WAYS TO IMPROVE SUICIDE PREVENTION FOR LGBTQ+ YOUTH

SEAN R. DIMENT

Major: Biology

Class of 2022

ABSTRACT

LGBTQ+ youth are at an increased risk for suicide due to a variety of stressors that are rooted in stigma and intolerance of their sexual and/or gender identities. Combatting LGBTQ+ youth suicide requires decreasing stigma and addressing existing socioeconomic issues through public policy, but that will take political will and time. In contrast, cultivating resilience can occur immediately, help mediate the negative effects of these struggles, and create protective factors against suicide. I discuss existing suicide prevention framework, and practices that cultivate resilience through social support, self-care, and finding meaning. I also suggest examining social media, especially Tik Tok, to deliver resilience enhancing education and to expand literature to identify specific, efficacious resilience practices within the LGBTQ+ community to help reduce the tragically high rate of suicide and suicide ideation.

INTRODUCTION:

RISK FACTORS FOR SUICIDE IN LGBTQ+ YOUTH

In 2021, the Trevor Project (TP), a crisis intervention and suicide prevention organization for lesbian, gay, bisexual, transgender, and queer & questioning (LGBTQ) people under 25, released findings from their National Survey on LGBTQ Youth Mental Health. The study, which surveyed roughly 35,000 LGBTQ youth (13-24) across the United States, found that 42% of LGBTQ youth seriously considered suicide in the past year, with transgender and nonbinary youth populations having a suicide ideation rate over 50%.1 The Trevor Project’s data corroborates with a systematic review of the LGBTQ youth suicide, which found transgender youth were 5.87 times more likely to attempt suicide compared to heterosexual youth, and overall, LGBTQ youth were 3.5 times more likely to attempt suicide.2

Risk factors for suicide in LGBTQ+ youth stem from general stressors along with lack of acceptance and intolerance that leads to discrimination, anxiety, depression, bullying, self-harm, substance abuse, isolation, conversion therapy, food insecurity, homelessness, internalized homophobia, and a lack of outlets to receive support to mitigate these issues.1,3-7 Minority stress theory helps explain the unique stressors faced by the LGBT community and the adverse mental and physical health effects that result and contribute to suicide ideation.8 Some risk factors for suicide are experienced more by certain groups within LGBTQ youth.1 LGBTQ youth of color endure additional stressors on the basis of race, especially Black and Indigenous LGBTQ youth.1,8 This is seen where TP found that while 72% and 62% of LGBTQ youth experienced symptoms of generalized anxiety disorder and depression respectively, LGBTQ youth of color were less likely to have access to mental healthcare and more likely to face discrimination.1,8 Transgender & nonbinary youth also experience additional stressors due to gender identity compared to cisgender youth, living with greater food insecurity and being subjected to higher rates of conversion therapy.1, 8 To help mitigate these challenges, TP and other crisis lines are available to support the immediate mental health crises of LGBTQ+ youth.

LGBTQ+ YOUTH SUICIDE PREVENTION FRAMEWORK

The National Suicide Prevention Hotline (NSPH), The Trevor Project (TP), and Crisis Text Line (CTL) are three notable suicide prevention crisis lines. While the NSPH and TP offer both text and call support, CTL is entirely text-based.9,10 Of the three, TP is specifically tailored for LGBTQ youth.1 However, in CTL’s 2020 annual report, they noted that 45% of overall conversations were from LGBTQ+ identifying people, and 75% of overall conversations were from people 24 and younger.9 While not all conversations on this platform are suicide related, the issues often discussed are risk factors for suicide such as depression, anxiety, loneliness, and self-harm.3,4,5,9

Assessing the efficacy of some of these platforms remains a challenge. A systematic literature review of the effectiveness of crisis lines found that it was difficult to assess the effectiveness of crisis lines at preventing suicide in the long run, though in the immediate, results supported that these types of services were useful.10 However, there is not much information that deliberately measures the impact of crisis lines at stopping LGBTQ+ suicide.

