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Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among

Sexually Diverse Adolescents: A Multiple Mediation Analysis

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DOI: 10.1080/13811118.2017.1358224

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 Archives of Suicide Research

ISSN: 1381-1118 (Print) 1543-6136 (Online) Journal homepage: http://www.tandfonline.com/loi/usui20

Non-Suicidal Self-Injury, Sexuality Concerns, and

Emotion Regulation among Sexually Diverse
Adolescents: A Multiple Mediation Analysis

Gloria Fraser, Marc Stewart Wilson, Jessica Anne Garisch, Kealagh Robinson,
Madeleine Brocklesby, Tahlia Kingi, Angelique O’Connell & Lynne Russell

To cite this article: Gloria Fraser, Marc Stewart Wilson, Jessica Anne Garisch, Kealagh Robinson,
Madeleine Brocklesby, Tahlia Kingi, Angelique O’Connell & Lynne Russell (2017): Non-Suicidal
Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A
Multiple Mediation Analysis, Archives of Suicide Research, DOI: 10.1080/13811118.2017.1358224

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 Archives of Suicide Research, 0:1–21, 2017
Copyright © International Academy for Suicide Research
ISSN: 1381-1118 print/1543-6136 online
DOI: 10.1080/13811118.2017.1358224

none defined

Non-Suicidal Self-Injury,
Sexuality Concerns, and Emotion
Regulation among Sexually
Diverse Adolescents: A Multiple
Downloaded by [Victoria University of Wellington] at 13:09 07 September 2017

Mediation Analysis
Gloria Fraser, Marc Stewart Wilson, Jessica Anne Garisch,
Kealagh Robinson, Madeleine Brocklesby, Tahlia Kingi,
Angelique O’Connell, and Lynne Russell

Despite increasing interest in the prevalence and correlates of Non-Suicidal

Self-Injury (NSSI) in adolescent populations, relatively few studies have
examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The
current study explored sexuality concerns and elevated emotion
dysregulation as potential mechanisms underlying the relationship between
sexual orientation and elevated non-suicidal self-injury (NSSI). A
community sample of 1,799 adolescents completed a questionnaire
assessing NSSI, sexual orientation, sexuality concerns, and emotion
regulation. Across the study, 20.6% of adolescents reported a history of
NSSI. Adolescents who identify as “mostly heterosexual,” “bisexual,” and
“mostly homosexual” were more likely to engage in NSSI than gay/
lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis
showed that emotion regulation, but not sexuality concerns, mediated the
relationship between sexual orientation and NSSI. The current study
tested two theoretical pathways by which sexual orientation could predict
NSSI engagement. Findings suggest that literature on general
psychological processes, as well as group-specific minority stressors, can shed
light on high rates of NSSI among LGB populations. Specifically, the
challenges faced by LGB adolescents may undermine the development of
emotion regulation. As such, this should be a key target of intervention
with LGB adolescents engaging in NSSI.

Keywords emotion regulation, LGBT, non-suicidal self-injury, NSSI, sexual orientation, youth

Non-Suicidal Self-Injury (NSSI) has been prevalence of this phenomenon among

the subject of a burgeoning literature in adolescents and young adults (Klonsky &
the last decade, with researchers increas- Olino, 2008; Lloyd-Richardson, Perrine,
ingly interested in understanding the high Dierker, & Kelley, 2007; Muehlenkamp

1
 NSSI, Sexuality Concerns, and Emotion Regulation
& Gutierrez, 2007). NSSI among lesbian,
gay, and bisexual (LGB) young people
has received significantly less attention,
although initial findings indicate that
LGB young people are particularly at risk
of engaging in NSSI (Batejan, Jarvi, &
Swenson, 2015). The mechanisms underly-
ing this relationship, however, are not well
understood.
Given that NSSI has been associated
with a wide range of negative outcomes
Downloaded by [Victoria University of Wellington] at 13:09 07 September 2017
(Hilt, Nock, Lloyd-Richardson, &
Prinstein, 2008; Nock, Joiner, Gordon,
Lloyd-Richardson, & Prinstein, 2006),
there is an urgent need to establish why
LGB young people are significantly more
likely to engage in NSSI than heterosexual
adolescents, in order to develop effective
prevention and intervention strategies for
this group. To this end, we propose that
integrating insights from the literature on
both group-specific minority stressors and
general psychological processes will provide
insight into the relationship between NSSI
and sexual orientation.
NSSI AND SEXUAL ORIENTATION
NSSI is defined as the self-performed, cul-
turally unacceptable, direct and deliberate
destruction of bodily tissue which occurs
in the absence of suicidal intent (Interna-
tional Society for the Study of Self-Injury,
2016; Klonsky & Glenn, 2009). While
the most common form of self-injury is
generally recognized to be cutting or
carving the skin (Swenson, Spirito, Dyl,
Kittler, & Hunt, 2008), NSSI behavior
also encompasses scratching, burning, hit-
ting, biting, picking at wounds, inserting
objects under the skin, and pulling one’s
hair (Klonsky & Olino, 2008; Nock
et al., 2006). Prevalence estimates of ado-
lescent and young adult NSSI are variable,
most likely due to the use of differing
assessment methodologies and definitions
of self-injury across studies, although recent
2 VOLUME 0 . NUMBER 0 . 2017
meta-analyses estimate a prevalence rate of
approximately 18% (Muehlenkamp, Claes,
Havertape, & Plener, 2012; Swannell,
Martin, Page, Hasking, & St John, 2014).
Although the study of NSSI and sexual
orientation is still in its infancy, an
emerging literature demonstrates that
LGB adolescents are at a significantly
higher risk of engaging in NSSI than het-
erosexual adolescents (Deliberto & Nock,
2008; Reisner, Biello, Perry, Gamarel, &
Mimiaga, 2014). In particular, a non-
heterosexual sexual orientation predicts
both lifetime and past-year NSSI (Wilcox
et al., 2012), but appears unrelated to an
increased frequency of NSSI behaviors
among those who self-injure (Sornberger,
Smith, Toste, & Heath, 2013).
Batejan and colleagues (2015)
recently conducted the first meta-analysis
of NSSI and sexual orientation research
studies, finding that, overall, non-
heterosexual individuals are three times
more likely to engage in NSSI than hetero-
sexual individuals. Three of the 15 studies
reviewed focussed on adolescents, and
results showed that the effect of sexual
orientation on NSSI was increased among
adolescent samples when compared to
college student populations and adult sam-
ples (Batejan et al., 2015). Specifically,
non-heterosexual adolescents were approxi-
mately six times more likely to report
engaging in NSSI than heterosexual
adolescents. A number of studies have
found that among LGB individuals, those
who identify as bisexual or questioning
(unsure of their sexual orientation) show
at least double the prevalence rates of NSSI
(e.g., Balsam, Beauchaine, Mickey, &
Rothblum, 2005; Batejan et al., 2015;
Oswalt & Wyatt, 2011).
Studies examining the relationship
between NSSI and sexual orientation have
predominantly been conducted in the
United States and Canada. For instance,
of the 15 studies reviewed in Batejan and
colleagues’ (2015) meta-analysis, 14 were

