Familial Factors Related to Suicidal Ideation of Latina Adolescents in the United States

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1 Archives of Suicide Research, 18: , 2014 Copyright # International Academy for Suicide Research ISSN: print= online DOI: / Familial Factors Related to Suicidal Ideation of Latina Adolescents in the United States Brandy Piña-Watson, Linda G. Castillo, Kimberly M. Rodriguez, and Sara Ray The purpose of this study was to examine whether a Latina adolescent s perception of mother connectedness, father connectedness, parental caring, autonomy granting from parents, and parental interest in their child s school life predicts suicidal ideation above and beyond known risk factors of adolescent depression and acculturation. Using the National Longitudinal Study of Adolescent Health (Add Health) Wave 1, 2 secondary logistic regression data analyses were conducted on a sample of 345 Latina adolescents. Results of correlational analyses indicated that perceived mother connectedness, father connectedness, parental caring, and academic interest were positively related; depression and nativity were negatively related to reports of suicidal ideation. Additionally, in a model with adolescents who reported having both a mother and father figure present in their life, depression and academic interest were significant predictors of suicidal ideation. In a second model, which included all Latinas regardless of the presence of both parents, depression, nativity, perceived academic interest, and caring were significant predictors. Implications are discussed for suicide prevention and intervention with Latina adolescents. Keywords adolescent, family, Latina, protective factors, resiliency, suicidal ideation U.S. Latina adolescents have higher rates of suicidal ideation than adolescents of European (18.4%) and African decent (17.4%) with only Native Americans having a higher rate (NAHIC, 2006). According to the 2010 Youth Risk Behavior Surveillance System (YRBSS), in the previous year 21.0% of Latina adolescents reported suicidal ideation. Depression and acculturation are known risk factors for suicidality (Whaley & Francis, 2006), while perceived caring and connection with parents are protective (Garcia, Skay, Sieving et al., 2008). Using Zayas and colleagues model as a framework (2000, 2005), which accounts for the interaction of sociocultural and familial factors to provide an explanation for Latina suicide attempts, this study focuses on the adolescent s perception of parental connectedness, caring, autonomy, and parental academic interest. We use these factors to determine the salience of familial factors in predicting suicidal ideation beyond known individual risk factors of adolescent depression, age, and acculturation. 213

2 Latina Suicidal Ideation Acculturation, a multi-dimensional process that an individual goes through as a result of the interaction with a new culture, is associated suicidal ideation (Romero, Carvajal, Volle et al., 2007). Zayas and colleagues (2005) contend that acculturation differences may influence the parent-daughter relationship negatively and have an indirect influence on suicidal ideation. Furthermore, high acculturation is associated with Latina suicidal ideation (Hovey & King, 1996; Tortolero & Roberts, 2001). Scholars have noted that adolescents often acculturate more quickly than their parents. In the U.S. culture, autonomy is viewed as an important aspect of adolescent s development because it allows the individual to develop independence. However, autonomy conflicts with the Latino value of collectivism and may create tension between a Latina and her less acculturated parents (Zayas, Bright, Alvarez-Sanchez et al., 2009, Zayas, Lester, Cabassa, et al., 2005). Autonomy can be a protective resource because it could help them develop effective coping strategies for dealing with life stressors (Lee & Bell, 2003). However, we could not find studies that examined the influence of autonomy on Latina suicide ideation. As such, we examined parental encouragement of autonomy as a potential protective resource to suicidal ideation. Familismo is a key protective resource for Latinas population and is taken into account in Zayas and colleague s (2000, 2005) models of Latina adolescent suicidality through its emphasis on family connectedness. Family connectedness is the perceived extent to which a family member cares, understands, and communicates with an individual (Zayas, Bright, Alvarez-Sanchez et al., 2009). Family relations are a predictor of suicidal ideation (Kobus & Reyes, 2000). For instance, one study found that Latino adolescents