The Role of Intersectionality on Suicidal Ideation in Younger Adulthood

THE ROLE OF INTERSECTIONALITY ON SUICIDAL IDEATION IN YOUNGER ADULTHOOD

David Snoberger III

A Thesis

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

MASTER OF ARTS

December 2020

Committee:

Danielle Kuhl, Advisor

John Boman IV

Jenjira Yahirun

David Snoberger III

ABSTRACT

Danielle Kuhl, Advisor

The aim of this study is to provide a comprehensive picture of younger adults and their risks with suicidal ideation, in order to develop more thoughtful interventions. Using Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health, I examined the association between intersectional statuses, discrimination, and suicidal ideation. In addition to using intersectional theory, I draw on minority stress theory to motivate my study. I incorporated a measure of discrimination to accurately examine how endorsing one or more intersectional statuses changes the variation in suicidal ideation of younger adults. I found that sexual minorities, those who are discriminated against, and those who are nonwhite and female report a higher odds of expressing suicidal ideation compared to sexual majorities, those who are not discriminated against, and those who are white and male. I found that discrimination did not moderate or mediate the relationship between intersectional statuses and suicidal ideation. This study underscores the challenges intersectional individuals face when it comes to how discrimination negatively impacts mental health, and specifically, suicidal ideation.

To the LGBTQ+ community, thank you.

ACKNOWLEDGEMENTS

I would like to briefly thank the women in my life that have gotten me to this point. To

start, I would like to thank my mom, Jennifer Snoberger, for supporting my dreams beginning at

a young age, and giving me the tools to be successful and make this thesis happen in the first

place. I would like to thank the amazing professors I had in undergrad, Dr. Laura Lansing, Dr.

Elizabeth Mansley, Dr. Julie Smith, and Dr. Mary Shuttlesworth for guiding me through my

undergrad journey, for giving me the courage to speak out in class, and to help me grow as a

human being. I would like to thank my grad school professors, Dr. I-Fen Lin, Dr. Kara Joyner,

Dr. Jenjira Yahirun, and Dr. Danielle Kuhl for helping me to navigate graduate schooling, proofreading my papers, and giving me the confidence to defend my thesis. Finally, I would like to thank my wonderful support system, Brianna Ports, Jordan Morrison, Corrine Wollet,

Cheyanne Marsh, Miranda Sweetman, Justina Beard, Brittany Ganser, Marisa Guido, and Taylor

Kotsur for being there for me during my highs and lows in my time as a graduate student thus far.

I would not be here if it weren’t for the strong women in my life.

TABLE OF CONTENTS

Page

INTRODUCTION ...... 1

Early Diagnostic Research on Suicidal Ideation ...... 2

Minority Stress Theory and Suicidal Ideation ...... 3

Intersectionality and Suicidal Ideation...... 5

Other Minority Statuses and Intersectionality ...... 8

Current Study ...... 10

HYPOTHESES ...... 11

DATA AND METHODS ...... 12

MEASURES ...... 14

Dependent Variable ...... 14

Suicidal Ideation ...... 14

Key Independent Variables ...... 14

Discrimination...... 14

Sexual Minority ...... 14

Immigrant Status ...... 14

Religious Minority ...... 15

Gender Minority...... 15

Racial Minority ...... 15

Education ...... 15

Control Variables ...... 15

ANALYTIC STRATEGY ...... 17 vii

RESULTS ...... 18

DISCUSSION AND CONCLUSIONS ...... 20

REFERENCES ...... 24

APPENDIX A. TABLES ...... 32

Running head: INTERSECTIONALITY AND SUICIDAL IDEATION 1

INTRODUCTION

Suicidal ideation (SI) has become an increasingly pervasive issue for younger adults in the United States, with nearly 15 out of every 100,000 25-34 year olds in the United States having thought about suicide beginning in 2009, and this rate has been climbing throughout the decade (American Foundation for Suicide Prevention, 2020). Younger adults face extensive challenges throughout this stage in life, such as the completion of collegiate studies and entering the work force for the first time in their field, raising a family, etc. For many, these challenges come with discrimination and abusive behavior in institutions such as the work force and in neighborhoods, which are strongly associated with negative mental health outcomes such as suicidal behavior (Sutter & Perrin, 2016). For instance, lesbian, gay, bisexual, and transgender

(LGBT) younger adults are at increased risk of expressing suicidal behavior compared to their non-sexual minority counterparts (Irwin, et al., 2014), and racial minorities experience microaggressions and other implicit forms of discrimination which are associated with higher rates of suicidal behavior (O’Keefe, et al, 2014). Less known, however, are the mechanisms of SI risk for younger adults ascribing to multiple minority statuses at once. Minority stress theory

(Meyer, 2003) argues that negative health outcomes are linked to experiences of prejudice and stigma associated with membership in a minority group. More recent examinations of the plurality of minority statuses, to which many younger adults increasingly belong, reveal how common discriminatory behaviors are (Garnett, et al., 2014), and how these behaviors disproportionately affect LGBT and other minority younger adults. Past research that has examined intersectionality and its relationship with SI has used inaccurate measures of minority status such as additive intersectionality, or simply looking at demographic characteristics of respondents to determine patterns of inequality, which in some ways may be an incorrect marker INTERSECTIONALITY AND SUICIDAL IDEATION 2 of the true experiences that intersectional adults face in the real world (Bowleg, 2008).

