Content uploaded by Alberto Valido Delgado
Author content
All content in this area was uploaded by Alberto Valido Delgado on Feb 27, 2019
Content may be subject to copyright.
Journal of Child and Family Studies
https://doi.org/10.1007/s10826-019-01339-2
ORIGINAL PAPER
Predictors of Suicidal Ideation and Attempts among LGBTQ
Adolescents: The Roles of Help-seeking Beliefs, Peer Victimization,
Depressive Symptoms, and Drug Use
Tyler Hatchel 1●Katherine M. Ingram1●Sasha Mintz2●Chelsey Hartley3●Alberto Valido1●Dorothy L. Espelage1●
Peter Wyman3
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Objectives Suicide is a leading causes of death for adolescents, and is a developmental period with the highest rates of
suicide attempts. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are a high-risk population for suicidal
ideations and behaviors when compared with their non-LGBTQ counterparts. However, a dearth of research exists on the
protective factors for suicidal ideation and attempts specifically within the LGBTQ population. The current study proposes a
model in which peer victimization, drug use, depressive symptoms, and help-seeking beliefs predict suicidal ideation and
attempts among a statewide sample of LGBTQ adolescents.
Methods Among 4867 high school students in 20 schools, 713 self-identified as LGBTQ and had higher rates of attempts
and ideation than their non-LBGTQ peers. Two logistic regression analyses were used to predict suicidal ideation and
attempts among the 713 LGBTQ students (M=age 15 years).
Results Results indicated that intentions to use drugs, peer victimization, and elevated depressive symptoms predicted both
suicidal ideation and attempts. Additionally, help-seeking beliefs predicted suicidal attempts but not ideation, while the
interaction of help-seeking beliefs and depressive symptoms significantly predicted suicidal ideation.
Conclusions These findings underscore the importance of increasing access to effective treatment services for depression and
promoting safe and accepting school and community cultures for LGBTQ youth in particular.
Keywords Suicidal ideation ●Suicidal behaviors ●LGBTQ youth ●Substance use ●Aggression
Suicide is a critical public health concern. In 2016, suicide
was the tenth overall leading cause of death in the United
States, with almost 45,000 people dying by suicide (CDC
2016). Adolescence has been identified as a key suicide
prevention window period (Wyman 2014), with suicide
being the second leading cause of death among adolescents
ages 10–24 years (CDC 2016). In addition to high rates of
suicide deaths among adolescents, the prevalence of suicide
risk behaviors have been rising. From 2007 to 2017, rates of
suicidal ideation and suicide planning significantly
increased among high school students across the United
States (CDC 2017). In an effort to guide suicide prevention
work, the U.S. National Strategy for Suicide Prevention (U.
S. Surgeon General 2001) and the Institute of Medicine
(Goldsmith et al. 2002) identified lesbian, gay, bisexual,
transgender, or questioning (LGBTQ) youth as a particu-
larly high-risk population for suicidal ideations and beha-
vior. Decades of research, as well as recent data, have
consistently found that LGBTQ youth are at greater risk of
experiencing suicidal ideations and attempts when com-
pared to their heterosexual counterparts (CDC 2017; Gar-
ofalo et al. 1999; Haas et al. 2010).
Suicidal thoughts and behaviors range from seriously
considering suicide, creating a suicide plan, to making a
*Tyler Hatchel
tylerh42@ufl.edu
1Department of Psychology, University of Florida, 945 Center
Drive, P.O. Box 112250, Gainesville, FL, USA
2Violence and Injury Prevention-Mental Health Promotion Branch,
Colorado Department of Public Health and Environment,
Denver, CO, USA
3Department of Psychiatry, University of Rochester School of
Medicine and Dentistry, Rochester, NY, USA
1234567890();,:
1234567890();,:
suicide attempt. Many more people seriously consider sui-
cide or make a suicide attempt than die by suicide, with
some researchers estimating about 25 attempts for every
suicide death and three people with suicidal ideation for
every person with an attempt (Goldsmith et al. 2002; Nock
et al. 2008). Especially considering the variance in these
reported rates, it is critical to understand the differences in
predictors and mechanisms between those who present with
suicidal ideation and those who attempt suicide. A prior
suicide attempt is one of the most reliable predictors of
future attempts and death by suicide in general populations
(Bostwick et al. 2016).
Past research has often cited risk factors for suicide that
are actually risk factors for suicidal ideation, and not for the
progression from ideation to attempts (Klonsky and May
2014). For instance, mental health disorders such as
depression and other mood disorders are very strongly
associated with suicidal ideation when compared to those
who have never been suicidal, but fail to distinguish idea-
tors from attempters (Kessler et al. 1999). This general
pattern was also found in literature examining the suicide
risk factors of hopelessness and impulsivity (Klonsky and
May 2010; Nock and Kazdin 2002). This may be because,
historically, suicide theories and research have conflated the
question of why people have suicidal desires with why
people act on these desires (Durkheim 1951; Shneidman
1993).
Theories and empirical research over the last decade have
taken on an ideation-to-action framework and have begun to
offer differing explanations for suicidal thoughts and the
capability to act on these thoughts (Joiner 2005; Klonsky
and May 2015). Recent research has found that among
adolescents, hopelessness and depression were elevated
among individuals who experienced suicidal ideations
(Taliaferro and Muehlenkamp 2014), whereas a history of
self-injury and alcohol use were indicative of individuals
who attempted suicide (O’Brien et al. 2014). However,
there is a paucity of literature that addresses the risk and
protective factors separately for suicidal ideations and
attempts among the LGBTQ adolescent population.
The Interpersonal Theory of Suicide (IPTS) may help us
understand the mechanisms by which LGBTQ youth are at
greater risk of suicidal thoughts and behavior (Joiner 2005).
The IPTS posits that suicidal ideation is influenced by two
interpersonal experiences: feeling that one does not belong
to meaningful relationships and groups (i.e., thwarted
belongingness) and that one is a burden on others (i.e.,
perceived burdensomeness; Joiner 2005). Thwarted
belongingness is characterized by feelings of loneliness and
is commonly reported by LGBTQ youth due to LGBTQ-
related victimization and bullying experiences (Kosciw
et al. 2012). Perceived burdensomeness is characterized by
self-hatred and feeling like a liability to others, which is also
experienced by LGBTQ youth, specifically when “coming
out”to their friends and family (Baams et al. 2015; Hilton
and Szymanski 2011; Oswald 1999). Substantial empirical
evidence links thwarted belongingness and perceived bur-
densomeness to suicidal ideation and behavior (Joiner et al.
2012; Van Orden et al. 2006). Research shows the com-
bined experience of thwarted belongingness and perceived
burdensomeness confers greater risk for suicidal ideation
and behavior, even after controlling for strong covariates
including depression (Joiner et al. 2009; Van Orden et al.
2008). While research on the IPTS and mechanism for risk
is well established, the differing mechanisms associated
with suicidal ideation and behaviors among LGBTQ youth
remain relatively understudied.
In addition to the IPTS, the Minority Stress Theory
(MST) may shed some light on the nature of suicide among
LGBTQ youth (Meyer 1995). The MST posits that indivi-
duals of marginalized identities (e.g., sexual or gender
minority) experience chronic stress due to stigmatizing
social contexts (Meyer 1995). Internalized bias, specifically
internalized homophobia, is a common manifestation of
minority stress characterized by individuals with sexual
minority identities internalizing societal homophobia. This
experience is immensely and chronically distressing, and
contributes to upholding oppressive norms (Meyer 2003;
Newcomb and Mustanski 2016; Szymanski et al. 2008).
