Examining the Interplay Among Family, Culture, and Latina Teen Suicidal Behavior

Abstract

In this article, we explored 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 revealed that Latina teens who attempted suicide lacked the resources to forge meaningful social ties. Without the tools to bridge experiences of cultural contradiction, girls in our sample 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.

For the past 20 years, epidemiological and survey research has confirmed the high rate of suicidal behaviors by U.S. Latina adolescents. The Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance System reveals that adolescent Latinas between the ages of 14 and 18 years are almost twice as likely to plan or attempt suicide than non-Hispanic White or African-American adolescent females (CDC, 1996, 2008, 2012). Additional surveys conducted at local, regional, and national levels have reported similar findings and documented above-average rates across sub-groups, including Colombian, Cuban, Dominican, Ecuadorian, Mexican, Nicaraguan, and Puerto Rican Latinas (Baca-Garcia et al., 2010; Fortuna, Perez, Canino, Sribney, & Alegria, 2007; Rew, Rhomas, Horner, Resnick, & Beuhring, 2001; Romero, Edwards, Bauman, & Ritter, 2014; Tortolero & Roberts, 2001).

This epidemiological pattern has motivated continued research with Latina teens to investigate why they appear to be at higher risk. Unfortunately, researchers often privilege quantitative research, and qualitative analyses of suicidal behavior remain few in number (Duarté-Velez & Bernal, 2007; Hjelmeland & Knizek, 2010; Staples & Widger, 2012). In this article, we analyze qualitative interviews with adolescents and their parents to explore the context within which teens’ suicidal actions are situated. By utilizing these multiple perspectives to ground our analysis, we explore how a suicide attempt symbolizes a specific cultural reality, wherein an adolescent grapples with understanding her own life, the broader social world, and her place within it.

Rather than implicate culture as a causal factor, we theoretically frame social interaction as the driving force of culture to shed light on what attempted suicide communicates. In doing so, we build on examinations of suicidal behavior that take culture as a starting point for conceptualizing the high risk of attempted suicide among Latinas. We use a cultural framework to guide our analysis of qualitative interviews conducted with Latina teen attempters and their parents, as well as Latina teens with no lifetime history of suicidal behavior and their parents. To contextualize decisions to attempt suicide, we highlight how these youth sometimes find themselves grappling with their very existence as they navigate diverse and often contradictory social worlds.

Locating the Influence of Culture on Suicidal Behavior

Explanations for attempted suicide by Latinas often foreground psychosocial attributes or cultural values. Recognizing that individual psychology develops within interpersonal dynamics, researchers have directed attention toward understanding the various ways in which lack of social connection contributes to the onset of suicidal behavior. Conceptualizations of social isolation span the intrapsychic and social, emphasizing how psychological experiences and cognitive perceptions of belonging both shape and are shaped by the strength of social ties (Giddens, 1966; Trout, 1980; Whitlock, Wyman, & Moore, 2014). Joiner (2009) postulated that individual perceptions and experiences of social alienation, coupled with thinking and feeling that one is a burden to one’s social network, give rise to thoughts of death and suicide. The absence of a social network that mitigates psychological suffering or encourages help-seeking behavior further increases risk for attempted suicide (Whitlock et al., 2014).

Culture enters into this psychosocial framework for understanding suicidal behavior among Latinas in a number of ways. Within a substantial body of research, scholars conceptualize culture as either a protective factor or a risk factor that shapes an individual’s likelihood of engaging in a suicidal act. For example, many investigators have cited the high cultural value of family and family connectedness, or familismo, among Latinos as a potential protective factor (Chu, Goldblum, Floyd, & Bongar, 2010). In this scholarship, researchers operationalize familism as a cultural value that guides family dynamics in ways that emphasize interpersonal harmony. Because familism promotes reciprocity and cooperation among family members, it protects adolescents from engaging in harmful behaviors (Germán, Gonzales, & Dumka, 2009).

Other researchers have conceptualized culture as a risk factor, particularly when adolescents exhibit different cultural values than those expressed by their parents, or when the insistence of fidelity to cultural values becomes oppressive. For example, strict adherence to familism can create an enmeshed family environment, thwarting an adolescent’s individual autonomy. Quantitative studies have linked these circumstances to poorer outcomes for Latina adolescents, including increased risk for suicidal behaviors (Fortuna et al., 2007; Marsiglia, Kulis, Parsai, Villar, & Garcia, 2009).

