Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

Two pathways to Mexico: Forced deportation or voluntary return of parents and US citizen children

Hundreds of thousands of undocumented Mexican immigrants were deported from the United States or returned to Mexico voluntarily in the past two decades, taking with them their US-born citizen children (USCC). A family's relocation-forced deportation or voluntary return-and the subsequent settlement and adjustment to Mexico affect everyone's well-being. We interviewed 18 USCC whose parents were forcibly deported and 18 whose parents returned voluntarily about their circumstances, experiences, and perceptions. Four categories of relocation and adjustment issues emerged. USCC with deported parents felt the sudden and harsh arrest, detention, deportation, and separation from parents, and family reunification after deportation. Those in the voluntary-return group told of concerns about the planned separation and relocation to Mexico. Both groups experienced issues of family reintegration and adjustment to a new environment. While relocation prompted similarities and differences in families' settlement, issues unique to families played a part in children's adjustment. Clinicians in both the United States and Mexico must take into consideration the nature of the relocation, families' distinctive reactions, and the individual child's experience as some USCC will remain in Mexico and others will return to the US Mexican clinicians will encounter USCC still settling and adjusting to Mexico, and USCC who decide to remain permanently in Mexico. US clinicians may encounter USCC facing the challenges of re-entering American society, joining educational institutions, and becoming part of the labor force. USCC forming families may feel the impact of their pasts in parenting dynamics.

Father-Daughter Relationships among Latina Adolescents Who Attempted Suicide: An Exploratory Dyadic Analysis

Among adolescents, Latinas are at an increased risk of experiencing suicidal ideation and attempts compared to non-Hispanic, White youth. Previous research indicates that family dynamics are influential as both protective and risk factors. Although significant research has been conducted over the past several decades examining the mother-daughter relationship, few studies have examined the father-daughter relationship among Latina adolescent suicide attempters. The relationship dynamics between fathers and daughters of Latina descent are both similar and unique compared to mother-daughter relationships. Given this, an in-depth analysis is warranted. To address this gap, the present study utilized dyadic thematic analysis to describe father-daughter relationships (N = 10 dyads, 20 individual interviews) and fathers' reactions to their Latina daughters' suicide attempt(s). Three themes emerged from the results (a) dynamic proximity, which describes the variation in emotional and physical closeness between fathers and daughters; (b) father as protector, which describes fathers' roles in protecting or failing to protect their daughters; (c) responses to the suicide attempt, which describes the various ways fathers responded to daughters' suicide attempts, ranging from helpful action to apathy. Themes gleaned from in-depth interviews informed a deeper understanding of these complex, multifaceted relationships, and how they may be linked to fathers' responses to daughters' suicide attempts. Implications for future research and clinical practice with youth at risk for suicidal ideations and behaviors, along with the impact of such experiences on families, are discussed.

Sibling relationships among U.S. citizen children of undocumented Mexican parents

Current U.S. immigration policies disproportionately impact Mexican-origin mixed-status families, yet few studies examine the consequences of immigration enforcement (e.g., immigration-related arrest and detention) and deportation on sibling dynamics. Given this gap, this study focuses on the experiences and changes within sibling relationships in the aftermath of parental detention and deportation. We analyzed a subsample of 20 citizen children interviews (7 sibling dyads; 2 sibling triads) from a multi-site binational study that examined the psychosocial functioning of U.S. citizen children with undocumented Mexican parents. Using inductive thematic analysis, we explored the roles and functional importance of sibling relationships before and after experiences of parents' detention and deportation. Our findings suggest that prior to detention or deportation experiences, sibling relationships were described as "normal." After these experiences, however, sibling relationships changed and developed protective adaptations, including more open communication about their experiences and the assumption of caregiving roles. In cases where deportation did not occur, there still existed the threat of future immigration-related action, which contributed to fear and an inability to share feelings and experiences among siblings. Our findings suggest that sibling relationships might serve as an important locus of stability and protection. Yet, adaptive communication may not emerge as long as the threat of apprehension, detention, and deportation exists.

System Dynamics of Cognitive Vulnerabilities and Family Support Among Latina Children and Adolescents

The paper describes an approach to developing a data-driven development of a feedback theory of cognitive vulnerabilities and family support focused on understanding the dynamics experienced among Latina children, adolescents, and families. Family support is understood to be a response to avoidant and maladaptive behaviors that may be characteristic of cognitive vulnerabilities commonly associated depression and suicidal ideation. A formal feedback theory is developed, appraised, and analyzed using a combination of secondary analysis of qualitative interviews (N = 30) and quantitative analysis using system dynamics modeling and simulation. Implications for prevention practice, treatment, and future research are discussed.

Trajectories of Well-Being Among Latina Adolescents Who Attempt Suicide: A Longitudinal Qualitative Analysis

Significant research questions persist regarding the short- and long-term outcomes of Latina adolescents who attempt suicide. To address these limitations, we utilize an ecodevelopmental framework to identify potential factors that shape differential outcomes following a suicide attempt. Through an exploratory, longitudinal, qualitative research design, we investigate two research questions: How do trajectories of well-being vary among Latina teens after a suicide attempt? What risk and protective factors might contribute to different trajectories? We conducted qualitative interviews with 17 Latina participants living in predominantly low-income households in New York City. Interviews took place within the 6 months following their suicide attempts, and again, 12 months later. Analysis revealed three distinct trajectories after a suicide attempt: resilience, tenuous growth, and chronic stress. Our findings elucidate potential factors that contribute to resilience following a suicide attempt and underscore the importance of prevention and intervention programs that foster adolescents' connectivity across ecodevelopmental contexts.

