Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths

The Developmental Collision Hypothesis: An Empirical Test With Three Generations of Sexual Minority Youth

Sexual minority youth experience disproportionate rates of mental health symptomatology relative to their heterosexual peers. Less is known about why these disparities have persisted despite growing public awareness of sexual diversity. The developmental collision hypothesis states that increased cultural visibility of sexual diversity has accelerated the developmental timing of sexual minority identity formation processes such that they collide with early adolescence, a uniquely sensitive period for experiencing identity-based stigma and associated mental health vulnerability. To test this hypothesis, levels and relations between ages of sexual minority identity development milestones, frequency of LGBT-related victimization, and depressive symptoms were examined across three age-matched but cohort-distinct samples of sexual minority adolescents. Data come from three secondary datasets of sexual minority youth who were adolescents in the 1990s, 2000s, and 2010s, respectively: the Challenges and Coping Study, the Victimization and Mental Health among High Risk Youths Study, and the Risk and Protective Factors for Suicide among Sexual Minority Youth Study (n = 1312; Mage = 17.34, SD = 1.30; 52% female). Adolescents from more recent cohorts reported earlier mean ages of several milestones but similar frequencies of LGBT-related victimization relative to those from less recent cohorts. Path analysis models showed that earlier milestones were associated indirectly with more depressive symptoms through LGBT-related victimization. Notably, earlier ages of self-identification and disclosure of a sexual minority identity were also directly related to less depressive symptoms. Few generational differences in relations between constructs emerged. Findings garner initial support for the developmental collision hypothesis and suggest that LGBT-related victimization, rather than earlier milestones themselves, increases mental health vulnerability.

Minority Stressors, Social Provisions, and Past-Year Suicidal Ideation and Suicide Attempts in a Sample of Sexual Orientation and Gender Identity/Expression Minority People in Canada

Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.

Non-suicidal Self-Injury, Suicidal Behaviors, and Mental Health Symptoms among Sexual Minority Youth with Juvenile Justice System Involvement

Sexual minority youth have long remained an understudied population within the juvenile justice system, despite emerging evidence suggesting that sexual minority youth are overrepresented. Recent literature indicates that system-involved sexual minority youth may have more behavioral health concerns than their heterosexual counterparts. Even so, more work is needed to elucidate the unique needs of sexual minority youth who become involved in the system, especially as it pertains to suicidal behaviors and non-suicidal self-injury (NSSI). The present study provided a descriptive evaluation of the prevalence of sexual minority youth making early system contact and their mental health concerns. Of the 218 justice-involved youth from a Northeastern family court in the sample, over a quarter identified as a sexual minority (n = 58). Our findings indicated that these youth evidenced significantly higher scores on a mental health screener compared to their heterosexual counterparts, evidencing greater symptomology on scales indicative of depression/anxiety, thought disturbance, etc. Further, sexual minority youth reported higher rates of lifetime, past year, and past month NSSI as well as lifetime and past year suicide attempts. These findings highlight the need to support the well-being of sexual minority youth in the juvenile justice system by screening for and addressing their mental health needs in this unique setting.

Firearms Availability Among High-School Age Youth With Recent Depression or Suicidality

BACKGROUND AND OBJECTIVES

Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS).

METHODS

We conducted a probability-based, cross-sectional Web survey of 1914 parent-teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment.

RESULTS

Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36).

CONCLUSIONS

High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.

Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth

OBJECTIVE

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24).

METHOD

The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider.

RESULTS

Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt.

CONCLUSIONS

These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.

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.

Effects of "It Gets Better" Suicide Prevention Videos on Youth Identifying as Lesbian, Gay, Bisexual, Transgender, Queer, or Other Sexual or Gender Minorities: A Randomized Controlled Trial

Purpose:

The “It Gets Better” project (IGBP) features video narratives of lesbian, gay, bisexual, transgender, queer persons or persons with other sexual or gender minority identities (LGBTQ+) of overcoming coming-out-related difficulties. This is the first experimental study investigating effects of these videos.

Methods:

We conducted a double-blind randomized controlled trial on-site in Austria and online in German-language settings from January to November 2020 with LGBTQ+ youth (14–22 years; n = 483), randomized to an IGBP (n = 242) or control video (n = 241). Suicidal ideation (primary outcome), help-seeking intentions, hopelessness, mood, and sexual identity were assessed at baseline (T₁), postexposure (T₂), and 4-week follow-up (T₃). We assessed differences among gender identities, sexual orientations, with regard to depressive symptoms, and the role of identification. Data were analyzed with linear mixed models and mediation analysis.

