Keywords

In the early 1960s, clinicians sounded the alarm that many LatinaFootnote 1 teens were presenting in emergency rooms for care after a suicide attempt. Trautman (1961), a clinician at Lincoln Hospital in the South Bronx of New York City, published the first reports about the suicide attempts of Puerto Rican adolescent patients. He hypothesized that these behaviors resulted from the process of adjustment to the new culture that the teens were undergoing because of their immigration to the United States. Although clinicians serving Latino families continued to share anecdotal data about this phenomenon, the issue remained for the most part understudied until the early 1990s, when the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance Survey (CDC, 1996) provided confirmation of the scope of disparities in suicidal behaviors between Latinas and their White and Black counterparts, both male and female. Subsequent CDC YRBS reports confirmed this health disparity (2000, 2002, 2004) and triggered efforts to explain why so many Latina adolescents living in the United States presented with suicidal ideation, planning, and attempts. The new research sought to identify avenues to reduce the prevalence of these high-risk behaviors.

Epidemiological findings such as those in the CDC YRBS are central to the initial description of health disparities in the population. After health disparities have been identified in these studies, researchers often explore which phenomena are related to the disparity, generating hypotheses that will be tested through explanatory studies designed to test causality. There are two traditions informing the approach to explore and explain health disparities: one seeks to identify contextual factors relevant to the difference and the other involves an intragroup approach. Examples of the former approach seek to identify contextual factors (e.g., social, environmental) that affect a subgroup of the population more intensely, contributing to its higher levels of disease or injury. The intragroup approach involves identifying elements within the subgroup experiencing higher rates of disease or injury (e.g., culture) that can account for the disparity. In the United States, research on mental health disparities affecting ethnocultural minorities tends to privilege the intragroup approach (see, for example, Feldman et al., 2010) because of the well-established relationship between culture and mental health (see, for example, Kleinman, 2008). Thus, the choice to apply an intragroup approach to explain health disparities is not arbitrary, but rather one that emerges from theoretical and methodological practices that carry implications for how research questions are formulated and answered.

In this chapter, we review the scholarship that addresses intragroup dimensions of Latina adolescent suicide attempts.Footnote 2 We focus specifically on the familial, cultural, and community protective and risk factors linked with the suicide attempts of Latina adolescents growing up in the United States. We begin with a review of the epidemiological data about Latina suicide attempts, describe the conceptual models that frame this research, briefly introduce some cultural dimensions suggested to be relevant to understand Latinos, and thus their behaviors and health outcomes, and then discuss research findings. We review two types of studies addressing protective and risk factors for suicide attempts among Latina teens: research that describes the role of protections and risks without quantification (e.g., qualitative studies), and studies that model protections and risks to quantify their effect on suicide attempts (e.g., quantitative and system dynamics research). We conclude this chapter with a reflection on the state of this area of research and provide suggestions to advance our understanding of this health disparity.

The Epidemiology of Latina Adolescents Suicide Attempts

Almost four decades of epidemiological research has shown that Latina adolescents in the United States are at elevated risk for suicide attempts (Centers for Disease Control and Prevention [CDC], 1996, 2000, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018, 2020; Razin et al., 1991; Roberts & Chen, 1995). In this research, a suicide attempt is defined as a nonfatal, self-inflicted destructive act with the explicit or implied intent to die (Goldsmith et al., 2002). Fortunately, while still higher than White teens, in recent years there has been a decrease in the prevalence of suicide attempts among Latinas. Today, nearly one in 10 Latina teens attempts suicide, compared with one in 14 White, and 1 in 10 Black teenage girls (CDC, 2020). Yet, despite declines in suicide attempts, Latina teens have been found to present high reattempt rates. One study has found that up to 62% of Latina attempters make a second attempt, a rate that is an order of magnitude higher than that for adolescents in other racial and ethnic groups (Hausmann-Stabile et al., 2012). In addition, compared to their male counterparts, Latina teens report higher rates of suicidal ideation (21% vs. 12.6%), suicide planning (17.6% vs. 11.1%), and suicide attempts (13.5% vs. 6.9%, CDC, 2020). The elevated rates of suicide attempts equally affect Latinas of different national origin (Fortuna et al., 2007; Garcia et al., 2008; Tortolero & Roberts, 2001).

