Suicidality among gay, lesbian and bisexual youth: the role of protective factors

Asian Rainbow Youth in New Zealand: Protective Factors

PURPOSE

To explore the impacts of double minority status (ethnic and sexual/gender minority) and protective factors associated with the emotional wellbeing and mental health of Asian Rainbow (sexual/gender minority) youth in New Zealand.

METHODS

The data were extracted from the Youth19 Rangatahi survey, which surveyed 7,374 students from 45 mainstream secondary schools. The comparison groups were Asian non-Rainbow youth and Pākehā (New Zealand European) Rainbow youth. A secondary analysis was performed examining the associations between postulated protective factors and the emotional wellbeing and mental health outcomes of Asian Rainbow youth.

RESULTS

Asian Rainbow youth had higher odds of depressive symptoms, anxiety, and suicidal thoughts and attempts and lower odds of good emotional wellbeing compared to Asian non-Rainbow youth. However, Asian Rainbow youth had lower odds of anxiety compared to Pākehā Rainbow youth. Among Asian Rainbow youth, family acceptance and feeling safe at school were associated with higher odds of good emotional wellbeing, and lower odds of depressive symptoms, anxiety, and suicidal thoughts. Several other protective factors were also associated with 1 or more (but not all) of the emotional wellbeing and mental health indicators.

DISCUSSION

This study suggests that family acceptance and feeling safe at school may serve as important buffers mitigating risks of adverse emotional wellbeing experienced by Asian Rainbow youth.

Intergenerational Solidarity During Emerging Adulthood: Associations with Psychological Distress and Satisfaction with Life in Southern Europe

Background

Intergenerational solidarity between parents and emerging adult offspring requires more substantial attention at the present time. Changing demographic structures and transformations in family dynamics over recent decades have increased both opportunities and the need for parent-child interactions and exchanges of support and affection during emerging adulthood.

Purpose

The study had two aims: first, to explore patterns in intergenerational solidarity in accordance with different sociodemographic characteristics of emerging adults; and second, to analyse associations between intergenerational solidarity and emerging adults' psychological distress and satisfaction with life.

Methods

Participants were 644 emerging adult university students from Southern Europe (Spain and Portugal), aged between 18 and 29 years, who completed a self-report questionnaire designed to assess variables linked to sociodemographic aspects (gender, country of residence, sexual orientation, living status, family income), intergenerational solidarity, psychological distress and satisfaction with life.

Results

The results indicated some differences in intergenerational solidarity patterns in accordance with a range of sociodemographic characteristics. They also revealed significant associations between intergenerational solidarity dimensions and emerging adults' satisfaction with life and psychological distress. Moreover, affective solidarity was found to fully mediate the relationship between associational, functional and normative solidarity and emerging adults' adjustment. In the case of conflictual solidarity, affective solidarity was found to partially mediate the relationship between this dimension of intergenerational solidarity and emerging adults' distress and to fully mediate the relationship between this same dimension and emerging adults' satisfaction with life.

Conclusion

The results indicate that it is important to take sociodemographic diversity into account when exploring relationships between emerging adults and their parents. They also suggest that affective solidarity acts as a protective factor in promoting emerging adults' adjustment.

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Protective Associations between Supportive Environment and Suicidality among Minority and Majority Adolescents

OBJECTIVE

To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups.

METHODS

Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored.

RESULTS

All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34-3.51, p-values < 0.0005; high school ORs: 1.19-3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42-3.72, p-values < 0.006; high school ORs: 1.38-3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups.

CONCLUSIONS

These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups.

Interpersonal protective factors for LGBTQ+ youth at multiple intersecting social identities and positions

Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.

The onset of mental health disparities in sexual minority and majority youth: evidence from the UK Millennium Cohort Study

Decades of research shows that sexual minority youth (SMY) display heightened risk for mental health problems, although the onset of such disparities remains unclear. The Millennium Cohort Study is the largest nationally representative longitudinal study of adolescents in the United Kingdom. In this study, participants (N = 10,047, 50% female) self-reported their sexual identity at age 17 and had parent-reported mental health data, from the Strengths and Difficulties Questionnaire, reported across five waves at ages 5, 7, 11, 14, and 17. Multilevel linear spline models, stratified by sex, were used to examine mental health trajectories between sexual identity groups (completely heterosexual, mostly heterosexual, SMY). SMY showed heightened peer problems from the baseline assessment at age five, increasing over time, and heightened emotional problems from age 11, increasing over time. Mostly heterosexual youth showed heightened emotional problems at age 11 in males, and at age 17 in females. Findings are discussed in light of the literature on minority stress and gender conformity in youth. The use of parent-reported mental health data means that estimates are likely to be conservative. We conclude that interventions supporting SMY should start early and be available throughout adolescence.

Emotional arousal and reflective functioning among parents participating in attachment-based family therapy for LGBTQ+ young adults and their nonaccepting parents

OBJECTIVE

Parents' rejection of their LGBTQ + young adults can have a negative impact on their young adult's psychological welfare, and on the young adult-parent relationship. Parents' ability to reflect on their child's pain and unmet needs is thought to evoke empathy and compassion, and reduce rejection. Empirical and clinical evidence suggest that parents' level of reflective functioning (RF) is impacted by their level of emotional arousal (EA). This study examined the association between parents' EA and RF within the context of attachment-based family therapy for nonaccepting parents and their LGBTQ+ young adults.

