Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents

The Interpersonal Theory of Suicide: State of the Science

In this state-of-the-science review, we summarize the key constructs and concepts within the interpersonal theory of suicide. The state of the scientific evidence regarding the theory is equivocal, and we explore the reasons for and some consequences of that equivocal state. Our particular philosophy of science includes criteria such as explanatory reach and pragmatic utility, among others, in addition to the important criterion of predictive validity. Across criteria, the interpersonal theory fares reasonably well, but it is also true that it struggles somewhat-as does every other theory of suicidality-with stringent versions of predictive validity. We explore in some depth the implications of the theory and its status regarding people who are minoritized. Some implications and future directions for research are also presented.

Preparedness of Practicing Nurses in the Care of Sexual and Gender Diverse People in the United States: A Scoping Review

BACKGROUND

Sexual and gender diverse (SGD) people in the United States (US) experience health inequities due to societal stigma and marginalisation. The nursing workforce must provide evidence-based affirming, inclusive and culturally responsive care for SGD people to meet individual and community health needs and eliminate disparities.

AIMS

The purpose of this scoping review was to synthesise what is known about (1) nurses' knowledge, skills and attitudes related to caring for SGD people in the US and (2) the existence, development and evaluation of SGD-related educational offerings available to practicing nurses in the US to develop the knowledge and skills needed to promote the health and wellbeing of SGD individuals, families and communities.

METHODS

This review followed the scoping review methodology and PRISMA for Scoping Reviews (PRISMA-ScR).

DATA SOURCES

In conjunction with a health librarian, an electronic literature search was conducted using PubMed, LGBT Health, CINAHL, ERIC and Health Source-Nursing.

RESULTS

Thirty-two studies were included in this review, including quantitative and qualitative studies that sought to understand the knowledge, attitudes and clinical experiences of nurses related to the care of SGD people; studies that tested educational interventions and studies that identified educational barriers and facilitators. Major gaps in education, practice and research, as well as methodological limitations of existing studies, were noted.

CONCLUSION

Nurses would benefit from expanded access to effective standardised foundational SGD-related health continuing education to help prepare them to care for diverse patient populations. Equity, inclusivity and dignity are key values of the nursing profession. It is imperative that nurses have the knowledge and skills to apply these values consistently in day-to-day professional practice across populations and settings.

IMPACT

There is an urgent need to develop standardised, easily accessible evidence-based educational content to address nurses' knowledge of and attitudes towards caring for SGD people.

REPORTING METHOD

This study adhered to the PRISMA-ScR reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to this study.

Racial/ethnic differences in the bullying victimization-suicidality link among LGBQ high school students in the United States

Although the relationship between bullying victimization and suicidal behaviors of lesbian, gay, bisexual, transgender, and questioning (i.e., unsure of their sexual orientation) students has been well documented in research, few studies have focused on how bullying victimization might be related to suicidal behaviors among youth with intersectional identities. This study examines associations between bullying victimization and suicidal behaviors across racial/ethnic groups in a sample of lesbian, gay, bisexual, and questioning (LGBQ) students. Data for this cross-sectional study were derived from the Center for Disease Control and Prevention's Youth Risk Behavior Survey combined data set (2003-2019), with a sample of 95,603 students who identified as LGBQ. Analyses included descriptive statistics and logistic regression. We found that homophobic bullying victimization was associated with higher odds of suicidal ideation and plans among the total sample and Black and Hispanic students. School-based bullying victimization was associated with higher odds of suicidal ideation, plans, and attempts among white and Hispanic students and higher suicidal ideation among multiracial-non-Hispanic students. Cyberbullying victimization was not associated with suicidal behavior among Asian students, but it was associated with all forms of suicidal behavior among youth of other racial/ethnic identities. Addressing bullying victimization and suicidality with culturally relevant, evidence-based violence prevention strategies is critical.

Suicidal Ideation and Behaviors Among LGBTQ+ Adolescents and Young Adults Who Have Experienced Sexual Violence: A Scoping Review of the Literature

INTRODUCTION

The relationship between sexual violence (SV) experiences and suicidal ideation (SI) is known. However, when applied to lesbian, gay, bisexual, transgender, queer, and more (LGBTQ+) populations, the impact that experiences with SV have on the severity and magnitude of SI continues to be explored. A scoping review of the literature was conducted to summarize the current literature related to SI experienced by LGBTQ+ adolescents and young adults (AYAs) who have experienced SV.

METHODS

Studies were found by searching electronic databases. To be included in the review, the study must have (a) been written in the English language, (b) been conducted in the United States, (c) presented empirical data, (d) been exclusively focused on LGBTQ+ AYAs, (e) focused on experiences with SV or have analyses separate from other types of violence, and (f) investigated suicidality as an outcome. All relevant studies published to date were included. Forty-one articles were retrieved for full-text review, of which five were determined to meet eligibility.

RESULTS

LGBTQ+ AYAs were significantly associated with increased rates of SI compared with their cisgender heterosexual peers. LGBTQ+ AYAs were also associated with higher rates of SV victimization, ranging from intimate partner violence to previous child sexual abuse. Higher rates of depression were also associated with the population studied in each included article.

CONCLUSION

The relationship between SV and SI in this population is not well studied, as highlighted through this completed review. Targeting this knowledge gap through future research can lead to intervention development for this population niche.

