CPTSD, Minority Stress, and Suicide Risk in LGBTQ+ Adults

Traumatology | 2025, Vol. 31, No. 1, p. 45 - 55

The Role of Complex Posttraumatic Stress Disorder in the Associations Between Minority Stressors and Self-Reported Suicide Likelihood in LGBTQ+ Adults

Ines Cano-Gonzalez; Department of Psychological Science, The University of Texas Rio Grande Valley

Ruby Charak; Department of Psychological Science, The University of Texas Rio Grande Valley

Roman Ronzón-Tirado; Department of Biological and Health Psychology, Autonomous University of Madrid

Jorge I. Cantu; Department of Psychological Science, The University of Texas Rio Grande Valley

“It is well-documented that lesbian, gay, bisexual, trans, and queer individuals (LGBTQ+) experience mental health problems at rates higher than cisgender heterosexual individuals, which may increase the chances of suicide-related outcomes (such as passive thoughts of death, active suicidal ideation, and suicidal intent; Moagi et al., 2021; Thoma et al., 2019). For example, Nam et al. (2019) found that bisexual (41.9%) and gay/lesbian (15.9%) adults from the United States reported higher suicide ideation rates than cisgender heterosexual individuals (9.2%). Moreover, Srivastava et al. (2021) explored lifetime suicide attempts among LGBTQ+ people and identified that individuals with minority gender identities reported higher rates of suicide attempts than those with minority sexual identities (24.9% vs. 44.4%). Therefore, it is critical to explore factors that place LGBTQ+ individuals at a higher risk of mental health difficulties, which, in turn, increases the risk of suicide-related outcomes, such as the self-reported likelihood of suicide” (p. 45).

“In the present study, we hypothesized that (a) after controlling for the effect of conventional trauma, greater exposure to cumulative minority stress experiences of cisheterosexism will be associated with a greater level of PTSD (i.e., reexperience, avoidance, hypervigilance) and DSO (i.e., negative self-concept, affective dysregulation, disturbances in relationships), which, in turn, will increase the likelihood of suicidal behavior (self-reported); (b) after controlling for the effect of conventional trauma, minority stressor types of cisheterosexism(i.e., discrimination/ harassment, victimization due to sexual/gender minority, rejection by family of origin, discrimination due to gender expression, isolation related to gender/sexual minority, and vicarious trauma) will be uniquely associated with higher levels of PTSD and DSO, which will increase the self-reported likelihood of suicidal behavior” (p. 46 - 47).

A total of 730 participants accessed the survey, and 540 participants completed it and met the inclusion criteria (i.e., self-identified as LGBTQ+ individuals). For the present study, an effective sample of 229 participants with trauma exposure were selected. The 229 LGBTQ+ identifying adults were in the age range of 18–60 years old (M= 31.21, SD= 9.60). All participants were residing in Spain, 82.4% self-identifying as Caucasian (n = 187), 10.6% as Latinx (n = 24), and 7.0% as other/multiracial (n = 16). Most of the participants identified as cisgender (women: 29.2%, n = 66; men: 37.6%, n = 85) and to a lesser extent as transgender and gender diverse (TGD; woman: 4.0%, n= 9; man: 8.8%, n= 20; and nonbinary/ other: 20.3%, n = 46). Participants identified their sexual orientation as either lesbian (15.3%, n = 35), gay (33.6%, n = 77), bisexual (40.6%, n= 93), heterosexual (3.5%, n= 8), or pansexual/ asexual/other (7.0%, n = 16)” (p. 47). The measures used included: the Daily Heterosexist Experiences Questionnaire (DHEQ), the Life Events Checklist (LEC-5), the International Trauma Questionnaire (ITQ), and the Suicidal Behaviors Questionnaire-Revised (SBQ-R).

“Findings are congruent with prior studies indicating that daily cisheterosexism experiences are common among LGBTQ+ individuals (Balsam et al., 2013). Regarding mental health prevalence, as discussed in Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al. (2023), findings indicated that CPTSD is more prevalent than PTSD among LGBTQ+ adults. More frequent CPTSD diagnoses are befitting, being that the disorder is related to prolonged exposure to stressors (Brewin et al., 2017) and that LGBTQ+ individuals are at an elevated risk of experiencing a number of accumulating stressors since childhood (Craig et al., 2020; Mustanski et al., 2016).  Lastly, the rate of individuals at-risk of suicide behavior (54.4%) is higher in the present study but congruent with findings that LGBTQ+ individuals are at a higher risk of suicide (37.9%; Gnan et al., 2019). Notably, TGD individuals reported higher levels of daily cisheterosexism experiences than cisgender LGB individuals” (p .49).

“Hypothesis 1, which explored the cumulative influence of minority stressors of cisheterosexism on suicide intent, was partially supported. Findings indicate that after controlling for the effect of conventional trauma types, the accumulation of minority stressors of cisheterosexism was associated with self-reported likelihood of suicide intent through DSO, which comprises negative self-concept, affective dysregulation, and disturbances in relationship” (p. 49-50).

“Cumulative minority stressors of cisheterosexism were associated with PTSD at the bivariate level; however, in the mediation model, no significant association between PTSD and self-reported suicide intent was found. The association between cumulative minority stressors of cisheterosexism and PTSD is in line with previous studies that indicate that the accumulation of minority stressors is associated with the DSM-5 PTSD diagnosis (Solomon et al., 2021). Nonetheless, the lack of significant association of PTSD with the likelihood of suicide appears to be in contradiction with prior studies that indicated that PTSD (as per DSM-5) is a risk factor for suicide-related outcomes… Hypothesis 2, which explored the impact of specific minority stressors of cisheterosexism on suicide intent, was partially supported. Individuals with greater cisheterosexist experiences of gender expression-related harassment and isolation reported higher levels of DSO, which influenced a higher likelihood of suicide intent” (p. 50). 

“The present study findings should be interpreted with the following limitations in mind. First, the study was based on a convenience sample of LGBTQ+ adults from Spain, and results cannot be generalized to LGBTQ+ populations at large. Second, the cross-sectional design of the study does not allow causality among the study variables to be assumed. Notably, Hayes and Rockwood (2020) suggest that mediation analysis with cross-sectional data, when proposed with an appropriate causal argument, can be helpful in understanding the influential role of the variables. In the present study, our assumptions that minority stressors of cisheterosexism precede PTSD, DSO, and suicidal risk were based on the minority stress theory (Brooks, 1981; Meyer, 2003). Third, only one item was used to measure the self-reported likelihood of suicide intent. Although this decision was made to provide a better temporal understanding of the model, using only one item to measure suicide may limit the understanding of these constructs. Fourth, variables such as age or ethnicity that can impact the risk of suicide (Jo et al., 2017; Lorenzo-Luaces & Phillips, 2014) were not considered in the present study” (p. 50-51).