Predictors of Sexual Minority Youth's Reported Suicide Attempts and Mental Health

Vortex of regret: How positive and negative coping strategies correlate with feelings of guilt

Bad coping behavior and guilt may reinforce each other as a negative feedback loop. Social contexts and expectations may also create cognitive dissonance in coping individuals and affect the effectiveness of coping styles. This study examines the associations between the feeling of guilt and specific coping styles belonging to both groups of positive and negative coping styles. We conducted Bayesian Multiple Regression analyses on secondary data from 3784 high school students in China. Positive coping is associated more with reduced feelings of guilt compared to negative coping. However, some positive coping styles were found to be positively associated with a sense of guilt, especially those involving confrontation against or conformity to social expectations. Most negative coping styles are positively associated with guilt, and substance use has the strongest influence among the examined negative coping styles. The findings suggest that the consideration of sociocultural contexts is very important in supporting those with guilt issues, especially adolescents in societies with dominant traditional East Asian values.

Development of best practice guidelines for clinical and community service providers to prevent suicide in LGBTQA+ young people: A Delphi expert consensus study

OBJECTIVE

The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia.

METHODS

We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14-25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines.

RESULTS

A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people.

CONCLUSION

These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people.

Family as a Pathway to Suicidal Behaviors Through Depression Symptoms and Internalized Homophobia

Research consistently highlights how systemic and social factors can adversely impact mental health, and the potential buffering effects of family support, yet raced sexual minorities are vastly underrepresented among these studies. As rates of suicide increase among Black people and remain high among men and those in gender and sexually diverse communities, this study sought to examine to relationships between family dynamics and suicidality among young Black men who have sex with men (MSM) in young adulthood. We used an online survey to conduct a logistic regression to examine family factors (family support, open family communication, other adult support, and other adult value), depression symptoms, and internalized homophobia on suicide attempts. The conceptualization of the study's design and interpretation of the results were informed by minority stress theory and the phenomenological variant of ecological systems theory. The results indicate that higher levels of family support and open family communication were associated with lower levels of suicidality. Implications for future research and applications for healthcare providers and human services professionals who support young Black MSM in emerging adulthood 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.

Attachment-based family therapy versus nondirective supportive therapy for lesbian, gay, bisexual and questioning adolescents with depression, and suicidal ideation: An exploratory study

INTRODUCTION

Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are particularly at risk for suicidal ideation; however, little clinical research is focused on treating this population. Attachment-based family therapy (ABFT) is among the few empirically supported youth suicide treatments adapted for LGBQ adolescents. The purpose of this exploratory study is to determine the differential treatment effects and rates of change for LGBQ and heterosexual adolescents with depression and suicidal ideation receiving either ABFT or family enhanced nondirective supportive therapy (FE-NST).

METHOD

The sample included 129 adolescents (31% LGBQ), ages 12-18 randomized to the two treatment groups. Multilevel modeling was used to examine individual changes in depression and suicidal ideation over the 16-week treatment.

RESULTS

Results revealed that LGBQ adolescents in the ABFT condition showed a greater rate of reduction in depressive symptoms over treatment, slope = -0.94, p < 0.001, than did LGBQ adolescents in the NST condition, slope = -0.41, p = 0.12. Heterosexual adolescents showed symptom reduction in both treatment conditions (ABFT slope = -0.47, p < 0.001; NST slope = -0.79, t (113) = -7.48, p < 0.001). Changes in suicidal ideation were found across time, but not across conditions.

CONCLUSION

LGBQ adolescents in the ABFT condition had a sharper decrease in depressive symptoms and better outcomes at week 16.

Associations of Psychological Distress and Alcohol Use Patterns Among Older Adults of Sexual Minority Status and Heterosexual Peers

BACKGROUND

There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use.

OBJECTIVE

The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns.

METHODS

This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption.

RESULTS

Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use.

CONCLUSION

Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial

BACKGROUND

Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk.

OBJECTIVE

We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months.

