200,000 from1990-10

The Progression: It starts with sadness or hopelessness, 2013

Source: CDC, 2014

Female Both Genders0

51015

202530

35404550

White

Black

Hispanic

Then moves to ideation, seriously considering suicide attempt, 2013

Source: CDC, 2014

Female Both Genders0

5

10

15

20

25

30

White

Black

Hispanic

Next, making a suicide plan, 2013

Female Both Genders0

5

10

15

20

25

White

Black

Hispanic

Source: CDC, 2014

Culminating in a suicide attempt, 2013

Female Both Genders0

2

4

6

8

10

12

14

16

White Black

Hispanic

Source: CDC, 2012

Arizona

Colorado

Florid

a

Illinois

New Mexic

o

New YorkTexa

s

Puerto Rico

(2005)

02468

10121416

Suicide Attempts of Adolescent Girls in Core Hispanic States, 2009

WhiteBlackLatina

Data on California and New Jersey not availableData on African Americans in Arizona, Colorado, New Mexico not available (insufficient sample)

Arizona

Colorado

Florid

a

Illinois

New Jerse

y

New Mexic

o

New YorkTexa

s

Puerto Rico

02468

101214161820

Suicide Attempts of Adolescent Girls in Core Hispanic States, 2011

WhiteBlackLatina

Data on California not availableData on African Americans in Arizona, Colorado, New Jersey New Mexico not available (insufficient sample)

Arizona Florida Illinois New Jersey

New Mexico

New York

Texas Puerto Rico

0

5

10

15

20

25

Suicide Attempts of Adolescent Girls in Core Hispanic States, 2013

WhiteBlackLatina

Data on California not availableData on African Americans in Arizona, New Jersey New Mexico not available (insufficient sample)

Theoretical Basis to Examine and Treat Latinas

Adolescent development: Autonomy-connection/relatedness Need mentors who teach, tutor, guide, inspire

Development systems theory: Reciprocal influence of person and environment

Family systems theory: Cohesion vs. Flexibility Communication

Reciprocal exchange of affection, respect, admiration. Emotional attunement to other Perspective-taking

Sets variations in family structure, interactions, & child-rearing that prime and shape affects HISPANIC FAMILISM

Obligation to family & individual identity Enforces traditions, beliefs, family interactions

Influences psychological representations and affects; sets limits of tolerance for emotions

Provides context & rules for interactions (where, when, how, and how intensely)

Provides categories & lexicons for emotional expressions (“idioms of distress”)

Cultural Basis for Research

Our Research Questions Why do some Latinas attempt suicide and others

don’t despite similar characteristics?

What are the elements in the suicide attempts of young Latinas?

Our Study 122 attempters, 88 mothers, 19 fathers

110 non-attempters, 83 mothers, 17 fathers

Girls’ average age: 15 years

Parents’ average education: 10th -11th grade

Familism, Parent-Adolescent Conflict, & Self-Esteem

Total Sample (N=226)

Attempters (n=121)

Non-Attempt (n=105)

M SD M SD M SD t/χ2 Values

Parent-Adol. Conflict 5.20 4.61 6.59 4.84 3.72 3.85 t(206)=-4.70***

Internalizing 20.67 11.13 25.98 10.70 14.95 8.47 t(212)=-8.31***

Self-Esteem 29.28 5.72 26.85 5.29 31.94 4.95 t(209)=7.20***

*p<.05 **p<.01 ***p<.001

Results

Acculturation Attempters and Non-Attempters did not differ Teens more acculturated than parents

Familism Attempters and Non-Attempters did not differ Teens less familistic than parents

Affection, Communication, & Support Attempters reported lower levels than Non-Attempters Attempters rated mothers significantly lower than non-

attempters rated their mothers

Mother-Daughter Mutuality/Reciprocity

Mutuality with mothers Attempters lower in mutuality with moms than Non-Attempters Girls generally rated mothers lower in mutuality Gap greater between attempters/mothers than between non-

attempters/mothers

Attempters’ moms perceive selves to be attuned to daughters Daughters disagree: mothers not attuned

Non-attempters’ moms perceive selves to be attuned to daughters Daughters agree: mothers pretty much attuned

Why Mother-Daughter Mutuality Matters*

A one-point increase in measure (MPDQ) of mutuality is associated with a 57% decrease in the probability of being an attempter

* insufficient data on fathers

Prolonged tension between girl and parents Relations with divorced parents Household chores; breaking house rules Perceived favoritism for sibling

Often about a boyfriend, dating, sexuality—developmental struggle of autonomy

Privacy and boundaries Romantic relations Personal attire

Intense argument with parents just prior Felt guilt at threat to family integrity

The Crisis Event or Trigger

Trigger and intense emotional experience

Overwhelming, contradictory, emotions

Helpless

Agitation Feeling Trapped

Meaning of the Suicide Act

Self-PunishmentSelf-Blame

“I was thinking, ‘Oh, I should just kill myself. I’m not worth it anymore.” [16 year-old; blade from a pencil sharpener]

“I wanted to kill myself. I didn’t want to cause any more problems. I felt so bad for everything.” [14 year-old; pills]

Emotional Release

“I have so much pain inside, it’s kind of like I cry inside…I guess when I cut myself, I feel like I’m letting endless words or anything through the blade. I’m taking out my pain.” [16 year-old; razor blade]

Revenge “I went to rub it in my mom’s face. I was like, ‘that’s why I

went in to the bathroom and swallowed the bottle of pills.’” [13 year-old; 11 Tylenol with Codeine]

Control “It was like a breath of fresh air for me, cause it’s like my mom

wasn’t the one who was hurting me, like she didn’t have control over the hurt I felt.” [15 year-old; razor blade]

Family Sociocultural Environment

Adolescent Development

Culture and Cultural

Traditions

Family Functioning

Subjective Experience of Family Crisis

Emotional Vulnerability

Psychosocial Functioning

Suicide Attempt

Simple Conceptual Model for Project