Every 40 seconds, someone dies by suicide, amounting to 800,000 lives lost every year. In the United States suicide is the 3rd leading cause of death among individuals 15 – 24 years-old, and young LGBTQ+ people are at increased risk for seriously contemplating suicide, making a plan to kill themselves, and attempting to take their lives compared to their heterosexual peers. A 2018 study conducted by Qwell Community Foundation and Dell Medical School researchers found that 26% of young adults in Central Texas thought about suicide at least one day during the past week.
To address this staggering public health problem, a new study led by The University of Texas Southwestern Medical Center, Dell Medical School and The Steve Hicks School of Social Work at The University of Texas at Austin, and Texas Health Institute is rethinking suicide prevention. The study, Reach Out and Connect (ROC) Project: Suicide Prevention in Sexual and Gender Diverse Young Adults in Primary Care in Texas is shifting where we intervene on suicide in LGBTQ+ young adults. Historically, suicide prevention occurs after an attempt has already been made and for good reason. A recent suicide attempt is a strong predictor of death by suicide. In other words, someone who has recently attempted suicide is likely to try again and die by suicide. Their project seeks to intervene much sooner.
Funded by the Patient-Centered Outcomes Research Institute (PCORI) the research is taking a patient-centered approach to understand needs and wants related to working with this population in primary care settings to focus on preventing suicide before young people are in crisis. Currently in its pilot phase, the study is working with primary care and other health clinics in Dallas and Austin, with plans to expand to 36 clinic sites across Texas. The researchers recently completed Phase 1 of the study in which they collected data and worked with a young adult advisory board to understand barriers related to implementing a suicide prevention project in primary care settings with young adult LGBTQ+ Texans. Participants from Phase 1 of the study often described fear of disclosing suicidal thoughts and mental health concerns in general.
“This fear related of loss of autonomy for talking about mental health or suicide can be a real concern for a number of young adults” said Dr. Lauren Gulbas, Associate Professor in the Steve Hicks School of Social Work at UT Austin, suicide expert, and co-investigator on the study, “and it’s understandable for individuals who have been hospitalized. It can be a traumatic experience for some young people.” In fact, several of their study participants during the team’s formative work discussed this fear and noted that it is hard to know what is “okay” to say, so they may not say anything at all about how they are feeling out of fear of being hospitalized. Their experiences with hospitalization may have been traumatic they do not want to seek out care out of concern that they may have the same experience. Unfortunately, this can lead to people not getting the care that they need, which can have serious consequences.
Dr. Phillip W. Schnarrs, Associate Professor of Population Health and Co-Primary Investigator on the study notes this is not just a problem for ROC Project, “This is a major concern because it is not just a barrier to recruitment for our study, but has implications for prevention measures like universal suicide screening in primary care.” Universal suicide screening in primary care settings is supported by the National Alliance of Mental Illness as a “safety net” to identify individuals experiencing suicidal ideation or at risk for suicide as roughly half of individuals who die by suicide are never diagnosed with a medical condition, but as Schnarrs points out, “If young people do not feel safe talking about their mental health or if they are experiencing suicidal ideation simply increasing screening may not help. This is especially true for young LGBTQ+ folks who often experience discrimination or stigma in clinical settings.”
So, what can been done?
The team has worked with the project’s Engagement Team which includes TransFORWARD a PCORI-funded stakeholder engagement project that is a collaboration between Texas Health Institute, Transgender Education Network of Texas, and Equality Texas, as well as other key stakeholders and a young adult advisory board to develop strategies that involve creating safer spaces for LGBTQ+ young adults and encourage young people to talk about their mental health. “This has been a collaborative project from the start,” said Dr. Liz Arnold, Professor and Vice Chair for Research in the Department of Family and Community Medicine at The University of Texas Southwestern Medical Center and Primary Investigator on the study. “The only way we can effectively develop strategies is to communicate that these are safe spaces to talk about mental health for LGBTQ+ young adults and to co-design these strategies with them.”
John Oeffinger from Texas Health Institute and the project Engagement Team lead agrees. “What I have learned in my experience as co-lead on TransFORWARD, is that it all begins with inclusion. If we want to save lives, we first have to engage young people who have struggled with suicidal ideation in the past to understand how we can co-create spaces that are affirming and supportive for young LGBTQ+ adults, especially when they might feel like there is nobody safe to talk to about their identity let alone their mental health. It’s the only way to ensure we can truly understand how to engage young LGBTQ+ people in these settings.”
The ROC Project team will be hold a hybrid town to discuss the project, some of their preliminary findings, and next steps. The town hall will also include a community panel discussion focused on barriers and solutions to suicide prevention is primary care and sexual health clinics in Texas. The Town hall will be held on September 24, 2022 from 2:00 – 4:00 PM at The University of Texas Dell Medical School. For more information about the Town Hall Event please visit out registration page https://redcap.link/ROCProjectRegistration.