METHODS

Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants' willingness and adoption of SPI and STARS and staff's experiences with delivering the program.

RESULTS

Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022.

CONCLUSIONS

This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48177.

Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

Background

Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).

Methods

We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.

Results

A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]).

Conclusion

Implications for clinical practice, policy, and future research are discussed.

The role of parents' and friends' support in preventing suicide attempts among French sexual minority adolescents

OBJECTIVES

French sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents' and friends' support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France.

MATERIALS AND METHODS

Data were drawn from a French cross-sectional study entitled "Portraits d'adolescents". Parental support was defined by satisfactory relations between participants and their parents. Friends' support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth.

RESULTS

Data from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11-3.18]; p < 0.0001). Both parents' and friends' support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35-0.46] and 0.61 [0.51-0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27-0.65]), independently of other variables.

DISCUSSION

Prevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts.

CONCLUSIONS

French LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.

Conditions for Social Exclusion Leading to Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People

Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress-vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.

Effect of Sexual Knowledge, Attitude and Quality of Life on Marital Satisfaction of Aged Couples in South Iran: APIM-SEM Analysis

Marital satisfaction is important for health and well-being among aged couples. The aim of this study is to explore the relationship between knowledge, sexual attitude, and quality of life with marital satisfaction of aged couples of over 60 years in southern Iran. This APIM analytical study was performed on 510 aged couples in southern Iran in 2020. Proportionate stratified sampling was randomly performed in three stages relative to the aging population in main cities in the south Iran. Data collection tools included demographic information (age, education, occupation, living alone, type of disability, etc.), sexual knowledge and attitude scale (SKAS-10), quality of life scale (SF-12), and marital satisfaction questionnaire. Mean score of marital satisfaction, sexual attitude, sexual knowledge, and QoL (SF-12) was 49.71 (SD = 14.8), 27.5 (SD = 7.3), 24.7 (SD = 8.5), and 31.49 (SD = 3.2), respectively. The present study showed that sexual knowledge and attitude, quality of life, are among the estimators of marital satisfaction in aged couples.

The moderating role of sexual minority status in the associations of the experience and tolerance of shame-related emotions to suicide risk

OBJECTIVE

This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status.

METHODS

Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk.

RESULTS

Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust.

CONCLUSION

Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.

An Integrated Conceptual Model to Understand Suicidality among Queer Youth to Inform Suicide Prevention

In this article, we apply and combine elements from four theoretical frameworks (i.e., Minority Stress Theory, Person-in-Environment and Risk and Resilience Framework, Interpersonal-Psychological Theory of Suicide, and Intersectionality) to explain the problem of queer youth suicide through our integrated conceptual model, Queer Prevention of Youth Suicidality Model (Queer-PRYSM). The need for this conceptual model is based on the current state of the literature, including mixed empirical findings on factors related to queer youth suicidality, no scholarly consensus on specific contributing factors regarding high rates of suicidality among queer youth (including queer youth subgroups), and the absence of a unifying theory to explain the queer youth suicide risk. To address these limitations in theory, evidence, and scholarship explaining suicidality among queer youth we present our integrated model with growing, current, relevant research with queer youth. Queer-PRYSM includes minority stressors specific to queer youth, mental health problems, interpersonal-psychological factors, socioecological factors (i.e., family, school, peers, and community), and intersectionality concepts. Queer-PRYSM is essential to understanding the relationship of distal and proximal risk and protective factors in queer youth suicide and developing evidence-informed suicide preventive interventions that can be incorporated into practice, policy, and system structures.

Transphobic Adverse Childhood Experiences as a Determinant of Mental and Sexual Health for Young Trans Women in the San Francisco Bay Area

This study characterized the prevalence of transphobic adverse childhood experiences (ACEs) among young trans women (YTW) and assessed its relationship with poor mental health and sexual risk. A survey was administered between 2012 and 2014 to 300 YTW aged 16-24 living in the San Francisco Bay Area. Transphobic childhood verbal abuse, physical abuse, and high transphobic childhood adversity were endemic, and we found strong associations with depression, posttraumatic stress disorder, and any and receptive anal intercourse. ACEs may be critical social determinants of mental and sexual health for YTW and validated measures to screen for ACEs are needed, along with interventions that provide gender-affirmative support for parents.