Dating Violence Victimization, Perpetration and Suicidality Among Adolescents

Few studies have focused on evaluating the relationship between dating violence (DV) and suicide during the critical period of adolescence, particularly for transgender and gender-diverse (TGD) youth. The study examined the relationship between experiencing DV victimization and perpetration in the past 6 months and suicidality (ideation and attempts) among male, female, and TGD adolescents. This study used data from a longitudinal randomized trial examining the effectiveness of myPlan, a healthy relationship and safety planning app intervention for adolescents, to a control website. Data for this study was collected virtually, in which participants completed surveys through online platforms. A convenience sample was recruited through youth organizations and posting on online platforms including social media. N = 610 adolescents age 15-17 years, who resided in the U.S. experienced DV in the past 6 months, had access to a safe device, and were able to access online surveys were included in this study. The majority were female (63.8%) with (19.5%) TGD and 16.7% male. Nearly 22% of the sample identified as Hispanic/Latino and 61.0% as white. Participants completed an online survey consisting of measures of socio demographics, DV victimization and perpetration via the Conflict of Adolescent Dating Relationships Inventory (CADRI), and suicidality. The primary outcome was the association between DV victimization and perpetration on suicidality. Different forms of DV were accounted for including emotional/relational, physical, and sexual DV. Logistic regressions determined differences in the rate of DV victimization and perpetration on suicidality between gender groups (cisgender female, cisgender male, and TGD). A stratified analysis was conducted to test if the relationship between DV and suicidality differed across gender identity. Approximately one-third (32.2%) of adolescents reported suicidality in the past 6 months. TGD adolescents were more likely to report suicidality compared to males (20.6%, p < .05) and females (32.7%, p > .05). The overall odds of suicidality increased as frequency of emotional/relational DV victimization (OR = 1.37, p < .001), physical DV victimization (OR = 1.59, p < .001) and sexual DV victimization (OR = 1.42, p < .001) increased. These relationships were not significant for DV perpetration. When stratifying findings by gender groups, all forms of DV victimization significantly increased the odds of suicidality for females as well as female perpetration of physical violence. For males, all forms of DV victimization and perpetration were associated with increased odds of suicidality, although not significant due to the smaller sample size. While DV victimization is associated with increased odds of suicidality for TGD, perpetration of DV is associated with decreased odds of suicidality, although not significant due to small sample size. The findings from this study provide further insight into experiences of DV and suicidality among gender diverse youth and can guide future interventions aimed at preventing DV and suicide among adolescents.

Protective and Risk Factors for Suicidal Ideation and Behavior Among Sexual Minority Women in the United States: A Cross-Sectional Study

Purpose: The purpose of this study was to understand the factors associated with suicidal ideation and behavior and serious suicidal ideation and behavior among sexual minority women (SMW), including resilience, discrimination, mental health, and sociodemographic characteristics. Methods: Web-based surveys were conducted with SMW from across the United States during January-February, 2022 using psychometric valid tools. Bivariate, hierarchical regression, and logistic regression analyses were used to analyze the data. Results: Of 497 participants, 70% were identified as bisexual and 30% as lesbian. The mean scores for anxiety, depression, and stress were significantly higher among bisexual women compared to their lesbian counterparts (p < 0.05). The proportion of serious suicidal ideation and behavior was higher among bisexual women compared to lesbian women (53.9% vs. 41.2%, p = 0.012). Conversely, the mean scores of resilience were lower among bisexual women compared to lesbian women (139.7 ± 33.4 vs. 147.5 ± 33.6, p = 0.024). Lesbian women had nearly 57.4% lower odds of having serious suicidal ideation and behavior as compared to bisexual women (adjusted odds ratio = 0.426; p = 0.023). Experiencing anxiety, depression, victimization distress, and family discrimination distress were positively associated with serious suicidal ideation and behavior, whereas personal resilience and family cohesion were negatively associated with serious suicidal ideation and behavior. Conclusions: Tackling structural inequities such as racism and homophobia remains vital to improving the mental health of SMW. Interventions to strengthen social and familial supports may be particularly impactful, especially at the family level.

Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 18-24 show highest rates of past month suicidal thoughts

INTRODUCTION

Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults.

METHODS

To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults.

RESULTS

Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-24) showed greater lifetime and past month suicidal thoughts and behaviors relative to adults ages 45+. Adults ages 18-24 also showed greater past month suicidal ideation than adults ages 25-44; however, there were no group differences in lifetime suicidal thoughts and behaviors and past month suicidal behavior between adults ages 18-24 and 25-44.

CONCLUSIONS

Although suicidal thoughts and behaviors are most common among young SGM adults, other age groups do still show concerning rates of suicidal thoughts and behaviors, suggesting that this risk might extend to later years of life. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.

Outlining Individual and Contextual Factors Related to LGBTQ+ Bullying: A Systematic Review of Two Decades of Research

Scientific interest in lesbian, gay, bisexual, transgender, queer and any other sexual orientation, gender identity and/or expression (LGBTQ+) bullying in educational settings has grown exponentially in recent years. However, the varied ways of measuring its occurrence and associated factors have made it difficult to achieve a holistic understanding of this problem. Therefore, this systematic review aimed to provide an updated overview of individual and contextual factors related to LGBTQ+ bullying over the past two decades, based on the measurement approach to this phenomenon. Studies published from 2000 to 2020 were analyzed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses strategy. Inclusion and exclusion criteria were applied in a staggered process, and 111 articles met all the criteria. Studies focusing on LGBTQ+ bullying victimization or aggression were eligible for inclusion. Our analysis revealed LGBTQ+ bullying is usually examined by measures of general aggressions (47.8%) from the victims' perspective (87.3%). The best-represented factors across studies were individual characteristics (63.1%; n = 70), especially participants' sexual orientation and gender identity and expression (68.5%). Boys/males, from a binary gender perspective, and sexual and gender minority youth in general, were more at risk of being targeted for LGBTQ+ bullying. Although contextual factors were far less well-represented, the results revealed that gay-straight alliances, anti-homophobia policies, and social support act as protective factors. This review highlights the need to analyze LGBTQ+ bullying considering the full spectrum of sexual and gender diversity, to examine in more detail its contextual risk/protective factors, and to design public policies and psychoeducational programs in order to address the low effectiveness of generic interventions. Implications for future research and practice are discussed.

Interpersonal violence and suicide risk: Examining buffering effects of school and community connectedness

Background

Exposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents.

Methods

Baseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts.

Results

Sexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection.

Conclusion

The buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.

Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts

INTRODUCTION

Sexual and gender minority (SGM) people are at increased risk for suicidal thoughts and behaviors relative to their cisgender heterosexual peers. However, most research in this area has focused on youth, limiting our understanding of suicide risk among SGM adults.

METHODS

To address this gap in the literature, the present study examined suicidal thoughts and behaviors among SGM adults across different age groups using a sample of 10,620 US adults.

RESULTS

Consistent with the literature on youth, SGM adults showed higher rates of suicidal thoughts and behaviors than cisgender heterosexual adults. When examining prevalence rates across various age groups, young adults (18-25) showed greater suicidal thoughts and behaviors relative to adults ages 45+. However, adults ages 25-44 actually showed the highest rate of past month suicidal thoughts compared to adults ages 18-25.

CONCLUSION

These findings suggest that suicide risk for SGM extends beyond youth and highlights the need for more research on middle-age SGM adults. Additional resources for SGM adults that are not only tailored toward youth and young adults are warranted.

Trends in Self-Injurious Thoughts and Behaviors Among US Adults, 2015-2019: Differential Risk According to Sexual Orientation

BACKGROUND

Suicide continues to be one of the leading causes of death in the United States and lesbian, gay, and bisexual (LGB) individuals are disproportionately at risk of suicide in comparison to heterosexuals.

METHODS

We examined data from adults participating for five waves (2015-2019) of the National Survey on Drug Use and Health. We first determined whether there is differential risk of suicidal thoughts, suicide plans, and suicide attempts (self-injurious thoughts and behaviors [SITBs]) in the past year according to current sexual orientation. We then estimated linear trends in prevalence of each SITB outcome stratified by each sexual orientation category.

RESULTS

We estimate that compared to heterosexual men and women, gay and bisexual men and lesbian and bisexual women are at greater odds of past-year suicidal thoughts, suicide plans, and suicide attempts, respective to their sexes. Between 2015 and 2019, suicidal thoughts increased among bisexual men (by 34.3%, p = 0.037), lesbian women (by 18.4%, p = 0.033), and bisexual women (by 15.7%, p < 0.001). Prevalence of suicide plans increased among heterosexual men (by 15.3%, p = 0.017), gay men (by 28.5%, p = 0.037), and bisexual women (by 23.2%, p < 0.001). Suicide attempts increased among bisexual women by 26.6% (p < 0.001).

CONCLUSIONS

Sexual minority identity is a risk factor for SITBs. Bisexual women in particular are not only at greater risk for SITBs, but estimated prevalence has increased in recent years. More attention needs to be paid to LGB populations regarding future suicide prevention efforts.

Experiences of sexual violence and their associations with suicidal ideation and behavior in the past year: an analysis of adults from the 2021 Ace Community Survey

BACKGROUND

This research assessed forms of sexual violence and their associations with suicidal ideation among adults identifying on the asexual identity spectrum.

METHODS

A secondary data analysis was conducted among adults, identifying on the asexual spectrum of asexual, gray-asexual, or demisexual, from the 2021 Ace Community Survey (n = 8,715). Multiple logistic regression analyses determined potential associations between sexual violence and suicidal ideation, adjusting for the covariates of age group, gender, education, racial/ethnic minority, employment, and asexual spectrum identity.

RESULTS

Demisexual individuals were at statistically greater odds of suicidality compared to gray-asexual and asexual individuals. Sexual violence victims were more likely to be suicidal compared to non-victims. This was especially true for attempted rape and suicidal consideration (OR = 2.10, 95% CI (1.60, 2.75), planning (OR = 1.76, 95% CI (1.32, 2.34), and attempts (OR = 3.15, 95% CI (2.07, 4.81).

CONCLUSIONS

Asexual victims of sexual violence were more likely to be suicidal compared to non-victims. Demisexual individuals were more likely to be suicidal compared to asexual individuals. These findings demonstrate the need for additional research on sexual violence and suicide.

Trends in Suicide Among Lesbian, Gay, and Bisexual Hispanic Individuals: National Violent Death Reporting System Data from 2012-2016

Due to multiple minority stressors, persons who are Hispanic and lesbian, gay or bisexual (LGB) can experience an increased risk of injury and death, including suicide. We examined trends and correlates of deaths by suicide among LGB Hispanic individuals using data from the National Violent Death Reporting System from 2012 to 2016 (N = 1,132). A multilevel mixed-effects logistic regression model examined time-series trends associated with suicide between LGB and heterosexual individuals, controlling for sociodemographic and clinical characteristics. Over time, increases in suicide were larger among LGB Hispanic individuals. Increased odds associated with suicide were also attributed to women, individuals with a higher education level, those who experienced mental health problems, those with alcohol-related problems, and individuals with a history of mental illness. LGB Hispanic individuals continue to see an increased risk for suicidality. Health intervention and policy efforts should focus on the multiple minority stressors experienced by this population.

Is Trauma Exposure More Harmful for Sexual Minority Youth? Differences in Trauma-Suicide Associations in a Nationally Representative Sample of U.S. Youth and Implications for Suicide Prevention

Purpose

Lesbian, gay, and bisexual (LGB) youth experience disproportionately high rates of suicidality and exposure to traumatic events, such as sexual violence and teen dating violence. Rates of suicidality and exposure to traumatic events also vary by sexual minority subgroup. The purpose of this study was to: (1) explore the impact of LGB identity on the relationship between violence exposure and suicide; and (2) to examine variations by sexual identity.

Method

A subsample of respondents who reported on their sexual identity in the Youth Risk Behavior Survey (n = 14,690) was used to examine if the associations between sexual and dating violence with suicide outcomes (suicidal ideation, planning, and suicide attempt) depended on the sexual identity of the respondent. Logistic regression models were fitted with an interaction effect to quantify heterogeneity of associations across identity strata.

Results

Overall interaction tests mostly indicated heterogeneity of associations between sexual violence and physical dating violence. Several contrast of strata associations suggested substantive probability differences between sexual minority respondents and their heterosexual peers.

Conclusion

While exposure to violence was broadly associated with increased probability of experiencing any type of suicidality, LGB and questioning youth were significantly more likely to experience suicidality compared to their heterosexual peers. Gay and lesbian youth demonstrated the strongest probability of experiencing suicidal thoughts and behaviors among survivors of sexual violence, while bisexual youth may be more at risk following dating violence. Implications for future research and suicide prevention are discussed.

The relationship between school bullying victimization and mental health among high school sexual minority students in China: A cross-sectional study

BACKGROUND

School bullying has become a matter of global concern for the general public. Sexual minority youth (SMY) may experience minority stress and victimization which are known to adversely affect mental health and happiness. However, a few scholars explored and linked sexual orientation with campus bullying, depression, and anxiety symptoms under the specific cultural background of China.

OBJECTIVE

This study was to examine the effect of traditional and cyber bullying victimization on depression and anxiety among Chinese sexual minority adolescents.

METHODS

This is a cross-sectional survey with a total of 3841 subjects among senior high school students in Hunan Province, China. Related information was collected through a series of self-reported questionnaires. The association between variables was examined via a set of logistic regressions.

RESULTS

Homosexuality (OR: 6.398; 95 % CI: 3.321 to 12.325), bisexuality (OR: 3.146; 95 % CI: 1.499 to 6.603) and uncertainty of sexual orientation (OR: 2.341; 95 % CI: 1.516 to 3.615) were significantly associated with a combination of traditional and cyber bullying victimization. Compared to the heterosexual group, the sexual minority students, especially the bisexual students has a higher risk of depressive mood (OR: 2.349; 95 % CI: 1.664 to 3.316) and anxiety mood (OR: 3.049; 95 % CI: 2.150 to 4.324). Further multivariate binary hierarchical regression showed that the effects of sexual orientation and mental health were statistically significant only among those who are not involved in bullying victimization, OR values are from 1.929 (95 % CI: 1.061 to 3.507) to 3.209 (95 % CI: 2.090 to 4.927).

CONCLUSIONS

Homosexuals are most likely to be victims of a combination of traditional and cyber bullying victims. Bisexuals are most at risk for emotional problems. Sexual minorities in particular, showed differences in mental health risks between bullied and non-bullied groups. More attention needs to be paid to bullying and mental health among sexual minority students in China.

Comparing the Effects of Victimization, School Connectedness, and Social Support on Heterosexual and Sexual Minority Adolescent Suicidality in the United States: A Partial Test of Minority Stress Theory

In the United States, sexual minority adolescents are among the subpopulations at the highest risk for suicide; yet, predictors of suicidality among this unique group remain significantly understudied. Drawing from Meyer's minority stress theory (MST), this study examines whether general stressors act as predictors of adolescent suicidality and whether differences exist in the variation of these effects between heterosexual and sexual minority adolescents. Specifically, multivariate logistic regression models were developed to examine the impact that victimization, school connectedness, and social support have on heterosexual and sexual minority adolescent suicidality using a sample of 166,176 U.S. adolescents drawn from the 2019 Minnesota Student Survey. Participants ranged from 10 to 18 years of age and identified as heterosexual, bisexual, gay or lesbian, questioning, pansexual, queer, or as none of these. Findings highlight that sexual minorities (Exp(B) = 1.870, p < .001) were roughly twice as likely to report suicidality compared to their heterosexual peers. All victimization measures were highly predictive of suicidality among heterosexual and sexual minority adolescents. Overall, adolescents who were less connected to their school setting and more socially isolated were also more likely to experience suicidality; however, such effects were not reflected uniformly in every item measuring school connectedness and social support. Findings highlight important avenues for policies implementation aimed at mitigating the effects of multiple sources of stressors on adolescents' mental health and reducing adolescents' suicide rates. Interventions tailored to the unique needs of sexual minority adolescents are needed to address their disproportionate representation among those at risk for suicide.

Gender-Affirming Care and Comprehensive Sexuality Education

ABSTRACT

Every year, an estimated 246 million children are subject to some form of gender-based violence, including mistreatment, bullying, psychological abuse, and sexual harassment. Lesbian, gay, bisexual, transgender, two-spirit, or questioning youth are at a heightened risk of experiencing violence and have unique health, educational, and social needs. Fostering an atmosphere of support and acceptance can help alleviate many of these negative outcomes.

Nursing pre-licensure and graduate education for LGBTQ health: A systematic review

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ) people experience discrimination and health disparities compared to heterosexual cisgender people. Clinicians report discomfort and insufficient preparation for providing care to LGBTQ people and nursing has been slow to integrate LGBTQ health into curricula.

PURPOSE

Conduct a systematic review to examine and critically appraise peer-reviewed literature on nursing student knowledge, skills, and attitudes (KSAs) regarding LGBTQ health and the development/evaluation of LGBTQ health content in nursing curricula.

METHODS

A systematic review was conducted (N = 1275 articles from PubMed, LGBT Health, CINAHL, ERIC, and Health Source-Nursing/Academic Edition).

FINDINGS

Twenty articles met inclusion criteria. Twelve studies described curricular interventions; however, there were few validated tools to evaluate content coverage or KSAs. Four themes emerged specific to LGBTQ health content inclusion.

DISCUSSION

While an emerging science of LGBTQ nursing education has been identified, more work is needed to build and evaluate a comprehensive curricular approach for full programmatic integration of LGBTQ health.

CONCLUSION

As nursing programs build LGBTQ content into nursing curricula, care must be taken to integrate this content fully with the depth of curricular content in population health, social determinants of health, social justice, intersectionality, cultural competence, and political advocacy.

TWEETABLE ABSTRACT

Greater integration of LGBTQ health content into nursing education should be a priority for nursing education.

Sexual minority youth's mental health and substance use: The roles of victimization, cybervictimization, and non-parental adult support

Victimization is a well-established driver of sexual minority youth's (SMY) mental health and substance use risk. The current study examined and extended this research by exploring how victimization, cybervictimization, and non-parental supportive adults contribute to SMY's vulnerability to poor mental health and substance use. Using data from the first representative sample of Texas youth that measures sexual identity, we analyzed sex-stratified models of the association between sexual identity, mental health, and substance use, and the confounding effects of victimization, cybervictimization, and non-parental adult support. Victimization was more common among SMY and accounted for a greater proportion of sexual identity disparities on mental health and substance use, especially for males. Sexual minority females were more likely to report cybervictimization than heterosexual youth, and cybervictimization was associated with mental health risk. SMY reported fewer available non-parental supportive adults, which was associated with more sadness, suicidality, and polysubstance use. Our study adds to extant evidence that victimization drives SMY's increased susceptibility to mental health and substance use risk. Schools should implement inclusive policies that prohibit bullying based on sexual minority identity and offer professional development opportunities for supporting SMY.

