Cultural Consensus Modeling to Identify Culturally Relevant Risk and Protective Factors for Suicide among Sexual Minority Youth - ABSTRACT Sexual minority youth report significantly higher rates of past year suicidal ideation (19.4%-30.3%) and suicide attempts (6.6%-22.7%), as compared with heterosexual students (9.3% and 3.8%, respectively). Theoretical models of suicide and the interventions they inform have been developed with limited representation of sexual minority populations, thereby limiting their relevance for sexual minority youth. We will be the first to make use of a rigorous, multi-method, ethnographic approach, called Cultural Consensus Modeling (CCM), to leverage rich qualitative data on sexual minority youth (ages 15-25 years) and their motivations for suicide, to develop models and assessment tools generated specifically from these motivations. We will then evaluate cultural models for their association with more traditional suicide predictors derived from IPTS (perceived burdensomeness, thwarted belongingness, acquired capability). Guided by a conceptual framework that integrates the interpersonal-psychological theory of suicide (IPTS) and minority stress theory, our central hypothesis is that derived cultural models will point to the importance of redefining IPTS variables through the lens of minority stress. The CCM methodology is iterative in nature with initial study phases informing subsequent phases, verifying and further testing derived cultural models. Aim 1 will recruit 50 sexual minority youth (ages 15-25 years) with a past-year history of suicidal ideation. Making use of “free listing” CCM methodology, youth will be asked to identify risk factors (common reasons) for suicidal thoughts and behaviors among peer sexual minority youth. We hypothesize that sexual minority youth will generate IPTS-related motivations for suicide as well as motivations related to minority stress. Aim 2 will recruit a new sample of 100 at-risk sexual minority youth who will rate the culture-relevance of factors generated in Aim 1 on a 5-point Likert scale. This process identifies unique clusters of individuals (cultural consensus models) who place greater importance on particular factors and we hypothesize that more than one cultural consensus model will emerge. Aim 3 will utilize a subset of participants (N=30) who completed Aim 2 to represent each identified cultural model. Qualitative interviews will be conducted to gather in-depth information on each cultural model. Informed by the results of Aims 1-3, Aim 4 will recruit a new sample of 200 at-risk sexual minority youth, alongside measures of IPTS and minority stress/discrimination to test the hypotheses that (1) cultural models will map well onto own reasons for suicidal thoughts and behaviors; (2) cultural models will align with individual differences in IPTS and minority stress/discrimination, and that (3) models that align with minority stress/discrimination will most strongly predict suicide severity, pointing to the importance of redefining IPTS variables through the lens of minority stress theory. The proposed work responds to urgent calls for research on the risk factors for suicidal behaviors in sexual minority youth and will, for the first time, provide empirically derived treatment targets for culturally relevant treatment adaptation of suicide prevention programs
