Lindsay A. Taliaferro, Jennifer J. Muehlenkamp, Myeshia N. Price, Tiffany M. Eden, Stephanie Cook, Kiara L. Moore, Robert D. Dvorak, Eric W. Schrimshaw
{"title":"将基于优势的交叉方法整合到黑人女同性恋、男同性恋、双性恋、变性人、酷儿和有问题青年的自杀风险研究中","authors":"Lindsay A. Taliaferro, Jennifer J. Muehlenkamp, Myeshia N. Price, Tiffany M. Eden, Stephanie Cook, Kiara L. Moore, Robert D. Dvorak, Eric W. Schrimshaw","doi":"10.1002/mhs2.70025","DOIUrl":null,"url":null,"abstract":"<p>Suicide among Black lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ + ) youth constitutes a significant public health concern (Congressional Black Caucus <span>2019</span>). Research shows 44% of Black LGBTQ+ youth seriously considered suicide and 16% attempted suicide during the previous 12 months, compared to 37% and 11%, respectively, of White LGBTQ+ youth (The Trevor Project <span>2023</span>). Black LGBTQ+ youth are 5.8 times more likely than Black cisgender heterosexual youth to report suicidal ideation and behavior (henceforth suicidality) (Mereish et al. <span>2019</span>). Further, Black youth may underreport suicidality due to a lack of culturally valid suicide risk assessment tools (Francois et al. <span>2025</span>), thus, rates may be higher than they appear using existing tools. Given this population's heightened risk for suicide, researchers must identify risk and protective factors associated with increasing and decreasing suicidality among Black LGBTQ+ youth using an intersectional lens (Price-Feeney et al. <span>2020</span>).</p><p>Intersectionality represents a conceptual framework introduced by Black feminist scholars to understand and examine interlocking, structural-level systems of power and oppression (e.g., systems of heterosexism, cisgenderism, racism) as they collectively shape individuals’ lived experiences and patterns of health inequities (Abrams et al. <span>2020</span>; Collins and Bilge <span>2020</span>; Combahee River Collective <span>1977</span>; Crenshaw <span>1989</span>). Within an intersectionality framework, an intersectional methodological research approach considers distinct ways marginalized social positions work together relationally in connection with systems of power for different groups to understand and address health inequities among specific populations (Bowleg and Bauer <span>2016</span>; Gardner et al. <span>2025</span>; McCall <span>2005</span>). For example, Black LGBTQ+ youth may experience multiple intersectional systems of oppression (e.g., racism and heterosexism/cisgenderism) and forms of discrimination (e.g., racist bigotry and homophobia/transphobia) that elevate their risk for suicide (Balsam et al. <span>2011</span>; Opara et al. <span>2020</span>). An intersectional approach also can demonstrate Black LGBTQ+ youth's capacity to become empowered by holding multiple minoritized social positions, feel strengthened to advocate for themselves and their communities, and experience identity harmony, self-acceptance, and empathy (Bowleg <span>2013</span>; Ghabrial <span>2017</span>, <span>2019</span>; Ghabrial and Andersen <span>2023</span>). Strengths-based intersectional research with Black LGBTQ+ youth can show how holding multiple minoritized positions may serve an adaptive role by allowing youth to shift identities and glean diverse external supports to better address their current needs (Pittinsky et al. <span>1999</span>), mitigating suicide risk. Thus, to understand the complex nature of suicide among Black LGBTQ+ youth, researchers must utilize an intersectional methodological approach informed by an intersectionality framework that considers intracategorical (within group) and intercategorical (between group) complexity within sampling designs (McCall <span>2005</span>), measurement of intersectional risk and protective factors (e.g., intersectional survey/interview questions, state-level equality indices), intersectional data analytic approaches, and interpretation of study findings within an intersectionality framework. We propose an integrated causal model of suicide risk that incorporates an intersectional methodological approach into established suicide risk theories (see Figure 1).</p><p>Projects integrating the Minority Stress Theory (Brooks <span>1981</span>; Meyer <span>2003</span>) and suicide-related theories utilizing an intersectional approach could advance research and understanding of suicidality among Black LGBTQ+ youth. Studying effects of intersectional minority stressors is new to suicide research, where most studies examine single-position minority stressors or additive models of risk (Mallory and Russell <span>2021</span>). For Black LGBTQ+ youth, holding multiple minoritized social positions may intensify the minority-based stressors experienced (Bowleg <span>2008</span>; Bruce et al. <span>2011</span>; Collier et al. <span>2013</span>), elevating risk for suicide. A better understanding of how intersectional minority stressors affect suicide risk among Black LGBTQ+ youth would inform the development of tailored prevention interventions.</p><p>Minority stress may come from multiple stressors, including structural oppressions (e.g., discriminatory state policies/laws) (Alvarez et al. <span>2022</span>; Sheftall et al. <span>2022</span>) and negative interactions within schools, families, and communities (stigmatization, victimization, discrimination) that lead to intrapersonal stressors (internalized homophobia/transphobia/racism, expectations of rejection, identity concealment) (Hatchel et al. <span>2021</span>; Holloway and Varner <span>2021</span>; McMahon et al. <span>2011</span>; Mustanski and Espelage <span>2020</span>), each of which can increase suicide risk (Opara et al. <span>2020</span>; Toomey et al. <span>2017</span>). While minority stressors alone may increase risk, current suicide theories, such as the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV; O'Connor and Kirtley <span>2018</span>), suggest additional psychological mediators (e.g., entrapment) and moderators (e.g., protective factors) of that pathway (Baams et al. <span>2015</span>; Joiner and Silva <span>2012</span>; O'Connor and Kirtley <span>2018</span>). Specifically, the IMV model suggests individual-level processes, such as positive perceptions of oneself (e.g., identity affirmation/pride) and coping abilities (e.g., civic engagement), represent moderators influencing whether negative experiences, such as external and internalized minority stressors, develop into feelings of entrapment, which precede the onset of suicidality. The IMV model also proposes positive social relationships and community engagement that foster feelings of connection, belonging, and support as moderators of the transition from entrapment to suicide ideation and intent. While a robust body of research supports the IMV model in understanding suicide risk (Souza et al. <span>2024</span>), very few studies have tested these ideas within Black and/or LGBTQ+ populations, and all fail to account for structural factors impacting these processes. Integrating minority stress and suicide theories within an intersectional approach to better account for structural, community, interpersonal, and individual influences on suicide risk and protection would expand upon current theories to account for external factors impacting suicide (Alvarez et al. <span>2022</span>; Hjelmeland and Knizek <span>2016</span>; Opara et al. <span>2020</span>; Standley <span>2020</span>).</p><p>Further, existing research and theory on suicide among Black LGBTQ+ youth remains limited by risk-based, deficit-focused models (Haas and Rohlfsen <span>2010</span>; Hatchel et al. <span>2021</span>). To advance the science on suicidality, we need to examine theoretically-relevant, Black LGBTQ + -specific protective factors across socioecological levels that may diminish adverse effects of intersectional minority stressors and structural oppressions on suicidality (Busby et al. <span>2020</span>; Hatchel et al. <span>2021</span>).