Factors associated with 'feeling suicidal': the role of sexual identity

The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV

Background

Men who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation.

Methods

We conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation.

Results

The participants were aged 18-76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x ²/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (β = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (β = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect.

Conclusions

This study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.

Key characteristics including sex, sexual orientation and internet use associated with worse mental health among university students in Brazil and implications

BACKGROUND

The symptoms of anxiety and depression disorders are multifactorial and can trigger a series of problems especially among university students. The aim of this study was to assess the prevalence and associated factors with anxiety and depression symptoms among first-semester university students at a Federal University in Brazil given the paucity of such data and the first semester is the most stressfultime.

METHODS

Cross-sectional study with first-semester university students. The questionnaire included socio-demographic variables, lifestyles, health conditions and the Depression Anxiety Stress Scales. Descriptive analysis was performed, followed by bivariate analysis and Poisson regression analysis.

RESULTS

Three hundred and fifty-six students (65.2%) across a range of courses in their first semester participated. The prevalence of anxiety was 42.5% and depression 33.2%. Regarding symptoms of anxiety and depression disorders, a positive association was observed among females, non-heterosexual, non-white skin color, excessive internet use, lack of physical activity, not attending university parties, having psychological counseling, history of anxiety in first- or second-degree relatives, poor self-rated health and use of psychotropic medicines.

CONCLUSIONS

Due to the high prevalence of anxiety and depression symptoms, the importance of developing programs to promote mental and physical health of university students is highlighted.

Discrimination experienced by sexual minority males in Australia: Associations with suicidal ideation and depressive symptoms

INTRODUCTION

Discrimination has been under-examined as a social determinant of the higher rates of poor mental health experienced by sexual minorities. The objectives of our study were to: 1) assess whether discrimination was independently associated with poor mental health among sexual minority males, and 2) assess the potential mediation role of discrimination in the associations between sexual minority status and poor mental health.

METHODS

We used cross-sectional data on 13,230 males aged 18-55 years from the Australian Longitudinal Study on Male Health; bisexual and homosexual males comprised 1.5% and 1.6% of the sample, respectively. We fit Poisson regression and zero-inflated negative binomial regression models to examine suicidality, depressive symptoms and perceived discrimination in the past two years as correlates of suicidality and depressive symptoms.

RESULTS

Statistically significant differences were observed in the prevalence of perceived discrimination by sexual orientation (p < 0.001), with the highest prevalence among bisexual (29.3%) and homosexual (40.4%) males, and the lowest prevalence among heterosexual males (18.6%). After adjusting for confounding, bisexual/homosexual males had higher rates of perceived discrimination (IRR = 1.88, p < 0.001), recent suicidal ideation (IRR = 1.51, p = 0.008), lifetime suicide attempt (IRR = 2.09, p < 0.001) and recent depressive symptoms (IRR = 1.34, p < 0.001) than heterosexual males. Analysis of β-coefficients suggested that discrimination may mediate a small to moderate proportion of the association between sexual minority status and poor mental health.

LIMITATIONS

Use of cross-sectional data.

CONCLUSION

Poor mental health is more common among sexual minority males, and discrimination may be a contributor to these mental health disparities. Reducing discrimination should be considered as part of a strategy to improve the mental wellbeing of sexual minority males.

Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people in Australia: Correlates of suicidality among LGBQ Australians

INTRODUCTION

To examine demographic and psychosocial correlates of suicidal ideation and suicide attempts among a large cross-section of sexual orientation populations in Australia, including lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people.

METHODS

A national survey was conducted involving 5,174 cisgender LGBQ participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts.

RESULTS

In all, 37.2% reported suicidal ideation and 3.9% a suicide attempt in the past 12 months. The likelihood of suicidal ideation was greater for those who identified as queer or felt treated unfairly or socially excluded due to their sexual orientation, and lower for those in a committed relationship, who felt part of LGBTIQ communities, or felt accepted in family, work, and health services. The likelihood of suicide attempts was greater for those aged younger or had recently experienced verbal abuse or social exclusion, and lower for those in a committed relationship or who felt part of LGBTIQ communities.

