6 - (IOP 24) Social Safety Predicts Acute Increases in Suicidal Ideation in Rural LGTBQ Adults

Background: Suicidal thoughts and behaviors (STBs) are a major public health concern. LGBTQ adults experience disproportionate STB prevalence. LGBTQ people’s STB disparities are primarily attributed to stigmatization of LGBTQ identities. Traditionally, stigma has been thought to affect LGBTQ health through minority stress, which include discrimination, harassment, microaggressions, and self-stigma. However, minority stress does not fully explain STB or other health disparities LGBTQ people experience. Diamond and Alley (2022) proposed a novel stigma-related process that may operate in conjunction with minority stress: social safety. Social safety is defined as “reliable social connection, inclusion, and protection,” all of which are considered fundamental human needs. Given that LGBTQ people are stigmatized, they may have lower social safety than people with non-stigmatized sexual orientations and gender identities. This study assessed whether low social safety predicted suicide ideation on a momentary timescale. We assessed these relations at a momentary timescale given that suicide ideation and social safety fluctuate quickly, and constructs must be measured at the true timescales at which they operate.

Method: N=83 rural LGBTQ adults ages 18-64 years with lifetime suicide plan or attempt and past-year suicide ideation responded to five ecological momentary assessment (EMA) prompts per day for 21 days (observation n=8,456). In each EMA, participants reported current suicide ideation intensity and current social safety (0 to 100). Multilevel models tested whether social safety at Time T prospectively predicted suicide ideation at Time T+1. Social safety was person-mean centered.

Results: At a within-person level, social safety at Time T significantly and negatively predicted suicide ideation at Time T+1 (b = -0.23, se = 0.025, t = -9.23, p < 0.01). At a between-person level, social safety significantly and negatively predicted suicide ideation (b = -0.27, se = 0.012, t = -23.5, p < 0.01). This means that (1) for a given individual, feeling less socially safe than usual predicted higher suicide ideation and (2) people who generally felt less (vs. more) socially safe had more intense suicide ideation.

Discussion: This study tested how a novel stigma-related process predicted acute suicide ideation in LGBTQ adults. Indeed, at both a within- and between-person level, lower social safety predicted higher suicide ideation. While additional research is needed to operationalize social safety and determine its relationship with STBs, findings suggest that STB disparities in LGBTQ adults may arise through multiple stigma-related processes, including minority stress (i.e., presence of negative experiences) and social safety (i.e., absence of positive experiences).