Research Brief: Black LGBTQ Youth Mental Health

Summary

While many are thriving, lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are more likely to report depression and suicidality compared to straight/cisgender peers.1–3 Challenges experienced by LGBTQ youth may be particularly salient for those who are also Black. Mental health concerns are treatable and suicide is preventable. However, being Black in the United States has its own unique experiences coupled with its own specific challenges, and very little is known about how to address the needs of Black LGBTQ youth. Research has documented a variety of challenges faced by Black youth, including post-traumatic stress disorder, depression, and anxiety.4–6 Although mental health concerns have been found in both LGBTQ youth and Black youth, these findings are related to chronic stress stemming from the marginalized social status these individuals have in society.7,8 The intersection of identities for Black LGBTQ youth may make them particularly susceptible to mental health concerns and facing inadequate access to culturally appropriate care. Using data from a large national survey of LGBTQ youth, this brief examines depressed mood, suicidality, and mental health service use among Black LGBTQ youth.

Results

Black LGBTQ youth experience rates of depressed mood and suicidality similar to all LGBTQ youth. Among Black LGBTQ youth in this sample, 66% reported depressed mood in the past 12 months, 35% reported seriously considering suicide in the past 12 months, and 19% reported a past year suicide attempt. These rates are comparable those reported in the overall sample of LGBTQ youth.9 The significantly higher rates of suicidality among transgender and/or non-binary youth in the overall sample are also found among Black transgender and/or non-binary youth. Black transgender and/or non-binary youth reported double the rate of seriously considering (27% vs 59%) and attempting suicide (15% vs 32%) in the past 12 months compared to cisgender Black LGBQ youth. The proportion of transgender and/or non-binary youth seriously considering suicide in the past year was above 50% for each sub-group including transgender women, transgender men, non-binary youth assigned male at birth, and non-binary youth assigned female at birth.

 

Despite having similar rates of mental health disparities, Black LGBTQ youth are significantly less likely to receive professional care. While 47% of LGBTQ youth overall reported receiving psychological or emotional counseling from a professional in the past year, only 39% of Black LGBTQ youth reported having done so. Among those who seriously considered suicide, only half of Black LGBTQ youth received psychological or emotional counseling compared to 3 out of 5 LGBTQ youth overall.

Methodology

A quantitative cross-sectional design was used to collect data through an online survey platform between February and September 2018. A sample of LGBTQ youth ages 13–24 who resided in the United States were recruited via targeted ads on social media. A total of 34,808 youth consented to complete The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health with a final analytic sample of 25,896. The current analyses focused on the 668 youth who reported being “Black or African American,” exclusively. Items indicating past 12 months depressed mood (“sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities,”) seriously considering suicide, and attempting suicide were taken from the CDC’s Youth Risk Behavior Surveillance Survey. Youth were also asked whether they, “received psychological or emotional counseling from a mental health professional?” in the past 12 months.

Looking Ahead

These findings not only support investment in Black LGBTQ youth mental health, but also development and wide application of community-derived prevention programs in which key stakeholders including respected community and church leaders; parents, grandparents, and other family members; and Black LGBTQ youth themselves are included in the process. Black LGBTQ youth are just as likely to experience suicidality as other LGBTQ youth, with over a third seriously considering suicide in the past year and 1 in 5 reporting an attempt. However, Black LGBTQ youth are accessing professional care at lower rates, suggesting existing models of care have failed at providing Black LGBTQ youth access to appropriate and acceptable mental health services. Indeed, most suicide prevention programs for youth often take a “one-size-fits-all approach” and lack the cultural grounding necessary for effective prevention in Black LGBTQ youth.10

The Trevor Project’s crisis services team aims to provide LGBTQ youth with high quality, culturally-grounded care. To better support Black LGBTQ youth we have worked to create a diverse team of counselors that is aligned with the demographics of the youth we serve. We also use counselor training materials that are inclusive of diverse identities, and avoid stereotypes. Our research team is committed to ongoing dissemination of data that allows Trevor and others to better understand and address the needs of Black LGBTQ youth. Further, Trevor’s advocacy team continues to focus on promoting data collection on sexual orientation and gender identity as part of violent death investigations to accurately count and understand violent deaths, including suicide, among Black LGBTQ individuals.

References

  1. Bostwick, W. B., Meyer, I., Aranda, F., Russell, S., Hughes, T., Birkett, M., & Mustanski, B. (2014). Mental health and suicidality among racially/ethnically diverse sexual minority youths. American Journal of Public Health, 104(6), 1129-1136.
  2. Kann, L., McManus, T., Harris, W.A., Shanklin, S.L., Flint, K.H.,Queen, B., et al. (2018). Youth risk behavior surveillance-United States, 2017. Morbidity and Mortality Weekly Report Surveillance Summaries, 67(8), 1-114.
  3. Stettler, N.M., & Katz, L.F. (2017). Minority stress, emotion regulation, and the parenting of sexual minority youth. Journal of GLBT Family Studies, 13(4), 380-400.
  4. Alim, T., Graves, E., Mellman, T., Aigbogun, N., Gray, E., Lawson, W., & Charney, D. (2006). Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. Journal of the National Medical Association, 98(10), 1630-1636.
  5. Walsemann, K. M., Gee, G. C., & Geronimus, A. T. (2009). Ethnic differences in trajectories of depressive symptoms: disadvantage in family background, high school experiences, and adult characteristics. Journal of Health and Social Behavior, 50(1), 82-98.
  6. William, D.R., Gonzáles, H.M., Neighbors, H., Nesse, R., Abelson, J.M., Sweetman, J., Jackson, J.S. (2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Archives of General Psychiatry. 64(3),305–315.
  7. Jones, S. C. T., & Neblett, E. W. (2017). Future directions in research on racism-related stress and racial-ethnic protective factors for Black Youth. Journal of Clinical Child and Adolescent Psychology, 46(5), 754-766.
  8. Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129( 5), 674-697.
  9. The Trevor Project. (2019). National Survey on LGBTQ Mental Health. New York, New York: The Trevor Project.
  10. Bluehen-Unger, R.G., Stiles, D.A., Falconer, J., Grant, T.R., Boney, E.J., & Brunner, K.K. (2017). An exploration of culturally grounded youth suicide prevention programs for Native American and African American Youth. International Journal of Learning, Teaching and Educational Research, 16(2), 48-61.

For more information please contact: [email protected]

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Fighting for Trans Youth in Florida and Beyond

The Trevor Project is working closely with LGBTQ organizations and activists across the country in opposing an onslaught of new bills aimed at criminalizing medically necessary care for transgender youth. You can learn more about why denying best-practice, gender-affirming care would put lives at risk by reading this op-ed by Trevor’s Medical Director, Dr. Alexis Chavez.

Most recently, Trevor’s advocacy team was proud to support Equality Florida in opposing HB 1365 at a House Health Quality Subcommittee on Monday, February 3rd. With this bill, extremist politicians were threatening doctors with up to 15 years in prison for affirming trans youth in their identities. But trans advocates, allies, parents, doctors, mental health professionals, and fierce supporters from across the state showed up in full force to support trans youth and stop this bad bill.

