Joanna Broder
February 17, 2012 — Strong social support may help protect gay, lesbian, bisexual, and transgender (LGBT) youth against suicidal thoughts, new research suggests.
The first longitudinal prospective study to examine factors predictive of suicidal ideation and self-harm in this vulnerable, high-risk population indicates that support from friends and family may offer the greatest protection.
"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," senior author Brian Mustanski, PhD, a clinical psychologist and associate professor of medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, Illinois, said in a release.
"I think it really informs us as to what sort of avenues we can take to help reduce suicide in gay youth," he told Medscape Medical News.
The study is published in the March issue of the American Journal of Preventive Medicine.
Suicide More Common in Gay Youth
Suicide is the third-leading cause of death among adolescents. However, LGBT youth are at least twice as likely to attempt suicide as their heterosexual counterparts. Contemplating suicide is a precursor of suicide attempts, prior research shows.
Understanding the risk factors for suicidal ideation is "crucial for improving prevention and treatment strategies," the authors write.
The investigators examined suicide risk factors such as depression and feelings of hopelessness in a general adolescent population along with a variety of LGBT-specific risk factors such as gay-specific victimization and gender nonconformity.
The study followed an ethnically diverse cohort of 246 Chicago-area LGBT youth aged 16 to 20 years at baseline for 2.5 years. The study population was not randomized. Participants self-identified their sexual orientation; they were recruited from a variety of sources, including flyers distributed in LGBT-identified neighborhoods and group listservs. Each participant completed a baseline interview, then 4 follow-up interviews were conducted 6 months apart.
Researchers chose to focus on suicidal ideation and self-harm as the main outcome measures, rather than suicide attempts, because different people mean different things by the phrase "suicide attempt," Dr. Mustanski said.
"By focusing specifically on these precursors that we can define much more clearly, it really gives us a much better window into what the risk and protective factors are," he said.
Self-Harm Risk
At baseline, participants were asked whether they had ever attempted suicide. They were also asked about their level of gender nonconformity, impulsivity, and sensation seeking.
During follow-up interviews, participants were asked about suicidal ideation, feelings of hopelessness, self-harm, bullying due to their sexual orientation, and level of support from family and friends.
Hierarchic linear modeling was used to examine between-person differences and within-person changes in suicidal ideation and self-harm over time.
Results showed that a history of attempted suicide (P = .05), impulsivity (P = .01), prospective LGBT victimization (P = .03), and low social support (P = .02) were all associated with an increased risk for suicidal ideation.
Prior suicide attempts (P < .01), sensation seeking (P = .04), female gender (P < .01), childhood gender nonconformity (P < .01), prospective hopelessness (P < .01), and victimization (P < .01) were all associated with greater self-harm.
On average, each experience of LGBT victimization was associated with a 2.5-fold increased risk for self-harm behavior.
"Well Done"
Commenting on the findings for Medscape Medical News, Anthony D’Augelli, PhD, a clinical and community psychologist and professor of human development and family studies at Pennsylvania State University in University Park, Pennsylvania, described the study as "extremely well done."
"There are a few longitudinal studies of this population, but none that have studied the issue of suicidality over time, so it makes it quite distinctive in that sense," said Dr. D'Augelli.
"Being LGBT as a young person is extremely stressful...the need for support is pretty intense," he added.
The other message for mental health professionals, said Dr. D'Augelli, is not to be judgmental and to use gender-neutral language when engaging with LGBT patients.
The authors and Dr. D'Augelli have disclosed no relevant financial relationships.
Am J Prev Med. 2012;42:221-228. Full article
Medscape Medical News © 2012 WebMD, LLC
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