Modeling change in suicidal ideation among transgender adults: a within-person intensive longitudinal test of gender minority stress and resilience theory
Sarah E. Victor, Elizabeth Hoelscher, E. Kale Edmiston, Terry H. Trieu, Devon Sandel-FernandezAbstract
Background
Transgender and nonbinary (trans) people face elevated risk for suicidal ideation (SI); yet, many do not experience SI, necessitating study of mechanisms contributing to, or buffering against, trans suicide risk. Gender minority stress and resilience theories have been tested cross-sectionally; however, no work has tested these models in the daily lives of suicidal trans adults.
Methods
Trans adults with past-month suicidal thoughts or behaviors ( N = 47) were enrolled for a virtual research study involving a baseline set of interviews and questionnaires, followed by a 4-week ecological momentary assessment protocol. Ecological momentary assessment surveys were administered six times daily and assessed various minority stressors and momentary SI; each day’s first survey assessed resilience factors. Dynamic structural equation modeling was used to disentangle within- and between-person effects of minority stress and resilience factors on changes in SI.
Results
We observed that interpersonal and intrapersonal minority stressors predicted proximal within-person changes in SI over several hours; however, between-person estimates of resilience did not moderate the minority stress–SI relationship, as argued by extant theory.
Conclusions
Although the sample demonstrated adequate geographic, age, and gender diversity, participants were primarily White, limiting generalizability to racial minority trans people, and those outside the United States. Results suggest that interventions targeting minority stress and resilience factors may be appropriate for suicidal trans people, alongside social and political efforts to address discrimination and other interpersonal harms faced by trans people.