By Hazel Marzetti.
Yasmin: For LGBT+ young people specifically, just societally, if you have a feeling, especially when you’re young that you’re not going to be accepted and it’s going to be harder for you to sort of move through the world because of your identity, that brings a real feeling of hopelessness.
Suicide is a leading cause of death amongst young people aged 15-29, second only to road traffic accidents . Amongst this young population lesbian, gay, bi and trans (LGBT+) young people are estimated to be somewhere between 2 and 4 times more likely than cisgender (non-trans), heterosexual young people to think about, plan and attempt suicide [2, 3, 4]; and it is thought that bi  and trans  youths may be at a particularly heightened risk. Although this disparity is widely acknowledged, less is known about the factors contributing to this inequality or about the factors that might keep young people safe and well . This said, it is often argued that discrimination, stigma and harassment play a key role in explaining why LGBT+ young people think about, attempt and die by suicide  . However, this has been criticised for not sufficiently accounting for the interaction between factors specifically affecting the LGBT+ population and those that affect both the wider youth population and the general population as a whole [7, 10].
Here in the UK there is a paucity of research exploring this topic and this is particularly the case in Scotland; and there is even less research using qualitative research methods. This is where my research focuses: I have used qualitative research methods to try and understand young LGBT+ people’s experiences of suicide in Scotland. I used conversational interviews with 24 LGBT+ young people aged 16-24 who had experienced suicidal distress. Although my doctoral research project explored contributory and protective factors, for this World Suicide Prevention day blog I wanted to take the opportunity to tell you about my participants’ suggestions for actions that could be taken to reduce LGBT+ youth suicide in the future.
Participants reported a myriad of both LGBT+ specific factors and more general contributory and protective factors to their suicidal thoughts and attempts. However, their suggestions for reducing LGBT+ youth suicide in the future clustered around 2 topics: reducing stigma and improving support.
The majority of participants in the study had experienced stigma and harassment directed at their LGBT+ identity, and many had experienced further stigma about their mental health, self-harm and suicide experiences. Many had experienced directly homophobic, biphobic or transphobic comments or attacks for example parents telling their daughter that she was “destroying the family” by coming out as gay or the trans man filmed whilst using the boys’ toilets at school. However, this was aided by a broader culture which positioned LGBT+ identities as a deviant disruption to a cisgender, heterosexual status quo [11, 12, 13]. This context facilitated a range of micro-aggressions, jokes, comments or questions that reminded young people of their difference to their cisgender, heterosexual peers .
Sophie: There were repeated comments, even if it wasn’t malicious, it was just as a joke at the time. So, at one point I would have people at school, my dad, and my brother, all at the same time, with different intents, telling me, you’re disgusting, it’s fucking wrong. And if someone tells you something enough, you start to believe it, and that’s where I was really badly self-harming, or I was staying out late, so I didn’t have to go home. And that was a really, really bad time.
To combat this queerphobic cultural context, participants suggested that we needed to invest firmly in an LGBT+ informed curriculum in schools (for more information on what is currently being done please see: https://www.gov.scot/groups/lgbt-inclusive-education-implementation-group/). For the young people in my study this had 3 benefits: (i) reducing stigma amongst the school population; (ii) helping young LGBT+ people see themselves reflected and thus easing the processes of exploring their LGBT+ identity; and (iii) creating future generations with greater acceptance of LGBT+ people.
With regard to mental health stigma, some participants felt that mental health was something that was talked about at school in a manner that positioned it outwith the classroom, rather than understanding that many students at school would themselves have experience mental health problems. Changing this narrative was important to participants in the study, who felt that instead of learning about this in an abstract manner, they should instead be taught to identify warning signs of the deterioration of the own mental health, ways to maintain wellbeing by reaching out and communicating their emotions, and ways to effectively support peers.
Much of the messaging around suicide prevention relates specifically to the help-seeking behaviours of those that are thinking about suicide, encouraging people to reach out and seek support. However, many participants in this study had been very proactive in seeking help for their suicidal distress, but had not managed to access support, often due to lack of resources in services they tried to access.
Lynsey: it’s not even where to go, it’s there being resources when you’re there I think.
As a result, participants strongly advocated for an expansion in mental health services (both adult and child and adolescent) in order to ensure that when a young person reached out, support was able to be provided. Further to this, participants felt when they had accessed services, mental health professionals had not always been knowledgeable about LGBT+ issues and therefore that a greater awareness would help to improve service provision. Finally, as has been found elsewhere young people often seek help from peers [15, 16], prior to seeking professional help, and so it was suggested that it would be useful to have more formalised peer support training for young people to help them to feel more confident and comfortable if their peers reached out to them.
Take away message
To conclude this article, I want to talk to readers about what each and every one of us can do to help reduce LGBT+ youth suicide, which is now an even more of a pressing concern during the pandemic with some young people left trapped in difficult home situations . For LGBT+ young people social isolation, feeling like a burden and experiencing entrapment were often intertwined with the rejection, stigma and harassment they faced in response to their LGBT+ identity, increasing risk of suicidal thoughts and attempts. These experiences provided the backdrop against which other challenges such as adverse childhood experiences and educational difficulties were faced, further increasing risk. The cumulative weight of both LGBT+ specific and more general factors interacting provided the context in which participants had begun to see their lives as unliveable. Whilst the every day average Jo probably can’t do a tremendous amount about the large structural barriers such as the erasure of LGBT+ people and people experiencing mental health conditions in classroom or the under-resourcing of mental health provision, there are every-day actions to help. Some of it starts with educating ourselves to make up for failings in our education system; some of it is about making sure that we don’t stand silently by when others make inappropriate comments or jokes; and some of it is about supporting organisations who do specialist work (I’ve listed some below, although of course it is not an exhaustive list).