MST has provided a useful framework for understanding
the relations among the marginalization experiences of
sexual minority youth and associated poor outcomes (Hat-
zenbuehler 2009; Lick et al. 2013). This distress may help
account for the overrepresentation of LGBTQ youth among
students grappling with high levels of anxiety, depression,
and risky drug use patterns (Kosciw et al. 2016).
LGBTQ students are disproportionately victimized in
schools, with 85.2% of students reporting sexuality-based
verbal harassment over the past year, with 39.7% at extre-
mely high frequencies, according to a U.S. national sample
(Kosciw et al. 2016). Regarding physical harassment,
27.0% of students from this sample reported being physi-
cally victimized at school based on their sexuality, with
7.5% reporting victimization with high frequency (Kosciw
et al. 2016). These rates of victimization are also consistent
across other forms of peer violence such as cyberbullying,
relational aggression, and sexual harassment (Kosciw et al.
2016). Additionally, LGBTQ students in this sample
reported their sexual orientation being the most common
focus of the attack (Kosciw et al. 2016). A recent study of
248 sexual minority youth in Chicago (ages 16–20 years at
baseline) found that, over the course of four years, 10% of
the sample experienced moderate and increasing peer vic-
timization, about 5% experienced steadily high peer victi-
mization, and about 20% experienced high but declining
peer victimization (Mustanski et al. 2016). This study
Journal of Child and Family Studies
highlights the chronicity of at least moderately frequent
victimization experiences for about one third of the sample.
In addition to peer victimization, depression has been
shown to be associated with suicide in youth. Sixty percent
of adolescent suicide victims had a depressive disorder at
the time of death (Brent et al. 1999). Research suggests that
depression is the strongest predictor of suicidal ideation
(Cash and Bridge 2009). In one study, 85% patients with
major depressive disorder had suicidal ideation (Kovacs
et al. 1993). This is especially concerning among LGBTQ
youth as LGBTQ youth show increased levels of depression
compared to non-LGBTQ youth (Kosciw et al. 2012).
Behavioral health outcomes, including drug use, are also
concerning as they relate to chronic experiences of min-
ority stress (Kosciw et al. 2016). Specifically, LGBTQ
youth are at a higher risk for problematic use of drugs when
compared to their non-LGBTQ peers (CDC 2016;Kosciw
et al. 2016). Further, a recent meta-analysis identified a
significant association between identity-related distress and
drug use among LGBTQ adolescents, highlighting the role
of minority stress (Goldbach et al. 2014). Another expla-
nation scholars have explored for the prevalence of drug
use is affiliations with deviant peers. LGBTQ youth often
form or enter deviant (i.e. isolated) peer groups resulting
from victimization experiences perpetrated by mainstream-
affiliated peers (Hueber et al. 2015). Several studies have
found that students’bond (defined as attachment and
commitment; Catalano et al. 1996) to their school com-
munity facilitates drug use prevention. The model proposes
that when students feel attached and committed to their
school community, they are therefore socially obligated to
uphold norms and standards (Fergusson et al. 2002;Mad-
dox and Prinz 2003). However, once students become
deviant or isolated and no longer feel this obligation, drug
use can proliferate and even become a relative norm within
deviant groups (Fergusson et al. 2002; Maddox and Prinz
2003).
Additionally, given that LGBTQ students have likely
experienced chronic stressors, there is substantial evidence
supporting drug use functioning as a coping mechanism.
One study found that among college students, negative
affect and coping motives mediated the pathway from
experiences of discrimination to problematic alcohol use
(Dawson et al. 2005). However, coping experiences of
LGBTQ adolescents is an understudied area in the extant
literature. Goldbach and Gibbs (2015) employed a qualita-
tive design to explore the unique coping processes
employed by 48 racially diverse sexual minority students.
Regarding relevant constructs, their findings were con-
sistent with studies of LGB adults; adolescents also reported
using drugs to cope with effects of minority stress, among
other strategies. With respect to compounding experiences
of minority stress, a study of LGB adults found that
discrimination on this basis alone did not predict increased
odds of developing a drug use disorder, but LGB-related
discrimination in combination with racially or gender-based
discrimination did increase risk of developing a disorder
(McCabe et al. 2010). How drug use fits into the larger
experience of minority stress among LGBTQ youth strug-
gling with suicide remains relatively understudied. None-
theless, across populations, drug use heightens risk for
death by suicide both acutely and distally (Vijayakumar
et al. 2011). Given the prevalence of direct exposure to bias-
based aggression like homophobia, it is unsurprising that
LGBTQ youth face an elevated risk of developing an array
of internalizing mental health symptoms (e.g., anxiety,
depression, and suicidality; McDermott et al. 2017) as well
as externalizing symptoms (e.g., problematic drug use;
Goldbach et al. 2014).
Research on protective factors has identified willingness
to seek help as a powerful buffer against the development or
escalation of negative outcomes among youth generally,
and sexual minority youth in particular (Clement et al.
2015; McDermott and Roen 2016; McDermott et al. 2017).
Even if students are grappling with mental or behavioral
health issues, if they feel positively about seeking help, they
are more likely to do so and see more positive outcomes in
the future (McDermott et al. 2017). Feeling comfortable
seeking help is closely related to the real or perceived social
supports available. Youth in general report preferring to
turn to peers rather than adults when contemplating suicide,
despite evidence suggesting that aid from an adult or mental
health professional may be more beneficial (Eisenberg et al.
2016; Wyman et al. 2008). Youth experiencing suicidal
thoughts who disclose and seek help from adults are more
likely to perceive that adults will respond positively to
suicide concern and that their peers and family would
support their help-seeking action (Pisani et al. 2012).
Among LGBTQ youth, friends, and especially LGBTQ
friends, may be more supportive than family members
(Doty et al. 2010; McDermott 2015).
These findings align with the IPTS in that social support
buffers against feelings of thwarted belongingness and
provide a realistic pathway for seeking help. However, help
seeking likely becomes most relevant during times of dis-
tress. For students at high risk, willingness to seek help
from social supports may moderate pathways linking min-
ority stress to mental health issues like suicidal thoughts and
behaviors. This also aligns with the extant literature on
social support generally and among LGBTQ youth, which
often conceptualizes and models these factors as interaction
effects (Luthar et al. 2000; Hatchel et al. 2018; Hatchel et al.
2018). Therefore, promoting and normalizing help seeking
represents an important avenue for attenuating grave out-
comes associated with minority stress, such as death by
suicide.
Journal of Child and Family Studies
For a number of reasons (feasibility among them), a
dearth of research exists on the relations among the afore-
mentioned constructs specifically among LGBTQ youth. To
this end, the current study proposes a model in which peer
victimization, drug use, depressive symptoms, and help-
seeking beliefs predict suicidal ideation and behavior
among a statewide sample of LGBTQ adolescents. The
following hypotheses and research questions were devel-
oped: (H1) Peer victimization will predict both suicidal
ideation and behavior. (H2) Likelihood of future drug use
will predict both suicidal ideation and behavior. (H3)
Depressive symptoms will predict both suicidal ideation and
behavior. (H4) Help-seeking beliefs will predict both sui-
cidal ideation and behavior. (H5) Help-seeking beliefs will
moderate the relation between depressive symptoms and
suicidality. (RQ1) How will the predictors vary in their
effects on ideation vs. behavior? (RQ2) Will the models
vary as a function of LGBTQ identity?
