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Try out PMC Labs and tell us what you think. Learn More. This study was intended to analyze the intersection of experience of sexual stigma low-socioeconomic status, and suicide attempt amongst young Brazilians 11—24 years old. Network analysis provided support for a Minority Stress Model, oriented around whether participants had experienced sexual stigma. Of particular note were the increases in rates of reported community and familial physical assault, molestation, and rape for those who had experienced sexual stigma.

An analysis of centrality statistics demonstrated that both experiences of this Minority Stress Model were fundamentally different, and that those disparities increased over the time frame observed in this study. At the center of this model, shortest paths statistics exhibited a direct conditioned connection between experiencing sexual stigma and suicide attempts. We discuss the social and historical contexts that contributed to these dynamics, and emphasize the need for policy change.

Almost universally, normative sexuality has been limited to heterosexual frameworks, which is to say that social infrastructures are, explicitly or implicitly, deed to privilege the lives of those who embody this standard, and disadvantage those who do not Warner, In line with Herek's definition , sexual stigma can manifest itself institutionally, indirectly affecting particular individuals and as a felt stigma or perceived stigma, in terms of physical and psychological violence.

Non-heterosexuals or those perceived to be non-heterosexual are often subject to a slew of prejudice and discrimination such as bullying Poteat and Espelage, , physical abuse Saewyc et al. Those who had experienced sexual stigma also tend to have ificantly worse educational level Kosciw et al. Of particular concern, sexual stigma have been shown to increase the risk of developing depression Hatzenbuehler et al. Recent meta-analytic research has demonstrated that non-heterosexual individuals have an increased risk for suicide Haas et al. These disparities are further augmented in contexts with limited or non-existent state protection Hatzenbuehler et al.

In , the World Health Organization issued a report aimed at increasing awareness and suicide prevention in the global public health agenda, with a specific emphasis on the vulnerability of non-heterosexual cohorts WHO, Despite a More alarmingly, suicide attempt rates in Brazil have been estimated at 3.

In another study, focused on a cohort from to , Mello-Santos et al. Furthermore, Souza et al. All cities analyzed exhibited increased suicide mortality average increase of all 11 cities. A Brazilian report on sexual and gender minority violations provided additional evidence that analyses of young people are a vital focus, as Nonetheless, there is still no literature in Brazil showing the health impact of this kind of violation. Bostwick et al. Additionally, research by Mustanski and Liu , and Stone et al.

In an attempt to understand why minority populations demonstrate ificantly reduced well-being, Meyer conceptualized the Minority Stress Model. This model posits that health outcomes are products of the interactions between coping resources and stressors Meyer et al. Stressors are experienced as direct discrimination; expected discrimination; and internalized prejudice toward one's perceived identity Meyer, Conversely, a sense of belonging to a supportive community McLaren et al.

Dunn et al. Our research was intended to replicate important aspects and extend on these studies in order to analyze the intersection of sexual stigma and suicide attempts amongst young Brazilians. In addition to the factors described above, those who live in poverty are more vulnerable to a wide range of stressful life circumstances, from financial uncertainty Milne and Plourde, and food insecurity Olson, ; Drewnowski and Specter, to homelessness Ziesemer et al.

However, they are not a homogenous group. Concerning socioeconomic status, Patel and Kleinman performed a literature review, which demonstrated that poverty, as a whole, had only a weak direct relation to higher rates of psychological dysfunction. However, variables that tend to occur at higher rates in low-SES contexts—the experience of financial, food, or residential insecurity, rapid social change, exposure to violence, and risk of poor physical health—each had stronger associations with mental health vulnerabilities. Rasmussen et al. Recognizing the high degree of variation in conditions between various social strata, we sought to concentrate on groups that have been identified as particularly vulnerable to minority stress conditions.

