A comprehensive model of LGBTQ+ youth suicide attempts to advance LGBTQ+-specific and -sensitive suicide prevention

Background: The LGBTQ+ population, especially youth, is particularly vulnerable to suicide attempts. Existing models and theories – as well as suicide prevention strategies – are either LGBTQ+-specific but lack consideration of the broader living situations not directly related to SOGI (sexual orientation and gender identity), or they are general and fail to account for the specificities of LGBTQ+ youth suicide attempts. Therefore, our study investigated the processual dynamics, background, and subjective meaning of suicide attempts among LGBTQ+ youth, experiences with care and support, and the role of SOGI in these processes. Methods: Qualitative problem-centred interviews were conducted with LGBTQ+ youth in Switzerland who had attempted suicide one to three times between the ages of 14 and 25. Applying a multi-perspective approach, persons from their social environment were also interviewed if possible. Data collection and analysis followed Grounded Theory methodology, including 'theoretical sampling'. The final sample comprised 41 individuals: Seven bisexual/lesbian cisgender women, four bisexual/gay cisgender men, 15 transgender/nonbinary persons with various sexual orientations, three heterosexual cisgender persons, and 12 persons from their respective social environments. Results: The role of SOGI-related factors in the suicide attempt process of LGBTQ+ youth can be described along three types: a) SOGI-related factors, such as SOGI-related bullying or impeded access to gender-affirming care, being the main drivers of the suicide attempt process. b) Other, general factors, such as unsafe familial conditions, school performance pressure and sexualised violence, being the primary reasons for the suicide attempt, but SOGI-related factors exacerbating suicidality in the background. c) SOGI-related and non-SOGI-related factors being similarly important in the suicide attempt process and interplaying to lead to the suicide attempt. In all three types, experiences with access to care and support were found to be a crucial dimension for the suicide attempt process. Discussion: The processual model developed offers a comprehensive understanding of LGBTQ+ youth suicide attempts, aligning SOGI-related and non-SOGI-related factors, along with access to care and support. This study provides a foundation for the development and advancement of LGBTQ+-specific and -sensitive suicide prevention strategies, as well as their coordination with and acknowledgement by general suicide prevention strategies and public health policy.