The incorporation of culture within studies on Latina teen suicide attempts represents a significant move forward to understanding the complexity of suicidal behavior. At the same time, the proliferation of this research has contributed to a rather monolithic view of culture. Much of this scholarship defines culture as a shared set of values that drives individual behavior. Although this approach accurately portrays one aspect of culture, the reliance on this definition alone has resulted in the reification of culture as an immutable, bounded, and discrete system (Zayas & Gulbas, 2012). The challenge is to engage a definition of culture that acknowledges the dynamic quality of human behavior, both individually and socially, across time and space. It is here that an anthropological perspective can provide utility.

Recent anthropological views of culture highlight its relational and interactive qualities (Canino & Guarnaccia, 1997; Hirsch, 2003; Ware & Kleinman, 1992). That is, culture is rooted in social relationships that organize a person’s emotions, perceptions, experiences, and actions. Culture is at work, so to speak, in processes of social interaction. This concept of culture references not only value orientations and things that can be seen and heard, such as clothing, language, and participation in rituals; but also the inter-relational processes that lie behind those elements and shape a person’s experience of being-in-the-world (Krause, 2002; Ware & Kleinman, 1992).

An interactionist perspective does not deny that culture comprises a shared set of values and beliefs, but it acknowledges that this sharing takes place through interaction (Angrosino, 2000). As Krause explains (1995), people engage others in social worlds—in cities, neighborhoods, work and school environments, and families. In this engagement, individuals configure and reconfigure cultural elements within the context of their own lives to make sense of everyday social experiences (Krause, 1995). For researchers engaged in cross-cultural studies, the purpose of cultural analysis is to throw into relief those shared worlds of interpersonal experience (Ware & Kleinman, 1992).

This conceptualization of culture articulates a specific way of understanding the links between culture and suicidal acts. The goal is to link the attempter’s experience to the broader sociocultural forces that the attempter both encounters and surrenders to (Lee & Kleinman, 2000). A suicide attempt by a young Latina, then, can be thought of as an episode marked with a unique kind of sociality. As Staples and Wagner comment, “the act occurs within a nexus of bodies and relationships, in which ‘self’ and ‘other’ provides some form for meaning but always collapse back into each other” (2012, p. 194). To locate culture’s influence on suicidal behavior, one should begin with an examination of social interaction. Following Haworth-Hoeppner (2000) and Zavella (2011), we argue that the family, and particularly the dynamic between children and their parents, is a key social location for conducting cultural analysis.

Methods

In this article, we analyze qualitative data collected from a larger mixed-methods project that explored suicide attempts among adolescent Latinas in low-income families in New York City (see Zayas, Lester, Cabassa, & Fortuna, 2005). The research team recruited participants who disclosed a suicide attempt from mental health services associated with a large Latino-serving agency, one municipal hospital, a private psychiatric hospital, and a private general hospital with psychiatric emergency and outpatient departments. Local community agencies, including after-school, prevention, and youth development programs, and primary care medical clinics aided with the recruitment of participants with no lifetime history of reported suicidal behavior.

Among all participants, girls and their parents provided consent for participation in the study. Procedures for recruiting and obtaining informed consent proceeded as follows. First, agency intake supervisors and community agency liaisons identified girls who met inclusionary criteria. Then, the agency staff discussed the study with both the adolescent and parents. At this stage, non-attempter families who expressed interest were then referred to the research team, who contacted the girl and parents for consent. When attempters and their families expressed interest, the staff member informed the family that the girl’s therapist would need to grant approval to participate. With agreement from the family, the adolescent was assessed by her therapist for her readiness to participate. Following approval, the therapist referred the attempting adolescent and her parents to the research team for consent.

After research participants granted consent, researchers scheduled interview appointments. Adolescent interviews occurred prior to parent interviews. Approximately 95% of adolescent interviews occurred the same day that consent was granted. Parent interviews then followed, either the same day or within a week after completing the interview with the adolescent. The research team sought and received IRB approval at all institutions involved in project activities.

In this article, we present data from a subsample of 10 parent-child units with a teen suicide attempter (6 mother-daughter dyads, 1 father-daughter dyad, and 3 mother-daughter-father triads) and 10 child-parent units with an adolescent with no lifetime history of suicidal behavior (9 mother-daughter dyads and 1 mother-daughter-father triad). The overall number of participants in this sub-sample totaled 44. In this sub-sample, the average age of the girls was 15.7 years. Both mothers and fathers had a mean age of approximately 40 years. Research participants identified with seven Hispanic subgroups: Colombian, Dominican, Ecuadoran, Mexican, Puerto Rican, Salvadoran, and Venezuelan.

