Emotion Regulation and Self-Harm among Sexual and Gender Minority Youth

Suicide is the second leading cause of death for adolescents and young adults worldwide. Suicide prevention efforts would be advanced by understanding of why some youth are at disproportionately higher risk compared to others. Sexual and gender minority (SGM) youth report higher rates of self-harm than heterosexual/cisgender youth. Minority Stress Theory suggests that higher rates of victimization increase risk for adverse health within SGM populations. This dissertation examined the relationships between minority stress, emotion regulation, and self-harm behaviors in adolescence and young adulthood. This approach integrated developmental perspectives to examine cross-cutting underpinnings of SGM disparities. Through two complementary studies I characterized the associations between emotion regulation and self-harm in university students identified as being at elevated risk for suicide and in psychiatric emergency patients. In the first study I examined emotion regulation, behavioral disinhibition, and their interaction as influences on self-harm in a cross-sectional sample of university students ages 18 years and older who were identified through online suicide risk screening. Specifically, I focused on acceptance of emotional responses and negative urgency, the tendency to engage in behaviors to avoid distress. Results indicated bivariate relationships between acceptance, negative urgency, and self-harm. In multivariate analyses controlling for age and sex, only acceptance was associated with recent non-suicidal self-injury (NSSI), suicide attempts, and any self-harm. These relationships were not moderated by SGM status. In the second study, I examined the histories of self-harm and crisis service usage and conducted a longitudinal mediation test of the Minority Stress Model within a sample of psychiatric emergency patients ages 13 to 25 years. SGM youth reported more chronic histories of NSSI and crisis service usage. Moreover, among youth who reported both NSSI and suicide attempts, SGM youth reported a slower speed of transition between these two types of self-harm behaviors. Longitudinally, three emotion regulation strategies were tested as potential mediators of the relationships between victimization, internalizing symptoms, and self-harm. Results indicated that rumination was a mechanism prospectively linking victimization to self-harm via increased internalizing symptoms. Additionally, reappraisal was not associated with victimization but was associated with reduced risk of self-harm via reductions in internalizing symptoms. Suppression was associated with recent victimization but did not exert influences on future internalizing symptoms or self-harm. These mediation effects were found for the overall sample and for heterosexual/cisgender youth but not SGM youth. This pair of studies examined transdiagnostic domains of functioning within samples that were characterized by elevated but heterogeneous suicide risk. Together, they highlight the importance of examining general factors that may underpin self-harm and psychopathology disparities, particularly the use of both adaptive and maladaptive forms of emotion regulation.PHDPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/144145/1/jberona_1.pdfDescription of jberona_1.pdf : Restricted to UM users only

Rumination, Brooding, and Reflection: Prospective Associations with Suicide Ideation and Suicide Attempts

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151274/1/sltb12507_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151274/2/sltb12507.pd

Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department

Objective: The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Method: Participants were 81 adolescents, ages 14?19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Results: Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). Conclusions: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140322/1/cap.2014.0049.pd

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High‐Risk Adolescents

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136513/1/sltb12273.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136513/2/sltb12273_am.pd

Variation in Suicide Risk among Subgroups of Sexual and Gender Minority College Students

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163395/2/sltb12637_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163395/1/sltb12637.pd

Acutely Suicidal Adolescents Who Engage in Bullying Behavior: 1-Year Trajectories

AbstractPurposeProspective longitudinal research is needed to examine associations between bullying behaviors and trajectories of suicidal ideation and behavior and overall functional impairment. The specific aims of the present study are to: (1) characterize differences in baseline functioning between acutely suicidal adolescents who are classified into bullying perpetrator and non-bully groups and (2) examine the 1-year trajectories of these two groups of adolescents.MethodParticipants were 433 psychiatrically hospitalized suicidal adolescents (72% female), ages 13 to 17 years. Participants reported suicidal ideation, depression, anxiety, substance use, adaptive functioning, and bullying behavior. Six items from the Youth Self-Report were used to classify adolescents into bullying perpetrator (n = 54) and non-bully (n = 379) groups. Follow-up assessments were conducted at 6 weeks, 3 months, 6 months, and 12 months.ResultsAt hospitalization, adolescents in the bully group reported significantly higher levels of suicidal ideation, substance use, and functional impairment. Suicidal ideation differences remitted at six weeks. The elevated functional impairment of the bullying perpetrator group persisted across the 12-month period.ConclusionAdolescents who met bullying perpetrator group criteria were characterized by more severe suicidal ideation and higher levels of proximal risk factors for suicide. Bullying behavior was not stable over time but was associated with elevated suicide risk when present. These findings highlight the importance of specifically assessing for and targeting bullying behavior at multiple time points when treating suicidal adolescents

Psychosocial Functioning in Transgender Youth after 2 Years of Hormones.

BACKGROUND: Limited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol). METHODS: We characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory-II, the Revised Childrens Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome. RESULTS: A total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants. CONCLUSIONS: In this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)

Variation in Suicide Risk among Subgroups of Sexual and Gender Minority College Students

ObjectiveSexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities.MethodForty-one thousand four hundred and twelve college students (62% cis-female, 37% cis-male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt).ResultsGender minority students (i.e., transgender, genderqueer/non-binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within-group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or 'other sexual minority'. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students.ConclusionsThese findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk