Sexual minority youth report significantly higher rates of past year suicidal ideation (19.4%-30.3%) and suicide attempts (6.6%-22.7%), as compared with heterosexual students (9.3% and 3.8%, respectively).1 Theoretical models of suicide2-3 and the interventions they inform4-8 have been developed with limited representation of sexual minority populations, thereby limiting their relevance for sexual minority youth. We will be the first to make use of a rigorous, multi-method, ethnographic approach, called Cultural Consensus Modeling (CCM), to leverage rich qualitative data on sexual minority youth motivations for suicide and to develop models and assessment tools generated specifically from these motivations. We will then evaluate these cultural models for their association with theoretically derived suicide predictors. Guided by a conceptual framework that integrates the interpersonal-psychological theory of suicide (IPTS) and minority stress theory,9-10 our central hypothesis is that derived cultural models will point to the importance of redefining IPTS variables through the lens of minority stress. CCM provides an ethnographic, bottom-up approach in which individuals define the boundaries of a phenomenon (e.g., suicidal thoughts/behaviors) shared by a cultural group (e.g., sexual minority youth).
Phase 1 asks “What are common reasons for suicide among peer sexual minority youth?” In Phase 1, youth (ages 15-25 years, who endorse a sexual minority identity and have a lifetime history of suicidal thoughts) respond to questions about reasons for suicide among other sexual minority youth; allowing them to draw upon shared cultural knowledge. Phase 2 asks “To what extent are common reasons identified in Phase 1 valued by peers? Are there distinct subgroups (cultural models) that value reasons/factors differently?” In Phase 2 youth rate the extent to which factors identified in Phase 1 are valued by their peers. This process identifies unique clusters of individuals (cultural consensus models) who place greater importance on particular factors. Phase 3 aims to deepen our understanding of the identified cultural models through qualitative interviews. Phase 3 utilizes qualitative interviews with informants from Phase 2 who represent different cultural consensus models. Phase 4 asks “Do one’s own reasons for suicidal behaviors map onto cultural models that emerged in Phases 2-3? Does membership in a cultural model align with individual differences in IPTS and minority stress? Which cultural models predict suicide severity best?” Phase 4 examines the extent to which cultural consensus models apply to individuals’ own reasons for suicidal thoughts and behaviors and their association with expected correlates (IPTS, minority stress theory).
The proposed work aligns with stated AFSP priorities to advance research “related to underrepresented communities, health and mental health disparities and inequities”.16 Completing the CCM iterative phases will offer an evidence-based multi-method and bottom-up model of the shared cultural determinants of suicidal thoughts and behaviors among sexual minority youth, as perceived by sexual minority youth themselves. This will inform (1) a culturally relevant questionnaire that, in future studies, can be scrutinized for its psychometric properties, (2) culturally relevant treatment targets, and (3) clear recommendations for how theoretical models of suicide should be adapted for studying and prevention SM suicide.
