The Mediating Role of Family Acceptance and Conflict on Suicidality among Sexual and Gender Minority Youth

Abstract

Introduction

Prior research suggests sexual and gender minority (SGM) youth are profoundly impacted by levels of parental support. This study assessed mediating effects of generalized family acceptance and conflict on lifetime suicidal behaviors among a large diverse sample comprising both SGM and non-SGM youth in early adolescence, when intervention to optimize family dynamics may be critical.

Materials

Using data from the first-year follow-up of the Adolescent Brain Cognitive Development Study based in the United States, mediation was tested using a binary logistic regression model fitted with a generalized structural equation. Models included SGM status as the independent variable, family acceptance or family conflict sum score as the mediator, and the presence of lifetime suicidal behaviors as the dependent variable. Models adjusted for age, birth-assigned sex (as reported by the parent/guardian), and race/ethnicity.

Results

Of 11,235 youths, lifetime suicidal behaviors were reported by 1.5% (n = 164). Youths with SGM identities reported 40% less parental acceptance and 47% greater family conflict, compared to non-SGM peers. Both parental acceptance and family conflict partially mediated associations between SGM identification and odds of lifetime suicidal behavior (ps = .001).

Conclusions

Identification of modifiable risk factors for suicidality in this vulnerable population, including parental acceptance and family conflict, is critical to improving health outcomes. Clinicians should work with SGM youth and their families starting in childhood to optimize family dynamics and bolster acceptance to potentially reduce adverse health outcomes.

HIGHLIGHTS

• Youths with SGM identity reported 40% less parental acceptance than non-SGM peers.

• Parental acceptance was associated with lower odds of lifetime suicidal behaviors.

• Family factors partially mediated associations between SGM status and suicidal behaviors.

Keywords:

• Children
• LGBT
• parent
• suicidal behaviors
• suicide
• transgender

ACKNOWLEDGMENT

The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. There are no acknowledgements of support or assistance. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s). The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of Uniformed Services University (USU), the Department of the Air Force, the United States Department of Defense, or the U.S. Government.

DATA AVAILABILITY STATEMENT

Data used in the preparation of this article were obtained from the Adolescent Brain Cognitive Development (ABCD) Study (https://abcdstudy.org), held in the National Institute of Mental Health Data Archive (NDA). This is a multisite, longitudinal study designed to recruit more than 10,000 children aged 9–10 years and follow-up with them over 10 years into early adulthood. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, and U24DA041147. A full list of supporters is available at https://abcdstudy.org/federal-partners/. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/principal-investigators.html. ABCD consortium investigators designed and implemented the study and/or provided data but did not necessarily participate in analysis or writing of this report. This article reflects the views of the authors and may not reflect the opinions or views of the National Institutes of Health or ABCD consortium investigators. The ABCD data repository grows and changes over time.

Additional information

Notes on contributors

David A. Klein

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Anwar E. Ahmed

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Mikela A. Murphy

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Arielle T. Pearlman

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Nia Johnson

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Joshua C. Gray

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.

Natasha A. Schvey

David A. Klein, MD, MPH, Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA; Department of Family Medicine, Uniformed Services University, Bethesda, MD, USA. Anwar E. Ahmed, PhD, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA. Mikela A. Murphy, BA, Arielle T. Pearlman, BA, and Nia Johnson, BS, The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA. Joshua C. Gray, PhD, and Natasha A. Schvey, PhD, Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD, USA.