1. A Theoretical Look at Sexual Minority Victimization and Outness to Family as a Protective Factor Against Suicide Attempts Charlotte M. Siegel University of Montana, Department of Psychology

2. Sexual Minorities / LGBTQ Sexual Minorities – defined in terms of two distinct characteristics: 1. Sexual Orientation 2. Gender Identity (Haas et al., 2011) LGBTQ – lesbian, gay, bisexual, transgender, and queer

3. Health Disparities “…LGB people have higher prevalence of mental disorders than heterosexual people.” (Meyer, 2003) Sexual minorities experience increased rates of: Substance use disorders Mood disorders Anxiety disorders (Haas et. al., 2011)

4. Suicide Disparities General PopulationLGB Population 0.6% of people 18+ attempted suicide in 2012 (SAMHSA, 2013 http://www.samhsa.gov/data/NSDUH/2k12MH_FindingsandDetTables/2K12MHF/ NSDUHmhfr2012.htm#sec3-1 ) LGB population is 6 - 18x more likely to attempt suicide (Fergusson, Horwood, & Beautrais, 1999; Herrell et. al., 1999) General PopulationTransgender Population 11.5 completed suicides per 100,000 people (Haas et. al., 2011) 800 complete suicides per 100,000 people (Haas et. al., 2011)

5. The Face of Statistics

6. Suicide Theory Anomie – Internal needs * External forces (Durkheim, 1951) Interpersonal Theory of Suicide – 1. Thwarted belongingness 2. Perceived burdensomeness 3. Acquired capability (Van Orden, et. al., 2010)

7. Sexual Minority Health Outcomes Victimization =  Risk of suicide (Shields, 2003) Perceived family support =  Risk of suicide (Mustanski & Lui, 2013) Identity Disclosure / Outness =  Risk of suicide (Morris, 2001)

8. Sexual Minority Stress (Meyer, 2003) Minority status Sexual Racial/ethni c Gender Minority status Sexual Racial/ethni c Gender + vs. – outcomes + vs. – outcomes General stressors Internalized homophobia Proximal stress processes Expected rejection Concealment Internalized homophobia Proximal stress processes Expected rejection Concealment Distal stress processes: Prejudiced events Distal stress processes: Prejudiced events Coping, social support access Environmental circumstances Sexual identity Characteristics of identity Prominence Valence Integration Characteristics of identity Prominence Valence Integration

9. Sexual Minority Stress (Meyer, 2003) Minority status Sexual Racial/ethni c Gender Minority status Sexual Racial/ethni c Gender + vs. – outcomes + vs. – outcomes General stressors Internalized homophobia Proximal stress processes Expected rejection Concealment Internalized homophobia Proximal stress processes Expected rejection Concealment Distal stress processes: Prejudiced events Distal stress processes: Prejudiced events Coping, social support access Environmental circumstances Sexual identity Characteristics of identity Prominence Valence Integration Characteristics of identity Prominence Valence Integration Suicide

10. Sexual Minority Stress (Meyer, 2003) Minority status Sexual Racial/ethni c Gender Minority status Sexual Racial/ethni c Gender + vs. – outcomes + vs. – outcomes General stressors Internalized homophobia Proximal stress processes Expected rejection Concealment Internalized homophobia Proximal stress processes Expected rejection Concealment Distal stress processes: Prejudiced events Distal stress processes: Prejudiced events Coping, social support access Environmental circumstances Sexual identity Characteristics of identity Prominence Valence Integration Characteristics of identity Prominence Valence Integration Victim- ization Suicide

11. Sexual Minority Stress (Meyer, 2003) Minority status Sexual Racial/ethni c Gender Minority status Sexual Racial/ethni c Gender + vs. – outcomes + vs. – outcomes General stressors Internalized homophobia Proximal stress processes Expected rejection Concealment Internalized homophobia Proximal stress processes Expected rejection Concealment Distal stress processes: Prejudiced events Distal stress processes: Prejudiced events Coping, social support access Environmental circumstances Sexual identity Characteristics of identity Prominence Valence Integration Characteristics of identity Prominence Valence Integration Outness to family Victim- ization Suicide

12. Missing Literature Distal Stress: Victimization Distal Stress: Victimization Outcomes: Suicide Attempts Outcomes: Suicide Attempts Social Support: Outness to family Social Support: Outness to family ? ?

13. Hypothesis Outness to family will be a significant protective factor against the interaction of victimization and lifetime suicide attempts.

14. Method & Participants 722 sexual minority adults ages 18 – 91 (M = 30.00, SD = 13.85) Recruited nationally from university-affiliated LGBTQ groups, community organizations, and Facebook Online survey methodology Demographics Gender: female (45.7%), male (33.8 %), transgender M to F (4.4%), transgender F to M (5.1%) and other (7.5%) Sexual orientation: gay (28.7%), lesbian (21.9%), bisexual (23.6%), and queer/questioning/other (18.5%) Ethnicity: Caucasian (85.0%), Ethnic minorities (15%)

15. Instrumentation (Measures) Demographics (age, gender, race, ethnicity, sexual identity) Outness (OI; Mohr & Fassinger, 2000) Subscales: Outness to the world, Out to family Victimization (adapted from Herek & Berrill, 1990) Psychological Distress (DASS-21; Antony, Bieling, Cox, Enns, & Swinson, 1998) Suicide Have you ever attempted suicide? a. Yes b. No If yes, how many times have you attempted suicide in your lifetime? ____

16. Analyses A negative binomial regression was used to assess outness to family as a moderator of victimization and lifetime suicide attempts Covariates: age, gender, ethnicity, sexual identity, depression, anxiety, and general (i.e., non-family specific) outness to world Predictors: Outness to family Victimization Family outness*victimization interaction Dependent variable: Number of lifetime suicide attempts

17. Results 28% reported ≥ 1 suicide attempts (Range = 0 – 50, M =.73, SD = 2.46) The interaction model was significant, omnibus  2 = 205.53, df = 14, p <.001 A simple effect for victimization remained beyond the interaction, b =.60, Wald  2 = 49.61, df = 1, p <.001. Outness to family moderated positive association between victimization and lifetime suicide attempts, b = -.20, Wald  2 = 12.86, df = 1, p <.001 * 1 unit  in outness =.20  in suicide attempts

18. Results

19. Discussion Findings support hypothesis Family outness moderated the positive association between victimization and number of lifetime suicide attempts, therefore being out to family appears to be a protective factor 28% lifetime suicide attempts consistent with previous findings Findings highlight significance of family concerning LGBTQ mental health and suicidality Important implications for treatment of suicidality in LGBTQ clients and for developing suicide prevention strategies

20. Directions for Future Research Strategies to encourage family outness Other protective factors against suicide Outness to family and strength of family support Cultural-specific interactions with minority stress and suicidality

21. The Face of Statistics

22. Acknowledgements I would like to extend a huge thank you to Nicholas Livingston, MA, Bryan Cochran, PhD, and all the lab members for their contribution, support and guidance.

23. References Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176-181. Bontempo, D. E., & D’Augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364-374. Durkheim, E. (1951). Suicide: A study in sociology. New York Free Press. Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880. Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R.,... Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of Homoseuxality, 58(1), 10-51. Herek, G. M., & Berrill, K. T. (1992). Documenting the victimization of lesbians and gay men: Methodological issues. (pp. 270-286). Thousand Oaks, CA, US: Sage Publications, Inc, Thousand Oaks, CA.

24. References Herrell, R., Goldberg, J., True, W. R., Ramakrishnan, V., Lyons, M., Eisen, S., et al. (1999). Sexual orientation and suicidality: a co-twin control study in adult men. Archives of General Psychiatry, 56(10), 867–874. Mereish, E. M., O’Cleirigh, C., & Bradford, J. B. (2014). Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychology Health & Medicine, 19(1), 1-13. Meyer, I. (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin, 129(5), 674-694. Mohr, J., Fassinger, R. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33, 66-90. Morris, J. F., Waldo, C. R., & Rothblum, E. D. (2001). A model of predictors and outcomes among lesbian and bisexual women. American Journal of Orthopsychiatry, 71(1), 61-71. Mustanski, B., & Liu, R. T. (2013). A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Archives of Sexual Behavior, 42(3), 437-448.

25. References Shields, J. P., Whitaker, K., Glassman, J., Franks, H., & Howard, K. (2011). Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco. Journal of Adolescent Health, 50, 418-420. Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings (HHS Publication No. 13-4805). Retrieved from http://www.samhsa.gov/data/NSDUH/2k12MH_FindingsandDetTables/2K12MHF/NSDUHmhfr2012.htm #sec3-1 Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575-600.