Examination of Risk and Protective Factors Associated with Suicidal Ideation Among Sexual and Gender Minority Midlife and Older Adults

Abstract

Purpose: Sexual and gender minority (SGM) individuals have an elevated risk for suicidal ideation (SI) compared to their heterosexual and cisgender peers. However, existing research has primarily focused on SGM youth and young adults, with limited attention given to the aging SGM population. This thesis aims to examine the multifaceted risk and protective factors associated with lifetime SI among SGM midlife and older adults. By integrating the Health Equity Promotion Model and Fluid Vulnerability Theory, this study explores: (1) how social positions, such age, gender, race/ethnicity, sexual orientation, and socioeconomic status, contribute to baseline risk of SI; (2) whether historical/environmental factors, including experiencing discrimination and victimization, influence SI; (3) the role of psychological and behavioral factors that function as risk or protective mechanisms affecting acute risk of SI. Methods: A secondary analysis was conducted utilizing data from the 2014 National Health, Aging, and Sexual/Gender Study, conducted by the Goldsen Institute. A total of 2,425 SGM individuals born before the year of 1965 were included in the analysis. Descriptive statistics were computed to summarize the sociodemographic characteristics, and a multivariable logistic regression model was applied to examine the strength and direction of the associations between SI and the hypothesized predictors from historical/environmental, psychological, and behavioral domains, after controlling for demographic variables. Results: The results indicated that transgender identity, lifetime discrimination, and lifetime victimization emerged as significant baseline risk factors for SI. In the acute risk domain, SI was mainly impacted by depression, drug addiction, and lack of nutrition, while resilience and physical activity served as protective factors. It is worth noting that several factors that are commonly considered to be SI predictors, such as age, sexual orientation, educational attainment, income level, anxiety, and alcoholism, were not significantly associated with SI in the current study. Discussion and Implications: These findings revealed the importance of understanding SI among SGM midlife and older adults through an intersectional and life course lens. Specifically, SI among this marginalized population should be viewed as a response to the broader, accumulated adversities from both personal experiences and structural-level inequities across the lifespan. Clinically, these results underscore the need for developing trauma-informed, culturally responsive SI intervention strategies that focus on behavioral health and personal resilience for this marginalized community. From a policy standpoint, this study demonstrates the importance of strengthening antidiscrimination protections and promoting equitable access to healthcare services across senior service settings for SGM older adults.