A Puzzling Problem

Teenager Evelyn Espinoza’s depression had taken her down a path to where ending it all seemed like the only way out. But the handful of pills she took was rejected by her body, and her life was spared--a “sign from God” that it wasn’t time to die, she now says.

The first inkling of deep sadness came in the sixth grade, when her body started to mature in spite of the little girl inside. “The world started changing for me,” she said. “I grew up fast, faster than I should have.”

Thoughts about suicide haunted her and she tried twice to take her life, at 14 and 17, the last time over a dispute with her parents, who did not want her to go to college. Luckily, she now says, her body refused the pills both times.

The tragedy of teenage suicide, with its devastating effects on families and other loved ones, is a well documented phenomenon in today’s society. Suicide is the third leading cause of death for young people in the United States.

But taking even some specialists in the field by surprise is the extent of suicidal behavior among Latino adolescents. New studies reveal that U.S.-born Latino teenagers, and especially girls, are at high risk of feeling depressed, seriously considering suicide and attempting it. Although the evidence has been silently piling up in academic journals and government reports, it has only now begun to gain the attention of a few researchers.

“Why are so many Latino youths attempting suicide?” asked Glorisa Canino, a researcher of Latino teenage mental health.

The studies are puzzling because they uncover high levels of depression and suicidal behavior in Latino youths, even though the actual rate of Latino teenagers killing themselves is lower than that of African American and white teenagers.

Although experts still cannot fully explain the discrepancy--mostly because there is a dearth of research in the area of adolescent mental health--some believe that suicide-related behavior among Latinos constitutes a cry for help, particularly from children of immigrant parents. For some of these teenagers, researchers believe, growing up between two cultures is taking a toll on psychological well-being.

“I feel like either way I don’t fit in,” said Espinoza of her experience as a Latina growing up in East Los Angeles. She was pressed between a Latino and a mainstream American culture, she said, dual realms she has never been able to fully embrace.

Ana Nogales, a psychologist with private practices in Los Angeles and Santa Ana, sees the dilemma in her patients. “It is a real problem. [Latino] teenagers are being caught in between two worlds. It takes a great deal of effort to cope with that. It’s not easy,” she said.

A Time of Transition

In Latino girls, “serious consideration of suicide” has reached “ominous and epidemic proportions,” according to the Washington-based National Coalition of Hispanic Health and Human Services Organizations.

The latest national numbers from the Centers for Disease Control and Prevention reveal that about one in three (30.3%) high school Latinas report having seriously considered suicide, compared to one in five African American girls (22%) and one in four white girls (26.1%).

About 14.9% of Latino high school girls attempt to kill themselves, a rate about 1 1/2 times that for African American (9%) and white (10.3%) girls, the agency reported.

Although most would agree that the transition from childhood to adulthood is not easy for anyone, adolescence seems to be a more difficult period for girls--who face what some experts call the “goodbye to girlhood” crisis when they confront social and sexual maturation.

But above and beyond the normal adolescent pressures, Latino girls may face a different set of issues, says Jane Delgado, president of the Hispanic health coalition.

The four most serious threats to the health of American girls today are pregnancy, depression, substance abuse and delinquency, according to the coalition. Latinas lead girls nationwide in three of these--suicide attempts, alcohol and drug abuse, and pregnancy--says the agency.

The question is why.

Latino girls are influenced by their culture’s expectations of what their roles and responsibilities should be as women, Delgado and others say. At the same time, what oozes from TV, magazines and billboards is a constant invitation to adopt the culture of mainstream America.

“I never saw a Hispanic family on TV, so I thought about my family, ‘This is weird. This is not how it’s supposed to be,’ ” said Espinoza.

For one of her best friends, Jessie Funes, growing up in a Latino home was also tough. She seriously considered suicide after she confronted her family with the fact that she is a lesbian.

“My family is from El Salvador. You get married at a certain age, and you’re supposed to be thinking about your family and your husband, and I was not even on that scale. I was completely in another world,” she said.

Funes was 14 when she came out to her mother. “She cried; she felt I was the sin that God had sent her,” Funes said. “She was like, ‘What did I do wrong? Maybe we can send you somewhere where they can fix you. This doesn’t happen in the family.’ ”

Although many gay teenagers go through similar experiences with their families, Funes, 18, feels that coming from a Latino household made the experience more difficult.

A string of phrases she had constantly heard illustrated her dilemma: “You [shall] not forget about your Latin roots, and going to church, and not forget the Virgen de Guadalupe, and not forget that you have to have kids and you have to have a male around you, someone to protect you, especially if you’re female.”

Three calls to Teen Line, a Los Angeles-based hotline for which teenage volunteers field calls from troubled peers, helped her overcome her suicide thoughts. Now Funes gives back to the same organization, participating in outreach programs for gay and lesbian high school students.

‘A Lot . . . Come From Broken Families’

At the hotline headquarters, volunteers say that the majority of callers are white but that a high percentage of calls come from Latinos and other minorities.

“I see more family problems [among Latinos],” said Ben Pourrabani, a volunteer at Teen Line for more than two years. “The parents usually work, and [the teenagers] have to fend for themselves more than other people. The [Latino] girls that call are a little more dependent. Most of the calls I get from [Latino] girls are about relationships; they’re usually more distressed than normal.”