Results:

There was no overall effect on suicidal ideation, but nonbinary/transgender individuals experienced a small-sized improvement (T₂: mean change [MC] from baseline MC = −0.06 [95% confidence interval {CI} −0.16 to 0.05], p = 0.60; mean difference [MD] to controls MD = −0.42 [95% CI −0.79 to −0.06], p = 0.02, d = −0.10). An indirect preventive effect on suicidal ideation at T2 through the degree of identification with the protagonist in the video was observed. There was improvement in help-seeking intentions in the intervention group (T₂: MC = 0.25 [95% CI 0.15 to 0.35], p < 0.001; MD = 0.28 [95% CI 0.01 to 0.54], p < 0.05, d = 0.09).

Conclusion:

Video narratives featuring coping might have some potential to decrease suicidal ideation and encourage help-seeking among vulnerable youth identifying with videos, but effects are small and short-lived.

Study Registration:

German Clinical Trial Registry (DRKS00019913).

Homonegativity Scores in Response to Static Same-Sex Imagery versus Observable Behavioral Change in Response to an Interactive Gay Male Target

Homonegativity research tends to focus on the identities of gay men and lesbian women through inauthentic means such as vignettes and signifiers like t-shirts with pro-gay slogans. Such research also tends to neglect sexual behavior. These issues were addressed in the present mixed-methods study. Heterosexual male (n = 196) and female (n = 219) participants were asked to complete measures of old-fashioned and modern homonegativity toward gay men and lesbian women after viewing a set of stimuli depicting gay male, lesbian female, or heterosexual couples. Participants also completed an interview with the researcher where he self-identified as a gay male and observed any changes in behavior following his disclosure. Findings indicated that male participants showed higher levels of modern homonegativity than female participants, regardless of the images viewed, and had higher odds of exhibiting negative behavioral change in response to the researcher's self-disclosure. Also, participants who viewed images of lesbian couples kissing or embracing had lower odds of showing negative behavioral change.

Ambient Discrimination, Victimization, and Suicidality in a Non-Probability U.S. Sample of LGBTQ Adults

Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at a higher risk for suicidality compared to the general population. A growing body of research has investigated this risk, particularly with attention to systemic factors such as discrimination and harassment. Unfortunately, research has only examined the impact of direct discrimination on suicidality and has neglected to examine how ambient discrimination (i.e., witnessing or being made aware of discriminatory behaviors directed at someone other than yourself in your group) relates to suicidality. Additionally, although some links exist between discrimination and suicidality, the mechanisms by which these are related are understudied. This study aimed to address these gaps by exploring the effect of ambient discrimination on suicidal ideation and examining psychological pain as a mediator in this relationship. Data were collected from a sample of 200 LGBTQ-identified individuals (M age = 35 years; 53.5% female; 86% White). Results of independent t tests and a one-way multivariate ANOVA revealed greater vulnerability for ambient/direct discrimination and psychache among individuals identifying as transgender, queer, and other. Regression and mediation analyses revealed that while both ambient and direct discrimination predicted suicidal ideation, only direct discrimination accounted for unique variance in the outcome; however, both ambient and direct discrimination contributed unique variance to psychological pain, which fully mediated their relationships to suicidal ideation. Results of this study may begin to provide insight into the pathways of risk and points of intervention for suicidality in the LGBTQ community.

Patterns of Bullying Behavior by Sexual Orientation

Bullying has a long-lasting effect on both victims and their perpetrators; however, there is little literature dedicated to understanding the roles of sexual minority adolescents beyond being a victim or the specific types of bullying behaviors (verbal, relational, physical) in which sexual minority adolescents engage. Even less is known about the experiences of mostly heterosexual youth, as distinct from their lesbian, gay, and bisexual (LGB) peers. This exploratory study sought to identify sexual orientation differences in bullying behavior participation using a random cluster sample obtained from a county school district in the Southeastern United States. The sample included 3,463 middle and high school students from 66 schools. Four latent classes of bullies and victims emerged, with similar patterns of behaviors for heterosexual, mostly heterosexual, and LGB groups.

A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide

BACKGROUND

LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations.

OBJECTIVES

The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups.

DATA SOURCES

MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020).

STUDY ELIGIBILITY CRITERIA

Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years).

SYNTHESIS METHODS

2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses.

RESULTS

Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences.

CONCLUSIONS

Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives.

PROSPERO REGISTRATION NUMBER

CRD42019130037.

