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. Author manuscript; available in PMC: 2023 Jul 11.
Published in final edited form as: Suicide Life Threat Behav. 2020 Aug 3;50(6):1158–1166. doi: 10.1111/sltb.12679

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults

John R Blosnich 1, Susan De Luca 2,3, Megan C Lytle 4, Chris Brownson 5
PMCID: PMC10334798  NIHMSID: NIHMS1908745  PMID: 32744388

Abstract

Objective:

To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults.

Method:

This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18–29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults.

Results:

Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97–5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities.

Conclusions:

Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.

Keywords: suicidal ideation, sexual orientation, religion

1 |. INTRODUCTION

Suicide continues to be the 10th leading cause of death in the United States (US) (Hedegaard, Curtin, & Warner, 2018), and the current suicide death rate among adolescents and young adults is the highest in nearly 20 years (Miron, Yu, Wilf-Miron, & Kohane, 2019). Young adulthood (ages 18–29) is a crucial time of stress from forging independence, increased health risk behaviors, and potential emergence of mental illness (Arnett, Žukauskienė, & Sugimura, 2014). For example, among the more than 10 million adults in the United States who reported suicidal ideation in the last year, the prevalence of suicidal ideation among young adults is four times higher than adults aged 50 or older (Substance Abuse & Mental Health Services Administration, 2018). Suicidal ideation is specifically high among young adults who identify as lesbian, gay, bisexual, queer, or who are questioning their sexual orientation (i.e., sexual minority) (Blosnich & Bossarte, 2012; Tsypes, Lane, Paul, & Whitlock, 2016). Although many studies elucidated risk and protective factors related to suicidal ideation among sexual minorities (Haas et al., 2010), few examined how one specific factor, religiosity, which is generally held as protective against suicidal ideation (Bonelli & Koenig, 2013) may actually be associated with suicidal ideation for sexual minorities.

Although difficult to define, Bergan and McConatha (2001) conceptualized religiosity as “various dimensions associated with religious beliefs and involvement (p. 24).” Despite the different ways religiosity has been measured in research—from attendance of religious services, to rating importance of religion, to simply having a religious affiliation—literature concordantly shows that religiosity is generally protective against poor mental health and suicidal phenomena (Bonelli & Koenig, 2013). Religiosity is theorized to be health promoting in terms of increasing avenues of social support, feelings of belongingness that come with shared values and practices, and preventing self-harm behaviors through doctrines that forbid suicide or suicidal thinking (Pescosolido & Georgianna, 1989; Stack, 1992). However, recent research casts doubt whether these protective factors hold for sexual minorities because some religions may purposefully or inadvertently stigmatize sexual minority people, for instance by maintaining same-sex attraction is sinful or refusing to acknowledge same-sex marriages (Clarke, Brown, & Hochstein, 1989). Qualitative studies of sexual minorities have documented consistent narratives of stress and lack of connectedness related to nonaffirming experiences with religion (Jacobsen & Wright, 2014; Jeffries et al., 2014; Levy & Reeves, 2011; Schuck & Liddle, 2001).

Though scant, quantitative studies corroborate personal narratives in qualitative studies. For example, Meyer, Teylan, & Schwartz (2015) found that, among a sample of sexual minorities, religious counseling for mental health was positively associated with suicide attempt, whereas medical treatment for mental health was negatively associated with suicide attempt. In two different studies among college students, Lytle, De Luca, Blosnich, and Brownson (2015) noted that Jewish and Christian sexual minorities had significantly higher prevalence of suicidal ideation than their peers in the same religious affiliation, and that greater importance of religion was protective against suicidal ideation for heterosexuals but was positively associated with suicidal ideation among sexual minorities (Lytle, Blosnich, De Luca, & Brownson, 2018). Although providing evidence of disparities, these past studies were not equipped to examine more nuanced measures of religion, such as specific denomination.

Some religious affiliations have core tenets that stigmatize sexual minorities (e.g., same-sex sexual behavior as sinful) and ban sexual minority individuals from religious leadership (Besen & Zicklin, 2007; Garneau & Schwadel, 2013; Olson, Cadge, & Harrison, 2006). However, some religious affiliations, such as Unitarian Universalist faith, openly support and welcome sexual minority congregants (Green, 2003). Thus, religion may function protectively for sexual minorities as it does for heterosexuals if sexual minorities can find affirming religions, such as affiliations that do not condemn same-sex attractions as a sin, support, and perform same-sex marriages, and allow sexual minorities to hold leadership roles in the religious organization (Rosenkrantz, Rostosky, Riggle, & Cook, 2016; Rostosky, Riggle, Brodnicki, & Olson, 2008). Consequently, understanding the nuances among different denominations can help to disentangle the complexity of how religion is related to suicidal ideation among sexual minorities in the United States.