Method
Participants
Participants were a sample of students enrolled in 20 high
schools (N=4867) participating in baseline data collection
for a randomized clinical trial testing the effects of Sources
of Strengths (LoMurray 2005; Wyman et al. 2010). Self-
reported sexual orientation was straight (83.5%), gay or
lesbian (2%), bisexual (6.9%), questioning (3.2%), and
other (2.5%). Only students who reported not being het-
erosexual and/or reported being transgender were included
in the LGBTQ models (N=713). Students in this sample
were predominantly Hispanic (43.4%), White (40.3%), and
Multiracial (8.1%). Ages ranged from 12 to 18 years (M=
15 years) and most were in 9th grade (42.6%), 10th grade
(38.4%) and 11th grade (18.2%). Self-reported gender was
male (23.0%), female (66.3%), transgender (4.3%), and
other (5.9%). The non-LGBTQ sample (N=4154) was also
largely Hispanic (47.0%) and White (44.0%). Ages ranged
from 12 to 18 years (M=15 years) and most were in 9th
grade (42.1%), 10th grade (38.8%) and 11th grade (18.2%).
Self-reported gender was male (54.8%), female (44.6%).
Procedure
The study was approved by institutional review boards
(IRBs). A waiver of documentation of parent consent was
approved by the IRBs such that all parents received infor-
mation letters and could opt their child out of participation
by returning a form, calling the school or emailing research
staff. Eligible students were provided information about the
study and those who provided verbal assent were enrolled to
complete online surveys. Data collection occurred during
regular class times with the supervision of one of the
researchers in each classroom. Most students completed an
online survey, but paper surveys were used for Spanish
speaking students and if there were connectivity issues with
the online survey. Students were provided with a log-in id
and password that was unique to each student, and they did
not enter their names. Students could skip any questions
that they did not feel comfortable answering and could stop
participation at any point. They were provided with
resources at the end of the survey for suicidal concerns,
depression issues, and sexual violence. Data collection was
completed during the fall of 2017 and a report with school
level outcomes was offered to school administrators as part
of the study. All students and parents were informed that
survey responses would be de-identified and therefore no
individual data would be reviewed for the purpose of crisis
intervention or referrals.
Measures
Help-seeking beliefs
Help-seeking beliefs were measured with the Help-Seeking
from Adults at School scale (Schmeelk‐Cone et al. 2012;
Wyman et al. 2010). The measure assesses students’beliefs
and perceived norms about getting help for emotional dis-
tress. The scale consists of seven items beginning with the
stem, “If I was really upset and needed help…” students
responded to questions covering intentions to seek help (“I
would talk to a counselor or other adult at school”),
expectations of receiving help (“I believe a counselor or
other adult at school could help me”), and perceived norms
about seeking help (“My friends…” or “My family……
would want me to talk to a counselor or other adult at
school”). Students responded to each item using a four-
point Likert scale (Strongly Disagree =“1”through
Strongly Agree =“4”). The Cronbach’s alpha was .87 for
the LGBTQ sample and .89 for the non-LGBTQ sample.
Suicidal ideation
Suicidal ideation during the past 6 months was measured
with the question “…have you seriously considered sui-
cide?”Student responses were: No =“0”or Yes =“1.”
Suicidal attempts
Suicidal attempts during the past 6 months were measured
with one question “…how many times did you actually
attempt suicide?”. Students were only asked whether they
attempted suicide if they answered “Yes”to either the sui-
cidal ideation or planning questions. Response options
Journal of Child and Family Studies
included: 0 times “0”, 1 time “1”, 2 or 3 times “2”, 4 or 5
times “3”, and 6 or more times “4”. Responses were
dichotomized.
Peer victimization
Victimization from peers was assessed using the 4-item
University of Illinois Victimization Scale (UIVS; Espelage
and Holt 2001). Students are asked how often the following
things have happened to them in the past 30 days (i.e.,
“Other students called me names”,“Other students made
fun of me”,“Other students picked on me”, and “I got hit
and pushed by other students”). Response options include:
“Never”,“1 or 2 times”,“3 or 4 times”,“5 or 6 times”, and
“7 or more times.”Construct validity of this measure was
supported through exploratory and confirmatory factor
analyses and convergence with peer nominations of victi-
mization (Espelage and Holt 2001). Higher scores indicate
more self-reported victimization. A Cronbach alpha coeffi-
cient of .86 was found for the LGBTQ sample and .89 for
the non-LGBTQ sample.
Likelihood of future drug use
Drug use was measured with 4 questions asking students
how likely they would engage in drug use behaviors during
the next 6 months. Students were asked “How likely are you
in the next 6 months to …”: (1) “smoke cigarettes”; (2) “get
drunk or very high on alcohol”; (3) “use marijuana”; and (4)
“use prescription drugs to get high.”Response options
ranged from: Not at all likely “0”; Somewhat likely “1”; and
Very likely “2.”We did not ask about current alcohol and
drug use because one of the IRBs viewed this behavior as
illegal and therefore unethical without further investigation.
A Cronbach alpha coefficient of .76 was found for the
LGBTQ sample and .75 for the non-LGBTQ sample.
Depressive symptoms
Depressive Symptoms were measured using the Short
Mood and Feelings Questionnaire (SMFQ; Angold et al.
1996). The SMFQ (13 items) has well-established content
and criterion-related validity, with significant and high
correlations between the SMFQ and the longer version
(MFQ), the Children’s Depression Inventory, and the
Diagnostic Interview Schedule for Children. Scores ranged
from 0 to 26, with higher scores indicating more depressive
symptoms (Angold et al. 1995). This scale asks adolescents
to indicate how much they felt or acted certain ways in the
last 30 days. Examples include: “I felt miserable or
unhappy”, and “I thought nobody really loved me”.
Response options were: Never “0”; Sometimes “1”; and
Most of the time “2”with higher scores indicating more
depressive symptoms. A Cronbach alpha coefficient was .94
for both samples.
Data Analyses
Hierarchical logistic regression analyses were completed
with IBM SPSS 24.0 to determine whether the set of vari-
ables and interactions predicted the health outcomes of
interest (i.e., suicidal ideation and attempts). The assump-
tions for normality were acceptable for all variables other
than suicidal attempts which was dichotomized. Two main
regression analyses were modeled for both samples—one
with suicidal ideation (Y/N) as the outcome and the other
with suicide attempts (Y/N) as the outcome. For all models,
(1) peer victimization was added to the first step, followed
by (2) help-seeking beliefs, (3) depressive symptoms, and
(4) likelihood of future drug use, then the interaction term
between (5) depressive symptoms and help-seeking atti-
tudes was added to the third step. Age and sex were con-
trolled for as covariates. All predictors were centered before
calculating product terms to protect against multicollinearity
(Tabachnick and Fidell 2007). The significant interaction
effects were illustrated by graphing the regression equation
at relevant beta values of the moderator (i.e., help-seeking
beliefs).
Missing data ranged from 2.5 to 5.0% depending on the
item. Little’s missing completely at random (MCAR) test
indicated that the data were missing at random (χ2=
463.33, p=.34). This enables the utilization of imputation
with minimal risk of biased estimation. The maximization
estimation method was implemented to impute the missing
data as it is believed to be superior to methods like list-wise
deletion or mean substitution (Schlomer et al. 2010).
Results
Descriptive statistics are depicted in Table 1and bivariate
correlates are shown in Table 2. In the sample of 713 stu-
dents identifying as LGBTQ, 42% reported considering
suicide in the past six months and 29% reported attempting
suicide at least once in the past six months. In contrast, via
the sample of 4154 non-LGBTQ identified youth, 14%
reported suicidal ideation and 9% reported suicide attempts.
LGBTQ Sample
Suicidal ideation
Results of the analyses demonstrated that the set of five
predictors successfully distinguished between LGBTQ
adolescents who reported suicidal ideation and those who
did not, χ2(7) =261.78, p<.001. The predictors, as a
Journal of Child and Family Studies
whole, accounted for 44% of the variance in suicidal idea-
tion. Specifically, the model correctly predicted the outcome
category for 83% of adolescents who were not actively
suicidal and 69% for those who were. This offered an
overall prediction success rate of 77%.