METHODS

43 therapy sessions drawn from six different cases were coded for parental RF and EA, based on 30-second segments. This generated a total of 343 observations for analyses.

RESULTS

Hierarchal linear modeling revealed that parents' level of RF was a function of their concomitant EA, with moderate levels of arousal predicting the highest RF levels.

CONCLUSION

Moderate EA may facilitate optimal parental reflective functioning. With nonaccepting parents, who typically present for treatment with high levels of maladaptive fear and shame, therapists would do well to assess their level of arousal and, when indicated, employ downregulating interventions before inviting them to reflect on their young adult's experience and needs.

Family connectedness and sexual minority Asian Americans' eating behavior regulation

To date, psychosocial and interpersonal protective factors such as family connectedness have received little attention in studies of eating behaviors among sexual minority Asian Americans. Therefore, we investigated associations of family connectedness and two types of eating behavior regulation motives and the moderating role of individualism in these associations among 134 sexual minority Asian American young adults. Linear regression models assessed the main and interaction effects of family connectedness and individualism on introjected and identified eating behavior regulation motives. We observed a significant interaction effect between family connectedness and individualism only on introjected regulation. For participants with low levels of individualism, those who reported high levels of family connectedness had lower scores for introjected regulation of eating behavior. The findings of this study highlight the importance of examining strengths related to sexual minority Asian Americans by demonstrating the important role family connectedness plays in eating behavior regulation motives, particularly for those with lower individualism.

Protective factors of suicidal behaviors in children and adolescents/young adults: A literature review

BACKGROUND

Suicidal behaviors present a public health challenge in children and adolescents. Although the risk factors have long been well documented, protective factors have only been documented for a few years, and there has not been a literature review concerning the suicidal behaviors of children and adolescents since 2006.

METHODS

Relevant articles were collected using the Medline/PubMed, Web of Science, and ScienceDirect databases. Studies meeting the following inclusion criteria were included: age of participants from 6 to 19 years, qualitative and quantitative cohort or case-control studies, multivariate analysis studies, and studies with significant results for at least one protective factor. The methodology used in this review is based on the PRISMA criteria.

RESULTS

A total of 26 studies were included in this review, which highlights various individual and environmental protective factors. The results were too heterogeneous to perform a meta-analysis, and therefore the discussion is in the form of a narrative summary. High-quality relationships with family and in the school environment were the most frequently found protective factors. The presence of positive links with peers, with other adults, and with the culture of origin was also noted. On an individual level, self-esteem, emotional intelligence, and particular coping abilities were found to be the most important protective factors.

CONCLUSION

There are numerous important protective factors for suicidal behaviors in children and adolescents and also for adapting care to their needs. A future challenge will be to determine the best protective factors to be consolidated or strengthened using self-assessment tools that are already in use or being developed.

Gender identity and expression in relation to depression and anxiety in racial and ethnic minority youth: Evaluations of intersectionality in a population-based study

INTRODUCTION

Transgender and gender non-conforming (TGNC) youth experience higher rates of depression and anxiety. Risk for these outcomes in racial and ethnic minority populations remains unclear. This study aimed to examine disparities in depression and anxiety at the intersection of race and ethnicity and TGNC status in a population-based sample.

METHODS

Data were from the 2019 Minnesota Student Survey. Students (n = 119,648) completed questions about their race, ethnicity, gender identity and expression, depression, and anxiety.

RESULTS

Within racial and ethnic groups, TGNC youth generally had greater risk for depression and anxiety. Significant associations for gender minority identity ranged from ORDepression = 2.25 for Black youth who do not identify as male to ORDepression = 5.08 for non-minority ethnicity youth who do not identify as female. For perceived gender expression in cisgender youth, significant associations ranged from ORDepression = 1.17 for Black youth assigned female at birth and ORAnxiety = 1.17 for other-minority ethnicity youth assigned female at birth to ORDepression = 1.46 for non-minority ethnicity youth assigned female at birth and ORAnxiety = 1.46 for American Indian/Alaskan Native youth assigned male at birth. Within-TGNC-youth comparisons yielded a few racial/ethnic differences relative to White peers. Significant differences ranged from ORAnxiety = 0.53 to ORAnxiety = 1.41 for cisgender females.

LIMITATIONS

The cross-sectional data limits our ability to test causation.

CONCLUSIONS

Multiple-minority youth were not universally at increased risk for depression and anxiety, indicating an intersectional framework is important for understanding risk for these outcomes in TGNC youth. Future research identifying potential risk and protective factors is needed to advance screening and treatment strategies for multiple-minority TGNC youth populations.

Traumatic Stress and Resilience Among Transgender and Gender Diverse Youth

Traumatic stress increases the risk for mental health conditions and adversely impacts health, academic performance, and coping. Transgender and gender diverse (TGD) youth experience higher rates of abuse and maltreatment and interpersonal and community-embedded discrimination than their cisgender peers. Neurobiologic stress responses and social stress theory provide useful frameworks for understanding the effects of discrimination, stigma, and rejection. Despite facing higher rates of interpersonal trauma, TGD youth are quite resilient when able to access supports and affirming trauma-informed services. Clinicians play an important role in identifying and addressing traumatic stress impacting TGD youth and bolstering resilience.

