Conference Agenda

Introduction: Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ+) communities experience disproportionately high rates of suicide. Despite this, most gatekeeper training programs are not designed to reflect the social contexts, structural barriers, and relational dynamics that shape suicide risk and help-seeking within these communities. In particular, many trainings insufficiently address how marginalization and institutional mistrust structure suicide risk and pathways to care for 2S/LGBTQ+ people. This presentation examines how 2S/LGBTQ+ community members envision effective, inclusive, and sustainable online gatekeeper training for suicide prevention.

Methods: We conducted qualitative interviews with 50 2S/LGBTQ+ adults across Canada. Participants were invited to reflect on what they would want to see included in a gatekeeper training program. Data were analyzed using reflexive thematic analysis.

Results: Three interrelated themes were identified. First, participants emphasized that gatekeeper training must meaningfully engage with the complexity and diversity of 2S/LGBTQ+ lives rather than collapsing experiences under a single umbrella category. This included explicit attention to systemic and institutional harms—such as racism, transphobia, and colonialism—and to widespread mistrust of police and healthcare systems. Second, participants highlighted the importance of guidance on boundaries, self-care, and emotional regulation to support sustainable gatekeeping. Many described tensions between feeling responsible for supporting peers in crisis and questioning their own capacity to help, underscoring the emotional labour inherent in peer support roles. Third, participants envisioned gatekeeper training grounded in collective responsibility and community care rather than individual action alone. They advocated for models that foster ongoing networks of support, including online forums, buddy systems, and partnerships with local 2S/LGBTQ+ organizations.

Conclusions: Participants articulated a vision for online gatekeeper training that is intersectional, community-embedded, relational, and sustainable. Centering collective care and structural contexts—rather than focusing solely on individual skill acquisition—may enhance the relevance and effectiveness of suicide prevention interventions for 2S/LGBTQ+ communities.

Introduction: Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ+) communities experience disproportionately high rates of suicidality, yet gatekeeper trainings are rarely tailored to their realities. Existing gatekeeper trainings often overlook population-specific risk factors relevant to 2S/LGBTQ+ communities such as minority stress and oppression. This project aimed to address these gaps through the co-design of an online gatekeeper training tailored to the needs and contexts of 2S/LGBTQ+ individuals.

Methods: The project was informed by a systematic review of online suicide prevention programs and qualitative interviews with 2S/LGBTQ+ community members and suicide prevention experts. Findings guided the development of a two-day co-design workshop involving 24 participants with diverse lived experiences. Co-design was used as a collaborative approach to engage 2S/LGBTQ+ community members as partners in identifying and prioritizing the core content, pedagogical principles, and design features of an online gatekeeper training. The workshop incorporated structured group discussions, voting activities, and storyboarding to translate empirical evidence and community knowledge into a preliminary training model.

Results: Three key priorities emerged. First, participants identified essential gatekeeping competencies, including recognizing suicide risk across in-person and online contexts; fostering trust through empathetic, non-stigmatizing communication; navigating referrals to formal and community-based supports; and maintaining boundaries and self-care in peer support roles. Second, participants emphasized foundational values, including cultivating “courageous spaces,” addressing suicide directly without sensationalism, and integrating content on systemic oppression and cultural responsiveness. Third, participants proposed design features to support accessibility and sustainability, such as modular learning pathways, multimodal and neurodiversity-affirming content, interactive components, emotional check-ins, confidentiality safeguards, and a customizable resource directory.

Conclusions: Centering lived experience through co-design articulated key elements for an online gatekeeper training aligned with the diverse realities of 2S/LGBTQ+ communities. These elements are currently being translated into an intervention, supporting a more inclusive, relevant, and affirming approach to suicide prevention.

Introduction: LGBTQ+ people experience higher rates of suicidal thoughts, attempts and deaths when compared to their heterosexual, cisgender counterparts. Consequently, in the UK, all four national suicide prevention policies have named LGBTQ+ communities as needing specialist, culturally competent, prevention efforts, co-produced with LGBTQ+ communities. However, what such provision should, or even could, look like remains undefined.

Methods: To address this gap in practice-based knowledge, we interviewed 20 practitioners working in UK suicide prevention with LGBTQ+ people. Semi-structured narrative interviewing methods were used, and analysed using Reflexive Thematic Analysis. The sample included healthcare practitioners (8); non-healthcare staff in statutory services (4); and Third sector practitioners (11); four participants had multiple roles.

Results: In exploring practitioners’ perspectives on LGBTQ+ suicide prevention, I was confronted by a persistent conceptual question on the ontological status of suicide as either a medical issue or a social issue. The liminal status of suicide, between medical and social, is not unique to LGBTQ+ people. However, participants in this study articulated how the normative positioning of LGBTQ+ people experiencing distress or crisis as somehow different or other could have significant consequences for who was seen as responsible for suicide prevention and where it was deemed possible for a person to receive care and support. A key challenge in the provision of LGBTQ+ suicide prevention appeared to be the dual, intersecting specialism that this population was seen as requiring: specialist LGBTQ+, and specialist suicide prevention, practice. As such, regardless of where an individual sought help, the service almost always saw itself as not quite the right provider.

Conclusion: This research highlights how the quest for an imagined ‘perfect’ prevention provision may result in significant gaps in actual service provision experienced by LGBTQ+ people in crisis, with more work needed to bridge this gap and provide support when needed.