</p><p>Advancing suicide prevention efforts with Black LGBTQ+ youth requires proactive research, practice, and policy/advocacy action steps. Researchers must examine effects of Black LGBTQ+ specific protective factors across socioecological levels over time on theoretical pathways of suicide risk utilizing an intersectional approach. Suicidologists must apply innovative methods of ecological momentary assessments, daily diary, continuous physiological monitoring, and longitudinal designs to expand current understanding of the complex influences of daily risk and protective experiences on concurrent, next day, and longer subsequent suicidality (Kleiman et al. <span>2023</span>). Integrating lived experiences through inductive, qualitative methods remains essential for decolonizing the study of suicide (White et al. <span>2016</span>), understanding nuanced and unique experiences influencing suicide risk and protection, designing effective measures (e.g., intersectional and culturally-relevant suicide risk assessment tools), and developing culturally-appropriate suicide prevention interventions for Black LGBTQ+ youth. Researchers also must appreciate historical experiences and justifiable mistrust of research efforts within Black and LGBTQ+ communities and ensure Black LGBTQ+ youth advisory boards provide stewardship for research projects. In practice, we must increase access to training programs and mentorship for students to eliminate barriers for Black LGBTQ+ individuals pursuing careers in research. Suicide prevention efforts must intentionally focus on ameliorating suicide among Black LGBTQ+ youth by developing and implementing tailored multi-faceted and multi-sectoral interventions that aim to eliminate the overlapping systems of oppression contributing to suicide risk (Bowleg <span>2023</span>; Zubizarreta and Beccia <span>2025</span>), while strengthening protective factors across socioecological levels that may reduce risk among this population. Social justice represents a core construct of intersectionality (Collins <span>2019</span>), and policy/advocacy efforts must address social injustices that characterize social inequities and mental health disparities among Black LGBTQ+ youth by addressing political determinants of health (Kline et al. <span>2023</span>; Paceley et al. <span>2023</span>) and structural-level racism, heterosexism, and cisgenderism (Alvarez et al. <span>2022</span>; Hatzenbuehler <span>2016</span>; Zubizarreta and Beccia <span>2025</span>). Efforts also must involve advocating to enhance modifiable Black LGBTQ + -specific protective factors, including structural-level factors, to ensure Black LGBTQ+ youth have equal opportunities to thrive.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":94140,"journal":{"name":"Mental health science","volume":"3 3","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mhs2.70025","citationCount":"0","resultStr":"{\"title\":\"Integrating a Strengths-Based Intersectional Approach to the Study of Suicide Risk Among Black Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth\",\"authors\":\"Lindsay A. Taliaferro, Jennifer J. Muehlenkamp, Myeshia N. Price, Tiffany M. Eden, Stephanie Cook, Kiara L. Moore, Robert D. Dvorak, Eric W. Schrimshaw\",\"doi\":\"10.1002/mhs2.70025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Suicide among Black lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ + ) youth constitutes a significant public health concern (Congressional Black Caucus <span>2019</span>). Research shows 44% of Black LGBTQ+ youth seriously considered suicide and 16% attempted suicide during the previous 12 months, compared to 37% and 11%, respectively, of White LGBTQ+ youth (The Trevor Project <span>2023</span>). Black LGBTQ+ youth are 5.8 times more likely than Black cisgender heterosexual youth to report suicidal ideation and behavior (henceforth suicidality) (Mereish et al. <span>2019</span>). Further, Black youth may underreport suicidality due to a lack of culturally valid suicide risk assessment tools (Francois et al. <span>2025</span>), thus, rates may be higher than they appear using existing tools. Given this population's heightened risk for suicide, researchers must identify risk and protective factors associated with increasing and decreasing suicidality among Black LGBTQ+ youth using an intersectional lens (Price-Feeney et al. <span>2020</span>).