To fill gaps in the literature about how specific religious denominations and affiliations may be associated with suicidal ideation among sexual minority young adults, we capitalized on existing data that contain a rare inclusion of three key items: religious affiliation, sexual orientation, and suicidal ideation. We hypothesize that (1) sexual minority young adults will be more likely than their heterosexual peers to report either an affiliation as Unitarian/Universalist or atheist/agnostic/secular; (2) among all religious affiliations except Unitarian/Universalist and atheist/agnostic/secular, sexual minorities will have greater odds of suicidal ideation in the past 12 months compared to their heterosexual peers; and (3) among sexual minorities, Unitarian/Universalist affiliation will be negatively associated with suicidal ideation in the past 12 months compared to all other religious affiliations.

2 |. METHODS

2.1 |. Sample

This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education (i.e., the Consortium), which both focused on mental health among college students. Both survey years incorporated stratified random samples of students from 4-year universities and colleges from across the United States who completed Web-based survey instruments. In the 2006 survey year, 26,451 students participated and in 2011, 26,292 students participated, representing response rates of 24.3% and 26.3%, respectively. These response rates are similar to those achieved in other Web-based surveys of college-based samples (Krebs et al., 2011; Sutfin et al., 2011; Vahratian, Patel, Wolff, & Xu, 2008), including the American College Health Association’s National College Health Assessment (American College Health Association, 2007). Additional details about the Consortium data and methodology have been previously published (Drum, Brownson, Denmark, & Smith, 2009). Questionnaire items germane to the present research questions were identical or very similar across the two survey years (see measures for further description), enabling us to combine 2006 and 2011 study data. Because the scope of the project involved the period of young adulthood (ages 18–29), we excluded respondents missing age (n = 1275; 2.4%) or who were 30 years of age or older (n = 9692; 18.4%).

2.2 |. Religious affiliation

In both survey years, respondents were asked to indicate their religious affiliation. In 2006, the response options were as follows: agnostic, atheist, Buddhist, Christian, Hindu, Islamic, Jewish, Native American religion, nonreligious/secular, Unitarian/Universalist, or other. In 2011, the response options were as follows: none, agnostic, atheist, Buddhist, Christian, Hindu, Jewish, Muslim, Native American religion, Unitarian or Universality, or other. A key difference between survey years was that in 2011, if a student indicated Christian, they could specifically indicate if they were Catholic, LDS (Latter Day Saint), or Protestant. We first combined categories that were identical: Buddhist, Christian, Hindu, Jewish, Native American Religion, and Unitarian/Universalist. We then combined similar categories: Islam and Muslim were recoded into one category; none, agnostic, atheist, and nonreligious/secular were combined into one category.

Finally, we examined respondents who indicated “other” and wrote brief descriptions of their religious affiliation in an open-ended field of the survey. In 2006, 1297 respondents ages 18–29 wrote in answers, and 946 respondents ages 18–29 in 2011 wrote in answers. Authors reviewed the answers to reach consensus about recoding a respondent from the “other” category into a mainstream religious affiliation category. For example, in 2006, 180 respondents who indicated “other” wrote in “Catholic,” and these individuals were recoded into the Catholic category. Other examples include persons who wrote in “Baptist,” “Adventist,” or “Episcopalian” being recoded into the Protestant category, and persons writing in “Mormon” or “Church of Jesus Christ of Latter Day Saints” were recoded into the LDS category. Since not all Christians specified a denomination, the Christian group was relabeled, “Unspecified Christian.” We excluded individuals who were missing religious affiliation (n = 712; 1.7%), and we excluded Native American religious affiliation due to small sample size (n = 70). From the total of 2243 write-in answers across both survey years, 51.0% (n = 1143) were recoded into mainstream religious affiliations; the remaining ambiguous write-in answers (e.g., “nondenominational” or “spiritual”) were left as “other” and excluded from analyses.

2.3 |. Sexual orientation

During both survey years, participants were asked to self-identify their sexual orientation. Response options were similar across survey years: gay/lesbian, bisexual, heterosexual, questioning. We dichotomized this sexual orientation into heterosexual and sexual minority (i.e., gay/lesbian, bisexual, questioning). In 2011, respondents could indicate “other” and write in their sexual identity. Again, the authors reviewed answers from 259 respondents and recoded answers that mapped into the sexual minority category (e.g., queer, homosexual, pansexual, fluid) and answers that mapped into the heterosexual category (e.g., straight). A total of 174 (67.2%) of the write in responses were recoded, and we excluded individuals missing data on sexual orientation (n = 459; 1.1%).

2.4 |. Suicidal ideation in the past 12 months

In 2006, participants were asked, “Have you ever seriously considered attempting suicide?” and in 2011, participants were asked, “Have you ever seriously considered attempting suicide at some point in your life?” Participants who answered affirmatively were then asked, “During the past 12 months, have you seriously considered attempting suicide?” (item was worded identically in 2006 and 2011). Persons who answered yes to the second question were considered to have suicidal ideation in the past 12 months. Persons missing data on the suicidal ideation questions were excluded from analyses (n = 405; 1.0%).

