‘Constantly invalidated by an intolerant and uncaring world’: Perceived etiology of suicidal thoughts among transgender, nonbinary, and gender expansive black, indigenous, and other people of color

Background: Transgender, nonbinary, gender-expansive (TNGE) Black, Indigenous, and Other People of Color (BIPOC) have one of the highest rates of suicidal ideation and suicide attempts. As recommended by the cultural framework of suicide, examining culturally relevant lay beliefs and attitudes, such as community perspectives on where suicidal ideation originates, is integral for suicide prevention. Doing so may aide in identifying avenues of support for TNGE BIPOC with chronic suicidal ideation. Aims: This study aimed to examine how TNGE BIPOC community members perceive the etiological foundation of suicidal ideation. Method: Short-answer responses were collected from 110 participants in a national cross-sectional survey within the United States. Data were analyzed utilizing a directed content analysis approach to thematically categorize etiological factors. Result: Participants described four major areas regarding perceived etiology of suicidal thoughts including: (1) chronic trauma and stress; (2) societal and cultural expectations; (3) biological factors; and (4) structural oppression. The most salient etiological factor was structural oppression which was endorsed by 60% of the sample. Conclusions: Results suggest that experiences of structural oppression should be incorporated in assessing TNGE BIPOC clients’ beliefs about suicide and suicide prevention, given its relative saliency within this sample. Further research is needed to adequately understand how cumulative stress and social-cultural expectations impact the development of suicidal ideation among TNGE BIPOC.