Suicide Attempt Rates and Associations with Discrimination Are Greatest in Early Adulthood for Sexual Minority Adults Across Diverse Racial and Ethnic Groups

Purpose: The study purpose was to investigate differences in past 5-year suicide attempts among racially/ethnically diverse sexual minority (SM) and heterosexual adults across the life course and examine the association of discrimination with past 5-year suicide attempts among SM adults. Methods: Using nationally representative data collected from 2012 to 2013, we assessed differences in age-varying prevalence of past 5-year suicide attempts among Black, Hispanic, and White SM and heterosexual adults (ages 18-60). We tested whether the association between discrimination and suicide attempts differed by race/ethnicity among SM adults. All secondary data analyses were approved by the Institutional Review Boards of The Pennsylvania State University and University of Maryland. Results: Compared with heterosexual adults of any race/ethnicity, SM adults exhibited elevated suicide attempt rates until the late twenties when prevalence for Black and Hispanic SM adults declined. Disparities persisted into the mid-40s for White SM adults. Among SM adults of all races/ethnicities, the relationship between SM discrimination and suicide attempts was strongest between ages 18 and 25. For SM adults reporting SM discrimination, odds of suicide attempts were 3.6 times higher for White SM adults and 4.5 times higher for Black and Hispanic SM adults, relative to same-race/ethnicity SM adults who did not report SM discrimination. The effect of SM discrimination was robust among Black and Hispanic SM young adults even when accounting for racial/ethnic discrimination. Conclusions: SM adults of all racial/ethnic groups demonstrated disparities when contrasted with heterosexual adults of any race/ethnicity, although ages characterized by heightened prevalence rates of suicide attempts differed by race/ethnicity. Early adulthood is a critical period for intervention seeking to disrupt the association between SM discrimination and suicide attempts.

Perceptions of LGBQ+ youth and experts of suicide prevention video messages targeting LGBQ+ youth: qualitative study

Background

Young lesbian, gay, bisexual, transgender, queer as well as other sexual/gender minorities (LGBTQ+) persons have higher rates of suicidal ideation and behavior compared to their non-LGBTQ+ peers, particularly during their coming out. The “It Gets Better” project is a multi-national media campaign that aims to reduce suicide among LGBTQ+ adolescents by providing personal narratives of hope delivered by mainly adult LGBTQ+ persons. There is only little knowledge so far on how young LGBTQ+ people as well as experts in suicide prevention and counseling perceive these videos, and how to potentially improve the videos based on their perceptions.

Methods

A total of n = 19 LGBQ+ adolescents and young adults and n = 9 experts participated in focus groups to discuss perceptions of a selection of “It Gets Better” videos. Eight focus groups were conducted to assess perceptions on the process of watching the videos, possible effects on young LGBQ+ viewers in general, and suicidal LGBQ+ youth in particular, as well as factors that were relevant to their perceptions.

Results

Messages were found to be helpful in terms of promoting hope. LGBQ+ youth identified several key strategies to increase identification with messages, which they considered crucial for their effectiveness. Criticism emerged from a perceived lack of diversity in terms of portrayed sexual identities, and some shallowness in the portrayal of suicidal ideation and how things can get better. The experts’ perceptions of the videos were largely consistent with LGBQ+ youth, highlighting a positive potential of videos to support coming out and identity building processes.

Conclusions

Young people and experts view the videos as helpful and relevant, but identified several strategies to better tailor them to the needs of LGBTQ+ adolescents, including suicidal peers. The insights gained are useful to the increasing number of suicide prevention projects using personal narratives of coping delivered via media to help prevent suicide.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09853-5.

Prevalence and clinical indices of risk for sexual and gender minority youth in an adolescent inpatient sample

OBJECTIVE

Rates of self-injurious thoughts and behaviors have increased in adolescents over the past two decades. Sexual and gender minority (SGM) youth report elevated rates of self-injurious thoughts and behaviors compared to heterosexual and cisgender youth. Studies of factors influencing suicide risk in SGM youth remain limited, however, and have largely been conducted in community or epidemiological samples.

METHOD

The present study aimed to address these limitations by examining the prevalence and clinical characteristics of sexual and gender minority youth in a sample of 515 youth admitted to an adolescent inpatient unit. In addition, the present study aimed to compare rates of self-reported self-injurious thoughts and behaviors, adverse early childhood experiences, and rates of rehospitalization in sexual and gender minority compared to non-sexual and gender minority youth.

RESULTS

Results show that nearly 40% of the sample identified as sexual and/or gender minority. Sexual minority youth reported higher rates of suicidal ideation (t = -6.19, p < .001), higher rates of prior suicidal behavior (Chi2 = 27.44, p < .001) and non-suicidal self-injury (Chi2 = 48.09, p < .001), and greater numbers of adverse childhood experiences (t = -3.99, p < .001); gender minority youth reported higher rates of suicidal ideation (t = -3.91 p = .001). There were no group differences for SGM youth in rates of rehospitalization in the 6-months following initial admission. These results held when controlling for sex assigned at birth and current depression status in multi-variate analyses.

