Predicting acute and dynamic suicide risk in rural sexual minorities - PROJECT SUMMARY/ABSTRACT Sexual minority adults experience suicidal thoughts and behaviors (STBs) at rates 3–6 times higher than heterosexual adults: Up to 20% of sexual minority adults seriously consider suicide each year, compared to 4% of heterosexual adults. Sexual minorities are not a monolithic group, and STB prevalence varies by people’s intersectional identities. For example, STB prevalence varies by rurality, such that rural sexual minorities have higher STB prevalence than urban sexual minorities. Regardless of one’s identities, STB risk occurs in acute and dynamic patterns. This means that STB risk changes quickly, over hours or days. Clarifying acute and dynamic STB risk processes provides critical information on how to predict, prevent, and treat STBs. However, there is a complete absence of research on sexual minorities’ acute and dynamic STB risk processes. This is a critical barrier to progress in suicide prediction and prevention. In response to the NOSI for Research on the Health of Sexual and Gender Minority Populations (MD-22-012), the goal of this K08 is to examine how acute and dynamic STB risk processes predict future STBs in rural sexual minority adults. This K08 uses exploratory sequential mixed methods to complete two studies and four research aims. In Study 1, Aim 1 will use qualitative interviews to explore rural sexual minority adults’ perceived STB risk processes within and outside rural and LGBTQIA+ communities. Qualitative data will inform assessments in Study 2. Study 2 includes a fully remote ecological momentary assessment (EMA) protocol. The EMA protocol includes 6 surveys per day for 21 days, where participants will report on their STBs, known STB risk factors (stigma, low belonging), and the risk processes identified in Study 1. Aim 2 will determine the feasibility and acceptability of rural sexual minority adults completing a fully remote STB EMA protocol. Aim 3 will use EMA data to estimate acute, dynamic, multivariate STB risk factor networks. Aim 4 will use STB risk factor network parameters to predict STBs at 3- and 6-month follow-up. The research aims will provide pilot data for an R01 assessing the intersectionality of sexual minority adults’ rurality, gender, race, and ethnicity on STB risk processes. To accomplish these research aims, I will complete training activities related to four training aims: (1) develop expertise in sexual minority health, (2) build skills in qualitative and mixed methods, (3) learn advanced EMA methods, and (4) conduct person-specific data analyses. I will complete training activities under a team of expert mentors. The scientific environment at the Pennsylvania State University and its College of Medicine offers ample scientific and practical resources to successfully complete the proposed research and training aims and to achieve my long-term career goal of becoming an independent clinical scientist. The proposed K08 will launch my independent research career focused on clarifying intersectional STB risk processes for sexual minorities across the rural–urban continuum and informing therapeutic targets for sexual minority STB prevention.
