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. Author manuscript; available in PMC: 2021 May 26.
Published in final edited form as: Crisis. 2020 Mar 6;41(6):429–436. doi: 10.1027/0227-5910/a000657

Heterosexism and Suicidal Ideation: Racial Differences in the Impact of Social Support among Sexual Minority Adults

Michael A Trujillo 1,*, Paul B Perrin 2, Richard S Henry 2, Annie E Rabinovitch 3
PMCID: PMC8153968  NIHMSID: NIHMS1679379  PMID: 32141329

Abstract

Background:

Heterosexism has been identified as being a contributing factor of suicidality in sexual minority adults (SMA), and social support is believed to be important for mitigating these effects. Research evaluating racial/ethnic differences in suicidality among SMA is limited despite racial/ethnic minorities being at greater risk.

Aims:

To examine the associations between heterosexism, suicidal ideation, and social support in a sample of racially/ethnically diverse SMA.

Methods:

SMA (N = 239) were recruited as part of an online survey on sexuality and health based in the United States.

Results:

There were significant positive main effects of heterosexism and significant negative main effects for non-White racial/ethnic identity on suicidal ideation. There were significant negative main effects for social support from family and a significant other but not from friends. A significant interaction of social support from a significant other and racial/ethnic identity was qualified by a significant three-way interaction with heterosexism. Social support from a significant other buffered the effect of heterosexism on suicidal ideation among non-White but not among White SMA. All other interactions were not significant.

Conclusion:

Support from a significant other may be important for suicidality, particularly for racial/ethnic minority SMA.

Lesbian, gay, bisexual, and queer (LGBQ) adults report higher levels of suicidal ideation (SI; Hill & Pettit, 2012) compared to heterosexuals. Fergusson and colleagues (2005) found that over a four-year period, gay men were seven times more likely to report SI, and lesbians were three times more likely. King and colleagues (2008) found that sexual minority adults (SMA) were two and a half times more likely to have attempted suicide compared to their heterosexual counterparts.

The predominant model used to explain why SMA are at higher risk for mental health problems, including suicidality, is the minority stress model (Meyer, 2003). This model asserts that oppressed social groups, including racial/ethnic and sexual minorities, experience high stress and greater negative life events (e.g., threats to physical integrity) directly related to their marginalized position. In the case of SMA, heterosexism—the cultural ideology that works to the disadvantage of sexual minorities—is associated with potent minority stressors (Herek, 1990). Minority stress has been theorized to contribute to suicide (Meyer, Frost, & Nezhad, 2015) supported by a robust literature documenting this association in SMA (e.g., Díaz, Ayala, Bein, Henne, & Marin, 2001; Haas et al., 2011; Lea, de Wit, & Reynolds, 2014).

The minority stress model posits social support can ameliorate the negative impact of heterosexism (Meyer, 2003), which can have implications for suicidality. Social support confers reduced psychological distress (Lehavot & Simoni, 2011), and protects against suicidal ideation (Liu & Mustanski, 2012; Plöderl et al., 2014) in SMA. More recent work implicates social support as a unique form of resilence for SMAs in the face of stigma (Kwon, 2013), and it is frequently used as a coping strategy against heterosexism (McDavitt et al., 2008).

Research as begun to examine the impact of different sources of social support, such as family, peers, and significant others among LGBQ people. Much of this work has focused on support from family, which has been negatively associated with distress over time (McConnell, Birkett, & Mustanski, 2016) and suiciality (Ryan, Huebner, Díaz, & Sanchez, 2009), while presence of support can protect against mental health problems (Rothman, Sullivan, Keyes, & Boehmer, 2012). Nevertheless, families are not always willing or able to provide support and point to support from peers and significant others as important support networks that impact mental health (McConnell et al., 2016). Surprisingly, little work has examined social support as a way to explain differential effects of heterosexism on suicidality among SMA, particularly in domains other than family and warrant additional research.