CONCLUSIONS

The study illuminates the importance of assessing SGM status in clinical care and highlights the need to evaluate sexual and gender minority specific risk factors for self-injurious thoughts and behaviors in youth.

Comparison of Perceived Burdensomeness, Thwarted Belongingness, Capability for Suicide, and Suicidal Ideation among Heterosexual and Sexual Minority Individuals in Mississippi

This study sought to compare risk factors for suicidal ideation among heterosexual and sexual minority college students from a previously understudied conservative region of the United States. Suicidal ideation, thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide were examined. It was found that PB was significantly higher among sexual minorities than heterosexual individuals, TB and capability were not significantly different, and suicidal ideation was not significantly different when controlling for depression but was significant when depression was not a covariate. Additionally, among sexual minorities and heterosexuals, TB and PB were correlated with ideation and that the strength of the relationship between PB and ideation was dependent on how much TB the individual is experiencing. Sexual minorities, when compared to heterosexual individuals, do not have higher TB or capability, but do have higher levels of PB and suicidal ideation.

LGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does it Make?

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations-which provide LGBTQ-focused support and services-have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15-21; M = 18.81; n = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study

Background

Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality.

Methods

A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13–25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality.

Results

Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide.

Conclusions

Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality.

Intersectionality and Health Behaviors Among US High School Students: Examining Race/Ethnicity, Sexual Identity, and Sex

BACKGROUND

Little research exists examining the impact of multiple minority identities, particularly sexual orientation, race/ethnicity, and sex on health-risk behaviors like mental health, substance use, violence, and sexual risk among high school students in the United States. In this study, we use a nationally representative dataset to examine differences between non-Hispanic white heterosexuals (HSs) and non-Hispanic white sexual minority, black HS, black sexual minority, Hispanic HS, and Hispanic sexual minority students.

METHODS

Data from the 2015 wave of the Youth Risk Behavioral Surveillance System were used in this study. Chi-square and hierarchical logistic regression models examined differences between the groups on outcomes including: (1) mental health and suicide, (2) alcohol, tobacco, and illicit substances, (3) sexual risk and protective factors, and (4) school and physical and/or sexual violence.

RESULTS

Whereas sexual minority youth (SMY) generally demonstrate poorer health outcomes compared to HSs, SMY who are also racial/ethnic minorities often have even poorer health outcomes, particularly relating to substance use, sexual risk behaviors, physical/sexual violence, and suicide.

CONCLUSIONS

The need for culturally tailored education and school-based interventions that consider intersections between race/ethnicity, sexual identity, and biological sex are warranted to address health disparities related to mental health and suicide, substance use, sexual risk, and violence.

An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

BACKGROUND

Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential.

OBJECTIVE

The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY.

METHODS

SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol.

RESULTS

Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

CONCLUSIONS

AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13462.

Is There a Need for LGBT-Specific Suicide Crisis Services?

Abstract. Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches.

Sexual minority youth, social change, and health: A developmental collision

Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change in the space of a single generation, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people - perhaps particularly for youth - has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. In light of swift sociocultural changes, combined with emergent findings regarding the health and wellbeing of sexual minority youth, we suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility. The result is a new reality for sexual minority youth health and disparities.

Hispanic Parental Experiences of Learning a Child Identifies as a Sexual Minority

Sexual minority youth (SMY) who do not feel loved and supported by their families face greater challenges and often experience various health disparities. The coming-out process is often difficult for all SMY and their families. While there is limited research on the impact of sexual orientation disclosure on families, there is even less that focuses exclusively on Hispanic families. This qualitative study explores the impact on a sample of Hispanic parents of having a child come out as lesbian, gay, or bisexual. The results demonstrate that while coming out is often challenging for SMY and their families, these challenges may be exacerbated for Hispanics due to cultural factors that contribute to children living at home longer and negative reactions to being gay. Parental reactions, impacts of disclosure on the family, and the impact of cultural factors are discussed. This study helps illuminate how cultural factors influence the coming out experience of Hispanic parents. These findings are important for understanding the experiences of these families in order to provide culturally appropriate resources for families navigating the coming out process.

Denial of disordered eating behaviors, suicide, and non-suicidal self-injury in young women

This study assessed the unique explanatory power of denial of disordered eating in understanding non-suicidal self-injury (NSSI) and suicidality. Undergraduate women (N = 360) completed an online survey about NSSI, suicide risk, disordered eating behaviors, and denial of disordered eating. Denial of disordered eating was associated with NSSI and suicidality above and beyond engagement in disordered eating alone and demographic covariates. This study provided support that denial of disordered eating behaviors assists in understanding risk for NSSI and suicidality. Campus programing might include psychoeducation about the negative consequences of denial and emphasize the importance of disclosure to trusted confidants.

