Decades of research demonstrate that suicidal behavior is a prevalent public health problem among gay, lesbian, and bisexual (i.e. sexual minority or LGB) populations.1
Furthermore, among the general population, emerging adulthood (ages 18–24 years) is an age group with demonstrated risk for suicidal behavior, with suicide being the third leading cause of death among members of this group,2
and specifically, colleges and universities may be a unique environment regarding suicidal behavior and emerging adulthood.3
Given these overlapping high risk characteristics, college-attending sexual minorities may be a population of concern regarding prevention of suicidal behavior.
To begin, Arnett suggests numerous characteristics and reasons substantiating emerging adulthood as distinct from adolescence and adulthood, with the main hallmarks of forging identity, developing independence, and recalibrating worldviews and perceptions.4
For example, given stress associated with negotiation of identity formation, it is likely that sexual minority emerging adults could face even greater pressure given societal and institutional adversities leveled at sexual minorities (e.g., heterosexism and homophobia). However, perhaps most notably, emerging adulthood represents a developmental period during which risk behavior and injury increase greatly from adolescence, including substance use,5
high prevalence of self-injurious behaviors,6
and more than twofold increases in the rates of homicide and suicide.7
Though seemingly straightforward, self-injurious behavior, suicidal ideation, suicide attempts, and suicide are quite complex,8
differentially related – yet arguably distinct – phenomena. For example, suicide ideation does not always result in attempts,9
and while a suicide attempt is one of the strongest predictors of actual suicide,10
the majority of people who attempt suicide do not die by suicide.11, 12
Additionally, Busch, Fawcett, & Douglas reviewed information on 76 inpatient suicides and found that only half had prior suicide attempts, and of the 40% who were admitted with suicidal ideation, nearly 80% of them had denied active ideation prior to their suicide.13
Similarly, regarding self-injurious behavior and suicide, Whitlock and Knox found that among their non-clinical sample of college students, less than half those who reported self-injurious behavior also reported suicidality (i.e., ideation or attempt), yet self-injurious behavior was significantly associated with suicidality.14
Compared to research about sexual minority adolescents and suicidal behavior,15–19
there are relatively fewer studies focused on suicidal behavior during the developmental period of emerging adulthood. Most of the critical early studies established an association between sexual minority status and suicidal behavior, demonstrating prevalence differences when compared to their heterosexual peers.1
Less is empirically known about what actually drives the disparity in suicidal behavior among this minority population. A recent study by House et al. found that interpersonal trauma and discrimination were both independently and synergistically associated with self-injurious behavior and suicide attempts among a sample of sexual minority adults.20
Silenzio and colleagues found that depression and drug use were associated with suicide ideation among a representative sample of young adult sexual minorities, but that these risk factors did not significantly predict attempts as they did for heterosexuals.21
In spite of findings among adolescents that demonstrate a relationship between victimization and suicidal behavior18, 19, 22
, a study of mostly sexual minority young adults recruited from gay community organizations found that victimization was not statistically significantly associated with either ideation or attempt.23
Finally, Ryan et al. reported that young adult sexual minorities who reported high family rejection in adolescence had a greater that 8-fold increase in odds of reporting a suicide attempt.24
The literature suggests that socially-based stressors experienced by sexual minorities (e.g., familial rejection, violence victimization) may be differentially associated with suicidal behavior in gay and bisexual populations, both in terms of the specific stressor and ideation and attempt.
Garnering relatively less attention in the sexual minority health literature than suicide, self-injurious behavior is a burgeoning area of research in sexual minority health risk issues. Self-injurious behavior is generally conceptualized as less a derivative of suicidal intent than it is an instrumental behavior for affect regulation,25, 26
however, several studies document associations between non-suicidal self injury and suicidal behaviors among clinical27, 28
and nonclinical29, 30
samples. A developing field of research notes an association between sexual minority status and self-injurious behavior among both adolescents and young adults,14, 31, 32
however empirical investigations into the underlying reasons for these associations remain relatively scant.
It is of utmost importance to note that we are aware of no evidence, nor sound theoretical reasoning to suggest that there is anything inherently suicidogenic or self-injury-inducing about sexual minority status. Rather, the mechanisms conferring elevated risk of self-injurious and suicidal behavior likely stem from stressors at multiple levels – from familial strain during coming out processes to sociopolitical structures that at best ignore and at worst devalue sexual minority persons.33
Harkening the work of Durkheim34
among others, one theoretical framework, the Minority Stress Model, posits that hegemonic structures upholding heterosexism and homophobia create stressors (e.g., discrimination, stigma, victimization) that may result in mental distress among those with sexual minority status.36
Using this rubric, many studies have shown that the excess burden of mental health problems experienced by sexual minorities can be explained by socially-based, minority stressors like discrimination and violence.37
However, it is unknown if discrimination may have independent associations with self-injurious behavior, suicidal ideation or attempt in sexual minority emerging adults.
Furthermore, minority stress has been theorized to work in more insidious ways, such as potentially contributing to intimate partner violence (IPV) in same-sex couples for multiple reasons (e.g., gender stereotypes, family rejection of partner, internalized homophobia, discordant “outness” of a partner).38–40
Studies with probability-based samples show higher prevalence of different forms of IPV (e.g., verbal, sexual, physical) among same-sex partners compared with opposite sex couples.41–43
Additionally, female victims of heterosexual IPV had increased likelihood of suicidal behavior when compared with women who did not experience such victimization,44–46
but we are unaware of research that has explored similar associations between IPV and suicidal behavior in sexual minority emerging adults.
In addition to unclear or inconsistent associations of stressors with suicidal behavior, there is some concern about combining gay/lesbian and bisexual samples. Often with sexual minority research, gay/lesbian and bisexuals are combined to address issues with small sample sizes and statistical power. However, much research has shown that gays/lesbians and bisexuals – while conceptually similar in regard to assuming a non-heterosexual identity – exhibit different dimensions of identity, risk profiles, and health outcomes, with bisexuals often having higher prevalence of risk behaviors.47–49
Given a seeming convergence of findings that demonstrate elevated prevalence of suicidal behaviors among sexual minorities when compared to their heterosexual counterparts, this project attempted to discern the association of risk factors with self-injurious behavior, suicide ideation, and suicide attempt among a large national sample of sexual minority young adults attending college. Specifically, rather than use sexual orientation as a predictor of suicidal behaviors, we examined stressors within sexual orientation groups and their associations with the outcome behaviors, analyzing data for gays/lesbians separately from bisexuals. Generally, we hypothesized that both gay/lesbian and bisexual groups would report significantly more socially-based stressors (i.e., family problems, intimate partner violence, physical assault, sexual assault, and discrimination) than their heterosexual counterparts. Additionally, we predicted that these stressors would be associated with self-injurious behaviors, suicide ideation, and suicide attempt among the sexual minority groups, such that sexual minorities who report experiencing the stressors will have increased odds of suicidal behaviors compared with their sexual minority peers who do not report the stressor.