Help-Seeking for Suicidality Among Rural LGBTQ+ Youth: A Constructivist Grounded Theory Study

Rural gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) youth face heightened suicidality risk due to social and structural health inequities, including isolation, stigma, and inaccessible mental health services. However, little is known about how LGBTQ+ youth seek help when experiencing suicidality. This constructivist grounded theory study examines the help-seeking processes of rural LGBTQ+ youth experiencing suicidality. Drawing on semi-structured interviews with 15 rural-based LGBTQ+ youth (aged 16-25) in Quebec, Canada, we inductively developed the Theory Map of Suicidality Help-Seeking among Rural LGBTQ+ Youth. This theory conceptualizes help-seeking as a cyclical and iterative social process shaped by the interplay between constraints and agency. The first thematic process, concealing LGBTQ+ identities and suicidality, showed how rural conservative social norms (particularly cis-heteronormative expectations) led participants to conceal both their LGBTQ+ identity and their suicidal distress, thereby delaying help-seeking. The second process, confronting systemic barriers, captured how participants confronted geographic isolation, limited availability of formal mental health resources, and inconsistent LGBTQ+ competence among providers. The third process, bridging support, highlighted how participants adjusted to navigate community-based strategies, online resources, and trusted adults to bridge informal supports. Taken together, these processes reveal that help-seeking for suicidality among rural LGBTQ+ youth is dynamic and indelibly shaped by social and structural rural contexts. The Theory Map of Suicidality Help-Seeking among Rural LGBTQ+ Youth offers insights to guide tailored suicide prevention interventions that align with and respond to the unique help-seeking experiences of rural LGBTQ+ youth.