Since the start of 2023, a record number of anti-LGBTQ+ bills have been introduced into state legislatures. According to University of Maryland Associate Professor Ethan Mereish, such current events add to the list of daily thoughts and experiences that lead LGBTQ+ teens to report having suicidal and non-suicidal self-harm thoughts.
Mereish recently led a first-of-its-kind study, published in the Journal of Psychopathology and Clinical Science, that asked 12-19 year-old LGBTQ+ teens to fill out a brief "daily dairy" survey for 28 days. The teens were asked to identify the unique kinds of stress they experience as a member of the LGBTQ+ community, aka "minority stress," and assess and record any suicide and/or nonsuicidal self-injury ideation they likewise experienced that day.
"All of us experience stress, like when we're running late and stuck in traffic, or when we need to deliver a big presentation. But on top of those general stressors, LGBTQ+ people experience unique and chronic stressors related to their identities as a result of heterosexism and cissexism, that then put them at greater risk for poor health outcomes," Mereish explained.
What the researchers found is that on days where participants reported experiencing more minority stressors, they also reported more suicide ideation and more nonsuicidal self-injury ideation than on days they experienced less minority stressors. Mereish said these stressors were "interpersonally from others like microaggressions or discrimination, from the extent that they feel the need to hide or conceal their identity, and from the extent that they feel bad about their identity because of internalized stigma."
This study is among the first to empirically support the connection between minority stress and suicide and/or nonsuicidal self-injury ideation on a day-to-day basis. The majority of related research projects, Mereish said, take a more cross-sectional or long-term longitudinal approach.
"A limitation of these longitudinal studies is that suicidality is a lot more dynamic; feeling suicidal is a lot more dynamic and a lot more frequent for some people than once every six to twelve months," he added. "When you wait six months to a year, you miss out on a lot of important information."
Part of the reason why studies like Mereish's aren't common is that, simply, they're tricky.
"We want to understand how these processes unfold naturally over time and day-to-day without us intervening. We want to understand how minority stress serves as a risk factor for suicide, but at the same time, we want to make sure the youth are safe, and so we have to intervene if they engage in non-suicidal self-injury like cutting or other self-harming behaviors, or attempted suicide. We have an ethical duty to reach out to participants whose responses we're concerned about and make sure they're safe," Mereish said.
Mereish and his research team reviewed survey responses each morning, and contacted participants whose responses they felt necessary to follow up on. If needed—and was so for one study participant—the teen's guardians were called, then the in-distress teen referred for inpatient psychiatric care.
"We really need interventions at every level because minority stressors haven't really decreased, and I project they will increase in states where some of these new anti-LGBTQ+ bills are becoming laws," concluded Mereish. "At the school and county levels, having affirmative, intersectional, and anti-bullying policies and staff and teacher trainings that incorporate, protect, and affirm LGBTQ+ teens; at the therapist level, affirming teens and teaching them how to manage their emotions in a way that allows them to be resilient and healthy; at the community level, providing affirming spaces and activities for LGBTQ+ teens to connect and thrive, and at the policy level, stopping these bills from becoming law, and doing advocacy work to counter those that do can actually have an impact on reducing suicide rates. We have a lot of work to do."
