1
|
Brown SL, Chen Q, Valencia EMH, Victor SE, Scott LN. A Prospective Examination of Sexual Orientation and Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors Among a Diverse Sample of At-risk Young Adult Women. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:280-293. [PMID: 39100883 PMCID: PMC11293462 DOI: 10.1037/sgd0000593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Minoritized sexual orientation is an established correlate for suicide ideation (SI) and nonsuicidal self-injury (NSSI); however, prospective associations between sexual orientation and SI and NSSI is limited. The current study builds on existing literature by examining sexual orientation as a prospective distal risk factor for SI and NSSI risk among a diverse sample of young women after adjusting for histories of SI and/or NSSI and empirically supported correlates and risk factors. Participants were 135 young adult women (aged 18-24), who were predominately Black with approximately half of the sample experiencing poverty. Participants completed an interview that assessed SI and NSSI at baseline and 6- and 12-month follow-ups. A single item was used to collect participants' self-identified sexual orientation at baseline. Minoritized sexual orientation was strongly associated with NSSI history and future SI and NSSI, adjusting for baseline correlates and predictors of interest. Psychological and physical victimization, race, and poverty were non-significant prospective predictors of SI and NSSI. Race and poverty did not moderate the associations between sexual orientation and follow-up SI and NSSI. These findings suggest young adult women who self-identify as lesbian, gay, bisexual, queer, or questioning (LGBQ) are more likely than those who identify as heterosexual to experience both SI and NSSI in the following year. Sexual orientation should be part of a culturally-informed comprehensive risk assessment. A culturally-informed intersectionality approach may be necessary to identify culturally-specific risk and resiliency factors for SI and NSSI that can guide effective prevention and intervention strategies for LGBQ individuals.
Collapse
Affiliation(s)
- Sarah L. Brown
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Qi Chen
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Evelyn M. Hernandez Valencia
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Sarah E. Victor
- Texas Tech University, Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Lori. N Scott
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| |
Collapse
|
2
|
Brown SL, Seymour NE, Mitchell SM, Moscardini EH, Roush JF, Tucker RP, Cukrowicz KC. Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective? ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1091-1101. [PMID: 35044597 PMCID: PMC8891054 DOI: 10.1007/s10508-021-02186-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 06/14/2023]
Abstract
Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (Mage = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.
Collapse
Affiliation(s)
- Sarah L Brown
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychological Sciences, Texas Tech University, Mail Stop 2051, Lubbock, TX, 79409-2051, USA
| | - Nicole E Seymour
- Department of Psychological Sciences, Texas Tech University, Mail Stop 2051, Lubbock, TX, 79409-2051, USA
| | - Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University, Mail Stop 2051, Lubbock, TX, 79409-2051, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Emma H Moscardini
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Jared F Roush
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Mail Stop 2051, Lubbock, TX, 79409-2051, USA.
- School of Veterinary Medicine, Texas Tech University, Texas Tech University, Amarillo, TX, USA.
| |
Collapse
|
3
|
Salway T, Plöderl M, Liu J, Gustafson P. Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. Am J Epidemiol 2019; 188:239-249. [PMID: 30188991 DOI: 10.1093/aje/kwy200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
Collapse
Affiliation(s)
- Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, University Clinic of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Bejakovich T, Flett R. “Are you sure?”: Relations between sexual identity, certainty, disclosure, and psychological well-being. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1427647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ross Flett
- Massey University, Palmerston North, New Zealand
| |
Collapse
|
5
|
Hottes TS, Bogaert L, Rhodes AE, Brennan DJ, Gesink D. Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis. Am J Public Health 2016; 106:e1-12. [PMID: 27049424 DOI: 10.2105/ajph.2016.303088] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment. OBJECTIVES To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples. SEARCH METHODS In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities. SELECTION CRITERIA We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand. DATA COLLECTION AND ANALYSIS Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using τ(2). MAIN RESULTS We pooled 30 cross-sectional studies, including 21,201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability. AUTHOR'S CONCLUSIONS Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide. PUBLIC HEALTH IMPLICATIONS Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Collapse
Affiliation(s)
- Travis Salway Hottes
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Laura Bogaert
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Anne E Rhodes
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - David J Brennan
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Dionne Gesink
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| |
Collapse
|
6
|
Talley AE, Brown SL, Cukrowicz K, Bagge CL. Sexual Self-Concept Ambiguity and the Interpersonal Theory of Suicide Risk. Suicide Life Threat Behav 2016; 46:127-40. [PMID: 26190166 PMCID: PMC4720578 DOI: 10.1111/sltb.12176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self-concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self-ascribed a non-exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self-concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co-occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.