Conceptual Models of Latina Adolescent Suicide Attempts

Starting in the 1990s, theorists and researchers developed new or tested existing theories to explain why Latina adolescents were vulnerable to attempting suicide. With the support of federal agencies, a group of researchers embarked on developing approaches that were attentive to unique dimensions of Latina adolescents’ experiences and culture, with the goal of identifying intragroup, ethnic-specific mechanisms at play in their suicidal behaviors. The best-known conceptual model for Latina adolescent suicide attempts is Zayas’ Ecodevelopmental Model (2005). More recently, Gulbas led two teams focusing on advancing theory in this area. In 2018, Gulbas and colleagues developed a system dynamics model to understand the onset of suicidal behaviors among Latina adolescents. Then in 2019, Gulbas and colleagues tested the cultural and developmental appropriateness of Joiner’s Interpersonal–Psychological Theory of Suicide (IPTS) to explain the suicide attempt risk of Latinas. These theoretical developments share a common perspective that acknowledges that an understanding of suicidal behaviors could not focus solely on disproportionate risk, but rather should consider the role and interactions of broader ecological factors—including familial, cultural, and community dimensions—in shaping protections and risk. Furthermore, by incorporating culture as an important dimension to understand the suicidal behaviors of Latinas, these models propose a significant move forward to untangle the complexity of these behaviors.

Zayas’ Ecodevelopmental Model of Latina Suicide Attempts

In 2005, Zayas and colleagues developed a theoretical model suggesting that at the core of the suicidal crisis of Latina teens are sociocultural processes (e.g., acculturation, gender socialization), family dynamics (e.g., conflict, mutuality), and adolescent developmental issues (e.g., autonomy and independence). The model proposes that the suicide attempts of Latina adolescents emerge as the result of a linear trajectory involving increasing conflict between the teen and her caregivers related to the normative developmental processes of increasing autonomy and independence. Cultural elements can exacerbate the potential for conflict due to differential understandings of gender socialization practices and expectations. These conflicts aggravate the girl’s emotional vulnerability and can shape the potential for suicidal behaviors. Zayas’ model advances the theoretical conceptualization of Latina suicide attempts in multiple ways. It recognizes that explanations based solely on individual-level processes are insufficient to account for suicidal behaviors disparities among ethno-racial groups. It draws attention to ethnocultural dynamics as they shape normative developmental transitions and relationships among families of immigrant backgrounds. Finally, it emphasizes an ecological consideration of protections and risks for suicidal behaviors.

Gulbas’ System Dynamics Approach to Charting Suicide Risk in Latina Adolescents

More recently, Gulbas et al. (2018, n.d.) developed an empirically supported system dynamics model charting suicide risk among Latina adolescents. A key tenet of system dynamics research is that complex human behaviors emerge via multiple, mutual, and continuous interactions between individuals and their ecological contexts (see Richardson, 2011; Sterman, 2000). Gulbas’ feedback theory is organized around seven constructs identified as salient by Latina teens related to psychological functioning (e.g., including emotional vulnerabilities, avoidant coping, experiences of high-risk behaviors), familial and social dimensions (e.g., family conflict, social support), cultural socialization and ethnic identity. Additionally, these authors identified several exogenous stressors to the system that were important to the perceived onset of emotional vulnerabilities among adolescents. These included migration of a parent or close family member and experiences of physical or sexual assault. Specifically, these stressful experiences can trigger a reinforcing loop that shapes psychosocial risk through emotional vulnerabilities, avoidant coping, high-risk behaviors, and family conflict. Over time, the reinforcing loop shapes a trajectory toward suicidal thoughts and behaviors. Among the innovations of this model are the use of system dynamics to identify mechanisms that could be altered through interventions at various levels of the model; and the confirmation that suicide feedback trajectory among Latinas is not deterministic, despite the presence of salient risk factors.