who perceived low connectedness were more at risk for suicidal ideation than those who perceived high family connectedness. Furthermore, participants who could communicate with their parents were less likely to display suicidal ideation (Garcia, Skay, Sieving et al., 2008). Mother-daughter mutuality, defined as reciprocal empathy and engagement between the mother and daughter, is an important factor in preventing Latina adolescent suicidality (Zayas, Kaplan, Turner et al., 2000). Studies have shown that mother-daughter connectedness is related to a perception of mothers who were affectionate, communicative, and supportive of their autonomy and independence (Zayas, Bright, Alvarez-Sanchez et al., 2009) as well as lower suicide attempts (Turner, Kaplan, Zayas et al., 2002). Similarly, father connectedness is related to suicidality whereby father presence is related to lower suicide attempts (Zayas & Dyche, 1995; Turner, Kaplan, Zayas et al., 2002). Because Latina adolescents spend a majority of their day in school, parental interests in school life provides a manner in which parents can connect to their children. Adolescents that perceive their parents as concerned about their academic achievement demonstrate increased levels of motivation and overall student success (Mombourquette, 2007). Although we could not find any current studies on how parental interest in their adolescent s school life is related to suicidal ideation, research suggests that overall parental involvement is related to adolescent mental health (Flouri & Buchanan, 2002). Few studies have examined predictors Latina adolescent suicidal ideation and those that have utilized a small sample size and were restricted to a specific local community. As such, the purpose of this study was to use a national sample to determine which specific familial factors served as predictors of Latina suicidal ideation. We hypothesized that familial factors would negatively predict suicidal ideation above and beyond depression and acculturation. 214 VOLUME 18 NUMBER

3 B. Piña-Watson et al. METHODS Wave 1 of the National Longitudinal Study of Adolescent Health (Add Health) was analyzed. Since only Latina females between the ages of 13 and 18 were included in this study the sample size was 345. Demographics are reported in Table 1. Measures The outcome, suicidal ideation, was measured with one question: During the past 12 months, did you ever seriously think about committing suicide? The response options for this item were 0 (No) and 1 (Yes). Individual Factors. The Center for Epidemiologic Studies Depressive Symptoms Scale (CES-D; Radloff, 1977) measures TABLE 1. Sample Characteristics (n ¼ 224) % M SD Age Nativity Born Outside of U.S Born in U.S Self-identified Hispanic group or culture Mexican 54.7 Puerto Rican 15.6 Central=South American 11.5 Cuban 4.7 Chicano 5.3 Other Latino 12.9 Parent Status Both Parents Present 65 Father Absent 33 Mother Absent 2 Both Parents Absent 0 Self-reported suicidal ideation Yes 19.4 No 80.6 symptoms of depression. Items asked questions about the frequency of depressive symptoms that the participant experienced in the past week with responses ranging from 0 (Never or rarely) to3(most or all of the time). Nativity, which is used as a standard marker of acculturation in health research (Abraido-Lanza, Chao, & Florez, 2005), was used as a proxy measure for acculturation. The variable was dichotomized with a score of 0 indicating birth outside the U.S. and 1 indicating birth inside the U.S. Familial Factors. An exploratory factor analysis was used to determine the familial factor variables. The sum of the 6-item mother connectedness scale ranged from 6 30 with higher scores indicative of higher connectedness. The sum of the 4-item father connectedness scale ranged from 4 20 with higher scores indicative of higher connectedness. The sum of the 3-item parental caring scale ranged from 3 15 with higher scores indicative of higher perceived parental caring. The sum of the 5-item autonomy granting scale ranged from 0 5 with higher scores indicative of higher perceived autonomy granting from parents. Finally, the sum of the 4-item parental academic interest scale ranged from 0 4 with higher scores indicative of higher perceived parental academic interest. RESULTS Table 2 displays correlation coefficients, alphas, means, and standard deviations for each variable. Additionally, two hierarchical logistic regressions were conducted. Logistic regression is used to predict a categorical outcome variable with one or more predicting independent variables. This analysis measures the relationship between a dichotomous outcome variable (suicidal ideation) and independent variables through an odds ratio. Due to the considerable proportion of Latina adolescents missing a caregiver, two ARCHIVES OF SUICIDE RESEARCH 215

