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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Affect Disord. Author manuscript; available in PMC 2016 June 1.
Published in final edited form as:
PMCID: PMC4397160
NIHMSID: NIHMS670061

Associations of Racial/Ethnic Identities and Religious Affiliation with Suicidal Ideation among Lesbian, Gay, Bisexual, and Questioning Individuals

Abstract

Background

Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals.

Methods

Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation.

Results

Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation.

Limitations

Cross-sectional design and self-reported data.

Conclusions

Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.

Keywords: Suicidal Ideation, LGBT, Race/Ethnicity, Religious Affiliation

Background

Lesbian, gay, bisexual, and questioning (LGBQ) individuals are approximately twice as likely to attempt suicide as non-LGBQ individuals (Blosnich and Bossarte, 2012; King et al., 2008; Silenzio et al, 2007; Whitlock and Knox, 2007). Evidence shows differences in suicidal behavior based on racial/ethnic identity (Baca-Garcia et al., 2010; Baca-Garcia et al., 2011a; Crosby et al., 2011) and religious affiliation (Stacker and Lester, 1991; Steven and Kposowa, 2011; Taliaferro et al., 2009) within the general population, but it is unclear how these identities may operate among LGBQ college students. Moreover, the public health burden for suicidal behavior among LGBQ individuals warrants understanding differences in prevalence of death ideation (i.e., passive suicidal ideation) versus active suicidal ideation (Baca-Garcia et al., 2011b; Beck et al., 1977), which could inform suicide prevention efforts geared toward LGBQ individuals across cultures. In terms of racial/ethnic identity, although Black LGB individuals tend to have lower prevalence of mental health disorders than their Latino and non-Hispanic white LGB counterparts (Meyer et al., 2008; O’Donnell et al., 2011), Black and Latino LGB individuals are more likely to report suicidal ideation and attempt suicide than non-Hispanic white LGB individuals (Meyer et al., 2008; Mustanski et al., 2010; O’Donnell et al., 2011; Remafedi, 2002; Ryan et al., 2009) Further, religion can be both a stressor and a source of support in the LGB community, as some religious LGBQ individuals may feel estranged from their religious organizations (Barnes and Meyer, 2012; Buchanan et al., 2001; Herek et al., 2002; Schnoor, 2006; Sherry et al., 2010). Consequently, the intersection of identities, especially identities that correlate with active and passive suicidal ideation, may provide salient information about the heterogeneity of suicide risk within LGBQ populations.

Over the years, scholars have started to examine various levels of suicidal ideation, especially in relation to suicide attempts (Baca-Garcia et al., 2011b; Van Orden et al., 2013; Van Orden et al., 2014). Specifically, death ideation (i.e., passive suicidal ideation) is often operationalized as the perception that life was not worth living or that individuals wished they were dead whereas active suicidal ideation is usually measured by seriously considering suicide (Van Orden et al., 2013; Van Orden et al., 2014). Although passive suicidal ideation tends to be considered more frequently among older adults (Van Orden et al., 2013; Van Orden et al., 2014), research suggests that adults with death ideation had a similar level of risk for attempting suicide as those who solely reported suicidal ideation (Baca-Garcia et al., 2011b). Further, individuals with both death ideation and suicidal ideation had the greatest odds for attempting suicide (Baca-Garcia et al., 2011b). Therefore, examining suicidal ideation at various levels of severity may provide additional information about suicidal behaviors among LGBQ individuals.

Individuals negotiating multiple marginalized identities (e.g., sexual orientation, racial/ethnic identity, and religious affiliation) may have different risk and protective factors for suicidal ideation in comparison to those who identify primarily with one salient marginalized identity. The Cultural Model of Suicide provides a framework to examine how intersecting identities relate to suicidal ideation (Chu et al., 2010). This model suggests that the cultural sanctions, idioms of distress, minority stress, and social discord individuals experience may vary by culture and level of integration (Chu et al., 2010), and these factors may be particularly salient among college populations, since college is often the first opportunity for emerging adults to explore their intersecting identities. For example, choosing identities on college applications, deciding how to identify on campus, and individuating from their families may help students begin negotiating multiple identities (Peña-Talamantes, 2013; Stewart, 2008). Further, college may be the first experience individuals have with engaging diverse groups of people, which may broaden their thinking about intersecting identities.