2.5 |. Socio-demographics

Sample characteristics included gender (men or women), international student status (yes or no), and partnership status (single/not currently dating or partnered/dating). Answer options to the question about racial/ethnic identity varied between survey years (e.g., the 2006 survey used “Asian-American,” whereas the 2011 survey used “Asian or Asian-American [e.g., Chinese, Japanese, Korean]”). Because of the lack on congruence and risk of misclassification, we recoded race/ethnicity as white or minority racial identity. Additionally, because the main outcome was suicidal ideation in the past 12 months, history of mental illness is a major correlate (Klonsky, May, & Saffer, 2016). Unfortunately, the surveys did not include questions about mental illness diagnoses; however, we included one item that was identically worded in both survey years to account for a history of mental illness. The item read, “Have you ever taken medication for mental health concerns?” with response options of yes or no. This item was chosen over an item about past counseling and mental health treatment because the responses about past mental health treatment included options that are more reflective of everyday stressors (e.g., massage therapy) instead of a mental health diagnosis. Conversely, we believed the question about medication for mental health concerns to more accurately identify students who are most likely have mental health diagnoses such as depression and anxiety. Because socio-demographics were not key variables of interest for the present analyses, missing data were handled with listwise deletion.

2.6 |. Analyses

We examined differences between heterosexual and sexual minority respondents on all study variables using chi-square tests and reporting frequencies and percentages. To test how religious affiliation was associated with suicidal ideation in the past 12 months, we used multiple logistic regression models stratified by sexual minority status and adjusted for socio-demographic characteristics. We also adjusted for survey year, but because the analytic sample was restricted to the period of young adulthood, we did not adjust for age. We used the atheist/agnostic/secular category as the reference because this group would lack the religious-based factors that protect people from suicidal ideation (e.g., social connectedness, moral objection to self-harm). To test the hypothesis that, among sexual minorities, having a Unitarian/Universalist affiliation would be protective against suicidal ideation compared to other religious affiliations and compared to atheist/agnostic/secular, we coded Unitarian/Universalist as the reference category against which all other affiliations were compared in the multiple logistic regression model. We report adjusted odds ratios (aOR) and 95% confidence intervals, and statistical significance was assessed using p < .05. The institutional review board of [institution name masked for peer review] approved this study.

3 |. RESULTS

The final analytic sample included 40,150 respondents, and 6.7% (n = 2679) of the sample self-identified as sexual minority. Compared to heterosexual respondents, a greater proportion of sexual minority respondents were men, identified as racial/ethnic minority, and were international students (Table 1). Sexual minority and heterosexual respondents differed in religious affiliation. For example, sexual minorities were more likely to identify as atheist/agnostic/secular compared to their heterosexual peers (44.0% vs. 24.4%, p < .001). Sexual minority respondents had more than twice the prevalence of heterosexual respondents of taking medication for mental health concerns in their lifetime (31.6% vs. 15.0%, p < .001).

TABLE 1.

Socio-demographics and mental health treatment among college students (ages 18–29) by sexual minority status, National Research Consortium of Counseling Centers in Higher Education 2006 and 2011

Heterosexual Sexual minority
(n = 37,471) (n = 2679)
N (%) n (%) p
Gender
 Men 14,124 (37.7) 1060 (39.6) 0.024
 Women 23,257 (62.1) 1591 (59.4)
Race
 White 27,618 (73.7) 1539 (57.5) <0.001
 Minority 8765 (23.4) 918 (34.3)
 International student 2827 (7.5) 234 (8.7) 0.025
Current relationship status
 Single/not currently dating 15,628 (41.7) 1136 (42.4) 0.071
 Partnered/dating 21,729 (58.0) 1467 (54.8)
Religious affiliation
 Atheist/Agnostic/Secular 9161 (24.4) 1179 (44.0) <0.001
 Unspecified Christian 15,495 (41.3) 707 (26.4)
 Catholic 4396 (11.7) 167 (6.2)
 Protestant 3555 (9.5) 129 (4.8)
 Latter Day Saint 659 (1.8) 14 (0.5)
 Universalist Unitarian 266 (0.7) 59 (2.2)
 Jewish 1017 (2.7) 76 (2.8)
 Islam 481 (1.3) 30 (1.1)
 Buddhist 475 (1.3) 59 (2.2)
 Hindu 729 (1.9) 41 (1.5)
Ever taken medication for mental health concerns 5634 (15.0) 846 (31.6) <0.001
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Note: Total may not sum to 100% due to missing data.

