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Pressures on Latina teens show in suicide attempts
By ERIC ADLER
The Kansas City Star

Michele Limas, 13, a student at Northeast Middle School, is cheerful and optimistic but acknowledges the pressures Hispanic girls face.

Diana Morales, 10, isn’t among those who harbor darker thoughts, but often takes on adult responsibilities as her parents speak mostly Spanish. She held her sister Tanya, 2, recently at Cabot Westside Health Center.

Teens like Denisse Mendez (left) and Ana Lopez at Northeast Middle School in Kansas City have an upbeat outlook, but the 13-year-olds recognize problems facing Hispanic girls.

“The girls want to become American. They want to do what American girls do. Their parents want to keep them in their culture. It’s stressful. It’s frustrating.”

Brandy Herrera, a program leader with the Wyandot Mental Health Center


They are 13-year-old girls: bright, Mexican and, they say through a translator, happy.

Still…

How many of you, they’re asked, have a female friend or relative who has attempted suicide?

The five girls at Northeast Middle School, tentative, look toward one another.

Four raise their hands.

“It is because of the pressures,” seventh-grader Maria Rivera says.

Across America, the debate over U.S. immigration policy has reached fever pitch.

In recent days, millions of pro- and anti-immigrant advocates have taken to the streets in protest as lawmakers, horns locked, remain at a standstill over divisive issues: Should the U.S.-Mexico border be clamped shut or opened wider? Should millions of undocumented workers and their families be granted amnesty?

Yet coursing beneath the surface of this churning debate is a grave paradox now gaining national and local attention: For those who risk their lives coming to America, living in America may be hazardous to their health — and for no one more urgently than Hispanic teenage girls.

“This is the land of opportunity,” says Luis H. Zayas, a professor of social work and psychiatry at Washington University in St. Louis. “We risk our lives for opportunity.”

Indeed, nationwide, the state of immigrant health on all fronts is now getting closer attention.

In St. Louis, Zayas is now one year into a four-year, $1.8 million study, funded by the National Institute of Mental Health, of perhaps the most disturbing trend:

Close to 25 percent of Hispanic teenage girls — one in four, more than any other group of teens — report having seriously considered committing suicide. The group includes not just Mexican teens, but also teens of other Latin heritages.

One in five has made a suicide plan. According to figures collected by the Centers for Disease Control and Prevention, 15 percent — almost double the national average — have attempted suicide at least once.

Upbeat teens, Maria and her friends at Northeast Middle say they have never felt so despondent. But they well recognize how common suicide attempts are among other Hispanic teenage girls like them.

Brandy Herrera, a program leader with the Wyandot Mental Health Center, recalls one teen who tried to kill herself with pills.

“I talk to girls about it all the time,” Herrera says. “The girls want to become American. They want to do what American girls do. Their parents want to keep them in their culture. It’s stressful. It’s frustrating.”

In Kansas City, health workers are responding.

At the Cabot Westside Health Center, where the clientele is largely Hispanic, more than 25 percent of its 7,000 annual patients reported suffering some form of depression or anxiety.

Again teenage Hispanic girls are among the most vulnerable. Forty-five percent reported having, within one year, prolonged feelings of sadness or hopelessness that lasted at least two weeks.

Armed with a $113,000 grant from the Healthcare Foundation of Greater Kansas City, Cabot will soon begin to add mental health screenings to all annual exams and checkups. Counseling will be offered at the nearby Mattie Rhodes Center, a nonprofit that provides children with social services, counseling, art and other programs.

Among those programs is GLOBE — an acronym for Guidance, Learning and Opportunities in a Bi-cultural Environment — at Northeast Middle.

Each day after school, Maria Rivera and other seventh- and eighth-graders, mostly Mexican and new to the United States, gather to improve their English and math skills. They also talk personally about the challenges of living in a new world.

On this recent day, the five girls — Maria, Michele Limas, Ana Lopez, Denisse Mendez and Cristal Valdez — spoke of living between the old and new traditions of Mexico and America. They spoke of how, as girls, the pressures, obligations and expectations are far more intense than for boys.

In the U.S., they say, they are the ones who, as “responsible girls,” are called upon to translate for their parents. They read the mail. They answer the phone. They interpret the bills. They take off school to go to help talk to doctors. They help their parents navigate the bus system or social services.

Boys are given greater freedom, they said, and girls are expected to be pious in more traditional Mexican ways, to restrict makeup, to resist dating, to cook when their parents work at night, to clean and to take care of their younger brothers and sisters.