conducted in the United States. A link
between NSSI and sexual orientation has,
however, been found outside of North
America; in a Flemish sample, adolescents
who engaged in NSSI scored significantly
higher on distress related to their sexual
orientation than those who had not
engaged in NSSI (Gandhi, Luyckx, Maitra,
& Claes, 2015). Furthermore, in a nation-
ally representative English sample non-
heterosexual participants were 2.82 times
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more likely to have ever engaged in self-
harm than their heterosexual peers
(Chakraborty, McManus, Brugha,
Bebbington, & King, 2011). Within New
Zealand, adults who reported experiencing
same-sex attraction had a higher risk of
self-harm than those who did not (Skegg,
Nada-Raja, Dickson, Paul, & Williams,
2003). Moreover, New Zealand secondary
school students who reported attraction to
“the same sex” or “both sexes” had higher
prevalence estimates of self-harm than het-
erosexual students (Lucassen et al., 2011).
Taken collectively, these findings provide
convincing evidence that results from
United States studies may be generalized
to other populations, although there
remains a notable absence of international
perspectives within the NSSI literature.
Additionally, there is preliminary evi-
dence which suggests that the strength of
the relationship between sexual orientation
and NSSI may differ between men and
women. In a large-scale study of NSSI in
a U.S. college population (N = 14,372),
Whitlock et al. (2011) found a significant
interaction between sexual orientation and
sex. Specifically, the relationship between
sexual orientation and NSSI was predomi-
nantly confined to females; men who iden-
tified as mostly straight were more likely to
report engaging in NSSI than straight men,
but there were no differences in NSSI rates
when comparing straight men with bisex-
ual, mostly gay, and gay men. In contrast,
another study within a college population
found no evidence that gender moderated
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
the relationship between sexual orientation
and NSSI (Sornberger et al., 2013). Given
the lack of empirical research in this area, as
well as ongoing debate as to the existence of
gender differences in NSSI (for discussion,
see Bresin & Schoenleber, 2015), the
nature of the relationship between gender,
sexual orientation, and NSSI remains
unclear.
MECHANISMS LINKING NSSI AND
SEXUAL ORIENTATION
The finding that non-heterosexual indivi-
duals are at a higher risk of engaging in
NSSI than heterosexual individuals is rela-
tively robust across the small number of
studies available, however the mechanisms
of this relationship are not well understood.
Several researchers have suggested that a
minority stress framework (Brooks, 1981;
Meyer, 2003) may have theoretical utility
in developing an explanation for the high
prevalence of NSSI among LGB people.
According to minority stress theory,
LGB people are stigmatized as a result of
their minority status, and consequently
experience disproportionately high levels
of social and individual stressors (e.g.,
external events such as discrimination and
bullying, increased vigilance and expectation
of rejection, and internalization of negative
societal attitudes; Meyer, 2003). Elevated
stress, in turn, has a severe negative impact
on the health and wellbeing of LGB popula-
tions (Meyer, 2003), and may account for
adverse outcomes such as an increased pre-
valence of NSSI (Muehlenkamp, Hilt,
Ehlinger, & McMillan, 2015). Minority
stress may be particularly germane to LGB
adolescents, as those perceived as different
during a period of identity formation are
more likely to experience peer victimization
and bullying, as well as a reduction in social
support (Williams, Connolly, Pepler, &
Craig, 2005). Although minority stress
theory has been utilized to explain the high
3
 NSSI, Sexuality Concerns, and Emotion Regulation
prevalence of NSSI among LGB people by a
number of researchers (e.g., Batejan et al.,
2015; Bostwick et al., 2014; Sornberger
et al., 2013), very few studies have empiri-
cally tested this hypothesis. One notable
exception is Muehlenkamp et al.’s (2015)
study of sexual minority college students,
where discriminatory events and expecta-
tions of rejection were combined into a
single minority stress variable. Results
showed that minority stress predicted NSSI,
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and that this relationship was mediated by
feelings of burdensomeness.
Further evidence for minority stress
theory is seen in House, Van Horn,
Coppeans, & Stepleman’s (2011) Inter-
net-based survey of LGBT individuals, in
which interpersonal trauma and experi-
ences of discrimination cross-sectionally
predicted NSSI. In addition, Liu and
Mustanski (2012) examined the risk factors
that contributed to high rates of self-harm
in LGBT youth, finding that general risk
factors such as higher levels of sensation
seeking and greater history of suicide
attempt were associated with higher rates
of self-harm. They also found that
LGBT-specific risk factors such as the victi-
mization of LGBT youth predicted greater
self-harm (Liu & Mustanski, 2012), pro-
viding support for the hypothesis that
LGBT youth report high rates of self-
injurious behaviors due to unique stressors
they experience that come about as a result
of their sexual orientation.
Minority stress has been predomi-
nantly assessed using self-report measures
such as the Heterosexist Harassment,
Rejection, and Discrimination Scale
(HHRD; Szymanski, 2006), the Stigma
Scale (Martin & Dean, 1987), and the
Internalized Homophobia Scale, (Ross &
Rosser, 1996) with college-aged students
or adults (e.g., Hamilton & Mahalik,
2009; Kimmel & Mahalik, 2005; Lehavot
& Simoni, 2011). However, there is reason
to believe that the measures may not
capture minority stress among LGB
4 VOLUME 0 . NUMBER 0 . 2017
adolescents. Many LGB adolescents may
not have yet shared their sexual orientation
with others, and thus may have little
experience with many of the discriminatory
events outlined in these scales (e.g., the
HHRD includes items such as “How many
times have you been treated unfairly by
strangers because you are LGB?”). Indeed,
data from the Youth’07 study conducted
in New Zealand, whose sample also had a
mean age of 15, showed that approximately
two-thirds of gay/lesbian participants and
just over half of bisexual participants had
not come out (Lucassen et al, 2011).
However, prior research suggests that
LGB adolescents who have not disclosed
their sexual orientation still worry about
disappointing parents, emotional rejection,
and future discrimination (D’augelli,
Hershberger, & Pilkington, 1998;
Saltzburg, 2007). Therefore, when measur-
ing minority stress among LGB adolescents
it may be more appropriate to assess inter-
nal stressors (e.g., worry or concern related
to sexuality) than external stressors.
Although the extant literature provides
preliminary evidence that minority stress is
critical in linking NSSI and sexual orienta-
tion, it is implausible that minority stress
alone can account for the high prevalence
of NSSI among LGB adolescents. Indeed,
as Hatzenbuehler (2009) notes, “minority
stress theory does not focus on the
psychological processes through which
stigma-related stress contributes to
psychopathology” (p. 3; emphasis added).
Hatzenbuehler (2009) introduces a psycho-
logical mediation framework, arguing that
development of effective theories on the
determinants of mental health disparities
in LGB populations requires integration
of both group-specific minority stressors
(e.g., prejudice and discrimination), as well
as general psychological processes. That is,
examining the psychological processes
which conferring risk for NSSI that both
LGB and heterosexual adolescents share
could have important implications for

