What’s New in Psychology?

Intersectionality and Suicide Risk

Jim Windell

           If some 12 million American adults think about suicide each year and nearly 50,000 actually take their own lives annually, who are the people at highest risk for suicidal behaviors?

           Many previous studies have examined how individual demographic factors – such as race and gender – are associated with suicide risk. But no studies have demonstrated how different factors combine to influence overall risk.

           But researchers at Penn State College of Medicine recently analyzed annual National Survey on Drug Use and Health responses from more than 189,000 individuals who provided information on their gender, race, sexual orientation, ethnicity and how rural their environment. The study’s goal was to learn how these factors intersect or combine to affect risk of suicidal thoughts and behaviors.

           According to Lauren Forrest, Ph.D., assistant professor of psychiatry and behavioral health at Penn State College of Medicine, “We already know that some groups – like LGBTQIA+ individuals or women – are at increased risk for suicidal thoughts and behaviors.” However, Forrest points out, every person possesses multiple identities, identities related to gender, race and sexual orientation, for example. Some combinations of identities, for example, Black bisexual women, may be associated with unique suicide risk profiles. “But we can’t see these unique risk profiles if we only look at one identity at a time,” says Forrest, “which is what we’ve been doing thus far in research. It’s important to investigate how prevalence of suicidal thoughts and behaviors varies across intersectional identities, so we can identify populations most at risk and develop interventions specifically for those groups and their unique experiences driving their suicidal thoughts and behaviors.”

           Forrest goes on to say that her and her colleagues research is based on intersectionality theory, which was first proposed by Black feminist scholars. Intersectionality theory proposes that health inequities for any group – whether based on gender, sexual orientation, race and ethnicity and/or rurality – arise not due to people’s identities, such as gender, themselves but due to interlocking structural systems of power, privilege and oppression.

           Forrest explains that a person can face various types of discrimination based on their gender, race, ethnicity, sexual orientation or simply by where they live. Discrimination can be experienced across levels of influence, which are layered, or nested, within one another. An individual person – the smallest level – is nested within an interpersonal network of peers, family, friends and immediate neighbors. That interpersonal network is nested within a community, and a community is nested within society – the structural systems – at large.

           Structural discrimination occurs when there are laws that impose on certain individuals’ rights or welfare, and/or when certain prejudicial attitudes or behaviors are socially acceptable across society. For instance, laws opposing or restricting gay rights is an example of structural discrimination based on sexual orientation. This type of discrimination can set the stage for LGBTQIA+ people to experience more discrimination in their communities, since communities are nested within societies. This discrimination can become more intense on an interpersonal level, too, since interpersonal levels are nested within communities, which are nested within structures.

           The study found that the intersectional group with the highest prevalence of suicidal ideation was Hispanic bisexual women living in rural areas. Twenty percent of Hispanic bisexual women living in rural areas had thought about killing themselves in the last year before they took the survey. By contrast, the intersectional group with the lowest prevalence of suicidal ideation was Hispanic heterosexual men living in large metropolitan counties; only 3% had contemplated suicide in the year before completing their surveys.

           “When people face multiple types of structural discrimination, such as discrimination based on their sexual orientation and their race, which might be even more heightened in rural areas versus urban areas, it makes sense that the effects of discrimination could compound on one another,” Forrest says. “Discrimination, especially when it’s occurring across identities and levels of influence, is painful. Over time, these repeated and compounding painful discrimination experiences could ultimately contribute to some people contemplating or attempting suicide.”

           Forrest commented that her research in this area is just getting started. She plans to continue studying how structural level risk factors, such as structural stigma, interact with individual-level risk factors, such as psychiatric disorders, to jointly impact suicide risk among LGBTQIA+ people living in rural areas. She said her ultimate goal is to collect and analyze data that can ultimately influence policy decisions, especially those relating to health equity.

           “I’m passionate about this area of research because it’s important for mental health providers to understand that factors across levels of influence impact suicide risk,” Forrest says. “We often consider, assess and intervene upon individual-level risk factors, like psychiatric disorders. But I’d argue that we rarely, if ever, consider how the structural processes that drive health inequities may be impacting the person sitting in front of us in the therapy or assessment room.”

           To read the original article, find it with this reference:

Forrest, L.N., Beccia, A.L., Exten, C., Gehman, S. & Ansell, E.B. (2023). Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality. JAMA Psychiatry. 80(10):1037–1046. doi:10.1001/jamapsychiatry.2023.2295