</p><p>Intersectionality represents a conceptual framework introduced by Black feminist scholars to understand and examine interlocking, structural-level systems of power and oppression (e.g., systems of heterosexism, cisgenderism, racism) as they collectively shape individuals’ lived experiences and patterns of health inequities (Abrams et al. <span>2020</span>; Collins and Bilge <span>2020</span>; Combahee River Collective <span>1977</span>; Crenshaw <span>1989</span>). Within an intersectionality framework, an intersectional methodological research approach considers distinct ways marginalized social positions work together relationally in connection with systems of power for different groups to understand and address health inequities among specific populations (Bowleg and Bauer <span>2016</span>; Gardner et al. <span>2025</span>; McCall <span>2005</span>). For example, Black LGBTQ+ youth may experience multiple intersectional systems of oppression (e.g., racism and heterosexism/cisgenderism) and forms of discrimination (e.g., racist bigotry and homophobia/transphobia) that elevate their risk for suicide (Balsam et al. <span>2011</span>; Opara et al. <span>2020</span>). An intersectional approach also can demonstrate Black LGBTQ+ youth's capacity to become empowered by holding multiple minoritized social positions, feel strengthened to advocate for themselves and their communities, and experience identity harmony, self-acceptance, and empathy (Bowleg <span>2013</span>; Ghabrial <span>2017</span>, <span>2019</span>; Ghabrial and Andersen <span>2023</span>). Strengths-based intersectional research with Black LGBTQ+ youth can show how holding multiple minoritized positions may serve an adaptive role by allowing youth to shift identities and glean diverse external supports to better address their current needs (Pittinsky et al. <span>1999</span>), mitigating suicide risk. Thus, to understand the complex nature of suicide among Black LGBTQ+ youth, researchers must utilize an intersectional methodological approach informed by an intersectionality framework that considers intracategorical (within group) and intercategorical (between group) complexity within sampling designs (McCall <span>2005</span>), measurement of intersectional risk and protective factors (e.g., intersectional survey/interview questions, state-level equality indices), intersectional data analytic approaches, and interpretation of study findings within an intersectionality framework. We propose an integrated causal model of suicide risk that incorporates an intersectional methodological approach into established suicide risk theories (see Figure 1).</p><p>Projects integrating the Minority Stress Theory (Brooks <span>1981</span>; Meyer <span>2003</span>) and suicide-related theories utilizing an intersectional approach could advance research and understanding of suicidality among Black LGBTQ+ youth. Studying effects of intersectional minority stressors is new to suicide research, where most studies examine single-position minority stressors or additive models of risk (Mallory and Russell <span>2021</span>). For Black LGBTQ+ youth, holding multiple minoritized social positions may intensify the minority-based stressors experienced (Bowleg <span>2008</span>; Bruce et al. <span>2011</span>; Collier et al. <span>2013</span>), elevating risk for suicide. A better understanding of how intersectional minority stressors affect suicide risk among Black LGBTQ+ youth would inform the development of tailored prevention interventions.</p><p>Minority stress may come from multiple stressors, including structural oppressions (e.g., discriminatory state policies/laws) (Alvarez et al. <span>2022</span>; Sheftall et al. <span>2022</span>) and negative interactions within schools, families, and communities (stigmatization, victimization, discrimination) that lead to intrapersonal stressors (internalized homophobia/transphobia/racism, expectations of rejection, identity concealment) (Hatchel et al. <span>2021</span>; Holloway and Varner <span>2021</span>; McMahon et al. <span>2011</span>; Mustanski and Espelage <span>2020</span>), each of which can increase suicide risk (Opara et al. <span>2020</span>; Toomey et al. <span>2017</span>). While minority stressors alone may increase risk, current suicide theories, such as the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV; O'Connor and Kirtley <span>2018</span>), suggest additional psychological mediators (e.g., entrapment) and moderators (e.g., protective factors) of that pathway (Baams et al. <span>2015</span>; Joiner and Silva <span>2012</span>; O'Connor and Kirtley <span>2018</span>). Specifically, the IMV model suggests individual-level processes, such as positive perceptions of