LIMITATIONS

Participants were recruited largely through paid Facebook advertising and the sample may therefore not be representative of all LGBQ adults in Australia. However, a representative population-level study would require the collection of population demographic data to provide the necessary and sexual identity is not included in the Australian Census.

CONCLUSION

These findings highlight an urgent need for supporting LGBQ people and may help inform tailored support services, including culturally-safe suicide prevention programs. These could involve peer support, trauma-informed counselling, supporting committed relationships, and addressing marginalization in the wider community.

The Relationship Between Indicators of Depression and Anxiety and Sexual Orientation in Canadian Women

Previous studies examining the associations between women's sexual orientation and mental health have obtained inconsistent results. Whereas some studies have suggested that status as a lesbian or bisexual woman may be associated with greater mental health risk, others have suggested that bisexual women may be specifically vulnerable to mental health problems. The current study examined two competing models in a non-clinical sample of Canadian women (N = 278). The first model predicted that women who reported bisexual attraction would endorse more indicators of depression and anxiety compared to women who reported monosexuality (either same- or opposite-sex attraction). The second model predicted that women who reported relatively greater same-sex attraction would exhibit elevated indicators of depression and anxiety compared to women who reported opposite-sex attraction. Consistent with Model 1, greater bisexual attraction predicted greater endorsement of indicators of depression and anxiety compared to greater same-sex or opposite-sex attraction. These findings suggest that, in women, bisexuality may be associated with higher risk of depression and anxiety than monosexuality. Future research may benefit from exploring risk factors potentially unique to the mental health of bisexual women.

Suicidal Behavior Among People Living with HIV (PLHIV) in Medical Care in Estonia and Factors Associated with Receiving Psychological Treatment

People living with HIV (PLHIV) have higher rates of suicidal behavior than the general population. This study assessed suicidal behavior (ideation and/or attempts, ever and in the past 12 months) among PLHIV receiving outpatient HIV medical care in Estonia and associations between suicidal behavior and psychological treatment. The cross-sectional study collected data from January to November 2013 using a self-report questionnaire. Eight hundred PLHIV participated, 39 % (n = 306) of whom had been suicidal. Lifetime prevalence was 36 % for suicidal ideation and 20 % for attempts. Younger age, incarceration, having ever abused alcohol and also injected drugs, having lived with HIV for more than 10 years, and being depressed were associated with lifetime suicidal behavior. Suicidal behavior within the past 12 months was reported by 20 % (n = 156) of respondents. Of these, 27 % received psychological treatment (counseling and/or psychotherapy), 20 % had taken antidepressants, and 49 % sedatives. Individuals perceiving a need for treatment were significantly more likely to receive psychological treatment when experiencing suicidal behavior (OR 25.65, 95 % CI 2.92-225.47). In conclusion, suicidal behavior is frequent among PLHIV but psychological treatment is not often received. One of the barriers to treatment is patients' lack of perceived need for help.

Self-compassion and life satisfaction in gay men

Studies have shown that gay men are at increased risk for anxiety and depression due to social oppression; research suggests that self-compassion is positively associated with life-satisfaction and emotional resilience. In a sample of 68 gay men (M age = 39.7 yr., SD = 16.3), the influence of self-compassion on satisfaction with life was examined while controlling for age, income, and openness about sexual orientation. Analysis of the data revealed that self-compassion was a significant predictor of satisfaction with life. Implications of this finding were discussed.

Are LGBT populations at a higher risk for suicidal behaviors in Australia? Research findings and implications

The aim of this article is to review the Australian literature about suicidality in minority sexual identity and/or behavior groups in order to determine the evidence base for their reported higher vulnerability to suicidal behaviors than heterosexual and non-transgendered individuals in the Australian context, as well as to identify the factors that are predictive of suicidal behaviors in these groups in Australia. A literature search for all available years (until the end of 2012) was conducted using the databases Scopus, Medline, and Proquest for articles published in English in peer-reviewed academic journals. All peer-reviewed publications that provided empirical evidence for prevalence and predictive factors of suicidal behaviors among LGBT individuals (or a subset thereof) in Australia were included. Reference lists were also scrutinized to identify "gray" literature for inclusion. The results revealed that there is only limited research from Australia. Nevertheless, although no population-based studies have been published, research indicates that sexual minorities are indeed at a higher risk for suicidal behaviors. In order to further the understanding of suicidal behaviors and potential prevention among LGBT groups in the Australia, further research is needed, particularly on fatal suicidal behaviors.