Among college students, research suggests that although racial/ethnic minorities report higher prevalence of single-incident suicidal ideation (i.e., endorsed suicidal thoughts once on an annual assessment), there were no differences in persistent suicidal ideation (i.e., endorsed suicidal ideation on more than one annual assessment) based on racial/ethnic identity (Wilcox et al., 2010). Moreover, while higher levels of internalized heterosexism and internalized racism are associated with lower self-esteem and higher levels of psychological distress among racial/ethnic minority LGB individuals (Szymanski and Gupta, 2009), in general, evidence does not support the supposition that racial/ethnic minority LGB individuals have greater prevalence of mental health disorders compared to non-Hispanic white LGB persons (Cochran et al., 2007; Dube and Savin-Williams, 1999; Hayes et al., 2011; Meyer et al., 2008; Mustanski et al., 2010; O’Donnell et al., 2011). Despite similar prevalence of mental disorders, evidence suggests that racial/ethnic minority LGB individuals have greater odds of attempting suicide in comparison to their non-Hispanic white LGB peers (Mustanski et al., 2010; O’Donnell et al., 2011), and same-sex attraction among Black and Latino students has been associated with suicidal ideation (O’Donnell et al., 2004). This issue is further complicated since college students of color may be less likely than their non-Hispanic white peers to self-disclose their suicidal ideation to mental health providers, unless directly asked about their suicidality (Morrison and Downey, 2000).

In addition to racial/ethnic identity, religious identity has been associated with suicidal ideation through religious sanctions related to suicidal behavior (e.g., low acceptability of suicide) (Boyd and Chung, 2012; Neeleman et al., 1997). Although the integration of a LGB sexual orientation and religious affiliation is often assumed to be a negative experience, some LGB individuals may negotiate their religious affiliation with their sexual orientation by self-identifying as spiritual or affiliating with an affirming religious organization (Buchanan et al., 2001; Lease et al., 2005; Sheey et al., 2010). Participation in LGB-affirming religious organizations has been associated with lower levels of internalized homonegativity and higher levels of psychological health and spirituality (Barnes and Meyer, 2012; Lease et al., 2005). While involvement with non-affirming religious organizations was linked to internalized homonegativity, it was not directly associated with negative mental health outcomes (Barnes and Meyer, 2012). Among LGB individuals, Christians tend to report greater prevalence of conflict between the intersection of their religious affiliation and sexual orientation than Jewish, Atheist, and Agnostic LGB individuals (Schuck and Liddle, 2001). However, in a predominantly Christian sample, LGB individuals with a religious affiliation reported lower odds of attempting suicide compared to LGB persons without a religious affiliation (Kravlovec et al., 2012).

Overall, little is known about how intersecting identities, such as racial/ethnic identity or religious affiliation, of LGBQ individuals are associated with active or passive suicidal ideation, especially among college students. Research has started to examine the relationship of racial/ethnic identity and suicidal ideation among LGBQ individuals; however, the sample sizes tend to be small (Meyer et al., 2008; O’Donnell et al., 2011; Remafedi, 2002), and research is scant about how religious affiliation is linked to suicidal ideation among LGBQ individuals. Our aim was to explore how LGBQ individuals across racial/ethnic identities and religious affiliations differed from their non-LGBQ peers in terms of suicidal ideation and whether or not the degree of ideation varies. Moreover, we examined within-group differences of suicidal ideation among LGBQ individuals. Based on previous research we hypothesized: (1) in comparison to non-LGBQ individuals, LGBQ individuals would have higher prevalence of suicidal ideation (both passive and active), (2) in comparison to non-Hispanic white LGBQ students, LGBQ individuals of color would have higher prevalence of suicidal ideation (both passive and active), and (3) in comparison to Christian LGBQ individuals, LGBQ individuals with other or no religious affiliations would have higher prevalence of suicidal ideation (both passive and active).

