Characterizing Suicidal Ambivalence Among LGBTQ+ Adults (Board#8)

Abstract : LGBTQ+ youth and young adults have higher rates of suicide ideation (SI) and suicide attempts compared to non-LGBTQ+ individuals (e.g., Miranda-Mendizábal et al., 2017; Perez-Brumer et al., 2017); however, research has largely not attempted to characterize LGBTQ+ individuals’ SI, including suicidal ambivalence. Suicidal ambivalence is the co-occurrence and active shifting of an individual’s wish to live and wish to die (Brown et al., 2005). Overall, there are still many questions about how suicidal ambivalence is operationalized and measured, and its connection to suicide risk correlates.
Traditionally, suicidal ambivalence is measured using a difference score between the wish to live and the wish to die self-report items from the Beck Scale for Suicide Ideation (BSS; Beck et al., 1988; Brown et al., 2005). Although studies provide some insight into suicidal ambivalence, difference scores using two items from the BSS do not differentiate the wish to die (by an unspecified cause) and the wish to die by suicide. Furthermore, difference scores have only considered two SI facets: the wish to live and the wish to die. Thus, there is a need to consider additional nuanced and potentially more specific SI and ambivalence facets when attempting to understand person-centered experiences of SI among high-risk groups, such as LGBTQ+ individuals.
Thus, in the current study, we identified the best-fitting latent class solutions of SI, using seven BSS items that include an ambivalent response option as latent class analysis (LCA; a person-centered analytic approach) indicators. Second, we tested if and how established SI risk factors (i.e., age, gender, sexual orientation, suicide-specific rumination, another SI measure, depression symptoms, and anxiety symptoms) relate to participants’ estimated class membership.
Participants were recruited from several online listservs dedicated to LGBTQ+ topics. Inclusion criteria included: (a) being aged 18 years or older, (b) self-identifying as a sexual (i.e., not exclusively heterosexual) and/or gender (i.e., not cisgender) minority, and (c) residing in the U.S. Participants completed self-report measures, including the BSS, demographics, and suicide risk correlates.
A three-class solution best fits the data with classes including a high-risk non-ambivalent class (Class 1), a lower-risk higher-ambivalence class (Class 2), and a lower-risk lower-ambivalence class (Class 3). Higher scores on SI, depression, anxiety, and suicide-specific rumination were associated with greater odds of being in Class 2 compared to Class 3. Men had higher odds than women and those in the gender-diverse category of being in Class 2 compared to Class 3. Those in the gay/lesbian group had higher odds than those in the bisexual/pansexual group of being in Class 2 compared to Class 3.
These findings suggest cognitive and affective features may increase the risk of suicidal ambivalence, which is consistent with previous research on suicidal ambivalence (e.g., Lento et al., 2013; O’Connor et al., 2012a, 2012b). This is somewhat inconsistent with previous literature that suggests individuals identifying as bisexual and queer report higher SI compared to other sexual identities (Lyons et al., 2022; Nystedt et al., 2019; Rogers & Taliaferro, 2020). These discrepancies highlight the potential significance of considering a suicidal ambivalence response style rather than just higher total scores on SI measures, which may lack nuances in item content responding when attempting to characterize an individual’s SI who identifies as LGBTQ+; however, these discrepancies may also be a product of our sample and sampling strategy, in addition to other limitations. Additional research and replication are needed to clarify these findings further.
Our findings also have clinical implications. The BSS is a commonly administered SI assessment tool, enabling clinicians to examine response patterns for ambivalence and track changes over time. Our findings also suggest that suicidal ambivalence is a nuanced experience among LGBTQ+ adults, and interventions should attempt to acknowledge and address these nuances through tailored interventions. In addition, a minority stress model should be applied to understand stressors in the LGBTQ+ community that could facilitate SI, whereas efforts to change sexual and gender identities would be harmful. Limitations and additional implications will be further discussed.

Learning objectives:
1. Participants will learn about the importance of nuanced facets of suicidal ambivalence.
2. Participants will learn about suicidal thoughts and ambivalence among LGBTQ+ adults.
3. Participants will learn about the risk correlates of suicidal thoughts and ambivalence.