Addressing the Social Determinants of Suicidal Behaviors and Poor Mental Health in LGBTI Populations in Australia

The purpose of this article is to describe and assess-as well as identify and rectify gaps in-intervention and prevention initiatives that specifically address poor mental health outcomes and suicidal behaviors in lesbian, gay, bisexual, transgender, and intersex (LGBTI) populations in Australia. It begins with an overview of the evidence base for heightened vulnerability to suicidal behaviors among LGBTI people in Australia. It then provides a discussion on the public health implications for LGBTI-targeted mental health initiatives and the prevention of and timely intervention in LGBTI suicidal behaviors. We conclude that the literature supports an increased risk for poorer mental health outcomes and suicidal behaviors in LGBTI populations in the Australian context. Psychological distress and suicidal behaviors in LGBTI people in Australia have social determinants that can and have been addressed through the provision of interventions with a strong evidence base in reducing these outcomes, implemented at a nationwide level, including training of health professionals and gatekeepers to mental health services and the general public. We conclude that the current Australian focus appears to address many of the social determinants of suicidal behaviors and poor mental health in LGBTI people but requires sustained and uniform government support if it is to continue and to produce measurable results.

Intersecting identities and the association between bullying and suicide attempt among New York city youths: results from the 2009 New York city youth risk behavior survey

OBJECTIVES

We examined the intersections of sexual minority, gender, and Hispanic ethnic identities and their interaction with experiences of bullying in predicting suicide attempt among New York City youths.

METHODS

We performed secondary data analysis of the 2009 New York City Youth Risk Behavior Survey, using logistic regression to examine the association of sexual identity, gender, ethnicity, and bullying with suicide attempt. We stratified results on these measures and reported adjusted odds ratios.

RESULTS

Compared with non-sexual minority youths, sexual minority youths had 4.39 and 1.96 times higher odds, respectively, of attempting suicide and reporting bullying. Identity variables did not interact with bullying in predicting suicide attempt individually; however, a four-way interaction term was significant. The effect of bullying on suicide attempt was strongest among non-Hispanic sexual minority male youths (odds ratio = 21.39 vs 1.65-3.38 for other groups).

CONCLUSIONS

Sexual minority, gender, and ethnic identities interact with bullying in predicting suicide attempt among New York City youths. Interventions to limit both the prevalence and the effect of bullying among minority youths should consider an intersectional approach that considers ethnic, gender, and sexual identities.

Sexual minority youth victimization and social support: the intersection of sexuality, gender, race, and victimization

In comparison to heterosexual youth, sexual minority youth are more likely to experience victimization. Multiple studies have connected anti-gay prejudice and anti-gay victimization to negative outcomes. Research shows that social support may protect sexual minorities from the harmful effects of anti-gay victimization. However, rates of victimization and the negative outcomes linked to sexual identity within the sexual minority community have been relatively unexplored. Using data from three years of statewide data from heterosexual and sexual minority adolescents in grades 9-12, this study examines victimization, substance use, suicidality, and access to social support by sexuality. Results indicate that sexual minority youth are at increased risk for victimization, substance use, suicidality, and social isolation compared to their heterosexual counterparts. Results also indicate that there is very little bivariate difference within the sexual minority community. Multivariate results indicate differences among sexual minorities' experiences with victimization and substance use.