Overall, after adjusting for socio-demographic characteristics and ever receiving medication for mental health concerns, sexual minority young adults had 4.5 times greater odds of suicidal ideation in the past 12 months compared to their heterosexual peers (aOR = 4.52, 95% CI = 3.97–5.16; Table 2). In multivariable models stratified by religious affiliation, sexual minority respondents were significantly more likely than their heterosexual peers to report suicidal ideation in the past 12 months (except for Unitarian/Universalist and Islam). For example, compared to heterosexual Catholics, sexual minority Catholics had over five times the odds of suicidal ideation in the past 12 months (aOR = 5.25, 95% CI = 3.23–8.52).

TABLE 2.

Suicidal ideation in past 12 months between sexual minority and heterosexual college students (ages 18–29), overall and by religious affiliation, National Research Consortium of Counseling Centers in Higher Education 2006 & 2011

Suicidal ideation in past 12 months
Unadjusted bivariate Multivariablea
Overall n (%) p aOR (95% CI)
 Heterosexual 1164 (3.1) <0.001 Ref
 Sexual Minority 602 (22.5) 4.52* (3.97–5.16)
Religious affiliation Atheist/Agnostic/Secular
 Atheist/Agnostic/Secular
  Heterosexual 387 (4.2) <0.001 Ref
  Sexual Minority 179 (15.2) 2.53* (2.04–3.13)
 Unspecified Christian
 Heterosexual 406 (2.6) <0.001 Ref
  Sexual Minority 259 (36.6) 8.78* (6.96–11.07)
Catholic
  Heterosexual (n = 4393) 125 (2.8) <0.001 Ref
  Sexual Minority (n = 167) 29 (17.4) 5.25* (3.23–8.52)
 Protestant
  Heterosexual (n = 3343) 111 (3.1) <0.001 Ref
  Sexual Minority (n = 119) 17 (13.2) 3.22* (1.74–5.95)
Latter day saint
  Heterosexual (n = 659) 13 (2.0) <0.001 Ref
  Sexual Minority (n = 14) 3 (21.4) 11.81* (1.40–99.32)
 Unitarian/Universalistb
  Heterosexual (n = 266) 9 (3.4) 0.003 Ref
  Sexual Minority (n = 59) 11 (18.6) 1.77 (0.50–6.29)
Jewishb
  21 (2.1) <0.001 Ref
  Sexual Minority (n = 59) 16 (21.1) 4.94* (2.02–12.09)
 Islamc
  Heterosexual (n = 481) 13 (2.7) 0.061 Ref
  Sexual Minority (n = 30) 3 (10.0) 1.60 (0.19–13.33)
 Buddhist
  Heterosexual (n = 475) 14 (2.9) <0.001 Ref
  Sexual Minority (n = 59) 11 (18.6) 5.12* (2.03–12.88)
 Hinduc
  Heterosexual (n = 728) 20 (2.7) <0.001 Ref
  Sexual Minority (n = 41) 9 (21.9) 9.22* (3.32–25.64)
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Abbreviations: aOR, adjusted odds ratio; CI, confidence interval.

a

Adjusted for gender, international student status, partnership status, race/ethnicity, survey year, and ever taken medication for mental health concerns.

b

International student status omitted from final model because of perfect prediction.

c

Race/ethnicity omitted from final model because of perfect prediction.

*

p < 0.05

Different patterns emerged among heterosexual and sexual minority groups when comparing the associations of different religious affiliations with suicidal ideation in the past 12 months. For heterosexuals, Unspecified Christian, Catholic, Protestant, Latter Day Saint, and Jewish affiliations were all associated with significantly lower odds of suicidal ideation in the past 12 months compared to heterosexuals who identified as atheist/agnostic/secular (Table 3). However, an opposite association emerged for sexual minorities: Compared to sexual minorities who identified as atheist/ agnostic/secular, Unspecified Christian and Catholic sexual minorities had greater odds of suicidal ideation in the past 12 months (aOR = 1.68, 95% CI = 1.24–2.28 and aOR = 1.77, 95% CI = 1.07– 2.91, respectively).

TABLE 3.

Association of religious affiliations with suicidal ideation in the past 12 months among college students (ages 18–29) by sexual minority status, National Research Consortium of Counseling Centers in Higher Education 2006 & 2011

Suicidal ideation in the past 12 monthsa
Heterosexual
 Sexual Minority
(n = 34,892)
 (n = 2193)
aOR (95% CI) aOR (95% CI)
Religious affiliation
 Atheist/Agnostic/Secular Ref Ref
 Unspecified Christian 0.7* (0.65–0.89) 1.68* (1.24–2.28)
 Catholic 0.6* (0.51–0.76) 1.77* (1.07–2.91)
 Protestant 0.68* (0.54–0.85) 1.28 (0.68–2.38)
 Latter Day Saint 0.53* (0.30–0.93) 1.35 (0.26–7.04)
 Universalist Unitarian 0.73 (0.35–1.49) 0.59 (0.22–1.60)
 Jewish 0.51* (0.33–0.80) 0.95 (0.43–2.10)
 Islam 0.59 (0.31–1.13) 0.39 (0.05–3.05)
 Buddhist 0.77 (0.41–1.33) 1.63 (0.74–3.59)
 Hindu 0.76 (0.44–1.30) 1.83 (0.62–5.40)
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Abbreviations: aOR, adjusted odds ratio; CI, confidence interval.

a

Adjusted for gender, international student status, partnership status, race/ethnicity, survey year, and ever taken medication for mental health concerns.

*

p < 0.05

Additionally, among sexual minorities, after adjusting for covariates, Unspecified Christian and Catholic sexual minorities had nearly three times the odds of suicidal ideation in the past 12 months (aOR = 2.84, 95% CI = 1.04–7.72 and aOR = 2.98, 95% CI = 1.01–8.80, respectively) compared to sexual minorities who were Universalist/Unitarian (Table 4).

TABLE 4.

Association of religious affiliations with suicidal ideation in the past 12 months among sexual minority college students (ages 18–29), National Research Consortium of Counseling Centers in Higher Education 2006 & 2011

Sexual Minority
(n = 2205)
aOR (95% CI)
Religious affiliation Universalist/Unitarian Ref
 Atheist/Agnostic/Secular 1.58 (0.60–4.20)
 Unspecified Christian 2.84* (1.04–7.72)
 Catholic 2.98* (1.01–8.80)
 Protestant 2.15 (0.68–6.78)
 Latter Day Saint 2.27 (0.34–15.36)
 Jewish 1.60 (0.47–5.53)
 Islam 0.66 (0.07–6.38)
 Buddhist 2.74 (0.79–9.55)
 Hindu 3.09 (0.72–13.17)
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Abbreviations: aOR, adjusted odds ratio; CI, confidence interval.

a

Adjusted for gender, international student status, partnership status, race/ethnicity, survey year, and ever taken medication for mental health concerns

*

p < 0.05

4 |. DISCUSSION

This study took a unique approach of examining whether religious affiliation was associated with lower odds of suicidal ideation among sexual minority young adults. The data supported the first hypothesis that sexual minority young adults would be overrepresented among Universalists/Unitarians and individuals identifying as atheist/agnostic/secular. There was partial support for the second hypothesis in that sexual minorities across most religious affiliation strata had significantly greater odds of suicidal ideation in the past 12 months compared to their heterosexual peers. However, the data did not support that sexual minority Universalist/Unitarian affiliation or sexual minority atheist/agnostic/secular individuals had significantly lower odds of suicidal ideation in the past 12 months compared to their respective heterosexual peers. Lastly, there was partial support for the third hypothesis, as sexual minority Universalist/Unitarians had significantly lower odds of suicide ideation in the past 12 months compared to their sexual minority Unspecified Christian and Catholic counterparts. The findings corroborate previous research that operationalized religion in other ways (e.g., frequency of religious activities, seeking mental health counseling from religious sources [Baams, De Luca, & Brownson, 2018; Barnes & Meyer, 2012], importance of religious beliefs [Lytle et al., 2018]), suggesting that religiosity may not be protective against suicidal ideation for sexual minority populations in the way it is for heterosexual populations.

In a unique contribution, the results suggest that an affirming religion (i.e., Universalism/Unitarianism) displayed protective associations against recent suicidal ideation among sexual minorities. Universalist/Unitarian faith is well known as a religious affiliation that openly affirms sexual and gender minority individuals (Oppenheimer, 1996), and qualitative evidence supports sexual minority people changing their faith to and finding solidarity in Universalist/Unitarian faith communities (Schuck & Liddle, 2001), suggesting that for some sexual minorities, finding a community of faith through religion is an important element for their well-being. It is possible that the affirming experiences in Universalist/Unitarian faith communities of allowing sexual minorities to live openly, be leaders in the organization, support same-sex marriage, and advocate for equal rights create the religious environments in which sexual minorities can have acceptance, social connection, and community integration in ways not afforded to them in religious affiliations that are not affirming.

Faith-based organizations’ participation is crucial in suicide prevention, yet negative messaging around sexual minorities may weaken such efforts to seek help while experiencing distress. The National Strategy for Suicide Prevention promotes collaboration of faith-based partners in suicide prevention (U.S. Department of Health & Human Services, 2012), but their most recent publication never mentions the complicated relationship between some religions and sexual minorities (National Action Alliance for Suicide Prevention & Faith Communities Task Force, 2019). The knowledge generated from our previous work, and this current study further strengthens the need to develop empirically driven, culturally sensitive prevention campaigns and policy recommendations for an increasingly diverse population of adolescents and young adults. Help-seeking among distressed adolescents and emerging adults is not fully understood (Wyman, 2014), especially among historically under-represented groups (Knox, Conwell, & Caine, 2004). Underserved minority populations often report insufficient culturally informed services and resources (De Luca, Blosnich, Hentschel, King, & Amen, 2016; De Luca, SchmeelkCone, & Wyman, 2015; De Luca, Yan, Lytle, & Brownson, 2014). Although sexual minority adults engage in mental health services at greater rates than their heterosexual peers (Blosnich, Nasuti, Mays, & Cochran, 2016), there is limited information regarding sexual minority adolescents.

Moreover, there are few faith-based prevention efforts developed for sexual minority individuals. The Family Acceptance Project (FAP) has developed trainings, consultations, and interventions to help families, practitioners, educators, and religious leaders better support sexual and gender minorities within the context of their faith, family, and culture (Ryan, 2010). Specifically, the FAP created a LDS booklet incorporating quotes from religious leaders and personal stories to help families balance their religious beliefs with providing more accepting environments (Ryan, 2013). Although their research and trainings tend to focus on promoting health and well-being among adolescent sexual minorities, this work could be adapted and used more broadly among faith-based organizations and college counseling centers. In addition, The Trevor Project’s LGBTQ on Campus for Students is a brief online training to make colleges and universities safer and more supportive (Marshall, 2016; The Trevor Project, 2019). Though this program is currently being assessed, this type of resource that promotes prosocial and intergroup contact may have the potential to reduce bias, especially within religiously affiliated higher education institutions. Moreover, because of the diversity of religions in the United States, further research is necessary to understand faith-based suicide prevention efforts across an array of religious affiliations (e.g., Judaism, Islam, Buddhism).

These results have several limitations. As a cross-sectional analysis, it is not possible to evaluate causal links between the study variables and suicidal ideation in the past 12 months. Although the wording of items between the two survey years was nearly identical in most instances, there remains a possibility that differential item wording—however slight—could introduce response bias. The field struggles with the best operationalization of religious identity (e.g., affiliation, personal importance of beliefs, attendance of religious services) (Hall, Meader, & Koenig, 2008), and due to limited items across survey years, this analysis only used affiliation, which could invite measurement and omitted variable biases. Not to mention, participants most likely endorsed their current religious affiliation rather than the religion they were raised, which could help explain why hypothesis two was only partially supported. The samples sizes of some of the sexual minority groups were small (e.g., 14 sexual minorities indicated Latter Day Saint affiliation), which likely hampered statistical power. Additionally, although there is heterogeneity among sexual minority groups, sexual minorities were combined because of small sample sizes. Despite being a large nationwide sample, the respondents were college-attending young adults with arguably more resources than similar-aged young adults who are not enrolled in college, so results may not generalize to different populations. Although we accounted for racial/ethnic identity in these analyses through covariate adjustment, there may be unmapped implications of sexual minority, racial/ethnic identity, and religious affiliation that could be explored in future analyses that can account for intersectionality (Lester & Walker, 2017). Unfortunately, the numbers of sexual minority respondents who were also racial/ethnic minority were too small to drive such analyses when stratified across 10 different religious affiliation categories in the present analyses. Lastly, our measure of ever taking medication for a mental health concern was broad and may not have fully captured history of mental illness.

Limitations notwithstanding, this analysis is among one of the first and largest to disentangle sexual orientation differences among specific religious identities, including some specific Christian denominations. The results uphold a sobering pattern that sexual minority young adults have disproportionately high prevalence of suicidal ideation (Hottes, Bogaert, Rhodes, Brennan, & Gesink, 2016), to an extent that the long-held protective association of religious affiliation had no statistically significant protective association. In fact, in some instances, religious affiliation was positively associated with suicidal ideation for sexual minorities. The National Strategy for Suicide Prevention both identifies sexual minorities as a specific minority population of focus for prevention and encourages faith-based partnerships for suicide prevention (U.S. Department of Health & Human Services, 2012). Increasingly, research is revealing how complicated these two initiatives may be (Barnes & Meyer, 2012; Gibbs & Goldbach, 2015; Lytle et al., 2018), highlighting a vacuum of guidance on constructive plans for equity in suicide prevention.

ACKNOWLEDGEMENTS

Dr. De Luca’s effort was partially supported by grant, P2CHD042849, Population Research Center, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Funding information

National Institute of Child Health and Human Development, Grant/Award Number: P2CHD042849

Footnotes

CONFLICT OF INTEREST

The views expressed are those of the authors and do not necessarily reflect the position or policy of the institutions, National Institutes of Health, or the United States Government.