Adverse Childhood Experiences and Adult Tobacco Use Among Sexual and Gender Minority Populations: Examining the Role of Mental, Social, and Community Health

Purpose: We sought to evaluate the relationship between adverse childhood experiences (ACEs) and tobacco use, to assess the intersection of sexual orientation or gender identity (SOGI), and to explore risk and protective aspects of mental, social, and community health. Methods: This was a secondary analysis of the sexual and gender minorities (SGM) subsample (n = 1102) from a 2019 Community Health Needs Assessment. Nested binary logistic regression models were created to evaluate associations between ACEs and type of tobacco use: (1) cigarette use versus no cigarette or electronic nicotine delivery systems (ENDS) use, (2) ENDS use versus no cigarette or ENDS use, and (3) dual use versus use of either cigarettes or ENDS. Results: The sample population that reported four or more ACEs and ENDS use had statistically significant adjusted odds ratios (aORs) when adjusting the models for sociodemographic variables (aOR = 2.55; 95% confidence intervals [CIs]: 1.54-4.22), SOGI (aOR = 2.44; 95% CI: 1.46-4.10), current mental health (aOR = 2.23; 95% CI: 1.32-3.75), and social and community health (aOR = 2.19; 95% CI: 1.30-3.71). The sample population that reported poor mental health had statistically significant aORs when adjusting the models for sociodemographic variables, SOGI, and mental health (aOR = 2.26; 95% CI: 1.32-3.89) and social and community health (aOR = 2.06; 95% CI: 1.17-3.54). There was no statistically significant finding related to the other tobacco use variables (tobacco use and dual use). Conclusion: We found that high-risk ACEs were positively associated with cigarette use and ENDS use. SGM populations have differing experiences when considering community and social support.

Trends and Disparities in Suicidality Among Heterosexual and Sexual Minority/Two-Spirit Indigenous Adolescents in Canada

PURPOSE

To explore trends in sexual orientation group differences in suicidality among Indigenous adolescents and evaluate whether gaps between heterosexual and sexual minority/Two-Spirit adolescents have changed over time.

METHODS

Leveraging pooled school-based population data from five waves of the British Columbia Adolescent Health Survey (1998-2018), we used age-adjusted logistic regression models, separately for boys and girls, to examine 20-year trends and disparities in past year suicidal ideation and suicide attempts among heterosexual and sexual minority/Two-Spirit Indigenous adolescents (N = 13,788).

RESULTS

Suicidal ideation increased among all sexual orientation groups in 2018 compared to previous survey waves. Suicide attempts spiked for heterosexual girls in 2003, remained stable for heterosexual boys, and decreased for sexual minority/Two-Spirit boys and girls over time. Compared to their heterosexual peers, sexual minority/Two-Spirit boys had higher odds of suicidal ideation since 1998, whereas sexual minority/Two-Spirit girls had higher odds of suicidal ideation since 2003. Sexual minority/Two-Spirit (vs. heterosexual) boys were approximately 4-7 times more likely to attempt suicide since 2008, whereas sexual-minority/Two-Spirit (vs. heterosexual) girls were approximately 3-4 times more likely to attempt suicide since 2003. These gaps in suicidality were persistent across time.

DISCUSSION

Sexual minority/Two-Spirit Indigenous adolescents are at an elevated risk for suicidality compared to their heterosexual Indigenous peers. While trends of suicidal ideation worsened for all Indigenous adolescents, suicide attempts either lessened or remained stable over time. Greater efforts are needed to help reduce suicidality among Indigenous adolescents in Canada, especially among sexual minority/Two-Spirit young people.

Associations Between School Absence and School Violence by Sexual Identity

INTRODUCTION

Sexual minority youth are disproportionately exposed to school violence compared with their heterosexual peers. It is unknown whether the associations between school absence and exposure to school violence vary by sexual identity.

METHODS

In 2021, data were combined from the 2015, 2017, and 2019 national Youth Risk Behavior Surveys to produce nationally representative samples of U.S. high-school students who identified as gay/lesbian (n=1,061), identified as bisexual (n=3,210), were not sure of their sexual identity (n=1,696), or identified as heterosexual (n=35,819). Associations were examined between 3 school violence exposures (being threatened/injured with a weapon at school, being bullied at school, and being in a physical fight at school) and school absence due to safety concerns. In each sample, multivariable logistic regression models were used to calculate adjusted prevalence ratios adjusted for sex, race/ethnicity, grade, current substance use, being offered/sold drugs at school, feeling sad/hopeless, and suicidal thoughts. Adjusted prevalence ratios were considered statistically significant if 95% CIs did not include 1.0.

RESULTS

Exposure to school violence and school absence due to safety concerns were more prevalent among sexual minority students than among heterosexual students. Associations between exposure to school violence and school absence due to safety concerns were similar across sexual identity groups. For example, school absence was associated with being threatened/injured with a weapon at school among gay/lesbian (adjusted prevalence ratio=3.00), bisexual (adjusted prevalence ratio=3.66), those not sure (adjusted prevalence ratio=4.56), and heterosexual (adjusted prevalence ratio=3.75) students.

CONCLUSIONS

Associations between school absenteeism and school violence exist in each sexual identity group. Therefore, programs providing safe and supportive school environments may result in reduced absenteeism among all students.

Emotional changes following discrimination induction in gender- and sexuality-diverse adolescents

Sexual and gender minority (SGM)-identifying adolescents are particularly vulnerable to negative psychological outcomes, including engagement in nonsuicidal self-injury (NSSI). However, little is known about why these relationships exist. We used experimental methods to test the psychological mediation framework in an online sample of 328 adolescents who reported female sex at birth and a range of sexual and gender identities. Participants reported on depressive symptoms, self-criticism (both self-report and implicit), NSSI, and discrimination. They also completed a discrimination-based mood induction to test emotional reactivity. At baseline, SGM participants reported higher levels of implicit and self-reported self-criticism, depressive symptoms, discrimination, and higher rates of NSSI compared with cisgender, heterosexual participants (ps < .03). Following the discrimination induction, SGM-identifying participants exhibited larger emotional reactivity compared with cisgender heterosexual participants, as measured by change in negative mood, F(1, 326) = 7.33, p = .01, ηp2 = .02, and state self-criticism, F(1, 326) = 4.67, p = .03, ηp2 = .014, but not implicit affect toward the self. This effect was associated with baseline depressive symptoms, self-criticism, NSSI history, and discrimination. Post hoc analyses revealed that participants who tended to reframe experiences of discrimination as opportunities for growth exhibited attenuated emotional reactivity to the induction; findings remained significant after adjusting for SGM status and event severity (ps < .001). Results indicate that adolescents identifying as SGM may experience elevated psychological distress compared with their cisgender heterosexual peers and that stigma-related stressors may increase emotion dysregulation and maladaptive cognitive styles, paralleling previously proposed psychological mediation models. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Health Communication and Sexual Orientation, Gender Identity, and Expression

The purpose of this article is to provide guidance on completing a thorough, competent, and culturally appropriate health history with details specific to the care of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons and communities.

Dialectical behavior therapy for adolescents (DBT-A): Outcomes among sexual minorities at high risk for suicide

The alarming rates and pervasiveness of suicidal and self-destructive behaviors (e.g., non-suicidal self-injury) among young sexual minorities represent a major public health concern. We set out to examine whether an empirically driven treatment for suicide and self-harm, dialectical behavior therapy for adolescents (DBT-A), provides benefits for adolescents who identify as gay, lesbian, bisexual, or questioning (LGBQ). LGBQ adolescents (n = 16) were compared with non-LGBQ peers (n = 23). Psychological measures were collected before and after participation in a comprehensive DBT-A program. LGBQ participants demonstrated significant improvements in emotion regulation, depression, borderline symptoms, and coping strategies; changes were comparable to their heterosexual peers.

Self-harm and suicidality among LGBTIQ people: a systematic review and meta-analysis

Research evidence has consistently documented a higher risk of suicidality in the Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) population. This systematic review and meta-analysis aimed to report a detailed description of research data regarding the risk of Attempted Suicide (SA), Suicide Ideation (SI), and Non-Suicidal Self-Injury (NSSI) behaviours for LGBTIQ people and their subgroups. Medline, Scopus, PsycINFO, and EMBASE were searched for studies reporting a comparative estimation of SA, SI, and NSSI rates among LGBTIQ population and the general population (i.e. heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment. Pooled analyses were based on odds ratios (ORs, with 95% CIs), estimated through inverse variance models with random effects. Fifty studies were selected for the quantitative synthesis and included fifty samples involving 3.735.601 controls and 87.252 LGBTIQ people. LGBTIQ people reported an increased risk of SA (OR:4.36[95%CI:3.32;5.71]), SI (OR:3.76[95%CI:3.02;4.69]), and NSSI (OR:4.24[95%CI:3.23;5.55]). Among LGBTIQ subgroups, the Bisexual group has shown the highest risk of suicidality (SA, OR:6.71; SI, OR:5.04; NSSI, OR: 5.03), followed by the Lesbian-Gay for attempted suicide (SA, OR:6.03), and the Transgender-Intersex-Queer for suicide ideation and non-suicidal self-injury (SI and NSSI, OR:3.42). The quality of the evidence ranged from low to moderate. Our findings have shown that LGBTIQ people report a higher risk of suicidality compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQI mental health needs and suggest supportive strategies as well as preventive interventions (e.g. supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity and mortality in this at-risk population.

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.

The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors

The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.

Adolescent stress experiences over time study (ASETS) protocol: design and methods of a prospective longitudinal study of sexual minority adolescents in the USA

INTRODUCTION

Sexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet the mechanisms that drive these concerns remain poorly understood. Minority stress theory, the predominant model for understanding these disparities, posits that poorer outcomes are due to the stress of living in a violently homophobic and discriminatory culture. Although numerous studies report associations between minority stress and behavioural health in adolescence, no study has comprehensively examined how minority stress may change throughout the course of adolescence, nor how stress trajectories may predict health outcomes during this critical developmental period.

METHODS AND ANALYSIS

Between 15 May 2018 and 1 April 2019, we recruited a US national sample of diverse SMA (n=2558) age 14-17 through social media and respondent-driven sampling strategies. A subset of participants (n=1076) enrolled in the longitudinal component and will be followed each 6 months until 1 July 2022. Primary outcomes include symptoms of depression, anxiety and post-traumatic stress disorder; suicidality and self-harm and substance use. The key predictor is minority stress, operationalised as the Sexual Minority Adolescent Stress Inventory. We will use parallel cohort-sequential latent growth curve models to test study hypotheses within a developmental framework.

ETHICS AND DISSEMINATION

All participants provided assent to participate, and longitudinal participants provided informed consent at the first follow-up survey after reaching age 18. All study procedures were reviewed and approved by the University of Southern California Social-Behavioral Institutional Review Board, including a waiver of parental permission given the potential for harm due to unintentional 'outing' to a parent during the consent process. The final anonymous data set will be available on request, and research findings will be disseminated through academic channels and products tailored for the lay community.

Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents

Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.

Violence and sexual risk taking reported by young people at Swedish youth clinics

BACKGROUND

Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people's health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health.

METHODS

This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis.

RESULTS

Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81-4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70-4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32-3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence. Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men.

CONCLUSIONS

Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.

Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: a randomized controlled trial of Proud & Empowered

Background

Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns.

Methods

We report on an RCT of an intervention—Proud & Empowered—with four high schools. Measures assess the intervention’s impact on mental health symptoms.

Results

Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition.

Conclusions

Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies.

Trial Registration

The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial #NCT04041414.

Systematic review of risk and protective factors for suicidal and self-harm behaviors among children and adolescents involved with cyberbullying

Cyberbullying is associated with increased risk of suicidal and self-harm behaviors in children and adolescents. However, no review to date has explored factors that exacerbate and mitigate this relationship. This systematic review concerns research on factors that influence the impact of cyberbullying on suicidal and self-harm behaviors. Four bibliographic databases were explored and references in included articles were searched. We identified 727 articles and retained 66 that met inclusion criteria. Research has identified multiple risk factors which have been associated with increased suicide risk in general (mental health problems, substance abuse, loneliness, stress, sexual orientation/gender identity issues and violent behaviors). Others risk factors more specific to cyberbullying were: Autism Spectrum Disorder, Intellectual and Developmental Disorders, obesity, having asthma and severity of cyberbullying. Fewer studies concern protective factors. School connectedness, restrictive style of parenting, parental support, life satisfaction, having a healthy diet, personal skills and having family dinners were associated with less risk of suicidal and self-harm behaviors following cyberbullying. These protective factors suggest prevention strategies to reduce the impacts of cyberbullying by teaching better personal skills, promoting school social connections and proposing family interventions. More research is needed including exploration of the differential impacts of different forms of cyberbullying, and evaluations of the impacts of programs to increase personal skills, improve family relationships and foster school connectedness to reducing suicidal and self-harm behaviors in this vulnerable population.