A Review of Gay Men’s Health

This article focuses on how health practitioners can better understand and intervene with gay men. Gay men’s health is situated within 3 prominent theoretical models (ie, minority stress, gender socialization, and identity development) and associated with 3 constructs (ie, internalized homonegativity, internalized homophobia, and internalized heterosexism) to contextualize gay men’s health concerns. Throughout the article, the authors draw particular attention to research that emphasizes the strengths of gay men, as this is a notable gap in the extant literature. Furthermore, HIV/AIDS is a central concern of gay men, and this article focuses on how cultural identities and factors may intersect with HIV/AIDS status among gay men and have implications for health decision making. Affirmative clinical interventions based on theory and research are presented throughout the article, which can be applied by health professionals in various settings. Given the confusion around terminology, lack of knowledge of available resources, and prevailing negative societal myths about gay men, the article provides a glossary of definitions for unclear terms, actively disputes myths that are not empirically supported, and provides a list of available resources.

Racial and sexual identity-related maltreatment among minority YMSM: prevalence, perceptions, and the association with emotional distress

Bullying is a form of violence characterized as an aggressive behavior that is unprovoked and intended to cause harm. Prior studies have found that lesbian, gay, bisexual, and transgender (LGBT) youth experience high levels of bullying related to their sexuality and this harassment can lead to engagement in risk behaviors, depression, and suicide. Ethnic/racial minority young men who have sex with men (YMSM) may experience dual levels of stigma and maltreatment due to both their sexuality and their race. The aim of the current study was to assess the prevalence and perceptions of racial and sexual identity-based abuse among a sample of minority YMSM, and whether this maltreatment plays a role in the emotional distress of these youth. We found that overall 36% and 85% of participants experienced racial and sexuality-related bullying, respectively. There was a significant association between experiencing a high level of sexuality-related bullying and depressive symptomatology (p=0.03), having attempted suicide (p=0.03), and reporting parental abuse (p=0.05). We found no association between racial bullying and suicide attempts. In a multivariable logistic regression model, experiencing any racial bullying and high sexuality-related bullying were significant predictors of having a CES-D score ≥16; adjusted odds ratio (OR) 1.83 and 2.29, respectively. These findings contribute to the existing literature regarding the negative experiences and daily stressors facing LGBT youth with regard to both their minority status and LGBT identities. Future interventions for racial/ethnic minority YMSM should provide assistance to achieve a positive view of self that encompasses both their racial and sexual identities.

HIV infection and mental health: suicidal behaviour--systematic review

Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+ individuals had committed suicide; 2.4% HIV+ study participants commit suicide; approximately 20% of HIV+ people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally "suicidal" (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions - predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.

Examining sexual health differences between lesbian, gay, bisexual, and heterosexual adults: the role of sociodemographics, sexual behavior characteristics, and minority stress

Many studies focus on the differences in mental health between lesbian, gay, bisexual (LGB), and heterosexual individuals. Less attention has been paid to the differences in various aspects of sexual health and the potential explanations for these differences. Data from a Dutch population study on sexual health (aged 19-70 years; N = 4,333) were used to examine the potential differences in sexual satisfaction, sexual victimization, sexual dysfunction, and sexual health care need. At the same time, this study examined whether the differences could be attributed to differences in general factors influencing sexual health (sociodemographic variables and sexual behavior characteristics) or to LGB-specific factors (minority stress). The results showed that bisexual women and bi- and homosexual men had more often experienced sexual coercion and reported a higher need for sexual health care than their heterosexual counterparts. Both general determinants (e.g., a higher number of sexual partners or being single) and LGB-specific factors (e.g., internalized homonegativity or negative social reactions related to sexual orientation) were associated with different aspects of sexual health. Interventions aimed at improving the sexual health of LGB individuals should focus on general risk factors, as well as on LGB-specific stressors. Methodological limitations of the study and implications for further research are discussed.

