A grounded theory of sexual and gender minority suicide risk: The sexual and gender minority suicide risk and protection model

Sexual and gender minority (SGM) individuals experience higher rates of suicidal thoughts and behaviors (STBs) compared to cisgender and heterosexual individuals. Increased risk for STBs can be conceptualized via (a) suicide risk models (e.g., ideation-to-action frameworks) and (b) SGM health literature (e.g., minority stress frameworks); yet, integration of these literatures in conceptualizing SGM suicide risk is lacking. As such, the current study generated a grounded theory of SGM suicide, addressing the following research questions: What factors do SGM individuals describe as contributing to and/or thwarting: (a) the development of suicidal ideation? and (b) the progression from suicidal ideation to attempt? SGM adults from the United States (N = 30) completed semistructured interviews via video conferencing. Data analysis was conducted in four stages (i.e., open coding, focused coding, axial coding, and theoretical coding) per grounded theory methodology. The SGM suicide risk and protective (SuRAP) model was constructed, which outlines the role of (a) precipitating vulnerabilities and stressors, including minority stress; (b) lacking a solution (i.e., development of negative cognitions); (c) halting the suicide cascade (i.e., protective factors); and (d) acquiring capability for suicide (e.g., accessing lethal means) in suicidal ideation and suicide attempt among SGM individuals. Therapeutic modalities such as affirmative dialectical behavior therapy, which addresses minority stress and suicide risk factors (e.g., distress intolerance, interpersonal ineffectiveness), may be of utility in SGM suicide prevention based upon the SGM SuRAP model.