1. Suicidal ideation among transgender youth Arnold H. Grossman, PhD, LMSW 1, John A. Frank 1, Zachary Y. Barletta 1, Stephen T. Russell, PhD 2 1. Department of Applied Psychology, New York University, New York, NY 2. Family Studies and Human Development, University of Arizona, Tucson, AZ Introduction The purpose of the study is to examine if Joiner’s (2005) Interpersonal Theory of Suicide can be used to explain to suicide ideation among transgender youth  a population with disproportionately high suicide ideation and attempts but minimal research leading to interventions efforts that effectively address them (Clements-Nolle, Marx & Katz, 2006; Goldblum et al., 2012; Grossman & D’Augelli, 2007). Joiner posits that suicide ideation results from the confluence of two psychological states, thwarted belongingness and perceived burdensomeness, and that the presence of suicide ideation with the acquired ability for lethal self- injury leads to suicide attempts. Such acquired ability for lethal self-injury results from habituation to pain and provocative events e.g. physical abuse (Joiner). This study tested if the two psychological states of thwarted belongingness and perceived burdensomeness are related to suicide ideation among transgender youth. The analyses also included additional factors that have been found to be associated with suicidal ideation or attempts among transgender individuals, such as: LGBTQ-related victimization (Clements-Nolle, Marx & Katz; Goldblum et al.) parental psychological abuse, and parental physical abuse (Grossman & D’Augelli), to assess if any of these factors predict suicide ideation beyond Joiner’s model. 1 1. Please contact Dr. Arnold Grossman at arnold.grossman@nyu.edu for information regarding specific measures used to assess additional factors. Sample & Method Data come from the first of four waves in a longitudinal panel study of the risk and protective factors of suicide among 1061 lesbian, gay, bisexual, trans*, and questioning (LGBTQ) youth and participants with same-sex attraction in three cities in the northeast, southwest, and west coast of the United States. The majority of the youth were recruited from community-based agencies or college groups for LGBTQ youth, and other participants were referred by earlier participants. Only trans* participants (N = 129, ages 15-21 at time of recruitment, M = 18.7, SD = 1.7) were included in the current analysis. Of the included trans* participants, 34.1% identified as trans-women, 31.0% identified as trans-men, 10.9% identified as a male-to- different-gender, and 24% identified as a female-to-different- gender. Regarding race and ethnicity, 27.1% were White, 24.8% Black or African-American, 6.2% Asian, 3.1 % American Indian or Alaskan Native, 0.8% Native Hawaii or Other Pacific Islander, 26.4% reported more than one race, 11.6% did not report a race; and 31.8% were of Hispanic or Latino background. Participants completed a survey packet of measures that assessed suicidal thinking, mental health variables, their life experiences as sexual and gender minority youth, and demographic information. Measures Suicide Ideation Suicide ideation was measured by the negative subscale of the Positive and Negative Suicide Ideation Inventory (PANSI; Gutierrez & Osman, 2008). The subscale is an 8-item measure and participants use a 5- point scale from none of the time (1) to most of the time (5) to report the relative frequency of the items within the past two weeks (α =.94). Thwarted Belongingness & Perceived Burdensomeness Thwarted belongingness (5 items, α =.87) and perceived burdensomeness (7 items, α =.74) were measured by their respective subscales of the Interpersonal Needs Questionnaire (INQ; Van Orden et al., 2008). Participants use a 7-point scale ranging from not at all true of me (1) to very true of me to report how they relate to the individual items. [Sample item: ”“These days, I feel like a burden on the people in my life.” Analyses & Results A multiple regression analysis was conducted with negative suicide ideation as the dependent variable. The two hypothesized psychological states present in Joiner’s model (i.e., perceived burdensomeness and thwarted belongingness) were entered in this model as proposed independent variables. The statistics for this analysis are reported in Table 1. A second step-wise regression analyses was also conducted to determine if any other variables better accounted for variance in suicide ideation. In the step-wise regression, LGBTQ-related victimization, parental psychological abuse, and parental physical abuse were included in addition to the initial Joiner variables. The statistics for the step-wise regression are reported in Table 2. Conclusion & Implications The results suggest that suicide ideation among transgender youth may have a unique developmental pathway, such that perceived burdensomeness is independently predictive of suicidal ideation, rather than the joint presence of perceived burdensomeness and thwarted belongingness. The