Internalized stigma and lifetime suicidal thoughts and behaviors among gay and bisexual men of color: a cross-sectional investigation

PURPOSE: This cross-sectional study examined associations of internalized racism and internalized heterosexism with lifetime suicidal thoughts and behaviors among ethnoracial minority gay and bisexual men. METHODS: Participants were 471 gay (46.5%) and bisexual (53.5%) ethnoracial minority men (Black American, 49.5%; Asian American, 23.2%; Latino/Hispanic American, 18.0%, and 9.3% Other ethnoracial minorities) recruited through Qualtrics Panels for an online survey conducted from September to December 2020. Lifetime suicidal ideation, planning, and attempts were assessed separately. Endorsement of at least one indicator defined a composite outcome reflecting any lifetime suicidal thoughts or behaviors. RESULTS: Lifetime suicidal ideation, planning, and attempts were reported by 43.6%, 27.5%, and 25.1% of participants, respectively. Internalized racism scores were significantly higher among participants reporting each indicator or the composite, whereas internalized heterosexism scores were significantly higher only among those reporting attempts or the composite. In Model 1, which included both forms of internalized stigma and demographic characteristics, internalized racism, but not internalized heterosexism, was associated with greater odds of any lifetime suicidal thoughts or behaviors. The association between internalized racism and any lifetime suicidal thoughts or behaviors was no longer statistically significant in Model 2, which added discrimination and perceived stress. CONCLUSION: These findings suggest that internalized stigma warrants consideration alongside broader psychosocial stressors in research on suicidal thoughts and behaviors among ethnoracial minority gay and bisexual men. Longitudinal research is needed to establish temporal ordering and clarify whether and how these factors may inform suicide prevention efforts.