Suicide risk and prevention research published in LGBT journal

Few studies to date have examined how certain stressors can cause high suicide rates among minority individuals including transgender individuals. More than 47,000 people die by suicide every year in the United States, and studies show that at least 10% of members in the lesbian, gay, bisexual and transgender (LGBT) community have attempted suicide at least once in their lives. These startling statistics have enacted new waves of detection, prevention and intervention for those at risk of suicide, but more research and action are needed.

Gender minority theory

Why do minority individuals experience more adverse mental and physical outcomes? One proposed explanation is the gender minority theory involving distal and proximal stressors along with several resilience factors. Distal stressors include gender-based victimization, discrimination, rejection, and non-affirmation of gender identity. Proximal stressors are experienced within the psyche of an individual such as transphobia, negative expectations related to gender identity and concealment of one’s gender identity.

The gender minority stress theory suggests potential reasons why these stressors may increase the risk of suicide, but community resiliency has never been factored into the equation. A group of TU psychology students decided to take on the task of exploring the moderating role of resiliency in the relationship between stressors, trauma exposure and suicide risk. Their findings were published in the Journal of LGBT Issues in Counseling this spring.

The original study began in 2017 as the dissertation of PhD student Jim Scholl (BA ’13, MA ’16, PhD ’19) who focused on gender minority stress and trauma within a trans sample. “I talked him into including a four-item self-report measure on suicide risk,” said doctoral student Chelsea Cogan (MA ’18). “He was gracious enough to let me run with different ideas I had on what to look at within his sample.”

Cogan took on the primary role of conducting analyses, writing the results and writing the bulk of the paper’s introduction. Scholl contributed the data and methods, and then-undergraduate student Hannah Cole (BS ’18) assisted with formatting and discussion. Professor of Psychology Joanne Davis served as the project’s faculty adviser.

“The goal was to try and find protective factors within the trans population primarily through the gender minority theory framework,” Cogan explained. “The idea is that this relationship can be moderated by community resiliency, such that the higher levels of community resiliency an individual possesses, the less impact the distal and proximal stressors have on their mental and physical well-being.”

Assessing the role of resilience

A total of 155 self-identified transgender individuals participated in the study and completed a basic demographics measure. Data was collected in the fall of 2017. The TU students used the gender minority stress and resilience measure to assess nine constructs: gender-related discrimination, gender-related rejection, gender-related victimization, non-affirmation of gender identity, internalized transphobia, negative expectations for future events, concealment, community connectedness and pride. Other methods included a life events checklist to determine the total number of traumatic experiences reported by the individuals and a suicide behaviors questionnaire that looks at suicidal ideation, behaviors, communication and likelihood of future suicide attempts.

Analyses revealed the community resilience factors specified in the gender minority stress theory were not sufficient to mitigate the risk of suicide. Community resilience did not significantly moderate the relationships between minority stressors, trauma exposure and suicide risk.

“Unfortunately, there is no definitive answer as to why community resilience was not a significant moderator,” Cole said. “One theory that we touch on briefly in the paper is that in order to access the community and draw resilience from it, individuals would likely need to be out and visible in a way that could potentially expose them to greater stigma and even violence, which could wash out the benefits gained from community resilience. Another thing to consider is that we only looked at community resilience, rather than individual level factors like hardiness, and therefore may have limited the complete picture.”

Sharing the findings in a national journal

According to Cogan, the TU team was surprised to learn that community resilience was not a factor. She said this is the first study to include all three components of the gender minority stress theory as they relate to suicide risk. As a result, they felt it was crucial to submit their findings to the Journal of LGBT Issues in Counseling to reach a broad range of clinical providers who regularly interact and work with trans individuals.

“This study is important because it demonstrates the need for much more research into protective factors to help decrease suicide risk within trans individuals,” Cogan said. “It also further demonstrates how integral assessing for the presence of distal and proximal stressors (in addition to trauma exposure) is when assessing suicide risk with trans clients.”

Although Cole has since graduated from TU, she says her involvement in the project and other TU research has sparked her passion for research and advocacy in sexual and gender minority communities. She plans to begin a clinical psychology program in the fall under the mentorship of a professor who studies violence prevention and intervention in the LGBT population. “I hope to continue this work throughout my career with the ultimate aim of increasing access to competent, sensitive care for historically underserved communities,” she stated.

Cogan explained next steps in this research would involve further examining the gender minority stress theory variables and replicating the findings in another sample to explore other potential protective factors, such as social connection, etc. Now that the research is published, more work remains to be accomplished, but Cogan and Cole agree the study is beneficial in reducing trauma exposure, violence and negative mental and physical health outcomes in the transgender and gender diverse communities.

See the published paper The Moderating Role of Community Resiliency on Suicide Risk in the Transgender Population.