Nonverbal expressions of shame predict suicidal ideation among rurally-situated, but not urban situated, lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults

In the United States (US), lesbian, gay, bisexual, transgender, and queer (LGBTQ) people experience disproportionate rates of suicidality associated with minority stress. This study aimed to investigate whether nonverbal expressions of experienced stigma (i.e., shame) predicted suicidal ideation among LGBTQ individuals with a focus on location-based disparities (comparing those living in a more rural setting to those living in a more urban setting). More specifically, we examined whether nonverbal expressions of shame predicted suicidal ideation three months later and whether this relationship was moderated by region. LGBTQ individuals (N = 133) from one rurally-situated and one urban location were videorecorded while talking about a time they felt bad about their LGBTQ identity in an observational, prospective (two-time point) design. Recordings were coded for the intensity of nonverbal expressions of shame (shoulders slumped, chest narrowed). Participants also completed several self-report measures including state shame and suicidal ideation at both the time of the recording and three months later. Moderation analyses revealed that for LGBTQ adults living in more rural settings, nonverbal shame, predicted increased suicidal ideation three months later (Bstd = 0.64, p = .005), and this was not the case for those living in more urban settings (Bstd = -0.08, p = 0.70). Self-reported shame did not predict suicidal ideation for LGBTQ adults from more rural or urban locations. These findings highlight the importance of recognizing nonverbal cues in context (i.e., in locations with more structural stigma) when assessing mental health risks and when shaping interventions for LGBTQ populations.