Gender Literacy Across Childhood and Adolescence

Gender--once an afterthought despite its significant yet unspoken role in the average American's daily life (public restrooms, clothes shopping, grooming, sports teams)--has become a fraught sociopolitical issue. The concept of gender as a construct, once relegated to the realm of Women's and Gender Studies courses, went mainstream while concurrently, gender reveal parties have experienced a surge in popularity. Meanwhile, youth (and adults) have become increasingly comfortable exploring their gender identities and expression, which has led to an increase in inquiries regarding gender-affirming care--along with an accompanying backlash resulting in an increasing number of states attempting to enact restrictions and bans, effectively turning healthcare for transgender youth into the latest political battlefield. This section will define and provide an overview of common gender- and sexual orientation-related terminology and basic topics in order to establish an understanding for the remainder of the articles in this edition.

Young People's Mental Health Changes, Risk, and Resilience During the COVID-19 Pandemic

Importance

As young people's mental health difficulties increase, understanding risk and resilience factors under challenging circumstances becomes critical.

Objective

To explore the outcomes of the COVID-19 pandemic on secondary school students' mental health difficulties, as well as the associations with individual, family, friendship, and school characteristics.

Design, Setting, and Participants

For this cohort study, follow-up data from the My Resilience in Adolescence (MYRIAD) cluster randomized clinical trial were collected across 2 representative UK cohorts. Mainstream UK secondary schools with a strategy and structure to deliver social-emotional learning, with an appointed head teacher, and that were not rated "inadequate" in their latest official inspection were recruited. A total of 5663 schools were approached, 532 showed interest, and 84 consented. Cohort 1 included 12 schools and 864 students, and cohort 2 included 72 schools and 6386 students. COVID-19 was declared a pandemic after cohort 1 had completed all assessments (September 2018 to January 2020), but cohort 2 had not (September 2019 to June 2021).

Exposures

Cohort 2 was exposed to the COVID-19 pandemic, including 3 national lockdowns. Associations of individual, family, friendship, and school characteristics with students' mental health were explored.

Main Outcomes and Measures

Changes in students' risk for depression (Center for Epidemiological Studies-Depression scale); social, emotional, and behavioral difficulties (Strengths and Difficulties Questionnaire); and mental well-being (Warwick-Edinburgh Mental Well-Being Scale).

Results

Of the 7250 participants included, the mean (SD) age was 13.7 (0.6) years, 3947 (55.4%) identified as female, and 5378 (73.1%) self-reported their race as White. Twelve schools and 769 of the 864 students (89.0%) in cohort 1 and 54 schools and 2958 of the 6386 students (46.3%) in cohort 2 provided data and were analyzed. Mental health difficulties increased in both cohorts but to a greater extent among students exposed to the pandemic, including for risk of depression (adjusted mean difference [AMD], 1.91; 95% CI, 1.07-2.76); social, emotional, and behavioral difficulties (AMD, 0.76; 95% CI, 0.33-1.18); and mental well-being (AMD, -2.08; 95% CI, -2.80 to -1.36). Positive school climate, high home connectedness, and having a friend during lockdown were protective factors during the pandemic. Female gender and initial low risk for mental health difficulties were associated with greater mental health deteriorations. Partial school attendance during lockdown was associated with better adjustment than no attendance when returning to school.

Conclusions and Relevance

This cohort study of secondary school students demonstrated that to promote mental health and adjustment, policy interventions should foster home connectedness, peer friendship, and school climate; avoid full school closures; and consider individual differences.

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.

Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience

BACKGROUND

Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors.

METHODS

In a national cross-sectional survey, 3713 LGBT adolescents, aged 11-19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts.

RESULTS

A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome.

CONCLUSIONS

Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes.

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.

Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs

Sexual and gender minority individuals (e.g., gay, bisexual, non-binary, transgender; SGMI) are 2-6 times as likely as cisgender heterosexual individuals to experience alcohol or other substance use disorders. SGMI participate in 12-Step groups, such as Alcoholics Anonymous (AA), at high rates. Though social support is an established mechanism through which 12-Step programs support reductions in substance use, little is known about SGMI's experiences of the social support in 12-Step programs. This qualitative study aims to understand the experiences of social and community support among SGMI involved in 12-Step programs. This study employed thematic analysis to interpret open-ended responses from 302 SGMI who had participated in 12-Step programs. Data was from The PRIDE Study, a large, national, online. longitudinal, cohort study of SGMI. Two themes emerged about how SGMI experienced social and community support in 12-Step programs: beneficial connections and harmful environments. Beneficial connections included a sense of community, shared experiences, and skills provision. Harmful environments included marginalization, oppression, violence, and bullying. This study highlights the variability of experiences of SGMI participating in 12-Step programs. These findings suggest that many SGMI may benefit from 12-Step programs but may need support in coping with potential harms that can emerge through participation.

