Internalized Sexual Orientation Stigma, Depression, and Suicidal Ideation Among Queer Adults In the United States: Structural Equation Modeling Findings

Background: Compared to heterosexual adults, sexual minority adults (henceforth referred to as queer), are at an elevated risk for depression and suicidal ideation. Studies have established relationships between minority stress, such as internalized sexual orientation stigma (ISOS), depression, and suicidality. However, no known research has explored relationships between implicit ISOS, explicit ISOS, depression, and suicidality. This study seeks to address gaps in the field by further elucidating relationships between implicit ISOS, explicit ISOS, depression, and suicidal ideation for both interventions geared toward queer individuals, and more broad suicide prevention efforts. It is hypothesized that there will be significant, positive relationships between both implicit and explicit ISOS and depression, and that as ISOS and depression increase, the likelihood that an individual endorses suicidal ideation will also increase.

Methods: The present study uses data from a large national two-wave quantitative panel survey study using a diverse sample of queer adults from the United States (N = 500). Implicit ISOS was measured using a newly developed instrument, the Implicit Internalized Sexual Orientation Stigma Affect Misattribution Procedure (Internal-SOS-AMP). Confirmatory factor analysis was used to evaluate a one-factor model. General structural equation modeling (SEM) was used to explore pathways and relationships between implicit ISOS, explicit ISOS, depression, and suicidal ideation.

Results: Based on theory and prior research, our model depicts relationships between implicit ISOS as a first order factor, explicit ISOS, depressive symptoms, and suicidal ideation. The presented model indicates a statistically significant positive relationship between implicit and explicit ISOS (β = 0.14, p < .01). As explicit ISOS increased, individuals also reported greater depressive symptoms (β = 0.29, p < .001). Individuals with higher depression levels were 2.38 times more likely to endorse suicidal ideation in the last month compared to those reporting less depressive symptoms. Age was inversely related to suicidal ideation endorsement. For each 1-year increase in age, the odds of endorsing suicidal ideation within the last month decreased by approximately 1.5%.

Conclusions: To our knowledge, this is the first study to examine relationships between implicit and explicit ISOS, depression, and suicidal ideation among queer adults using general SEM. In addition to significant contributions to address the dearth of research on distinct measures of implicit ISOS and explicit ISOS among queer adults, this study provides important insights into the nuanced relationships between the different types of ISOS and their associations with suicidal ideation. Future research should focus on how these relationships change over time while examining the nuances of ISOS related to multiple queer identities. Our models provide supportive evidence on the potential causal relationships between these constructs over time, which is crucial in the development of primary, secondary, and tertiary suicide prevention initiatives and assessing for suicide risk among queer adults. These findings have practical implications for queer populations’ mental health. Suicide prevention efforts with queer individuals should pay particular attention to developmental considerations for young adult subgroups and be responsive to the distinct forms of implicit and explicit ISOS, and mechanisms that drive the health disparities.