Background: LGBTQ+ youth are at high risk for suicidal ideation and behaviours. Especially during coming out, parental acceptance can promote resilience, whereas rejection may contribute to suicidality. Parents frequently face emotional, social, and informational challenges when their child comes out as LGBTQ+. This qualitative study aimed to explore what parents who have coped with their child’s coming out find relevant to support children and make them more suicide resilient.

Methods: Three focus groups with parents (n = 23) and one with LGBTQ+ youth (n = 13) were conducted, with the latter aimed at capturing youths’ perspectives on parental support. Participants included youth and parents of transgender, gender nonconforming, and cisgender children with diverse sexual orientations. Discussions were guided by semi-structured questions and analysed using thematic analysis.

Results: Findings revealed several key aspects of parental support. Parents emphasized maintaining open communication, offering a sense of security, and seeking peer or professional support. Beyond the initial disclosure, managing the social environment involved defending the child in social contexts and fostering self-confidence. In the context of gender transition, parents highlighted prioritizing the child’s well-being and taking time to gather appropriate information for medical decision-making with their children. Finally, key messages to other parents focused on letting go of heteronormative expectations and preconceived ideas about the child’s future.

Conclusion: The parental narratives provide insight into parental views on how to increase suicide resilience in LGBTQ+ children, and served as a basis for the development of a media intervention featuring short videos created by parents to support other parents in the process of their children’s coming out. The video effects will be tested in a randomised controlled trial regarding their effectiveness in increasing suicide resilience in LGBTQ+ children.

Funding: This research was funded in whole or in part by the Austrian Science Fund (FWF)

10.55776/PAT8309124

Background: Suicide is a major global health crisis disproportionally affecting sexual and gender diverse youth (SGDY). Minority stressors, political rhetoric, hopelessness, depression, previous attempts, cognitive factors, adverse childhood experiences and family rejection heighten SGDY suicidality risks. These complex risks, as well as persistent challenges in accessing competent clinical care, suggest that tailored interventions, such as affirmative cognitive behavioral therapy (AFFIRM), which validates identities and strengthens hopefulness, have promise. Drawing on the interpersonal theory of suicide, this study aimed to identify the longitudinal impact of AFFIRM participation on SGDY suicidality.

Methods: Following ethical approval, SGDY were enrolled into the AFFIRM group intervention. Participants (N=786) ranged from 14–29 years old at baseline (M = 22.12, SD = 4.60) with a range of racialized identities. Gender (Transgender 31%, Woman 28%, Non-Binary 26%, Male 19%, Queer 10%, Two-Spirit 2%) and sexual orientation (Gay 28%, Queer 25%, Pansexual 17%, Bisexual 16%, Lesbian 11%, Straight 7%, Ace 4%). The synchronous groups clustered participants by developmental stage. SGDY completed the DSM-5 Cross-Cutting Symptom Measure at multiple time points (pre-test, post-test, six months, and one year) to evaluate changes in suicidal ideation and attempts. Bayesian logistic mixed-effects models were utilized.

Results: Compared with baseline (i.e., pre-test), the likelihood of not reporting a suicide attempt was nearly five times higher at the six-month follow-up (OR = 5.31, 95% CI: 2.46, 12.07) and nearly 10 times higher at the one-year follow-up (OR = 29.96, 95% CI: 9.78, 106.23) after AFFIRM completion. Suicide ideation decreased, but was not statistically significant.

Conclusion: The results of this study provide important insights into the effects of affirmative CBT on suicidality among SGDY. Clinical applications, including those delivered virtually, and key mechanisms of change in affirmative CBT (e.g., hope and coping), will be described.

Background: High rates of suicidal thoughts and attempts have been reported in transgender and gender-diverse (TGD) individuals. Besides generally known risk factors, gender dysphoria and gender minority stressors, such as discrimination and stigma, can exacerbate suicidality. Although gender-affirming medical care (GAMC) can improve mental health, suicidality might persist or develop throughout GAMC. Identifying risk and protective factors in this group is necessary to determine different risk profiles and develop targeted suicide prevention approaches.
The psychosocial autopsy interview with close ones of people who died by suicide can provide insights into risks and triggers; however, no such instrument exists for TGD suicides yet.

Methods: In the ENIGI dataset, we used chi-square tests to compare risk and protective factors between four groups (N=477) which differed regarding the presence of suicidality at clinical intake for GAMC and 4-6 years into care; regression models assessed age-specific differences in predictors of suicidality.
Secondly, we conducted a medical record review of former clients of a gender clinic who died by suicide (N=49). Recurring themes were extracted to develop a semi-structured psychosocial autopsy interview specifically designed for the TGD population.

Results: In the group comparison, the group developing suicidality during GAMC scored poorly on GAMC-related factors, like body satisfaction and perceived barriers to receiving GAMC. Across groups and in the regression models, social factors, such as loneliness and social support, played an important role. No age effects were found.
Themes in the medical records included dissatisfaction with GAMC and to a lesser extent gender minority stress, besides known risk factors like affective and personality disorders. Questions regarding these themes were incorporated into existing psychosocial autopsy interviews.

Conclusion: These findings highlight the significance of social factors in mitigating suicide risk among TGD individuals. Psychosocial autopsy interviews are expected to elucidate the possible protective role of GAMC.