For the present analysis, we selected interviews for inclusion in the subsample because the narratives were particularly descriptive and rich in detail. This practice of selecting interviews is common in qualitative research because the goal of analysis is to unpack participants’ experiences, perceptions, and meanings of a particular phenomenon (Kvale & Brinkmann, 2008). This decision was also motivated by the fact that many participants in the overall sample equivocated over the intent of their actions (n = 17). To facilitate an analysis of the meanings of a suicide attempt as experienced from the perspective of the adolescent, we excluded interviews from the sub-sample if the attempting adolescent did not explicitly state in the qualitative interview that the intention of her actions was to die.

Qualitative Interview

Interviewers conducted in-depth, open-ended interviews with research participants in Spanish or English, depending on the preference of the participant. All interviews were digitally recorded, transcribed, and analyzed in the original language of the interview. During the qualitative interview, interviewers asked participants (adolescents, mothers, and fathers) questions about their relationships with other family members; experiences of conflict and conflict resolution, including an example of a recent event; the distribution of household responsibilities, rules, and discipline; and life outside the household, such as school activities and dating. When applicable, interviewers elicited a retrospective and detailed narrative of the suicide attempt from the perspective of the adolescent and her parents.

Data Analysis

Utilizing a comparative approach advocated by Ayres and colleagues (2003), we developed a strategy for data analysis that contextualized adolescent experiences of daily life within parent-child dynamics and contributed to an in-depth understanding of attempted suicide. By comparing how themes manifested in specific patterns across cases (attempters and non-attempters), we aimed to identify characteristics that were unique to suicide attempters. By shifting our analysis within and across cases, and between the individual and the family, we were able to maintain a focus on accounts of interactions between teens and their parents to gain insight into the cultural conditions that surrounded a suicide attempt.

In Stage 1, we constructed family case summaries for all cases in the data set to contextualize interpersonal relationships between teens and their parents (Knafl & Ayres, 1996). As detailed by Knafl and Ayres (1996), creating a family case summary required two procedures: (a) developing guidelines to inform the writing process, and (b) writing the summary based on the guidelines. The guidelines encouraged consistent preparation of summaries by emphasizing key themes to focus on while working across multiple interviews.

To ensure the guidelines accurately represented the data and incorporated participants’ definitions, experiences, and thoughts about family interaction, the research team read and coded individual transcripts for salient themes. These themes then formed the basis for the guidelines. To create a family case summary, each member of the research team read the individual interviews from a particular family unit and recorded research memos about each case. Using the guidelines, the research team member then wrote a narrative case report that integrated data from the transcripts and research memos into a single narrative account, or family case summary (see Gulbas et al., 2011).

In Stage 2, we conducted a second coding pass on interviews with attempters to identify salient themes associated with attempted suicide (Ryan & Bernard, 2003). This entailed line-byline coding of the sequences of events, experiences, emotions, and interactions prior to, during, and after the suicide attempt according to the perspective of the attempter. The product of this activity was a list of statements by all participants, which we sorted and organized into categories. We then contextualized each of these categories, or themes, by identifying and articulating the ways in which they manifested in the family case summaries.

In Stage 3, we used qualitative comparative analysis (Ragin, 1999) to examine how themes patterned in different combinations across cases. Qualitative comparative analysis (QCA) is an analytical technique that considers the qualitative complexity within each case, while providing the opportunity to systematically examine empirical patterns across cases (Rihoux, Ragin, & Berg-Schlosser, 2009). The goal of QCA is to identify and compare different configurations of sets of themes that account for the phenomenon under investigation (Bernard, 2013). In doing so, QCA focuses attention to what Ragin refers to as “causal complexity” (1999, p. 1227), which assumes that a complex phenomenon, such as suicidal behavior, cannot be attributed to singular causal explanations. Rather, the purpose is to assess how different configurations of themes relate to the occurrence of a phenomenon, thereby revealing the potential pathways that give rise to such phenomenon (Ragin, 1999).

Based on the principles of Boolean algebra, QCA enables the investigation of patterns by analyzing various combinations of themes that exist in dichotomous states, such as present or absent (Bernard, 2013). Accordingly, we coded all adolescent interviews with and without a history of attempted suicide for the presence and absence of themes identified in Stage 2. We then organized this coding into a QCA table, or “truth table,” which delineated all of the possible combinations among themes given their presence or absence (Bernard, 2013:492–499; Haworth-Hoeppner, 2000; Ragin, 1999). Using the QCA table as a basis for additional interpretation, we were able to analyze how certain thematic patterns were linked to the occurrence of attempted suicide, contextualizing our analysis and findings within family case summaries.

Results

We identified three major themes as salient in Latinas’ narratives of their decisions to attempt suicide: subjective distress, interpersonal discord, and emotional isolation. In the cases presented below, we use descriptions and quotations from Latina teens and their parents to exemplify how these themes manifested in the data. We also draw on a specific case of a teen we pseudonymously call Daniela to illustrate how these themes operated dynamically and in conjunction with one another, but also to delineate how her case compares to other Latina teens who did and did not attempt suicide. Each participant has been given a pseudonym.

Subjective Distress

Experiences of distress figured prominently within the narratives of Latina teens who attempted suicide, although adolescents located the source of distress in different ways. For example, Daniela identified her floundering academic performance as the cause of distress: “It’s just like a constant feeling of failure. I went to school, and it was just like, I just don’t feel like I’m gonna do well. I just started thinking about, you know, failing. And I don’t wanna fail.” Daniela admitted that she was not passing math, and her suffering was exacerbated by the fact that she had received rejection letters from colleges. To Daniela, academic difficulties signified her failure as a member of the family, and she framed her rejection in the plural. As she put it, “We are not getting into my colleges.” Daniela’s mother and father expressed similar opinions and concerns. Like Daniela, her parents’ definition of a good daughter was wrapped up in school performance—her potential success reflected not only individual achievement, but also the success of the family. As her father exclaimed, “You know, her diploma is in jeopardy. It’s not fair to us.”

Although Daniela appropriated these messages from her parents, she also engaged in a process of defining academic success in terms of what mattered most to her. Success not only symbolized being a good daughter, but in an ironic twist, it could also provide an avenue for escape from her family. As she described, “I’m supposed to go to live in college … It’s just sometimes I just don’t wanna be home. It’s just, I don’t know. I just feel like I’m stuck.” Academic achievement would allow her to go away to collage to make something of herself—for herself. Instead, she was failing school, and she perceived that this failure would result in her being “stuck” at home for the rest of her life. With no “solution” to her distress, Daniela attempted suicide for the third time: “I started taking the pills. And I just kept on taking them, and taking them, and taking them.”

Like Daniela, two other Latina attempters in our sample located their suffering within the broader realm of scholastic performance. Both perceived their efforts toward improving their academic standing as being hindered. They believed help to be unavailable or that their personal struggles went unnoticed. As Lola described,

I guess I started thinking about, like, my life, like about school. I’m not doing so good. I’m like, “What am I doing with my future?” And I guess it made me kind of sad. [My mom] screams at me. She’s like, “Why don’t you do better? Why don’t you try?” I do try.

In these cases, adolescent attempters and their parents interpreted the path to academic success differently, and family ideas about school performance came into conflict with one another. For Latina teens, success was something that could not be achieved on one’s own, and efforts toward improvement necessitated acknowledgment. Conversely, parents in these cases perceived academic success as a basic and fundamental responsibility. As Lola’s mother recalled, “I don’t remember these issues growing up. You just did what you had to do, and that was pretty much was the end of it. You just do it. You don’t get a gold star.”

In contrast to Daniela’s experience, a frequent source of subjective distress among attempters was abuse, whether it was direct experience of sexual or physical abuse (n = 4) or witnessing domestic violence (n = 1). Carmen described that, every day, she was filled with fear about going home from school because she never knew when it would be the day that she would “go [home] and see my mother on the floor.” Her fear was all-encompassing, and prevented her from being able to concentrate on her life. As she described, “Like for me, I can’t be there. For me, I’m scared to see all of that. I’m, I’m terrified. I, I can’t see my mother looking like that, she getting beat up for no reason.” Carmen had witnessed several occasions when her father tried to strangle her mother, causing her to feel hopeless about the future, both for her mother and herself. As she stated, “They are never going to change … I know sooner or later that’s gonna happen again about the issues with my father and my mother.” With no end to the abuse in sight, she tried to kill herself: “I went to my room, I locked myself [in], and I just start cutting myself.”

Interpersonal Discord

A second major theme that emerged in the analysis of interviews was interpersonal discord. Participants categorized discordant patterns of interaction as harmful to family dynamics. Often, interpersonal discord stemmed from enduring patterns of interactional behavior wherein family members were unable to demonstrate to one another that they were active participants in the family through respect, empathetic awareness, mutual understanding, and open communication.

Before Daniela’s suicide attempt, for example, her ability to communicate with her parents, and vice versa, reached an impasse. In response, Daniela’s parents resorted to secretive measures, such as reading her journal and monitoring her cell phone activity, to learn about her daily life. Her parents aimed to protect their daughter from both the dangers of street life and what they perceived to be as a growing social reality for many of Daniela’s peers: engagement in life-altering behaviors such as substance abuse and sexual activity. Daniela’s father explained that he just wanted her to “stay away from people who have no direction in life, you know, people who just wanna exist as far as just being a thug.” Daniela perceived her parent’s actions as an unwarranted violation of her privacy. Even though Daniela thought that she told her parents about her whereabouts, her parents felt that she had grown secretive and told lies about where she was going and with whom.

The interpersonal discord between Daniela and her parents continued after the suicide attempt. Her father reasoned that Daniela’s behavior was “self-imposed. It wasn’t a sickness. This was a need of attention, and I feel no desire to give her the attention or to feel pity for her.” Because of the attempt, Daniela’s father cancelled a family trip to Latin America to see extended kin, and he cited Daniela’s attempted suicide as costing him “thousands and thousands and thousands of dollars.” Daniela’s suffering, from the perspective of her parents, only served to highlight their financial stress. For Daniela, her emotional torment continued to fall on deaf ears.

Interpersonal discord could also originate from incongruous attitudes about household rules and responsibilities. For example, one attempter, Sofia, described frequent arguments with her mother about chores. When Sofia successfully completed her chores in a timely manner, she thought her efforts went unnoticed by her mother. Her mother, in contrast, interpreted her daughter’s behavior in terms of resistance:

She just doesn’t want to listen. I hope it’s a phase, I just don’t think it’s a phase. I wanna know what it is with her. Because what happens is her anger comes to, “I don’t have to do this.” That attitude, it’s like, it’s a disrespect. I’m not your child. I’m your mother.

For Sofia, the perceived lack of praise and recognition signified that she did not matter to her mother. During one fight with her mother, she remembered her mom telling her, “I don’t care what you do no more. I don’t care!” The constant struggle to communicate with her mother about her responsibilities in the household exacerbated Sofia’s feeling that her participation was inconsequential, and this shaped her decision to attempt suicide. She thought, “so you don’t care if I die … and then I took the pills.”

In other cases, interpersonal discord manifested in a context of deteriorating structures of social support that could arise because of migration, divorce, or death. For example, in the case of Lorena, her mother was an undocumented immigrant to the United States, whereas her father was a U.S. citizen. Her father was abusive, both physically and verbally, and he would use his citizenship to maintain his power over his wife and children. He threatened that if any family member ever told the authorities about the abuse, he would have his wife deported. As Lorena recalled,

My mom was scared ‘cause she didn’t have her papers. She was scared to call the police on my dad ‘cause my dad was a citizen. And she was like, “If he’s not here, who’s gonna pay the bills?” And my dad would always tell my mom, “I’ll call the cops and say you’re an immigrant, and you’ll get deported.”

Lorena, overwhelmed by the abuse and her powerlessness in the situation, experienced her entire world as “collapsing.” Her suicide attempt represented a way to hasten what she perceived to be as her inevitable demise.

Emotional Isolation

The third theme, “emotional isolation,” signified experiences of loneliness and detachment. Although many attempters were physically surrounded by individuals—family members, neighbors, friends, and boyfriends—they felt that they had no one to talk to who would understand their social world. The experience of emotional isolation reflected a tension between feeling lonely and an inability to connect with others in meaningful ways. Many attempters expressed a need to belong—to make a place for themselves in their social world—but their current relationships did not fulfill the need to create meaning. The inability to forge meaningful connections engendered experiences of emotional isolation.

In Daniela’s case, she was surrounded by family in their small New York apartment, but she still felt utterly alone. She had a group of friends that she liked to “hang out with,” but solely for the purposes of hanging out. Daniela expressed that she wanted to be out of the house, “just doing something.” She did not describe her relationships with her friends as meaningful, but rather in terms of providing her with a distraction. As Daniela explained, “Some people are just people I just hang out with.” She recognized that her friends represented the very kinds of people from whom her parents were trying to protect her, and her friends provided a potent symbol of her devious behavior. Daniela reflected that her parents “want to compare me to something bad, [to] anybody that, you know, is messing up their lives.”

In most cases, emotional isolation stemmed from feeling disconnected and alienated from other family members. Often, adolescents thought their parents were directing too much attention to another family member. As one attempter noted, “Everybody was making like a big deal over my sister, because she was getting her driving permit and stuff. And, you know, my parents like, as usual, weren’t paying attention to me.”

Sometimes, Latina attempters experienced emotional isolation after losing a family member with whom they had established deep and intimate connections. In the case of Lourdes, the death of her father left a void in her life that she felt she could not reconcile. As she described,

I was thinking about why he died, and me and him used to be best friends. He used to take me out. So that day I wanted to die real bad, cause I wanted to be with my father, to see how my father was doing, to see how hard it is for my father to be there and not me.

On the day of her suicide attempt, family tensions amplified Lourdes’ nostalgic memories of her relationship with her father. After prolonged arguments with her mother and sister, Lourdes perceived suicide as a way to rekindle a relationship that would end her emotional isolation, even if it resulted in her death.

As these examples reveal, the particular circumstances that produced feelings of emotional isolation varied, yet in each case, fractures in specific family relationships were experienced individually as alienating. Without recourse to change these circumstances, the young Latinas perceived themselves as being “trapped,” with “no escape,” and “stuck.” Powerless to change the situation, they came to see suicide as the only solution.

A Comparison of Themes through QCA

Table 1 delineates all of the possible logical combinations among the three themes given their dichotomous variability (i.e., presence or absence) and how these different combinations of themes configured across cases of adolescents who attempted suicide and teens with no lifetime history of suicidal behavior. In 9 of the 10 families with an adolescent suicide attempter, all themes were present. In these cases, the convergence of various situations shaped suicidal behavior among Latina adolescents: (a) subjective distress that was experienced relationally; (b) conflicting ideas about the roles, responsibilities, and obligations among family members in ways that unhinged Latinas’ relational subjectivities; and (c) feelings of emotional isolation and loneliness that exacerbated intrafamilial tensions or loss.

Table 1.

Qualitative Comparative Analysis of Themes across Cases

Distress	Discord	Isolation	Suicide Attempter (n=10)	Non – Attempter (n=10)
no	no	no	0	4
yes	no	no	1	1
no	yes	no	0	2
no	no	yes	0	0
yes	yes	no	0	3
yes	no	yes	0	0
no	yes	yes	0	0
yes	yes	yes	9	0

In these nine cases, the inability to forge a grounded experience—a sense of being and belonging—centered on cultural divides between teens and their parents. Parents drew on traditional representations of the family to manage the behavior of their daughters, highlighting generational transformations that had transpired over time. Many parents recounted how they grew up in environments that privileged the respect of parental authority. As one mother framed it, “I’m the mom. You have to respect me.”

Parents often expressed nostalgia for a time and place that they perceived to be more authentic – one in which children respected traditional family values:

In my time, it was so different. It’s not the same timing, but the values are still the same. If you want respect, you earn respect by respecting yourself and others. You know, nowadays, that attitude itself, it’s like, that’s a disrespect. It’s like, “Go to your room,” and it’s “No!” My parents, we had limits, and we knew our limits.

This mother longed for a time when children held in high esteem the rules and responsibilities established by parents. Although the notion of “respect” was still salient “nowadays,” she perceived her daughter as failing to appreciate—and uphold—it. Daniela’s father communicated similar frustrations that his daughter did not “get it,” proclaiming that it “kind of pisses me off.”

Conversely, daughters confronted profound cultural paradoxes when determining what was best for them, as opposed to what was best for their family. One adolescent, who attempted suicide by drinking bleach, proclaimed that her parents failed to reflect on her own needs: “They don’t think about me because I need to have my own time, I need to be able to go out.” In Daniela’s case, what her parents interpreted as secretive behavior was an attempt to set her own boundaries around her life:

My parents got frustrated with me because I just wanna meet my friends and stuff like that. It’s not because I wanna push them out of my life, and that’s what my mother always says. You know, my mother thinks that I don’t have any respect for her and that I don’t love her. I love my mom a lot, and I love my father. I don’t know how to tell them certain things, you know, that I don’t want them to meet everybody ‘cause not everybody is somebody that I wanna bring into my house.

Daniela’s life unfolded in two worlds, that of her parents and that of her peers. Her father wanted her friends to comprise “you know, the top crowd. The one who is studying.” Daniela thought that she did not live up to such high expectations, as evident by her failing grades and inability to get into college. Accordingly, she socialized with a group of individuals who represented her perceived subjectivity. Daniela experienced the struggle to balance these multiple ways of being as all-encompassing, overwhelming, and isolating. She grappled with finding her place in her world, giving in to the overpowering pressure by the combination of subjective distress, interpersonal discord, and emotional isolation: “I just wanted to end everything ‘cause I don’t feel like there was any solution so I just overdosed.”

It is important to note that one family with an attempter did not correspond to this dominant pattern. In this particular family, the only theme present was subjective distress. The Latina adolescent, Yvonne, described becoming deeply depressed, and she could not identify any reason for feeling this way. She woke up one day feeling that life was pointless. Yvonne was very close with her mother, and she told her mother how she was feeling. The mother immediately recognized that her daughter’s feelings were not something to be taken lightly. The mother called the pediatrician, who provided a psychiatric referral – but there was not an opening available for another two months. Yvonne’s mother made the appointment, but it proved to be too long to wait. One month before her appointment, Yvonne ingested acetaminophen, ibuprofen, an antihistamine, and what she described as, “some red pills” that she found in the kitchen.

Some themes were not exclusive to families with an adolescent suicide attempter. Additional review of Table 1 shows several combinations of themes were found within families with an adolescent with no reported lifetime history of suicidal behavior. In six of these cases, themes of subjective distress and interpersonal discord configured in different ways, but the theme of emotional isolation never emerged among non-attempting adolescents. In the absence of interpersonal discord, non-attempters credited parents with helping to manage subjective distress: “My mom, she’s the one that looks out for me. I know if something bad was to happen to me, the first to worry, it’ll be her.” However, the presence of interpersonal discord as a theme did not always induce or exacerbate psychological suffering. As one non-attempter described, “You do something about it, or you just let it go.” For these cases, adolescents perceived imperfect dynamics among family members as a normal process of development.

Among non-attempting adolescents who experienced both subjective distress and interpersonal discord, emotional isolation was absent because they referenced the support that they received outside of the home. One teen described her teacher as her “second mother,” and her classroom like “a family, like it was my second home.” This sense of belonging could also be achieved through friendship, close relationships with school guidance counselors, or support received by active involvement in church. These adolescents actively crafted their place in the world by building attachments with those in whom they recognized similar experiences of distress and discord or with those who were able to help normalize the conflict they experienced.

Discussion

Taken together, these results suggest a complex dynamic between the adolescent and her family. For the suicide attempter, interpersonal discord and subjective distress shaped experiences of emotional isolation. Conversely, emotional isolation symbolized how adolescents were unable to construct shared meanings in their social interactions. Latina attempters were not able to ground their experiences of being-in-the-world, leaving them feeling disconnected, alienated, and overwhelmed by their existence.

Through attention to family dynamics, we gain insight into the shifting cultural influences on suicidal behavior. We see how culture is a dynamic process, wherein individuals actively draw on cultural elements to interpret and find meaning in everyday life. For example, interpersonal discord revealed the individualist tensions within patterns of family dynamics, wherein personal discontent thwarted the possibility of family harmony. When compounded with experiences of emotional neglect or abuse, this anguish eroded the young Latina’s sense of place within her family. In lieu of an interpersonal dynamic that emphasized a unified sense of family harmony and interdependent collaboration, teens and their parents expressed conflicting and often contradictory conceptions of the family. The collapse of relational ties that might otherwise help to ground the youth’s sense of place in her world left her feeling alienated and shaped her decision to attempt suicide. In this way, subjective distress that was endured psychologically was experienced relationally (Kleinman & Kleinman, 1991).

As noted, elevated rates of suicidal behavior among Latina teens have been documented for more than 50 years, beginning with the work of clinical psychologist Edgar Trautman in 1961. To be sure, rates of attempted suicide among Latina teens have fluctuated over time, paralleling trends in the general female adolescent population. For example, the percentage of Latina teens who have attempted suicide has declined from just over 20% in 1995 to 13.5% in 2011 (Romero et al., 2014, p. 3). Despite this decline, Latina adolescents continue to exhibit disproportionately higher rates of attempted suicide than their peers.¹

Rather than viewing the persistence of this phenomenon as a result of culture as a black box, we encourage a critical evaluation of what these high rates communicate about the attempter’s experience. Doing so can reveal how suicidal behavior is “remarkably similar across diverse contexts” (Staples & Widger, 2012:196). For example, in the broader anthropological scholarship on suicidal behavior, cultural conflict emerges as a key theme. Whether because of shifting ideas and practices about gender (Lee & Kleinman, 2000), intergenerational responsibilities to the family (Traphagan, 2004), or changes in cultural values through processes of globalization (Chua, 2011), these studies reveal the link between culture change and suicide. Our analysis illustrates similar processes at work. Latina teen attempters are “betwixt and between assigned cultural positions” (Gutmann, 1996:31). Without the tools to bridge her transcultural worlds, the young Latina feels isolated and alone (Zayas, Gulbas, Fedoravicius, Cabassa, 2010). With nothing left to help her deal with her suffering, she might succumb to behaviors aimed at self-destruction.

