Minority Stress, Community Connectedness and Suicidal Ideation: A Longitudinal Examination Among Three Generations of Sexual Minority Adults

Background and Purpose: Sexual minority adults (henceforth, LGB+ adults) face a disproportionate burden of suicidal ideation compared to the general population. Guided by the minority stress theory, external minority stress such as everyday discrimination and proximal minority stressors such as internalized homophobia can contribute to the negative mental health among LGB+ adults. However, there is a lack of evidence of the within-person effect of minority stress on suicidal ideation over time. In addition, previous cross-sectional studies were inconsistent about the role of community connectedness on suicidal ideation. The current study will address previous gaps by using a longitudinal design to answer three research questions: (1) how do suicidal ideation and minority stress change over time? (2) what is the within- and between- person association between minority stress, community connectedness, and suicidal ideation? (3) does community connectedness buffer the association between minority stress and suicidal ideation?

Methods: This study used a three-wave nationally representative dataset from the Generations Study (N=1,488 at baseline, and 707 at Wave 3), collected between 2016 and 2019 among three generations of LGB+ adults in the United States, including the younger cohort aged 18-25, the middle cohort aged 34-42, and the older cohort aged 52-59. The dependent variable was past-year suicidal ideation. Independent variables were everyday discrimination, internalized homophobia and community connectedness that are measured using standardized scales across three years. Sociodemopgranic, geographic variables and general stressors and coping of suicidal ideation were included as control variables guided by theories. Random-intercept logistic regression models were used to separate between- and within-person associations.

Results: This study confirms that LGB+ adults who live in states with broader legal protections for LGBTQ+ population, as categorized by the Human Rights Campaign’s state equality index, reported less everyday discrimination (b=-0.10, p<0.001) and internalized homophobia (b=-0.10, p<0.001) compared to LGB+ adults who live in states with least legal protection. LGB+ adults who experienced more everyday discrimination were more likely to report suicidal ideation than those who experienced less everyday discrimination (OR=4.46, 95% CI= 2.75, 7.23). However, a decrease in discrimination within a person was not associated with a decrease in suicidal ideation over three years. Within-person increase in community connectedness buffers the within-person association between internalized homophobia and suicidal ideation (b=-2.70, p=0.024).

Conclusion. The findings provide compelling evidence to advocate for state-level anti-discrimination policy for LGBTQ population at large. In addition, the lack of within-person association indicated that people who experienced discrimination in the past may carry that negative impact over time. Clinicians can help LGB adults to interpret their experience of discrimination and build resilience, for example, by affirming how other people treated them does not reflect who they are as a person. Community connectedness plays a protective role in reducing suicidal ideation when people experience increased internalized homophobia. Social workers can actively work to build positive connections within the LGBTQ community as part of their practice. However, more research is needed to unpack the nuances in the effect of community connectedness.