Suicidal Ideation and Suicide Attempt Among Transgender Women in a Minority Stress and HIV Endemic Setting

Purpose: This study aimed to examine which gender minority stressors explained differences in suicidal ideation and suicide attempt among transgender women in a human immunodeficiency virus (HIV) prevention and care context. Methods: Transgender women living with or impacted by HIV risk ( N = 79) were enrolled in the study in South Florida between 2020 and 2022. Distal and proximal minority stress experiences were assessed using the Gender Minority Stress and Resilience Measure, and suicidal ideation and suicide attempt were assessed using the Columbia Suicide Severity Rating Scale. We utilized stochastic search variable selection to identify which theoretical gender minority stressors were empirically relevant in this sample. We utilized linear and logistic regressions to examine the direct and indirect associations between data-driven gender minority stressors and suicidal ideation and suicide attempt. Results: Rejection, negative expectations, and nondisclosure were empirically selected and associated with suicidal ideation severity. Consistent with the minority stress model, negative expectations and nondisclosure were significant intermediary variables in the relationship between rejection and suicidal ideation. Contrary to the minority stress model, nondisclosure emerged as a protective factor. No gender minority stressors explained differences in suicide attempt. Conclusion: Specific components of gender minority stress explained differences in suicidal ideation but not suicide attempt among transgender women impacted by HIV risk. Rejection-based pathways (including via negative expectations and nondisclosure) may be particularly important to attend to when assessing suicide risk and tailoring psychosocial suicide prevention interventions for transgender women in HIV prevention and care settings.