Said Amy Chernuchin, a volunteer of two years: “A lot of [Latinos who call] come from broken families. A lot of the females that I speak to have children out of wedlock. Most of them don’t have parent figures [they can depend on].”

Nogales believes that the experiences of her Latino patients are different from those of other teenagers in distress. She says many Latino girls se aguantan, meaning that they don’t disclose much of their feelings, a pattern they were told to follow when growing up.

“Whites or blacks may be able to reach out for help much easier than Latinas,” Nogales said.

At the Assessment and Treatment Services Center in Orange County, social worker Rose Escutia says that as Latino mothers increasingly join the work force to supplement their household income, more Latino daughters are dealing with depression.

As it then falls on the eldest daughter to care for her younger siblings, the responsibility of being a caretaker at a young age clashes with the expectation that she also must succeed in school, Escutia said.

“On one side, while going to school, society tells you to . . . be independent,” she said. “But being raised in a Latino background, the family wants you to stay more dependent to the family. The girls feel stuck, and they feel guilty that they cannot provide everything the family is expecting. That’s where the depression comes in.”

Escutia also has noted that the adolescent Latinas who are having the most difficulty come from homes where a stepfather is in charge, or where there is drug, alcohol or domestic abuse.

“You don’t see the same stresses in Latino boys,” Escutia said. “They don’t have the same responsibilities at home, and they can go out and play and compete in sports. They have an outlet. Girls do not come up and say they want to hurt themselves. But they are verbalizing that they don’t believe they are worth anything. They don’t think they can do anything right. And they think they don’t have a future.”

Still, in spite of the distress expressed by the teenagers Escutia works with, she does not think they are suicidal over their difficulties. Several youth workers in Orange County also said the Latino teenagers they see do not seem in any more despair than members of other ethnic groups.

Finding out how the experiences of Latino teenagers locally relate to the behaviors reported in national studies presents one of many challenges for specialists in the field.

Even as the Centers for Disease Control report and other studies reveal what some consider worrying trends about Latino teenagers’ mental health, other questions surface that may not have an immediate answer.

“Part of the problem is that there’s very little research,” said Canino, a professor at the University of Puerto Rico. On the topic of ethnic differences in adolescent mental health, “there’s nothing, almost nothing,” she said.

Researchers wonder, for example, how Latino teenagers react to the stress of acculturation. Teenagers from other cultures, such as those of Asian descent, are also torn between two worlds.

“You’ve got to think that a lot of Asians are in a much higher socioeconomic state in general than Mexican Americans are,” said Robert Roberts, who researches teenage mental health at the University of Texas. It could be that the context in which Latino teenagers live, “the sum of their life experience,” is more toxic, he said.

And too little is really known about suicidal behavior in Asian Americans and some other minorities, said Roberts. Many of the vexing questions on the subject will not be answered until more studies are funded to explore ethnic differences in mental health, Roberts and others say.

Differences Between Genders

Another issue on which research is lacking is why girls of all ethnic groups attempt suicide more frequently than boys even though the rates of actual suicide are higher for boys. Some researchers point out that boys are more likely to use firearms in their attempts, which more often leads to a fatal outcome than pills or other methods preferred by girls.

Meanwhile, those working directly with teenagers are focusing their efforts on prevention.

“I have the feeling that one of the No. 1 ways in which Latino girls are going to communicate [their problems] is to their friends,” said Jay Nagdimon, director of the Suicide Prevention Center at the Didi Hirsch Community Mental Health Center in Culver City.

Nagdimon said teenagers should thus learn to recognize the signs of depression and suicidal behavior, so they can do the right thing if one of their friends talks of suicide.

According to Delgado, the best-adjusted Latino teenagers are those who learn to navigate between the two cultures. One clear message from national focus groups of parents, children and social workers organized by the Hispanic health coalition is the need for more bilingual and bicultural role models and mentors for Latino girls.

Delgado also said parents can help by being involved in a positive way and by understanding that the teenage years are difficult. Parents should not make children feel that their problems are not serious just because they are young, she said.

“Don’t just be there to reprimand. The issues young people go through are just as traumatic” as adult problems, she said.

Escutia also encourages teenage Latinas to get involved in social activities outside the home.

“A lot of these girls get stuck trying to survive in both worlds,” she said. “They don’t have role models who can show them that it is achievable, that you can hold on to your culture and be successful in this country and this society.”

Times staff writer Maria Elena Fernandez contributed to this story.

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How to Recognize Suicidal Behavior

These are some suicide warning signs in teenagers, according to Teen Line, a project affiliated with Cedars-Sinai Medical Center:

* Person exhibits sense of hopelessness, self-criticism, social withdrawal and a preoccupation with death or dying.

* Person has recently lost a loved one, there is a history of suicide in the family, or there is an absence of a caring parental figure.

* Person shows loss of appetite, excessive sleep or insomnia, sudden personality changes or unusual rebellious behavior.

* Person is giving away prized possessions or writing a will.

A suicidal person’s feelings must not be denied, experts say. A response like, “Oh, you don’t really want to die--you’re exaggerating,” does not help, according to Teen Line.

Some hotline numbers

* Teen Line, open daily from 6 to 10 p.m. (310) 855-HOPE or (800) TLC-TEEN

* Los Angeles Suicide Prevention Center, 24-hour line, both English and Spanish. (877) 7-CRISIS or (310) 391-1253

* California Youth Crisis Line, 24 hours, both English and Spanish. (800) 843-5200