Abstract
Objectives
Suicide is a leading causes of death for adolescents, and is a developmental period with the highest rates of suicide attempts. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are a high-risk population for suicidal ideations and behaviors when compared with their non-LGBTQ counterparts. However, a dearth of research exists on the protective factors for suicidal ideation and attempts specifically within the LGBTQ population. The current study proposes a model in which peer victimization, drug use, depressive symptoms, and help-seeking beliefs predict suicidal ideation and attempts among a statewide sample of LGBTQ adolescents.
Methods
Among 4867 high school students in 20 schools, 713 self-identified as LGBTQ and had higher rates of attempts and ideation than their non-LBGTQ peers. Two logistic regression analyses were used to predict suicidal ideation and attempts among the 713 LGBTQ students (M = age 15 years).
Results
Results indicated that intentions to use drugs, peer victimization, and elevated depressive symptoms predicted both suicidal ideation and attempts. Additionally, help-seeking beliefs predicted suicidal attempts but not ideation, while the interaction of help-seeking beliefs and depressive symptoms significantly predicted suicidal ideation.
Conclusions
These findings underscore the importance of increasing access to effective treatment services for depression and promoting safe and accepting school and community cultures for LGBTQ youth in particular.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5(4), 237–249.
Angold, A., Erkanli, A., Costello, E. J., & Rutter, M. (1996). Precision, reliability and accuracy in the dating of symptom onsets in child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 37(6), 657–64. https://doi.org/10.1111/j.1469-7610.1996.tb01457.x.
Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 688–696. https://doi.org/10.1037/a003899.
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38(7), 989–1000. https://doi.org/10.1007/s10964-008-9389-1.
Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100. https://doi.org/10.1176/appi.ajp.2016.15070854.
Brent, D. A., Baugher, M., Bridge, J., Chen, T., & Chiapetta, L. (1999). Age- and sex-related risk factors for adolescent suicide. Journal of American Academy of Child and Adolescent Psychiatry, 38(12), 1497–1505. https://doi.org/10.1097/00004583-199912000-00010.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior. Current Opinion in Pediatrics, 21, 613–619. https://doi.org/10.1097/MOP.0b013e32833063e1.
Catalano, R. F., Kosterman, R., Hawkins, J. D., Newcomb, M. D., & Abbott, R. D. (1996). Modeling the etiology of adolescent substance use: a test of the social development model. Journal of Drug Issues, 26(2), 429–455. https://doi.org/10.1177/002204269602600207.
Centers for Disease Control and Prevention. (2016). Web-based Injury Statistics Query and Reporting System (WISQARS). US Department of Health and Human Services, National Center for Injury Prevention and Control. https://www.cdc.gov/injury/wisqars/index.html. Accessed 12 Sept 2018.
Centers for Disease Control and Prevention. (2017) Youth Risk Behavior Survey—Data Summary & Trends Report: 2007–2017. Youth Risk Behavior Survey. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf. Accessed 12 September 2018.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129.
Dawson, D. A., Grant, B. F., & Ruan, W. J. (2005). The association between stress and drinking: modifying effects of gender and vulnerability. Alcohol and Alcoholism, 40(5), 453–460. https://doi.org/10.1093/alcalc/agh176.
Doty, N. D., Willoughby, B. L., Lindahl, K. M., & Malik, N. M. (2010). Sexuality related social support among lesbian, gay, and bisexual youth. Journal of Youth and Adolescence, 39(10), 1134–1147. https://doi.org/10.1007/s10964-010-9566-x.
Duong, J., & Bradshaw, C. (2014). Associations between bullying and engaging in aggressive and suicidal behaviors among sexual minority youth: the moderating role of connectedness. Journal of School Health, 84(10), 636–645. https://doi.org/10.1111/josh.12196.
Durkheim, E. (1951). Suicide: A study in sociology. New York: Free Press.
Eisenberg, M. E., McMorris, B. J., Gower, A. L., & Chatterjee, D. (2016). Bullying victimization and emotional distress: is there strength in numbers for vulnerable youth? Journal of Psychosomatic Research, 86, 13–19. https://doi.org/10.1016/j.jpsychores.2016.04.007.
Espelage, D. L., & Holt, M. K. (2001). Bullying and victimization during early adolescence: peer influences and psychosocial correlates. Journal of Emotional Abuse, 2(2–3), 123–142. https://doi.org/10.1300/J135v02n02_08.
Fergusson, D. M., Swain-Campbell, N. R., & Horwood, L. J. (2002). Deviant peer affiliations, crime and substance use: a fixed effects regression analysis. Journal of Abnormal Child Psychology, 30(4), 419–430.
Garofalo, R., Wolf, R. C., Wissow, L. S., Woods, E. R., & Goodman, E. (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatrics & Adolescent Medicine, 153(5), 487–493. https://doi.org/10.1001/archpedi.153.5.487.
Goldbach, J. T., & Gibbs, J. (2015). Strategies employed by sexual minority adolescents to cope with minority stress. Psychology of Sexual Orientation and Gender Diversity, 2(3), 297–306. https://doi.org/10.1037/sgd0000124.
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority stress and substance use in sexual minority adolescents: a meta-analysis. Prevention Science, 15(3), 350–363. https://doi.org/10.1007/s11121-013-0393-7.
Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M. & Bunney, W. E. (2002). Reducing Suicide: A National Imperative. Washington, DC: National Academy Press.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., & Russell, S. T. (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of Homosexuality, 58(1), 10–51. https://doi.org/10.1080/00918369.2011.534038.
Hatchel, T., Merrin, G. J., & Espelage, A. D. (2018). Peer victimization and suicidality among LGBTQ youth: the roles of school belonging, self-compassion, and parental support. Journal of LGBT Youth. https://doi.org/10.1080/19361653.2018.1543036.
Hatchel, T., Subrahmanyam, K., & Negriff, S. (2018). Adolescent peer victimization and internalizing symptoms during emerging adulthood: the role of online and offline social support. Journal of Child and Family Studies, 1–11. https://doi.org/10.1007/s10826-018-1286-y.
Hatzenbuehler, M. L. (2009). How does sexual minority stigma “Get Under the Skin”? A psychological mediation framework. Psychological Bulletin, 135(5), 707–730. https://doi.org/10.1037/a0016441.
Hilton, A. N., & Szymanski, D. M. (2011). Family dynamics and changes in sibling of origin relationship after lesbian and gay sexual orientation disclosure. Contemporary Family Therapy: An International Journal, 33(3), 291–309. https://doi.org/10.1007/s10591-011-9157-3.
Huebner, D. M., Thoma, B. C., & Neilands, T. B. (2015). School victimization and substance use among lesbian, gay, bisexual, and transgender adolescents. Prevention Science, 16(5), 734–743. https://doi.org/10.1007/s11121-014-0507-x.
Joiner, T. E. (2005). Why people die by suicide. Cambridge: Harvard University Press.
Joiner, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. D. (2009). Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118(3), 634–646. https://doi.org/10.1037/a0016500.
Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal self-injury, suicidal behavior, and their co-occurrence as viewed through the lens of the interpersonal theory of suicide. Current Directions in Psychological Science, 21(5), 342–347. https://doi.org/10.1177/0963721412454873.
Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617–626. https://doi.org/10.1001/archpsyc.56.7.617.
Klonsky, E. D., & May, A. M. (2010). Rethinking impulsivity in suicide. Suicide and Life-Threatening Behavior, 40, 612–619. https://doi.org/10.1521/suli.2010.40.6.612.
Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide and Life-Threatening Behavior, 44(1), 1–5. https://doi.org/10.1111/sltb.12068.
Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114.
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12, 307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204.
Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN.
Kosciw, J. G., Greytak, E. A., Giga, N. M., Villenas, C., & Danischewski, D. (2016). The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender and queer youth in our nation’s schools. New York: GLSEN.
Kovacs, M., Goldston, D., & Gatsonis, C. (1993). Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. Journal of American Academy of Child and Adolescent Psychiatry, 32(1), 8–20. https://doi.org/10.1097/00004583-199301000-00003.
Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 43(8), 1571–1578. https://doi.org/10.1007/s10508-014-0266-6.
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548. https://doi.org/10.1177/1745691613497965.
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. https://doi.org/10.1016/j.amepre.2011.10.023.
Livingston, N. A., Heck, N. C., Flentje, A., Gleason, H., Oost, K. M., & Cochran, B. N. (2015). Sexual minority stress and suicide risk: identifying resilience through personality profile analysis. Psychology of Sexual Orientation and Gender Diversity, 2(3), 321 https://doi.org/10.1037/sgd0000116.
LoMurray, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck: The North Dakota Suicide Prevention Project.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: a critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164.
Maddox, S. J., & Prinz, R. J. (2003). School bonding in children and adolescents: conceptualization, assessment, and associated variables. Clinical Child and Family Psychology Review, 6(1), 31–49.
McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952. https://doi.org/10.2105/AJPH.2009.163147.
McDermott, E. (2015). Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the ‘failed’self. Health, 19(6), 561–577. https://doi.org/10.1177/1363459314557967.
McDermott, E., Hughes, E., & Rawlings, V. (2017). The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study. Journal of Public Health. https://doi.org/10.1093/pubmed/fdx135.
McDermott, E., & Roen, K. (2016). Queer youth, suicide and self-harm: troubled subjects, troubling norms. Basingstoke: Palgrave Macmillan.
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674.
Mustanski, B., Andrews, R., & Puckett, J. A. (2016). The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. American Journal of Public Health, 106(3), 527–533. https://doi.org/10.2105/AJPH.2015.302976.
Newcomb, M. E., & Mustanski, B. (2016). Developmental change in the effects of sexual partner and relationship characteristics on sexual risk behavior in young men who have sex with men. AIDS and Behavior, 20(6), 1284–1294. https://doi.org/10.1007/s10461-015-1046-6.