REFERENCES

  1. American College Health Association. (2007). American college health association national college health assessment spring 2006 reference group data report (abridged). Journal of American College Health, 55(4), 195–206. [DOI] [PubMed] [Google Scholar]
  2. Arnett JJ, Žukauskienė R, & Sugimura K (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. [DOI] [PubMed] [Google Scholar]
  3. Baams L, De Luca SM, & Brownson C (2018). Use of mental health services among college students by sexual orientation. LGBT Health, 5(7), 421–430. 10.1089/lgbt.2017.0225 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barnes DM, & Meyer IH (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82(4), 505–515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bergan A, & McConatha JT (2001). Religiosity and life satisfaction. Activities, Adaptation & Aging, 24(3), 23–34. [Google Scholar]
  6. Besen Y, & Zicklin G (2007). Young men, religion and attitudes towards homosexuality. Journal of Men, Masculinities and Spirituality, 1(3), 250. [Google Scholar]
  7. Blosnich J, & Bossarte R (2012). Drivers of disparity: differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students. Journal of American College Health, 60(2), 141–149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Blosnich JR, Nasuti LJ, Mays VM, & Cochran SD (2016). Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course. American Journal of Orthopsychiatry, 86(1), 69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bonelli RM, & Koenig HG (2013). Mental disorders, religion and spirituality 1990 to 2010: a systematic evidence-based review. Journal of religion and health, 52(2), 657–673. [DOI] [PubMed] [Google Scholar]
  10. Clarke JM, Brown JC, & Hochstein LM (1989). Institutional religion and gay/lesbian oppression. Marriage & Family Review, 14(3–4), 265–284. [Google Scholar]
  11. De Luca SM, Blosnich JR, Hentschel EA, King E, & Amen S (2016). Mental health care utilization: how race, ethnicity and veteran status are associated with seeking help. Community Mental Health Journal, 52(2), 174–179. [DOI] [PubMed] [Google Scholar]
  12. De Luca S, Schmeelk-Cone K, & Wyman P (2015). Latino and Latina Adolescents’ help-seeking behaviors and attitudes regarding suicide compared to peers with recent suicidal ideation. Suicide and Life-Threatening Behavior, 45(5), 577–587. [DOI] [PubMed] [Google Scholar]
  13. De Luca S, Yan Y, Lytle M, & Brownson C (2014). The associations of race/ethnicity and suicidal ideation among college students: A latent class analysis examining precipitating events and disclosure patterns. Suicide and Life-Threatening Behavior, 44(4), 444–456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Drum DJ, Brownson C, Denmark AB, & Smith SE (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40(3), 213–222. [Google Scholar]
  15. Garneau CR, & Schwadel P (2013). Pentecostal affiliation. Review of Religious Research, 55(2), 339–353. [Google Scholar]
  16. Gibbs JJ, & Goldbach J (2015). Religious conflict, sexual identity, and suicidal behaviors among LGBT young adults. Archives of suicide research, 19(4), 472–488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Green JC (2003). A liberal dynamo: The political activism of the unitarian-universalist clergy. Journal for the Scientific Study of Religion, 42(4), 577–590. [Google Scholar]
  18. Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, … Rosario M (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of Homosexuality, 58(1), 10–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hall DE, Meador KG, & Koenig HG (2008). Measuring religiousness in health research: Review and critique. Journal of Religion and Health, 47(2), 134–163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hedegaard H, Curtin SC, & Warner M (2018). Suicide mortality in the United States, 1999–2017. NCHS data brief no 330. Hyattsville, MD: National Center for Health Statistics. [PubMed] [Google Scholar]
  21. Hottes TS, Bogaert L, Rhodes AE, Brennan DJ, & Gesink D (2016). Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: a systematic review and meta-analysis. American Journal of Public Health, 106(5), e1–e12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Jacobsen J, & Wright R (2014). Mental health implications in Mormon women’s experiences with same-sex attraction: A qualitative study. The Counseling Psychologist, 42(5), 664–696. [Google Scholar]
  23. Jeffries WL IV, Okeke JO, Gelaude DJ, Torrone EA, Gasiorowicz M, Oster AM, … Bertolli J (2014). An exploration of religion and spirituality among young, HIV-infected gay and bisexual men in the USA. Culture, Health & Sexuality, 16(9), 1070–1083. [DOI] [PubMed] [Google Scholar]
  24. Klonsky ED, May AM, & Saffer BY (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12, 307–330. [DOI] [PubMed] [Google Scholar]
  25. Knox KL, Conwell Y, & Caine ED (2004). If suicide is a public health problem, what are we doing to prevent it? American Journal of Public Health, 94(1), 37–45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Krebs CP, Barrick K, Lindquist CH, Crosby CM, Boyd C, & Bogan Y (2011). The sexual assault of undergraduate women at Historically Black Colleges and Universities (HBCUs). Journal of Interpersonal Violence, 26(18), 3640–3666. [DOI] [PubMed] [Google Scholar]
