Latina Teen Suicide and Bullying

Abstract

Latina adolescents experience depression and suicidal ideations in a disproportionate manner compared to their non-Latina counterparts. We investigate suicide and depressive symptoms among a state-wide sample (N = 650) of adolescent Latina girls with a focus on bullying as a predictor. Bullying rates are higher than previous studies have found for victimization at school (23%), cybervictimization (26%), school bully (18%), and cyberbully (18%). Rates for depressive symptoms (49%), suicide ideation (23%), suicide plan (17%), and suicide attempt(s; 13%) are higher than national averages. After controlling for depressive symptoms, girls who have been bullied were 1.5 times more likely to attempt suicide compared to girls who have not been victims. However, being a bully increased likelihood of suicide ideation (1.5) and suicide plan (1.4) compared to not being a bully. There is a continued need to prevent depressive symptoms and suicide among Latina girls and to further investigate the effects of bullying.

Keywords

adolescent suicide bully

In the United States, suicide is the fourth leading cause of death among young people and the second leading cause of death among youth aged 10 to 19 years in Canada (Cash & Bridge, 2009; Eaton et al., 2012; Steele & Doey, 2007). Even though data trends from the 2009 Youth Risk Behavior Survey (Center for Disease Control and Prevention, 2009) indicate that prevalence of youth suicide-related behaviors has decreased over the last decade, current data indicate that 13.8% of 9th through 12th grade students in public and private schools throughout the United States reported having seriously considered attempting suicide and 6.3% of students attempted suicide one or more times during the 12 months before the survey. While suicide is uncommon in childhood and early adolescence, it increases markedly in the late teens and continues to rise until the early twenties (Gould, Greenberg, Velting, & Shaffer, 2003). Suicide rates in the general population tend to be higher among boys than girls, but typically girls have higher rates of suicidal ideation and attempted suicide (Cash & Bridge, 2009; Gould et al., 2003). A persistent disparity has been documented for Latina girls since the 1960s which indicates that they have among the highest depressive symptoms and suicide ideation compared to other ethnic and gender groups (Rasmussen, Negy, Carlson, & Burns, 1997; Roberts & Chen, 1995; Roberts, Roberts, & Chen, 1997; Trautman, 1961). The high rates of Latina girls’ suicide attempts were initially concentrated among Puerto Rican teens in large urban areas, but since the 1960s, suicide and depression rates have also increased among girls of other Latino ethnic subgroups (see Zayas, Lester, Cabassa, & Fortuna, 2005 for a review). Latina adolescents are among the fastest growing ethnic and gender subgroups in the United States today, and in several states, they are the largest ethnic minority under the age of 18 years. In the current, study we focus on statewide Arizona data; this state was chosen because of the high overall percentage of Latinos statewide (29.6%; 91% of whom are of Mexican descent), and the large percentage of Latino youth under the age of 18 years (26.3%; U.S. Census Bureau, 2009).

Current epidemiological reports indicate that, nationally, Latinas continue to report the highest rates of depressive symptoms and suicidal ideation (Eaton et al., 2008; Eaton et al., 2012; U.S. Census Bureau, 2009). For instance, Eaton and colleagues (2011) noted that Latina adolescents are two times more likely to engage in suicidal behavior than their White or Black peers. In 2007, an estimated 42.3% of Latina girls reported feeling sad or hopeless almost every day for two or more weeks in a row, a rate higher than females of other ethnic groups (White: 34.6%; Black: 34.5%) and males (White: 17.8%; Black: 24%; and Latino: 30.4%; Eaton et al., 2008). In that same year, Latinas had the highest rates for seriously considering suicide (21.1%) and attempting suicide (14.0%) compared to other females (White: 17.8%, 7.7%; Black: 18%, 9.9%) and males (White: 10.2%, 3.4%; Black: 8.5%, 5.5%; and Latino: 10.7%, 6.3%). Finally, Latinas were also more likely than other ethnic groups to have been treated by a doctor for a suicide attempt that resulted in injury, poisoning, or overdose, 3.9% compared to 2.0% nationally (Eaton et al., 2008).

