The T-ROTS study protocol: A randomized controlled trial of cognitive behavioral therapy - Suicide prevention for transgender and gender diverse young people

Background: Transgender and gender diverse (TGD) young people are at higher risk of suicidality than their cisgender peers. TGD youth experience a peak in mental health challenges during adolescence and young adulthood, with 93 % of first suicide attempts occurring before age 25. The heightened risk of suicidality can be explained through experienced gender dysphoria, gender minority stress and feelings of thwarted belongingness and perceived burdensomeness. Aims: This protocol describes the T-ROTS study (TRans yOung people Therapy Suicide prevention): a single-blind randomized controlled trial examining the efficacy of online cognitive behavioral therapy for suicide prevention developed for TGD young people (CBT-SP-TGD) aged 16–28. The experimental group receiving CBT-SP-TGD will be compared to the control group receiving general online cognitive behavioral therapy for suicide prevention, which is the treatment as usual (TAU). Methods: The primary objective of this study protocol is to describe how we will investigate the efficacy of a CBT-SP-TGD, in reducing suicidal ideation and behavior, and depression, compared to TAU, measured at three months follow-up. The secondary objective is to describe how we will investigate if CBT-SP-TGD helps to decrease participants' minority stress, self-injurious behavior, maladaptive coping strategies and increase participants’ adaptive coping strategies and emotion regulation. We also describe how we will explore intervention effects between different gender identities, and if suicidal ideation is reduced through decreasing thwarted belongingness and perceived burdensomeness. Conclusion: T-ROTS aims to advance understanding of outcomes, mechanisms, and core components of interventions targeting suicidality disparities between cisgender and TGD individuals. It will provide practical guidance for improving mental health and suicide prevention treatment for TGD populations.