establishing intervention targets in
work with LGB adolescents engaging in
NSSI.
NSSI AS EXPERIENTIAL AVOIDANCE
One well-established theoretical framework
for understanding the psychological
processes which underlie NSSI is the
Experiential Avoidance Model (EAM;
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Chapman, Gratz, & Brown, 2006). The
EAM suggests that NSSI operates in a
self-perpetuating cycle; a stimulus elicits
an unwanted emotional response, creating
an urge to escape from the ensuing
emotional arousal. Individuals (with fewer
emotion regulation “tools” available to
them) then engage in NSSI in order to
reduce or eliminate emotional arousal,
and, when this is effective, the self-
injurious behavior is negatively reinforced.
A number of factors underlie experiential
avoidance tendencies, such as high emotion
intensity, poor distress tolerance, and
acceptance of emotional responses
(Chapman et al., 2006). Taken together,
the EAM suggests that individuals who lack
functional emotion regulation skills are
more likely to seek to avoid emotions,
and may therefore be vulnerable to
engaging in NSSI (Chapman et al., 2006;
Garisch & Wilson, 2010; Gratz & Roemer,
2004).
There is considerable evidence to sug-
gest that understanding the role of emotion
regulation is key to explaining NSSI.
Although NSSI appears to serve multiple
concurrent functions, affect regulation is
often the most commonly reported reason
for engaging in NSSI across many studies
(see for example, Klonsky, 2011; Klonsky
& Glenn, 2009; Zetterqvist, Lundh,
Dahlström, & Svedin, 2013). Indeed, in a
community sample of Australian adults,
participants who reported engaging in
NSSI were more likely to use avoidant
coping strategies than those who did not
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
report engaging in NSSI, and also showed
higher levels of emotional suppression
(Hasking, Momenia, Swannell, &
Sharman, 2008). Similarly, in a sample of
New Zealand adolescents, engaging in
NSSI was associated with a decreased abil-
ity to manage, understand and communi-
cate emotions (Garisch & Wilson, 2015).
Although there is a strong emphasis on
the function of affect regulation in the gen-
eral NSSI literature, only a handful of pre-
vious studies have considered the
importance of emotion regulation in the
self-injurious behavior of LGB individuals.
A study examining motivations for cutting
behavior in a community sample of LGBT
youth found that almost three-quarters of
participants engaged in cutting to decrease
their emotion experience, and just over half
reported cutting in order to increase their
emotional experience (Nickels, Walls,
Laser, & Wisneski, 2012). Muehlenkamp
et al. (2015) point out that LGB indivi-
duals may share risk factors for NSSI with
heterosexual individuals, such as emotional
dysregulation, but that unique social stres-
sors compound their risk and overwhelm
existing coping skills.
In conjunction with additional social
stress, several studies have found that
LGB individuals experience heightened
emotion dysregulation relative to their
heterosexual peers (Hatzenbuehler,
McLaughlin, & Nolen-Hoeksema, 2008;
Matthews, Hughes, Johnson, Razzano, &
Cassidy, 2002). Hatzenbuehler (2009)
argues that high levels of stigma-related
stress undermine coping and emotion
regulation strategies, as the effort required
to manage a devalued social identity in
the face of stigmatization “may eventually
diminish individuals’ resources and there-
fore their ability to understand and adap-
tively regulate their emotions” (p. 11). As
such, we posit that understanding the role
of emotion regulation is key in developing
an explanation for the high rates of NSSI
among LGB adolescents.
5
 NSSI, Sexuality Concerns, and Emotion Regulation
THE CURRENT STUDY
The focus of this research is to gain further
insight into the mechanisms underlying the
relationship between sexual orientation and
NSSI; there is an urgent need for research
clarifying the theoretical underpinnings of
this relationship, in order to inform pre-
vention and intervention initiatives. Given
the dearth of research on NSSI and sexual
orientation conducted outside of North
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America, our focus on NSSI in New
Zealand is particularly warranted.
In light of minority stress theory
(Brooks, 1981; Meyer, 2003) and the
EAM (Chapman et al., 2006), we propose
that the high prevalence of NSSI among
LGB adolescents is best explained by a
combination of minority-specific stressors
and elevated emotion dysregulation. In
other words, LGB individuals are more
likely to engage in NSSI than heterosexual
individuals as a result of worry about the
societal consequences of identifying as
LGB. This stress elevates the emotional
dysregulation of many LGB adolescents,
further intensifying their risk of engaging
in NSSI.
HYPOTHESES
H1: LGB adolescents will report
higher rates of NSSI than
heterosexual adolescents, and
bisexual adolescents will be
particularly at risk of engaging
in NSSI.
H2: LGB adolescents will be more
likely to report concerns about
their sexuality than heterosex-
ual adolescents. Furthermore,
sexuality concerns will mediate
the link between sexual orienta-
tion and NSSI.
H3: LGB adolescents will report
lower mean levels of emotion
regulation than heterosexual
6 VOLUME 0 . NUMBER 0 . 2017
adolescents, and emotion
regulation will mediate the link
between sexual orientation and
NSSI.
H4: Both sexuality concerns and
emotion regulation will med-
iate the link between sexual
orientation and NSSI when
entered into a simultaneous
model.
METHOD
Overview
The Youth Wellbeing Study (YWS) is
a longitudinal research project with a
specific focus on NSSI among young
New Zealanders that began in 2012. The
current study analyzed data from a grand
dataset (N = 1897), which combined data
from the first three waves of the YWS.
Every participant who took part in the
YWS between 2012 and 2015 is repre-
sented once in this dataset. For participants
who took part in multiple waves of the
YWS, responses to their most recent
completed questionnaire were included in
the dataset. Ethical approval was granted
by National Health and Disability Ethics
Committee. Sixteen secondary schools in
the greater Wellington region agreed to
participate in the study.
Participants
We limited our analyses to the 1,799
participants (94.8% of the total sample)
who reported their sexual orientation, as
well as whether they had engaged in NSSI.
With regard to gender, 56.5% (n = 1,015)
of the sample identified as female, 43.1%
(n = 776) as male, and 0.3% (n = 5) as
transgender. Three participants chose not
to report their gender. Participants were
aged between 13 and 18, with a mean age
of 15.16 (SD = 2.61). The majority of

participants reported their main ethnic
group identification as New Zealand
European/Pākehā (77.7%, n = 1398),
followed by Māori (indigenous New
Zealander; 5.8%, n = 104), and Samoan
(2.6%, n = 46). 10.2% (n = 183) of the
sample identified with another ethnic
group. Four participants did not report
their ethnicity, and 3.3% (n = 64) of the
sample reported that they could not choose
only one ethnic group.
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To examine whether our sample is
representative of secondary school students
in the Wellington region, we compared
sample demographics with government
statistics (Ministry of Education, 2016).
The sample was representative with regard
to socioeconomic status, but females were
slightly over-represented (56.5% in the
YWS vs 49.2% in the Wellington region)
and males slightly under-represented
(43.1% in the YWS vs 50.8% in the Well-
ington region). New Zealand European/
Pākehā students were also over-represented
in our sample, and Māori, Pasifika, and
Asian students under-represented.
Measures
Participants completed either a paper
questionnaire or an online version of the
questionnaire via a web link, depending
on the resources available and preference
of the school. The survey contained demo-
graphic questions, as well as a number of
scales examining NSSI, sexual orientation,
sexuality concerns, emotion regulation,
and other measures of psychological well-
being. All measures were self-report, and
were chosen as they are concise, with sound
psychometric properties.
Sexual Orientation. The sexual orienta-
tion measure was patterned after Kinsey’s
conceptualization of a continuum of sexual
attraction (Kinsey, Pomeroy, Martin, &
Sloan, 1948). Following previous studies
in which the original 7-point response scale
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
was collapsed into five categories (e.g.,
Tsypes, Lane, Paul, & Whitlock, 2015;
Whitlock et al., 2011), participants were
asked “How would you describe your sexu-
ality?” Possible response options included
“100% heterosexual (straight),” “mostly
heterosexual (straight), but somewhat
attracted to people of my own sex,” “bisex-
ual (attracted to males and females
equally),” “mostly homosexual (gay/
lesbian), but somewhat attracted to people
of the opposite sex,” “100% homosexual
(gay/lesbian),” and “not sexually attracted
to either males or females.”
Sexuality Concerns. Sexuality concerns, a
measure of minority stress, was assessed
using a modified item from the Sexual
Identity Distress Scale (Wright & Perry,
2006). Participants were asked “Do you
worry about your sexuality?” Possible
response options included “no,” “some-
times,” “often,” and “I’d rather not say.”
Responses of “I’d rather not say” were
coded as missing variables for these
analyses.
Emotion Regulation. Emotion regulation
was measured using the Emotion Regula-
tion Index for Children and Adolescents
(ERICA; MacDermott, Gullone, Allen,
King, & Tonge, 2010). The ERICA is a
16-item self-report tool for assessing
emotion regulation during the middle
childhood and adolescent years. The
ERICA yields three subscales reflecting
important emotion regulation competen-
cies. The 5-item Emotional Self-Awareness
scale assesses emotional recognition and
flexibility, up-regulation of positive affect,
and down-regulation of negative affect
(e.g., “When I get upset, I can get over it
quickly”). The 7-item Emotional Control
scale assesses socially inappropriate
emotional expressions and responses (e.g.,
“I do things without thinking about
them first;” reverse scored). The 4-item
Situational Responsiveness scale assesses
7
 NSSI, Sexuality Concerns, and Emotion Regulation
social sensitivity and socially appropriate
emotional responding in social situations
(e.g., “When others are upset, I become
sad or concerned for them”). Reponses
were measured on a 5-point Likert scale
(1 = Strongly Disagree to 5 = Strongly
Agree), and were averaged to create an
overall measure of emotion regulation
(α = .81). Higher scores indicate better
regulation of emotions.
NSSI Engagement. Lifetime engage-
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ment in NSSI was measured using a
modified version of Lundh, Karim, and
Quilisch’s (2007) simplified version of the
Deliberate Self-Harm Inventory (DSHI-s).
The DSHI-s is a 17-item, behaviorally
based, self-report questionnaire designed
for use in an adolescent sample. This mea-
sure assesses 14 types of NSSI, as well as the
frequency and duration of NSSI engage-
ment. Specifically, the DSHI asks whether
and how often participants have engaged
in each behavior intentionally, but “with-
out wanting to kill yourself.” NSSI beha-
viors include “cutting your wrist, arms, or
other areas of your body,” “burning your-
self with a cigarette, lighter or match,”
and well as more extreme forms of NSSI
such as “breaking your own bones.” Partici-
pants rate on a 5-item scale ranging from 0
to 4 whether they have never done this,
have thought about this, but have never
done it, have done this a few times, or have
done this many times. Responses to the
DSHI were summed to create a continuous
NSSI score. The DSHI has previously
showed good internal consistency
(α = .82, Gratz, 2001) and been validated
for use in adolescent samples (Lundh
et al., 2007).
Procedure
Upon approval from the schools
involved, parents and caregivers of students
under age 16 were sent an information and
consent pack about the study, and students
with parental consent were invited to
8 VOLUME 0 . NUMBER 0 . 2017
participate. Of the completed consent
forms returned, 75.9% provided parental
consent for the student to take part in the
study. This overall rate of consent is
consistent with other longitudinal research
of NSSI among secondary school students
requiring active parental consent (e.g.,
Andrews, Martin, Hasking, & Page,
2014). Those aged 16 and above were
invited to participate without explicit
parental consent. Students were introduced
to the study during a school assembly, at
which time the voluntary nature of the
survey and the limits of confidentiality
were explained to the students. This was
emphasized again at the time the survey
was administered.
The location of, and time available for,
survey administration varied across schools.
A registered clinical psychologist was
present at each school during survey
administration in the event that any
student had concerns, or was in need of
support during the administration of the
survey. On completion, all students were
given an information sheet with contact
details for services that were available to
give further support if required.
In order to maximize the sample size
across all analyses, participants who
completed the variables of interest were
included in each analysis. As such,
sample sizes vary slightly for each analysis.
Missing data were also computed where
possible. As the ERICA shows adequate
internal consistency, in cases where
participants had completed at least 80%
of the ERICA scale items, missing cells
were populated with a mean of all
completed ERICA items before an average
score was calculated. Given that the
DSHI-s functions as a symptom check list,
missing responses to DSHI-s items were
assumed to indicate the absence of that
NSSI behavior. As such, they were replaced
with zeros (see Lundh et al., 2007 for a
similar method of computing missing
DSHI-s data).
 G. Fraser et al.

RESULTS conducted two independent samples t-tests.