Due to the level of need in these populations, our study was deed to focus on low-SES young people. Consequently, this study sought to investigate the extent to which sexual stigma experiences affected the prevalence and dynamics around suicide attempts in two cross-sections of low-SES Brazilian young people. Implementing network analysis Epskamp et al. Measures of minority stress included experience of prejudice including heterosexism, racism, and sexism , community and familial abuse, and negative life events.

Extant literature on suicidality supports the inclusion of measures of positive self-esteem Johnson et al. Additional demographic measures included gender, ethnicity skin color; see Williams et al. Whilst we are utilizing a non- a priori network analysis, we do expect a separation between stressor and protective variables to emerge from the data, and a clear relationship between sexual discrimination and suicide attempts to become apparent. Whilst we believe that there is sufficient evidence to suggest that there will be a positive association between sexual stigma experience and suicide attempt, shortest path and centrality statistics will allow us to clarify whether this is a direct or mediated relationship; how strong that relationship is; and the extent to which the model revolves around that relationship.

Subsequently, we hypothesized that there will be fundamental differences between the configuration and associations that emerge for sexual stigma experiences of young people. The Brazilian Youth Research survey Koller et al. The first cross-section was collected between and , whilst the second was collected between and Five basic indicators were chosen to analyze the status of each of the neighborhoods: income and literacy level of household head, household construction material masonry, wood, etc. They are appropriate criteria within the Brazilian context, since they mark differences between lower and higher income neighborhoods.

The neighborhoods that were below a cut line for at least two indicators were included in the potential sample size. Thereafter, a stratified sample of the geographic regions of the city was performed. From that subset, 10 neighborhoods were chosen from each of the cities, based on those criteria.

Public schools were randomly chosen from the subsets. Thereafter, all students in the selected schools were invited to participate in the study. This process was repeated for the second data collection. The samples for each cross-section are independent i. The database was composed of data collected by surveys that were approved by the Ethics Committees of the universities of the participating sites.

The ethical aspects that guarantee the integrity of the participants were ensured, based on the Brazilian legislation that is in accordance with international ethical parameters for research involving human subjects. School coordination ed a Term of Agreement concerning the involvement in the research and parents or guardians ed a term that allowed the adolescents to participate in the study.

Adolescents over 18 ed the term by themselves. There was no financial compensation to partake. The instrument was applied collectively in classrooms in accord to institutional time schedules in paper version, with the presence of the research team to supervise and clarify their doubts concerning the questionnaire items.

The were analyzed with the postulated minority stress systems as the predictor variable, and suicide attempt as the dependent variable. From the overall survey, we extracted the measures found in both studies and examined how they operated with respect to suicide attempts, focusing on the role of having experienced sexual stigma. Protective factors included measures of positive self-esteem, educational satisfaction, and community support.

Risk variables constituted measures of abuse within the participant's community and family, prejudice, and negative self-esteem. Biosociodemographic information was used to infer how these variables operated across gender, skin color, and belief in God. One other category, pardo , was used, which commonly refers to Brazilians of a mixed-race, typically a mixture of white, Afro and native Brazilian. Thus, for this study, participants were divided in two groups: white and young people of color.

The first cross-section was made up of 7, young Brazilians. The second was comprised of 2, young Brazilians, bringing the total to 9, participants over the entire study. The average age of the participants was Network analysis utilizes a range of algorithms to produce various spatially meaningful graphical representations of data, illustrating the pairwise interactions edges that constitute the systems of variables vertices. The Fruchterman-Reingold algorithm enables the data to be portrayed in relative space, wherein variables with stronger associations hang together, while less strongly related variables are repelled from one another Fruchterman and Reingold, To begin with, we produced association networks using bivariate correlations, using qgraph R package Epskamp et al.

Bivariate correlations networks are useful to visualize general patterns in data, but also can bring lot of spurious relationships, making these networks to be fully connected. Further algorithms can be used to discriminate key variables in the whole system, enabling the control of spuriousness. Next, we sought to hone our explanatory precision by executing the partial correlation network.

