This article was downloaded by: [Adams State University] On: 04 November 2014, At: 10:00 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Archives of Suicide Research Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usui20

Measures of Sexual Minority Status and Suicide Risk among Young Adults in the United States a

b

Elbert P. Almazan , Michael E. Roettger & Pauline S. Acosta

c

a

Central Michigan University , Mount Pleasant , Michigan , USA

b

Pennsylvania State University , University Park , Pennsylvania , USA

c

Cerritos College , Norwalk , California , USA Accepted author version posted online: 10 Mar 2014.Published online: 22 Jul 2014.

To cite this article: Elbert P. Almazan , Michael E. Roettger & Pauline S. Acosta (2014) Measures of Sexual Minority Status and Suicide Risk among Young Adults in the United States, Archives of Suicide Research, 18:3, 274-281, DOI: 10.1080/13811118.2013.824832 To link to this article: http://dx.doi.org/10.1080/13811118.2013.824832

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions

Archives of Suicide Research, 18:274–281, 2014 Copyright # International Academy for Suicide Research ISSN: 1381-1118 print=1543-6136 online DOI: 10.1080/13811118.2013.824832

Downloaded by [Adams State University] at 10:00 04 November 2014

Measures of Sexual Minority Status and Suicide Risk among Young Adults in the United States Elbert P. Almazan, Michael E. Roettger, and Pauline S. Acosta Multiple measures of sexual minority status are necessary to accurately describe the diversity of attractions, identities, and behaviors in sexual minority populations. We investigated whether four measures of sexual minority status (sexual minority attraction, sexual minority identity, sexual minority lifetime behavior, and sexual minority recent 12-month behavior) were associated with suicidal thoughts and suicide attempts among young adults ages 24 to 34 in the United States. We analyzed data from Wave IV (2007–2008) of the National Longitudinal Study of Adolescent Health. We employed logistic regression models in the analysis. Multiple sexual minority status measures had significant associations with increased suicidal thoughts among women and men. Multiple sexual minority status measures had significant associations with increased suicide attempts among women, but not among men. Diverse sexual minority populations are at increased risk for suicidal thoughts and suicide attempts. Multiple measures of sexual minority status should be utilized in future studies of sexual minority status and suicide risk. Suicide prevention programs should ensure intervention is available across diverse sexual minority populations. Keywords

disparities, homosexuality, LGB, measurement, sexual orientation, suicide

INTRODUCTION

populations because (1) not every sexual minority is consistent with same-sex experiences across attraction, identity, and behavior and (2) the timing of the first same-sex experiences in attraction, identity, and behavior varies among sexual minorities (Savin-Williams & Ream, 2007). For example, many sexual minorities experience same-sex sexual behaviors, but do not self-describe themselves with a sexual minority identity such as lesbian, gay, or bisexual. Many sexual minorities who do self-describe themselves as lesbian, gay, or bisexual have not experienced their first same-sex sexual behavior. Using only

In this study, we examine whether sexual minority status is associated with suicide risk utilizing multiple measures of sexual minority status. Many studies using large epidemiological surveys are starting to use multiple measures of sexual minority status to more accurately describe sexual minority populations (Bostwick, Boyd, Hughes et al., 2010; Brewster & Tillman, 2012; Lindley, Walsemann, & Carter, 2012; McCabe, Hughes, Bostwick et al., 2009). The use of multiple measures of sexual minority status is necessary to describe sexual minority

274

Downloaded by [Adams State University] at 10:00 04 November 2014

E. P. Almazan, M. E. Roettger, and P. S. Acosta

measure of sexual minority status such as a sexual orientation identity measure or a sexual orientation behavior measure excludes many other sexual minorities. Previous studies on sexual minority status and suicide risk during adulthood (e.g., Bolton & Sareen, 2011; Conron, Mimiaga, & Landers, 2010; Loosier & Dittus, 2010; Mathy, Cochran, Olsen et al., 2011; Wang, Ha¨usermann, Wydler et al., 2012) had mostly relied on a single measure of sexual minority status. One study by Plo¨derl, Kralovee, and Fartacek (2010) used multiple measures of sexual minority status in examining sexual orientation differences in suicide attempts in Austria. In that study, sexual minority fantasies, sexual minority sexual behaviors, sexual minority relationships, and sexual minority identities were associated with increased risk for suicide attempts. Our study differs from the Austrian study by analyzing slightly different measurements of sexual minority status, using a sample obtained through random sampling rather than snowball sampling, and examining suicidal thoughts in addition to suicide attempts. With our study, we can assess whether we can replicate the findings from the Austrian study and further confirm that different measures of sexual minority status can be associated with increased risk for suicidality. METHODS