Achieving health equity in US suicides: a narrative review and commentary

Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.

The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.

To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.

Sexual Shame and Emotion Dysregulation: Key Roles in the Association between Internalized Homonegativity and Sexual Compulsivity

Sexual minority men (SMM) are at increased risk for mental health problems due to effects of sexual minority stigma (e.g., internalized homonegativity (IH)). Both IH and emotion dysregulation are contributors to sexual compulsivity; however, the role of feelings of sexual shame have not been examined in this association. A sample of 982 HIV-negative SMM completed online surveys (Mage = 42.4, SD = 13.74). Path analyses indicated significant direct effects of IH on sexual shame (β = 0.44, p < .001), emotion dysregulation (β = 0.19, p < .001), and sexual compulsivity (β = 0.22, p < .001). Modeled simultaneously, the association between sexual shame and sexual compulsivity (β = 0.26, p < .001) was significant, as was the association between emotion dysregulation and sexual compulsivity (β = 0.27, p < .001). Finally, an indirect effect of IH on sexual compulsivity through both sexual shame (p < .001) and emotion dysregulation (p < .001) was significant, and the association between IH and sexual compulsivity was reduced to non-significant (β = 0.01, p = .74). Targeting feelings of sexual shame and emotion dysregulation in clinical interventions may help reduce the negative health impact of sexual compulsivity among SMM.

Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience

Purpose: This article examines factors associated with suicidal ideation and suicide attempts in the past 12 months among lesbian, gay, bisexual, pansexual, queer, asexual, or other non-heterosexual identifying youth (LGBQA+). Methods: A national Australian cross-sectional online survey was conducted involving 4370 cisgender LGBQA+ participants aged 14-21 years from September to October 2019. Multivariable logistic regression analyses were performed to examine significant factors associated with suicidal ideation and suicide attempts in the past 12 months. Research ethics approval for the WTI4 study was granted by the La Trobe University Human Research Ethics Committee and the ACON Research Ethics Review Committee. Results: Overall, 56.4% of participants reported suicidal ideation and 8.9% a suicide attempt in the past 12 months. Multivariable regression results show that participants aged younger than 18 years, lesbian (compared with gay) identifying, those living in rural or remote locations (compared with inner city), those reporting any verbal, physical, or sexual harassment or assault based on sexual orientation or gender identity, or who had a religious family or household, or had experienced conversion practices in the past 12 months reported higher levels of suicidal ideation or suicide attempts. Those who reported feeling part of their school reported lower levels of suicidal ideation and suicide attempts. Conclusion: High levels of suicidal ideation and suicide attempts among young LGBQA+ people in Australia highlight a need for the ongoing inclusion of LGBQA+ youth as a priority population for suicide prevention. The findings illustrate key factors associated with a greater risk of suicidality among young LGBQA+ people. These findings can be used to inform the provision of tailored support services, including culturally safe suicide prevention programs and efforts to address stigma, discrimination, and conversion practices.

Minority Stress and Suicidal Ideation and Suicide Attempts Among LGBT Adolescents and Young Adults: A Meta-Analysis

Purpose: This meta-analytic study examined associations between minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults (aged 12-25 years). Methods: Identified studies were screened using the inclusion and exclusion criteria. Studies had to include an association between a minority stressor and a suicidality outcome and were categorized into 10 meta-analyses. Overall effect sizes were calculated using three-level meta-analyses. In addition, moderation by sampling strategy was examined. Results: A total of 44 studies were included. Overall, LGBT bias-based victimization, general victimization, bullying, and negative family treatment were significantly associated with suicidal ideation and/or suicide attempts. Associations of discrimination and internalized homophobia and transphobia with suicidal ideation and/or suicide attempts were not significant. No moderation effects were found for sampling strategy. Conclusion: Although overall effect sizes were small, our meta-analytic study shows a clear link between various types of minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults.

Verbal Disclosure and Mental Health Among Gay Latino and Gay White Men

We examined the relationship between verbal disclosure of sexual orientation and mental health among gay Latino and gay White men. In Study 1, we recruited 164 gay Latino ( n = 81) and gay White ( n = 83) men via Amazon’s Mechanical Turk (MTurk). Participants completed measures assessing the degree to which they verbally disclosed their gay identity to others, as well as their depression and anxiety symptoms. Increased verbal disclosure predicted better mental health among gay White men only; no statistically significant relationships emerged among gay Latinos. In Study 2, we recruited 281 gay Latino ( n = 130) and White ( n = 151) men via MTurk, in which feelings of shame and guilt independently mediated the relationship between verbal disclosure and mental health. Among gay White men, increased verbal disclosure predicted less shame and guilt, which predicted better mental health. These relationships did not emerge for gay Latinos.

Understanding the processes underlying self-harm ideation and behaviors within LGBTQ+ young people: A qualitative study

OBJECTIVE

This study aims to understand the processes underlying self-harmful thoughts and behaviors, with and without suicidal intent, among LGBTQ+ young people.

METHOD

Nineteen semi-structured interviews took place between October 2019 and May 2020. Participants were aged between 16 and 25 years, had experiences of self-harm ideation and behaviors, and were part of the LGBTQ+ umbrella. A range of sexualities and gender identities were represented: eleven participants were cisgender, six were transgender and two were non-binary. Interviews were transcribed verbatim and anonymised. Thematic analysis and reflective member-checking were used to develop a thematic framework.

RESULTS

Three themes were developed from the interviews and evaluated by four participants who engaged with reflective member-checking. Findings indicated that internal processes and external responses to being LGBTQ+ resulted in self-harmful thoughts and behaviors. Alongside these, additional stressors related to being a young person were led to difficulties with self-harm.

CONCLUSIONS

Findings from this study indicate that young people often struggle with accepting their LGBTQ+ identity for a number of reasons, whether this is due to access to a resource or their own feelings about their identity. These negative self-perceptions can be enhanced by poor responses from others and additional life stressors which impact their self-esteem or self-perception.HIGHLIGHTSUnderstanding and accepting that one is LGBTQ+ is not always a simple process, struggling with these thoughts can influence self-harm.Lack of LGBTQ+ terminology hinders self-acceptance and caused young people to engage with self-harm.Peers and family members responses to a young people's LGBTQ+ identity is highly significant and can directly led to self-harmful thoughts and experiences.

Sexual Orientation Identity Development Milestones Among Lesbian, Gay, Bisexual, and Queer People: A Systematic Review and Meta-Analysis

This paper is a systematic review and meta-analysis on sexual orientation identity development milestones among people who are lesbian, gay, bisexual, or another sexual minority identity (LGB+). Common milestones measured in the 30 studies reviewed were becoming aware of queer attractions, questioning one's sexual orientation, self-identifying as LGB+, coming out to others, engaging in sexual activity, and initiating a romantic relationship. Milestones occurred in different sequences, although attraction was almost always first, often followed by self-identification and/or sexual activity; coming out and initiating a romantic relationship often followed these milestones. Meta-analysis results showed that the mean effect sizes and 95% confidence intervals varied by milestone: attraction [M _age=12.7 (10.1, 15.3)], questioning one's orientation [M _age=13.2 [12.8, 13.6]), self-identifying [M _age=17.8 (11.6, 24.0)], sexual activity [M _age=18.1 (17.6, 18.6)], coming out [M _age=19.6 (17.2, 22.0)], and romantic relationship [M _age=20.9 (13.2, 28.6)]. Nonetheless, results also showed substantial heterogeneity in the mean effect sizes. Additional meta-analyses showed that milestone timing varied by sex, sexual orientation, race/ethnicity, and birth cohort. Although patterns were found in LGB+ identity development, there was considerable diversity in milestone trajectories.

Religious Identity Dissonance: Understanding How Sexual Minority Adolescents Manage Antihomosexual Religious Messages

Sexual minority adolescents from religious contexts may be at high risk of mental health issues due to religious identity dissonance. This study investigated the cognitive strategies used to manage antihomosexual religious messages and resolve religious identity dissonance among sexual minority adolescents. In 2014, 46 adolescents were interviewed in Los Angeles, CA. Youths were prompted to discuss experiences with religion, antihomosexual messages, and their strategies for managing these messages. Ninety-one percent of the sample reported hearing antihomosexual religious messages. Messages came from multiple sources (e.g., parents, pastors) and contained three types of content (i.e., creation, sin, and afterlife). A quarter of the sample reported religious identity dissonance. Three primary strategies to manage antihomosexual messages emerged. Findings indicate that all youths, including nonreligious youths, use cognitive strategies to manage negative messages and that these strategies relate to current religious identification.

Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior

OBJECTIVES

To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents.

METHODS

A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016.

RESULTS

Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77).

CONCLUSIONS

Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.

A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide

BACKGROUND

LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations.

OBJECTIVES

The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups.

DATA SOURCES

MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020).

STUDY ELIGIBILITY CRITERIA

Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years).

SYNTHESIS METHODS

2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses.

RESULTS

Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences.

CONCLUSIONS

Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives.

PROSPERO REGISTRATION NUMBER

CRD42019130037.

Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services

Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.

Disclosing sexuality: Gay and bisexual men's experiences of coming out, forced out, going back in and staying out of the 'closet' in prison

Many papers have been written on the process of coming out by individuals with predominantly same-sex sexual orientation but few of these papers have explored the concept of how people negotiate the idea of coming out in prison. We conducted in-depth interviews with 13 prisoners and one ex-prisoner in New South Wales, Australia, who self-identified as gay, homosexual or bisexual men. Data was collected and analysed using an inductive or grounded theory framework since very little was known on the sexual behaviours and identities of Australian prisoners prior to the study and elsewhere. We examined and discussed the lived experiences of prisoners whose disclosure stories were seen to fall under four thematic categories: 'coming out', 'forced out', 'going back in' and 'staying out of the closet' on entering prison. Respondents were required continuously and contextually to manage their sexual identities and disclosure to different audiences while incarcerated. Findings suggest that the prison environment and its attendant heteronormative values and hyper-masculine culture, apply significant pressure on gay and bisexual men on how to manage their sexual identities and disclose their sexuality in prison.

Associations of Discrimination, Suicide Ideation Severity and Attempts, and Depressive Symptoms Among Sexual and Gender Minority Youth

We examined the unique associations among discrimination, suicidal thoughts, suicide attempts, and depressive symptoms in a sample of sexual and gender minority (SGM) youth as well as interpersonal mediators of these associations. Participants included 94 SGM youth (M_age = 18; SD = 2.88) recruited from SGM-specific drop-in centers. We used mediation analyses to test the mediating effects of perceived burdensomeness and thwarted belongingness on the associations between discrimination and suicidal ideation, suicide attempts, and depressive symptoms, accounting for childhood trauma and sociodemographic variables (age, gender identity, race, and sexual orientation). Within our nonclinical community sample of SGM youth, 49% reported a lifetime suicide attempt, 84% reported current suicide ideation, and 82% reported current depressive symptoms. Experiencing discrimination was associated with greater likelihood of suicide attempts and depressive symptoms, and greater perceived burdensomeness and thwarted belongingness, over and above the effects of childhood trauma and sociodemographic variables. Discrimination was indirectly associated with greater depressive symptoms through perceived burdensomeness and thwarted belongingness, and with greater severity of suicidal ideation through perceived burdensomeness. Findings suggest clinicians should assess for discrimination and include a focus on perceived burdensomeness and thwarted belongingness as targets of intervention for suicide and depression.

Peer Victimization and Mental Health Outcomes for Lesbian, Gay, Bisexual, and Heterosexual Youth: A Latent Class Analysis

BACKGROUND

Lesbian, gay, bisexual, and questioning (LGBQ) adolescents are at increased risk of poor mental health due to minority stress, a chronic stress associated discrimination, social rejection, and victimization brought on by prejudicial attitudes towards LGBQ individuals. To improve understanding of the differential impact of various kinds of victimization on mental health outcomes for LGBQ adolescents, we analyzed data from the 2015 Youth Risk Behavior Survey (YRBS) for victimization and mental health symptom clusters and associations high school youth and compared by sexual orientation and gender.

METHODS

Separate Latent Class Analysis (LCA) was conducted to identify profiles of both victimization and mental health symptoms for participants (N = 15,624). Subsequently, stratified weighted logistic regression models were used on an eligible analytic sample of 11,458 to assess differences in the association of victimization and mental health between LGBQ and heterosexual high school students.

RESULTS

In each LCA, participants were assigned to one of 3 classes for victimization (minimal, 81.3%; bullying, 12.5%; or physical/sexual violence, 6.2%) and 1 of 2 classes for mental health symptoms (minimal, 81.2%; severe, 18.8%). LGBQ participants were overrepresented in physical/sexual violence and bullying victimization profiles. Both bullying and physical/sexual violence profiles were associated with almost 5 times the odds of endorsing severe mental health symptoms.

CONCLUSIONS

This study expands our understanding of the relationship between types and effect of peer victimization for LGBQ and heterosexual youth with implications for school health and prevention efforts through increased positive school climate for LGBQ students.

Substance Use and Suicide Attempts Among Adolescent Males Who Are Members of a Sexual Minority: A Comparison of Synthesized Substance-Use Measures

Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a significant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n = 849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on use frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (quasi-information criterion = 853.9969) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared with those who used none (adjusted prevalence ratio = 3.35, 95% confidence interval: 2.41, 4.66). A 3-latent-class model had the second best fit to the data (quasi-information criterion = 878.4464), with the highest prevalence of suicide attempts (adjusted prevalence ratio = 2.54, 95% confidence interval: 1.80, 3.57) among the high-substance-use class compared with the low-use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.

Integrating Minority Stress Theory and the Interpersonal Theory of Suicide among Sexual Minority Youth Who Engage Crisis Services

OBJECTIVE

The present study sought to integrate minority stress theory (MST) and the interpersonal theory of suicide (ITS) to better understand high rates of suicide among sexual minority youth (SMY). To date, the ITS and MST have largely advanced independently from one another even though the research base for each theory contains gaps that the other theory may help fill.

METHOD

Using data from a national sample of 564 SMY (aged 12-24) recruited from an LGBTQ youth-focused suicide crisis prevention provider, we examined structural equation models to understand how perceived burdensomeness and thwarted belongingness mediate the relationship between minority stress and suicidal ideation and attempt.

RESULTS

Sexual minority stress was significantly associated with both perceived burdensomeness and thwarted belongingness in models predicting suicidal ideation and attempt. Moreover, minority stress had a direct effect on suicide attempt and an indirect effect on both suicidal ideation and suicide attempt through burdensomeness.

CONCLUSIONS

Given that minority stress is associated with greater thwarted belongingness, perceived burdensomeness, and suicide attempts, there should be greater demand for continuing education centered on sexual minority populations and population-specific services. Identifying burdensomeness as a minority stress-suicide mechanism highlights the potential gains of piloting recently developed burdensomeness interventions among SMY.

Sexual minorities and teen suicide attempts in a southeastern state with prominent exclusionary policies

This study examines differences in suicide-related behaviors between heterosexual and sexual minority youth in a southeastern state with exclusionary policies. Furthermore, it seeks to further knowledge regarding risk factors for suicide attempts among sexual minority high school students. Utilizing the 2017 Youth Risk Behavior Survey data, descriptive analysis tests, and logistic regression tests were conducted. Findings indicate that sexual minorities were three times as likely to experience suicidal thoughts and plans but four times as likely to attempt suicide. Risk factors were noted for sexual minority youth. Policy advocacy is recommended to decrease suicide-related behaviors among this population.

Victimization, depression, and the suicide cascade in sexual minority youth

Background: Suicidality remains disproportionately prevalent among sexual minority youth, necessitating novel methods of understanding suicide risk in this population. Victimization and depression are especially salient suicide risk factors.Aims: We aimed to test if victimization and depression were associated with suicidality at each step of a suicide cascade: Ideation, planning, and suicide attempts.Method: In sample of sexual minorities from the 2015 and 2017 Youth Risk Behavior Survey, we tested nine measures of victimization and depression associated with three outcomes in succession: Suicidal ideation among the full sample (n = 3357), suicide planning among those with ideation (n = 1475), and suicide attempts among those who planned suicide (n = 1073).Results: Depression was associated with suicidal ideation (aPR = 3.93, 95% CI 3.36-4.60), planning (aPR = 1.38, 95% CI 1.12-1.69), and attempts (aPR = 1.78, 95% CI 1.32-2.41) in successive subsamples. Victimization measures had different associations with suicidality at each successive stage, with the strongest associations observed with suicidal ideation in the general sample and suicide attempts among those who planned suicide.Conclusions: This may have implications for anti-victimization intervention effectiveness at each stage of suicidality. Additional research into this association among transgender and gender non-conforming youth is recommended.

Sexual orientation differences in non-suicidal self-injury, suicidality, and psychosocial factors among an inpatient psychiatric sample of adolescents

Within broader community samples, sexual minority adolescents (SMA, e.g., lesbian, gay, bisexual, queer) are at greater risk than their heterosexual counterparts for nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors. The present study investigated whether sexual minority orientation continues to confer additional risk for these behaviors in an already higher-risk sample of youth. Frequency and function of NSSI, suicidal behavior, and psychosocial factors were assessed in a sample of 52 adolescents (aged 12-18 years) admitted to an inpatient psychiatric unit due to suicide risk; 27 of them identified as SMA, and 25 as heterosexual (HA). Greater proportions of SMA reported engaging in lifetime NSSI, compared to HA, with a greater variety and frequency of NSSI behaviors and greater endorsement of intrapersonal NSSI functions. SMA reported higher levels of suicide ideation than HA, but not suicidal behavior. Group differences in NSSI and SI persisted when controlling for the greater prevalence of abuse and levels of peer-victimization reported by SMA. In inpatient clinical settings, SMA may be more likely than heterosexual youth to engage in NSSI, including more severe forms, and to experience suicide ideation. Providing alternative coping mechanisms may serve as treatment goals for reducing NSSI in SMA.

Encountering sexual and gender minority youth in healthcare: an integrative review

AIM

To describe the encounters with sexual and gender minority (SGM) youth in healthcare based on the existing research.

BACKGROUND

The development of sexual orientation and gender identity can create challenges in an SGM youth's life, and they may need support from health professionals. Heteronormativity has been recognised as a barrier to the identification of diversity in sexuality and gender, and no previous literature review has studied heteronormativity thoroughly.

METHODS

An integrative review following Whittemore and Knafl was conducted. A literature search was systematically undertaken in six databases (PubMed/MEDLINE, CINAHL, Cochrane Library, PsycINFO, Eric, and Academic Search Premier). Finally, 18 research articles were included. Data were analysed deductively with the theoretical framework from Stevi Jackson's (2006) article to understand the role of heteronormativity in the healthcare of SGM youth.

