Abstract
This short-term prospective study examined general and lesbian, gay, bisexual, and transgender (LGBT)-specific risk and protective factors for suicide attempts in an ethnically diverse sample of LGBT youth (N = 237, 47.7 % male). A structured psychiatric interview assessed clinical depression and conduct disorder symptoms, as well as past and prospective suicide attempts over a 1-year follow-up period (91 % retention). Participants completed questionnaires measuring general risk factors for suicide attempts, including hopelessness, impulsiveness, and perceived social support. They also completed measures of LGBT-specific suicide risk factors, including gender nonconformity, age of first same-sex attraction, and LGBT victimization. Correlation and multivariate regression analyses were conducted to examine the relations between predictors and suicide attempt, and to identify mediators. Of nine variables examined, seven were related to lifetime history of attempted suicide: hopelessness, depression symptoms, conduct disorder symptoms, impulsivity, victimization, age of first same-sex attraction, and low family support. Depressive symptoms and hopelessness mediated the relation between multiple risk and resilience factors and suicide attempts. Suicide attempt history was the strongest predictor of prospective suicide attempts. Participants who previously attempted suicide (31.6 % of the sample) had more than 10 times greater odds of making another attempt in the 1-year follow-up period than were those who had made no previous attempt. These results highlight the need for suicide prevention programs for LGBT youth and suggest the importance of addressing depression and hopelessness as proximal determinants and family support and victimization, which have more distal effects.
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Notes
Throughout the article, the LGBT acronym is used to describe the “LGBT community” or specific study samples that included all LGBT subgroups. The LGB acronym is used for samples that included lesbian, gay, and bisexual participants but did not include or specifically identify transgender participants.
Participants self-reported their age and date of birth at baseline. Identification checks were conducted at a later wave of data collection to confirm date of birth, which resulted in the adjusted sample size.
References
Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96, 358–372.
Bolland, J. M., McCallum, D. M., Lian, B., Bailey, C. J., & Rowan, P. (2001). Hopelessness and violence among inner-city youths. Maternal and Child Health Journal, 5, 237–244.
Brent, D. (2009). In search of endophenotypes for suicidal behavior. American Journal of Psychiatry, 166, 1087–1089.
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
Canty-Mitchell, J., & Zimet, G. D. (2000). Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. American Journal of Community Psychology, 28, 391–400.
Centers for Disease Control and Prevention. (2011). Ten leading causes of death by age group. Retrieved 7 July 2011, from www.cdc.gov/injury/wisqars/index.html.
D’Augelli, A. R. (2002). Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry, 7, 433–456.
D’Augelli, A. R., Grossman, A. H., Salter, N. P., Vasey, J. J., Starks, M. T., & Sinclair, K. O. (2005). Predicting the suicide attempts of lesbian, gay, and bisexual youth. Suicide and Life-Threatening Behavior, 35, 646–660.
D’Augelli, A. R., & Hershberger, S. L. (1993). Lesbian, gay, and bisexual youth in community settings: Personal challenges and mental health problems. American Journal of Community Psychology, 21, 421–448.
D’Augelli, A. R., Hershberger, S. L., & Pilkington, N. W. (1998). Lesbian, gay, and bisexual youth and their families: Disclosure of sexual orientation and its consequences. American Journal of Orthopsychiatry, 68, 361–371.
Dervic, K., Brent, D. A., & Oquendo, M. A. (2008). Completed suicide in childhood. Psychiatric Clinics of North America, 31, 271–291.
Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Langstrom, N., & Landen, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6, ArtID: e16885.
Dunn, L. B., & Jeste, D. V. (2001). Enhancing informed consent for research and treatment. Neuropsychopharmacology, 24, 595–607.
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.
Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Sexual orientation and mental health in a birth cohort of young adults. Psychological Medicine, 35, 971–981.
Fitzpatrick, K. K., Euton, S. J., Jones, J. N., & Schmidt, N. B. (2005). Gender role, sexual orientation and suicide risk. Journal of Affective Disorders, 87, 35–42.
Friedman, M. S., Koeske, G. F., Silvestre, A. J., Korr, W. S., & Sites, E. W. (2006). The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. Journal of Adolescent Health, 38, 621–623.
Galfalvy, H., Oquendo, M. A., Carballo, J. J., Sher, L., Grunebaum, M. F., Burke, A., et al. (2006). Clinical predictors of suicidal acts after major depression in bipolar disorder: A prospective study. Bipolar Disorders, 8, 586–595.
