Abstract
Transgender and gender diverse (TGD) youth experience chronic and acute stress associated with their gender identity contributing to their increased risk of suicide and suicide ideation (SI) compared to non-TGD peers. This study examined how invalidating and accepting gender-related experiences with a parent impact SI severity among TGD adolescents cross-sectionally and longitudinally, within-person. Participants were 15 TGD adolescents with past month SI recruited across community and clinical settings. Adolescents completed a baseline assessment of validated interviews and self-report measures on parental invalidation and SI severity. Over a 14-day follow-up period, adolescents reported instances of parental gender invalidation and acceptance, relative stress of those experiences, and SI severity multiple times/day via ecological momentary assessment (EMA). Bivariate associations of parental invalidation and acceptance with SI were examined at baseline, while multilevel models examined the relationship within-person over follow-up. Cross-sectionally, greater perceived invalidation and non-affirmation by their parents was associated with more severe SI. Over the follow up, instances of perceived parental invalidation were associated with passive SI within-person. Findings partially support the minority stress theory and social safety perspective by showing that perceived gender-invalidation from parents affects SI in TGD adolescents, both cross-sectionally and longitudinally. Further research is needed to identify specific emotional and cognitive factors, such as perceived stress, that contribute to the risk of SI among TGD youth and inform the development of targeted interventions for this vulnerable population.
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Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author, E. C. E.. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
Notes
This decision was made to increase the likelihood of capturing the dynamic interpersonal processes (e.g., parent support) influencing SI over the follow-up period and to ensure a foundational parent-adolescent relationship, while minimizing sample bias against non-traditional family structures (e.g., joint custody arrangements).
Percentage based on n = 14; one parent selected “Prefer not to say” in response to annual household income query.
If an adolescent failed to respond to 50% or more SCs within-day, one-to-two additional SC surveys were scheduled for either later that same day (if availability permitted) or the following day to support compliance.
Though adolescents were not explicitly asked to report their medications, they were asked about illicit substance use, including any non-prescribed medication, during their risk assessment. None of the enrolled adolescents reported non-prescribed gender-affirming hormone replacement therapy.
Two items were imputed across two separate adolescents: one item from the SIQ and one item from the PAGES-Y. Bivariate analyses yielded a similar pattern of results and significance when run on complete-only data.
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The authors would like to thank the adolescents and their families who volunteered to participate in this research. Without their honesty, vulnerability, and commitment, this project would not have been possible. The authors would also like to thank research assistants Emily Han and Maya Patel for their work on this project, including recruitment efforts, data collection and management, and supporting the safety of participating families.
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This research was supported in part by an American Psychological Foundation 2019 Visionary Grant awarded to Erika C. Esposito.
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Esposito, E.C., Ellerkamp, H., Eisenberg, A.M. et al. Suicide Ideation Among Transgender and Gender Diverse Adolescents: The Role of Parental Invalidation of Adolescents’ Gender Identity. Res Child Adolesc Psychopathol (2024). https://doi.org/10.1007/s10802-024-01203-y
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DOI: https://doi.org/10.1007/s10802-024-01203-y