Zayas and colleagues (2005) propose an ecodevelopmental conceptual model to guide further research on Latina suicide rates that moves beyond documentation of ethnic disparities and leads to a richer understanding of the complex environmental influences on girls’ mental health. Empirical work using this model has focused on family context and found that conflict within families accounted for both internalizing and externalizing behaviors among Latina teens (Coatsworth et al., 2002; Zayas et al., 2005). Latina girls are more likely to report knowing family members who have committed suicide, which is one additional family factor that may influence suicide outcomes (Rew, Thomas, Horner, Resnick, & Beuhring, 2001). However, few studies have explored the impact of peers as an ecodevelopmental context for Latina girls despite the fact that peer influence increases significantly during adolescence and the need for belonging and acceptance among peers becomes paramount for all adolescents (Peskin, Tortolero, & Markham, 2006; Peskin, Tortolero, Markham, Addy, & Baumler, 2007). There is a need to investigate peer-to-peer influences on depression and suicide, and we turn to cutting edge research on bullying and victimization to understand the impact of peer context on suicide among Latina girls.

Existing research on adolescent suicide has demonstrated that victimization by bullying increases the risk for suicidal ideation and behaviors (Steele & Doey, 2007) and exacerbates the likelihood of suicide attempts among individuals who have been the victims of bullying compared to their nonvictim peers (Klomek, Sourander, & Gould, 2011). A recent review of over 37 studies that examined bullying and suicide among children and adolescents from the United States, Canada, several European countries, South Korea, Japan, and South Africa, found that in almost all of the studies a connection existed between being bullied and suicidal thoughts (Kim & Leventhal, 2008). When asked what most often served as the antecedent to their suicidal behaviors, youth most often cited interpersonal problems (Klomek, Sourander, & Gould, 2010). Bullying is generally defined as aggression that is intentional, repeated, and characterized by an imbalance of power between the perpetrator and the target (Hinduja & Patchin, 2011; Olweus, 1993). In addition to bullying, advances in technology have also given rise to cyberbullying, which is characterized as harassment and mistreatment that is perpetrated by using technology including the internet and cellular phones (Hinduja & Patchin, 2010). Cyberbullying offers perpetrators a higher degree of anonymity and 24 hour access to their victims that makes it an increasingly critical and complex issue to address (Klomek et al., 2010). Generally, bullying behaviors can be divided into four categories including direct-physical (e.g., theft, assault), direct-verbal (e.g., threats, insults), indirect relational (e.g., social ostracizing, rumor spreading), and cyberbullying (Klomek, Sourander, & Gould, 2009). In addition, research indicates that youth who are victimized, or who bully others, are at high risk of depression, suicide ideation, and suicide attempts compared with adolescents not involved in bullying behavior (Klomek, Marrocco, Kleinman, & Gould, 2007; Mills, Guerin, Lynch, Daly, & Fitzpatrick, 2004; van der Wal, de Wit, & Hirasing, 2003). Moreover, preliminary results from a U.S. study of bullying indicates that students who are involved in frequent bullying—regardless of their role as the victim, perpetrator or both—without concurrent depression or suicidal ideations at the time of bullying, were found to later be at risk for depression and suicidality (Klomek et al., 2011). One study suggested that being a victim of bullying is prevalent among Latino youth and comparable to other populations; and rates do not appear to vary by gender (Peskin et al., 2006). They also report that the most common behaviors were teasing and upsetting others for fun by using name calling or picking on students (Peskin et al., 2006). Peskin and colleagues (2007) report in a separate study that victims in high school report more internalizing symptoms; however, they did not include measures of suicide in their study (Peskin et al., 2007).

