Preventing suicidality among Dutch Lesbian, Gay, Bisexual and Transgender (LGBT) youth through a web-based intervention addressing suicidality in relation to sexual and gender identity issues

Background Dutch Lesbian, Gay and Bisexual (LGB) youth (Kuyper, 2015) are 3-5 times more likely to attempt suicide than heterosexual youth, and Transgender (T) individuals are 10 times more likely to attempt suicide than nontransgender individuals. Sexual orientation and gender-related issues (“minority stress”) play a pivotal role to suicidality among LGBT youth (Russell & Fish, 2016). Minority stressors (Meyer, 2003) refer to the anticipation of perceived stigma, and experienced negative reactions youth are confronted with due to their non-normative sexual and gender identities, as well as the internalization of such experiences. (Anticipated) stigmatization induces stress and is related to anxiety and self-rejection, and for some even to depression and suicidality (Meyer, 2003). Due to their specific needs and their minority status (Durso & Meyer, 2016), access to effective care is poor for suicidal LGBT youth. A web based treatment for suicidal ideation is appealing to youth (e.g., Lai, Maniam, Chan, & Ravindran, 2014) and it this maybe even more so for minority youth who wish to keep their anonymity (Steinke et al., 2017). We expect that an web-based intervention aimed at reducing suicidal ideation and sexual identity- and gender-related issues among LGBT youth will lead to an improvement of coping with minority stress and eventually to a reduction of suicidality. Main Research Question To what extent is a web-based Cognitive Behavioral Therapy (CBT)-intervention designed specifically for LGBT youth an effective and feasible treatment to reduce suicidality among LGBT youth in The Netherlands? Approach 1. Before we develop the web-based intervention, we first conduct interviews with healthcare professionals, LGBT youth and parents of LGBT youth to identify: 1)The mental healthcare needs of LGBT youth regarding their suicidality; 2)The web-based healthcare needs of LGBT youth; 3)Success factors in relation to working and interacting with LGBT youth; 4)Sensitive approaches in improving the relationship between LGBT youth and their parents with regard to preventing suicidality. 2.We develop a web-based intervention for the treatment of suicidal ideation among LGBT youth based on: a) ‘Reframe-IT’, an existing blended CBT for at-risk adolescents, and ‘Living with Deadly Thoughts’ a self-help online CBT training for suicidal adults, both with proven effectiveness in reducing suicidal ideation. b) an existing face–to-face CBT intervention (‘ESTEEM’) with proven effectiveness among gay and bisexual men in enhancing coping with minority stress and decreasing depression. Reframe-IT and Living with Deadly Thoughts will be adapted to a LGBT population; ESTEEM will be adapted for web-based use with adolescent participants. 3. Considering that parents play an important role in LGBT youth’s coping with minority stress, LGBT youth could benefit from skills to interact with their parents. Hence we will develop contents for the web-based intervention on this topic. Vice versa, parents could be made more aware of warning signs of suicidality in their LGBT children and minority stressors. Hence we will develop contents for a web portal for parents of LGBT youth. 4. Clinical psychologists at 113 Suicide Prevention The Netherlands will be trained by the CBT-expert who developed ESTEEM (Dr. Pachankis) to deliver the intervention, whilst the research team monitors all the research components of the intervention. 5. With an experimental design we will test the effectiveness of the web-based intervention among LGBT youth of 16-27 years old, compared to a treatment as usual group Sample, Research Approach and Recruitment With two focus group interviews among 16 healthcare professionals, experiences with LGBT youth and perspectives towards web-based interventions are assessed. With 20 individual interviews among LGBT youth with a history of suicidality, and 25 parents of LGBT youth with a history of suicidality, experiences with healthcare and communication about suicidality and minority stress are assessed. With an experimental study among 120 LGBT youth, the effectiveness of the web-based intervention is tested. All participants will be recruited offline and online via our broad range of collaborative partners and the network of our (co)-applicants. Anticipated Gains and Products 1.A web based application with E-modules focused on suicidality in LGBT youth 2.Four scientific peer-reviewed articles and a dissertation 3.A brief report including a fact sheet describing the web-based intervention for suicidal LGBT youth professionals and volunteers 4.A protocol for 113 therapists who will deliver the intervention 5.A video instruction for (future) 113 therapists 6.Two accessible articles for professionals 7.A concluding symposium for professionals and volunteers 8.A update of a web portal (“Iedereenisanders”) with information for both LGBT youth and parents of LGBT youth with recommendations and referrals.