Feasibility and Cost of Using Instagram to Recruit Adolescents to a Remote Intervention

PURPOSE

The purpose of this study was to describe the feasibility, cost-effectiveness, and generalizability of a strategy for recruiting adolescents into research studies through social media.

METHODS

We designed and tested six Instagram advertisements (ads) with a combination of Instagram campaign objectives (Traffic vs. Reach) and types of placement (Story vs. Feed). The goal was to obtain remote assent and screen for a larger remote behavioral intervention study. The eligibility criteria for screening were being aged 13-17 years, residing in the United States, and English-speaking. The eligibility for the larger study was past year cybervictimization and smartphone ownership. A target sample was 80 participants, randomly assigned to a control or intervention group and followed up for 16 weeks. Recruitment rates and cost-per-enrolled participant with different advertising strategies, demographics, and retention were examined using descriptive statistics.

RESULTS

The six ads were run over 907.5 hours, generating 1,069,747 impressions, 2,051 click-throughs, and 663 completed screening surveys. Of 493 eligible participants, 24.4% assented to participate, 69.4% completed enrollment, and 4.8% dropped/withdrew after randomization. Average advertising costs were $52/participant; the lowest-cost strategy (Traffic campaign + Feed ad placement) was $19/enrolled participant. The study sample was largely white (81.3%), non-Hispanic (87.5%), and female (77.5%) with an average age of 15.33 years. Nearly half of the participants were identified as lesbian, gay, or bisexual. More than 96% of participants were retained at the 16-week follow-up.

CONCLUSIONS

Instagram can be a feasible and cost-effective way to recruit adolescents for a remote study. This method may be ideal for recruiting hard-to-reach audiences.

A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial

BACKGROUND

Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth.

OBJECTIVE

This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying.

METHODS

From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant-led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models.

RESULTS

Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=-.66, SE 0.08, P=.04 at 8 weeks and β=-.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02).

CONCLUSIONS

This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216.

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey

Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents.

Experienced Homophobia and Suicide Among Young Gay, Bisexual, Transgender, and Queer Men in Singapore: Exploring the Mediating Role of Depression Severity, Self-Esteem, and Outness in the Pink Carpet Y Cohort Study

Purpose: No prior study has been published on suicide-related behaviors among gay, bisexual, transgender, and queer (GBTQ) men in Singapore, where sexual relations between men are criminalized. This study explores the association and mediational pathways between experienced homophobia and suicidal ideation or suicide attempts among young GBTQ men in Singapore.

Methods: Results of this study were derived from baseline data of the Pink Carpet Y Cohort Study, Singapore's first prospective cohort study among young GBTQ men. The sample comprised 570 young GBTQ men 18 to 25 years of age who were HIV negative or unsure of their HIV status. Statistical analyses were conducted through descriptive statistics, multivariable logistic regression, and structural equation modeling techniques.

Results: Of 570 participants, 58.9% (n = 308) reported ever contemplating suicide, whereas 14.2% (n = 76) had ever attempted suicide. Controlling for key demographic variables, multivariable logistic regression revealed that experienced homophobia and depression severity were positively associated with a history of suicidal ideation, whereas depression severity and outness were positively associated with a history of suicide attempts. Mediation analyses revealed that depression severity and self-esteem partially accounted for the relationship between experienced homophobia and suicidal ideation, whereas depression severity and outness partially accounted for the relationship with suicide attempts.

Conclusions: The prevalence of suicidal ideation and past suicide attempts was found to be high in a sample of young GBTQ men in Singapore. Interventions to address experienced homophobia and discrimination among young GBTQ men are needed urgently in Singapore.

Violence Experiences in Childhood and Adolescence Among Gay Men and Transgender Women Living in Perú: A Qualitative Exploration

The overall goal of this study was to qualitatively explore the different types of violence experienced by gay men (GM) and transgender women (TW) living in Peru during childhood and adolescence, as well as their potential consequences and sources of protection. Participants were selected using purposive sampling. Recruitment took place in a community-based organization in Lima, Peru. In all, 32 GM and 23 TW participated in a total of four Focus Group Discussions (FGD) and 25 in-depth interviews (IDI). Qualitative data collection was conducted between July and October 2016. Four FGD took place with GM (n = 21) and one with TW (n = 9). In addition, 11 IDI with GM and 14 with TW were conducted. Data were analyzed using descriptive inductive analysis. Three main types of violence were experienced in childhood and adolescence: (a) violence occurring in the home or otherwise perpetrated by family members, (b) school-based violence, and (c) sexual violence. Both GM and TW experience violence within and outside school and home. School systems should make teachers and parents aware of the impact of homophobic and transphobic bullying and violence. Certain modifications in schools, such as having all-gender bathrooms and promoting activities that are not grounded in gender roles, could be very effective at reducing homophobic and transphobic violence. Schools should also address sexual violence more actively, among both male and female students. Parents' attitudes toward homosexuality and gender diversity need to be addressed by future interventions.

Longitudinal Associations between Police Harassment and Experiences of Violence among Black Men Who Have Sex with Men in Six US Cities: the HPTN 061 Study

Interactions with the police may result in police brutality, particularly for people of color. Black men who have sex with men (BMSM) face disproportionate risk of police contact and may experience elevated violence risk. We measured longitudinal associations between discriminatory police harassment (DPH) and subsequent risk of a range of interpersonal violence experiences, including intimate partner violence (IPV). In this study, we estimated associations between DPH motivated by racism, homophobia, or both, and subsequent violent experiences (being physically harassed, hit, threatened with weapons, and intimate partner violence) among BMSM. Bivariate and multivariable regression analyses were used to control for demographic and behavioral factors. Among 1160 BMSM included at 12-month follow-up, experiencing DPH motivated by racism and homophobia was associated with over four times the odds of being threatened with violence (AOR 4.85, 95% CI 3.20, 7.33), four times the odds of or experiencing violence defined as being punched, kicked, or beaten, or having an object thrown at them (AOR 4.51, 95% CI 2.82, 7.19), and nearly three times the odds of physical partner abuse (AOR 3.49, 95% CI 1.69, 7.19). Findings suggest that for BMSM, DPH is associated with the threat and experience of violence, with a dose-response relationship between DPH motivated by one or more causes. Given that BMSM are a population particularly vulnerable to both police harassment related to race and sexual orientation and violence coupled with stigma, additional research evaluating mechanisms linking these associations is needed in order to develop additional supportive interventions.