And we won! The bill has been defeated! 

The Trevor Project’s National Advocacy Campaign Manager, Troy Stevenson, was on the ground in Tallahassee to support Equality Florida’s efforts. “Stopping this bill is a resounding victory for the health, safety, and dignity of trans youth in Florida. Let this be a lesson to other states considering similar bills that vitriolic attacks on trans youth won’t be tolerated without a fight. The people elected to represent us must stop targeting the most vulnerable young humans. By holding the line and stopping this misguided legislation in its track, Equality Florida and fair-minded Floridians everywhere have helped save young lives,” said Stevenson.

The Trevor Project is monitoring similar legislation in states across the country like South Dakota and South Carolina and will continue to do all we can to assure trans youth that we are fighting for them each and every day.

If you or someone you know is feeling hopeless or suicidal, contact The Trevor Project's TrevorLifeline 24/7 at 1-866-488-7386. Counseling is also available 24/7 via chat every day at TheTrevorProject.org/Help, or by texting START to 678678.

Suicidality Disparities by Sexual Identity Persist from Adolescence into Young Adulthood

EXECUTIVE SUMMARY

About The Trevor Project

The Trevor Project is the world's largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people. The Trevor Project offers a suite of 24/7 crisis intervention and suicide prevention programs, including TrevorLifelineTrevorText, and TrevorChat as well as the world’s largest safe space social networking site for LGBTQ youth, TrevorSpace. Trevor also operates an education program with resources for youth-serving adults and organizations, an advocacy department fighting for pro-LGBTQ legislation and against anti-LGBTQ rhetoric/policy positions, and a research team to discover the most effective means to help young LGBTQ people in crisis and end suicide. If you or someone you know is feeling hopeless or suicidal, our trained crisis counselors are available 24/7 at 1-866-488-7386 via chat www.TheTrevorProject.org/Help, or by texting START to 678678.

About This Work

Significant increases in suicide deaths have occurred over the past 10 years in the U.S., particularly among adolescents and young adults (Curtin & Heron, 2019). However, suicide can be prevented through comprehensive public health strategies aimed at reducing risk factors and increasing protective factors (The Trevor Project, 2019a). Increased knowledge about populations at highest risk for suicide can assist prevention efforts aimed at ending suicide and enhancing well-being for those individuals. National prevalence data on lesbian, gay, and bisexual (LGB) high school students, collected as part of the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System (YRBS), indicate that LGB youth are more than four times as likely to attempt suicide compared to straight peers (Kann et al., 2018). Recently, the CDC released a report focused on transgender high school students, with similar disparities found in suicidality among transgender compared to cisgender students as between LGB and straight students (Johns et al., 2019). Further, The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health found that 39% of LGBTQ youth ages 13–24 reported seriously considering suicide in the previous 12 months (The Trevor Project, 2019b). Among adults, individuals ages 18–25 have the highest rates of suicide attempts (Substance Abuse and Mental Health Services Administration, 2019). Thus, there is an urgent need to understand suicide disparities among LGB young adults ages 18–25, including how they compare to findings among high school students. In 2015 the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) included questions on sexual identity for the first time. The NSDUH is currently the only national-level dataset to use probabilistic sampling and include questions on both sexual identity and suicidality among this age group. This report is the first to compare findings on suicidality among LGB youth ages 18–25 to those among LGB U.S. high school students, including the provision of adjusted odds ratios to assess suicidality risk among LGB youth compared to straight peers.

Key Findings

The magnitude of disparities in suicidality between straight and LGB adolescents persists into young adulthood. 

  • Even when adjusting for additional factors, LGB young adults ages 18–25 were more than four times as likely to report planning and attempting suicide in the past year compared to straight peers.
  • 10.4% of LGB youth ages 18–25 reported making a suicide plan in the past year compared to 2.6% of straight peers.
  • 5.7% of LGB youth ages 18–25 reported a suicide attempt in the past year compared to 1.3% of straight peers.


LGB young adults ages 18–25 were three times as likely to report a major depressive episode in the past year compared to their straight peers.

  • 30.9% of LGB youth ages 18–25 met criteria for a major depressive episode in the past year compared to 11.1% of straight peers.
  • A greater proportion of bisexual young adults ages 18–25 met criteria for a major depressive episode (32.7%) compared to gay/lesbian young adults (26.8%).


The data currently collected do not allow for nationally representative analyses on gender identity or suicide deaths. 

  • National surveys of youth and young adult experiences now include questions on sexual identity but do not consistently include questions on gender identity.
  • Death record databases do not currently include accurate information on sexual identity and gender identity that would allow for analyses to include deaths by suicide in addition to suicide ideation and attempts.

Methodology Summary

Prevalence rates by sexual identity for past year suicidal thoughts, plans, and attempts are compared to rates among high school students based on the 2017 YRBS. NSDUH diagnostic prevalence rates are provided for major depressive disorder based on the Diagnostic and Statistical Manual of Mental Disorders criteria. Logistic regressions were used to predict suicidality among youth ages 18–25 based on sexual identity while controlling for sex, race/ethnicity, and income. For high school students, logistic regressions were conducted to predict depressive symptoms and suicidality while adjusted for race/ethnicity and gender.

Notes on Terminology

The acronym LGB is used rather than LGBTQ, as the NSDUH dataset does not collect data on transgender, queer, or questioning identities. Additionally, we focus on ages 18–25 rather than 18–24, as the most detailed age variable in the 2018 NSDUH dataset combines ages 24 and 25 rather than providing discrete single ages. YRBS data are representative of high school students in the U.S., with the majority of students (87%) falling between the ages of 14 and 17.

BACKGROUND

Significant increases in suicide deaths have occurred over the past 10 years in the U.S. (Curtin & Heron, 2019). Suicide is the second leading cause of death among individuals ages 10–24 (Hedegaard, Curtin, & Warner, 2018), and previous suicide attempts are one of the strongest predictors of death by suicide (Dervi, Brent, & Oquendo, 2008). Further, in a recent global meta-analysis, those diagnosed with depression were at nine times greater risk of dying by suicide (Conner et al., 2019). Suicide can be prevented through comprehensive public health strategies aimed at reducing risk factors and increasing protective factors (The Trevor Project, 2019a). Increased knowledge about populations at highest risk for suicide can assist prevention efforts aimed at ending suicide and enhancing well-being for those individuals. Lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals are particularly vulnerable due to heightened minority stress, marked by increased victimization, rejection, and the internalization of LGBTQ stigma (Meyer, 2003).