Evaluating the Interpersonal-Psychological Theory of Suicide among Latina Adolescents using Qualitative Comparative Analysis

The Interpersonal-Psychological Theory of Suicide (IPTS) has emerged as an empirically supported theory of suicide risk, yet few studies have utilized IPTS to examine the suicidal behaviors of Latina adolescents. In this study, we explore the cultural and developmental appropriateness, as well as the explanatory fit, of IPTS within a sample of Latina adolescents. Data for this project were drawn from qualitative interviews conducted with Latina adolescents with (n=30) and without (n=30) histories of attempted suicide. We employed a deductive qualitative approach to define and compare core constructs of IPTS (perceived burdensomeness, thwarted belongingness, and acquired capability), and then use qualitative comparative analysis to evaluate how core constructs were linked with the occurrence of a suicide attempt. Consistent with IPTS, perceived burdensomeness, thwarted belongingness, and acquired capability were present in 20 of the 30 adolescents who had attempted suicide, and absent in 22 of the 30 adolescents with no lifetime history of suicidal behaviors. Notably, alternative combinations of IPTS constructs were found in 10 cases of adolescents who attempted suicide, suggesting a need to adjust IPTS to fit the developmental and cultural contexts of Latina teens. Although our results suggest predominantly positive support for IPTS, participants varied in terms of how their experiences resonated with the conceptual definitions put forward by the theory. Ultimately, our findings point to the ways in which developmental tensions are exacerbated by broader sociocultural dynamics, contributing to a broader understanding of suicide risk among ethnic minority adolescents.

Treatment Narratives of Suicidal Latina Teens

In this article, we examine the treatment narratives of Latina adolescent suicide attempters to understand their experiences undergoing care. For this study, we conducted content and thematic analysis of 68 interviews with Latina adolescent suicide attempters. Most teens who described positive experiences undergoing treatment (n = 39, 44.1%) did so when discussing outpatient mental health services (n = 30, 72.9%). Latinas felt that the providers who fostered their autonomy and connectedness helped them become active agents in their recovery. Clinicians serving suicidal Latinas must allow them to exercise agency while feeling emotionally connected to providers. To help Latinas manage their suicidality, treatments need to address the teens' developmental needs.

Integration of Unaccompanied Migrant Youth in the United States: A Call for Research

Between October 2013 and July 2016, over 156,000 children traveling without their guardians were apprehended at the US-Mexico border and transferred to the care of the Office of Refugee Resettlement (ORR). During that same period, ORR placed over 123,000 unaccompanied migrant youth-predominantly from Central America-with a parent or other adult sponsor residing in the US. Following placement, local communities are tasked with integrating migrant youth, many of whom experience pre- and in-transit migration traumas, family separation, limited/interrupted schooling, and unauthorised legal status, placing them at heightened risk for psychological distress, academic disengagement, maltreatment, and human trafficking. Nonetheless, fewer than 10% of young people receive formal post-release services. This paper addresses the paucity of research on the experiences of the 90% of children and youth without access to post-release services. To bridge this gap, this article: (a) describes the post-release experiences of unaccompanied youth, focusing on legal, family, health, and educational contexts; (b) identifies methodological and ethical challenges and solutions in conducting research with this population of young people and their families; and (c) proposes research to identify structural challenges to the provision of services and to inform best practices in support of unaccompanied youth.

Charting Directions for Research on Immigrant Children Affected by Undocumented Status

Three groups of children from Mexico and Central America are vulnerable to effects of US immigration policies: 1) foreign-born children who entered the US with undocumented immigrant parents; 2) unaccompanied children who entered the US alone; and 3) U.S.-born citizen children of undocumented immigrant parents. Despite the recent demographic growth of these youth, scholarship on their strengths and challenges is under-theorized and isolated within specific disciplines. Hence, service providers, researchers, and policymakers have insufficient research to inform their efforts to support the children's wellbeing. A group of scholars and service-providers with expertise in immigrant children convened to establish consensus areas and identify gaps in knowledge of undocumented, unaccompanied, and citizen children of undocumented immigrant parents. The primary goal was to establish a research agenda that increases interdisciplinary collaborations, informs clinical practice, and influences policies. This report summarizes key issues and recommendations that emerged from the meeting.

Processes of Belonging for Citizen-Children of Undocumented Mexican Immigrants

In this article, we focus on the developmental contexts of middle childhood and early adolescence to explore the lives of citizen-children living with undocumented Mexican parents. We draw on the concept of belonging to highlight the distinct situation of citizen-children and the ways in which they come to understand their place in a world. To capture the experiences of citizen-children born to undocumented Mexican immigrant parents and their sense of belonging to place and community, we conducted in-depth interviews with 83 citizen-children in late childhood and early adolescence in three groups. One group of citizen-children lived in Mexico after their parents' deportation. Another group remained in the U.S. after parents were detained or deported. The third group did not have a parent in deportation proceedings. Qualitative analyses of children's recorded interviews revealed their experiences of discovery of parents' undocumented status; political, social and material exclusion; and rupture of family ties. Children were keenly aware that birthright citizenship afforded them numerous privileges unavailable to their parents, but that it did not extend to the very privilege, they valued most: an intact family. The loss of parents through detention or deportation forced some children to consider existential questions about who they were and where they belonged, sometimes pitting family members against one another. Our findings suggest that belonging is intimately tied to broader forces of legal persecution that go beyond individualized notions of illegality and have deep, possibly lasting psychological effects.

Exploring the Effects of U.S. Immigration Enforcement on the Well-being of Citizen-Children in Mexican Immigrant Families

In this article, we draw on ecocultural theories of risk and resilience to examine qualitatively the experiences of U.S. citizen-children living with their undocumented Mexican parents. Of central importance is the fact that citizen-children's daily lives are organized around the very real possibility that their undocumented parents could one day be detained and deported. Our purpose is to render visible the various ways in which citizen-children confront and navigate the possibilities-and realities-of parental deportation. We develop a framework to conceptualize the complex multidimensional, and often multidirectional, factors experienced by citizen-children vulnerable to or directly facing parental deportation. We situate youth well-being against a backdrop of multiple factors to understand how indirect and direct encounters with immigration enforcement, the mixed-status family niche, and access to resources shape differential child outcomes. In doing so, we offer insights into how different factors potentially contribute to resilience in the face of adversity.

Toward an Understanding of Suicide Risks in Young Hispanic Females

Hispanic adolescents in the United States have been virtually neglected in the literature on youth suicide. Among Hispanic youth, adolescent females constitute a subgroup at risk for depression and suicidal behavior. The author reviews extant literature on adolescent suicide, and discusses such psychosocial and cultural factors as socioeconomic disadvantage, traditional gender-role socialization, acculturation, cultural identity, and intergenerational conflict within the context of suicide attempts among adolescent Hispanic females. It is proposed that the interactive effects of these factors may contribute to suicide attempts among low income, first and second-generation Hispanic adolescent females.

Evaluating an Abbreviated Version of the Hispanic Stress Inventory for Immigrants

This study evaluates an abbreviated version of the Hispanic Stress Inventory-Immigrant version (HSI-I) with a nonclinical sample of 143 adult Hispanic immigrants residing in a large midwestern city. The HSI-I consists of 73 items and 5 distinct subscales that assess psychosocial experiences on five dimensions, namely, occupational/economic, parental, marital, immigration, and familial/cultural. Five items with the greatest loading in each of the five sub-scales were aggregated to compose the abbreviated HSI-I. Exploratory factor analysis supports a two-factor structure that combines factors identified in previous research. Internal consistencies are acceptable across all subscales, ranging from .68 to .83. Convergent validity of the abbreviated HSI-I revised is supported with moderately positive relations through self-report measures of depression, anxiety, and anger mood levels. These findings provide initial support for the reliability and validity of the abbreviated HSI-I in Hispanic adults.

Depression, Acculturation, and Motivations for Alcohol Use among Young Colombian, Dominican, and Puerto Rican Men

Increasing numbers of young Hispanic men are being treated for alcohol abuse and its consequences. To provide culturally competent services, there must be an understanding of subcultural differences in the antecedents of alcohol abuse and drinking problems. The present study examined the impact of depression, acculturation, and motivations as antecedents for drinking and drinking-related problems among 288 Colombian, Dominican, and Puerto Rican men. Path analyses suggest that for all three groups, depression is associated with drinking for psychological motivational reasons. Psychological motivations, in turn, have a direct impact on heavy drinking and drinking problems. The model for Puerto Ricans suggests psychological motivations are the only direct predictor of drinking problems. For Dominicans, depression appears to be an important direct contributor to drinking problems, whereas for Colombians, acculturation seems to directly contribute to drinking problems. Implications for practice and research are discussed.

Acculturation and Teaching Behaviors of Dominican and Puerto Rican Mothers

The relationship between acculturation and maternal teaching behaviors was studied by observing 101 low-income Puerto Rican and Dominican mothers in a teaching task with their preschool children and rating six teaching behaviors frequently used by parents. Puerto Rican mothers tended to be more acculturated than Dominican mothers. Although the two groups tended to prefer teaching behaviors that involved giving directives, visual cues, and modeling, Puerto Rican mothers made significantly more use of inquiry and praise, and Dominican mothers used more modeling behaviors. Significant correlations for the total sample were found between acculturation and three teaching behaviors (inquiry, praise, and modeling). These correlations were thefunction of group difference in acculturation and not socioeconomic status. Acculturation was only significantly related to negative verbal feedback and visual cues in teaching, and positively related to modeling among Puerto Rican mothers.

A Retrospective on "The Suicidal Fit" in Mainland Puerto Ricans: Research Issues

The so-called "suicidalfit"among Puerto Ricans in New York City was reported by Trautman (1961a, 1961b) over two decades ago. Based on a sample of 93 Puerto Ricans who, under severe emotional stress, attempted suicide in almost identical circumstances, his writings provide an early view of suicidal behavior among Puerto Ricans in the South Bronx during the late-1950s. In the intervening time, very little has appeared further documenting and elucidating suicidal behavior among Puerto Ricans, and other Hispanics, in the mainland United States. The paucity of available knowledge for clinicians and researchers about the nature of suicide among contemporary New York Puerto Ricans poses seriousproblemsfor mental health programs and practice. This article reviews Trautman's research, commenting on methodology and interpretations of findings, and discusses implications for mental health research with mainland Puerto Ricans and other Hispanic groups.

Perceived discrimination and sexual precursor behaviors in Mexican American preadolescent girls: The role of psychological distress, sexual attitudes, and marianismo beliefs

OBJECTIVES

This study explored the relation between perceived discrimination and sexual precursor behaviors among 205 Mexican American preadolescent middle school girls. In addition, this study examined whether psychological distress and sexual attitudes mediated and whether marianismo beliefs moderated this relation.

