3 - (SYM 121) The Moderating Effect of Gender Identity in a Stepped Care Trial for Suicide and Self-harm Prevention Among Adolescents and Young Adults

Background: Compared to their heterosexual and cisgender peers, sexual and gender minority (SGM) youth report far higher rates of suicidal ideation and suicide attempts (Bauer et al., 2015, Haas et al., 2010). Among SGM youth, transgender and gender diverse youth are at especially high risk for suicide and self-harm behavior (Toomey et al. 2018). The current study presents data from a randomized clinical trial of stepped care for suicide and self-harm prevention in adolescents and young adults. 301 youths aged 12-24 were enrolled with the following inclusion criteria: either past year suicidal behavior or suicidal ideation with method and intent or past-year depression, plus previous suicide attempt and/or ≥ 3 non-suicidal self-injury episodes. Youth were randomized into two treatment arms based on the zero suicide framework: health system zero suicide quality improvement (ZSQI) and ZSQI plus stepped care for suicide prevention that triaged participants to suicide-specific treatments based on assessed risk levels.       

Methods: Moderation analyses were run to determine if gender minority identity demonstrated an interaction effect on treatment outcomes and level of care during the 12 month follow up time point. Only participants with complete gender identity data were used for these analyses.

Results: There was an interaction effect for gender minority identity on level of care and the outcome of self-harm at the 12 month follow up time point χ² (1, N = 282) = 4.03, p = .045.

Conclusion: As transgender and gender diverse youth are at elevated risk for suicide and self-harm, even when compared to sexual minority youth, it is essential to identify treatments to address this disparity. There is preliminary evidence to indicate that the experimental arm in the present study (ZSQI plus stepped care for suicide prevention) was especially effective in reducing self-harm outcomes for gender minority youth when comparing against treatment outcomes for cisgender youth. Further research may be warranted to identify components of this treatment that may function as active ingredients in driving this treatment effect.