Research on LGBTQ populations has been slowed by a lack of federally collected data on sexual identity and gender identity. Despite decades of research indicating that LGBTQ individuals are exposed to minority stress, which increases risk for experiencing challenges related to depression and suicidality (Meyer, 2003), national-level prevalence studies have only recently begun to include items on sexual identity and gender identity. In 2015 the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System (YRBS) included a question to ascertain sexual identity for the first time in its standard questionnaire used by the states and large urban school districts. There data were crucial for documenting adverse mental health indicators among lesbian, gay, and bisexual (LGB) high school students, including greater depressive symptoms and more than four times the rate of attempting suicide in the past 12 months compared to straight peers. In 2017, 10 states and nine large urban school districts included a YRBS question to measure the proportion of high school students who identify as transgender. Analysis of this dataset revealed that a higher proportion of transgender students reported all suicide risk outcomes, including seriously considering, planning, and attempting suicide, compared to cisgender students. YRBS findings have been prominently featured by the CDC in publicly available infographics on sexual identity and gender identity and published reports on sexual identity and gender identity (Kann et al., 2016; Johns et al., 2018; Johns et al., 2019). The widespread dissemination of YRBS findings on suicidality can support policies, programs, and practices aimed at reducing disparities for LGBTQ high school students.

Representative data on LGBTQ young adults over the age of 18 has not been widely disseminated or compared to disparities among high school students. In 2015, the National Survey on Drug Use and Health (NSDUH) added a question on sexual identity. The NSDUH is administered annually and is the only nationally representative source of federally collected information on suicidality among LGB adults. Given that the highest rates of suicide attempts among adults occur among those ages 18–25 (Substance Abuse and Mental Health Services Administration, 2019), and findings that LGB high schools students are more than four times as likely to attempt suicide compared to straight peers (Kann et al., 2016), there is a dire need for widely disseminated findings related to suicidality among LGB young adults ages 18–25. A clear understanding of disparities in depression and suicidality by sexual identity among not only high school aged youth, but also those ages 18–25, is necessary to inform national prevention strategies, advocate for policy changes, and advance research efforts.

METHODOLOGY

NSDUH and YRBS Comparative Analyses. All NSDUH analyses were conducted for young adults ages 18 to 25 years using the most recent dataset collected in 2018. All YRBS analyses were conducted for high school aged youth using the most recent dataset collected in 2017. Descriptive analyses were conducted with both NSDUH and YRBS data by sexual identity (gay/lesbian, bisexual, and straight) to estimate the proportion of individuals who identify as LGB as well as the 12-month prevalence of suicidal ideation (seriously think about trying to kill themselves in the past 12 months), suicide plan (making a plan to kill themselves in the past 12 months), and suicide attempt (attempting suicide one or more times in the past 12 months). For youth ages 18–25, estimates by sexual identity are provided for past year major depressive episode using Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, as collected in the 2018 NSDUH. Although the YRBS does not collect diagnostic data to determine criteria for a major depressive episode, it does include a single item asking youth whether they felt so sad or hopeless nearly every day for at least two weeks in the past year that they stopped doing some usual activities. We provide this data for illustrative purposes of examining disparities related to symptoms of depression; however, the two measures are conceptually distinct and should not be directly compared.

NSDUH and YRBS use a complex, multistage sampling strategy and provide sampling weights to generate estimates of the U.S. civilian, noninstitutionalized population and U.S. high school students, respectively. For all analyses, the complex samples module of SPSS 25 was used to account for the complex sample design and sample weights for the NSDUH and YRBS datasets.

Adjusted Odds of Suicidality and Depression. Multivariate logistic regression models were applied to examine the association of sexual identity (LGB compared to straight) with suicidality (seriously considering suicide, making a suicide plan, and suicide attempts), and major depressive episode) among young adults ages 18–25 after controlling for race/ethnicity, gender, and federal poverty status. Because the YRBS does not include an indicator of socioeconomic status, logistic regressions were conducted to predict depressive symptoms and suicidality while adjusted for race/ethnicity and gender.

RESULTS

Comparing High School Students to Youth Ages 18–25

Sexual identity. Nearly 12% of young adults ages 18–25 identified as gay/lesbian (2.8%) or bisexual (8.9%). Prevalence rates for gay/lesbian (2.4%) and bisexual (8.0%) high school students in the 2017 YRBS were not significantly different from those obtained for those ages 18–25. The percentage of individuals who were unsure of their sexual identity was significantly less among those ages 18–25 with less than one percent (.6%) indicated that they did not know their sexual identity, compared to 4.2% among high school students who indicated they were “not sure.”

Suicidality. A significantly higher proportion of LGB high school students and young adults ages 18–25 reported seriously considering, planning, and attempting suicide compared to straight peers (See Table 1). Overall, rates of seriously considering, planning, and attempting suicide were significantly lower among youth ages 18–25 compared to high school students. The magnitude of the disparities between straight and LGB youth for seriously considering suicide in the past year were reduced among those ages 18–25 (8.9% straight vs. 27.3% LGB) compared to high school students (13.3% straight vs. 47.7% LGB). However, the magnitude of disparities for making a plan to attempt suicide among those ages 18–25 (2.6% straight vs. 10.4% LGB) compared to high school students (10.4% straight vs. 38.8% LGB) and attempting suicide among those ages 18–25 (1.3% straight vs. 5.7% LGB) compared to high school students (23.0% straight vs. 38.8% LGB) remained relatively stable. Figure 1 provides prevalence rates for lesbian/gay, bisexual, and straight youth for each suicidality indicator among high school students based on YRBS data and among young adults ages 18–25 based on NSDUH data. A larger percentage of bisexual high school students endorsed each suicidality indicator compared to gay/lesbian students, with the proportion of bisexual and gay/lesbian youth ages 18–25 who reported suicidality being virtually identical.

Table 1. Weighted Prevalence Rates of Past Year Suicidality by Sexual Identity

High School Students Straight High School Students Lesbian/Gay/Bisexual Ages 18–25 

Straight

Ages 18–25 Lesbian/Gay/Bisexual
Estimate 95% CI Estimate 95% CI Estimate 95% CI Estimate 95% CI
Seriously thought about killing self in past year 13.30% 12.5–14.3% 47.70% 43.7–51.8% 8.90% 8.2–9.5% 27.30% 24.5–30.4%
Made plans to kill self in past year 10.40% 9.3–11.7% 38.00% 34.5–41.7% 2.60% 2.3–2.9% 10.40% 8.4–12.8%
Attempted to kill self in past year 5.40% 4.6–6.4% 23.00% 18.6–28.0% 1.30% 1.1–1.7% 5.70% 4.3–7.5%

Figure 1: Weighted Prevalence Rates of Past Year Suicidality by Sexual Identity

Depression. Among LGB young adults ages 18–25, 30.9% met DSM criteria for a major depressive episode in the past year compared to 11.1% of straight peers. A greater proportion of bisexual young adults ages 18–25 met criteria for a major depressive episode (32.7%) compared to gay/lesbian young adults (26.8%). The YRBS uses a single item asking students whether they felt so sad or hopeless nearly every day for at least two weeks in the past year that they stopped doing some usual activities. Among LGB high school students, 63.0% endorsed this item on depressive symptoms, compared to 27.5% among straight high school students. Rates were higher for bisexual students (66.0%) compared to gay/lesbian students (53.1%).

