ArticleBMC public health2025
Bullying and depression serially mediate the association between perceived gender nonconformity and suicidality among US adolescents: a theory driven intersectional analysis.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAdolescent suicidality has become an alarming public health concern. Perceived gender nonconformity has been identified as a risk factor for suicidality. Several factors (e. g. bullying and depression) have been posited as potential mechanisms through which perceived gender nonconformity is associated with suicidality; however, nascent research indicates instability in these associates due to youth's exposure to intersectional forms of marginalization. This study aimed to examine an intersectional serial mediation model of adolescent suicidality by investigating the consistency of bullying and depression as prominent potential mediating mechanisms.
methodsHypotheses were tested using data derived from youths who participated in the 2019 Youth Risk Behavior Surveillance System (n = 70,047). We constructed an initial serial multiple mediation model that included all participants to examine whether the association of perceived gender nonconformity with suicidality among youth was mediated by bullying and/or depression. The goal of this model was to investigate the total and direct effects, reflected by the standardized regression coefficient and significance among the independent and dependent variables, and to assess 3 indirect effects, which that showed a change in suicidality for every 1-unit change in perceived gender nonconformity that the potential mediator mediated. We then conducted a multigroup analysis, using youth's intersectional identities as a group variable.
resultsOverall, perceived gender nonconformity was positively associated with suicidality. This association was serially mediated by bullying and depression; however, these effects varied by youth's intersectional social location. The direct association between perceived gender nonconformity and suicidality consistently emerged among all straight youth groups, with Black Straight Females and Males being notable exceptions. The full hypothesized serial mediation model could only be reproduced among Hispanic Straight Males; however, a partial mediation via bullying was demonstrated among White Bisexual Males.
conclusionsThis research has implications for understanding the potential underlying mechanisms that link perceived gender nonconformity to suicidality among adolescents. The hypothesized cascade of contextual risk factors for adolescent suicidality seems to be more harmful among Hispanic Straight Males. Studying contextual mechanisms can help develop therapeutic interventions that target adolescents most at-risk of suicidality.
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