The LGBT Health & Development Program

Research Blog—Treating Suicidality in LGB Youth: The Importance of Family Support

Posted on September 10th, 2015 by IMPACT in Families Blog, Featured, Research Blog. No Comments

Written by Kelsey Howard, IMPACT intern.

person showing palm of hand will yellow ribbon painted on it

Photo Credit: Jared Keener, “National Suicide Prevention,” 09, 2013.

Lesbian, gay, bisexual, and transgender (LGBT) youth are at an increased risk for suicide compared to heterosexual youth. Previous research has identified risk and protective factors that predict whether or not LGBT youth will attempt suicide. Among these predictors is family support. LGBT youth who report low family support are more likely to have a lifetime history of suicide attempts. However, LGBT youth who report better support are less likely to attempt suicide [1].

Recently, research has started to focus on adapting family-based suicide prevention programs for use with LGBT youth. For example, researchers have adapted attachment-based family therapy (ABFT) for use with lesbian, gay, and bisexual (LGB) youth and their non-accepting parents [2]. ABFT focuses on improving the relationships between youth and parents by promoting trust, safety, and support. After repairing the relationship between youth and their parents, ABFT then focuses on helping youth build the skills necessary to stay psychologically healthy.

ABFT was developed to treat depressed and suicidal youth. Typical ABFT focuses on five tasks related to relationships and symptoms of depression and suicide:

  • Relational reframe Task – Shifts the focus from treating symptoms to improving family relationships and parent-child attachment
  • Adolescent Alliance Task – Therapist builds relationship with adolescent
  • Parent Alliance Task – Therapist builds relationship with parent
  • Reattachment Task – Parent and adolescent focus on past and present conflict in their relationship.  Therapists encourage good communication, problem solving, and acceptance
  • Competency Promoting Task – Focuses on developing skills related to psychological health

ABFT with LGB youth focuses on these five tasks with some modifications to address relationship issues specific to LGB youth and their parents [2]. Notably, ABFT with LGB youth emphasizes acceptance for LGB parents, exploring the process of overcoming obstacles to acceptance. Therapists spend more time building relationships with parents and youth individually and take time coaching both parents and youth on how to approach relationship issues related to youths’ sexuality. Finally, the competency promoting task emphasizes access to LGB-specific resources and community groups for youth, along with educational materials for parents.

Preliminary findings and qualitative surveys suggest that ABFT can help treat suicidality and promote healthy attachment in LGB youth [3]. This study reported preliminary results for ten LGB teens who reported suicidal ideation and symptoms of depression. Nine of the ten teens had attempted suicide in the past. Teens and their parents participated in 12 weeks of ABFT. Following treatment, teens reported decreased suicidal ideation. Additionally, teens who completed treatment reported a decrease in anxiety surrounding relationships with their mother.

This study suggests that family-focused treatments can reduce suicidality in LGB youth. However, the ABFT LGB model is not without its limits. For example, the developers of the model report that some parents remain resistant to change following treatment. Future research should highlight the role of alternative support systems for youth with treatment resistant and unaccepting families. Additionally, future research should test family-based treatments with transgender youth, who may face a higher risk of suicide than LGB youth [4].

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[1] Mustanski, B., & Liu, R. (2013). A Longitudinal Study of Predictors of Suicide Attempts Among Lesbian, Gay, Bisexual, and Transgender Youth. Archives of Sexual Behavior, 42(3), 437-448. doi: 10.1007/s10508-012-0013-9

[2] Diamond, G.M., & Shpigel, M.S. (2014).  Attachment-based Family Therapy for Lesbian and Gay Young Adults and their Persistently Nonaccepting Parents. Professional Psychology: Research and Practice, 45 (4), 258-268.

[3] Diamond, G.M., Diamond, G.S., Levy, S., Closs, C., Ladipo, T., & Siqueland, L. (2011). Attachment-Based Family Therapy for Suicidal Lesbian, Gay, and Bisexual Adolescents: A Treatment Development Study and Open Trial with Preliminary Findings. Psychotherapy, 49(1) 62-71.

[4] Grossman AH, D’Augelli AR. Transgender youth and life-threatening behaviors. Suicide & life-threatening behavior 2007;37:527-537.

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