oneself (e.g., identity affirmation/pride) and coping abilities (e.g., civic engagement), represent moderators influencing whether negative experiences, such as external and internalized minority stressors, develop into feelings of entrapment, which precede the onset of suicidality. The IMV model also proposes positive social relationships and community engagement that foster feelings of connection, belonging, and support as moderators of the transition from entrapment to suicide ideation and intent. While a robust body of research supports the IMV model in understanding suicide risk (Souza et al. <span>2024</span>), very few studies have tested these ideas within Black and/or LGBTQ+ populations, and all fail to account for structural factors impacting these processes. Integrating minority stress and suicide theories within an intersectional approach to better account for structural, community, interpersonal, and individual influences on suicide risk and protection would expand upon current theories to account for external factors impacting suicide (Alvarez et al. <span>2022</span>; Hjelmeland and Knizek <span>2016</span>; Opara et al. <span>2020</span>; Standley <span>2020</span>).</p><p>Further, existing research and theory on suicide among Black LGBTQ+ youth remains limited by risk-based, deficit-focused models (Haas and Rohlfsen <span>2010</span>; Hatchel et al. <span>2021</span>). To advance the science on suicidality, we need to examine theoretically-relevant, Black LGBTQ + -specific protective factors across socioecological levels that may diminish adverse effects of intersectional minority stressors and structural oppressions on suicidality (Busby et al. <span>2020</span>; Hatchel et al. <span>2021</span>).</p><p>Advancing suicide prevention efforts with Black LGBTQ+ youth requires proactive research, practice, and policy/advocacy action steps. Researchers must examine effects of Black LGBTQ+ specific protective factors across socioecological levels over time on theoretical pathways of suicide risk utilizing an intersectional approach. Suicidologists must apply innovative methods of ecological momentary assessments, daily diary, continuous physiological monitoring, and longitudinal designs to expand current understanding of the complex influences of daily risk and protective experiences on concurrent, next day, and longer subsequent suicidality (Kleiman et al. <span>2023</span>). Integrating lived experiences through inductive, qualitative methods remains essential for decolonizing the study of suicide (White et al. <span>2016</span>), understanding nuanced and unique experiences influencing suicide risk and protection, designing effective measures (e.g., intersectional and culturally-relevant suicide risk assessment tools), and developing culturally-appropriate suicide prevention interventions for Black LGBTQ+ youth. Researchers also must appreciate historical experiences and justifiable mistrust of research efforts within Black and LGBTQ+ communities and ensure Black LGBTQ+ youth advisory boards provide stewardship for research projects. In practice, we must increase access to training programs and mentorship for students to eliminate barriers for Black LGBTQ+ individuals pursuing careers in research. Suicide prevention efforts must intentionally focus on ameliorating suicide among Black LGBTQ+ youth by developing and implementing tailored multi-faceted and multi-sectoral interventions that aim to eliminate the overlapping systems of oppression contributing to suicide risk (Bowleg <span>2023</span>; Zubizarreta and Beccia <span>2025</span>), while strengthening protective factors across socioecological levels that may reduce risk among this population. Social justice represents a core construct of intersectionality (Collins <span>2019</span>), and policy/advocacy efforts must address social injustices that characterize social inequities and mental health disparities among Black LGBTQ+ youth by addressing political determinants of health (Kline et al. <span>2023</span>; Paceley et al. <span>2023</span>) and structural-level racism, heterosexism, and cisgenderism (Alvarez et al. <span>2022</span>; Hatzenbuehler <span>2016</span>; Zubizarreta and Beccia <span>2025</span>). Efforts also must involve advocating to enhance modifiable Black LGBTQ + -specific protective factors, including structural-level factors, to ensure Black LGBTQ+ youth have equal opportunities to thrive.