Demographic Characteristics
In the overall sample, 20.6% of adoles-
cents reported engaging in NSSI at least
once in their lifetime. A further 9.6% of
the sample reported that they had thought
about engaging in NSSI, but had never
done so. With regards to sexual orientation,
89% (n = 1601) of the sample identified as
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Given the small sample sizes of the mostly
homosexual and homosexual groups, for
the purposes of the current analysis,
participants who identified as heterosexual
or mostly heterosexual were coded as het-
erosexual, and those who identified as
bisexual, mostly homosexual, or homosex-
ual were coded as LGB. Asexual partici-
pants were excluded from the analysis. In
line with our hypotheses, participants in

heterosexual, 6.4% (n = 116) as mostly the LGB group (n = 71, M = 1.49,

heterosexual, 3% (n = 54) as bisexual,
0.5% (n = 9) as mostly homosexual, 0.6%
(n = 11) as homosexual, and 0.4% (n = 8)
as asexual. The distribution of all study
variables in the different gender and sexual
orientation groups are presented in Table 1.
Spearman’s correlations across all study
variables are shown in Table 2.
Group Differences: Emotion Regulation,
Sexuality Concerns, and Prevalence
of NSSI
To examine mean differences in sexual-
ity concerns and emotion regulation among
the various sexual orientation groups, we
SD = .63) reported greater sexuality
concerns than those in the heterosexual
group (n = 1684, M = 1.11, SD = .35),
t(71.71) = 5.06, p < .001, d = 0.75. Con-
sistent with previous research, participants
in the LGB group (n = 74, M = 3.42,
SD = .52) also reported lower emotion reg-
ulation than those in the heterosexual
group (n = 1706, M = 3.74, SD = .50), t
(1778) = 5.33, p < .001, d = 0.62.
A binary logistic regression was
conducted to determine whether the NSSI
rate among LGB participants (the com-
bined bisexual, mostly homosexual, and
homosexual groups; n = 74, 19.2%) was
greater than that of heterosexual

TABLE 1. Distribution of Study Variables by Gender and Sexual Orientation

History of NSSI DSHI score Emotion regulation Sexuality concerns

% (n) M (SD) M (SD) M (SD)

Overall sample (n = 1799) 20.6% (370) 22 (.50) 3.73 (.51) 1.13 (.36)
Gender
Male (n = 776) 9.9% (77) .10 (.36) 3.74 (.49) 1.08 (.30)
Female (n = 1015) 28.7% (291) .31 (.57) 3.72 (.52) 1.16 (.39)
Transgender (n = 5) 40% (2) .71 (.58) 3.47 (.71) 1.50 (.76)
Sexual orientation
Heterosexual (n = 1601) 17.8% (285) .18 (.44) 3.76 (.50) 1.08 (.29)
Mostly heterosexual (n = 116) 38.8% (45) .50 (.78) 3.52 (.46) 1.50 (.61)
Bisexual (n = 54) 57.4% (31) .74 (.82) 3.41 (.51) 1.59 (.67)
Mostly homosexual (n = 9) 66.7% (6) .76 (.65) 3.38 (.49) 1.33 (.50)
Homosexual (n = 11) 27.2% (3) .31 (.46) 3.50 (.62) 1.18 (.40)
Asexual (n = 8) 12.5% (1) .10 (.17) 3.89 (.58) 1.13 (.35)
Note. M = Mean; SD = Standard Deviation.

ARCHIVES OF SUICIDE RESEARCH 9

 NSSI, Sexuality Concerns, and Emotion Regulation

TABLE 2. Spearman’s Correlations between Study Variables

1. 2. 3. 4. 5. 6.
a
1. Sexuality
2. DSHI score .25**
3. Age .10** .04
4. Sexuality concernsb .34** .17** –.01
5. Emotion regulation –.16** –.38** –.04 –.16**
6. Male/Femalec –.11* –.28** .07** –.11** .01
a
Sexuality (1 = heterosexual, 2 = mostly heterosexual, 3 = bisexual, 4 = mostly homosexual, 5 = homosexual).
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b
Sexuality Concerns (1 = not concerned, 2 = sometimes concerned, 3 = often concerned).
c
Male/Female (0 = female, 1 = male). Note. Spearman’s rho was used due to the categorical gender variable.
*p < .05, **p < .01.

participants (the combined heterosexual dichotomous measure of NSSI engagement

and mostly heterosexual groups; n = 1717,
54.1%). Asexual participants were excluded
from the analysis. A dichotomous measure
of NSSI engagement was used as the
outcome variable. The model was
significant (χ2(4) = 42.01, p < .001,
Nagelkerke R2 = .04), showing that
participants who identified as LGB were
4.95 times more likely to report lifetime
engagement in NSSI than their heterosex-
ual peers.
To investigate whether specific sexual
orientations were significant predictors of
lifetime NSSI engagement, we conducted
a second binary logistic regression. Five
dummy-coded variables (mostly heterosex-
ual, bisexual, mostly homosexual, homo-
sexual, and asexual, with heterosexual as
the reference group for each) were used
as independent variables. As before, a
was used as the outcome variable. This
analysis revealed a significant model
(χ2(4) = 72.37, p < .001, Nagelkerke
R2 = .06). Within this model, identifying
as mostly heterosexual (vs. heterosexual),
bisexual (vs. heterosexual), and mostly
homosexual (vs. heterosexual) were signifi-
cant predictors of lifetime engagement in
NSSI. The regression coefficients for all
variables are included in Table 3. Partici-
pants who identified as mostly homosexual
were over nine times more likely to report
having engaged in NSSI at some point in
their lifetime than heterosexual individuals.
Bisexual participants were more than six
times more likely to report engaging in
NSSI than heterosexual participants.
Interestingly, asexual and gay/lesbian parti-
cipants were no more likely to engage in
NSSI than heterosexual participants.

TABLE 3. Logistic Regression Model Showing Predictive Effects of Sexual Orientation on NSSI

B SE B Wald p Odds Ratio

Constant −1.53 .07 548.30 .00 .21

Homosexual .55 .68 .65 .42 1.73
Mostly Homosexual 2.22 .71 9.80 .00 9.24
Bisexual 1.83 .28 41.78 .00 6.22
Mostly Heterosexual 1.07 .20 28.42 .00 .66
Asexual −.42 1.07 .15 .70 −.02
Note. Heterosexual participants were used as the reference group for each independent variable, n = 1799.

10 VOLUME 0 . NUMBER 0 . 2017

 G. Fraser et al.

Moderation Analysis were conducted with Sexuality as the pre-

In light of the mixed findings seen in
previous literature regarding the interaction
between sexual orientation and gender, we
assessed the moderating effect of gender
on the relationship between sexual orienta-
tion and NSSI. Because of their small
sample size, participants who identified as
transgender were excluded from this
analysis. There was a significant interaction
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dictor variable, Emotion Regulation or
Sexuality Concerns as a mediator, and a
continuous measure of NSSI (DSHI score)
as the outcome. In line with our
hypotheses, both Emotion Regulation
(R2 = .154, F(2, 1741) = 158.469,
p < .001) and Sexuality Concerns
(R2 = .056, F(2, 1715) = 50.54, p < .001)
mediated the relationship between Sexual-
ity and NSSI. Sobel tests assessing the

between sexual orientation and gender
(n = 1747, B = .19, SE = .04, 95% BC
CI = .11, .28; p < .001).
To further examine the nature of this
interaction, we calculated and plotted the
simple slopes for the relationship between
sexual orientation and NSSI for men and
women. The positive relationship between
sexual orientation and NSSI was statisti-
cally significant at the p < .05 threshold
for both men and women, however, this
effect was stronger within the female
(B = .269, SE = 0.03, p < .001) as
compared to the male group (B = .078,
SE = 0.03, p = 0.02).
Mediation Analyses
To examine the mechanisms of the
relationship between sexual orientation
and NSSI two individual tests of mediation
indirect path for Emotion Regulation
(z = 6.15, p < .001) and Sexuality Con-
cerns (z = 4.21, p < .001) were both signif-
icant. As such, both variables were retained
in a multiple mediator model that simulta-
neously estimated indirect pathways for
each mediator. See Figure 1 for standar-
dized estimates of direct paths in each of
the individual mediator tests. To assess
the effects of Emotion Regulation and
Sexuality Concerns together, we then con-
ducted a multiple mediation analysis using
PROCESS, a conditional process model-
ling program which allows researchers to
examine multiple moderators and media-
tors simultaneously (Hayes, 2012). All
indirect effects were subjected to follow-
up bootstrap analyses with 1,000 bootstrap
samples and a 95% confidence interval.
The combined indirect effect of Sexuality
Concerns and Emotion Regulation was

FIGURE 1. Standardized regression coefficients for the relationship between Sexuality and NSSI as mediated by
Emotion Regulation and Sexuality Concerns. Standardized regression coefficients between Sexuality
and NSSI, controlling for the mediator, are in parentheses. Note. **p < 0.001, n (Emotion Regula-
tion as mediator) = 1,744, n (Sexuality Concerns as mediator) = 1,718.

ARCHIVES OF SUICIDE RESEARCH 11

 NSSI, Sexuality Concerns, and Emotion Regulation
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FIGURE 2. A multiple mediation model of Sexuality and NSSI through Sexuality Concerns and Emotion
Regulation. Unstandardized regression coefficients are provided along the paths. Note. *p < 0.05,
**p < 0.001, n = 1,708.
significant (R2 = .16, F(3, 1704) = 108.98,
p < .001), indicating that the set of media-
tors explained the relationship between
Sexuality and NSSI. The specific indirect
effect of each mediator was then examined
to determine whether either individual
variable significantly mediated the effect
of Sexuality on NSSI while also assessing
the other mediator. Emotion Regulation
was the only unique indirect pathway med-
iating the relationship between Sexuality
and NSSI (CI = .03, .07). Sexuality Con-
cerns did not significantly contribute to
the total indirect effect above and beyond
Emotion Regulation (CI = −3.0E4, .03).1
See Figure 2 for the unstandardized
estimates of each direct pathway.
1
Given the significant interaction between sexual
orientation and gender on NSSI, we also ran the
multiple mediation analysis while holding gender
constant. As before, transgender participants were
excluded from this analysis due to small sample size.
The inference was unchanged when controlling for
gender. The combined indirect effect of Sexuality
Concerns and Emotion Regulation remained signifi-
cant (n = 1702, R2 = .19, F(4, 1697) = 101.21,
p < .001). Emotion regulated mediated the relation-
ship between Sexuality and NSSI (CI = .03, .07),
while Sexuality Concerns did not contribute to the
total indirect effect (CI = −.002, .03).
12 VOLUME 0 . NUMBER 0 . 2017
DISCUSSION
The current study sought to investigate the
relationship between NSSI and sexual
orientation in a sample of community
adolescents, as well as to gain insight into
the mechanisms underlying this relation-
ship. Overall, 20.6% of our sample
reported lifetime engagement in NSSI, a
result which is comparable to prevalence
rates reported in a recent meta-analysis of
NSSI in nonclinical adolescent samples
(Swannell et al., 2014).
NSSI and Sexual Orientation
Drawing upon previous research, we
expected that rates of NSSI among LGB
adolescents would be significantly higher
than those of heterosexual adolescents.
Our results supported this hypothesis.
Specifically, LGB adolescents were approxi-
mately five times more likely to report life-
time engagement in NSSI than participants
who identified as heterosexual or mostly
heterosexual. This finding is consistent
with data from Batejan and colleagues’
(2015) meta-analysis of NSSI and sexual
orientation, which showed that non-
heterosexual adolescents were six times