Prevalence and Risk Factors for Nonsuicidal Self-Injury in Transgender and Gender-Expansive Youth at a Rural Gender Wellness Clinic

Purpose: Transgender and gender-expansive (TGE) populations are at increased risk for nonsuicidal self-injury (NSSI). Rural TGE populations are understudied and underserved in terms of mental health services. The purpose of this study was to determine lifetime prevalence of NSSI among TGE youth at a rural gender wellness clinic and identify demographic and clinical characteristics associated with NSSI. Methods: The Gender Wellness Center Pediatric Patient Registry, a comprehensive database of 185 TGE youth ≤25 years of age, provided an estimate of the lifetime prevalence of NSSI. Univariate logistic regression models were utilized to test associations between patient demographic and clinical characteristics and NSSI. Variables that met the threshold for significance in the univariate analyses (p<0.05) were entered into a multivariate logistic regression model. All statistical analyses were conducted in SAS v.9.4. Results: Prevalence of NSSI in the sample was 36.8% (n=68). In unadjusted logistic regression models, risk factors for NSSI included female assigned sex at birth, transmasculine spectrum gender identity, history of mood disorder, history of suicidal ideation (SI) or attempt, and history of abuse (p<0.05). In the adjusted model, variables significantly associated with NSSI included female assigned sex at birth, history of mood disorder, and history of SI or attempt. Conclusion: NSSI was highly prevalent in this sample of rural TGE youth, confirming the need for screening and early interventions that target the unique vulnerabilities of TGE youth. The complex interplay of sex assigned at birth, mood disorders, and NSSI requires further research.

Differences in Adolescent Experiences of Polyvictimization and Suicide Risk by Sexual Minority Status

Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co-occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N = 13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2 + types of victimization; n = 1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA.

Association between sexual abuse victimization during the life course and suicidal behaviors in male and female college students in China: Timing, duration, types and patterns

BACKGROUND

A certain link between sexual abuse (SA) victimization and suicidal behaviors has been confirmed, but it remains unclear whether this association varies with regard to SA characteristics and gender.

METHODS

Participants were 4034 college students drawn from a cross-sectional study conducted in Hefei, China. Gender-stratified latent class analysis (LCA) and logistic regression models were used to examine the relationships between timing, duration, types and patterns of SA victimization and suicidal behaviors.

RESULTS

For the males, SA in the elementary school or earlier period was associated with suicidal ideation (OR: 3.29, 95%CI: 2.20-5.38), plans (OR: 3.44, 95% CI: 1.54-7.77) and preparations (OR:3.05, 95% CI: 1.19-7.74). All types of SA were significantly associated with the four types of suicidal behaviors. Dose-response relationship and cumulative effect were found between duration, types of SA victimization and suicidal behaviors. Three latent classes of SA victimization were identified for males and females, respectively. For males, the "moderate SA" class and "persistent SA" class were associated with the four types of suicidal behaviors. For the females, SA during the university period was associated with suicidal ideation (OR: 2.47, 95% CI: 1.24-4.93). Only suicidal ideation was associated with the "moderate SA" class.

LIMITATIONS

The cross-sectional survey design did not allow to conclude any causality.

CONCLUSIONS

The relationship between SA victimization and suicidal behaviors varies in terms of SA victimization characteristics and the relationships were stronger in males than in females.

Suicidal ideation in gender and sexual minority students in the largest Brazilian University

OBJECTIVE

Identifying the presence of suicidal ideation and associated factors among university students from a public university in Brazil.

METHODS

A cross-sectional study was performed with 72 university students between 18 and 29 years old. Were used a sociodemographic data questionnaire and the Beck's Suicidal Ideation Scale.

RESULTS

The suicidal ideation was significantly in the participants, as well as the association of gender, gender identity, sexual orientation and housing with it.

CONCLUSIONS

The suicidal ideation in this population is important, and there is a need to explore the factors related, such as gender, sexual orientation, gender identity and housing.

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.

"It's Not Okay for You to Call Me That": How Sexual and Gender Minority Youth Cope with Bullying Victimization

Sexual and gender minority youth (SGMY) have higher rates of bullying than their heterosexual peers and must disproportionately cope with bullying victimization. The purpose of this research is to highlight various coping strategies employed by SGMY. We conducted 20 cross-sectional, semi-structured online interviews with SGMY about their bullying experiences and coping strategies. We coded interviews with descriptive qualitative research to illustrate a comprehensive summary of bullying-related coping methods. We found SGMY engage in multiple coping strategies that include (1) emotion-focused coping-rumination; self-harm and considering or attempting suicide; seeking social and emotional support; engaging in creative endeavors; self-acceptance and community connectedness-and (2) problem-focused coping-reporting the bully; confronting the bully; conceal orientation; ignoring the bullying; and changing environment. Additionally, most SGMY reported using multiple coping techniques or changing how they coped over time (i.e., coping flexibility). These findings can inform future interventions to promote positive coping mechanisms among SGMY.

Suicide assessment and treatment in pediatric primary care settings

TOPIC

This article will briefly review screening for depression and suicidal ideation in primary care and school-based clinics, with a focus on in-depth screening for imminent suicide risk, developing a safety plan, and incorporating handoffs to urgent and emergency mental health care personnel. The article will cover current definitions of levels of suicidal risk and clinic-based protocols for a team approach to adolescents in crisis.

PURPOSE

To provide primary care and behavioral health nurses with evidence-based suicide risk screening and assessment tools and best practices for using them in patient-centered encounters with adolescents with suicidal thinking or behavior.

SOURCES USED

Journal articles, books, and reports.

CONCLUSION

Past studies have shown that many individuals who died by suicide had seen a primary care provider in 30 days before their deaths. Nurses in primary care settings should develop clinic-based protocols for screening all adolescents for suicide risk, developing safety plans, and providing suicidal youth and families with monitoring, appropriate referrals, follow-up, and support.

Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women

Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.