Testing predictors of change in suicide ideation among transgender and gender-diverse adults

Suicide is a leading cause of death worldwide and rates of suicidal thoughts and behaviours (STBs) are elevated among transgender and gender diverse (TGD) people. Longitudinal research is needed to identify predictors of STBs among TGD people and to inform gender-affirming, culturally responsive care aimed at promoting long-term well-being and reducing preventable suffering and death. The Gender Minority Stress and Resilience (GMSR) model offers a promising framework for understanding suicide-related outcomes among TGD people by emphasizing distal and proximal minority stressors alongside resilience factors - however, empirical tests remain limited. Additionally, early adversity and resilience are rarely integrated into tests of the GMSR model. We examined an extended GMSR model in relation to suicide ideation frequency, considering childhood maltreatment as a novel antecedent alongside resilience. Participants were 382 gender-diverse adults recruited internationally who completed assessments at four timepoints over 12 months. Bivariate correlations showed that childhood abuse was associated with greater minority stress, lower resilience, and more frequent suicide ideation. In the longitudinal moderated mediation model, childhood abuse predicted greater distal minority stress, which in turn predicted elevated proximal stress four months later. However, neither distal nor proximal stress predicted subsequent suicide ideation, and resilience did not moderate these pathways. Overall, findings provide partial support for the GMSR framework in relation to minority stress processes, but do not support longitudinal pathways linking minority stress or resilience to ideation. Results highlight the importance of further examining dynamic, time-varying predictors of suicide risk in TGD populations and implications for ideation-to-action models of suicide.