Research evaluating racial/ethnic differences in suicidality among SMA populations is limited. Higher rates of suicidality have been identified among non-White populations (Cochran, Mays, Alegria, Ortega, & Takeuchi, 2007; Lytle, De Luca, & Blosnich, 2014), even in the absence of depression and substance use (O’Donnell, Meyer, & Schwartz, 2011). This may be especially important for racial/ethnic SMA as they report greater stigma-related stressors (Meyer, Schwartz, & Frost, 2008), and may be likely to contend with anti-LGB attitudes and traditional family values within their racial/ethnic communities (Muñoz-Laboy, 2008; S. Schwartz & Meyer, 2010). The family is often recognized as an important resource for many racial/ethnic minority populations (S. J. Schwartz, 2007), and it is likely to protect against stress if family dynamics are healthy suggesting it as an important support domain to consider in the context of heterosexism; however, research remains limited on social support from friends and significant others among SMA of color. While some research indicates that SMA of color have less general support (Meyer et al., 2008), they may also have access to resources and skills that increase resilience in the face of heterosexism (Moradi et al., 2010).

Notwithstanding well-documented associations between heterosexism and suicidality among SMA, understudied is how this relationship may differ as a function of social support. Similarly, little research has sought to examine these relationships within a racial/ethnic minority context despite the increased risk for stigma and suicide among this population. The current study seeks to fill this gap in the literature. It is hypothesized that in a sample of racially/ethnically diverse SMA, social support will moderate the association between heterosexism and suicidal ideation, but that SMA of racial/ethnic minority backgrounds will experience greater benefits from social support, particularly from family, given the documented importance of social support in communities of color.

Method

Participants

Participants (N = 239) were LGBQ individuals who were recruited as part of an online survey in the United States. Individuals were eligible for the study if they were at least 18 years old and identified as a sexual minority. Demographic information can be found in Table 1. Participants who identified as White/European-American (non-Latino) were categorized as White; individuals who identified as any other race/ethnicity were categorized as non-White for the purpose of current analyses.

Table 1.

Demographics of Study Sample.

Characteristic %
Age, M(SD) 31.48 (11.35)
Woman 62.8
Race
 White (non-Latino) 28.9
 Black/African-American (non-Latino) 24.7
 Asian/Asian-American/Pacific Islander 20.5
 Latino/Hispanic 10.0
 American-Indian/Native-American 3.3
 Multiracial/Multiethnic 11.7
 Other 0.8
Sexual Orientation
 Gay/Lesbian 46.9
 Bisexual 30.1
 Queer 20.1
 Other 2.9
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Note. M=mean; SD=Standard Deviation

Measures

Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS).

Experiences of heterosexism were assessed with the HHRDS (Szymanski, 2006), a 14-item self-report. For the present study, the term “LESBIAN” was substituted with the phrase “an LGBTQ individual” to evaluate numerous forms of heterosexism experienced by different sexual minorities. The score for the overall measure was used for the current analyses.

Suicide Behaviors Questionnaire (SBQ).

The Suicide Behaviors Questionnaire (SBQ; Linehan, 1996) is a 34-item measure that assesses suicidal ideation and behaviors; however, for the purpose of this study only the 5-item Suicidal Ideation subscale of the measure was used. This subscale measures suicidal ideation in the past several days, months, year, as well as over one’s lifetime with higher scores indicating higher levels of suicidal ideation. The scoring algorithm weights more recent suicidal ideation more highly, giving a longer-term index of ideation but being a better reflection of current ideation.

Multidimensional Scale of Perceived Social Support (MSPSS).

The MSPSS (Zimet, Dahlem, Zimet, & Farley, 1988) is a 24-item self-report measure used to assess subjective social support across three dimensions: Social Support from Family, Social Support from Friends, and Social Support from a Significant Other.

Procedure

SMA were recruited to participant in an anonymous online survey through national and regional internet forums and groups, particularly those that cater to people of color (e.g., National Gay Black Men’s Advocacy Coalition). Participants were compensated with a $15 Amazon.com electronic gift card. All participants fully consented prior to participation in the IRB-approved study.

Statistical Analyses

Prior to running the primary analyses, the data were assessed for assumptions of normality using SPSS Version 22.0. Primary analyses consisted of a moderated moderation conducted using Model 3 of the Hayes PROCESS macro (version 3.0; Hayes, 2018) assessing whether social support moderates the association between heterosexism and suicidal ideation and whether this moderation was further moderated by race/ethnicity. Tests used 5,000 bootstrap samples. All models accounted for age and gender. To correct for multiple testing, a Benjamini-Hochberg correction was applied.