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>\",\"PeriodicalId\":94140,\"journal\":{\"name\":\"Mental health science\",\"volume\":\"3 3\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mhs2.70025\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Mental health science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/mhs2.70025\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mental health science","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/mhs2.70025","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
黑人女同性恋、男同性恋、双性恋、跨性别、酷儿和质疑(LGBTQ +)青年的自杀构成了一个重大的公共卫生问题(国会黑人核心小组2019年)。研究显示,在过去的12个月里,44%的黑人LGBTQ+青年认真考虑过自杀,16%的人试图自杀,而白人LGBTQ+青年的这一比例分别为37%和11% (the Trevor Project 2023)。黑人LGBTQ+青年报告自杀意念和行为(因此有自杀倾向)的可能性是黑人顺性异性恋青年的5.8倍(Mereish et al. 2019)。此外,由于缺乏文化上有效的自杀风险评估工具,黑人青年可能会少报自杀率(Francois et al. 2025),因此,比率可能比使用现有工具时显示的更高。鉴于这一人群的自杀风险较高,研究人员必须使用交叉视角确定与LGBTQ+黑人青年自杀率上升和下降相关的风险和保护因素(Price-Feeney et al. 2020)。交叉性代表了黑人女权主义学者引入的一个概念框架,用于理解和研究相互关联的结构级权力和压迫系统(例如,异性恋主义、顺性别主义、种族主义系统),因为它们共同塑造了个人的生活经历和健康不平等的模式(Abrams等人,2020;Collins and Bilge 2020;Combahee River Collective 1977;克伦肖1989)。在交叉性框架内,交叉方法学研究方法考虑了边缘化社会地位与不同群体的权力系统相互作用的不同方式,以理解和解决特定人群之间的健康不平等问题(Bowleg和Bauer 2016;Gardner等人,2025;考尔2005)。例如,黑人LGBTQ+青年可能会经历多重交叉的压迫系统(例如,种族主义和异性恋/反性别主义)和歧视形式(例如,种族主义偏见和同性恋/变性恐惧症),这些都增加了他们自杀的风险(Balsam et al. 2011;Opara et al. 2020)。交叉方法还可以展示黑人LGBTQ+青年通过持有多个少数群体的社会地位而获得权力的能力,增强为自己和社区辩护的能力,并体验身份和谐、自我接受和同理心(Bowleg 2013;Ghabrial 2017, 2019;Ghabrial and Andersen 2023)。针对黑人LGBTQ+青年的基于优势的交叉研究可以显示,持有多个少数群体职位可以通过允许青年转变身份和收集不同的外部支持来更好地满足他们当前的需求,从而发挥适应性作用,从而降低自杀风险(Pittinsky et al. 1999)。因此,为了理解黑人LGBTQ+青年自杀的复杂性,研究人员必须利用交叉性框架,考虑抽样设计中的类别内(组内)和类别间(组间)复杂性(McCall 2005),交叉风险和保护因素的测量(例如,交叉调查/访谈问题,州一级平等指数),交叉数据分析方法,以及在交叉性框架内对研究结果的解释。我们提出了一个自杀风险的综合因果模型,该模型将交叉方法纳入到已建立的自杀风险理论中(见图1)。整合少数民族压力理论的项目(Brooks 1981;Meyer 2003)和自杀相关理论利用交叉方法可以推进研究和理解黑人LGBTQ+青年的自杀行为。研究交叉少数压力源的影响对自杀研究来说是新的,大多数研究都是研究单一位置的少数压力源或风险的附加模型(Mallory和Russell 2021)。对于黑人LGBTQ+青年来说,拥有多个少数群体的社会地位可能会加剧他们所经历的基于少数群体的压力源(Bowleg 2008;Bruce et al. 2011;Collier et al. 2013),增加自杀风险。更好地了解交叉少数族裔压力因素如何影响LGBTQ+黑人青年的自杀风险,将为制定量身定制的预防干预措施提供信息。少数民族压力可能来自多种压力源,包括结构性压迫(例如,歧视性国家政策/法律)(Alvarez et al. 2022;Sheftall et al. 2022)和学校、家庭和社区内部的负面互动(污名化、受害、歧视),导致个人压力源(内化的同性恋恐惧症/变性恐惧症/种族主义,拒绝的预期,身份隐瞒)(Hatchel et al. 2021;Holloway and Varner 2021;McMahon et al. 2011;Mustanski and Espelage 2020),每一种都会增加自杀风险(Opara et al. 2020;Toomey et al. 2017)。 虽然单独的少数压力源可能会增加风险,但目前的自杀理论,如自杀行为的综合动机-意志模型(IMV);O'Connor and Kirtley 2018)提出了该途径的其他心理中介(例如,诱捕)和调节因子(例如,保护因素)(Baams et al. 2015;乔伊纳和席尔瓦2012;O’connor and Kirtley 2018)。具体而言,IMV模型表明,个人层面的过程,如对自己的积极感知(如身份肯定/骄傲)和应对能力(如公民参与),是影响负面经历(如外部和内部少数群体压力源)是否发展成困住感(在自杀发生之前)的调节因素。IMV模型还提出了积极的社会关系和社区参与,这些关系和社区参与促进了联系感、归属感和支持感,是从诱捕到自杀意念和意图转变的调节因素。虽然有大量的研究支持IMV模型来理解自杀风险(Souza et al. 2024),但很少有研究在黑人和/或LGBTQ+人群中测试这些观点,而且都没有考虑到影响这些过程的结构性因素。在交叉方法中整合少数民族压力和自杀理论,以更好地解释结构,社区,人际关系和个人对自杀风险和保护的影响,将扩展当前理论,以解释影响自杀的外部因素(Alvarez等人,2022;Hjelmeland and Knizek 2016;Opara et al. 2020;史坦利2020)。此外,现有的关于LGBTQ+黑人青年自杀的研究和理论仍然局限于基于风险的、以缺陷为中心的模型(Haas和Rohlfsen 2010;Hatchel et al. 2021)。为了推进自杀科学,我们需要在社会生态层面上研究与理论相关的黑人LGBTQ +特定保护因素,这些因素可能会减少交叉少数族裔压力因素和结构性压迫对自杀的不利影响(Busby et al. 2020;Hatchel et al. 2021)。推进黑人LGBTQ+青年的自杀预防工作需要积极主动的研究、实践和政策/倡导行动步骤。研究人员必须利用交叉方法研究跨社会生态水平的黑人LGBTQ+特定保护因素对自杀风险理论途径的影响。自杀学家必须应用生态瞬间评估、每日日记、连续生理监测和纵向设计的创新方法,以扩大当前对日常风险和保护经历对并发、第二天和更长时间后续自杀的复杂影响的理解(Kleiman et al. 2023)。通过归纳、定性的方法整合生活经验,对于非殖民化自杀研究(White et al. 2016),理解影响自杀风险和保护的细微和独特的经历,设计有效的措施(例如,交叉和文化相关的自杀风险评估工具),以及为黑人LGBTQ+青年制定文化合适的自杀预防干预措施至关重要。研究人员还必须了解黑人和LGBTQ+社区的历史经验和对研究工作的合理不信任,并确保黑人LGBTQ+青年顾问委员会为研究项目提供管理。在实践中,我们必须为学生提供更多的培训项目和指导,以消除LGBTQ+黑人从事研究工作的障碍。自杀预防工作必须有意识地集中于改善黑人LGBTQ+青年的自杀,通过制定和实施量身定制的多方面和多部门干预措施,旨在消除导致自杀风险的压迫系统重叠(Bowleg 2023;Zubizarreta和Beccia 2025),同时在社会生态层面加强保护因素,可能会降低这一人群的风险。社会公正代表了交叉性的核心结构(Collins 2019),政策/宣传工作必须通过解决健康的政治决定因素来解决社会不公平和黑人LGBTQ+青年心理健康差异的社会不公正问题(Kline等人,2023;Paceley et al. 2023)和结构层面的种族主义、异性恋主义和顺性别主义(Alvarez et al. 2022;Hatzenbuehler 2016;Zubizarreta and Beccia, 2025)。努力还必须涉及倡导加强可修改的黑人LGBTQ+特定保护因素,包括结构层面的因素,以确保黑人LGBTQ+青年有平等的发展机会。作者没有什么可报告的。作者声明无利益冲突。
Integrating a Strengths-Based Intersectional Approach to the Study of Suicide Risk Among Black Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Youth