Differentiating protective factors for transgender individuals who experience suicidality: The role of optimism as a mediator

As a result of experiencing oppression-based stressors and trauma, suicide rates for lesbian, gay, bisexual and transgender (LGBTQ+) individuals are much higher than in the general population, and for trans and gender non-binary (TGNB) individuals specifically, rates of suicidality are even higher. To best understand how to engage in suicide prevention and intervention efforts for TGNB individuals, it is therefore crucial to understand factors that may mitigate suicidality for TGNB individuals. The purpose of this study was to examine the relationship between protective factors-body acceptance, optimism, social support and pride-and suicidality for TGNB adults. A total of 139 TGNB participants completed an online survey about suicidal behaviours, transgender-specific risk factors and transgender-specific protective factors. High rates of suicidality were observed in our sample. Initial results suggested that only optimism was inversely significantly related to suicidality. Given that optimism, which suggests a belief in a better future, has been found in previous studies to buffer the effects of deleterious stressors, optimism was also examined as a mediator between body acceptance (a key feature of gender dysphoria) and suicidality. Results suggested that optimism did mediate the relationship between body acceptance and suicidality. Optimism appears to be an important protective factor against suicidality for TGNB individuals and thus a potentially important target of intervention.

An exploration of at-risk youths' resilience within the context of a correctional centre in Eswatini

Literature highlights that youth in correctional centres face multiple risk factors which can be buffered by resilience. This study aimed to explore and describe the experiences of at-risk youth in a juvenile correctional centre in Eswatini regarding their resilience. The participants were purposively sampled and engaged in individual (n = 41) and group (n = 25) data collection. Following thematic analysis, the findings revealed four main themes: Understanding of resilience, protective factors to resilience, risk factors to resilience and youth's recommendations for resilience. This study provides insight into resilience of youth from youth's perspective that may be useful in rehabilitation or programme development.

Adolescent connectedness: cornerstone for health and wellbeing

Approaches to youth development that enhance connectedness and opportunities for young people are key to adolescent health and wellbeing argue Robert Blum and colleagues

An exploration and description of experiences of at-risk youth in a correctional center in Eswatini regarding a resilience intervention program

Resilience-focused programs advocate nurturing positive adoptive traits to inform prevention and intervention efforts. Considering that no resilience intervention programs have been developed specifically for at-risk youth in correctional centers in Eswatini, the authors developed a program with this focus through a combination of literature review and earlier empirical research with correctional officers and youth in a correctional center in Eswatini. This study aimed to evaluate the program through exploration and description of experiences of at-risk youth in a correctional center in Eswatini regarding the program. A purposive sample of 16 youths in a correctional center in Eswatini participated in a World Café, and data were analyzed thematically. Three themes were identified: Positive outcomes of participation, challenges encountered in the program, and recommendations for the program.

Adverse Childhood Experiences, Suicidal/Self-Harming Thoughts, and Suicide Attempts Among LGB and Heterosexual Utahns

Current research suggests that sexual minorities living in Utah may be at higher risk for experiencing suicidal/self-harming thoughts and suicide attempts than heterosexuals in Utah. However, to date no research has been conducted examining potential reasons sexual minorities living in Utah may be at higher risk. Using two representative samples of Utahns, we examine (a) disparities in adverse childhood experiences (ACEs) between sexual minorities and heterosexual Utahn, (b) how ACEs and sexual orientation may predict recent suicidal/self-harming thoughts and lifetime prevalence of suicide attempts, and (c) how sexual orientation and ACEs might interact to predict suicidal outcomes. Results with each sample showed that sexual minority Utahns reported higher levels of ACEs and suicidal/self-harming thoughts than heterosexual Utahns. Both sexual orientation and ACEs uniquely predicted suicidality when both were entered into regression models, but no interaction effects were found between these predictors.

Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

The Mediating Role of Family Acceptance and Conflict on Suicidality among Sexual and Gender Minority Youth

INTRODUCTION

Prior research suggests sexual and gender minority (SGM) youth are profoundly impacted by levels of parental support. This study assessed mediating effects of generalized family acceptance and conflict on lifetime suicidal behaviors among a large diverse sample comprising both SGM and non-SGM youth in early adolescence, when intervention to optimize family dynamics may be critical.

MATERIALS

Using data from the first-year follow-up of the Adolescent Brain Cognitive Development Study based in the United States, mediation was tested using a binary logistic regression model fitted with a generalized structural equation. Models included SGM status as the independent variable, family acceptance or family conflict sum score as the mediator, and the presence of lifetime suicidal behaviors as the dependent variable. Models adjusted for age, birth-assigned sex (as reported by the parent/guardian), and race/ethnicity.

RESULTS

Of 11,235 youths, lifetime suicidal behaviors were reported by 1.5% (n = 164). Youths with SGM identities reported 40% less parental acceptance and 47% greater family conflict, compared to non-SGM peers. Both parental acceptance and family conflict partially mediated associations between SGM identification and odds of lifetime suicidal behavior (ps = .001).

CONCLUSIONS

Identification of modifiable risk factors for suicidality in this vulnerable population, including parental acceptance and family conflict, is critical to improving health outcomes. Clinicians should work with SGM youth and their families starting in childhood to optimize family dynamics and bolster acceptance to potentially reduce adverse health outcomes. HIGHLIGHTSYouths with SGM identity reported 40% less parental acceptance than non-SGM peers.Parental acceptance was associated with lower odds of lifetime suicidal behaviors.Family factors partially mediated associations between SGM status and suicidal behaviors.

Family processes: Risk, protective and treatment factors for youth at risk for suicide

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components have been incorporated into most youth suicide treatments. Unfortunately research on if these family processes moderator, mediator or change as a result of treatment is limited. Recommendations for future research are offered.

