4 - (SYM 27) Internalized Distress Fully Mediates the Relationship Between Exposure to Minority Stressors and Suicidal Thoughts and Behaviors in Sexual Minority Adults

Background: Exposure to minority stressors (MS), (e.g., discrimination, prejudice, and systemic inequities), confers greater risk for suicidal thoughts and behaviors (STBs) in sexual minorities; yet, how this risk is conferred remains unclear. Meyer’s minority stress model infers that MS contribute to internalized distress, which, in turn, may increase STB risk. To examine this potential pathway, a longitudinal path model was utilized to test whether internalized distress mediated the relationship between exposure to MS, including healthcare related MS, and STBs in a sample of non-transgender sexual minority adults (n = 660). 

Methods: A secondary analysis was conducted on data from the Generations study, which longitudinally surveyed adults with minoritized sexual orientation from 2016 to 2019. Data are reported in three waves, one for each year of recruitment. At wave 1, the majority of the sample identified as cisgender (48.6% female) and 7% identified as non-binary/genderqueer. 53.6% identified as lesbian or gay, 33% as bisexual, and 13.3% as another sexual minority. 73.9% reported a lifetime history of suicidal ideation, 57.1% endorsed history of suicide planning, and 22.7% had history of a suicide attempt. The path model was estimated with robust maximum likelihood and featured the following latent variables: (1) inequities in healthcare access, with four items from the Healthcare Stereotype Threat Scale as indicators; (2) exposure to MS, with the inequities in healthcare access latent variable and sum scores of the Everyday Discrimination Scale and Felt Stigma Scale as indicators; (3) anxiety, with two items from the Kessler-6 as indicators; (4) depression, with four items from the Kessler-6 as indicators; and (5) an internalized distress factor with anxiety and depression factors as indicators. STBs were operationalized as a single observed variable indicating severity of STBs within the past year. Exposure to MS was measured at wave 1, internalized distress at wave 2, and STBs at wave 3. 

 
Results and Implications: The model fit well (CFI = .97, TLI = .96, RMSEA = .06) and supported a full longitudinal mediation effect of internalized distress on the association between exposure to MS and STBs (𝛽 = .18, p < .001). Experiencing MS such as discrimination, stigma, and systemic inequities may contribute to STBs in sexual minority adults through internalized distress. An improved understanding of the relationship between MS and internalized distress may better inform intervention efforts towards reducing STBs in sexual minorities.