(PS9-A6) Mechanisms of the Association Between Sexual Orientation and Suicide Risk: The Role of Non-suicidal Self-injury versus Sexual Victimization

Sexual minorities are at an increased risk for all forms of suicide, specifically in comparison to their heterosexual counterparts (Shields, 2012). Sexual minorities also report elevated rates of non-suicidal self-injury (NSSI; Liu et al., 2019) and sexual victimization (SV; Rothman et al., 2011), both of which are well-established predictors of suicide that commonly co-occur. Although NSSI and SV both have the propensity to increase suicide risk, they often require varying interventions. Thus, understanding the extent to which SV histories and features of NSSI act as mechanisms for suicide in sexual minorities may improve the implementation of interventions for this population. The current study sought to test whether the relationship between sexual orientation and suicide risk (e.g., ideation, attempts) can be explained by SV history and various NSSI features (e.g., medical severity, lifetime frequency, and lifetime number of methods).

Participants were university students (n = 365; 79.9% female, 63.3% white, 14.9% bisexual, M_age = 20.00 years, SD_age = 2.69) who completed The Inventory of Statements About Self-Injury (ISAS; Klonsky & Glenn, 2009), the Suicide Behavior Questionnaire – Revised (SBQ-R; Osman et al., 2001), and the Sexual Experiences Survey—Long Form Victimization (SES-LFV; Koss et al., 2006). A parallel mediation with 10,000 bootstrapped samples was conducted using PROCESS macro in SPSS. Results indicated that the total effect of sexual orientation on suicide risk was significant, (c path: b = 0.590, p < .01, 95% CI [0.903, 0.191]). Sexual orientation was significantly related to increased NSSI severity, (a¹ path: b = 0.109, p < .05), and increased NSSI severity was significantly associated with elevated suicide risk (b¹ path: b = 1.489, p </em>< .001). Engagement in more NSSI methods was also significantly associated with increased suicide risk (b² path: b = 0.330, p < 0.05). NSSI severity mediated the relationship between sexual orientation and suicide risk (95% CI [0.054, 0.290]). The direct effect of sexual orientation on suicide risk remained significant, (c’ path: b = 0.419, p < .01, 95% CI [0.714, 0.136]) after accounting for the indirect effect of NSSI severity suggesting a partial mediation.

 These results indicate the importance of prioritizing interventions for self-injurious behaviors, specifically medically severe NSSI, as a means of reducing suicide risk prior to addressing sexual trauma for sexual minorities presenting with co-occurring NSSI and SV histories. While NSSI severity certainly adds to the relationship between sexual orientation and suicide risk, sexual minorities continue to be at an elevated risk for suicide even in the absence of severe NSSI. Thus, both NSSI severity and minority sexual orientations should be considered independent risk factors for suicide and therefore be addressed accordingly in clinical settings. Future research may consider addressing the limitations of the current study by focusing on the role of minority-specific risk factors in their relationship to suicide risk, specifically in samples of sexual minorities engaging in NSSI, in order to adapt more specialized interventions to address the unique needs of the broader LGBTQ+ community.