Joiner’s Interpersonal–Psychological Theory of Suicide

In 2019, Gulbas and colleagues evaluated the cultural and developmental appropriateness of Joiner’s Interpersonal–Psychological Theory of Suicide (IPTS ; Joiner, 2005; Van Orden et al., 2010) to explain Latina teen suicide attempts. Although Joiner’s model attends primarily to psychological processes, the ecological context appears in the theory through direct or indirect experiences of violence (e.g., at home or in the community) that desensitize individuals and increase their threshold of pain tolerance, reinforcing the trajectory from suicidal feelings and thoughts to attempts. Despite being developed with adults in mind, Joiner’s model has emerged as an empirically supported theory of suicide risk among adolescents (see, for example, Barzilay et al., 2015; Stewart et al., 2017). Gulbas’ team compared the IPTS core constructs (perceived burdensomeness, thwarted belongingness, and acquired capability) and then evaluated how these were linked with the occurrence of a suicide attempt. Although their findings suggest predominantly positive support for the application of IPTS to explain suicide attempt risk among Latinas, there are some variations between the lineal trajectory of risk proposed by Joiner and those identified among Latina teens. Specifically, Gulbas and colleagues observed that the adolescents’ developmental tensions are exacerbated by broader sociocultural dynamics (e.g., immigration, cultural conflict) unique to adolescent Latinas. Gulbas’ testing of Joiner’s IPTS contributes to a broader understanding of suicide risk among Latina adolescents that incorporates developmental and cultural dimensions.

Familial, Cultural, and Community Protective and Risk Factors for Suicide Attempts Among Latina Teens

Research on the suicide attempts of Latina adolescents has prioritized ecological, intra-ethnic approaches that highlight the role of psychosocial and cultural attributes. Rather than comparing Latinas to their White or Black counterparts to identify universal and culturally specific targets of intervention, this scholarship has focused on disentangling what distinctive features of this group protect from or increase risk for suicidal behaviors. To do so, researchers have built a body of scholarship using a variety of methods and approaches. These include quantitative (see, for example, Kuhlberg et al., 2010 and Peña et al., 2011) and qualitative (see, for example, Gulbas et al., 2019 and Nolle et al., 2012) methods, using primary (see, for instance, Zayas et al., 2010) and secondary-data analysis (see, for example, Boyas et al., 2019). More recently, researchers have applied system dynamics, a mathematical computer simulation feedback model combining assessing the role of standard variables associated with suicide attempts and culturally specific dimensions (see Gulbas et al., 2018; unpublished manuscript). This body of knowledge was built using data collected among clinical (see, for example, Zayas & Gulbas, 2012) and nonclinical samples collected in schools (see, for example, Price & Khubchandani, 2017) and in community settings (see, for example, Gulbas et al., 2019). Furthermore, some researchers compared clinical and nonclinical samples of Latina teens and included in their analysis data collected from their caregivers (see Baumann et al., 2010). These approaches have created a deeper understanding of the experiences of Latina teens with or without suicide attempts, and how it is for them to grow up within their families, along with their peers, and in their communities. In this section, we review the literature to address protective or risk factors across three main topics: family dynamics, cultural dimensions (including cultural values about gender, family expectations, idioms of distress, migration, acculturation, and generational status), and community (schools).

Familial Protective and Risk Factors for Suicide Attempts Among Latinas

Most of the research on Latina suicide attempts has focused on familial processes and parent-daughter dynamics that protect or increase the risk for suicidal behaviors among teens (see Table 16.1). Several factors contribute to the choice to foreground familial factors over universal psychological processes or macro ecological dynamics. First, independently of race or ethnicity, the association between parent-child relationships—including conflicts—for youth suicidal behaviors is well-established (see, for example, Adams et al., 1994; Bilgin et al., 2007; Chang et al., 2020). Furthermore, as a child enters adolescence, their behavior, socialization, and expectations change, often resulting in stressful adjustment for caregivers and changes in family life. Regardless of ethnicity and race, adolescence is a time in which parent-child conflicts are more frequent and intense than in any other age (Laursen et al., 1998; Montemayor, 1983), with conflicts peaking at middle adolescence (Greydanus & Bashe, 2003; Santrock, 2015). In addition to these reasons for the focus on family dynamics, research on Latinos in the United States has stressed the importance of the cultural value of family and family connectedness, also referred to as familismo,Footnote 3 as a factor in a variety of Latino child outcomes (see, for example, Stein et al., 2015; Toyokawa & Toyokawa, 2019). Lastly, families offer an analytical microcosm of the relational and dynamic qualities in which, through interactions with others, culture organizes adolescents’ emotions, perceptions, behaviors, and experiences (see, for example, Canino & Guarnaccia, 1997). Thus, analyzing family dynamics has the potential to offer an understanding of intra-ethnic dynamics that could help explain why so many Latina adolescents attempt suicide.