Collapse
|
7
|
Tsypes A, Lane R, Paul E, Whitlock J. Non-suicidal self-injury and suicidal thoughts and behaviors in heterosexual and sexual minority young adults. Compr Psychiatry 2016; 65:32-43. [PMID: 26773988 DOI: 10.1016/j.comppsych.2015.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Despite consistently greater rates of non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs; i.e., suicidal ideation, method/plan, and attempts) in lesbian, gay, and bisexual (LGB) individuals, prevalence, characteristics, and relations between these dangerous thoughts and behaviors are equivocal. The present study sought to examine and compare the rates of NSSI and STBs in a large sample of sexual minority and majority young adults. METHODS Participants were 12,422 college students (ages 18-29; 57.3% female) who self-reported demographic characteristics, NSSI frequency, the number of NSSI forms used, the number of NSSI functions, as well as STB history (i.e., ideation, method/plan, and attempts). Each participant's degree of SA was assessed via a 7-point scale (i.e., K0-K6) from Alfred Kinsey's research of sexual attraction and sexual experiences. This scale was collapsed to create five categories of SA: exclusively other SA (K0), mostly other SA (K1/2), equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6). RESULTS Consistent with previous research, we found that being a sexual minority young adult was associated with significantly higher odds of STBs compared to being a heterosexual young adult. In addition, compared to the exclusively other SA group (K0), being in the mostly other SA group (K1/2), equally other and same SA group (K3), or mostly same SA group (K4/5) was associated with significantly higher odds of NSSI engagement. Among those with NSSI, we found that the number of NSSI forms was significantly associated with suicide attempts, but was not associated with either suicidal ideation or suicide method/plan in the mostly other SA group (K1/2) or in the equally other and same SA group (K3). We also found a significant curvilinear relation between NSSI frequency and STBs in the mostly other SA group (K1/2) and between NSSI frequency and suicide method/plan and attempt in the exclusively other SA group (K0). In addition, we revealed specificity with regard to the relation between the number of lifetime NSSI episodes and risk for STBs among the equally other and same SA (K3), mostly same SA (K4/5), and exclusively same SA (K6) groups. CONCLUSION Our findings suggest that among sexual minority young adults, equally other and same SA individuals may be at higher risk of NSSI and STBs than their sexual minority counterparts. In addition, these findings extend previous research by suggesting that the relations between NSSI frequency, number of forms, and number of functions and STBs might vary according to SA. A multi-theory based explanation is provided to explain the key findings and the study implications are discussed.
Collapse
Affiliation(s)
- Aliona Tsypes
- Department of Psychology, Binghamton University (SUNY), 4400 Vestal Parkway East, Binghamton, NY 13902.
| | - Robert Lane
- Department of Psychology, St John's University, 8000 Utopia Parkway, Jamaica, NY 11439
| | - Elise Paul
- Bronfenbrenner Center for Translational Research, Cornell Research Program on Self-Injury and Recovery, Cornell University, Beebe Hall, 110 Plantations Rd. Ithaca, NY 14853, USA; Department of Human Development, Cornell University, G87 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853, USA
| | - Janis Whitlock
- Bronfenbrenner Center for Translational Research, Cornell Research Program on Self-Injury and Recovery, Cornell University, Beebe Hall, 110 Plantations Rd. Ithaca, NY 14853, USA; Department of Human Development, Cornell University, G87 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853, USA
| |
Collapse
|