Conclusion & Implications
Suicidal ideation among transgender youth
Arnold H. Grossman, PhD, LMSW 1, John A. Frank 1, Zachary Y. Barletta 1, Stephen T. Russell, PhD 2
1. Department of Applied Psychology, New York University, New York, NY
2. Family Studies and Human Development, University of Arizona, Tucson, AZ
Introduction
The purpose of the study is to examine if Joiner’s (2005)
Interpersonal Theory of Suicide can be used to explain to suicide
ideation among transgender youth a population with
disproportionately high suicide ideation and attempts but minimal
research leading to interventions efforts that effectively address
them (Clements-Nolle, Marx & Katz, 2006; Goldblum et al., 2012;
Grossman & D’Augelli, 2007). Joiner posits that suicide ideation
results from the confluence of two psychological states, thwarted
belongingness and perceived burdensomeness, and that the
presence of suicide ideation with the acquired ability for lethal selfinjury leads to suicide attempts. Such acquired ability for lethal
self-injury results from habituation to pain and provocative events
e.g. physical abuse (Joiner).
This study tested if the two psychological states of thwarted
belongingness and perceived burdensomeness are related to
suicide ideation among transgender youth. The analyses also
included additional factors that have been found to be associated
with suicidal ideation or attempts among transgender individuals,
such as: LGBTQ-related victimization (Clements-Nolle, Marx &
Katz; Goldblum et al.) parental psychological abuse, and parental
physical abuse (Grossman & D’Augelli), to assess if any of these
factors predict suicide ideation beyond Joiner’s model.1
Measures
Analyses & Results cont.
Suicide Ideation
Suicide ideation was measured by the
negative subscale of the Positive and
Negative Suicide Ideation Inventory (PANSI;
Gutierrez & Osman, 2008). The subscale is
an 8-item measure and participants use a 5point scale from none of the time (1) to most
of the time (5) to report the relative
frequency of the items within the past two
weeks (α = .94).
In the initial analysis of Joiner’s theory, the
regression model including thwarted
belongingness and perceived burdensomeness
was significant, (F (2, 119) = 33.53, p < .001)
and accounted for 36% of the variance in
suicide ideation scores. However, at this stage,
only perceived burdensomeness was
associated with ideation (see Table 1 for β and
t-scores). Thwarted belongingness did not
account for variance in suicide ideation beyond
the variance related to perceived
burdensomeness.
Thwarted Belongingness & Perceived
Burdensomeness
Thwarted belongingness (5 items, α = .87)
and perceived burdensomeness (7 items, α
= .74) were measured by their respective
subscales of the Interpersonal Needs
Questionnaire (INQ; Van Orden et al., 2008).
Participants use a 7-point scale ranging from
not at all true of me (1) to very true of me to
report how they relate to the individual
items. [Sample item: ”“These days, I feel like
a burden on the people in my life.”
1. Please contact Dr. Arnold Grossman at arnold.grossman@nyu.edu for information regarding
Limitations
specific measures used to assess additional factors.
Analyses & Results
Sample & Method
Data come from the first of four waves in a longitudinal panel
study of the risk and protective factors of suicide among 1061
lesbian, gay, bisexual, trans*, and questioning (LGBTQ) youth
and participants with same-sex attraction in three cities in the
northeast, southwest, and west coast of the United States. The
majority of the youth were recruited from community-based
agencies or college groups for LGBTQ youth, and other
participants were referred by earlier participants. Only trans*
participants (N = 129, ages 15-21 at time of recruitment, M =
18.7, SD = 1.7) were included in the current analysis. Of the
included trans* participants, 34.1% identified as trans-women,
31.0% identified as trans-men, 10.9% identified as a male-todifferent-gender, and 24% identified as a female-to-differentgender.
Regarding race and ethnicity, 27.1% were White, 24.8% Black
or African-American, 6.2% Asian, 3.1 % American Indian or
Alaskan Native, 0.8% Native Hawaii or Other Pacific Islander,
26.4% reported more than one race, 11.6% did not report a
race; and 31.8% were of Hispanic or Latino background.