Methods

Sample and Procedures

Data are from the 2006 National Research Consortium of Counseling Centers in Higher Education. This dataset is a stratified random sample of students from 70 U.S. institutions of higher education with comparable samples to other national college surveys (Drum et al., 2009). Compared to national demographics, the data includes a similar number of students from public and private institutions as well as individuals from four diverse geographic locations (Drum et al., 2009). Surveys were administered via a web-based questionnaire to undergraduate and graduate students with response rates of 24% and 25%, respectively. A total of 26,451 students completed the survey in the spring of 2006; however, after excluding international students, our analytic sample included 24,626 individuals. Additional information about the sample and methodology has been published previously (Drum et al., 2009).

Dependent Variables

The Research Consortium survey included items measuring various levels of severity in suicidal ideation (Drum et al., 2009; Wong et al., 2001); therefore, we individually examined passive and active suicidal ideation. Participants were asked if they had passive suicidal thoughts in the past 12-months (i.e., “I wish it would all end” and “I wish I was dead”), active suicidal ideation in the past 12-months (i.e., “during the past twelve month, have you seriously considered attempting suicide”), and lifetime active suicidal ideation (i.e., “have you ever seriously considered attempting suicide”). The response options for the passive suicidal questions included no response, no or yes. The response options for the active suicidal ideation questions were coded as no =0 and yes = 1.

Independent Variables

Participants selected all racial/ethnic groups that applied to them after the following prompt, “With the understanding that these categories might be limiting, which ethnicity best describes you?” The item responses included: African American/Black, Alaska Native/American Indian, Asian American, Caucasian/White, Hispanic-American/Latino, and International/Foreign Student. Multiple responses were recoded into a Multiracial group. Consistent with previous research, the final racial ethnic categories included Black, Asian, Latino, non-Hispanic white, and the remaining racial/ethnic groups were combined to create an “Other” racial/ethnic group (Blosnich and Bossarte, 2012). As previously mentioned, we excluded the international/foreign students. Specifically, nationality was not a separate question; therefore, rather than making assumptions about the racial/ethnic identity of international students, these individuals were not included in our analytic sample. Participants were also asked about their religious affiliation, and chose one of following response options: Agnostic, Atheist, Buddhist, Christian, Hindu, Islamic, Jewish, Native American Religion, Non-religious/Secular, Unitarian/Universalist, and Other. Consistent with previous research, the Atheist and Agnostic groups were combined (Schuck and Liddle, 2001) and for the purposes of this study the number of religious affiliations were further reduced to include the three religions with the highest proportions based on the 2012 census (United States Census, 2012). Thus, Buddhist, Hindu, Native American Religion, and Unitarian/Universalists were added to the Other religious affiliation group. The final religious affiliation categories included: Non-religious, Jewish, Muslim, Atheist/Agnostic, Christian, and Other religious affiliation. Participants indicated their sexual orientation as bisexual, gay/lesbian, heterosexual, or questioning. For the purpose of this study, sexual orientation was recoded into LGBQ = 0 vs. non-LGBQ = 1. Additional demographic information included sex (male = 2 and female = 1) and age (in years).

Statistical Analysis

Chi-square tests were used to examine group differences in suicidal ideation (both passive and active) between sexual orientation (i.e., LGBQ vs. non-LGBQ) by racial/ethnic identity and religious affiliation; where cell sizes were < 5, Fisher’s exact tests were used. Unadjusted prevalence and standard errors were calculated to explore the group differences between racial/ethnic identities and religious affiliations among LGBQ individuals. A series of multivariable logistic regression models, adjusted for age and sex, were used to test the association of individuals’ identities with suicidal ideation (both passive and active). Hosmer-Lemeshow tests were used to assess the goodness-of-fit for each logistic regression. SPSS version 20 was used for all analyses. This project was approved by the IRB of the University of Rochester Medical Center.

