A recent study in the Journal of Psychopathology and Clinical Science reveals that LGBTQ+ youth experience intensified suicidality and tendencies toward self-injury on the same day they encounter stressors related to their minority status.
The research, led by Ethan Mereish from the University of Maryland in collaboration with colleagues from various academic and medical institutions, underscores the validity of established theoretical models that attempt to explain the mental strain felt by the LGBTQ+ population.
“Our findings support the minority stress model and demonstrate that both external and internal minority stressors are short-term predictors of suicidal ideation (SI) and non-suicidal self-injury (NSSI) ideation among sexual and gender minority youth (SGMY),” Mereish and colleagues write.
“Additionally, a strength of our study is the focus on multiple types of minority stressors, including external (e.g., harassment, discrimination) and internalized (i.e., concealment of one’s sexual orientation and/or gender identity and internalization of stigma) minority stressors. This is especially relevant during adolescence as SGMY develop their gender and sexual identities, experience cognitive, affective, and social maturation, and are susceptible to the added burden of social exclusion and marginalization related to minority stress and stigma.”
Earlier research has shown that sexual and gender minorities are more likely to struggle with suicidality, self-harm, and other mental and physical health issues than their cisgender and heterosexual peers. The minority stress model has been instrumental in attributing part of this disparity to the stigma that LGBTQ+ youth face, along with the stressors that manifest from such stigma, which tend to adversely affect their mental and physical health. Stressors can be external (such as discrimination) or internal (for instance, the concealment of sexual orientation or gender identity and internalization of stigma).
When societal protection is extended to LGBTQ+ youth, their suicide risk declines. Studies have demonstrated reduced suicide rates among LGBTQ+ youth following the implementation of legal protections for these individuals. Similarly, positive interpersonal experiences (like using a transgender youth’s chosen name) are also found to help reduce suicidality. While substantial research supports the minority stress model, there’s a shortage of studies exploring how these stressors impact suicidality in LGBTQ+ youth on the very day the stressors are experienced.
To fill this research gap, the current study aimed to explore the correlation between minority stress and suicidal thoughts and behaviors (STB) as well as non-suicidal self-injury (NSSI) ideation. The researchers employed daily diaries filled out by LGBTQ+ youth aged 12 to 19 who reported experiencing at least two stressors related to their minority status in the past 30 days.
The study had 92 eligible participants, with 91% identifying as a sexual minority and 33% as a gender minority. The demographic distribution included 69% White, 14% multiracial, 8% Black or African American, 4% Asian, 2% American Indian or Alaska Native, and 2% identifying as Other. Hispanic or Latino/a/x individuals made up 24% of the participants.
Participants completed a semi-structured interview and a baseline battery, including demographic information and treatment experiences, and the Columbia Suicide Severity Rating Scale to measure STB and NSSI. At that time, they also received daily diary training and began using the daily diary for 28 days.
This daily diary training included information and instructions, including the safety and confidentiality protocol if self-injurious behaviors were endorsed, that they would be sent a link to a daily survey via email and text at 8 pm or another agreed-upon time, that they would receive notifications at 9:30 pm if they had not completed the survey, and that if surveys were not completed by 8 am the following day, they would be considered missed reports. Moreover, part of the daily diary included reflecting on the past 24 hours while completing the surveys.
The daily surveys included items generated by the researchers for measuring internalized minority stressors (e.g., internalized stigma and identity concealment), the Everyday Identity Stress Scale (EISS) to measure external minority stressors, the Differential Emotion Scale, the Difficulties in Emotion Regulation Scale, items adapted from the Self-Injurious Thoughts and Behaviors Interview, and items from the Self-Injurious Thoughts and Behaviors Interview. Once the participants had completed the daily monitoring period, they would be interviewed again so that the researchers could assess for minority stress, STB, and NSSI during days in which they did not complete the daily diary. Participants were then compensated and received a list of mental health resources.
Upon analyzing the data, the researchers found that older participants were more likely to experience suicidality and ideation. Plurisexual individuals (those attracted to multiple genders) and those questioning their sexual orientation reported higher levels of NSSI ideation.
Daily minority stressors were found to be tied to both the intensity of suicidal thoughts and self-harm ideation across all groups. These stressors were also associated with daily negative affect and difficulties regulating emotions.
The researchers concluded that the minority stressors faced by LGBTQ+ youth are linked to their emotional dysregulation and negative emotions, which in turn increase the intensity of their suicidal ideation and NSSI ideation.
The study significantly adds to the body of research supporting the minority stress model, shedding light on the immediate impact of minority-related stressors, whether internal or external, on LGBTQ+ youth. Amidst rising discrimination against sexual and gender minorities both in the U.S. and globally, the findings underscore the urgency of protective measures to safeguard LGBTQ+ youth from escalating violence and hostility.
Mareish, E. H., Peters, J. R., Brick, L. A., Killam, M. A., Yen, S. (2023). A Daily Diary Study of Minority Stressors, Suicidal Ideation, Non-suicidal Self-Injury Ideation, and Affective Mechanisms Among Sexual and Gender Minority Youth. Journal of Psychopathology and Clinical Science, 132(4), 372-384. https://doi.org/10.1037/abn0000813 (Link)