Access, appraisals, and endorsement of mental health care on college campuses  (2019)

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Examining the intersections of race/ethnicity and sexual minorities

Sexual minorities (LGBQ) are roughly twice as likely to attempt suicide as non-LGBQ individuals. Students reporting a recent attempt (past 12 months) are less likely to access mental health services compared to their peers without a recent attempt. Evidence shows differences in suicidal behaviors among racial/ethnic minorities within the general population, but it is unclear how these interactions operate among LGBQ college students. Additionally, answers still remain regarding the help-seeking behaviors and attitudes of LGBQ college students and how their coping resources present among racial/ethnic minorities who also are LGBQ. Consequently, the intersection of identities, especially identities that correlate with suicidal behavior, may provide salient information about the heterogeneity of suicide risk within LGBQ populations and how they seek help from informal and formal sources of care.

Previous work has not addressed patient-centered care via students’ recommendations to improve services and have focused only on lifetime suicidal behaviors, which may not be representative of students’ current situation.

The over-arching aims of the study are to explore how LGBQ individuals across racial/ethnic identities differed from their non-LGBQ peers in terms of ideation. Furthermore, how LGBQ individuals across racial/ethnic identities differed from their non-LGBQ peers related to help seeking behaviors and attitudes and their recommendations for care.  Moreover, we will examine within-group differences of suicidal behavior and help seeking among LGBQ individuals. Based on previous research we hypothesized: (1) in comparison to non-LGBQ individuals, LGBQ individuals would have higher prevalence of suicidal behavior (2) in comparison to non-Hispanic white LGBQ students, LGBQ individuals of color would have higher prevalence of suicidal behavior, and (3) in comparison to non-Hispanic white LGBQ students, LGBQ individuals of color would have lower prevalence of help seeking.

The Cultural Model of Suicide provides a framework to examine how intersecting identities relate to suicidal behavior. This model suggests that the cultural sanctions, idioms of distress, minority stress, and the social discord individuals experience may vary by culture and level of integration and these factors may be particularly salient among college populations, since college is often the first opportunity for emerging adults to explore their intersecting identities.

Data are from the 2011 University of Texas’s Research Consortium (RC) database of 73 colleges and universities nationwide. The researcher will examine students’ self-reported help seeking attitudes and behaviors, their coping resources and their recommendations for improvements in mental health promotion services following their recent suicidal ideation. As there are already known disparities in help seeking related to gender and racial/ethnic groups, the researcher will stratify models based on race/ethnicity, gender and LGBQ separately, while also examining in-group differences, to observe potential differences in these domains. The RC’s data is the only nationally representative mixed-methods study examining college students’ help seeking attitudes and behaviors and their evaluation of the effectiveness of seeking care from a variety of formal and informal sources of support during times of distress.

The study will serve as pilot data to address two federal initiatives: 1) upstream prevention approaches to care and 2) improved screening of those at-risk for suicide in community settings. Results from this study will educate researchers on these pivotal mechanisms related to suicide prevention and will advise clinicians and policy makers on empirically-based standards of accessible care.