Goldsmith, S. K., & Institute of Medicine (U.S.) Committee on Pathophysiology & Prevention of Adolescent & Adult Suicide. (2002). Reducing suicide: A national imperative. Washington, DC: National Academies Press.
Goldston, D. B., Sergent Daniel, S., Reboussin, D. M., Reboussin, B. A., Frazier, P. H., & Kelley, A. E. (1999). Suicide attempts among formerly hospitalized adolescents: A prospective naturalistic study of risk during the first 5 years after discharge. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 660–671.
Grossman, A. H., & D’Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37, 527–537.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., … Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58, 10–51.
Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730.
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen-Hoeksema, S. (2008). Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry, 49, 1270–1278.
Hockenberry, S. L., & Billingham, R. E. (1987). Sexual orientation and boyhood gender conformity: Development of the Boyhood Gender Conformity Scale (BGCS). Archives of Sexual Behavior, 16, 475–492.
Janis, I. B., & Nock, M. K. (2009). Are self-injurers impulsive?: Results from two behavioral laboratory studies. Psychiatry Research, 169, 261–267.
Joiner, T. E., Brown, J. S., & Wingate, L. R. (2005). The psychology and neurobiology of suicidal behavior. Annual Review of Psychology, 56, 287–314.
Kann, L., Olsen, E. O., McManus, T., Kinchen, S., Chyen, D., Harris, W. A., et al. (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9–12-youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR Surveillance Summaries, 60, 1–133.
Kazdin, A. E., French, N. H., Unis, A. S., Esveldt-Dawson, K., & Sherick, R. B. (1983). Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children. Journal of Consulting and Clinical Psychology, 51, 504–510.
Kazdin, A. E., Rodgers, A., & Colbus, D. (1986). The Hopelessness Scale for Children: Psychometric characteristics and concurrent validity. Journal of Consulting and Clinical Psychology, 54, 241–245.
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., et al. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70.
Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology, 62, 297–305.
Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42, 221–228.
MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614.
MacKinnon, D. P., & Fritz, M. S. (2007). Distribution of the product confidence limits for the indirect effect: Program PRODCLIN. Behavior Research Methods, 39, 384–389.
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., … Hendin, H. (2005). Suicide prevention strategies: A systematic review. Journal of the American Medical Association, 294, 2064–2074.
Mathy, R. M. (2002). Transgender identity and suicidality in a nonclinical sample: Sexual orientation, psychiatric history, and compulsive behaviors. Journal of Psychology & Human Sexuality, 14, 47–65.
McDaniel, J. S., Purcell, D., & D’Augelli, A. R. (2001). The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life-Threatening Behavior, 31, 84–105.
Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56, 23–31.
Moser, D. J., Schultz, S. K., Arndt, S., Benjamin, M. L., Fleming, F. W., Brems, C. S., … Andreasen, N. C. (2002). Capacity to provide informed consent for participation in schizophrenia and HIV research. American Journal of Psychiatry, 159, 1201–1207.
Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40, 673–686.
Mustanski, B. S., Garofalo, R., & Emerson, E. M. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health, 100, 2426–2432.
Mustanski, B., Newcomb, M., & Garofalo, R. (2011). Mental health of lesbian, gay, and bisexual youth: A developmental resiliency perspective. Journal of Gay & Lesbian Social Services, 23, 204–225.
Parker, I. (2012). The story of a suicide. The New Yorker, 87, 36–51.
Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness scale. Journal of Clinical Psychology, 51, 768–774.
Phillips, G., & Over, R. (1995). Differences between heterosexual, bisexual, and lesbian women in recalled childhood experiences. Archives of Sexual Behavior, 24, 1–20.
Plöderl, M., & Fartacek, R. (2005). Suicidality and associated risk factors among lesbian, gay, and bisexual compared to heterosexual Austrian adults. Suicide and Life-Threatening Behavior, 35, 661–670.
Plöderl, M., & Fartacek, R. (2009). Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians. Archives of Sexual Behavior, 38, 400–410.
Remafedi, G., Farrow, J. A., & Deisher, R. W. (1991). Risk factors for attempted suicide in gay and bisexual youth. Pediatrics, 87, 869–875.
Renaud, J., Berlim, M. T., Begolli, M., McGirr, A., & Turecki, G. (2010). Sexual orientation and gender identity in youth suicide victims: An exploratory study. Canadian Journal of Psychiatry, 55, 29–34.