more likely to engage in NSSI than
heterosexual adolescents.
Previous research has also found that
the prevalence of NSSI varies between
gay/lesbian and bisexual adolescents
(Balsam et al., 2005; Oswalt & Wyatt,
2011). As such, we examined potential
differences in rates of NSSI among partici-
pants of different sexual orientations. In
line with our predictions, we found that
bisexual participants were particularly at
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risk of engaging in NSSI; results showed
that they were more than six times more
likely to engage in NSSI than heterosexual
participants. Adolescents who identify as
mostly homosexual were nine times more
likely to engage in NSSI than heterosexual
adolescents. A potential explanation for
these findings is that as well as facing
homophobia, many bisexual individuals
experience a specific type of discrimination
called biphobia (Ochs, 1996). Biphobia is
based on negative stereotypes about bisexu-
ality, and includes beliefs that bisexual
people are actually gay or lesbian indivi-
duals who are transitioning to their true
identity, or who are in denial about their
sexual orientation (Israel & Mohr, 2004).
Consequently, bisexual individuals may be
ostracized by both heterosexual and
lesbian/gay communities (Welzer-Lang,
2008). The combination of discrimination
and reduced social support may increase
NSSI risk for these adolescents (Nickels,
2013).
It is also possible that some of the
adolescents in the bisexual, mostly homo-
sexual, and mostly heterosexual groups
are questioning their sexual orientation.
Batejan and colleagues (2015) suggest that
because their identities are undetermined,
individuals who self-identify as questioning
may experience stress and confusion,
which exacerbates their risk of NSSI.
Indeed, although few studies have specifi-
cally examined NSSI among questioning
individuals, both Sornberger et al. (2013)
and Whitlock, Eckenrode, and Silverman
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
(2006) found that questioning individuals
in their university samples were signifi-
cantly more likely to engage in NSSI
than both heterosexual and gay/lesbian
individuals.
As we did not include “questioning” as
an option in our measure of sexual orienta-
tion, we are not able to ascertain whether
those in the bisexual and mostly homosex-
ual groups are particularly vulnerable to
engaging in NSSI following experiences of
biphobia, or because of uncertainty about
their identity. Nevertheless, recent research
indicates that both interpretations are
plausible, and are not necessarily mutually
exclusive (Batejan et al., 2015). Consider-
ing the exceptionally high rates of NSSI
among adolescents who identify as mostly
homosexual in our sample, coupled with
the equivocal nature of current research in
this area, furthering our understanding of
NSSI among bisexual and questioning
adolescents represents an important area
of future research.
It was surprising to find that gay/
lesbian participants were no more at risk
of engaging in NSSI than heterosexual
participants. It is possible that gay/lesbian
adolescents are not at an elevated risk of
engaging in NSSI because they do not
experience biphobia, or the same level of
uncertainty about their identity, as do
adolescents in the bisexual, mostly hetero-
sexual, and mostly homosexual groups
(Sornberger et al., 2013). This finding is,
however, inconsistent with several studies
that have reported significantly higher
rates of NSSI among non-heterosexual
individuals than heterosexual individuals
(Deliberto & Nock, 2008; Reisner et al.,
2014; Skegg et al., 2003). A potential
explanation for these contradictory results
is that it was impossible to differentiate
rates of NSSI among gay/lesbian indivi-
duals from those of bisexual individuals in
some of the aforementioned studies, as
the responses of all non-heterosexual parti-
cipants were collapsed into one category for
13
 NSSI, Sexuality Concerns, and Emotion Regulation
the purposes of analyses (e.g., Deliberto &
Nock, 2008; Reisner et al., 2014).
Although the finding that gay/lesbian
adolescents are no more likely to engage
in NSSI than heterosexual adolescents is
encouraging, as it could indicate that
circumstances are improving for young
gay and lesbian New Zealanders, these
results must be interpreted cautiously. As
mentioned previously, it is possible that a
number of gay/lesbian young people in
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our sample have not yet come out, and
consequently reported their sexual orienta-
tion as heterosexual (see Lucassen et al.,
2011). As such, we may have underesti-
mated the true rate of NSSI engagement
among gay/lesbian adolescents. Another
possibility is that there is a small difference
in rates of NSSI between gay/lesbian and
heterosexual adolescents, but that we did
not have adequate statistical power to
detect the difference, as only 11 partici-
pants identified as gay/lesbian.
The statistically significant interaction
between gender and sexual orientation pro-
vides additional evidence that the relation-
ship between sexual orientation and NSSI
is stronger for women than it is for men
(see Whitlock et al., 2011). Future studies
should investigate the reasons for this
apparent gender difference. A plausible
interpretation for this result is that sexual
minority women face “double jeopardy”
(Beale, 1970)—that the effects of gender-
based disadvantage and a stigmatized sexual
orientation are compounded.
Mechanisms Linking NSSI and Sexual
Orientation
Whereas our findings regarding the
relationship between sexuality and NSSI
largely replicate past research, our analyses
investigating two possible reasons why
LGB people may be at increased risk for
NSSI provides a novel contribution to the
literature. Hatzenbuehler’s (2009) psycho-
logical mediation framework provides a
14 VOLUME 0 . NUMBER 0 . 2017
theoretical model to explain why LGB
individuals are at an increased risk for
mental health difficulties, relative to
heterosexual individuals. Specifically,
Hatzenbuehler (2009) suggests that
integrating findings from literature on
minority-specific group processes with the
literature on general psychological pro-
cesses can illuminate the ways in which
stigma negatively affects mental health.
Although Hatzenbuehler did not specifi-
cally investigate NSSI as a mental health
outcome, we proposed that this framework
could help to shed light on the high rates of
NSSI among LGB adolescents.
Following a review of minority stress
theory (Brooks, 1981; Meyer, 2003), and
the EAM (Chapman et al., 2006), we
examined emotion regulation and sexuality
concerns as potential mediators of the rela-
tionship between NSSI and sexuality. Our
hypotheses were partially supported. As
predicted, we found that, when entered
into single mediation models, both emo-
tion regulation and sexuality concerns
mediated the relationship between sexuality
and NSSI. However, when sexuality con-
cerns and emotion regulation were entered
simultaneously into a multiple mediator
model only emotion regulation retained a
significant indirect effect on NSSI. This
indicates that within this model, emotion
regulation accounted for the effect of sexu-
ality concerns. An alternative possibility is
that minority stress and emotion regulation
do jointly moderate the relationship
between sexuality and NSSI, but that the
“sexuality concerns” question used in the
current study was too broad for use as a
measure of minority stress. Our limited
measure of minority stress was, in part, a
result of drawing our data from a larger,
pre-existing study. Future research should
use a more comprehensive measure, and
include specific questions as to the content
of adolescents’ sexuality-related worries.
Our findings suggest that LGB adoles-
cents have higher rates of NSSI than

