Minority Sexual Orientation, Gender Identity Status and Suicidal Behavior: Serial Indirect Effects of Hope, Hopelessness and Depressive Symptoms

  • Jameson K. Hirsch
  • Tracy J. Cohn
  • Catherine A. Rowe
  • Sarah E. Rimmer
Original Article


Death by suicide, and suicidal behaviors, are a significant public mental health problem, and individuals who are lesbian, gay, bisexual, transgendered and questioning (LGBTQ), may be at increased risk. Potential underlying mechanisms of this association are unknown, but may involve the impact of LGBTQ status on future orientation and mood. Our purpose was to determine the influence of sexual identity, sequentially, on cognitive and emotional functioning, and consequent relation to suicidal behavior. In a sample of 349 college students, we used serial mediation models to investigate the relation between self-identification as LGBTQ and suicidal behavior, with hope and hopelessness as first-order mediators and depression as a second order mediator. Supporting hypotheses, we found that LGBTQ status was related to less hope and greater hopelessness and, in serial fashion, to depressive symptoms and consequent suicidal behavior. Our findings may have clinical implications. Resolution of hopelessness and depression, and promotion of hopefulness, perhaps via Motivational Interviewing and Cognitive Behavioral Therapy strategies, such as goal-setting, may reduce suicidal risk in LGBTQ young adults.


Sexual minority Gender identity Trait hope Depression Suicidal behavior College students LGBTQ 


Compliance with Ethical Standards

Conflict of Interest

All authors report no conflicts of interest.


