Latina girls sound a life and death alarm

By Claudia Kolker

Knife in her hand, brother banging insistently on the door, 16-year-old Ciomara did something she'd never done before. She poised the blade she'd swiped for months across her forearm and leaned into it, hard. An image popped to mind: her best friend, who'd attempted suicide with pills.

Ciomara pulled the blade toward her vein.

Then abruptly she dropped the knife, pressed a shirt to her arm and answered the door as if she hadn't just tried to die.

Ciomara -- identified by a fictitious name because she is a minor –- had reasons to despair. Her stepfather had sexually violated her, in secret, since she was 8. Yet it was only when Ciomara was 14, after she'd told her mother and her stepfather was finally gone, that the teenager thought of suicide for the first time. “I just wanted a solution,” she tries to explain, raising her shoulders helplessly.

To researchers' alarm, suicide has become the solution for a disturbing number of other Latina teens.

Most haven't suffered sexual abuse. Yet something -- some mix of normal stresses and the particular pressures of being Latina -- is fueling a far higher rate of attempted suicide among them than any other group. Ciomara's life reflected many of those crosscurrents: trying to function at school, living with an unbearable secret at home; exuberantly plunging into American teen hobbies –- she competes in karate tournaments –- while navigating for a non-English speaking mother who left her support system behind when she ventured to a new country.

Almost one-quarter of Latina teens seriously contemplate killing themselves, data show. Nearly 15% -- twice the national average -- attempt it, according to 2005 research by the Centers for Disease Control and Prevention.

Why do so many girls, in a culture so rich with family support, feel this despair?

Nobody is sure, says Luis H. Zayas, a professor of social work and psychiatry at Washington University in Missouri. “It has been known about for the longest time -- since the 1960s,” Zayas says. But almost no research exists to explain it. Perhaps the first in-depth study to find out the causes comes from Zayas, currently in the second year of a five-year, federally funded study of 200 Latinas and their parents.

Already, Zayas and others who work with Latina teens agree, several factors seem clear. Above all, trying to conform to American life at school and traditional values at home can act like a magnifying glass. Normal adolescent problems can inflame.

Ciomara's experience typifies many of those conflicting demands. Telling her story in a conference room at the Houston Area Women's Center, the teenager is sweet-mannered and attentive. She's wearing a baseball cap in black pinstripe, grey t-shirt, cargo pants and high-topped sneakers with red laces. She doesn't fidget.

“My stepfather was a father figure, which I wanted,” Ciomara says. “I didn't say anything because he was getting along with my mother.” Then, in ninth grade, Ciomara began to act out, using pot and pills, flying into rages. “I would get a lot of anger because of him. I was crying more, getting more sad. I didn't want ‘that’ to be the cause of what I was feeling. But I was sending my mother signs.”

Despite years of school instruction about good touch, bad touch and the importance of reporting abuse to adults, the person Ciomara finally told about her stepfather was a friend. The girl’s mother called Child Protective Services. Finally, Ciomara told her own mother.

Somehow, Ciomara says, her mother got it across that though she would defend her daughter, she would do so reluctantly. “I think she just sided with me because I was her daughter,” the teenager says. A 36-year-old who walked here from Central Mexico at age 14, Ciomara’s mother had no job, no money and few friends or relatives to turn to. Distraught, she began telling Ciomara the family's chaotic state was Ciomara's fault.

Within a few months, Ciomara began slicing at her forearms. A friend at school had showed her how. “It works. Emotionally and physically, it gives you relief,” Ciomara says. But the avalanche of despair would always crash down again.

The story is familiar to Houston psychiatrist Sylvia Muzquiz. Latinos are less likely to seek professional help when a child is showing suicidal tendencies, such as having mood swings or withdrawing, she says. To some extent, that's economic.

