Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee.
Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee.
JAMA Pediatr. 2024 Nov 1;178(11):1155-1163. doi: 10.1001/jamapediatrics.2024.3133.
With a recent surge in anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ+) policies and associated news and media coverage, there is a need to study the association of LGBTQ+ focused news or media exposure and short-term changes in suicidal ideation (SI) among LGBTQ+ youth.
To examine within-person direct and indirect associations between exposure to general and LGBTQ+ negative news or media and SI intensity through expectations of rejection.
DESIGN, SETTING, AND PARTICIPANTS: This intensive longitudinal cohort study used a smartphone-based ecological momentary assessment (EMA) protocol wherein participants responded to EMAs 3 times per day for 28 consecutive days. Young adults aged 18 to 24 years who self-identified as LGBTQ+, resided in Tennessee, and had past-year SI and at least mild depression (defined as a score ≥5 on the Patient Health Questionnaire-9) were eligible for inclusion. Participants were recruited through social media advertisements, LGBTQ+ community organizations, and mental and behavioral health clinics. Participants were recruited between March 30, 2023, and August 23, 2023, and data analyses were conducted from August 28, 2023, through April 20, 2024.
At each EMA, participants reported on recent exposure to negative news or media. A 3-level categorical exposure variable denoted (1) no news or media exposure (reference); (2) exposure to general negative news or media; and (3) exposure to LGBTQ+ negative news or media. Each EMA also assessed expectations of rejection due to LGBTQ+ identity on a scale of 0 (not at all) through 10 (very much).
Three primary outcomes assessed current (ie, "right now") intensity of active SI, passive SI, and self-harm ideation, each measured on a scale from 0 (not at all) to 10 (very strong). Multilevel modeling approaches were used to account for the hierarchical structure of EMA data, with assessments (level 1) nested within people (level 2). Linear mixed models and multilevel mediation models were used to examine within-person associations between exposure to negative news or media and the 3 primary outcomes, as well as the mediating role of expectations of rejection.
Of 31 total participants, 22 were assigned female sex at birth (71%), and 16 (52%) self-identified as transgender or gender diverse. The median (IQR) participant age was 21 (18-22) years, and a total of 2189 EMAs were completed, with a median (range) compliance of 90.5% (41.7%-100%). At the within-person level, recent exposure to LGBTQ+ negative news or media was significantly associated with increased active SI (estimate [b], 0.14; 95% CI, 0.04-0.25; P = .009), passive SI (b, 0.23; 95% CI, 0.04-0.41; P = .02), and self-harm ideation (b, 0.13; 95% CI, 0.02-0.23; P = .02). No statistically significant associations were detected for exposure to general negative news or media. In multilevel mediation models, heightened expectations of rejection explained some of the total effect of exposure to LGBTQ+ negative news or media on active SI (23%) and passive SI (37%).
This intensive longitudinal cohort study found that SI intensity modestly increased in the hours immediately following exposure to LGBTQ+ negative news or media among LGBTQ+ young adults. These findings have timely implications for research and intervention, particularly within sociopolitical and geographic contexts where news or media coverage about LGBTQ+ topics is intensified.
随着最近反同性恋、双性恋、跨性别或酷儿（LGBTQ+）政策的激增，以及相关新闻和媒体报道的增加，有必要研究 LGBTQ+ 新闻或媒体接触与 LGBTQ+ 青年短期自杀意念（SI）变化之间的关联。
通过对拒绝的期望，研究 LGBTQ+ 焦点新闻或媒体接触与 SI 强度之间的直接和间接关联。
设计、设置和参与者：这是一项密集的纵向队列研究，使用基于智能手机的生态瞬时评估（EMA）协议，参与者每天 3 次回复 EMA，连续 28 天。18 至 24 岁的年轻人，自我认同为 LGBTQ+，居住在田纳西州，过去一年有过 SI，且至少有轻度抑郁（定义为患者健康问卷-9 得分≥5），符合入组条件。参与者通过社交媒体广告、LGBTQ+ 社区组织和精神与行为健康诊所招募。参与者于 2023 年 3 月 30 日至 2023 年 8 月 23 日期间招募，数据分析于 2023 年 8 月 28 日至 2024 年 4 月 20 日进行。
在每次 EMA 中，参与者报告最近接触的负面新闻或媒体。一个 3 级分类暴露变量表示（1）没有新闻或媒体暴露（参考）；（2）接触一般负面新闻或媒体；（3）接触 LGBTQ+负面新闻或媒体。每次 EMA 还评估了由于 LGBTQ+身份而产生的拒绝期望，范围从 0（一点也不）到 10（非常）。
三个主要结果评估了当前（即“现在”）的主动 SI、被动 SI 和自我伤害意念的强度，每个结果的评估范围均为 0（一点也不）至 10（非常强烈）。采用多层次建模方法来解释 EMA 数据的层次结构，评估（第 1 级）嵌套在人（第 2 级）中。线性混合模型和多层次中介模型用于研究接触负面新闻或媒体与 3 个主要结果之间的个体内关联，以及期望拒绝的中介作用。
在 31 名参与者中，有 22 名被分配为女性出生（71%），16 名（52%）自我认同为跨性别或性别多样化。参与者的中位（IQR）年龄为 21（18-22）岁，共完成 2189 次 EMA，中位（范围）依从率为 90.5%（41.7%-100%）。在个体内水平上，最近接触 LGBTQ+负面新闻或媒体与主动 SI（估计值[b]，0.14；95%CI，0.04-0.25；P = .009）、被动 SI（b，0.23；95%CI，0.04-0.41；P = .02）和自我伤害意念（b，0.13；95%CI，0.02-0.23；P = .02）显著相关。没有检测到接触一般负面新闻或媒体的统计学上显著关联。在多层次中介模型中，对拒绝的期望升高解释了 LGBTQ+负面新闻或媒体接触对主动 SI（23%）和被动 SI（37%）的总效应的一部分。
这项密集的纵向队列研究发现，在 LGBTQ+ 年轻成年人中，接触 LGBTQ+ 负面新闻或媒体后的几个小时内，SI 强度适度增加。这些发现对研究和干预具有及时意义，特别是在新闻或媒体对 LGBTQ+ 主题的报道加剧的社会政治和地理背景下。
