Identifying Distinct Subgroups of Lesbian, Gay, and Bisexual Youth for Suicide Risk: A Latent Profile Analysis

Unpacking the 'black box' of suicide: A latent class analysis predicting profiles of suicidal ideation in a longitudinal cohort of adolescent girls from India

INTRODUCTION

Indian women account for 37% of global suicide-related deaths. As suicide is a growing concern among adolescent girls, identifying the social determinants of suicide with this group targeted prevention. We selected social determinants that include intersectional identities and broader syndemics; we then used longitudinal data from a prospective cohort of adolescent girls from Northern India to classify them into unique profiles across multiple socioecological levels.

METHODS

Girls aged 10-19 (N = 11,864) completed self-report questionnaires measuring socio-demographic and trauma exposure variables. At three-year follow-up, they were asked to indicate current suicidal ideation (SI). We conducted latent class analysis (LCA) to classify profiles and then predicted risk of current SI at three-year follow-up.

RESULTS

LCA supported a four-class solution: a 'privileged' class (Class 1; n = 1,470), a 'modal' class (Class 2; n = 7,449), an 'intergenerational violence' class (Class 3; n = 2,113), and a 'psychological distress' class (Class 4; n = 732). Classes significantly predicted odds ratios (OR) for SI at follow up; women in Class 4 were associated with the greatest likelihood of SI (OR 1.84, 95% CI 1.38, 2.47), suggesting that psychological distress factors confer greatest risk.

CONCLUSION

Results of the distinct classes of risk and protective factors indicate targets for policy-level interventions. Disrupting cycles of psychological distress and substance use, increasing access to behavioral interventions, and intervening to mitigate intergenerational violence may be particularly impactful with this population.

Suicidality and Non-Suicidal Self-Injury: A Narrative Review of Measurement, Risk, and Disparities among Minoritized and System-Involved Youth in the USA

Suicidality and non-suicidal self-injury (NSSI) among youth in the United States continue to be a growing and serious public health concern. With alarming rates of suicide trending in the wrong direction, researchers are committed to bending the curve of suicide and reducing rates by 2025. Understanding the antecedents and conditions, existing measures, and disparate prevalence rates across minoritized groups is imperative for developing effective strategies for meeting this goal. This study presents a narrative review of the operationalization, measurement, risk factors (e.g., firearms and social media), and disparities across race, ethnicity, age, gender identity, ability, sexual orientation, immigration statuses, and system involvement (e.g., foster care and juvenile justice) of suicidality and non-suicidal self-harm across youth in the United States. Implications for research, practice, and policy approaches that incorporate positive youth development, cultural, and youth participation in interventions are discussed.

Risk and protective factors for suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people, from countries with a high global acceptance index (GAI), within the context of the socio-ecological model: A scoping review

INTRODUCTION

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people experience higher prevalence rates of suicidality than their heterosexual and/or cisgender peers. However, there is limited research that can inform suicide prevention efforts. Our aim was to synthesize quantitative, qualitative, and mixed methods research on risk and protective factors among LGBTQ+ young people, from countries with a high Global Acceptance Index.

METHODS

A scoping review guided by Arksey and O'Malley's five-stage framework, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews protocol. Five databases and grey literature were searched for relevant studies. Identified factors were clustered by thematic type, according to the socio-ecological model to identify empirical trends and knowledge gaps. The mixed methods appraisal tool was used for quality assessment of studies.

RESULTS

Sixty-six studies met our inclusion criteria. Overall, 59 unique risk factors and 37 unique protective factors were identified. Key risk factors include past suicidality, adverse childhood experiences, internalized queerphobia, minority stress, interpersonal violence, bullying, familial conflict, and anti-LGBTQ+ policies/legislation. Key protective factors include self-affirming strategies, adult/peer support, at-school safety, access to inclusive healthcare, family connectedness, positive coming out experiences, gender-affirming services and LGBTQ+ inclusive policies and legislation.

CONCLUSIONS

Overall, our findings affirm that multiple risk and protective factors, at all levels of the socio-ecological model, interact in complex, unique and diverse ways upon suicidality among LGBTQ+ young people. Implications for suicide prevention are discussed. Further empirical studies are required, particularly at the communities, policies, and societal levels of the socio-ecological model, and these studies should include a focus on protective factors and significant within-group differences.

The role of sleep duration in suicide risk among sexual and gender minority adolescents

BACKGROUND

Short sleep duration is linked with suicide risk in adolescence. Sexual and gender minority (SGM) adolescents experience substantially increased risk for suicide compared to their non-SGM peers.

METHODS

We investigated the role of sleep duration in SGM adolescent suicide risk using population-based, cross-sectional data from the 2022 Minnesota Student Survey (MSS; N = 85,610, Mage = 14.8). Adolescents reported average school-night sleep duration; those reporting <6 h were classified as having very short sleep duration. The MSS additionally assessed past-year suicidal ideation and suicide attempt. Mediation analyses assessed the role of sleep duration in explaining associations between SGM identity and suicide risk. Further, to examine intervention mechanisms, among SGM adolescents (n = 20,171, 23.6%), a logistic regression model assessed associations among demographic factors, perceived parental care, and very short sleep duration.