Adjusted Odds of Depression and Suicidality

After controlling for race/ethnicity, gender, and poverty status, LGB individuals ages 18–25 were more than four times as likely to make a plan to attempt suicide (aOR=4.09, p<.001) and attempt suicide (aOR=4.27, p<.001), more than three and a half times as likely to seriously consider suicide (aOR=3.60, p<.001), and more than three times as likely to report a major depressive episode (aOR=3.20, p<.001) in the past year compared to their straight peers (See Table 2). After controlling for race/ethinicty and gender, LGB high school students were more than four and a half times as likely to make a plan to attempt suicide (aOR=4.78, p<.001) and more than four times as likely to attempt suicide (aOR=4.42, p<.001) compared to their straight peers. The 95% confidence intervals for making a suicide plan and attempting suicide overlap, indicating that any differences between the adjusted odds for high school students and those ages 18–25 are not significant. The adjusted odds of seriously considering suicide were higher among LGB high school students than among those ages 18–25, with LGB high school students (aOR=5.26, p<.001) more than five times as likely to seriously consider suicide as straight students. LGB high school students (aOR=3.76, p<.001) were almost four times more likely than straight high schools students to report feeling so sad or hopeless nearly every day for at least two weeks in the past year that they stopped doing some usual activities (See Table 3).

Table 2. Adjusted odds of depression and suicidality among lesbian, gay, and bisexual young adults ages 18–25 compared to straight peers 

Seriously considered suicide in past 12 months Suicide plan in past 12 months Suicide attempt in past 12 months Major depressive episode in past 12 months
aOR 95% CI aOR 95% CI aOR 95% CI aOR 95% CI
Gender (male ref)
  Female 1.19 1.02–1.40 1.12 .84–1.48 1.11 0.77–1.61 1.67 1.43–1.94
Income (more than 2x poverty level ref)
  Up to 2x poverty threshold 1.02 0.84–1.23 0.91 .71–1.15 1.14 0.78–1.67 0.87 .75–1.02
  Living in poverty 1.01 0.86–1.2 1.10 .87–1.39 0.97 0.67–1.41 0.92 .77–1.09
Race/Ethnicity (non-Hispanic White ref)
  Black/African American 0.75 0.60–0.94 1.04 .70–1.54 1.53 .93–2.52 0.54 0.43–0.68
  American Indian/ Alaskan Native 1.54 0.87–2.71 2.54 1.20–5.39 4.62 2.19–9.74 0.94 0.50–1.79
  Pacific Islander 0.26 0.05–1.29 NA NA NA NA 0.39 0.11–1.36
  Asian 0.67 0.45–0.97 0.66 .36–1.20 0.59 0.24–1.41 0.64 0.50–0.83
  More than one race 1.46 1.03–2.05 2.18 1.33–3.55 2.61 1.43–4.79 1.18 0.83–1.70
  Hispanic 0.71 0.58–0.86 0.91 .68–1.23 1.23 0.79–1.92 0.81 0.67–0.97
Sexual Identity

(straight ref)

  LGB 3.60 3.01–4.31 4.09 3.06–5.46 4.27 2.86–6.36 3.20 2.68–3.81

Table 3. Adjusted odds of depressive symptoms and suicidality among lesbian, gay, and bisexual high school students compared to straight peers

Seriously considered suicide in past 12 months Made a suicide plan in past 12 months Attempted suicide in past 12 months Depressive symptoms in past 12 months
AOR 95% CI AOR 95% CI AOR 95% CI AOR 95% CI
Gender (male ref)
Female 1.81 1.59–2.05 1.65 1.42–1.92 1.66 1.25–2.20 2.44 2.22–2.68
Race/Ethnicity (non-Hispanic White ref)
Black/African American 0.63 0.54–0.75 0.79 0.57–1.10 1.28 0.86–1.89 0.81 0.66–0.99
American Indian/Alaskan Native 1.32 0.64–2.76 1.08 0.51–2.27 0.92 0.22–3.87 1.39 0.67–2.88
Pacific Islander 1.21 0.90–1.62 2.04 1.14–3.66 1.77 0.78–4.04 0.96 0.59–1.55
Asian 0.97 0.70–1.35 1.38 0.92–2.09 0.93 0.36–2.39 1.07 0.86–1.32
More than one race 1.28 0.95–1.72 1.62 1.22–2.14 1.68 1.21–2.33 1.36 1.05–1.75
Hispanic 0.87 0.78–0.97 1.02 0.83–1.23 1.30 0.92–1.82 1.15 1.01–1.31
Sexual Identity

(straight as ref)

LGB 5.26 4.44–6.22 4.78 3.86–5.91 4.42 3.25–6.01 3.76 3.20–4.42

LOOKING AHEAD

These data highlight the need for suicide prevention strategies focused on LGB youth from adolescence into young adulthood. With more than 1.8 million LGBTQ youth ages 13–24 seriously considering suicide each year (Green, Price-Feeney, & Dorison, 2019), it is imperative to address suicidality across the full age range. Below we outline implications for research, advocacy, and practice based on our findings. We also highlight implications specific to The Trevor Project.

Implications for Research. There is limited nationwide data examining suicidality across the lifespan, particularly specific to LGBTQ individuals. Similarly, existing studies have shortcomings with respect to how sexual identity was assessed and the inclusion of gender identity. Enhanced national data collection on sexual identity and gender identity, as well as suicidality, would allow greater understanding of disparities across different LGBTQ youth identities, including attention to how the intersectionality of multiple marginalized identities impacts suicidality. Additionally, there is an urgent need to develop and test novel prevention and intervention strategies for LGBTQ youth that are able to be successfully disseminated and implemented on a wide-scale.

Implications for Advocacy. These data highlight the need for LGBTQ-specific suicide prevention policies, funding streams dedicated to suicide prevention among LGBTQ youth, and advocacy efforts to improve sexual identity and gender identity data collection. Data on gender identity is lacking compared to data on sexual identity, and there is an urgent need to include measures of gender identity given the even greater disparities in suicidality among transgender and/or non-binary youth compared to cisgender youth (Price-Feeney, Green, & Dorison, In press). Additionally, the current data were based on suicidality outcomes among LGB youth, but not deaths by suicide, because reliable data are not available. It is critical that advocacy efforts focus on promoting the valid and reliable measurement of sexual identity and gender identity as part of violent death investigations in order to accurately understand factors related to the loss of young LGBTQ lives to suicide.

Implications for Practice. Despite recent strides in advancing LGBTQ rights, there are still astounding disparities in mental health among LGBTQ youth. These disparities highlight the need for LGBTQ-affirmative mental health services, particularly in regions of the U.S. where youth may have few treatment options. There is a need to enhance the LGBTQ-competence of community providers, including those who serve LGBTQ youth in school settings.

Implications for Trevor. These results motivate our commitment to save young LGBTQ lives. Importantly, these data fully support The Trevor Project’s focus on serving both LGBTQ youth and young adults in crisis. Because these findings document that disparities in suicidality persist for LGB youth beyond the age of 18, it is imperative that LGBTQ focused crisis services be available for young adults in addition to adolescents. And given the dearth of data on LGBTQ youth and young adults, these results also motivate Trevor’s continued research on suicidality among LGBTQ youth, so that we may better understand risk and protective factors and measure the impact of our efforts to end LGBTQ youth suicide.