METHOD

A categorical confirmatory factor analysis (CCFA) of the Marianismo Beliefs Scale (MBS) was conducted to test the factor structure with a preadolescent Mexican American population (ages 11-14). A path analysis of analytic models was then performed to examine the hypothesized relations between perceived discrimination, psychological distress, sexual attitudes, marianismo beliefs, and sexual precursor behaviors.

RESULTS

Results of the CCFA did not support the original 5-factor structure of the MBS for preadolescent Latina girls. However, a revised version of the MBS indicated an acceptable model fit, and findings from the path analysis indicated that perceived discrimination was both directly and indirectly linked to sexual precursor behaviors via psychological distress. Marianismo was not found to moderate the relation between perceived discrimination and sexual risk behaviors, however certain marianismo pillars were significantly negatively linked with sexual attitudes and precursor behaviors.

CONCLUSIONS

This study underscores the importance of psychological distress in the perceived discrimination and sexual precursor link as well as the compensatory aspects of marianismo against sexual precursor behaviors in Mexican American preadolescent girls. (PsycINFO Database Record

Deportation experiences and depression among U.S. citizen-children with undocumented Mexican parents

BACKGROUND

There is a critical need to document the mental health effects of immigration policies and practices on children vulnerable to parental deportation. Few studies capture the differential experiences produced by U.S. citizen-children's encounters with immigration enforcement, much less in ways that analyse mental health outcomes alongside the psychosocial contexts within which those outcomes arise.

METHODS

We explore the psychosocial dimensions of depression in U.S. citizen-children with undocumented Mexican parents to examine differences between citizen-children affected and not affected by parental deportation. An exploratory mixed-method design was used to integrate a quantitative measure of depression symptoms (CDI-2) within qualitative data collected with 48 citizen-children aged 8 to 15 with and without experiences of parental deportation.

RESULTS

Stressors elicited by citizen-children in the qualitative interview included an inability to communicate with friends, negative perceptions of Mexico, financial struggles, loss of supportive school networks, stressed relation with parent(s) and violence. Fifty percent of citizen-children with probable depression - regardless of experiences with parental deportation - cited 'stressed relation with parents,' compared to 9% without depression. In contrast, themes of 'loss of supportive school network' and 'violence' were mentioned almost exclusively by citizen-children with probable depression and affected by parental deportation.

CONCLUSIONS

While citizen-children who suffer parental deportation experience the most severe consequences associated with immigration enforcement, our findings also suggest that the burden of mental health issues extends to those children concomitantly affected by immigration enforcement policies that target their undocumented parents.

The Distress of Citizen-Children with Detained and Deported Parents

In immigration enforcement, many undocumented immigrants with children are often detained and deported. But it is their US-born citizen-children that have been overlooked in immigration debates and enforcement policies and practices. Citizen-children are at risk for negative psychological outcomes when families are fractured and destabilized by arrest, detention, and deportation. The children risk being torn from their parents and, often, their undocumented siblings. To add to the small but growing empirical base on the effects of living under the threat of deportation and actual deportation of parents, we compared the psychological status of three groups of citizen-children: (1) a group living in Mexico with their deported parents; (2) a group in the US with parents affected by detention or deportation; and (3) a comparison group of citizen-children whose undocumented parents were not affected by detention or deportation. We compared children on self-report and parent-report measures of behavioral adjustment, depression, anxiety, and self-concept. Across the three groups we found elevated levels of distress, and differences between children who had experienced a parent's detention or deportation and those who had not. We discuss findings in the context of children's clinical needs, future research, and implications for immigration enforcement policy and practices.

An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas

To date, there is little research to validate empirically differences between nonsuicidal self-injurious behavior (NSSI) and attempted suicide among Latina adolescents. Understanding the characteristics and contextual features of self-harmful behaviors among Latina teens is a critical public health and social justice matter given the disproportionate rates of attempted suicide and anticipated population growth of this vulnerable group. In this article, we draw on an ecodevelopmental model to focus attention on factors in the sociocultural environment that shape suicidal behaviors and NSSIs. Through analysis of qualitative interviews conducted with girls who used NSSI (n = 18), attempted suicide (n = 29), used NSSI and attempted suicide (n = 8,) and had no reported lifetime history of self-harm (n = 28), we describe the sociocultural factors that shaped psychosocial vulnerabilities and gave rise to decisions to use NSSI or attempt suicide. Our analysis revealed that adolescents who engaged in NSSI perceived their negative feelings as something that could be controlled through self-injurious acts, whereas powerlessness was a theme underlying the emotional states of girls who attempted suicide. When NSSI ceased to function as a mechanism for control, girls came to sudden decisions to attempt suicide. Most teens identified specific, and often multiple, situations that induced intense affective states and shaped decisions to inflict self-harm. Two situational experiences emerged as particularly salient and promising for subsequent studies on self-harmful behaviors among Latina adolescents: transnational stress and bullying. We describe each of these and offer suggestions for future research and practice.

Examining the interplay among family, culture, and latina teen suicidal behavior

In this article, we explore the relationships among culture, family, and attempted suicide by U.S. Latinas. We analyzed qualitative interviews conducted with Latina teen suicide attempters (n = 10) and their parents. We also incorporated data collected from adolescents with no reported history of self-harm (n = 10) and their parents to examine why some individuals turned to suicide under similar experiences of cultural conflict. Our results reveal that Latina teens who attempted suicide lacked the resources to forge meaningful social ties. Without the tools to bridge experiences of cultural contradiction, the girls in our study described feeling isolated and alone. Under such conditions, adolescents turned to behaviors aimed at self-destruction. Unlike their peers who attempted suicide, adolescent Latinas with no lifetime history of attempted suicide were able to mobilize resources in ways that balanced experiences of acculturative tension by creating supportive relationships with other individuals.