Additionally, trends of the relationship between younger adult membership in multiple minority statuses and SI have not been explored in a nationally representative sample of younger adults.

The aim of this study is to provide a more comprehensive picture of younger adults and their risks with SI in the framework of minority stress and intersectionality to develop more thoughtful interventions.

Early Diagnostic Research on Suicidal Ideation

The examination of SI, or the wish to commit suicide even though an attempt may not have happened, began with the realization that warning signs existed for individuals who attempted suicide (Beck, et al., 1979). The focus on psychometric instrumentation to examine suicidal behaviors focused on psychological variables associated with suicidality, even acknowledging that, “Although demographic variables are useful to demarcate groups of individuals at high risk for suicide, they have little practical utility in the assessment of a specific individual.” (Beck, et al., p. 344) Thus, one of the most widely used tools to screen individuals at risk of SI could not adequately explore key social or structural correlates that could be related to

SI.

At around this time, other disciplines began to examine the role that socialization played in SI. Sociologists continued to build on Durkheim’s original (1897) framework of social integration, or the idea that individuals are influenced by the relational networks to which they belong. Durkheim was one of the first researchers to examine the role of social belonging and cohesion on those who expressed suicidality through his first-hand examinations. Other sociologists focused on combining psychological concepts such as forensic autopsies or investigating the individuals who committed suicide and their social networks to find more INTERSECTIONALITY AND SUICIDAL IDEATION 3 structural answers to suicide, though these methods were empirically flawed (Wray, Colen, &

Pescosolido, 2011). In the meantime, other disciplines, such as public health, attempted to find other trends to target resources toward at-risk groups with mixed results. Though diagnostic testing of those who expressed suicidal behavior got better as a result of revisions in the

Diagnostic and Statistical Manual of Mental Disorders (DSM), SI rates have increased since the

1990s, especially for younger adults (Rueter & Kwon, 2005).

Upward trends in SI rates led scholars in their attempts to uncover previously untapped or unexplored sociodemographic differences for those who expressed SI, such as gender differences. For instance, women are more likely to attempt suicide than men, though this is often ignored due to men having a higher rate of completed suicide than women (Beautrais,

2006). Other sociodemographic characteristics further explored were marginalized group status, such as membership in the LGBT community (Gibbs & Goldbach, 2015, and Russel & Fish,

2016). These trends uncovered the methodological shortcomings of not exploring group characteristics when using clinical instrumentation to examine SI and other suicidal behaviors.

With the increasing attention toward minority status groups, researchers are now able to situate arguments on the social structure-suicidal ideation link using better methodology and better theories.

Minority Stress Theory and Suicidal Ideation

Minority stress theory, with roots in the exploration of the stigmatization of African

American women in the 1970s, describes the discrimination and prejudice that minority group members experience from others in society (Moritsugu & Sue, 1983). While the early incorporation of minority stress theories applied to marginalization in environments such as the workplace, the impact on the mental health of individuals in minority groups became clearer in INTERSECTIONALITY AND SUICIDAL IDEATION 4

Meyer’s (1995) critical analysis of the mental health of gay men in New York City. Meyer’s insights focused on the story of Bobby Griffith, a man from California who struggled to come to terms with his homosexuality due to the social stigma he faced from his family and friends, which led to his suicide. The spate of suicides in the LGBT community during the 1990s gave rise to examination of the psychological consequences of consistent discrimination and stress related to identifying as part of a minority status group. Traits observed in the LGBT community include internalized homophobia, or taking negative societal attitudes toward a minority status and directing them inward; perceived stigma, or feeling as though others do not accept them due to being in said minority status group; and discrimination and violence, or explicitly negative outcomes from others, such as restricted access to housing, or even physical violence. As posited and supported by Meyer (1995), gay men experienced high rates of internalized homophobia, stigma, and prejudice from society which put them at significantly increased risk of engaging in suicidal behavior. Though groundbreaking in uncovering the impact of negative mental health outcomes associated with minority stress processes, studies in the 90s such as these focused only on gay men, and thus, did not give context toward the multifaceted stressors faced by minority women or others who identified as outside the normative model.

To build on Meyer’s (1995) advancements in the study of minority stress among gay men, Cochran (2001) included models specifically for lesbian women who also faced minority stress symptoms. Population estimates of the rate of mental health disorders among lesbian and bisexual women put this group at a nearly 50% chance of reporting one or more mental illnesses, higher than gay or bisexual men, and significantly higher than their straight counterparts.

Gilman, et al. (2001) were able to replicate these findings, finding higher rates of mental illness for those in a sexual minority status, but even higher rates of suicidal behaviors for lesbian and INTERSECTIONALITY AND SUICIDAL IDEATION 5 gay women as compared to their gay or bisexual male and straight counterparts. Even in Meyer’s

(2003) follow-up to his original study on mental health outcomes of LGBT individuals, he found higher levels of endorsement of suicidal behavior for lesbian and bisexual women as compared to their gay and bisexual male counterparts. Although these differences were explicitly laid out by other public health scholars and psychologists (Haas, et al., 2010), none of them could explain the gendered processes that existed, though gendered identities and experiences likely interact with sexuality and/or racial identities to contribute to such significant gulfs in suicidal thoughts and behavior for LGBT women as compared to men.

Intersectionality and Suicidal Ideation

First coined by Crenshaw (1989) when examining discriminatory behavior toward

African-American women because of not only their race, but their gender as well, researchers have attempted to use intersectionality to bridge the gaps in the mental health literature that have been oft-overlooked by other scholars. More specifically, Crenshaw posits that relationships built from inequality take center stage in the interactions that people have on a daily basis. In essence, from interactions in a work environment to talking to teachers and even in conversations with doctors and other health care providers, inequality because of socially constructed factors such as race and gender can be spread. (McCall, 2005). Even in the framework of social science research, contextual insights into inequality are important in every stage of research, from understanding sampling frames to ensuring our interpretations are not inadvertently perpetuating or reinforcing class stereotypes (Cole, 2009).

With better understandings of the role that intersectionality plays in the social fabric of society, intersectionality has also been brought into the discourse of mental health outcomes.

Evaluation of intersectionality’s potential contributions to social science research led to more INTERSECTIONALITY AND SUICIDAL IDEATION 6 balanced discussions on the effects of marginalized status and mental health outcomes, and highlighted the compounding nature of minority experiences within an unequal society; as

Havinksy (2012:1712) notes, intersectionality brings attention to the “varied and fluid configurations of social locations and interacting social processes in the production of inequities.

This lens has allowed researchers to explore how individuals experience discrimination and stigma from their community and peers, and how this can perpetuate negative mental health outcomes. Using the National Study of Adolescent to Adult Health (Add Health), Evans &

Erickson’s (2018) evaluation of the link between intersectionality and depression demonstrates that intersectional processes of discrimination clearly exist during adolescent development. This finding is supported by meta-analysis of the impact of being ascribed to multiple minority status groups and its net negative effect on mental health outcomes on adolescents (Patil, et al., 2018), and these results have been replicated for adults as well (Clements-Nolle, Marx, & Katz, 2008, and Lewis, et al., 2017).

However, previous studies examining the role intersectionality has on mental health outcomes have used incomplete or misleading methods to examine how minority stress is associated with minority group differences. Bowleg (2008) argued that two key arguments on intersectionality have been made in the literature: additive (i.e., Black + Lesbian + Woman), versus intersectional (Black Lesbian Women). Quantitatively, many researchers base their analytic sample on minority group characteristics listed by the participant, such as being black, or being female, but not actually exploring their personal views or stressors that directly impact their intersectional status. The direct issue with additive intersectionality is that it looks at people’s experiences in a vacuum: is a black woman in the work force truly only being discriminated against because they are black as well as female, or because being black and INTERSECTIONALITY AND SUICIDAL IDEATION 7

female is transformative and creates a different identity for these individuals, which is then how

they are judged performatively? Looking at the words of intersectional researchers such as

Weber and Parra-Medina (2003), people who are of an intersectional status are not judged

independently for each of their roles: rather, this new role formed is where discriminatory

behavior comes from.

Another way of examining non-additive intersectional identities is to use a multiplicative

approach. Instead of adding race+sex+sexuality, scholars instead examine the interactions

between and among these identities. As Black and Veenstra (2011) showed, a multiplicative

approach (interacting ethnicity*gender) uncovers the nuances associated with interacting

statuses: self-reported health is reported differently for men and women who hold certain ethnic

identities—the effect of gender on self-reported health is contingent upon ethnic status. Jackson and Williams (2006) also use this multiplicative approach to show variability in how SES affects different health outcomes, including suicide. They find that racial minorities experience higher rates of chronic stress, which can be manifested in problematic coping skills such as drugs and alcohol use, which is associated with higher rates of SI. Thus, instead of examining people on just additive demographic statuses, examining perceived discrimination they face because of the transformative nature of their identity is a more accurate way to examine how intersectionality plays a role in suicidal behavior.

In fact, minority statuses themselves likely also interact with discrimination to affect SI.

In one example, looking at African and Caribbean youths, a significant association was found between exposure to discriminatory behavior, and higher rates of suicidal ideation (Assari,

Lankarani, & Caldwell, 2017). In recent literature, scholars have found that experiences of discrimination based on being a racial and sexual minority are associated with increased risk of INTERSECTIONALITY AND SUICIDAL IDEATION 8

SI and other negative mental health outcomes (Sutter & Perrin, 2016). Yet the question remains,

does the experience of discrimination increase SI for racial minorities just as much as it does for

sexual minorities? Does discrimination affect SI similarly for a single minority status, or does the

multiplication of racial and sexual minority status compound the effect of discrimination on SI?

These questions remain unanswered. While we know that minority statuses are associated with

negative mental health outcomes such as SI among young adults, we have not uncovered the

complex processes that link those minority statuses to SI.