Suicide among Black lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ + ) youth constitutes a significant public health concern (Congressional Black Caucus 2019). Research shows 44% of Black LGBTQ+ youth seriously considered suicide and 16% attempted suicide during the previous 12 months, compared to 37% and 11%, respectively, of White LGBTQ+ youth (The Trevor Project 2023). Black LGBTQ+ youth are 5.8 times more likely than Black cisgender heterosexual youth to report suicidal ideation and behavior (henceforth suicidality) (Mereish et al. 2019). Further, Black youth may underreport suicidality due to a lack of culturally valid suicide risk assessment tools (Francois et al. 2025), thus, rates may be higher than they appear using existing tools. Given this population's heightened risk for suicide, researchers must identify risk and protective factors associated with increasing and decreasing suicidality among Black LGBTQ+ youth using an intersectional lens (Price-Feeney et al. 2020).
Intersectionality represents a conceptual framework introduced by Black feminist scholars to understand and examine interlocking, structural-level systems of power and oppression (e.g., systems of heterosexism, cisgenderism, racism) as they collectively shape individuals’ lived experiences and patterns of health inequities (Abrams et al. 2020; Collins and Bilge 2020; Combahee River Collective 1977; Crenshaw 1989). Within an intersectionality framework, an intersectional methodological research approach considers distinct ways marginalized social positions work together relationally in connection with systems of power for different groups to understand and address health inequities among specific populations (Bowleg and Bauer 2016; Gardner et al. 2025; McCall 2005). For example, Black LGBTQ+ youth may experience multiple intersectional systems of oppression (e.g., racism and heterosexism/cisgenderism) and forms of discrimination (e.g., racist bigotry and homophobia/transphobia) that elevate their risk for suicide (Balsam et al. 2011; Opara et al. 2020). An intersectional approach also can demonstrate Black LGBTQ+ youth's capacity to become empowered by holding multiple minoritized social positions, feel strengthened to advocate for themselves and their communities, and experience identity harmony, self-acceptance, and empathy (Bowleg 2013; Ghabrial 2017, 2019; Ghabrial and Andersen 2023). Strengths-based intersectional research with Black LGBTQ+ youth can show how holding multiple minoritized positions may serve an adaptive role by allowing youth to shift identities and glean diverse external supports to better address their current needs (Pittinsky et al. 1999), mitigating suicide risk. Thus, to understand the complex nature of suicide among Black LGBTQ+ youth, researchers must utilize an intersectional methodological approach informed by an intersectionality framework that considers intracategorical (within group) and intercategorical (between group) complexity within sampling designs (McCall 2005), measurement of intersectional risk and protective factors (e.g., intersectional survey/interview questions, state-level equality indices), intersectional data analytic approaches, and interpretation of study findings within an intersectionality framework. We propose an integrated causal model of suicide risk that incorporates an intersectional methodological approach into established suicide risk theories (see Figure 1).
Projects integrating the Minority Stress Theory (Brooks 1981; Meyer 2003) and suicide-related theories utilizing an intersectional approach could advance research and understanding of suicidality among Black LGBTQ+ youth. Studying effects of intersectional minority stressors is new to suicide research, where most studies examine single-position minority stressors or additive models of risk (Mallory and Russell 2021). For Black LGBTQ+ youth, holding multiple minoritized social positions may intensify the minority-based stressors experienced (Bowleg 2008; Bruce et al. 2011; Collier et al. 2013), elevating risk for suicide. A better understanding of how intersectional minority stressors affect suicide risk among Black LGBTQ+ youth would inform the development of tailored prevention interventions.