Results

Overall, 5.4% (n = 1,333) of students identified as LGBQ and 94.6% (n=23,184) identified as non-LGBQ. The mean age of the sample was 24.98 years old (SD = 7.71), and 62.3% identified as female. Approximately 82% of respondents identified as non-Hispanic white and roughly 65% reported Christian affiliation. Additional demographic information is presented in Table 1.

Table 1
Demographics

Suicidal Ideation between LGBQ and non-LGBQ students, by Race/Ethnicity

Across all racial/ethnic groups, LGBQ students were more likely to report lifetime active suicidal ideation than non-LGBQ individuals (see Table 2). Black LGBQ students were more likely to endorse passive suicidal ideation, “I wish this would all just end” (53.6% vs. 34.2%) and “I wish I was dead” (26.1% vs. 7.0%) in comparison to Black non-LGBQ students. Asian LGBQ individuals were more likely to report, “I wish I was dead” (25.0% vs. 13.3%) in comparison to their Asian non-LGBQ counterparts. Non-Hispanic white LGBQ individuals were more likely to endorse “I wish this would all just end” (52.4% vs. 31.8%), “I wish I was dead” (23.2% vs. 8.9%), and that they had seriously considered suicide within the past 12-months (13.5% vs. 4.7%) in comparison to non-Hispanic white non-LGBQ students. LGBQ students who identified with Other racial/ethnic groups were more likely to report “I wish this would all just end” (53.0% vs. 40.0%), “I wish I was dead” (25.8% vs. 12.3%), and that they had seriously considered suicide within the past 12-months (21.2% vs. 6.6%) in comparison to their non-LGBQ counterparts.

Table 2
Suicidal ideation among LGBQ and non-LGBQ students, by race

Suicidal Ideation between LGBQ and non-LGBQ students, by Religious Affiliation

Across most religious affiliations (all except Muslim and Jewish), LGBQ students were more likely to report lifetime active suicidal ideation than non-LGBQ students (see Table 3). In addition, LGBQ students with a Non-religious affiliation were more likely to endorse “I wish this would all just end” (44.7% vs. 35.3%), “I wish I was dead” (21.1% vs. 11.2%), and that they had seriously considered suicide within the past 12-months (11.6% vs. 5.5%) in comparison to their non-LGBQ counterparts who identified as Non-religious. LGBQ Atheist/Agnostic individuals were more likely to report “I wish this would all just end” (56.7% vs. 38.4%), “I wish I was dead” (30.0% vs. 13.7%), and that they had seriously considered suicide within the past 12-months (15.6% vs. 6.9%) in comparison to their non-LGBQ counterparts. LGBQ individuals who identified with an Other religious affiliation were more likely to endorse “I wish this would all just end” (52.3% vs. 35.5%), “I wish I was dead” (23.0% vs. 11.7%), and that they had seriously considered suicide within the past 12-months (14.0% vs. 5.9%) in comparison to non-LGBQ students who identified with an Other religious affiliation. LGBQ Christian students were more likely to report “I wish this would all just end” (52.6% vs. 31.0%), “I wish I was dead” (19.4% vs. 7.9%), and that they had seriously considered suicide within the past 12-months (11.3% vs. 4.1%) in comparison to their non-LGBQ Christian counterparts.

Table 3
Suicidal ideation between sexual orientation, by religion

Suicidal Ideation among LGBQ students, by Race/Ethnicity

Latino LGBQ students had lower odds of reporting that they “wished they were dead” (OR = 0.41; 95% CI = 0.21 – 0.81, see Table 4) in comparison to their non-Hispanic white LGBQ counterparts. In comparison to non-Hispanic white LGBQ students, Latino LGBQ individuals had lower odds of lifetime suicidal ideation (OR = 0.56; 95% CI = 0.34 – 0.93) whereas students who identified with Other racial/ethnic groups had greater odds of endorsing lifetime suicidal ideation (OR = 1.69, 95% CI = 1.01 – 2.84). There were no other significant differences in either passive or active suicidal ideation between non-Hispanic white LGBQ students and LGBQ individuals of color.