It also reflects a certain cultural distrust. “This is a community that is very skeptical,” says Norma Westurn, the Brazilian-born director of a Latino health clinic in Dallas. “We don't trust 100%. We come from governments that are corrupt, where you can't trust authorities, so it's difficult for anyone outside the culture to say, I have all these nice things to help you. If you persist, you'll get through.”

Even if Latinos do seek professional help, Muzquiz says, they often go to a primary care physician, who usually has little experience or expertise in managing mental health issues.

Many parents may find it hard to distinguish between normal adolescent angst and a mental health problem. But Latinos’ strong, entwined family systems, which can bolster teens without serious problems, may discourage those who really need help from getting it.

“There's always the comadre, mi prima, mi amiga” to talk to, Muzquiz says. “Yet there are issues that probably need a mental health professional, and absolutely they should come in earlier.”

Girls also have to manage culture shock when traditional, often rural, families confront the fast-paced, individualistic United States. Gender expectations make the clash more jarring.

“I think the culture shock makes psychiatric problems more likely,” says Lina Lopez, a child psychiatrist with the University of Texas Mental Health Institute. At home, girls are expected to prioritize the family group, translate for their parents and care for siblings; at school, they're pressured to compete, be sexual and independent.

Often, the biggest pressures are at school, not at home. That's common for teenagers. But for Latinas, not fitting in -- culturally, academically or economically -- can be crushing. Westurn, the director of the private Centro de Mi Salud in Dallas, once treated a Mexican boy who dyed his hair blond hoping to fit in. Though his English was perfect, Anglo students didn't accept him nor did Latinos. Eventually he covered himself with tattoos and joined a gang. “I was fascinated by the processes he put himself through physically to fit in,” Westurn says. A girl, she adds, might have turned on herself instead.

Communication, though, may be the single biggest difficulty for Latina teens. Research shows language is the steepest obstacle to Latino health care, keeping one in six children away from needed doctor's visits. Language also comes between immigrant parents and children.

“Often the daughters are not fluent in Spanish, and the mothers can't speak English,” says freelance interpreter Elena Vega, who has worked with dozens of suicidal girls in Houston hospitals and support groups. “Even if they share an idiom, daughters’ and parents’ experience may be so distant there's no vocabulary to voice it.”

Latinas’ suicide attempts may often be cries for help, experts think. That may explain another part of the mystery: why Latinas’ levels of suicide completion are actually lower, at 2.4, than other groups. Their strong family culture may be one of the reasons. “These girls may feel as if they need to make a strong statement to show that talking to mi prima no es suficiente,” says psychologist Mary Herzog, who works with Children & Youth Services in the County of Orange (Calif.) Health Care Agency.

But Herzog says, in her experience, once a Latino family realizes the problem is beyond its scope, the whole group will rally around the teenager.

For Ciomara, it took the crusted slash on her arm for her mother to see the seriousness of her distress. She took her daughter to the hospital, and social workers then sent both to the women’s center, which holds support groups for abuse survivors. In those meetings, Ciomara says, she finally felt heard for the first time.

Her mother, waiting patiently outside as Ciomara tells her story, comes into the conference room.  The woman is tall, with a tousle of blond hair and blue jeans. She could be an older sister.

“Talk,” Ciomara's mother declares, in Spanish. “It's the only thing you can do as a parent.”

It may never be easy. “I don't know all the words I want in Spanish," Ciomara says. Even recently, she was trying to tell her mother, who speaks little English, about a boy she thought was cute. “She said, ‘He's not a monkey,’” Ciomara says, laughing. “But I didn't know how to say it. I had to call a friend.”

Es guapo, she finally told her mother.

Tu Conexión*

National Hopeline Network: 1-800-784-2433 or www.hopeline.com/

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or www.suicidepreventionlifeline.org/

American Association of Suicidology’s Fact Sheets in English and Spanish: www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=185

San Francisco Suicide Prevention: www.sfsuicide.org/html/about.html

* All links are provided for informational reasons only; inclusion on this list does not imply endorsement of these organizations, their philosophies or their sponsors.