Please take care of yourself this World Suicide Prevention Day.
Organisations you might want to check out:
- LGBT Youth Scotland: https://www.lgbtyouth.org.uk/
- Mind Out: https://www.mindout.org.uk/
- Switchboard LGBT: https://switchboard.lgbt/
- Mermaids: https://mermaidsuk.org.uk/
- Proud Trust: https://www.theproudtrust.org/for-young-people/lgbt-youth-groups/proud-trust-groups/
- LGBT Health and Wellbeing: https://www.lgbthealth.org.uk/
 World Health Organisation. (2014). Preventing suicide A global imperative. Luxembourg. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1
 di Giacomo, E., Krausz, M., Colmegna, F., Aspesi, F., & Clerici, M. (2018). Estimating the risk of attempted suicide among sexual minority youths. JAMA Pediatrics, 1–8. https://doi.org/10.1001/jamapediatrics.2018.2731
 Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., … Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. Journal of Adolescent Health, 49(2), 115–123. https://doi.org/https://dx.doi.org/10.1016/j.jadohealth.2011.02.005
 Miranda-Mendizábal, A., Castellví, P., Parés-Badell, O., Almenara, J., Alonso, I., Blasco, M. J., … Alonso, J. (2017). Sexual orientation and suicidal behaviour in adolescents and young adults: Systematic review and meta-analysis. British Journal of Psychiatry, 211(2), 77–87. https://doi.org/10.1192/bjp.bp.116.196345
 Rimes, K. A., Shivakumar, S., Ussher, G., Baker, D., Rahman, Q., & West, E. (2018). Psychosocial Factors Associated With Suicide Attempts, Ideation, and Future Risk in Lesbian, Gay, and Bisexual Youth. Crisis, 40(2), 83–92. https://doi.org/10.1027/0227-5910/a000527
 Connolly, M. D., Zervos, M. J., Barone II, C. J., Johnson, C. C., & Joseph, C. L. M. (2016). The Mental Health of Transgender Youth: Advances in Understanding. Journal of Adolescent Health, 59(5), 489–495. https://doi.org/10.1016/j.jadohealth.2016.06.012
 McDermott, E., & Roen, K. (2016). Queer Youth, Suicide and Self-Harm Troubled Subjects, Troubling Norms. London: Palgrave Macmillan. Retrieved from https://link-springer-com.ezproxy.lib.gla.ac.uk/content/pdf/10.1057%2F9781137003454.pdf
 Hatzenbuehler, M. L., & Pachankis, J. E. (2016). Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth Research Evidence and Clinical Implications. The Pediatric Clinics of North America, 63(6), 985–997. https://doi.org/10.1016/j.pcl.2016.07.003
 Meyer, I. H., Luo, F., Wilson, B. D. M., & Stone, D. M. (2019). Sexual orientation enumeration in state antibullying statues in the United States: Associations with bullying, suicidal ideation, and suicide attempts among youth. LGBT Health, 6(1), 9–14. https://doi.org/10.1089/lgbt.2018.0194
 Bryan, A., & Mayock, P. (2017). Supporting LGBT Lives? Complicating the suicide consensus in LGBT mental health research. Sexualities, 20(1–2), 65–85. https://doi.org/10.1177/1363460716648099
 Ahmed, S. (2006). Queer Phenomenology. Durham and London: Duke University Press.
 Ansara, Y. G., & Hegarty, P. (2012). Cisgenderism in psychology: pathologising and misgendering children from 1999 to 2008. Psychology & Sexuality, 3(2), 137–160. https://doi.org/10.1080/19419899.2011.576696
 Rich, A. (1980). Compulsory heterosexuality and lesbian existence. Signs: Journal of Women in Culture and Society, 5(4).
 Munro, L., Travers, R., & Woodford, M. R. (2019). Overlooked and Invisible: Everyday Experiences of Microaggressions for LGBTQ Adolescents. Journal of Homosexuality, 66(10), 1439–1471. https://doi.org/10.1080/00918369.2018.1542205
 Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Children, Violence and Bullying: International Perspectives, 31, 271–281. https://doi.org/10.1521/suli.22.214.171.124.24219
 McDermott, E., Hughes, E., & Rawlings, V. (2016). Queer Futures. Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour. Final Report. Retrieved from http://www.queerfutures.co.uk/wp-content/uploads/2016/06/Queer-Futures-Final-Report.pdf
 Kneale, D., & Bécares, L. (2020). The mental health and experiences of discrimination of LGBTQ + people during the COVID-19 pandemic : Initial findings from the Queerantine Study, 1–25.
Hazel Marzetti (@HazelMarzetti) is a doctoral researcher at the University of Glasgow’s MRC/CSO Social and Public Health Sciences Unit and the Suicide Behaviour Research Laboratory. She is interested in the ways that qualitative research can improve understanding of health inequalities, particularly amongst marginalised and oppressed groups. In her spare time Hazel is a youth work assistant at LGBT Youth Scotland in Edinburgh.