Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services.

Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.

Values Clarification as a Reflective Practice for Preclerkship Medical Students.

Introduction: Values clarification is a structured, reflective process individuals engage in to better understand their own beliefs and priorities. We designed a workshop on values clarification to help preclerkship medical students anticipate and manage potential conflicts between their personal values and professional expectations. Methods: We assigned participating students a values clarification exercise as prework. The 2-hour workshop included introductory remarks, a presentation by two physicians on personal ethical challenges they had faced, and faculty-facilitated small groups. In the small groups, students discussed moral discomfort in the context of various health care scenarios. Students were invited to complete an optional postworkshop survey with Likert-scale and short-answer questions. We analyzed the qualitative data and formulated 10 emerging themes. Results: Thirty-eight of 180 participating students (21%) returned the survey. Of these, 30 (79%) agreed the workshop helped them appreciate that their values might come into conflict with professional obligations, 26 (68%) agreed they would be able to apply what they learned to future scenarios, and 30 (79%) agreed the workshop helped them understand their colleagues' values. The most prominent themes identified were that students found the physician panel especially meaningful and that the workshop helped students examine their own values and prepared them to better understand their future patients' values. Discussion: Our workshop is unique in that it does not focus on a single area in health care but addresses moral discomfort broadly. To the best of our knowledge, it is the first values clarification curricular initiative developed for preclerkship medical students.