Chicago, United States - The manic depression that gripped young Christine Ruiz had grown so acute by the time she had reached high school she was suicidal.
She began self-harming and abusing alcohol and painkillers but, despite the alarming decline in her mental health, everyone around her assumed she was just a typical angst-ridden Latina teenager.
Self-harm seemed like a way for her to take control. "I always felt like I wasn't in charge of my body," Ruiz says.
Her troubled story offers insights into why Hispanic teenagers have one of the highest teen suicides rates in the United States.
It's [depression] a public health issue and it has real psychiatric and behavioural consequences, including suicide.
According to a 2012 report from the Centers for Disease Control and Prevention, 13.5 percent of Hispanic female students in grades 9-12 admitted attempting suicide - significantly higher than their black (8.8 per cent) and non-Hispanic (7.9 percent) peers.
Dr Rosa Gil, president of the Comunilife non-profit organization, which runs the Life is Precious programme for suicidal teens, warns that a staggering 17 percent of Latina adolescents in New York are actively considering suicide.
Many experts believe that the burden of adapting to a new culture faced by these girls - many from migrant families - is contributing to soaring suicide rates.
"The girls get acculturated much faster than their mothers," says Gil. "Because of machismo and marianismo - the veneration of feminine virtues - young women are raised to be docile and dependent. This creates conflict for girls who are more acculturated."
Research in 2011 suggested better communication within Latino families can decrease the likelihood of suicide - an objective at the heart of the Life is Precious programme.
"We're cultural brokers," says Gil. "We try to explain to the mothers that girls in this country are more independent. We are trying to bridge the relationships between mother and daughter."
Bullying in the US
Bullying and abuse can also raise the stakes. According to one study, Latina girls who have been bullied are 1.5 times more likely to attempt suicide.
Psychiatrist Dr Lisa Fortuna, the director of Child and Adolescent Multicultural Health Research at the University of Massachusetts Medical School, says bullying has become a major issue.
"I see a lot of kids, Latinos included, who develop significant depression because of chronic harassment," she says. "It's a public health issue and it has real psychiatric and behavioural consequences, including suicide."
For Yeli Zivkovich, everything changed at the age of 14 when she was sexually abused by two female classmates.
At high school she remained friends with her abusers - a relationship she describes as "Stockholm Syndrome" after the psychological phenomenon whereby hostages empathise with their captors - while enduring vicious gossip.
By the time she was 19 and still deeply troubled by her experiences, she was working in a dead-end job, had fallen into serious debt - and was suicidal.
"I didn't get the guidance I needed in high school," says Zivkovich, now 27.
Dr Gil believes bullying has become a major problem in the US.
"We have seen an increase among the girls we serve in the Life is Precious programme. In New York three weeks ago, a 12-year-old committed suicide because of bullying and family issues. The girls are getting younger and younger."
The environment many of these Latina girls grow up in can be a factor in their depression.
Christine Ruiz, now 27, believes her small agricultural town - 95 per cent Latino and with little to offer - deepened her desperation.
Dr Azara Santiago-Rivera, national director of the Chicago School of Professional Psychology Latino Mental Health Initiative, says: "We are focusing all of our attention on cultural dimensions and family relationships and overlooking important environmental factors."
"If we're going to design intervention that's effective, we need to look at family and environment."
Stigma of mental illness
The stigma of mental illness in the Latino community - and the shame associated with their condition - may also prevent girls from seeking professional help.
Patricia Valoy, 26, says she grew up knowing that her maternal grandmother had committed suicide, but her entire family always denied it. "There's a stigma," she says. "They say she was poisoned."
When as a teenager she became depressed and suicidal, her family discouraged her from discussing it.
"What happens in your house, stays in your house," she says. "The family unit is so important in Latino culture, and anything that can break that down is considered taboo."
The media plays a very important role in prevention [of suicide]. We need to teach our communities what to look for.
Research conducted through the New York State Psychiatric Institute found that there is greater stigma towards mental illnesses among non-whites, including Latinos, who often seek help from family members or priests before turning to professionals.
The Latino community also lacks mental health professionals equipped to deal with its specific needs.
"Quite often, clinicians who are experts in their field forget that acculturation is an important factor," says Santiago-Rivera.
"We don't necessarily assess language and identity issues. It's not that clinicians aren't interested in them, it's that they're not integrated into their assessment process."
A 2012 report found that many Latinos attribute poor access to mental health services to shortages of bilingual and bicultural professionals, a lack of educational programmes for youths, and deficiencies in culturally sensitive services.
There is also little awareness of mental health issues in the Latino community.
"The problem doesn't seem to be going away," says Dr Gil. "The media plays a very important role in prevention. We need to teach our communities what to look for."
Dr Fortuna believes there is now an urgent need for a national, culturally-specific campaign and the media should encourage parents to understand the problems faced by their bilingual and bicultural children.
"We need to be speaking frankly and having conversations early to develop emotional literacy," she says.
Follow Erika L. Sanchez on Twitter: @OhHellsNah
Source: Al Jazeera