From Evidence to Action: Supporting Suicide Prevention for LGBTIQA+ Young People
Caution
This blog post discusses risk and protective factors present for children and young people who have died by suicide, drawing on both published literature and data related to young people who have died in NSW.
Some people may find it confronting or distressing.
If you need help or support, please contact:
- Lifeline on 13 11 14
- Beyond Blue on 1300 22 4636
- Kids Helpline on 1800 55 1800.
- 13YARN – 13 92 76
- QLife – 1800 184 527
ARTD recently worked with staff from the New South Wales Ombudsman (NSW Ombudsman), on behalf of the NSW Child Death Review Team (CDRT), alongside our lived experience co-researchers and academic partners. The project aimed to better understand protective and risk factors for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexually or gender diverse (LGBTIQA+) young people experiencing suicidal distress, and how prevention can be strengthened across the NSW service system.
This blog outlines how we worked together, what we found, and how the work will be used by the CDRT to strengthen prevention.
The context
Youth suicide has been increasing over the past few decades.1 The NSW CDRT, supported and convened by the NSW Ombudsman, reviews and maintains a register of the deaths of all children and young people aged from birth to 17 years in NSW. The CDRT analyses this data to identify trends, undertake research and make recommendations to reduce the risk of preventable deaths of children in the future.
The CDRT’s biennial report of child deaths in 2020 and 2021 highlighted that LGBTIQ+ young people are at higher risk of dying by suicide than their non-LGBTIQ+ peers.2 Of the young people who died by suicide in 2020 and 2021, 17% identified as LGBTIQ+.3
In response to these findings, the CDRT commenced work to better understand these deaths and identify opportunities for prevention. The CDRT commissioned ARTD to conduct a literature review and desktop review of effective suicide preventative measures, protective factors and risk factors for LGBTIQA+ young people, as well as existing countermeasures to support LGBTIQA+ young people in NSW. The CDRT separately undertook a case series study to understand the risk factors commonly associated with death by suicide among LGBTIQA+ young people in NSW from 2018-2023, and to determine if these align with known risk factors identified in the literature review.
The ARTD and CDRT work were combined into a report available here: Suicide-related deaths among sexually diverse, gender diverse and/or intersex children and young people.
What we did
Our approach involved working on the literature and desktop reviews concurrently, so each could inform the other.
Literature review
We worked collaboratively with the CDRT, our lived experience co-researchers and academic partners to develop our search strategy and search terms for a rapid literature review of the protective factors, risk factors and evidence-based preventative measure related to LGBTIQA+ young people experiencing suicidal thoughts and behaviours.
Desktop review
For the desktop review, we took a system mapping approach, whereby we:
- Searched for all publicly available supports, services and policies (termed collectively as countermeasures) for LGBTIQA+ young people in NSW and neighbouring states.
- Collated these into a structured spreadsheet
- Shared the spreadsheet with LGBTIQA+ youth organisations in NSW to ensure we weren’t missing anything.
The spreadsheet then formed the basis of our analysis of gaps and overlaps in the current NSW system to assist the CDRT to develop recommendations.
We met regularly with the CDRT to discuss overlapping themes emerging from the literature review and desktop review, and the case series study being conducted by the CDRT. This allowed findings to be triangulated to provide more robust evidence for the CDRT’s recommendations. We also engaged with the CDRT Suicide Sub-Committee at key points to confirm our approach and discuss and refine interpretation of findings. Working collaboratively enabled a more holistic evidence base, linking what the literature told us to findings from the case series study and desktop review.
What we found
The literature review identified key protective factors, risk factors and preventive measures for which there is the greatest evidence.
Key protective factors were:
- Supportive family relationships: Supportive parental and family relationships were the most prominent protective factor within our literature review.
- Social connectedness: Both having a number of close and trusted friends and being socially accepted by peers are protective factors.
- Positive school experience: Including a safe environment and accepting and caring staff, is highly protective for LGBTIQ+ young people.
- Gender affirmation for TGD young people: Being supported to access gender affirming medical care and legal gender affirmation is protective for trans and gender diverse (TGD) young people.
Key risk factors were:
- bullying and discrimination
- harmful parental and family relationships
- adverse childhood experiences
- intersectional barriers (e.g. racism, cultural exclusion).
The preventative measures were school policies, practices and interventions, affirming care and LGBTIQ+ specific organisations and services.
Through the desktop review, we identified 90 countermeasures across NSW and neighbouring states, ranging from helplines and counselling services to advocacy initiatives and policy settings. Some additional countermeasures were also identified by CDRT during later stakeholder consultation on the report.
Some key observations included:
- over half of countermeasures focus on promoting protective factors
- around one-third provide direct mental health or suicide prevention support
- services are often delivered by not-for-profit organisations
- there is a mix of targeted LGBTIQA+ services and inclusive mainstream services.
While this reflects a relatively broad service landscape, there is an opportunity to increase services that support the key protective factors and promote preventative measures found in the literature.
What happens next
Through the combination of CDRT’s case series study and our literature and desktop review, the CDRT has developed seven recommendations and tabled these to Parliament in their report, Suicide-related deaths among sexually diverse, gender diverse and/or intersex children and young people. The CDRT both monitors and publicly reports on the acceptance and implementation of all its recommendations. This information is published in the CDRT Annual Reports and on the CDRT’s website.
The CDRT has also published our literature and desktop review as a standalone report. This ensures the work is accessible to the sector as a resource in its own right, supporting service providers, policy-makers and researchers to build on the evidence base