results, interpreted in conjunction with Hendricks’ and Testa’s (2012) conceptual framework for clinical work with transgender clients, suggest that thwarted belongingness may not be related to suicide ideation among transgender individuals who have developed a minority identity. Hendricks and Testa suggest that developing a minority identity facilitates an in-group identification and community membership process that leads to substantial social support− a resiliency process which may be particularly relevant to the study’s sample as all participants identified as transgender and most belonged to community-based agencies or college groups for LGBTQ youth. Future research should focus on whether a trans* identity and/or community membership buffers against low belongingness. However, the results indicate that perceived burdensomeness is associated with suicidal ideation among transgender youth. Hendricks and Testa suggest that perceived burdensomeness may result from the proximal stressor of internalizing societal transphobia and consequently negatively evaluating oneself and seeing oneself as solely a burden to the individuals in one’s life. Future research should address this possibility in order to appropriately direct intervention efforts that could reduce internalized transphobia among transgender youth. Parental psychological abuse is also related to suicidal ideation, in support of previous findings by Grossman and D’Augelli (2007). It is noteworthy to mention that LGBTQ-based victimization and parental physical abuse did not relate to suicidal ideation but have been previously found to be related to suicide attempts (Clements-Nolle, Marx & Katz; Goldblum et al.; Grossma & D’Augelli). Future research should seek to examine if these phenomena lead to an acquired capacity for lethal self- injury, as opposed to suicidal ideation, to determine whether they are significant constructs related to attempting suicide but not suicidal ideation. Limitations As community-based sampling was used e.g., snowball sampling, recruitment at community organizations and LGBTQ groups, one must exercise caution when applying results to gender minority youth who may not openly identify as trans* and/or belong to groups for LGBTQ youth. Additionally, all data were obtained through self-reports, e.g., parental abuse. References Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69. Goldblum, P., Testa, R. J., Pflum, S., Hendricks, M., Bradford, J., & Bongar, B. (2012) The relationship between gender-based victimization and suicide attempts in transgender people. Professional Psychology: Research and Practice, 43, 468-475. Grossman, A.H., & D’Augelli A. R. (2007) Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behaviors, 37, 527-537. Guitierrez, P.M., & Osman, A. (2008). Adolescent suicide: An integrated approach to the assessment of risk and protective factors. IL: Northern Illinois University Press. Hendricks, M. L., & Testa, R. J. (2012) A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43, 460-467. Joiner, Jr., T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press. Van Orden, K.A., Wine, T.K., Gordon, K.H., Bender, T.W., & Joiner Jr., T.E. (2008).Suicidal desire and the capability for suicide: Tests of interpersonal- psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72-83. Analyses & Results cont. In the initial analysis of Joiner’s theory, the regression model including thwarted belongingness and perceived burdensomeness was significant, (F (2, 119) = 33.53, p <.001) and accounted for 36% of the variance in suicide ideation scores. However, at this stage, only perceived burdensomeness was associated with ideation (see Table 1 for β and t-scores). Thwarted belongingness did not account for variance in suicide ideation beyond the variance related to perceived burdensomeness. Step 1 (Perceived Burdensomeness) In the first step of the analyses, the regression model including perceived burdensomeness was significant, (F (1, 119) = 65.79, p <.001) and accounted for 36% of the variance in suicide ideation scores. However, this step did not improve upon the regression model that included perceived burdensomeness and thwarted belongingness. Step 2 (Perceived Burdensomeness and Psychological Abuse). The model produced in the second step of this analysis accounted 39% of variance in suicide ideation (F (2, 1159) = 37.62, p <.001). This model improved upon the model that included thwarted belongingness and perceived burdensomeness and accounted for significantly more variance in suicide ideation scores. In this model, perceived burdensomeness and parental psychological abuse were significantly related to suicide ideation (see Step 2 section of Table 1 for β and t-scores). Excluded Variables. LGBTQ-related victimization, and parental physical abuse were not included in models produced by the step- wise regression. They did not account for variance in suicide ideation beyond what was accounted for by perceived burdensomeness and parental psychological abuse.