RESULTS

As compared to non-SGM adolescents, SGM adolescents reported substantially higher prevalence of past-year suicidal ideation and suicide attempt and 2.6× higher prevalence of very short sleep duration (all p < 0.001). Mediation analyses demonstrated that very short sleep duration partially mediated the pathway between SGM identity and past-year suicidal ideation (15.5% mediated) and suicide attempt (17.2% mediated). Among SGM adolescents, a striking positive dose-response relationship was observed between level of perceived parental care and very short sleep duration. As perceived parental care decreased, so too did hours of sleep.

DISCUSSION

Sleep duration is a crucial and understudied mechanism underlying suicide risk disparities affecting SGM adolescents. Family-based interventions may improve SGM adolescent sleep and reduce suicide risk.

Profiles of Risk for Self-injurious Thoughts and Behaviors Among System-Impacted Girls of Color

OBJECTIVE

Suicide is a leading cause of death among youth in custodial settings. Prior research investigating risk factors for suicide among system-impacted youth fail to incorporate an intersectional framework to contextualize suicide risk among system-impacted girls of color.

METHOD

Profiles of risk for self-injurious thoughts and behaviors (SITBs) were investigated in a sample of 240 racially and ethnically diverse system-impacted girls (mean [SD] age = 14.5 [1.7] years, Hispanic/Latinx 49.6%, Black 37.1%). Participants completed self-report measures evaluating traditional risk factors for suicide (mental health symptoms, trauma exposure) as well as assessments of minority stress (eg, daily discrimination) and recent engagement in SITBs at baseline and 3-month follow-up.

RESULTS

Latent profile analysis revealed 3 distinct profiles: low-risk, characterized by relatively low levels of suicide risk indicators (n = 102); high-risk internalizing, characterized by elevations in internalizing symptom indicators (n = 96); and high-risk comorbid, characterized by relatively high levels of suicide risk indicators (n = 42). Girls in the high-risk profiles reported more SITBs at baseline and 3-month follow-up than girls in the low-risk profile.

CONCLUSION

Results suggest that indicators of suicide risk can be used to classify system-impacted girls into profiles that differ concurrently and prospectively on SITBs. Findings could be used to inform more accurate risk and referral assessments for system-impacted girls of color, whose SITB-related challenges may be overlooked or framed as criminal. These findings highlight the continued need for assessments evaluating multiple indicators of risk for SITBs in the juvenile legal system.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

A latent class analysis using the integrated motivational-volitional model of suicidal behaviour: Understanding suicide risk over 36 months

BACKGROUND

The use of latent class analysis (LCA) to understand suicide risk is often not guided by theoretical frameworks. This study used the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour to inform the classification of subtypes of young adults with a suicidal history.

METHODS

Data from young adults in Scotland (n = 3508) were used in this study including a subgroup of participants (n = 845) with a history of suicidality. LCA using risk factors from the IMV model was conducted on this subgroup, and the subgroups and non-suicidal control group were compared. Trajectories of suicidal behaviour over 36 months was compared between the classes.

RESULTS

Three classes were identified. Class 1 (62 %) had low scores on all risk factors, Class 2 (23 %) had moderate scores, and Class 3 (14 %) had high scores on all risk factors. Those in Class 1 had a stable low risk of suicidal behaviour, while those in Class 2 and 3 showed marked variation over time, although Class 3 had the highest risk across all timepoints.

LIMITATIONS

The rate of suicidal behaviour in the sample was low, and differential dropout may have impacted the findings.

CONCLUSIONS

These findings suggest that young adults can be classified into different profiles based on suicide risk variables derived from the IMV model, which still distinguishes them 36 months later. Such profiling may help determining who is most at risk for suicidal behaviour over time.

Illicit drug use among lesbian, gay, bisexual, pansexual, trans and gender diverse, queer and asexual young people in Australia: Intersections and associated outcomes

INTRODUCTION

High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self-reported concern with drug use among LGBTQA youth in Australia.

METHODS

A cross-sectional survey was conducted involving 6418 LGBTQA participants aged 14-21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self-reported concern with drug use.

RESULTS

Overall, 26.4% of participants aged 14-17 and 41.9% aged 18-21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self-identified concern about drug use were observed among participants reporting challenging life experiences.

DISCUSSION AND CONCLUSIONS

Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA-related prejudice or harassment, or homelessness.