Exiling children, creating orphans: when immigration policies hurt citizens

Citizen-children born in the United States to undocumented immigrants have become collateral damage of immigration enforcement. These children suffer the effects of immigration laws designed to deport large numbers of people. In removal proceedings, parents often must decide to either leave their citizen-children behind in the care of others or take them to a country the child may have never known. Accordingly, immigration policy frequently creates two de facto classes of children: exiles and orphans. In discussing these classes, the authors offer a summary of how U.S. citizen-children come into contact with the immigration enforcement system. The article explores the impact of detention and deportation on the health, mental health, and developmental trajectories of citizen-children and argues for reforms in policy and practice that will adhere to the highest standards of child welfare practice. By integrating these children into the immigration discourse, practitioners and policymakers will be better able to understand the effects of immigration enforcement, reduce harm to children, and provide for the protection of their rights.

Aspirations of Latina adolescent suicide attempters

Parents' aspirations and expectations are communicated to their offspring. Children internalize their parents' aspirations and accept some of the expectations while rejecting others, all part of the developmental process and identity-consolidation. When the aspirations and expectations of youth and parents are incongruent, the outcomes in youths' behavior can be deleterious, such as when adolescents manifest suicidal behaviors. We examined aspirations expressed by 12 Latina adolescent suicide attempters and their parents and compared them to 12 non-suicidal Latinas and parents. Qualitative analyses revealed that incongruence of aspirations between girls and their parents were greater among suicidal teens. Suicidal and non-suicidal Latinas presented contrasting aspirations: the former on gaining independence and the latter on completing their education and pursuing careers. Findings may inform developmental research and ways in which clinicians and policymakers can help Latinas achieve their own and their parents' aspirations.

Are suicide attempts by young Latinas a cultural idiom of distress?

The high rates of suicide attempts among adolescent Hispanic females in the United States have been well established by epidemiological and clinical studies. In this paper, we review the research history of Latina suicide attempts and their characteristics. Then we apply multi-faceted conceptual and empirical criteria found in the anthropological and psychiatric literature about cultural idioms of distress to the suicide attempts of young Latinas. We contrast the suicide-attempt phenomenon to the well-known ataque de nervios and propose that the phenomenon may reflect a developmental or cultural variant of the ataque. The attempt-as-idiom proposition is intended to invite discussion that can deepen our understanding of the cultural roots of the suicide attempts and their possible designation as cultural idiom. Establishing the meaning of suicide attempts within a cultural perspective can assist psychological and psychiatric research and clinical interventions.

Sacrifice for the sake of the family: expressions of familism by Latina teens in the context of suicide

Familism is a core value promoted by many individuals of Hispanic or Latino descent that emphasizes the primacy of the family over the individual. This study illuminates some aspects of the relationship between familism and adolescent suicidal behavior. Qualitative data from 24 female Hispanic teens with and without a history of suicidal behaviors and their parents were analyzed to understand the ways in which familism is expressed in their lives. Both suicide attempters and nonattempters demonstrate familism by making material or emotional (or both) sacrifices for the sake of their families. However, for those attempters who expressed a clear intent to die, a third type of sacrifice emerged: Girls expressed a desire to kill themselves in order to make things better for their families, literally sacrificing themselves for the sake of family. Findings point to the complexity of familism in understanding the risks of suicide attempts among teen Latinas and to the value of mixed methods in studying deeply the cultural factors that influence problem behaviors.

Means, Intent, Lethality, Behaviors, and Psychiatric Diagnosis in Latina Adolescent Suicide Attempters

This article describes the means, intent, lethality, behavioral profile, and psychiatric diagnosis of adolescent Latina suicide attempters. From a large mixed-methods project studying the sociocultural processes of Latina suicide attempts, we selected 76 subjects for this report. In addition to quantitative research data, medical records were available for all 76 subjects and qualitative data from in-depth interviews for 34 of them. Using the qualitative and quantitative research data, we explored the intent and behavioral profile of the suicidal adolescents. Medical records provided additional information about the means the adolescents used in their attempts and about their psychiatric diagnosis. The lethality of suicide attempts was coded using the LSARS and the LSARS-II. Findings showed that Latina adolescent suicide attempts are of low lethality. Consistent with the literature, most adolescents reported that they attempted by using means available in their homes (cutting and overdosing with medications were the predominant methods). Interesting discrepancies emerged when comparing adolescents' self-reported behavioral profiles with clinicians' psychiatric diagnoses. This report has implications for diagnosis and treatment approaches for both inpatient and outpatient service providers.

US cultural involvement and its association with suicidal behavior among youths in the Dominican Republic

OBJECTIVES

We examined how US cultural involvement related to suicide attempts among youths in the Dominican Republic.

METHODS

We analyzed data from a nationally representative sample of youths attending high school in the Dominican Republic (n = 8446). The outcome of interest was a suicide attempt during the past year. The US cultural involvement indicators included time spent living in the United States, number of friends who had lived in the United States, English proficiency, and use of US electronic media and language.

RESULTS

Time lived in the United States, US electronic media and language, and number of friends who had lived in the United States had robust positive relationships with suicide attempts among youths residing in the Dominican Republic.

