Suicidal Ideation, Attempts, and Thought-to-Action Transitions Among Young Adults with Marginalized Sexual and Gender Identities Experiencing Homelessness: A Seven City Study

Background/Purpose: Young adults experiencing homelessness (YAEH) endure high rates of suicide-related morbidity (i.e., suicidal ideation and suicide attempts), but rates are markedly higher among sexual and gender minority young people (SGMY). Yet, a limited body of work focuses on this group. Consequently, current work does not adequately examine personal and social forces that may contribute to suicidal experiences among homeless SGMY. This is a serious oversight given that SGMY are more likely to both be homeless and report suicidal experiences. The present study addressed this major gap by examining the prevalence and correlates of suicidal ideation (SI), suicide attempts (SA), and ideation-to-attempt transitions among homeless SGMY. Notably, the ideation-to-action transition has emerged as a critical but under-studied point of investigation.

Methods: This study included 432 SGMY who were part of a larger cross-sectional research project (n= 1426; Mage = 20.9) that involved recruitment from homeless service agencies in seven US cities. Participants completed a survey about their personal characteristics (i.e., demographic, mental health, social experiences) and a social network interview about their relationships (e.g., social support sources). Logistic regression analyses were used for three outcomes: past-year suicidal ideation (0= no SI; 1 yes SI), suicide attempt (0= no SA; 1= yes SA), ideation-to-attempt transition (0= yes SI but no SA; 1= yes SA). Any personal and social network predictors found to be significantly correlated with the corresponding outcome at the p<.05 level in bivariate analyses were included in a final multivariate regression model for each outcome.

Results: Of our SGMY, 39% and 21% reported past-year SI and SA, respectively. Of SGMY with past-year SI, 48.5% made a suicide attempt. The following correlates were observed in multivariate models. For SI, correlates included adverse childhood experiences, correctional system involvement, psychiatric hospitalization history, PTSD, depression, marijuana use, and intimate partner support. For SA, correlates included age, adverse childhood experiences, psychiatric hospitalization history, PTSD, depression, and family support. For ideation-to-action transitions, correlates included age, adverse childhood experiences, and PTSD. Odds ratios were all small-to-moderate effect sizes. Identity-related variables (e.g., discrimination/bias-related victimization) were significantly associated with SI/SA in bivariate analyses, but not in multivariate models.

Conclusion/Implications: That almost half of SGMY experienced SI/SA in the past year alone is alarming. That one out of every two SGMY who think about suicide actually make a suicide attempt highlights a critical need to identify and enhance supports for those experiencing SI. Our results suggest that many well-established intrapersonal risk factors (e.g., depression) also need to be addressed among homeless SGMY. Additionally, these findings indicate that adverse childhood experiences and PTSD may contribute to experiences across the suicidal continuum, including the often-lethal transition from suicidal ideation to action. This points to the benefits of integrating a trauma-informed perspective across common systems of care engaged by homeless SGMY (e.g., homelessness service centers) as well as potential service access points (e.g., online resources). Support from different sources may also attenuate (e.g., family) or aggravate (e.g., intimate partner) risk for different suicidal experiences, showcasing that not all social connection is protective.