Other Minority Statuses and Intersectionality

Minority statuses based on characteristics besides race, gender, or sexuality can greatly

influence minority stress through discrimination. A few to consider are socioeconomic status,

immigrant status, and religious status. For instance, being of a lower socioeconomic class

(Jackson & Williams, 2006) may also play a role in negative mental health outcomes for younger

adults. For example, being from an impoverished neighborhood (Dupere, et al., 2009) is

associated with higher levels of SI expression. Also, among gay men, those who identify as

lower SES are at greater risk of experiencing SI than their higher-SES counterparts (Ferlatte, et al., 2018). This has also been demonstrated in women who are exposed to poverty, as they report higher rates of SI than their higher-SES counterparts (Kim, et al., 2016). Furthermore, LGBT young adults who are impoverished are more likely to have unmet physical and mental health needs, and this can exacerbate mental health concerns such as SI (Gilman, et al., 2001). Thus, class differences can further exacerbate other minority status inequalities that young adults experience.

Another minority status that can be problematic for young adults is being of an immigrant status (Donath, et al., 2019). Adolescent immigrants must deal with stress not only from adapting INTERSECTIONALITY AND SUICIDAL IDEATION 9

to new languages or interacting with new peers, but also from heightened familial stress and

negative peer reactions such as hostility (Cho & Haslam, 2010), and this hostility can continue

into younger adulthood. Immigrant adolescents who are exposed to higher levels of

discrimination report higher levels of stress, and worse mental health than their non-immigrant

counterparts (Rios-Salas & Larson, 2015). This can be exacerbated in neighborhoods with low

immigrant density, which may make it hard for immigrants to find peers who may be supportive

of one another (Pan & Carpiano, 2013). This increased stress can lead to higher rates of SI in

young immigrant populations, and this can be applicable to a number of different immigrant

groups, such as Asian and Central American (Hovey, 2000) immigrants. Thus, immigrant status

is an important consideration when examining the link between minority group status and SI.

Finally, a potential minority status often ignored is belonging to a religious minority,

such as atheism (Lytle, et al., 2015). Religious minorities have historically received harsh

discrimination from adherents of majority religions, and when combined with race and sexuality,

those who belong to a religious minority may face multiplicative stigmatization. For example,

many people ignorantly assume that sexual minorities cannot be connected to religion, but many

LGBT people, and especially LGBT adolescents, adhere to some form of religion or spirituality

(Toscano, 2017). Religiosity can help with a sense of belonging and social cohesion for many

minority groups, although backlash from non-accepting religious peers can negatively influence mental health outcomes (Rostosky, et al., 2016).

While it is important to merge minority stress processes and intersectional statuses in studies of SI, basic descriptive differences in SI among people who ascribe to multiple minority status groups are not well known. For instance, is the prevalence of SI similar for gay men compared to gay women? What about for gay, black women? In almost all LGBT and INTERSECTIONALITY AND SUICIDAL IDEATION 10 intersectional studies of mental health, the experiences of either all sexual minorities or all racial minorities, regardless of other statuses, are lumped together. Glimpses into this literature have found that differences exist for SI expression between, for instance, Hispanic, gay individuals compared to black, gay individuals (Mueller, et al., 2015). Less is known about intersections among, for instance, ethnicity and socioeconomic status, and how discrimination stemming from these statuses may lead to SI. Usually due to small sample sizes, multiple minority identities are not easy to examine, but an in-depth examination of multiplicative intersectional statuses is one way to demonstrate different levels of inequality across various groups, which could help communities create more balanced policies for discrimination and bullying prevention for social minorities.

Current Study

While previous literature has attempted to articulate the role of minority stress on SI, no study to date has examined its connection to SI using a multiplicative intersectional minority status approach. Below, I propose to examine not only sexual minority status, but gender, race,

SES, immigrant, and religious minority statuses, to explore whether how these identities are related to discrimination, which in turn may affect SI. As well as this, I also look at how multiple minority status interact with one another and my amplify suicidal ideation in intersectional groups. Using longitudinal, nationally representative data, this study contributes to the scholarship on minority stress theory, intersectionality, and mental health. These findings can help parents, teachers, and community interventionists who work with young minority populations. Below I outline my specific hypotheses.

INTERSECTIONALITY AND SUICIDAL IDEATION 11

HYPOTHESES

H1: Sexual minorities, females, racial minorities, immigrants, lower-SES persons, and religious minorities will report a greater likelihood of SI than non-sexual minorities, males, whites, native-

born, middle- and higher-SES persons, and religious majorities.

H2: Those who identify as belonging to multiplicative minority statuses are more likely to

express SI than those who identify as belonging to a single minority status.

H3: Perceived discrimination will moderate the association between minority statuses and SI:

e.g., perceptions of more frequent discrimination will amplify the influence of multiplicative

statuses on SI, whereas more frequent discrimination will have a weaker influence on SI for

those who identify with a single minority status. INTERSECTIONALITY AND SUICIDAL IDEATION 12

DATA AND METHODS

This study used data from the National Longitudinal Study of Adolescent to Adult Health

(Add Health), which is a study of adolescents who were first surveyed in grades 7-12 in the

United States in 1994-1995. Using a stratified sample of 80 different high schools, students responded to a self-administered questionnaire, with blacks being oversampled in Wave 1. After the initial in-school questionnaire of 90,000 students, 20,745 adolescents were interviewed in their homes (Wave 1), and home interviews continued for Waves 2, 3, and 4, which occurred in

1996, 2002, and 2008/9, respectively. Of the 20,745 adolescents interviewed in homes at Wave

1, 15,701 of these adolescents responded in Wave 4 when they were ages 24-33. The analytic

sample here uses information from respondents who were interviewed at Wave 1, and then re-

interviewed at Wave 4. The purpose of using Wave 4 in this study is that this is the first wave of

data that asks respondents about experiences of discrimination, and respondents are still at the

age of younger adulthood, or roughly 24-33, when SI is still somewhat prevalent.