4 Latina Suicidal Ideation TABLE 2. Correlation and Alpha Coefficients for Independent and Dependent Variables (n ¼ 224) Depression 2. Nativity.03 þ 3. Age.03 þ MC.34 þ FC.41 þ AI.18 þ Autonomy.02 þ Caring.26 þ SI.42 þ þ.25 þ.22 þ.23 þ.03 þ.31 þ A M SD Note: MC ¼ Mother Connectedness; FC ¼ Father Connectedness; AI ¼ Academic Interest; SI ¼ Suicidal Ideation. Nativity, Age and Suicidal Ideation variables do not have an alpha coefficient due to being single items. Nativity and Suicidal Ideation do not have means or standard deviations due to being a dichotomous variable. All correlations reported are Pearson correlation coefficients, except those denoted with þ, which indicates point-biserial correlation between a nominal and continuous variable. p <.05; p <.001. models were tested to allow for children with both caregivers, in addition to those with only one present, to be considered. To use mother and father connectedness as predictors, Model 1 included only participants with both parents present (n ¼ 224). Depression, nativity, and age were entered in the first block followed by the familial factors. The final model showed good model fit with 89.3% of the cases classified correctly and a non-significant chi-square [v 2 (8, 224) ¼ 10.00, p >.05]. Within the full model for adolescents with a mother and father present, depression (B ¼.13, p <.001) and academic interest (B ¼.39, p <.05) were the only statistically significant predictors of suicidal ideation. For each unit increase in depression, the odds of the participant reporting ideation increased by a factor of For parental academic interest, the odds of reporting suicidal ideation increased by a factor of.68. Parental academic interest was the strongest predictor within the model. For Model 2, in order to include absentparent participants, father connectedness was deleted. As in Model 1, depression, nativity, and age were entered in the first block followed by the familial factors. The final model had good model fit as indicated by its ability to classify 83.4% of the cases correctly and a non-significant chi-square [v 2 (8, 338) ¼ 7.30; p >.05]. Within the full model, depression (B ¼.11, p <.001), nativity (B ¼ 1.16, p <.01), academic interest (B ¼.34, p <.05), and parental caring (B ¼.18, p <.01) were statistically significant predictors of suicidal ideation. For each unit increase in depression, the odds of the participants reporting ideation increased by a factor of Being born inside the U.S. increased the probability of suicidal ideation by a factor of For perceived parental academic interest, results indicate that for each unit increase the odds of participants reporting suicidal ideation increased by a factor of.71 and.83, respectively. Full statistical reporting of both regression analyses are presented in Table VOLUME 18 NUMBER

5 B. Piña-Watson et al. TABLE 3. Results of Hierarchical Logistic Regression Analysis 95% CI for Exp(B) B S.E. Wald (v 2 ) Exp(B) Lower Upper Latinas with Mother and Father Figures Present (n = 224) Step 1 Depression Nativity Age Step 2 Depression Nativity Age Mother Connectedness Father Connectedness Academic Interest Autonomy Caring All Latinas (n = 338) Step 1 Depression Nativity Age Step 2 Depression Nativity Age Mother Connectedness Academic Interest Autonomy Caring Note: CI ¼ confidence interval. p <.05; p <.01; p <.001. Higher scores on depression indicate higher levels of reported depressive symptoms; nativity is coded 0 ¼ born outside of U.S. and 1 ¼ born in the U.S.; higher scores on mother and father connectedness indicate higher perceived levels of connection with their respective parents; higher scores on academic interest indicate the adolescent perceives that their parents have a higher level of interest in their academic endeavors; higher scores on autonomy granting indicate the parents allow their adolescent more autonomy for making choices; higher scores on caring indicate the adolescent perceives higher levels of caring from their parents, combined. DISCUSSION The purpose of this study was to investigate the influence of adolescents perceptions of familial variables on suicidal ideation above and beyond known risk factors of adolescent depression, nativity, and age for Latina adolescents. Two logistic regressions were performed in order to account for the experience of Latinas who may not have had both caregivers present. Consistent with the literature, depression was a ARCHIVES OF SUICIDE RESEARCH 217