At school:

“Get good grades,” Ana says.

“To have a career,” Maria says.

“To be the best,” Cristal says, even when the language barrier makes academic achievement frustrating and difficult.

After high school, the children of undocumented workers are not eligible for college financial aid. Often 12th grade is the end of the line for those who are not forced to leave school early to help support the family financially. Such financial, and emotional, support frequently lasts well into adulthood.

“In Mexican culture, it typically falls to the oldest girl — to girls in general — to take care of the parents as they grow old,” said Sheila Olivares, the Mattie Rhodes youth advocate who runs the GLOBE program at Northeast Middle School.

To be sure, the girls all believe that they are living better lives in the U.S. than in Mexico. That is why their parents came, they say. In Mexico, they say, there is little work and fewer opportunities. Unless a family can afford to pay for education past the sixth grade, it stops. And here, the girls say, they feel safer than in Mexico.

“More protected,” Maria says.

Yet, as other research shows, the effects of assimilation into American culture are complex.

Poverty, mastery of English, family support, community resources, employment, as well as how tightly one adheres to old-world traditions, make it difficult to make any single overarching conclusion.

In some health respects, living in the U.S. isn’t all bad. Many researchers, for example, are studying a phenomenon known as the “Latino Mortality Paradox” — the unexpected finding that, despite having lower socioeconomic status, Latino people from Mexico and many other countries who now live in the U.S. generally outlive African-Americans and non-Latino whites. It is unknown why.

“Our group thinks it might have something to do with differences in philosophy of life,” says Ana Abraido-Lanza, who studies the paradox at Columbia University’s Mailman School of Public Health. That philosophy includes an emphasis on family rather needs than personal needs, she says.

Most studies, meantime, show how unhealthy a new life in the U.S. can be.

“You might come to the United States expecting better opportunities for yourself and your family,” Abraido-Lanza says. “The longer you’re here, you realize those results don’t materialize as you expected. You face racism, classism, limited opportunities.

“Food is higher in fat. You work longer hours. You face longer commutes.”

In March 2005, the Annual Review of Public Health published a large paper on “Acculturation and Latino Health in the United States.” It analyzed major studies on the topic.

“Although not absolute, the strongest evidence points toward a negative effect … on health behaviors overall,” the paper says.

Smoking, drinking, drug use, bad nutrition, obesity, asthma, diabetes, high blood pressure, heart disease, anxiety, depression: The more Latinos tie themselves to American culture, the worse all these become for many people.

Although not all.

“From my point of view it’s better here,” says Margarita Morales, who was seen at Cabot recently with her daughters, Diana, 10, and Tanya, 2.

She does recognize, however the pressures and adult responsibilities her daughter has already been forced to face.

“It is harder for her,” Morales says.

Over the next four years, Zayas, at Washington University, plans to study 200 Latina teens — of Mexican and other heritages — in the hope of finding the differences between those who have attempted suicide and those who have not. The study, which will be conducted in New York City, where Zayas formerly worked, will also include talks with the girls’ parents.

“We are hearing things about the pressures these girls are feeling — around issues with their families, with boyfriends, with sibling problems,” Zayas says. “If we had rates of TB (tuberculosis) at the level we have of these suicide attempts, we’d have a national czar on prevention.”

But for many Latina teens, it’s part of coming to America.

“To have a better life,” Cristal Valdez says. “To have a better future.”

Teen suicide and depression by the numbers, ages 14 to 18

Teens feeling sad or hopeless for at least two weeks continuously

(average 28.6 percent)

Hispanic girls: 44.9

White girls: 33.3

Black girls: 30.8

Hispanic boys: 25.9

Black boys: 21.7

White boys: 19.6

Teens who seriously considered suicide

(average 16.9 percent)

Hispanic girls: 23.4

White girls: 21.2

Black girls 14.7

Hispanic boys: 12.9

White boys: 12.0

Black boys: 10.3

Teens who made suicide plan

(average 16.5 percent)

Hispanic girls: 20.7

White girls: 18.6

Black girls: 12.4

Hispanic boys: 14.6

White boys: 13.9

Black boys: 8.4

Teens who attempted suicide

(average 8.5 percent)

Hispanic girls: 15.0

White girls: 10.3

Black girls: 9.0

Black boys: 7.7

Hispanic boys: 6.1

White boys: 3.7

Source: Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance, 2003. Results based on more than 15,000 questionnaires nationwide. For full report, see http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5302a1.htm .