Even infrequent involvement in bullying behavior is associated with higher risk of depression and suicidality, particularly among girls (Klomek et al., 2007). There are typically gendered differences in the types of bullying behaviors that individuals engage in with males more typically experiencing overt and physical victimization versus females who are more likely to experience indirect and relational victimization. There is evidence that relational victimization has a greater impact on mental health status compared to overt victimization (Klomek et al., 2010). Some research has found that girls who are involved in any kind of bullying, either as bullies, victims, or bullies/victims, have significantly higher risks for suicide ideation and suicidal behavior than students not involved in bullying behaviors (Kim, Koh, & Levanthal, 2005). Kaltiala-Heino, Rimpela, Mattunen, Rimpela, & Rantanen, (1999) and Klomek et al., (2007) found that suicidal ideation was most common among bullies/victims, with no significant gender differences. Yet, other research suggests that girls who are victims of bullying are more likely to exhibit suicidal behaviors and completed suicides compared to those who are neither bullies nor victims (Klomek, Sourander, Niemela, et. al., 2009). In sum, a significant predictor for suicide ideation and attempts has been victimization and bullying. Given the disproportionate rates of suicide and depressive symptoms among Latina girls, in the current study, we investigate the relationship between being bullied, being a bully, and suicide rates among Latina girls in Arizona. We study the following questions in a statewide sample of Latina girls in Arizona:

What are the rates of depressive symptoms, suicide ideation and attempts?

Is victimization or bullying associated with suicide ideation and attempts even after controlling for depressive symptoms?

Are there different effects for bullying versus cyberbullying? Are there different effects for being a victim or being a bully?

Method

Participants

The total sample was comprised of 1491 high school students in Arizona (49% female) whose demographic characteristics are shown in Table 1. Two participants had 75% missing data on the variables of interest and were deleted from further analysis. In this study we focus on a subsample of participants who self-identified as Hispanic ethnicity and were female (N = 650), which was 28% of the total unweighted sample.

Table 1.

Sample Characteristics.

	N	%
Grade
9th Grade	160	25.2
10th Grade	117	18.6
11th Grade	167	26.6
12th Grade	180	28.7
No grade or other	1	0.2
Missing	3	0.5
Age
14 years old	55	8.8
15 years old	137	21.8
16 years old	144	22.9
17 years old	170	27.1
18 years old or older	121	19.3
Missing	1	.2
Victimized at school
Yes	150	23.0
No	495	76.2
Missing	5	0.8
Bully others at school
Yes	114	17.6
No	528	81.2
Missing	8	1.2
Cybervictim
Yes	171	26.3
No	475	73.1
Missing	4	0.6
Cyberbully
Yes	120	18.4
No	527	81.1
Missing	3	0.5
Depressive symptoms
Yes	318	48.9
No	329	50.6
Missing	3	0.5
Suicide ideation
Yes	153	23.5
No	494	76.0
Missing	3	.5
Suicide plan
Yes	109	16.8
No	534	82.2
Missing	3	1.1
Suicide attempts
No	489	75.2
1 time	36	5.5
2 or 3 times	30	4.6
4 or more times	9	1.5
Missing	86	13.2

Measures

Items were selected from the Arizona Youth Risk Behavior Survey (YRBS) of 2009. The Center for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System to determine the prevalence and co-occurrence of health-risk behaviors in high school students (CDC, 2004). The system uses biennial school-based surveys of representative samples of students in grades 9 to 12 at national, state, and local levels. States receive funding to conduct the YRBS. States must use 66% of the questions from the standard YRBS questionnaire provided by CDC, have no more than 99 items, and response options must be no more than eight mutually exclusive choices. Optional questions are available from CDC. The most recent reliability study was conducted in 1999. Test-re-test at a two-week interval found that 22% of items had significant difference prevalence on the two administrations. Fourteen percent of items had significantly different prevalence findings on the two administrations and both kappa coefficients < 61%. These items were revised or deleted from later versions. A more detailed description of the procedures used by CDC to develop and validate the survey is beyond the scope of this article but can be found in the Center for Disease Control (2004) publication. There are no measures of socioeconomic status or language in these surveys.

