Thwarted Belongingness and Perceived Burdensomeness Explain the Relationship Between Sleep Problems and Suicide Risk Among Adults Identifying as Sexual and/or Gender Minorities

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Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups.