Abstract
The purpose of this study was to better understand the sociocultural and logistical treatment needs and barriers of low-income Latinx suicidal youth; and to solicit feedback and identify best practices to adapt and implement a suicide treatment program for this population in a community mental health clinic. Working with the largest mental health care provider for urban area under- and uninsured patients, we conducted semi-structured interviews with Latinx suicidal youth (n = 6), their parents (n = 6), and clinical staff (n = 8). Interviews were audio-recorded, transcribed, and analyzed thematically using a deductively-driven codebook corresponding to interview domains. We supplemented semi-structured interview findings with knowledge gleaned from an exhaustive literature search, including best practice findings from other studies. We also conducted a brief provider survey to ensure a diverse sample. Many parents and providers focused on several unmet mental health needs and multiple barriers to accessing treatment that are common among uninsured populations: a need to prioritize parent and adolescent work schedules, lack of transportation, unstable housing, and unmet childcare needs. Additionally, participants described several factors that play a critical role in treatment: stigma, religion, fear related to immigration, gender roles, and acculturation. We mapped these findings, along with literature-identified best practices, to create components of a culturally-tailored adaptation. We combined primary and secondary evidence of Latinx suicidal youth and families’ mental health needs and barriers to treatment to propose a tailored adaption of an intensive outpatient program that provides transdiagnostic, suicide-specific care to Latinx adolescents and families in a community setting.
Highlights
-
Rates of suicidal behavior in Latinx youth are high.
-
Access to culturally tailored treatment programs are limited for Latinx youth.
-
Cultural adaptations are feasible, acceptable, and enhance care in this population.
Similar content being viewed by others
References
Acarturk, Z., Alyanak, B., Cetinkaya, M., Gulen, B., Jalal, B., & Hinton, D. (2019). Adaptation of transdiagnostic CBT for Turkish adolescents: examples from culturally adapted multiplex CBT. Cognitive and Behavioral Practice, 26(4), 688–700. https://doi.org/10.1016/j.cbpra.2019.02.007.
Aggarwal, N., Cedeño, K., Guarnaccia, P., Kleinman, A., & Lewis-Fernández, R. (2016). The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators. SpringerPlus, 5, 384 https://doi.org/10.1186/s40064-016-2037-4.
Aponte-Rivera, V., Dunlop, B. W., Ramirez, C., Kelley, M. E., Schneider, R., Blastos, B., & Craighead, W. E. (2014). Enhancing Hispanic participation in mental health clinical research: development of a Spanish-speaking depression research site. Depression and Anxiety, 31(3), 258–267. https://doi.org/10.1002/da.22153.
Asarnow, J. R., Hughes, J. L., Babeva, K. N., & Sugar, C. A. (2017). Cognitive-behavioral family treatment for suicide attempt prevention: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 506–514. https://doi.org/10.1016/j.jaac.2017.03.015.
Balis, T., & Postolache, T. (2008). Ethnic differences in adolescent suicide in the United States. International Journal of Child Health and Human Development, 1(3), 281–296.
Barrera, Jr, M., Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology, 81(2), 196–205. https://doi.org/10.1037/a0027085.
Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23, 67–82. https://doi.org/10.1007/bf01447045.
Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361–368. https://doi.org/10.1037/a0016401.
Borges, G., Orozco, R., Rafful, C., Miller, E., & Breslau, J. (2012). Suicidality, ethnicity and immigration in the United States. Psychological Medicine, 42(6), 1175–1184. https://doi.org/10.1017/S0033291711002340.
Brent, D., Greenhill, L., Compton, S., Emslie, G., Wells, K., Walkup, J., & Turner, J. (2009). The Treatment of Adolescent Suicide Attempters Study (TASA): predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child & Adolescent Psychiatry, 48(10), 987–996. https://doi.org/10.1097/CHI.0b013e3181b5dbe4.
Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., & Douaihy, A. B. (2013). Protecting adolescents from self-harm: a critical review of intervention studies. Journal of the American Academy of Child & Adolescent Psychiatry, 52(12), 1260–1271. https://doi.org/10.1016/j.jaac.2013.09.009.
Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Grupp-Phelan, J., & Campo, J. V. (2014). Prioritizing research to reduce youth suicide and suicidal behavior. American Journal of Preventive Medicine, 47(3 Suppl 2), S229–S234. https://doi.org/10.1016/j.amepre.2014.06.001.
Center for Disease Control and Prevention. (2015). Suicide facts at a glance. https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf.
Céspedes, Y. M., & Huey, S. J. (2008). Depression in Latino adolescents: a cultural discrepancy perspective. Cultural Diversity and Ethnic Minority Psychology, 14(2), 168–172. https://doi.org/10.1037/1099-9809.14.2.168.
Cope, D. G. (2014). Methods and meanings: credibility and trustworthiness of qualitative research. Oncology Nursing Forum, 41(1), 89–91. https://doi.org/10.1188/14.ONF.89-91.
Crabtree, B., & Miller, W. (1999). A template approach to text analysis: developing and using codebooks. In B. Crabtree & W. Miller (Eds), Doing qualitative Research in primary care: multiple strategies (pp. 93–109). Newbury Park, CA: Sage Publications.
Curtin, S.C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States, 1999–2014. NCHS Data Brief, 241, 1–8.
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 49(2), 122–131. https://doi.org/10.1016/j.jaac.2009.11.002.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. https://doi.org/10.1037/bul0000084.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Hellemans, S., De Mol, J., Buysse, A., Eisler, I., Demyttenaere, K., & Lemmens, G. (2011). Therapeutic processes in multi-family groups for major depression: Results of an interpretative phenomenological study. Journal of Affective Disorders, 134(1–3), 226–234. https://doi.org/10.1016/j.jad.2011.05.050.
Hinton, D., & Patel, A. (2017). Cultural adaptations of cognitive behavioral therapy. The Psychiatric Clinics of North America, 40(4), 701–704. https://doi.org/10.1016/j.psc.2017.08.006.
Huey, S. J., Tilley, J. L., Jones, E. O., & Smith, C. A. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10, 305–338. https://doi.org/10.1146/annurev-clinpsy-032813-153729.
Isasi, C., Rastogi, D., & Molina, K. (2016). Health issues in Hispanic/Latino youth. Journal of Latina/o Psychology, 4(2), 67–82. https://doi.org/10.1037/lat0000054.
Kann, L., Kinchen, S., Shanklin, S. L., Flint, K. H., Kawkins, J., & Harris, W. A., Centers for Disease Control and Prevention (CDC). (2014). Youth risk behavior surveillance—United States, 2013. Morbidity and Mortality Weekly Report, 63(4), 1–168.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., & Queen, B., Centers for Disease Control and Prevention (CDC). (2018). Youth risk behavior surveillance—United States, 2017. Morbidity and Mortality Weekly Report, 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1.
Kennard, B., Emslie, G., Mayes, T., Nakonezny, P., Jones, J., Foxwell, A., & King, J. (2014). Sequential treatment with fluoxetine and relapse–prevention CBT to improve outcomes in pediatric depression. American Journal of Psychiatry, 171(10), 1083–1090. https://doi.org/10.1176/appi.ajp.2014.13111460.
Kennard, B., Mayes, T., King, J., Moorehead, A., Wolfe, K., Hughes, J., & Emslie, G. (2019). The development and feasibility outcomes of a youth suicide prevention intensive outpatient program. Journal of Adolescent Health, 64(3), 362–369. https://doi.org/10.1016/j.jadohealth.2018.09.015.
Lewis- Fernández, R., & Kleinman, A. (1995). Cultural psychiatry: theoretical, clinical and research issues. The Psychiatric Clinics of North America, 18(3), 433–448.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., & Linehan, M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. Journal of the American Medical Association Psychiatry, 75(8), 777–785. https://doi.org/10.1001/jamapsychiatry.2018.1109.
Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, & Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(10), 1082–1091. https://doi.org/10.1016/j.jaac.2014.07.003.
Morse, J. M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212–1222. https://doi.org/10.1177/1049732315588501.
Neblett, Jr., E. W., Rivas-Drake, D., & Umaña-Taylor, A. J. (2012). The promise of racial and ethnic protective factors in promoting ethnic minority youth development. Child Development Perspectives, 6(3), 295–303. https://doi.org/10.1111/j.1750-8606.2012.00239.x.
Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic Interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54(2), 97–107. https://doi.org/10.1016/j.jaac.2014.10.009.
Peña, J. B., Wyman, P. A., Brown, C. H., Matthieu, M. M., Olivares, T. E., Hartel, D., & Zayas, L. H. (2008). Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adolescents in the USA. Prevention Science: the oficial journal of the Society for Prevention Research, 9(4), 299–310. https://doi.org/10.1007/s11121-008-0105-x.
Pina, A., Polo, A., & Huey, S. (2019). Evidence-based psychosocial interventions for ethnic minority youth: the 10-year update. Journal of Clinical Child & Adolescent Psychology, 48(2), 1–24. https://doi.org/10.1080/15374416.2019.1567350.
Potochnick, S., & Perreira, K. (2010). Depression and anxiety among first-generation immigrant Latino youth. The Journal of Nervous and Mental Disease, 198(7), 470–477. https://doi.org/10.1097/NMD.0b013e3181e4ce24.
Raymond-Flesch, M. (2017). To address health disparities for Latino youth, promote their engagement in health care. Journal of Adolescent Health, 60(5), 477–478. https://doi.org/10.1097/CHI.0b013e3181b5dbfe.
Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., & Hughes, J. (2009). Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. Journal of the American Academy of Child & Adolescent Psychiatry, 48(10), 1005–1013. https://doi.org/10.1097/chi.0b013e3.
Teasdale, J. D., Segal., Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623. https://doi.org/10.1037//0022-006x.68.4.615.
US Department of Health and Human Services, Centers for Disease Control and Prevention. (2018). High school Youth Risk Behavior Surveillance System data tool. https://www.childtrends.org/indicators/suicidal-teens.
Acknowledgements
This project was funded by the University of Texas Southwestern Medical Center Community-Based Pilot Research Grants. We are grateful for the teens, families, and clinicians who provided invaluable feedback that contributed to the adaptation and development of the program. We especially would like to acknowledge Rochelle Schutte, MA, Carol North, MD, and John Burruss, MD, who partnered with us to adapt this program for a community mental health setting. In addition, we are grateful to Dr Simon Lee who provided guidance on the qualitative methods used in this study. We would also like to acknowledge the support and partnership of the Hannah4Hope foundation, an organization that continues to inspire us through their meaningful contributions to our community.
Author information
Authors and Affiliations
Contributions
BDK: designed and executed the study, led data analyses, and wrote the paper. AM: collaborated with the design and writing of the manuscript. SS: collaborated with the design of the study, analyzed the data, and writing of the manuscript. AEB and HM: collaborated with the design and writing of the results. KG, RW, MMM: collaborated in the writing and editing of the final manuscript. RTH: collaborated with the design of the study, assisted with data analyses and writing of the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
BDK receives research support from the National Institute of Mental Health and royalties from Guilford Press, and she serves on the Board of Trustees of the Jerry M. Lewis, M.D. Research Foundation. The other authors report no conflict of interests or financial disclosures.
Ethics Statement
This project received IRB approval from University of Texas Southwestern Medical Center. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
Informed Consent
Informed consent was obtained from all participants for being included in the study. Additional informed consent was obtained from all individuals for whom identifying information is included in this article.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kennard, B., Moorehead, A., Stewart, S. et al. Adaptation of Group-Based Suicide Intervention for Latinx Youth in a Community Mental Health Center. J Child Fam Stud 29, 2058–2069 (2020). https://doi.org/10.1007/s10826-020-01718-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-020-01718-0