Table 4
Adjusted odds of suicidal ideation among LGBQ racial/ethnic minority1 and LGBQ religious minority2 individuals

Suicidal Ideation among LGBQ student, by Religious Affiliation

Compared to Christian LGBQ students, Jewish LGBQ students had lower odds of “wishing it would end” (OR = 0.45; 95% CI = 0.23 – 0.87), “wished they were dead” (OR = 0.29; 95% CI = 0.09 – 0.95), and lifetime suicidal ideation (OR = 0.37, 95% CI = 0.17 – 0.83). However, Atheist/Agnostic LGBQ students (OR = 1.67; 95% CI = 1.19 – 2.33) had higher odds of “wishing they were dead.” There were no other significant differences in either passive or active suicidal ideation between Christian LGBQ individuals and their LGBQ counterparts with Other or Non-religious affiliations.

Discussion

Results revealed variation among intersecting identities and suicidal ideation among LGBQ college students, suggesting that although some LGBQ individuals with multiple minority statuses may experience elevated prevalence of suicidal ideation, others do not. The results of this study were consistent with previous research that found racial differences in suicidal behavior among LGB individuals (Meyer et al., 2008; Mustanski et al., 2010; O’Donnell et al., 2011; Remafedi, 2002; Ryan et al., 2009). However, by examining both passive and active suicidal ideation, we were able to examine unique differences among LGBQ individuals. In addition, this study expands upon prior research that suggests religion can function as a support or a stressor among LGBQ individuals since some religious affiliations were associated with greater odds of reporting passive suicidal ideation (i.e., Atheist/Agnostic LGBQ individuals) while other affiliations correlated with lower odds (i.e., Jewish LGBQ individuals).

Although age and sex were not the focus of this study, these variables were significantly associated with suicidal ideation among LGBQ students. We included both undergraduate and graduate students in the sample, and found that older LGBQ individuals had lower odds of passive suicidal ideation (“wish it would end” and “wish they were dead”) as well as lower odds of active suicidal ideation (past 12 month suicidal ideation). These findings are consistent with previous research that found older LGB college students were less likely to endorse suicidal ideation (Lytle et al., 2014). Further, evidence suggests that females are more likely to report suicidal ideation than males (Oquendo et al., 2007), and our results expand upon these findings. Specifically, we found that female LGBQ students had higher odds of active and passive suicidal ideation in comparison to their male counterparts.

Across all racial/ethnic groups, we found that LGBQ students were more likely to report lifetime suicidal ideation than their non-LGBQ counterparts, thus providing some support for our first hypothesis. Although non-Hispanic white LGBQ individuals and LGBQ students who identified with Other racial/ethnic groups were consistently more likely to report both passive and active suicidal ideation, the results for Black, Asian, and Latino LGBQ individuals varied. Our findings are similar to a 2010 study that examined suicidality among LGBT youth across cultures since both studies found that Black and non-Hispanic white sexual minorities reported a higher prevalence of suicidal ideation in comparison to their Latino peers (Mustanski et al., 2010). Moreover, our findings corroborate previous research that suggests Asian and Latino LGB individuals reported similar odds of endorsing suicidal behavior in the past year as non-LGB individuals (Cochran et al., 2007). Our findings suggest that Latino LGBQ individuals tend to have lower prevalence of both active and passive suicidal ideation in comparison to Black, Asian, White, and Other racial/ethnic LGBQ individuals; however, additional research is needed to further examine the root of these differences.

In terms of our second hypothesis, the results were somewhat surprising. Compared to non-Hispanic white LGBQ students, Latino LGBQ individuals were less likely to report that they “wished they were dead” and were less likely to endorse lifetime suicidal ideation. These results differ from previous research that suggests same-sex attraction among Black and Latino youth was associated with suicidal ideation (O’Donnell et al., 2004). The cause behind these contradictory findings is unclear, but may be suggestive of the how differences in age and/or level of resiliency between high school and college students may be associated with suicidal ideation. Additional research is needed to examine passive and active suicidal ideation among Latino LGBQ individuals, especially among adolescents and emerging adults. Although previous research tends to focus on comparing Black and Latino LGB individuals with non-Hispanic white LGB individuals, we found that individuals who identified with Other racial/ethnic identities had greater odds of endorsing lifetime suicidal ideation than non-Hispanic white students, suggesting that additional research focusing on within group differences among LGBQ individuals is needed to better understand their risk for suicidal behaviors.

The relationship between religious affiliation and suicidal ideation among LGBQ individuals is not well understood, and this study has started to fill this gap in the literature by examining suicidal ideation among LGBQ individuals from diverse religious affiliations. One of the few articles that examined the relationship between religious affiliation and suicidality among LGB individuals found that religion could either be a protective or a risk factor (Kralovec et al., 2012). Kralovec and colleagues (2010) reported that religiously affiliated LGB had lower odds of attempting suicide than LGB individuals who were not religiously affiliated; however, religion was associated with internalized homophobia, which was then correlated to suicidal ideation. Although Kralovec’s sample was predominantly Christian and focused on suicide attempts, this study corroborates our finding that among LGBQ individuals, religion can either be a protective or a risk factor. Researchers have also found that religious LGBQ individuals may feel estranged from their religious organizations, experience internalized heterosexism (Herek et al., 2009), or struggle with negotiating their intersecting identities (Schnoor, 2006). Therefore, further research, including in-depth qualitative work, is necessary to begin exploring the personal components of religious affiliation negotiation among LGBQ populations and how such negotiations may impact mental health.

When compared to their Christian peers, Jewish LGBQ students were less likely to endorse passive suicidal ideation as well as lifetime suicidal ideation. On the other hand, in comparison to Christian students, Atheist/Agnostic LGBQ individuals were more likely to report that they wished they were dead. Therefore, our third hypothesis that Christian LGBQ individuals would have lower levels of suicidal ideation received limited support. However, since this sample was approximately 65% Christian, additional research examining the influence of religious affiliation on suicidal ideation among LGBQ individuals is needed, especially since the literature focusing on how the intersection of religious affiliation and sexual orientation is associated with suicidal behaviors is scant.

The public health burden for suicidal behavior among LGBQ individuals is great. These results not only provide a foundation for future research but also may impact suicide prevention programs for LGBQ college students. For instance, the results of this study provide support for using The Cultural Theory and Model of Suicide when working with LGBQ individuals from diverse backgrounds (Chu et al., 2010). To begin with, both medical and mental health providers who work with college students should recognize that LGBQ individuals across cultures might have a higher prevalence of suicidal ideation and individuals may present with either passive or active suicidal ideation. As previously mentioned, it is essential that providers directly inquire about suicidal thoughts and behaviors (Morrison and Downey, 2000). Statements such as, “I wish it would all end” or “I wish I was dead,” should not be overlooked, especially since death ideation (passive suicidal ideation) has similar odds of being associated with suicide attempts as active suicidal ideation (Baca-Garcia et al., 2011b). Moreover, professionals should ask whether an individual has wished it would all end or wished that she or he was dead in order to assess death ideation.