Minority stress may come from multiple stressors, including structural oppressions (e.g., discriminatory state policies/laws) (Alvarez et al. 2022; Sheftall et al. 2022) and negative interactions within schools, families, and communities (stigmatization, victimization, discrimination) that lead to intrapersonal stressors (internalized homophobia/transphobia/racism, expectations of rejection, identity concealment) (Hatchel et al. 2021; Holloway and Varner 2021; McMahon et al. 2011; Mustanski and Espelage 2020), each of which can increase suicide risk (Opara et al. 2020; Toomey et al. 2017). While minority stressors alone may increase risk, current suicide theories, such as the Integrated Motivational-Volitional Model of Suicidal Behavior (IMV; O'Connor and Kirtley 2018), suggest additional psychological mediators (e.g., entrapment) and moderators (e.g., protective factors) of that pathway (Baams et al. 2015; Joiner and Silva 2012; O'Connor and Kirtley 2018). Specifically, the IMV model suggests individual-level processes, such as positive perceptions of oneself (e.g., identity affirmation/pride) and coping abilities (e.g., civic engagement), represent moderators influencing whether negative experiences, such as external and internalized minority stressors, develop into feelings of entrapment, which precede the onset of suicidality. The IMV model also proposes positive social relationships and community engagement that foster feelings of connection, belonging, and support as moderators of the transition from entrapment to suicide ideation and intent. While a robust body of research supports the IMV model in understanding suicide risk (Souza et al. 2024), very few studies have tested these ideas within Black and/or LGBTQ+ populations, and all fail to account for structural factors impacting these processes. Integrating minority stress and suicide theories within an intersectional approach to better account for structural, community, interpersonal, and individual influences on suicide risk and protection would expand upon current theories to account for external factors impacting suicide (Alvarez et al. 2022; Hjelmeland and Knizek 2016; Opara et al. 2020; Standley 2020).
Further, existing research and theory on suicide among Black LGBTQ+ youth remains limited by risk-based, deficit-focused models (Haas and Rohlfsen 2010; Hatchel et al. 2021). To advance the science on suicidality, we need to examine theoretically-relevant, Black LGBTQ + -specific protective factors across socioecological levels that may diminish adverse effects of intersectional minority stressors and structural oppressions on suicidality (Busby et al. 2020; Hatchel et al. 2021).
Advancing suicide prevention efforts with Black LGBTQ+ youth requires proactive research, practice, and policy/advocacy action steps. Researchers must examine effects of Black LGBTQ+ specific protective factors across socioecological levels over time on theoretical pathways of suicide risk utilizing an intersectional approach. Suicidologists must apply innovative methods of ecological momentary assessments, daily diary, continuous physiological monitoring, and longitudinal designs to expand current understanding of the complex influences of daily risk and protective experiences on concurrent, next day, and longer subsequent suicidality (Kleiman et al. 2023). Integrating lived experiences through inductive, qualitative methods remains essential for decolonizing the study of suicide (White et al. 2016), understanding nuanced and unique experiences influencing suicide risk and protection, designing effective measures (e.g., intersectional and culturally-relevant suicide risk assessment tools), and developing culturally-appropriate suicide prevention interventions for Black LGBTQ+ youth. Researchers also must appreciate historical experiences and justifiable mistrust of research efforts within Black and LGBTQ+ communities and ensure Black LGBTQ+ youth advisory boards provide stewardship for research projects. In practice, we must increase access to training programs and mentorship for students to eliminate barriers for Black LGBTQ+ individuals pursuing careers in research. Suicide prevention efforts must intentionally focus on ameliorating suicide among Black LGBTQ+ youth by developing and implementing tailored multi-faceted and multi-sectoral interventions that aim to eliminate the overlapping systems of oppression contributing to suicide risk (Bowleg 2023; Zubizarreta and Beccia 2025), while strengthening protective factors across socioecological levels that may reduce risk among this population. Social justice represents a core construct of intersectionality (Collins 2019), and policy/advocacy efforts must address social injustices that characterize social inequities and mental health disparities among Black LGBTQ+ youth by addressing political determinants of health (Kline et al. 2023; Paceley et al. 2023) and structural-level racism, heterosexism, and cisgenderism (Alvarez et al. 2022; Hatzenbuehler 2016; Zubizarreta and Beccia 2025). Efforts also must involve advocating to enhance modifiable Black LGBTQ + -specific protective factors, including structural-level factors, to ensure Black LGBTQ+ youth have equal opportunities to thrive.