Results

Preliminary Analyses

Means and standard deviations for all variables are presented for all racial/ethnic groups in Table 2; however, all non-White racial/ethnic groups were collapsed into one group in all analyses.

Table 2.

Correlation Matrix, Means, and Standard Deviations

1 2 3 4 5
1. Heterosexism (0.92) .26* −.28* −.46*** −.29*
2. Suicidal Ideation .29*** (0.93) −.37** −.09 −.43***
3. SS: Family −.37*** −.22** (0.91) .38** .41***
4. SS: Friends −.31*** −.17** .35*** (0.91) .40**
5. SS: Significant Other −.26** −.26** .40*** .52*** (0.96)
Mean (SD), White (NL) 2.14 (0.84) 11.14 (18.87) 12.81 (4.74) 16.14 (3.47) 17.06 (3.76)
Mean (SD), Black (NL) 2.32 (0.85) 10.56 (16.61) 13.31 (4.32) 14.67 (3.84) 14.64 (4.89)
Mean (SD), AA/PI 2.26 (0.78) 9.80 (16.58) 12.53 (4.33) 14.86 (3.68) 14.30 (4.73)
Mean (SD), Latino/Hispanic 2.21 (0.68) 5.54 (10.59) 13.21 (5.16) 16.54 (3.35) 17.00 (3.39)
Mean (SD), AI/NA 2.72 (0.65) 1.87 (3.18) 13.63 (2.87) 14.75 (3.20) 15.00 (4.14)
Mean (SD), Multiracial 2.57 (1.22) 6.71 (9.80) 10.89 (5.29) 15.54 (3.92) 14.96 (5.74)
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Note. SS=Social Support; NL=Non-Latino; AA/PI=Asian American/Pacific Islander; AI/NA=American Indian/Native American; SD=Standard Deviation; Values along the diagonal reflect reliability coefficients for each respective scale. Shaded values below the diagonal reflect correlations among non-White Respondents. Non-shaded values above the diagonal reflect correlations among White Respondents.

*

p < .05

**

p < .01

***

p < .001

Correlation matrix.

A series of correlations were conducted separately by race/ethnicity. Nearly all correlations in the overall sample were statistically significant (Table 2). Heterosexism was positively associated with suicidal ideation and negatively associated with measures of social support. Social support measures were positively associated with each other and were negatively associated with suicidal ideation. A similar pattern of associations was identified in both the White and Non-White subsamples with one exception: suicidal ideation and social support from friends were not associated in the White subsample.

Primary Analyses

Prior to analyses, potential differences across all variables were examined by sexual orientation identity to identify if these differences should be accounted for. No group differences were identified across any variable (ps ≥ .059) and therefore not included in models.

Social Support from Family.

The overall model of heterosexism, social support from family, and racial identity predicting SI was significant [F(9, 229) = 4.43, p < .001, R2 = .15]. There was a significant main effect for heterosexism such that greater experiences of heterosexism was associated with greater suicidal ideation (Table 3). There were significant main effects for social support and non-White racial/ethnic identity such that SMA with greater social support and who identified as non-White had with less suicidal ideation. All two-way interactions were not statistically significant (ps ≥ .066). The three-way interaction was not statistically significant (p = .214).

Table 3.

Model Summary Predicting Suicidal Ideation.

Predictor Estimate (SE) 95% Bias-corrected bootstrap confidence interval
Social Support – Family
Heterosexism 3.54 (1.31) ** 0.95 to 6.13
SS-Family −0.71 (0.23) ** −1.15 to −0.26
Non-Whitea −5.42 (2.41) * −10.17 to −0.67
Heterosexism × SS-Family 0.12 (0.23) −0.34 to 0.58
Heterosexism × Non-White 0.83 (2.90) −4.89 to 6.55
SS-Family × Non-White 0.94 (0.51) −0.06 to 1.94
Heterosexism × SS-Family × Non-White −0.69 (0.56) −1.79 to 0.40
R2 .15
Social Support – Friends
Heterosexism 4.38 (1.29) *** 1.84 to 6.93
SS-Friends −0.24 (0.32) −0.85 to 0.36
Non-Whitea −4.92 (2.38) −9.61 to −0.24
Heterosexism × SS-Friends −0.17 (0.27) −0.70 to 0.35
Heterosexism × Non-White −1.53 (2.79) −7.02 to 3.96
SS-Friends × Non-White 0.05 (0.70) −1.32 to 1.43
Heterosexism × SS-Friends × Non-White −0.16 (0.60) −1.34 to 1.03
R2 .10
Social Support – Significant Other
Heterosexism 2.77 (1.23) 0.35 to 5.18
SS-SO −1.02 (0.22) *** −1.46 to −0.58
Non-Whitea −9.17 (2.28) *** −13.67 to −4.67
Heterosexism × SS-SO 0.24 (0.22) −0.19 to 0.66
Heterosexism × Non-White 1.81 (2.67) −3.46 to 7.08
SS-SO × Non-White 1.61 (0.55) ** 0.53 to 2.69
Heterosexism × SS-SO × Non-White −1.71 (0.55) ** −2.79 to −0.63
R2 .21
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Note. SS-SO=Social Support-Significant Other; SE=Standard Estimate. All analyses accounted for age and gender.

a

Reference category is White, non-Latino.

*

p < .05

**

p < .01

***

p < .001

Social Support from Friends.

The test of the overall model predicting SI from heterosexism, social support from friends, and racial/ethnic identity was statistically significant [F(9, 229) = 2.85, p = .003, R2 = .10]. There were statistically significant main effects for heterosexism such that it was positively associated with suicidal ideation (Table 3). There were no significant main effects for non-White racial/ethnic identity and social support (p ≥ .047). There were no significant two- or three-way interactions (ps ≥ .513).

Social Support from Significant Other.

The overall model of heterosexism, social support from a significant other, and race/ethnic identity predicting SI was significant [F(9, 229) = 6.69, p < .001, R2 = .21]. There were significant main effects for social support, and racial/ethnic identity (Table 3). There was a significant two-way interaction of social support and non-White racial/ethnic identity with all other two-way interactions not statistically significant (ps ≥ .278). However, these effects were qualified by a significant three-way interaction (Figure 1) with a significant increase in R2 due to the interaction, F(1, 229) = 9.75, p = .003, ΔR2 = .03. An examination of the conditional effects indicated that experiences of heterosexism were associated with SI at the highest levels (84th percentile) of social support but not at any other levels of support among White SMA. Among non-White SMA, heterosexism was positively associated with SI at all but the highest level of social support (Table 4). All other conditional effects were not significant and therefore, not interpreted.

Figure 1.

Figure 1.

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Three-way interaction of heterosexism, social support from a significant other, and race/ethnic minority status predicting past suicidal ideation

Table 4.

Conditional Direct Effects by Non-White Status of Heterosexism on Suicidal Ideation Moderated by Social Support from a Significant Other

SS-SO Percentile (SS-SO Score) Estimate (SE) 95% Bias-corrected bootstrap confidence interval
White
 16th (11.00) −5.15 (3.65) −12.33 to 2.04
 50th (16.00) 2.10 (2.24) −2.32 to 6.52
 84th (20.00) 7.90 (2.75) ** 2.48 to 13.33
Non-White
 16th (11.00) 4.47 (1.40) ** 1.72 to 7.22
 50th (16.00) 3.18 (1.47) * 0.28 to 6.08
 84th (20.00) 2.15 (2.02) −1.83 to 6.13
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Note. SS-SO=Social Support-Significant Other; SE=Standard Estimate.

*

p < .05

**

p < .01

Discussion

The association between heterosexism and suicidality among SMA has been well established, though less understood is how this relationship may differ as a function of social support and even further, how racial/ethnic status additionally impacts this association. The current results expand on previous findings (Lea et al., 2014) by examining social support as a moderator and the potential differences in this moderation by racial/ethnic status. The results of this study indicate that there are racial/ethnic differences in the way that social support operates to impact suicidal ideation. Additionally, not all social support is considered equal in its potential protective effects on SI and that the source of the support should be considered in the context of experiences of heterosexism.