Participants completed a survey packet of measures that
assessed suicidal thinking, mental health variables, their life
experiences as sexual and gender minority youth, and
demographic information.
The results suggest that suicide ideation among transgender youth may
have a unique developmental pathway, such that perceived
burdensomeness is independently predictive of suicidal ideation, rather
than the joint presence of perceived burdensomeness and thwarted
belongingness.
The results, interpreted in conjunction with Hendricks’ and Testa’s (2012)
conceptual framework for clinical work with transgender clients, suggest
that thwarted belongingness may not be related to suicide ideation among
transgender individuals who have developed a minority identity. Hendricks
and Testa suggest that developing a minority identity facilitates an in-group
identification and community membership process that leads to substantial
social support− a resiliency process which may be particularly relevant to
the study’s sample as all participants identified as transgender and most
belonged to community-based agencies or college groups for LGBTQ
youth. Future research should focus on whether a trans* identity and/or
community membership buffers against low belongingness.
However, the results indicate that perceived burdensomeness is
associated with suicidal ideation among transgender youth. Hendricks and
Testa suggest that perceived burdensomeness may result from the
proximal stressor of internalizing societal transphobia and consequently
negatively evaluating oneself and seeing oneself as solely a burden to the
individuals in one’s life. Future research should address this possibility in
order to appropriately direct intervention efforts that could reduce
internalized transphobia among transgender youth. Parental psychological
abuse is also related to suicidal ideation, in support of previous findings by
Grossman and D’Augelli (2007).
It is noteworthy to mention that LGBTQ-based victimization and parental
physical abuse did not relate to suicidal ideation but have been previously
found to be related to suicide attempts (Clements-Nolle, Marx & Katz;
Goldblum et al.; Grossma & D’Augelli). Future research should seek to
examine if these phenomena lead to an acquired capacity for lethal selfinjury, as opposed to suicidal ideation, to determine whether they are
significant constructs related to attempting suicide but not suicidal ideation.
A multiple regression analysis was conducted
with negative suicide ideation as the dependent
variable. The two hypothesized psychological
states present in Joiner’s model (i.e., perceived
burdensomeness and thwarted belongingness)
were entered in this model as proposed
independent variables. The statistics for this
analysis are reported in Table 1.
A second step-wise regression analyses was
also conducted to determine if any other
variables better accounted for variance in
suicide ideation. In the step-wise regression,
LGBTQ-related victimization, parental
psychological abuse, and parental physical
abuse were included in addition to the initial
Joiner variables. The statistics for the step-wise
regression are reported in Table 2.
Step 1 (Perceived Burdensomeness) In the
first step of the analyses, the regression model
including perceived burdensomeness was
significant, (F (1, 119) = 65.79, p < .001) and
accounted for 36% of the variance in suicide
ideation scores. However, this step did not
improve upon the regression model that
included perceived burdensomeness and
thwarted belongingness.
Step 2 (Perceived Burdensomeness and
Psychological Abuse). The model produced
in the second step of this analysis accounted
39% of variance in suicide ideation (F (2, 1159)
= 37.62, p < .001). This model improved upon
the model that included thwarted belongingness
and perceived burdensomeness and accounted
for significantly more variance in suicide
ideation scores. In this model, perceived
burdensomeness and parental psychological
abuse were significantly related to suicide
ideation (see Step 2 section of Table 1 for β
and t-scores).
Excluded Variables. LGBTQ-related
victimization, and parental physical abuse were
not included in models produced by the stepwise regression. They did not account for
variance in suicide ideation beyond what was
accounted for by perceived burdensomeness
and parental psychological abuse.
As community-based sampling was used e.g., snowball sampling,
recruitment at community organizations and LGBTQ groups, one must
exercise caution when applying results to gender minority youth who may
not openly identify as trans* and/or belong to groups for LGBTQ youth.
Additionally, all data were obtained through self-reports, e.g., parental
abuse.
References
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