  27. Lester D, & Walker RL (2017). Religiosity is a protective factor for suicidal ideation in European American students but not in African American students. OMEGA-Journal of Death and Dying, 74(3), 295–303. [DOI] [PubMed] [Google Scholar]
  28. Levy DL, & Reeves P (2011). Resolving identity conflict: Gay, lesbian, and queer individuals with a Christian upbringing. Journal of Gay & Lesbian Social Services, 23(1), 53–68. [Google Scholar]
  29. Lytle MC, Blosnich JR, De Luca S, & Brownson C (2018). Association of religiosity with sexual minority suicide ideation and attempt. American Journal of Preventive Medicine, 54(5), 644–651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Lytle MC, De Luca SM, Blosnich JR, & Brownson C (2015). Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals. Journal of Affective Disorders, 178, 39–45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Marshall A (2016). Focus: sex and gender health: Suicide prevention interventions for sexual & gender minority youth: An unmet need. The Yale Journal of Biology and Medicine, 89(2), 205. [PMC free article] [PubMed] [Google Scholar]
  32. Meyer IH, Teylan M, & Schwartz S (2015). The role of help-seeking in preventing suicide attempts among lesbians, gay men, and bisexuals. Suicide and Life-Threatening Behavior, 45(1), 25–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Miron O, Yu K-H, Wilf-Miron R, & Kohane IS (2019). Suicide rates among adolescents and young adults in the United States, 2000–2017. JAMA, 321(23), 2362–2364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. National Action Alliance for Suicide Prevention, & Faith Communities Task Force. (2019) Suicide prevention competencies for faith leaders: Supported life before, during, and after a suicidal crisis. Washington, DC: Education Development Center. [Google Scholar]
  35. Olson LR, Cadge W, & Harrison JT (2006). Religion and public opinion about same-sex marriage. Social Science Quarterly, 87(2), 340–360. [Google Scholar]
  36. Oppenheimer M (1996). “ The Inherent Worth and Dignity”: Gay Unitarians and the birth of sexual tolerance in liberal religion. Journal of the History of Sexuality, 7(1), 73–101. [Google Scholar]
  37. Pescosolido BA, & Georgianna S (1989). Durkheim, suicide, and religion: Toward a network theory of suicide. American Sociological Review, 54(1), 33–48. [PubMed] [Google Scholar]
  38. Rosenkrantz DE, Rostosky SS, Riggle ED, & Cook JR (2016). The positive aspects of intersecting religious/spiritual and LGBTQ identities. Spirituality in Clinical Practice, 3(2), 127. [Google Scholar]
  39. Rostosky SS, Riggle ED, Brodnicki C, & Olson A (2008). An exploration of lived religion in same-sex couples from Judeo-Christian traditions. Family Process, 47(3), 389–403. [DOI] [PubMed] [Google Scholar]
  40. Ryan C (2010). Engaging families to support lesbian, gay, bisexual, and transgender youth: The family acceptance project. Prevention Researcher, 17(4), 11–13. [Google Scholar]
  41. Ryan C (2013). Generating a revolution in prevention, wellness, and care for LGBT children and youth. Temple Political & Civil Rights Law Review, 23, 331. [Google Scholar]
  42. Schuck KD, & Liddle BJ (2001). Religious conflicts experienced by lesbian, gay, and bisexual individuals. Journal of Gay & Lesbian Psychotherapy, 5(2), 63–82. [Google Scholar]
  43. Stack S (1992). Religiosity, depression, and suicide. In Shumaker JF (Ed.), Religion and mental health (pp. 87–97). New York, NY: Oxford University Press. [Google Scholar]
  44. Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18–5068, NSDUH Series H-53). Rockville, MD: Substance Abuse and Mental Health Services Administration. [Google Scholar]
  45. Sutfin EL, McCoy TP, Reboussin BA, Wagoner KG, Spangler J, & Wolfson M (2011). Prevalence and correlates of waterpipe tobacco smoking by college students in North Carolina. Drug and Alcohol Dependence, 115(1–2), 131–136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. The Trevor Project (2019). Programs & services: LGBTQ on campus. Retrieved December 13, 2019 from https://www.thetrevorproject.org/about/programs-services/lgbtq-on-campus/.
  47. Tsypes A, Lane R, Paul E, & Whitlock J (2016). Non-suicidal self-injury and suicidal thoughts and behaviors in heterosexual and sexual minority young adults. Comprehensive Psychiatry, 65, 32–43. [DOI] [PubMed] [Google Scholar]
  48. U.S. Department of Health and Human Services, Office of the Surgeon General, & National Action Alliance for Suicide Prevention (2012). 2012 National Strategy for Suicide Prevention: Goals and objectives for action. Washington, DC: U.S. Department of Health and Human Services. [PubMed] [Google Scholar]
  49. Vahratian A, Patel DA, Wolff K, & Xu X (2008). College students’ perceptions of emergency contraception provision. Journal of Women’s Health, 17(1), 103–111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Wyman PA (2014). Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47(3), S251–S256. [DOI] [PMC free article] [PubMed] [Google Scholar]

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