Table 16.1 Familial protective and risk factors for suicide attempts among Latinas.
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Most of the research on familial protective and risk factors for suicide attempts among Latinas has focused on describing relational and experiential dimensions, such as the quality of the relationships (see, for example, Gulbas et al., 2011) and communication between caregivers and teens (see, for example, Zayas et al., 2011). Overall, this literature has confirmed the protective role of caring, empathic, affectionate, and engaged relationships between caregivers and Latina adolescents. Relevant risk factors for suicide attempts include lack of parental care for the teen, poor communication and engagement, and support, and increased conflicts, incongruent expectations and/or aspirations between caregivers and teens. Conflicts among adolescents and caregivers are elevated among families with suicide attempters compared to those without (Gulbas et al., 2015) and often precede the onset of suicide attempts (Zayas et al., 2010). Latina suicide attempters have been found to report greater levels of emotional and physical neglect and/or maltreatment than their non-attempter peers (see, for example, Unikel et al., 2006). Unaddressed family and sexual violence increase parent-adolescent conflicts (Szlyk et al., 2019). Suicidal teens often report feeling unloved and isolated (Gulbas et al., 2015). Furthermore, Unikel et al. (2006) found that about one-third of Mexican-American teens that were interviewed for their study and reported a history of suicide attempts had experienced sexual abuse compared to about one-tenth of their peers who did not self-harm.

Not surprisingly, the picture emerging from this research is that loving, functional, and supportive Latino families are more effective at navigating conflicts with adolescent members through communication and support, and that the quality of the communication between the teens and their caregivers, particularly their mothers, is important for the girls’ well-being. Communication and support, in turn, protect the girls from the normative emotional vulnerabilities experienced during adolescence and reduce the risk for suicidal behaviors.

Cultural Protective and Risk Factors for Suicide Attempts Among Latinas

The research on the cultural protective and risk factors for suicide attempts among Latina adolescents has relied on different views of culture. While some researchers have conceptualized culture as material and value orientations, such as the use of language or endorsement of values (see, for example, Peña et al., 2011), others advance a view of culture that integrates value orientations and material conditions into social interactions that shape and manifest a person’s emotions, perceptions, and experiences (see, for example, Zayas & Gulbas, 2012). The former view of culture has dominated the research on the suicide attempts of Latina teens, focusing primarily on exploring two broad areas: acculturation and associated phenomena (e.g., generational status, migration), and cultural values (e.g., gender socialization, familism).

Acculturation refers to the process of cultural change that takes place in the context of cultural exchanges that result in new cultural formations (Guarnaccia & Hausmann-Stabile, 2016). Initially, anthropologists used groups as the unit of analysis of acculturation processes. Later, as the study of acculturation expanded from anthropology to sociology and—more importantly—psychology, the unit of analysis shifted from groups to individuals (Guarnaccia & Hausmann-Stabile, 2016). As described by Berry (2015), at the group level, acculturation involves changes in social structures and institutions, and in cultural practices; and at the individual level, it is about changes in a person’s behaviors and psychology. Another important change that took place as psychologists began to contribute actively to the study of acculturation is that the focus of study moved from the processes of acculturation to the outcomes of acculturation (Guarnaccia & Hausmann-Stabile, 2016). To assess the outcomes of acculturation, researchers mainly focus on either assimilation or biculturalism (Guarnaccia & Hausmann-Stabile, 2016). Assimilation perspectives are based on the sociological conceptualization of acculturation (see, for example, Shaull & Gramann, 1998), which assumes a unidirectional movement from the culture of origin to the host culture. Assessments of acculturation as assimilation ask about the dominant culture acquisition (e.g., English proficiency). The bicultural view of acculturation is based on Berry’s work (2006) and aims at assessing the simultaneous and distinct involvement in the culture of origin and the host culture (see, for example, language of origin use at home and English proficiency at school). Scholars interested in the study of cultural change following immigration have also used generational status (see, for example, Peña et al., 2008) as a proxy for acculturation, as it captures dimensions central to the acculturation process, such as cultural change.

It is not surprising that acculturation and its proxies have been a focus of attention in the study of Latina suicide attempters. Among the reasons given for this interest is that the majority of immigrant Latinos living in the United States arrived in the country since 1990 (see, for example, Flores, 2017), suggesting that this group is adapting to the dominant culture. Furthermore, the literature has suggested that both developmental and acculturation changes are at the core of adaptation problems experienced by this population (see, for example, Cervantes & Cordova, 2011). Acculturation requires that Latina teens learn and adapt to sociocultural contexts that have different cultural scripts (Smokowski & Bacallao, 2011) that sometimes offer contradictory definitions of the self, interpersonal dynamics, and gender roles. The experience of navigating different cultural worlds—the one at home and that of the “outside”—can be challenging for some teens. Furthermore, it has been theorized that cultural conflicts between Latina adolescents and their less acculturated parents may play a central role in destabilizing the teen-parent relationship (see, for example, Zayas et al., 2005). For example, conflict might arise between caregivers endorsing familismo and their children socialized to American cultural values that stress individuality and independence (see, for example, Fortuna et al., 2007; Marsiglia et al., 2009). Conflicts between the teen and her caregivers may be experienced as culturally dissonant because of the importance of the Latino cultural value of familismo.

