Comparison of Lifetime Suicide Attempts and Recent Suicidal/Self-Harming Thoughts Among Sexual Minority and Heterosexual Utahns: Results from a Population-Based Survey

Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population.

RECENT FINDINGS

There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.

"I Just Wanted Support": Examining How LDS Clergy May Effectively Minister to Sexual and Gender Minority Congregants

This study explored why members of the Church of Jesus Christ of Latter-day Saints (LDS) who identify as sexual or gender minorities (SGM) speak with clergy regarding their SGM identities, as well as what LDS SGMs find helpful and unhelpful in these conversations. A sample of 25 current or former LDS SGMs participated in semi-structured interviews, which were analyzed using thematic analysis. Participants reported six overarching reasons for talking with clergy, including church procedures, seeking guidance, seeking emotional comfort, seeking repentance, seeking openness, and other people's initiation. Participants reported several ways clergy were helpful, including empathic listening, openness, and affirmative spiritual care. Participants further reported several ways clergy were unhelpful, including punishing, lacking empathic listening, having a limited worldview, and pathologizing. Clergy may benefit from understanding why LDS SGMs are speaking with them, and from utilizing helpful approaches such as empathic listening skills in their ministering efforts.

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.

“He Just Wanted Me to Do What Was Best for Me”: Latter-Day Saint Clergy’s Counsel to Sexual and Gender Minorities and Its Impact

The purpose of this study was to understand counsel given to sexual and gender minority individuals by clergy in the Church of Jesus Christ of Latter-day Saints (CJCLDS), the impact of that counsel, and individuals’ perceptions of meetings with clergy. Twenty-five current and former members of the CJCLDS who identify as sexual and gender minorities (SGM) participated in 30–60 min semi-structured interviews focused on their interactions with clergy in the CJCLDS. Participants reported receiving various forms of counsel, including encouragement to adhere to church doctrine, counsel focused on self-acceptance, messages that clergy would support congregants’ agency and self-determination, counsel focused on increasing faith, and no answers. Participants reported a variety of perceptions of meetings with clergy including wishing clergy were more educated on the experiences of SGMs, hurtful experiences, expectations of mistreatment, recognition that clergy are doing their best, and gratitude for clergy. Interactions with clergy had long-lasting and far-reaching consequences including loss of trust in religious leaders, restriction of church membership, disengagement from faith, engagement with faith, nuanced or lost beliefs, and impacts on mental health. Results suggest that Latter-day Saints clergy working with SGM individuals may be experienced as most effective when they provide safe and supportive spaces for congregants to share their experiences, use approaches that focus on self-determination and agency, seek education/training from CJCLDS-specific LGBTQ+ organizations, and recognize that many SGM congregants approach interactions with clergy with trepidation and fears of mistreatment.

Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States

IMPORTANCE

Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.

OBJECTIVES

To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US.

DESIGN, SETTING, AND PARTICIPANTS

This study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities).

EXPOSURES

SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners).

MAIN OUTCOMES AND MEASURES

Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE.

RESULTS

Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion.

CONCLUSIONS AND RELEVANCE

This economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.

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.

Discrimination, Mental Health, and Suicidal Ideation among Sexual Minority Adults in Latin America: Considering the Roles of Social Support and Religiosity

Despite the high rates of discrimination and mental health issues experienced by lesbian, gay, bisexual, and transgender (LGBT) adults at an international level, very little research has focused on this population in Latin America. As a result, the purpose of this study was to explore relationships among discrimination experiences, mental health (i.e., anxiety and depressive symptoms), suicidal ideation, religiosity, and social support in LGBT adults in Latin America. A sample of 99 participants from the region completed an online survey assessing these constructs. Results suggested that 51.5% of the sample reported lifetime suicidal ideation. Experiences with harassment/rejection-type discrimination predicted suicidal ideation, while work/school-type discrimination predicted mental health problems (anxiety and depression). Depressive symptoms predicted suicidal ideation, while anxiety symptoms alone did not. Further, depressive symptoms mediated relationships between work/school discrimination and suicidal ideation, as well as between harassment/rejection discrimination and suicidal ideation. Moderated mediation analyses suggested that high, but not low or moderate levels of social support and religiosity buffered LGBT adults in Latin America against discrimination, specifically by weakening links among discrimination, depressive symptoms, and suicidal ideation. Clinical intervention research with LGBT adults in Latin America should focus on increasing social support networks for this population and on helping LGBT adults reconcile conflicts between religious identities and sexual or gender minority identities, as healthy religiosity may serve as a protective factor against mental health problems generally, and suicidal ideation specifically.