CONCLUSIONS

Our results are consistent with previous research that found increased risk for suicide or suicide attempts among Latino youths with greater US cultural involvement. Our study adds to this research by finding similar results in a nonimmigrant Latin American sample. Our results also indicate that suicide attempts are a major public health problem among youths in the Dominican Republic.

Can Better Mother-Daughter Relations Reduce the Chance of a Suicide Attempt among Latinas?

National surveys and other research on adolescent Latinas show that adolescent females have higher rates of suicidal ideation, planning, and attempts than other ethnic and racial minority youth. Internalizing behaviors and family conflicts are commonly associated with suicidality in research on adolescents. In the case of Latinas, we explore the connection between adolescent Hispanic cultural involvement, mother-adolescent mutuality, internalizing behaviors, and suicidality. This paper presents data from a study of 232 Latinas, some with a recent history of suicide attempts (n = 122). The results show that higher adolescent Hispanic cultural involvement was associated with greater mother-daughter mutuality and thus led to reduction in the likelihood of suicide attempts. The relationship between mother-daughter mutuality and suicide attempts among Latinas is mediated by specific internalizing behaviors (withdrawn depressive). Our findings highlight the positive effect that Latino cultural values have in the relationship between Latina adolescent and their mothers and confirm the importance that internalizing behaviors and the mother-daughter relationship have for suicide attempters.

Familism, family environment, and suicide attempts among Latina youth

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.

Ganando Confianza: Research Focus Groups with Immigrant Mexican Mothers

Immigrant families with children with developmental disabilities must be served using culturally sensitive approaches to service and research to maximize treatment benefits. In an effort to better understand cultural issues relevant to the provision of parenting programs for immigrant Mexican mothers of children with developmental disabilities, we conducted sustained focus groups through which we could learn more about our participants and thereby improve services. This paper reports on the challenges and lessons learned from these groups. We characterize the key lessons as (a) recruitment and retention is more than agreement to participate; (b) confidentiality is not just a word but an activity; (c) the complicated nature of language; (d) cultural norms shape the group process; (e) appreciating the value of taking time; and (f) gender issues and group interaction. Service providers and researchers who work with Mexican families may benefit from our experiences as they promote and develop programs and projects in the developmental disabilities field.

Family Relationships and Latina Teen Suicide Attempts: Reciprocity, Asymmetry, and Detachment

Using qualitative data collected from adolescent Latinas and their parents, this article describes ways in which family relationships are organized within low-income Latino families (n = 24) with and without a daughter who attempted suicide. Based on a family-level analysis approach, we present a framework that categorizes relationships as reciprocal, asymmetrical, or detached. Clear differences are identified: Families of non-attempters primarily cluster in reciprocal families, whereas families with an adolescent suicide attempter exhibit characteristics of asymmetrical or detached families. Our results highlight the need for detailed clinical attention to family communication patterns, especially in Latino families. Clinicians may reduce the likelihood of an attempt or repeated attempts by raising mutual, reciprocal exchanges of words and support between parents and daughter.

Familism, mother-daughter mutuality, and suicide attempts of adolescent Latinas

National surveys in the U.S. reveal that Latina adolescents have higher rates of suicide attempts than females of other ethnic and racial groups. Past reports indicate that the suicide attempts among Latinas are lodged within family contexts in which sociocultural and individual experiences influence parental and adolescent behaviors. To better understand the parent-adolescent relations that explain the Latina suicidal phenomenon, we examined how the high value on family unity and support, as reflected by familism, and its effects on mother-daughter mutuality (i.e., reciprocal empathy and engagement) were evident in a group of adolescent Latinas with suicide attempts and a group of adolescent Latinas without suicide attempts. Drawing from data on 169 mother-daughter dyads recruited from Latino communities in a Northeastern metropolis and who self-identified as being of Latino origin or heritage, we considered how differences in familism between mothers and daughters influenced their sense of mutuality, the adolescents' internalizing and externalizing behaviors, and suicide attempts. Results show that gaps in familism (mothers scoring higher than their daughters on the scale) predicted less mother-daughter mutuality and more externalizing behaviors in the adolescents. Also, mother-daughter mutuality was negatively related to internalizing and externalizing behaviors which, in turn, predicted suicide attempts. Findings point to further research on family interactions that raise the risk for suicidality in Latino youth, particularly to including fathers and siblings in study designs. Clinical implications point to enhancing family and dyadic communication skills focusing mutuality while observing the cultural value of familism.

Familism, parent-adolescent conflict, self-esteem, internalizing behaviors and suicide attempts among adolescent Latinas

Adolescent Latinas continue to report higher levels of suicide attempts than their African-American and White peers. The phenomenon is still not understood and is theorized to be the result of the confluence of many cultural, familial, and individual level factors. In Latino cultures, belief in the importance of the family, the value known as familism, appears to protect youth's emotional and behavioral health, but parent-adolescent conflict has been found to be a risk factor for suicide attempts. The role of familism in relation to parent-adolescent conflict, self-esteem, internalizing behaviors, and suicide attempts has not been studied extensively. To address this question, we interviewed 226 adolescent Latinas, 50% of whom had histories of suicide attempts. Using path analysis, familism as a cultural asset was associated with lower levels of parent-adolescent conflict, but higher levels of internalizing behaviors, while self-esteem and internalizing behaviors mediated the relationship between parent-adolescent conflict and suicide attempts. Our findings point to the importance of family involvement in culturally competent suicide prevention and intervention programs. Reducing parent-daughter conflict and fostering closer family ties has the added effect of improving self-esteem and shrinking the likelihood of suicide attempts.

