Reference no: EM13340713

Leona B. is a 13-year-old Hispanic girl in the 7th grade. She recently told one of her classmates that she was thinking of killing herself. The classmate told Leona’s mother, who brought her in for evaluation and treatment.

Leona’s mother reports that Leona has been increasingly irritable, rude, and oppositional over the past year. When you interview Leona separately, she reports that she has been feeling “very, very down” for almost a whole year. She reports that she has felt “down” nearly every day during this time, and that there have been no long periods where she felt normal. She describes herself as having been more irritable and tired all the time. She has dropped out of the swim team and almost never visits her friends anymore. She notices that her appetite is much less than it used to be, but she has not lost any weight. Recently, Leona has experienced significant difficulty getting to sleep and waking up again in the morning.

Leona also reports significant problems with headaches and stomachaches, especially during the last year. She believes these are what have contributed to her increasing irritability. Because she has been so irritable, Leona has been getting in fights with her siblings and her close friends. She has lost one friendship because of these fights, and another is “on shaky ground.” These interpersonal conflicts have contributed most strongly to her thoughts of suicide. Leona reports that she has felt like “the world is falling apart” and that as a result she has thought about drowning herself in the pool at school or slashing her wrists with a razor blade. She has actually scratched her wrist with a razor blade, leaving a scar, but causing herself no serious harm.

When you ask her about her family life, Leona says that her parents got divorced when she was 12. Her father moves back and forth between her hometown and Mexico, seeing Leona only infrequently. Money is tight in Leona’s family as a result of their limited income. Leona feels a lot of shame about this situation, especially since she now attends a private school with many wealthy classmates. You learn that after sixth grade, Leona was accepted into a scholarship program for gifted children and moved from her urban public school to a suburban private middle school. Although she was initially able to make some friends, she believes that most of her classmates look down on her. Leona also tells you that her father is currently in the hospital with serious heart problems. Her mother was once briefly hospitalized after a suicide attempt. Her grandmother has suffered from mood problems and alcoholism.

Leona’s grandmother is not supportive of Leona mom taking her to see a mental health professional. Her grandmother believes that she just needs to eat better and go to confession with the priest more regularly because this is just a phase that girls go through. Mental health treatment is not appropriate in her view.