Although the value for family closeness is not unique to Latino families (Schwartz, 2007), familismo has been hypothesized as a central cultural value for Latinos (see, for example, Calzada et al., 2013). This cultural value emphasizes interpersonal harmony among family members (Gulbas et al., 2015). Sabogal et al. (1987) describe three interconnected dimensions of familismo. The first aspect of this cultural value refers to familial obligations, described as the belief that family members are responsible for providing economic and emotional support to their kin. The second dimension, family as perceived support and emotional closeness, refers to the notion that members are steadfast resources of help during crises and should have close relationships supported (and conducive) to a sense of family unity. The last dimension, family as referent, is the idea that the behaviors displayed by family members should meet the expectations set by others within the family. The prioritization of family needs over personal interests—sometimes including sacrifice for the benefit of the family—and the responsibility that family members have to provide emotional support to one another (Ferrari, 2002; Hill & Torres, 2010) may cause acute distress in Latina teens when they find themselves in conflicts with their parents around their personal needs or autonomy.

Gender is another dimension that has received the attention of researchers interested in the cultural protective and risk factors associated with suicide attempts among Latinas. This is because it is often assumed that Latino parents’ expectations for their teen daughters embrace parenting and gendered cultural values that value obedience (see, for example, Calzada et al., 2010; Delgado-Gaitan, 1994; Harwood et al., 1995; Lara-Cantú et al., 1990), and that these are in conflict or are incompatible with American cultural values that stress adolescent autonomy, independence, and gender equality (see, for example, Zayas, 2011).

Lastly, researchers have considered whether Latina adolescents’ suicide attempts can be conceptualized as a cultural idiom of distress. Idioms of distress represent a broad spectrum of emotional, physical, and cultural responses to suffering (Hollan, 2004). Rather than classifying these responses as illness or syndromes, understanding them as cultural languages allows researchers to attend to the cultural elements that shape these responses to distress, and to uncover what they might highlight about the broader worldview in which the idiom of distress is embedded (Kirmayer & Sartorius, 2007). In its presentation, an idiom of distress can overlap with international syndromic classifications, as it is the case for panic attacks and ataques de nervios (see, for example, Lewis-Fernández et al., 2002), but they are different in that they develop from distinct cultural frameworks. A culturally informed analytical approach of suicide attempts as idioms of distress is directed to understand how the experiential nature of suffering and distress is interpreted through the lens of culture, and thus becomes interpreted as illness or dysfunctional behaviors in the first place (Zayas & Gulbas, 2012).

Research findings of the role of cultural protective and risk factors in the suicide attempts of Latinas offer a complex picture (see Table 16.2). Although acculturation and related phenomena have received significant attention from investigators, their role in adolescent suicide attempts is still unclear. For example, in studies that rely on quantitative metrics of acculturation and that conceptualize it as a process leading to biculturalism (see, for example, Turner et al., 2002; Zayas et al., 2009), suicide attempters and non-attempter Latina adolescents reported equal acculturation levels and acculturation gaps with their caregivers. This suggests that the impact of acculturation on suicide attempts may be either mediated or moderated by other factors, or it might not be as significant as suggested in the Zayas et al. (2005) model. Alternatively, it might be a problem inherent to the way that some quantitative metrics register acculturation. For example, the Bidimensional Acculturation Scale for Hispanics (BAS; Marin & Gamba, 1996) relies only on language-based items to create an acculturation score that does not capture acculturation processes across different dimensions, such as changes in attitudes and values (Cabassa, 2003). Thus, instead of acculturation, these studies may be comparing the level of linguistic proficiency among attempters and non-attempters, as well as the linguistic proficiency disparities between the teens and their caregivers.

