Suicidal Thoughts, Racial-Gendered Discrimination, and Post-Traumatic Sequelae: Ecological Momentary Assessment of the Discrimination and Trauma Suicide Risk Network within a BIPOC TNGE Community Sample
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Abstract
High rates of suicidal thoughts and behaviors (STBs) are an urgent issue among transgender, nonbinary, and gender-expansive (TNGE) Black, Indigenous, and other People of Color (BIPOC) that require scientific study to identify effective interventions that lower suicide risk. Key drivers in the development of vulnerability to suicide and suicidal ideation are trauma exposure (Grandison et al., 2022; LeBouthillier et al., 2015; Panisch et al., 2022; Poindexter et al., 2022; Zatti et al., 2017), discrimination (Cheng et al., 2010; Cramer et al., 2022; Goodwill et al., 2021; Hwang et al., 2008; Keum et al., 2022; Maksut et al., 2020; Oh et al., 2019), and PTSD symptomatology (Ford et al., 2015; Marie et al., 2019; Stanley et al., 2021). Despite extant literature detailing the intersection of trauma and discrimination as a unique vulnerability, scientific analyses of discrimination-related suicidal states among TNGE BIPOC remain limited. Furthermore, due to the fluid nature of suicide risk (Rudd 2000; 2006), analyses that capture the variability of suicidal thoughts in real time are optimal. Consequently, this study examined the relationship between exposure to racial-gendered discrimination, trauma symptoms from discrimination, risk factors, protective factors, and suicidal ideation within a sample of TNGE BIPOC (n = 27) using an ecological momentary assessment design. As informed by the theoretical models of minority stress (Meyer, 2003) and the racial-cultural model of suicide (Wong et al., 2014), the analysis prioritized advancing an understanding of the impact of oppression and intersectional vulnerability on suicide risk. Results indicate significant variability across suicidal ideation variables per Interclass Correlation Coefficients (ICC), Root Mean Square of Successive Differences (RMSSD), as well as intensity and severity descriptive statistics. The average level and variability of the capability to resist suicidal urges emerged as a variable of particular interest in comparison to past studies. All other variables exhibited considerable variability and varying levels of stability (post-traumatic stress, racial-gendered discrimination, mood states, post-traumatic growth, and community connectedness). In their respective models, both racial-gendered discrimination and post-traumatic stress concurrently and prospectively predicted increases in suicidal ideation at statistically significant levels. However, in the integrated model between racial-gendered discrimination and post-traumatic stress, only post-traumatic stress predicted suicidal ideation at statistically significant levels concurrently and prospectively. All mood variables (i.e. hopelessness, hopefulness, loneliness, and burdensomeness) predicted suicidal ideation at statistically significant levels at both the concurrent and prospective levels in their respective models. In the integrated model, hopelessness and loneliness predicted increases in suicidal ideation concurrently, but only hopelessness predicted suicidal ideation prospectively. Regarding community connectedness, all three forms of community connectedness (i.e. gender, racial-ethnic, and racial-gendered) were significant predictors of suicidal ideation at the concurrent level but not the prospective level. However, only gender-based community connectedness significantly predicted suicidal ideation in the integrated community connectedness model, at the concurrent level but not the prospective level. As a whole, findings provide further evidence regarding the short-term variability of key variables (i.e. suicidal ideation, racial-gendered discrimination, and post-traumatic stress) and the saliency of discrimination and trauma as a unique suicide risk network. Future research regarding intersectional, trauma-informed suicidology for TNGE BIPOC should focus on the following areas: (1) assess the impact of racial-gendered oppression on suicidal ideation in conjunction with post-traumatic stress; (2) capability to resist suicidal urges within the context of racial-gendered oppression and resulting post-traumatic stress; (3) variability of racial-gendered discrimination and post-traumatic stress as it pertains to predicting suicidal ideation in short-term multi-level modeling; and (4) how to examine community connectedness more precisely and identify the specific ways in which varying types of support across contexts interact with STBs. Clinically, the present study emphasizes the need to integrate psychoeducational interventions pertaining to the discrimination and trauma suicide risk network into routine clinical care with chronically suicidal TNGE BIPOC, utilize community work and peer support as a form of prevention, and explore shifting baselines of suicide risk developmentally within the context of patients’ clinical presentations.