The final analytic sample has some restrictions. Wave 1 consisted of 20,745 respondents.

I first restricted the sample to those who participated in Wave 4 (N=15,701). Then, I restricted

the sample to those who had valid responses on the dependent variable of suicidal ideation

(N=15,595). I then dropped respondents who were missing on any of the independent and control

variables, which led to 94 participants being dropped (N=15,501). The unweighted sample is

15,501. Last, I dropped respondents who were missing on design effect measures (N=14,616).

This left me with an overall analytic sample of 93.07% of all respondents from Wave 4. Means

taken from the sample before and after list-wise deletion were similar, indicating that the analytic

sample should not be biased, and thus I use list-wise deletion this analysis. Using Wave 1 allows

me to determine whether social contexts and minority statuses when participants were in high INTERSECTIONALITY AND SUICIDAL IDEATION 13 school greatly influenced rates of SI in young adulthood, although some minority statuses come from W4.

INTERSECTIONALITY AND SUICIDAL IDEATION 14

MEASURES

Dependent Variable

Suicidal Ideation. The dependent variable of focus is SI which was measured at Wave 4.

The respondents were asked, “During the past 12 months, did you ever seriously think about committing suicide?” Those who indicated that yes, they had thought about suicide in the last year were coded as 1, while those who indicated that no, they had not thought about suicide in the last year were coded as 0, (Bearman & Moody, 2004).

Key Independent Variables

Discrimination. This variable is based on the question from Wave 4 which asks, “In your day-to-day life, how often do you feel you have been treated with less respect or courtesy than other people?” Responses range from 0, which indicate the respondent never feels like they are treated with less respect, to 3, which indicates this happens often, and this measure of discrimination has been used previously to examine how discrimination plays a role in mental health outcomes (Dush & Pittman, 2019).

Sexual Minority. This variable is created based on a question from Wave 4 which asks,

“Please choose the description that best fits how you think about yourself.” The original response categories range from 1 to 6, with 1 = 100% heterosexual, 2 = mostly heterosexual, 3 = bisexual,

4 = mostly homosexual, 5 = 100% homosexual, and 6 = not sexually attracted to either males or females (asexual). I recoded these so that responses of 2 through 6 = 1, or sexual minority and responses of 1 = 0 (sexual majority) (Silva & Evans, 2020).

Immigrant Status. This variable is based on a question from Wave 1 which asks, “Were you born a U.S. citizen?” Those who responded no are coded as 1 for being an immigrant, and those who said yes are coded as 0 for being a non-immigrant (Yahirun, 2019). INTERSECTIONALITY AND SUICIDAL IDEATION 15

Religious Minority. This variable is based on a question from Wave 1 which asks, “What

is your present religious affiliation?” Individuals who responded as being a part of a Protestant,

Catholic, or other Christian religion were coded as 0, and those who responded as another

religious affiliation, such as Jewish, Atheist, or a religion other than a traditional, mainstream

Christian religion were coded as 1, as being a religious minority (Rostosky, Danner, & Riggle,

2008).

Gender Minority. This variable (Wave 1) is a dummy variable, with 0 coded as male, and

1 coded as gender minority. This is done because of social stratification towards women who

statistically outnumber men, but experience marginalization due to perceptions of weaknesses

due to a reverence towards masculinity, as well as historically poor treatment of women in

America (Harnois, 2005)

Racial Minority. This variable (Wave 1) was constructed based on whether the

respondent reported if they were white or not. If the respondent indicated they were white, they

were coded as 0. If they responded that they were not white, they were coded as 1 for racial

minority (Boman, Rebellon, & Meldrum, 2016).

Education. This variable was constructed based on the Wave 4 question, “What is the

highest level of education that you have achieved to date?” I created a scale such that those who

had not received a high school education were coded as 0, those who completed a high school or equivalent degree were coded as 1, those who attended some college were coded as 2, those who completed college were coded as 3, and those who completed more than an undergraduate degree were coded as 4 (Dennison & Demuth, 2018).

Control Variables INTERSECTIONALITY AND SUICIDAL IDEATION 16

Controls for this study include a measure of age in years, and rural location, determined by whether the respondent lives in an area with 500 or fewer residents per square mile (Slutske,

Deutsch, & Piasecki, 2016).