  1. Alessi, E. J. (2014). A framework for incorporating minority stress theory into treatment with sexual minority clients. Journal of Gay & Lesbian Mental Health, 18(1), 47–66. doi: 10.1080/19359705.2013.789811.CrossRefGoogle Scholar
  2. Anestis, M. D., Moberg, F. B., & Arnau, R. C. (2014). Hope and the interpersonal-psychological theory of suicidal behavior: replication and extension of prior findings. Suicide and Life-threatening Behavior, 44(2), 175–187. doi: 10.1111/sltb.12060.CrossRefPubMedGoogle Scholar
  3. Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324–333.CrossRefPubMedGoogle Scholar
  4. Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. The American Journal of Psychiatry, 142(5), 559–563.CrossRefPubMedGoogle Scholar
  5. Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100. doi: 10.1016/0272-7358(88)90050-5.CrossRefGoogle Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation.Google Scholar
  7. Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865.Google Scholar
  8. Beitman, B. D. (1987). The structure of individual psychotherapy. New York: Guilford Press.Google Scholar
  9. Casey, C. M. (2013). A positive psychology intervention for building hope: a case approach. Dissertation Abstracts International: Section B: The Sciences and Engineering, 73(10-B(E)). (UMI No. AAI3509730).Google Scholar
  10. Centers for Disease Control and Prevention (2009). Suicide and self inflicted injuries. Retrieved from http://www.cdc.gov/nchs/fastats/suicide.htm.
  11. Chakraborty, A., McManus, S., Brugha, T. S., Bebbington, P., & King, M. (2011). Mental health of the non-heterosexual population of England. The British Journal of Psychiatry, 198, 143–148. doi: 10.1192/bjp.bp.110.082271.CrossRefPubMedGoogle Scholar
  12. Chang, E. C., Sanna, L. J., Hirsch, J. K., & Jeglic, E. L. (2010). Loneliness and negative life events as predictors of hopelessness and suicidal behaviors in Hispanics: evidence for a diathesis-stress model. Journal of Clinical Psychology, 66(12), 1242–1253. doi: 10.1002/jclp.20721.CrossRefPubMedGoogle Scholar
  13. Cohn, T. J., & Leake, V. S. (2012). Affective distress among adolescents who endorse same-sex sexual attraction: urban versus rural differences and the role of protective factors. Journal of Gay & Lesbian Mental Health, 16(4), 291–305. doi: 10.1080/19359705.2012.690931.CrossRefGoogle Scholar
  14. Craig, S. L., & McInroy, L. (2013). The relationship of cumulative stressors, chronic illness and abuse to the self-reported suicide risk of black and Hispanic sexual minority youth. Journal of Community Psychology, 41(7), 783–798. doi: 10.1002/jcop.21570.CrossRefGoogle Scholar
  15. Daniel, S. S., & Goldston, D. B. (2012). Hopelessness and lack of connectedness to others as risk factors for suicidal behavior across the lifespan: implications for cognitive-behavioral treatment. Cognitive and Behavioral Practice, 19(2), 288–300. doi: 10.1016/j.cbpra.2011.05.003.CrossRefGoogle Scholar
  16. Duggleby, W. D., Degner, L., Williams, A., Wright, K., Cooper, D., Popkin, D., & Holtslander, L. (2007). Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. Journal of Pain and Symptom Management, 33(3), 247–257. doi: 10.1016/j.jpainsymman.2006.09.013.CrossRefPubMedGoogle Scholar
  17. Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880. doi: 10.1001/archpsyc.56.10.876.CrossRefPubMedGoogle Scholar
  18. Grewal, P. K., & Porter, J. E. (2007). Hope theory: a framework for understanding suicidal action. Death Studies, 31(2), 131–154. doi: 10.1080/07481180601100491.CrossRefPubMedGoogle Scholar
  19. Gutierrez, P. M., Osman, A., Barrios, A. X., & Kopper, B. A. (2001). Development and Initial Validation of the Self-Harm Behavior Questionnaire. Journal of Personality Assessment, 77(3), 475–490.Google Scholar
  20. Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from http://www.afhayes.com/public/process2012.pdf
  21. Heintzelman, S. J., & King, L. A. (2014). Life is pretty meaningful. American Psychologist, 69(6), 561–574. doi: 10.1037/a0035049.CrossRefPubMedGoogle Scholar
  22. Irwin, J. A., Coleman, J. D., Fisher, C. M., & Marasco, V. M. (2014). Correlates of suicide ideation among LGBT Nebraskans. Journal of Homosexuality, 61, 1172–1191. doi: 10.1080/00918369.2014.872521.CrossRefPubMedGoogle Scholar
  23. Kisch, J., Leino, V., & Silverman, M. M. (2005). Aspects of suicidal behavior, depression, and treatment in college students: results from the spring 2000 National College Health Assessment Survey. Suicide and Life-threatening Behavior, 35(1), 3–13. doi: 10.1521/suli. Scholar
  24. Kwon, P., & Hugelshofer, D. S. (2010). The protective role of hope for lesbian, gay, and bisexual individuals facing a hostile workplace climate. Journal of Gay & Lesbian Mental Health, 14(1), 3–18.CrossRefGoogle Scholar
  25. Lamis, D. A., & Malone, P. S. (2011). Alcohol-related problems and risk of suicide among college students: the mediating roles of belongingness and burdensomeness. Suicide and Life-threatening Behavior, 41(5), 543–553. doi: 10.1111/j.1943-278X.2011.00052.x.CrossRefPubMedPubMedCentralGoogle Scholar
  26. LeVassseur, M. T., Kelvin, E. A., & Grosskopf, N. A. (2013). 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. American Journal of Public Health, 103(6), 1082–1089. doi: 10.2105/AJPH.2012.300994.CrossRefGoogle Scholar
  27. Linehan, M. M., & Nielsen, S. L. (1981).  Assessment of suicide ideation and parasuicide: Hopelessness and social desirability. Journal of Consulting and Clinical Psychology, 49(5), 773-775.Google Scholar
  28. Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42(3), 221–228. doi: 10.1016/j.amepre.2011.10.023.CrossRefPubMedGoogle Scholar
  29. Rojas, S. M., Leen-Feldner, E. W., Blumenthal, H., Lewis, S. F., & Feldner, M. T. (2014). Risk for suicide among treatment seeking adolescents: the role of positive and negative affect intensity. Cognitive Therapy and Research. doi: 10.1007/s10608-014-9650-8.Google Scholar
  30. Safren, S. A., & Heimberg, R. G. (1999) Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents.. Journal of Consulting and Clinical Psychology, 67(6), 859–866.Google Scholar
  31. Savin-Williams, R. C., & Ream, G. L. (2003). Suicide attempts among sexual-minority male youth. Journal of Clinical Child and Adolescent Psychology, 32(4), 509–522. doi: 10.1207/S15374424JCCP3204_3.CrossRefPubMedGoogle Scholar
  32. Scourfield, J., Roen, K., & McDermott, L. (2008). Lesbian, gay, bisexual, and transgender young people’s experiences of distress: resilience, ambivalence, and self-destructive behaviors. Health and Social Care in the Community, 16(3), 329–336. doi: 10.1111/j.1365-2524.2008.00769.x.CrossRefPubMedGoogle Scholar
  33. Snyder, C. R. (1994). The psychology of hope: you can get there from here. New York: Free Press.Google Scholar
  34. Snyder, C. R. (1995). Conceptualizing, measuring, and nurturing hope. Journal of Counseling & Development, 73, 355–360.CrossRefGoogle Scholar
  35. Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., et al. (1991). The will and the ways: development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585. doi: 10.1037/0022-3514.60.4.570.CrossRefPubMedGoogle Scholar
  36. Snyder, C. R., LaPointe, A. B., Crowson Jr., J. J., & Early, S. (1998). Preferences of high- and low-hope people for self-referential input. Cognition and Emotion, 12(6), 807–823. doi: 10.1080/026999398379448.CrossRefGoogle Scholar
  37. Steen, J. H. (2004). Measuring the efficacy of the Snyder hope theory as an intervention with an inpatient population (C. Richard Snyder). Dissertation Abstracts International Section A: Humanities and Social Sciences, 65(6-A), 2103. (UMI No. AAI3136238).Google Scholar
  38. Stone, D., Luo, F., Ouyang, L., Lippy, C., Hertz, M. F., & Crosby, A. E. (2014). Sexual orientation and suicide ideation, plans, attempts, and medically serious attempts: evidence from local youth risk behavior surveys, 2001-2009. American Journal of Public Health, 104(2), 262–271. doi: 10.2105/AJPH.2013.301383.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Troister, T., & Holden, R. R. (2010). Comparing psychache, depression, and hopelessness in their associations with suicidality: a test of Shneidman’s theory of suicide. Personality and Individual Differences, 49(7), 689–693. doi: 10.1016/j.paid.2010.06.006.CrossRefGoogle Scholar
  40. Valle, M. F., Huebner, E. S., & Suldo, S. M. (2006). An analysis of hope as a psychological strength. Journal of School Psychology, 44(5), 393–406. doi: 10.1016/j.jsp.2006.03.005.CrossRefGoogle Scholar
  41. Vincent, P. J., Boddana, P., & MacLeod, A. K. (2004). Positive life goals and plans in parasuicide. Clinical Psychology & Psychotherapy, 11, 90–99.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jameson K. Hirsch
    • 1
  • Tracy J. Cohn
    • 2
  • Catherine A. Rowe
    • 1
  • Sarah E. Rimmer
    • 2
  1. 1.Department of PsychologyEast Tennessee State UniversityJohnson CityUSA
  2. 2.Department of PsychologyRadford UniversityRadfordUSA

Personalised recommendations