These networks are a class of model were edges represent conditional i. This model is known as Pairwise Markov Random Fields, and is estimated through L1-regularized neighborhood regression. After several iterations, extended Bayesian information criteria EBIC, Chen and Chen, is applied for model selection for a level of penalty parameter in general between.

As qgraph is deed for dichotomous, ordered categorical or continuous data, biosociodemographic were necessarily represented on two-levels e. Most of the others variables in the model were dichotomised to increase its sensibility, for example, zero representing a complete absence of a variable e. For this reason, we used non-parametric approximations of correlation matrix Liu et al. Network analysis allowed us to detect structural differences between stressor and protective factors surrounding suicide attempts amongst low-SES young Brazilians. In particular, it enabled us to observe whether equivalent models existed for participants that have experienced sexual stigma SS vs.

In order to analyse the influence of individual variables in the networks, we utilized the centrality function from the qgraph package, focusing on four specific centrality statistics. Strength reflects the relative weight of connections between a given node and its neighbors. Betweenness describes the of shortest paths that pass-through a given node i. Shortest paths represent the most efficient route between two variables, based on the absolute edge weights relationship strengths.

It allowed us to find the nodes that mediate the relationship between two variables, if there was no direct relationship present Opsahl et al. Key variables are addressed in the Discussion. Whilst centrality statistics provided an impression of how variables work as part of the minority stress system, odds ratios were used to shift in the proportions of participants affected by the factors that affect suicide attempt.

This study sought to compare changes in suicide attempt rates in young Brazilians between and , focusing on differences between participants who had or had not experienced sexual prejudice. Network Analysis confirmed the existence of a Minority Stress Model in both cross-sections, with reliably clear divisions between protective and stress factors at a macro level.

The spatial structure from the Fruchterman-Reingold correlation graph layout has been maintained for comparative clarity. These findings are also reflected in the centrality statistics. In both cross-sections, the variables with the strongest, closest, and greatest betweenness centrality are distinctly different for those with no experiences of sexual stigma vs. Items in the centrality analysis that are above 1. Disparities between SS and NSS item centrality are key to this analysis, and are seen in the differences between markers.

Furthermore, ificant changes between cross-sections are marked by differences of 1. Key items are analyzed in the Discussion. One variable that did remain constant for both groups was gender, demonstrating ificantly more centrality in both cross-sections for those that have not experienced sexual stigma. Specifically, identifying as female was associated with greater odds of experiencing stressors in those that have not experienced sexual stigma, but play a non-ificant role for those who experienced sexual stigma.

Centrality statistics by cross-section and experience of sexual stigma. Focusing on the independent and dependent variables, and the stressor variables that appear to have contributed most to systematic changes between the — and — cross-sections, sexual stigma, familial rape, familial molestation, and communal molestation were all directly related to suicide attempts. It is notable that, in the — cross-section, the relationship with communal rape was mediated by familial rape, perhaps alluding to ways in which a lack of familial support makes young people more vulnerable to communal abuse.

However, in —, all of these variables directly relate to suicide attempts, indicating that these environments had become more vulnerable for young people that had experienced sexual stigma. More details can be found in the Supplementary Material Data Sheets 1 — 7. In terms of individual variable change, odds ratios for variables that experienced marked proportional change between — and — or between participants who experienced sexual stigma vs.

Our have demonstrated that, in the — cross-section, a sexual minority stress model, oriented around perceived sexual discrimination, existed amongst low-SES young Brazilians, undermining the well-being of those who had experienced sexual stigma. In this initial cross-section, these systems of inequality put young Brazilians who had experienced sexual stigma at 1. In practical terms, this means that certain stressors are likely to play a more central and severe role in the production of sexual minority suicide risk. However, it also means that it is possible to de more targeted responses to undermine the key stressors that comprise experience of sexual stigma.

This is to say that, between — and —, the odds ratio for suicide attempt, comparing those with and without experience of sexual stigma has more than doubled from 1.

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