Suicide and LGBTTI Youth - Dr Mathijs Lucassen


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Presentation by Mathijs Lucassen at the symposium LGBTTI Wellness & Suicide: What do we need to change? Hosted in Auckland on 27 February 2013 by Auckland DHB, Affinity Services, OUTLine NZ, Rainbow Youth and the Mental Health Foundation.

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Suicide and LGBTTI Youth - Dr Mathijs Lucassen

  1. 1. “SUICIDE AND LGBTTI YOUTH” Mathijs Lucassen PhDResearch Fellow - Werry Centre for Childand Adolescent Mental Health & Youth’12 Team, Department of Psychological Medicine & School of Nursing University of Auckland
  2. 2. OVERVIEW Definitions – suicide and LGBTTI young people Suicide and young people generally Suicide and LGBTTI young people Two specific interventions/research projects
  3. 3. DEFINITIONS - SUICIDE Suicidal ideation = Refers to thoughts of harming or killing oneself. Attempted suicide = Is a non-fatal, self- inflicted destructive act with explicit or inferred intent to die. Suicide = Is a fatal self-inflicted destructive act with explicit or inferred intent to die.(O‟Carroll et al., 1996)
  4. 4. DEFINITIONS – LGBTTI YOUNG PEOPLE Is this young person….Bisexual?
  6. 6. Trends in youth suicide rates per 100 000 people 15-19 years1816 Italy14 UK OECD-3312 USA Australia10 NZ8 Linear (Italy) Linear (OECD-33)6 Linear (NZ)420 1985 1990 1995 2000 2005 2010 Source Dr Sonia Lewycka (Youth‟12 Team)
  7. 7. RISK FACTORS FOR YOUTH SUICIDE INCLUDE… ↑ Age (Brent et al., 1999) Male sex (Fergusson, Woodward, & Horwood, 2000) Ethnicity (Beautrais, 2001; Borowsky, Resnick, Ireland, & Blum, 1999; Fortune et al., 2010) Severe and frequent suicidal ideation (Lewinsohn, Rohde, & Seeley, 1996) Previous suicide attempt (Brent et al., 1999) Lethality of suicide attempt (Brent et al., 1998)
  8. 8. RISK FACTORS FOR YOUTH SUICIDE INCLUDE… Inter-personal conflict or loss (Brent et al., 1999) Mental ill-health (Brent et al., 1998) Maltreatment (Brent et al., 1999) Exposure to suicide (Brent et al., 1989; Bridge, Goldstein & Brent, 2006)
  9. 9. PROTECTIVE FACTORS FOR YOUTH SUICIDE INCLUDE… Sound mental and emotional wellbeing Good social skills Problem-solving abilities Positive engagement with school Family cohesiveness(Fortune et al., 2010)
  12. 12. YOUTH’07 REPRESENTATIVE NZ SAMPLE(Lucassen et al., 2011; Rossen, Lucassen, Denny, & Robinson, 2009)
  13. 13. YOUTH’07 6% „SEXUAL MINORITY‟ YOUTH1% 3%2% 2% 92% Opposite-sex attracted Same-sex attracted Both-sex attracted Not sure Attracted to neither sex
  14. 14. Longitudinal Christchurch Health and Development Study 2.8% LGB(Fergusson, Horwood & Beautrais, 1999)
  15. 15. YOUTH’07… Mostof the sexual minority youth were not suicidal and did not have significant depressive symptoms…But
  16. 16. YOUTH’07 - INCREASED RISK… n (%) OR (95% CL) p v a lu eCu rre n t d e p re s s iv e <.0001s y m p to m sOpposit e-sex 687 (9.5) 1.0Sa m e-sex 16 (23.3) 1.9 (1.1-3.1)Bot h -sex 86 (32.3) 3.7 (2.8-4.7)Not su r e 30 (21.8) 2.1 (1.3-3.3)Neit h er 14 (9.7) 1.0 (0.6-1.7)Atte m p te d s u ic id e <.0001Opposit e-sex 291 (4.0) 1.0Sa m e-sex 10 (13.9) 4.8 (2.4-9.6)Bot h -sex 59 (21.7) 7.0 (5.2-9.4)Not su r e 14 (10.1) 2.4 (1.1-5.1)Neit h er 8 (5.0) 1.1 (0.6-1.9)
  17. 17. YOUTH’07 – INCREASED RISK… n (%) OR (95% CL) p v a lu eD e libe ra te ly s e lf- <.0001h a rm e dOpposit e-sex 1426 (19.4) 1.0Sa m e-sex 27 (36.9) 2.8 (1.8-4.4)Bot h -sex 156 (57.9) 5.8 (4.4-7.6)Not su r e 44 (30.4) 1.8 (1.1-2.7)Neit h er 20 (13.4) 0.6 (0.4-0.9)
  18. 18. Christchurch Health and Development Study (Fergusson, Horwood & Beautrais, 1999) % OR (95% CL) p v a lu eMa jo r d e p re s s io n(14 to 21 y e a rs o f <.001age)H et er osexu a l 38.2% 1.0LGB 71.4% 4.0 (1.8-9.3)Atte m p te d s u ic id e <.001(e v e r)H et er osexu a l 7.1% 1.0LGB 32.1% 6.2 (2.7-14.3)
  21. 21. WHY ARE LGBTTI YOUTH AT INCREASED RISK? ↑ Rates of bullying/victimisation  Family rejection  ↑ Substance abuse  ↑ Rates of mood disorders (e.g. depression) (Bridge, Goldstein, & Brent, 2006; Russell & Joyner, 2001)
  22. 22. BRIEFLY - TWO RESEARCH PROJECTS Rainbow SPARX Rainbow Youth’s Education Package in Schools (a formal evaluation)