Latina attempters are not only between cultural worlds, but between cultural subjectivities. The cultural contradictions embedded in experiences of daily life are deeply engrained in their experiences of being. For these young Latinas, cultural contradictions engender a crisis of selfhood, revealing tensions between an individuated self, which offers the hope of escape from familial discord, and the relational self, which represents the very way by which they have come to experience the world (Lester, 2005, p. 305). The experience of emotional isolation reflects this tension: Latina teen suicide attempters feel utterly alone in the world (individual), while simultaneously experiencing an inability to forge meaningful connections with others (relational).

Unlike their peers who attempt suicide, adolescent Latinas with no lifetime history of suicidal behavior have been able to mobilize resources in ways that balance these subjective tensions, usually in ways that create meaningful, relational ties with other individuals. Without these resources, a young Latina might find herself in a liminal state in which neither cultural subjectivity—the individual or the relational—is entirely legitimized. Without the means to ground her being-in-the-world, the young Latina turns to suicide because, in the words of Daniela, “there is no other solution.”

As mentioned above, scholarship on Latino families often cites familism as a central cultural value (Harwood, 2002). Although our research illustrates that the dynamics within families with a suicide attempter complicates this cultural conception, it supports the idea that individuals in Latino families experience psychological processes relationally (Falicov, 1998). This research reveals the need for theories that inform our understanding of subjectivities located in those spaces that are in-between. Such an approach would advance studies on the relationship between culture and suicidal behavior by moving beyond the dichotomization of cultural worlds as oriented toward either the individual or group (Kleinman & Kleinman, 1991).

Limitations and Implications for Future Research

Although the results from our research are consistent with the extant literature that emphasizes the primacy of social isolation in shaping decisions to attempt suicide (Joiner, 2009; Whitlock et al., 2014), we acknowledge several limitations that restrict the generalizability of our findings. For example, we selected qualitative interviews for inclusion in the sub-sample based on the richness of detail provided by the participant about the intent of her actions. It must be noted that this approach prioritizes the linguistic expression of experiences of suicidal behavior and hinders an analysis of the heterogeneity of suicidal intent and action. As Lester (2012) notes, this approach assumes that adolescents have words to describe the ways in which they are thinking and feeling. Subsequent research is needed to understand the various modes by which attempted suicide is experienced and communicated, particularly given that many adolescents sometimes express ambiguity regarding their behaviors (Andover, Morris, Wren, & Bruzzese, 2012).

Another limitation is the directed focus on Latina youth. To be sure, Latino boys attempt suicide, although to a lesser degree than Latinas (Romero et al., 2014). Future research is needed that includes girl and boy participants to assess the gender dynamics that shape suicidal behavior. Current research in this area suggests that gender affects the modality by which attempted suicide occurs and the reasons for choosing to end one’s life (Niehaus, 2012; Owens & Lambert, 2012; Staples, 2012), although such conclusions generally come from studies of adult populations. Research with teens across genders would contribute to our understanding of the gendered, developmental, and social dimensions of suicidal behavior.

Conclusions

In this article, we explored the relationships among culture, family, and U.S. Latina teen suicide attempts. By incorporating data from individuals without a lifetime history of suicide, our research allows for an examination of why some individuals turn to suicide under similar experiences of cultural conflict. Our results indicate the importance of understanding the relational experiences of psychological suffering in its diverse forms.

Ultimately, this research provides a culturally-grounded view of suicidal behavior by considering the meaning of a suicide attempt within the context of Latina teens’ social relationships. Importantly, the insider perspective guides against a tendency for researchers to assume which cultural values are salient to the worldview of research participants (Kleinman & Benson, 2006). Attending to the insider perspective highlights when acculturative conflict between an adolescent and her parents is perceived as a normal process of development or when psychological suffering is intensified as a result of cultural conflict.

Biographies

Lauren E. Gulbas, PhD, is an anthropologist and assistant professor in the School of Social Work at the University of Texas, Austin, TX, USA.

Luis H. Zayas, PhD, is a professor, endowed chair, and Dean of the School of Social Work at the University of Texas, Austin, TX USA.