In the first model, tests of the individual parameters
revealed peer victimization differentiated between
those who reported suicidal ideation and those who did not
(b =.42, z=29.89, p< .001). In the second model,
depressive symptoms was the strongest predictor (b =2.44,
z=129.04, p< .001). Reported depressive symptoms
increased the probability of suicidal ideation by a multi-
plicative factor of 11.44; that is, LGBTQ adolescents were
almost 12 times more likely to endorse suicidal ideation if
they were experiencing depressive symptoms. Greater
likelihood of future drug use also predicted suicidal idea-
tion; the more future drug use reported, the more likely they
were to report ideation (b =.81, z=12.84, p<.001). Spe-
cifically, in the order of roughly 2 times more likely than
their peers who did not report future drug use. The inter-
action term between help-seeking beliefs and depressive
symptoms significantly predicted suicidal ideation (b =.87,
z=6.18, p<.01). Plotting of the relationship between
depression and ideation for students with varying levels of
help-seeking beliefs (–1 SD, Mean, +1 SD) showed that
those who reported higher help-seeking beliefs and more
depressive symptoms were more likely to endorse ideation
than those with lower help-seeking beliefs (Fig. 1). See
Table 3for a summary.
Suicide attempts
The set of five predictors successfully distinguished
between LGBTQ adolescents who reported suicidal beha-
viors and those who did not, χ2(7) =111.09, p<.001. The
predictors accounted for 22% of the variance in suicidal
behavior. Precisely, the model correctly predicted the out-
come category for 90% of adolescents who did not endorse
suicidal behavior and 28% for those who did. This offered
an overall prediction success rate of 72%.
In the first model, tests of the individual parameters
revealed peer victimization differentiated between
those who reported suicidal ideation and those who did not
(b =.52, z=33.66, p<.001). In the second model, three of
the individual parameters significantly differentiated
Table 2 Bivariate correlations between study variables
Help-seeking
beliefs
Peer victimization Depressive symptoms Future drug use Suicidal ideation Suicidal attempts
LGBTQ adolescents
Help-seeking beliefs –
Peer victimization −.17* –
Depressive symptoms −.23* .32* –
Future Drug use −.26* .29* .31* –
Suicidal ideation −.18* .21* .57* .30* –
Suicidal attempts −.17* .26* .35* .26* .52* –
Non-LGBTQ adolescents
Help-seeking beliefs –
Peer victimization −.15* –
Depressive symptoms −.21* .33* –
Future Drug use −.22* .17* .26* –
Suicidal ideation −.14* .26* .55* .26* –
Suicidal attempts −.13* .24* .41* .23* .55* –
Note. *p< .01
Table 1 Descriptive statistics for study variables
Mean SD Range
LGBTQ Adolescents
Help-seeking beliefs 1.70 .59 0–3
Peer victimization .62 .97 0–4
Depressive symptoms .96 .59 0–2
Future drug use .31 .48 0–2
Suicidal ideation .42 .49 0–1
Suicidal attempts .30 .46 0–1
Non-LGBTQ Adolescents
Help-seeking beliefs 1.80 .62 0–3
Peer victimization .35 .73 0–4
Depressive symptoms .50 .51 0–2
Future drug use .18 .36 0–2
Suicidal ideation .14 .35 0–1
Suicidal attempts .12 .37 0–1
Journal of Child and Family Studies
between those who reported suicidal behavior and those
who did not. Help-seeking beliefs reduced the probability of
reporting suicidal behavior (b =−.23, z=1.87, p<.05).
These beliefs decreased the probability of suicidal behavior
by multiplicative factor of .80. Depressive symptoms were
the strongest predictor (b =1.15, z=41.55, p<.001). Sta-
ted depressive symptoms increased the probability of sui-
cidal behavior by a multiplicative factor of 3.16.
Specifically, LGBTQ adolescents were at least three times
more likely to endorse suicidal behavior if they were
experiencing depressive symptoms. Greater likelihood of
future drug use and peer victimization also predicted sui-
cidal behavior –the greater future drug use and peer vic-
timization reported the more likely they were to report
suicidal behavior (b =.55, z=7.97, p<.01; and b =.29,
z=8.65, p<.01). In detail, LGBTQ adolescents were at 1.7
times more likely to endorse suicidal behavior if they
reported future drug use and 1.3 times more likely if they
reported being victimized by their peers. The interaction
between help-seeking beliefs and depressive symptoms
predicting suicide attempts was not significant. See Table 4
for a summary.
Non-LGBTQ Sample
Suicidal ideation
Results of the analyses demonstrated that the set of five
predictors successfully distinguished between non-LGBTQ
adolescents who reported suicidal ideation and those who
did not, χ2(7) =1089.15, p<.001. All of the predictors
accounted for 46% of the variance in suicidal ideation.
Precisely, the model correctly predicted the outcome cate-
gory for 97% of adolescents who were not actively suicidal
and 44% for those who were. This offered an overall pre-
diction success rate of 89%.
Peer victimization differentiated between those who
reported suicidal ideation and those who did not in the first
model (b =.77, z=194.84, p<.001). Non-LGBTQ
Table 3 Logistic regression on
suicidal ideation Predictor B (SE) Wald χ2Odds ratio 95% CI
LGBTQ adolescents
Model 1
Peer victimization .42 (.09) 21.89** 1.52 [1.27, 1.80]
Model 2
Peer victimization −.01 (.11) .01 .99 [.80, 1.22]
Help-seeking beliefs −.12 (.17) .43 .89 [.63, 1.26]
Depressive symptoms 2.44 (.22) 129.04** 11.44 [7.51, 17.41]
Future drug use .81 (.23) 12.84** 2.24 [1.44, 3.49]
Model 3
Help-seeking beliefsx Depressive symptoms .87 (.35) 6.18* 2.38 [1.20, 4.72]
Non-LGBTQ adolescents
Model 1
Peer victimization .77 (.06) 194.84** 2.16 [1.94, 2.40]
Model 2
Peer victimization .32 (.07) 21.39** 1.38 [1.20, 1.58]
Help-seeking beliefs −.05 (.10) .28 .95 [.78, .1.16]
Depressive symptoms 2.77 (.13) 481.87** 15.95 [12.45, 20.42]
Future drug use 1.05 (.14) 54.84** 2.86 [2.17, 3.78]
Model 3
Help-seeking beliefs × depressive symptoms .17 (.19) .76 1.18 [.81, 1.73]
Note.*p< .01, **p< .001
2
3
4
5
6
7
8
minus 1 SD Mean plus 1 SD
Suicidal Ideation
Depressive Symptoms
minus 1 SD Help Seeking
Beliefs
Mean Help Seeking Beliefs
plus 1 SD Help Seeking
Beliefs
Fig. 1 Intceraction of depressive symptoms x help-seeking beliefs on
suicidal ideation for LGBTQ adolescents
Journal of Child and Family Studies
adolescents were at least 2 times more likely to endorse
suicidal ideation if they were reported being victimized by
peers. In the second model, test of individual parameters
revealed three variables that predicted suicidal ideation—
depressive symptoms (b =2.77, z=481.97, p<.001)
which increased the probability of suicidal ideation by a
multiplicative factor of 15.95; future drug use (b =1.05,
z=54.84, p<.001) which increased the probability of
suicidal ideation by a multiplicative factor of 2.86; and peer
victimization (b =.32, z=21.39, p<.001) which increased
the probability of suicidal ideation by a multiplicative
factor of 1.37. The interaction effect was not significant (see
Table 3).
Suicide attempts
The set of five predictors effectively distinguished between
non-LGBTQ adolescents who reported suicidal behaviors
and those who did not, χ2(7) =638.79, p<.001. The
predictors accounted for 33% of the variance in suicidal
behavior. Specifically, the model correctly predicted the
outcome category for 98% of adolescents who did not
endorse suicidal behavior and 28% for those who did. This
offered an overall prediction success rate of 90%.