Table 16.2 Cultural protective and risk factors for suicide attempts among Latinas
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Furthermore, studies that have relied on qualitative analysis, compared to those using quantitative methods, have produced a more nuanced description of adolescent acculturation in terms of changes in cultural attitudes and values, as well as about how Latina teens and their parents experience and resolve their cultural tensions. For example, when researchers found that Latina teens and their caregivers differed in their endorsement of cultural values (e.g., about family, roles, and expectations), they also reported that these differences resulted in conflicts and discord among family members (see, for example, Gulbas et al., 2015). As described in the previous section, conflicts between the teens and their caregivers are a significant risk factor for suicidal behaviors among Latinas.

The picture that emerges from the studies on generational status and suicide attempts is puzzling. Two studies found that having been an immigrant increases the likelihood of attempting suicide among Latina teens (see, for example, Hall et al., 2018), while two other studies reported the opposite, that belonging to second or later generations increases this risk when compared to new arrivals (see, for example, Peña et al., 2008). The latter findings on generational status might carry implications for understanding the role of acculturation in the suicide attempts of Latinas. This is because later-generation teens are raised in the United States by parents who are themselves presumably socialized to American culture because they were US-born. There is a robust body of literature demonstrating that first-generation immigrants generally have many initial health and mental health advantages over their US-born counterparts and that these advantages erode the longer immigrant groups reside in the United States (see, for example, Alegría et al., 2008). This phenomenon has been labeled the acculturation hypothesis (Scribner, 1996).

Research on Latina suicide attempters has not been able to provide concrete answers about the role played by value orientations, specifically the teens and their caregivers’ endorsement of familismo, on the teens’ self-harm behaviors. Some investigators have suggested that familismo operates as a protective factor, reducing conflict between the teen and her parents (see, for example, Peña et al., 2011), but others have found that the suppression of conflicts with parents due to familismo increases the teen’s internalizing behaviors and reduces her self-esteem, which in turn, increases her likelihood of reporting suicidal behaviors (Kuhlberg et al., 2010). Zayas et al. (2009) go as far as to suggest that familismo may not play a major role in the adolescents’ suicide attempts.

The dissonance in research findings about acculturation, generational status, and familismo is not found in the research about value orientations around gender roles and expectations. In this area, all the studies we reviewed confirm that the teens and their parents express conflicting and often contradictory expectations about the girls’ roles and behaviors (Gulbas et al., 2015), especially when compared to boys (Humensky et al., 2017). These differential perspectives lead to conflicts between caregivers and teens, which in turn can trigger the suicidal crisis (Humensky et al., 2017; Zayas et al., 2010).

Finally, the exploration of the cultural roots of Latina adolescent suicide attempts suggests that these represent an idiom of distress and posits that they may be a developmental or cultural variant of ataque de nervios (Zayas & Gulbas, 2012). Ataques de nervios are a well-established idiom of distress experienced by Caribbean, Mexican, and Central American women (Davis & Low, 1989). As described by Zayas and Gulbas (2012), the adolescents’ suicide attempts share many phenomenological, contextual, and historical characteristics with ataques de nervios, even though suicide attempts seem to manifest at a higher rate among Latina adolescents, whereas ataques are usually experienced by adult women.

Community Protective and Risk Factors for Suicide Attempts among Latinas

The research on community protective and risk factors for suicide attempts among Latinas has focused mostly on schools (see Table 16.3). Among Latinas, Hall et al. (2018) found that a positive relationship with and encouragement from adults at school protected teens from suicidal behaviors. Bullying, cyber-bullying, and threats at school increased the odds of suicide attempts among adolescent Latinas (Boyas et al., 2019; Price & Khubchandani, 2017; Romero et al., 2018). Academic experiences and aspirations have been a focus of attention, too. We include them here because, even though they refer to the teens’ internal processes and not directly to what happens at school, they are related to the teens’ experience of being in school and can inform targets of suicide attempt prevention for Latinas in educational settings. Qualitative researchers have observed that Latina adolescents who attempt suicide tend to interpret academic failures as proof of their perceived inadequacy (Gulbas et al., 2015), and that, when compared to their non-suicidal peers, they describe fewer personal, academic, and professional expectations (Hausmann-Stabile et al., 2013). While most often Latina teens who attempt suicide report experiencing detachment or alienation within family relationships (see, for example, Zayas et al., 2009), and even violence and abuse at home (see, for example, Unikel et al., 2006), some adolescents also describe experiences of discrimination and violence in their broader social spheres (see, for example, Gulbas et al., 2019; Prince & Khubchandani, 2017). Experiences of discrimination and/or violence in the community may, according to the IPTS (Joiner, 2005; Van Orden et al., 2010) increase an adolescent’s sense of alienation and her tolerance of pain, increasing, in turn, the risk for suicide attempts (Brooks et al., 2020).

Table 16.3 Community protective and risk factors for suicide attempts among Latinas
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Conclusion and Future Directions

Research on the familial, cultural, and community protective and risk factors for Latina adolescents suicide attempts has built a substantial body of scholarship using a variety of methods (qualitative, quantitative) and approaches (including primary and secondary data analysis, system dynamics, etc.) to understand what can promote the girls’ well-being and reduce their self-harm. Among the strengths of this scholarship is that—for the most part—it is informed by theory. The models applied in this scholarship were either developed exclusively to explain the suicide attempts of Latinas (see Gulbas et al., 2018; Gulbas et al., n.d.; Zayas et al., 2005), or developed for other groups (for example, IPTS, Joiner, 2005) and tested with data collected among Latina suicide attempters (see Gulbas et al., 2019). The richness of this interdisciplinary body of scholarship is enhanced by its use of data collected among clinical and nonclinical samples, bringing to light a deeper understanding of the lives and experiences of Latina teens with or without suicide attempts.

Overall, this research has confirmed the importance of nurturing and caring relationships for the well-being of Latina adolescents and has provided further support for the role of universal (i.e., independent of ethnicity) protective and risk factors for adolescent suicidal behaviors, located at the familial and community levels. Important universal protective factors are the role of functional and caring caregivers at home (see, for example, Adams et al., 1994; Brent et al., 1993; Summerville et al., 1994) and caring adults and safe peer relationships at school (see, for example, Kutsyuruba et al., 2015). Many of the risk factors identified in this research, such as family conflict, are also noted as risks for suicide attempts in non-Latino adolescents (see, for example, Brent & Mann, 2003; Bridge et al., 2006), and in suicidal youth in Latin America. For example, research conducted by Herrera et al. (2006) in Nicaragua, and by Hausmann-Stabile and her team (in press) in Colombia, indicated that the relationship between teens who attempted suicide and their parents were often conflictive, and that attempters reported poor communication with their caregivers and a lack of mentoring and support.

Although the studies reviewed here have advanced our understanding of the familial risk and protective factors for suicide attempts, we still do not have definitive reasons as to why so many Latina teens attempt suicide. This is in part because, rather than implicating each one of these protective and risk dimensions as a causal factor for suicide attempts among Latinas, this scholarship has examined them as a starting point to understand what is associated with these behaviors. From this foundation, researchers studying Latina adolescents suicide attempts could advance the field by testing causal explanations for the behaviors, an issue that has been extremely challenging across suicide scholarship on other populations (see Cha et al., 2018).

We lack definitive answers about the cultural protections and risks for suicide attempts among Latinas beyond the agreement that the differential endorsement of gender values reported by Latina parents and adolescents leads to conflicts between them, which in turn are associated with the girls’ self-harm. More importantly, the scholarship is not in agreement about the role of acculturation in the teens’ suicide attempts. The lack of definitive answers in this area may be in part because of the overall challenges posed by the study of acculturation (see Guarnaccia & Hausmann-Stabile, 2016) or because of acculturation measurement issues (see Cabassa, 2003). There are several underlying conceptual and methodological issues that need to be addressed before this scholarship can move forward. First, although there is a general understanding that the cultural incorporation of Latino youth in the United States is kaleidoscopically complex, this perspective has—for the most part—not been embraced by researchers. This may be in part because understanding diverse experiences of acculturation, especially in ways that attend to within-group heterogeneity (e.g., immigration histories, national heritage, geographical context), requires complex longitudinal research designs. Second, the difficulty in straddling different cultures hypothesized for Latina teens has been observed among non-Latino adolescents from other groups with high rates of suicidal behaviors. For instance, indigenous youth in Canada and in the United States have high rates of attempted suicide and suicide death (see Harder et al., 2012). Perhaps the underlying mechanism in the relationship between acculturation and suicidal behaviors among Latinas has to do less with the teens’ process of cultural change, and more with the contexts in which it takes place.

The central limitation of the research on cultural protective and risk factors for suicidal behaviors among Latinas may be that this scholarship relies on a conceptualization of culture that is decontextualized. For example, a decontextualized approach of culture assumes that the acculturation of a teen in a predominantly White rural area would be similar to that of an adolescent growing up in an urban Latino ethnic enclave. Furthermore, this research attributes a homogeneity to Latino and American cultures that contradicts their diversity. Despite being labeled under one demographic category, Latinos in the United States are a heterogenous group in terms of immigration experiences and language use (Guarnaccia et al., 2007), income (Semega et al., 2019), and citizen status (Neo-Bustamante et al., 2020) among others. Similarly, research has identified distinct subcultures in the United States based on racial origin, ethnic ancestry, religious affiliation, and social structures (see, for example, Lieske, 1993, 2010), that in turn have been linked with, for example, regional patterns of individualism and collectivism (Vandello & Cohen, 1999), and policy variation of support for low-income families (Meyers et al., 2001). Developmentally informed ethnographic research about Latino and dominant cultures across multiple settings, attuned to class, gender, and their diversity, among others, might generate evidence of the dynamic nature of cultural processes, and a more nuanced understanding of the role of contexts in shaping acculturation and well-being trajectories among youth of immigrant backgrounds.

This body of research has confirmed other universal protective and risk factors for suicidal behaviors. Not surprisingly, safe schools and neighborhoods are important for the well-being of Latina adolescents, and, therefore, the protection from suicidal behaviors. The role of bullying and cyber-bullying as risk factors for suicide attempts among Latinas (see, for example, Romero et al., 2018) is in line with previous research on non-Latino adolescents (see, for example, Van Geel et al., 2014). What may be unique to Latinas is that among the risks that they experience in the community are discrimination and marginalization because of their ethnicity and/or immigrant status.

As stated in the introduction to this chapter, the choice of focus on extra- or intra-ethnic protective and risk dimensions to explain suicidal behavior disparities among adolescents is not arbitrary. It emerges from theoretical lenses and methodological practices that carry implications for how questions are formulated, approached, and answered. Furthermore, these approaches are nested within professional traditions that are not always in conversation with other scientific disciplines concerned with similar issues. In the case of Latina suicide research, investigators have embraced an intra-ethnic perspective as a starting point to explain a health disparity between this group and their non-Latino counterparts. This may have led to neglecting the dynamic nature of the relationship between the extra and intragroup dimensions, an understanding that places the disparity as situated within complex and dynamic sociocultural contexts in which the “extra” and the “intra” shape each other. Rather than approaching Latina suicide attempt disparities as an either/or project, future research in this area could conceptualize the disparity as both/and, as simultaneously extra- and intra-ethnic. This would make it possible to conceptualize the suicide disparity as emerging from structural factors contextualizing and shaping ethnic minority suicidal behaviors, as well as intragroup dynamics of response to these structures that contribute to this outcome. The first step toward a shift in the approach could engage researchers focusing on Latinas in dialog with scholars who study adolescent suicidal behaviors in other disciplines (e.g., public health, anthropology, psychiatry, and sociology), and those who focus on other populations. This could help build up a common understanding of the universal and group-specific dynamics that shape adolescent suicidal behaviors, test explanatory models, and identify universal and group-specific targets of prevention and treatment.

Future research needs to look for innovative research methods and engage the intersectional dynamics that shape the lives of Latina adolescents, with variation by race, ethnicity, gender, sexual orientation, and other dimensions of diversity. Several promising areas include syndemic (see Singer, 2000, 2009) and resilience approaches. Syndemic theory proposes a conceptual and methodological approach that allows researchers to test how the accumulative effects of risk results in health vulnerabilities at the population level such as suicidal behavior disparities (see, for example, Mustanski et al., 2014). In contrast, a resilience approach highlights what prevents suicide attempts among Latina teens growing up in contexts of similar risk.

Given current demographic trends in the United States, specifically the predicted increase in the percentage of racial and ethnic minority adolescents to about 60% in 2050 (Office of Population Affairs, 2019), it is critical that suicide researchers understand the role of diverse experiences in shaping and protecting adolescents to ensure Latina adolescents live to reach their fullest potential. To this end, the next steps in this area should aim to apply the knowledge gained into effective real-world prevention and treatment interventions. To date, most suicide interventions apply evidence-based models that target micro-level risk factors in isolation, such as cognitive deficits or poor family functioning (see, for example, Ougrin et al., 2015). Although salient, interventions must also be able to address the dynamic interplay of multiple risk factors across individual, interpersonal, and cultural domains to promote the development of more effective prevention strategies across diverse populations. Given the persistent nature of disparities of suicidal behaviors among Latina adolescents, our ability to intervene effectively remains a critical endeavor.