6 Latina Suicidal Ideation significant predictor of suicidal ideation in both models (Turner et al., 2002). Logistic regression results showed that nativity was a strong and significant predictor. This is consistent with other studies that suggest the acculturation process is associated with intergenerational family conflicts and in turn may explain why first-generation adolescents have lower rates of suicidal behavior (Peña, Wyman, Brown et al., 2008). However, the model that included only Latinas with both mother and father figures present did not show the same effect. Future research should focus on determining the intricacies that may be at play, which could lead to this discrepancy. Mother connectedness was not a significant predictor; however, it had a negative correlation with suicidal ideation, which is consistent with previous research (Zayas, Bright, Alvarez-Sanchez et al., 2009; Zayas, Lester, Cabassa, et al., 2005). Further, father connectedness was not a significant predictor, which contradicts previous research (Turner, Kaplan, Zayas, et al., 2002); however, it was negatively correlated with suicidal ideation. It is possible that items used in this study did not capture the essence of what makes a Latina feel connected with her parents. Future research should examine the factors that make a Latina adolescent feel connected with her parents. A noteworthy finding was that parental interest in their adolescent s school life was a significant predictor in both models. A one-unit increase in participants who reported having parents who talked to them about how they were doing in school decreased the odds by 31% that they would report suicidal ideation. This supports previous research about the importance of parental involvement in school (Coatsworth, Pantin, & Szapocznik, 2002). Since this is the first study to examine parental interest in school and its relationship to suicidal ideation, future research is needed. Lastly, autonomy granting was not a significant predictor and conflicts with research that suggests Latina adolescents autonomy can create friction in the family that, in turn, can lead to risk of suicide attempts (Zayas, Kaplan, Turner et al., 2000, Zayas, Lester, Cabassa et al., 2005). Further investigation into the role that autonomy granting has on the parent-daughter relationship is needed. Limitations and Future Research The AddHealth data is archival which has drawbacks. For example, suicidal ideation was a single item, which only provides information on the presence of ideation, not frequency, intensity, and duration. Additionally, the use of nativity as an acculturation proxy was limiting. Although it is a standard measure in health research, future research can build on these findings by looking at acculturation multidimensionally and the mechanisms through which this relationship occurs. Another limitation is the data was collected a decade ago, which could pose a threat given societal changes; however, Latina adolescents have consistently reported a high rate of suicidal ideation since Despite the limitations of this study, the strengths of focusing on a high risk, understudied population, with a large nationally representative sample greatly outweighs the drawbacks. CONCLUSION This study provides insight into familial factors that predict Latina adolescent suicidal ideation. Parents, who connect with, communicate, and show interest in their adolescent s life, including school, can affect suicidal ideation even when depression is present. In addition to psychotropic and therapy interventions that treat the individual, the family system should be taken into consideration. Health professionals can work in conjunction with schools in offering 218 VOLUME 18 NUMBER

7 B. Piña-Watson et al. Latino parents opportunities to be more involved in their child s school. Utilizing a community-school collaboration can help improve parent-daughter relations as well as reduce the prevalence of suicidal ideation. AUTHOR NOTE Brandy Piña-Watson, Linda G. Castillo, Kimberly M. Rodriguez, and Sara Ray, Texas A&M University, College Station, Texas, USA. Correspondence concerning this article should be addressed to Brandy Piña- Watson, Department of Educational Psychology, Texas A&M University, MS 4225, College Station, TX bmpwatson@gmail.com REFERENCES Abraido-Lanza, A. F., Chao, M. T., & Florez, K. R. (2005). Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Social Science & Medicine, 61, Coatsworth, J. D., Pantin, H., & Szapocznik, J. (2002). Familias unidas: A family-centered ecodevelopmental intervention to reduce risk for problem behavior among Hispanic adolescents. Clinical Child and Family Psychology Review, 5, Flouri, E., & Buchanan, A. (2002). The protective role of parental involvement in adolescent suicide. Crisis, 23, Garcia, C., Skay, C., Sieving, R., Naughton, S., & Bearinger, L. (2008). Family and racial factors associated with suicide and emotional distress among Latino students. Journal of School Health, 78, Hovey, J. D., & King, C. A. (1996). Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. Journal of the American Academy of Child Adolescent Psychiatry, 35, Kobus, K., & Reyes, O. (2000). A descriptive study of urban Mexican American adolescents perceived stress and coping. Hispanic Journal of Behavioral Sciences, 22, Lee, J. M., & Bell, N. J. (2003). Individual differences in attachment-autonomy configurations: Linkages with substance use and youth competencies. Journal of Adolescence, 26, Mombourquette, C. A. (2007). A study of the relationship between the type of parental involvement and high school student engagement, academic achievement, attendance, and attitude toward school. Dissertation Abstract International, 68. (UMI No. AAT ) Retrieved from Dissertations and Theses database. National Adolescent Health Information Center. (2006). Fact sheet on suicide: Adolescents & young adults. San Francisco: University of California. Peña, J. B., Wyman, P. A., Brown, C. H., Matthieu, M., Olivares, T., Hartel, D., & Zayas, L. (2008). Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adolescents in the USA. Prevention Science, 9, Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, Romero, A. J., Carvajal, S. C., Volle, F., & Orduña, M. (2007). Adolescent bicultural stress and its impact on mental well-being among Latinos, Asian Americans, and European Americans. Journal of Community Psychology, 35, Tortolero, S. R., & Roberts, R. E. (2001). Differences in nonfatal suicide behaviors among Mexican and European American middle school children. Suicide and Life Threatening Behavior, 31, Turner, S., Kaplan, C., Zayas, L. H., & Ross, R. (2002). Suicide attempts by adolescent Latinas: An exploratory study of individual and family correlates. Child and Adolescent Social Work Journal, 19, Whaley, A. L., & Francis, K. (2006). Behavioral health in multiracial adolescents: The role of Hispanic=Latino ethnicity. Public Health Reports, 121, Youth Risk Behavior Surveillance System [YRBSS], Division of Adolescent and School Health, Centers for Disease Control and Prevention. (2010). Youth Online [Online Database] Zayas, L. H., Bright, C., Alvarez-Sanchez, T., & Cabassa, L. J. (2009). Acculturation, familism and mother-daughter relations among suicidal and non-suicidal adolescent Latinas. Journal of Primary Prevention, 30, Zayas, L. H., & Dyche, L. A. (1995). Ethnic issues in the treatment of Hispanic adolescent suicide ARCHIVES OF SUICIDE RESEARCH 219

8 Latina Suicidal Ideation attempters. In J. K. Zimmerman & G. M. Asnis (Eds.), Einstein psychiatry monograph series: Vol. 12. Treatment approaches with suicidal adolescents (pp ). New York, NY: Wiley. Zayas, L. H., Kaplan, C., Turner, S., Romano, K., & Gonzalez-Ramos, G. (2000). Understanding suicide attempts by adolescent Hispanic females. Social Work, 45, Zayas, L. H., Lester, R. J., Cabassa, L. J., & Fortuna, L. R. (2005). Why do so many Latina teens attempt suicide? A conceptual model for research. American Journal of Orthopsychiatry, 75, TH EUROPEAN SYMPOSIUM ON SUICIDE AND SUICIDAL BEHAVIOUR Welcome to the 15th European Symposium on Suicide and Suicidal Behaviour (ESSSB15) which will take place on August 27-30, 2014 in Tallinn, Estonia, under European Psychiatric Association (EPA) Patronage. The ESSSB is a bi-annual event, where people acting in the field of suicide research and prevention researchers, clinicians, volunteers can meet, share experiences and present recent achievements in order to save lives all over the world. The ESSSB offers a high-level scientific programme with plenary lectures, poster and parallel sessions, and workshops, but also social events that connect conference participants in an informal way. The slogan of the ESSSB15 Suicide prevention is mental health promotion emphasizes an integrated and hopeful approach to suicide prevention. The ESSSB15 will be organised in a vibrant Nordic city Tallinn, the capital of Estonia. Conference organiser is the Estonian-Swedish Mental Health and Suicidology Institute (ERSI, Information about the ESSSB15 will be updated regularly on the website and in the Facebook. Looking forward to see you in Tallinn! Prof Dr Airi Värnik ESSSB15 President Prof Merike Sisask and Peeter Värnik ESSSB15 Vice-presidents 220 VOLUME 18 NUMBER