In the first model, peer victimization discriminated
between those who reported suicidal behavior and those
who did not (b =.70, z=149.90, p<.001). Non-LGBTQ
adolescents were at least two times more likely to endorse
suicidal behavior if they were reported being victimized by
peers. In the second model, test of individual parameters
revealed three factors that predicted suicidal behavior—
depressive symptoms (b =1.97, z=282.95, p<.001)
which increased the probability of suicidal behavior by a
multiplicative factor of 7.18; future drug use (b =.99, z=
49.59, p<.001) which increased the probability of suicidal
ideation by a multiplicative factor of 2.68; and peer victi-
mization (b =.30, z=19.30, p<.001) which increased the
probability of suicidal ideation by a multiplicative factor of
1.35 (see Table 4). In the third mode, the interaction term
between help-seeking beliefs and depressive symptoms was
not significant.
Discussion
This study further advanced the suicide literature by
examining predictors of suicidal ideation and suicide
attempts among a relatively large sample of high school
students. Consistent with previous research, this sample of
LGBTQ students reported frequent suicidal ideation and
attempts. More specifically, 40% of the sample reported
suicidal ideation in the last six months, which is consistent
with the 43% reported ideation in the past year in a
nationally representative sample (Zaza et al. 2016). This
difference could be partially explained by the reporting time
difference of six months versus a year. The LGBTQ
Table 4 Logistic regression on
suicidal behavior Predictor B (SE) Wald χ2Odds ratio 95% CI
LGBTQ adolescents
Model 1
Peer victimization .52 (.09) 33.66** 1.69 [1.41, 2.01]
Model 2
Peer victimization .29 (.10) 8.65* 1.34 [1.10, 1.62]
Help-seeking beliefs −.23 (.17) 1.87 .80 [.57, 1.10]
Depressive symptoms 1.15 (.18) 41.76* 3.16 [2.23, 4.49]
Future drug use .55 (.19) 7.97* 1.73 [1.18, 2.52]
Model 3
Help-seeking beliefs × depressive symptoms .38 (.28) 1.83 1.47 [.84, 2.55]
Non-LGBTQ adolescents
Model 1
Peer victimization .70 (.06) 149.90** 2.01 [1.79, 2.24]
Model 2
Peer victimization .30 (.07) 19.30** 1.36 [1.18, 1.55]
Help-seeking beliefs −.16 (.11) 2.33 .85 [.69, 1.05]
Depressive symptoms 1.97 (.12) 282.95** 7.18 [5.71, 9.03]
Future drug use .99 (.14) 49.60** 2.68 [2.04, 3.53]
Model 3
Help-seeking beliefs × depressive symptoms .28 (.17) 2.58 1.32 [.84, 1.86]
Note.*p< .01, **p< .001
Journal of Child and Family Studies
adolescents in our sample have a a higher prevalence of
both suicidal ideation and attempts compared to their non-
LGBTQ peers. Concerning suicide attempts, 29% of our
sample reported attempting suicide in the last 6 months,
which is consistent with 29% of LGBTQ youth who
attempted in the last year in a nationally representative
sample, which is much higher than the 6% of attempts by
heterosexual youth (Zaza et al. 2016). This extraordinarily
high rate of attempts is particularly alarming in light of
evidence that each suicide attempt substantially increases
risk for future attempts and death by suicide (Bostwick et al.
2016).
IPTS and MST were utilized to inform our understanding
of factors that are associated with greater rates of suicidal
ideation and attempts (Joiner 2005; Meyer 1995). IPTS
suggests that LGBTQ youth are at greater risk for suicidal
ideation because peer victimization and rejection increase
thwarted belongingness and perceived burdensomeness;
MST points to the chronic stress associated with being a
gender or sexual minority as a result of stigmatizing social
contexts, such as school. Thus, depression, peer victimiza-
tion, help-seeking beliefs and intent to use drugs were
examined as predictors of both suicidal ideation and
attempts. As hypothesized, LGBTQ youth who reported
high levels of depression were significantly more likely to
report suicidal ideation than LGBTQ youth with less
depression. LGBTQ Youth with high levels of depression
were three times more likely to attempt suicide in the last
six months in comparison to LGBTQ youth with less
depression. Of note, the differential prediction of depression
between ideation and attempts is consistent with the
research where depression and other mood disorders are
very strongly associated with suicidal ideation when com-
pared to those who have never been suicidal, but fail to
distinguish ideators from attempters (Kessler et al. 1999).
Greater peer victimization experiences were predictive of
both suicidal ideation and attempts. Higher rates of peer
victimization and the associated adverse outcomes, includ-
ing suicidal thoughts and attempts, among LGBTQ youth
have been demonstrated by countless studies (Birkett et al.
2009; Huebner et al. 2015; Kosciw et al. 2012; Robinson
and Espelage 2011; Ybarra et al. 2015). There is substantial
empirical evidence linking general peer victimization and
suicidal ideation and our results align well (Duong and
Bradshaw 2014; Eisenberg et al. 2016; Livingston et al.
2015; Poteat et al. 2013). However, peer victimization did
not predict suicidal ideation when the other predictors were
added to the model. One interpretation of our findings is
that elevated depression in particular explains the risk for
ideation among LGBTQ youth, and that peer victimization
may serve to precipitate attempts within this vulnerable
group. That is, peer victimization may potentiate ideation-
to-action. An important priority for future studies with
LGBTQ populations is to prospectively study the transition
from ideation to attempts.
It is worth noting that there is another dimension of
victimization that our present study does not tap into, and
that is the intention behind the aggression. Bias-based
aggression, like homophobic bullying, may be better at
predicting ideation in line with MST (Meyer 2003). This
has been demonstrated by a number of other studies (Baams
et al. 2015; Lea et al. 2014; Liu and Mustanski 2012;
Russell et al. 2011; Whitaker et al. 2016). Our finding
specific to peer victimization needs to be replicated,
examined within a longitudinal framework, and interpreted
with caution.
Like peer victimization, endorsement of help-seeking
beliefs was differentially predictive of suicidal ideation and
attempts, which did not support our initial hypothesis. Help-
seeking beliefs did not predict ideation, but low help-
seeking beliefs were associated with suicide attempts. It is
possible that there is a correlation between low help-seeking
beliefs, which include limited expectations of being helped,
and hopelessness that is a well-established predictor of
suicidal attempts. This is an association that should be
explored further. When help-seeking beliefs were examined
as a moderator of depression and suicidal ideation and
attempts, this moderating effect was found only for ideation.
Closer examination of the interaction between depression
and help-seeking beliefs indicated that LGBTQ youth with
the highest levels of depression and highest levels of posi-
tive help-seeking beliefs were modestly more likely to
report suicidal ideation. This finding could indicate that
youth who are willing to report ideation and depression on
self-report measures might be seeking help given their
heightened level of distress (McDermott et al. 2017).
Another interpretation is that having both help-seeking
beliefs and depressive symptoms was indicative of open-
ness to reporting their ideation. The results are somewhat
unintuitive since previous research has demonstrated that
receiving support offers a buffering effect (Clement et al.
2015; McDermott and Roen 2016; McDermott et al. 2017).
Help-seeking beliefs may be an important seqeula to
receiving support, while not offering the same kind of
effect. Future work should explore how to translate beliefs
into actually receiving much needed support. In contrast,
help-seeking did not moderate the association between
depression and likelihood of a suicide attempt, which is
another source of data that suggests a distinction between
factors that increase likelihood of suicidal ideation and
likelihood of attempts.