"Our feelings are valid" - reviewing the lesbian, gay, and bisexual affirmative approaches in a mental health setting

In recent years, although research into support mechanisms for managing distress experienced by Lesbian Gay and Bisexual (LGB) communities has increased. Stigma-related discrimination related to sexual minority status remains. This is further compounded by stigma against mental illnesses thus creating double jeopardy. This review will outline recent discoveries by exploring existing theories highlighting factors that explain health disparities for cisgender LGB people. It appears that the experience of the LGB population and the use of psychological therapies is varied across the spectrum. Some focus upon symptom reduction as part of the experience, but others talk about not being validated. Some mention minority stress constructs, alongside the psychological mediation framework, which offers a potential theoretical understanding of the experiences of the LGB population who receive psychological therapies.

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.

Suicidality Among Transgender Youth: Elucidating the Role of Interpersonal Risk Factors

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth (n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth.

National suicide management guidelines recommending family-based prevention, intervention and postvention and their association with suicide mortality rates: systematic review

BACKGROUND

Suicidal behaviour remains a major public health concern and countries have responded by authoring guidelines to help mitigate death by suicide. Guidelines can include family-based recommendations, but evidence for the level and category of family-based involvement that is needed to effectively prevent suicide is unclear.

AIMS

To explore the association between family-based recommendations in guidelines and countries' crude suicide rates. PROSPERO registration: CRD42019130195.

METHOD

MEDLINE, Embase, PsycInfo, Web of Science and WHO MiNDbank databases and grey literature were searched within the past 20 years (1 January 2000 to 22 June 2020) for national guidelines giving family-based recommendations in any of three categories (prevention, intervention and postvention).

RESULTS

We included 63 guidelines from 46 countries. All identified guidelines included at least one family-based recommendation. There were no statistically significant differences seen between mean World Health Organization crude suicide rates for countries that included only one, two or all three categories of family-based recommendations. However, a lower spread of crude suicide rates was seen when guideline recommendations included all three categories (mean crude suicide rates for one category: 11.09 (s.d. = 5.71); for two categories: 13.42 (s.d. = 7.76); for three categories: 10.68 (s.d. = 5.20); P = 0.478).

CONCLUSIONS

Countries should work towards a comprehensive national suicide guideline that includes all categories of family-based recommendations. Countries with previously established guidelines should work towards the inclusion of evidence-based recommendations that have clear implementation plans to potentially help lower suicide rates.

Someone to talk to: the association of mentorship and cyberbullying with suicidality among US high school students

OBJECTIVE

Suicide is the second-leading cause of death in youth. We tested whether having a mentoring relationship associated with lower risks for suicidality, particularly among youth at higher risk due to cyberbullying.

METHODS

This study pooled the 2017 Youth Risk Behavior Survey (YRBS) data from five jurisdictions that asked students if there was at least one teacher or other adult in their school that they could talk with, if they have a problem (mentorship). Students self-reported cyberbullying exposure and suicidality in the past 12 months. Odds of suicidal ideation, planning, and attempts were estimated using multivariable weighted logistic regression in overall and sex-stratified stepwise models. Interactions between mentorship and cyberbullying were also tested.

RESULTS

Of the 25,527 student respondents, 87% reported having a mentoring relationship. Mentoring relationships were associated with lower odds of suicidal ideation (aOR, 0.44; 95% CI 0.33-0.57), planning (aOR, 0.59; 95% CI 0.41-0.85), and suicide attempts (aOR, 0.42; 95% CI 0.31-0.56). Stratified analyses showed a significant interaction between cyberbullying and mentorship with suicidal attempts among males, and a near-significant association between cyberbullying and mentorship with suicidal thoughts among females. Compared to male students with no cyberbullying and no mentorship, odds of attempting suicide were lower for males with no cyberbullying and mentorship (aOR, 0.55, 95% CI 0.32-0.92), higher for males with cyberbullying and no mentorship (aOR, 7.78, 95% CI 3.47-17.47), but not significantly different for males with cyberbullying and mentoring relationships (aOR, 1.49, 95% CI 0.86-2.48). Similarly, compared with females with no cyberbullying and no mentorship, odds of having suicidal thoughts were lower for females with no cyberbullying and mentorship (aOR, 0.40, 95% CI 0.28-0.57), and higher for females with cyberbullying and no mentorship (aOR, 2.54, 95% CI 1.59-4.07).

CONCLUSION

School-based mentoring may mitigate risk of suicidality among adolescents and limit the toxic effects of cyberbullying.

Improving "Life Chances": Surveying the Anti-Transgender Backlash, and Offering a Transgender Equity Impact Assessment Tool for Policy Analysis

Transgender inclusion within policy is critical yet often missing. We propose a policy tool to assesses human rights, access to resources and opportunities, language, and implications for transgender and nonbinary individuals. Acknowledging trans communities as standard policy practice can serve as an essential practice to shift dialogue and norms.

