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CHICAGO —The manic depression that gripped Christine Ruiz had grown so acute by the time she reached high school that she was suicidal.
She began abusing alcohol and painkillers but her family and friends assumed she was just a typical angst-ridden teenager.
Self-harm seemed like a way for her to take control. "I always felt like I wasn't in charge of my body," Ruiz says.
Ruiz’s story offers insights into why Hispanic teenagers have one of the highest teen suicide rates in the United States.
According to a 2012 report from the Centers for Disease Control and Prevention, 13.5 percent of Hispanic female students in grades 9 through 12 admitted attempting suicide — a percentage that is significantly higher than among their black (8.8 percent) and non-Hispanic (7.9 percent) peers. And a 2011 CDC report found that Manhattan had the highest rate — 17 percent — of Latina high school students who had seriously considered suicide.
Many experts believe that the burden of adapting to a new culture is contributing to soaring suicide rates among Hispanic girls, who often come from immigrant families.
Dr. Rosa Gil is the president of the New York–based health and human services nonprofit Comunilife, which runs the Life is Precious program for suicidal teens. "The girls get acculturated much faster than their mothers," says Gil. "Because of machismo and marianismo — the veneration of feminine virtues — young women are raised to be docile and dependent. This creates conflict for girls who are more acculturated."
Research in 2011 suggested that better communication within Latino families can decrease the likelihood of suicide, an objective at the heart of the Life is Precious program.
"We're cultural brokers," says Gil. "We try to explain to the mothers that girls in this country are more independent. We are trying to bridge the relationships between mother and daughter."
Bullying in the United States
Bullying and abuse often make things worse. According to a 2013 study in the Hispanic Journal of Behavioral Sciences, Latina girls who have been bullied are 1.5 times more likely to attempt suicide.
Psychiatrist Dr. Lisa Fortuna, the director of Child and Adolescent Multicultural Health Research at the University of Massachusetts Medical School, says bullying has become a major issue.
"I see a lot of kids, Latinos included, who develop significant depression because of chronic harassment," she says. "It's a public health issue and it has real psychiatric and behavioral consequences, including suicide."
For Yeli Zivkovich, everything changed at the age of 14 when she was sexually abused by two female classmates.
At high school she remained friends with her abusers — a relationship she describes as "Stockholm Syndrome" after the psychological phenomenon in which hostages empathize with their captors — while enduring vicious gossip.
Five years after the initial abuse, and still deeply troubled by her experience, she was working in a dead-end job, had fallen into serious debt — and was suicidal.
"I didn't get the guidance I needed in high school," says Zivkovich, now 27.
Dr. Gil believes bullying has become a major problem in the United States.
"We have seen an increase among the girls we serve in the Life is Precious program. In New York three weeks ago, a 12-year-old committed suicide because of bullying and family issues. The girls are getting younger and younger," she said.
Home environment is an important factor in depression.
Christine Ruiz, now 27, believes living in her small agricultural town — 95 percent Latino and with few job opportunities to offer — deepened her desperation.
Dr. Azara Santiago-Rivera, director of the Chicago School of Professional Psychology National Latino Mental Health Initiative, says, "We are focusing all of our attention on cultural dimensions and family relationships and overlooking important environmental factors. If we're going to design intervention that's effective, we need to look at family and environment."
Stigma of mental illness
The stigma associated with mental illness in the Latino community may also prevent girls from seeking professional help.
Patricia Valoy, 26, says she grew up knowing that her maternal grandmother had committed suicide, but her family always denied it. "There's a stigma," she says. "They say she was poisoned."
When as a teenager she became depressed and suicidal, her family discouraged her from discussing it.
"What happens in your house, stays in your house," she says. "The family unit is so important in Latino culture, and anything that can break that down is considered taboo."
Research conducted through the New York State Psychiatric Institute found that there is a greater stigma attached to mental illness among non-whites, including Latinos, who often seek help from family members or priests before turning to professionals.
The Latino community also lacks adequate mental health professionals equipped to deal with its specific needs.
"Quite often, clinicians who are experts in their field forget that acculturation is an important factor," says Dr. Santiago-Rivera in Chicago.
"We don't necessarily assess language and identity issues. It's not that clinicians aren't interested in them, it's that they're not integrated into their assessment process."
A 2012 report found that many Latinos attribute poor access to mental health services to shortages of bilingual and bicultural professionals, a lack of educational programs for youths, and deficiencies in culturally sensitive services.
There is also little awareness of mental health issues in the Latino community.
"The problem doesn't seem to be going away," says Dr. Gil of Comunilife. "The media plays a very important role in prevention. We need to teach our communities what to look for."
The Massachusetts psychiatrist Dr. Fortuna believes there is now an urgent need for a national, culturally-specific campaign and that the media should encourage parents to understand the problems faced by their bilingual and bicultural children.
"We need to be speaking frankly and having conversations early to develop emotional literacy," she says.