Sexual Minority Adults: A National Survey on Depression, Religious Fundamentalism, Parent Relationship Quality & Acceptance

Sexual minority persons from religious families may experience low acceptance by parents, however, little is known about the relationship of religiosity and parent relationships on mental health into adulthood. This study sought to test a moderated mediation model predicting depression based on religious fundamentalism, parent acceptance, and parent-child relationship quality. Sexual minority adult participants (n = 384) from across the U.S. completed a web-based, anonymous survey. Results found a conditional indirect effect of religious fundamentalism on depression through parent acceptance with the parent-child relationship quality moderating the relationship between parent acceptance and depression. This was significant up to age 52. Clinical implications and future research with sexual minority adults and their families are explored.

A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations

Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.

A National Survey on Depression, Internalized Homophobia, College Religiosity, and Climate of Acceptance on College Campuses for Sexual Minority Adults

Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants (n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.

Development of the Sexual Minority Adolescent Stress Inventory

Although construct measurement is critical to explanatory research and intervention efforts, rigorous measure development remains a notable challenge. For example, though the primary theoretical model for understanding health disparities among sexual minority (e.g., lesbian, gay, bisexual) adolescents is minority stress theory, nearly all published studies of this population rely on minority stress measures with poor psychometric properties and development procedures. In response, we developed the Sexual Minority Adolescent Stress Inventory (SMASI) with N = 346 diverse adolescents ages 14–17, using a comprehensive approach to de novo measure development designed to produce a measure with desirable psychometric properties. After exploratory factor analysis on 102 candidate items informed by a modified Delphi process, we applied item response theory techniques to the remaining 72 items. Discrimination and difficulty parameters and item characteristic curves were estimated overall, within each of 12 initially derived factors, and across demographic subgroups. Two items were removed for excessive discrimination and three were removed following reliability analysis. The measure demonstrated configural and scalar invariance for gender and age; a three-item factor was excluded for demonstrating substantial differences by sexual identity and race/ethnicity. The final 64-item measure comprised 11 subscales and demonstrated excellent overall (α = 0.98), subscale (α range 0.75–0.96), and test–retest (scale r > 0.99; subscale r range 0.89–0.99) reliabilities. Subscales represented a mix of proximal and distal stressors, including domains of internalized homonegativity, identity management, intersectionality, and negative expectancies (proximal) and social marginalization, family rejection, homonegative climate, homonegative communication, negative disclosure experiences, religion, and work domains (distal). Thus, the SMASI development process illustrates a method to incorporate information from multiple sources, including item response theory models, to guide item selection in building a psychometrically sound measure. We posit that similar methods can be used to improve construct measurement across all areas of psychological research, particularly in areas where a strong theoretical framework exists but existing measures are limited.

A Clinically Neglected Topic: Risk of Suicide in Transgender Individuals

INTRODUCTION

The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide.

METHODS

In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-referenced to the participants' sociodemographic characteristics, and information about their families' general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed.

RESULTS

The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21.

CONCLUSION

Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence.

Developmental Latent Patterns of Identification as Mostly Heterosexual Versus Lesbian, Gay, or Bisexual

Scant research exists on the development of mostly heterosexual identity, the largest sexual orientation minority subgroup. We used longitudinal latent class analysis to characterize the patterns of identification with lesbian, gay, bisexual (LGB), or mostly heterosexual identities from ages 12 to 23 in 13,859 youth (57% female) in a U.S. national cohort. Three classes emerged: completely heterosexual (88.2%), mostly heterosexual (9.5%), and LGB (2.4%). LGB class youth generally identified with sexual minority identities by ages 12-17. In contrast, mostly heterosexual class youth identified with sexual minority identities gradually, with steady increases in endorsement starting at the age of 14. Developmental implications of these differential patterns are discussed.

Good Gay Buddies for Lifetime: Homosexually Themed Discourse and the Construction of Heteromasculinity Among Chinese Urban Youth

Starting as an Internet meme, the homosexually themed gao-ji discourse recently became popular among Chinese urban youth in describing intimate relationships among heterosexual men. Positioned within a body of scholarship on the interplay between language, homophobia, and the construction of heteromasculinity, this article suggests that the gao-ji discourse manifests a form of male homosociality, through which new boundaries of Chinese heteromasculinity may be renegotiated. Based on qualitative interviews with college students, the article first tracks the genealogy of the gao-ji discourse in the wake of China's booming Internet culture. The main body focuses on unpacking the daily use of the gao-ji discourse, with an attention to the two latent functions it serves (i.e., expanding heteromasculine behaviors and reiterating heteromasculine identities). In conclusion, I argue that the prevalence of the gao-ji discourse mainly resolves straight men's anxieties against the background of growing public awareness of homosexuality; therefore, it cannot necessarily translate into social acceptance of homosexuality.

Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis

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.

Sexual identity development: relationship with lifetime suicidal ideation in sexual minority women

AIMS AND OBJECTIVES

This study draws on a life course perspective to evaluate in a sample of sexual minority women: (1) the relationship between age at reaching sexual identity milestones and risk of suicidal ideation, (2) developmental stages or stages of sexual identity development that represent greatest risk and (3) the relationship between age of reaching milestones and parental support.

BACKGROUND

Research shows higher rates of suicidal ideation among sexual minority women than heterosexual women. Evidence suggests this is partly accounted for by risk factors including sexual identity development and parental support. However, it remains unclear whether there are stages of particularly high risk.

DESIGN

This is a cross-sectional study. Data come from a prospective study of sexual minority women that used convenience and respondent-driven sampling methods.

METHODS

Using logistic regression, we examined associations among age at sexual identity developmental milestones, parental support and suicidal ideation in a large (N = 820), ethnically diverse sample of sexual minority women.

RESULTS

Compared with women who first wondered about their sexual identity in adulthood, those who first wondered in early, middle or late adolescence had greater odds of lifetime suicidal ideation. Younger age at subsequent milestones (first decided or first disclosed) was not associated with heightened risk of suicidal ideation. Parental support was independently associated with suicidal ideation.

CONCLUSIONS

Findings suggest that where one is in the process of identifying as a sexual minority may be more important than age in understanding risk of suicidal ideation in this population. As individuals come to accept and integrate their sexual minority identity risks associated with younger age diminish.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare providers who work with youth should routinely ask about sexual orientation and suicidal ideation and be aware that youth in the earliest stages of coming out as sexual minority may be at particularly high risk of suicide.

Who's Gay? Does It Matter?

To answer the question “Who's gay?”—and its logical follow-up, “Does it matter?”—researchers usually define homosexuality with reference to one of three components or expressions of sexual orientation: sexual/romantic attraction or arousal, sexual behavior, and sexual identity. Yet, the three components are imperfectly correlated and inconsistently predictive of each other, resulting in dissimilar conclusions regarding the number and nature of homosexual populations. Depending on which component is assessed, the prevalence rate of homosexuality in the general population ranges from 1 to 21%. When investigators define the homosexual population based on same-sex behavior or identity, they enhance the possibility of finding a biological basis for homosexuality and a compromised mental health (suicidality).

Impact of Mentors During Adolescence on Outcomes Among Gay Young Adults

Using the National Longitudinal Study of Adolescent Health and the Adolescent Health and Academic Achievement study datasets, this study examined whether natural mentoring relationships during adolescence were associated with young adult outcomes among lesbian, gay, and bisexual (LGB) persons. Outcomes in three domains were investigated: education and employment, psychological wellbeing, and substance use and abuse. Results indicated that LGB persons reporting natural mentors during adolescence were about three times as likely to graduate from high school as those without. Discussion surrounds strategies to foster mentoring relationships within the school environment or community.

Negative Treatment by Family as a Predictor of Depressive Symptoms, Life Satisfaction, Suicidality, and Tobacco/Alcohol Use in Vietnamese Sexual Minority Women

PURPOSE

Research linking family rejection and health outcomes in sexual minority people is mostly limited to North America. We assessed the associations between negative treatment by family members and depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in sexual minority women (SMW) in Viet Nam.

METHODS

Data were from an anonymous internet survey (n = 1936). Latent class analysis characterized patterns of negative treatment by family members experienced by respondents. Latent class with distal outcome modeling was used to regress depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use on family treatment class, controlling for predictors of family treatment and for two other types of sexual prejudice.

RESULTS

Five latent family treatment classes were extracted, including four negative classes representing varying patterns of negative family treatment. Overall, more than one negative class predicted lower life satisfaction, more depressive symptoms, and higher odds of attempted suicide (relative to the non-negative class), supporting the minority stress hypothesis that negative family treatment is predictive of poorer outcomes. Only the most negative class had elevated alcohol use. The association between family treatment and smoking status was not statistically significant. The most negative class, unexpectedly, did not have the highest odds of having attempted suicide, raising a question about survivor bias.

CONCLUSION

This population requires public health attention, with emphasis placed on interventions targeting the family to promote acceptance and to prevent negative treatment, and interventions supporting those SMW who encounter the worst types of negative family treatment.

