Social-Ecological Determinants of Suicidal Ideation Among Sexual and Gender Minority Adults: A Cross-Sectional Study in the United States.

: Sexual and gender minority (SGM) adults are at an increased risk for suicide and suicidal ideation compared with cisgender/heterosexual adults. Due to the complexity of suicidal ideation, individual, social, and systemic factors must be considered. The purpose of this study was to identify determinants of suicidal ideation among SGM adults using constructs from the Social-Ecological Model (SEM). : This was a cross-sectional study of data collected from 1034 SGM adults between 27 January and 7 February 2022, and variables reflected the four constructs of the SEM, including individual, family, community, and societal levels. Hierarchical multiple linear regression was used to enter the variables in blocks. : The final model explained 55% of the variance in suicidal ideation, and determinants of suicidal ideation were identified at all four levels. At the individual level, factors were depression ( < 0.001, β = 0.231), anxiety ( < 0.001, β = 0.279), vigilance distress ( = 0.036, β = 0.157), not being out/open ( = 0.046, β = 1.136), having some college education ( = 0.002, β = -1.875), and personal strength ( = 0.012, β = -0.131). Family of origin discrimination distress was significant at the family level ( = 0.016, β = 0.174). Social resources ( < 0.001, β = -0.113), victimization distress ( < 0.001, β = 0.795), and harassment/discrimination distress ( = 0.035, β = 0.179) were significant at the community level. At the social level, SGM protective state law score ( = 0.43, β = -0.35) and having a proposed or enacted transgender sports ban ( = 0.027, β = 1.480) were significant. : Understanding the factors across the various levels of the SEM that influence suicidal ideation allows for the development of multi-level, social-ecological suicide prevention programs. Such programs can address the unique needs of SGM individuals and help mitigate suicidal ideation.