Victim and bully measures

Four items were used to assess victimization and bullying others. Students were asked “During the past 12 months, how frequently have you been harassed or bullied on school property?” and “During the past 12 months, how frequently have you harassed or bullied someone else on school property?” Response options ranged from 1 = never, 2 = once or twice, 3 = monthly, 4 = weekly, 5 = daily. The same responses were used for the following two questions: “During the past 12 months, how frequently have you been electronically bullied, such as through email, chat rooms, instant messaging, web sites, or text messaging?” and “During the past 12 months, how frequently have you electronically bullied someone else, such as through email, chat rooms, instant messaging, web sites, or text messaging?”

Procedure

Two-stage cluster sampling was used to obtain representative samples of students in grades 9 to 12 in each state. Only public schools were included. In the first stage, schools were selected with the probability of selection being proportional to the size of enrollment at the school. In the second stage, classes were randomly selected from those either of a required subject or from all intact classes during a required period. All students in the selected classes were eligible to participate. Local procedures for parental permission were followed. In most cases, trained data collectors administered the surveys to students reading a standardized script that included an introduction to the survey. The data collectors recorded information that was used to verify sample selections procedures and to weight data. In some cases, teachers of selected classes administered the surveys to their students using the standardized script. All surveys were self-administered during one class period. Privacy was encouraged by spacing of student desks and cover sheets to conceal their responses while they were completing the survey. Students who were absent on the day of data collection were given an opportunity to take the survey at a later time administered either by the data collector or school personnel.

States sent completed questionnaires to Westat where they were scanned and raw data extracted. Raw electronic datasets were then sent to CDC where data were cleaned and edited for out-of-range responses, logical consistency, and missing data. Edited data were sent to Westat for weighting, and the weights were merged to the edited data file by CDC and then provided to states.

Data Analysis

All analyses were conducted using Predictive Analytics SoftWare version 19.0. Variables included in this analysis, and response options, are listed in Table 1 and described above.

We used dichotomous variables (depressive symptoms, suicide ideation, suicide plan) for most analyses with “yes” and “no” responses. The response options for the variable, number of suicide attempts, had five response options (never, once, two or three times, four or five times, six or more times). In addition, the number of cases at each level was small, so we compared those who had made any attempts with those who had not done so. All dichotomous variables were re-coded so that 0 = no and 1 = yes. A missing data analysis was conducted on the variables of interest. For variables of interest, percent missing range from .5% (depression and considered suicide) to 13.2% (suicide attempts). We computed Little’s missing completely at random (MCAR) statistic (21.807), which indicated that the data were missing completely at random. Eight-six cases had missing data only on the suicide attempts variable. We decided to include only those students who had a response to the suicide attempt variable in the sample, resulting in a loss of 13% of cases. Because there was insufficient data to impute missing values, we deleted missing cases listwise in all analyses.

Results

The sample includes 650 females who self-identified as Hispanic and who provided a response on the suicide attempt variable. The distribution by grade is shown in Table 1. Approximately 48.9% of participants indicated they had experienced depressive symptoms in the last year, 23.5% had considered suicide, 16.8% had made a suicide plan, and 11.6% reported attempting suicide at least once in the previous year. Regarding bullying and victimization, we approximated Olweus’s (1993) criterion for bullying/victimization and found that 23% reported being victimized at school in the past year, and 26.3% were victimized electronically. Reported rates for bullying others at school were 17.6% and 18.4% for electronic bullying. There were no significant differences by grade level or age on any of these variables.

Table 2 presents the correlations among these variables. Having thoughts of suicide, making a suicide plan and attempting suicide were all strongly correlated with each other (range r = .55-.61, p<.01). Being a cybervictim and being a cyberbully were strongly associated (r = .64, p<.01); whereas for being a bully and victim at school the correlation was considerably weaker (r = .20, p<.01), but still in a positive direction. Being a victim at school and in cyberspace were positively correlated as was being a bully in both contexts. Having more depressive symptoms was associated with more suicide thoughts, plans, and attempts, and being more likely to be a victim and a bully (See Table 2).

Table 2.

Correlations Among Variables of Interest.

