Emotion Regulation and Self-Harm among Sexual and Gender Minority Youth

Abstract

Suicide is the second leading cause of death for adolescents and young adults worldwide. Suicide prevention efforts would be advanced by understanding of why some youth are at disproportionately higher risk compared to others. Sexual and gender minority (SGM) youth report higher rates of self-harm than heterosexual/cisgender youth. Minority Stress Theory suggests that higher rates of victimization increase risk for adverse health within SGM populations. This dissertation examined the relationships between minority stress, emotion regulation, and self-harm behaviors in adolescence and young adulthood. This approach integrated developmental perspectives to examine cross-cutting underpinnings of SGM disparities. Through two complementary studies I characterized the associations between emotion regulation and self-harm in university students identified as being at elevated risk for suicide and in psychiatric emergency patients. In the first study I examined emotion regulation, behavioral disinhibition, and their interaction as influences on self-harm in a cross-sectional sample of university students ages 18 years and older who were identified through online suicide risk screening. Specifically, I focused on acceptance of emotional responses and negative urgency, the tendency to engage in behaviors to avoid distress. Results indicated bivariate relationships between acceptance, negative urgency, and self-harm. In multivariate analyses controlling for age and sex, only acceptance was associated with recent non-suicidal self-injury (NSSI), suicide attempts, and any self-harm. These relationships were not moderated by SGM status.

In the second study, I examined the histories of self-harm and crisis service usage and conducted a longitudinal mediation test of the Minority Stress Model within a sample of psychiatric emergency patients ages 13 to 25 years. SGM youth reported more chronic histories of NSSI and crisis service usage. Moreover, among youth who reported both NSSI and suicide attempts, SGM youth reported a slower speed of transition between these two types of self-harm behaviors. Longitudinally, three emotion regulation strategies were tested as potential mediators of the relationships between victimization, internalizing symptoms, and self-harm. Results indicated that rumination was a mechanism prospectively linking victimization to self-harm via increased internalizing symptoms. Additionally, reappraisal was not associated with victimization but was associated with reduced risk of self-harm via reductions in internalizing symptoms. Suppression was associated with recent victimization but did not exert influences on future internalizing symptoms or self-harm. These mediation effects were found for the overall sample and for heterosexual/cisgender youth but not SGM youth. This pair of studies examined transdiagnostic domains of functioning within samples that were characterized by elevated but heterogeneous suicide risk. Together, they highlight the importance of examining general factors that may underpin self-harm and psychopathology disparities, particularly the use of both adaptive and maladaptive forms of emotion regulation.