Concerning differences between LGBTQ adolescents
and their non-LGBTQ peers, the data largely demonstrate
similarities concerning predictors of both suicidal ideation
Journal of Child and Family Studies
and behavior. Elevated depression was associated with both
suicidal ideation and attempts for both groups, as was
higher likelihood of future alcohol and drug use as well as
peer victimization. These findings align well with the extant
literature (CDC 2016; Kosciw et al. 2016). The main
between-group differences were associated with help-
seeking beliefs, which predicted diminished reports of sui-
cidal behavior among only LGBTQ adolescents. Likewise,
the interaction between depressive symptoms and help-
seeking beliefs on suicidal ideation only emerged for the
LGBTQ group. Given the feelings of isolation, depression,
and hopelessness that are not uncommon among LGBTQ
adolescents (Kosciw et al. 2012), it is likely that having
positive beliefs around help seeking is more powerful in
attenuating one’s potential to act on suicidal thoughts.
Similarly, since there is considerable stigma associated with
both being LGBTQ and having mental health problems
(Meyer 2003), it seems probable that this marginalized
group is more likely to report their high levels of distress
via discreet methods. Since there is a clear paucity of
research on help-seeking beliefs among LGBTQ adoles-
cents, these results should be interpreted with caution and
replicated.
The public health significance of reducing youth suicidal
attempts across general and specific high-risk populations is
increasing. Suicide death rates have continued to rise from
2010 to 2015 (the last year reported), most notably for
10–14 year olds by 53% and for 15–19 year olds (CDC
2016) whose death rates have increased by 30%. Our
findings of high rates of suicide ideation and attempts
among LGBTQ youth is cause for concern and also
demonstrate that depression, peer victimization, drug use,
and help-seeking beliefs are all worthy of consideration for
new prevention approaches among this high-risk popula-
tion. First, our findings underscore the importance of
increasing access to effective treatment services for
depression and promoting safe and accepting school and
community cultures. Of additional interest is our finding
that positive help-seeking beliefs may be helpful for
LGBTQ youth struggling with both ideation and depres-
sion. It is unclear how positive help-seeking beliefs and
expectations can be promoted among diverse LGBTQ
adolescents, and exploring this issue should be a priority for
future research and intervention studies.
Limitations and Future Research
There are important limitations to our study. First, the data
are cross-sectional and no conclusions can be made
regarding directionality among the predictors and suicidal
ideation or attempts. Future studies using longitudinal data
are needed to disentangle the relationships uncovered in this
study. Second, LGBTQ participants were examined as a
homogenous group even though their experiences are likely
to be diverse. Therefore, the findings of this study do not
offer precise conclusions concerning how groups within the
LGBTQ youth community may vary. Lastly, participants
were selected from the state of Colorado, therefore findings
may not generalize to a wider population at the state,
national, or international level.
Future research will benefit from large scale longitudinal
studies to uncover the distinct predictors and protective
factors of suicidal ideation and attempts and, in particular,
the transition from ideation to attempts. Studies with access
to nationally representative samples will be needed to
understand the higher risk of suicidality among LGBTQ
youth. Specifically, research should focus on when and why
individuals transition from suicidal ideation to suicide
attempts (Klonsky et al. 2016). This knowledge will be
essential to the creation of successful interventions and
prevention programs geared towards those at a heightened
risk, like LGBTQ youth.
The present study sought to advance the field by devel-
oping the literature on predictors of suicidal ideation and
suicide attempts among LGBTQ youth and their peers.
Whereas a large number of prior studies have assessed
mental health and drug use risk factors, a strength of our
study was to assess the role of help-seeking beliefs, which
incorporated expectations of receiving help and peer and
family support for help seeking. Our finding regarding low
help seeking and increased likelihood of attempts points to
new directions for research and prevention. Another
strength of the study was the relatively large sample of
LGBTQ adolescents selected from 20 different schools
across the state of Colorado with diverse levels of urban and
rural development.
Funding Data in this manuscript were drawn from a grant from the
Centers for Disease Control and Prevention (1 U01 CE002841) to
Dorothy L. Espelage and Peter Wyman (Co-PIs).
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Ethical Approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards. IRB approval was received from the University of Florida,
the University of Rochester, the Colorado Department of Public
Health, and Texas Tech University.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
Publisher’s note: Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Journal of Child and Family Studies
References
Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., &
Silver (1995). Development of a short questionnaire for use in
epidemiological studies of depression in children and adolescents.
International Journal of Methods in Psychiatric Research,5(4),
237–249.
Angold, A., Erkanli, A., Costello, E. J., & Rutter, M. (1996). Preci-
sion, reliability and accuracy in the dating of symptom onsets in
child and adolescent psychopathology. Journal of Child Psy-
chology and Psychiatry,37(6), 657–64. https://doi.org/10.1111/j.
1469-7610.1996.tb01457.x.
Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress
and mechanisms of risk for depression and suicidal ideation
among lesbian, gay, and bisexual youth. Developmental Psy-
chology,51(5), 688–696. https://doi.org/10.1037/a003899.
Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and ques-
tioning students in schools: the moderating effects of homophobic
bullying and school climate on negative outcomes. Journal of
Youth and Adolescence,38(7), 989–1000. https://doi.org/10.
1007/s10964-008-9389-1.
Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016).
Suicide attempt as a risk factor for completed suicide: even more
lethal than we knew. American Journal of Psychiatry,173(11),
1094–1100. https://doi.org/10.1176/appi.ajp.2016.15070854.
Brent, D. A., Baugher, M., Bridge, J., Chen, T., & Chiapetta, L.
(1999). Age- and sex-related risk factors for adolescent suicide.
Journal of American Academy of Child and Adolescent Psy-
chiatry,38(12), 1497–1505. https://doi.org/10.1097/00004583-
199912000-00010.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and
suicidal behavior. Current Opinion in Pediatrics,21, 613–619.
https://doi.org/10.1097/MOP.0b013e32833063e1.
Catalano, R. F., Kosterman, R., Hawkins, J. D., Newcomb, M. D., &
Abbott, R. D. (1996). Modeling the etiology of adolescent sub-
stance use: a test of the social development model. Journal of
Drug Issues,26(2), 429–455. https://doi.org/10.1177/
002204269602600207.
Centers for Disease Control and Prevention. (2016). Web-based Injury
Statistics Query and Reporting System (WISQARS). US
Department of Health and Human Services, National Center for
Injury Prevention and Control. https://www.cdc.gov/injury/wisqa
rs/index.html. Accessed 12 Sept 2018.
Centers for Disease Control and Prevention. (2017) Youth Risk
Behavior Survey—Data Summary & Trends Report: 2007–2017.
Youth Risk Behavior Survey. https://www.cdc.gov/healthyyouth/
data/yrbs/pdf/trendsreport.pdf. Accessed 12 September 2018.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko,
S., Bezborodovs, N., & Thornicroft, G. (2015). What is the
impact of mental health-related stigma on help-seeking? A sys-
tematic review of quantitative and qualitative studies. Psycholo-
gical Medicine,45(1), 11–27. https://doi.org/10.1017/
S0033291714000129.
Dawson, D. A., Grant, B. F., & Ruan, W. J. (2005). The association
between stress and drinking: modifying effects of gender and
vulnerability. Alcohol and Alcoholism,40(5), 453–460. https://
doi.org/10.1093/alcalc/agh176.
Doty, N. D., Willoughby, B. L., Lindahl, K. M., & Malik, N. M.
(2010). Sexuality related social support among lesbian, gay, and
bisexual youth. Journal of Youth and Adolescence,39(10),
1134–1147. https://doi.org/10.1007/s10964-010-9566-x.
Duong, J., & Bradshaw, C. (2014). Associations between bullying and
engaging in aggressive and suicidal behaviors among sexual
minority youth: the moderating role of connectedness. Journal of
School Health,84(10), 636–645. https://doi.org/10.1111/josh.