To examine the associations between different measures of sexual minority status and suicidal thoughts and suicide attempts, we analyzed data from Wave IV (2007–2008) of the National Longitudinal Study of Adolescent Health (otherwise known as Add Health) (Harris, Halpern, Whitsel et al., 2009). The Add Health study has a nationally-representative sample of 90,118 individuals who were enrolled in grades 7 to 12 in the United States during 1994– 1995. A core subsample of 20,745 persons

participated in a series of in-depth survey interviews since 1994–1995. A total of 15,196 Add Health participants from the core subsample took part in the Wave IV interview. They were ages 24–34 at the time of the interview. The sampling of individuals was conducted through 132 middle schools, junior high, and high schools, which were representative of secondary schools in the United States. Because cluster sampling was utilized in the survey design, sample weights were used in our analysis to estimate unbiased results that are nationally representative. After excluding respondents with no survey weights or missing data, our analysis used a sample of 14,625 respondents (7,819 women and 6,806 men). We utilized two measures of suicide risk: thoughts and attempts. Suicidal thoughts is a dichotomous variable that measures whether the individual reported yes to following question: ‘‘During the past 12 months, have you ever seriously thought about committing suicide?’’ Suicide attempts is a dichotomous variable that measures whether the individual reported one or more suicide attempts to the following question: ‘‘During the past 12 months, how many times have you actually attempted suicide?’’ We looked at four measures of sexual minority status: attraction, identity, lifetime behavior, and recent 12-month behavior. Sexual minority attraction is a dichotomous variable that measures whether the individual reported romantic attraction to the same sex. No sexual orientation attraction reported or missing is a dichotomous variable that measures whether the individual reported no attraction or gave incomplete information. Heterosexual attraction is a dichotomous variable that measures whether individuals who reported romantic attraction only to the opposite sex. Individuals who reported heterosexual attraction are the reference group in the analysis. Sexual minority identity is a dichotomous variable that measures whether the individual self-reported as being mostly straight,

ARCHIVES OF SUICIDE RESEARCH

275

Downloaded by [Adams State University] at 10:00 04 November 2014

Sexual Minority Status and Suicide

bisexual, mostly gay, or gay. No sexual orientation identity reported or missing is a dichotomous variable that measures whether the individual reported no identity or gave incomplete information. Heterosexual identity is a dichotomous variable that measures whether the individual self-reported as being straight. Individuals who selfreported as being straight are the reference group in the analysis. Sexual minority lifetime behavior is a dichotomous variable that measures whether the individual reported sexual behavior with the same sex in his or her lifetime. No sexual orientation lifetime behavior reported or missing is a dichotomous variable that measures whether the individual reported no sexual behavior or gave incomplete information. Heterosexual lifetime behavior is a dichotomous variable that measures whether the individual reported sexual behavior only with the opposite sex in his or her lifetime. Individuals who reported heterosexual lifetime behavior are the reference group in the analysis. Sexual minority recent 12-month behavior is a dichotomous variable that measures whether the individual reported sexual behavior with the same sex in the past 12 months. No sexual orientation recent 12-month behavior reported or missing is a dichotomous variable that measures whether the individual reported no sexual behavior or gave incomplete information in the past 12 months. Heterosexual recent 12-month behavior is a dichotomous variable that measures whether the individual reported sexual behavior only with the opposite sex in the past 12 months. Individuals who reported heterosexual recent 12-month behavior are the reference group in the analysis. Our control variables included sociodemographic characteristics such as gender, race=ethnicity, age, education, income, and relationship status. Control variables from the Add Health were coded in a similar way as the control variables in Lindley, Walsemann, & Carter (2012). Our analyses were conducted in gender-specific samples.

276

Gender differences were observed in the associations between sexual minority status measures and other health outcomes such as smoking and drinking (Lindley, Walsemann, & Carter, 2012). Perhaps gender differences would emerge in the associations between sexual minority status and suicide outcomes. Our analyses used survey weights to take into account cluster sampling and attrition. First, we examined the descriptive statistics of our variables. Second, we employed multivariate logistic regression to investigate the associations between the measures of sexual orientation and suicide outcomes.