(In)Visibilidade da Vivência Homoparental Feminina: entre Preconceitos e Superações

Resumo Este artigo teve como objetivo investigar a ambiguidade quanto à (in)visibilidade das vivências homoparentais femininas no cenário brasileiro: situações em que o preconceito se revela com crueldade; e, por outro lado, situações em que as mulheres superam esta discriminação e assumem as suas orientações afetivo-sexuais, bem como o projeto de ser mãe. Foram entrevistadas quatro mulheres que se assumem como lésbicas e têm filhos e a entrevista aberta foi o instrumento utilizado para colher os dados. A análise de conteúdo das entrevistas evidenciou que as famílias homoparentais chefiadas por lésbicas vivem um momento paradoxal em relação aos direitos humanos da população LGBT. Por um lado, verificam-se diversas expressões de preconceito e violência homofóbica na vida dessas mulheres; mas, por outro, também são relatadas circunstâncias em que as mulheres superaram esta discriminação e assumem as suas orientações afetivo-sexuais, bem como o projeto de ser mãe.

The Role of Social Connectedness and Sexual Orientation in the Prevention of Youth Suicide Ideation and Attempts Among Sexually Active Adolescents

The impact of types of social connectedness-family, other adult, and school-on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk of suicide ideation and attempts by sexual orientation, types of social connectedness, and their interaction. Among all youth, each type of connectedness modeled singly conferred protective effects for suicide ideation. Family and other adult connectedness protected against suicide attempts. When modeled simultaneously, family connectedness protected against ideation and attempts. Sexual orientation modified the association between other adult connectedness and suicide ideation. Findings suggest that family connectedness confers the most consistent protection among all youth and sexual orientation does not generally modify the association between connectedness and suicidal behavior.

The role of help-seeking in preventing suicide attempts among lesbians, gay men, and bisexuals

One possible approach to prevention of suicide attempts is to encourage help-seeking among individuals at risk. We assessed whether different forms of treatment were associated with lower odds of a suicide attempt in a diverse group of 388 lesbian, gay, and bisexual (LGB) adults aged 18-59, sampled from New York City venues. Of individuals who attempted suicide, 23% sought mental health or medical treatment and 14% sought religious or spiritual treatment prior to the suicide attempt. Black and Latino LGBs were underrepresented in mental health or medical treatment and Black LGBs were overrepresented in religious or spiritual treatment. Seeking mental health or medical treatment was not associated with lower odds of a suicide attempt; seeking religious or spiritual treatment was associated with higher odds of a suicide attempt. We discuss these results and posit hypotheses for further research of this understudied topic.

Sexual orientation and non-suicidal self-injury: a meta-analytic review

The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46-3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention.

Sexual orientation and risk factors for suicidal ideation and suicide attempts: a multi-centre cross-sectional study in three Asian cities

Purpose

Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China.

Methods

The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15–24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts.

Results

The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65).

Conclusions

Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities.

Sexual orientation disparities in mental health: the moderating role of educational attainment

PURPOSE

Mental health disparities between sexual minorities and heterosexuals remain inadequately understood, especially across levels of educational attainment. The purpose of the present study was to test whether education modifies the association between sexual orientation and mental disorder.

METHODS

We compared the odds of past 12-month and lifetime psychiatric disorder prevalence (any Axis-I, any mood, any anxiety, any substance use, and comorbidity) between lesbian, gay, and bisexual (LGB) and heterosexual individuals by educational attainment (those with and without a bachelor's degree), adjusting for covariates, and tested for interaction between sexual orientation and educational attainment. Data are drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of non-institutionalized US adults (N = 34,653; 577 LGB).

RESULTS

Sexual orientation disparities in mental health are smaller among those with a college education. Specifically, the disparity in those with versus those without a bachelor's degree was attenuated by 100 % for any current mood disorder, 82 % for any current Axis-I disorder, 76 % for any current anxiety disorder, and 67 % for both any current substance use disorder and any current comorbidity. Further, the interaction between sexual orientation and education was statistically significant for any current Axis-I disorder, any current mood disorder, and any current anxiety disorder. Our findings for lifetime outcomes were similar.

CONCLUSIONS

The attenuated mental health disparity at higher education levels underscores the particular risk for disorder among LGBs with less education. Future studies should consider selection versus causal factors to explain the attenuated disparity we found at higher education levels.

Experiencing Violence and Enacting Resilience: The Case Story of a Transgender Youth

Research about victimization among sexual minority youth has focused on documenting the prevalence and consequences of such experiences. Lacking in the literature is an in-depth exploration of the social context of both risk and resilience in the face of violence. This is especially true for transgender youth who are largely absent from the dominant discourse. This case story provides an example of how one transgender youth interpreted and adaptively responded to the discrimination and prejudice she encountered. Katie's story illustrates the process of resilience. Despite the adversity she has faced, she shares stories of pride and strength in a culture that considers her as "other."

Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local Youth Risk Behavior Surveys, 2001-2009

OBJECTIVES

We examined the associations between 2 measures of sexual orientation and 4 suicide risk outcomes (SROs) from pooled local Youth Risk Behavior Surveys.

METHODS

We aggregated data from 5 local Youth Risk Behavior Surveys from 2001 to 2009. We defined sexual minority youths (SMYs) by sexual identity (lesbian, gay, bisexual) and sex of sexual contacts (same- or both-sex contacts). Survey logistic regression analyses controlled for a wide range of suicide risk factors and sample design effects.

RESULTS

Compared with non-SMYs, all SMYs had increased odds of suicide ideation; bisexual youths, gay males, and both-sex contact females had greater odds of suicide planning; all SMYs, except same-sex contact males, had increased odds of suicide attempts; and lesbians, bisexuals, and both-sex contact youths had increased odds of medically serious attempts. Unsure males had increased odds of suicide ideation compared with heterosexual males. Not having sexual contact was protective of most SROs among females and of medically serious attempts among males.

CONCLUSIONS

Regardless of sexual orientation measure used, most SMY subgroups had increased odds of all SROs. However, many factors are associated with SROs.

Victimization among female and male sexual minority status groups: evidence from the British Crime Survey 2007-2010

International surveys of victims show crime rates in England and Wales, including hate crimes, are among the highest in Europe. Nevertheless, sexual minority status is a less considered risk factor in general victimization research. This study used sexual minority status and sex to predict victimization across British Crime Surveys from 2007-2010. Logistic regression analyses showed sexual minority status groups were more likely than heterosexuals to be victimized from any and some specific crimes. However, bisexuals rather than lesbians or gay men were more consistently victimized, notably by sexual attacks and within the household. Implications for understanding victimization among these groups are discussed.

Becoming the Parent of a GLB Son or Daughter

Recent research has documented the importance of parental reactions to disclosure for sexual minority youth (SMY) (e.g., Ryan, Huebner, Diaz, & Sanchez, 2009). The purpose of this study was to develop a deeper understanding of the parent perspective of the disclosure to family experience of SMY ages 14-21. In-depth interviews were conducted with eight parents in the United States who had experienced a child disclose their lesbian, gay, or bisexual (LGB) orientation to them. Constructivist grounded theory and symbolic interaction theory informed the methodology and data analysis for the project. Analysis revealed that the process of becoming the parent of an LGB son or daughter is an appropriate narrative to conceptualize the parental experience of the disclosure to family process. The findings highlight how disclosure introduces new roles into the existing family system, which affects the consideration and interpretation of the salience of particular identities, such as being the parent of an LGB son or daughter. Understanding how parents experience the disclosure to family process - particularly, how they understand and re-envision the meaning of being a parent - is crucial for research and intervention to help families become supportive of SMY. Limitations and suggestions for future research are presented.

Resilience in Lesbian, Gay, and Bisexual Individuals

To promote psychological health among lesbian, gay, and bisexual (LGB) individuals, more comprehensive research on resilience factors in LGB individuals is needed. This article presents a theoretical framework based on the existing literature, with an eye toward guiding future research in this area. Social support clearly serves as a resilience factor for LGB individuals, in part through its ability to lower reactivity to prejudice. Social support is particularly effective when it specifically supports people’s sexual orientation and is congruent with individuals’ developmental needs. The ability to accept emotions and to process them in an insightful manner also buffers the negative impact of prejudice. In addition, hope and optimism allow LGB individuals to maintain psychological health when faced with prejudice.

Sexuality and suicidality: matched-pairs analyses reveal unique characteristics in non-heterosexual suicidal behaviors

The present findings offer new perspectives on differences between suicide-risk heterosexuals and non-heterosexuals (lesbian, gay, bisexual, and questioning: LGBQ). Results from an anonymous online survey, employing standardized scales, showed that LGBQ participants reported significantly greater suicide-risk than heterosexuals. Seventy-nine matched pairs of suicide-risk LGBQ and heterosexuals were examined by individual suicide risk factors. Results showed no significant differences on separate measures of suicidal ideation; however, LGBQ participants were more likely to report suicide attempts, disclosure of suicidal intentions, and prediction of future suicide attempts. The LGBQ group also indicated greater likelihood of going online to develop new personal relationships. Multiple regression modeling was conducted to guide outreach and support efforts, revealing unique factors predicting help-seeking denial of suicide-risk LGBQ. Implications include the importance of online support and considering sexual minorities not just as a potential high-risk group, but also as a population with unique suicide risks and behaviors.