4 - (OP13) Suicidal Ideation and Suicide Attempt Among Transgender Women in a Minority Stress and HIV Endemic Setting

Background: Transgender women are impacted by significant disparities in suicide risk relative to cisgender counterparts. Gender minority stress has been shown to increase suicidal ideation and attempt among transgender women, but findings on which minority stressors are more strongly linked with suicide outcomes vary in groups with different intersecting risks. HIV-related risk is an underexamined but important intersecting stressor, given that it disproportionately affects transgender women and also increases the risk for suicide in the general population. As such, this study aimed to examine which gender minority stressors explained differences in suicidal ideation and suicide attempt among transgender women in an HIV prevention and care context.

Methods: Transgender women living with or impacted by HIV risk (N = 81) were enrolled in the study in South Florida between 2020-2022. Distal and proximal minority stress experiences were assessed using the Gender Minority Stress and Resilience Measure, and suicidal ideation and suicide attempt were assessed using the Columbia Suicide Severity Rating Scale. We utilized stochastic search variable selection to identify which theoretical minority stress factors were empirically relevant in this sample. We utilized linear and zero-inflated negative binomial regressions to examine the direct and indirect associations between data-driven minority stress factors with the outcomes of suicidal ideation and suicide attempt.

Results: Rejection, negative expectations, and nondisclosure were empirically identified for inclusion in the suicidal ideation model. Rejection (b = 0.53, p < 0.001, 95% CI = [0.30, 0.76]) and negative expectations (b = 0.06, p = 0.03, 95% CI = [0.01, 0.11]) were directly associated with suicidal ideation severity. Nondisclosure was inversely associated with suicidal ideation severity (b = -0.10, p = 0.010, 95% CI = [-0.18, -0.02]). Consistent with the minority stress model, negative expectations (b = 0.07, 95% Bootstrap CI [0.001, 0.208]) and nondisclosure (b = -0.10, 95% Bootstrap CI [-0.223, -0.010]) were significant intermediary variables in the relationship between rejection and suicidal ideation. Contrary to the minority stress model, nondisclosure emerged as a protective factor. Negative expectations was empirically identified for inclusion in the suicide attempt model but was not significantly associated with suicide attempt history (b = 0.04, 95% CI [-0.006, 0.080], p = 0.088).

Conclusion: Specific components of gender minority stress explained differences in suicidal ideation but not suicide attempt among transgender women impacted by HIV risk. Rejection-based pathways (including via negative expectations and nondisclosure) may be particularly important to attend to when assessing suicide risk and tailoring psychosocial suicide prevention interventions for trans women in HIV prevention and care settings. Suicide prevention and other psychosocial intervention efforts situated at the intersection of minority stress and HIV risk may be bolstered by addressing interpersonal factors that mitigate identity-based rejection, and intrapersonal factors that contribute to the internalization of rejection and stigma.