'The black dog just came and sat on my face and built a kennel': Gay men making sense of 'depression'

This article reports on in-depth interviews with gay men about their experiences and understanding of depression. It is a key outcome of the collaboration between social researchers, general practitioners and community partners to investigate the management of depression in gay men in primary care settings. As part of the qualitative arm of the project in-depth interviews were conducted with 40 gay men in Sydney and Adelaide (Australia). The approach to discourse analysis is informed by Hallidayan systemic functional linguistics. Six constructions of depression were identified: (1) depression as a constellation of symptoms; (2) symptoms constructed as experience; (3) depression as agent; (4) depression as mental processes; (5) not meeting social expectations; and (6) engaging with psychiatric discourse: constructing alternative positions. Gay men draw on the biomedical model of depression as low mood and loss of pleasure as well as on constructions of depression in terms of social experience. The biomedical model of depression is, however, not positioned as unproblematic. Rather, gay men align or disalign with this discourse according to their own experience, thereby enacting diverse masculinities. Gay men's discourses of depression are inextricably linked to the community activism of gay men and their community organizations in the context of the HIV epidemic, as well as a synergy between gay men and their doctors.

The constitution of 'lavender families': a LGB perspective

AIM

To explore and describe lesbian, gay and bisexual people's families of origin and families of choice.

BACKGROUND

As a family group lesbian, gay and bisexual people engage with nurses when they interface with any health care service. All health practitioners need to be aware of the existence and constitution of lesbian, gay and bisexual families to provide appropriate health care, including health promotion and education.

DESIGN

Survey.

METHOD

From April to July 2004 a national survey of lesbian, gay and bisexual persons was carried out. Participants were recruited through mainstream and lesbian, gay and bisexual media and venues. A total of 2269 participants completed the survey instrument either electronically or via hard copy. The 133-item instrument included a range of closed-response questions in a variety of domains of interest. The article reports on results from the family and relationships domain.

RESULTS

Findings identified that lesbian, gay and bisexual families present with a variety of both constructed and biological kinship ties and relationships. These relationships vary from supported to estranged in terms of biological family and exclusivity through to non-exclusivity with regard to partners. Variations also exist in relation to the presence or absence of children and whether these were born before or after 'coming out'.

CONCLUSIONS

Lesbian, gay and bisexual families bring with them to health care services a wide array of life experiences. Therefore it is vital that when interacting with this group of people nurses avoid making assumptions about how gay, lesbian and bisexual people construct their identities and relationships. Furthermore, it may be difficult to ascertain a person's sexual identity when meeting them for the first time.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to ensure that they do not assume families seeking healthcare are heterosexual. Providing lesbian, gay and bisexual families with opportunities to disclose sexual identity without fear of disapproval or prejudice is integral to providing a quality and appropriate health service.

Suicidal ideation in UK HIV clinic attenders

BACKGROUND

HIV has been associated with elevated suicidal ideation. Although new treatments have changed prognosis, they also bring new challenges. This study measured suicidal ideation in HIV clinic attenders in the United Kingdom (London/Southeast) and explored associated factors.

METHOD

All 1006 attenders at five HIV clinics were approached, of which 903 met inclusion criteria and 778 participated (86% response). Participants provided detailed information on suicidal ideation, demographics, treatment, adherence, symptoms (psychological and physical on Memorial Symptom Assessment Schedule), quality of life (EuroQol) information, HIV disclosure, clinical variables, sexual risk behaviour and treatment optimism.

RESULTS

There was a 31% prevalence of suicidal ideation. Factors associated with suicidal ideation were being a heterosexual man, black ethnicity, unemployment, lack of disclosure of HIV status, having stopped antiretroviral treatment (compared to treatment or treatment naive), physical symptoms, psychological symptoms and poorer quality of life. There was no association with sexual risk behaviour. Sex/sexuality and ethnicity were independently associated with suicidal ideation: the odds of suicidal ideation increased almost two-fold for heterosexual men compared with gay men or women and for black respondents compared with White or Asian respondents. Lack of disclosure was independently associated with a two-fold increase in odds of suicidal ideation. Elevated physical and psychological symptoms were strong independent predictors of suicidal ideation. Independent predictors of suicidal ideation were very similar among the subgroup of 492 patients on antiretroviral treatment.

CONCLUSION

Despite advances in treatment, suicidal ideation rates among HIV-positive clinic attenders are high. Emotional support and attention to mental health provision and social context are strongly endorsed.