Although LGBQ individuals tend to have a greater prevalence for suicidal ideation in comparison to their non-LGBQ counterparts, there are significant within group differences among LGBQ persons. It is unclear why Latino and Jewish LGBQ individuals had lower odds of both active and passive suicidal ideation; therefore, additional qualitative research to better understand protective factors among these groups of individuals may inform suicide prevention interventions geared toward LGBQ individuals. In terms of working with LGBQ individuals from diverse backgrounds, it is important to consider culturally specific experiences that are associated with suicidality such as minority stress and social isolation (Chu et al., 2010). For instance, providers could assist LGBQ clients with examining the complex relationship between multiple salient identities, support individuals who are trying to negotiate these identities, and help them connect with affirming resources in their community. In terms of training, it is imperative that mental health and public health professional programs include multicultural issues in their coursework, especially since we found discrepancies in regard to how students within a culture responded to questions about suicidal ideation (Chu et al., 2010; Sherry et al., 2010).

Despite the strengths of this research, there are several limitations. First, this sample is from only 70 institutions, it may not generalize to the general U.S. college population. Moreover, these data are for persons enrolled in college (i.e., both graduate and undergraduate) and may not generalize to persons not enrolled in college, as previous studies have found differences in health behaviors based on college-attending status (Blanco et al., 2008; Wu et al., 2007). Second, the data only had self-identified LGBQ status, which is an umbrella acronym that is constantly in flux and varies by age cohort, culture, and identity development (Morales, 1990; Saewyc et al., 2004; Savin-Williams and Diamond, 2000). Consequently, persons who do not self-identify, use different labels, or none at all, may not be represented. Third, participants were only asked for their current religious affiliation, not about the religious affiliation they were raised with or the strength of their religiosity. Therefore, it is unclear whether the religious affiliation of these individuals has evolved; especially since some LGBQ individuals may negotiate intersecting identities by affiliating with an affirming religious organization (Buchanan et al., 2001; Lease et al., 2005; Sheey et al., 2010). Fourth, due to small sample size among attempters in this study, we focused on passive and active suicidal ideation as outcomes; results with attempted suicide may produce different results. Fifth, due to the small, sample sizes, the results should be interpreted with caution. Finally, as a cross-sectional dataset, no causal mechanisms for elevated suicidal prevalence could be examined.

In conclusion, our findings suggest that both racial/ethnic identity and religious affiliation may indicate differential prevalence of active and passive suicidal ideation among LGBQ individuals. As previously mentioned, the results of this study have implications for practice, research, and training. Specifically, this study demonstrates that it may be helpful to consider both passive and active suicidal ideation, especially among individuals from diverse backgrounds. Therefore, medical providers as well as mental health professionals should inquire about death ideation while assessing for suicide risk. Further, additional research focusing on the cultural factors associated with the increased prevalence of suicide among LGBQ populations is needed to inform policy and practice.

Acknowledgments

The project described in this publication was supported partially by postdoctoral fellowships to Megan C. Lytle and John Blosnich in an Institutional National Research Service Awards from the National Institute of Mental Health (5T32MH020061). Dr. Lytle has also received support from the University of Rochester CTSA award number KL2TR000095 from the National Center for Advancing Translational Sciences of the National Institutes of Health.

Role of Funding

The funding sources included in the Acknowledgments had no involvement in study design, collection, analysis and interpretation of the data; writing of the report; and in the decision to submit the paper for publication.

The opinions expressed in this work are those of the authors and do not necessarily represent those of the funders, institutions, the Department of Veterans Affairs, or the U.S. Government.

Footnotes

Contributors

Megan C. Lytle was responsible for drafting the manuscript, analyzing the results, and interpreting the data. Susan M. De Luca, John R. Blosnich, and Chris Brownson contributed with writing and revising the manuscript. I will be serving as the corresponding author for this manuscript. All of the authors noted on the byline have agreed to the byline order and to submission of the manuscript in this form. I have assumed responsibility for keeping my coauthors informed of our progress through the editorial review process, the content of the reviews, and any revision made.

Conflict of Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Megan C. Lytle, University of Rochester Medical Center, Department of Psychiatry, Rochester, NY.

Susan M. De Luca, School of Social Work, University of Texas at Austin, The University of Texas at Austin, Austin, TX.

John R. Blosnich, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.

Christopher Brownson, Counseling and Mental Health Center, The University of Texas at Austin, Austin, TX.

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