Creating a Minority Stress Index to Examine Mental Health Impacts of Discrimination Among Transgender and Gender Nonbinary Adults

Purpose: This study analyzed the differing impact of discrimination on mental health outcomes among transgender and gender nonbinary (TGNB) adults. Methods: We utilized data from the 2015 U.S. Transgender Survey. Mental health outcomes included psychological distress, suicidal thoughts, and a suicide attempt. To determine the impact of discrimination categories, we utilized a weighted quantile sum (WQS) regression approach to create a minority stress index (MSI). The MSI included seven discrimination categories: interpersonal, workplace, health care, religious, public services, housing, and verbal and/or physical attack. Results: The average psychological distress score was 10.65 points (standard deviation = 6.05), range: 0-24. Nearly 82% and 39% of TGNB adults reported ever having suicidal thoughts and a suicide attempt, respectively. Verbal and/or physical attack and religious discrimination had the most significant weights in the MSI for each mental health outcome. Every 0.1 point increase in the MSI significantly increased the psychological distress score by 0.468 points (95% confidence interval [CI] = 0.434-0.503; p < 0.0001), and the odds of suicidal thoughts and a suicide attempt by 27.07% (95% CI = 24.15-30.05; p < 0.0001) and 28.46% (95% CI = 26.34-30.61; p < 0.0001), respectively. Conclusion: This study introduces a novel method for analyzing experiences of minority stress in health disparities research. By using the WQS regression method, we were able to parse out the indicators of minority stress that had the greatest impact on mental health outcomes. There is a continued need for interventions to mitigate the high rates of suicidality and psychological distress among TGNB populations.

Rates and predictors of Alcoholics Anonymous attendance across sexual orientations

Sexual minority (e.g., gay, lesbian, bisexual) individuals experience alcohol dependence at 2-6 times the rates of heterosexual individuals. Among the general population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems in the United States. Yet, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance among sexual minorities. This paper aims to: 1) Compare rates of AA attendance across sexual orientations; 2) Compare relationships between AA attendance and common predictors of AA attendance across sexual orientations. Using five waves of the National Alcohol Survey (N = 7862 respondents with at least one lifetime AUD symptom), this study found lesbian and bisexual women, but not gay and bisexual men, had greater odds of attending AA, even while controlling for lifetime AUD severity, gender, race/ethnicity, age, religiosity, and current income. Interaction models for women showed there was a stronger association between older age and AA attendance, a stronger association between greater religiosity and AA attendance, and a weaker association between lifetime AUD severity and AA attendance for sexual minority women relative to heterosexual women. This study did not find significant interactions between sexual orientation and these covariates for men. These results suggest AA may serve as a promising resource for sexual minority individuals experiencing alcohol-related problems, particularly for sexual minority women who are older, more religious, and have less severe AUD.

Suicides Among Lesbian, Gay, Bisexual, and Transgender People: Medical Examiner Reports in the Special Wards of Tokyo, Japan, 2009-2018

Purpose: We aimed to report the occurrence of suicide death and to reveal the characteristics among LGBT people in the special wards of Tokyo. Methods: All suicide deaths between 2009 and 2018 were identified from the Tokyo Medical Examiner's Office database, and the characteristics were compared between LGBT people and non-LGBT people by retrospective review of the medical examiner reports. Results: Among 17,638 people who died by suicide, 84 (0.5%) were identified as LGBT people, of which a large proportion was gay males (51.2%) and transgender people (42.9%). Smaller proportions of lesbian (3.6%) and bisexual (2.4%) females were identified. Compared with suicides among non-LGBT people, there were several differences in the circumstances surrounding suicides among LGBT people, namely method of suicide, source of income, and number of household members (transgender people), and toxic substance in poisoning and medical history (gay males). Conclusions: The results tentatively suggest the risk or supportive factors that should be considered for preventing suicides among LGBT people; however, the present data are likely to be underestimated. To better understand suicides among LGBT people, systematic efforts to collect sexual orientation and gender identity data for suicide are needed.

Medical Trauma in LGBTQIA Youth: Adapting Trauma-Informed Affirming Clinical Practices

Lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual (LGBTQIA) youth are more likely than cisgender heterosexual youth to experience traumatic stress across all social systems, including within family, school, and health care settings. LGBTQIA youth may be particularly susceptible to traumatic stressors associated with medical illness or injury and health care, due to both to higher baseline levels of stress and adversity and unique identity-linked stressors pervasive across systems of care. Pediatric providers can greatly impact mental health in their LGBTQIA patients by providing trauma-informed care that is affirming of gender and sexual identities. This article presents foundational concepts pertaining to medical trauma and practice priorities for pediatric providers, who are uniquely positioned to mitigate medical traumatic stress experienced by LGBTQIA youth. [Pediatr Ann. 2021;50(9):e379-e383.].

Suicidality Among Psychiatrically Hospitalized Lesbian, Gay, Bisexual, Transgender, Queer, and/or Questioning Youth: Risk and Protective Factors

Purpose: The study purpose was to compare suicide risk between lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ) and non-LGBTQ adolescents in a psychiatric hospital. Methods: Data were obtained from self-report measures completed by patients 12-17 years of age (n = 334) in a Midwestern psychiatric hospital from 2016 to 2017. Factors analyzed included sexual orientation, gender identity, suicidality, depression, nonsuicidal self-injury, abuse, substance use, bullying, perceived discrimination, and adult support. Results: Nearly one-third of patients identified as LGBTQ. A lifetime suicide attempt was reported by 69.6% of LGBTQ patients compared with 43.6% of non-LGBTQ patients. However, the prevalence of suicide attempts among LGBTQ patients with high adult support did not differ from that of non-LGBTQ patients. In the full logistic regression model adjusting for 13 factors, the adjusted odds ratio of a suicide attempt was 5.25 among transgender/questioning patients and 2.41 among nontransgender lesbian, gay, bisexual, queer, or questioning patients. All risk factors, apart from substance use, were more prevalent among LGBTQ than non-LGBTQ patients (p < 0.005). Among LGBTQ patients of color (Black/Latinx/Other), 91.3% had a lifetime suicide attempt versus 62.3% of White LGBTQ patients (p = 0.009). Conclusion: LGBTQ patients overall, and LGBTQ patients of color in particular, had higher rates of suicide attempts than non-LGBTQ patients. LGBTQ patients also had a higher prevalence of risk factors for suicide; however, the study variables did not fully explain the higher prevalence of suicide attempts. Future research should further examine possible risk factors for suicide among LGBTQ youth, such as stigma and discrimination.

Conceptualizing relationships among transgender and gender diverse youth and their caregivers

Family support and acceptance are protective for transgender and gender diverse (TGD) youths' mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships within the family system. In this qualitative study, we explored perspectives of TGD youth and their caregivers regarding youth-caregiver and caregiver-caregiver relationships within the family system. We recruited a community-based sample of 20 families (20 TGD youth, ages 7 to 18 years, and 34 caregivers) from 3 U.S. geographic regions. TGD youth represented multiple gender identities; caregivers included mothers (n = 21), fathers (n = 12), and 1 grandmother. Each family member completed an individual semistructured interview that included questions about family relationships. Interviews were transcribed verbatim and transcripts were analyzed using a thematic analysis approach. Analyses revealed complex bidirectional family relationships, highlighting 5 contextual factors influencing these relationships: school, community, workplace, religion, and extended family. TGD youths' identity development was inextricably linked to how caregivers respond to, adjust to, and learn from their children, and how caregivers interact with one another. Findings illustrate how caregiver acceptance and family cohesion may be linked and how youth and caregivers identified shared contextual factors impacting the family system. This research highlights the importance of situating TGD youth and caregivers as equal partners in family level approaches to affirm and support TGD identity development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychosocial correlates of posttraumatic growth among U.S. young adults during the COVID-19 pandemic

Given the prolonged nature of the COVID-19 pandemic, the purpose of this study was to examine the association between posttraumatic growth (PTG) among young adults during the COVID-19 pandemic and their psychosocial characteristics, specifically: distress tolerance; resilience; family connectedness; depression, anxiety, and PTSD symptoms; and COVID-19-related worry. The study utilized data from 805 U.S. young adults (18-30 years) who completed online surveys during the COVID-19 pandemic across two waves (April-August 2020 and September 2020-March 2021). Overall, young adults reported low PTG scores. PTSD symptoms and COVID-19-related worry significantly predicted higher levels of PTG, while their depression symptoms predicted lower levels of PTG. Resilience and family connectedness significantly predicted higher levels of PTG, and distress tolerance significantly predicted lower levels of PTG after accounting for sociodemographic characteristics and negative influential factors. Compared to Whites, Asians were less likely to report PTG. In general, young adults have not perceived personal growth from the pandemic; however, young adults with certain psychosocial factors appear to be predisposed to such PTG. This study highlights the importance of exploring and elucidating the potential positive trajectories following the adversity of the COVID-19 pandemic.

"Is it us or is it me?": Family experiences of connectedness following a reflecting team intervention

The present study examined family-wide versus individual perceptions of, and changes in, family connectedness in response to a one-time reflecting team (RT) intervention. Seventy-six families (N = 208 individuals), recruited during family therapy, completed family connectedness measures before and after the RT intervention. A subset of adults (n = 26) completed 1-week follow-up measures. Three-level (family, individual, time) multilevel models were used to partition sources of variance in connectedness while permitting different fixed and random effects for adults and minors. Results indicate that family connectedness is a characteristic of whole-families (34% of the variance), individuals (43%), and change over time (23%), including measurement error. Additionally, participants reported higher family connectedness after the RT. This study demonstrates the importance of considering family connectedness as a multilevel relationship construct that potentially changes in response to RT.

Risk and Protective Factors for Adolescent Relationship Abuse across Different Sexual and Gender Identities

Little is known about the characteristics and context of adolescent relationship abuse victimization across youth of different sexual and gender minority identities. This study sought to examine this in a national sample of 14-15-year-old youth. The sample comprised 3296 youth who reported having been in a relationship, of which 36% (n = 1197) were exclusively cisgender heterosexual; 41% (n = 1, 349) cisgender sexual minority; and 23% (n = 750) gender minority, the majority of whom were also sexual minority. More than half of all youth who had been in a relationship, dated or hooked up with someone had experienced some form of adolescent relationship abuse victimization. Gender minority youth, in particular transgender boys and non-binary youth assigned female at birth, were more likely to be victims of multiple types of adolescent relationship abuse compared to cisgender youth. Perpetrator gender varied for sexual and gender minorities and was more homogenous for cisgender heterosexual youth. Several factors were associated with adolescent relationship abuse for all youth, although alcohol use, and parental trust and communication emerged as particularly important for sexual and gender minority youth. Overall, findings address multiple gaps in the literature and contribute to the understanding of adolescent relationship abuse across different sexual and gender identities.