INTERSECTIONALITY AND SUICIDAL IDEATION 17

ANALYTIC STRATEGY

To test my hypotheses, I used a multitude of statistical tests. Before I ran my modelling, I ran tests of heteroskedasticity and multicollinearity to ensure that my independent variables were not highly correlated with one another, as well as if these variables’ standard errors were

normally distributed (Kaufman, 2013). While these tests indicated these variables were

heteroskedastic, which is normal in social science research and is corrected for by the use of

weighted data, these tests also indicated that these variables were indeed not collinear. I also chose logistic regression techniques because of its versatility with a binary dependent variable, as well as using multiple independent variables as pre

To begin my tabling, in Table 1 I present descriptive statistics of my sample. Next, I use a series of logistic regression models to determine SI based on different minority statuses, such as whether being a sexual minority is associated with higher rates of SI than being a sexual majority

(Table 2); whether the interaction of sexual minority and other minority statuses is associated with higher rates of SI (Table 3); whether being a gender minority interacted with other minority statuses to increase the risk of SI (Table 4); whether being a racial minority interacted with other minority statuses to increase the risk of SI (Table 5); and finally, whether discrimination moderates the relationship between various minority statuses and their association with SI (Table

6). INTERSECTIONALITY AND SUICIDAL IDEATION 18

RESULTS

Table 1 presents the descriptive statistics of SI and its predictors. Over 6% of the respondents indicated they had thought about suicide within the last year, a non-trivial percentage. As well as this, nearly 14% of participants indicated being a part of some sort of sexual minority status, whether that being gay, bisexual, or asexual. Nearly 36% of respondents belong to a racial minority status, whether that being Hispanic, African American, Asian, or

Native American. Surprisingly, with a mean of close to one, on average, many of the respondents indicated they received discriminatory behavior at least rarely. Questions like these are rarely introduced in intersectional literature, and while the mean does not indicate frequent treatment of disrespect, many respondents do still perceive that they are treated disrespectfully.

Table 2 presents the full logistic models of the predictor variables on SI. Model 1 includes controls only, and Model 2 includes controls as well as various minority statuses such as gender, racial, and sexual minority statuses. Model 2, consistent with prior research, shows that two of the minority status variables are associated with being more likely to endorse SI: identifying as a sexual or religious minority is significantly associated with higher endorsement of SI, net of the controls from Model 1. Most surprising, however, is the relationship between discrimination and SI (Model 3). Participants who perceive more frequent discrimination, on average, are more likely to endorse SI than those who perceive less frequent discrimination.

Table 3 presents a series of logistic models regressing SI on the predictor variables while including interaction terms for sexual minority status with other minority statuses. No significant interactions were found.

Table 4 presents the logistic models regressing SI on the predictor variables while including interaction terms for gender minorities with other minority statuses. One significant INTERSECTIONALITY AND SUICIDAL IDEATION 19 result was found: In model 10, the positive association between religious minority status and suicidal ideation is reduced for women. Thus, religious minority status on its own increases the chance of endorsing SI (Table 2), but this effect seems to be even stronger for men and not women.

Table 5 presents the logistic models regressing SI on the predictor variables while including interaction terms for racial minorities and other minority statuses. The significant interaction found was, in model 13, that racial minority women experience, on average, more endorsement of SI than white women. This supports previous literature on the differences that nonwhite women face when it comes to environmental stressors that are unique to these subgroups. This supports hypothesis 2 that those who report multiple minority statuses—in this case, being female and nonwhite—are more likely to endorse SI.

Table 6 presents the logistic model regressing SI on the predictor variables while including interaction terms for discriminatory behaviors. No significant interactions were found, thus, failing to reject the null hypothesis that perceived discrimination will moderate the relationship between various minority statuses and SI.

INTERSECTIONALITY AND SUICIDAL IDEATION 20

DISCUSSION AND CONCLUSIONS

This thesis introduced a measure of discrimination, as well as other variables associated

with intersectionality, to examine whether and how ascribing to one or more minority statuses is

associated with SI in younger adults. I hypothesized that (1) those in minority groups will report

higher levels of SI than those in non-minority groups, (2) those who identify to multiple minority statuses are more likely to express SI, and (3) that discrimination will moderate the association between minority statuses and SI. I found that some of my hypotheses were partially supported.

To begin, those who are a sexual or religious minority, as well as those who report lower levels of education are more likely to endorse SI compared to their straight, religious majority, more educated counterparts. This supports Hypothesis 1 and falls in line with previous research that those who are in the LGBT community, as well as those who have been unable to achieve high levels of education struggle with their mental health more than their non LGBT, more educated peers. In many ways, this echoes the disadvantage and inequality of resources that these two groups have, and highlights the challenges that face social minority groups in the United

States.

Secondly, those who are both female and nonwhite report greater likelihood of SI, and this partially supports Hypothesis 2, that multiplicative statuses are important considerations when predicting SI rates. This supports and further enhances the arguments made by previous intersectional work that not only can multiplicative intersectionality tease out where variance in mental health outcomes lie in areas such as race and gender, but it can also add more depth to previous assertions in mental health literature that, for instance, African Americans have lower rates of mental illness than whites. Intersectionality can delve deeper into the manifestations of mental health imbalance such as suicidal ideation, as shown in this work. Quite curiously, INTERSECTIONALITY AND SUICIDAL IDEATION 21

women reporting being in a religious minority actually report lower likelihoods of SI than their

male counterparts. In the future, work should explore how women may use less patriarchal and

male dominated religious ideologies that may be protective towards SI. The final hypothesis, that

discrimination moderates the association between minority statuses and SI, was not supported.