This report is a collaborative effort from the following individuals at The Trevor Project:

Amy Green, PhD
Director of ResearchSamuel Dorison, LLM, MSc
Chief Strategy & Innovation Officer
Myeshia Price-Feeney, PhD
Research Scientist

Recommended Citation: Green, A.E., Price-Feeney, M. & Dorison, S.H. (2019). Suicidality Disparities by Sexual Identity Persist from Adolescence into Young Adulthood. New York, New York: The Trevor Project.

Media inquiries, please contact: 

Kevin Wong
Head of Communications
[email protected]
212.695.8650 x407

For research-related inquiries, please contact: 

Amy Green, PhD
Director of Research
[email protected]
310.271.8845 x242

References

Conner, K. R., Bridge, J. A., Davidson, D. J., Pilcher, C., & Brent, D. A. (2019). Meta-analysis of mood and substance use disorders in proximal risk for suicide deaths. Suicide and Life‐Threatening Behavior, 49(1), 278-292.

Curtin, S. C., & Heron, M. P. (2019). Death rates due to suicide and homicide among persons aged 10–24: United States, 2000–2017. National Center for Health Statistics Data Brief, 330, Hyattsville, MD: National Center for Health Statistics.

Dervic, K., Brent, D. A., & Oquendo, M. A. (2008). Completed suicide in childhood. Psychiatric Clinics of North America, 31(2), 271-291.

Grant, B. F., Saha, T. D., Ruan, W. J., Goldstein, R. B., Chou, S. P., Jung, J., … & Hasin, D. S. (2016). Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiatry, 73(1), 39-47.

Green, A.E., Price-Feeney, M. & Dorison, S.H. (2019). National Estimate of LGBTQ Youth Seriously Considering Suicide. New York, New York: The Trevor Project.

Hedegaard H., Curtin S.C., & Warner M. (2018). Suicide mortality in the United States, 1999–2017. National Center for Health Statistics Data Brief, 330, Hyattsville, MD: National Center for Health Statistics.

Johns, M.M., Lowry, R., Andrzejewski, J., Barrios, L.C., Zewditu, D., McManus, T., et al. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school student–19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report, 68(3), 65-71.

Johns M.M., Lowry R., Rasberry C.N., et al. (2018). Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students — United States, 2015–2017. Morbidity and Mortality Weekly Report, 67, 1211–1215

Kann L., Olsen E.O., McManus T., et al. (2016). Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites. 2015. Morbidity and Mortality Weekly Report Surveillance Summaries, 65, 1-202.

Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.

Price-Feeney, M. Green, A.E., & Dorison, S.H. (In press). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2019). 2018 National Survey on Drug Use and Health Data. Rockville, MD.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014). The TEDS Report: Age of Substance Use Initiation among Treatment Admissions Aged 18 to 30. Rockville, MD.

The Trevor Project. (2019a). The Trevor Project research brief: Fostering the mental health of LGBTQ youth. Available at: https://www.thetrevorproject.org/2019/05/30/research-brief-fostering-the-mental-health-of-lgbtq-youth Accessed January 21, 2020.

The Trevor Project (2019b). National Survey on LGBTQ Mental Health. New York, New York: The Trevor Project.

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Research Brief: Gender-Affirming Care for Youth

Summary

Historically, any identification with activities or expression outside of strict gender roles that were expected to align with one’s sex assigned at birth (SAB) have been frowned upon. Today, there is recognition of the differences between concepts such as gender roles, SAB, gender identity, and gender expression. Youth who do not identify with their SAB may identify as transgender and/or nonbinary (TGNB). TGNB individuals experience higher rates of mental health challenges, with anxiety and depression experienced at nearly 10 times the rate of their cisgender peers (Becerra-Culqui et al., 2018). Furthermore, according to The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health, 54% of transgender and non-binary youth reported seriously considering suicide in the last year, and 29% made a suicide attempt (The Trevor Project, 2019a). Building on decades of empirical evidence linking minority stress to health disparities, research has recently begun to elucidate the relationship between chronic discrimination against TGNB individuals and the mental health disparities they experience (Hatzenbuehler, 2009, Testa et al., 2017).

While minority stress increases these mental health disparities — including the risk of anxiety, depression, and suicidality — among TGNB individuals, gender-affirming care has been shown to improve mental health. Gender-affirming care for TGNB youth may involve social, medical, and legal aspects. Gender-affirming care has been shown to reduce suicide ideation and attempts in transgender individuals, along with social support, familial support, and reduction of discrimination (Bauer et al., 2015, The Trevor Project, 2019b). This brief will review the empirical evidence on psychosocial outcomes related to gender-affirming care for youth with implications for how TGNB youth can be supported.

Results 

Social

Social transition is the primary affirmative care intervention for prepubertal TGNB youth and involves encouraging them to present in the way that feels most genuine to them. It may also include the use of a different name or pronouns aligned with their gender identity.

The evidence for social transition builds upon what is already known regarding positive family and social support; that is, family acceptance of LGBTQ youth is associated with positive mental health (Ryan et al., 2010), whereas higher rates of family rejection are associated with the opposite. For example, young adults from highly accepting families attempt suicide at significantly reduced rates compared to those in low accepting families (31% versus 57%) (Ryan et al., 2009).

TGNB children who have socially transitioned demonstrate comparable levels of self-worth and depression as non-TGNB children. This has been demonstrated in research that asks parents to report on their child’s mental health (Olson et al., 2016) as well as asking the youth themselves (Durwood et al., 2017). Although TGNB youth who have socially transitioned report slightly higher levels of anxiety compared to non-TGNB peers (Durwood, et al., 2016; Olson et al., 2016) the fact that self-worth and depression outcomes are equal is powerful due to the significantly worse mental health outcomes experienced by non-supported TGNB youth.

Further, research has specifically shown lower suicidal ideation and suicidal behavior when a TGNB youth’s chosen name is consistently used. The more contexts that it is used (home, school, work, and friends), the stronger the effects (Russell et al., 2018). Usage of chosen name resulted in a 29% decrease in suicidal ideation and a 56% decrease in suicidal behavior for each additional context in which it was used.

Medical

Medical affirming care can include treatments that postpone physical changes as well as treatments that lead to changes that would affirm one’s gender identity. Pubertal suppression, commonly known as “puberty blockers,” is used to delay the onset of puberty, and hormone therapy is used to promote gender-affirming physical changes. Pubertal suppression and hormone therapy are two components of patient-centered care for youth that have been supported by empirical evidence (WPATH, 2012).

Pubertal suppression may be used for youth currently in the early stages of puberty who are experiencing distress over their sex assigned at birth and their gender identity. Delaying puberty can provide youth more time to explore their gender identity without the development of unwanted physiological changes and may also serve as a precursor to gender-affirming hormone therapy (GAHT). GAHT allows TGNB youth to develop physical characteristics that align with their gender identity. GAHT is specifically appropriate for TGNB youth who have already entered puberty or following a period of pubertal suppression.

Pubertal suppression is associated with decreased behavioral and emotional problems as well as decreased depressive symptoms (de Vries et a., 2011). Prior to pubertal suppression, 44% of youth experienced clinically significant behavioral problems; however, after an average of two years of pubertal suppression only 22% experienced them. And 30% experienced clinically significant emotional problems prior to pubertal suppression compared to 11% after two years of care. Pubertal suppression has also been shown to significantly improve overall psychological functioning after only six months of care (Costa et al., 2015). Additionally, transgender individuals who desired and received pubertal suppression as adolescents have significantly lower lifetime suicidal ideation compared to those who desired but did not receive it (Turban et al., 2020).

Research on GAHT for youth demonstrates positive effects on body image and overall psychological well-being as well as reduced suicidality. GAHT decreases both emotional and behavioral problems (de Vries et al., 2014), similar to what is seen in pubertal suppression. Recent research has also shown that GAHT decreases suicidality, with one study of transgender youth demonstrating that after approximately 1 year of treatment the average level of suicidality was 1/4th what it was before treatment (Allen et al., 2019).

Legal

Affirmative legal interventions allow a young person to change their name and/or gender on their legal documents, including their birth certificate, driver’s license, passport, and social security card. The laws on changing birth certificates or driver’s licenses vary on a state by state basis, whereas changes to a passport or social security card are determined at a federal level.

Early research with TGNB adults has shown that a legal name change may be considered a structural public health intervention that improves access to care and increases socioeconomic stability (Hill 2018). Research has also shown that discriminatory social policies, such as same sex marriage bans, directly contribute to adverse mental health outcomes (Hatzenbuehler 2010). Although more research on the psychosocial benefits of legal interventions for TGNB youth is necessary, existing research on affirming social transitions provides support for the expected psychosocial benefits of legal support for TGNB identities.

Looking Ahead

There have been many opponents to gender-affirming care for TGNB youth. Some of the hesitance regarding gender-affirming care may be due to a misunderstanding of the causes of mental health challenges in TGNB individuals. This brief demonstrates why such care is not only ethical, but medically-necessary (WPATH, 2016). Further, regret is low for gender-affirming care interventions, and a study of 55 transgender adults who had received gender-affirming care as adolescents showed that not one individual experienced regret (de Vries et al., 2014).

As the evidence for gender-affirming care grows, medical and mental health organizations are increasingly shifting to support it. Many major medical organizations have guidelines for working with transgender individuals centered around respect for the patient and shared decision making (American Psychological Association, 2015; American Psychiatric Association, 2018), with some organizations releasing statements explicitly opposing any efforts to prevent access to gender-affirming care. (American Academy of Child and Adolescent Psychiatry, 2019). Given the well-documented risks of negative mental health and suicidality outcomes among TGNB, it is necessary that those serving TGNB provide care that is patient-centered, affirming, and evidence-based.

Although available data solidly highlight the psychosocial benefits of gender-affirming care for TGNB youth, there remains a critical need for additional physical and mental health outcomes data, including through longitudinal studies. Large-scale data collection will better elucidate the risks and benefits of individual treatment options, so that youth and their families can make evidence-informed decisions regarding care. There is also a need for research on how legal and policy decisions about TGNB individuals impact their mental health and well-being. Such data will be crucial to advocacy efforts aimed at supporting TGNB youth.

The Trevor Project is committed to promoting the wellness of all LGBTQ young people and supports gender-affirming care as an evidence-based practice to support TGNB youth. Trevor’s advocacy team is dedicated to fighting against anti-TGNB policy positions and for policies that ensure that young people have access to beneficial gender-affirming care. Our research team conducts studies which seek to improve our understanding of ways to end suicide and reduce disparities for LGBTQ youth, including ways to better support TGNB youth. Our public education programs aim to further increase knowledge of ways to support TGNB youth in schools and communities. And our 24/7 crisis services via call, text, or chat ensure that every young person who reaches out to us receives the help they need in that moment.

References

Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7(3), 302–311.

American Academy of Child and Adolescent Psychiatry (2019). Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth. Available at: https://www.aacap.org/AACAP/Latest_News/AACAP_Statement_Responding_to_Efforts-to_ban_Evidence-Based_Care_for_Transgender_and_Gender_Diverse.aspx. Accessed January 1, 2020.

American Psychiatry Association (2018). Position Statement on Access to Care for Transgender and Gender Variant Individuals Available at: https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2018-Access-to-Care-for-Transgender-and-Gender-Diverse-Individuals.pdf. Accessed January 1, 2020.

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832– 864.

Bauer G.R., Scheim A.I., Pyne J., Travers R., Hammond R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15, 525.

Becerra-Culqui T.A., Liu Y., Nash R., et al. (2018). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141(5),e20173845.

Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: a systematic review. Pediatrics, 141(4), e20173742.

Costa R., Dunsford M., Skagerberg E., Holt V., Carmichael P., & Colizzi M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. Journal of Sexual Medicine,12, 2206–2214.

de Vries A.L., McGuire J.K., Steensma T.D., Wagenaar E.C., Doreleijers T.A., & Cohen-Kettenis P.T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696-704.

de Vries A.L., Steensma T.D., Doreleijers T.A., and Cohen-Kettenis P.T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.

Durwood L., McLaughlin K.A., & Olson K.R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 116-123.

Hatzenbuehler M.L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5),707–730.

Hatzenbuehler, M. (2010). Social factors as determinants of mental health disparities in LGB populations: Implications for public policy. Social Issues and Policy Review. 4(1):31-62.

Hill, B.J., Crosby, R., Bouris, A. et al. (2018). Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color. Sex Res Soc Policy, 15(1):25-33.

Olson K.R., Durwood L., DeMeules M., & McLaughlin K.A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223.

Ryan C., Huebner D., Diaz R.M., & Sanchez J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352.

Ryan C., Russell S.T., Huebner D., Diaz R., & Sanchez J. (2010) Family acceptance in adolescence and the health of LGBT young adults. Journal of Child & Adolescent Psychiatric Nursing, 23(4):205–213.

Russell S.T., Pollitt A.M., Li G., & Grossman A.H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), 503–505.

Testa R.J., Michaels M.S., Bliss W., Rogers M.L., Balsam K.F., Joiner T. (2017). Suicidal ideation in transgender people: Gender minority stress and interpersonal theory factors. Journal of Abnormal Psychology,126(1), 125–136.

The Trevor Project. (2019a). National Survey on LGBTQ Mental Health. New York, New York: The Trevor Project.

The Trevor Project. (2019b). The Trevor Project research brief: Fostering the mental health of LGBTQ youth. Available at: https://www.thetrevorproject.org/2019/05/30/research-brief-fostering-the-mental-health-of-lgbtq-youth Accessed January 21, 2020.

Turban, J.L., King, D., Carswell J.M., & Keuroghlian, A.S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725

WPATH (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People Version 7. Available at: https://www.wpath.org/publications/soc Accessed January 22, 2020.

WPATH (2016). Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. Available at: https://www.wpath.org/newsroom/medical-necessity-statement Accessed January 1, 2020.

For more information please contact: [email protected]

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South Dakota Lawmakers Propose Medical Care Ban Harmful to Transgender Youth

South Dakota legislators recently proposed HB 1057, a bill that would criminalize medical care for any transgender patient under the age of 18, even when such care is deemed medically necessary and has the consent of the patient’s parents. The proposed legislation goes against medical care best practices for transgender youth, which are backed by the American Academy of Pediatrics and other leading medical authorities.