heterosexual adolescents because they have
lower average rates of emotion regulation.
According to the EAM (Chapman et al.,
2006), decreased emotion regulation
increases the likelihood of engaging in
NSSI when emotionally aroused, as NSSI
functions to terminate unwanted emotional
states. Although the present study is the
first to test this model, our findings are
consistent with those of related research;
Hatzenbuehler, McLaughlin, and Nolen-
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Hoeksema (2008) and Matthews and
colleagues (2002) have also found that
LGB individuals have heightened emotion
dysregulation when compared with hetero-
sexual individuals. Importantly, this
process could explain NSSI among LGB
adolescents who do not directly experience
prejudice or discrimination, but who worry
about future experiences of stigma and
rejection, or who ruminate about others
discovering their (potentially concealed)
identity (Hatzenbuehler, 2009).
Theoretical and Practical Implications
Our findings provide evidence for
Hatzenbuehler’s (2009) psychological med-
iation framework. Critically, it appears that
the psychological processes underlying
NSSI engagement are the same for LGB
and heterosexual adolescents; disparities
between the groups in rates of NSSI appear
to be best explained by differing stressors.
Specifically, it appears that LGB adoles-
cents must contend with the threat of
discrimination and misunderstanding that
comes from a stigmatized identity, as well
as the everyday stressors of adolescence.
The outcomes of this research suggest
some potentially helpful strategies for
working with LGB adolescents who engage
in NSSI. First, the high rates of NSSI
among LGB adolescents indicates that a
brief screening for NSSI should be
included in any assessment with adoles-
cents who do not identify as heterosexual,
or who are questioning their sexuality.
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
Second, our findings indicate that it is
particularly important to target emotion
dysregulation with LGB adolescents
engaging in NSSI, as minority stress may
undermine the development of adaptive
coping strategies.
Strengths, Caveats, and Future Directions
The current study makes a valuable
contribution to NSSI literature. Impor-
tantly, ours is the first study to examine
NSSI among people of diverse sexual orien-
tations in New Zealand using a multi-item,
rather than a single-item measure of NSSI.
Prior research shows that single-item mea-
sures may result in underestimating rates
of NSSI (Muehlenkamp et al., 2012). As
such, measures such as the DSHI-s may
be more useful for assessing the true preva-
lence of NSSI. The present study also
explored why LGB adolescents are more
likely to engage in NSSI than heterosexual
adolescents, using a large, non-clinical, rela-
tively heterogeneous sample of adolescents.
Despite these strengths, a few caveats
of the present study must be noted.
Although our measure of sexual orientation
allowed us to compare rates of NSSI
between LGB adolescents of different sex-
ual orientations, we did not provide partici-
pants with a complete list of possible sexual
orientations. For example, adolescents who
identify as pansexual (attracted to members
of all gender identities/expressions), demi-
sexual (only experience sexual attraction
after forming a strong emotional connec-
tion), or polysexual (attracted to people of
many, but not all, genders) would have
been unable to report their sexual orienta-
tion using our measure.
It is arguably impossible to provide a
checklist measure that exhaustively lists all
possible sexual orientations, leading some
researchers to use an open-item measure
of sexual orientation (e.g., Greaves et al.,
2016). While this ensures inclusivity of
all sexual orientations, we propose that
15
 NSSI, Sexuality Concerns, and Emotion Regulation
adolescents may be more likely to report
identifying as “mostly heterosexual” or
“mostly homosexual” if the option is
offered, than if they are presented with an
open-item measure. Indeed, in a study
regarding health survey questions Austin,
Conron, Patel, and Freedner (2007) found
that adolescents preferred sexual orienta-
tion measures which also provided inter-
mediate options of “mostly heterosexual”
or “mostly homosexual,” as it reflected
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their experience of feeling between cate-
gories. Given the high rates of NSSI among
adolescents who identify as “mostly homo-
sexual,” it is arguably essential to utilize
measures that can capture adolescents with
identities that fall between categories. As
such, researchers could consider using
checklist measures in future studies that
include these intermediate options, but
could provide an additional open-ended
item to ensure that no sexual orientations
are excluded by the measure.
Our measure of gender also requires
modification in future studies. It is essential
to use inclusive measures of gender identity
in any quantitative study, to ensure that all
participants are able to report their gender
(see Fraser, Bulbulia, Greaves, Wilson, &
Sibley, 2017 for discussion). This is
particularly important in NSSI research,
however, as past research shows that trans-
gender and gender nonconforming people
are particularly vulnerable to engaging in
NSSI (Marshall, Claes, Bouman,
Witcomb, & Arcelus, 2016). While we
provided participants the option of identi-
fying as transgender, we did not stipulate
that participants could check more than
one box (e.g., “female” and “transgender”).
As such, we cannot say with confidence
that we identified all transgender people
in our sample; many transgender people
identify as male or female, rather than as
transgender (Cahill & Makadon, 2014).
We are considering the use of an open-
ended measure of gender in future research,
which will also ensure that participants
16 VOLUME 0 . NUMBER 0 . 2017
with nonbinary gender identities are not
excluded from reporting their gender.
Another limitation of the current study
is the use of a non-linear measure of sexual
orientation in our mediation analyses,
although linear regression assumes a linear
relationship between the dependent and
independent variables (Field, 2013). A
more statistically sound approach may have
been to conduct a multiple mediation ana-
lysis using dummy coded sexual orientation
groups as categorical independent variables,
where each sexual minority group was com-
pared with heterosexual individuals. Apart
from the heterosexual group, however, all
sexual orientation groups had a very small
sample size. As such, if we had divided
the sample into groups based on sexual
orientation it is unlikely that we would
have had the statistical power required to
observe these effects (Field, 2013). Future
studies with larger sample sizes would have
the statistical power to carry out more
appropriate analyses.
Given the cross-sectional nature of our
study design, we are limited in our ability
to conclude that emotional dysregulation
has a causal role in NSSI engagement
among LGB adolescents. Although our
findings provide preliminary support for
this hypothesis, future research should
extend findings from the present study
using a longitudinal design. This would
help to clarify whether LGB adolescents
experience decreases in emotion regulation
following experiences of minority-specific
stress, and whether this, in turn, predicts
later NSSI engagement.
CONCLUSION
The current study sought to examine rates
of NSSI among New Zealand adolescents
of differing sexual orientations, as well as
to investigate potential mechanisms of the
relationship between sexuality and NSSI.
As predicted, our results show that LGB
adolescents are more likely to engage in

NSSI than heterosexual adolescents. Addi-
tionally, it appears that bisexual and mostly
homosexual adolescents are most at risk of
engaging in NSSI. Our results also showed
that emotion regulation mediates the rela-
tionship between sexuality and NSSI, while
sexuality concerns did not. These findings
provide evidence to suggest that an under-
standing of general psychological processes
is key in providing an account of the men-
tal health disparities between heterosexual
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and LGB adolescents. The current study
makes a unique contribution to the wider
literature, and highlights the importance
of targeting emotion dysregulation in inter-
vention with both LGB and heterosexual
adolescents who engage in NSSI.
AUTHOR NOTE
Gloria Fraser, Psychology, Victoria
University of Wellington, Kelburn Parade,
Wellington, New Zealand.
Marc Stewart Wilson, Psychology,
Victoria University of Wellington, Kelburn
Parade, Wellington, New Zealand.
Jessica Anne Garisch, Psychology,
Victoria University of Wellington, Kelburn
Parade, and Child and Adolescent Mental
Health Service, Capital and Coast District
Health Board, Wellington, New Zealand.
Kealagh Robinson, Psychology,
Victoria University of Wellington, Kelburn
Parade, Wellington, New Zealand.
Madeleine Brocklesby, Psychology,
Victoria University of Wellington, Kelburn
Parade, Wellington, New Zealand.
Tahlia Kingi, Psychology, Victoria
University of Wellington, Kelburn Parade,
Wellington, New Zealand.
Angelique O’Connell, Psychology,
Victoria University of Wellington, Kelburn
Parade and Child and Adolescent Mental
Health Service, Capital and Coast District
Health Board, Wellington, New Zealand.
Lynne Russell, Health Promotion
Agency, Wellington, New Zealand.
ARCHIVES OF SUICIDE RESEARCH
G. Fraser et al.
Correspondence concerning this article
should be addressed to Gloria Fraser,
School of Psychology, Victoria University
of Wellington, Psychology, Level 6,
Easterfield Building, Kelburn Parade,
Wellington 6140 New Zealand. E-mail:
gloria.fraser@vuw.ac.nz
FUNDING
This work was supported by the Health
Research Council of New Zealand: [Grant
Number 11/645].
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