Nock, M. K., & Kazdin, A. E. (2002). Examination of affective, cognitive, and behavioral factors and suicide-related outcomes in children and young adolescents. Journal of Clinical Child and Abnormal Psychology, 31, 48–58. https://doi.org/10.1207/S15374424JCCP3101_07.
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., & Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192, 98–105. https://doi.org/10.1192/bjp.bp.107.040113.
O’Brien, K. H. M., Becker, S. J., Spirito, A., Simon, V., & Prinstein, M. J. (2014). Differentiating adolescent suicide attempters from ideators: examining the interaction between depression severity and alcohol use. Suicide & Life-Threatening Behavior, 44(1), 23 https://doi.org/10.1111/sltb.12050.
Oswald, R. F. (1999). Family and friendship relationships after young women come out as bisexual or lesbian. Journal of Homosexuality, 38(3), 65–83. https://doi.org/10.1300/J082v38n03_04.
Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., & Wyman, P. A. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence, 41(10), 1312–1324. https://doi.org/10.1007/s10964-012-9766-7.
Poteat, V. P., Sinclair, K. O., DiGiovanni, C. D., Koenig, B. W., & Russell, S. T. (2013). Gay–straight alliances are associated with student health: a multischool comparison of LGBTQ and heterosexual youth. Journal of Research on Adolescence, 23(2), 319–330. https://doi.org/10.1111/j.1532-7795.2012.00832.x.
Robinson, J. P., & Espelage, D. L. (2011). Inequities in educational and psychological outcomes between LGBTQ and straight students in middle and high school. Educational Researcher, 40(7), 315–330. https://doi.org/10.3102/0013189X11422112.
Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J. (2011). Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. Journal of School Health, 81(5), 223–230. https://doi.org/10.1111/j.1746-1561.2011.00583.x.
Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1–10. https://doi.org/10.1037/a0018082.
Schmeelk‐Cone, K., Pisani, A. R., Petrova, M., & Wyman, P. A. (2012). Three scales assessing high school students’ attitudes and perceived norms about seeking adult help for distress and suicide concerns. Suicide and Life‐Threatening Behavior, 42(2), 157–172. https://doi.org/10.1111/j.1943-278X.2011.00079.x.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Lanham, MD: Jason Aronson.
Szymanski, D. M., Kashubeck-West, S., & Meyer, J. (2008). Internalized heterosexism: a historical and theoretical overview. The Counseling Psychologist, 36(4), 510–524. https://doi.org/10.1177/0011000007309488.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Boston, MA: Allyn & Bacon/Pearson Education.
Taliaferro, L. A., & Muehlenkamp, J. J. (2014). Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year. Suicide and Life-Threatening Behavior, 44(1), 6–22. https://doi.org/10.1111/sltb.12046.
U.S. Surgeon General. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville: U.S. Dept. of Health and Human Services, Public Health Service.
Van Orden, K. A., Lynam, M. E., Hollar, D., & Joiner, Jr., T. E. (2006). Perceived burdensomeness as an indicator of suicidal symptoms. Cognitive Therapy and Research, 30(4), 457–467. https://doi.org/10.1007/s10608-006-9057-2.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. https://doi.org/10.1037/0022-006X.76.1.72.
Vijayakumar, L., Kumar, M. S., & Vijayakumar, V. (2011). Substance use and suicide. Current Opinion in Psychiatry, 24(3), 197–202. https://doi.org/10.1097/YCO.0b013e3283459242.
Whitaker, K., Shapiro, V. B., & Shields, J. P. (2016). School-based protective factors related to suicide for lesbian, gay, and bisexual adolescents. Journal of Adolescent Health, 58(1), 63–68. https://doi.org/10.1016/j.jadohealth.2015.09.008.
Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47(3), S251–S256. https://doi.org/10.1016/j.amepre.2014.05.039.
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104–115. https://doi.org/10.1037/0022-006X.76.1.104.
Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., & Wang, W. (2010). An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100(9), 1653–1661.
Ybarra, M. L., Mitchell, K. J., Kosciw, J. G., & Korchmaros, J. D. (2015). Understanding linkages between bullying and suicidal ideation in a national sample of LGB and heterosexual youth in the United States. Prevention Science, 16(3), 451–462. https://doi.org/10.1007/s11121-014-0510-2.
Zaza, S., Kann, L., & Barrios, L. C. (2016). Lesbian, gay, and bisexual adolescents: population estimate and prevalence of health behaviors. JAMA, 316(22), 2355–2356. https://doi.org/10.1001/jama.2016.11683.
Funding
Data in this manuscript were drawn from a grant from the Centers for Disease Control and Prevention (1 U01 CE002841) to Dorothy L. Espelage and Peter Wyman (Co-PIs).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was received from the University of Florida, the University of Rochester, the Colorado Department of Public Health, and Texas Tech University.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hatchel, T., Ingram, K.M., Mintz, S. et al. Predictors of Suicidal Ideation and Attempts among LGBTQ Adolescents: The Roles of Help-seeking Beliefs, Peer Victimization, Depressive Symptoms, and Drug Use. J Child Fam Stud 28, 2443–2455 (2019). https://doi.org/10.1007/s10826-019-01339-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-019-01339-2