Previous literature has highlighted the challenges that those who ascribe to minority statuses face in everyday society, as well as how this negatively impacts mental health outcomes

(Seng, et al., 2012). Especially for groups such as sexual minorities, and minority women, these instances of perceived discrimination are very clear (Tejera, Horner-Johnson, & Andersen,

2019). These struggles can pile up and can lead to negative coping mechanisms such as SI

(Buitron, et al., 2016). In the past, discriminatory behavior and its relation to SI has usually been observed in adolescent populations, but this research highlights that discriminatory behaviors towards intersectional individuals impacts mental health outcomes well into young adulthood.

This literature highlights the importance of looking at perceived discrimination when examining intersectionality: without including the measure of discrimination, we would not know the full extent of the risk factors that minority status individuals face on a daily basis, and we would not know how this translates to SI as a whole. Previous literature has ignored personal experiences of discrimination which can directly impact mental health even in adulthood, and while interactions between discrimination and other minority statuses were not found here, those who are discriminated against do report more SI, which can be incredibly damaging, especially to intersectional individuals.

This research is not without limitations, however: I was unable to further delineate minority groups such as religious and racial minorities into more distinct groups due to sample size constraints. Being unable to determine, for instance, inherent culture differences in SI INTERSECTIONALITY AND SUICIDAL IDEATION 22 between Native Americans and Hispanics could have biased the results (Baiden, et al., 2020).

Next, while a measure of discrimination was included in this study, it would be more useful to see more questions related to what kind of discriminatory behavior occurs to individuals on a daily basis. While respondents reported on average experiencing at least a small degree of discrimination in their lives, it is still unknown where these individuals are being discriminated against—i.e., whether it is in the workplace, at home, etc.

Researchers should consider how to better ask questions related to discrimination and mental health with minority status groups. With the gaps observed in mental health and physical health outcomes of groups such as sexual minorities, better questions associated with their potential stressors should be addressed in future waves. As well as this, researchers need to continue to find innovative ways to ask questions to intersectional individuals that can fully tackle the unique challenges they face in daily life.

My research fits into more contemporary literature examining the effects of intersectionality on mental health outcomes (Evans & Erickson, 2019), while extrapolating these recent inroads for younger adults, and more specifically, on particularly problematic behavior such as SI. SI has been on the rise in early adulthood which has caused researchers to not only try to explain this phenomenon, but also address what can be done to reverse this rise. Clearly, better cultural sensitivity, as well as a better understanding of the various cultural stressors associated with intersectional individuals, are necessary in clinical and workplace interventions.

Intersectional individuals need to be viewed with more empathy, and communities need to be aware of how marginalization can be particularly multiplicative for those who are intersectional

(Herrera-Spinelli, 2019). This empathy and better cultural understanding need to be implemented for intersectional individuals early on in life in institutions that can replicate and reinforce INTERSECTIONALITY AND SUICIDAL IDEATION 23 discrimination, such as schooling, where teachers and counselors need to be more aware of how intersections of gender, race, SES, immigrant and religious statuses can color how minority adults are treated in society.

INTERSECTIONALITY AND SUICIDAL IDEATION 24

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INTERSECTIONALITY AND SUICIDAL IDEATION 32

APPENDIX A. TABLES

Table 1: Descriptive Statistics (n = 14,616) Variable Mean SD Min. Max. Suicidal Ideation .066 .249 0 1 Sexual Minority .139 .346 0 1 Gender Minority .534 .499 0 1 Religious Minority .222 .416 0 1 Racial Minority .359 .480 0 1 Discrimination .968 .823 0 3 Education 2.137 1.066 0 3 Age 28.895 1.743 24 33 Rural .372 .483 0 1 INTERSECTIONALITY AND SUICIDAL IDEATION 33

Table 2: Series of logit model regressing suicidal ideation on predictors, n = 14,616 Model 1 Model 2 Model 3 Variable Coef. SE Coef. SE Coef. SE Sexual Minority -- -- .808 .122*** .763 .123***

Gender Minority -- -- .065 .126 .054 .126

Religious Minority -- -- .393 .104*** .390 .106***

Racial Minority -- -- -.049 .093 -.083 .096

Immigrant -- -- -.321 .208 -.209 .210

Discrimination ------.550 .057***

Education -.195 .041*** -.211 .043*** -.160 .044***

Age .010 .028 -.008 .028 -.004 .028

Rural -.092 .101 -.030 .102 -.016 .102

Intercept -.2.93 .076 -1.785 2.252 -2.813 2.197

Model Statistics Wald χ2 8.53*** 15.31*** 21.44***

INTERSECTIONALITY AND SUICIDAL IDEATION 34

Table 3: Series of logit models regressing suicidal ideation on predictors, n = 14,616 Model 4 Model 5 Model 6 Model 7 Model 8 Variable Coef. (SE) Coef. (SE) Coef. (SE) Coef. (SE) Coef. (SE) Sexual Minority .763*** .817*** .791*** .752*** .746*** (.113) (.123) (.132) (.127) (.126)

