Social Defeat, Psychosis, and Suicidality Linked in Sexual Minority Youth

A cross-sectional study examines the associations between psychotic experiences and suicidal behaviors among sexual minority college students.


A recent article published in the Social Psychiatry and Psychiatric Epidemiology analyzed cross-sectional data and found sexual minority college students among 140 schools reported greater odds of having psychotic experiences as well as suicidal ideation, suicide plans, and suicide attempt. The results highlighted the role of social-behavioral risks and may provide evidence for the social defeat and disempowerment theory of psychosis.

“Sexual minorities are at elevated risk for suicidal behavior and are also more likely to report psychotic experiences,” Hans Oh, the primary author and an assistant professor from the University of Southern California, writes. “However, to date, there are no studies that have examined whether the associations between psychotic experiences and suicidal behaviors are conditional on sexual minority status.”

According to the existing literature, psychotic experiences have been correlated to suicidal behaviors, which include suicidal ideation, suicide plans, and suicide attempt. In addition, the LGBTQ+ population is more likely to report psychotic experiences and suicidal behaviors. Hence, it is not hard to imagine that there could be existing relationships between psychotic experiences, minority status, and suicidal behaviors.

For the study, participants were asked to answer “Yes” or “No” to their experiences of suicidal ideation, plans, and attempts. Then they were asked to report their experiences of psychosis using the Composite International Diagnostic Interview Psychosis Screen from the World Health Organization. Specifically, they were to answer if they experienced the following experiences over the past 12 months: (1) having a feeling something strange and unexplainable was going on that other people would find hard to believe, (2) having a feeling that people were too interested in you or that there was a plot to harm you, (3) having a feeling that your thoughts were being directly interfered or controlled by another person, or your mind was being taken over by strange forces, and (4) having an experience of seeing visions or hearing voices that other people could not see or heard.

The researchers conducted multivariable logistic regressions over 100,000 college students from across 140 schools, adjusting for sociodemographic characteristics (i.e., age, gender, race/ethnicity) and social-behavioral risks (i.e., financial distress, abuse, loneliness, drug use).

They found higher proportions of sexual minority students reported a psychotic experience. when compared to heterosexual students. Among sexual minority students, 15.87% endorsed at least one psychotic experience. In addition, all suicidal behaviors were more common among sexual minority students than heterosexual students.

“Psychotic experiences were associated with significantly greater odds of suicidal ideation, a suicide plan, and suicide attempt, adjusting for sexual minority status and sociodemographic characteristics,” the authors explain. “Sexual minority status was associated with significantly greater odds of having suicidal ideation, a suicide plan, and suicide attempts.”

The study proposed that the presence of other known risk factors for suicidal behaviors such as financial distress, trauma, abuse, loneliness, and drug use may explain the differences in findings. These results also may suggest psychosis may be an indicator of social defeat and disempowerment, which can contribute risk for suicidal behaviors. As a result, the authors called for more studies to examine people with marginalized identities and people with high rates of socio-environmental risk exposures.

The author concludes:

“We confirmed that psychotic experience and sexual minority status were each associated with increased odds of suicidal behaviors in a large sample of young adult college students. We found that the associations between psychotic experiences and suicidal behaviors were moderated by sexual minority status.”



*See MIA’s Suicide Hotline Transparency Project for more awareness of suicide prevention and resources.



Oh, H., Koyanagi, A., Leaune, E., Zhou, S., Kelleher, I., & Devylder, J. E. (2022). Psychotic experiences, sexual minority status, and suicidal behavior among young adult college students in the United States. Social psychiatry and psychiatric epidemiology, 1-5. (Link)