RESULTS

Table 1 shows the descriptive statistics, including 7.6% of women and 6.7% of men reported suicidal thoughts in the past year and 1.9% of women and 1.3% of men reported one or more suicide attempts in the past year. The descriptive statistics on sexual orientation and demographic variables were similar to a previous study using data from the 2007–2008 interview wave of the Add Health study (Lindley, Walsemann, & Carter, 2012). Multivariate Analyses

Table 2 displays the results of the multivariate logistic regression models. In Table 2, odds ratios, 95% confidence intervals, and p-values are presented. First, we examined the associations between the sexual minority status measures and suicidal thoughts after controlling for sociodemographic characteristics. Among women, all sexual minority status variables were significantly associated with increased risk for suicidal thoughts. The strengths of the associations between different measures of sexual minority status and suicidal thoughts among women were not statistically different.

VOLUME 18  NUMBER 3  2014

E. P. Almazan, M. E. Roettger, and P. S. Acosta

TABLE 1. Sample Characteristics, Weighted Means, and Weighted Percentages: National Longitudinal Study of Adolescent Health Wave IV United States, 2007–2008

Downloaded by [Adams State University] at 10:00 04 November 2014

Characteristic Suicidal Thought Suicide Attempt Sexual orientation attraction Heterosexual attraction Sexual minority attraction No sexual orientation attraction reported or missing Sexual orientation identity Heterosexual identity Sexual minority identity No sexual orientation identity reported or missing Sexual orientation lifetime behavior Heterosexual lifetime behavior Sexual minority lifetime behavior No sexual orientation lifetime behavior reported or missing Sexual orientation recent 12-month behavior Heterosexual recent 12-month behavior Sexual minority recent 12-month behavior No sexual orientation recent 12-month behavior reported or missing Race=ethnicity White Black Hispanic Asian Other Agea Education Less than high school diploma High school diploma=GED Post high school College degree or higher Household income $0-39,999 $40,000–74,999 $75,000 or higher Missing Income Relationship status Single

Women (N ¼ 7,819) % or mean

Men (N ¼ 6,806) % or mean

7.6 1.9

6.7 1.3

89.2 9.5 1.0

94.7 4.1 1.1

79.3 19.9 .8

92.9 6.4 .7

81.2 14.2 4.6

88.5 6.0 5.4

80.6 4.4 15.1

83.9 3.1 13.4

65.6 16.3 11.8 3.3 2.8 28.3

66.2 15.1 11.9 3.5 3.2 28.5

7.4 14.1 44.7 33.8

10.1 21.3 41.5 27.1

33.4 33.4 26.3 6.9

28.9 33.9 30.1 7.1

32.5

40.5 (Continued )

ARCHIVES OF SUICIDE RESEARCH

277

Sexual Minority Status and Suicide

TABLE 1. Continued

Characteristic Married Cohabiting Divorced=separated=widowed

Women (N ¼ 7,819) % or mean

Men (N ¼ 6,806) % or mean

41.6 15.8 10.1

34.6 16.4 8.5

Downloaded by [Adams State University] at 10:00 04 November 2014

Note. Unless otherwise noted, variables are dichotomous or categorical and can be interpreted as percentages. Percentages may not add up to 100 because of rounding. a Continuous variable, mean presented.

Among men, all sexual minority status variables were significantly associated with increased risk for suicidal thoughts. The strengths of the associations between different measures of sexual minority status and suicidal thoughts among men were not statistically different. In addition, women and men were not statistically different from each other in the strengths of associations between different measures of sexual minority status and suicidal thoughts. Second, we examined the associations between the sexual minority status measures and suicide attempts after controlling for sociodemographic characteristics. Among women, all sexual minority status variables except for sexual minority attraction were significantly associated with increased risk for suicide attempts. Among the measures of sexual minority status that were significantly associated with suicide attempts in the female sample, the strengths of those associations were not statistically different from each other. Among men, none of the sexual minority status variables were significantly associated with increased risk for suicide attempts. DISCUSSION

The purpose of this study was to use multiple measures of sexual minority status to accurately describe diverse sexual minority populations in examining the association