The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis

PURPOSE

To estimate the association between same-sex marriage legalization and deaths by suicide among youth.

METHODS

The study used country-level suicide data sourced from the Global Burden of Disease Study for all 36 Organisation for Economic Co-operation and Development countries for the period 1991-2017. We analyzed the suicide rates of all youth, male youth, and female youth aged 10-24 years using multiple policy-evaluation methods-difference-in-differences, matrix completion, and generalized synthetic control via expectation-maximization-to estimate the impact of same-sex marriage legalization at the country level. Secondary analysis considered several covariate specifications, evaluated the immediacy and persistence of the estimated associations, and assessed whether any observed association was limited to early adopters of same-sex marriage.

RESULTS

The state-of-the-art matrix completion analysis indicated that same-sex marriage legalization was associated with a decline in the youth suicide rate of 1.191 deaths per 100,000 individuals (95% CI = -1.66, -.64; p < .001), corresponding to a reduction of 17.90% compared to the youth suicide rate at the time of legalization. This decline was most pronounced in males for whom the suicide rate fell by 1.993 (CI = -2.76, -1.12; p < .001) compared to a decrease of .348 for female youth (CI = -.60, -.06; p = .02), corresponding to decreases of 19.98% and 10.90%, respectively. These associations persisted after legalization, but to differing degrees depending on model specification.

CONCLUSIONS

Developed countries that are yet to legalize same-sex marriage have an opportunity to put downward pressure on youth suicide.

Sexual assault, sense of belonging, depression and suicidality among LGBQ and heterosexual college students

To compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among lesbian, gay, bisexual, queer and questioning (LGBQ) and heterosexual students. Participants: A total of 60,194 students from 60 US campuses who participated in the 2017-2018 Healthy Minds Study. Methods: Three-way interaction effects were analyzed using PROCESS macro models in SPSS. Results: Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b = -0.06, p= 0.042, CI: -0.12 to -0.00), and suicidality (b = -0.10, p= 0.004, CI: -0.01 to -0.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health. Conclusion: Enhancing sense of belonging may represent a strategy to mitigate depression and promote suicide prevention, particularly among LGBQ students.

Family Belongingness Attenuates Entrapment and Buffers Its Association with Suicidal Ideation in a Sample of Dutch Sexual Minority Emerging Adults

Sexual minority emerging adults are more likely to engage in suicidal ideation than their heterosexual counterparts. Experiences of homophobic violence are associated with suicidal ideation. Yet, the specific mechanisms linking homophobic violence to suicidal ideation remain unclear. Entrapment and social belongingness were tested to determine their relevance for understanding the link between homophobic violence and suicidal ideation. A sample of sexual minority Dutch emerging adults (N = 675; ages 18-29, M = 21.93 years, SD = 3.20) were recruited through online platforms and flyers. Homophobic violence was expected to be positively associated with suicidal ideation and entrapment. The association between homophobic violence and suicidal ideation was expected to be indirectly linked through entrapment. We explored whether various sources of social belongingness moderated the path between entrapment and suicidal ideation and whether those sources of social belongingness moderated the indirect effect of homophobic violence on suicidal ideation through entrapment. Results showed that homophobic violence and entrapment were positively associated with suicidal ideation and that family belongingness was negatively associated with suicidal ideation. Homophobic violence and suicidal ideation were not indirectly linked through entrapment. The interaction effect between entrapment and family belongingness was significant, suggesting that, on average, the effect of entrapment on suicidal ideation decreased when family belongingness was high. These results suggest that family belongingness may reduce the association between entrapment and suicidal ideation while adjusting for homophonic violence. Reducing entrapment and improving family belongingness may be useful targets for programs aimed at preventing suicidal ideation among sexual minority emerging adults.

The Mediating Role of Attachment Avoidance in the Association between Sexual Orientation and Mental Health

The current study examined whether attachment avoidance mediates the association between being a sexual minority (gay men or lesbian women) and poorer mental health outcomes. For this purpose a community-dwelling sample of 350 gay men and lesbian women (M = 30.39, SD = 6.82) and 445 heterosexual men and women (M = 26.95, SD = 3.11) completed measures of attachment avoidance, depressive symptoms, anxiety symptoms and life satisfaction. Results showed that gay men and lesbians reported poorer mental health. Moreover, attachment avoidance had a mediating effect on the association between being a sexual minority and depressive symptoms, anxiety symptoms and life satisfaction. These findings are some of the first to suggest empirical support for the role of attachment avoidance in accounting for the mental health vulnerability of gay men and lesbians. The results contribute to a better understanding of the minority stress model and should be addressed by practitioners.

Differential Risks for Suicidality and Mental Health Symptoms Among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services

Purpose: We examined whether health risks among sexual minority youth (SMY) differ by gender identity (transgender, nonbinary, and cisgender). Methods: Data were collected on suicide attempts (lifetime and someday), depression and post-traumatic stress disorder (PTSD), and minority stress among SMY accessing crisis services. Results: In the multivariate regression models, compared to their cisgender peers, transgender and nonbinary youth were at higher risk for suicide attempt (lifetime and someday), depression, and PTSD. Minority stress was a significant predictor for all the models. Conclusion: Crisis service organizations working to reduce suicidality among SMY should be sensitive to diverse experiences of gender identity.