12196.
Durkheim, E. (1951). Suicide: A study in sociology. New York: Free
Press.
Eisenberg, M. E., McMorris, B. J., Gower, A. L., & Chatterjee, D.
(2016). Bullying victimization and emotional distress: is there
strength in numbers for vulnerable youth? Journal of Psychoso-
matic Research,86,13–19. https://doi.org/10.1016/j.jpsychores.
2016.04.007.
Espelage, D. L., & Holt, M. K. (2001). Bullying and victimization
during early adolescence: peer influences and psychosocial cor-
relates. Journal of Emotional Abuse,2(2–3), 123–142. https://doi.
org/10.1300/J135v02n02_08.
Fergusson, D. M., Swain-Campbell, N. R., & Horwood, L. J. (2002).
Deviant peer affiliations, crime and substance use: a fixed effects
regression analysis. Journal of Abnormal Child Psychology,30
(4), 419–430.
Garofalo, R., Wolf, R. C., Wissow, L. S., Woods, E. R., & Goodman,
E. (1999). Sexual orientation and risk of suicide attempts among a
representative sample of youth. Archives of Pediatrics & Ado-
lescent Medicine,153(5), 487–493. https://doi.org/10.1001/a
rchpedi.153.5.487.
Goldbach, J. T., & Gibbs, J. (2015). Strategies employed by sexual
minority adolescents to cope with minority stress. Psychology of
Sexual Orientation and Gender Diversity,2(3), 297–306. https://
doi.org/10.1037/sgd0000124.
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S.
(2014). Minority stress and substance use in sexual minority
adolescents: a meta-analysis. Prevention Science,15(3),
350–363. https://doi.org/10.1007/s11121-013-0393-7.
Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M. & Bunney, W. E.
(2002). Reducing Suicide: A National Imperative. Washington,
DC: National Academy Press.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D.,
D’Augelli, A. R., & Russell, S. T. (2010). Suicide and suicide
risk in lesbian, gay, bisexual, and transgender populations: review
and recommendations. Journal of Homosexuality,58(1), 10–51.
https://doi.org/10.1080/00918369.2011.534038.
Hatchel, T., Merrin, G. J., & Espelage, A. D. (2018). Peer victimiza-
tion and suicidality among LGBTQ youth: the roles of school
belonging, self-compassion, and parental support. Journal of
LGBT Youth.https://doi.org/10.1080/19361653.2018.1543036.
Hatchel, T., Subrahmanyam, K., & Negriff, S. (2018). Adolescent peer
victimization and internalizing symptoms during emerging
adulthood: the role of online and offline social support. Journal of
Child and Family Studies,1–11. https://doi.org/10.1007/s10826-
018-1286-y.
Hatzenbuehler, M. L. (2009). How does sexual minority stigma “Get
Under the Skin”? A psychological mediation framework. Psy-
chological Bulletin,135(5), 707–730. https://doi.org/10.1037/a
0016441.
Hilton, A. N., & Szymanski, D. M. (2011). Family dynamics and
changes in sibling of origin relationship after lesbian and gay
sexual orientation disclosure. Contemporary Family Therapy: An
International Journal,33(3), 291–309. https://doi.org/10.1007/
s10591-011-9157-3.
Huebner, D. M., Thoma, B. C., & Neilands, T. B. (2015). School
victimization and substance use among lesbian, gay, bisexual,
and transgender adolescents. Prevention Science,16(5), 734–743.
https://doi.org/10.1007/s11121-014-0507-x.
Joiner, T. E. (2005). Why people die by suicide. Cambridge: Harvard
University Press.
Joiner, T. E., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J.
D., Lewis, R., & Rudd, M. D. (2009). Main predictions of the
interpersonal-psychological theory of suicidal behavior: empirical
Journal of Child and Family Studies
tests in two samples of young adults. Journal of Abnormal Psy-
chology,118(3), 634–646. https://doi.org/10.1037/a0016500.
Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal self-
injury, suicidal behavior, and their co-occurrence as viewed
through the lens of the interpersonal theory of suicide. Current
Directions in Psychological Science,21(5), 342–347. https://doi.
org/10.1177/0963721412454873.
Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and
risk factors for lifetime suicide attempts in the national comor-
bidity survey. Archives of General Psychiatry,56, 617–626.
https://doi.org/10.1001/archpsyc.56.7.617.
Klonsky, E. D., & May, A. M. (2010). Rethinking impulsivity in
suicide. Suicide and Life-Threatening Behavior,40, 612–619.
https://doi.org/10.1521/suli.2010.40.6.612.
Klonsky, E. D., & May, A. M. (2014). Differentiating suicide
attempters from suicide ideators: a critical frontier for suicidology
research. Suicide and Life-Threatening Behavior,44(1), 1–5.
https://doi.org/10.1111/sltb.12068.
Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): a
new theory of suicide rooted in the “ideation-to-action”frame-
work. International Journal of Cognitive Therapy,8(2), 114–129.
https://doi.org/10.1521/ijct.2015.8.2.114.
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide
attempts, and suicidal ideation. Annual Review of Clinical Psy-
chology,12, 307–330. https://doi.org/10.1146/annurev-clinpsy-
021815-093204.
Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., &
Palmer, N. A. (2012). The 2011 National School Climate Survey:
The experiences of lesbian, gay, bisexual and transgender youth
in our nation’s schools. New York: GLSEN.
Kosciw, J. G., Greytak, E. A., Giga, N. M., Villenas, C., & Dani-
schewski, D. (2016). The 2015 National School Climate Survey:
The experiences of lesbian, gay, bisexual, transgender and queer
youth in our nation’s schools. New York: GLSEN.
Kovacs, M., Goldston, D., & Gatsonis, C. (1993). Suicidal behaviors
and childhood-onset depressive disorders: a longitudinal investi-
gation. Journal of American Academy of Child and Adolescent
Psychiatry,32(1), 8–20. https://doi.org/10.1097/00004583-
199301000-00003.
Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian,
gay, and bisexual young adults in Australia: associations with
psychological distress, suicidality, and substance use. Archives of
Sexual Behavior,43(8), 1571–1578. https://doi.org/10.1007/
s10508-014-0266-6.
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and
physical health among sexual minorities. Perspectives on Psy-
chological Science,8(5), 521–548. https://doi.org/10.1177/
1745691613497965.
Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in
lesbian, gay, bisexual, and transgender youth. American Journal
of Preventive Medicine,42(3), 221–228. https://doi.org/10.1016/
j.amepre.2011.10.023.
Livingston, N. A., Heck, N. C., Flentje, A., Gleason, H., Oost, K. M.,
& Cochran, B. N. (2015). Sexual minority stress and suicide risk:
identifying resilience through personality profile analysis. Psy-
chology of Sexual Orientation and Gender Diversity,2(3), 321
https://doi.org/10.1037/sgd0000116.
LoMurray, M. (2005). Sources of strength facilitators guide: Suicide
prevention peer gatekeeper training. Bismarck: The North
Dakota Suicide Prevention Project.
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of
resilience: a critical evaluation and guidelines for future work.
Child Development,71(3), 543–562. https://doi.org/10.1111/
1467-8624.00164.
Maddox, S. J., & Prinz, R. J. (2003). School bonding in children and
adolescents: conceptualization, assessment, and associated
variables. Clinical Child and Family Psychology Review,6(1),
31–49.
McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd,
C. J. (2010). The relationship between discrimination and sub-
stance use disorders among lesbian, gay, and bisexual adults in
the United States. American Journal of Public Health,100(10),
1946–1952. https://doi.org/10.2105/AJPH.2009.163147.
McDermott, E. (2015). Asking for help online: Lesbian, gay, bisexual
and trans youth, self-harm and articulating the ‘failed’self.