278

between sexual minority status and suicide risk. Overall, our findings showed that multiple measures of sexual minority status were associated with increased risk for suicidal thoughts and suicide attempts. We found that multiple measures of sexual minority status had significant associations with increased suicidal thoughts among women and men. We also found that multiple measures of sexual minority status had significant associations with increased suicide attempts among women. Yet, none of the sexual minority status measures had significant associations with increased suicide attempts among men. Our study found that the strengths of the associations were not statistically different across different measures of sexual minority status. While the risk of suicidal thoughts and suicide attempts may not be different between sexual minority populations, the risk factors that lead to suicidality may be different between sexual minority groups. For example, sexual minorities who self-identify themselves as lesbian, gay, or bisexual could face stressors that are different from the stressors experienced by sexual minorities who do not selfdescribe themselves with a sexual minority identity. Future research should explore whether different sexual minority populations experience different risk factors that lead to suicide outcomes. The lack of significant associations between different measures of sexual

VOLUME 18  NUMBER 3  2014

ARCHIVES OF SUICIDE RESEARCH

279

1.00 2.27 (1.44, 3.58) .79 (.25, 2.51) 1.00 2.77 (1.82, 4.22) 2.96 (.80, 10.88) 1.00 2.49 (1.61, 3.84) 1.22 (.59, 2.50) 1.00 2.77 (1.55, 4.97) 1.18 (.77, 1.79)

1.00 2.83 (2.10, 3.82) 1.15 (.33, 3.96) 1.00 2.32 (1.80, 3.01) .46 (.05, 4.22) 1.00 2.29 (1.75, 3.00) 1.02 (.60, 1.74) 1.00 1.63 (1.07, 2.48) .94 (.56, 1.55)

Male OR, (95% CI)

1.00 2.23 (1.08, 4.59) 1.35 (.53, 3.42)

1.00 2.10 (1.15, 3.84) 1.78 (.66, 4.82)

1.00 2.09 (1.14, 3.83) 2.09 (.23, 19.06)

1.00 2.05 (.95, 4.45) 2.28 (.45, 11.55)

Female OR, (95% CI)

1.00 .73 (.17, 3.14) .42 (.12, 1.46)

1.00 .60 (.19, 1.88) .71 (.22, 2.35)

1.00 0.63 (.19, 2.14) 4.74 (1.28, 17.61)

1.00 .21 (.04, 1.15) 2.27 (.56, 9.23)

Male OR, (95% CI)

Suicide attempt

Note. Ref ¼ reference group; CI ¼ confidence interval; OR ¼ odds ratio. Models include controls (not shown) for race=ethnicity, age, education, household income, and relationship status.  p < .05.  p < .01.  p < .001. Two-tailed tests.

Model 1: Sexual orientation attraction Heterosexual attraction (Ref) Sexual minority attraction No sexual orientation attraction reported or missing Model 2: Sexual orientation identity Heterosexual identity (Ref) Sexual minority identity No sexual orientation identity reported or missing Model 3: Sexual orientation lifetime behavior Heterosexual lifetime behavior (Ref) Sexual minority lifetime behavior No sexual orientation lifetime behavior reported or missing Model 4: Sexual orientation recent 12-month behavior Heterosexual recent 12-month behavior (Ref) Sexual minority recent 12-month behavior No sexual orientation recent 12-month behavior reported or missing

Female OR, (95% CI)

Suicidal thought

TABLE 2. Weighted Logistic Regression Analyses of Associations between Sexual Orientation Measures and Suicide Risk by Gender: National Longitudinal Study of Adolescent Health Wave IV, United States, 2007–2008

Downloaded by [Adams State University] at 10:00 04 November 2014

Downloaded by [Adams State University] at 10:00 04 November 2014

Sexual Minority Status and Suicide

minority status and suicide attempts among men suggests further investigation. Our findings are similar to result found in a previous study using the Add Health data. Russell and Toomey (2012) discovered that the association between sexual minority status and suicide attempts became non-significant from adolescence to adulthood among men. It should be noted that both studies used a sample of young adults aged 24–34 in 2007–200, in which findings can only be generalized to a specific age cohort and historical time. Future research should investigate the reasons why sexual minority status may not matter for suicide attempts among men in this age cohort. Perhaps the economic conditions (e.g., higher pay, occupational segregation) that favor young adult men over young adult women as they begin their career trajectories (Petersen & Morgan, 1995) are protective factors that ameliorate the effect of sexual minority status on suicide attempts among sexual minority men. One limitation of the study was the use of cross-sectional data to make causal inferences that sexual minority status influences suicidal thoughts and suicide attempts. It is possible with the survey questions that suicidal thoughts and attempts could occur prior to changing from a heterosexual status to sexual minority status. A prospective study would resolve whether sexual minority status does have an effect on suicidal thoughts and suicide attempts. Another limitation of the study was not looking at subgroups within a sexual minority status group (e.g., gay and lesbian versus bisexual within the sexual minority identity group). Yet, some of our variables such as suicide attempts had a low N for many subgroups, which can be too small to make statistical conclusions about some subgroups. Larger survey collections are needed to make generalizations about specific subgroups. Our study highlighted the diversity of attractions, identities, and behaviors in sexual minority populations and found that