Gender Minority .054 .074 .058 .053 .053 (.126) (.124) (.125) (.126) (.126)

Religious Minority .390 .397*** .415** .389*** .389*** (.106) (.105) (.118) (.106) (.106)

Racial Minority -.083 -.084 -.083 -.077 -.082 (.096) (.096) (.096) (.100) (.096)

Immigrant -.209 -.213 -.212 -.209 -.204 (-210) (.209) (.210) (.210) (.210)

Discrimination .550*** .551*** .551*** .549*** .550*** (.057) (.057) (.057) (.057) (.057)

Education -.160 -.165*** 1.589*** -.160*** -160*** (.044) (.044) (3.76) (.044) (.044)

Age -.004 -.002 -.004 -.004 -.004 (.028) (.027) (.028) (.028) (.028)

Rural -.016 -.017 -.016 -.015 -.014 (.102) (.102) (.102) (.102) (.102)

Sexual Minority* -.356 Gender Minority (.258)

Sexual Minority * -.180 Religious Minority (.226)

Sexual Minority * -.075 Racial Minority (.254)

Sexual Minority * -.410 Immigrant (.765 )

N 14616 14616 14616 14616 1461 6

INTERSECTIONALITY AND SUICIDAL IDEATION 35

Table 4: Series of logit models regressing suicidal ideation on predictors, n = 14,616 Model 9 Model 10 Model 11 Variable Coef. (SE) Coef. (SE) Coef. (SE) Sexual Minority .763*** .794*** .764*** (.113) (.118) (.123)

Gender Minority .054 .093 .060 (.126) (.131) (.125)

Religious Minority .390 .364*** .390*** (.106) (.106) (.106)

Racial Minority -.083 -.082 -.083 (.096) (.096) (.096)

Immigrant -.209 -.209 -.203 (.210) (.207) (.210) . Discrimination .550*** .552*** .550** (.057) (.057) (.057)

Education -.160 -.158*** -.160*** (.044) (.044) (.044)

Age -.004 -.005 -.004 (.028) (.028) (.028)

Rural -.016 -.019 -.016 (.102) (.102) (.102)

Gender Minority * -.476* Religious Minority (.204)

Gender Minority * .188 Immigrant (.469)

N 14616 14616 14616

INTERSECTIONALITY AND SUICIDAL IDEATION 36

Table 5: Series of logit models regressing suicidal ideation on predictors, n = 14,616 Model 12 Model 13 Model 14 Variable Coef. (SE) Coef. (SE) Coef. (SE) Sexual Minority .763*** .771 .764*** (.113) (.123) (.123)

Gender Minority .054 .110 .053 (.126) (.121) (.126)

Religious Minority .390 .389*** .413*** (.106) (.106) (.111)

Racial Minority -.083 -.085 -.088 (.096) (.099) (.094)

Immigrant -.209 -.209 -.215 (.210) (.209) (.212) . Discrimination .550*** .551*** .550*** (.057) (.057) (.057)

Education -.160 -.162*** -.160*** (.044) (.044) (.044)

Age -.004 -.004 -.004 (.028) (.028) (.028)

Rural -.016 -.016 -.017 (.102) (.101) (.101)

Racial Minority * .501* Gender Minority (.230)

Racial Minority * .153 Religious Minority (.231)

N 14616 14616 14616

INTERSECTIONALITY AND SUICIDAL IDEATION 37

Table 6: Series of logit model regressing suicidal ideation on predictors, n = 14,616 Model 15 Model 16 Model 17 Model 18 Model 19 Model 20 Variable Coef. (SE) Coef. (SE) Coef. (SE) Coef. (SE) Coef. (SE) Coef. (SE) Sexual Minority .763*** .747*** .763*** .765*** .762*** .762*** (.113) (.139) (.123) (.123) (.123) (.123)

Gender Minority .054 .053 .053 .054 .053 .053 (.126) (.126) (.131) (.125) (.126) (.126)

Religious Minority .390*** .390*** .390*** .424*** .390*** .390*** (.106) (.106) (.106) (.106) (.106) (.106)

Racial Minority -.083 -.082 -.083 -.084 -.052 -.052 (.096) (.096) (.096) (.096) (.114) (.114)

Immigrant -.209 -.209 -.209 -.210 -.216 -.216 (.210) (.210) (.210) (.210) (.213) (.213) . Discrimination .550*** .546*** .550*** .558*** .543*** .542** (.057) (.061) (.057) (.059) (.060) (.060)

Education -.160*** -.160*** -.160*** -.161*** -.159*** -.159*** (.044) (.044) (.044) (.044) (.044) (.044)

Age -.004 -.004 -.004 -.004 -.004 -.004 (.028) (.028) (.028) (.028) (.028) (.028)

Rural -.016 -.015 -.016 -.015 -.016 -.016 (.102) (.102) (.112) (.101) (.102) (.102)

Discrimination * .041 Sexual Minority (.133)

Discrimination * .002 Gender Minority (.112)

Discrimination * -.098 Religious Minority (.110)

Discrimination * -.076 Racial Minority (.134)

Discrimination * -.076 Immigrant (.134)

N 14616 14616 14616 14616 14616 14616