Another important factor to consider in the context of LGBTQ+ Youth Suicide Prevention is the impact of public policy. When same-sex marriage was legalized in 2015, suicide ideation amongst LGBTQ youth decreased.7,11 Conversely, the same is true, as anti-LGBTQ legislation can increase risk for suicidality by encouraging stigma.6,7 Therefore, legislation focused on affirming LGBTQ+ identity and alleviating the socioeconomic struggles affecting the health of LGBTQ+ youth would greatly benefit LGBTQ+ suicide prevention, but these efforts are challenged by the recent slew of anti-LGBTQ legislation.12

RESILIENCE PRACTICES & PROTECTIVE FACTORS AGAINST SUICIDE

Resilience is commonly defined as the process of positively adapting or coping despite the stressors and adversity one experiences.13 A person’s social circles, selfcare practices, and sense of meaning compose important roles in their individual resilience.13,14 Having and practicing resilience helps buffer the negative effects of stress and stress related disorders, such as anxiety and depression, through biopsychosocial mechanisms, resulting in better well-being and secondarily reduce the risk of suicide.13-15 The extra benefit of resilience is its plasticity, meaning it is not static, and can be cultivated.13

Community resilience, known as the strategies by which a community helps foster and maintain well-being, is also important in the context of LGBTQ+ youth, as individual resilience can be limited by minority stressors.14 For LGBT youth, community resilience is affected by visibility, role models, community values, and access to LGBT specific resources.14 To best maximize the protective factors that result from resilience, both individual and community resilience must be cultivated. I provide a non-exhaustive list of specific individual resilience practices along with protective factors against suicide in Table 1(page 17). Some of the resilience practices are general, while others are LGBTQ+ specific and relate to the tenets of community resilience. The relationship between the protective factors against suicide, both interpersonal and intrapersonal, with resilience practices is imperative to highlight. Often times, what falls under the umbrella term of resilience directly affects well-documented suicide protective factors.6,13

Resilience practices can also occur between the pillars simultaneously. For example, if someone were a part of an LGBTQ+ identity organization which hosted run clubs or meditation times, the impact of such practices on the overall well-being and resilience of that person would be especially impactful.

Noting the possible mixed effects of navigating faith-based organizations for

TABLE 1: Resilience Practices & Suicide Protective Factors

• Finding affirming friends and connecting with supportive family members. 1, 3, 4, 13, 14, 16

• Running, weight lifting, yoga, or any form of exercise. 1, 13

• Connecting with a spiritual group, cultural org, or faith-based organization. 1, 13

NonExhaustive List of Resilience Practices

• Joining organizations & support groups that relate to individual interests and reflect individual identity. 1, 13, 14, 16

• Having access to supportive, affirming physical & mental healthcare providers. 3, 4, 13, 14, 16

• Crisis Lines like Trevor Project, Crisis Text Line, & National Suicide Prevention Hotline. 10

• Getting appropriate amounts of sleep and resting. 13

• Meditation & breathing exercises. 13

• Eating nutritional foods. 1,13

• Doing an activity that brings joy and offers a form of expression: reading, drawing, writing, creating etc. 1, 13

• Cognitive reframing of stressors. 13

• Volunteering and supporting others. 13

• Developing dreams and ambitions for one’s life. 13, 16

• Actively recognizing and building selfworth. 1, 13, 16

• Participating in LGBTQ rights activism. 3, 14, 16

• Availability of effective, culturally appropriate physical and mental healthcare providers. 3, 4, 6, 13, 14, 16

• Cultural and religious beliefs that discourage suicide. 1, 3, 4, 6, 13

• Acceptance and support from family, friends, and community; having pronouns respected. 1, 3, 4, 6, 14

• Positive role models and LGBTQ visibility. 3, 6, 14

• Self-care & problem-solving skills. 3, 4, 13, 14, 16

LGBTQ+ youth is important as well. Engaging with such an organization is not required to find meaning or community, but it is a commonly suggested practice in resilience education. To maximize the protective factors against suicide for LGBTQ+ youth, careful consideration of faith-based organizations’ affirmation of LGBTQ+ identity is imperative. Religious institutions have systemically oppressed LGBTQ+ people through encouraging intolerance, discrimination, conversion therapy, and contributing to sexual abuse.1,17 These actions harm the well-being of LGBTQ+ youth and contribute to LGBTQ+ suicidality.1-7