280

all sexual minority populations are at greater risk for suicidal thoughts and suicide attempts compared to the heterosexual population. Multiple measures of sexual minority status should be utilized in future studies of sexual minority status and suicide risk. Suicide intervention programs that target sexual minorities should include persons who self-identify themselves as lesbian, gay, or bisexual as well as persons who have same-sex attractions and behaviors but do not identify themselves as lesbian, gay, or bisexual. AUTHOR NOTE

Elbert P. Almazan, Central Michigan University, Mount Pleasant, Michigan, USA. Michael E. Roettger, Pennsylvania State University, University Park, Pennsylvania, USA. Pauline S. Acosta, Cerritos College, Norwalk, California, USA. Correspondence concerning this article should be addressed to Elbert P. Almazan, Central Michigan University, Department of Sociology, Anthropology, and Social Work, 142 Anspach Hall, Mount Pleasant, MI 48859, USA. E-mail: almaz1ep@cmich. edu FUNDING

This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant POI-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss

VOLUME 18  NUMBER 3  2014

E. P. Almazan, M. E. Roettger, and P. S. Acosta

Downloaded by [Adams State University] at 10:00 04 November 2014

and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www. cpc.unc.edu/addhealth). No direct support was received from grant POI-HD31921 for this analysis. Direct support for the analysis was provided by the NIH=NICHD-funded University of Colorado, Boulder Population Center (R24HD066613).

REFERENCES Bolton, S.-L., & Sareen, J. (2011). Sexual orientation and its relation to mental disorders and suicide attempts: findings from a nationally representative sample. The Canadian Journal of Psychiatry, 56, 35–43. Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100, 468–475. Brewster, K. L., & Tillman, K. H. (2012). Sexual orientation and substance use among adolescents and young adults. American Journal of Public Health, 102, 1168–1176. Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100, 1953–1960. Harris, K. M., Halpern, C. T., Whitsel, E., Hussey, J., Tabor, J., Entzel, P., & Udry, J. R. (2009). The National Longitudinal Study of Adolescent Health: Research Design. Retrieved from http:// www.cpc.unc.edu/projects/addhealth/design

Lindley, L. L., Walsemann, K. M., & Carter, J. W., Jr. (2012). The association of sexual orientation measures with young adults’ health-related outcomes. American Journal of Public Health, 102, 1177–1185. Loosier, P. S., & Dittus, P. J. (2010). Group differences in risk across three domains using an expanded measure of sexual orientation. The Journal of Primary Prevention, 31, 261–272. Mathy, R. M., Cochran, S. D., Olsen, J., & Mays, V. M. (2011). The association between relationship markers of sexual orientation and suicide: Denmark 1990–2001. Social Psychiatry and Psychiatric Epidemiology, 46, 111–117. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104, 1333–1345. Petersen, T., & Morgan, L. A. (1995). Separate and unequal: Occupation-establishment sex segregation and the gender wage gap. American Journal of Sociology, 101, 329–365. Plo¨derl, M., Kralovec, K., & Fartacek, R. (2010). The relation between sexual orientation and suicide attempts in Austria. Archives of Sexual Behavior, 39, 1403–1414. Russell, S. T., & Toomey, R. B. (2012). Men’s sexual orientation and suicide: evidence for U. S. adolescent-specific risk. Social Science & Medicine, 74, 523–529. Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36, 385–394. Wang, J., Ha¨usermann, M., Wydler, H., Mohler-Kuo, M., & Weiss, M. G. (2012). Suicidality and sexual orientation among men in Switzerland: Findings from 3 probability surveys. Journal of Psychiatric Research, 46, 980–986.

ARCHIVES OF SUICIDE RESEARCH

281

Measures of sexual minority status and suicide risk among young adults in the United States.

Multiple measures of sexual minority status are necessary to accurately describe the diversity of attractions, identities, and behaviors in sexual min...
122KB Sizes 4 Downloads 3 Views