Health,19(6), 561–577. https://doi.org/10.1177/
1363459314557967.
McDermott, E., Hughes, E., & Rawlings, V. (2017). The social
determinants of lesbian, gay, bisexual and transgender youth
suicidality in England: a mixed methods study. Journal of Public
Health.https://doi.org/10.1093/pubmed/fdx135.
McDermott, E., & Roen, K. (2016). Queer youth, suicide and self-
harm: troubled subjects, troubling norms. Basingstoke: Palgrave
Macmillan.
Meyer, I. H. (1995). Minority stress and mental health in gay men.
Journal of Health and Social Behavior,36,38–56.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in
lesbian, gay and bisexual populations: conceptual issues and
research evidence. Psychological Bulletin,129, 674–697. https://
doi.org/10.1037/0033-2909.129.5.674.
Mustanski, B., Andrews, R., & Puckett, J. A. (2016). The effects of
cumulative victimization on mental health among lesbian, gay,
bisexual, and transgender adolescents and young adults. Amer-
ican Journal of Public Health,106(3), 527–533. https://doi.org/
10.2105/AJPH.2015.302976.
Newcomb, M. E., & Mustanski, B. (2016). Developmental change in
the effects of sexual partner and relationship characteristics on
sexual risk behavior in young men who have sex with men. AIDS
and Behavior,20(6), 1284–1294. https://doi.org/10.1007/s10461-
015-1046-6.
Nock, M. K., & Kazdin, A. E. (2002). Examination of affective,
cognitive, and behavioral factors and suicide-related outcomes in
children and young adolescents. Journal of Clinical Child and
Abnormal Psychology,31,48–58. https://doi.org/10.1207/
S15374424JCCP3101_07.
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M.,
Beautrais, A., & Williams, D. (2008). Cross-national prevalence
and risk factors for suicidal ideation, plans and attempts. British
Journal of Psychiatry,192,98–105. https://doi.org/10.1192/bjp.
bp.107.040113.
O’Brien, K. H. M., Becker, S. J., Spirito, A., Simon, V., & Prinstein,
M. J. (2014). Differentiating adolescent suicide attempters from
ideators: examining the interaction between depression severity
and alcohol use. Suicide & Life-Threatening Behavior,44(1), 23
https://doi.org/10.1111/sltb.12050.
Oswald, R. F. (1999). Family and friendship relationships after young
women come out as bisexual or lesbian. Journal of Homo-
sexuality,38(3), 65–83. https://doi.org/10.1300/J082v38n03_04.
Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston,
D. B., Tu, X., & Wyman, P. A. (2012). Associations between
suicidal high school students’help-seeking and their attitudes and
perceptions of social environment. Journal of Youth and Ado-
lescence,41(10), 1312–1324. https://doi.org/10.1007/s10964-
012-9766-7.
Poteat, V. P., Sinclair, K. O., DiGiovanni, C. D., Koenig, B. W., &
Russell, S. T. (2013). Gay–straight alliances are associated with
student health: a multischool comparison of LGBTQ and het-
erosexual youth. Journal of Research on Adolescence,23(2),
319–330. https://doi.org/10.1111/j.1532-7795.2012.00832.x.
Robinson, J. P., & Espelage, D. L. (2011). Inequities in educational
and psychological outcomes between LGBTQ and straight
Journal of Child and Family Studies
students in middle and high school. Educational Researcher,40
(7), 315–330. https://doi.org/10.3102/0013189X11422112.
Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J.
(2011). Lesbian, gay, bisexual, and transgender adolescent school
victimization: implications for young adult health and adjustment.
Journal of School Health,81(5), 223–230. https://doi.org/10.
1111/j.1746-1561.2011.00583.x.
Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for
missing data management in counseling psychology. Journal of
Counseling Psychology,57,1–10. https://doi.org/10.1037/a
0018082.
Schmeelk‐Cone, K., Pisani, A. R., Petrova, M., & Wyman, P. A.
(2012). Three scales assessing high school students’attitudes and
perceived norms about seeking adult help for distress and suicide
concerns. Suicide and Life‐Threatening Behavior,42(2),
157–172. https://doi.org/10.1111/j.1943-278X.2011.00079.x.
Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to
self-destructive behavior. Lanham, MD: Jason Aronson.
Szymanski, D. M., Kashubeck-West, S., & Meyer, J. (2008). Inter-
nalized heterosexism: a historical and theoretical overview. The
Counseling Psychologist,36(4), 510–524. https://doi.org/10.
1177/0011000007309488.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statis-
tics. Boston, MA: Allyn & Bacon/Pearson Education.
Taliaferro, L. A., & Muehlenkamp, J. J. (2014). Risk and protective
factors that distinguish adolescents who attempt suicide from
those who only consider suicide in the past year. Suicide and Life-
Threatening Behavior,44(1), 6–22. https://doi.org/10.1111/sltb.
12046.
U.S. Surgeon General. (2001). National strategy for suicide preven-
tion: Goals and objectives for action. Rockville: U.S. Dept. of
Health and Human Services, Public Health Service.
Van Orden, K. A., Lynam, M. E., Hollar, D., & Joiner, Jr., T. E.
(2006). Perceived burdensomeness as an indicator of suicidal
symptoms. Cognitive Therapy and Research,30(4), 457–467.
https://doi.org/10.1007/s10608-006-9057-2.
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., &
Joiner, T. E. (2008). Suicidal desire and the capability for suicide:
tests of the interpersonal-psychological theory of suicidal beha-
vior among adults. Journal of Consulting and Clinical Psychol-
ogy,76(1), 72–83. https://doi.org/10.1037/0022-006X.76.1.72.
Vijayakumar, L., Kumar, M. S., & Vijayakumar, V. (2011). Substance
use and suicide. Current Opinion in Psychiatry,24(3), 197–202.
https://doi.org/10.1097/YCO.0b013e3283459242.
Whitaker, K., Shapiro, V. B., & Shields, J. P. (2016). School-based
protective factors related to suicide for lesbian, gay, and bisexual
adolescents. Journal of Adolescent Health,58(1), 63–68. https://
doi.org/10.1016/j.jadohealth.2015.09.008.
Wyman, P. A. (2014). Developmental approach to prevent adolescent
suicides: research pathways to effective upstream preventive
interventions. American Journal of Preventive Medicine,47(3),
S251–S256. https://doi.org/10.1016/j.amepre.2014.05.039.
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone,
K., Guo, J., & Pena, J. B. (2008). Randomized trial of a gate-
keeper program for suicide prevention: 1-year impact on sec-
ondary school staff. Journal of Consulting and Clinical
Psychology,76(1), 104–115. https://doi.org/10.1037/0022-006X.
76.1.104.
Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K.,
Petrova, M., Yu, Q., & Wang, W. (2010). An outcome evaluation
of the Sources of Strength suicide prevention program delivered
by adolescent peer leaders in high schools. American Journal of
Public Health,100(9), 1653–1661.
Ybarra, M. L., Mitchell, K. J., Kosciw, J. G., & Korchmaros, J. D.
(2015). Understanding linkages between bullying and suicidal
ideation in a national sample of LGB and heterosexual youth in
the United States. Prevention Science,16(3), 451–462. https://
doi.org/10.1007/s11121-014-0510-2.
Zaza, S., Kann, L., & Barrios, L. C. (2016). Lesbian, gay, and bisexual
adolescents: population estimate and prevalence of health beha-
viors. JAMA,316(22), 2355–2356. https://doi.org/10.1001/jama.
2016.11683.
Journal of Child and Family Studies
- A preview of this full-text is provided by Springer Nature.
- Learn more
Preview content only
Content available from Journal of Child and Family Studies
This content is subject to copyright. Terms and conditions apply.