FINDINGS

The encounters with SGM youth consisted of two simultaneous themes. Heteronormative care included three elements: (1) the effect of heteronormativity on health professionals' competence to work with SGM youth, (2) false assumptions about SGM youth, and (3) the influence of heteronormativity on encounters with SGM youth. Diversity-affirming care included two elements: (4) the considerateness of health professionals towards SGM youth and (5) inclusive care of SGM youth.

CONCLUSION

This review summarised how SGM youth were encountered in healthcare and how heteronormativity was affecting their healthcare. Furthermore, this review identified elements that supported diversity-affirming care. With diversity-affirming care, SGM youth may access the information and support they need from healthcare. Further research is needed about how diversity-affirming care can be applied to the healthcare of SGM youth and how elements of heteronormative care are occurring globally in the healthcare of SGM youth. The perceptions of transgender and other gender minority youth were under-represented in the studies and research needs to focus more on how they are encountered in healthcare.

Psychosocial Factors Associated With Suicide Attempts, Ideation, and Future Risk in Lesbian, Gay, and Bisexual Youth

BACKGROUND

Lesbian, gay, and bisexual (LGB) youth have elevated suicidality rates.

AIMS

To investigate LGB-related and other factors associated with suicide attempts, suicidal ideation, and future suicide risk in a large UK sample.

METHOD

Logistic regression was used to investigate factors associated with suicidality in 3,275 LGB young adults from the Youth Chances project.

RESULTS

Suicide attempts (lifetime) were reported by 13.6% of participants; 45.2 % had suicidal ideation in the past year and 9.5% said future suicide attempts were likely. LGB stigma and discrimination experiences were significantly associated with all three aspects of suicidality. These included school stigma factors (e.g., teachers not speaking out against prejudice, lessons being negative about sexual minorities), negative reactions to coming out from family and friends, and LGB-related harassment or crime experiences. Bisexuality, not feeling accepted where one lives, younger sexual minority identification, and younger coming out were also associated with suicidality. Significant non-LGB factors included female gender, lower social support, anxiety/depression help-seeking, experiences of abuse/violence, and sexual abuse.

LIMITATIONS

This study is cross-sectional and further research is needed to test out whether any of these factors have a causal relationship with suicidality.

CONCLUSION

A wide range of LGB stigma and discrimination experiences are associated with increased suicidality in LGB youth. Health, social care, and education professionals supporting young people should address LGB-specific risk factors.

Characteristics and Correlates of Lifetime Suicidal Thoughts and Attempts Among Young Black Men Who Have Sex With Men (MSM) and Transgender Women

This study examined characteristics and correlates of lifetime suicidal thoughts and suicide attempts among HIV-negative young Black men who have sex with men (MSM) and transgender women (transwomen) between 16 and 29 years of age ( N = 161). In our sample, 36.6% of young Black MSM and transwomen reported a history of lifetime suicidal thoughts, while 16.1% reported prior suicide attempts. Using multivariable analysis, a history of intimate partner violence, greater psychological distress, and higher perceived sexuality discrimination were significantly associated with lifetime suicidal thoughts. Childhood sexual abuse history, greater psychological distress, lower score for outness, and higher perceived sexuality discrimination were significantly related to suicide attempts among young Black MSM and transwomen. Efforts to identify and understand factors associated with lifetime suicidal thoughts and attempts are urgently needed to inform the development and implementation of culturally relevant mental health prevention strategies for young Black MSM and transwomen.

Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature

This systematic literature review addresses risk and protective factors associated with suicidal ideation and attempts in young men who have sex with men (YMSM). The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsychArticles, and PsychInfo yielded 14 articles. Risk factors included (1) not being enrolled in school, (2) earlier sexual debut, (3) substance use/abuse, (4) homelessness, (5) bullying and victimization, (6) fear of community violence, (7) and parental abuse. Protective factors included (1) positive sexual minority LGBT stereotypes, (2) family acceptance, (3) school and peer support, (4) high self-esteem, and (5) adaptive coping mechanisms.