Patterns and predictors of adolescent life change during the COVID-19 pandemic: a person-centered approach

The present study investigated patterns of adolescent life changes across multiple life domains and utilized a holistic-interactionistic perspective to examine their individual, familial, and societal correlates with a sample of 2544 Chinese parent-adolescent dyads. Adolescents were aged from 10 to 19 years old (50.16% girls). Latent profile analysis revealed five life change profiles, including three improved profiles at various degrees, one unchanged profile, and one worsened profile. The majority of adolescents had an improved or unchanged life. Multinomial logistic regression analyses found that most of the individual, familial, and societal factors predicted the group memberships. Notably, parent-adolescent conflict was a significant factor that predicted memberships of all patterns. These findings show the resilience of adolescents and indicate the need for policies and interventions that consider the holistic nature of adolescents' person-context system, especially during a global crisis such as the COVID-19 pandemic.

Sleep disturbance and suicide risk among sexual and gender minority people

Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.

Leveraging latent profile analysis to synthesize childhood and adolescent risk factors for suicidal ideation

Person-centered typologies identified with latent profile analysis can clarify patterns of chronic and acute risk factors for suicidal ideation. We derived five profiles of individuals using cognitive, behavioral, and familial factors relating to suicidal ideation risk factors. Participants (n = 1,142) were assessed at age 8 using the Laboratory Temperament Assessment Battery and mother-reported parenting measures and at age 14 using interviews about clinical symptoms and suicidal ideation. The best-fitting model included five profiles: typical, elevated adolescent symptomology, mildly elevated typical, low childhood persistence, and very low childhood persistence/mixed symptoms. Participants in the elevated adolescent symptomology and very low childhood persistence/mixed symptoms profiles were 2.6 and 5.3 times more likely to report suicidal ideation compared with the typical profile. Overall, our results underscore how using a person-centered pattern recognition approach and incorporating facets of childhood behavior may enhance conceptualizations of adolescent suicidal ideation risk.

Latent profile analysis to identify subgroups of Chinese sexual minority adolescents at risk of suicidality

BACKGROUND

This study aimed to identify latent class profiles of sexual minority adolescents (Men Sexually attracted to Men, Women Sexually attracted to Women, and Bisexual) with elevated suicidal ideation.

METHODS

Data were collected from 18 secondary schools in China. Sub-group classifications were identified using variables associated with suicidal ideation in sexual minority adolescents, including parental relationship quality, electronic equipment time, school bullying, and sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index to measure sleep. Anxiety was measured using the Generalized Anxiety Disorder 7 (GAD-7), depression was measured using the Patient Health Questionnaire 9 (PHQ-9), hypomania using the Hypomanic Checklist-32 (HCL-32), positive coping style was identified using the Trait Coping Style Questionnaire, and self-efficacy was measured by the General Self-Efficacy Scale.

RESULTS

Four distinctive profiles were derived from the data. Compared to "low-risk" group (Class 3), the "adolescent with mood problems" group (Class 2) had a 9.81 times higher risk of suicidal ideation; the those who classified as "severe bullied adolescent" (Class 4) had a 9.26 times higher risk of suicidal ideation. and the "adolescents with low self-efficacy" group (Class 1) had a 4.48 times higher risk of suicidal ideation.

CONCLUSIONS

Sexual minority adolescents with mood problems have the highest risk of suicidal ideation, followed by adolescents frequently being bullied at school. Interventions aimed at reducing suicide risk among sexual minority adolescents may benefit from attending to such profile factors identified in this study to develop targeted clinical care.

Adolescent social networks matter for suicidal trajectories: disparities across race/ethnicity, sex, sexual identity, and socioeconomic status

BACKGROUND

Examining social networks, characterized by interpersonal interactions across family, peer, school, and neighborhoods, offer alternative explanations to suicidal behaviors and shape effective suicide prevention. This study examines adolescent social networks predicting suicide ideation and attempt trajectories transitioning to adulthood, while revealing differences across racial/ethnic, sex, sexual identity, and socioeconomic status.

METHODS

Participants included 9421 high school students (Mage = 15.30 years; 54.58% females, baseline) from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health, 1994-2008. Latent class growth analyses were conducted to identify suicide ideation and attempt trajectories. Multivariate multinomial logistic regressions examined the relationships between social network characteristics during adolescence and suicidal trajectories. Interaction terms between social networks and sociodemographic characteristics were included to test moderation effects.

RESULTS

Three suicidal ideation trajectories (low-stable, high-decreasing, moderate-decreasing-increasing) and two suicide attempt trajectories (low-stable, moderate-decreasing) were identified. Greater family cohesion significantly reduced the probability of belonging to high-decreasing (Trajectory 2) and moderate-decreasing-increasing (Trajectory 3) suicidal ideation trajectories, and moderate-decreasing (Trajectory 2) suicide attempt trajectory. Race/ethnicity, sex, and sexual identity significantly moderated the associations between social networks (household size, peer network density, family cohesion, peer support, neighborhood support) and suicidal trajectories.

CONCLUSIONS

Social networks during adolescence influenced the odds of belonging to distinct suicidal trajectories. Family cohesion protected youth from being in high-risk developmental courses of suicidal behaviors. Social networks, especially quality of interactions, may improve detecting adolescents and young adults at-risk for suicide behaviors. Network-based interventions are key to prevent suicidal behaviors over time and suicide intervention programming.