	1	2	3	4	5	6	7	8
1. Victim at school	1.00
2. Bully at school	.20**	1.00
3. Cybervictim	.20**	.17**	1.00
4. Cyberbully	.17***	.37**	.64**	1.00
5. Depressive symptoms	.16***	.10**	.19**	.14**	1.00
6. Suicide ideation	.15**	.19**	.15**	.15**	.34**	1.00
7. Suicide plan	.15**	.15**	.12**	.17**	.25**	.55**	1.00
8. Suicide attempt	.20***	.19**	.14***	.14**	.25**	.61**	.56**	1.00

Note: *p < .05. **p < .01. ***p < .001.

We conducted hierarchical logistic regression analyses with dichotomous suicide variables as the outcome variables (See Table 3). We entered depression in the first step, and the cyberbullying and the victimization variables in the second step. For the suicide attempt outcome variable 17% of the variance was accounted for, and results indicated the participants who were depressed were 4.7 times more likely to have made a suicide attempt than those who were not. Girls who reported being a victim of bullying at school were 1.5 times more likely to report a suicide attempt. The bullying at school, cyberbullying and victimization variables were not significant predictors of suicide attempts.

Table 3.

Logistic Regression Results.

	Odds ratio	95% confidence interval
Suicide attempts
Depressive symptoms	4.74***	2.55-8.81
Victim at school	1.51 *	1.10-2.08
Bully at school	1.28	0.92-1.78
Cybervictim	1.10	0.72-1.70
Cyberbully	1.20	0.76-1.89
Suicide ideation
Depressive symptoms	5.13****	3.29-8.02
Victim at school	1.20	0.63-1.11
Bully at school	1.51**	0.50-0.87
Cybervictim	1.10	0.65-1.27
Cyberbully	1.20	0.57-1.22
Suicide plan
Depressive symptoms	3.44***	0.18-0.47
Victim at school	1.32	0.99-1.76
Bully at school	1.40*	1.06-1.84
Cybervictim	0.89	0.61-1.31
Cyberbully	1.42	0.95-2.12

Note: *p < .05. **p < .01. ***p < .001.

A similar analysis was conducted with suicide ideation (considered suicide) as the dependent variable accounting for 21% of the variance. Latinas who reported experiencing depression in the previous year were 5.1 times more likely to consider suicide than those who were not depressed. Those who bullied others at school were 1.5 times more likely to have made a suicide attempt than their peers who did not report bullying others at school. Finally, the analysis was repeated with making a suicide plan as the dependent variable accounting for 14% of the variance. Results were similar with the odds ratio for depression being 3.44 in this case. Bullying others at school increased the odds of making a suicide plan by 1.4.

Discussion

The purpose of this study was to investigate the association between bullying, cyberbullying and suicide among Latina girls in Arizona. Results suggest that Latina’s rates of depressive symptoms (49%), suicide ideation (24%), suicide plan (17%), and suicide attempts (12%) are quite a bit higher than national rates. Depressive symptoms were strongly associated with suicide ideation, plan, and attempts, as anticipated and as has been demonstrated in previous literature. Rates of victimization (23% school/26% cyber) and bullying (18% school/18% cyber) are quite a bit higher than rates presented in studies with similar populations (12% victims/7% bullies (Peskin et al., 2007). These findings point to a need to examine and better understand the peer-related factors that may contribute to higher levels of victimization, bullying, depression, and suicide among Latinas.

Compared to national trends, our state-wide data of Latina adolescents, predominantly of Mexican descent, indicates higher than national rates of suicide ideation, plans, and attempts. The CDC indicates that nationally Latino female youth report higher levels of suicide-related thoughts and behaviors compared to males with 11.1% reporting having made a suicide attempt, 15.4% reporting having made a suicide plan, and 20.2% reported having seriously considered attempting suicide during the past year (Suicide Prevention Resource Center, 2011). Our study suggests that victimization and bullying are higher than average compared to other studies with Latino samples (Peskin et al., 2006, 2007). In our study, suicide attempts were significantly associated with depressive symptoms and being a victim of a bully. This is consistent with previous research on bullying (Steele & Doey, 2007). Although being a victim of cyberbullying was reported as prevalent as being bullied at school, it was not a significant predictor in the current study. In our study, we also find evidence that girls who report bullying others are more at risk for suicidal thoughts and making a suicide plan; this is consistent with emerging epidemiological research in the United States (Kim et al., 2005; Klomek et al., 2011). Certainly, future research can further investigate these effects; however, they may also indicate the need for restorative practices in schools and with families for girls who are found bullying others (Ahmed & Braithwaite, 2006; Liebmann, 2007)

