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Mental health clinicians in inner-city mental health centers serving high concentrations of Hispanic residents have observed that many of the adolescent Hispanic females are referred after suicide attempts. Some confirmation of this phenomenon has come from a recent report from the Centers for Disease Control and Prevention (CDC, 1996) that shows that adolescent Hispanic females have a 21 percent prevalence of suicide attempts, whereas African American and non-Hispanic white females have rates of 10.8 percent and 10.4 percent, respectively. Furthermore, adolescent Hispanic females are also twice as likely as African American and non-Hispanic white adolescent females to have made suicide attempts requiring medical attention (CDC, 1996). Adolescent males overall have lower rates of suicide attempts (CDC, 1996). A small body of literature describing suicide attempts by adolescent Hispanic females has emerged gradually, but the careful empirical scrutiny that these attempts deserve has not occurred.
To provide conceptual direction to clinical and research efforts, this article presents a model for understanding the suicide attempts of adolescent Hispanic females in U.S. urban centers. The model integrates knowledge gleaned from theoretical formulations, clinical experience, and research reports on suicidal behavior by Hispanic and non-Hispanic adolescents and proposes that some factors cut across ethnic and racial groups, whereas other factors appear to have a distinct effect on adolescent Hispanic females. That we focus on suicide attempts by adolescent Hispanic females should not be read as implying that all Hispanic females (or males, for that matter) are prone to suicidal behavior, just as no small group with homogeneous medical or psychiatric problems represents the larger population. If we extrapolate from the CDC (1996) report, we see that the vast majority (80 percent) of adolescent Hispanic females do not attempt suicide.
The model presented here is intended to deepen understanding of the phenomenon of adolescent Hispanic female suicide attempts and to better inform clinical practice. In fact, conceptual models for understanding ethnic and racial minority groups frequently neglect the ecological circumstances underlying social and mental health problems and instead point to individual and family sources of problems. The difficulty in understanding disenfranchised racial and ethnic minority populations comes about when social workers rely on experiences of the dominant mainstream population and fail to highlight the unique experiences, strengths, and resilience, as well as the dynamic forces that underlie the specific problems of ethnic minority groups. The social work profession has a unique interest in understanding suicide attempts for at least two reasons. First, it has a firm commitment to serve oppressed groups through direct practice, program development, and policy initiatives. Second, the ecological approach of social work naturally encourages attention to both external and internal environments, as well as their dynamic interaction. Prevention and intervention efforts deriving from this understanding would include attention to resilience and protective factors, not just problematic ones (Norman, Turner, & Zunz, 1994).
Suicide Attempts by Adolescent Hispanic Females
During the late 1950s, Trautman (1961a, 1961b) identified the so-called "suicidal fit" among Puerto Rican people in the South Bronx, many of whom were young females. The suicidal fit was often an impulsive act of ingesting pills or a household cleanser during a stressful situation related to disturbances in family relations, typically with a spouse or mother. Most of the individuals had no thought of death, were often unaware of their thoughts, and did not manifest psychotic symptoms. Trautman hypothesized that relocation to a new geographic and cultural context was related to the suicide attempt.
Razin et al. (1991) reported that at a municipal hospital in New York City serving an ethnically and racially diverse low socioeconomic population, adolescent Hispanic females "represent[ed] more than 25 percent of all patients admitted to the hospital for suicidal behavior" (p. 46). Robles (1995) also reported that in Dade County, Florida, Hispanic females were 22 percent of public school students but 35 percent of the student suicide attempts. Although the term suicidal fit has been discarded, the phenomenon, which seemed at first to be a phenomenon among the Puerto Rican population, has been reported among adolescent females of diverse Hispanic backgrounds, such as Cuban, Dominican, Mexican, and Nicaraguan (Berne, 1983; Ng, 1996; Razin et al., 1991; Robles, 1995; Trautman, Rotheram-Borus, Dopkins, & Lewin, 1991). The changing demographics of the Hispanic population in the United States may help account for this diversity. Between 1990 and 1994 the number of Hispanic people in the United States grew from about 21 million to 27 million, a 28 percent growth rate compared with a 6 percent growth rate for the total U.S. population during the same period (U.S. Bureau of the Census, 1995). This growth has been accompanied by an increase in Hispanic national-origin diversity. In 1980 people of Puerto Rican ethnic origin in New York City made up more than 61 percent of the Hispanic population, and people of Dominican ethnic origin were only 9 percent (Hispanic Research Center, 1995). In 1990 people of Puerto Rican ethnic origin were 50 percent of the Hispanic population (although the number of people remained nearly the same), and the proportion of people of Dominican ethnic origin rose to nearly 20 percent. The remaining 30 percent of the Hispanic population was made up of people of Colombian, Ecuadoran, Mexican, and other Central and South American ethnic groups (Hispanic Research Center, 1995). Although substance abuse is correlated highly with suicide attempts among adolescents in general (Berman & Jobes, 1991), similar findings have not been reported for adolescent Hispanic females who attempted suicide (Berne, 1983; Ng, 1996; Razin et al., 1991; Trautman, 1961a, 1961b).
An Integrative Model for Understanding the Suicide Attempts
The model assumes that the factors do not exclude the possible influence of other factors (for example, biological factors) but that they represent the most salient ones and that the intensity of the interaction of the factors depends on the specific adolescent or family context for the suicide attempt. The suicide attempt typically occurs within the context of a progressive intensification in conflicts between the adolescent and her parents. An acute situation, usually an intense argument with parents regarding issues associated with autonomy or sexuality, embodied in the adolescent's involvement with a boyfriend, often triggers the suicide attempt.
Socioeconomic conditions (for example, parental education and occupation) also are major influences. Fewer incidents of suicide attempts are reported among middle-class adolescent Hispanic females than among girls of lower socioeconomic status (SES) (Ng, 1996; Razin et al., 1991; Zimmerman, 1991). This difference may be explained by the effects of parental education and acculturation on child-rearing beliefs and practices. As both education and acculturation rise, parents' interaction with their adolescent children becomes characterized by more democratic and less authoritarian parenting behaviors. As less disparity exists among parents and daughters, they may be more in tune with each others' values and agree on some values (for example, hold similar views about child-rearing and differ on career and courtship choices; Canino, 1982). Also, more education and acculturation may lead parents to avail themselves of both formal (for example, teachers and counselors) and informal (for example, coworkers and ministers) supports and information to help them and their daughters cope with the tasks of adolescence. Although low self-esteem may be associated with the phenomenon of suicide attempts, its effect should not be viewed in isolation from other factors, such as those associated with family organization and functioning and developmental coping strategies. Many low SES families demonstrate developmentally sensitive and responsive parenting and strong parent-daughter relations.
- Zayas, Luis H., Kaplan, Carol, Turner, Sandra, Romano, Kathleen, Gonzalez-Ramos, Gladys, Social Work, Jan2000, Vol. 45, Issue 1
Reflection Exercise #4