  23. 23. SPARX
  24. 24. UNIQUE ISSUES…Ways participants can Environments & tell that they are their impact different Ways Depression & participants sexuality cope
  26. 26. SPARX: THE RAINBOW VERSION Expressed interest in study (N=44) Not enrolled (N=17) Participants enrolled (N=27) Did not meet criteria (N=6) Depressive symptoms pre-intervention (N=21) Withdrew (N=2) Completed intervention (N=19) [91% of pre-intervention] Lost to follow-up (N=2) Completed three month follow up (N=17) [81% of pre-intervention]
  27. 27. SPARX: THE RAINBOW VERSION –FINDINGS Sexual minority youth were more likely to complete treatment (p=0.007) 85% of sexual minority youth thought the treatment would appeal to other young people Depressive symptoms  significantly from pre- to post-intervention (p<0.0001) with a large pre to post effect size (d=1.01) & this positive change was maintained at follow-up
  28. 28. DO YOU THINK RAINBOW SPARX HELPED YOU FEEL BETTER? “Yes, it made me feel a lot better. I have been much happier because I was able to relate and use the information that I learnt to better my situation” (Troy, 16).
  29. 29. DO YOU THINK RAINBOW SPARX HELPED YOU FEEL BETTER? “Not really, but it did give me something to do at nights so it kind of helped” (Lara, 17).
  30. 30. DO YOU THINK RAINBOW SPARX HELPED YOU FEEL BETTER? “…it worked for me” (Bob, 13).
  31. 31. RAINBOW YOUTH’S EDUCATION PACKAGE - EVALUATION 237 Yr 9 and 10 students from two schools participated in x 2 workshops (sexuality and gender diversity) School climates perceived to be “hard” and “bullying/mocking” for LGBTTI students ¾ believed the workshops would ↓ bullying (Burford, Lucassen, Penniket & Hamilton, unpublished report)
  32. 32. QUESTIONS…
  33. 33. REFERENCESBeautrais, A.L. (2001). Child and young adolescent suicide in New Zealand. Australian and New Zealand Journal of Psychiatry, 35, 647-653.Brent, D.A., Baugher, M., Bridge, J., Chen, T., & Chiappetta, L. (1999). Age- and sex-related risk factors for adolescent suicide. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1497-1505.Brent, D.A., Kerr, M.M., Goldstein, C., Bozigar, J., Wartella, M., & Allan, M.J. (1989). An outbreak of suicide and suicidal behavior in a high school. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 918- 924.Brent, D.A., Perper, J.A., Goldstein, C.E., Kolko, D.J., Allan, M.J., Allman, C.J., et al. (1988). Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry, 45, 581-588.Bridge, J.A., Goldstein, T.R., & Brent, D.A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3/4), 372-394.Borowsky, I.W., Resnick, M.D., Ireland, M., & Blum, R.W. (1999). Suicide attempts among American Indian and Alaska Native youth: Risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 153, 573-580.Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56(10), 876-880.Fergusson, D.M., Woodward, L.J., & Horwood, L.J. (2000). Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological Medicine, 30, 23-39.Fortune, S., Watson, P., Robinson, E., Fleming, T., Merry, S., & Denny, S. (2010). Youth’07: The health and wellbeing of secondary school students in New Zealand: Suicide behaviours and mental health in 2001 and 2007. Auckland: The University of Auckland.
  34. 34. Lewinsohn, P.M., Rohde, P., & Seeley, J.R. (1996). Adolescent suicidal ideation and attempts: Prevalence, risk factors, and clinical implications. Clinical Psychology Science and Practice, 3, 25-36.Lucassen et al. (2011). Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students. Australian and New Zealand Journal of Psychiatry, 45, 376- 383.O’Carroll, P.W., Berman, A.L., Marris., R.W., Moscicki, E.K., Tanney, B.L., & Silverman, M.M. (1996). Beyond the Tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26, 237-252.Rossen, F.V., Lucassen, M.F.G., Denny, S., & Robinson, E. (2009). Youth’07 The health and wellbeing of secondary school students in New Zealand: Results for young people attracted to the same sex or both sexes. Auckland: The University of Auckland.Russell, S., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91(8), 1276-1281.