Latina suicide and depressive symptoms continue to be a significant public health issue that deserves more attention to increase awareness, understanding, and intervention. Our study reveals that Latina girls report high rates of victimization, bullying, depressive symptoms, suicide ideation, suicide plans, and suicide attempts. In our study, suicide attempts were associated with being a victim; however, suicide ideation and plans were also associated with being a bully, which may indicate a need to explore the use of restorative practices that aim to heal both victim and bully. Social interactions with peers that result in bullying or victimization require further investigation utilizing an ecodevelopmental model, particularly among Latina girls.

Although the CDC YRBS data set provides a unique epidemiological picture of a representative sample of high school students, there are limitations to the measurement approach and the resultant dataset. For example, test-retest has demonstrated that up to 22% of the items had different prevalence for a two week interval; the rate was 14% at two different administrations. The majority of unreliable items have been dropped, but given the type of administration there is likely a larger margin of error than with other large datasets. In this study, we rely on a one item epidemiological measure; yet, the gold standard for mental health assessment is multiple sessions of one-on-one clinical interviews (Rogler, 1999). Additionally, the typical quantitative epidemiological screening tools are standardized with non-Latino Caucasian middle class samples of teens and adults who may have different cultural norms of emotion expression and different thresholds for mental illness than Latina adolescents (Roberts, Lewinsohn, & Seeley, 1991; Rogler, 1999). Future studies may further explore the measurement approach with this population and consider qualitative studies, new measurement techniques and multirespondents (peers, teachers, and parents). We recommend that future epidemiological studies incorporate reliable and valid scales rather than single items because each of these constructs are multidimensional. Our statewide sample is a strength of this study and represents a wide range of socioeconomic backgrounds; as such, it is important to note that our data need to be considered within the statewide political climate of Arizona that has been increasingly anti-immigrant and anti-Latino, which may impact the experiences of adolescents in terms of stereotypes, discrimination, and racial profiling that can lead to victimization (McNeill, Niemann, & Pizarro, 2001; O’Leary, 2009; Santa Ana & Gonzales de Bustamante, 2012). Our study demonstrates the need for more scientifically rigorous studies with state-wide comparisons to investigate the protective and risk factors that influence bullying and mental health of adolescents.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Andrea J. Romero is a Fitch Nesbitt associate professor in Family Studies and Human Development and Mexican American studies at the University of Arizona. Her training is in applied social psychology with an emphasis on quantitative methods. Her teaching focuses on Chicano/Latino psychology. Her research interests are on the development of resilience of adolescents, positive youth development and adolescent health. Her research investigates social, cultural, and family influences, kon adolescent health disparities for mental health and risky behaviors.

Christine Bracamonte Wiggs is a research specialist and serves as the assistant director of the Arizona Center for Research and Outreach (AZ REACH) in the Norton School of Family and Consumer Sciences at the University of Arizona. Her research training is in public health and family studies and human development. Her research interests focus on the important role that afterschool and out-of-school time contexts serve in influencing positive youth development, especially among diverse youth populations.

Celina Valencia is a graduate student in Family Studies and Human Development at the University of Arizona. Her undergraduate work is in women’s studies with a Chicana/Latina concentration and political science at the University of Arizona. Her research interests are in health disparities, identity development among adolescents, and gender.

Sheri Bauman is a professor and director of the counseling and mental health master’s degree program in the department of disability and psychoeducational studies at the University of Arizona. Prior to earning her doctorate in counseling psychology from New Mexico State University, she worked in public education for 30 years, 18 of those as a school counselor. Her research focuses on bullying and victimization, including cyberbullying, and the developmental aspects of the use of technology.

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