The results of the main effects of heterosexism, social support, and race/ethnicity are interesting in light of prior work. Individuals with a non-White racial/ethnic identity had lower SI compared to SMA with a White identity which is in direct contrast to previous research indicating racial/ethnic minority SMA are at greater risk for suicidality (Lytle et al., 2014). One reason for this discrepancy may be due to differences in age across the samples, which is especially important as suicidality decreases with age and in particular among racial/ethnic SMA (Lytle et al., 2014). Social support from family and from a significant other also exhibited unique main effects such that greater support was associated with reduced SI. These results are in line with prior work noting the importance of support from family (Ryan et al., 2009) and from a significant other (Vincke & Bolton, 1994) for mental health and suicidality among LGBQ samples.

Somewhat in line with our hypotheses, social support did serve as a moderator of the heterosexism-SI relationship supporting the minority stress model (Meyer, 2003). However, support from a significant other rather than from family was identified as more important for SI and only for SMA of color. Previous work examining social support as a protective factor against SI has generally only examined support from family or peers (Mustanski, Newcomb, & Garofalo, 2011; Plöderl et al., 2014) or has generally collapsed the different sources of support into one overall score (Liu & Mustanski, 2012). Also, SMA may find social support from a significant other more effective as they are likely to have a shared experience with heterosexism. Given that experiences of heterosexism are distressing, SMA—and particularly racial/ethnic minority SMA as they may be less out to families due to a fear of familial rejection (Richter, Lindahl, & Malik, 2017)—may feel more comfortable turning to someone with knowledge of the experience. Additionally, parental social support has been posited to be less important for psychological distress as LGB young adults age (Mustanski et al., 2011), suggesting that support from a different source may be more important in adulthood. Future work should aim to examine suicidality in racial/ethnic SMA across the lifespan and extend work examining social support from a significant other.

In support of our hypothesis, we found that there was a significant racial/ethnic difference in the moderated relationship between heterosexism and SI with non-White SMA benefiting most from social support from a significant other compared to White SMA. Specifically, support from a significant other among non-White SMA was identified as being salient for mitigating the effects of heterosexism evidenced by the reduced strength of association at increasing levels of support when compared to White SMA. These results support an emerging theory, the resilience hypothesis (Moradi et al., 2010) positing that because of experiences with racism prior to coming out, racial/ethnic LGB individuals are inoculated against the effects of stress related to heterosexism and may fare better than White SMA because of their greater ability to cope with minority stress. By extension, SMA of color may be able to switch to another cultural-specific mental framework, “frame switching” (Hong, Morris, Chiu, & Benet-Martínez, 2000) as a self-protection strategy when they experience rejection (Branscombe, Schmitt, & Harvey, 1999; Tajfel & Turner, 1986). Therefore, it may be that SMA of color switch from a sexual orientation frame to a racial/ethnic cultural frame as a means of distancing themselves from the identity that is being rejected thereby being protected against the impact of heterosexism. Furthermore, though additional work is necessary, it is also possible that racial/ethnic SMA utilize support from a significant other as the primary form of coping with adverse experiences because they do not have access to support from family given the stigma they may experience within their own families (Díaz et al., 2001; Muñoz-Laboy, 2008).

The results among White SMA are interesting given the contrasting direction of association at the lowest and highest levels of social support. To illuminate this finding, group differences by demographic characteristics were examined and revealed age as an important difference such that older people reported more low verus high social support. As older White SMA experience greater rejection around their sexual identity, they may be more motivated to identify with and enhance the positive attributes of their group (Tajfel & Turner, 1986) particularly following rejection. In doing so, older SMA may be more likley to recall the historical narrative of resiliency of the LGBT community in the face of discrimination, thereby mitigating its impact on suicidality. However, given the dearth of work taking an intersectional approach to suicidality and heterosexism, future work should aim to expand on these results to better understand the interrelations of these constructs. That only one three-way interaction emerged suggests that social support from a significant other plays an especially important role for SI but that this this may be most effective for non-White compared to White SMA.

Limitations

This study does have limitations. Respondents were grouped into White versus non-White racial/ethnic status which fails to consider within group differences in the racial/ethnic minority group. Future work should aim to examine these groups separately as prior work has found significant differences in suicidality (Lytle et al., 2014; O’Donnell et al., 2011) among the different racial/ethnic groups. Additionally, social support in other domains (e.g., religious groups) nor suicide attempts were assessed suggesting an area for future work. The current study was cross-sectional in nature and prevents causal inference. Also, this study is limited by the small size and self-selected nature of the sample.

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