Acculturation, familism and mother-daughter relations among suicidal and non-suicidal adolescent Latinas

We examined the role of acculturation, familism and Latina mother-daughter relations in suicide attempts by comparing 65 adolescents with recent suicide attempts and their mothers to 75 teens without any attempts and their mothers. Attempters and non-attempters were similar in acculturation and familistic attitudes but attempters report significantly less mutuality and communication with their mothers than non-attempters. Mothers of attempters reported lower mutuality and communication with their daughters than mothers of non-attempters. Small increments in mutuality decreased the probability of a suicide attempt by 57%. Acculturation and familism do not appear to play major roles in suicide attempts but relational factors may. Instituting school-based psychoeducational groups for young Latinas, particularly in middle school, and their parents, separately and jointly, and focusing on raising effective communication and mutuality between parents and adolescent daughters are important primary prevention strategies.

Diagnostic, symptom, and functional assessments of Hispanic outpatients in community mental health practice

With increased US Hispanic diversity come diagnostic challenges associated with culture, language, and expression of mental disorders. In a community-based clinic, we compared diagnostic agreement between Hispanic and non-Hispanic clinicians, and a structured diagnostic instrument, in live and videotaped interviews with Hispanic adults. Percentage agreement and kappas show low diagnostic reliability between clinicians, and between clinicians and instrument. Significant differences appeared in rates of various diagnoses. Non-Hispanic clinicians rated patients' functional capacity and symptom-severity as significantly worse than Hispanic clinicians. Findings match past research with Hispanic patients and raise questions about diagnostic reliability in multi-cultural community mental health practice.

Recruiting Urban Latina Adolescents and Their Families: Challenges and Lessons Learned in Suicide Attempts Research

Recruiting samples with unique characteristics dispersed across services and geography is hard to identify because of legal status and stigma create research challenges. Public health, however, requires sustained recruitment efforts. We describe challenges and solutions in recruiting urban adolescent Latinas who had attempted suicide. Procedures for recruitment and human subject protections were established, yet logistic obstacles emerged. Program directors failed to support the research; therapists were slow to identify subjects and to meet inclusionary criteria; numbers of prospective participants were lower than originally calculated; girls and parents were hard to reach; and interview appointments were missed. From challenges came solutions: to use fewer agencies, do better participant surveillance, monitor staff participation, and build rapport and relationships with staff. In-service research training to develop agency research infrastructure generated support among providers and administrators. Our experience may be helpful to other researchers conducting studies with similar populations.

Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among latino adolescents in the USA

This study investigated the relation between suicide attempts and immigrant generation status using the Latino subset of the National Longitudinal Study of Adolescent Health, a school-based, nationally representative sample. This study also examined whether generation status predicted risk factors associated with elevated suicide behaviors, namely illicit substance use, problematic alcohol use, and depressive symptoms. Finally, hypothesizing that elevated depressive symptoms and substance use mediate the relation between immigrant generation status and suicide attempts among Latino adolescents, a path model was tested. Our findings revealed immigrant generation status was a determinant for suicide attempts, problematic alcohol use, repeated marijuana use, and repeated other drug use for Latino adolescents. US-born Latinos with immigrant parents (i.e., second-generation youth) were 2.87 (95% CI, 1.34, 6.14) times more likely to attempt suicide, 2.27 (95% CI, 1.53, 3.35) times more likely to engage in problematic alcohol use, 2.56 (95% CI, 1.62, 4.05) times more likely to engage in repeated marijuana use, and 2.28 (95% CI, 1.25, 4.17) times more likely to engage in repeated other drug use than were foreign-born youth (i.e., first-generation youth). Later-generations of US-born Latino youth with US-born parents were 3.57 (95% CI, 1.53-8.34) times more likely to attempt suicide, 3.34 (95% CI, 2.18-5.11) times more likely to engage in problematic alcohol use, 3.90 (95% CI, 2.46, 6.20) times more likely to engage in repeated marijuana use, and 2.80 (95% CI, 1.46, 5.34) times more likely to engage in repeated other drug use than were first-generation youth. Results from the path analysis indicated that repeated other drug use may mediate the effect of generation status on suicide attempts.

Suicidal behavior inLatinas: explanatory cultural factors and implications for intervention

We posit that the high rates of suicidal behavior by teenage Hispanic females reported in large-scale surveys can be understood as a cultural phenomenon, a product of specific elements of the history, tradition, ideology, or social norms of a particular society, and that treatment interventions must take family and cultural factors into consideration. For over a decade, surveys have reported that among ethnic and racial minority youth in the United States, Latinas have the highest rates of suicidal behavior compared to African American and non-Hispanic White adolescent females. However, other research shows that the psychological profiles of suicidal Latina adolescent girls and the risk factors for Latina suicidal behavior may not be that different from non-Hispanic suicidal adolescent females. The unique situation of adolescent Latinas involves the convergence of cultural and familial factors (i.e., familism, acculturation, relatedness, autonomy, etc.) with the developmental, social, and individual factors frequently associated with suicidal behaviors. Based on this background, family-oriented interventions appear to be the most appropriate approach to the prevention and treatment of Hispanic suicidal girls. Factors implicated in Latina suicidal behavior and community-based interventions that include the adolescent and her family are suggested.

Assessing psychosocial stressors among Hispanic outpatients: does clinician ethnicity matter?

OBJECTIVE

Psychosocial and environmental stressors are a well-documented factor in the etiology, progression, and maintenance of psychiatric disorders. Clear guidelines on identifying them are lacking. When the patient and provider are of different cultures, the clinician may not properly understand and identify stressors. This study explored clinician ethnicity and identification of stressors.

METHODS

A total of 88 adult Hispanic outpatients in a community clinic were separately evaluated by pairs of clinicians (Hispanic and non-Hispanic) drawn from a pool of 47, as part of a larger study. Axis IV data are reported here.

RESULTS

Clinicians identified few psychosocial stressors. Non-Hispanic clinicians identified significantly more problems related to the primary support group and educational problems than Hispanic clinicians.

CONCLUSIONS

Clinician ethnicity played a role in identification of psychosocial and environmental problems. Because stressors often affect the presenting problem and course of treatment, failure to properly identify and address them in treatment may influence service outcomes.

Assessing psychosocial stressors among Hispanic outpatients: does clinician ethnicity matter?

OBJECTIVE

Psychosocial and environmental stressors are a well-documented factor in the etiology, progression, and maintenance of psychiatric disorders. Clear guidelines on identifying them are lacking. When the patient and provider are of different cultures, the clinician may not properly understand and identify stressors. This study explored clinician ethnicity and identification of stressors.

METHODS

A total of 88 adult Hispanic outpatients in a community clinic were separately evaluated by pairs of clinicians (Hispanic and non-Hispanic) drawn from a pool of 47, as part of a larger study. Axis IV data are reported here.

RESULTS

Clinicians identified few psychosocial stressors. Non-Hispanic clinicians identified significantly more problems related to the primary support group and educational problems than Hispanic clinicians.

CONCLUSIONS

Clinician ethnicity played a role in identification of psychosocial and environmental problems. Because stressors often affect the presenting problem and course of treatment, failure to properly identify and address them in treatment may influence service outcomes.

A Cross-National Comparison of Adolescent Alcohol and Drug Use Behaviors: U. S. Hispanics and Youth in the Dominican Republic

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However, cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Prevention's (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.

Diagnosing co-occurring substance-related disorders: agreement between SCID, Hispanic clinicians, and Non-Hispanic clinicians

OBJECTIVE

Given the composition of the mental health and substance abuse workforce in the United States, Hispanic immigrants are often assigned to non-Hispanic, English-speaking clinicians. This produces challenges in communication and in understanding linguistic and cultural nuances and greatly impacts the accuracy of diagnoses and the delivery of appropriate services. With the inclusion of objective criteria in diagnostic categories, clinician-to-clinician agreement ought not to be impacted by the ethnicity of the client or the clinician. Both practice and research, however, suggest that this is not the case, particularly when diagnosing co-occurring mental health and substance abuse disorders. We explored the degree to which Hispanic and non-Hispanic clinicians agreed with each other and with the Structured Clinical Interview for DSM-IV-TR, Research Version (SCID) when diagnosing co-occurring substance-related disorders.

METHOD

Using a naturalistic design, 88 adult clients were videotaped in diagnostic intake interviews (utilizing the DSM-IV-TR) with Hispanic or non-Hispanic clinicians. Videotapes were then viewed and rated by clinicians who were ethnically cross-matched to those on tape. Clients were also administered the SCID. Data were collected from September 15, 2003, through February 7, 2005.

RESULTS

Non-Hispanic clinicians diagnosed significantly more substance-related disorders than Hispanic clinicians, and both Hispanic and non-Hispanic clinicians significantly under-diagnosed substance-related diagnoses compared to the SCID. Clinicians had very low diagnostic reliability with each other and with the SCID. Implications for the assessment, diagnosis, and treatment of co-occurring substance-related disorders are discussed.

CONCLUSION

Findings seem to concur with past research suggesting that clinicians may be influenced by factors other than the diagnostic criteria (e.g., cultural and social biases) when diagnosing, and that they may make erroneous attributions of pathology when diagnosing across cultures.

Legal status, emotional well-being and subjective health status of Latino immigrants

Among the many stresses that undocumented Latino immigrants experience, worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health. To better document these effects, this study examined the relationship between deportation concern and emotional and physical well-being among a group of Latino immigrants in a midwestern city. One-hundred-forty-three persons were recruited through community sources. Fifty-six participants (39%) expressed concern with seeking services for fear of deportation, while 87 did not endorse this concern. Measures of emotional distress, Hispanic immigrant stress and subjective health status were administered. Results indicate that Latino immigrants with concerns about deportation are at heightened risk of experiencing negative emotional and health states (particularly anger), Hispanic immigrant stress associated with extrafamilial factors and substandard health status. Findings inform policymakers of culturally relevant stressors of undocumented Latino immigrants that help to create and perpetuate the health and mental health disparities of this group.

Maternal depression and adolescent behavior problems: an examination of mediation among immigrant Latino mothers and their adolescent children exposed to community violence

This study examines the psychological and behavioral effects of exposure to community violence of 47 Latino mothers and their young adolescent children. Using data gathered from multiple sources, this study tests the associations between lifetime exposure to community violence, maternal depression, and child behavior problems. More than 80% of the youngsters ranging from age 11 to 14 years and 68% of the mothers reported being exposed to at least one act of community violence either as a victim or as a witness. Analyses reveal that maternal depression is a mediator of child behavior problems, reducing the direct effect of community violence exposure by more than 50%. Findings suggest that maternal depression is a factor more important than child's community violence exposure in contributing to young adolescents' behavioral problems.