The Trevor Project recognizes these legislative attacks on transgender youth as harmful, and encourages lawmakers to instead work towards creating safe, affirming environments for all young people to thrive.

“Transgender youth deserve to be loved and affirmed, not demonized by the very people elected to represent them,” said Sam Brinton (they/them pronouns), Head of Advocacy and Government Affairs at The Trevor Project. “We know based on the work we do every day at The Trevor Project that respecting and affirming a young person’s identity is critical to their health and wellbeing. Blanket bans on medically necessary care for transgender youth contradict the resounding conclusion of nearly every major medical association in the United States and would put young lives at risk in South Dakota.”

In The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health, 76% of LGBTQ youth felt that the recent political climate impacted their mental health or sense of self. In addition, 78% of transgender and non-binary youth reported being the subject of discrimination due to their gender identity.

Over the last year, The Trevor Project has supported over 150 crisis contacts in South Dakota. As troubling as that is, that’s less than 5% of the number of South Dakota’s LGBTQ youth who we estimate to be in crisis and could benefit from our services. The Trevor Project’s experience also shows that anti-transgender rhetoric and legislation cause real harm. In 2017, The Trevor Project reported that crisis contacts from transgender youth more than doubled following the president’s tweet regarding transgender military service members and the announcement of a “bathroom bill” in the Texas legislature.


Progress in Virginia: Protecting Youth from Conversion Therapy

2020 legislative sessions have begun across the nation and Virginia is the first to take action on protecting LGBTQ youth from the dangerous and discredited practice of conversion therapy. A subcommittee of the Virginia Senate Education and Health Committee voted this morning to move SB 245, which prohibits licensed health care providers from subjecting minors to conversion therapy, to a full committee vote as soon as this Thursday.

Casey Pick, The Trevor Project’s Senior Fellow for Advocacy and Government Affairs, was in Richmond this morning to testify before the subcommittee in favor of these vital protections. From her prepared remarks, “many of the young people that we serve are survivors or have a credible fear that their family members will compel them to go through conversion therapy. Supervisors for The Trevor Project’s crisis services report that these issues come up regularly, and as often as weekly. Data collected on TrevorLifeline, TrevorText, and TrevorChat show that since 2010 hundreds of youth in crisis have reached out to The Trevor Project with specific concerns around this practice and terms like ‘conversion therapy,’ ‘reparative therapy,’ and ‘ex-gay’ have appeared on our text-based platforms with disturbing frequency.”

The legislation, introduced by Senator Scott Surovell, prohibits mental health practitioners licensed by a regulatory board of the Virginia Department of Health Professions from engaging in conversion therapy with any person under 18 years of age and provides that such counseling constitutes unprofessional conduct and is grounds for disciplinary action. Furthermore, the bill prohibits state funds from being used for the purpose of conducting conversion therapy, referring a person for conversion therapy, or awarding a grant or contract to any entity that does either.

The Trevor Project is proud to fight alongside fellow advocates who have been working for years to protect LGBTQ youth in Virginia through both the legislative and regulatory process, including champions from Equality Virginia, PFLAG, Born Perfect, and various medical and mental health organizations from across the Commonwealth.


Conversion Therapy: What’s Happening in 2020?

Since 2012, 18 states and the District of Columbia have acted to protect LGBTQ youth from the dangerous and discredited practice of conversion therapy — with Utah poised to become the 19th state in the coming weeks. That momentum looks to continue in 2020: the states of Florida, Missouri, Virginia, Kentucky, and West Virginia have already filed such bills for the 2020 legislative session, with Oklahoma, Minnesota, and others preparing to take action before the sessions begin.

According to The Trevor Project’s research, LGBTQ youth who report having at least one accepting adult were 40% less likely to report a suicide attempt in the past year. As more community leaders take action to protect young people from the trauma of conversion therapy, imagine how supported and affirmed LGBTQ youth will feel about their identities.

That’s why The Trevor Project’s Advocacy team continues to work with the leaders and local advocates across the country to educate more lawmakers and their constituents about the harms of conversion therapy. We work together to ensure that these vital protections continue to progress state by state; as well as within the federal government.

If you’d like to join the effort to save young lives across the nation, please visit TheTrevorProject.org/50B50S to learn more.


The Trevor Project Files Amicus Brief at the 4th Circuit Supporting Protections Against Conversion Therapy in Maryland

As 2019 comes to a close, The Trevor Project continues to advocate  for LGBTQ youth in America’s courts. Today we submitted an amicus brief at the 4th Circuit Court of Appeals in the case of Doyle v. Hogan defending Maryland’s law protecting youth from the dangerous and discredited practice of conversion therapy.

In this case, Doyle is an infamous conversion therapist based in northern Virginia; Hogan is Governor Hogan, who signed Maryland’s bill protecting the state’s youth into law in 2018. Earlier this year, a federal district court upheld the law as constitutional — we were proud to submit a friend-of-the-court brief then, as well.

Our current brief, in addition to citing The Trevor Project’s direct experience serving LGBTQ youth who contact us after being subjected to conversion therapy and data from our 2019 LGBTQ Youth Mental Health Survey, has been updated to include the latest social science research published in the American Journal of Public Health and JAMA Psychiatry regarding the dangers of conversion therapy aimed at an individual’s gender identity. From personal stories to rigorous scientific surveys, the evidence is clear — protecting youth from conversion therapy is an important part of preserving LGBTQ mental health.

The Trevor Project was represented in this matter by pro bono counsel from Gibson Dunn, including Stuart Delery, Lora MacDonald, Corey Singer, and Dione Garlick.


Jonathan Van Ness, Madison Beer, Ian Alexander, and More Share Self-care Tips for LGBTQ Youth

By Kevin Wong (he/him)

As the holidays and new year approach, The Trevor Project recognizes that the season can be a particularly stressful time for LGBTQ young people. According to Tia Dole, Ph.D., the Chief Clinical Operations Officer for The Trevor Project, “we hear from LGBTQ young people across the country, so we know that they can sometimes have complex family relationships. Family time tends to be magnified during the holidays, and self-care can be an important step in identifying ways to support ourselves.”

To determine a self-care routine, “it’s important to discover what helps you feel cared for, relaxed, and able to cope with everything that’s going on,” according to the organization’s coming out handbook. To help LGBTQ youth explore holiday self-care methods for themselves, we asked some of our most supportive celebrities and influencers to share their self-care routines.

“During the holidays, take extra time to really take care of yourself more than you normally would,” says Queer Eye star Jonathan Van Ness. As a mental health advocate, he often shares the importance of chasing passions and finding safe spaces for people to be themselves. “Whatever brings you self and life affirming joy — your version of figure skating or gymnastics — or taking time to try something new that you’re really excited about, can be really helpful when dealing with social anxiety during the holidays because it gives you something to look forward to and to get to know yourself better.”

Singer Madison Beer says, “for some reason my anxiety spikes up during the holiday season,” so she uses “grounding techniques” to help. “Biting a lemon, or chewing ice really help [to] ground me. Try the 54321 ritual when you’re feeling anxious — 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.”

She also likes to practice self-care throughout the year. “I take time with myself. As simple as that may sound, my bubble baths, face masks, movie watching, reading and painting have really instilled self value within me. I struggled for a long time with how I perceive myself and I still do, but really taking time to be alone and do whatever it might be [that] you love is crucial.”

Time with respectful chosen family is important to actor Ian Alexander, who suggests “surrounding yourself with your chosen family who will respect your correct pronouns and won’t make any ignorant comments about your gender presentation, sexuality, [and] politics.”

According to Dole, “it can be helpful to tell a friend or supportive adult about how you’re feeling — there’s power in knowing you are not alone and have an empathetic ear.” Ian Alexander landed on a similar idea — he recommends to “ask a friend to call you at a random point during the day (or come up with a crisis code word or emoji together) so that you have an excuse to leave the room and get a break. This can buy you 5-10 minutes to breathe, recollect yourself, and prepare to face that homophobic great aunt again.”

Finding the right balance between time with friends, family, and yourself is complicated – something YouTuber Connor Franta understands well. “As much as the holidays are about cherished time spent with others, don’t forget to take moments to check in with yourself,” he says. “Have a bath, take a nap, ground your mind, recharge your body, then go back to surrounding yourself with people you love.”

“You deserve a break this holiday,” agrees fellow mental health advocate and YouTuber Jordan Doww. As a method of self-care, he prioritizes his mental health and ensures he has time to reflect. “I make sure to not spread myself too thin but also to spend time with those who mirror the same love and support I always give.”

Dole reminds us, “regardless of your relationship to the holidays, self-care plans are integral to showing ourselves the love we deserve.” If you or an LGBTQ young person you know would like to explore a safe self-care plan, reach out for free support from The Trevor Project’s 24/7 TrevorLifeline, TrevorText, and TrevorChat services. And as Madison Beer says, “I hope everyone remembers they are loved by their family here at The Trevor Project!”


Research Brief: Lethal Means Safety to Reduce Youth Suicide

Summary

Suicide is the leading cause of violent deaths in the U.S. and the second leading cause of all deaths for youth ages 10–24 (Centers for Disease Control and Prevention, 2019). However, the large majority of U.S. adults, including health care professionals, are unable to correctly identify the most common causes (suicide versus homicide) and means (firearms versus non-firearms) of violent deaths (Morgan et al., 2018). These misperceptions can hinder support and funding for suicide prevention as well as implementation of effective prevention strategies. The role of firearms in deaths by suicide is particularly important as they are the most lethal means available, with a lethality rate that is more than 80% compared to a lethality rate of under 2% for overdoses (Conner, Azrael, & Mille, 2019; Shenassa, Catlin, & Burka, 2003). Lethal means are objects (e.g., medications, firearms, knives) that are used to engage in suicide attempts, and lethal means safety counseling is one of the few evidence-based strategies found to significantly reduce suicide deaths (Zalsman et al., 2016). Lethal means safety counseling involves assessing whether a person at risk for suicide has access to lethal means and working with them and their support system to limit their access to those means in times of crisis. Given the lethality of firearms, the high rates of death by suicide among youth, and the importance of lethal means safety counseling as a suicide prevention strategy, it is imperative to examine lethal means in relation to deaths by suicide among youth. There is also a vital need for data on sexual orientation and gender identity to understand how lethal means impact deaths by suicide among LGBTQ youth. This research brief utilizes data from the Centers for Disease Control and Prevention (CDC’s) National Vital Statistics System to examine suicide deaths among U.S. youth ages 10–24.

Results 

In 2017, firearms were the most common means of suicide deaths among youth ages 10–24 in the U.S., accounting for nearly half of all deaths by suicide. The proportion of suicides attributed to firearms were highest in the South (55%) compared to the Northeast (45%), Midwest (48%), and West (45%). Rates were also lower among youth ages 10–14 (39%), compared to those ages 15–19 (46%), and 20–24 (51%). White non-Hispanic (50%) and Black/African American (50%) youth were more likely to die by suicide using a firearm compared to American Indian/Alaskan Native (38%), Hispanic (37%), and Asian/Pacific Islander (30%) youth.
Between 2007 and 2017 there was a more than 60% increase in the number of suicide deaths by firearms among youth ages 10–24. The number of total suicide deaths among youth ages 10–24 and the number that were firearm-related have both increased every year between 2007–2017. Strikingly, the number of firearm-related suicides more than tripled between 2007 and 2017 for youth ages 10–14. Greater than 60% increases were found across each of the major U.S. census regions. Increases in suicide rates cannot be accounted for by population growth as there was only a 2% increase in the population of youth ages 10–24 between 2007 and 2017 (US Census Bureau, 2019).

Methodology

Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. The CDC’s Web-Based Injury Statistics Query and Reporting System was used to compile National Vital Statistics data on annual suicide counts for youth ages 10–24. Suicide rates were examined by means and segmented by 5-year age groups (10–14, 15–19, and 20–24 years), race/ethnicity based, and U.S. Census regions (Northeast, South, Mid-West, and West). The cause-of-death lists are based on the International Classification of Diseases-10. Of note, suicide rates in the National Vital Statistics System are likely an underestimate of the actual prevalence because some suicides, particularly those resulting from overdoses, might be inappropriately counted as an accidental death or unintentional injury (Stone et al. , 2017).

Looking Ahead

The most recently available national data on deaths by suicide indicates firearms as the primary means involved in suicide deaths among youth. Further, total suicide deaths and firearm related suicide deaths are continuing to increase among youth ages 10–24. In order to achieve the goal of ending suicide among youth, there is a dire need for funding devoted to better understanding the causes of suicide and to the implementation of practices known to reduce suicide deaths. In line with our collaborative Model School District Policy on Suicide Prevention, The Trevor Project supports the evidence-based practice of lethal means safety counseling (Zalsman et al., 2016), which suggests limiting a youth’s access to mechanisms for carrying out a suicide attempt in times of crisis.

Additionally, there is currently a lack of systematic data collection on sexual orientation and gender identity (SOGI) at the time of death, which limits our understanding of the risks that lead to violent death among LGBT youth, a population more than four times as likely to attempt suicide compared to peers (Johns et al., 2019; Kann et al., 2018). For example, the aforementioned data was able to be segmented by means, census region of the U.S., age group, and race/ethnicity, but not sexual orientation or gender identity. Currently, The Trevor Project and other leading suicide prevention organizations are working to improve training and procedures on the collection of sexual orientation and gender identity as part of death investigations. Through the ongoing efforts of our research, education, advocacy, and crisis services programs The Trevor Project continually works towards a day when suicide is no longer a major cause of death for youth.

References

Centers for Disease Control and Prevention (2019). Web-based Injury Statistics Query and Reporting System (WISQARS) [Data tool]. Retrieved from https://webappa.cdc.gov/sasweb/ncipc/leadcause.html. Accessed on October 10, 2019.

Conner A, Azrael D., Miller M. (2019). Suicide case-fatality rates in the United States, 2007 to 2014: A Nationwide population-based study. Annals of Internal Medicine, 171, 885–895.

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