Adapting and Testing a Digital Single Session Intervention for Coping with Minority Stress for Use with Suicidal LGBTQIA+ Adolescents on Inpatient Units

Sexual and gender minority youth (SGMY) have elevated rates of suicidal behavior – three times greater for sexual minority youth and six times greater for gender diverse adolescents. Consistent with this, as many as 50% of patients in adolescent psychiatric inpatient units are SGMY. Numerous studies point to minority stressors (identity-related negative experiences such as micro-aggressions, insults, invalidation) as both a broad and proximal factor in SMGY suicidal behavior, including in the high-risk time following psychiatric hospitalization. Adding programming to help youth cope with minority stressors should be an integral part of any suicide prevention intervention for SGMY, including during hospitalizations for suicidal behavior. To address numerous barriers that seriously limit most units from developing and including therapy programs on these topics, we propose adapting and implementing Project RISE, a digital self-guided single session intervention to bolster SGMY’s abilities to cope with minority stress. Preliminary evidence demonstrates RISE’s acceptability and efficacy in community samples, suggesting potential utility as an adjunctive, low-cost therapy in inpatient settings addressing a currently unmet need.

Aim 1 of the project will identify potential adaptations to content and potential barriers to implementation in inpatient settings through semi-structured focus groups separately conducted with SMGY previously hospitalized for suicidal behavior and with staff members on adolescent psychiatric units.

Themes and feedback will be integrated into RISE-SP (suicide prevention) and a protocol for Aim 2, an open trial of RISE-SP (n=40) with SGMY hospitalized in Butler Hospital’s inpatient unit. We will collect data on feasibility and acceptability, as well as preliminary evidence of immediate and 2-week follow up engagement on target treatment mechanisms (identity stigma, identity pride, self-hate, and hopelessness) and suicide ideation (primary outcome), as well as effects on depression and anxiety (secondary outcomes).

These initial findings will be used as pilot data for NIH proposals for a multisite study implementing and testing RISE-SP. This project aligns with multiple current priorities of the AFSP, including interventions targeting heightened suicide risk for LGBTQ+ adolescents (and specifically, reaching those at highest risk given recent suicidal behavior) and research with high potential impact given the scalable, affordable, and easy to implement intervention.