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Suicide and Self-Injury

Unique impact of shame and multi-level distal minority stress on suicide risk among sexual and gender minority young adults: Implications for individual- and structural-level interventions

(PS2-D90) Unique Impact of Shame and Multi-level Distal Minority Stress on Suicide Risk Among Sexual and Gender Minority Young Adults: Implications for Individual- and Structural-level Interventions

Friday, November 18, 2022

10:30 AM – 11:30 AM EST

Location: Westside Ballroom, 5th Floor

Author(s)

AS

Ash M. Smith, B.S.

Doctoral Student
The Graduate Center, City University of New York
Brooklyn, New York

Co-Author(s)

Danielle S. Berke, Ph.D.

Assistant Professor
Hunter College, City University of New York
New York, New York
ML

Madalyn Liautaud, M.A.

Doctoral Student
The Graduate Center, City University of New York
New York, New York
MR

Mollie Ruben, Ph.D.

Assistant Professor
University of Maine
Orono, Maine

Elevated rates of suicidal ideation and attempt are well documented in sexual and gender minority (SGM) populations (Adams et al., 2017; James et al., 2016; King et al., 2008; Kann et al., 2016). Minority stress theory (Meyer, 2003; Hendricks & Testa, 2013) suggests that disproportionate exposure to proximal (i.e., internally-directed) and distal (i.e., externally-directed) minority stressors may account for population-level SGM disparities in suicidality (Clements-Nolle et al, 2006; D’Augelli et al., 2005; Hatzenbuehler, 2011; Perez-Brumer et al., 2015; Mustanski & Liu, 2013; Ploderl & Fartacek, 2007; Saewyc et al., 2020; Sutter & Perrin, 2016). Shame proneness is a modifiable intervention target (Luoma et al., 2012) implicated as a mechanism of suicidality in SGM populations (Hatzenbuelher, 2009; Mereish et al., 2019; Puckett et al., 2017). However, most studies that examine modifiable risk factors related to distal minority stress focus on interpersonal minority stress (e.g., identity-based harassment, rejection, and discrimination). There is a lack of research geared toward identifying intervention targets impacted by structural minority stress (e.g., discriminatory policies, lack of legal protections for SGM populations, intolerant general community attitudes towards SGM individuals). Even fewer studies examine the shared variance among intervention targets and both structural and interpersonal minority stress. The current study leverages structural equation modeling to establish the role of shame in the relationship between suicidality and structural and interpersonal minority stress experienced by SGM young adults in low-structural-stigma (urban; N = 65) and high-structural-stigma (rural; N = 65) environments. The indirect effect of structural and interpersonal on suicidality through shame proneness was not significant (ß = 0.171, p = .191, CI = 0.0501214, 0.0934055). The total effect was significant (ß = 1.488, p < .001, CI = 0.4297413, 0.8147179). Neither interpersonal nor structural minority stress exposure predicted shame. However, shame (ß = 0.071, p < 0.001) and structural stigma (ß = 0.784, p < 0.005) independently predicted suicidality; moreover, the main effect of interpersonal minority stress on suicidality nearly reached significance (ß = 0.534, p = 0.080). Findings purport shame as a target for individual-level intervention, and structural stigma as a target for structural intervention, to reduce suicide risk. Additional study is needed to establish causal relationships among shame proneness, structural and interpersonal distal minority stress, and suicidality in SGM communities. Findings are discussed in terms of the need for additional research on the role of shame in clinical interactions and the potential promise of acceptance and commitment therapy approaches. We explore the potential value of multi-level intervention frameworks that may help better position researchers, clinicians, interventionists, and communities to actively address disparities in suicide risk in SGM populations through structural change.