Rich, C. L., Fowler, R. C., Young, D., & Blenkush, M. (1986). San Diego suicide study: Comparison of gay to straight males. Suicide and Life-Threatening Behavior, 16, 448–457.
Rosario, M., Schrimshaw, E. W., & Hunter, J. (2005). Psychological distress following suicidality among gay, lesbian, and bisexual youths: Role of social relationships. Journal of Youth and Adolescence, 34, 149–161.
Rotheram-Borus, M. J., Hunter, J., & Rosario, M. (1994). Suicidal behavior and gay-related stress among gay and bisexual male adolescents. Journal of Adolescent Research, 9, 498–508.
Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276–1281.
Russell, S. T., & Toomey, R. B. (2012). Men’s sexual orientation and suicide: Evidence for U.S. adolescent-specific risk. Social Science and Medicine, 74, 523–529.
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, 859–866.
Savin-Williams, R. C. (2001a). A critique of research on sexual-minority youths. Journal of Adolescence, 24, 5–13.
Savin-Williams, R. C. (2001b). Suicide attempts among sexual-minority youths: Population and measurement issues. Journal of Consulting and Clinical Psychology, 69, 983–991.
Schneider, S. G., Farberow, N. L., & Kruks, G. N. (1989). Suicidal behavior in adolescent and young adult gay men. Suicide and Life-Threatening Behavior, 19, 381–394.
Schrimshaw, E., Rosario, M., Meyer-Bahlburg, H., & Scharf-Matlick, A. (2006). Test–retest reliability of self-reported sexual behavior, sexual orientation, and psychosexual milestones among gay, lesbian, and bisexual youths. Archives of Sexual Behavior, 35, 220–229.
Seiffge-Krenke, I., Aunola, K., & Nurmi, J. E. (2009). Changes in stress perception and coping during adolescence: The role of situational and personal factors. Child Development, 80, 259–279.
Shaffer, D., Fisher, P., Hicks, R. H., Parides, M., & Gould, M. (1995). Sexual orientation in adolescents who commit suicide. Suicide and Life-Threatening Behavior, 25, 64–71.
Shaffer, D., Fisher, P., & Lucas, C. (2004). The Diagnostic Interview Schedule for Children (DISC). In M. Hersen (Ed.), Comprehensive handbook of psychological assessment, Vol. 2: Personality assessment (pp. 256–270). Hoboken, NJ: Wiley.
Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., et al. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339–348.
Spirito, A., & Esposito-Smythers, C. (2006). Attempted and completed suicide in adolescence. Annual Review of Clinical Psychology, 2, 237–266.
Stanford, M. S., Mathias, C. W., Dougherty, D. M., Lake, S. L., Anderson, N. E., & Patton, J. H. (2009). Fifty years of the Barratt Impulsiveness Scale: An update and review. Personality and Individual Differences, 47, 385–395.
UCSD Task Force on Decisional Capacity. (2003). Procedures for determination of decisional capacity in persons participating in research protocols. Retrieved 8 January 2006, from http://irb.ucsd.edu/decisional.shtml.
U.S. Public Health Service. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.
van Heeringen, C., & Vincke, J. (2000). Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 35, 494–499.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600.
Wenzel, A. E., & Beck, A. T. (2008). A cognitive model of suicidal behavior: Theory and treatment. Applied and Preventive Psychology, 12, 189–201.
Wichstrom, L., & Hegna, K. (2003). Sexual orientation and suicide attempt: A longitudinal study of the general Norwegian adolescent population. Journal of Abnormal Psychology, 112, 144–151.
Xavier, J. M., Bobbin, M., Singer, B., & Budd, E. (2005). Needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8, 31–47.
Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55, 610–617.
Acknowledgments
This research was funded in part by grants from the American Foundation for Suicide Prevention and the William T. Grant Foundation. We gratefully acknowledge the consultation of Drs. Ritch Savin-Williams and Rob Garofalo on the design of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders or consultants.
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Mustanski, B., Liu, R.T. A Longitudinal Study of Predictors of Suicide Attempts Among Lesbian, Gay, Bisexual, and Transgender Youth. Arch Sex Behav 42, 437–448 (2013). https://doi.org/10.1007/s10508-012-0013-9
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DOI: https://doi.org/10.1007/s10508-012-0013-9